Transoral endoscopic resection of low-grade, cricoid chondrosarcoma : endoscopic management of a series of seven patients with low-grade cricoid chondrosarcoma.

BACKGROUND: Low-grade chondrosarcomas account for 1 % of all laryngeal tumors and typically arise in the cricoid cartilage. They are usually indolent, slow-growing cancers that are locally invasive and rarely metastasize. Surgical excision is considered the treatment of choice. Radiotherapy and chemotherapy generally are ineffective. Surgical management must balance tumor clearance with preservation of laryngeal functions (swallowing, voice, and respiration). METHODS: Prospective outcome analysis of seven patients operated with endoscopic resection for low grade cricoid chondrosarcomas. RESULTS: Mean age at presentation was 61 years (range 49-75), male:female ratio was 4:3. All patients are currently alive and free of disease with an average follow-up of 80 months (range 63-138). Overall 5-year survival is 100 %, 5-year disease-free survival rate 85.7 %, and overall recurrence rates 14.3 %. One of the seven patients developed a limited recurrence at 21 months and underwent a second endoscopic resection. During initial management two patients needed temporary tracheotomy. Successful decannulation and normal breathing were obtained within 3 months with no long-term sequelae. The airway calibre of the remaining patients was minimally affected. All patients have normal postoperative swallowing function and adequate voice that is unassisted by amplification. CONCLUSIONS: These findings support the use of endoscopic resection for managing selected newly diagnosed cases of cricoid chondrosarcoma as well as the role of repeated endoscopic resection for managing cases of recurrent cricoid chondrosarcoma.

Mini-invasive lateral oropharyngectomy for T3-T4a oropharyngeal cancer.

Mandibular swing is the approach of choice for resection of advanced oropharyngeal carcinomas without bone involvement. This approach requires a mandibulotomy, which is associated with complications. A prospective outcome analysis was performed for 21 patients operated without mandibulotomy for T3-T4a oropharyngeal carcinoma. Tumour size was categorized as T3 in 14 patients (66.7 %) and as T4a (33.3 %) in 7 patients. Twelve patients were N0 (57.1 %), 2 (9.5 %) were N1, and 7 (33.3 %) were N2. Surgical margins were negative in 18 cases (85.7 %), positive in 1 (4.8 %), and close in 2 (9.5 %). Average hospital stay was 14.5 days (range 10-22). Adjuvant treatment (radiotherapy or concurrent chemoradiotherapy) was administered to all but three patients previously irradiated. In all cases radiotherapy started within 42 days of surgery. The 3-year overall survival was 85.7 %, and relapse-free survival was 71.4 %. Oropharyngectomy without mandibulotomy has the same indications as mandibular swing. It provides good access to achieve satisfactory clearance of tumours, sparing patients the morbidity associated with mandibulotomy.

Effect of surgical technique on electrode impedance after cochlear implantation.

OBJECTIVES: We compare the evolution of electrode impedance values (IVs) following either conventional cochlear implantation or implantation by the soft surgery (SS) technique. METHODS: We performed a retrospective chart review of 20 consecutive adult patients who underwent implantation with the Nucleus CA 24 device between 2004 and 2007. Five patients with preoperative residual hearing at the frequencies 256, 512, and 1,024 Hz underwent implantation by an SS cochlear implantation technique (SS group), and the 15 other patients underwent a conventional implantation technique (conventional cochleostomy [CC] group). The active electrodes were classified as distal (17 to 22), middle (10 to 16), or proximal (3 to 9) according to their position in relation to the tip of the electrode array. Their IVs were collected at 1, 3, 12, 24, and 36 months after implantation. Changes in auditory thresholds at 3 and 24 months were reported for patients in the SS group. RESULTS: The postoperative IVs of both the CC and SS groups decreased significantly between 1 and 3 months after implantation (p < 0.05) and then remained stable. The IVs after 12 months were significantly lower (p < 0.05) in the SS group than in the CC group. CONCLUSIONS: Patients who underwent the SS technique displayed lower long-term electrode IVs than did their counterparts in the CC group. If electrode IVs are indeed an indirect representation of cochlear fibrosis, the use of the SS technique in lieu of the CC technique could reduce fibrotic development.

Recurrent pleomorphic adenoma: results of surgical treatment.

BACKGROUND: Recurrent parotid pleomorphic adenoma surgery increases the risk of facial nerve injury, and there is also a risk of ulterior recurrence. METHODS: Postoperative results from 62 consecutive patients operated for recurrent pleomorphic adenoma were analyzed. It was the first recurrence for 49 patients (79%), the second or more for 13 patients (21%). RESULTS: Total parotidectomy was performed in 69.4% of cases. Skin resection was performed in 47 patients (75.8%). Resection of a facial nerve branch was performed in seven patients (11.3%). Pathologic examination findings revealed carcinoma ex pleomorphic adenoma in 10/62 cases (16.1%) and microscopic multinodular disease in 39 patients (62.9%). Nine patients had preoperative facial palsy, 95% had postoperative facial paralysis ≥ grade II (House-Brackmann scale), and 11.3% still had ≥ grade III facial palsy after 1 year. Six patients developed another recurrence after our intervention (9.68%). Moreover, carcinoma was discovered after a new intervention in 40% of these patients. Initial partial parotid surgery [hazard ratio (HR) = 8.477, P = 0.008], microscopic multinodular recurrent disease (HR = 11.717, P = 0.005), and ≥ 1 recurrence number (HR = 10.608, P = 0.01) were associated with increased risk of ulterior recurrence. CONCLUSION: Surgery is recommended in pleomorphic adenoma recurrence because of the high rate of carcinoma ex pleomorphic adenoma (16.1%). Nevertheless, a definitive facial paralysis ≥ grade III rate of 11.3% is reported after multiple nerve dissection. New recurrence after surgery is less frequent if the initial treatment for pleomorphic adenoma is total parotidectomy.

Laryngeal dedifferentiated liposarcoma.

BACKGROUND: Soft tissue liposarcomas are quite common in the adult population, whereas liposarcoma of the larynx is exceedingly rare. METHODS: We describe an exceptional case of liposarcoma of the posterior aspect of the left arytenoid in a 62-year-old woman who was treated with two endoscopic excisions and adjuvant radiotherapy (RT). This is the 32nd case of laryngeal liposarcoma reported in the English literature. RESULTS: After a 20 months follow-up, no local, regional recurrences or distant metastases were detected, and no functional complications are described for the patient. CONCLUSION: This case report highlights that endoscopic surgical treatment enables excellent organ and functional preservation. However, recurrence of laryngeal liposarcoma is the principal risk, so extended follow-up is essential. RT has no defined role in treatment but can be discussed, especially considering the surgical margins and recurrence status.