Delayed lower cranial neuropathy is a rare complication following primary radiotherapy for head and neck cancer, and has been most associated with nasopharyngeal carcinoma with minimal data regarding this outcome in the treatment of the oropharynx. No reports, to the authors' knowledge, have described this complication following intensity modulated radiation therapy (IMRT) for oropharyngeal primaries. Once encountered, this adverse outcome can have serious impacts on speech and swallowing. We present here our institution's experience with delayed cranial neuropathies following primary radiation therapy for oropharyngeal squamous cell carcinoma, as well as document the only reported case following IMRT.
Invasive fungal sinusitis is a morbid pathology that typically affects immunocompromised patients and may quickly progress to fulminant disease. The purpose of this study was to measure the sensitivity and specificity of touch preparation of nasal debridement specimens as a rapid diagnostic tool for invasive fungal sinusitis. A retrospective chart review was performed of 22 patients undergoing nasal debridement due to suspicion for invasive fungal sinusitis over a 10-year period. Thirteen patients had touch preparation of nasal specimens followed by routine histologic processing; two of these patients underwent 2, and 1 patient had 3 separate debridements, for a total of 17 touch preparations performed. The sensitivity and specificity of touch preparation were calculated by correlating the initial results with the presence of fungal invasion on final pathologic analysis. The sensitivity of touch preparation was 56% (95% confidence interval [CI]: 0.23-0.85), specificity was 100% (95% CI: 0.60-1.00), positive predictive value was 100% (95% CI: 0.46-1.00), and negative predictive value was 67% (95% CI: 0.35-0.89). This procedure may be a useful adjunct in situations requiring rapid diagnosis of invasive fungal sinusitis but should not be used as the sole criteria for determining the need for surgical intervention.
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