International Journal of Otolaryngology and Head & Neck Surgery

Published by Scientific Research Publishing
Online ISSN: 2168-5460
Makkah Otolaryngology-Head and Neck DATABASE (MO-HND) interface.
Diagnosis distributions of 1178 patients attending Otolaryngology—Head and Neck Surgery clinic. 
Diagnosis distributions of 1178 Otolaryngology-Head and Neck Surgery clinic patients according to subspecialty.
Distributions of requested investigations for 1178 patients attending the Otolaryngology—Head and Neck Surgery clinic. 
Objectives: An Otolaryngology—Head and Neck Surgery clinic is an integral part of any modern tertiary center outpatient department. The objective of this article is to present our experience in developing a local electronic Makkah Otolaryngology—Head and Neck DATABASE (MO-HND) and provide a roadmap for the development of Otolaryngology—Head and Neck Surgery clinics in other tertiary centers. Methods: This is a prospective audit of all patients attending our clinic over 3 months period (July to September 2014). The data were recorded using our MO-HND. Results: A total of 1178 patients were included. The mean age was 27.7 ± 6.7 years. Participants included 586 males (49.7%) and 592 females (50.3%). There were 1139 (96.6%) Saudi and 39 (3.4%) non-Saudi patients. The specialist clinic undertook most of the workload (66%). The majority of surgery bookings (94%) were carried out through a consultant clinic. Of all participants, 80% were diagnosed with general ENT conditions, 21% underwent a procedure in the clinic, and 29% required further investigations. The surgical conversion rate was 16.3%. Conclusion: Electronic DATABASES have become important tools for improving medical services. Primary and secondary level medical centers and hospitals should increase their role in alleviating pressure from tertiary and qua-ternary level hospitals. In turn, a model concentrated on subspecialty clinics and services should be developed.
Results of surgical treatment in 125 patients with thyroid masses who attended to a Unit of the Department of ENT, Head and Neck Surgery of Govt. Medical College associated SMHS Hospital Srinagar in the first decade of this century are presented. Age of the patients ranged from 17 to 68 years peaking in the fourth decade of life (Figure 1 and Figure 2). Near 85% of the patients with thyroid masses were female and most of the cases (76%) euthyroid at the time of presentation. Depending upon the expertise of the pathologist, the FNA cytology has a good role in the preoperative diagnosis of thyroid masses especially the malignant types (Figure 3 and Figure 4). The specificity of FNA cytology in detecting malignant thyroid tumors in this study was 100% and the sensitivity was 73.08%. The overall diagnostic accuracy was 83.20%. 45.60% of the thyroid masses proved on excision biopsy to be malignant of which papillary carcinoma continued to be the most common malignant thyroid tumor followed by the medullary, the follicular and the undifferentiated types. Radionuclide scanning gave equivocal results in distinguishing between the benign and the malignant thyroid nodules in this study, but it was useful in evaluating indeterminate cases of FNA cytology. Magnetic resonance imaging of neck was used as an adjunctive imaging modality in assessing the extent of the primary malignant thyroid lesion, its direct extra-thyroidal spread and regional nodal metastases (Figure 5 and Figure 6). Different surgical techniques utilized in dealing with the thyroid masses included partial thyroidectomies and total thyroidectomy with or without modified neck dissection and the results are discussed.
Introduction: Hearing disability is a condition that affects normal ear function, as much in adulthood as in the first years of life. According to the 2005 Census, 6.3% of the Colombian population has some type of disability, of which 17.4% have hearing limitations, including those with hearing devices. Elucidating the conditions of this population and identifying the factors related to hearing disability will permit the management of strategies from different sectors to mitigate the consequences associated with this limitation. Objective: To estimate the self-perception of hearing disability in Colombia and to determine the factors associated with this limitation. Materials and Methods: The present study is cross-sectional, based on the analysis of secondary information obtained from the Registry for Localization and Characterization of Persons with Disability (RLCPD) during the 2002-2008 period. Socio-demographic and healthcare variables were analyzed. Results: 13.6% (102,648/750,377) of the population reported hearing limitations even with the use of special hearing devices. 43.52% (44,041) of people over 3 years of age could neither read nor write. 29.39% (30,145) of people who reported this limitation are not affiliated to any sort of health insurance system. Factors found to be associated with hearing limitations were: socioeconomic stratus (OR: 1.33; CI 95% 1.25; 1.42), illiteracy (OR: 1.44; CI 95% 1.42; 1.46) and lack of affiliation to a health insurance system (OR: 1.03; CI 95% 1.01; 1.04). Conclusion: People registered with hearing disability live under vulnerable conditions; among them, most/the majority pertained to a segment of the population with low economic resources and had difficulty obtaining/accessing work, education and healthcare services.
Objective: To explore the expression of IL-27, Th17 cells and CD4+CD25+ regulatory T cells (Treg) as well as its associated cytokines in peripheral blood of patients with allergic rhinitis (AR). Method: From March 2012 to May, the peripheral blood of 24 cases of AR patients (AR group) and 16 cases of healthy volunteers (control group) was collected, and the percentage of Th17 cells and Treg cells in the peripheral blood was detected by flow cytometry (FCM); the levels of IL-27, IL-17 and IL-10 in serum was detected by ELISA. Result: The percentage of Th17 cells in AR group and the control group was 1.76% ± 0.60% and 0.59% ± 0.17%, respectively. It was higher in AR group than in control group, and the difference between two groups was statistically significant (P 0.05). Conclusion: In the peripheral blood of AR patients there was a reduction of IL-27 level and imbalance of Th17/Treg cell function. IL-27 on Th17/Treg cells adjustment may play an important role on the pathogenesis of the AR.
Objective: To study the epidemiological aspects of syndromic hearing loss (HL) in deaf and mute children below 15 years of age. Materials and methods: The study “Epidemiological study of different syndromes in 300 deaf and mute children” was conducted on 300 deaf and mute children below 15 years of age at Rohtak (Haryana) from August 2013 to July 2014. Three hundred deaf and mute candidates were included in the study from various schools for deaf and mute children in the Rohtak city and deaf and mute children attended the ENT outdoor at the Department of Otolaryngology and Head and Neck Surgery, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India, for the evaluation of their deafness. Information regarding patient’s age, sex, religion, age of presentation, residence, family history of deafness, consanguineous marriage in the family, socioeconomical status of the family, literacy and occupation of the parents, and developmental history of the candidate was recorded from the parents and guardians using a standard questionnaire. Audiological tests were done to determine the type and the degree of HL. Results: Out of 300 deaf and mute children, syndromic HL was found in 44 cases (14.66%). Most common systems involved in syndromic HL were ocular in eight patients (18.18%) followed by skeletal in four patients (9.09%) and craniofacial malformation in four cases (9.09%). Out of 300 deaf and mute cases, well-recognized syndromes were found in five cases (1.66%) and the most common syndrome found was Waardenburg’s syndrome (2 cases). In the 44 syndromic HL cases, 36 patients were males (81.81%) and 8 patients were females (18.18%). Out of 44 syndromic HL cases, 42 (95.45%) were Hindu by religion and 2 (4.54%) were Muslim. Residence wise, 20 patients (45.45%) were from a rural area and 24 patients (54.54%) were from an urban area. Out of 44 syndromic HL cases, fathers were illiterate in 5 cases (11.36%), while mothers were illiterate in 23 cases (52.27%), while fathers were educated in 39 cases (88.63%) and mothers were educated in 21 cases (47.72%). By occupation, fathers were laborers in 25 cases (56.81%) and mothers were housewives in 38 cases (86.36%). Socioeconomically, 31 patients (70.45%) were from the lower–middle and middle socioeconomical status, while 11 cases (13.63%) were from the lower socioeconomical status. History of consanguineous marriage was present in two cases (4.54%). Both these cases were Hindu by religion. Family history (genetic etiology) of HL was present in six cases (13.63%) and acquired cases were found in nine cases (20.45%). In 29 cases (65.90%), no etiology was found.Conclusion: From the above results, we can see that syndromic HL is more common in the male urban child. Mothers who are illiterate and housewife are a risk factor for deafness. Syndromic HL is more common in the lower and lower–middle socioeconomical status families. Any newborn with ocular skeletal and craniofacial abnormalities should be urgently evaluated for deafness. Keywords: Childhood deafness, Deafness epidemiological profile, Syndromic hearing loss.
Background: Management of N0 neck in patients with head and neck squamous cell carcinoma (HNSCC) remains a subject of continued debate. Prognostic biomarkers might provide useful information for treatment selection and adjustment. Objective: To evaluate the prognostic relevance of VEGF-A and Ki-67 expression to types of neck management. Methods: This prospective study included 140 patients with HNSCC. Tumor expression of VEGF-A and Ki-67 was measured by immunohistochemistry. Based on tumor size and site criteria, 88 patients with N0 neck were categorized as high, intermediate and low risk of subclinical neck diseases and accordingly treated by elective neck dissection (END), irradiation (ENI) and observation. Adjuvant treatment was given to tumor with close or positive margins. A multivariate Cox regression model was used to identify prognostic factors. Impact of biomarker expression, treatment type and risk category on disease-specific survival (DSS) in the setting of N0 neck were evaluated by Kaplan-Meier survival and adjusted hazard ratio (HR). Results: Coexpression of VEGF-A and Ki-67 (HR = 2.351, p = 0.021) and positive node (HR = 2.301, p = 0.009) were independent prognostic factors for HNSCC. In the setting of N0 neck, marker coexpression has an HR of 4.97 (p = 0.004) independent of treatment modalities (p = 0.069) and risk categories (p = 0.971). Alternatively, neither marker expression was predictive of a better treatment outcome for END compared to ENI, as suggested by the odds of patients being survived 15.4 times greater (p = 0.01) and the 5-year DSS rates of 85.1% versus 44.7% (p = 0.008). Conclusion: Coexpression of VEGF-A and Ki-67 is a suggestion of tumor microinvasiveness in addition to risk of lymph node metastasis and may indicate the need of adjuvant treatment despite negative tumor margins. Neither marker expression serves an indicator for the selection of END over ENI in neck management.
Introduction Oral squamous cell carcinoma, the fifth most common cancer worldwide, is a major cause of morbidity and mortality in India. It most commonly occurs in middle-aged and older individuals. Typically, they tend to be preceded by a premalignant state for a long time. The present study evaluates the clinicopathological profile of patients with oral lesions and the role of malpractices that promote carcinogenesis in the oral mucosa and the use of Ki-67 as an important predictor of the same. Materials and methods The expression of Ki-67 was studied in paraffin-embedded tissue sections of oral lesions of all the cases after taking a detailed history and examination. Results The study was conducted on 65 patients with 25 dysplastic and 40 malignant lesions. Males were affected more frequently than females. The most common age group affected was 31 to 60 years with mean age of 45.4 years. Anterior twothird of tongue (41%) was the most commonly affected site. 95% of the patients had a history of addiction in form of smoking, tobacco chewing and betel nut. Out of 25 cases of dysplasia, 11 showed low expression while out of 40 cases of squamous cell carcinoma only three showed low and 29 showed high expression of Ki-67. Conclusion The expression of Ki-67 correlates well with the disease progression from dysplasia to carcinoma of the oral cavity. It is therefore a marker of malignant transformation and carcinogenesis in oral premalignant lesions and in future it may serve as a prognostic tool in the early detection of malignancy. How to cite this article Maheshwari V, Sharma SC, Narula V, Verma S, Jain A, Alam K. Prognostic and Predictive Impact of Ki-67 in Premalignant and Malignant Squamous Cell Lesions of Oral Cavity. Int J Head Neck Surg 2013;4(2):61-65.
mass arising from palatine arch fig. 2: Computed tomography scan of neck with sagittal view showing mass
Pleomorphic adenoma (PA) is the most common benign tumor of the salivary glands and has both epithelial and mesenchymal tissues. It most commonly arises from the parotid or submandibular glands. Rarely, it arises from the minor salivary glands. We report here a case of pleomorphic adenoma arising from the soft palate and both sides of anterior tonsillar pillars in a 75-year-old man. This patient was presenting painless slow growing large swelling in the soft palate over 20 years causing mechanical obstruction of airway and food. The entire tumor mass was excised along with overlying mucosa. How to cite this article Swain SK, Sahu MC, Tripathy R. A Giant Pleomorphic Adenoma of the Palatine Arch in a 75-Year-Old Man: A Case Report with Review of Literature. Int J Head Neck Surg 2015;6(1):23-25.
Patient characteristics in different age groups. 
Treatment and prognosis in different age groups. 
Background: With the recent aging of society, the need for medical treatment of elderly patients with head and neck cancer seems to have been increasing. Method: The present study analyzed all 103 patients with head and neck cancer ≥80 years, and we compared results with those of the previous generation (Group P; range: 75 - 79 years) comprising 104 patients treated in the same period. Results: We provided treatment just as wanted and could not choose it often. The reasons were oncological factors such as unresectable tumor or distant metastasis, refusal of treatment, and physical factors such as poor PS or number of comorbidities. Conclusion: Treatment choices should be based on the wishes and motivations of the patient and the medical assessment of physical function. When a patient ≥80 years old is treated, the high incidence of complications and severity of the disease should be considered.
Cystic Lesions in the neck have a long differential diagnosis. Thymic cysts are considered rare in the cervical region, whereas they are more common in the superior mediastinal region. They may become more important diagnosis especially in the younger age group. In this article we will consider two cases, one male and other female with similar features and both being diagnosed as having cervical thymic cysts. How to cite this article Mahuvakar AD, Nabi SMAA, Gujrathi AB, Ambulgekar VK, Garud S, Khokle P. Cervical Thymic Cysts— Rare Abnormality: A Report of Two Cases. Int J Head Neck Surg 2015;6(2):90-92.
X-Ray STNL showing edema of the epiglottis (thumb sign).
Post operative day 7-near normal epiglottis.
Post operative day-10.
Post operative day-14.
Background: Epiglottic abscess in an otherwise healthy adult is seen as a rare sequelae of acute epiglottitis. It is a life threatening condition which requires emergency management, which if not done early, may result in fatality. Respiratory infections, exposure to environmental chemical or trauma which may lead to inflammation and infection of the structures around the throat which may lead on to epiglottitis, and an epiglottis abscess very rarely. In our case, patient was immediately managed by doing an emergency tracheostomy followed by incision and drainage in the OPD (outpatient department). This emphasizes on need for emergency airway management by doing a tracheostomy there by facilitating incision and drainage in a case of epiglottic abscess as a daycare procedure. Aim: The primary aim of this clinical record is to emphasize the need for immediate airway management in epiglottic abscess there by facilitating incision and drainage as an OPD (out-patient department) Procedure. Case Presentation: A 45-year-old man presented to the OPD (outpatient department) with complaints of dysphagia, odynophagia, muffled voice, noisy breathing for the previous 7 hours. On clinical examination pt was in stridor & respiratory distress. Since the pt was in stridor, it was immediately shifted to the OT (operation theatre), and an emergency tracheostomy was done and the airway was secured, following which a video laryngoscopic examination was done in the OPD, which revealed oedematous enlarged epiglottis with pus pointing obscuring the laryngeal inlet. Abscess was incised and drained, and pus was sent for culture & sensitivity. Pt was treated with I. V (intravenous) antibiotics as per culture reports and subsequent video laryngoscopic examination revealed near normal epiglottis with an adequate laryngeal inlet. Conclusion: Patients with epiglottic abscess are at increased risk of airway compromise, hence in such patients airway should be immediately secured by doing an emergency tracheostomy. This case shows the benefits of an emergency tracheostomy for doing incision and drainage for epiglottic abscess as an OPD procedure.
Nasal septal abscess is an uncommon condition, yet presents as a rhinological emergency. Its symptoms resemble upper respiratory tract infection and the diagnosis may be missed leading to intracranial complication and cosmetic deformity. We present a healthy patient with idiopathic nasal septal abscess who complained of acute complete nasal obstruction, fever and nasal pain. Common aetiologies, causative agents, complications and management of nasal septal abscess are discussed.
Introduction We report a rare case of isolated parotid abscess due to Mycobacterium fortuitum in an immunocompetent adult female, which to the best of our knowledge (on internet search) is the first case of its type. Methodology Diagnosis was based on MTBDR CM assay (Hain's) culture, followed by a positive TBAg MPT64 culture for MOTT. The patient was treated with abscess drainage and antibiotics with good results. A parotidectomy was not required in our patient. Conclusion Mycobacterium fortuitum parotid abscess is very rare. A knowledge of the pathogenicity of this organism and careful culture methods seem to be the key of accurate diagnosis. Treatment protocols are still subject to research. How to cite this article Chhapola Shukla S, Matta I. Mycobacterium Fortuitum causing Isolated Parotid Abscess in an Immunocompetent Adult Female: A Case Report and Review of Literature. Int J Head Neck Surg 2015;6(3):125-127.
Objective: The purpose of this study is to evaluate the effectiveness and safety of CT-guided percutaneous drainage (CPD) in the management of deep neck abscesses. Factors associated with successful treatment in patients with DNA will be identified. Methods: We retrospectively studied 29 patients who presented to the department of otolaryngology with deep neck abscesses between April 2011 and April 2015. These 29 patients were managed with CPD after antibiotic therapy or needle aspiration failed. Data on patient demographics, location of infection, existing comorbidity, duration of hospitalization, treatment received, and complications were reviewed. Results: The average age of 29 patients, including 18 men and 11 women, was 56 years old. Abscess was found in parapharyngeal space (n = 16), submandibular space (n = 7), retropharyngeal space (n = 5) and pretracheal space (n = 1). The maximum transverse diameter of abscess ranged from 4.8 cm to 8.0 cm (mean 6.03 cm). Positive cultures were found in 24 cases and the most common pathogen found was Streptococcus viridans. Average hospital stay was 6.7 days. Deep neck abscesses were completely removed without residual in all patients. No one had complications and no one died during and after CPD. Conclusion: CPD is a safe and highly effective procedure for treating patients with deep neck abscesses who do not respond to antibiotics therapy. This technique can also provide reliable evidence on pathogens responsible for deep neck abscesses and help otolaryngologists choose effective treatment to achieve better clinical success rate. We recommend that most deep neck abscesses should be managed initially by CPD before resorting to open surgery.
Aims To assess preoperative and postoperative shoulder function by electromyography (EMG) in spinal accessory nerve (SAN) sparing neck dissections in head and neck cancers. Materials and methods A prospective study was done on 50 patients (51 shoulders) with histopathologically proven head and neck cancers with N0 or N1 neck who underwent nerve sparing neck dissections. Patients were assessed preoperatively and postoperatively at 3 weeks and 3 months by needle EMG and muscle strength tests of upper trapezius. Results and interpretation: At 3 weeks postoperatively, 11 shoulders (39.3%) in FND group and four shoulders (33.3%) in modified radical neck dissection (MRND) group showed severely abnormal EMG, while in supraomohyoid neck dissection (SOHND) group only two (18.2%) shoulders showed severely abnormal EMG. All patients who underwent nerve sparing neck dissections showed improvement in at least one category on the second electromyogram at 3 months. This could be attributed to neuropraxia or transient devascularization of the accessory nerve. In our study, 11 patients in FND group showed severely abnormal EMG finding, but they did not have as great a degree of shoulder dysfunction as would be expected. This could be due to factors like preoperative condition of other synergistic shoulder girdle muscles, postoperative exercises, etc. Conclusion SAN injuries are common in all types of nerve sparing neck dissections requiring aggressive physiotherapy for an improved shoulder function. To conclude, in patients in whom it is oncologically sound, nerve sparing neck dissections offers significant benefit in terms of shoulder function. How to cite this article Mohiyuddin A, Raj S, Merchant S, Oomen, Kottaram PJ. Electromyographic Assessment of Accessory Nerve Function Following Nerve Sparing Neck Dissection. Int J Head and Neck Surg 2013;4(1):19-23.
A patient with a squamous cell carcinoma of right retromolar area of the mandible and undergoing a staging neck dissection was noted to have a unique relationship of the internal jugular vein and spinal accessory nerve. At the upper end of the dissection (level II, Memorial Sloan-Kettering classification), the spinal accessory nerve was observed to pass directly through the internal jugular vein. Although previously described only once in the literature, this finding may be encountered by other surgeons who operate in this area and it is important that these anatomical variations are borne in mind to prevent inadvertent injury. To our knowledge, this must be the first case reported from India
Hereditary Hemorrhagic Telangiectasia (HHT) is an autosomal dominant disorder with variable expressivity. We present a 62-year-old patient with a rare, late-onset disease course featuring a novel mutation in ACVRL1, a signal transducer in the TGFβ/BMP pathway.
Distribution of patients. Shows how patients were recruited from referrals to the Otorhinolaryngology service, showing the number of excluded patients and the criteria for this exclusion. Additionally on the right branch we show other motives for referral due to altered hemostasis tests that were not the focus of the present study. 
Introduction: Activated partial thromboplastin time (aPTT) is one of the most used coagulation tests in preoperative evaluation. Incidental detection of a prolonged aPTT is a problem in primary care, in which the general pediatrician should be able to attend its initial management. Objective: To describe final diagnosis of patients with prolonged aPTT in preoperative study. Materials and Methods: This is a descriptive study of patients referred from otorhinolaryngology. Results: Totally, 508 adenoidectomies and/or tonsillectomies were performed in our center, 38 of which referred patients (7.5%) with prolonged aPTT, and 30 of which met inclusion criteria. The median age was 4 years. 56.6% of patients were males. 76.6% of patients normalized aPTT at the second follow-up. Among these, 73.9% showed a normal study, 4.3% ha2d lupus anticoagulant and in 21.7% Von Willebrand disease was detected. Among patients that persisted with prolonged aPTT, 42.8% had coagulant factors deficiency, 28.5% had lupus anticoagulant and in 28.5% of patients a diagnosis could not be achieved with the tests used in the present study. Multivariate analysis did not show correlation between final diagnosis and the variables measured. Conclusion: The presence of a prolonged aPTT in children under preoperative study is due to a pre-analytic factor in the majority of cases or to the presence of lupus anticoagulant, normalizing values on follow-up. We suggest that a new aPTT be performed on these patients, and only those that persist altered or present a symptoms and family history of coagulation disorders be referred to hematology.
MVIC upper trapezius 
MVIC anterior scalene 
MVIC levator scapulae 
Comparison between groups A and B of right side activity
Comparison between groups A and B of left side activity
ABSTRACT Objective: The aim of this study was to investigate activation pattern of neck muscles in patients with chronic neck pain of nontraumatic origin during static tasks. Materials and methods: Fifteen normal subjects were taken in group A and 15 patients with chronic neck pain of nontraumatic origin were taken in group B. Electromyography (EMG) activity was recorded from the sternocleidomastoid, anterior scalene, levator scapulae and upper trapezius muscles. Percentage maximum voluntary isometric contraction were calculated during static tasks, which included shoulder abduction to 90° and hold, shrug and hold, craniocervical flexion and hold. Results: There was no significant (p > 0.05) difference found in activation pattern of neck muscles when we compared right and left sides within groups A and B. But when we compared between groups, group B showed a significant (p < 0.05) increased activation pattern in anterior scalene, sternocleidomastoid, upper trapezius compared to normal subject’s neck muscles except levator scapulae which shows no significant difference between groups. Conclusion: It is concluded from the study that, in patient of nontraumatic origin of chronic neck pain, all the patients showed a significant increased level of EMG activity in neck muscles during performance of static activities as compared to asymptomatic controls. Keywords: EMG, Cervical muscles, Cervical radiculopathy, Movement dysfunction. How to cite this article: Chahal RK, Kumar P. Alteration in Activation Pattern of Neck Muscles in Patients with Chronic Neck Pain. Int J Head Neck Surg 2015;6(1):1-7.
Statistical relationship of acute otitis media with the study variables.
Introduction: Acute otitis media (AOM) is one of the most common ENT childhood diseases. Objective: To identify risk factors for AOM in children aged 0 to 5 years. Methods: This research work was a cross-sectional, descriptive and analytical study. It focused on 2040 children aged 0 to 5 years from both sexes, who were healthy or sick, and living in the Local government of Parakou for at least one year. Those children were randomly selected in all three districts of Parakou. Results: Frequency of AOM was 2.8% and their prevalence was estimated at 16.3%. The identified risk factors were persistent or chronic cases of rhinitis, exposure to charcoal and wood smoke, low socioeconomic status, personal history of AOM, AOM history among the siblings, and children's poor nutritional status. No relationship could be established between AOM occurrence and factors like sex, passive smoking, attendance of a day-care centre or stay in nursery, prematurity, exclusive breastfeeding and large number of siblings. Conclusion: The identification of those risk factors will help put in place appropriate measures to reduce AOM prevalence in Parakou.
pHPT; primary hyperparathyroidism, SA; solitary adenoma, MGD; multiglandular disease, MIBI; MIBI scintigraphy, US; ultrasound, CT; CT scan. 
Background: The objective of this study was to assess the additional yield of US and CT following a “negative” initial MIBI-scintigraphy (MIBI) in patients with primary hyperparathyroidism. Methods: Prospective data were collected regarding 100 consecutive patients, preferentially undergoing a minimally invasive parathyroidectomy (MIP). MIBI was the initial imaging study for localizing a solitary adenoma, followed by US and CT (US/CT) in “MIBI-negative”-patients. Results: Surgery led to normocalcemia in 98 patients (98%) after one operation. Overall 97 patients had solitary parathyroid disease while three patients had multiglandular disease. The sensitivity of imaging increased from 74% for MIBI alone to 92% following subsequent US/CT in “MIBI-negative”-patients. The positive predictive value of a “positive” MIBI was 96% and 76% of a positive US/CT following negative MIBI. The proportion of patients who underwent successful MIP increased from 60 to 72%. Conclusions: MIBI and the combination of US and CT are complementary imaging studies. Additional localization studies after a negative sestamibi scan enhances the number of patients with primary hyperparathyroidism profiting from a minimally invasive approach.
Kaplan-Meier curve for specific survival in sinonasal adenocarcinomas. 
Introduction and Objectives: Sinonasal tumours represent only 3% of all head and neck cancers. Adenocarcinoma is the second most frequent histopathology type. Hardwood exposure has been considered a risk factor. Sinonasal adenocarcinoma grows silently which leads to a late diagnosis and low survival rates. The aim of this study was to present our experience in the management of the patients with sinonasal adenocarcinoma. Method: Retrospective medical records review of patients with sinonasal adenocarcinomas (1974 to 2009). Results: From 301 patients with sinonasal tumors, 67 had histology of adenocarcinoma. Patient average age was 60.1 ± 11.1 years (30 - 84 years). 83.6% were man. 65.7% had history of working with wood. 70.1% of the patients had advance disease. The most common treatment strategy was external surgery (lateral rhinotomy (47.8%), sublabial (17.9%) or cranio-facial resection (6%)) or endoscopic approaches with postoperative radiotherapy. The 3 and 5 years overall survival rate were 60% and 49%, respectively. Conclusions: Our group study showed similar epidemiologic characteristics than other series. We confirmed sinonasal adenocarcinomas tendency to late diagnosis and wood dust exposure relation. In our experience, the limited surgical treatment (without craniofacial resection) and postoperative radiotherapy has good survival rates results, similar to other departments who consider the craniofacial resection as the standard treatment.
Objectives: The aim of the present study was to analyze the recovery rate of symptoms in patients with adenoid hypertrophy and investigate the role of nasal pathologies, allergy and gastroesophageal reflux (GER) as the reason of failure in patients with persistent symptoms. Patients and Methods: Patients undergoing adenoidectomy were enrolled in this study. There were 58 males and 42 females, aged between 1 - 13 years (mean ± SD: 4.9 ± 2.2 years). The parents of each child were questioned about the following symptoms; apnea, nasal obstruction, mouth breathing, snoring and nasal discharge. Presence or absence of nasal obstruction due to septal deviation and/or chonchal hypertrophy was noted. All children were evaluated for GER by upper gastrointestinal endoscopy or pH monitorization and for allergy by specific IgE analysis or skin prick test. Three months after the operation the children were re-examined and their parents were interviewed about persistent symptoms. Patients with persistent symptoms were re-evaluated with rigid endoscopy for residual adenoid vegetation. Results: Apnea was cleared in the entire group postoperatively. However, 9 patients complained of nasal obstruction, 16 patients had mouth breathing, 9 patients had snoring and 17 patients continued to have nasal discharge two months after the operation. Statistical assessment showed a significant difference for each symptom between the pre- and postoperative level (p Conclusions: Adenoidectomy alone is an effective treatment for nasal obstruction and obstructive sleep symptoms in children. Persistent obstructive symptoms are usually due to nasal pathology and allergy.
Clinicopathologic data on ten patients with histologic mucoepidermoid carcinoma arising from pleomorphic adeno- mas.
Background: Mucoepidermoid carcinoma ex-pleomorphic adenoma (MECxPA) is an extremely rare salivary gland malignancy. With only nine prior reported cases, this entity represents a challenging histopathological diagnosis. Methods: We present a case of a 71-year-old male with an enlarging left neck mass over several months. CT showed both a parapharyngeal space mass and a separate level II neck mass. Results: The patient underwent resection of the left parapharyngeal mass and ipsilateral selective level II-IV lymphadenectomy. The final pathologic diagnosis was metastatic high-grade mucoepidermoid carcinoma ex-pleomorphic adenoma. Conclusions: We describe a novel presentation of high-grade mucoepidermoid carcinoma ex-pleomorphic adenoma as a metastatic parapharyngeal mass.
Ultrasonography exam of the right gluteal region which shows the presence of a hypoechoic little mass, 17.4 × 12.3 × 16.1 mm, with posterior wall renfoircement. 
Sites of metastasis: update of metastases' locations.
MR (magnetic resonance) section of the pelvis confirming the presence of an extra-muscolar and subfas- cial mass in the right gluteal region. 
Histological exams documents pleomorphic ade- noma’s soft tissue metastasis nature. 
CT (Computerized tomography) scans of head and neck evidencing: (a) the presence of a mass under the left petrosa penetrating the mastoid cells and (b) being in contact with the labyrinthine system. 
Background: Pleomorphic adenoma constitutes the most common benign parotid gland tumor. Local recurrence after surgery has been described in 1%-5% of cases, and malignant evolution in 2%-9% of cases. Metastasizing pleomor-phic adenomas has rarely been reported. No histologic or molecular parameters exist at the present time that could predict the development of metastasis in these neoplasms. Methods and Results: A 54-year-old woman had a superficial left parotidectomy with facial nerve preservation for pleomorphic adenoma. She developed two recurrences in 2000 and 2001, but 25 years later the first operation she presented a metastasis in her right gluteal region with evidence of local recurrence. Conclusion: Metastatizing pleomorphic adenoma is a rare pathologic situation but, in case of swelling or lump appearance in patients with pleomorphic adenoma history, it should be taken in mind.
T2-weighted MRI in transversal plane showing the well demar-cated, mixed hyperintense and hypointense lesion of the palate.  
The Commonest histological types of minor salivary gland tumors.
T2-weighted MRI in sagittal plane revealing a mass confined to the palate. Fibrous capsules appearing as hypointense on T2-weighted images are characteristic of pleomorphic adenoma.  
Epithelial cells forming sheets, among them hyalinized bulks can be seen (hematoxylin and eosin, magnification 10 × 20).
Introduction: Minor salivary gland tumors are relatively rare, but have a higher chance of malignancy than major salivary gland tumors. The palate appears to be the most commonly involved site. The most frequent benign tumor is the pleomorphic adenoma. Case report: We report a case of a pleomorphic adenoma, which occurred in the hard and soft palate of a 34-year-old female and presented as an asymptomatic slow growing, painless mass. The patient was successfully treated with surgical excision. Discussion: Minor salivary gland tumors should be considered in the differential diagnosis of oral cavity and especially palate tumors. A histological examination is necessary due to the high percentage of malignancy.
Top-cited authors
Varun Rastogi
  • D.J. College of Dental Sciences & Research
Satya Ranjan Misra
  • Siksha O Anusandhan University
Pravin Kumar
  • National Institute for Locomotor Disabilities (Divyangjan), Kolkata, India
Mandeep ..
  • Postgraduate Institute of Medical Education and Research
Anshu Jain
  • Aligarh Muslim University