Studying Malnutrition-Related Factors in Patients with Head and Neck Cancer Following Surgery

Background: Nutritional dysfunction with or without aspiration is a common complication following head and neck cancer (HNC) surgery and patients frequently present with weight loss secondary to dysphagia and malnutrition.Aim: The aim of this study was to investigate the incidence of weight loss and malnutrition in patients with HNC following surgery through the Malnutrition Universal Screening Tool (MUST) scale.Methods: A total of 28 patients with a confirmed diagnosis of head and neck cancer mainly of the oral cavity referring for surgery for the first time were enrolled. A researcher-designed questionnaire was used for data collection. Further, a single nutritionist evaluated each patient’s nutritional status before and 6-8 weeks' post-surgery according to MUST to measure the level of malnutrition. Significance level was set at p<0.05.Results: Among the subjects, 57% were younger than 70 years; 61% were in stage II of cancer while the rest were in stage III. Weight, body mass index (BMI), serum hemoglobin, and albumin levels showed a significant reduction following surgery (p<0.05). Specifically, 18% had less than 5%, 36% had 5-10%, and 46% had >10% weight loss. According to MUST scale, 18% of Patients with HNC had low, 25% had moderate, and 57% had high risk of malnutrition. A significant relationship was found between severe malnutrition and patients older than 70 years of age.Conclusion: In head and neck cancer patients, weight loss increases the morbidity and mortality, therefore nutritional interventions should be initiated before cancer treatment begins and these interventions need to be ongoing after completion of treatment to ensure optimal outcome

Evaluation of Salivary Function Post-Partial Superficial Parotidectomy

Introduction: Parotid pleomorphic adenomas necessitate surgical intervention, with a growing emphasis on preserving salivary function post-surgery due to its critical role in maintaining oral health and overall quality of life. This study aims to evaluate a surgical method meticulously designed to preserve salivary function following partial superficial parotidectomy, utilizing Technetium-99m scintigraphy.Materials and Methods: This single-center prospective cohort study was conducted in Mashhad, Iran, between 2022 and 2023. The study encompassed 40 patients diagnosed with parotid pleomorphic adenomas, ages 20 to 64, undergoing partial superficial parotidectomy. The salivary function was evaluated using Technetium-99m scintigraphy three weeks post-operation.Results: Most participants underwent right parotid surgery (62.5%, n=25) instead of left parotid surgery (37.5%, n=15). The outcomes of the partial superficial parotidectomy indicated no complications during the three-week post-operative period. Saliva secretion rates on the operated side were preserved across the cohort. A significant difference in saliva secretion rates was observed between the operated and contralateral sides (P<0.01) for both right and left parotid surgery groups. No significant correlation was found between the time elapsed post-surgery and saliva secretion rates (P=0.48).Conclusion: Our study demonstrated that the superficial parotidectomy technique is notably effective when focused on preserving the salivary function of the deep parotid gland. Not only does it maintain saliva secretion on the operated side, but it also boasts an admirable safety profile. There were no recorded complications, and duct preservation was achieved in most instances

Reconstruction of Buccal Mucosa, Upper and Lower Lip Defect Using Free Radial Forearm Flap with Palmaris Longus Tendon: A Case Presentation

Introduction: Advanced lip carcinomas can invade adjacent structures. Performing surgery for these cancers will lead to defects in this anatomically and functionally important area and will cause post-op difficulties such as drooling, speech alterations and aesthetic considerations, if not properly managed. Case Report: In this study, we will introduce a radial forearm free flap with palmaris longus tendon to reconstruct a defect of a large lower lip carcinoma. Our patients was a male in the 7th decade of life with an advanced lower lip carcinoma invading the full thickness of the buccal mucosa, left commissure and the left third of the upper lip. Resection was performed with adequate margins; checked by frozen sections and radical modified neck dissection was also performed on the left side. Free radial forearm flap with palmaris longus tendon was harvested and anastomosed in the neck. Four months after surgery commissurroplasty was done and the flap volume reduced Conclusion: The radial forearm free flap with palmaris longus tendon provides a good functional lip with a reasonable aesthetics in our patient. The patient was satisfied with the result and there were no functional complaints such as drooling reported by him. We think that this flap could be a flap of choice for reconstruction of the large, full thickness lip defects

Outcomes of Autologous Fat Injection Laryngoplasty in Unilateral Vocal Cord Paralysis

Introduction: Unilateral vocal cord paralysis (UVCP) is not an uncommon finding. Several procedures are available to manage glottal insufficiency. We conducted a clinical trial to evaluate the outcome of fat injection laryngoplasty.   Materials and Methods: Liposuctioned lower abdomen fat was injected for augmentation of paralyzed vocal cord in 20 patients with UVCP. Autologous fat was harvested with an 18G needle and a 20-ml disposable syringe using a liposuction technique. Clinical follow-up after the injection was carried out from 1 to 6–21 months   Results: Voice and glottal protective function were significantly improved after the surgery. Vocal elements were immediately improved after the surgery, and after 1 year of follow-up. Conclusion:  Fat injection laryngoplasty by liposuction is simple, safe, effective and has a low cost for patients with UVCP with aspiration and breathy voice dysphonia

Nausea and Vomiting after Septorhinoplasty Using Alfentanil or Remifentanil

Introduction: The aim of this study was to compare Alfentanil with Remifentanil regarding postoperative nausea and vomiting. Materials and Methods: In this double-blind randomized controlled trial, we studied 60 patients, between 17-48 years old with American Society of Anesthesiologists class I or II undergoing septorhinoplasty. The patients signed informed consent and then were randomly divided into two groups. Induction was started similarly in both groups using Midazolam, Propofol and Atracurium whereas group one Alfentanil group (AL group) received Alfentanil and group two Remifentanil group (R group) received Remifentanil. We used Alfentanil with Propofol in the AL group or Remifentanil with Propofol in the R group as maintenance drugs. We assessed nausea and vomiting with Visual Analogue Scale (VAS) from the extubation time until 24 hours after the surgery. We used ondansetrone to relieve nausea. Results: Our patients had a mean age of 25.7±5.4. 75% were female and 25% were male. Duration of surgery had a mean time of 167.5±15.8 minutes and there was not statistically any difference between the two groups. We assessed nausea and vomiting incidence and severity on Visual Analogue Scale score in 0-1 hour, 1-6 hours and 6-24 hours after surgery. The highest nausea and vomiting incidence was in 1-6 hours after the surgery and the two groups were statistically the same. Conclusion: Our results did not show a statistically significant difference between using Alfentanil and Remifentanil as induction and maintenance drugs, regarding nausea and vomiting in the 24 hours post operation period.

Sialolipoma of salivary glands: Two case reports and review of the literature

Sialolipoma is a rare neoplasm of salivary glands, described as a distinct entity by Nagao et al. in 2001. Thirty-six cases of sialolipoma in minor and major salivary glands have been reported thus far in addition to the two new cases of sialolipoma arising in the major salivary glands in this study. Thirty-six cases of sialolipoma published in English language reports were analyzed considering gender, age, location, size, duration of symptoms, treatment mode, follow-up, and histologic findings. Congenital sialolipomas were considered in this study. The first case occurred in a 45-year-old female and presented as a localized swelling in right parotid area. The second case occurred in an 18-year-old female as a swelling in the left parotid region. On histopathological examination, these lesions were diagnosed as sialolipoma

Comparison of Effectiveness of Betamethasone gel Applied to the Tracheal Tube and IV Dexamethasone on Postoperative sore Throat: A Randomized Controlled Trial

Introduction: Postoperative sore throat is a common complaint in patients with endotracheal intubation and has potentially dangerous complications. This randomized controlled trial study investigated the incidence of postoperative sore throat after general anesthesia when betamethasone gel is applied to a tracheal tube compared with when IV dexamethasone is prescribed.   Materials and Methods: Two hundred and twenty five American Society of Anesthesiologist (ASA)-class I and II patients undergoing elective abdominal surgery with tracheal intubation were randomly divided into three groups: betamethasone gel, intravenous (IV) dexamethasone, and control groups. In the post-anesthesia care unit, a blinded anesthesiologist interviewed all patients regarding postoperative sore throat at 1,6, and 24 hours after surgery.   Results: The incidence of sore throat was significantly lower in the betamethasone gel group compared with the IV dexamethasone and control groups, 1, 6, and 24 hours after surgery. In the first day after surgery 10.7% of the betamethasone group had sore throat whereas 26.7% of the IV dexamethasone group and 30.7% of the control group had sore throat. Bucking before extubation was observed in 14(18.4%), 8(10.4%), and 9(12.2%) patients, in the IV dexamethasone, betamethasone gel, and control group, respectively.   Conclusion:  We concluded that wide spread application of betamethasone gel over tracheal tubes effectively mitigates postoperative sore throat, compared with IV dexamethasone application

HIV: An Epidemiologic study on Head and Neck Involvement in 50 Patients

Introduction: Acquired immunodeficiency syndrome (AIDS) is a worldwide infection. Because of the vast array of manifestations of AIDS and its many atypical presentations, it is becoming increasingly challenging for clinicians to accurately diagnose new lesions. Materials and Methods: In a descriptive cross-sectional study conducted from 2007 to 2010, 50 patients with a proven human immunodeficiency virus (HIV) infection were evaluated. Based on the findings of a physical examination and paraclinic tests, HIV signs and symptoms were recorded.   Results: The mean (range) age of the patients was 35.45 ±5.24 (5–55) years. Forty-two (84%) cases were male and eight were female. The mean duration of carrying the virus was 4.51 ±1.03 years. Oral manifestations were the most common (94%), followed by rhinologic (88%), otologic (66%), and finally neck (44%) manifestations.   Conclusion:  Head and neck presentations are very common in HIV patients; therefore otolaryngologists, as the first physicians who may encounter such patients, should be aware of this condition.

Relationship between the Expression of Matrix Metalloproteinase and Clinicopathologic Features in Oral Squamous Cell Carcinoma

Introduction: Squamous cell carcinoma of the oral cavity is one of the most important and common types of head and neck malignancy, with an estimated rate of 4% among all human malignancies. The aim of this study was to determine the association between expression of matrix metalloproteinase 2 and 9 and the clinicopathological features of oral squamous cell carcinoma (OSCC).   Materials and Methods: One hundred existing samples of formalin-fixed paraffin embedded specimens of OSCC were evaluated by immunohistochemistry staining for matrix metalloproteinase 2 and 9 antibodies. Samples were divided into four groups: negative, 50%. Patient records were assessed for demographic characteristics such as age and gender, smoking and family history of OSCC as well as tumor features including location, differentiation, stage and lymph node involvement.   Results: In this study, 58 patients (58%) were male and 42 (42%) female. The mean age of patients was 60.38±14.07 years. The average number of lymph nodes involved was 8.9±3.8. Tumoral grade, tumoral stage, lymphatic metastasis and history of smoking were significantly related to MMP2 and MMP9 expression.   Conclusion:  Our study demonstrated that MMP2 and MMP9 expression are important in the development of OSCC

Controlled vs Spontaneous Ventilation for Bronchoscopy in Children with Tracheobronchial Foreign Body

Introduction Tracheobronchial foreign body aspiration is a common life-threatening condition in children. There are controversies in the management of this condition, including the type of ventilation during bronchoscopy.  This study aims to compare anesthesia with controlled ventilation versus spontaneous ventilation in rigid bronchoscopy in children with foreign body aspiration.  Materials and Methods: Patients who were candidates for rigid bronchoscopy due to foreign body aspiration were randomly assigned to either anesthesia with spontaneous ventilation or controlled ventilation. End tidal CO2 (ETCO2), electrocardiogram (ECG), heart rate (HR), oxygen saturation (SpO2), non-invasive blood pressure (NIBP) and complications and accidents during the surgery and recovery were recorded for each patient. Surgeon comfort during the procedure was also evaluated for each patient. A 20% change in HR or NIBP was considered significant. SpO2 values under 90% are considered desaturation.  Results: Fifty-one patients (31 male and 20 female) entered the study. The mean age was 26.76 months, ranging from 6 to 100 months. Choking and cough were present in 94% and 96.1% of the patients, respectively. Nuts were the most common foreign body (76.9%). The controlled ventilation group had significantly fewer complications, and surgeon comfort was significantly higher in this group. Oxygen desaturation was significantly more prevalent in the spontaneous ventilation group during laryngoscopy and bronchoscopy (