Isolated hypoglossal palsy due to cervical osteophyte.

INTRODUCTION: Isolated hypoglossal nerve palsy is rare, and etiological diagnosis is difficult. We report a case of isolated hypoglossal compression by a cervical osteophyte in the hypoglossal canal exit. CASE STUDY: An 86-year-old woman with history of cervical spondylotic myelopathy consulted for a lesion of the free edge of the tongue with impaired elocution. Clinical examination found a bite lesion on the right free edge of the tongue with right lingual amyotrophy and associated left deviation on retraction. Isolated right hypoglossal palsy was diagnosed. Skull base CT found a cervical osteophyte compressing the hypoglossal nerve at the exit from the right hypoglossal canal. Surgery was contra-indicated by the patient's general health status. No motor recovery was observed at 6 months' follow-up, but the elocution disorders regressed under speech therapy. CONCLUSION: Hypoglossal palsy is infrequent, but generally a sign of skull base pathology. History-taking and careful examination guide rational selection of the radiological examinations required for etiological diagnosis.

Transoral robotic surgery for head and neck cancer: a series of 17 cases.

OBJECTIVES: Transoral robotic surgery (TORS) is an innovative surgical technique indicated for resection of selected head and neck cancers. The authors report their experience and discuss the indications, advantages and disadvantages of this technique. MATERIALS AND METHODS: Seventeen patients were operated by TORS in the Limoges University Hospital ENT department between March 2010 and January 2011. RESULTS: Tumour sites were the aryepiglottic fold (n=3), piriform sinus (n=2), lateral pharyngeal wall (n=3), posterior pharyngeal wall (n=2), base of tongue (n=3), vallecula (n=1), epiglottis (n=2) and arytenoid (n=2). One patient had two primary sites treated by TORS. This series comprised two stage I (11.7%), seven stage II (41.2%), six stage III (35.4%) and two stage IVa tumours (11.7%). Mean TORS set-up and operating times were 20.5 and 39.7 minutes, respectively. No major intraoperative complication was observed. One patient was reoperated on D5 for bleeding. Fifteen patients had clear surgical margins. Swallowing was restored on D2 for nine patients. The mean length of hospital stay was 10 days. Seven patients received adjuvant radiotherapy, seven patients were treated by chemoradiotherapy and three patients were submitted to simple clinical surveillance. CONCLUSION: TORS appears to provide new treatment options for head and neck cancers by extending the indications for endoscopic resection for selected cases of head and neck cancers. It allows effective cancer resection under excellent operating conditions with low morbidity and improved functional recovery. This new treatment modality needs to be evaluated in relation to other open surgery, endoscopic laser and chemoradiotherapy techniques.