Safety and outcome of three-dimensional transoral videolaryngoscopic surgery.

BACKGROUND: Transoral videolaryngoscopic surgery (TOVS) is widely used in Japan, and conventional two-dimensional (2D) endoscopic methods have been established. Three-dimensional (3D) endoscopic surgery offers superior distance perception because it provides stereoscopic views. Recently, we have developed 3D endoscopy for TOVS (3D TOVS). METHODS: This study included 46 patients with pharyngeal cancer who underwent 3D TOVS. The perioperative complications and survival curves were retrospectively analyzed. RESULTS: One patient with oropharyngeal cancer who underwent neck dissection and transoral resection simultaneously experienced postoperative hemorrhage of the neck. Another patient with oropharyngeal cancer underwent hemostasis for postoperative pharyngeal hemorrhage. There was one case of aspiration pneumonia. One patient developed cervical lymph node recurrence; however, there was no local recurrence or primary mortality. The 2-year overall survival, disease-specific survival, local control rates, locoregional control rate, and invasive disease-free survival were 90.9%, 100%, 100%, 97.4%, and 79.9%, respectively. CONCLUSIONS: Three-dimensional endoscopy can be safely applied to TOVS.

Multifocal and hormone-dependent epithelioid hemangioendothelioma with osteolysis of the second cervical vertebral body: report of an unprecedented surgical approach by using autologous bone graft.

We report the case of a 28-year-old female patient who complained of extreme neck pain when giving birth to a child. Magnetic resonance imaging (MRI) of the cervical spine demonstrated an osteolytic lesion at the second cervical vertebral body (C2). In this presentation, we highlight a transoral surgical approach in order to prevent instability of this osteolytic lesion. To the best of our knowledge, this is the first time that such a route of access has been described for this tumor entity. A histopathologic examination led to the diagnosis of epithelioid hemangioendothelioma. During a follow-up period of 33 months, the patient had no complaints.

Resección transoral de la apófisis estiloides por síndrome de Eagle: caso clínico / Transoral resection of the stiloyd process for Eagle síndrome: case report

El síndrome de Eagle está caracterizado por una elongación o una curvatura medial excesiva de la apófisis estiloides o por una calcificación del ligamento estilohioideo que puede provocar dolor cervicofacial o síntomas neurológicos por la compresión de los vasos o nervios del cuello. El tratamiento más eficaz es el quirúrgico y consiste en la resección de la apófisis estiloides; puede ser realizado por vía externa o mediante un abordaje transoral. Se describe el caso clínico de un paciente con síndrome de Eagle que fue tratado con éxito mediante un abordaje transoral, sin amigdalectomía y con asistencia de endoscopios. (AU)

Eagle syndrome is characterized by an elongation or excessive medial curvature of the styloid process or calcification of the stylohyoid ligament that can cause cervicofacial pain or neurological symptoms due to compression of the vessels or nerves of the neck. The most effective treatment is surgical and consists of resection of the styloid process, it can be performed by externally or through a transoral approach.The clinical case of a patient with Eagle syndrome who was successfully treated by a transoral approach, without tonsillectomy and with the assistance of endoscopes, is described. (AU)

Neck stiffness after transoral pharyngolaryngeal surgery for squamous cell carcinoma.

INTRODUCTION: Pyogenic spondylodiscitis is a rare, destructive intervertebral disc infection. CASE SUMMARY: We describe a case of C2-C3 pyogenic spondylodiscitis after transoral surgery of the posterior pharyngeal wall in a 64-year-old man with a history of oropharyngeal squamous cell carcinoma (SCC) treated by neck irradiation (45Gy). Ten years after initial treatment, he underwent total laryngectomy for laryngeal SCC, together with transoral resection of carcinoma in situ (CIS) of the posterior pharyngeal wall followed by BioDesign® tissue repair graft. Five months later, C2-C3 spondylodiscitis was diagnosed with the formation of a fistula between the posterior pharyngeal wall and the intervertebral disc. Antibiotic therapy was administered for a total duration of 3 months (multi-susceptible Escherichia coli). Eight months after the diagnosis of spondylodiscitis, the patient died from carotid artery rupture following another course of radiotherapy for lymph node recurrence. DISCUSSION: Larger-scale studies are necessary to evaluate the prevalence and risk factors of radiation-induced spondylodiscitis that currently remain poorly elucidated. The best treatment strategy (choice and duration of antibiotic therapy) and the optimal frequency of follow-up must be determined and the value of preventive measures (biomaterial, flap repair) needs to be evaluated.

Transoral resection with buccinator flap reconstruction vs. pull-through resection and free flap reconstruction for the management of T1/T2 cancer of the tongue and floor of the mouth.

AIM: To compare the most important techniques usually used in these patients. MATERIALS AND METHODS: A multicentric retrospective evaluation on patients treated for cT1/2 N0 OTFOM SCC was conducted; patients in group A were treated by transoral approach and miomucosal local flap while those in group B were treated by pull-through and free flap reconstruction. Oncologic, functional and quality of life evaluation was assessed. RESULTS: 55 patients were enrolled. Group A consisted of 35 patients and group B 20. At the 3-year follow-up 30 and 17 patients in group A and B were alive without disease. Tongue mobility index score was 23.3 in group A and 13.89 in group B (p < .001); Sydney swallowing mean score was 118.5 and 543.22 in group A and B (p < .001). EORTC QLC-C30 was of 33.57 in group A and 38.89 in group B (p = 0.057). CONCLUSION: T1/T2 cancers of the tongue and floor of the mouth can be equally treated with both techniques. Because of the fact that transoral resection with buccinators reconstruction provides better functional outcome, this technique should be preferred whenever appropriate.

Outcomes in modified transoral resection of diverticula for Zenker's diverticulum.

PURPOSE: Transoral resection of Zenker's diverticulum (TORD) was first reported in 2010. We present results for our modified approach to transoral resection (MTORD)-full-thickness cricopharyngeal myectomy, diverticulum sac excision, and suture closure of the pharyngotomy-and evaluate its safety and efficacy compared to endoscopic stapling and open approaches. METHODS: A retrospective study was performed in patients who underwent transoral resection of Zenker's diverticulum using MTORD, endoscopic stapler-assisted diverticulotomy (ESD), or trancervical diverticulectomy (TCD) from July 2009 to August 2017. Pre-operative evaluation included barium swallow and subjective characterization of swallowing dysfunction using the EAT-10 and Reflux Symptom Index (RSI). Complications, length of hospitalization, recurrence, and revision rates were also evaluated. RESULTS: Of 92 patients reviewed, 18 underwent MTORD, 45 underwent ESD and 29 underwent TCD. Major complications were only observed in ESD and TCD. Recurrence which required revision surgery was only observed in ESD. EAT-10 and RSI scores significantly improved and RSI scores normalized post-operatively for all approaches in short-term (< 1 year) follow-up. CONCLUSIONS: MTORD is a safe and effective option for complete Zenker's diverticulectomy. Complication rates are low. To date, no patient has required reoperation, although more cases and longer term follow-up are needed for more complete comparison to ESD and traditional open excision.

A safe transoral surgical approach to parapharyngeal tumor arising from deep lobe of parotid gland.

The management of parapharyngeal tumor is surgical, but the approach remains a challenge. Attention should be paid to avoidance intra-operative bleeding or cranial nerves damage. We report a case of a 67-year-old male complaining of left-ear fullness. A submucosal mass arising from the lateral wall of oropharynx on the left side was observed. Magnetic resonance imaging detected a mass arising from the parotid gland, in particular from the deep lobe, and a fine needle biopsy was compatible with "Warthin tumor." We performed a mini-invasive transoral approach under magnification, previous isolation of homolateral vessels. The decision on which surgical approach to be used is determined by site, size vascularity, and histology of the tumor. A literature review of the main surgical approaches was performed. We performed a combined transoral dissection under magnification with cervicotomic exposure of the neck vascular bundle allowing to dissect the tumor and manage any intra-operative complications.

Robotic approaches to the pharynx: tonsil cancer.

Treatment of squamous cell carcinoma of the oropharynx is challenging because of its effects on speech and swallowing, which may affect quality of life. Transoral robotic surgery may be an effective alternative to open surgery. Robotic lateral oropharyngectomy is best suited for early stage oropharyngeal squamous cell carcinoma, with the goal of avoiding or reducing the use or dose of adjuvant therapies. Successful robotic lateral oropharyngectomy requires appropriate training, detailed preoperative planning, organized operating room setup to obtain exposure, an understanding of the pertinent surgical anatomy, and knowledge of the postoperative care of the oncologic patient.

Transoral en bloc resection of superficial laryngeal and pharyngeal cancers.

BACKGROUND: The objective of this study was to evaluate the efficacy and safety of minimally invasive transoral en bloc resection of superficial pharyngeal and laryngeal cancers. METHODS: Forty-one superficial lesions (from 35 patients) were resected transorally under a surgical microscope using a monopolar cautery. Quality of life (QOL) was assessed using a questionnaire European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Cancer Module (EORTC QLQ-H&N35) 1 year after the surgery. RESULTS: Twenty-eight hypopharyngeal, 5 oropharyngeal, and 8 laryngeal cancers were operated on using this method. The surgical field was widely exposed with a wide-caliber scope or extending laryngoscope. A bimanual procedure under a surgical microscope enabled us to achieve en bloc resection. The local control rate was 98%. No postoperative dyspnea or dysphagia was observed. Postoperative QOL scores were favorable. CONCLUSIONS: Our transoral en bloc resection technique can be easily adopted, and it effectively maintained QOL after treatment.