Effect of Ozonated Water on Oral Mucositis and Pain Induced by Head and Neck Radiotherapy: A Cross-sectional Study

Background: Oral mucositis and local pain are the negative effects of the treatment of head and neck cancer with radiotherapy. Objectives: The study aimed to investigate the effect of ozonated water on the severity of mucositis and pain in (1) patients who were treated with ozonated water and (2) patients who were not treated with ozonated water. Methods: We randomly divided 93 patients with head and neck malignancy (aged 18 to 80) into three groups. Ozone-treated group 1 rinsed their mouth with 15 mL of ozonated water with a concentration of 20 - 50 ppm from the first session of radiotherapy for one minute before and after each session. Ozone-treated group 2 rinsed their mouth with 15 mL of ozonated water with a concentration of 20 - 50 ppm for three minutes and then swallowed it before and after each session. Ozone-treated groups 1 and 2 and the non-ozone-treated group received standard treatment if mucositis symptoms appeared in each patient. The minimum number of radiotherapy sessions was 30, and the minimum planned dose for each patient was 50 Gray. Anamnesis and the following clinical parameters were taken: the degree of mucositis, the use of corticosteroids, radiotherapy method, radiation dose, and Pain Visual Analog Scale. Multi-level and subgroup analyses were performed on the ozone-treated and non-ozone-treated levels. Results: The mean degrees of oral mucositis and pain were lower in the ozone-treated group 2 than in the ozone-treated group 1 and non-ozone-treated group (P < 0.05). The non-ozone-treated group had the highest degrees of oral mucositis and pain severity (P < 0.05). The Kruskal-Wallis H test showed that there was a statistically significant difference in the Visual Analog Scale of sessions 5, 10, 15, 20, 25, and 30 between different groups. However, there was no statistically significant difference in the Visual Analog Scale of session 1 (χ2 (2) = 1.022, P = 0.6). This study revealed that ozonated water can be used for preemptive pain control and mucositis. This finding aligned with previous studies. Also, former research proved the safety and efficacy of ozonated water in dentistry and medical uses. Conclusions: The use of ozonated water in patients with head and neck malignancy can reduce the pain severity and oral mucositis induced by radiotherapy. It seems that ozonated water can be used as a preemptive agent in patients who receive head and neck radiotherapy.

Mass-forming chronic invasive fungal sinusitis; an uncommon mimicker of head & neck malignancy

Introduction/Objective Invasive fungal sinusitis is a progressive infection affecting the nasal cavity and associated sinus spaces. Acute forms affect immunocompromised patients with debilitating systemic diseases while chronic forms usually occur in immunocompetent individuals. Methods/Case Report A 26-year-old immunocompetent male with daily Marijuana smoking consulted for acute swelling of the right eye with dull pain, photophobia, loss of vision and pressure of 4 day duration. He reported nasal congestion for approximately one year and over the previous 2 months developed exophthalmos. Imaging demonstrated a 4.9 x 4.3 x 4.1 cm invasive soft tissue mass in the right lamina papyracea with involvement of the paranasal sinus, right orbit, and intracranial space. The mass was presumed to represent a high-grade malignancy. Biopsy was performed and demonstrated granulomatous invasive fungal sinusitis. The patient underwent right orbitotomy and right extranasal ethmoidectomy. He was begun on empiric amphotericin B. After culture and sequencing identification of Curvularia species, voriconazole was added. Follow up imaging studies after two month of treatment still demonstrated residual mass forming lesion with 10-20% decrease in size. The patient has regained his vision after 4 month of treatment and he is expected to complete a six months course. If the mass forming lesion persists, a second round of surgical debridement will be performed. Results (if a Case Study enter NA) N/A Conclusion Curvularia is a dematiaceous fungus most commonly associated with allergic sinusitis, but can rarely become invasive in immunocompetent individuals. Histopathologically large fungal elements are easily recognizable but specific identification requires culture or ribosomal DNA sequencing by PCR. Mass-forming chronic fungal sinusitis overlaps clinically and radiologically with head and neck malignancies. Our report brings attention to this uncommon clinical variant of invasive fungal sinusitis that affects immunocompetent individuals.

Active pulmonary Koch’s in a locally advanced recurrent head and neck malignancy: a case report

Even though the global incidence of tuberculosis (TB) has been showing a declining trend every year, it is still a significant public health problem in India. On the other hand, cancer has also been the reason for considerable mortality and morbidity across this population. The incidence of TB has been reportedly increasing in patients with both pulmonary and non-pulmonary cancers. Incidence of pulmonary TB in head and neck malignancy is around 3.1% to 6.6%. We present a case history of 50 years old with locally advanced recurrent head and neck malignancy with active pulmonary Koch’s. The decision was to provide him supportive care and treating the infection was pragmatic in spite of expected delay in anti-cancer treatment. It is extremely important to come up with a proper protocol for the need of prophylactic treatment, detection and the concurrent treatment of both cancer and TB.

Mimics of perineural tumor spread in the head and neck

Perineural spread (PNS) is an important potential complication of head and neck malignancy, as it is associated with decreased survival and a higher risk of local recurrence and metastasis. There are many review articles focused on the imaging findings of PNS. However, a false-positive diagnosis of PNS can be just as harmful to the patient as an overlooked case. In this manuscript, we delineate and classify various imaging mimics of PNS. Mimics can be divided into the following categories: normal variants (including vascular structures and failed fat suppression), infections, inflammatory disease (including granulomatous disease and demyelination), neoplasms, and post-traumatic/surgical changes. Knowledge of potential mimics of PNS will prevent false-positive imaging interpretation, and enable appropriate oncologic management.

Outcomes after endovascular embolization for the treatment of nasal and oropharyngeal hemorrhage: safety, efficacy, and rebleeding

Background Intractable nasal and oropharyngeal hemorrhage may be treated with endovascular embolization, but limited data are available. We sought to evaluate the efficacy, safety, and factors associated with rebleeding. Methods A retrospective analysis of consecutive embolizations for nasal and oropharyngeal hemorrhage over a 10-year period at a single institution was performed. Outcomes included procedural success (defined as cessation of hemorrhage in the immediate postoperative period), rebleeding requiring an additional intervention, and procedural complications. Results A total of 47 embolizations on 39 patients were included. The mean age was 60 years (standard deviation 16.1), 23.1% of patients were women, and 21 (53.8%) patients had a previously diagnosed head/neck malignancy. Bleeding sites were the nose in 20 patients and oropharynx in 21 (two patients presented with both nasal and oral bleeding). Immediate procedural success was achieved in 45 (95.7%) embolizations. Rebleeding requiring an additional intervention occurred after 11 (23.4%) embolizations at a median of one day after the procedure. In the multivariate analysis, preoperative hypotension (odds ratio 4.78, 95% confidence interval 1.04–24.61) and the use of coils (odds ratio 6.09, 95% confidence interval 1.24–46.69) were associated with rebleeding requiring repeat intervention. Complications included two watershed strokes that were anticipated due to occlusion of the internal carotid artery. Conclusions In our experience endovascular embolization was a safe and effective treatment option for stopping oral and nasal hemorrhage. However, rebleeding was present after 23.4% of treatments and was associated with preoperative hypotension and the use of coils. Further study in a large multi-institutional cohort is warranted.

Carotid blowout syndrome: endovascular management of a lesser known oncological emergency: case report

Background Carotid blowout syndrome (CBS) refers to a fatal hemorrhagic complication of cervical carotid arteries that occurs due to rupture of the extracranial carotid artery or one of its major branches in patients treated for head and neck malignancy. In this article, we will discuss two different spectrum of CBS and endovascular approach. Case presentation Two cases of per oral bleeding presented in the emergency department. After patients were hemodynamically stabilized, CT angiography was done which showed type II CBS and type III CBS, respectively. This was followed by transfemoral supra-aortic digital subtraction angiogram coil embolization with scaffolding and anchoring technique, respectively, for the patients. Conclusions Early recognition of the predictors of CBS by a multidisciplinary team is critical. The endovascular treatment approach is relatively safe and effective with low rates of morbidity and mortality compared to surgical approach in CBS.

Complications after Functional Neck Dissection in Head and Neck Cancer Patients: An Observational, Retrospective, Single-Centre Study

<b><i>Introduction:</i></b> Functional neck dissection (FND) represents a surgical procedure usually associated with less morbidity. <b><i>Methods:</i></b> An observational, retrospective, analysis of patients diagnosed with any type of head and neck malignancy was designed to summarize and report the incidence of postoperative complications in patients undergoing FND including just those levels described for selective neck dissections in a tertiary university hospital between June 2016 and June 2019. <b><i>Results:</i></b> 131 patients met the inclusion criteria. The total number of sides studied was 200. 40.5% of the patients suffer a complication in the postoperative period, being the spinal accessory nerve (SAN) injury the most common complication (10%). We did not find any statistical ­correlation between the previous organ-preservation treatments and surgical complications (<i>p</i> = 0.207). An advanced T stage (<i>p</i> = 0.009) and the need of bilateral FND (<i>p</i> = 0.034) were significantly correlated with a higher risk of surgical complications. <b><i>Conclusion:</i></b> FND represents a useful technique. In this study, 40.5% of the patients suffer a complication in the postoperative period, being the SAN injury the most common complication. However, these data contribute to increasing our knowledge about surgical complications related to FND.

A COMPARATIVE STUDY ON COMPLICATIONS OF EMERGENCY AND ELECTIVE TRACHEOSTOMY IN ENT DEPARTMENT OF DMCH, LAHERIASARAI, BIHAR

Background: Both elective and emergency tracheostomy as life saving procedure is frequently performed. Tracheostomy can be associated with numerous (intraoperative and postoperative) complications. Methods: In this study 120 patients were studied age ranged from 9 years to 79 years in the Department of ENT, Darbhanga Medical College & Hospital, Laheriasarai, Bihar from January 2020 to December 2020. Results: Among 120 tracheostomized patients, 75 (62.5%) were patients of emergency tracheostomy group and 45 (37.5%) were patients of elective tracheostomy group. Laryngeal carcinoma and other head-neck malignancy were the common (67.34%) indications for emergency tracheostomy. Maxillofacial and laryngeal surgery (50.1%) was the common indications for elective tracheostomy. Haemmorage was the most common complication. The second most common complication were subcutaneous surgical emphysema and wound infection. Then the tube displacement, perichondritis and stomal stenosis/ granulation tissue formation were the complications. In all stages (intraoperative, immediate postoperative, early postoperative and late postoperative), the frequency of complications was more in emergency tracheostomy and it was statistically signicant (p<0.05). Conclusion: Complications are more in emergency than elective tracheostomy. Reduction of complications should be aim of all types of tracheostomy.