Pharyngocutaneous fistula is a readily encountered complication that occurs after surgery for laryngopharyngeal cancer. The development of pharyngocutaneous fistula increases hospitalization, delays postoperative adjuvant treatment, and can lead to serious complications such as wound infection and carotid artery rupture. Transoral robotic surgery (TORS) is actively being performed as a standard procedure for surgery of pharyngeal and laryngeal cancers. Many reports verified that TORS is advantageous in terms of perioperative outcomes such as decreased hospitalization and reduced rate of postoperative complications, free flap reconstruction, and tracheostomy or gastrostomy tube dependence relative to open surgery. However, careful selection of patients is mandatory and there are some critical points to consider in optimal treatment outcomes. Recently, we experienced a 47-year-old patient with tonsillar cancer who underwent lateral oropharyngectomy by TORS and radical neck dissection. Unfortunately, multiple pharyngocutaneous fistulae occurred following postoperative concurrent chemoradiotherapy (CCRT). Multiple phrayngocutaneous fistulae following TORS and postoperative CCRT have not been reported in the literature. Therefore, we report this case with a brief discussion supported by a review of the relevant literature.

Spontaneous cervical hematomas could lead to life-threatening complications, and aneurysms, retopharyngeal abscesses, parathyroid adenomas, laryngeal cysts, and neurogenic tumors should be distinguished as possible underlying causes. Symptoms accompanying spontaneous cervical hematoma include cervical swelling, ecchymosis, dysphagia, dyspnea and hoarseness. We recently experienced a case of spontaneous cervical hematoma in a 52-year-old woman, who initially presented with cervical swelling after severe coughing two days ago. Resultingly parathyroid adenoma was finally confirmed after mass excision. Therefore, we present this unique case with a review of the literature.

Parapharyngeal space (PPS) tumors are extremely rare, composing only 0.5% of all head and neck tumors. The PPS is shaped like an inverted pyramid bounded by the skull base superiorly and hyoid bone inferiorly. Recently, we experienced a 55-year-old female patient who visited the clinic with a presumed PPS tumor that had been incidentally identified by neck MRI. The patient underwent surgery for the removal of tumor by transoral approach following tonsillectomy. However, contrary to the initial expectations, no tumors were visible at the operative field and only observed were the evidence of chronic inflammatory tissues within the removed tonsil. To date, chronic follicular tonsillitis mimicking a PPS tumor has not been reported in the literature. Therefore, we report this case with a brief discussion of points to consider supported by a review of relevant literature.

Follicular thyroid carcinoma (FTC) is the second most common thyroid cancer, following papillary carcinoma. Metastasis to the orbital rim from FTC is very rare. We recently experienced a case of FTC with metastasis to the orbital rim in a 74-year-old woman, who initially presented with a huge thyroid mass and an asymptomatic solitary orbital rim lesion. The solitary orbital rim lesion was suspected to be a separate disease entity such as lymphoma from the preoperative imaging, but bone metastasis from FTC was finally confirmed after orbital rim resection and total thyroidectomy. During follow-up, the patient presented multiple bone metastasis, so the solitary orbital rim lesion was considered a clinical sign of systemic metastasis from FTC. Therefore, we present this unique case with a review of the literature.

It has been suggested that the role of neurogenic inflammation is to protect the airway from various noxious irritants in inhaled air. Repeated exposure to various irritating stimuli has become very common in daily life. However, the process that occurs in neurogenic inflammation after repeated exposure to irritating stimuli is not yet clearly understood. The aim of this study was to investigate the changes of microvascular leakage in the airways after re-exposure to capsaicin in an experiment using a rat model challenged/rechallenged with capsaicin. Twenty-four Sprague-Dawley rats were divided into four groups : a capsaicin-challenged group (10 microgram/kg of capsaicin, intravenous, n=6) and three capsaicin-rechallenged groups (10 microgram/kg of capsaicin, intravenous, n=6 in each group) corresponding to time intervals of 1, 3, or 6 hours after capsaicin-challenge. The amount of microvascular leakage in the nasal mucosa and trachea of the animal in each group was measured with extravasation of Evans blue dye (30 mg/kg, intravenous) using a spectrophotometer. In the nasal mucosa, a significant enhancement of microvascular leakage with capsaicin-rechallenge was observed at 3 hours after capsaicin-challenge (AVOVAR, * : p<0.01). However, there was no significant changes in the trachea. In conclusion, the protective mechanisms against repeated irritating stimuli in the nasal mucosa and trachea are different. After exposure to a noxious irritant, the airway defense mechanism mediated by an axon reflex in the nose may be up- regulated, while that in the trachea may not be changed.
Animals ; Axons ; Capsaicin* ; Evans Blue ; Irritants ; Models, Animal* ; Nasal Mucosa* ; Neurogenic Inflammation ; Nose ; Rats* ; Rats, Sprague-Dawley ; Reflex ; Trachea

BACKGROUND AND OBJECTIVES: With the recent development of endoscopic nasal surgery, endoscopic sphenopalatine artery ligation allows for secure control of posterior epistaxis with considerably low recurrence and complications. Surgical approaches to the sphenopalatine foramen to ligate the sphenopalatine artery are transantral, intranasal, and transseptal. However, the procedures have considerable limitations. Therefore, we have revised the transturbinal approach, which was described by Togawa for intranasal vidian neurectomy in 1977, to ligate the sphenopalatine artery in two patients of intractable posterior epistaxis, and describe our technique of the trans-inferior turbinate approach for endoscopic sphenopalatine artery ligation. SURGICAL TECHNIQUE: A longitudinal incision is made along the lower border of the inferior turbinate, and the mucoperiosteal flaps are developed to the lateral nasal wall. The posterior two-thirds of the inferior turbinate bone is removed from the lateral nasal wall. The posterior lateral nasal artery on the upper flap is positively identified, and followed to the posterior end of the middle turbinate bone. The sphenopalatine foramen can be localized after removing the posterior end of the middle turbinate bone, and the sphenopalatine artery is ligated with hemoclips or divided with bipolar electrocautery. RESULTS: With the trans-inferior turbinate approach, it was possible to identify and ligate the sphenopalatine artery and its branches in the sphenopalatine foramen with no immediate or delayed complications. CONCLUSION: The trans-inferior turbinate approach provides unobscured surgical access to the posterior nasal cavity, and enough working space for endoscopic manipulation. The posterior lateral nasal artery is a reliable surgical landmark leading to the sphenopalatine foramen.
Arteries* ; Electrocoagulation ; Epistaxis ; Humans ; Ligation* ; Nasal Cavity ; Nasal Surgical Procedures ; Recurrence ; Turbinates*

OBJECTIVES: The aim of this study was to compare the tooth bleaching effect of two whitening materials in toothpaste i.e., hydroxyapatite and hydrogen peroxide on. In a randomized, double blinded controlled clinical trial, 85 participants with tooth colorations were assigned to use one of three toothpastes containing either hydroxyapatite (0.25%), hydrogen peroxide (0.75%), or no active ingredient (placebo). The patients were examined at baseline and 1, 2, and 3 months after usage. METHODS: The patients underwent an oral examination, tooth shade measurement, and a subjective evaluation. During the oral examination, the patient's oral health status was determined. ShadeEye NCC and Vita classical shade guide were used to determine the tooth color. Further, the patients were asked to assess the color of their own teeth using a visual analog scale (VAS) scale (range, 1-5). RESULTS: According to the CIELAB system, a significantly greater color change (Deltab*) was observed in the hydrogen peroxide group (2.10+/-1.54) than in the hydroxyapatite (1.50+/-1.09) and control (0.94+/-0.75) groups after 3 months of toothpaste usage (P<0.002). The DeltaE*color change was not statistically significant among the 3 groups at each time point (P>0.05). The subjective evaluation results of the hydroxyapatite (P=0.023) and hydrogen peroxide (P=0.047) groups were statistically significant at each time point. CONCLUSIONS: The hydrogen peroxide-containing toothpaste caused significant lightening of tooth coloration than the hydroxyapatite and placebo toothpastes.
Diagnosis, Oral ; Durapatite* ; Humans ; Hydrogen Peroxide* ; Hydrogen* ; Oral Health ; Tooth ; Tooth Bleaching ; Toothpastes* ; Visual Analog Scale

Struma ovarii (SO) is a rare ovarian teratoma, which is diagnosed when thyroid tissue accounts for more than 50% of the teratoma. The majority of SO are benign, but malignant tumors have been reported in a small percentage of cases. Five percent of SO cases have been proven to be malignant and, as in the thyroid gland, papillary carcinoma is the most common histotype arising in SO. Because this tumor is rare, there are no guidelines regarding the management of this cancer. Usually, total thyroidectomy followed by radioiodine treatment is the treatment of choice in metastatic malignant struma ovarii, but therapeutic decisions should be made individually based on clinical and pathological data. We recently experienced a case of a 45-year-old woman finally confirmed as malignant struma ovarii with cervical thyroid cancer. Therefore, we present this unique case with a review of the literature.