Cafer Özdem

The use of Preoperative Lidocaine to Prevent Stridor and Laryngospasm after Tonsillectomy and Adenoidectomy

The most important complications from tonsillectomy and adenoidectomy are bleeding, stridor, and laryngospasm. This controlled, double-blind study was designed to investigate the effects of topical and intravenous lidocaine on stridor and laryngospasm. A total of 134 patients scheduled for elective tonsillectomy and/or adenoidectomy were randomly separated into four groups. In the topical lidocaine group 4 mg/kg of 2% lidocaine was applied to subglottic, glottic, and supraglottic areas before endotracheal intubation. Normal saline solution was used topically for the first control group. In the intravenous lidocaine group, patients were given 1 mg/kg of 2% lidocaine before extubation, and the same amount of 0.9% NaCl was given to the second control group. Postoperative stridor, laryngospasm, cyanosis, bleeding, sedation degree, and respiratory depression were observed, and plasma lidocaine levels were measured. Both topical and intravenous lidocaine groups revealed less stridor and laryngospasm than the control groups, and no difference was found between the topical and intravenous lidocaine groups except the higher sedation scores in the early postoperative period for the intravenous lidocaine group. (Otolaryngol Head Neck Surg 1998;118:880–2.)

The role of Helicobacter pylori infection in the cause of squamous cell carcinoma of the larynx

OBJECTIVE: Helicobacter pylori can cause chronic infection that has been linked to the development of both benign and malignant disease of the aerodigestive tract. The purpose of this study was to determine the link between H pylori infection and squamous cell carcinoma of the larynx (SCCL). METHODS: We estimated the presence of IgG antibodies against H pylori antigens by using ELISA technique in the sera of 26 patients with SCCL and 32 matched controls without carcinoma of the larynx. RESULTS: The incidence of seropositivity of patients with SCCL was 73.07% and of controls was 40.62%. These data support an etiologic role for H pylori infection on development of SCCL (χ 2 = 4.85, P < 0.05). CONCLUSION: H pylori infection of the upper aerodigestive tract might result in mucosal disruption, allowing for subsequent transformation by known carcinogens such as tobacco and alcohol.

Superior thyroid artery arising from the common carotid artery.

A 63-year-old man was admitted with a 2-month history of dyspnea and hoarseness dating back 9 months. He had a 50-year history of smoking but denied excessive alcohol consumption. Physical examinat ion revealed a 4-cm transglottic, exophytic tumor involving both vocal cords. A 2-cm lump in the left jugular lymphatic chain was palpable. Endoscopy revealed a large mass originating from the epiglottis and obscuring the deep laryngeal structures. Biopsy findings confirmed that the tumor was squamous cell carcinoma. A total laryngectomy with left radical neck dissection was carried out that included peritracheal and retrosternal dissection. During the neck dissection the superior thyroid artery was noted to arise from the common carotid artery (Fig. 1).

Role of Suprahyoid Neck Dissection in the Treatment of Squamous Cell Carcinoma of the Lower Lip

Treatment of squamous cell carcinoma of the lip is primarily surgical. Unlike other oral lesions, lower lip cancers do not metastasize to lower cervical lymph nodes without invading submental and submandibular lymph nodes. This study presents 30 patients with NO lower lip carcinoma who were treated by en bloc resection of the tumor with suprahyoid neck dissection. Occult metastasis was found in 4 patients (13%). Four patients, 3 of whom had no occult metastases, died of local or regional uncontrollable disease. Suprahyoid or modified radical neck dissection appears to be beneficial, even in small tumors of the lower lip, in detecting occult metastases.

Pentoxifylline effects on acute and late complications after radiotherapy in rabbit

Soft tissue damages after radiotherapy are an uncommon but serious complication. Late damage after radiation is the principal dose-limiting factor in radiation therapy today and is dependent on vascular pathology as a result of radiation. Pentoxifylline is a methylxanthine derivative that produces dose-related improvement in blood flow, lower blood viscosity, improved erythrocyte flexibility, and increased tissue oxygen levels. An agent that increases blood flow and tissue oxygen content may contribute to enhanced healing of soft tissue pathology. Sixteen adult New Zealand rabbits were separated into 2 groups and inspected for 30 weeks after radiation. We noted acute and chronic reactions and pathologic changes in different regions of the head and neck of rabbits. The prophylactic administration of pentoxifylline in the postirradiation period can reduce late soft tissue pathology, but it does not affect acute radiation reactions.

POSTOPERATIVE HYPERTENSION AFTER RADICAL NECK DISSECTION

Postoperative hypertension after radical neck dissection was detected in 20.2% of 109 neck dissections in our department between 1989 and 1993. It was probably caused by carotid sinus denervation and appeared after the vasodilation generated by anesthesia had subsided. If postoperative hypertension was encountered after the first operation, the risk of such hypertension after surgery on the contralateral side significantly increased.

Postoperative hypertension effect of carotid sinus denervation

Postoperative arterial blood pressures were monitored in 43 patients who had undergone bilateral neck dissection during a 6-week period at Ankara Numune Hospitals Ilnd Otorhinolaryngology Department. During the first operations, all cases received carotid sinus denervation, whereas no denervation was done for the opposite side dissections held 6 weeks later. Study and control groups were composed of the same patients to achieve an objective outcome for the risk of postoperative hypertension. Hypertension was observed in 10 (23%) of 43 patients after the first operations and 12 (28%) of 43 patients after the opposite side dissections, for which no carotid denervation was done. The difference between the rates was insignificant statistically. (Otolaryngol Head Neck Surg 1999;121: 150-2.)

A Unique Case of Intranasal Metastasis from Occult Poorly Differentiated Thyroid Carcinoma

BACKGROUND Poorly differentiated thyroid carcinomas (PDTCs) lie, both morphologically and behaviorally, between well-differentiated and undifferentiated carcinomas. Metastasis of poorly differentiated thyroid carcinoma to the intranasal cavity has not been reported previously in the literature. CASE REPORT A 48-year-old male patient presented with massive epistaxis and nasal obstruction. On nasal examination, a bleeding, vascular mass was seen filling the left nasal cavity. The histopathological report of the nasal mass was well-differentiated thyroid carcinoma metastasis. Whole body scintigraphy, ultrasonography and positron emission tomography were done to rule out other possible metastases in the body and determine the origin of the tumor, which was identified as the left lobe of the thyroid gland, and there were multiple metastases involving the lung, sacroiliac area, and left humerus. Histopathological examination of a thyroidectomy specimen revealed PDTC consisting of insular, follicular, and papillary components. Postoperatively, the patient received radioactive iodine ablation therapy (iodine-131) and a course of external beam radiation therapy to the sacroiliac area and other metastatic regions. No recurrences were observed in a follow-up period of 5 years after surgery. CONCLUSION The metastasis of differentiated thyroid carcinoma as a component of PDTC to the intranasal cavity has not been reported before. It is interesting that the well-differentiated component of the tumor was metastasized in our patient. Due to the aggressiveness of PDTC and the poor survival rates in patients who undergo surgery alone, a multidisciplinary treatment approach is required.