Extracranial head and neck neurogenic tumors: report of 47 cases.

UNLABELLED: Extracranial head and neck neurogenic tumors are rare and usually revealed by histological examination. The aim of this study was to review the clinical, radiological and therapeutic particularities of these tumors. METHODS: This retrospective study concerns 47 patients with neurogenic tumors of the head and neck, operated on between 1989 and 2011 (22 years period). All patients had complete physical examination and ultrasonography was performed when a cervical extension was found. CT scan and MRI were performed in 16 cases. Minimum follow up was 4 years. RESULTS:   A sinusonasal tumor was found in 9 cases and a cervical mass was seen in 28 cases. Parapharyngeal extension was observed in two cases. Two patients had tympano-jugular glomic tumors and 8 of them had a cervical soft tissue tumor. Complete surgical resection was performed in 46 patients. Histological examination revealed a benign tumor in 91% of cases (n=43), 24 of them were schwannomas. Malignant tumors were seen in 4 cases: esthesioneuroblastoma (3 cases) and malignant schwannoma (1 case). These patients received post operative radiotherapy. After surgery, two patients had Claude Bernard Horner syndrome and one had a definitive facial nerve palsy. CONCLUSION: Extracranial head and neck neurogenic tumors may have several aspects depending on their localisation and their histological type. Surgery, when performed, should be complete with minimum complications.

Ectopic lingual thyroid.

Ectopy of the thyroid gland is an abnormal embryological development. Its occurrence in children is rare. In this study, we report the case of a 12-year-old girl that presented with dysphagia and nocturnal dyspnea. Magnetic resonance imaging confirmed the presence of a lingual thyroid. Thyroid scintigraphy showed intense and elective uptake of radiotracer at the base of the tongue. Hormonal tests revealed hypothyroidism. Treatment consisted of opotherapy based on levothyroxine. Evolution has been favourable and the patient showed significant improvement with reduction of the dyspnea and the dysphagia and normalization of thyroid hormone tests.

Management of foreign bodies in the aerodigestive tract.

Foreign body (FB) aspiration and ingestion are frequently encountered by emergent otolaryngology services. The authors describe their experience in the management of FB cases in the aerodigestive tract. We carry a retrospective study about 626 patients who came or were referred to our department between 1996 and 2007 with a history or suspicion of a FB in the aerodigestive tract (except nasal and oropharyngeal FB). All of them have undergone rigid endoscopy under general anaesthesia. Children younger than 10 years were the most involved (36.9%) followed by patients between 71 and 80 years old (11.3%). The FB were visible on clinical examination in 39 cases. Chest and neck X-ray, showed radio-opaque FB in 302 cases (48.7%). A total of 626 rigid endoscopies were performed. FB were encountered in 549 patients (87.7%). The most involved sites were the oesophagus (51.9%) followed by the tracheobronchial tree (33.9%) and the hypopharynx (13.5%). Bones (22%) and coins (20.1%) were the most frequently encountered FB. Successful removal was achieved in 521 cases (94.9% of the FB found). The complication rate after rigid endoscopy was 1.3%. FB in the aerodigestive tract are frequent and may lead to severe complications. Removal through the rigid endoscope still has its place as the most reliable method. Prevention and public education for this serious problem should be considered.

Head and neck liposarcomas: a 32 years experience.

OBJECTIVE: The aim of this review is to study natural history, presentation, treatment and prognosis of head and neck liposarcomas. METHODS: We carry a retrospective study about 15 patients diagnosed and treated in our department between 1969 and 2001. Therapeutic modalities included surgery, radiotherapy and chemotherapy. RESULTS: Tumors were mostly localized at the neck (4 cases) and the scalp (3 cases). Cervical lymphadenopathy was found in 1 case. Chest X-ray found showed metastases in 2 cases. Histological types of liposarcomas were the following: myxoid (5 cases), well differentiated (4 cases), pleomorphic (4 cases), round cell (1 case) and dedifferentiated (1 case). Twelve patients underwent surgery. Complete excision was performed in 7 cases. In the other 5 cases, exeresis was incomplete and 4 of them received postoperative radiotherapy. Three patients were not operated because of vascular involvement (1 case) or metastasis (2 cases), and they all received radiotherapy alone. After initial treatment, complete remission was achieved in 7 cases (46.7%). A recurrence occurred in 8 cases (53.3%). Two of these patients were reoperated and another one received chemotherapy. In the other 5 cases, the tumor was uncontrollable and no additional treatment has been proposed. Five-year survival rate was 87% for patients who underwent surgery alone, 75% for those who underwent surgery and postoperative radiotherapy, and 0% for those treated by radiotherapy alone. CONCLUSION: The mainstay of treatment of head and neck liposarcomas is surgical excision and the prognosis is largely determined by the histological grade and the clinical stage.