Neck dissection versus “watchful-waiting” in early squamous cell carcinoma of the tongue our experience on 127 cases

Background Early oral squamous cell carcinoma (EOSCC) represents about 90% of the oral cancers especially in older males. The etiology is multifactorial, strongly related to tobacco and alcohol abuse, but also infective agents, Human papillomaviruses (HPV16-18), genetic factors and pre-neoplastic lesions seem to be implicated. There is no consensus in the literature for the treatment of early squamous cell carcinoma of the tongue (stages I–II); both an elective neck dissection policy and a watchful-waiting policy have their proponents in the different centers. Methods The records of 127 patients with EOSCC of the tongue treated in our Department between 2007 and 2011, with cN0 neck staging, who underwent resection of the primary tumor with or without elective neck dissection, were reviewed. Results We divided the patients into two groups, in Group 1 the 66 patients who received an elective neck dissection 30 days later from the primary surgery have been included, and in Group 2 the 61 patients undergoing “watchful waiting” observation for the development of nodal metastases have been collected. Statistical calculations were performed using Chi-square and t student test. Conclusions A significant difference was found between the two groups as concerns tumor stage and pathologic tumor classification (p < 0.001). No significant differences were present between the two groups as concerns mean follow up (P = 0.2), relapse rate (p = 0.3) and relapse-free survival time (p = 0.2). In T1 stage tumors with depth of infiltration ≤4 mm, or low grade (G1-G2), the “watchful waiting” strategy for cervical metastases is appropriate, given the low regional recurrence rate (15%) and overall survival of 100%. In case of T2 lesions with depth of infiltration ≥4 mm or high grade (G3) we prefer to perform the elective neck dissection, with 13% of local recurrence and 100% of survival at 6 years

Efficacy of Hilotherapy face mask in improving the trend of edema after orthognathic surgery: a 3D analysis of the face using a facial scan app for iPhone

Cryotherapy after orthognathic surgery is essential for the control of facial edema. The aim of our study is to evaluate the efficacy of Hilotherapy face mask in reducing facial edema after orthognathic surgery, studying facial surfaces with an innovative, fast, economical 3D facial scan system based on an iPhone app

Comparative Study of Human and Automated Screening for Antinuclear Antibodies by Immunofluorescence on HEp-2 Cells

Background: Several automated systems had been developed in order to reduce inter-observer variability in indirect immunofluorescence (IIF) interpretation. We aimed to evaluate the performance of a processing system in antinuclear antibodies (ANA) screening on HEp-2 cells. Patients and Methods: This study included 64 ANA-positive sera and 107 ANA-negative sera that underwent IIF on two commercial kits of HEp-2 cells (BioSystems® and Euroimmun®). IIF results were compared with a novel automated interpretation system, the “CyclopusCADImmuno®” (CAD). Results: All ANA-positive sera images were recognized as positive by CAD (sensitivity = 100%), while 17 (15.9%) of the ANA-negative sera images were interpreted as positive (specificity = 84.1%), =0.799 (SD=0.045). Comparison of IIF pattern determination between human and CAD system revealed on HEp-2 (BioSystems®), a complete concordance in 6 (9.37%) sera, a partial concordance (sharing of at least 1 pattern) in 42 (65.6%) cases and in 16 (25%) sera the pattern interpretation was discordant. Similarly, on HEp-2 (Euroimmun®) the concordance in pattern interpretation was total in 5 (7.8%) sera, partial in 39 (60.9%) and absent in 20 (31.25%). For both tested HEp-2 cells kits agreement was enhanced for the most common patterns, homogenous, fine speckled and coarse speckled. While there was an issue in identification of nucleolar, dots and nuclear membranous patterns by CAD. Conclusion: Assessment of ANA by IIF on HEp-2 cells using the automated interpretation system, the “CyclopusCADImmuno®” is a reliable method for positive/negative differentiation. Continuous integration of IIF images would improve the pattern identification by the CAD

The Pectoralis Major Myocutaneous Pedicled Flap

The pectoralis major myocutaneous pedicled flap is a commonly used flap for reconstructive head and neck surgery, but associated with high complication rates. The purpose of this study was to evaluate a refined surgical technique that can reduce flap complications and compare the proposed technique with the conventional surgical technique. A retrospective analysis was performed on 35 consecutive patients affected by malignant tumors of the head and neck, who underwent a pectoralis major myocutaneous pedicled flap reconstruction in our institution, between 2004 and 2009. Patients were divided into 2 groups: group 1 treated by the classic surgical technique, and group 2 treated by the refined surgical technique. Our main outcome measures were the success of the reconstructions and the complications. The overall complication rate in patients who underwent our revisited surgical technique was significantly lower than that in patients who underwent conventional surgical technique (P = 0.001). The results of our study reinforce the value of the pectoralis major flap in the reconstruction of head and neck defects and shows how little refinement of the surgical technique can significantly reduce the onset of complications. © 2013 by Mutaz B. Habal, MD

Extracranial primary and secondary meningiomas

Meningioma is a well-recognized tumour of the central nervous system. However, extracranial non-dural or ectopic meningiomas are rare and in most of the reported cases, meningiomas are diagnosed only after histopathologic examination. Over the last 5 years, the authors have seen three cases. In these case reports, they discuss the salient features of these lesions, which can aid the preoperative diagnosis and management of these patients. One of the cases is a rarity, owing to the extreme extracranial position which allowed the pressure of the tumour abrade the adjacent structures. In one case, reconstruction of the skull bone using polymeric materials (Acrylic matter) was necessary. In the other two cases, titanium plates and screws were used to reconstruct the jaw

Rare fibrolipoma of the tongue: A case report

Introduction: Lipoma is a benign tumor infrequent in the oral cavity, particularly in the tongue: indeed, lipomas only represent approximately 0.3% of all tongue neoplasia. Compared to conventional lipoma, fibrolipoma of the tongue is a very rare lesion that accounts for around 25-40% of tongue lipomas, and until now, to the best of our knowledge, only 14 cases have been described in which histological diagnosis of fibrolipoma was specifically confirmed. We report the case of a patient with a voluminous fibrolipoma of the tongue, treated by means of surgical excision. Fibrolipoma excision, like that described in this report, sometimes may be laborious, because fibrous bands appear to be focally infiltrating adjacent tissues, giving rise to some doubts about the nature of the lesion. Case presentation: We report the case of a voluminous fibrolipoma of the tongue in a 71-year-old Caucasian woman. Conclusions: Because of its histological characteristics, abundance of connective and secondary changes/atrophy, fibrolipoma may appear as infiltrating adjacent tissues and may cause doubts of differential diagnosis with malignant infiltrating lesions. Surgical excision is the elective treatment. However, an accurate differential diagnosis, postsurgical histological examination and careful follow-up are required

Complications after parotid gland surgery Our experience

AIM: Complications after parotid surgery include deficit of the facial nerve, wound complications, as sialocele and salivary fistula, and Frey syndrome; the goal of this study was to evaluate the relationship between the type of parotid surgery performed and the incidence of each of these complications. MATERIAL OF STUDY: A total of 184 patients were evaluated and 158 were included in the study. Four different kinds of intervention were made: extracapsular dissection, partial superficial parotidectomy; superficial parotidectomy and total parotidectomy. The incidence of each complication was studied and correlated to the type of surgery performed. Statistical analysis was done using the chi-square test of independence. RESULTS: From all cases examined, 86 patients developed facial nerve complications with 59 minor asymmetry, 19 partial weakness and 8 complete weakness. Forty patients had wound complications, 28 sialocele and 12 salivary fistula. Sixteen patients developed Frey syndrome. DISCUSSION: Facial nerve complications and Frey syndrome were significantly related to superficial or total parotidectomy, differently extracapsular dissection and partial superficial parotidectomy had more cases of wound complications. CONCLUSION: The kind of complications that occur after parotid surgery depends on surgery performed. Chi-square test has a statistically significant result and confirms this kind of relationship (P <.0001)