Head-neck Region Research Articles

Bilobed Flap in Reconstruction of Nasal Defect

Basal cell carcinoma (BCC) is the most common type of skin cancer, which arises from the basal layer of the epithelium. It is a slow growing tumor and has a low metastatic potential, it accounts for 70–80% of all cutaneous malignancies in the head face and neck region .Defects near nasal tip and ala of the nose are one of the most difficult site to cover in a single stage, bilobed flap is reported to be used very effectively to close the defect in these areas. This article reports a case of basal cell carcinoma involving the ala of the nose which was excised and the reconstruction was done using bilobed flap.

Dermoscopy in the Diagnosis of Cutaneous Leishmaniasis.

Cutaneous leishmaniasis (CL) is a protozoan infectious disease. Dermoscopy is a noninvasive diagnostic tool that has been applied to several skin diseases, including infestations. To determine the dermoscopic patterns of CL lesions and to investigate whether a relationship exists between dermoscopic characteristics and the disease duration, localization, and type of CL lesions. Seventy-nine patients (48 male, 31 female) from Hatay, Turkey, were enrolled in the study and a dermoscopic evaluation was performed on 139 lesions. Images of CL lesions were taken via polarized light contact dermoscopy. Chi-square and Fisher exact tests were used for statistical analyses and P values <0.05 were considered significant. Generalized erythema was seen in all CL lesions. Vascular structures (94.2%), yellow tears (75.5%), and a white starburst-like pattern (58.3%) were the other most common dermoscopic features. Hyperkeratosis (P = 0.001) and white starburst-like pattern (P < 0.001) were more prevalent in the extremities than elsewhere. Among vascular structures, linear irregular (45.8%), hairpin (43.5%), and comma-shaped (25.9%) patterns were the most common dermoscopic findings. Linear irregular (P = 0.023) and arborizing vessels (P = 0.001) were observed in the head-neck region. Dotted (P = 0.009), hairpin (P < 0.001), and glomerular-like (P = 0.016) morphological findings were more prevalent in the extremities. Statistical significances in disease duration were detected in microarborizing (P = 0.027) and arborizing (P = 0.004) vessels and were most prevalent with a disease duration of >6 months. Hairpin vessels were prevalent in the plaque and nodulo-ulcerative type of lesions. Dotted vessels were most commonly seen in the plaque type (47.4%) of lesions. Generalized erythema, yellow tears, and starburst-like patterns, as well as linear irregular, hairpin, comma-shaped, and arborizing vessels, were the most commonly detected dermoscopic features of CL lesions. We suggest that the presence of these features can be helpful when diagnosing CL lesions by dermoscopy.

Redo Tracheostomy: Our Experience, Problems Encountered and How to Overcome Them.

Tracheostomy is a life-saving procedure done electively or most commonly in emergency basis. In patients with diagnosed case of cancer in upper airway tract they usually require tracheostomy at some point of time during their whole treatment procedure. Patients receiving radiotherapy or chemotherapy or combination of these are at high risk of developing post treatment changes in neck anatomy. Redo tracheostomy due to any reasons in such types of patients is a surgical challenge. The purpose of this article is to share our surgical technique in redo tracheostomy. During a period of two years 39 patients with diagnosed cancer in head neck region underwent redo tracheostomy at the hand of the author. Twenty-six patients were had received chemoradiation for their primary cancer and 6 patients were planned for second surgery due to recurrence disease in oral cavity. Reasons for redo tracheostomy are: sixteen patients were post chemoradiation on follow up with accidental expulsion of tube, 17 patients were recurrence/residual disease and 6 patients were plan for second surgery due to recurrence disease. In 9 cases the surgery was started by other doctor and taken over by the author due to profuse bleeding (5 cases) and failure to localised the trachea (4 cases). Among the 39 patients successful redo tracheostomy was possible in all. Mild surgical emphysema was encountered in 3 patients which was not significant. There was no other complication related to tracheostomy till the patients were discharge from the hospital. When redo tracheostomy is required in a post chemoradiation patients maintaining the proper dissection plane and procedure is important to avoid unnecessary complication intraoperatively.

The Effect of N-butyl-2-Cyanoacrylate on Wound Healing in Head Neck Region

OBJECTIVE To compare the histological regeneration characteristics of open wound on head neck by a topical antiseptic solution (Batticon ® solution 5%; Adeka, Samsun, Turkey ) or a tissue adhesive (N-butyl-2-cyanoacrylate, Glubran 2, GEM Company, Italy) in experimentally created rabbit auricular open wound. MATERIAL AND METHOD Twenty-eight female rabbits (New Zealand genus), weighing 3 to 4 kg, were handled daily for 2 weeks prior to surgical manipulation to condition them to behavior testing. The control group consisted of seven rabbits. The 21 rabbits were randomly divided into three groups based on the harvesting day. In control group a segment of ear auricula was resected and sent to histological examination for comparison with the study group findings. In the study group both auricular skin of each animal was exposed and 1x1 cm epidermal resection area was created open wound in rabbit ears that is to be a model for open tissue injury and applied as a topical antiseptic solution (Batticon ® solution 5%; Adeka, Samsun, Turkey) on one side and by application of tissue adhesive (Glubran 2, GEM Company, Italy) on the other side. Following this application at 2 nd , 4 th and 6th days the animals were harvested and histological regeneration characteristics of open wound examined by electron microscopy and compared to the control group’s histological findings. RESULTS Electron microscopic examination of open wound at consecutive 2 nd , 4 th and 6 th days revealed increased regeneration findings in tissue adhesive group when compared to a antiseptic solution group. CONCLUSION Based on the findings of this animal study we conclude that N-butyl-2-cyanoacrylate is an appropriate material for open wound on head and neck region.

Candidiasis: Red and White Manifestations in the Oral Cavity.

Candidiasis is a very common malady in the head neck region. This review will concentrate on intraoral, pharyngeal and perioral manifestations and treatment. A history of the origins associated with candidiasis will be introduced. In addition, oral conditions associated with candidiasis will be mentioned and considered. The various forms of oral and maxillofacial candidiasis will be reviewed to include pseudomembranous, acute, chronic, median rhomboid glossitis, perioral dermatitis, and angular cheilitis. At the end of this review the clinician will be better able to diagnose and especially treat candidal overgrowth of the oral facial region. Of particular interest to the clinician are the various treatment modalities with appropriate considerations for side effects.

Child injuries in the Syrian Civil War

Objective: During wars, many soldiers and civilians either get injured or die. In civil wars, older people, women, and children are more vulnerable to injuries and traumas. The aim of this study is to reveal the demographic features and variety as well as the characteristicsof the injuries in children who were impacted from the Syrian civil war and underwent surgeries in the plastic, reconstructive and aesthetic surgery department. Patients and Methods: This is a retrospective study which initially included 121 children aged 0–18 years out of a total of 402 Syrian patients treated in the plastic, reconstructive and aesthetic surgery department between December 2011 and December 2016. Results: Of 83 children with war injuries treated in our clinic, 42% were female and 58% were male. Forty-one percent of the injuries were located in the head-neck region. 43.4% of the injuries were due to burns. Thirty-six percent of the injuries were located on the extremities. All the patients underwent a total of 242 surgeries. The mean number of surgeries per child was 2.9. The mean time of hospitalization was 17.12% days. Conclusion: The results of the study show that children are impacted just as much or more thanadults in the Syrian civil war and had more severe injuries than those effected by similar wars and terrorist attacks.

Paederus dermatitis: An observational study

Aim: Paederus dermatitis (PD) is a form of irritant contact dermatitis caused by Paederus spp. It can mimic many dermatological conditions. In this study, we aimed to evaluate clinical characteristics of the cases with Paederus dermatitis. Material and Methods: The study included the patients with PD who admitted to our outpatient clinic between May 2017 and November 2018. The study was carried out in a private hospital at Batman province, a city in the southeast Anatolia region of Turkey. Clinical and demographical features of all the cases were retrospectively reviewed. Results: A total of 44 patients were enrolled in the study. The mean age of the patients was 25.2 years. The disease peaked in August and September. The most common localization was head-neck region. On the dermatologic examination, three main clinical patterns were observed: dermatitis linearis (n=31, 70.4%), localized pustular dermatosis (n=4, 9%) and kissing dermatitis (n=7, 15.9%). Two (4.54%) cases showed a combination of two patterns. Three cases (6.8%) had periorbital involvement. Conclusion: Paederus dermatitis is a form of irritant contact dermatitis which can easily be misdiagnosed. Awareness about the clinical patterns of the disease and its typical features is essential for true diagnosis and management.

Concurrent chemoradiation with paclitaxel versus cisplatin in locally advanced head and neck cancer patients - A prospective comparative study

Background: External beam radiotherapy with concurrent chemotherapy has become the mainstay of treatment for locally advanced head and neck cancers. Objective: The objective of this study was to compare paclitaxel to cisplatin as an agent for concurrent chemoradiation in locally advanced squamous cell carcinoma of head neck region in terms of toxicities and response to treatment. Materials and Methods: Biopsy-proven Stage III and Stage IVA head and neck squamous cell cancer patients were included in the study. The study arm patients received concurrent dose of paclitaxel 20 mg/m2 I/V 1 h infusion 4 h before radiation, repeated weekly for 6 cycles. Patients in the control arm received concurrent dose of cisplatin 30 mg/m2 I/V 1 h infusion 4 h before radiation, repeated weekly for 6 cycles. Patients of both arms received a total dose of 66 Gy external beam radiation, 200 cGy/day, 5 fractions in a week in 6.5 weeks treated on a Theratron 780E Cobalt-60 teletherapy unit. Results: Acute Grades III and IV renal toxicity and nausea were reported significantly more number of cases in cisplatin arm in comparison to paclitaxel arm. There was no statistically significant difference observed in the groups in terms of treatment response and failure pattern (χ2 = 3.63, df = 1, level of significance 0.05). On follow-up, up to 6 months, 51.85% of cases are disease free in the control arm and 50.66% of cases in the study arm. Conclusion: Low-dose weekly paclitaxel concurrent with external beam radiation therapy given in conventional fractionation is comparable to concurrent cisplatin in locally advanced head and neck squamous cell carcinoma in terms of efficacy. There is lower incidence of severe renal toxicity and vomiting with concurrent paclitaxel than with cisplatin.

Pediatric Dog Bite Injuries in Central Texas

PurposeIdentify children at greatest risk for dog bite injuries and to provide injury prevention recommendations. MethodsA retrospective review of patients aged ≤18 years treated for dog bite injuries from October 2011 to October 2016 was performed. Data collected included patient demographics, parental presence, time of injury, dog breed and ownership status, injury location and characteristics, need for operative intervention, and hospitalization. ResultsOne-hundred and two patients met the inclusion criteria. The mean age was 5.84 years, and 43.1% were preschool-aged (2–5 years). Parental presence was reported in 43.6% of cases, and most attacks occurred in the evening (46.8%). Injuries often involved the head–neck region (92.1%), and 72.5% were of major severity. Pet dogs were responsible for 42% of injuries, and pit bull was the most-identified breed (36.2%). Most injuries occurred while the child was at home (57.8%) and was petting or playing with the dog (28.4%). Intervention in the operating room was required in 34.3% of patients. Major injury was more likely to require operative intervention (p = 0.015) but was not associated with patient age, sex, pet status, or the need for hospitalization. ConclusionsPreschool-aged children are more likely to be injured by dog bites, and dog bites can result in major injury to the head and neck region. Prevention efforts should focus on dog training, public education (children and adults), vigilant adult supervision, and a zero-tolerance policy. Level of clinical evidenceLevel IV—case series with no comparison group. Type of studyPrognostic.

Detection of HPV infection in head and neck cancers: Promise and pitfalls in the last ten years: A meta-analysis.

The current controversial discussion on the disease-specific survival of patients with human papillomavirus (HPV)-positive (+) and -negative (−) squamous cell carcinoma (SCC) of the head neck region was the motivation for the present meta-analysis. Different detection methods for HPV are available, though these often lack sensitivity. As a consequence, there may be false interpretation of HPV positivity. A bias concerning HPV status and therefore also survival rates is serving a non-durable relevance in the discussion of tailored therapies. A literature search was performed via the online database PubMed/NCBI, and data extraction and statistical analysis were conducted. A total of 139 studies published between 2004 and 2014 were evaluated in the present meta-analysis. The HPV detection methods, patient characteristics, tumor localizations and stages, as well as (neo-) adjuvant therapies and survival times were analyzed. The average incidence rates of HPV+ patients with oropharyngeal tumors were higher than those of patients with cancers of other regions of the head and neck. Upon evaluating the results of different detection methods no significant differences were identified. We have compared the HPV incidence rates of each detection method, when studies have used more than one. Regarding overall survival, the pooled adjusted hazard ratio (HR) for oropharyngeal SCC was 0.31 [95% confidence interval (CI)=0.27–0.36]. Unfortunately, only 3 equivalent studies were available on nonoropharyngeal tumors, for which the pooled adjusted HR was 1 (95% CI=0.73–1.36). Overall, the evaluation demonstrated that the survival rates reported in numerous studies were not evaluated multifactorially and important confounders were excluded from the statistics. The HPV detection methods used were often not sufficient in representing HPV positivity. In addition, oropharyngeal and oral SCCs were assessed together in the localization. The widely differing number of HPV+ patients in each of the various studies may be explained by insufficient detection methods and by a lack of localization distinction. The considerations of a tailored therapy according to HPV status should be rejected based on the present information. The previously published studies should be read critically and do not represent a basis for therapeutic decisions.

A lightweight rapid application development framework for biomedical image analysis

Biomedical imaging analysis typically comprises a variety of complex tasks requiring sophisticated algorithms and visualising high dimensional data. The successful integration and deployment of the enabling software to clinical (research) partners, for rigorous evaluation and testing, is a crucial step to facilitate adoption of research innovations within medical settings. In this paper, we introduce the Simple Medical Imaging Library Interface (SMILI), an object oriented open-source framework with a compact suite of objects geared for rapid biomedical imaging (cross-platform) application development and deployment. SMILI supports the development of both command-line (shell and Python scripting) and graphical applications utilising the same set of processing algorithms. It provides a substantial subset of features when compared to more complex packages, yet it is small enough to ship with clinical applications with limited overhead and has a license suitable for commercial use. After describing where SMILI fits within the existing biomedical imaging software ecosystem, by comparing it to other state-of-the-art offerings, we demonstrate its capabilities in creating a clinical application for manual measurement of cam-type lesions of the femoral head-neck region for the investigation of femoro-acetabular impingement (FAI) from three dimensional (3D) magnetic resonance (MR) images of the hip. This application for the investigation of FAI proved to be convenient for radiological analyses and resulted in high intra (ICC=0.97) and inter-observer (ICC=0.95) reliabilities for measurement of α-angles of the femoral head-neck region. We believe that SMILI is particularly well suited for prototyping biomedical imaging applications requiring user interaction and/or visualisation of 3D mesh, scalar, vector or tensor data.

Cytohistopathological appraisal of unusual locations of epidermoid inclusion cysts

Background: Epidermoid inclusion cysts are common benign lesions of the pilosebaceous origin that encountered anywhere in the body. Most common sites are hairy and non hairy areas mainly scalp, back, neck and trunk. Objective of present study was to highlight and document the cytohistomorphological features of epidermoid inclusion cysts (EIC) at unusual locations of the body in our tertiary care center.Methods: The present study is retrospective, cross sectional study done on cytohistopathological specimen over a period of 30 months from June 2016 to December 2017. A total of 82 cases of EIC were included in the study. All the sites were included in the study that is usual as well as unusual. Sebaceous and dermoid cysts were excluded from the study. Unusual sites of EIC were collected, tabulated and compared with existing literature.Results: The most common affected site of EIC in our study was head, neck and face (42.7%) followed by extremities and axilla (29%), back (11%) and chest/abdomen (8.6%). Peak incidence of EIC was found in 31 to 40 years (34.1%) with male preponderance (1.5:1). The unusual sites encountered were oral cavity and tonsil in head neck region, sole in the extremities, breasts and testis.Conclusions: The study highlights the importance of FNAC in early diagnosis and histopathology for confirmation and treatment purposes in epidermoid inclusion cysts. It provides prompt response to avoid cosmetic and functional disabilities in unusual locations of common lesions like EIC because the differentials may from inflammatory to malignant ones.

Effects of Curcumin on Squamous Cell Carcinoma of Tongue: An In Vitro Study.

The Squamous Cell Carcinoma of the Tongue (TSCC) is the most frequent cancer of oral cavity often characterized by poor prognosis. Conventional therapies are not very efficient and often may cause serious side effects. In this context, introduction of natural substances as possible adjuvant in the treatment and prevention of cancer is becoming a relevant topic. In fact, curcumin has been used for decades in Chinese traditional medicine for its beneficial effects. Curcumin has anticancer properties in many tumors however, its action on the tongue carcinoma is not entirely clear and many other investigations are necessary. Curcumin seems to be a good adjuvant in the treatment of head and neck tumors. However, these studies are generic and there are not many specific studies on TSCC, the most frequent and most aggressive cancer of the head-neck region. Our goal is to demonstrate its effectiveness also for TSCC. In this study, we evaluated the effects of curcumin on TSCC cells using different concentrations (1, 5, 10, 20 and 50 µM) and 3 different treatment times (24, 48 and 72 hours). The inhibition of adhesion, proliferation, viability, migration and apoptosis was studied. IC50 value of curcumin is about 10 µM and there have been inhibitory effects even for treatments at low concentrations. Curcumin reduces migration and progression of TSCC cells and it promotes apoptosis and inhibits tumorigenesis. These results suggest the possible use of curcumin as an anti-cancer agent in TSCC. However, in vivo studies are needed to confirm these effects and overcome its low bioavailability.

MENSTRUAL DÖNEMDE VE ÖNCESİNDE TEMPOROMANDİBULAR EKLEM, BAŞ-BOYUN, YÜZ-KULAK BÖLGESİ AĞRILARININ GÖRÜLME SIKLIĞININ ARAŞTIRILMASI: PİLOT ÇALIŞMA

Amaç: Kadınlarda menstrual dönemde östrojen seviyesinin düşmesine bağlı olarak ağrı hassasiyetinde değişimler olduğu savunulmaktadır. Bu çalışmada menstrual dönemi ve öncesinde temporomandibular eklem (TME), baş-boyun, yüz-kulak ağrılarının görülme sıklığının araştırılması amaçlanmıştır. Gereç ve Yöntem: Menstrual periotları sorunsuz ve düzenli olan kadın bireyler çalışmaya dahil edildi. Hastalar, menstrual dönemde olan ve olmayan olarak iki gruba ayrıldı. Tüm hastalara TME hastalıkları için TMR/ATK (Temporomandibular Rahatsızlık/ Araştırma Teşhis Kriterleri) muayene anket formu uygulandı. Ek olarak TME, yüz-kulak, baş-boyun bölgesinde ağrı varlığı değerlendirildi. Bulgular: Gruplar arasında istatistiksel olarak anlamlı bir farklılık bulunmadı. Tüm hastaların % 50’si tek bölge ağrısı bildirmişlerdir. Hastaların % 23.5’inde TME ağrısı mevcuttur. TME şikayeti bulunan hastaların % 73.5’i menstrual dönemde değildir. Sonuç: Kadınlar menstruasyon döneminde daha çok baş-boyun ağrılarından, menstrual dönem öncesinde TME ağrılarından etkilenmektedirler. Anahtar Kelimeler: Menstruasyon, Tempromandibular eklem, baş boyun, yüz, kulak, ağrı THE INCIDENCE OF PAIN IN THE TEMPOROMANDIBULAR JOINT, HEAD-NECK REGION AND FACE-EAR REGION BEFORE AND DURING MENSTRUAL PERIOD: A PILOT STUDY ABSTRACT Aim: It is defended that pain sensation changes during menstrual period due to decreased estrogen level. The present study aimed to investigate the incidence of pain in the temporomandibular joint (TMJ), head-neck region and face-ear region before and during menstrual period. Materials and Methods: Female subjects with regular and problem-free menstrual period were enrolled in the study. Patients were grouped as the women who were in the menstrual period and the women who were not. All patients completed RDC / TMD (Research Diagnostic Criteria for Temporoman- dibular Disorder) questionnaire form for the symptoms of TMJ disorders. In addition, presence of pain in the TMJ, head-neck region and face-ear region was also assessed. Results: There was no statistically significant difference between the groups. Half of (50%) overall patients reported pain in a single region. TMJ pain was present in 23.5% of the patients. Of the patients having TMJ pain, 73.5% were not in the menstrual period. Conclusion: Women usually suffer from head-neck pain during menstrual period but from TMJ pain before menstrual period. Keywords: Menstruation, temporomandibular joint, head-neck, face, ear, pain.

External Auditory Canal Paraganglioma with Chronic Otitis Media of Ear: A Rare Coexistence.

Paraganglioma is a rare benign tumour accounts for 0.6% of the all the malignancies affecting the head neck region. They originate from the paraganglionic cells from neuroendocrine tissues from skull base to the pelvic floor. Very rarely, temporal bone gets involved by the disease and it is the middle ear and mastoid complex which gets affected by the disease. Isolated involvement of the external auditory canal without the involvement of the tympanomastoid region is very unusual and only 5 cases have been reported in the literature till date. Again, coexisting middle ear disease with the canal paraganglioma is very rare and always being a challenge for thediagnosis due to its atypical presentation and its histopathogical features. Here, we present an atypical case of an external auditory canal paraganglioma, masquerading as complicated chronic otitis media.

Oncology Gold Standard® practical consensus recommendations for the use of monoclonal antibodies in the management of squamous cell carcinoma of head and neck.

We present the 2017 Oncology Gold Standard Practical Consensus Recommendation for use of monoclonal antibodies in the management of advanced squamous cell carcinoma of head neck region.

Proton Therapy for Lymphoma: A Multi-institutional Patterns of Care Study

Patients with Hodgkin (HL) or Non-Hodgkin's Lymphoma (NHL) are at risk of developing radiation-induced toxicities. Multiple dosimetric reports demonstrate normal tissue sparing with the use of proton therapy (PT), especially when targeting mediastinal volumes. To test the hypothesis if this has resulted in increased use of PT in lymphoma patients, we investigated the characteristics of patients with HL or NHL treated with PT within the prospective Proton Collaborative Group (PCG) registry. We reviewed 139 consecutive patients with HL or NHL treated with PT within seven PCG institutions between the years 2010 and 2016. Patients receiving PT alone (without any component of photon therapy) were analyzed. In addition to descriptive analyses, analyses of variance/ANOVA (to compare means) and regression analyses (to compare categorical variables) were used. Disease diagnosis was HL: 83 (60%) and NHL: 56 (40%). Median age was 33.5 years (range, 6.5-90) stratified into age groups of children <19 years: 15%, adolescent and young adults (AYA) 19-39 years: 44% and adults ≥ 40 years: 40% patients, respectively. Majority of the patients were female (53%) and white (66%). Stage grouping was I/II: 60%, III/IV: 14% and relapsed/refractory (R/R): 17%. Bulky disease was reported in 32% of patients. Chemotherapy prior to PT was received in 83% of patients. The median PT dose was 30.6 Gy(RBE) (range, 19-54). The median PT dose in the three age-cohorts (<19, 19-39 and ≥ 40 years) was 21, 30.6 and 36 Gy(RBE), p < 0.001; the three stage groups (I/II, III/IV and R/R) was 30.6, 30 and 36.3 Gy(RBE), p < 0.001 and diagnosis (HL, NHL) was 30.6 and 36 Gy(RBE), p<0.001, respectively. On multivariate regression analysis, older age (p<0.001), NHL diagnosis (p =0.004) and R/R stage (p=0.014) predicted for higher PT dose with no impact of gender and enrollment date. Mediastinum/hilum, either alone (27%) or with nodal head-neck region (28%) were the most common anatomical sites treated followed by nodal head-neck alone (10%). Miscellaneous treated sites included paranasal sinuses/orbit/salivary glands (7%), axilla with or without other sites (7%), Waldeyer’s ring (3%), spine (3%) or others (15%). In parallel to the overall cancer patient numbers treated with PT within the registry, the absolute numbers of lymphoma patients has increased from 2010 to 2016, though the proportion of lymphoma patients stayed relatively constant (range, 1-2.3%). Through review of the prospectively maintained registry data, we demonstrate stable proportional use of PT in lymphoma with predominant use seen in HL, AYA age-group, early-stage disease and PT targeting mediastinum/hilar regions. This analysis provides a benchmark to assess impact of NCCN recommendations which in the year 2015 has emphasized consideration of advanced radiation modalities including PT for patients with lymphomas.

COMPLEX REGIONAL PAIN SYNDROME TYPE II (CAUSALGIA) IN HEAD NECK REGION: A CASE REPORT

Complex regional pain syndrome (CRPS) with localized erythema and hyperthermia of skin can be a perplexing clinical situation and has created varied diagnostic dilemmas for clinicians. Various cases of CRPS in the extremities have been documented, but in the head neck region, it is quite uncommon and only 13 cases have been reported since 1947 and here lies the importance of reporting the case. A 30-year-old female reported to the OPD with complain of severe pain, occasional swelling, change in overlying skin temperature, and color in left lower one-third region of face near mandibular angle since 2½ years. She had a trauma to that region 3 years back. The history and clinical examination revealed that the patient met “Budapest Clinical Criteria” for diagnosis of CRPS Type II and was treated with amitriptyline, pregabalin, methylcobalamine, steroids, and other supportive treatments. The patient showed marked improvement in pain control. Therefore, history and clinical examination and early diagnosis are crucial for the better treatment outcome in CRPS Type II.

The relationship between incompletely excised basal cell carcinoma and recurrence rate

Objective :To define the relationship between margin of clearance at sites of excision and the recurrence rate of basal cell carcinoma in head and neck regionMethods: This study was conducted on 65 patients in Al-Diwanyia teaching hospital who underwent surgery for basal cell carcinoma in the head neck region between 2007 and 2008 and followed up for a period of 3 years .The patients were evaluated according :site and type of Bcc ,whether or not the excision was complete ,tumor recurrence , gender and age of the patients . The size of tumor was less than 2cm in all patientsConclusion: a risk of recurrence in incompletely excised basal cell carcinoma was more common in younger age group patients and we recommend close clinical follow up for other patients .

Does Bony Regrowth Occur After Arthroscopic Femoroplasty in a Group of Young Adolescents?

To evaluate femoral head-neck bone regrowth and PROs in skeletally immature patients that underwent arthroscopic femoroplasties over a minimum 2-year period. Eleven skeletally immature hips (10 patients) with open femoral head physes underwent femoroplasty between October 2008 and November 2013. Inclusion criteria were minimum 2-year follow-up with patient-reported outcomes (PROs) and radiographs preoperatively, at 2weeks, and at a minimum of 2years postoperatively. Exclusion criteria were >16 years of age, preoperative Tönnis grade >1 and previous hip conditions. Preoperative radiographs were used to assess skeletal immaturity, which was indicated by a Risser score ≤4 and femoral head physis >1mm. Alpha angles were measured preoperatively, at 2weeks, and at a minimum of 2years postoperatively. PROs, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) score, were measured preoperatively and at the latest follow-up. Mean age at surgery was 14.7years (range: 13.2-15.9). Mean follow-up was 35.7months (range: 23.3-61.4). All hips tested positive for anterior impingement preoperatively. The mean preoperative alpha angle was 61.8°, which decreased to 41.5° postoperatively (P < .0001) and was 40.7° at a minimum of 2years postoperatively. No bony regrowth was documented at the latest follow-up. Mean improvements in scores were as follows: mHHS= 58.5 to 79.8 (P < .0001), NAHS= 56.8 to 87.1 (P= .008), HOS-SSS= 34.3 to 78.3 (P= .004), and VAS score= 7.5 to 1.3 (P<.0001). Mean patient satisfaction was 8.7 ± 1.7. One hip (9.0%) required revision arthroscopy at 31.1months. No postoperative complications were reported. Bony regrowth of the femoral head-neck region did not occur in this study of skeletally immature females who underwent arthroscopic femoroplasty. In this group of patients, hip arthroscopic treatment of FAI and labral tears is a safe and favorable intervention because of its high patient satisfaction and outcome scores and absence of postoperative complications. Level IV, prognostic study.