Surgical management of mandibular and maxillary central giant cell granuloma

Abstract Background Central giant cell granuloma is a benign intraosseous lesion of bone. It frequently affects the head and neck region, particularly the maxillary and mandibular bones. Despite the availability of various nonsurgical treatment options, surgery is still the most effective treatment option for granulomas that do not respond to medical treatment, cause significant bone deformities, or result in extensive bleeding. In this article, we aimed to show the importance of surgery in certain patients by sharing our experience with five patients who were operated on in our clinic. Case presentation In this case series, five patients who attended our clinic with central giant cell granuloma disease and underwent surgical treatments were retrospectively evaluated utilizing the hospital database records. Demographic and medical information, symptoms at admission, the results of CT and MRI imaging, pathologic results, previous treatments, and the surgical therapy performed at our clinic were all considered. Surgical procedures were performed in five patients; marginal mandibulectomy in two, segmental mandibulectomy in one, and partial maxillectomy in the other two. The granulation tissues in the cavity were removed using curettage and a diamond burr. Primary suture, secondary healing, palatal obturator repair, and free fibula flap reconstruction techniques were performed. Conclusions The objective of surgical therapy for central giant cell granuloma is to remove the mass with appropriate surgery and repair it properly with the least amount of morbidity and risk of recurrence possible

Assessment Of Pediatric Cricopharyngeal Achalasia With High Resolution Manometry

Cricopharyngeal achalasia (CPA) is an uncommon cause of oropharyngeal dysphagia (OPD) which is the failure of upper esophageal sphincter (UES) to relax during bolus passage. The diagnostic challenges in OPD have been overcome with the use of high resolution manometry (HRM) in children where a catheter based biomechanical evaluation testing of the oropharyngeal swallowing is performed. Herein, we present a case with severe dysphagia diagnosed as CPA utilizing HRM testing. An 8-year-old boy was seen in our clinic with a two-year history of difficult swallowing, recurrent respiratory tract infections, hypoxia and seizure secondary to aspiration. Esophagography revealed an indentation of the cricopharangeal muscle (CPM) in the cervical part of the esophagus. Videofluroscopic swallow studies (VFSS) revealed cricopharyngeal bar at level of C5-6 and diffuse dysmotility in esophagus. Conventional esophageal manometry revealed absence of peristaltic activity throughout the esophagus. Esophagogastroduodenoscopy revealed narrowing in upper esophagus that with applied force allowed passage of the endoscope. The patient underwent UES dilatation 6 times. He had temporary relief of symptoms. Since he did not have sustained response to dilatation, a botulinium toxin (5IU/each quadrant) injection (BTI) to CPM was performed twice. His symptoms recurred at the end of 3 months. HRM was performed revealing weakness of CPM and uncoordinated contractions and relaxations in UES. We could not reliably differentiate if HRM findings were a sign of primary illness or secondary to BTI. Swallowing rehabilitation was adjusted based on HRM findings. He is still under follow-up with mild dysphagia to certain solids. CPA is an uncommon cause of dysphagia with limited therapeutic options. HRM should be performed in OPD before considering any treatment modality including esophageal dilatation and BTI. HRM has become gold standard diagnostic tool in OPD that provides objective evaluation of pharyngeal and UES motility in children.WoSScopu

Serum Neopterin Concentrations and Tryptophan Degradation Pattern in Patients with Late Stage Larynx Carcinoma

As the disease-free 5-year-survival of late stage laryngeal carcinoma patients is extremely low, indoleamine-2,3-dioxygenase-1 (IDO)-induced tryptophan degradation may represent an immune escape mechanism which plays an important role in cancer spreading in advanced stage laryngeal cancers. We examined whether the late stage laryngeal cancer enhances tumor immune evasion by the expression of systemic IDO activities and chronic cellular immune activation. Twenty-two of 42 male laryngeal cancer patients were classified as late stage cancer according to American Joint Committee on Cancer (AJCC) criteria. Their serum neopterin, tryptophan and kynurenine concentrations were compared with 30 cancer-free individuals. IDO activity was approved by correlation between serum neopterin and kynurenine/tryptophan. Late stage cancer patients preoperatively showed a significantly higher IDO activity compared to controls and early stage cancer cases. Six months after tumor removal, late stage cancer patients although having higher serum neopterin concentration compared to early stage patients or controls, they showed a significant decrease in IDO activity and tryptophan consumption. Increased systemic IDO activity may provoke the escape of tumor cells from the immune surveillance of the host. High IDO activity is due to the presence of tumor mass. Persistence of high serum neopterin levels despite tumor removal may indicate poor prognosis.WoSScopu

Comparison Of Voice And Swallowing Parameters After Endoscopic Total And Partial Arytenoidectomy For Bilateral Abductor Vocal Fold Paralysis A Randomized Trial

IMPORTANCE Total arytenoidectomy is claimed to increase risk of aspiration and cause more voice loss than other operations performed for bilateral abductor vocal fold paralysis (BVFP). However, objective evidence for such a conclusion is lacking. There is no study comparing swallowing and voice after total and partial arytenoidectomy. OBJECTIVE To compare voice and swallowing parameters after endoscopic total and partial arytenoidectomy for BVFP. DESIGN, SETTING, AND PARTICIPANTS In this prospective, randomized, double-blind, case-control study conducted at a tertiary referral university, the study population comprised 20 patients with BVFP. INTERVENTIONS Endoscopic total and partial arytenoidectomy. MAIN OUTCOMES AND MEASURES Decannulation, duration of operation, Voice Handicap Index, acoustic and aerodynamic analysis, postoperative breathing ability, subjective comparison of preoperative and postoperative voice, speech intensity, and functional outcome swallowing scale. RESULTS Median duration of partial and total arytenoidectomies were 59 and 49 minutes, respectively. This difference was statistically significant (P = .04). Comparisons of preoperative and postoperative Voice Handicap Index, acoustic and aerodynamic measures, postoperative breathing ability, subjective comparison of preoperative and postoperative voice, speech intensity, and functional outcome swallowing scale were not statistically significantly different between both groups. CONCLUSIONS AND RELEVANCE Endoscopic total and partial arytenoidectomy are very successful static surgical options for BVFP. Partial takes longer than total arytenoidectomy. They both provide a comfortable airway, acceptable voice, and acceptable deglutition. It may be a sound practice to perform partial arytenoidectomy initially for primary BVFP cases and reserve total arytenoidectomy for revision cases.WoSScopu

Management of Acquired Atresia of the External Auditory Canal

OBJECTIVE: The aim was to evaluate surgical techniques and their relationship to postoperative success rate and hearing outcomes in acquired atresia of the external auditory canal. MATERIALS and METHODS: In this article, 24 patients with acquired atresia of the external auditory canal were retrospectively evaluated regarding their canal status, hearing, and postoperative success. RESULTS: Acquired stenosis occurs more commonly in males with a male: female ratio of 2-3:1; it seems to be a disorder affecting young adults. Previous ear surgery (13 patients, 54.2%) and external ear trauma (11 patients, 45.8%) were the main etiological factors of acquired ear canal stenosis. Mastoidectomy (12/13) and traffic accidents (8/11) comprise the majority of these etiological factors. Endaural incision is performed in 79.2% and postauricular incision for 20.8% of cases during the operation. As types of surgical approach, transcanal (70.8%), transmastoid (20.8%), and combined (8.4%) approaches are chosen. The atretic plate is generally located at the bony-cartilaginous junction (37.5%) and in the cartilaginous canal (33.3%); the bony canal is involved in a few cases only. Preserved healthy canal skin, split-or full-thickness skin grafts, or pre-or postauricular skin flaps are used to line the ear canal, but preserved healthy canal skin is preferred. CONCLUSION: The results of surgery are generally satisfactory, and complications are few if surgical principles are followed.WoSScopu