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ABSTRACT: Due to progressively expanded indications of endoscopic transnasal surgery, having different reconstructive options in the armamentarium becomes of paramount importance. We herein report our experience with the use of the temporo-parietal fascial flap after extended endoscopic procedures for malignancies of the clival and nasopharyngeal regions. We focus our report on the surgical anatomy of this flap and the technique for its intranasal transposition through an infratemporal corridor. The main steps of the procedure and anatomic landmarks were highlighted, thanks to previous cadaver dissection. Five patients underwent an extended endoscopic resection for malignant tumors: one with persistent clival chordoma, three with recurrent nasopharyngeal carcinomas, and 1 recurrent nasopharyngeal adenoid cystic carcinoma. In all patients a temporo-parietal fascial flap was harvested to protect critical structures or irradiated denuded bone. The Mean harvesting and hospitalization time were 120 min and 5 days, respectively. No major or minor complications were observed. Whenever local flaps are not available for oncologic reasons or previous surgery, the temporo-parietal fascial flap is a safe and relatively easy option to protect the residual skull base and critical structures such as the internal carotid artery and dura of the posterior cranial fossa, after extended endoscopic resections.
Archives of Oto-Rhino-Laryngology 09/2012; · 1.29 Impact Factor
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ABSTRACT: BACKGROUND: Many studies have recently emphasized the role of tumor angiogenesis and lymphangiogenesis in regional and distant spread of disease. Although early laryngeal cancer has a favorable oncologic outcome after conservative surgery or radiation therapy, we observed few cases with poor prognosis in terms of locoregional relapse, organ preservation, and survival. The aim of our study was to evaluate the immunohistochemical expression of CD31 and podoplanin to define angiogenic and lymphangiogenic patterns and their possible prognostic implications in previously untreated T1-T2 glottic squamous cell carcinoma. METHODS: Four hundred twenty-eight patients with previously untreated early-stage laryngeal cancer underwent a laser surgical resection in the period between January 1994 and December 2007. Twenty-seven cases with poor outcome were identified and compared with a selected sample of 28 patients. All specimens were negative for the presence of high-risk human papillomavirus genotypes. Patients were followed up until death or for at least 24 months after treatment. Three-micrometer sections were obtained from formalin-fixed and paraffin-embedded tumoral tissues, and an immunohistochemical evaluation was performed. Monoclonal antibodies against CD31 and podoplanin were used for the detection of blood and lymphatic vessels, respectively. A morphometric measurement was used for the analysis of angiogenesis whereas lymphangiogenesis was studied with a semiquantitative technique. The data were analyzed by use of chi-square and Mann-Whitney tests as appropriate. RESULTS: An increased tumor angiogenesis correlated with local relapse (p = .01), locoregional relapse (p = .01), and death of disease (p = .03). The presence of lymphatic vessels in peritumoral fields had an impact on local (p = .004) and locoregional recurrence (p = .01). CONCLUSIONS: Evaluation of angiogenesis and lymphangiogenesis in early-stage laryngeal cancer could be useful to identify patients at higher risk of recurrence and consequently to modulate treatment planning and follow-up strategy. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
Head & Neck 08/2012; · 2.40 Impact Factor
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ABSTRACT: Juvenile angiofibroma is a rare benign lesion originating from the pterygopalatine fossa with distinctive epidemiologic features and growth patterns. The typical patient is an adolescent male with a clinical history of recurrent epistaxis and nasal obstruction. Although the use of nonsurgical therapies is described in the literature, surgery is currently considered the ideal treatment for juvenile angiofibroma. Refinement in preoperative embolization has provided significant reduction of complications and intraoperative bleeding with minimal risk of residual disease. During the last decade, an endoscopic technique has been extensively adopted as a valid alternative to external approaches in the management of small-intermediate size juvenile angiofibromas. Herein, we review the evolution in the management of juvenile angiofibroma with particular reference to recent advances in diagnosis and treatment.
International Journal of Pediatrics 01/2012; 2012:412545.
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ABSTRACT: BACKGROUND: Malignancies of the nasolacrimal apparatus are rare lesions that usually originate from the lacrimal sac. To the best of our knowledge, this is the first case of a primary oncocytic carcinoma of the nasolacrimal duct reported in the literature. METHODS: A 43-year-old woman presented with a 3-month history of right epiphora. At nasal endoscopy, an exophytic lesion occupying the right inferior meatus was visible. Imaging studies showed an expansile lesion involving the nasolacrimal duct and the inferior meatus, but not invading the orbit or adjacent soft tissues. A biopsy was suggestive for an oncocytic lesion. RESULTS: A radical resection was obtained through an endoscopic extended medial maxillectomy with a definitive diagnosis of oncocytic carcinoma. Forty-two months after surgery there was no evidence of disease. CONCLUSIONS: In selected malignant lesions of the nasolacrimal duct not involving the adjacent soft tissues or lacrimal sac, an exclusive endoscopic approach can be considered. © 2011 Wiley Periodicals, Inc. Head Neck, 2011.
Head & Neck 06/2011; · 2.40 Impact Factor
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Archives of otolaryngology--head & neck surgery 06/2011; 137(6):629, 632-3. · 1.92 Impact Factor
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ABSTRACT: During the last years, multiple methods and a wide set of materials for skull base reconstruction have been described. In our experience, the ideal graft for duraplasty is the iliotibial tract due to its favorable characteristics in terms of thickness, pliability, and strength. In this report, we show the iliotibial tract-harvesting technique under endoscopic guidance with a minimally invasive approach using a cadaveric model. Two longitudinal incisions of 1 cm each were made at 4 cm down a line drawn between the anterior-superior iliac spine and the lateral margin of patella at the extremities of the middle third of the thigh. By using a set of instruments for endoscopic face-lifting, the graft was easily set up and harvested. The endoscopic approach is associated with less visible scars, but longer operative time in comparison with open traditional procedure. The pros and cons in terms of morbidity need to be evaluated by further studies on actual cases.
Skull Base 05/2011; 21(3):185-8. · 0.66 Impact Factor
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ABSTRACT: To identify factors that influence hospitalization time, complications, and prognosis of patients with ethmoid adenocarcinoma treated with different surgical techniques.
Single-institution retrospective review.
Academic tertiary care center.
Sixty-seven patients with ethmoid adenocarcinoma treated from January 1985 to August 2009 were retrospectively evaluated. Surgical treatment included endoscopic resection (n = 12), endoscopic resection with transnasal craniectomy (n = 17), cranioendoscopic resection (n = 9), external approaches limited to the ethmoid (n = 11), and craniofacial resection (n = 18).
A Cox model was adopted to relate time to death to previous treatment, pT category, grade, and surgical technique. The impact of the same variables on hospitalization time and risk of complications was assessed by linear regression and logistic regression, respectively.
The risk of complications increased for pT4a-b lesions (P = .02) and craniofacial resection (P = .01). Hospitalization time increased by 6.3 days for cranioendoscopic resection (P = .03) and by 11.7 days for craniofacial resection (P < .001). Three- and 5-year overall survivals were 68.0% (standard error = 5.8%) and 48.4% (standard error = 6.9%). Three-year survival was 76.62% and 51.81% for previously untreated and treated patients, respectively, and it was 92.98% and 33.33% in patients treated with endoscopic techniques and craniofacial resection, respectively. Multivariate analysis showed that previous treatment (hazard ratio of death = 3.9, P = .01) and craniofacial resection (HR = 5.16, P = .05) were mainly associated with survival.
Endoscopic techniques, in properly selected patients, were associated with a favorable oncologic outcome and a statistically significant reduction in both complication rate and hospitalization time. This study supports the role of endoscopic techniques in surgical treatment of ethmoid adenocarcinoma.
Otolaryngology Head and Neck Surgery 04/2011; 145(2):330-7. · 1.72 Impact Factor
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ABSTRACT: Malignant tumors of the sinonasal tract are rare, accounting for only 1% of all malignancies. Although they are associated with substantial histological heterogeneity, surgery plays a key role in their management. This review addresses the evolution of current treatments in view of the introduction of endoscopic resection techniques. The absence of facial incisions and osteotomies, decreased hospitalization time, better control of bleeding, improved visualization of tumor borders, and reduced morbidity and mortality rate are the major advantages of endoscopic techniques in comparison to traditional external approaches. The major criticisms focus on oncologic results in view of the short/intermediate follow-up of large series, which have commonly grouped together several histologies that may be associated with different prognoses. Since prospective studies contrasting the results of endoscopic and craniofacial resections are difficult to carry out given the rarity of the disease together with ethical issues, the creation of a large database would favor the analysis of several variables related to the patient, tumor, and treatment on survival performed on a large number of patients.
Current Oncology Reports 01/2011; 13(2):138-44. · 2.55 Impact Factor
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ABSTRACT: At present, transnasal endoscopic surgery is considered a viable option in the management of small-intermediate size juvenile angiofibromas (JAs). The authors critically review their 14-year experience in the management of this lesion to refine selection criteria for an endoscopic approach.
From January 1994 to May 2008, 46 patients were treated by a pure endoscopic resection after vascular embolization (87%). The lesions were classified according to Andrews (Andrews JC, et al., The surgical management of extensive nasopharyngeal angiofibromas with the infratemporal fossa approach, Laryngoscope 99:429-437, 1989) and Onerci (Onerci M, et al. Juvenile nasopharyngeal angiofibroma: A revised staging system, Rhinology 44:39-45, 2006) staging systems. All patients were followed by regular endoscopic and magnetic resonance imaging (MRI) examinations.
Lesions were classified as follows: stage I, n = 5; stage II, n = 24; stage IIIa, n = 14; stage IIIb, n = 3 according to Andrews classification system; stage 1, n = 9; stage II, n = 12; stage III, n = 26 according to Onerci's system. Unilateral blood supply was detected in 39 (85%) cases. Feeding vessels from the internal carotid artery (ICA) were also reported in 14 (30%) patients. Intraoperative blood loss ranged from 250 to 1300 mL (mean, 580 mL). In four (8.7%) cases, suspicious residual disease was detected by MRI. In one patient, a 1-cm persistent lesion was endoscopically removed because septoplasty was required and a slight increase in size was noticed. The other three lesions, all located in the root of the pterygoid plate, are nearly stable in size and are currently under MRI follow-up.
The improvement of surgical instrumentation and the experience acquired during a 14-year period have contributed to expanding the indications for endoscopic surgery in the management of JAs. Even stage III lesions may be successfully managed, unless the ICA is encased or if it provides an extensive blood supply. An external approach may be required when critical structures such as the ICA, cavernous sinus, or optic nerve are involved by lesions that are persistent after previous treatment; such a situation may prevent safe and radical dissection with a pure endoscopic approach. Better understanding of the factors influencing the growth of residual lesions is needed to differentiate those requiring re-treatment from those which can be simply observed.
American Journal of Rhinology and Allergy 03/2010; 24(2):e67-72.
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ABSTRACT: The objective of this study was to assess angiogenesis and lymphangiogenesis patterns in advanced oral/oropharyngeal cancer by immunohistochemical techniques.
Forty-five patients with advanced oral/oropharyngeal cancer, treated by primary surgery between January 1996 and December 2005, were selected. All cases were followed for at least 24 months. Angiogenesis and lymphangiogenesis were evaluated with antibodies against CD31 and podoplanin, respectively. Survival outcomes were calculated by the Kaplan-Meier method, whereas univariate comparisons were obtained by log-rank, chi-square, and Mann-Whitney tests.
Survival correlated with the area of peritumoral blood vessels (p = .02), whereas the number of intratumoral lymphatics (p = .02) correlated with the occurrence of nodal metastasis. The risk for distant metastasis correlated with the perimeter of intratumoral lymphatics (p = .02).
Peritumoral angiogenesis presented different expression patterns between survivors and patients who died of disease. Intratumoral lymphangiogenesis was correlated with a higher risk of developing lymph node (LN) and distant metastasis.
Head & Neck 11/2009; 32(6):786-92. · 2.40 Impact Factor
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Otolaryngology Head and Neck Surgery 09/2009; 141(2):288-9. · 1.72 Impact Factor
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ABSTRACT: Herein we present our experience in the management of fungus ball (FB) of the paranasal sinuses. Preoperative imaging strategy and findings, surgical technique, and pathologic and microbiologic results are discussed.
Retrospective chart review of patients with FB of the paranasal sinuses who underwent endoscopic surgery at the Department of Otorhinolaryngology of the University of Brescia, Italy.
From January 1990 to December 2006, 160 patients with sinonasal fungus ball were treated with a purely endoscopic approach. All patients underwent preoperative computed tomography (CT) and/or magnetic resonance (MR) imaging; an endo-oral dental x-ray or orthopantomography and odontological evaluation were also performed in patients with maxillary sinus localization. All removed material was sent for pathologic and microbiologic evaluation. All patients were prospectively followed with endoscopic control every 2 months during the first postoperative year and subsequently every 6 months.
The patient cohort included 118 females and 42 males, with an age from 19 to 85 years (mean, 52.7 years). FB was located in the maxillary sinus in 135 (84.4%) patients; in two cases both sinuses were affected. Sphenoid and ethmoid involvement was observed in 23 (14.4%) and 1 (0.6%) patients, respectively. Simultaneous ethmoid and sphenoid involvement was found in one (0.6%) case. In all patients complete removal of fungal debris was obtained through wide sinusotomy. No recurrence was observed.
Endoscopic surgery is a safe and effective treatment for paranasal sinuses FB. A proper imaging study by MR and/or CT can address diagnosis, which is based upon detection of fungal hyphae at histology.
The Laryngoscope 09/2009; 119(11):2275-9. · 1.75 Impact Factor
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ABSTRACT: The increasing expertise in the field of transnasal endoscopic surgery recently has expanded its indications to include the management of sinonasal malignancies. We report our experience with the endoscopic management of nasoethmoidal malignancies possibly involving the adjacent skull base.
A retrospective analysis was performed of patients treated by an exclusive endoscopic approach (EEA) or a cranioendoscopic approach (CEA) from 1996 to 2006 managed by two surgical teams at the Departments of Otorhinolaryngology of the University of Brescia, and the University of Pavia/Insubria-Varese, Italy.
One-hundred eighty-four patients were considered eligible for the present analysis. An EEA was performed in 134 patients and the remaining 50 patients underwent the CEA. The most frequent histotypes encountered were adenocarcinoma (37%), squamous cell carcinoma (13.6%), olfactory neuroblastoma (12%), mucosal melanoma (9.2%), and adenoid cystic carcinoma (7.1%). Overall, 86 (46.7%) patients received some form of adjuvant treatment. The patients were followed up for a mean of 34.1 months (range, 2-123 months). The 5-year disease-specific survival was 91.4 +/- 3.9% and 58.8 +/- 8.6% (p = 0.0004) for the EEA and CEA group, respectively.
To the best of our knowledge, this is the largest series reported to date of malignant tumors of the sinonasal tract and adjacent skull base treated with pure endoscopic or cranioendoscopic techniques. A 5-year disease-specific survival of 91.4% and 58.8% for the EEA and the CEA groups, respectively, seem to indicate that endoscopic surgery, when properly planned and in expert hands, may be a valid alternative to standard surgical approaches for the management of malignancies of the sinonasal tract.
American Journal of Rhinology 04/2008; 22(3):308-16. · 1.36 Impact Factor
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Otolaryngology Head and Neck Surgery 11/2007; 137(4):678-9. · 1.72 Impact Factor
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ABSTRACT: Major glottic incompetence is often encountered after total (Type IV) and extended (Type V) cordectomies and is responsible for poor vocal outcome. Even though the vast majority of patients do not complain of significant limitations in daily life, a selected number of them eventually require some sort of phonosurgical treatment in order to improve voice quality. Different techniques have been described in the literature to ameliorate long-term vocal outcome. The aim of the present report was to retrospectively describe our experience in this challenging clinical scenario. Between April 1999 and March 2005, 24 patients previously treated by Type IV-V endoscopic cordectomies for T1 and T2 glottic cancer presented unsatisfactory vocal outcome in spite of intensive speech therapy and therefore underwent some form of phonosurgical treatment at our Department after at least 12 months without evidence of local-regional recurrence. Patients were treated by medialization thyroplasty with a Montgomery System Implant (two cases), Gore-Tex strips (16 cases), medialization thyroplasty with Gore-Tex associated with anterior commissure laryngoplasty (three cases), and augmentation with Vox Implant injection (three cases). Nineteen patients had comprehensive evaluation by videolaryngoscopic examination and subjective, perceptual, and objective voice analysis both in the pre-phonosurgical treatment period and after at least 12 months. Comparison of pre- and postoperative videolaryngoscopic findings revealed improved glottic closure in 74% of patients. Comparison between the pre- and postoperative subjective, perceptual, and objective voice analysis by the Wilcoxon matched-pair test showed a statistically significant improvement from a Voice Handicap Index mean value of 46 (preoperative) to 21 (postoperative); an improvement for each parameter of the GRBAS scale with statistically significant differences for G, B, A, and S, while R showed only an improving trend; and statistically significant improvement in the mean values of Jitter, Shimmer, Noise to Harmonic Ratio, and Maximum Phonation Time. In conclusion, the different delayed phonosurgical procedures herein used demonstrate the possibility to improve vocal outcomes after total and extended cordectomies in selected and highly motivated patients that have not achieved satisfactory performance after prolonged and intensive speech therapy.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 11/2007; 264(10):1185-90. · 1.29 Impact Factor
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ABSTRACT: Treatment of glottic cancer by CO(2) laser endoscopic cordectomies can be associated with poor vocal outcome when the excision is extended beyond the superficial part of the thyro-arytenoid muscle. Different phonosugical techniques have been described in order to improve postoperative vocal outcome in patients undergoing this type of surgery. We herein present a new device for augmentation of residual vocal cord by video-endoscopic assisted primary intracordal autologous fat injection (PIAFI) performed at the end of transmuscular cordectomy. Twenty-four patients underwent transmuscular cordectomy and PIAFI for Tis and T1a glottic cancer. Eight cc of abdominal fat were obtained during the endoscopic procedure and processed. Infusion of intact parcels of fat tissue was performed to maximally reduce its resorption. PIAFI was performed in the residual vocal cord obtaining its immediate medialization, using a new device that permitted modulated (0.5 cc per click) injection. Fourteen patients were submitted to postoperative voice evaluation including subjective, perceptual, and objective assessment. The results were compared with those of 24 patients treated by transmuscular (Type III) cordectomy without subsequent PIAFI. No complications were observed as a result of PIAFI and the procedure did not significantly prolong overall surgical time. All patients were discharged the day after surgery. Comparison of vocal outcomes according to the Mann-Whitney and Wilcoxon tests showed a positive trend for patients submitted to PIAFI in terms of subjective and objective analysis. By contrast, a statistically significant improvement was reached in terms of perceptual analysis when comparing patients treated by Type III cordectomy alone with those submitted to this kind of procedure followed by PIAFI.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 11/2007; 264(10):1179-84. · 1.29 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Major glottic incompetence is often encountered after total (Type IV) and extended (Type V) cordectomies and is responsible
for poor vocal outcome. Even though the vast majority of patients do not complain of significant limitations in daily life,
a selected number of them eventually require some sort of phonosurgical treatment in order to improve voice quality. Different
techniques have been described in the literature to ameliorate long-term vocal outcome. The aim of the present report was
to retrospectively describe our experience in this challenging clinical scenario. Between April 1999 and March 2005, 24 patients
previously treated by Type IV–V endoscopic cordectomies for T1 and T2 glottic cancer presented unsatisfactory vocal outcome
in spite of intensive speech therapy and therefore underwent some form of phonosurgical treatment at our Department after
at least 12months without evidence of local-regional recurrence. Patients were treated by medialization thyroplasty with
a Montgomery System Implant (two cases), Gore-Tex strips (16 cases), medialization thyroplasty with Gore-Tex associated with
anterior commissure laryngoplasty (three cases), and augmentation with Vox Implant injection (three cases). Nineteen patients
had comprehensive evaluation by videolaryngoscopic examination and subjective, perceptual, and objective voice analysis both
in the pre-phonosurgical treatment period and after at least 12months. Comparison of pre- and postoperative videolaryngoscopic
findings revealed improved glottic closure in 74% of patients. Comparison between the pre- and postoperative subjective, perceptual,
and objective voice analysis by the Wilcoxon matched-pair test showed a statistically significant improvement from a Voice
Handicap Index mean value of 46 (preoperative) to 21 (postoperative); an improvement for each parameter of the GRBAS scale
with statistically significant differences for G, B, A, and S, while R showed only an improving trend; and statistically significant improvement in the mean values of Jitter, Shimmer, Noise to
Harmonic Ratio, and Maximum Phonation Time. In conclusion, the different delayed phonosurgical procedures herein used demonstrate
the possibility to improve vocal outcomes after total and extended cordectomies in selected and highly motivated patients
that have not achieved satisfactory performance after prolonged and intensive speech therapy.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 09/2007; 264(10):1185-1190. · 1.29 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Treatment of glottic cancer by CO2 laser endoscopic cordectomies can be associated with poor vocal outcome when the excision is extended beyond the superficial
part of the thyro-arytenoid muscle. Different phonosugical techniques have been described in order to improve postoperative
vocal outcome in patients undergoing this type of surgery. We herein present a new device for augmentation of residual vocal
cord by video-endoscopic assisted primary intracordal autologous fat injection (PIAFI) performed at the end of transmuscular
cordectomy. Twenty-four patients underwent transmuscular cordectomy and PIAFI for Tis and T1a glottic cancer. Eight cc of
abdominal fat were obtained during the endoscopic procedure and processed. Infusion of intact parcels of fat tissue was performed
to maximally reduce its resorption. PIAFI was performed in the residual vocal cord obtaining its immediate medialization,
using a new device that permitted modulated (0.5cc per click) injection. Fourteen patients were submitted to postoperative
voice evaluation including subjective, perceptual, and objective assessment. The results were compared with those of 24 patients
treated by transmuscular (Type III) cordectomy without subsequent PIAFI. No complications were observed as a result of PIAFI
and the procedure did not significantly prolong overall surgical time. All patients were discharged the day after surgery.
Comparison of vocal outcomes according to the Mann–Whitney and Wilcoxon tests showed a positive trend for patients submitted
to PIAFI in terms of subjective and objective analysis. By contrast, a statistically significant improvement was reached in
terms of perceptual analysis when comparing patients treated by Type III cordectomy alone with those submitted to this kind
of procedure followed by PIAFI.
Archiv für Klinische und Experimentelle Ohren- Nasen- und Kehlkopfheilkunde 09/2007; 264(10):1179-1184. · 1.29 Impact Factor
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ABSTRACT: To evaluate the prevalence of sublevel IIB lymph node (LN) metastases for head and neck primary tumors in a large cohort of patients.
Prospective study.
One referral university hospital and 2 national institutes of oncology.
Between 2003 and 2005, 297 patients (male to female ratio, 3.5:1; mean age, 58.8 years [range, 18-89 years]) affected by head and neck cancer were treated by surgery on the primary tumor and/or the neck. Primary site distribution included the following: oral cavity in 111 patients, larynx in 92, oropharynx in 32, thyroid gland in 22, skin of the lateral face or scalp in 16, hypopharynx in 11, unknown primary in 7, and parotid gland in 6. Sublevel IIB was evaluated for the number of LNs and pathologic N (pN) status.
All patients underwent unilateral or bilateral neck dissection (ND) with therapeutic or elective intent according to the primary site and clinical T (cT) and clinical N (cN) status. Sublevel IIB was selectively dissected at the beginning of ND, labeled, and processed independently.
The distribution of metastases among the different levels was analyzed. The influence of several factors (institution in which the surgical procedure was performed, sex of the patient, site of primary, histotype, pathologic T [pT] status, cN status, lower level involved in the neck together with sublevel IIB, association with sublevel IIA metastasis, ipsilateral number of involved levels, and previous surgical treatment limited on the primary site) on the prevalence of sublevel IIB metastasis was statistically evaluated by the Pearson chi(2) test or Fisher exact test.
A total of 443 NDs were performed (unilateral in 151 patients and bilateral in 146). Among the patients, the tumors were staged cN0/pN0 in 27%, cN+/pN+ in 50%, cN+/pN0 in 7%, and cN0/pN+ in 16%. The mean number of LNs collected at sublevel IIB was 5.4 (range, 0-24). The overall prevalence of sublevel IIB metastases was 5.6% (26 neck sides). Tumor histologic type in the sublevel IIB+ population was squamous cell carcinoma in 80%, papillary carcinoma in 8%, melanoma in 8%, and adenocarcinoma in 4%. The chi(2) test showed a significantly higher risk for LN metastases at sublevel IIB in patients affected by parotid gland primary tumors (33%), tumors of the skin or scalp (25%), unknown primary tumors (14%), and cancers of the oral cavity (10%) (P = .02) and in those clinically staged as cN+ (P < .001).
Sublevel IIB dissection is strongly recommended for all patients with cN+ tumors and in those affected by tumor of the parotid gland, skin, and scalp scheduled for elective ND. Patients affected by laryngeal cancer scheduled for elective ND can be considered the ideal candidates for preservation of sublevel IIB. However, whether this policy could be associated with a better functional outcome remains to be demonstrated by prospective studies on a large series of patients.
Archives of Otolaryngology - Head and Neck Surgery 09/2007; 133(9):897-903. · 1.63 Impact Factor
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ABSTRACT: Because of a better understanding of the anatomy from an endoscopic perspective, the acquisition of surgical experience, and concomitant technological advances, endoscopic resection of the anterior skull base (ASB) and overlying dura has now become a reality, opening new possibilities in the management of sinonasal malignancies. Here, the authors review a series of 62 patients, the largest reported to date, who underwent endoscopic transnasal craniectomy (ETC) and endoscopic dural repair for the management of selected sinonasal malignancies. Special emphasis is placed on the surgical technique, technical tricks, choice of materials for endoscopic dural repair, postoperative management, and complications.
From 2004, 62 patients underwent ETC at two referral hospitals, which extended anteroposteriorly from the frontal sinus to planum sphenoidale and laterolaterally from the nasal septum to the lamina papyracea (unilateral resection, n = 28; 45%) or from papyracea to papyracea (bilateral resection, n = 34; 55%). Duraplasty with a three-layer technique was performed using the iliotibial tract and fat tissue.
The most frequent histotypes were adenocarcinoma (58%) and olfactory neuroblastoma (22%). Forty-five (73%) patients were previously untreated. The incidence of early (T1-2, Kadish A-B) and advanced (T3-4, Kadish C) tumors was similar. The complication rate was 15%, mostly cerebrospinal fluid leaks (13%). Its prevalence did not correlate with patient age, medical comorbidities, previous treatment, presence of ASB involvement, or whether ETC was mono- or bilateral, but tended to correlate with advanced tumor stage, dural involvement, and the period of treatment. After a mean follow-up of 17.5 months (range, 1-54 months), 58 (94%) patients had no evidence of disease.
In correctly selected patients with sinonasal tumors involving the ASB, ETC offers a less invasive alternative than resection by an open approach with an acceptable morbidity.
American Journal of Rhinology and Allergy 24(1):60-5.
