Facial skin metastasis due to small-cell lung cancer: a case report

<p>Abstract</p> <p>Introduction</p> <p>Cutaneous metastases in the facial region occur in less than 0.5% of patients with metastatic cancer. They are an important finding and are not often the first sign leading to diagnosis.</p> <p>Case presentation</p> <p>We describe the case of a 64-year-old male patient who presented with dyspnea, pleuritic pain, loss of weight and a nodule on his left cheek. A chest X-ray revealed a left upper lobe mass with mediastinal lymphadenopathy. Excision biopsy of the facial nodule revealed small-cell lung carcinoma. Palliative chemo-radiotherapy was administered and the patient survived for 12 months.</p> <p>Conclusion</p> <p>A high index of suspicion is necessary for the early detection of facial cutaneous metastases. Appropriate treatment may prolong patient survival.</p

Oral rehabilitation with implant-based prostheses of two adult patients treated for childhood rhabdomyosarcoma

Background Rhabdomyosarcoma is the most common malignant tumor in the nasal and paranasal sinus area at childhood. Multimodal treatment for this disorder has severe side effects due to normal tissue damage. As a result of this treatment, facial growth retardation and oral abnormalities such as malformation of teeth and microstomia can cause esthetic and functional problems. Case reports Two cases are presented of patients with severe midfacial hypoplasia and reduced oral function as a result of treatment of rhabdomyosarcoma of the nasopharyngeal and nasal-tonsil region. With a combined surgical (osteotomy, distraction osteogenesis, implants) and prosthetic (implant-based overdenture) treatment, esthetics and function were improved

ICAR: endoscopic skull‐base surgery

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Endoscopic management of juvenile nasopharyngeal angiofibroma: our experience

Introduction: The endoscopic resection of juvenile nasopharyngeal angiofibroma (JNA) emerges as an alternative approach to open surgical procedures due to reduced morbidity and comparable recurrence rates. The purpose of this study is to present our experience with the endoscopic management of JNA. Patients/methods: Retrospective chart review of six male patients with mean age 14.6 years (range 10-21) who were treated endoscopically for JNA at our institution between the years 2003-2009. Two tumours were classified as stage I and 4 tumours as stage II according to the Fisch staging system. Three patients underwent preoperative embolisation. The endoscopic treatment involved posterior ethmoidectomy, middle meatal antrostomy, sphenoidotomy, clipping of the sphenopalatine artery and its branches and drilling of the pterygoid basis. All patients underwent magnetic resonance imaging 3 months post operatively and then at yearly follow up. Results: Mean follow up was 34 months (range 12-62). All but one patient were free of macroscopic disease. A patient with stage II JNA developed recurrence after 9 months. The residual tumour was resected endoscopically and the sphenopalatine foramen widened by drilling. The patient is free of disease 17 months postoperatively. The intra-operative blood loss was acceptable (450-800 ml, mean: 560ml) and no patient required a blood transfusion. Patients were discharged after 4 to 8 days (mean 5 days). No complications were reported. Conclusions: Our results are in line with those of other investigators regarding the endoscopic management of stage I and II JNA. The endoscopic approach is a safe and effective treatment modality for JNA due to the lack of external scars, minimal bone resection and enhanced visualization of the tumour extent

Nasal spirometry in the preoperative selection of patients for septoplasty

Introduction: there is no consensus over the best approach to selection of patients for septoplasty. Clinical examination is often inadequate and objective testing has not gained wide popularity due to technical, cost and training issues. The aim of this study was to evaluate bilateral nasal spirometry (BNS) as a quick and easily interpretable method of selecting appropriate candidates for septoplasty. BNS measures airflow asymmetry caused by a nasal septal deviation (NSD) and it is expressed as the nasal partitioning ratio (NPR). The NPR after decongestion can be used as an objective measure of the degree of NSD. NPR ranges from -1 (complete left nasal obstruction) to +1 (complete right nasal obstruction).Patients/methods: Thirty patients (25 males/5 females, mean age 33 years) with nasal obstruction and a NSD were assessed by subjective measures (NOSE score, 10 cm visual analogue scale, 10-point double vertical scale) and the BNS before and after septoplasty. Thirty healthy controls (25 males/5 females, mean age 31.7 years) were recruited for providing a reference range of NPR values. Results: All patients were subjectively improved after septoplasty but only those with NPR out of the normal limits (-0.25 to 0.24) had a significant reduction of NSD (Wilcoxon Signed ranks test, p<0.001). No correlation between subjective measures of nasal obstruction and NPR was observed. Conclusion: BNS is a rapid, easily interpretable, noninvasive technique which identifies patients with large NSDs who, irrespective of concomitant mucosal factors of nasal obstruction, warrant septoplasty. BNS is unreliable in cases of a septal perforation or an S type NSD and it cannot detect an insufficient nasal valve