Acanthosis nigricans in the head and neck region

Background: The sudden appearance of acanthosis nigricans on the skin of an individual is highly suggestive of an underlying clinical disease. However, there is no information on its possible association with head and neck disease in our environment. Objective: To determine the prevalence of acanthosis nigricans and identifying the underlying associated medical and oncologic factor in an Otorhinolaryngologic, head and neck practice.Method: This was a 12-month prospective study of patients seen at Otorhinolaryngology department of University College Hospital, Ibadan. Relevant clinical, anthropometric and biochemical information were obtained with an interviewer assisted questionnaire and data analyzed using descriptive statistics. Results: Of 764 patients, 85(11.13%) had head and neck malignancies, 15(1.96%) had diabetes mellitus in addition to the Otorhinolaryngologic, head and neck diseases. The body massindex values for male and female ranged from 18.26 – 25.68kg/m² and 17.94 – 30.25kg/m² respectively. Only two patients, one with nasopharyngeal cancer and the other with obesity in addition tochronic rhinosinusitis had acanthosis nigricans.Conclusion: Acanthosis nigricans is not common among Otorhinolaryngologic patients in our clinical setting with a prevalence of 0.003. Nevertheless, its presence should herald the suspicion of an underlying metabolic or oncologic disease.Keywords: Acanthosis Nigricans, Otorhinolaryngology, Head, Nec

A Meta-analysis of the randomized controlled trials on elective neck dissection versus therapeutic neck dissection in oral cavity cancers with clinically node negative neck

Die optimale Behandlung des klinischen N0 Halses bei Mundhöhlenkarzinomen wird in der Literatur kontrovers diskutiert. Je nach Größe und Lage des Primärtumors sowie der Histologie liegt die okkulte Metastasierungsrate bei Patienten mit klinischem N0-Hals bei circa 30%. Kopf-Hals-Onkologen und - Chirurgen stehen daher vor der Herausforderung, die Untergruppe der Patienten mit zervikalen, nodalen Mikrometastasen zu identifizieren, die einer elektiven Neck dissection zugeführt werden sollten. Die alleinige Palpation ist zur Bestimmung des Lymphknotenstatus absolut unzureichend. Die Sensitivitätsraten der bildgebenden Verfahren liegen trotz Verbesserungen in den letzten Jahren jedoch weiterhin nur bei 70 - 80%. Trotz der Zunahme an Wissen und Fortschritt in der Krebstherapie gibt es noch keine Methode zur korrekten Bestimmung der tatsächlichen Metastasierungssituation im Bereich des Halses. Obwohl Plattenepithelkarzinome des Kopf-Hals-Bereiches eine große Neigung zur Bildung von locoregionären und distanten Metastasen haben, konnten verschiedene Studien zeigen, dass vor allem Tumore in frühen Stadien häufig nicht metastasieren. Die Operation von Patienten ohne manifeste Lymphknotenmetastasen führt zu unnötigen Kosten, einer Verlängerung des Krankenhausaufenthalts und vermeidbaren Komorbiditäten. Wird der Hals jedoch nicht in das Therapiekonzept miteinbezogen obwohl nicht identifizierte Mikrometastasen vorliegen, kann dies zu einem unvorteilhaften Behandlungsergebnis mit erhöhter Morbidität und Mortalität führen. Die Realität ist, dass bei einigen Patienten mit klinischem N0-Hals keine Lymphknotenmetastasen bestehen und diese Patienten nicht überbehandelt werden dürfen. Die optimale onkologische Therapie der Halslymphknoten muss daher zum Ziel haben, die Funktion zu erhalten und die Morbidität nach Möglichkeit zu minimieren, was eine multidisziplinäre Behandlung erfordert. Obwohl viele retrospektive Studien zu oralen Karzinomen mit klinischen N0- Hals und deren Therapiemodalitäten vorliegen, gibt es keinen Konsens über die optimale Therapie und den etwaigen Nutzen einer elektiven Neck dissection bei Patienten mit Mundhöhlenkarzinomen und N0-Hals. Es gibt in der Literatur nur wenige prospektive Studien zu diesem Thema und es gibt bisher keine Evidenz, ob eine elektive Neck dissection einer therapeutischen Neck dissection bei Patienten mit Mundhöhlenkarzinomen und N0-Hals überlegen ist. Eine systematische Analyse der vorliegenden prospektiven, randomisierten, kontrollierten Studien ist daher erforderlich, um diese Frage zu beantworten. Insgesamt gibt es nur wenige randomisierte, kontrollierte Studien und keine dieser Studien hat eine Patientenpopulation über 80 Patienten untersucht. Die vorliegende Analyse untersuchte systematisch publizierte randomisierte, kontrollierte Studien hinsichtlich ungelöster Fragen zur elektiven Neck dissection versus therapeutischen Neck dissection bei Patienten mit oralen Karzinomen und klinischem N0-Hals und erstellte eine Metaanalyse ihrer Daten. Die Studie folgte den PRISMA-Leitlinien (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Das Ziel dieser Arbeit war, die Wirksamkeit der elektiven Neck dissection hinsichtlich der Verringerung von Lymphknotenrezidiven bei Patienten mit oralen Karzinomen mit klinischem N0-Hals zu evaluieren und die krankheitsspezifische Mortalität sowie das Überleben von Patienten nach elektiver Neck dissection gegenüber Patienten, die keine Neck dissection erhielten, zu bestimmen und zu vergleichen. Aus 613 Studien, die während der umfassenden Suche identifiziert wurden, erfüllten nur 4 randomisierte, kontrollierte Studien die Einschlusskriterien und wurden in die Meta-Analyse eingeschlossen. Die Gesamtzahl der Patienten aus den Studien betrug 283. In allen Studien waren die Patienten in zwei Gruppen randomisiert: Elektive Neck dissection (END)-Gruppe und Observation (OBS)-Gruppe. Es gab keinen statistischen Unterschied zwischen diesen beiden Gruppen in Bezug auf Geschlecht und Alter der Patienten, histologischen Typ und Staging. Alle Studien untersuchten histologische Entität, Rezidive im Bereich des Halses, Metastasen, Überleben und Follow- Up. Trotz der Absicht, andere Faktoren als primäre Zielparameter in dieser Meta- Analyse zu erfassen, ist der einzige klinisch bedeutungsvolle Endpunkt, um den Nutzen der elektiven Neck dissection zu messen, die krankheitsspezifische Mortalität. Die Meta-Analyse dieser Studien zeigte, dass die elektive Neck dissection die krankheitsspezifische Mortalität signifikant reduzieren kann und damit das Überleben verbessert {Fixed Effects-Modell RR = 0,57, 95% CI von 0,36 bis 0,89 , p = 0,014} oder {Random Effects-Modell RR = 0,59, 95% CI von 0,37 bis 0,96, p = 0,034}. Es ist jedoch möglich, dass dieser beobachtete Unterschied zwischen OBS- und END-Gruppe durch das Alter der Studien beeinflusst wurde und nicht zu beobachten wäre, wenn die Studien heute mit den neuesten Untersuchungsmethoden durchgeführt worden wären. Zusätzlich konnte gezeigt werden, dass die Durchführung einer elektiven Neck dissection das Risiko eines Lymphknotenrezidivs verringert. Eine verbesserte Überlebensrate nach elektiver Neck dissection bei Patienten mit frühen Stadien oraler Karzinome wurde ebenfalls in einigen retrospektiven Studien berichtet. Nur die Studie von Kligerman et al. [79] aus dieser systematischen Übersichtsarbeit zeigte einen statistisch signifikanten Nutzen der elektiven Neck dissection gegenüber engmaschiger Kontrolle hinsichtlich des krankheitsfreien Überlebens. Die systematische Übersichtsarbeit zeigte jedoch keinen signifikanten Vorteil der elektiven Neck dissection gegenüber wait-andsee hinsichtlich des Überlebens. Zusammenfassend kann festgehalten werden, dass die statistisch signifikante Verringerung der krankheitsspezifischen Mortalität und Lymphknotenrezidivrate die Notwendigkeit einer elektiven Neck dissection bei Patienten mit Mundhöhlenkarzinomen und klinischem N0-Hals rechtfertigen

Retrospective review of soft tissue sarcoma of head and neck in a West African hospital

Background: Soft tissue sarcomas like other malignancies, impact negatively on patients and their caregivers as well as pose a challenge to the managing physician with variable treatment outcomes. A review of related studies on Medline has shown the paucity of the literature on the disease in the West African sub-region. This study was designed to determine the prevalence and highlight the clinicopathologic features of soft tissue sarcomas managed at a tertiary health institution in West Africa.Methods: A 12-year retrospective review of medical records of patients managed with head and neck sarcomas at the University College Hospital, Ibadan, Nigeria was carried out.Results: There were 18 patients [12 (66.7%) males & 6 (33.3%) females]; ages ranging from 3 to 58 years. 16.7% of patients was children. The mean duration of symptoms was 10.5 months. The clinical presentation depended on the involved anatomical location and the most common anatomical location was the sinonasal region. Fourteen (77.8%) patients presented at advanced disease stage. Eight histologic sub-types were identified and rhabdomyosarcoma accounted for 44.4%. The treatment outcome was poor.Conclusion: Head and neck sarcomas are rare in West Africa. They have heterogeneous histologic sub-types which may involve different anatomic sites. Although the prognoses of some sarcomas of the head and neck are poor due to their biological behaviours, late stage disease presentation might have contributed to the worse management outcome seen in this study.Keywords: Clinicopathology; Head–neck; Sarcomas; Soft tissue; Tumours; West Afric

Factors contributing to poor management outcome of sinonasal malignancies in south-west Nigeria

Objective: To describe the clinico-pathologic manifestations of sinonasal malignancies, identify the contributing factors to delay in presentation and recommend ways of preventing them in a resource challenged environment.Design: A questionnaire based cross sectional descriptive study of patients with sinonasal malignancies between 2006 and 2011.Setting: Hospital based study at the Otorhinolaryngology Department, University College Hospital, Ibadan.Participants: 61 patients diagnosed with sinonasal malignancies Main outcome measures: Patients demographic and essential medical data were collected with a structured, interviewer assisted questionnaire and results analysed using descriptive statistics.Results: There were 28(45.9%) males and 33(54.I %) females; mean age 37years. The common presentations were epistaxis, nasal obstruction and facial asymmetry and 96.7% patients with squamous cell carcinoma presented in advanced disease stage (Stage 3 & 4). Over 47% patients presented a year after onset of symptoms. Factors which included  self-medication, wrong advice from relations/ friends to consult traditional  herbalist or quacks for treatment and traditional & religious beliefscontributed to delay in presentation to hospitals. High cost of medical treatment, unwelcoming attitudes of some hospital staff, lack of confidence in orthodox medicine and proximity to health facilities were reasons given for not considering hospital as the first place to seek medical treatment.Conclusion: Health education to create awareness of sinonasal malignancies and provision of affordable and accessible health facilities especially in rural areas are recommended ways to encourage patients to present early in hospitals. This will improve the management outcome and quality of life of patients with sinonasal malignancies.Keywords: Delayed presentation, Health care services, Outcome, Sinonasal malignancie

Case Report Rhinosinusitis; A Potential hazard of Nasogastric tube insertion

The nasogastric tube has been used frequently for enteral feeding and as anintranasal oxygen catheter. This practice is however associated with complications. We present a case of rhinosinusitis and sepsis in a diabeticpatient following the insertion of a nasogastric tube. Physicians should be aware of sinusitis as a possible cause of sepsis in patients with nasogastric tube insertion.Key words: Rhinosinusitis, Nasogastric Tub

Aerobic bacteria and fungal isolates in maxillary sinusitis of adults in a resource poor environment

Background: Infective rhinosinusitis is a common clinical condition which if left unattended to could result in various degrees of both morbidity and mortality. We aimed to identify aerobic and fungal organisms implicated in acute and chronic maxillary sinusitis and determine their antibiotic sensitivity patterns among adults in South Western Nigeria.Materials and methods: This was a cross sectional study of adults with clinical and radiological diagnosis of maxillary sinusitis treated at the University College Hospital, Ibadan over a period of one-year. Semi- structured questionnaire was administered to each consented adult to obtain relevant demographic and clinical data. Maxillary antral proof puncture was done to obtain specimen for microscopy, culture and sensitivity for aerobic bacterial and fungal isolates. Descriptive statistics was used in the data analysis.Results: Seventy-nine patients (49.4% males and 50.6% females) with acute maxillary sinusitis (17.7%), and chronic maxillary sinusitis (82.3%) were recruited into the study. The mean age of the patients was 32.9 years (SD=12.78; Range: 19- 59). All patients presented with rhinorrhea while 92.8% had nasal obstruction. Fifty eight (73.4%) patients had history of antibiotic usage before presentation. Eight (57.1%) of the specimens from acute maxillary sinusitis cases and 40 (61.5%) of the specimens from chronic maxillary sinusitis yielded significant growth of bacteria and fungi respectively while 2 (3.5%) yielded mixed bacterial growth. Organisms commonly isolated from these specimens were Streptococcus pneumonia, Staphylococcus aureus, Pseudomonas aeruginosa, Haemophilus influenzae, and Aspergillus spp. The bacteria isolates were sensitive to Amoxicillin, Ciprofloxacin, Perfloxacin, Sparfloxacin and Ceftriaxone.Conclusion: The leading aerobic bacterial isolates from acute and chronic maxillary sinusitis were Streptococcus pneumonia and Staphylococcus aureus respectively. Fungal infections are seen only in chronic cases. It is recommended that where there are no microbiologic laboratory facilities, any of Ciprofloxacin, Perfloxacin, Sparfloxacin, and Amoxicillin can be administered empirically to treat infective maxillary sinusitis.Keywords: Aerobic bacteria, Fungus, Maxillary sinus, Rhinosinusiti

An audit of Ear, Nose and Throat diseases in a tertiary health institution in South-western Nigeria

Introduction: This study is aimed at determining the pattern of ear, nose and throat diseases and their relationship with socio-demographic factors with auditing intent in a tertiary hospital in South-western Nigeria. Methods: Medical records of patients managed at the Department of Otorhinolaryngology, University College Hospital, Ibadan, Nigeria from 2006 to 2010 were reviewed for all essential clinical data. Results: There were 2641 (52.8%) males and 2360 (47.2%) females. Two thousand and fifty (41%) patients had age ≤15years old. Sixty three percent of the patients were Christians, 37% were Muslims and less than 1% had other religions. There were more patients in lower occupational classes than those in the upper classes. The average number of patients with ear, nose and throat diseases managed per month was eighty three. Patients with ear diseases were 3136 (62.7%), the nose diseases were 1153 (23.0%), the throat diseases were 479 (9.6%) and head/neck diseases were 233 (4.7%). Conclusion: This study showed that otitis media, obstructive adenoid, foreign bodies in the ear and throat infections were the common ear, nose, throat disorders seen in patients aged ≤15years whereas, hearing loss, rhinosinusitis and tumors were the common disorders of ear, nose and throat seen in patients aged 16 years and above. Although these disorders are not yet considered to be of public health importance, they contribute significantly to the existing burden of health problems in our environment. Therefore, there is a need for improved public awareness on ear, nose and throat diseases.Pan African Medical Journal 2013; 14:1, 1-

Tracheostomy Decannulation: Suprastomal Granulation Tissue in Perspective

Background: Suprastomal granulation tissue is a complication of tracheostomy which may make decannulation difficult and presents a therapeutic challenge to the Otorhinolaryngologists. The aims of this study therefore were to evaluate tracheostomy in black African population, determine the prevalence of suprastomal granulation tissue and provide updated information on it that will enable the otorhinolaryngologists to better understand and manage the lesion.Methods: We reviewed case files of patients who had tracheostomy between 1993 and 2007 at University College Hospital, Ibadan, Nigeria for essential clinical data.Results: Of the 256 patients who had tracheostomy, 133(51.95%) had prior orotracheal intubation for 10 – 21days. Suprastomal granulation tissue complicated 16 (6.25%) cases, this accounted for 88.89% of cases of failed decannulation. Indications for tracheostomy in these patients included severe head injury in 12 (75%), tetanus in 3 (18.75%)] and intubation granuloma in 1(6.25%) of these cases. Sixteen (4.3%) cases had stomal infection.Conclusion: This study showed that the prevalence of suprastomal granulation is high among our patients. There is a need for good surgical tracheostomy technique to prevent this complication and stomal infection should be promptly treated while cuffed orotracheal intubation for more than two weeks in unconscious and tetanus patients should be avoided

Synchronous congenital nasal piriform aperture stenosis and atresia : A rare accompaniment of mid-facial dystosis and cause of neonatal upper airway obstruction

Congenital nasal piriform aperture stenosis (CNPAS) is a recently distinguished clinical entity that causes airway compromise in neonate as a result of a narrowing of the nasal piriform aperture. It may be bilateral or unilateral. Often considered as a form of holoprosencaphaly. Being the narrowest part of the nasal airway, any slight reduction in its cross sectional area will profoundly increase the nasal airway resistance with the attendant clinical challenges. Readily making an accurate clinical diagnosis may be very challenging when CNPAS occurs in the setting of a craniofacial dysostosis. This communiqué is aimed at increasing awareness among clinicians involved in paediatric care of the clinical entity congenital nasal piriform aperture stenosis and atresia presenting atypically as synchronous disorder with midfacial dysostosis. Hence, it should be kept in mind as a rare mimicker of bilateral choanal atresia and requires mandatory high resolution computerized tomography to confirm the diagnosis

Foreign body in the Nasopharynx mimicking an obstructive adenoid

Foreign body in the nasopharynx is not a day-to-day experience in any Ear, Nose and Throat clinic as opposed to foreign bodies in the ear or nose. We present a case of food lodgment (piece of yam-dascorial) in the nasopharynx of a 2-year old male child. This was ignorantly dislodged into his nasopharynx by finger sweep procedure by the mother when the child chocked during feeding.Jos Journal of Medicine, Volume 7 No.