Dermoid Cysts of the Floor of the Mouth: Two Case Reports

Dermoid cysts in the floor of the mouth may be congenital or acquired. The congenital form, according to the main theory, originates from embryonic cells of the 1st and 2nd branchial arch. The acquired form may be due to traumatic or iatrogenic causes and as a result of the occlusion of a sebaceous gland duct. Its occurrence is less and is estimated to be from 1.6 to 6.4% of the dermoid cysts of the body in adults and 0.29% of the head and neck tumors occurring in children. They may also be classified as anatomical and histological. Anatomically, they are divided into median genioglossal, median geniohyoid, and lateral cysts, while histologically they are divided into epidermoid, dermoid cysts and teratomas. Clinically, a distinction between supra and inferior type as well as between central and lateral type is proposed in relation to themylohyoidmuscle and themidline, respectively. Histologically, an estimation of dermoid, epidermoid, and teratoid cysts is reported. Enucleation via intraoral and/or extraoral approach is the method of treatment. Two case reports of dermoid cysts in the floor of the mouth are presented in this paper, and an evaluation with regard to pathology, clinical findings, differential diagnosis, and treatment is discussed

Ιmmunological aspects in patients with nasal polyposis

Background: Chronic rhinosinusitis (CRS) is a highly prevalent inflammatory disease of the nose and the paranasal sinuses. CRS can be presented with two basic phenotypes, CR with (CRSwNP) or without nasal polyps (CRSsNP). There are no reports in Greek population concerning the presence and potential role of T cells in the polyp tissue of CRSwNP patients. The objective of the present study was to evaluate the frequency of CD4+ and CD8+ T cells as well as the CD4+/CD8+ ratio in these patients and their relation to clinical characteristics. The second objective was to identify CD4+ and CD8+ T cells, CRTH2 and PAR2 as prognostic biomarkers in peripheral blood and polyp tissue of CRSwNP patients. Methods: Thirty-three adult patients with CRSwNP were recruited at the E.N.T Dpt of G.H Papanikolaou Thessaloniki, Greece. Tissue samples from nasal polyps were collected during functional endoscopic sinus surgery procedures. Endoscopic scores of each CRS patient (Hadley’s nasal endoscopy score), the preoperative Lund-Mackay CT scores and the 22-item Sinonasal Outcome Test (SNOT22) were recorded. Blood eosinophil and neutrophil counts also included in the analysis. The presence of CD4+ and CD8+ lymphocytes was evaluated in tissue sections by immunohistochemistry. In the second part of the study 20 CRSwNP patients and 10 control subjects were recruited. CD4+, CD3+ CD45+, CD8+, CD294 and PAR2 antibodies were measured by flow cytometry in peripheral blood and polyp tissue of the recruited subjects. All data were analyzed with SPSS (version 21.0) and p 3.5, CD8+ T cells were positively correlated with the absolute count and percentage of eosinophils (p=0.042 r=0.684, p=0.036 r=0.699 respectively). Ιn a subgroup analysis, CRSwNP patients with blood eosinophils >5%, LMS and SNOT 22 were negatively correlated to CD4+ cells (p=0.029 r=-0.654, p=0.043 r=-0.618, respectively). In the second part of this study, results by flow cytometry showed that eosinophil percentages, as well as CRTH2 and PAR2 percentages in polyp tissue to be statistically significant higher in CRSwNP patients when compared to the control group. Conclusions: In this study, we recognized the potential importance of nasal CD8+ T cells in the pathophysiology of CRSwNP patients characterized also by eosinophil infiltration. Furthermore, clinical characteristics of the patients were also positively correlated with the eosinophilic inflammation and the severity of the disease. Indeed, in the second part of this study, CRSwNP patients were found with eosinophilic inflammation as well as with increased percentages of CRTH2 and PAR2.Εισαγωγή: Η χρόνια ρινοκολπίτιδα (ΧΡΚ) είναι μια εξαιρετικά διαδεδομένη φλεγμονώδης νόσος της ρινός και των παραρρίνιων κόλπων. Η ΧΡΚ μπορεί να παρουσιαστεί με δύο βασικούς φαινότυπους, ΧΡ με (CRSwNP) ή χωρίς ρινικούς πολύποδες (CRSsNP). Δεν υπάρχουν αναφορές στον ελληνικό πληθυσμό σχετικά με το ρόλο των Τ λεμφοκυττάρων σε ασθενείς με CRSwNP. Ο στόχος της παρούσας μελέτης ήταν να αξιολογήσει τη συχνότητα των CD4 + και CD8 + Τ λεμφοκυττάρων καθώς και την αναλογία CD4 + / CD8 + σε αυτούς τους ασθενείς και τη σχέση τους με τα κλινικά χαρακτηριστικά. Ο δεύτερος στόχος ήταν ο προσδιορισμός των CD4 + και CD8 + Τ λεμφοκυττάρων, CRTH2 και PAR2 ως προγνωστικών βιοδεικτών σε περιφερικό αίμα και ιστό από πολύποδες ασθενών με CRSwNP. Υλικά και Μέθοδοι: Τριάντα τρεις ενήλικες ασθενείς με CRSwNP στρατολογήθηκαν στο Τμήμα Ω.Ρ.Λ. του Γ.Ν Παπανικολάου Θεσσαλονίκης. Δείγματα ιστών από ρινικούς πολύποδες συλλέχθηκαν κατά τη διάρκεια ενδοσκοπικών χειρουργικών επεμβάσεων παραρρίνιων κόλπων. Η αξονική τομογραφία και οι ενδοσκοπικές βαθμολογίες κάθε ασθενούς CRS, όπως οι βαθμολογίες ρινικής ενδοσκόπησης κατά Hadley, οι προεγχειρητικές βαθμολογίες CT κατά Lund-Mackay και η δοκιμασία Sinonasal Outcome 22 καταγράφηκαν επίσης στην ανάλυση. Η παρουσία των CD4 + και CD8 + λεμφοκυττάρων αξιολογήθηκε σε τομές ιστού με ανοσοϊστοχημεία. Το δεύτερο μέρος της μελέτης περιλαμβάνει 20 ασθενείς με CRSwNP και 10 άτομα ως ομάδα ελέγχου. Τα αντισώματα CD4 +, CD3 + CD45 +, CD8 +, CD294 και PAR2 μετρήθηκαν με κυτταρομετρία ροής σε περιφερικό αίμα και ιστό από πολύποδες των ασθενών. Όλα τα δεδομένα αναλύθηκαν με SPSS (έκδοση 21.0) και το ρ 5%, τα LMS και SNOT 22 είχαν αρνητική συσχέτιση με τα CD4 + κύτταρα (p = 0,029 r = -0,654, p = 0,043 r = -0,618, αντίστοιχα). Στο δεύτερο μέρος αυτής της μελέτης, τα αποτελέσματα από την κυτταρομετρία ροής έδειξαν ότι τα ποσοστά ηωσινόφιλων, καθώς και τα ποσοστά CRTH2 και PAR2 στον ιστό πολυπόδων ήταν στατιστικά σημαντικά υψηλότερα σε ασθενείς με CRSwNP σε σύγκριση με την ομάδα ελέγχου. Συμπεράσματα: Σε αυτή τη μελέτη, αναγνωρίσαμε την πιθανή σημασία των ρινικών CD8 + T λεμφοκυττάρων CD8 + T στην παθοφυσιολογία των ασθενών με CRSwNP που χαρακτηρίζονται επίσης από διήθηση ηωσινόφιλων. Επιπλέον, τα κλινικά χαρακτηριστικά των ασθενών συσχετίστηκαν επίσης θετικά με την ηωσινοφιλική φλεγμονή και τη σοβαρότητα της νόσου. Πράγματι, στο δεύτερο μέρος αυτής της μελέτης, οι ασθενείς με CRSwNP βρέθηκαν με ηωσινοφιλική φλεγμονή καθώς και με αυξημένα ποσοστά CRTH2 και PAR2

The Supraclavicular Artery Island Flap for Pharynx Reconstruction

The supraclavicular artery island flap (SCAIF) is a reliable, easy-to-harvest and versatile fasciocutaneous flap that can be used for pharynx reconstruction. Instead of free flaps, it requires no microsurgical technique, reduced operating time and postoperative care, making it an ideal option, especially during the COVID-19 pandemic. The primary aim of our study was to present two cases of a total laryngectomy and reconstruction with the SCAIF during the pandemic. The secondary aim was to review the literature concerning surgical techniques, complications and contradictions of the SCAIF for pharynx reconstruction. A literature search was performed using the PubMed, ScienceDirect, Wiley Online Library, Google Scholar, Scopus and Cochrane Library databases, using MeSH terms: larynx AND reconstruction AND flap. Ten full-text articles comprising 92 patients with 93 supraclavicular flaps were included. The patch graft, pharyngeal interposition graft, tubularization or “U”-shaped SCAIF were the main surgical techniques. Pharyngocutaneous fistula was the most frequent postoperative complication, especially in patients with previous radiotherapy, but just 19% of patients required secondary intervention. The lack of donor-site morbidity, low flap loss rates and stenosis rates favored this reconstructive option. This review underlined that the SCAIF has comparable results with other reconstructive options, consolidating this flap in the workhorse of pharynx reconstruction