Failure of Concurrent Chemoradiotherapy for Organ Preservation in Laryngeal Cancer: Survival Outcomes and Recurrence Patterns.

Although definitive chemoradiation (CRT) has been used for locally advanced laryngeal cancer for more than 2 decades, studies focusing on CRT failures in advanced laryngeal cancer are scarce. In this study, we aimed to determine the failure patterns and the survival outcomes in the patients who had recurrence after concurrent CRT for laryngeal cancer. Clinical records of the patients who had definitive concurrent CRT for laryngeal cancer between 2001 and 2014 at a tertiary referral center were reviewed. The end points of the study were 1-, 2-, and 3-year overall survival (OS) and disease-specific survival (DSS).In our results, there were 48 failures and the mean time period from the first diagnosis of disease to the diagnosis of recurrence was 18.0 months (range 2-72; standard deviation: 15.6). The most common recurrence pattern was local recurrence in 21 (47.9%) patients followed by regional recurrence in 11 (22.9%) patients. The 1 and 3 years OS rates were 41.7%, and 19.2% for the entire cohort, and 64.5%, and 29.7% for the patients who had not systemic recurrence at presentation of recurrence, respectively. The 1 and 3 years DSS rates were 43.5%, and 20.0% for the entire cohort, and 69.0%, and 31.8% for the patients who had not systemic recurrence at presentation of recurrence, respectively. All patients who had systemic recurrence initially (n = 13) died within 9 months (median = 4 months, range: 1-9 months). This study reveals that survival outcomes are unfavorable in the CRT failures and careful patient selection is critical to minimize failures. In the presence of systemic recurrence, disease course is aggressive.

Laryngeal Chondroma: An Unusual Complication Endotracheal Entubation.

INTRODUCTION: Laryngeal cartilaginous framework tumors are very rare. Chondroma and chondrosarcoma are the most common types of these tumors. PATIENT PRESENTATION: A 27-year-old man with a history of intubation presented with exercise-induced dyspnea. A computed tomography scan of larynx showed a rounded and circumscribed mass without infiltration of the adjacent structures which obstructs 75% of airway. Histopathological investigation of the mass revealed the chondroma of the larynx. The patients' history of intubation trauma with the subsequent progressive onset of clinical symptoms demonstrates the relationship between these 2 entities. CONCLUSION: Clinicians should consider laryngeal chondroma in the differential diagnosis of dyspnea after endotracheal intubation.

Comparison of three different concurrent chemoradiation regimens for treatment of laryngeal cancer.

During last decades, laryngeal organ preservation strategies have emerged. The data about the oncological outcomes mainly come from multi-institutional prospective studies. In this study, we aimed to determine the oncological outcomes of different organ preservation regimens applied in routine practice. Patients who had definitive concurrent chemoradiation (CRT) for treatment of laryngeal cancer between January 2001 and June 2013 were retrospectively reviewed. There were 139 subjects who met the inclusion criteria. Three groups were defined: group A (n = 59) consisted of subjects who had concurrent cisplatin and radiotherapy (RT), group B (n = 47) consisted of subjects who had cisplatin/docetaxel-based concurrent CRT, and group C (n = 33) had induction chemotherapy before concurrent cisplatin and RT. The Kaplan-Meier estimated 5-year overall survival, disease-specific survival, disease-free survival, and local recurrence-free survival (LRFS) rates for the whole study group were 66.5, 69.2, 69.6, and 88.9 %, respectively. None of these survival rates were statistically different when the treatment arms were compared. The 3- and 5-year LRFS rates were significantly lower in subjects with a T4a tumor (p = 0.030). According to our results, the oncological outcomes of three different platinum-based concurrent chemotherapy schemes were similar and high local control rates could be achieved with the use of these protocols. Neoadjuvant chemotherapy before concurrent CRT was not superior to conventional concurrent treatment.

Clinical Characteristics of Recurrent Juvenile Nasopharyngeal Angiofibroma (JNA) After Radiation Therapy.

Juvenile nasopharyngeal angiofibroma (JNA) is a benign vascular tumor occurring in young males. Treatment of JNA is a complex procedure, especially in advanced cases with a high risk of major complications. We report the clinical, radiological and histological specialties of a rare case of recurrent JNA 3 years after radiation therapy in an 18-year-old boy. The patient underwent endoscopy assisted partial midfacial degloving approach. This treatment has been shown to be effective in advanced JNAs with minor morbidity.

Recurrent Lymphoepithelial Carcinoma of the Parotid Gland.

BACKGROUND: Lymphoepithelial carcinomas (LECs) are rare tumors of parotid gland. Although few cases were reported in literature, there is no reported recurrent case. METHOD: The authors report a case of recurrent LEC after 8 months of primary surgery. Total parotidectomy and selective neck dissection surgery were performed. Radiation therapy after surgery was planned. Patient had partial facial weakness in the early postoperative period that was getting better with follow-up. CONCLUSIONS: In the diagnosis of LECs of parotid region, nasopharyngeal carcinomas must be excluded. If LECs are not treated properly, recurrences may occur.

An unusual mass of nasal cavity: recurrent glomangiopericytoma.

Hemangiopericytomas are rare tumors of sinonasal region. In this article, we described a case of recurrent mass in right nasal cavity which presented with nasal obstruction and intermittent epistaxis. Patient had a surgical history on the same nasal region without any histopathological document. Abnormal bleeding was observed during surgery and mass was partially removed for histopathological investigation. The result was glomangiopericytoma of the sinonasal region. Although extended surgery was recommended to the patient including preoperative and perioperative measures for bleeding problem, patient preferred to follow-up rather than removal. The clinical progress and review of glomangiopericytoma have also been discussed.

The effect of infrahyoid muscle sectioning on hyoid bone position and oropharyngeal air column volume.

OBJECTIVE/HYPOTHESIS: To evaluate the spatial hyoid bone position and the oropharyngeal air column volume after infrahyoid muscle sectioning as a single procedure. STUDY DESIGN: Animal experiment. METHODS: Six adult New Zealand rabbits underwent sternohyoid, omohyoid, and thyrohyoid muscle sectioning for infrahyoid release. Preoperative and postoperative computed tomography scans were obtained and transferred to the Mimics software program. By using the program, preoperative and postoperative three-dimensional models of the spatial hyoid bone position and the oropharyngeal air column volume were determined and compared. RESULTS: After the surgical intervention, it was found that the hyoid bone significantly moved to a more anterior (P = .028, P = .046), and superior (P = .028, P = .028) position. The preoperative mean oropharyngeal air column volume (618.88 ± 176.54 mm(3) ) also increased after infrahyoid muscle sectioning (797.01 ± 155.33 mm(3) ). and this change was also statistically significant (P = .028). CONCLUSIONS: Infrahyoid release improves oropharyngeal air column volume, as the hyoid bone moves to a more anterior and superior position after this operation in an animal model. However, additional animal and human studies are necessary to evaluate a possible therapeutic role of this procedure. LEVEL OF EVIDENCE: NA.

Lateral skull base destruction: unusual clinical progress of lymphoma.

Lymphoma is a common tumor especially in pediatric population. It can originate every lymphoid tissue in the head and neck region. Head and neck lymphomas usually present with a slow-growing mass. We encountered a man who had a lymphoma that destroyed all soft tissues of the left lateral skull base. The unusual clinical progress is discussed in the article.

Neoplasms of the hard palate.

PURPOSE: Although the most common neoplastic lesion of the oral cavity is squamous cell carcinoma (SCC), primary neoplastic lesions of the hard palate have not been systematically reviewed to date. The aim of this study was to determine the histopathologic composition and characteristics of neoplasms of the hard palate. MATERIALS AND METHODS: A retrospective analysis of 66 patients with a primary neoplasm of the hard palate managed at the authors' institution from 1985 through 2012 was performed. Demographic features, malignancy rate, histopathologic characteristics and distribution, TNM staging results, metastasis patterns, and management strategies were investigated. RESULTS: The sample was composed of 66 patients (mean age, 45.0 yr; 57.6% men). Neoplasms were benign in 57.6% of cases and malignant in 42.4%. Epithelial neoplasms and mesenchymal neoplasms were encountered in 52 patients (78.8%) and 14 patients (21.2%), respectively. Minor salivary gland tumors (MSGTs) were the most common histopathologic group (60.6%), followed by benign mesenchymal tumors (15.2%), SCCs (12.1%), malignant melanomas (6.1%), lymphomas (3.0%), and sarcomas (3.0%). Although 75.0% of malignant epithelial neoplasms were at an advanced stage, there were no pN+ SCC or malignant MSGT cases at presentation. CONCLUSION: The most common neoplasms of the hard palate were MSGTs. SCCs were relatively rare in this series. Although three-fourths of neoplasms were at an advanced stage, neck metastasis was not a characteristic of malignant epithelial neoplasms located in the hard palate.

Parotid gland involvement as a presenting feature of Wegener's granulomatosis.

Salivary gland involvement is a rare presenting clinical feature of Wegener's granulomatosis (WG). Early recognition and identification of any unusual presentations of WG may enable the early commencement of appropriate treatment. We report a case in which the initial manifestation of the disease was parotid gland swelling, and discuss the management of the patient. WG should be considered in the differential diagnosis when salivary gland enlargement occurs with other otolaryngological symptoms.

[Pharyngocutaneous fistula rates after total laryngectomy in the organ preservation era]. / Organ koruma çaginda total larenjektomi sonrasi farengokütanöz fistül oranlari

OBJECTIVES: In this study, we aimed to determine and compare the pharyngocutaneous fistula (PCF) rates in patients undergoing primary total laryngectomy (TL) or those undergoing salvage TL following radiotherapy (RT)/chemoradiotherapy (CRT) failure. PATIENTS AND METHODS: Between January 2006 and January 2012, medical records of 91 male patients (mean age 61.0+10.3 years; range 36 to 88 years) who underwent TL in our clinic were retrospectively reviewed. RESULTS: Total laryngectomies were performed in 64 patients primarily and 27 of the patients as salvage TL following RT or CRT. Intraoperative mortality was 1.1%. Pharyngocutaneous fistula rates were 14.3%, 25.9%, and 17.8% in primary surgery group in patients with salvage laryngectomy following RT/CRT, and all groups, respectively. This difference was not statistically significant (p>0.05). The mean of PCF beginning time in primary surgery and salvage surgery patients were 19.0 and 12.7 days respectively. The mean time to recovery was 31.6 in primary surgery group and 60.0 days in salvage surgery group. When the beginning time of the fistula and recovery time were compared, the difference was also not statistically significant (p>0.05). CONCLUSION: Despite the lack of any statistically significant difference in our study, we found that post-TL PCF following RT/CRT occurs almost two times more frequently with earlier symptom onset and late recovery, compared to those undergoing primary surgery.

Salivary gland tumors in Turkey: demographic features and histopathological distribution of 510 patients.

The aim of this study was to evaluate the demographic and clinicopathologic data of salivary gland tumors managed at a tertiary referral medical center in Turkey. The data of 510 patients with salivary gland tumors managed during the period of January 1984 to May 2012, were reviewed. Only primary neoplasms derived from salivary glands were included. Out of 510 neoplasms, 352 (69.0 %) were classified as benign and 158 (31.0 %) were classified as malignant. There was a male predominance and male:female ratio was 1.23 (281/229). The most common location was parotid gland (372/510, 72.9 %) followed by minor salivary glands (97/510, 19.0 %) and submandibular gland (40/510, 7.9 %). The malignancy rates were 21.5, 40.0, and 56.7 % in parotid, submandibular, and minor salivary glands locations, respectively. The most common location for minor salivary gland neoplasms was oral cavity (61/97, 62.9 %). Pleomorphic adenoma (PA) was the most common histopathological type (45.3 %) in the whole study group and also among pediatric patients. The most common malignant neoplasms were adenoid cystic carcinoma (39/510, 7.6 %) and mucoepidermoid carcinoma (5.7 %). Salivary gland tumors are more common in men. The malignancy rate is almost three times higher in neoplasms derived from minor glands when compared to parotid gland. PA is the most common histopathological tumor type in all locations and in all age groups.

[A parotid gland lymphoma presenting with steroid-responsive recurrent sialadenitis: a case report]. / Steroide yanit veren reküren siyaladenit seklinde ortaya çikan atipik seyirli parotis bezi lenfomasi: Olgu sunumu.

Parotid gland located lymphomas are rarely seen. The most common lymphomas involving salivary gland include B-cell MALT (mucosa-associated lymphoid tissue) lymphomas. Of them, extranodal marginal zone B-cell lymphomas are the most frequently seen pathologies. They usually present with painless swelling of the parotid gland. The diagnosis is often based on parotidectomy. In this article, we report a 46-year-old male patient who was admitted with recurrent sialadenitis attacks which responded well to steroid treatment for three years, but recur after the cessation of the therapy. With the initial diagnosis of recurrent parotitis, the patient was scheduled for total parotidectomy for the definitive diagnosis and treatment. When the frozen-section of specimens during superficial parotidectomy revealed lymphoma, the operation was terminated.

Less known non-infectious and neuromusculoskeletal system-originated anterolateral neck and craniofacial pain disorders.

Pain syndromes of neuromusculoskeletal origin are not well-known by most of the clinicians working on head and neck area. As a result, most of the patients with these syndromes are either overlooked without having any treatment or they inappropriately have antibiotic treatments or surgical interventions such as dental extractions and tonsillectomies. Better recognition of the pain syndromes of the neck and face region or entities related to neuromusculoskeletal system may result in more appropriate and effective management of such conditions while avoiding unnecessary medical and surgical treatments. In this review, causes, clinical characteristics, diagnostic and treatment modalities of relatively less known craniofacial and neck pain entities including Eagle syndrome, carotidynia, glossopharyngeal neuralgia, superior laryngeal neuralgia, hyoid bone syndrome, acute calcific retropharyngeal tendinitis, temporal tendinitis, thyroid and cricoid cartilage syndromes, and mastoid process syndrome are summarized.

Can bile acids be an etiological factor for laryngeal carcinoma?

PURPOSE: The objective of this study is to show the accumulation of bile acids in laryngeal tissues of laryngeal carcinoma patients. MATERIALS AND METHODS: The present study compared the total bile acid level in the hypopharyngeal tissue, tumor tissue, and blood of 21 primary laryngeal carcinoma patients (study group) to that in the hypopharyngeal tissue and blood of 15 patients with benign laryngeal lesions (control group). RESULTS: The total bile acid level was significantly higher in the tumor and hypopharyngeal tissues of the study group than in the hypopharyngeal tissues of the control group; however, the difference in the blood total bile acid level between the 2 groups was not significant. CONCLUSION: Bile acids in reflux material accumulate in the laryngeal tissue in laryngeal carcinoma patients; therefore, bile acids should be considered a carcinogenic factor in the etiology of laryngeal carcinoma because of their mutagenicity due to DNA breaking, as they cause chronic inflammation due to intracellular accumulation.

Role of human papillomavirus in the clinical and histopathologic features of laryngeal and hypopharyngeal cancers.

OBJECTIVE: In this study, we aimed to evaluate the role of human papillomavirus (HPV) in the clinical and histopathologic features of laryngeal and hypopharyngeal cancers. METHOD: Paraffin wax-embedded sections consisting of 89 laryngeal and hypopharyngeal cancers from 210 patients were analyzed. Tissue samples were amplified by using a glucose 6-phosphatase dehydrogenase (G6PDH) control kit (Eurogentec, Seraing, Belgium), and G6PDH-positive samples were thought to have appropriate tissues by using a deoxyribonucleic acid (DNA) extraction kit (DNA mini kit, Qiagen, Germany). HPV and HPV-16 were detected by real-time polymerase chain reaction (PCR) using the L1 region. Real-time nested amplifications of MY09/11 products were done by GP5+/GP6+ primers and a cyanine-5-labeled HPV-16 DNA-specific probe. HPV-16-negative MY09/11 amplicons were sequenced by an OpenGene automated DNA sequencing system, and a similar percentage of sequences was calculated by GeneObjects software (Visible Genetics, Canada). RESULTS: Specimens from 89 subjects fitting the criteria were taken for PCR assay, and the HPV genome was analyzed in 65 cases because the remaining cases did not have enough tissue according to G6PDH amplification. HPV was positive in 27 cases (41.5%). HPV positivity was found to be associated with lymph node metastasis (LNM). Odds ratio analysis indicated that HPV positivity was an important factor for LNM but not for other parameters. CONCLUSIONS: HPV-16 infection can be associated with laryngeal carcinomas without LNM. Analysis of HPV positivity could be used as a prognostic factor.

[Use of dehydrated temporal fascia in chronic otitis media surgery and tympanoplasty]. / Kronik otit cerrahisi ve timpanoplastide dehidrate temporal fasya kullanilmasi.

OBJECTIVES: We evaluated the use of homograft dehydrated temporal fascia (Tutoplast) in repair of tympanic membrane perforations secondary to chronic otitis media. PATIENTS AND METHODS: Dehydrated temporal fascia was used during tympanoplasty in 17 patients (10 females, 7 males; mean age 34 years; range 15 to 53 years) with chronic otitis media. Operations were type 1 tympanoplasty in six patients, tympanoplasty and mastoidectomy in three patients, and revision tympanoplasty and/or mastoidectomy in the remaining patients. The patients were followed-up for at least two years. RESULTS: Complete wound healing was achieved without complications, and the material used was well tolerated in all the patients. Only one patient had a small perforation. The tympanic membranes were anatomically intact in 16 patients (94%). CONCLUSION: The use of dehydrated temporal fascia provides maximum microsurgical comfort due to its soft, flexible feature and maintenance of its delicacy even in contact with blood. Thus, dehydrated temporal fascia should be considered for selected cases for its ease of use and anatomical success.

Surgical treatment of elongated styloid process: experience of 61 cases.

AIM: To describe the management of patients with elongated styloid process syndrome (Eagle's syndrome). MATERIALS AND METHODS: Sixty-one patients with elongated styloid process were treated between 2000 and 2005. Computed tomography examination defines those whose symptoms suggest the diagnosis. Patients with styloid processes longer than 25 mm were treated by surgical resection. RESULTS: Fifty-seven (93.4%) of 61 patients treated for Eagle's syndrome became asymptomatic after resection. There were no serious complications. CONCLUSION: Patients with clinically and radiologically established elongated styloid process can be managed successfully by surgical resection using an external approach.