Thyroglossal Duct Cyst With Endolaryngeal Extension

Thyroglossal duct cyst (TDC) arises from the remnant thyroglossal duct tract as a cystic expansion. Patients most commonly present with a palpable cystic midline neck mass or discharge from a cervical sinus opening. TDC is the most common congenital head and neck lesion in children and adults, but endolaryngeal extension is a rare entity. The treatment of TDC is excision of the cyst and the whole sinus tract with the central part of the hyoid bone, as described by Sistrunk. It is necessary to preserve the thyrohyoid membrane and thyrohyoid perichondrium of the thyroid cartilage in cases with endolaryngeal extension. In this report, a case of TDC with endolaryngeal extension is presented, with diagnosis and management modalities

Recurrent Parotid Pleomorphic Adenomas: Our Clinical Experience

Objective:The aim of our study was to present our findings in a series of patients who were treated for recurrent parotid pleomorphic adenoma with their clinical, surgical, and follow-up information and to discuss them in light of the recent literature.Methods:Eleven patients who had revision surgery for recurrent pleomorphic adenoma at our institution were retrospectively analyzed for the clinical and radiological features of their lesions, surgery type, facial nerve management, and follow-up period.Results:Seven patients were females and four were males with an average age of 45 years. All patients underwent previous surgeries at other institutions. Revision surgery was performed with superficial parotidectomy in six patients and total conservative parotidectomy with preservation of the facial nerve in five patients. Two patients had lesions involving the facial nerve branches necessitating sacrifice of involved branches. One patient was given adjuvant radiotherapy because of adjacent lymphatic vessel involvement with tumor cells. During the mean follow-up period of 9.1 years, there were no recurrences in any of the patients.Conclusion:Management of patients with recurrent parotid pleomorphic adenomas must be carefully planned according to the size, location, and multicentricity of the tumor and involvement of the facial nerve. Surgery should aim at reaching tumor-free surgical margins. Sacrifice of the facial nerve should be considered only in cases with direct involvement. In the postoperative period, patients must be followed up regularly for early diagnosis of recurrences

Pharyngocutaneous Fistula after Total Laryngectomy: Risk Factors with Emphasis on Previous Radiotherapy and Heavy Smoking

Objective:In this retrospective cohort study, we aimed to determine the incidence of pharyngocutaneous fistula (PCF) after total laryngectomy (TL) and to define the possible predictors for PCF formation.Methods:The medical records of 198 patients with laryngeal squamous cell carcinoma who underwent TL were reviewed. After the exclusion of patients with history of free flap reconstruction, previous laryngeal surgery, and previous radiotherapy (RT) for other primary cancers, the risk factors for PCF were analyzed in 183 patients who were included in the study.Results:The overall incidence of PCF was 20.2%. A history of heavy smoking and previous RT were detected as independent risk factors in both univariate (p=0.004 and p=0.007, respectively) and multivariate (p=0.005) analyses. Preoperative tracheotomy (PT) longer than 14 days was a risk factor for PCF among patients with PT in the univariate analysis (p=0.031). Overall three- and five-year survival rates were statistically indifferent between the PCF and non-PCF groups (p>0.05). However, the overall five-year survival rate was lesser in the persistent PCF group (47%) than in the non-persistent PCF group (83%) (p=0.038).Conclusion:Heavy smoking and previous RT are independent risk factors for PCF, and the persistence of PCF decreases survival rates. Preventable measures should be taken to decrease the incidence and persistence of this complication of TL in the management of patients with possible risk factors

Role of Elective Neck Dissection in Early Stage Lip Cancers

Objective:To date, the management of the neck in early stage lower lip cancers remains controversial. The aim of this study is to investigate if prophylactic neck dissection is necessary in early stage lower lip cancers.Methods:Charts of 11 patients who underwent surgery of the primary site and neck because of T1–2N0 lower lip cancer between 1997 and 2011 were retrospectively examined. Clinical stages, surgeries, histopatological examination results, and loco-regional recurrences were evaluated.Results:Of the 11 patients, 10 were male (90.9%) and 1 was female (9.09%). The follow-up time of these patients was between 24-168 months (mean, 56.6 months). There were 5 patients with clinically diagnosed T1N0 tumors and 6 patients with clinically diagnosed T2N0 tumors. Suprahyoid neck dissection was performed in 4/5 T1N0 patients and supraomohyoid neck dissection was performed in the remaining 1 patient. For T2N0 tumors, 4 suprahyoid, 1 supraomohyoid, and 1 comprehensive neck dissection was performed. Histopathological examination revealed no occult metastasis in any of the patients. In 1 patient who had lower lip resection and suprahyoid neck dissection for T1N0 lower lip cancer, a contralateral neck metastasis was detected 22 months postsurgery, and a comprehensive neck dissection was performed.Conclusion:Our results show that in patients with T1N0 lower lip tumors, neck dissection may not be necessary; however, close follow-up is mandatory. Further researches with larger series dividing T2N0 tumors into subgroups for tumor size and thickness are necessary to determine neck treatment in these tumors

Assessment of Subepithelial Angiogenesis in Acquired Cholesteatoma between Pediatric and Adult Patients

Objective:The aim of this study was to compare subepithelial angiogenesis developing within the perimatrix of the cholesteatoma between pediatric and adult patients.Methods:Sixty-one patients who underwent mastoidectomy for the first intent because of chronic otitis media with cholesteatoma between 1993 and 2013 and from whom appropriate tissue specimens were taken were included in the study. The patients were classified in the pediatric patient group if they were under the age of 18 years and the adult patient group if they were 18 years and older. Immunohistochemical staining for CD-31 was performed on new sections taken during surgery and sections prepared from archived tissues in paraffin blocks. Results were compared between the groups.Results:A total of 61 patients, of whom 25 were pediatric and 36 were adult patients, were included in the study. The mean CD-31 immunopositive microvessel rates were 8.8 (3-15) and 6.61 (2-14) for the pediatric and adult patient groups, respectively. The difference between the groups was statistically significant (p=0.037). Correlation analysis showed a statistically significant negative correlation between the CD-31 immunopositive microvessel rates and age (p=0.036).Conclusion:Subepithelial angiogenesis developing within the perimatrix of the cholesteatoma of the pediatric patients was more expressed than that of the adult patients