Recurrent pleomorphic adenoma: results of surgical treatment.

BACKGROUND: Recurrent parotid pleomorphic adenoma surgery increases the risk of facial nerve injury, and there is also a risk of ulterior recurrence. METHODS: Postoperative results from 62 consecutive patients operated for recurrent pleomorphic adenoma were analyzed. It was the first recurrence for 49 patients (79%), the second or more for 13 patients (21%). RESULTS: Total parotidectomy was performed in 69.4% of cases. Skin resection was performed in 47 patients (75.8%). Resection of a facial nerve branch was performed in seven patients (11.3%). Pathologic examination findings revealed carcinoma ex pleomorphic adenoma in 10/62 cases (16.1%) and microscopic multinodular disease in 39 patients (62.9%). Nine patients had preoperative facial palsy, 95% had postoperative facial paralysis ≥ grade II (House-Brackmann scale), and 11.3% still had ≥ grade III facial palsy after 1 year. Six patients developed another recurrence after our intervention (9.68%). Moreover, carcinoma was discovered after a new intervention in 40% of these patients. Initial partial parotid surgery [hazard ratio (HR) = 8.477, P = 0.008], microscopic multinodular recurrent disease (HR = 11.717, P = 0.005), and ≥ 1 recurrence number (HR = 10.608, P = 0.01) were associated with increased risk of ulterior recurrence. CONCLUSION: Surgery is recommended in pleomorphic adenoma recurrence because of the high rate of carcinoma ex pleomorphic adenoma (16.1%). Nevertheless, a definitive facial paralysis ≥ grade III rate of 11.3% is reported after multiple nerve dissection. New recurrence after surgery is less frequent if the initial treatment for pleomorphic adenoma is total parotidectomy.

Laryngeal dedifferentiated liposarcoma.

BACKGROUND: Soft tissue liposarcomas are quite common in the adult population, whereas liposarcoma of the larynx is exceedingly rare. METHODS: We describe an exceptional case of liposarcoma of the posterior aspect of the left arytenoid in a 62-year-old woman who was treated with two endoscopic excisions and adjuvant radiotherapy (RT). This is the 32nd case of laryngeal liposarcoma reported in the English literature. RESULTS: After a 20 months follow-up, no local, regional recurrences or distant metastases were detected, and no functional complications are described for the patient. CONCLUSION: This case report highlights that endoscopic surgical treatment enables excellent organ and functional preservation. However, recurrence of laryngeal liposarcoma is the principal risk, so extended follow-up is essential. RT has no defined role in treatment but can be discussed, especially considering the surgical margins and recurrence status.

Amaurosis after lower eyelid laser blepharoplasty.

The transconjunctival CO(2) laser approach to lower eyelid blepharoplasty was used to treat a 66-year-old man presenting with bilateral lower eyelid herniated fat without excess skin. Early postoperative examination revealed left eye blindness. This report presents clinical circumstances of this rare complication and further discusses the most likely causative factors.