Head and neck surgery

This chapter addresses head and neck surgery. It begins with thyroglossal cyst, sinus, and fistula. A thyroglossal cyst is a fluid-filled sac resulting from incomplete closure of the thyroglossal duct. Meanwhile, a thyroglossal sinus results from persistence of the whole duct. The chapter then turns to branchial cyst, sinus, and fistula, before discussing salivary calculi, acute parotitis, and salivary gland tumours. Parotitis is inflammation of the parotid gland; most patients develop this condition as an acute episode of a chronic obstructive sialadenitis. The chapter also considers head and neck cancer, which refers to cancer of upper aerodigestive tract (UADT). In addition, it examines facial trauma and neck space infections.

Surgical treatment of large idiopathic macular ruptures with petals of the internal limiting membrane with incisions

Purpose. To study the results of surgical treatment of patients with large diameter idiopathic macular breaks by the proposed method of closing the defect with inverted petals of the internal limiting membrane with incisions. Material and methods. There were analyzed clinical results of surgical treatment of idiopathic macular breaks (IMB) by closing the defect with inverted lobes of the internal limiting membrane with incisions in 25 patients (25 eyes) between 45 and 63 years old. Men – 11 (44%), women – 14 (56%). Terms of treatment in the hospital since the appearance of changes in visual functions: 6 patients after 1.5-2 years, 19 patients after 6-8 months. Visual acuity at admission was: 0.01 in 4 patients; 0.02 in 5; 0.03 in 5; 0.06-0.09 in 6; 0.1-0.3 in 5. Macular ruptures were stage III, diameter from 450 to 730 microns (on average, 594.52± 114.06 microns). The follow-up period is 3 years. Results. In 25 patients underwent 25G endovitreal intervention with closing of the macular hole with the petals of internal limiting membrane. The visual acuity improvement was observed in 23 patients: up to 0,1 – 0,6 – in 20; up to 0,09 – in 3. In 2 patients visual acuity was 0.01-0.02, this may be due to incomplete closure of the macular opening and the duration of the disease. After 3 years of visual function remained stable. Conclusion. The use of inverted petals of internal limiting membrane in the treatment of large diameter IMB contributes to the closure of the macular breaks and restoration of the anatomical profile of the macular in 92% of cases. The increase of visual acuity up to 0.1 – 0.6 in 80% of cases. The stability of clinical results up to 3 years allows us to recommend this method of treatment in practice.

Unusual presentation of a first branchial arch fistula with maxillofacial infection: a case report

Background First branchial cleft anomaly (FBCA) is a rare congenital defect that arises due to incomplete closure of the ventral portion of the first and second branchial arches. There are variable complex clinical manifestations for patients with FBCA, which are prone to misdiagnosis and inadequate treatment. FBCAs usually involve the facial nerve with a consequent increased risk of facial nerve damage. Here, we present an unusual case of FBCA presenting with two preauricular pits in association with an abnormal maxillofacial cyst. Case presentation A 10-month-old girl presented to our department due to recurrent maxillofacial infections accompanied by swelling or abscess of the left cheek and purulent discharge from the preauricular pit for 4 months. A 3D-computed tomography (CT) fistulogram and magnetic resonance imaging (MRI) revealed two conjunctive tract lesions: one tract arose from the skin surface anteroinferior to the external auditory canal (EAC), through the deep lobe of the left parotid, and anteriorly extended to the left masseter; the other extended from the superficial lobe of the left parotid to the intertragic notch. After the maxillofacial infection was controlled by intravenous antibiotic administration, surgery was performed. Intraoperative tools, such as facial nerve monitors, microscopes, and methylene blue dyes, were used to facilitate the complete dissection and protection of the facial nerve. On follow-up over one year, the patient recovered well without facial palsy or recurrence. Conclusion FBCA with maxillofacial cysts is rare and prone to misdiagnosis. Physicians should pay attention to this anatomic variant of FBCA with the fistula track located deep inside the facial nerve and projected medially to the masseter.

A case of Meckel’s diverticulum with life-threatening recurrent gastrointestinal bleeding in an adult

Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinal system. It results from the incomplete closure of the omphalomesenteric canal in intrauterine life. It is mostly diagnosed in childhood with intestinal obstruction and bleeding. It is uncommon and often clinically silent in adults. Also, it is difficult to diagnose the patients with symptomatic Meckel’s diverticulum. We report a 28-year-old male who presented with life-threatening recurrent lower gastrointestinal (GI) bleeding and was operated with the diagnosis of Meckel’s diverticulum with duodenal ulcer.

Analytical study of the evolution’s number of hospitalizations in patients with spina bífida in comparation with region, sex, age range and deaths in Brazil

Background: Spina bifida is a congenital disease that occurs due to incomplete closure of the embryonic neural tube. It results in impacts of a wide variety of extensions, in different systems and levels of neurological changes, which define its prognosis. Objectives: To report the number of hospitalizations of the disease in different social sectors to establish a link between etiology and health promotion. Methods: Analytical epidemiological study carried out by research at DATASUS based on the number of hospitalizations of patients with spina bifida in Brazil, between January / 2012 to December / 2020, associated with the incidence of the age group, region, sex and deaths in the country. Results: The total number of hospitalizations between the years 2012 to 2020 was 9566, with 2015 being the year with the most hospitalizations, 1205. The Northeast region had the highest percentage of hospitalizations with 45%. About the gender, there is little difference, with 49.05% female and 50.94% male. The age group, the most prevalent is the one younger than 1 year (63.28%). Regarding the number of deaths, the northeast region stood out with 47% of deaths, followed by the southeast region with 27%. In addition, the age group with a predominance of deaths 74.5% was that of less than 1 year. Conclusion:This congenital malformation acts as an important cause of neonatal mortality and a risk factor for infant morbidity. Therefore, the need for public agencies to act is evident, since it is a change that can be prevented.

REPARATIVE REGENERATION AT THE END OF BONE FILING AFTER OSTOPLASTIC AMPUTATION

The aim: To study the role and place of bone grafting in the formation of bone stump after amputation. Materials and methods: 3 series of experiments were carried out on 44 rabbits with amputation of the thigh in the middle third and stump grafting using osteoplastic hermetic closure of the canal with a thin cortical plate (series I), closure of the canal with a spongy bone (series II), and loose closure of the canal with a cortical graft located at the entrance to the canal at an angle of 30° (ІІІ series). Observation period: 1, 3, 6 months. Histological examination method with vascular filling with 10% mascara-gelatin mixture. Results: In series I, in the majority of observations, a stump of a cylindrical shape with a bone locking plate of an osteon-beam structure and normalization of intraosseous microcirculation was formed. A slight displacement of the graft caused a violation of microcirculation. In series II, organotypic stumps were formed in all observations. In series III, incomplete closure of the bone marrow cavity led to sharp microcirculatory disorders and the course of the reparative process with pathological bone remodeling. Conclusions: The parameters of the favorable course of the reparative process and the formation of the organotypic bone stump are the safety of its cylindrical shape, the presence of a compact bone structure, normalization of intraosseous microcirculation.

Clinicopathological Study of Thyroglossal Cyst

Background: Thyroglossal cyst is a congenital malformation that occurs due to incomplete closure of the thyroglossal duct. Apart from quiescent embryological remnant, it presents clinically as a midline cystic swelling that moves with tongue protrusion; present at any age, often requires surgical excision. Objective: To evaluate the clinical features and treatment outcomes of patients with a thyroglossal duct cyst. Material and methods: This observational study was carried out in the Department of Surgery, Dept. of Otolaryngology, Ibn Sina Medical College, Dhaka, A total 40 cases of both sexes with the age 6-67 years, during the period of 2013 to 2018 (5 years) Results: A total 40 cases of thyroglossal cyst with mean age of 24.37 years were included in study. Of the total 40 cases, 20 (50%) patients were male and 20(50%) were female. Most common clinical presentation was painless midline cystic swelling was the main complaint in 30 patients (75%), followed by dysphagia 5 (12.5%), Sore throat 3 (7.5%) and globus 2 (5%) in descending order. Most common location of cyst was in infrahyoid region in 26 patients (65%), suprahyoid in 14 patients (35%). Conclusion: The most common presentation of thyroglossal cyst is a midline cystic swelling that moves with tongue protrusion. The standard surgical approach to thyroglossal cyst is Sistrunk’s operation with low recurrence rate. Malignancy within thyroglossal cyst is very rare but should be rule out in all cases. Bangladesh J Otorhinolaryngol; October 2020; 26(2): 153-157

Port site hernia repair using the VersaOne™ Fascial Closure System: a case report

The use of laparoscopic surgery has become widespread in recent years. One of its complications is port site hernia (PHS). It can be difficult to close the fascia at the time of laparoscopy, especially in obese patients, and there is a risk of herniation through a fascial defect with incomplete closure. It is important to ascertain closure of the defect when repairing PHS to prevent recurrence. We report a 47-year-old woman who developed a PHS at the superior aspect of the umbilicus. We repaired the defect using the VersaOneTM Fascial Closure System with laparoscopic guidance. This system allows the port site to be reliably closed while observing the suture from the abdominal cavity. The incision is the same size as a port site. If the abdominal wall is thick and the PHS has a diameter of ~10 mm, this method is considered to be indicated, regardless of the site.

Mechanisms, features, and significance of diastolic mitral regurgitation: a case series

Background Diastolic mitral regurgitation (DMR) is a type of functional mitral regurgitation. Its occurrence in the diastolic phase of cardiac cycle renders DMR an easily ignored entity. Confusing it with systolic mitral regurgitation occasionally happens. The reversal of left atrioventricular pressure gradient during diastole and the incomplete closure of mitral valve are the essential conditions for DMR. Diastolic mitral regurgitation develops under various situations, where the mechanisms of diastolic reversal of left atrioventricular pressure gradient differ. Case summary Patient 1 was a 50-year-old man diagnosed with 2:1 second-degree atrioventricular block (AVB). Patient 2 was a 70-year-old man diagnosed with first-degree AVB. Patient 3 was a 66-year-old man diagnosed with atrial fibrillation with long intermission and occasional atrial flutter with unequal conduction. Patient 4 was a 54-year-old woman diagnosed with dilated cardiomyopathy with complete left bundle branch block. Patient 5 was a 36-year-old man diagnosed with severe acute aortic regurgitation secondary to subacute bacterial endocarditis. Discussion Although the degree of DMR is relatively mild, its appearance generally prompts further clinical considerations. The appreciation of DMR has an incremental value for diagnosing and evaluating the underlying cardiovascular disease.

Effectiveness of angiotensin receptor inhibitors and non-lysine in functional mitral regurgitation

Objective: sacubitrile/valsartan is superior to valsartan in modifying functional mitral regurgitation (MR) for the better thanks to the double inhibition of the renin-angiotensin and neprilysin system. Material and methods. This double-blind study randomly assigned sacubitrile/valsartan or valsartan in addition to standard drug therapy for heart failure among 90 patients with heart failure with chronic functional MR (secondary to left ventricular (LV) dysfunction). The primary endpoint was a change in the effective area of the regurgitation hole during the 12-month follow-up. Secondary endpoints included changes in the volume of regurgitation, the final systolic volume of the left ventricle, the final diastolic volume of the left ventricle, and the area of incomplete closure of the mitral valves. Results. The decrease in the effective area of the regurgitation hole was significantly more pronounced in the sacubitrile/valsartan group than in the valsartan group (–0.048 ± 0.095 vs –0.012 ± 0.105 cm2; p = 0.032) in the treatment efficacy analysis, which included 90 patients (100%). The regurgitation volume also significantly decreased in the sacubitrile/valsartan group compared to the valsartan group (mean difference –7.3 ml; 95% CI 12.6–1.9; p = 0.009). There were no significant differences between the groups regarding changes in the area of incomplete closure of the mitral valves and LV volumes, with the exception of the index of the final LV diastolic volume (р = 0.044). There were no significant differences in the change in blood pressure between the two treatment groups. Conclusion. Among patients with secondary functional MR, sakubitril/valsartan reduced MR more than valsartan. Thus, angiotensin receptor inhibitors and neprilysin can be considered for optimal drug treatment of patients with heart failure and functional MR.