Necrotizing fasciitis of the head and neck is a rare, rapidly progressive infection involving the skin, subcutaneous tissue and fascia. We report three cases of necrotizing fasciitis that differ in their presentation and outcome. The first case involves a patient who presented with progressively enlarging anterior neck swelling that was later complicated by dehydration and reduced consciousness. The second case is a patient with neck swelling and ipsilateral otorrhea. The third case concerns a patient with a buccal ulcer complicated by ipsilateral facial swelling. All of them underwent a fasciotomy with wound debridement with the addition of a cortical mastoidectomy in the second case. Two of these patients recovered well. Unfortunately, the third case succumbed to death due to airway compromise and septicaemia. We advocate the importance of eradicating the source of infection followed by frequent, meticulous wound dressing and strict blood sugar control to obtain better outcomes in managing necrotizing fasciitis of the head and neck. However, involvement of the airway carries a grave prognosis despite aggressive treatment.

Synovial sarcoma is a rare soft tissue sarcoma of the head and neck region involving the parapharyngeal space. The diagnosis of synovial sarcoma can be very challenging to the pathologists. We present a rare case of parapharyngeal synovial sarcoma in a young female patient who had a two-month history of left cervical intumescent mass at level II. The fine needle aspiration cytology of the mass was proved inconclusive. Transcervical excision of the mass was performed and the first case of parapharyngeal sarcoma was identified in our center by fluorescence in situ hybridization (FISH) technique. Repeat imaging revealed residual tumor. The patient successfully underwent a second excision of the residual tumor and received adjuvant radiotherapy.
Adult ; Biopsy, Fine-Needle ; Combined Modality Therapy ; Female ; Humans ; In Situ Hybridization, Fluorescence ; Neoplasm, Residual ; Pharyngeal Neoplasms ; diagnosis ; pathology ; radiotherapy ; surgery ; Radiotherapy, Adjuvant ; Sarcoma, Synovial ; diagnosis ; pathology ; radiotherapy ; surgery ; Tomography, X-Ray Computed

Aims: To investigate the influence of carbon sources and additives/surfactants on the mycelium growth and exopolysaccharides (EPS) production, including the morphology during submerged cultivation of Pleurotus ostreatus in the minimal-medium as the base medium. Methodology and results: Pleurotus ostreatus was cultivated in different types of carbon sources to investigate the effects of carbon sources to mycelium growth and changes of mycelium morphology which directly affects the synthesis of EPS. In addition, additives or surfactants can increase the bioavailability of less soluble substrates in the cultured medium for the mycelium growth and indirectly affects the EPS production. In this study, the cultivation of P. ostreatus in the minimal-medium by using glucose as the carbon source with the addition of lecithin at 1% (w/v) gave the highest EPS production 4.53 ± 0.30 g/L, an increase of about 89.53% when compared to the cultivation without the addition of lecithin. Addition of lecithin changes morphology of the pellets outer layer and under microscope showing a dense hyphal network surrounding the pellets with the sizes of micro pellets almost 0.5-1.5 mm which contributed to the increase of EPS production after 14 days cultivation at 26 °C Conclusion, significance and impact of study The choice of the carbon source should not only be for high productivity rate of mycelium growth and EPS production, but a cheaper alternative source should also be considered. In conclusion, high mycelium biomass and EPS production was achieved either by changes of the morphology through the type of carbon source and addition of additives such as lecithin.