Oral mucosal melanoma: a malignant trap

Oral mucosal melanomas are highly malignant tumors. The 'chameleonic' presentation of a mainly asymptomatic condition, the rarity of these lesions, the poor prognosis and the necessity of a highly specialized treatment are factors that should be seriously considered by the involved health provider. We present the case of a 75-year-old man who was referred to the Ear, Nose and Throat department. His symptoms were voice alteration and saliva drooling, progressively worsening during the last few weeks. The absence of pain was the reason for the delay of seeking medical care. The diagnosis was an oversized oral melanoma. This is an example of how the time of diagnosis and the evolution of a disease could be seriously influenced by patient's behavior. Melanomas arising from oral mucosa have poor prognosis unless they are discovered and treated early. The vigilance of the physicians is necessary to have success in this difficult task

Metallic foreign body in middle ear: an unusual cause of hearing loss

This is a rare case report of a foreign metallic body found in the middle ear. During the use of an electric welding by a metalworker, a glowing drop of dissolved metal overrun, burning the skin of his external auditory meatus, perforated the tympanic membrane and finally was implanted around the ossicles as a foreign body. Due to difficulty of the physical examination and the moderate symptoms (hearing loss and sense of fullness), the foreign body was detected six months after the incident, by CT scanning and it was removed by a transcanal approach under general anesthesia. A successful ossiculoplasty-tympanoplasty was followed four weeks later

Nonmicrosurgical reconstruction of the auricle after traumatic amputation due to human bite

BACKGROUND: Traumatic auricular amputation due to human bite is not a common event. Nonetheless, it constitutes a difficult challenge for the reconstructive surgeon. Microsurgery can be performed in some cases, but most microsurgical techniques are complex and their use can only be advocated in specialized centers. Replantation of a severed ear without microsurgery can be a safe alternative as long as a proper technique is selected. METHODS: We present two cases, one of a partial and one of a total traumatic auricular amputation, both caused by human bites, that were successfully managed in our Department. The technique of ear reattachment as a composite graft, with partial burial of the amputated part in the retroauricular region, as first described by Baudet, was followed in both cases. RESULTS AND DISCUSSION: The prementioned technique is described in detail, along with the postoperative management and outcome of the patients. In addition, a brief review of the international literature regarding ear replantation is performed. CONCLUSION: The Baudet technique has been used successfully in two cases of traumatic ear amputation due to human bites. It is a simple technique, without the need for microsurgery, and produces excellent aesthetic results, while preserving all neighboring tissues in case of failure with subsequent need for another operation

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

Glomus Tumor of the Cheek: A Case Report

Glomus tumors are benign, subcutaneous neoplasms of the perivasculature. Though facial location is rare, the diagnosis of a glomus tumor should be considered in cases of undiagnosed painful facial nodules or chronic facial pain. Imaging aids in defining the tumor and planning a complete excision in order to avoid recurrence. Histological examination is mandatory after every attempted excision. A case of glomus tumor of the cheek along with the possible pitfalls of diagnosis and treatment and a brief review of the limited associated literature are presented

Management of a Buccal Space Mass: A Clinical Case Report

Background. Buccal space tumors constitute rare pathologies with significant histological diversity. They may pose serious diagnostic and therapeutic challenges for the head and neck surgeon. Methods. A case of buccal space tumor diagnosed and treated in a tertiary center is presented. Clinical presentation, imaging, and surgical approach are discussed, followed by review of the literature. Results. A 79-year-old male patient with a slowly growing painless mass on the right cheek presented to a head and neck reference center. Imaging revealed a tumor of the right buccal space with nonspecific characteristics. Imaging studies revealed extended infiltration of the masseter muscle as well as the anterior border of the parotid gland. FNA biopsy was performed but was nondiagnostic. The decision of surgical excision with a modified parotidectomy incision was taken. The lesion was completely excised with preservation of neighboring facial nerve branches and ipsilateral Stensen’s duct. The postoperative course was uneventful. Histological examination showed CLL/Lymphoma, and the patient was referred to the hematology department for staging and further management. Conclusion. Differential diagnosis of buccal space masses is very diverse. Despite challenges in the diagnostic and therapeutic approach, these entities may be managed surgically with minimal morbidity