A 65 year old man presented with a right upper cervical mass. A diagnosis of pleomorphic adenoma was reported on fine needle aspiration cytology (FNAC). CT scan however reported an intramuscular sternocleidomastoid swelling. The tumor was excised and a diagnosis of nodular fasciitis was made. It is important to be aware of this diagnosis and that FNAC reports may mimic that of a pleomorphic adenoma.
Matched MeSH terms: Head and Neck Neoplasms/diagnosis
This paper reviews economic evaluations of motorcycle helmet interventions in preventing injuries. A comprehensive literature review focusing on the effectiveness of motorcycle helmet use, and on mandatory helmet laws and their enforcement was done. When helmet laws were lifted between 1976-80, 48 states within the U.S.A. experienced a cost of $342,047 per excess fatality of annual net savings. Helmet laws in the USA had a benefit-cost ratio of 1.33 to 5.07. Taiwan witnessed a 14% decline in motorcycle fatalities and a 22% reduction of head injury fatalities with the introduction of a helmet law. In Thailand, where 70-90% of all crashes involve motorcycle, after enforcement of a helmet law, helmet-use increased five-fold, the number of injured motorcyclists decreased by 33.5%, head injuries decreased by 41.4%, and deaths decreased by 20.8%. There is considerable evidence that mandatory helmet laws with enforcement alleviate the burden of traffic injuries greatly. For low and middle-income countries with high rates of motorcycle injuries, enforced, mandatory motorcycle helmet laws are potentially one of the most cost-effective interventions available.
Matched MeSH terms: Head Protective Devices/utilization*
Submasseteric abscess is unusual in the head and neck region. Patients with this condition may be misdiagnosed as a parotid abscess due to the similarities in their presentation. Awareness and due recognition should be given to this unusual problem.
We report the outcome of 32 patients who underwent total hip replacement (THR) augmented with morsellized fresh frozen femoral head allografts and acetabular reconstruction cages. Nine patients underwent primary THR and 23 patients underwent revision THR. Follow-up ranged from two to 9 years. Two most common indications for the procedures as reported in literature were rheumatoid arthritis and aseptic loosening of the hip. All but one patient achieved good outcome with radiographs showing full incorporation of bone grafts and no evidence of loosening of the implants. Morsellized bone grafting used with acetabular reinforcement devices is valuable for addressing severe acetabular deficiencies.
Kimura’s disease (KD) is a rare, benign chronic inflammatory disease of unknown aetiology, typically presents in the Orientals as subcutaneous masses in the head and neck region that could be easily misdiagnosed as a malignant tumour, leading to unnecessary radical surgery or intensive cytotoxic therapy. It has been mainly reported in the Chinese and Japanese literature. It is difficult to diagnose before tissue biopsy and fine needle aspiration cytology (FNAC) has limited value. Hence, unless the pathologists are aware of this entity, it might be mistaken as a malignant lesion. We encountered a case of KD in a Malay patient presenting as a parotid mass that was initially diagnosed as Hodgkin’s lymphoma (HL). This disorder should be suspected in young male Asian patients presenting with a painless unilateral mass in the head and neck region with associated hypereosinophilia.
Being a rapidly developing country, a study was needed to see how we faired in treating head and neck cancer patients compared with international standards. Although being a retrospective study, this research shows that there is still a lot to be done in our developing nation in educating the general public about head and neck cancers as most of them presented in the later stages to us. There also needs to be a proper review about the treatment modality offered to patient as our survival results are far behind in certain categories of cancers compared with the developed nations.
Matched MeSH terms: Head and Neck Neoplasms/mortality*; Head and Neck Neoplasms/therapy
Motorcycle casualties represent significant number in road traffic accidents in Malaysia, and among all the injuries, facial injuries pose many significant problems physiologically, functionally, and aesthetically. The aim of this study was to analyze the pattern of maxillofacial as well as other injuries in motorcyclists who were seen at Hospital Universiti Kebangsaan Malaysia.Patients' records from January 2004 to December 2005 were reviewed. Data related to demographics, vehicle/object involved in collision, involvement as a rider or pillion, whether a helmet was worn or not, location of injuries on the face/facial bones, and other associated injuries were collected.A total of 113 cases of motorcycle accidents were recorded; 106 males and 7 females were involved. Mean age was 25.8 years. Among all the races, Malay had the highest involvement (72.3%), followed by Chinese (14.3%), Indians (8.9%), and others (5.4%). The types of collision were either a single-vehicle collision (i.e., skidded) or with another vehicle/s or object (e.g., tree, stone, or lamppost). The injuries were mainly seen on the lower face (46.9%) followed by midface (25.7%) and a combination of the midface and lower face (15%) and others (12.4%). The most frequent other associated injuries recorded were orthopedic and head injuries.
Matched MeSH terms: Head Protective Devices/statistics & numerical data
Paediatric subdural empyema is frequently seen in developing Asean countries secondary to rinosinusogenic origins. A cross-sectional analysis on the surgical treatment of intracranial subdural empyema in Hospital Kuala Lumpur (HKL), a major referral center, was done in 2004. A total number of 44 children who fulfilled the inclusion criteria were included into this study. The methods of first surgery, volume of empyema on contrasted CT brain, improvement of neurological status, re-surgery, mortality and morbidity, as well as the demographic data such as age, gender, sex, duration of illness, clinical presentation, probable origin of empyema, cultures and follow-up were studied. Chi-square test was performed to determine the association between surgical methods and the survival of the patients, neurological improvement, clearance of empyema on CT brain, re-surgery and long morbidity among the survivors. If the 20% or more of the cells were having expected frequency less than five, then Fisher's Exact test was applied. The level of significance was set at 0.05. SPSS version 12.0 was used for data entry and data analysis. There were 44 patients who were less than 18 years. Their mean age was 5.90 ± 6.01 years. There were 30 males (68.2%) and 14 females (31.8%) involved in the study. Malays were majority with 28 (63.6%) followed by Indian 8 (18.2%), Chinese 5 (11.4%) and others 3 (6.8%). The variables which were under interest were gender, race, headache, vomiting, seizures, sign of meningism, cranial nerve palsy, thickness site of abscess, first surgical treatment, improvement in neurological deficit, clearance of CT and whether re-surgery was necessary. All variables were found not to be associated with Henk W Mauser Score for PISDE grading. Comparison between this urban study and a rural setting study by the same corresponding author in the same period on subdural empyema was done. Common parameters were compared and it was found out that seizures were more prevalent in urban study where the patients are more than one year old (p=0.005). Mortality was much higher in urban study than the rural one (p=0.040). The larger proportion of urban group had volume of abscess less than or equal to 50 ml (p=< 0.001).
Post-radiation large vessel injury has not received as much attention as microvascular irradiation injury. A few studies have shown that common carotid intima-media thickness (IMT) is increased after radiotherapy to the head and neck. However, in most of these studies, the irradiated subjects also had other major risk factors for atherosclerosis. In this study, irradiated subjects with major risk factors such as hypertension, diabetes, history of previous cerebrovascular accident and connective tissue disorder were excluded.
Matched MeSH terms: Head and Neck Neoplasms/radiotherapy*
This study was carried out to compare the ultrastructure of fresh, capacitated and acrosome-reacted sperm. The sperm was treated with heparin for capacitation and calcium ionophore for acrosome reaction induction. Sperm samples were then prepared for ultrastructural studies and examined by transmission electron microscopy (TEM). Ultrastructural changes in plasma and acrosomal membranes, shape of the mitochondria and outer dense fibres, in capacitated and acrosome-reacted sperm were evident. The plasma membrane of fresh sperm was loosely fitted around the sperm head and the acrosomal membrane was closely opposed to the nucleus. The plasma and acrosomal membranes of the capacitated sperm were expanded, but disintegrated in the acrosome-reacted sperm. Mitochondria of fresh sperm appeared to be rounded in shape with plasma membrane closely opposed to it and the nine outer dense fibres were almost regular rounded in shape. However, in both capacitated and acrosome-reacted sperm, the mitochondria were almost regular and elongated in shape whilst the outer dense fibres were irregular in shape in the capacitated and acrosome-reacted sperm. There were no noticeable morphological changes found in the axonemal complexes in fresh, capacitated and acrosome-reacted sperm. Ultrastructural studies are able to provide detailed information on sequential events involving numerous physiological changes during fertilization.
Follicular adenoma defined as a well encapsulated benign neoplastic condition of thyroid follicles. We describe this interesting case of a boy presented with right sided neck swelling that was diagnosed as a branchial cyst but later after excision, the histopathology revealed follicular adenoma of the thyroid with hemorrhage and degenerative changes in the centre. To our knowledge, this is the first reported case of follicular thyroid adenoma presented as branchial cyst.
Radiotherapy is an important treatment modality for head and neck tumours. One of its major drawbacks is post-treatment salivary gland hypofunction. This study was performed to objectively evaluate the salivary gland function in post-irradiated head and neck tumour patients.
Matched MeSH terms: Head and Neck Neoplasms/radiotherapy*
We report a 56-year-old Malay woman with a tumour that involved the skin and caused hyoid bone erosion. There was no clinical or radiological evidence of regional lymph node involvement. A modified radical neck dissection with preservation of the accessory nerve and internal jugular vein was performed, followed by an "extended" Sistrunk operation. The surgical defect was reconstructed with a pectoralis major myocutaneous flap. Our literature review showed that this is the first reported thyroglossal duct carcinoma which involved the skin and required a pedicle flap reconstruction.
Matched MeSH terms: Head and Neck Neoplasms/pathology*; Head and Neck Neoplasms/surgery
Although around 70% of HIV+ cases used to have ocular manifestations, the late reporting of cases often results in severe forms of ocular morbidity that would otherwise have been prevented. The objective of this study was to describe the ocular manifestations of HIV and AIDS-related patients who had been admitted to TM Jafferji Hospital, Dar-es-Salaam, Tanzania.
Currently, of less than 50 cases of head and neck follicular dendritic cell (FDC) sarcoma reported in the literature, 5 have been found to occur in the background of Castleman disease. We report another case of head and neck FDC sarcoma with emphasise on its associated lesions and review the outcome of treatment from the existing cases in the literature.
Matched MeSH terms: Head and Neck Neoplasms/complications; Head and Neck Neoplasms/pathology*; Head and Neck Neoplasms/therapy
Necrotizing fasciitis of the head and neck is a rare, rapidly progressive infection involving the skin, subcutaneous tissue and fascia. We report three cases of necrotizing fasciitis that differ in their presentation and outcome. The first case involves a patient who presented with progressively enlarging anterior neck swelling that was later complicated by dehydration and reduced consciousness. The second case is a patient with neck swelling and ipsilateral otorrhea. The third case concerns a patient with a buccal ulcer complicated by ipsilateral facial swelling. All of them underwent a fasciotomy with wound debridement with the addition of a cortical mastoidectomy in the second case. Two of these patients recovered well. Unfortunately, the third case succumbed to death due to airway compromise and septicaemia. We advocate the importance of eradicating the source of infection followed by frequent, meticulous wound dressing and strict blood sugar control to obtain better outcomes in managing necrotizing fasciitis of the head and neck. However, involvement of the airway carries a grave prognosis despite aggressive treatment.
Most functional phaeochromocytomas/paragangliomas produce noradrenaline and/or adrenaline. Those that produce dopamine are rare. We describe the distinguishing clinical features of dopamine-secreting phaeochromocytomas and paragangliomas from those that secrete noradrenaline/adrenaline and the impact on their management. We present a case of a dopamine-secreting paraganglioma from our institution and review 14 case reports of dopamine-secreting phaeochromocytomas/paragangliomas published between 1984 and 2008. As observed in the literature, 80% of the tumours were extra-adrenal. Most patients presented with non-specific symptoms or mass effect without the classical presentation of catecholamine excess. The majority were diagnosed with urinary or plasma dopamine. Five patients had malignant tumours and 12 patients underwent surgical resection of the primary tumours. Unlike noradrenaline/adrenaline-secreting phaeochromocytomas/paragangliomas, dopamine-secreting tumours lack a classical presentation, are extra-adrenal and have a higher malignant potential. A routine inclusion of urinary or plasma dopamine as part of catecholamine screening in all suspected phaeochromocytomas and paragangliomas is recommended.
Matched MeSH terms: Head and Neck Neoplasms/diagnosis; Head and Neck Neoplasms/secretion; Head and Neck Neoplasms/surgery
The longlegged ant, Anoplolepis gracilipes (Fr. Smith) (Hymenoptera: Formicidae), is a highly invasive species that can aggressively displace other ant species. We conducted laboratory assays to examine interspecies aggression of A. gracilipes versus 15 sympatric ant species found in the urban environment and disturbed habitat in Malaysia: Monomorium pharaonis (L.), Monomorium floricola (Jerdon), Monomorium orientale Mayr, Monomorium destructor (Jerdon), Pheidole parva Mayr, Crematogaster sp., Solenopsis geminata (F.), Tapinoma indicum (Forel), Tapinoma melanocephalum (F.), Technomyrmnex butteli Forel, Dolichoderus thoracicus (Smith), Paratrechina longicornis (Latrielle), Oecophylla smaragdina (F), Camponotus sp., and Tetraponera rufonigra (Jerdon). A. gracilipes showed aggressive behavior toward all opponent species, except the smallest M. orientale. Opponent species size (body size, head width, and mandible width) was significantly correlated with A. gracilipes aggression level and mortality rate. We also found a significant positive relationship between A. gracilipes aggression level and the mortality of the opponent species. The results suggest that invasive populations of A. gracilipes would have the greatest impact on larger ant species. In addition, we examined the intraspecific aggression of A. gracilipes. We found that A. gracilipes from different localities in Malaysia showed intraspecific aggression toward one another. This finding differs from the results of studies conducted in Christmas Island earlier. Differences in the genetic variability among populations may explain these differing results.
PURPOSE: This study was designed to find a reliable Epstein-Barr virus (EBV) immunoglobulin (Ig) G-based diagnostic/screening test for nasopharyngeal carcinoma (NPC) able to demarcate between the NPC-related seropositivity of EBV IgG antibodies and that of other head and neck cancer (HNCA) and control groups. The NPC-associated immunosuppression affects EBV IgA much more than IgG, leading to inconsistent detection of NPC using EBV IgA antibodies.
MATERIALS AND METHODS: One hundred twenty-two HNCA patients, 42 NPC, 66 laryngeal carcinoma, and 14 hypopharyngeal carcinoma and 3 groups of 100 control subjects were enrolled in this study. Enzyme-linked immunosorbent assay (ELISA) was used to find a specific cutoff value for the NPC-related seropositivity of EBV IgG antibodies.
RESULTS: NPC group showed higher serum level of EBV IgG antibodies than control and other HNCA groups (P < .05). However, the traditional cutoff value, mean + 2 SDs of control subjects, failed to demarcate the seropositives of NPC patients from those of healthy population (P > .05). The new cutoff value, mean + 2 SDs of the seropositives group of control subjects who had already been grouped by the traditional cutoff value, proved successful. It succeeded to demarcate between the NPC-related EBV IgG seropositivity and that issued from the persistent, latent, or reactivated EBV infection in the population (P < .05). The sensitivity/specificity of NPC detection by the new cutoff-based ELISA kit, 76.19% and 86%, was close or higher than that of EBV IgA antibodies.
CONCLUSION: EBV IgG-based ELISA could be used for the diagnosis of NPC using a new cutoff threshold that excludes the population baseline of EBV IgG seropositivity.
Matched MeSH terms: Head and Neck Neoplasms/immunology