Excision has been the treatment of choice in benign non-tumorous obstructive disorders of the major salivary glands, when symptoms persisted in spite of conservative measures. Unfortunately surgical resection has been associated with a relatively high rate of adverse effects. To meet the need for a less invasive treatment modality for benign obstructive non-tumorous disorders (i.e., salivary stones or stenosis), sialendoscopy has been developed and implemented in several countries here among Denmark. This study is a 13-year retrospective registry-based study using The Danish National Patient Register. ICD-10 codes used for non-tumorous obstructive disease of the salivary glands were identified and used to extract patients potentially eligible for sialendoscopy in order to compare sialendoscopic surgery and extirpations of salivary glands. In 2012 sialendoscopy accounted for almost 20 % of all surgical interventions on the major salivary glands due to benign non-tumorous disease. Nationally and regionally the total number of resected major salivary glands due to benign obstructive disease also decreased significantly during the study period. A positive outcome, like the ones described here, will inspire further development and dissemination of gland preserving techniques, to great benefit for the patients.
Introduction: The Ramsay Hunt syndrome is characterized by herpetic lesions combined with peripheral facial nerve palsy. The disease is caused by a reactivation of the varicella zoster virus and can be deceiving since the herpetic lesions are not always present (zoster sine herpete) and might mimic other severe neurological illnesses. This article reviews the various forms of Ramsay Hunt syndrome and how they can give rise to diagnostic and therapeutic challenges. Material and method: Studies on the assessment and treatment of Ramsay Hunt syndrome were found by conducting a thorough literature search in PubMed, Medline, The Cochrane Library database and Google Scholar using the search words «varicella», «zoster», «ramsay hunt», «oticus», «cranial nerve», «facial nerve» and combinations thereof. The bibliographies of substantial articles were subsequently assessed. Results: About 12% of all peripheral facial nerve palsies are caused by varicella zoster virus. In more than 50% pain is the initial symptom making the diagnosis difficult. Female gender, and in general age above 50 years, renders patients more susceptible to Ramsay Hunt syndrome. The main prognostic factor is the severity of the initial symptoms. The occurrence rate of associated cranial polyneuropathy has been reported to be 1.8-3.2% and cranial nerves VII, VIII, IX are the ones most commonly affected. The full recovery rate is reported to be as low as 27.3% when multiple cranial nerves are involved. Combination therapy comprising of antiviral drugs and corticosteroids is recommened and should be initiated within 72 hours. Vaccination against varicella zoster virus is an interesting new development that might reduce the incidence of varicella zoster virus associated disease altogether. Conclusion: Ramsay Hunt syndrome is a difficult and severe diagnosis with a low full recovery rate. Extensive randomized trials are urgently needed to verify the optimal treatment and the efficacy of varicella zoster virus vaccine in both naïve and herpes zoster patients.
Neurofibroma is a benign tumour derived from the neural sheaths of peripheral nerves and composed of Schwann cells, fibroblast-like cells and intermediate cells. The usual clinical presentation of an oral neurofibroma is swelling. A 62-year-old woman was referred to our department of otorhinolaryngology with irritation and dysaesthesia of the lateral aspect of the tongue. The only finding was a slightly red area from which a biopsy was taken. The macroscopic findings observed by the surgeon were consistent with normal tongue tissue. The histopathological examination showed a small, rounded tumour closely approximated to an invagination of the surface epithelium and with a small lymphatic infiltrate. The tumour was a neurofibroma. A Schwannoma type B was considered but the presence of small nerves and positive neurofilament reaction favoured a neurofibroma. The patient had no other neurofibromas or skin lesions. At a 3-week follow-up visit all symptoms had resolved.
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