The significance of double mandibular osteotomy for surgical treatment of large aneurysm of internal carotid artery above mandibular angle. A case report and literature review.

The aim of this study is to report a case of an unusual large aneurysm of the internal carotid approached with a doubly mandibular osteotomy in order to prove the significance and the excellent result of the specified surgical procedure because of the cooperation of maxillofacial and vascular surgeons. The double mandibular osteotomy is described, as well as the bypass of the aneurysm and the anastomosis of the peripheral edges of the artery. The double mandibular osteotomy can deliver the internal carotid artery from the bifurcation to its entrance to the skull base through the carotid canal and can offer the opportunity to the vascular surgeon to perform the anastomosis easily, quickly and safely.

Management of a Giant Para-Pharyngeal Space Pleomorphic Adenoma of Deep Lobe of Parotid Gland Without Mandibular Swing Approach in a 17-Year Old Patient: Rare Case Report.

Pleomorphic adenomas comprise of 0.5% of all head and neck tumors. Pleomorphic adenoma affects patients from 4th to 6th decades. 10-12% of Pleomorphic adenomas arise from deep lobe of parotid gland that grow medially and involve the parapharyngeal space. Investigations play a role of paramount importance in treatment of para-pharyngeal tumors. CT scanning aids in evaluating the bone structures and possible calcification of the tumors. MRI provides precise tumor margins and the relationship of the tumor with its adjacent vital structures. The most common approaches to access these masses are the trans-oral, trans-mandibular, transcervical and trans-parotid trans-cervical approaches. Complete surgical excision of the lesion is the treatment of choice for such PPS tumors. The choice of surgical approach should enable the surgeon to maximize exposure for complete resection of the tumor while minimize functional and cosmetic morbidity. The various mandibulotomies are median mandibulotomy, para-symphyseal osteotomy, horizontal osteotomy, inverted 'L' osteotomy and double mandibular osteotomy. We report a rare case of giant pleomorphic adenoma arising from the deep lobe of parotid gland of the parapharyngeal space in a young patient. The excision was done in to without the mandibular swing approach making it one of the rare case reports.

Pull-through resection without free-flap reconstruction for lateral wall oropharyngeal cancer.

BACKGROUND: While transoral robotic surgery (TORS) is widely used for the management of lateral wall oropharyngeal carcinomas (OPC), open surgical techniques are still used in some cases. A pull-through method for open surgical resections of OPC has recently been introduced. We improved on this method by eliminating the need for subsequent free-flap reconstruction. METHODS: 16 patients with lateral wall OPC underwent pull-through resections. After resection, we used the digastric muscle, stylohyoid muscles, submandibular gland and the surrounding tissues to block the neck and oral cavity and to avoid reconstruction. RESULTS: This novel technique was performed without major complications or morbidities. The average post-operative hospital stay was 14.6 ± 6.1 days, and the average duration until initiation of oral intake post-operation was 6.5 ± 2.9 days. Oncological outcomes, post-operative course and function were acceptable. CONCLUSIONS: Our novel method provides an efficient and less invasive surgical technique than conventional open approaches.

True Parapharyngeal Space Tumors: Case Series from a Teaching Oncology Center.

The Parapharyngeal Space (PPS) tumors are rare tumors accounting for 0.5% of the tumors in head and neck region. A retrospective study conducted at Department of Surgical oncology, Vydehi institute of Medical Sciences & Research center, Bengaluru, between 2010 and 2015 identified nine cases treated for PPS tumors. Patients are diagnosed on the basis of clinical examination fine needle aspiration cytology and imaging and considered for excision by one of the varied surgical approaches {transoral(1), transcervical(4), transparotid(0), transcervical-transparotid(1), transmandibular(3) or intratemporal(0) approach}. The choice of approach is defined by the size of the tumor, suspicion of malignancy and the position of the tumor with regard to the superior extent and proximity to the skull base as well as its relation with neurovascular bundle.

A comparison of mandible preservation method and mandibulotomy approach in oral and oropharyngeal cancer: A meta-analysis.

OBJECTIVE: This study aims to compare the prognoses outcomes of mandibular preservation method (MPM) and the mandibulotomy approach (MLA) in oral and oropharyngeal cancer (OOPC) patients. METHOD: We searched PubMed, Web of Science, EMBASE, Chinese BioMedical Literature Database (CBM), Cochrane Library, and clinicaltrials.gov up to September 2016 to identify the studies that compared the prognoses of the MPM versus the MLA in OOPC patients. Two authors individually extracted the data and performed quality assessment. The surgical margins, overall survival rate, total and local recurrence rates, fistula formation, and other functional outcomes were evaluated. RESULT: Six studies with 309 patients were included in our analysis. No significant difference was found regarding the surgical margins, overall survival rate, total and local recurrence rates, and speech and tongue movement between the MPM and MLA groups. However, the MPM group showed a significantly lower fistula formation rate than the MLA group after the operation. CONCLUSION: These findings suggest that the MPM may provide a similar clinical outcome to the MLA, but that the MPM has a lower complication rate in the treatment of OOPC patients.

Giant Parapharyngeal Space Pleomorphic Adenoma of the Deep Lobe of Parotid Presenting as Obstructive Sleep Apnoea: A Case Report & Review of the Diagnostic and Therapeutic Approaches.

INTRODUCTION: Salivary gland tumours constitute about less than 4 % of all head and neck tumours. Pleomorphic adenoma, also called benign mixed tumour, is the most common tumour of the salivary glands. About 80-90 % of these tumours occur in the major salivary gland mainly parotid gland and 10 % of them occur in the minor salivary glands. AIMS AND METHODS: Aim of this case report is to discuss the unique case of giant parotid pleomorphic adenomas arising in the deep lobe involving the parapharyngeal space and difficulty in respiration at sleep during nights repoted at this institute. The patient was undergoing treatment for obstructive sleep apnea syndrome when she reported at this institute for disturbed sleep. Diagnosis was based on computed tomography scan and magnetic resonance imaging and cytology by means of fine needle aspiration biopsy. CONCLUSION: An exhaustive pre-operative diagnostic algorithm is mandatory before approaching such lesions involving parapharyngeal space. Fine needle aspiration biopsy is, in our opinion, mandatory to avoid histological surprises. The surgical approach varies according to the location of the tumour and should provide excellent visibility with wide surgical exposure to secure local neurovascular structures.

Chirurgische Zugangswege zum Mesopharynx.

Because of their localization and their extent, tumours of the deep oral cavity, the oropharynx and the parapharyngeal space are rarely accessible for CO2 laser dissection. Especially malignant tumours of the base of the tongue and the vallecula as well as salivary gland-related tumours of the parapharyngeal space need wide conventional surgical exposure to allow: resection respecting tumor margins (R0); oropharyngeal and tongue reconstruction using local and microvascular grafts; prevention of mass-bleeding caused by infectious destruction of large blood vessels. This article reviews the different surgical approaches to oropharyngeal tumours with special reference to "mandibular swing" procedures. Moreover, different graft techniques are critically assessed.