Aim: Review our case series of salvage total laryngectomies (STL) after 2010 using the downstate fistula formula (DFF) for the incidence of postoperative (post-op) pharyngocutaneous fistulas (PCF).
Background: Pharyngocutaneous fistulas (PCF) remains the most common complication after STL, even with the use of vascularized flaps at a rate of 30%. The DFF is a multipronged approach to prophylactically address risk factors contributing to PCF formation.
Technique: The DFF incorporates a watertight two-layer closure, pectoralis major myocutaneous flap reconstruction, antibiotic prophylaxis, delayed oral intake using a G-tube, salivary diversion, and an anti-reflux regimen.
Conclusion: Initial results of 11 patients treated by the DFF published in 2009 showed a 0% failure rate. A review of patients treated by DFF from 2010 continued to maintain a 0% failure rate.
Clinical significance: The use of the DFF in STL patients has reduced the incidence of PCF to zero with a reduced length of stay.
Background: Carcinosarcoma of the head and neck is a rare diagnostic entity constituting <1% of head and neck mucosal tumors. It most commonly occurs in the 6th and 7th decades of life with male predominance.
Methods: We, herein, present a case of a 72-year-old male who presented with swelling on the right side of his neck for 5–6 months. A positron emission tomography (PET) scan and computerized tomography (CT) scan were done, which showed a metabolically active tumor with enlarged necrotic level III right cervical lymph nodes.
Results: On fine needle aspiration cytology (FNAC), a diagnosis of squamous cell carcinoma was made, followed by which modified radical neck dissection (MRND) was performed. On the basis of morphology and immunohistochemical (IHC) findings, a diagnosis of carcinosarcoma was given.
Conclusion: Diagnosis of carcinosarcoma on core biopsy is quite challenging due to its overlapping features with spindle cell tumors.
DOI: 10.5005/jp-journals-10001-1541 |
Open Access |
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Nataraj U, Babu M, Godhani F. A Rare Case of Rhino-orbital Mucormycosis with Intracranial Tuberculosis in Latent Post Coronavirus Disease 2019 Diabetic Patient. Int J Head Neck Surg 2022; 13 (4):104-108.
Aim: To report a rare case of rhino-orbital mucormycosis with intracranial tuberculosis in a latent post-coronavirus disease 2019 (COVID-19) diabetic patient.
Background: Mucormycosis has been found to have a predilection for COVID-19 patients, while diabetes mellitus and other immunocompromised conditions act as independent risk factors for both. In this case, there is an additional immunocompromised risk factor of tuberculosis.
Case description: We report the case of a 61-year-old male patient, a long-standing diabetic with positive COVID antibodies, in an unvaccinated patient diagnosed with rhino-orbital mucormycosis with suspected intracranial extension. Magnetic resonance imaging (MRI) of the brain, paranasal sinuses (PNS), and orbit revealed sinusitis, predominantly involving both maxillary, ethmoid, and right medial frontal sinuses, with intracranial extension in the right basifrontal brain parenchyma, and involvement of right medial extraconal orbit abutting muscles. Potassium hydroxide (KOH) mount of nasal swab and nasal biopsy showed broad branching aseptate hyphae consistent with mucormycosis. Functional endoscopic sinus surgery (FESS) and neurosurgical intervention, together with microbiological evidence, supported the diagnosis of rhino-orbital mucormycosis with intracranial tuberculosis. Due to underlying uncontrolled diabetes and tuberculosis, it was difficult to manage medically. Amphotericin, the mainstay of treatment for mucormycosis being nephrotoxic, and as the patient has diabetic nephropathy, was an additional challenge to manage as he developed severe renal dysfunction. He was successfully managed with surgical intervention involving FESS, medial wall orbitotomy, frontal craniotomy with debridement, and antituberculosis treatment.
Conclusion: Diagnosis, reversal of risk factors, surgical debridement of infected tissue, and appropriate therapy forms the mainstay of the management of mucormycosis. The contributory risk factors should be managed adequately to decrease and control morbidity.
Clinical significance: Early and proper diagnosis of mucormycosis in an unvaccinated patient with positive covid antibodies, diabetes mellitus, and intracranial tuberculosis is essential and will further require aggressive management and surgical intervention at the earliest stage possible so as to prevent mortality.
Aim: Cutaneous squamous cell carcinoma (cSCC) of the head and neck is preferentially treated with primary surgical excision. We present a case of an advanced lesion appearing to respond to homeopathic supplementation with bitter apricot seed and hedge apple.
Background: Our patient presented with a large, biopsy-proven cSCC of the right nasal ala. Her workup revealed a synchronous primary lung adenocarcinoma necessitating delayed management of the cutaneous lesion. In the interim, she self-treated with oral bitter apricot seed and hedge apple supplements.
Case description: The patient demonstrated significant involution of the cutaneous lesion, and eventual surgical resection was negative for carcinoma.
Conclusion: The literature has in vitro evidence for the antiproliferative properties of compounds derived from hedge apples. Bitter apricot seed has little evidence supporting anticancer activity and is not recommended due to the risk of cyanide toxicity. However, there is little alternative explanation for her dramatic response other than these substances.
Clinical significance: We describe a case of cSCC of the head and neck that appears to have responded to bitter apricot seed and hedge apple.