Background Central giant cell granulomas are benign tumours of the mandible, presenting in children and young adults. Divided into non- and aggressive subtypes, the aggressive subtype is relatively rare and can occasionally progress rapidly, resulting in significant morbidity. Case presentation We present a case of an aggressive central giant cell granuloma (CGCG) in a six year-old female. The lesion originated in the right mandibular ramus and progressed rapidly to involve the condyle. Diagnosis was made using a combination of imaging and pathology. A timely en bloc resection of the hemi-mandible was performed with placement of a reconstructive titanium plate and condylar prosthesis. Conclusion Our case demonstrates the importance of considering CGCG in the differential diagnosis of rapidly progressive mandibular lesions in the pediatric population. Prompt diagnosis and management can greatly improve long-term outcomes.

BackgroundThyroid cancer rates are on the rise worldwide with over 5000 new cases estimated in Canada in 2012. The American Thyroid Association recommends the use of fine-needle aspiration biopsy (FNA) in the workup of thyroid nodules. Studies show that thyroid FNA accuracy may vary based on interpretation by cytopathologists in academic versus community centres. To date, there has been no literature published addressing the accuracy or utility of preoperative FNA in a Canadian community center. Our goals were to demonstrate the accuracy of thyroid FNA at our centre, and to compare our results to those published in the literature.MethodsMedical records for patients who underwent thyroidectomy performed by two otolaryngologists in Fredericton, NB, between September 2008 and February 2013 were reviewed. 125 patients with 197 FNAs were analyzed. Fisher’s Exact test was used to compare the malignancy rates in each FNA category, and Chi-Square test was used for FNA distribution comparison.ResultsThe distribution of all FNA diagnoses at our centre was as follows: 38 (19%) benign, 100 (51%) inconclusive, 8 (4%) suspicious for malignancy, 2 (1%) malignant, and 49 (25%) unsatisfactory. FNA distribution was significantly different between our centre and comparison centres (Chi-Square p < 0.05). Our malignancy rates within each category using each FNA sample as a data point were 26.3%, 29.0%, 75%, 100% and 12.2% respectively. Comparison to other community studies revealed that we have significantly higher malignancy rates with benign FNAs (Fisher’s exact p = <0.05). Analysis using our most malignant FNA data yielded similar results.ConclusionThyroid FNA accuracy varies between institutions, and this may affect its utility in the workup of a thyroid nodule at some centres. Expert cytopathology opinions may be an asset in interpreting FNA samples in small community centres where volumes are relatively low, however our data do not support this assertion. It is essential that physicians continue to use clinical judgment first and foremost when evaluating thyroid nodules.

No abstract

2c Laryngoscope, 1778-1782, 2018.

BackgroundIn the Canadian health care system, determining overall costs associated with a particular diagnostic subgroup of patients, in this case dizzy patients, is the first step in the process of determining where costs could be saved without compromising patient care. This study is the first Canadian study that evaluates these costs at a tertiary care hospital and will allow for the extrapolation of cost data for other similar academic health science centers, regional health initiatives, and provincial healthcare planning structures.MethodsWe conducted a retrospective cohort study of patients of any age presenting to The Ottawa Hospital (TOH), a tertiary care hospital, between January 1st, 2009 and December 31st, 2014 with a main diagnosis of dizziness or dizziness-related disease.De-identified patient information was acquired through TOH Data Warehouse and included a patient’s sex, age, arrival and departure dates, Elixhauser co-morbidity score, location of presentation (emergency department or admitted inpatient) presenting complaint, final diagnosis code, any procedure codes linked to their care, and the direct and indirect hospital costs linked with any admission.We derived the mean hospital costs and 95% confidence interval for each diagnosis. We obtained the number of patients who were diagnosed with dizziness within Ontario in year 2015–16 from Canadian Institute for Health Information (CIHI). A simple frequency multiplication was performed to estimate the total cost burden for Ontario based on the cost estimate for the same year obtained from TOH. Cost data were presented in 2017 Canadian dollars.ResultsThe average total hospital cost per patient with dizziness for the entire cohort is $450 (SD = $1334), with ED only patients costing $359 (SD = $214). The total estimated hospital cost burden of dizziness in Ontario is $31,202,000 (95% CI $29,559,000 – 32,844,000).ConclusionsThe estimated annual costs of emergency department ambulatory and inpatient dizziness in Ontario was calculated to be approximately 31 million dollars per year. This is the first step in identifying potential areas for cost savings to aid local and provincial policy-makers in allocation of health care spending.