Search

Many of the patients with COVID-19 have suffered respiratory distress requiring prolonged endotracheal intubation (ETI) resulting in laryngotracheal complication with an impact on breathing, phonation, and swallowing. Our aim is to describe laryngeal injuries diagnosed after ETI in patients with COVID-19 in a multicentre study., Methods: A prospective descriptive observational study was conducted from January 2021 to December 2021, including COVID-19 patients with laryngeal complications due to ETI diagnosed in several Spanish hospitals. We analyzed the epidemiological data, previous comorbidities, mean time to ICU admission and ETI, need for tracheostomy, mean time on invasive mechanical ventilation until tracheostomy or weaning, mean time in ICU, type of residual lesions, and their treatment., Results: We obtained the collaboration of nine hospitals during the months of January 2021 to December 2021. A total of 49 patients were referred. Tracheostomy was performed in 44.9%, being late in most cases (more than 7-10 days). The mean number of days of ETI until extubation was 17.63 days, and the main post-intubation symptoms were dysphonia, dyspnea, and dysphagia, in 87.8%, 34.7%, and 42.9%, respectively. The most frequent injury was altered laryngeal mobility, present in 79.6%. Statistically, there is a greater amount of stenosis after late ETI and after delayed tracheostomy, not observing the data with the immobility alterations., Conclusion: The mean number of days of ETI was long, according to the latest guidelines, with the need for several cycles of pronation. This long ETI may have had an impact on the increase of subsequent laryngeal sequelae, such as altered laryngeal mobility or stenosis.

Objectives: Ionizing radiation increases the expression of a number of salivary proteins involved in immunoregulatory networks related to infection, injury, inflammation, and cancer. Our main objective was to analyze whether there are significant differences in salivary cytokines before and after radiotherapy and whether any of them are associated to better outcomes after radiotherapy serving as a potential predictive biomarker of response to the treatment., Materials and Methods: We analyzed a panel of eight salivary markers (IL-4, IL-6, IL-8, and IL-10; MCP-1; TNF-α; VEGF; and EGF) in a group of HNC patients (N = 30), before and after irradiation treatment pre- and post-RT. We also compared these results with a group of healthy controls (N = 37). In both groups, we used stimulated saliva and we performed immunoassays based on multi-analyte profiling technology (Luminex xMAP)., Results: In our group of 30 HNC patients, 24 of them showed a good clinical response after radiotherapy treatment while 6 cases did not respond to radiotherapy. The data revealed a post-treatment increase in multiple cytokines in the stimulated saliva of HNC patients; the increases in IL-8 and MCP-1 were statistically significant (p ≤ 0.001 and p ≤ 0.0001, respectively). Analysis of receiver operating characteristic curves indicated the strong potential of IL-8 as a predictive biomarker of RT good outcomes (area under the curve = 0.84; p = 0.018)., Conclusions: After analyzing the panel of salivary cytokines, IL-8 showed the best association to the response to radiotherapy; in this sense, low IL-8 levels in the saliva of HNC patients before receiving irradiation therapy are associated with positive RT outcomes., Clinical Relevance: Salivary IL-8 expression in HNC patients undergoing RT may serve as a potential predictive biomarker of response to the treatment., (© 2021. The Author(s).)

Rhabdomyosarcoma is a malignant mesenchymal neoplasm that rarely presents as primary skin tumor. So-called amianthoid fibers are hyalinized collagen mats that have been described in myofibroblastic tumors but not in rhabdomyosarcoma. A 65-year-old male developed a submandibular nodule 9 years after an oral squamous cell carcinoma, which had been treated with chemotherapy and radiotherapy. Histological examination of the nodule revealed a pleomorphic rhabdomyosarcoma with extracellular collagen deposits reminiscent of so-called amianthoid fibers. By immunohistochemistry, the tumor cells were positive for vimentin, desmin, smooth muscle actin (SMA), muscle-specific actin (MSA), CD10, CD56, CD99, β-catenin and D2-40. However, only 15-20% of the tumor cells were positive for myoglobin, MyoD1 and myf-4/myogenin. We describe first so-called amianthoid fibers harboring blood capillaries in a rhabdomyosarcoma, suggesting that they are rigid collagen structures that lead to tumor vascularization. The low expression for myogenic regulatory proteins and strong expression for other markers may be misleading and do not contribute to the diagnosis of rhabdomyosarcoma., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Most salivary gland tumors are benign, malignant lesions accounting for 15-30% of the total. The most frequent site of salivary gland neoplasms is the parotid gland (80% of all cases). We present a case of malignant fibrohistiocytoma with atypical features due to its location (in the parotid region), size and rapid growth. Generally, this type of tumor arises in the lower limbs and in the abdomen. When located in the parotid gland, these lesions appear as a firm, slow growing and painless mass. Due to the low frequency of such lesions and their clinical behavior, the imaging study and fine-needle aspiration biopsy findings tend to diagnose them as pleomorphic adenoma. The definitive diagnosis requires microscopic study of the resection piece using immunohistochemical techniques. The treatment of choice is surgery, occasionally associated to radiotherapy. The success of treatment is dependent upon complete resection of the tumor - long term follow-up being necessary due to the risk of recurrence or distant metastasis.

There are several lesions which can present as a cyst or pseudocyst of the floor of the mouth with submental repercussion. The aim of this paper is to review the diagnosis methods which can help us to differentiate these lesions such as the surgical peculiarities of every tumour. We are reporting two cases of cystic/pseudocystic lesions of the floor of the mouth with submental repercussion. Both of them were epidermoid cysts. Ranulas, lipomas and lymphangiomas should be considered in the differential diagnosis. Imaging diagnosis, fine needle aspiration and adequate treatment in all of the tumours are reviewed. Both cases were operated via intraoral. They are now free of disease after at least one year. Differential diagnosis of cystic lesions of the floor of the mouth is important because the recommended surgery technique is not exactly the same in all of them. The firmness of the wall of dermoid cysts let their exeresis via intraoral even when they are of a big size. Exeresis of sublingual gland is recommended by most authors to treat ranulas, although it is followed by an important percentage of morbidity.

Simultaneous bilateral facial paralisis (SBFP) occurs in 0.3-2% of all facial paralisis. We report a case of SBFP in association with Lyme disease. A review of literature about SBFP is made, studing specially the one caused by Borrelia burgdorferi. We present a diagnostic guideline of SBFP. Suspect diagnosis of Lyme disease is based on clinical and epidemiological criteria. Culture isolation of this bacteria is difficult, therefore serologic testing is required. Neuroborreliosis treatment is intravenous Ceftriaxone or Cefotaxime. Oral Doxycycline is useful in the treatment of neuritis without central nervous system involvement.

Fifteen cases of nasosinusal inverted papilloma treated in our department from 1994 to 2000 are reported. The most frequent initial symptom was unilateral nasal obstruction. Some others symptoms were rhinorrea, facial pain and self limited epistaxis. The most frequent surgical procedure performed was the paralateral rhinotomy with medial maxillectomy. The median average for the follow up was 28 months, being diagnosed one recurrence. The paralateral rhinotomy with a medial maxillectomy, under functional endoscopic nasosinusal techniques are being more and more used, decreasing the indications of open techniques.

A retrospective series of 76 pedicled pectoralis major musculocutaneus flaps is presented. We used this technique in reconstruction after head and neck tumours resections and in complications of oncological surgery such as pharyngostomes or orostomes. Most of these flaps were used in reconstruction of oral cavity and in postradiotherapy salvaje surgery cases. We also analyse the presence of complications at the donor and receiver sites and its correlation with different parameters like protein levels, haemoglobin, administration of radiotherapy and its dose, previous quimiotherapy and the influence of systemic diseases.

It is classically been though that radical sinus surgery implies a difficulty for ulterior image diagnosis. The reason is postoperative fibrosis of soft tissue may be shown at TC scan as an occupation of paranasal sinuses. We realized that it does not usually happen. The aim of our study is to find out the appearance of sinuses after radical surgery performed to treat chronic sinusitis, mucocele and sinusal cysts. For so doing we have reviewed symptoms and radiological signs before and after surgery.