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ABSTRACT: To present a case of mucosal melanoma of the Eustachian tube with a focus on surgical technique and to review the literature on treatment of mucosal melanoma of the head and neck, and review cases involving the middle ear and/or Eustachian tube.
A 67-year-old man was diagnosed with mucosal melanoma of the middle ear and Eustachian tube.
The patient underwent primary surgical resection including transtemporal/transpetrosal approach, endoscopic nasopharyngectomy, infratemporal fossa dissection, temporomandibular joint resection, ipsilateral neck dissection (levels II-IV), and superficial parotidectomy.
The patient was discharged on postoperative Day 7 with a very good functional status. He did have early dysphagia and dysarthria as a result of the VII to XII anastomosis for facial nerve reconstruction, which did require PEG tube placement. However, at 4 months after surgery, the patient was eating solid foods and returning to normal activities. He received radiation therapy postoperatively. There has been no evidence of tumor recurrence at 8 months after treatment.
The standard treatment of head and neck mucosal melanoma is primarily surgical. Surgical removal of mucosal melanoma in the Eustachian tube/middle ear can present challenges in achieving microscopically negative margins. However, gross tumor resection with postoperative radiotherapy has been shown to improve locoregional control.
Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 12/2011; 33(2):239-43. · 1.44 Impact Factor
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ABSTRACT: To review our preliminary experience with diagnostic and therapeutic sialendoscopy for the management of non-neoplastic disorders of the salivary gland.
Retrospective chart review.
Thirty-three consecutive patients undergoing 36 sialendoscopy procedures performed at a tertiary medical center from July 2008 to July 2010 were included.
The mean age of presentation was 43 years (range, 7-74 years), and 61% of patients were male. Indications included sialolithiasis (47%; 17 of 36), recurrent sialadenitis (44%, 16 of 36), and Sjögren's syndrome (8%; three of 36). Successful endoscopy was performed in 97% (35 of 36). A papillotomy for access was necessary in 25% (nine of 36). In patients with sialolithiasis (n = 17), the mean size of the stones was 7.3 mm (range, 1-20 mm). Complete stone removal was achieved in 76% (13 of 17) of cases. Endoscopic stone removal was possible in 29% (five of 17), and a combined approach technique was required in 47% (eight of 17). Seventy-two percent (26 of 36) of patients had complete resolution of symptoms after sialendoscopy, with 19% (seven of 36) having partial resolution of symptoms. Patients with partial improvement of symptoms had a mean duration of improvement of 4.7 months. The overall complication rate was 22% (eight of 36). The major and minor complication rates were 3% (one of 36) and 19% (seven of 36), respectively.
Sialendoscopy is safe and effective in managing non-neoplastic salivary gland disorders with low rates of major complications. Knowledge of options to navigate the rate-limiting steps, like dilation of the papilla and careful case selection, are key to successful outcomes.
The Laryngoscope 02/2011; 121(2):299-303. · 1.75 Impact Factor
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ABSTRACT: Our aim was to survey the factors affecting access to cancer care in patients with head and neck cancer after Hurricane Katrina.
In this cross-sectional survey, 207 patients with head and neck cancer were identified post-Hurricane Katrina, but only 83 patients completed the questionnaires and were analyzed. Clinical, demographic, and socioeconomic data were recorded. Chi-square test and t test were used for comparisons.
Patients who felt that there was a lack of access to cancer care would have sought treatment earlier had they had better access to cancer care (chi-square[1] = 32; p < .0001). Patients who felt that there was a lack of access to cancer care also had difficulty receiving treatment (chi-square[1] = 48; p < .0001). Availability of transportation affected access to cancer care in patients with early-stage cancers (chi-square[1] = 4; p < .035).
In the postdisaster environment, patients who felt the lack of access to cancer care post-Hurricane Katrina would have sought treatment earlier with better access to cancer care. These patients also reported difficulty obtaining cancer treatment. Availability of transportation affected access to cancer care in patients with early-stage cancers. Clinical, demographic, and socioeconomic factors did not influence access to cancer care.
Head & Neck 01/2011; 33(1):37-44. · 2.40 Impact Factor
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Bridget Loehn MD,
Anna M. Pou MD,
Daniel W. Nuss MD,
Justin Tenney MD,
Andrew McWhorter MD,
Michael DiLeo MD,
Anagha C. Kakade MSC, DBM, PDCR,
Rohan R. Walvekar MD,
Bridget Loehn,
Anna M. Pou, Daniel W. Nuss,
Justin Tenney,
Andrew McWhorter,
Michael DiLeo,
Anagha C. Kakade,
Rohan R. Walvekar
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ABSTRACT: Background
Our aim was to survey the factors affecting access to cancer care in patients with head and neck cancer after Hurricane Katrina.Methods
In this cross-sectional survey, 207 patients with head and neck cancer were identified post–Hurricane Katrina, but only 83 patients completed the questionnaires and were analyzed. Clinical, demographic, and socioeconomic data were recorded. Chi-square test and t test were used for comparisons.ResultsPatients who felt that there was a lack of access to cancer care would have sought treatment earlier had they had better access to cancer care (chi-square[1] = 32; p < .0001). Patients who felt that there was a lack of access to cancer care also had difficulty receiving treatment (chi-square[1] = 48; p < .0001). Availability of transportation affected access to cancer care in patients with early-stage cancers (chi-square[1] = 4; p < .035).Conclusion
In the postdisaster environment, patients who felt the lack of access to cancer care post–Hurricane Katrina would have sought treatment earlier with better access to cancer care. These patients also reported difficulty obtaining cancer treatment. Availability of transportation affected access to cancer care in patients with early-stage cancers. Clinical, demographic, and socioeconomic factors did not influence access to cancer care. © 2010 Wiley Periodicals, Inc. Head Neck, 2011
Head & Neck 12/2010; 33(1):37 - 44. · 2.40 Impact Factor
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ABSTRACT: The objectives are to evaluate the applicability of the Pittsburgh staging system (PSS) (designed for primary temporal bone malignancies) to advanced periauricular cutaneous malignancies with temporal bone involvement and to study treatment outcomes and prognostic factors predicting recurrence-free survival. Ten patients with advanced periauricular cutaneous malignancy with temporal bone involvement were identified. Patients with primary temporal bone or parotid gland malignancies were excluded. All patients were clinically T4 at presentation by the American Joint Committee on Cancer (AJCC) staging system. Using Pittsburgh staging, six were T1 (stage I) and four were T4 (stage III). The mean follow-up was 13.6 months (3 to 24 months). Patients with basal cell carcinoma were managed with wide local excision and lateral temporal bone resection (WLE/LTBR) without adjuvant therapy. Two of three (66%) are alive and free of disease; one patient died of other causes. Treatment for squamous cell carcinoma patients involved multimodality therapy. Kaplan-Meier survival curves show a worse prognosis in terms of disease-specific survival for patients with higher-staged PSS tumors. This did not reach statistical significance. The PSS may provide additional prognostic information on advanced cutaneous malignancies of the temporal bone over the more widely used AJCC staging system. However, further prospective multicenter studies with larger sample size are required to validate our findings. Basal cell carcinoma was well controlled with WLE/LTBR alone without adjuvant therapy, whereas squamous cell carcinoma required multimodality therapy: WLE/LTBR and postoperative radiation with or without chemotherapy.
Skull Base 11/2010; 20(6):409-14. · 0.66 Impact Factor
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ABSTRACT: In recent years, there has been a surge of interest in developing alternative surgical approaches to the thyroid gland with a focus on cosmesis. Approaches can be either complete endoscopic approaches using CO(2) insufflation or endoscopy-assisted approaches. We describe a novel approach for thyroidectomy via a retro-auricular incision without gas insufflation using endoscopic assistance.
Six fresh human cadavers were utilized. Four head and neck specimens were used to assess the retro-auricular approach and the creation of surgical space in the lower neck. Three hemithyroidectomy in two fresh human cadavers procedures were performed via a retro-auricular approach. The end-point of the study was successful removal of the hemithyroid gland with preservation of the recurrent laryngeal nerve.
In all cases, the retro-auricular flap and subplatysmal plane could be achieved without difficulty. Three hemithyroid specimens were successfully removed in two cadaveric specimens using the retro-auricular approach with endoscopic guidance. Thyroid gland resection with identification and preservation of the recurrent laryngeal nerve could be achieved in all three procedures (100%).
The retro-auricular approach or the "Walvekar approach" permits adequate working space and an excellent endoscopic surgical view for removal of the ipsilateral hemithyroid gland with an option for a bilateral approach using a "gasless technique."
Surgical Endoscopy 11/2010; 24(11):2895-9. · 4.01 Impact Factor
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ABSTRACT: Surgical excision of the submandibular gland (SMG) is commonly indicated in patients with neoplasms, and non-neoplastic conditions such as chronic sialadenitis, sialolithiasis, ranula and drooling. Traditional SMG surgery involves a direct transcervical approach. In the recent past, alternative approaches to SMG excision have been described in effort to offer minimally invasive options or better cosmetic results. The purpose of this article is to describe the surgical approaches to the SMG and present relevant surgical anatomy via cadaveric dissection and a systematic review of literature to compare and contrast each technique.
Cadaveric dissection with fresh human cadaver heads followed by a review of the literature.
Cadaver heads were dissected via both the transcervical and transoral approaches to the submandibular gland with the use of endoscopic assistance when indicated. Key landmarks and anatomic relationships were recorded via photo documentation. A review of the literature was conducted using a Medline search for approaches to SMG excision, including indications, results and complications.
While the traditional SMG excision remains a direct transcervical approach, many other methods of excision are described that include open, endoscopic, and robot assisted resections. The approaches vary from being transcervical, submental, transoral or retroauricular.
Alternative approaches to the SMG are feasible but should be tailored to the individual patient based on factors such as pathology, patient preferences, availability of technology, and the experience and skill of the surgeon.
International journal of surgery (London, England) 09/2009; 7(6):503-9.
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ABSTRACT: Objectives: 1. Case report of foreign body and associated orbitoethmoid and skull base mucocele following orbital blowout fracture repair. 2. Literature review of orbital fracture repair complications and endoscopic removal of paranasal sinus and anterior skull base foreign body. Design: Case report and literature review. Setting: Tertiary-care academic otolaryngology practice. Results: Foreign body involvement of the orbit, paranasal sinuses, and skull base are relatively rare entities. In contrast, orbital blowout fractures are relatively common facial fractures. We report skull base involvement of a previously placed orbital floor implant complicated by mucocele formation and exophthalmos. Successful endoscopic removal and decompression of foreign body and associated mucocele were accomplished. Review of orbital floor fracture repair complications and paranasal sinus and skull base foreign body endoscopic removal were also performed. Conclusions: Transnasal endoscopic removal of complicated foreign bodies involving the orbit, paranasal sinuses, and anterior skull base can be successfully accomplished given appropriate patient selection and careful technique.
Skull Base Surgery 12/2008; 18(6):417-22. · 0.66 Impact Factor
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ABSTRACT: To discuss disaster planning, didactic reorganization, and clinical realignments useful in rebuilding academic otolaryngology residency programs after disaster.
We describe our reorganization and analysis of objective measures in resident education before and after Hurricane Katrina. Post-Katrina, the number of full-time faculty and part-time clinical instructors/gratis faculty has decreased (4 vs 9 and 36 vs 43, respectively), but the number of part-time LSU faculty (private-academic partnership) has increased (0 vs 3) with overall improved resident supervision. Resident complement decreased by 9.3%. Surgical case loads are essentially unchanged. Reorganization of the didactic schedule has increased attendance and maintained examination scores above national averages. Establishment of two new practice sites provided an adequate number of patients for residency training.
Poststorm reorganization has maintained or exceeded pre-Katrina performance standards. Establishment of communication and data retrieval proved irreplaceable and demand advance preparation.
Otolaryngology Head and Neck Surgery 04/2008; 138(3):394-7. · 1.72 Impact Factor
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ABSTRACT: To report the loss of reflex tearing after surgical treatment of juvenile nasopharyngeal angiofibroma (JNA).
A retrospective case series of 8 patients with surgical extirpation of JNA from 1995 to 2003 in a major teaching hospital setting was studied for symptomatic xerophthalmia.
One patient was lost to follow-up. Four of the remaining 7 patients reported a dry ipsilateral eye after surgical treatment of JNA.
The location of the pterygopalatine ganglion and its associated fibers in the pterygopalatine fossa is directly adjacent to the location of origin of JNA. Lacrimal innervation passes through the pterygopalatine ganglion. Given the extensive nature of advanced JNA and mandate for complete surgical excision, lacrimal dysfunction should be considered an expected consequence of surgery.
The loss of reflex tearing has not been reported as a consequence of JNA or its surgical treatment. EBM Rating: C.
Otolaryngology Head and Neck Surgery 11/2005; 133(4):605-10. · 1.72 Impact Factor
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ABSTRACT: Chondroblastoma is a highly destructive tumor, derived from immature cartilage cells, typically occurring in epiphyses of the long bones of adolescents and young adults. Those occurring in the temporal bone and TMJ area are likely to mimic TMJ symptoms. This report describes a unique case in which a chondroblastoma resulted in extensive destruction of the temporal bone, temporomandibular joint, mandibular condyle, and cranial base, including gross intracranial and extracranial involvement. With appropriate surgical management, the outcome for patients with chondroblastoma of the temporomandibular region is quite favorable. This case brings the total reported chondroblastomas to 59 in the temporal bone and eight in the mandibular condyle as of the date of submission of this article for publication.
Cranio: the journal of craniomandibular practice 05/2004; 22(2):160-8. · 0.66 Impact Factor
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ABSTRACT: Angiofibromas are uncommon vascular tumors with a strong predilection for the nasopharynx of adolescent males. Although they are slow growing and histologically benign, they have the potential to cause significant morbidity with laryngeal involvement.
We describe the clinical characteristics, histopathologic findings, differential diagnosis, preoperative evaluation, and management of a case of laryngeal angiofibroma.
The patient was initially seen with a 2 1/2-year history of progressive dyspnea and dysphagia. Preoperative evaluation suggested a vascular mass involving the left supraglottic larynx. A partial laryngopharyngectomy was performed without complication. The patient is alive and disease free 3 years postoperatively. Final histopathologic diagnosis is consistent with angiofibroma.
Laryngeal angiofibroma is an extremely rare entity. Adequate preoperative imaging is necessary to confirm the vascularity of this lesion, because ill-planned biopsy may lead to significant blood loss. The role of preoperative embolization of other laryngeal vascular lesions has been well documented and may be useful in the management of laryngeal angiofibroma.
Head & Neck 09/2002; 24(8):805-9. · 2.40 Impact Factor
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ABSTRACT: Nasopharyngeal papillomatosis is uncommon. Access and visualization make excision difficult, increasing the risk for recurrence. We present a novel technique for excision of nasopharyngeal papillomatosis.
A case series of 3 patients with recurrent papilloma of the nasopharynx (NP) were treated with endoscopic transnasal coblation. We used an Arthrocare EVac 70 Coblator (setting: coblation-9, coagulation-5).
Using transnasal endoscopic coblation, we performed complete excision in 3 patients with recurrent papilloma of the NP (4 total procedures). There were no complications. One patient had a minor recurrence, which was successfully re-excised with the same technique.
Nasopharyngeal papillomas can be difficult to excise. Multiple techniques have been described using a transoral approach, with no reported complications. However, surgical access to the entire NP is more challenging with a transoral approach. Also, bleeding and poor visualization secondary to bleeding can be encountered with these techniques. These problems were not encountered with transnasal coblation. The absence of eschar and decreased collateral thermal damage make coblation preferable to cauterization or laser excision. This proposed technique enables more complete visualization and removal of disease, which may reduce recurrence rates.
International forum of allergy & rhinology. 1(5):405-8.
