Lobular Capillary Hemangioma of the External Jugular Vein: A Rare Case Report.

INTRODUCTION: Hemangiomas are benign tumors that are very common in the head and neck region. However, intravascular hemangiomas are very rare. Hemangiomas are classified as capillary, cavernous or mixed tumors according to the proliferating cells. Ultrasound, computed tomography, MR imaging and angiography are useful diagnostic tools and are generally required when planning surgical treatment. Definitive diagnosis is established by histopathological examination, differentiating hemangiomas from other vascular tumors or malignancies. CASE REPORT: We present a rare case of capillary hemangioma protruding from the external jugular vein. In our patient, the tumor was totally removed under local anesthesia. No complications and no recurrence were observed in the following two years. CONCLUSION: Intravascular tumors can present as neck masses and a definitive diagnosis is made by histopathological examination. Imaging tools provide important information about anatomy, the extent of the tumor, and for surgical planning.

Salvage total laryngectomy: is a flap necessary? / Laringectomia total de resgate: o uso de retalho é necessário?

Abstract Introduction: Pharyngocutaneous fistula is the most significant complication after salvage total laryngectomy in patients who have received previous treatment with radiotherapy with or without chemotherapy. Objective: Our purpose is to review the fistula rate in radiated patients undergoing salvage total laryngectomy, to determine if the use of pectoralis major flap interposition reduces the incidence and duration of fistula and to examine other risk factors. Methods: We made a retrospective review of patients undergoing salvage total laryngectomy for exclusively larynx cancer after failure of primary curative radiotherapy between 2000 and 2017. General data from patients, risk factors and other complications were analyzed. Results: We identified 27 patients whose mean age was 66.4 years, mainly male (92.5%). The primary closure group without pectoralis major flap included 14 patients, and the group with pectoralis major flap closure included 13 patients. Pharyngocutaneous fistula was present in 15 patients (55.5%). Global pharyngocutaneous fistula rate was higher in the group of patients without pectoralis major flap comparing with those were the flap was interposed (78.6% versus 30.8%, p = 0.047). Also the pharyngocutaneous fistulas which need to be repaired with surgery (64.3% versus 7.7%, p = 0.03) and large pharyngostomes (64.3% versus 0%, p = 0.0004) were present in a higher rate in the group closed primary without pectoralis major flap. We did not find other risk factors with statistical significance. Oral diet initiation (84 days versus 21.5 days, p = 0.039) and the duration of hospitalization (98.3 days versus 27.2 days, p = 0.0041) were much lower in patients with a preventive pectoralis major flap. Two patients died as a consequence of complications of large pharyngostomes. Conclusions: Prophylactic pectoralis major flap reduced the incidence, severity and duration of fistula and should be considered during salvage total laryngectomy.

Resumo Introdução: A fístula faringocutânea é a complicação mais significativa após laringectomia total de resgate em pacientes que receberam tratamento prévio com radioterapia com ou sem quimioterapia. Objetivo: Revisar a taxa de fístula em pacientes irradiados submetidos a laringectomia total de resgate, para determinar se o uso de interposição de retalho do peitoral maior reduz a incidência e a duração da fístula e examinar outros fatores de risco. Método: Fizemos uma revisão retrospectiva de pacientes submetidos à laringectomia total de resgate para câncer exclusivamente laríngeo após falha da radioterapia curativa primária entre 2000 e 2017. Dados gerais dos pacientes, fatores de risco e outras complicações foram analisados. Resultados: Foram identificados 27 pacientes com média de 66,4 anos, principalmente do sexo masculino (92,5%). O grupo de fechamento primário sem retalho de peitoral maior incluiu 14 pacientes e o grupo de fechamento com retalho de peitoral maior incluiu 13 pacientes. Fístula faringocutânea esteve presente em 15 pacientes (55,5%). A taxa global de fístula faringocutânea foi maior no grupo de pacientes sem retalho de peitoral maior em comparação com aqueles que receberam o retalho (78,6% vs. 30,8%, p = 0,047). Além disso, as fístulas faringocutâneas que precisaram ser reparadas através de cirurgia (64,3% vs. 7,7%, p = 0,03) e grandes faringostomias (64,3% vs. 0%, p = 0,0004) apresentaram uma taxa mais alta no grupo fechado primariamente sem retalho do peitoral maior. Não encontramos outros fatores de risco com significância estatística. O início da dieta oral (84 dias vs. 21,5 dias, p = 0,039) e a duração da internação (98,3 dias vs. 27,2 dias, p = 0,0041) foram muito menores nos pacientes com uso preventivo do retalho do peitoral maior. Dois pacientes morreram em consequência de complicações de grandes faringostomias. Conclusões: O uso profilático do retalho do peitoral maior reduziu a incidência, a gravidade e a duração da fístula e deve ser considerado durante a laringectomia total de resgate.

Giant Thyroid Fibrosarcoma- A Case Report.

INTRODUCTION: Thyroid gland fibrosarcomas are extremely rare tumors, and only very few cases have been described in the literature. There are no set recommendations along with follow-ups regarding the treatment of these tumors. Moreover, the prognosis is poor with a very short life expectancy. CASE REPORT: We present an 81-year-old patient who was suffering from increasing dysphagia and dysphonia related to a painless giant cervical mass, which presented with progressive growth for the preceding months. After a core needle biopsy with a suspicion of a solitary fibrous tumor, total excision of the tumor was successfully performed, and the pathology examination revealed a fibrosarcoma. Following surgery, radiotherapy was decided in the oncological multidisciplinary meeting; however, the patient refused it. There were neither new clinical symptoms nor tumor recurrence after an 18-month follow-up. CONCLUSION: Although it is a very rare tumor, primary fibrosarcoma of the thyroid gland should be kept in mind in the differential diagnosis of neck tumors.

Salvage total laryngectomy: is a flap necessary?

INTRODUCTION: Pharyngocutaneous fistula is the most significant complication after salvage total laryngectomy in patients who have received previous treatment with radiotherapy with or without chemotherapy. OBJECTIVE: Our purpose is to review the fistula rate in radiated patients undergoing salvage total laryngectomy, to determine if the use of pectoralis major flap interposition reduces the incidence and duration of fistula and to examine other risk factors. METHODS: We made a retrospective review of patients undergoing salvage total laryngectomy for exclusively larynx cancer after failure of primary curative radiotherapy between 2000 and 2017. General data from patients, risk factors and other complications were analyzed. RESULTS: We identified 27 patients whose mean age was 66.4 years, mainly male (92.5%). The primary closure group without pectoralis major flap included 14 patients, and the group with pectoralis major flap closure included 13 patients. Pharyngocutaneous fistula was present in 15 patients (55.5%). Global pharyngocutaneous fistula rate was higher in the group of patients without pectoralis major flap comparing with those were the flap was interposed (78.6% versus 30.8%, p=0.047). Also the pharyngocutaneous fistulas which need to be repaired with surgery (64.3% versus 7.7%, p=0.03) and large pharyngostomes (64.3% versus 0%, p=0.0004) were present in a higher rate in the group closed primary without pectoralis major flap. We did not find other risk factors with statistical significance. Oral diet initiation (84 days versus 21.5 days, p=0.039) and the duration of hospitalization (98.3 days versus 27.2 days, p=0.0041) were much lower in patients with a preventive pectoralis major flap. Two patients died as a consequence of complications of large pharyngostomes. CONCLUSIONS: Prophylactic pectoralis major flap reduced the incidence, severity and duration of fistula and should be considered during salvage total laryngectomy.

The Human Laryngeal Innervation Revisited-The Role of the Neural Connections.

In spite that vascular inconvenients or immunological rejections have been solved in relation with larynx transplant, a successful functional reinnervation has not been achieved. Some studies have suggested that laryngeal nerve connection may contain motor fibers, which could explain unexpected evoked responses in electromyographic studies or the different positions adopted of the vocal folds after similar nerve lesions. Ten patients with unexpected evoked responses after laryngeal nerve stimulation were selected. All the patients underwent a total laryngectomy due to oncological causes. In every case, laryngeal nerve connections were observed. All of them were morphologic and histologic processed for choline-acetyltransferase immunohistochemistry. The presence of motor axons in the nerve connections has been demonstrated, which would explain that the motor innervation to the laryngeal muscles could be dual through these variable connections. This also would justify the difficulty of carrying out laryngeal nerve reinnervation procedures. Anat Rec, 302:646-651, 2019. © 2018 Wiley Periodicals, Inc.

Head and neck paragangliomas: Experience in 126 patients with 162 tumours.

INTRODUCTION: Head and neck paragangliomas are rare tumours of a neuroendocrine nature. The aim of this study was to show our experience in the management of these kind of tumours. METHODS: This was a retrospective study of head and neck paragangliomas diagnosed between 1978 and 2014. A total of 126 patients with 162 tumours were analysed. The paragangliomas included 88 jugulotympanic tumours, 53 carotid tumours and 21 vagal paragangliomas. RESULTS: Mean age at diagnosis was 53.1 years; 87 patients were female (69.1%) and 39, male (30.9%). Multifocality was present in 24 patients (19.1%). Germline mutations were found in 20 patients analysed; SDHD and SDHB were the most frequent. Surgery was performed on 72 isolated paragangliomas: these were 9 carotid, 21 tympanic, 37 jugular and 5 vagal paragangliomas. There were 25 isolated tumours that were observed periodically: 7 carotid, 3 tympanic, 9 jugular and 6 vagal paragangliomas; 5 jugular tumours were irradiated. Multifocal paragangliomas were individually treated, with a total of 26 surgical procedures and 36 tumours resected, 9 irradiated and 12 tumours periodically observed. Postoperative cranial nerve deficits in isolated carotid paragangliomas were lower (15%) compared with jugular tumours (45.5%, P=.04). Nerve deficit was found more frequently in tumours with intradural extension (100%) than in extradural tumours (37.5%, P=.007). CONCLUSIONS: Management of head and neck paragangliomas include surgery, radiotherapy and wait and scan policies. A combination of all of them is usually needed in patients with multifocal paragangliomas.

Functional role of human laryngeal nerve connections.

OBJECTIVES/HYPOTHESIS: Current knowledge of the functional role of human laryngeal nerves is based on traditional laryngeal neuroanatomic descriptions or contradictory electromyographic studies. The aim of this study was to clarify the functional role of neural connections between laryngeal nerves by correlating the different electromyographic patterns observed after laryngeal stimulation and the existence of different neural connections. STUDY DESIGN: Descriptive. METHODS: Electromyographic and morphologic study in 13 patients during total laryngectomy procedure. RESULTS: Seven patients showed an additional evoked response from the cricothyroid muscle after recurrent laryngeal nerve stimulation. External laryngeal nerve stimulation resulted in additional responses from the posterior cricoarytenoid muscle in three cases and from the arytenoid muscle in one. The presence of a neural connection was confirmed in all patients who showed an unexpected electromyographic response. CONCLUSIONS: The different connections between laryngeal nerves are at least partially of motor nature and play a role in the mobility of vocal folds.