Carmen Draghici

Carmen Draghici

Multiple Cutaneous Melanomas

Cutaneous melanoma is a malignant tumor that develops from melanocytes found in the basal layer of the epidermis. Even though it is not the most common type of skin cancer, it is the most aggressive one with an increasing incidence worldwide. The risk factors inherited in the appearance of melanoma are sun exposure together with severe sunburns in childhood and adolescence, high number of moles and genetic factors. We present the case of a 66 years old women with numerous skin sunburns in the past years who refer to our clinic for three pigmented skin lesions, with asymmetrical edges, elevated to the cutaneous plane, with a diameter of 2 cm for the largest one and chromatic dysmorphism, located on the posterior thorax. The dermoscopic examination was suggestive for cutaneous melanoma. We performed the surgical excision of all three cutaneous tumors and the histopathologic examination was performed. The diagnosis of all three lesions was of melanoma. A CT examination was made together with sentinel node biopsy. The aim of this paper is to present a rare case of simultaneous three skin melanomas and the treatment alternatives of this patient after clinical and paraclinical investigations.

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Intraoperative Monitoring of the Recurrent Laryngeal Nerve During Thyroidectomy

Following thyroidectomy, the preservation of the recurrent laryngeal nerve is the gold standard. Visual identification of the recurrent laryngeal nerve is mandatory during thyroidectomy. That technique has decreased the rate of permanent palsy during thyroid or parathyroid surgery (1). However, the palsy can occur when using only the visualization of the nerve, even in experienced hands (2).
Intraoperative nerve monitoring is a common technique in ear surgery, used to permanently monitor the facial nerve. This technique can be used in the thyroid surgery as well. Intraoperative neuromonitoring of the recurrent laryngeal nerve represents an adjuvant technique, until the visual identification and functional confirmation of the nerve.

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Transoral Approach of the Parapharyngeal Tumors

Parapharyngeal space has the shape of a reversed pyramid with the base at the cranial surface delimited by temporal and sphenoid bone and and the top pointing to the large horn of the hyoid bone.[1] Styloid diaphragm divides the parapharyngeal space into two regions with different anatomy and constituents: prestyloid space, anterior, conta-ining the deep lobe of the parotid gland, internal maxillary artery, inferior alveolar nerve, lingual, auriculo-temporal, and retrostyloid space, posterior, neurovascular, that contains the internal carotid artery, internal jugular vein, cranial nerves glossopharyngeal, vagus, accessory, hypoglossal and cervical sympathetic chain. [2]
Tumors arising in parapharyngeal space are rare, representing less than 1% of all head and neck malignancies. Any of the structures contained in this space can be a starting point for developing a tumor masses at this level. Most of these tumors are benign, approximately 20% are malignant. [1] The most common tumors of the salivary gland tissue derived from space and are epithelial in nature. Others are likely neurogenic, vascular, lymphatic, etc. [3]

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The Use of NBI in Early Detection and Follow up of the Laryngeal Malignancies

Laryngeal tumors are often discovered in advanced stages because the patients do not pay attention to early symptoms. Sometimes small tumors are difficult to see even if the surgeon performs a fiber optic exam that uses conventional white light. In the last years some technologies started to be used in order to help the surgeon to perform an early detection or to follow up de patient with laryngeal malignancies (1). Early detection of laryngeal neoplasm is one of the most important factors for the success of the treatment. Visualizing abnormal modification at the follow up exam for patient with laryngeal cancer will help the surgeon to initiate the treatment for the recurrence. Some of technologies such as autofluorescence or video contact endoscopy started to be used for early detection of laryngeal malignancies (2,3).

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