Pleomorphic Adenoma of the Salivary Glands: Two Atypical Locations

Pleomorphic adenoma is the most common tumor of the salivary glands, accounting for approximately 50% of salivary gland lesions. It develops mainly in the salivary glands: parotid (80%), submaxillary (10%), sublingual (1%) and in the accessory oral-pharyngeal glands (9%). The aim of this work was to report 2 cases of pleomorphic adenoma of atypical location and then to discuss the difficulties linked to its diagnostic and therapeutic management in the Malian context. They were a 40-year-old man and a 72-year-old woman. They were admitted to the ENT department of the “Luxembourg Mere-infant” hospital for oropharyngeal swelling for the first and swelling of the palate for the second. The clinical expression was a swelling in both cases, of a hard, mobile consistency with healthy mucosa on their surface. The remainder of the physical examination was unremarkable. The diagnosis of a tumor of the oropharynx and palate was made following clinical radiological examinations. The histopathological examination of the surgical specimen made it possible to make the diagnosis of pleomorphic adenoma of the palate and the left palatine tonsil. The follow-up surgery was straightforward, with a favorable outcome. Pleomorphic adenomas are relatively rare benign tumors of the accessory salivary glands;their clinical expression remains swelling. Therapeutic management is surgery and the diagnosis is confirmed by histopathological examination.

New Approach in the Management of Adult Epiglottic Abscess—A Case Report

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.

Papilloma of the Tongue: About a Clinical Case at the Center Hospitalier Universitaire CHU Gabriel Toure in Bamako

Introduction: Tongue papillomas are benign epithelial tumors of the tongue lining. It is a precancerous lesion of viral origin caused by the Human papilloma virus (HPV). Objective: To describe the clinical and histological manifestations of a particular type of oral papilloma. Observation: A young woman aged 28 years resident in Siguiri (Guinea), received in consultation for a painless mass on the tongue slow evolving for 6 months duration. There was no notion of mouth bleeding. She had no particular medical and surgical history and negative for retroviral test/HIV test. Examination of the oral cavity found a fungating mass in at Right or Left posterior third of the tongue, painful on contact, sessile and pedunculated and not bleeding on contact and of soft consistency. The excision of the tongue mass was performed under general anesthesia. Biopsy was taken and sent for HPE. The consequences were mild, allowing her to be released 3 days after surgery. Histological examination showed an acanthotic stratified para-keratinized squamous epithelium containing small parts of connective tissue and koilocytes containing connective tissue nuclei reminiscent of papilloma. There was no malignancy cell. Conclusion: The papilloma of the tongue is a benign proliferative lesion characterized by slow and painless growth. I would say early diagnosis and surgical excision should be done to avoid recurrence, contact bleeding and morbidity secondary to mass effect.

Carcinosarcoma of the Hypopharynx—A Rare Entity with Unique Surgical Procedure

Background: Carcinosarcoma of hypopharynx is a rare neoplasm with both malignant epithelial and mesenchymal components. They are highly aggressive in nature with controversial histogenesis. To our knowledge, there is no case reported of carcinosarcoma of hypopharynx managed with wide LASER excision and modified radical neck dissection followed by chemoradiation. Method and Result: 42-year-old male presented complaints of foreign body sensation in throat, and difficulty in swallowing and hoarseness for 4 months. On examination, a large smooth globular mass filling the supraglottis obscuring the view of endolarynx was noted and right side level-II cervical lymphadenopathy was found. CECT neck revealed a large hypopharyngeal mass abutting the supraglottis. Microlaryngoscopic biopsy was reported as high grade carcinosarcoma and PET scan was done after 1 week which revealed no any distant metastasis. The patient was taken for transoral pulsed carbon dioxide LASER excision with modified radical neck dissection, and postoperative chemoradiation was done and after two years of closed follow-up MRI was done which revealed no disease and the patient is absolutely free of disease till now. Conclusion: It was a rare case which was managed with complete LASER excision with neck dissection and postoperative chemoradiation and the patient is absolutely free of disease till now after 2 years of follow-up.

Primary endoscopic stapedotomy using 3 mm nasal endoscope:Audiologic and clinical outcomes

Objective:To report the use of a 3 mm rigid nasal endoscope in primary endoscopic stapedotomy and clinical and audiological outcomes.Materials and methods:Thirty patients diagnosed with primary otosclerosis underwent endoscopic stapedotomy that was performed using a 3 mm nasal endoscope(Karl Storz).At 6 months follow-up,the patients were evaluated for intraoperative findings,postoperative hearing outcomes and complications.Results:Canaloplasty was performed in 2(6.66%)patients,and no curettage of the canal wall was required in 12(40%)patients.Transposition of the chorda tympani nerve was conducted in 11(36.66%)patients.The average duration of surgery was 36 min(range 31e65 min).The air-bone gap(ABG)was 35 dB(range 24e50 dB)preoperatively and 14.63 dB(range 9e20 dB)postoperatively(p?0.00).At 6 months follow-up,<20 dB ABG was achieved in 93.33%of the patients.No major intraoperative/postoperative complications were detected.Conclusion:A 3 mm rigid nasal endoscope can be effectively used in stapedotomy to obtain adequate audiological outcomes.It can be considered as a better alternative to the standard microscope or 4 mm endoscope in preserving the posterior canal wall and chorda tympani nerve while minimizing operative time without causing significant complications.

Regulation of the expression of proinflammatory cytokines induced by SARS-CoV-2

An outbreak of a novel coronavirus was reported in Wuhan,China,in late 2019.It has spread rapidly through China and many other countries,causing a global pandemic.Since February 2020,over 28 countries/regions have reported confirmed cases.Individuals with the infection known as coronavirus disease-19(COVID-19)have similar clinical features as severe acute respiratory syndrome first encountered 17 years ago,with fever,cough,and upper airway congestion,along with high production of proinflammatory cytokines(PICs),which form a cytokine storm.PICs induced by COVID-19 include interleukin(IL)-6,IL-17,and monocyte chemoattractant protein-1.The production of cytokines is regulated by activated nuclear factor-kB and involves downstream pathways such as Janus kinase/signal transducers and activators transcription.Protein expression is also regulated by post-translational modification of chromosomal markers.Lysine residues in the peptide tails stretching out from the core of histones bind the sequence upstream of the coding portion of genomic DNA.Covalent modification,particularly methylation,activates or represses gene transcription.PICs have been reported to be induced by histone modification and stimulate exudation of hyaluronic acid,which is implicated in the occurrence of COVID-19.These findings indicate the impact of the expression of PICs on the pathogenesis and therapeutic targeting of COVID-19.

Prevalence of Otorhinolaryngeal Malignancies in Thanjavur Delta Region—A Prospective Study

Malignancy of otorhinolaryngeal region is the 6th common malignancy worldwide and nowadays the incidence is increasing in developing countries like India. This malignancy contributes to 23% of male and 6% of female population of India [1]. Malignancies included in this study are those of oralcavity, oropharynx, nasopharynx, hypopharynx, larynx, thyroid, nose, paranasal sinuses and salivary gland tumors. This study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery, Thanjavur Medical College, Thanjavur, Tamilnadu India, over a period of 2 years from August 2013 to February 2015. Histopathologically confirmed cases alone were taken for this study. In our study the laryngeal and hypopharyngeal malignancies outnumber the other regions. Males are more commonly affected and the age group of around 40 - 50 years is more commonly involved. Smoking and alcohol intake plays a major etiological factor. Cancer awareness programmes and health education regarding risk factors can help to reduce the incidence of malignancies in our Thanjavur delta region.

Endoscopic stapedotomy:A comparison between the conventional approach versus CO_(2)laser‐assisted surgery

Background:Although the utility of laser fiber in microscopic stapes surgery has been documented in the past,their role can be highly emphasized in endoscopic stapes surgery,especially in difficult anatomical situations.Methods:This is a retrospective analysis of cases where a total of 46 patients(22 in conventional stapedotomy and 24 in CO_(2) laser‐assisted stapedotomy)were included in the study.The clinical parameters were assessed both in the preoperative and postoperative periods in the respective groups and later compared 12 weeks after stapedotomy.Results:A total of 90.90%(20/22)of the patients in the conventional stapedotomy and 95.83%(23/24)of patients in laser‐assisted stapedotomy had<20 dB of AB gap in the postoperative period(P=0.71).Canaloplasty was required in six patients in the conventional stapedotomy and none of the patients in the laser group needed the same(P=0.01).Chorda tympani nerve was manipulated in 59.09%(13/22)and 25.00%(6/24)of cases in the conventional group and in the CO_(2) laser group,respectively(P=0.01).Conclusion:Although the audiological outcomes with fiber‐enabled CO_(2) laser in endoscopic stapedotomy are comparable to conventional surgery,it is a better tool in a narrow auditory canal,requiring minimal manipulation of the chorda tympani nerve.

Surgical management of extracranial nerve sheath tumours in a tertiary care center

Objective:Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structures.Methods:It is a retrospective study contained 13 consecutive patients of nerve sheath tumours involving the head and neck from March 2013 to February 2017 in the department of Otorhinolaryngology and Head Neck Surgery in a tertiary care referral hospital The retrospective clinical data,diagnostic procedures,surgical approaches and their complications are analyzed after 12 months of surgery.Results:Total 13 patients,7 were females and 6 were males.Painless neck swelling was the most common presentation found in 6 and the most common site of origin was the vagus nerve in the parapharyngeal space (6 patients).Transcervical excision of the tumour was performed in 7 patients.Six needed combined surgical approach for the excision of the tumours.Neurovascular injury was detected in 3 patients,and one patient had recurrent disease during the follow-up period.Conclusions:Excision of the nerve sheath tumours of head and neck is always a challenge to the surgeon because of their close proximity of the neurovascular structure.Although the transcervical approach is commonly practiced for the majority of the tumours,combined approaches can be effectively applied for extensive nerve sheath tumours with the satisfactory clinical outcome.

Glomus tympanicum removal using transcanal endoscopic assisted surgery:An experience with six cases

Objective:To evaluate an endoscopic approach in the management of glomus tumor,and also to investigate and evaluate its appropriateness and feasibility.Methods:Glomus tumors,also known as paragangliomas,are benign primary tumors of the middle ear.The advent of endoscopic ear surgery has provided new dimensions to the management of this highly vascular tumor.Retrospective analysis of six patients of glomus tympanicum,operated between July 2014 and June 2019,with modified Fisch classification Type A and B1,who were managed by a retroauricular transcanal endoscopic approach.Preoperative and postoperative analysis was done for these patients.Results:The chief complaint was pulsatile tinnitus,which disappeared in five cases and reduced in severity in one of them.Hearing was improved with reduction in air‐bone gap in all the cases.No major complications or recurrence were observed in any of the patients after 12 months of follow‐up.Conclusion:This endoscopic approach serves as a safe and reliable technique for tumor removal.It thus provides postoperative comfort for most of the patients.