Tahera Islam

Ultra percutaneous dilation tracheotomy vs mini open tracheotomy. A comparison of tracheal damage in fresh cadaver specimens

BackgroundTo compare the ultra percutaneous dilation tracheostomy (PDT) and mini open techniques (MOT) in randomized fixed and fresh cadavers. Assess degrees of damage to tracheal cartilage and mucosa via tracheal lumen and external dissection.MethodComparative cadaver study was performed, tracheostomy was placed in 36 cadavers (16 fixed, 20 fresh) from July 2004 to December 2004, in University of Alberta, Canada. PDT (size 7) were placed by intensivist and MOT (size 7) otolaryngologist. Both fixed and fresh cadavers were randomized. Evaluation was done according to gender, ease of landmark, mucosal and cartilage injuries.ResultsSignificant differences in mucosal injury (7 of 9 in UPDT VS 0 of 7 in MOT, p value 0.008), and cartilage injury (8 of 9 in UPDT VS 1 of 7 in MOT p value 0.012) were seen in fixed cadavers; and in fresh cadavers, mucosal injury (5 of 10 in UPDT VS 0 of 10 in MOT, p value 0.043), and cartilage injury (5 of 10 in UPDT VS 0 of 10 in MOT, p value 0.043).ConclusionsPDT resulted in severe damage to mucosa and cartilage, that might contribute to subglottic stenosis preventing decannulation. Considering the injury, MOT has better outcome than UPDT.

Recurrent unicystic maxillary ameloblastoma presenting as unilateral proptosis

Unicystic Ameloblastoma (UA) is a rare variant of ameloblastoma which is an odontogenic epithelial neoplasm, typically affecting mandibular ramus. Maxillary ameloblastoma is a rare entity with a more disastrous consequence. Although extremely rare, their highly recurrent and locally aggressive behavior can lead to invasion of vital structures surrounding maxilla (orbit, cranium) even after several years of conservative surgical management (limited resection, curettage). We report a case of 16-year-old girl presenting with proptosis of left eye, UA left maxilla, who was treated initially with limited resection (enucleation) and curettage and the lesion recurred after two years with a more aggressive behavior, causing destruction floor of orbit. To this date there are only 23 documented cases of orbital invasion and only three of the reports are in ophthalmic literature. The ophthalmologists need to be aware of this type of rare lesion presenting as proptosis.

Impact of body mass index on survival outcome in patients with differentiated thyroid cancer

INTRODUCTION Increased body mass index is known to be associated with the high prevalence of differentiated thyroid cancers; however data on its impact on survival outcome after thyroidectomy and adjuvant therapy is scanty. OBJECTIVE We aimed to evaluate the impact of body mass index on overall survival and disease free survival rates in patients with differentiated thyroid cancers. METHODS Between 2000 and 2011, 209 patients with differentiated thyroid cancers (papillary, follicular, hurthle cell) were treated with thyroidectomy followed by adjuvant radioactive iodine-131 therapy and thyroid-stimulating hormone suppression. Based on body mass index, patients were divided into five groups; (a) <18.5kg/m2 (underweight); (b) 18.5-25kg/m2 (normal weight); (c) 26-30kg/m2 (overweight); (d) 31-40kg/m2 (obese) and (e) >40kg/m2 (morbid obese). Various demographic, clinical and treatment characteristics and related toxicity and outcomes (overall survival, and disease free survival) were analyzed and compared. RESULTS Median follow up period was 5.2years (0.6-10). Mean body mass index was 31.3kg/m2 (17-72); body mass index 31-40kg/m2 was predominant (89 patients, 42.6%) followed by 26-30kg/m2 seen in 58 patients (27.8%). A total of 18 locoregional recurrences (8.6%) and 12 distant metastasis (5.7%) were seen. The 10 year disease free survival and overall survival rates were 83.1% and 58.0% respectively. No significant impact of body mass index on overall survival or disease free survival rates was found (p=0.081). Similarly, multivariate analysis showed that body mass index was not an independent prognostic factor for overall survival and disease free survival. CONCLUSION Although body mass index can increase the risk of thyroid cancer, it has no impact on treatment outcome; however, further trials are warranted.

Myxoma of the nasal bone

Myxoma is a benign tumor that arises from mesenchymal tissue, and found in the soft tissue and less commonly in the bone. The majority of bony myxomas of the head and neck occur in the jaws and maxilla. We report an extremely rare case of nasal bone myxoma in a 52-year-old man. The diagnosis was confirmed by biopsy. Due to the aggressive nature of the lesion the nasal bone was eroded by the disease. The patient underwent resection of the mass with reconstruction of the defect by septal cartilage. The patient remains tumor free after 5 years.

Epidermoid cyst of the suprasternal region: a rare case report.

Epidermoid and dermoid cysts constitute the common benign masses that involve the skin. They are classified as epidermoid cyst when the lining contains only squamous epithelium, ‘‘true’’ dermoid cysts when skin adnexa such as hair follicles, sebaceous glands, and sweat glands are present and teratoid cysts when tissues from all three germ layers, such as cartilage, bone, muscle, and respiratory or gastrointestinal epithelium are present. These lesions may arise anywhere in the body. Dermoid and epidremoid cyst of the head and neck account for 7% of all dermoid epidermoid cysts. Suprasternal region is an uncommon site of presentation for epidermoid cyst with the first case documented in Turkey in 2008 and recently six in india. We report a case of an epidermoid cyst in the suprasternal region, presented as a large mass associated with odynophagia and weight loss.