Charalampos Skoulakis

Epidermoid cyst of the floor of the mouth: two case reports

IntroductionEpidermoid cysts that appear in the midline floor of the mouth are, usually, a result of entrapped ectodermal tissue of the first and second branchial arches, which fuse during the third and fourth weeks in utero. The incidence in the floor of the mouth of the oral cavity is rare and development sites are the sublingual, submaxillary and submandibular spaces.It was present two cases of epidermoid cyst of the floor of the mouth and discussed the different surgical approaches for this lesion.Cases presentationTwo cases of midline epidermoid cysts of the floor of the mouth are presented, evaluating the different surgical approaches. The preoperative assessment was made using ultrasonography and computed tomography in both cases. Regarding surgical techniques used, a transcutaneous approach was adopted when the cysts were under the geniohyoid muscle and a midline incision of the oral mucosa along the lingual frenulum was used for sublingual cysts. During the postoperative course, there were no complications, except for mild edema in one case. Follow-up ranged between 5 months and 4 years; no recurrence or malignant changes were observed.ConclusionsSurgery of epidermoid cyst of the floor of the mouth is the treatment of choice. Access depends on the lesions location in relation to the mylohyoid or geniohyoid muscles. If the cyst is located over the mylohyoid, surgery is carried out only through the oral cavity, whereas the extraoral incision was necessary only when the cysts were under the geniohyoid muscle.

Validation of the Nasal Obstruction Symptom Evaluation (NOSE) Scale for Greek Patients

Objective Nasal Obstruction Symptom Evaluation (NOSE) scale is a validated disease-specific questionnaire for the assessment of Nasal Obstruction (NO). The aim of this study was to validate the Greek-NOSE questionnaire. Study Design Prospective instrument validation study. Setting Tertiary referral center. Subjects and Methods NOSE questionnaire was translated into Greek and then translated back into English. A prospective study was conducted on adult patients with NO due to septal deviation (SD). Test-retest evaluation of SD patients was carried out. Internal consistency was assessed with Cronbach’s alpha test and test-retest reliability with Pearson’s test (correlation), kappa (reproducibility), and Bland-Altman plot (extent of agreement). Validity was assessed by comparing scores of a control group of volunteers without NO to preoperative scores of SD patients undergoing septoplasty with Mann-Whitney test. Responsiveness was assessed by comparing preoperative to 3 months postoperative scores of SD patients with paired t test and evaluating the magnitude of surgery effect. Results Test-retest evaluation was accepted on 109 patients. The Greek-NOSE had good internal consistency (Cronbach’s alpha 0.74 for test and 0.76 for retest). All its items were significantly correlated between test and retest evaluation. NOSE showed high reproducibility (mean kappa: 0.75), and almost all differences in Bland-Altman plot were between agreement thresholds. Controls (123 volunteers) had significant lower score. Postoperative scores were significantly lower than preoperative, and magnitude of surgery effect was high, both indicating good responsiveness. Conclusion The Greek-NOSE questionnaire is a valid instrument with satisfactory internal consistency, reliability, reproducibility, validity, and responsiveness.

Hidrocystoma of the external auditory canal: a case report

BackgroundApocrine hydrocystomas arising in the external auditory canal are very rare. In this report a clinical case of apocrine hydrocystoma located in the cartilaginous part of the external auditory canal is presented.Case presentationA 64-year-old Caucasian female patient presented with a solitary nodule, located in the outer part of the external ear canal after repeated episodes of external otitis. For diagnostic purposes, computerized tomography was used. The patient underwent an excisional biopsy of the mass via an intra-aural incision and the surgical specimen was sent for histopathologic examination.ConclusionAn apocrine hidrocystoma inside the auricular canal is uncommon. It can cause recurrent external otitis and conductive hearing loss and should be treated with wide local excision and reconstruction of the external auditory canal for diagnostic and therapeutic purposes.

Treatment of nasal fractures by Paul of Aegina

OBJECTIVE: The most exact description of the management of nasal fractures given by any physician of ancient times belongs to Paul of Aegina (AD 625–690). The goal of this article is to describe the therapeutic methods and surgical techniques used by Paul of Aegina in the treatment of nasal injuries. STUDY DESIGN: We studied the original Greek texts and the translation published in Venice, titled “The seven books of excellent doctor Paul of Aegina.” The sixth book of his medical compendium is devoted to surgery. We identified the treatments and techniques applied to the restoration of injured noses. CONCLUSION: In this historical article we present the management of nasal fractures by Paul of Aegina. Paul of Aeginas conservative and surgical management for each form of injury was adopted by later physicians and influenced European medicine, a management surprisingly identical with the way nasal fractures are managed nowadays.

Cross-cultural adaptation and validation of the Greek OSA-18 questionnaire in children undergoing polysomnography.

OBJECTIVE Translations of validated questionnaires help to compare different countries/cultures populations and establish protocols for global health. OSA-18 is a validated disease-specific questionnaire for pediatric Obstructive Sleep Apnea (OSA). Our aim was to validate OSA-18 in Greek and correlate it with polysomnography results and OSA severity. STUDY DESIGN Prospective instrument validation study. SUBJECTS AND METHODS OSA-18 was translated in Greek and back into English. Children undergoing polysomnography due to snoring were recruited prospectively. OSA-18 was completed by parents during the initial clinic visit (test), in the evening prior to the sleep study (retest), and 3 months postoperatively for subjects who underwent adenotonsillectomy. Internal consistency and test-retest reliability were evaluated. Validity was assessed by exploring correlations between OSA-18 and AHI, by comparing OSA-18 of OSA and non-OSA groups, and by calculating questionnaires sensitivity and specificity for detecting OSA. Total scores of non-OSA, mild, moderate and severe OSA subgroups were compared. In OSA children who underwent adenotonsillectomy, preoperative and postoperative total scores were compared to assess responsiveness. RESULTS Test-retest questionnaires were fully completed for 141 children. OSA-18 in Greek had good internal consistency (Cronbachs alpha 0.951 for test and 0.947 for retest) and test-retest reliability (Pearsons correlation coefficients between test and retest scores: 0.850-0.946; P<0.05). Total and subscale OSA-18 scores and AHI were significantly correlated (Spearmans correlation coefficients: 0.376-0.633; P<0.01), while children with OSA had higher total OSA-18 score than those without OSA [median (interquartile range): 61 (35) vs. 38 (22), respectively; P<0.001)]. Sensitivity was 53.4%, suggesting poor validity compared to polysomnography. All OSA severity subgroups had significant higher score than non-OSA. OSA-18 scores postoperatively were significantly lower compared to preoperatively (22.91±5.49 vs. 67.13±15.27, respectively; P<0.001), indicating good responsiveness. CONCLUSION Greek OSA-18 is an instrument with satisfactory internal consistency, reliability, and responsiveness, but it is a poor predictor of OSA severity.

Frontal lobe abscess secondary to head trauma and nasal polyposis.

Cerebral frontal lobe abscess may be a frequent intracranial complication of paranasal sinusitis. An unusual case of cerebral abscess complicating massive polyposis is described in a patient with history of previous severe head trauma 30 years ago. Imaging evaluation using both computed tomography and magnetic resonance imaging is important to diagnose such rare entities.

Urine concentrations changes of cysteinyl leukotrienes in non-obese children with obstructive sleep apnea undergoing adenotonsillectomy

OBJECTIVE The main objective of the study was to compare preoperative to postoperative levels of urine-Cysteinyl leukotrienes (uCysLT) in children undergoing adenotonsillectomy (AT) for obstructive sleep apnea (OSA) in order to investigate whether exaggerated leukotriene activity is the cause or consequence of OSA. METHODS AND MATERIALS A prospective study was conducted on non-obese children (4-10 years old) referred for overnight PSG. Children with moderate/severe OSA treated with AT were included. A second PSG study performed 2 months postoperatively to confirm OSA resolution, and those with residual OSA were excluded. Morning urine specimens after both PSG studies were obtained and pre-operative uCysLT levels were compared to postoperative levels. RESULTS 27 children fulfilled the criteria and underwent a post-operative PSG study with three exclusions for residual OSA (postop-AHI>2), so the study group consisted of 24 children (mean age: 5.7 ± 2.1 years). Mean preoperative and postoperative AHI was 10.96 ± 5.93 and 1.44 ± 0.56 respectively. Mean preop-uCysLT were 21.14 ± 4.65, while after AT they significantly reduced to 12.62 ± 2.67 (P < 0.01). CONCLUSION uCysLT levels are significantly reduced after AT in non-obese children with moderate/severe OSA, suggesting that exaggerated leukotriene activity is mainly a consequence of OSA.

Brucella Melitensis As Causative Agent for Neck Abscess in an Endemic Area

Background: Brucellosis, a zoonotic disease, is very common in the Mediterranean basin and a major concern in livestock areas. We present a rare case of a Brucella-caused abscess in the neck of a stock-breeder in an endemic Greek area. Case Report: A 39-year-old male, living in the rural area of Thessaly, presented with a mass in the left area of his neck. Clinical examination and imaging tests revealed an abscess in the left sternocleidomastoid muscle. Sampling of the abscess by fine-needle aspiration yielded inflammatory fluid (17x103 cells/μL). Molecular sequencing (16S rRNA polymerase chain reaction) performed directly in the clinical sample identified the presence of Brucella melitensis within 24 hours after material sampling. The microorganism was isolated in agar media four days later. The Rose-Bengal test was negative, while the Brucellacapt test showed titer 1/320. Given the results obtained with these molecular techniques, the patient was offered treatment with streptomycin (1 g for 3 weeks) and oral doxycycline (100 mg twice daily for 6 weeks), concurrently. Conclusion: In areas endemic for brucellosis, the investigation of a patient with a neck abscess should include Brucella spp. among possible causative agents.

The impact of perioperative dexamethasone on swallowing impairment score after thyroidectomy: a retrospective study of 118 total thyroidectomies.

Dear Editor, Even though more than half of patients undergoing thyroidectomy complain of non-specific dysphagia, when no laryngeal nerve injury is involved the importance of this complication is often overlooked. Post-thyroidectomy swallowing problems include non-specific swallowing changes and discomfort, occasional dysphagia, painful swallowing, swallowing difficulty and sensation of a lump or coughing. These symptoms usually resolve after a short period but sometimes may persist long after surgery. Steroids are well known for their analgesic, antiinflammatory, immune-modulating and antiemetic effects. Furthermore, evidence in the literature supports the perioperative use of corticosteroids in thyroid surgery as prophylaxis for post-operative nausea and vomiting or analgesia. In our department, it is a common practice of some anaesthesiologist to use perioperative steroids in thyroid surgery, while some others do not; so some of our patients receive perioperative steroids and others do not. To our knowledge, the impact of steroids on swallowing symptoms after thyroidectomy has never been evaluated so far (PubMed search). The purpose of this study was to evaluate the impact of a single perioperative dexamethasone administration on postthyroidectomy swallowing symptoms as expressed by swallowing impairment score (SIS-6) questionnaire.