Quality of life in early age Spanish children treated for cleft lip and/or palate: a case-control study approach.

OBJECTIVE: The objectives of this study were to evaluate health-related quality of life (HRQoL) in 4-7-year-old children treated for cleft lip and/or palate (CL/P) compared to healthy controls and to estimate a possible association with cleft type, gender, age, and surgical re-interventions. MATERIALS AND METHODS: A total of 171 children with CL/P (mean age 5.7 years) and 186 healthy controls (mean age 5.5 years) were included in the study. Sixty-four (37.4%) children experienced both cleft lip and palate, 56 (32.8%) cleft lip only, and 51 (29.8%) cleft palate only. HRQoL in children was assessed by Kiddy-KINDL and COHIP-14 questionnaires and in parents by KINDL-p. Total score and dimensions of each questionnaire were compared between cleft children, their parents, and controls. RESULTS: The total scores and dimension scores of Kiddy-KINDL showed similar values between CL/P and control groups, except for "self-esteem" dimension (p = 0.036). The comparison of Kiddy-KINDL and KINDL-p showed a statistically significant total score (82.11 vs. 80.44, p = 0.047). The CL/P group presented significantly worse values with respect to controls in total score of COHIP-14 (10.53 vs 5.01, p < 0.001) and in all its dimensions. CONCLUSIONS: Children treated for CL/P had a negative impact on HRQoL at early age compared to controls. Significant differences were found in the psychological and functional dimensions related to lip and palatal affectation, respectively. Parents reported significantly worse scores than their children. HRQoL measurement provided valuable complementary information to better inform to parents and make clinical decisions in children with CL/P at early age. CLINICAL RELEVANCE: Our findings suggested that Spanish children between 4 and 7 years of age with a history of surgically treated CL/P experienced a poorer HRQoL when compared with their non-cleft peers.

Upper airway distress due to an oropharyngeal infantile myofibroma.

Infantile myofibroma is an uncommon fibrous tumour of infancy, usually present at birth. It is a rare cause of child airway obstruction, with only one neonatal case reported. We report an eight months age case which was referred to our Unit for increasing respiratory distress. CT scan showed a well defined margins mass measuring 7×5×5cm arising from the left parapharyngeal space and occupying the oropharynx. We performed a complete surgical resection through a transoral approach with no events during the surgery. The patient has been followed-up by the first author for five years with no signs of recurrence or sequelaes.

Management of parapharyngeal giant pleomorphic adenoma.

INTRODUCTION: Pleomorphic adenoma (PA) is found rarely in the parapharyngeal space (PPS). Because of late diagnosis due to slow growth, close proximity to vital neurovascular structures and risks of surgery, it poses a great difficulty for both diagnosis and surgical management. The preferred surgical approach to the PPS is the cervical-transparotid including a total parotidectomy with facial nerve preservation combined with a cervical access for dissection of cranial nerves and vascular structures thus allowing a safe removal of the tumor together with the parotid deep lobe. We report herein our experience in the management of giant PAs involving the prestyloid PPS and describe a not well-documented transparotid route by preservation of the parotid superficial lobe in combination with an intraoral approach. PATIENTS AND METHODS: In this retrospective study, three cases of patients having giant PAs involving the PPS are evaluated. All patients had signs of foreign body sensation in the throat and a growing mass bulging in the oropharynx. Diagnosis was based on MRI and upon preoperative intraoral biopsy. The average tumor size was 5.7 cm. Patients underwent surgery and excision of tumors via transparotid-intraoral approach. In two cases, the superficial lobe was preserved and afterwards put back in its anatomic location. RESULTS: All patients were discharged without complications, and no recurrences were observed. CONCLUSIONS: Preoperative diagnosis management of PPS giant tumors should be based on imaging and upon open transoral biopsy if possible. The transparotid-intraoral approach provided adequate visibility to remove large PAs involving the prestyloid PPS.

Resultados de la preservación de órgano en los carcinomas de cavidad oral y orofaringe / Results of organ preservation in carcinomas of the oral cavity and oropharynx

Para los tumores T1 N0-1 y la mayoría de los tumores T2N0-1 de orofaringe, tanto la cirugía como la radioterapia son opciones válidas de tratamiento. Para las neoplasias clasificadas como T3-4a o N2, la quimiorradioterapia concomitante (QRC) se considera la terapia estándar debido al elevado riesgo de recidiva locorregional o metástasis a distancia. Aunque no hemos podido encontrar estudios que comparen la cirugía (y reconstrucción) sobre primario y cuello con la QRC, la mayoría de los especialistas que manejan pacientes con cáncer avanzado de orofaringe considera los datos existentes suficientes para recomendar este abordaje alternativo de preservación de órgano en los casos con enfermedad locorregional avanzada. No obstante, siguen habiendo controversias en el caso del cáncer de la cavidad oral(AU)

Surgery and radiotherapy are valid treatment options in toth T1 N0-1 tumors and most T2 N0-1 tumors of the oropharynx. For T3-4.ª and N2 neoplasms, concomitant chemoradiotherapy is considered the standard therapy due to the high risk of locoregional recurrence or distant metastases. Although we have found no studies comparing surgery (and reconstruction) on primary and neck tumors with concomitant chemoradiotherapy, most specialists managing patients with advanced oropharyngeal cancer consider the existing data to be sufficient torecommend this alternative organ preserving approach in patients with advanced locoregional disease. Nevertheless, controversies remain in the case of oral cavity cancer(AU)

Airway obstruction due to metastatic renal cell carcinoma to the tongue.

Metastatic lesions in the tongue are extremely rare. Renal cell carcinoma is the most frequent kidney neoplasm, with a high tendency to metastasize. It is the third most frequent neoplasm to metastasize to the head and neck region. We report a case of a rapidly enlarging tongue metastasis causing airway obstruction in a patient with widespread disease. Local excision was the elected treatment to provide palliation of the obstruction.

Pleomorphic adenoma of the parotid in childhood.

INTRODUCTION: Pleomorphic adenoma is a benign growth that most often appears in the parotid gland where it is the most frequent type of tumour. Its appearance in childhood is rare and there are no large series available in this age group for comparison with its presentation in adults. Surgical treatment is similar in children and in adults; whilst the prognosis is good, they may become malignant and metastasize. MATERIAL AND METHOD: In this study, we present seven parotid pleomorphic adenomas in childhood treated in our Department and a review of the literature. The following data were evaluated: sex, age, affected side, clinical symptoms and period of evolution of the symptoms, surgical technique applied and complications observed. RESULTS: The mean age at presentation was 12.4 years. All patients were males with the right side affected in five patients. The treatment was conservative superficial parotidectomy in five patients, conservative total parotidectomy in one, and an enucleation including a wide safety margin in the last case. None of the patients exhibited any permanent postoperative complication. The mean follow-up was 41.3 months (26-58 months).