Giant submental dermoid cysts with near total obstruction of the oral cavity: report of 2 cases.

Dermoid cysts in the head and neck are a relatively uncommon entity with only 6.9% occurring in this site. They most commonly occur in the lateral third of the eyebrow with 26% found in the floor of the mouth.(1) They are believed to arise from failure of the overlying surface ectoderm to separate from underlying structures. Typically, dermoid cysts present as slow-growing nontender midline floor of the mouth or submental swellings that can develop to significant dimensions before producing symptoms.(2) We report 2 such cases where large dermoid cysts produced progressive dysphagia and breathing difficulty, resulting in acute presentation to our service.

Outcomes of Sinonasal Cancer Treated With Proton Therapy.

PURPOSE: To report disease outcomes after proton therapy (PT) for sinonasal cancer. METHODS AND MATERIALS: Eighty-four adult patients without metastases received primary (13%) or adjuvant (87%) PT for sinonasal cancers (excluding melanoma, sarcoma, and lymphoma). Common histologies were olfactory neuroblastoma (23%), squamous cell carcinoma (22%), and adenoid cystic carcinoma (17%). Advanced stage (T3 in 25% and T4 in 69%) and high-grade histology (51%) were common. Surgical procedures included endoscopic resection alone (45%), endoscopic resection with craniotomy (12%), or open resection (30%). Gross residual disease was present in 26% of patients. Most patients received hyperfractionated PT (1.2 Gy [relative biological effectiveness (RBE)] twice daily, 99%) and chemotherapy (75%). The median PT dose was 73.8 Gy (RBE), with 85% of patients receiving more than 70 Gy (RBE). Prognostic factors were analyzed using Kaplan-Meier analysis and proportional hazards regression for multiple regression. Dosimetric parameters were evaluated using logistic regression. Serious, late grade 3 or higher toxicity was reported using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4. The median follow-up was 2.4 years for all patients and 2.7 years among living patients. RESULTS: The local control (LC), neck control, freedom from distant metastasis, disease-free survival, cause-specific survival, and overall survival rates were 83%, 94%, 73%, 63%, 70%, and 68%, respectively, at 3 years. Gross total resection and PT resulted in a 90% 3-year LC rate. The 3-year LC rate was 61% for primary radiation therapy and 59% for patients with gross disease. Gross disease was the only significant factor for LC on multivariate analysis, whereas grade and continuous LC were prognostic for overall survival. Six of 12 local recurrences were marginal. Dural dissemination represented 26% of distant recurrences. Late toxicity occurred in 24% of patients (with grade 3 or higher unilateral vision loss in 2%). CONCLUSIONS: Dose-intensified, hyperfractionated PT with or without concurrent chemotherapy results in excellent LC after gross total resection, and results in patients with gross disease are encouraging. Patients with high-grade histology are at greater risk of death from distant dissemination. Continuous LC is a major determinant of survival justifying aggressive local therapy in nearly all cases.

Factors affecting swallow outcome following treatment for advanced oral and oropharyngeal malignancies.

BACKGROUND: Treatment for tumors of the oral cavity and the oropharynx disrupts normal swallow function. The ability for oral diet postoperatively varies and may be influenced by surgery and patient-related factors. METHODS: In all, 114 patients treated with surgery with and without chemoradiotherapy for advanced oral/oropharyngeal cancer were recruited. Clinicopathologic tumor parameters and reconstruction modalities were recorded. Swallow function was determined by oral intake, using the Functional Oral Intake Scale (FOIS) pretreatment and posttreatment. RESULTS: The median time to first attaining swallow function was 14 days. Patients were less likely to attain tube independence within 1 year of surgery if they received radiotherapy or had a low FOIS score preoperatively. Patients' time to first attaining swallow function postsurgery was inversely related to the FOIS score presurgery. CONCLUSIONS: Swallow function recovery postsurgery is better in patients with higher FOIS presurgery, smaller tumors, and no requirement for radiotherapy.

Reoperative mandibular reconstruction.

Ideal reconstruction of the mandible is important for a multitude of reasons and has been and continues to be among the most common surgical challenges for reconstructive surgeons of the head and neck. Historically, pedicle flaps, such as the pectoralis major and deltopectoral myocutaneous flaps, were workhorse flaps for lower facial third head and neck reconstruction. This article outlines the relevant anatomy of the perimandibular region, reconstructive options including second free flaps, relevant workup, and complications pertaining to reoperative mandibular surgery.