Purpose
Branchial cleft anomalies (BCAs) are developmental malformations of the head and neck region. Their histogenesis has been the subject of controversy and is not fully understood. This study ...aimed to test all present developmental theories (“branchial apparatus,” “precervical sinus,” “thymopharyngeal,” and “inclusion” theories) on a sample of 48 BCAs from a single institution.
Methods
We performed a retrospective analysis of clinical–epidemiological and anatomical–pathological characteristics of BCAs treated over a 12-year period in our hospital.
Results
Overall, 46 patients (24 52.17% women and 22 men 47.83%) underwent surgical excision of 48 BCAs. The mean patient age at presentation was 31.65 ± 19.40 years. Branchial cleft cysts were found in 42 (87.50%) cases, and branchial cleft sinuses were found in six (12.50%) cases. Eight (16.67%) BCAs were distributed in the preauricular region, 34 (70.83%) at the anterior border of the sternocleidomastoid muscle (SCM), three (6.25%) at the posterior border of the SCM, two (4.17%) in the suprasternal notch, and one (2.08%) in the retrosternal space. Histopathologically, 39 (81.25%) BCAs had a lymphoepithelial structure and nine (18.75%) BCAs had solitary epithelial cells. Inflammation and infection were observed in 24 (50%) and 12 (25%) cases, respectively.
Conclusion
None of the hypothesized developmental theories fully explain the embryonic origin of BCA in our study sample. A possible explanation of BCA histogenesis is through the hybrid “branchial inclusion” theory.
Histogenesis, nomenclature, and classification of branchial cleft anomalies (BCAs) have been subjects of controversy for decades. The purpose of this study was to investigate the accuracy of current ...developmental theories (congenital, lymph node, and hybrid branchial inclusion theories) in defining the anatomic and histopathological characteristics of BCAs.
Ninety consecutive patients with BCAs who underwent surgical excision were enrolled in this 2-center retrospective cohort study.
The present study included 90 patients: 46 (51.11%) women and 44 (48.89%) men (P > .05). The mean age at presentation was 31.89±17.31 years. Altogether, 92 BCAs were identified within the study population including 49 (53.26%) on the left side and 43 (46.74%) on the right side (P > .05). The BCAs included 79 (85.87%) branchial cleft cysts, 11 (11.96%) branchial cleft sinuses, and 2 (2.17%) branchial cleft fistulae. Three (3.26%) BCAs were distributed in the head regions, 88 (95.65%) in the neck regions, and 1 (1.09%) in the thoracic cavity. Following surgery, lymphoepithelial tissue was detected in the histopathological examination in 83 (90.22%) BCAs. The hybrid branchial inclusion theory exhibited significantly higher accuracy in defining patho-anatomic characteristics of BCAs than the branchial apparatus, precervical sinus, thymopharyngeal, and inclusion theories (90.22, 9.78, 2.17, 0.00, and 0.00%; respectively) (P < .05).
The novel branchial node (BN) classification system based on the hybrid branchial inclusion theory appears to be superior to other classification systems in determining the patho-anatomy of BCAs.
Uvod: Tireoglosalne ciste pripadaju najčešćim kongenitalnim malformacijama vrata. Nastaju zbog nepotpuna sraštavanja tireoglosalnog kanala. Predočavaju se kao otekline u središnjem dijelu vrata od ...korijena jezika do prsne kosti. Najčešće se dijagnosticiraju u mlađoj životnoj dobi. Lokalizirane su najčešće oko jezične kosti, a većina ih je smještena infrahioidno (65-80 %). Prikaz bolesnice: Žena, u dobi od pedeset šest godina javila se u hitnu otorinolaringološku ambulantu radi bolnosti desne strane vrata posljednjih dvanaest dana. Liječnik obiteljske medicine ordinirao je antibiotik kroz sedam dana, bol je regredirala, da bi se ponovno javila nakon nekoliko dana, te je ordiniran drugi antibiotik uz koji su tegobe perzistirale. Žalila se na oteklinu submentalno i bolno gutanje. U kliničkom statusu uočena je suprahioidna bolna oteklina, veličine 3 cm, uz bolno otvaranje usta. Učinjena je višeslojna kompjuterizirana tomografija vrata kojom je prikazana cistična tvorba iznad milohioidnog mišića. Upalni parametri su bili povišeni. Bili su prisutni i znaci okolnog celulitisa subkutanog tkiva submandibularne regije. Bolesnica je hospitalizirana, te je ordinirana parenteralna antibiotska terapija, na što je došlo do pada upalnih parametara i poboljšanja općeg stanja, te je peti dan hospitalizacije operirana. U općoj anesteziji učinjena je ekstirpacija medijalne suprahioidne ciste postupkom po Sistrunku. Bolesnica je nakon dva dana otpuštena na kućno liječenje uz peroralnu terapiju klindamicinom. Patohistološki nalaz upućivao je na upalno promijenjenu tireoglosalnu cistu. Na redovnim kontrolama otorinolaringologa, tri mjeseca nakon operacijskog zahvata, nije bilo znakova recidiva bolesti. Zaključak: Tireoglosalna cista dna usne šupljine je rijetka, osobito kod odrasle osobe u dobi od pedestšest godina. Potrebno je učiniti temeljiti klinički pregled, te diferencijalno dijagnostički razmišljati o tireoglosalnoj cisti kod bolesnika s oteklinom u području dna usne šupljine, a dijagnozu je potrebno potkrijepiti odgovarajućim dijagnostičkim metodama. Liječenje je kirurško uz empirijsku antimikrobnu terapiju. Pojava recidiva je rijetkost ukoliko je operacijski postupak proveden prema pravilima struke.
Introduction: Thyroglossal cysts (TC) are most common congential neck malformations. They areresulting after incomplete thyroglossal duct obliteration. A TC presents as a neck swelling in medial linewhich connects the base of the tongue to the thyroid gland. They are most often diagnosed at childhood andare usually located around hyoid bone, mostly in the infrahyoid region (65-80 %).Case report: A fifty-six-years-old woman comes to the emergency ear nose and throat clinic because ofpain on the right side of the neck for the past twelve days. According to the family physician, an antibioticwas prescribed for seven days, the pain regressed and reapppeared after a few days, azythromycin wasprescribed, with which the complaints persisted. She had submental swelling and painful swallowing.Clinical examination found painful suprahyoid swelling, about 3 cm in size, with painful opening of the mouth. An MSCT of the neck was performed which showed a cystic formation located above the mylohyoidmuscle, in the medial line, with intense peripheral imbibition, measuring 3.3 × 1.5 cm. The formationoccupies the area of the middle and posterior third of the floor of the oral cavity and reached the hyoid boneat the back. Inflammatory parameters were elevated. There are also signs of surrounding cellulitis of thesubcutaneus tissue of the submandibular region. The patient was hospitalized with parenteral antibiotictherapy, after the decrease in inflammatory parameters and improvement of the general condition, she wasoperated on the fifth day of hospitalization. Extirpation of the medial suprahyoid cyst according toSistrunk's procedure was performed under general anesthesia. After two days, the patient was dischargedto home treatment with oral climycin therapy. The received pathohistological finding indicate aninflammatory TC. There have been no signs of recurrence at postoperatively follow-up.Conclusion: The TC of the floor of the mouth is a rare condition. It is necessary to take a thoroughclinical examination and think about a TC as a differential diagnosis in patients with swelling in the area ofthe floor of the oral cavity, which need to be proven by appropirate diagnostic methods. Treatment issurgical with empiric antimicrobial therapy. Recurrence is rare if the surgical procedure was performedaccording to surgical rules.
Kapilarni hemangiom septuma Perković, Marko; Novaković, Josip; Penezić, Ana
Medica Jadertina,
12/2022, Letnik:
52, Številka:
3
Journal Article, Paper
Recenzirano
Odprti dostop
Hemangiomi su benigni vaskularni tumori koji nastaju proliferacijom kapilarnih endotelnih stanica. Lobularni kapilarni hemangiom je benigna lezija koja potječe iz vaskularnog tkiva kože, sluznice, ...mišića, pa i kosti. Nazalna lokalizacija je rijetka, a za ove lezije karakteristično je da brzo rastu. Mikrotrauma i trudnoća najčešći su etiopatogenetski čimbenici, te se smatra da su ti dobroćudni tumori hormonski inducirani. Hemangiome nosne sluznice treba razlikovati od hemangioma gornje čeljusti i nosnih kostiju kod kojih su simptomi različiti, kao i način liječenja. Najčešći simptomi kod intranazalne lokalizacije su jednostrana nazalna opstrukcija, epistaksa, te rinoreja. Od ekstranazalnih simptoma najčešće su primijećeni i opisani glavobolja te facijalna bol. Ovaj slučaj prikazuje muškarca s unilateralnom opstrukcijom nosa i povremenim krvarenjem, kojem je rinoskopijom uočena lezija u desnom kavumu s polazištem na septumu. Lezija je uspješno odstranjena kirurškim putem, a postoperativna patohistološka analiza ukazala je na kapilarni hemangiom septalne sluznice. Liječenje kapilarnih hemangioma septuma je kirurško odstranjenje tvorbe, a operativni zahvat relativno jednostavan i bezbolan, uz dobar postoperativni oporavak. Iako se smatra da se češće javljaju u trudnica, hemangiomi septuma mogu se javiti i u mlađih muškaraca, te ih je važno relativno brzo odstraniti, kako bi se isključila i maligna bolest kao uzrok unilateralnog krvarenja i nosne opstrukcije.
The markers of cell proliferation (Ki‐67) and apoptosis caspase‐3, TdT‐mediated biotin–dUTP nick‐end labelling (TUNEL) and the expression of syndecan‐1 and heat shock protein 70 (Hsp70) were analyzed ...immunohistochemically in 11 developing human palates, from developmental weeks 6 to 10. During fusion of the primary palate, the proportion of proliferating cells decreased from 42 to 32% and the proportion of apoptotic cells decreased from 11 to 7% in the medial‐edge epithelium. At later stages, the proportions of both types of cells decreased in the ectomesenchyme, except for proliferating cells in its non‐condensing part. At developmental weeks 9–10, the epithelial seam in the secondary palate comprised 28% proliferative cells and 5% apoptotic cells. While condensing ectomesenchyme contained more apoptotic cells than proliferating cells, the opposite was observed for the non‐condensing ectomesenchyme. Co‐expression of syndecan‐1 and Hsp70 was detected in cells budding from the epithelial seam. Our study indicates similar principles for human primary palate and secondary palate fusion, and parallel persistence of proliferation and apoptotic activity. While proliferation enables growth and fusion of different palatal primordia, apoptosis results in the removal of of large numbers epithelial cells at the fusion point. The disintegration of seam remnants seems to be executed through the processes of change in protein content and cell migration, probably leading to cell death as their final outcome.
The aim of this study was to establish the costs structure of medical treatment for the patients with maxillofacial fractures, to perform a treatment cost evaluation, describe the factors which ...considerably influence the costs and discover the ways of achieving financial savings in treated patients. The study group consisted of patients with maxillofacial fractures who were admitted and treated at the Department of Maxillofacial Surgery of the University Hospital Mostar in the period from January 2002 until December 2006. Data for the study were collected from the patients' databases, case histories and data obtained on the basis of individual payments for the treatment that was collected by Finance Department of the University Hospital of Mostar Most patients in this study were men (83%), of average age 34 +/- 19 years. Zygomatic bone fracture was the commonest injury. Open surgical procedure was performed in 84.7% of treated cases. The costs for the open procedure were considerably higher than conservative treatment. Medication cost made up a total of 37.9% and cost of hospital accommodation 27.3% out of total hospital charge. Cost reduction in treated patients with maxillofacial fractures should be achieved through protocols of urgent treatment of maxillofacial trauma patients immediately after sustaining an injury and with earlier discharge of the patients when postoperative complications are not expected.
Highlights • Proper patterning of cell proliferation enables growth of the tooth germ. • Decrease of proliferation correlates with differentiation of tooth cell lineages. • Shift from nuclear to ...cytoplasmic expression of Oct-4 influences cell differentiation. • Primary cilia signalling modulates differentiation of ameloblasts and odontoblasts.
The distribution of the Ki-67, bcl-2 and caspase-3 proteins was immunohistochemically analyzed in the developing human upper jaw (5th–10th gestational weeks).
During this period, proliferative ...activity gradually decreased from higher levels at the earliest stages (50–52%) to lower levels, both in the jaw ectomesenchyme and in the epithelium. The highest expression of bcl-2 protein was found in the epithelium and ectomesenchyme of areas displaying lower rates of cell proliferation. High levels of caspase-3 protein were detected during the earliest stages of jaw development, indicating an important role for apoptosis in morphogenesis of early derivatives of the maxillary prominences. The number of Ki-67, bcl-2 and caspase-3 positive cells changed in a temporally and spatially restricted manner, coincidently with upper jaw differentiation. While apoptosis might control cell number, bcl-2 could act in suppression of apoptosis and enhancement of cell differentiation. A fine balance between cell proliferation (Ki-67), death (caspase-3) and cell survival (bcl-2) characterized early human upper jaw development. A rise in the number of apoptotic cells always temporally coincided with the decrease in number of surviving bcl-2 positive cells within the palatal region. Therefore, the upper jaw development seems to be controlled by the precisely defined expression of genes for proliferation, apoptosis and cell survival.
The aim of this study was to establish the costs structure of medical treatment for the patients with maxillofacial fractures, to perform a treatment cost evaluation, describe the factors which ...considerably influence the costs and discover the ways of achieving financial savings in treated patients. The study group consisted of patients with maxillofacial fractures who were admitted and treated at the Department of Maxillofacial Surgery of the University Hospital Mostar in the period from January 2002 until December 2006. Data for the study were collected from the patients’ databases, case histories and data obtained on the basis of individual payments for the treatment that was collected by Finance Department of the University Hospital of Mostar. Most patients in this study were men (83%), of average age 34±19 years. Zygomatic bone fracture was the commonest injury. Open surgical procedure was performed in 84.7% of treated cases. The costs for the open procedure were considerably higher than conservative treatment. Medication cost made up a total of 37.9% and cost of hospital accommodation 27.3% out of total hospital charge. Cost reduction in treated patients with maxillofacial fractures should be achieved through protocols of urgent treatment of maxillofacial trauma patients immediately after sustaining an injury and with earlier discharge of the patients when postoperative complications are not expected.
The paper presents an adaptation of the microinverter platform from Texas Instruments to incorporate a battery energy storage system (BESS) alongside the development of the BESS system itself. ...Initially designed for unidirectional power flow between PV panels and an electric grid, the platform required modifications to accommodate bidirectional energy transfer for BESS integration. These modifications encompass software adjustments and hardware enhancements, which are all detailed within the paper. The electrical configuration includes selecting and deploying components such as DCDC power converters, microcontrollers, measured signals, and actuating signals to facilitate battery connection to the platform’s DC bus. Furthermore, a supervisory control and data acquisition (SCADA) system is devised for supervisory control and monitoring, with its implementation outlined. Control software tailored for the chosen microcontroller of the DCDC converters is described in terms of structure and functionality. A hardware-in-the-loop (HIL) methodology is employed to validate the proposed modifications and microgrid configuration. Utilizing the real-time simulator OPAL-RT, the paper presents experimental results and their analysis within the considered microgrid environment.
