Introduction

Pleomorphic adenomas are the most common benign parotid tumours in all populations. Management always consists of a curative superficial parotidectomy. However, rare cases described, in which these histological benign tumors metastasize to distant sites. We present an example of a recurrent parotid pleomorphic adenoma with a contralateral supraclavicular lymph node metastasis after several surgical interventions.

Case report

In this case, we reported reported a case of 29-years male with extensive metastasis in submandibular, submental and also very rarely seen contralateral supraclavicular lymph node metastasis. Parotidectomy with preservation of facial nerve and radiotherapy was given to the patient since the lesions were very aggressive.

Conclusion

The patient had several surgical interventions, so it is essential to do meticulous resection in the first surgery to prevent local recurrence and distant metastasis.

Keywords

Pleomorphic adenoma; Metastasizing pleomorphic adenoma; Salivary gland benign neoplasia.

Objectives
Cardiovascular surgery is increasingly performed in children for congenital malformations of the heart and great vessels. Observed as vocal fold immobility, recurrent laryngeal nerve injury is a well-described complication. As overall outcomes improve and patients live longer, the sequelae of vocal fold immobility amplify insignificance. Families are often unaware of the longterm issues related to vocal fold immobility especially with regard to need for alternative alimentation routes. We report on the incidence of use of feeding tubes, the timing of vocal fold function return and need for additional aerodigestive interventions.
Methods
We reviewed 65 patients <2-years who underwent cardiovascular surgery at a tertiary center from 2008-2013 and were diagnosed post-operatively with vocal fold immobility by fiberoptic examination. Results Patent ductus arteriosus and hypoplastic left heart syndrome were the most common of the cardiovascular anomalies included. The majority (92%) had unilateral left immobility. Recovery of motion was observed in 29% ranging from 1-month to 3-years. Hypoplastic left heart syndrome had a significant negative correlation with recovery. Forty-six percent required gastrostomy tube placement either to supplement their oral intake or to completely meet their nutritional needs. Forty-eight percent required subsequent aerodigestive surgery including direct laryngoscopy/bronchoscopy (22%), tracheostomy (8%) and vocal fold injection (5%). Conclusion Counseling of families and primary care providers regarding the impact of pediatric vocal fold immobility after cardiac surgery should include the high potential requirement for supplemental alimentation as well as the need for feeding and speech therapy. Longitudinal otolaryngology and speech pathology care is imperative with vocal fold immobility since the majority of these patients do not experience functional recovery and may require further interventions over time. Keywords Vocal cord paralysis; Pediatric cardiovascular surgery; Pediatric aerodigestive disorders; Voice; Swallow; Gastrostomy.

The coexistence of a head and neck cancer and a lymph node tuberculosis is rarely described. The problem is essentially diagnostic. We report the case of a patient with cervical lymphadenopathy and non suspect swelliing of nasopharynx. Histopathological study of lymph node reveled an association of a tubercular adenitis and a metastasis of a squamous cell carcinoma.

Objective
To evaluate the effectiveness of medial flap inferior turbinoplasty for the treatment of nasal obstruction in children.

Patients and Methods
This study was conducted at the ear nose throat (ENT) Department at Minia University Hospital, Minia, Egypt which include 40 children with bilateral nasal obstruction due to bilateral hypertrophied inferior turbinates that did not respond to medical treatment for 3 successive months in the form of (systemic antihistamines, systemic and local decongestant drugs and local corticosteroid spray) who attended the ENT outpatient clinic. All patients were subjected to turbinate reduction through medial flap inferior turbinoplasty.

Results
Forty patients with bilateral hypertrophied inferior turbinates were assessed. Ninety days after surgery, 90% of patients transformed from severe or moderate degrees of nasal obstruction “pre-operatively” to mild degree or completely with no nasal obstruction; 80% of patients had grade I improvement in nasal obstruction and 14 patients had only grade II improvement; only
10% of patients had crustation.

Conclusion
Medial flap inferior turbinoplasty is safe and effective in the treatment of nasal obstruction in children with almost no complications was recorded.

Keywords
Inferior turbinate hypertrophy; Inferior turbinoplasty; Nasal obstruction; Children.