Case Report

Cavernous Hemangioma Involving the Maxilla: A Case Report

Jahangir Ghorbani, Golfam Mehrparvar

The Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 5 No. 2 (2019), 1 December 2019 , Page 1-3

Background: Intraosseous vascular lesions are rare, they seldom occur in facial skeleton and maxilla is one of the least reported sites of involvement.

Case Presentation: We report a 45-year-old woman with cavernous hemangioma of maxillary bone involving inferior turbinate. It   showed osteolytic expansile nature in imaging. The mass was approached via facial degloving technique. Histologic evaluation revealed vascular lesion in favor of cavernous hemangioma.

Conclusion: Intraosseous vascular anomalies are one of the diagnoses of facial skeletal masses not routinely occurring to the mind especially in adults due to their rarity and various presentations. They can mimic other pathologies with regard to symptoms and imaging characteristics. They also should be differentiated from malignancies, though frequently the definite diagnosis will be uncertain until proven histologically.

Original Article

Background and Aim: The authors present advances in the surgical management of hypopharyngeal tumours in Hungary, specifically at the department of otorhinolaryngology and Head-Neck Surgery, Faculty of Medicine, University of Szeged. Resective and function-preserving surgical interventions performed via open operation are described separately. Indications for external exploration and the endoscopic-microscopic approach are also detailed, and the surgical repertoire used in the management of hypopharyngeal tumours at the department is presented. 

Results: At the department of Otorhinolaryngology, Head, and Neck Surgery, University of Szeged we have experienced a continuous increase in the number of hypopharyngeal tumours since the 1980s. It is not only the increased incidence that we have noted but the tumours are also getting more advanced. When focusing on the surgical management of hypopharyngeal tumours, we aim to achieve radical removal as well as retain certain functions, such as the ability of speech, which is an important aspect of the quality of life. 

Conclusion: Resection of hypopharyngeal tumors with laser increases the risk of recurrence, therefore it is only considered safe in some selected cases. Laryngoscopic assess and the straight line of CO2 laser determines the direction of laser line, which makes it difficult for surgeon to evaluate the involvement of deeper tissues. However, if the indications are closely observed, laser surgery is a potential alternative to surgical intervention in the treatment of small hypopharyngeal tumors.

Determining the Incidence of Complications Following Parotidectomy Surgery Based on Type of Drain

Mahdi Khajavi, Nader Akbari Dilmaghani, Mahbobe Oroei, Ali Hajjari

The Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 5 No. 2 (2019), 1 December 2019 , Page 1-7

Background:Parotidectomy surgery has different complications including facial nerve paralysis, hematoma, seroma, surgical site infection and flap necrosis. The temporary paresis of the facial nerve can occur due to stretching of the facial nerve or its branches in drain usage.


Aim:to investigate incidence of postsurgical complications in parotidectomy using of hemovac and penrose drain.


Methods:This longitudinal follow up study was performed in the patients with parotidectomy. The patients with temporary paresis of facial nerve in the recovery room, 24-48 hours, and one week after the surgery were determined. The data (characteristic variables and complications of parotidectomy) were introduced into SPSS 18 and analyzed. The significance level of statistical tests was considered less than 0.05.


Results:The mean age of patients was 44.40±15.28 years, and the total incidence of temporary paresis of facial nerve was 16.7%. The frequency percentage of temporary facial nerve paresis at three times of measurement was higher in the group with hemovac drain than group with penrose drain, though these differences were not statistically significant (p-value>0.05). The frequency percentage of hematoma was the same in both groups. Further, the incidence of temporary paresis of facial nerve was higher in complete parotidectomy than superficial parotidectomy, which was not statistically significant (p=0.085).


Conclusion:The findings of this study suggest that the temporary paresis of facial nerve may be less in using of penrose drain following parotidectomy. Since the penrose drain is less expensive compared to hemovac drain, thus it seems that penrose drain could be preferred on hemovac drain. In order to achieve more robust evidence in this regard, more studies with larger sample size and longer follow-up period are proposed for the future.

Studying Malnutrition-Related Factors in Patients with Head and Neck Cancer Following Surgery

Leila Vazifeh Mostaan, Sharifeh Haghjoo, Kazem Anvari, Mohammad Safarian, Kamran Khazaeni, Monavar Afzal Aghaei

The Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 5 No. 2 (2019), 1 December 2019 , Page 1-8

Background: Nutritional dysfunction with or without aspiration is a common complication following head and neck cancer (HNC) surgery and patients frequently present with weight loss secondary to dysphagia and malnutrition.

Aim: The aim of this study was to investigate the incidence of weight loss and malnutrition in patients with HNC following surgery through the Malnutrition Universal Screening Tool (MUST) scale.

Methods: A total of 28 patients with a confirmed diagnosis of head and neck cancer mainly of the oral cavity referring for surgery for the first time were enrolled. A researcher-designed questionnaire was used for data collection. Further, a single nutritionist evaluated each patient’s nutritional status before and 6-8 weeks' post-surgery according to MUST to measure the level of malnutrition. Significance level was set at p<0.05.

Results: Among the subjects, 57% were younger than 70 years; 61% were in stage II of cancer while the rest were in stage III. Weight, body mass index (BMI), serum hemoglobin, and albumin levels showed a significant reduction following surgery (p<0.05). Specifically, 18% had less than 5%, 36% had 5-10%, and 46% had >10% weight loss. According to MUST scale, 18% of Patients with HNC had low, 25% had moderate, and 57% had high risk of malnutrition. A significant relationship was found between severe malnutrition and patients older than 70 years of age.

Conclusion: In head and neck cancer patients, weight loss increases the morbidity and mortality, therefore nutritional interventions should be initiated before cancer treatment begins and these interventions need to be ongoing after completion of treatment to ensure optimal outcome.

Review Article

Stapedotomy and Stapedectomy Outcomes as Surgical Approaches in Juvenile Otosclerosis: A Systematic Review

Shahrokh Khoshsirat, Hassan Peyvandi, Zahra Abbasi, Mehdi Khajavi

The Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 5 No. 2 (2019), 1 December 2019 , Page 1-4

Background: Pediatric otosclerosis is characterized by progressive conductive hearing loss with a relatively low incidence, compared to adults. The treatment approaches range from conservative options, such as hearing aids, to surgical managements including stapedectomy and stapedotomy.


Aim: To compare hearing outcomes (air-bone gap<10 dB) after stapedectomy vs. stapedotomy in patients with juvenile otosclerosis.


Methods: We conducted a systematic search in Google scholar, PubMed, and Scopus. Studies reporting the outcomes of stapedectomy and/or stapedotomy and those specifically defining the mixed data from data of each procedure for the patients under the age of 18 years old with juvenile sclerosis were included. On the other hand, post-operative air-bone gap was extracted. There was no time limitation for search of studies.


Results: After evaluating all studies, post-operative air-bone gap below 10dB ranged from 66% to 91% of cases in stapedectomy group and from 66% to 92% in stapedotomy group.


Conclusion:Based on the reviewed studies, we found similar success rates in hearing outcome of the patients with juvenile otosclerosis following stapedotomy and stapedectomy.







Ribbon Synapse Reformation: A Key Role for the Hearing Restoration; A Review

Somayeh Niknazar, Ali Asghar Peyvandi, Hojjat-Allah Abbaszadeh, Shahrokh Khoshsirat

The Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 5 No. 2 (2019), 1 December 2019 , Page 1-6

Background: Auditory sensory epithelium of mammals has two types of mechanosensory cells including the inner hair cells (IHC) and outer hair cells (OHC). IHC in the mammalian inner ear is an important component for the sound perception. Information about the frequency, intensity, and timingof acoustic signals is transmitted rapidly and precisely via ribbon synapses of the IHCs to the type 1 spiral ganglion neurons (SGNs). Even in the absence of stimulation, these synapses drive spontaneous spiking into the afferent neuron. Evidence has shown that cochlear neuropathy leading to hearing loss may be a result of the damage to ribbon synapses


Aim:Here, we review how these synapses promote the rapid neurotransmitter release and sustained signal transmission. We also discuss the mechanisms involved in ribbon synapse reformation for hearing restoration.


Conclusion:Although cochlear ribbon synapses fail to regenerate spontaneously when injured, recent studies have provided evidence for cochlear synaptogenesis that will be relevant to regenerative methods for cochlear neural loss. A better understanding of mechanisms underlying synaptic reformation would be helpful in achieving reversal of sensorineural hearing loss.

Exosome Therapy in Spinal Cord Injury: A Review

Shahrokh Khoshsirat, Aliasghar Keramatinia, Maryam Sadat Khoramgah, Saeed Vafaei-Nezhad, Somayeh Niknazar, Shahram Darabi, Foozhan Tahmasebinia, Hassan Peyvandi, Hojjat-Allah Abbaszadeh

The Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 5 No. 2 (2019), 1 December 2019 , Page 1-8

Background: Injuries to the spinal cord (SCI) are one of the most detrimental central nervous system (CNS) injuries in developing countries. Today, treatment is one of the major issues facing the medical profession, and to date, there is no known promising treatment capable of fully healing injuries. There are various methods to repair and improve SCI, including the use of stem cells particularly mesenchymal stem cells (MSCs). Various studies have been performed on applying these cells in the treatment of SCI, whose results have confirmed the efficacy of using these cells specifically due to the paracrine secretion of these cells including growth factors, chemokines, cytokines, and small extracellular vesicles. Interestingly, among these paracrine molecules, exosomes may have the maximum therapeutic value and as such is widely investigated by researchers.

Aim: to fully focus on the usage of stem cell-derived extracellular vesicles on the healing of SCI in animal models.

Conclusion: Taken together, the extracellular nanovesicles have promising therapeutic potentials and their use in the treatment of SCI has been rapidly growing. In this review, we elucidated the effect of exosomes derived from bone marrow MSCs in SCI.

Cell Therapy and Tissue Engineering in Bone Defect Reconstruction; A Review

Shahrokh Khoshsirat, Maryam Sadat Khoramgah, Aliasghar Keramatinia, Somayeh Niknazar, Shahram Darabi, Foozhan Tahmasebinia, Hassan Peyvandi, Hojjat-Allah Abbaszadeh

The Journal of Otorhinolaryngology and Facial Plastic Surgery, Vol. 5 No. 2 (2019), 1 December 2019 , Page 1-8

Background: Extensive research on bone tissue engineering as a novel therapeutic approach to design and fabricate suitable scaffolds is in progress to overcome the limitations of conventional bone repair techniques. In recent years, tissue engineering and remedial medicine have come up with the strategy of designing, fabricating, and optimizing synthetic and natural scaffolds containing cells and growth factors to facilitate the direct and indirect mechanisms of bone tissue repair in the body. Based on many studies, cellular source, cell medium condition, and biological scaffolds are critical factors in bone defect repair in the field of tissue engineering.

Aim: In this review, we focus on the combination of mesenchymal cells derived from the human adipose tissue, stem cell-to-bone differentiation medium, and biocompatible polyvinyl alcohol-graphene oxide scaffolds in bone lesion repair to gain a better understanding of each factor. This would, in turn, help us design and develop optimal therapeutic approaches for bone repair and regeneration. 

Conclusion: The combination of mesenchymal cells and biocompatible scaffolds proved promising in the process of bone lesion repair.