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Gowrishankar S, Borsetto D, Marinelli J, Panizza B. Temporal bone management in external and middle ear carcinoma. Curr Opin Otolaryngol Head Neck Surg 2024; 32:138-142. [PMID: 38193562 DOI: 10.1097/moo.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review is to outline the temporal bone management of external and middle ear carcinoma. The review will outline the current evidence involved in deciding which surgical approach to take, as well as new advances in auditory rehabilitation and immunotherapy. RECENT FINDINGS Traditional surgical approaches include lateral temporal bone resection, subtotal temporal bone resection and total temporal bone resection. They can also involve parotidectomy and neck dissection depending on extension of disease into these areas. Options for auditory rehabilitation include osseointegrated hearing aids, transcutaneous bone-conduction implants, and active middle ear implants. Recent advances in immunotherapy have included the use of anti-PD-1 monoclonal antibodies. SUMMARY The mainstay of management of temporal bone disease involves surgical resection. Early-stage tumours classified according to the Pittsburgh staging tool can often be treated with lateral temporal bone resection, whereas late-stage tumours might need subtotal or total temporal bone resection. Parotidectomy and neck dissection might also be indicated if there is a risk of occult regional disease. Recent advances in immunotherapy have been promising, particularly around anti-PD-1 inhibitors. However, larger clinical trials will be required to test the extent of efficacy, particularly around combination use with surgery.
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Affiliation(s)
- Shravan Gowrishankar
- Department of Otolaryngology - Head & Neck Surgery, Cambridge University Hospitals NHS Trust
| | - Daniele Borsetto
- Department of Otolaryngology - Head & Neck Surgery, Cambridge University Hospitals NHS Trust
| | - John Marinelli
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ben Panizza
- Department of Otolaryngology - Head & Neck surgery, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Kaplan J, Lee ZH, Grome L, Yao CMKL, Mericli AF, Roubaud MS, Largo RD, Garvey PB. Sensory Outcomes for Inferior Alveolar Nerve Reconstruction with Allograft following Free Fibula Mandible Reconstruction. Plast Reconstr Surg 2023; 152:499e-506e. [PMID: 36780351 DOI: 10.1097/prs.0000000000010286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND As patient survival with head and neck cancer has improved, treatment goals have had to evolve to focus on improving quality of life. Traditionally, patients who have undergone mandibulectomy are left with an insensate chin and lower lip secondary to resection of the inferior alveolar nerve (IAN). The purpose of this study was to critically evaluate the authors' initial experience using processed nerve allografts (PNA) for IAN reconstruction following oncologic mandibulectomy and reconstruction with free fibula osteocutaneous flaps and to assess their patients' sensory outcomes. METHODS The authors performed a retrospective review of the first 32 patients who underwent immediate IAN reconstruction with PNA at the time of oncologic mandibulectomy and mandible reconstruction with free fibula osteocutaneous flaps at The University of Texas M. D. Anderson Cancer Center over a 1-year period. Semmes-Weinstein filament sensory testing was conducted at multiple surgical follow-up appointments to evaluate the quality of sensory recovery. RESULTS Thirteen of the 32 patients underwent postoperative Semmes-Weinstein filament testing. All 13 patients demonstrated partial return of sensation. At a mean follow-up of 8.33 months, the average level of sensation was 60.93% that of the unaffected side of the lower lip. CONCLUSIONS Patients were consistently afforded improvement in lower lip sensation using PNA-based IAN grafting as an adjunct to free fibula-based mandible reconstruction. The procedure adds no additional surgical morbidity and has shown consistent positive results.
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Affiliation(s)
- Jordan Kaplan
- From the Division of Plastic Surgery, Baylor College of Medicine
| | - Z-Hye Lee
- Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center
| | - Luke Grome
- From the Division of Plastic Surgery, Baylor College of Medicine
| | | | - Alexander F Mericli
- Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center
| | - Margaret S Roubaud
- Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center
| | - Rene D Largo
- Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center
| | - Patrick B Garvey
- Department of Plastic and Reconstructive Surgery, The University of Texas M. D. Anderson Cancer Center
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3
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Kim YC, Woo SH, Jeong WS, Oh TS, Choi JW. Impact of Dynamic Tongue Reconstruction on Sequential Changes of Swallowing Function in Patients Undergoing Total or Near-Total Glossectomy. Ann Plast Surg 2023; 91:257-264. [PMID: 37489967 DOI: 10.1097/sap.0000000000003629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
PURPOSE This study aimed to compare the effects of motor-innervated free flap on sequential changes of swallowing function in patients undergoing total or near-total glossectomy with laryngeal preservation. MATERIALS AND METHODS The medical charts of 21 patients who underwent tongue reconstruction after total or near-total glossectomy between April 2015 and December 2020 were retrospectively reviewed. Patients were divided into groups by reconstruction type: conventional, reconstruction using an anterolateral thigh free flap (n = 11), and dynamic, reconstruction using an anterolateral thigh with innervated vastus lateralis flap (n = 10). Demographics, surgical details, and survival outcomes were investigated. A videofluoroscopic penetration-aspiration scale and functional outcome swallowing scale were analyzed according to postoperative time courses, classified as within 6 months, 6 to 12 months, and after 12 months postoperative. A time-to-event analysis was performed for gastrostomy tube status. RESULTS The dynamic group showed improved swallowing outcomes at 6 to 12 months postoperative (dynamic vs conventional group, penetration-aspiration scale: 3 ± 1.51 vs 6 ± 1.63, P = 0.024; functional outcome swallowing scale: 1.89 ± 1.36 vs 4 ± 1.41, P = 0.009). In the multivariate analysis, the dynamic group showed a decreased probability of decompensated swallowing function at 6 to 12 months postoperative (odds ratio, 0.062; 95% confidence interval, 0.004-1.084; P = 0.057). A time-to-event analysis revealed no significant difference in gastrostomy tube status between the dynamic and the conventional group. CONCLUSIONS Considering higher mortality in patients subjected to total or near-total glossectomy, dynamic reconstruction with motor-innervated free flap is worth to perform in terms of enhancing the swallowing function within 1-year postoperative period, thereby improving the quality of life.
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Affiliation(s)
- Young Chul Kim
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, SeoulAsan Medical Center, Seoul, Korea
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Lee ZH, Ismail T, Shuck JW, Chang EI. Innovative Strategies in Microvascular Head and Neck Reconstruction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1194. [PMID: 37512006 PMCID: PMC10384542 DOI: 10.3390/medicina59071194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/13/2023] [Accepted: 06/13/2023] [Indexed: 07/30/2023]
Abstract
The field of reconstructive microsurgery has witnessed considerable advancements over the years, driven by improvements in technology, imaging, surgical instruments, increased understanding of perforator anatomy, and experience with microsurgery. However, within the subset of microvascular head and neck reconstruction, novel strategies are needed to improve and optimize both patient aesthetics and post-operative function. Given the disfiguring defects that are encountered following trauma or oncologic resections, the reconstructive microsurgeon must always aim to innovate new approaches, reject historic premises, and challenge established paradigms to further achieve improvement in both aesthetic and functional outcomes. The authors aim to provide an up-to-date review of innovations in head and neck reconstruction for oncologic defects.
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Affiliation(s)
- Z-Hye Lee
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Tarek Ismail
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, 4031 Basel, Switzerland
| | - John W Shuck
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Edward I Chang
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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5
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Hidaka T, Tanaka K, Mori H. Outcome evaluation using an artificial intelligence-based facial measurement software for facial nerve grafting in head and neck and skull base surgery. Head Neck 2023; 45:1572-1580. [PMID: 37080917 DOI: 10.1002/hed.27374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/09/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Interposition nerve grafting is an indispensable technique for facial nerve reconstruction in head and neck, and skull base surgery. The prognostic factors are inconclusive, partly due to limited objective assessment systems for facial nerve function. This study aimed to apply an artificial intelligence (AI)-based facial asymmetry measurement system to assess facial nerve grafting outcomes. METHODS We retrospectively reviewed data of 23 patients who underwent facial nerve grafting between 2011 and 2020. Oral asymmetry and synkinesis severity were measured using AI. RESULTS Oral movement recovered at 12-18 months postoperatively. Postoperative radiotherapy and a larger number of anastomosed distal stumps were significantly associated with poor and good final oral symmetry, respectively. Synkinesis severity was weakly correlated with the degree of oral movement recovery. CONCLUSIONS Oral function recovered without a strong correlation with synkinesis. Caution should be exercised in facial nerve grafting for cases with postoperative radiotherapy.
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Affiliation(s)
- Takeaki Hidaka
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kentaro Tanaka
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroki Mori
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Lee ZH, Chang EI, Hanasono MM. Management of the Facial Nerve in the Oncologic Setting. CURRENT SURGERY REPORTS 2023. [DOI: 10.1007/s40137-023-00354-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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7
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Vejbrink Kildal V, Tee R, Reissig L, Weninger WJ, Tzou CHJ, Rodriguez-Lorenzo A. Selective ansa cervicalis nerve transfer to the marginal mandibular nerve for lower lip reanimation: An anatomical study in cadavers and a case report. Microsurgery 2023; 43:142-150. [PMID: 36511397 PMCID: PMC10108162 DOI: 10.1002/micr.30992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/24/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Donor nerve options for lower lip reanimation are limited in patients undergoing oncological resection of the facial nerve. The ansa cervicalis nerve (ACN) is an advantageously situated donor with great potential but has not been examined in detail. In the current study, the anatomical technical feasibility of selective ACN to marginal mandibular nerve (MMN) transfer for restoration of lower lip tone and symmetry was explored. A clinical case is presented. METHODS Dissections were conducted in 21 hemifaces in non-embalmed human cadavers. The maximal harvestable length of ACN was measured and transfer to MMN was simulated. A 28-year-old male underwent ACN-MMN transfer after parotidectomy (carcinoma) and was evaluated 12 months post-operatively (modified Terzis' Lower Lip Grading Scale [25 observers] and photogrammetry). RESULTS The harvestable length of ACN was 100 ± 12 mm. A clinically significant anatomical variant ("short ansa") was present in 33% of cases (length: 37 ± 12 mm). Tensionless coaptation was possible in all cases only when using a modification of the surgical technique in "short ansa" cases (using an infrahyoid muscle nerve branch as an extension). The post-operative course of the clinical case was uneventful without complications, with improvement in tone, symmetry, and function at the lower lip at 12-month post-operative follow-up. CONCLUSIONS Selective ACN-MMN nerve transfer is anatomically feasible in facial paralysis following oncological ablative procedures. It allows direct nerve coaptation without significant donor site morbidity. The clinical case showed good outcomes 12 months post-operatively. A strategy when encountering the "short ansa" anatomical variant in clinical cases is proposed.
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Affiliation(s)
- Villiam Vejbrink Kildal
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Richard Tee
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Lukas Reissig
- Division of Anatomy, Medical University of Vienna, Vienna, Austria
| | - Wolfgang J Weninger
- Division of Anatomy, Medical University of Vienna, Vienna, Austria.,BioImaging Austria (CMI), Vienna, Austria
| | - Chieh-Han John Tzou
- Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior (Krankenhaus Goettlicher Heiland), Vienna, Austria.,Faculty of Medicine, Sigmund Freud University, Vienna, Austria.,Facial Palsy Center, TZOU Medical, Vienna, Austria
| | - Andrés Rodriguez-Lorenzo
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden.,Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Kenny HL, Jonas RH, Oyer SL. Postoperative Radiotherapy and Facial Nerve Outcomes Following Nerve Repair: A Systematic Review. Otolaryngol Head Neck Surg 2023; 168:1346-1352. [PMID: 36939391 DOI: 10.1002/ohn.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/12/2022] [Accepted: 11/19/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To compare outcomes of facial nerve repair or grafting following facial nerve-sacrificing procedures among patients treated with and without postoperative radiotherapy (RT). DATA SOURCES PubMed, OVID, Conference Papers Index, Cochrane Library, ClinicalTrials.gov. REVIEW METHODS Databases were searched using terms including "facial nerve," "graft," "repair," and "radiotherapy." Abstracts mentioning facial nerve repair and evaluation of facial nerve function were included for full-text review. Studies that utilized the House-Brackmann or similar validated scale for evaluation of postoperative facial nerve function were selected for review. All identified studies were included in a pooled t test analysis. RESULTS Twelve studies with 142 patients were included in the systematic review. All 12 studies individually demonstrated no significant difference in facial nerve outcomes between patients who received postoperative radiation and patients who did not. A pooled t test of data from all studies also demonstrated no significant difference in postoperative facial nerve function between the postoperative RT and non-RT groups (t stat = 0.92, p = .36). CONCLUSION This analysis, including 12 studies, demonstrated that among patients undergoing facial nerve grafting or repair, there was no significant difference in postoperative facial nerve function between postoperative RT and non-RT patients. Due to the small sample size and variability in study methods, further studies directly comparing outcomes between patients with and without postoperative RT would be beneficial.
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Affiliation(s)
- Hannah L Kenny
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Rachel H Jonas
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Samuel L Oyer
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
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The combined profunda artery perforator‐gracilis flap for immediate facial reanimation and resurfacing of the radical parotidectomy defect. Microsurgery 2022; 43:309-315. [PMID: 36541252 DOI: 10.1002/micr.30997] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND A radical parotidectomy with facial nerve sacrifice results in facial nerve paralysis as well as a volume and often cutaneous defect. Prior experience with nerve grafting and static suspension has yielded suboptimal results. The present report aims to examine the feasibility and outcomes of a combined free gracilis and profunda artery perforator (PAP) flap from a single donor site can reconstruct these extensive defects and potentially restore dynamic facial reanimation even in the setting of adjuvant radiation. PATIENTS AND METHODS A retrospective review of 10 patients (6 males and 4 females) was performed from 2016 to 2020 that underwent a combined PAP-gracilis reconstruction of a radical parotidectomy defect. All patients (mean age: 71.3 years; range: 52-83 years) received adjuvant radiation. A chimeric PAP-gracilis flap requiring a single microvascular anastomosis was performed in three patients while the remaining patients underwent a double free flap reconstruction. RESULTS The gracilis flap was innervated using the facial nerve stump, spinal accessory and massecteric nerve in three patients each. One patient's gracilis was innervated using the hypoglossal nerve. Three patients also underwent nerve grafting of the facial nerve. One patient was taken back to the operating room for a hematoma in the recipient site and there were not flap losses of either the PAP or gracilis flap. Two patients had delayed wound healing of the donor site that healed with conservative management. Average follow-up was 11.1 months (range: 8.1-19.5 months). Six patients were able to achieve dynamic animation while the others obtained a static reconstruction and did not have issues with drooling, eating, or speaking. CONCLUSIONS Immediate functional muscle transfer can potentially restore dynamic facial reanimation even following radiation. Combining reconstruction using a PAP-gracilis flap addresses the soft tissue deficit and facial paralysis using a single donor site in a single operation.
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10
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Choi JW, Kim YC, Park HJ, Oh TS, Jeong WS. The impact of dynamic tongue reconstruction using functional muscle transfer: A retrospective review of 94 cases with functional outcome analysis for various glossectomy defects. J Craniomaxillofac Surg 2022; 50:719-731. [DOI: 10.1016/j.jcms.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 07/09/2022] [Accepted: 07/16/2022] [Indexed: 10/16/2022] Open
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Prevalence of occult nodal metastases in squamous cell carcinoma of the temporal bone: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:5573-5581. [PMID: 35562514 PMCID: PMC9649468 DOI: 10.1007/s00405-022-07399-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/07/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Primary: To determine the rate of occult cervical metastases in primary temporal bone squamous cell carcinomas (TBSSC). Secondary: to perform a subgroup meta-analysis of the risk of occult metastases based on the clinical stage of the tumour and its risk based on corresponding levels of the neck. METHODS A systematic review and meta-analysis of papers searched through Medline, Cochrane, Embase, Scopus and Web of Science up to November 2021 to determine the pooled rate of occult lymph node/parotid metastases. Quality assessment of the included studies was assessed through the Newcastle-Ottawa scale. RESULTS Overall, 13 out of 3301 screened studies met the inclusion criteria, for a total of 1120 patients of which 550 had TBSCC. Out of the 267 patients who underwent a neck dissection, 33 had positive lymph nodes giving a pooled rate of occult metastases of 14% (95% CI 10-19%). Occult metastases rate varied according to Modified Pittsburg staging system, being 0% (0-16%) among 12 pT1, 7% (2-20%) among 43 pT2 cases, 21% (11-38%) among 45 pT3, and 18% (11-27%) among 102 pT4 cases. Data available showed that most of the positive nodes were in Level II. CONCLUSION The rate of occult cervical metastases in TBSCC increases with pathological T category with majority of nodal disease found in level II of the neck.
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Thielker J, Wahdan A, Buentzel J, Kaftan H, Boeger D, Mueller AH, Wittig A, Schultze-Mosgau S, Ernst T, Guntinas-Lichius O. Long-Term Facial Nerve Outcome in Primary Parotid Cancer Surgery: A Population-Based Analysis. Laryngoscope 2021; 131:2694-2700. [PMID: 34050959 DOI: 10.1002/lary.29666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVES/HYPOTHESIS To determine immediate postoperative and long-term facial nerve dysfunction after parotid cancer surgery, risk factors, and the role of facial reanimation surgery. STUDY DESIGN Population-based long-term analysis for all new primary parotid carcinoma cases in Thuringia from 1996 to 2019. METHODS Data of the cancer registries of Thuringia, a federal state in Germany, were analyzed in combination with hospital-based data on facial function. RESULTS About 477 patients (42.3% women; median age: 68 years) were included. It was observed that 6.7% had a preoperative facial nerve dysfunction, 11.7% received a radical parotidectomy, that is, that 5% had a normal preoperative facial function but needed radical surgery because of intraoperative detection of tumor infiltration into the facial nerve. About 10.2% received facial nerve reconstruction surgery. Immediate postoperative facial nerve dysfunction in the other patients was observed in 34.4% of the patients. Advanced T classification (odds ratio [OR] = 2.140; confidence interval [CI] = 1.268-3.611; P = .004) and neck dissection (OR = 2.012; CI = 1.027-3.940; P = .041) were independent risk factors for immediate postoperative facial nerve dysfunction. In addition, 22.0% showed no recovery during follow-up. Advanced T classification (OR = 2.177; CI = 1.147-4.133; P = .017) and postoperative radiotherapy (OR = 2.695; CI = 1.244-5.841; P = .012) were independent risk factors for permanent postoperative facial nerve dysfunction. CONCLUSION Patients with primary parotid cancer are at high risk for long-term facial nerve dysfunction. It seems that the possibilities of facial reanimation surgery needs to be utilized even more effectively. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Jovanna Thielker
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Ali Wahdan
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Jens Buentzel
- Department of Otorhinolaryngology, Suedharzklinikum Nordhausen, Nordhausen, Germany
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum Erfurt, Erfurt, Germany
| | - Daniel Boeger
- Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, Suhl, Germany
| | - Andreas H Mueller
- Department of Otorhinolaryngology, SRH Wald-Klinikum Gera, Gera, Germany
| | - Andrea Wittig
- Department of Radiotherapy and Radiation Oncology, Jena University Hospital, Jena, Germany
| | - Stefan Schultze-Mosgau
- Department of Oromaxillofacial Surgery and Plastic Surgery, Jena University Hospital, Jena, Germany
| | - Thomas Ernst
- University Tumor Center, Jena University Hospital, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
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Alam U, Shafqat I, Ahsan S, Alonso J, Han AY, Mukdad L, Wang M, Ahsan SF. Survival in Middle Ear Malignancy: A Population-Based Analysis Based on the SEER Database. Otolaryngol Head Neck Surg 2021; 165:122-128. [PMID: 33400624 DOI: 10.1177/0194599820980708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the clinical features and survival outcomes of patients with middle ear malignancies at a population level. STUDY DESIGN Retrospective cohort study with data from a national database. SETTING National database of middle ear malignancy. METHODS Records of patients diagnosed with a middle ear malignancy from 1973 to 2016 were extracted from the SEER database (Surveillance, Epidemiology, and End Results). SPSS (version 27; IBM) was used to conduct 5-year survival analysis. RESULTS The average survival for all 431 patients was 61.4 months. Five-year disease-specific survival for squamous cell carcinoma (SCCA), adenocarcinoma, other carcinoma, and noncarcinoma subtypes varied significantly at 54.6%, 82.1%, 71.8%, and 82.6%, respectively (P < .0001). There was an improved 5-year survival for patients with adenocarcinoma who received surgery versus those who did not (91.7% vs 65.1%; P = .023, log-rank). Five-year disease-specific survival was significantly better in patients aged <55 years (mean ± SD, 77.8% ± 0.39%) as compared with those >70 years (55.1% ± 5.1%) and those aged 55 to 69 years (60.2% ± 4.9%; P < .01 and P < .001, respectively, log-rank). Patients with SCCA were significantly older than those with adenocarcinoma (P < .0001). Noncarcinoma subtypes were more likely to present with local disease, as opposed to regional or distant disease, when compared with SCCA (P = .0027). CONCLUSION Prognosis and treatment outcomes for primary middle ear malignancies depend on histologic subtype and age at diagnosis. The noncarcinoma and adenocarcinoma subtypes carry the best prognoses. Patients with adenocarcinoma were most likely to benefit from surgery.
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Affiliation(s)
- Usman Alam
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Iram Shafqat
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Sara Ahsan
- University of California, Berkeley, California, USA
| | - Jose Alonso
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Albert Y Han
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Laith Mukdad
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Marilene Wang
- Department of Head and Neck Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Syed F Ahsan
- Department of Head and Neck Surgery, Kaiser Permanente, Anaheim, California, USA.,Department of Otolaryngology-Head and Neck Surgery, University of California-Irvine, Irvine, California, USA
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14
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Chimeric Anterolateral Thigh Flap for Primary Functional Reconstruction of Complex, Composite Near Total Hemi Facial Post Excision Defects. J Craniofac Surg 2020; 31:e337-e343. [PMID: 32168125 DOI: 10.1097/scs.0000000000006276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Microvascular free tissue transfer has revolutionized the management of complex composite head and neck defects. AIM To evaluate the functional and aesthetic outcomes in the primary reconstruction of post-excisional near total hemifacial defects with the chimeric anterolateral thigh flaps (cALT). MATERIALS AND METHODS The author as a prelude to this clinical study has done a cadaveric study on the quadriceps artery angiosome. In this retrospective cohort study, data are collected from the records of 6 patients who had undergone primary cALT flap reconstruction for their post excisional near total hemifacial defects from January 2013 to December 2017. All 6 patients with various advanced malignancies involving the hemiface underwent wide local excision. Wide local excision resulted in the loss of skin and critical facial muscles that led to near total hemiface composite defects. Reconstructions were done with the cALT flaps that included segment of the vastus lateralis muscle harvested on its independent neurovascular perforator pedicle and the skin paddle on a separate perforator. In all cases, the facial nerve stumps were anastomosed to the nerve to vastus lateralis for reanimation of the face. In addition, 4 patients underwent primary radical neck dissection, but all had postoperative radiotherapy and chemotherapy. RESULTS All patients attained well-pronounced nasolabial fold, symmetrical smile, and good oral competence in an average period of 10.75 months post operatively. In an average of 22 months follow up, none of them had locoregional recurrences. None required any secondary procedures. CONCLUSION In the post excisional near total hemifacial composite defects, primary functional reconstruction with tailored cALT flaps can bring good aesthetic and functional results.
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Yi CR, Oh TM, Jeong WS, Choi JW, Oh TS. Quantitative analysis of the impact of radiotherapy on facial nerve repair with sural nerve grafting after parotid gland surgery. J Craniomaxillofac Surg 2020; 48:724-732. [DOI: 10.1016/j.jcms.2020.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 04/22/2020] [Accepted: 05/23/2020] [Indexed: 11/26/2022] Open
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External auditory canal carcinoma: clinical characteristics and long-term treatment outcomes. Eur Arch Otorhinolaryngol 2020; 277:2709-2720. [PMID: 32367152 DOI: 10.1007/s00405-020-06019-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/26/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Evidence-based treatment recommendations for external auditory canal (EAC) carcinoma are lacking in available literature. This study aims to evaluate the clinical characteristics and long-term outcomes of EAC carcinoma in a tertiary referral centre in a period of 15 years and identify independent prognostic factors. METHODS Retrospective observational study enrolling all patients with primary EAC carcinoma who underwent primary surgical treatment at the Portuguese Institute of Oncology (Lisbon) between 2004 and 2018. Epidemiological, clinical, histopathological and surgical data were retrieved from clinical records and analysed. RESULTS Twenty-seven patients were identified, with a median age of 77 years (range 29-92 years) and a slight female predominance (59.3%). Squamous cell carcinoma (55.6%) was the most common histological type, followed by basal cell carcinoma (40.7%) and ceruminous adenocarcinoma (3.7%). Pittsburgh tumour staging was distributed as early stage in 51.9% (I: 40.7%; II: 11.1%) and advanced stage in 48.1% (III: 29.6%; IV: 18.5%). Median follow-up period was 21 months (interquartile-range: 47). Four patients (14.8%) showed recurrence; recurrence rate was significantly higher in individuals aged < 60 years (p = 0.025) and with lymphovascular invasion (p = 0.049). Median overall survival was 88 months and estimated 2-year and 5-year overall survival rates were both 66%. Survival rates were higher in early stage patients (p = 0.021) and in those without facial palsy (p = 0.032). CONCLUSION Based on the available evidence in this review, individuals aged < 60, facial nerve impairment, advanced stage lesions, presence of lymphovascular invasion and squamous cell carcinoma histology are all associated with poor outcome and may be considered when discussing optimal treatment strategies in patients with EAC carcinoma.
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Mehta GU, Muelleman TJ, Brackmann DE, Gidley PW. Temporal bone resection for lateral skull-base malignancies. J Neurooncol 2020; 150:437-444. [PMID: 32108295 DOI: 10.1007/s11060-020-03445-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 02/25/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Malignancies involving the temporal bone are increasingly common and require specialized multi-disciplinary care. Given this complex location, involvement of the lateral skull base and local neurovascular structures is common. In this review we discuss general principles for temporal bone resection, as well as alternative and complementary surgical approaches that should be considered in the management of patients with temporal bone cancer. METHODS A comprehensive review on literature pertaining to temporal bone resection was performed. RESULTS The primary surgical strategy for malignancies of the temporal bone is temporal bone resection. This may be limited to the ear canal and tympanic membrane (lateral temporal bone resection) or may include the otic capsule and its contents (subtotal temporal bone resection), and/or the petrous apex (total temporal bone resection). Management of adjacent neurovascular structures including the facial nerve, the carotid artery, and the jugular bulb/sigmoid sinus should be considered during surgical planning. Finally, adjunctive procedures such as parotidectomy and neck dissection may be required based on tumor stage. CONCLUSIONS Temporal bone resection is an important technique in the treatment of lateral skull-base malignancies. This strategy should be incorporated into a multi-disciplinary approach to cancer.
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Affiliation(s)
- Gautam U Mehta
- Division of Neurosurgery, House Institute, 2100 West 3rd Street, Ste 111, Los Angeles, CA, USA.
| | | | | | - Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
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Contemporary Concepts of Primary Dynamic Facial Nerve Reconstruction in the Oncologic Patient. J Craniofac Surg 2020; 30:2578-2581. [PMID: 31584554 DOI: 10.1097/scs.0000000000005619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Transection of the facial nerve and its branches during extensive ablative procedures in the oncologic patient causes loss of control of facial mimetic muscles with severe functional and aesthetic sequelae. In such patients with advanced tumorous disease, copious comorbidities, and poor prognosis, rehabilitation of the facial nerve has long been considered of secondary priority. However, recent advances in primary facial nerve reconstruction after extensive resection demonstrated encouraging results focusing on rapid and reliable restoration of facial functions. The authors summarize 3 innovative approaches of primary dynamic facial nerve reconstruction by using vascularized nerve grafts, dual innervation concepts, and intra-facial nerve transfers.
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Lovin BD, Gidley PW. Squamous cell carcinoma of the temporal bone: A current review. Laryngoscope Investig Otolaryngol 2019; 4:684-692. [PMID: 31890889 PMCID: PMC6929568 DOI: 10.1002/lio2.330] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The rarity of temporal bone squamous cell carcinoma (TBSCC) precludes a clear understanding of the disease and approach to its management. This review provides general background on the disease and discusses the current and emerging oncologic and rehabilitative management options. DATA SOURCES PubMed literature review. METHODS A review of the current literature was conducted to assess and collate up-to-date information regarding TBSCC management. RESULTS TBSCC is a rare and aggressive disease arising in the ear canal, temporal bone, or extratemporal sites. Prior radiation, chronic ear disease, or habitual ear picking may contribute to primary disease development. Because the symptoms of TBSCC and benign otologic disease are similar, TBSCC diagnosis may be delayed, allowing the tumor time to spread throughout the anatomically intricate temporal bone. The extent of the disease is determined based on imaging and is usually staged with the Pittsburgh Staging System. Temporal bone resection with parotidectomy and neck dissection is the current standard of care. Survival is generally good for early disease and poor for advanced disease, but chemotherapy is emerging as a promising treatment option. Auditory rehabilitation with osseointegrated hearing aids is recommended at initial oncologic resection. CONCLUSIONS The knowledge of and outcomes for TBSCC have improved with time, but because of the aggressive nature of the disease and the anatomic intricacy of the temporal bone, TBSCC treatment is complex and should be delivered by a multidisciplinary team. Inter-institutional collaboration may accelerate research for this rare disease. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Benjamin D. Lovin
- Bobby R. Alford Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexas
| | - Paul W. Gidley
- Department of Head and Neck SurgeryThe University of Texas MD Anderson Cancer CenterHoustonTexas
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Abstract
BACKGROUND The facial nerve and its branches are at risk of injury during dermatologic surgery. Few publications in the dermatologic literature discuss facial nerve injury and management. OBJECTIVE To review facial nerve injury and management, including static and dynamic repair techniques, and to review outcomes in facial nerve reconstruction. METHODS Two detailed literature reviews were performed using PubMed. First, articles reporting facial nerve injury and/or management in the dermatologic literature were identified. In addition, articles pertaining to outcomes in facial nerve reconstruction with a minimum of 20 patients were included. RESULTS Fifty-three articles reporting outcomes in facial nerve reconstruction were identified and consist of retrospective reviews and case series. Most patients achieve improvement in facial symmetry and movement with nerve repair. CONCLUSION Timing of facial nerve repair is an important consideration in management of facial nerve injury, with earlier repairs achieving better outcomes. Facial nerve repair does not result in normal facial movement, and improvements may require a year or more to be realized. Many options exist for facial nerve reconstruction, and patients with long-standing facial nerve injuries may still benefit from treatment.
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Mc Loughlin L, Gillanders SL, Smith S, Young O. The role of adjuvant radiotherapy in management of recurrent pleomorphic adenoma of the parotid gland: a systematic review. Eur Arch Otorhinolaryngol 2018; 276:283-295. [DOI: 10.1007/s00405-018-5205-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 11/09/2018] [Indexed: 02/03/2023]
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Righini S, Festa BM, Bonanno MC, Colombo V, Luca N. Dynamic tongue reconstruction with innervated gracilis musculocutaneos flap after total glossectomy. Laryngoscope 2018; 129:76-81. [DOI: 10.1002/lary.27176] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Stefano Righini
- Department of Head and Neck Oncologic and Reconstructive Surgery; San Giuseppe Hospital-Multimedica Group
| | | | | | - Valeria Colombo
- Department of Head and Neck Oncologic and Reconstructive Surgery; San Giuseppe Hospital-Multimedica Group
| | - Nicola Luca
- Department of Head and Neck Oncologic and Reconstructive Surgery; San Giuseppe Hospital-Multimedica Group
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Evidence Based Tailored Parotidectomy in Treating External Auditory Canal Carcinoma. Sci Rep 2018; 8:12112. [PMID: 30108249 PMCID: PMC6092432 DOI: 10.1038/s41598-018-30536-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 08/01/2018] [Indexed: 11/20/2022] Open
Abstract
Carcinoma of the external auditory canal (EAC) is a rare tumor and little information is available regarding parotid gland in surgically treating EAC carcinomas. This study aimed to investigate the mode of parotid involvement in EAC carcinoma through staging and histopathological analysis, and to establish surgical guidelines for the parotid gland management when there is no clinical evidence of parotid involvement. Sixty-five patients with EAC carcinoma who underwent temporal bone resection and any type of parotidectomy simultaneously were retrospectively reviewed. The rate of direct parotid invasion and parotid nodal involvement was analyzed according to the stage and histopathological findings. Among the 65 patients, 39 were confirmed to have squamous cell carcinoma (SCC) and 26 were confirmed to have adenoid cystic carcinoma (ACC). Direct parotid invasion occurred in 7 of 39 patients with SCC, only in the advanced stages, and in 15 of 26 patients with ACC, regardless of stage. Metastasis to the parotid node was noted in 6 patients with advanced-stage SCC, whereas no patient with ACC showed parotid nodal metastasis. For adequate tumor control with low risk of surgical complications, evidence based tailored parotidectomy should be applied. With no evidence of parotid involvement, an elective parotidectomy can be excluded in early SCC, whereas a total parotidectomy is recommended for advanced SCC. In ACC, basal resection of the parotid gland rather than a superficial or total parotidectomy should be performed at all disease stages.
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Muelleman T, Chowdhury NI, Killeen D, Sykes K, Kutz JW, Isaacson B, Staecker H, Lin J. Effect of Piecemeal vs En Bloc Approaches to the Lateral Temporal Bone on Survival Outcomes. Otolaryngol Head Neck Surg 2018; 158:716-720. [DOI: 10.1177/0194599818758994] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Lateral temporal bone resection (LTBR) has traditionally been performed en bloc in accordance with oncologic principles. Occasionally, this is not possible due to a low tegmen or lateralized vasculature. We sought to determine if outcomes of piecemeal and en bloc LTBR are comparable. Study Design Retrospective review. Setting Two academic medical centers. Subjects and Methods Multi-institutional retrospective cohort study. Current Procedural Terminology codes were used to identify patients with T1 to T3 squamous cell carcinoma of the external auditory canal (EAC) who underwent LTBR from 2005 to 2015. Kaplan-Meier curves were constructed to compare total survival between the 2 treatment approaches. Pairwise comparisons were performed using χ2 and Fisher exact tests (significance at P = .05), as appropriate. Results Twenty-five patients were identified. Ten patients underwent en bloc LTBR; 15 underwent piecemeal LTBR. Median follow-up time was 11 months (range, 1-60 months). There was not a significant difference in overall survival between en bloc (38.9 months; 95% confidence interval [CI], 22.7-55.2) compared to piecemeal (37.5 months; 95% CI, 21.1-53.9) procedures ( P = .519). Estimates of disease-free survival also did not reveal statistically significant differences: estimated mean disease-free survival was 48.1 months (95% CI, 33.7-62.6) in en bloc patients and 32.5 months (95% CI, 17.1-47.8) in piecemeal patients ( P = .246). Conclusion These data suggest that piecemeal resection can be considered for cases of squamous cell carcinoma involving the external auditory canal where anatomic constraints preclude a safe en bloc resection. Larger studies or studies with a longer follow-up time may provide improved insight into survival comparisons.
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Affiliation(s)
- Thomas Muelleman
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - Naweed I. Chowdhury
- Department of Otolaryngology–Head and Neck Surgery, Vanderbilt University, Nashville, Tennessee, USA
| | - Daniel Killeen
- Department of Otolaryngology–Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kevin Sykes
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - J. Walter Kutz
- Department of Otolaryngology–Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Brandon Isaacson
- Department of Otolaryngology–Head and Neck Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Hinrich Staecker
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
| | - James Lin
- Department of Otolaryngology–Head and Neck Surgery, University of Kansas, Kansas City, Kansas, USA
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Management of salivary gland malignant tumor: the Policlinico Umberto I, "Sapienza" University of Rome Head and Neck Unit clinical recommendations. Crit Rev Oncol Hematol 2017; 120:93-97. [PMID: 29198342 DOI: 10.1016/j.critrevonc.2017.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/22/2017] [Indexed: 02/07/2023] Open
Abstract
Salivary gland malignant tumor (SGMT) is a malignant disease requiring multidisciplinary approach. The rare incidence and the consequent lack of robust evidence-based medicine has called for a comprehensive update to draw recommendations for clinical practice. This paper is a summary of the XXX Head and Neck Unit guidelines regarding the management of SGMT. Recommendations include the indications for exclusive and adjuvant therapy, as well as metastatic management, for both major and minor SGMT.
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Cristóbal L, Linder S, Lopez B, Mani M, Rodríguez-Lorenzo A. Free anterolateral thigh flap and masseter nerve transfer for reconstruction of extensive periauricular defects: Surgical technique and clinical outcomes. Microsurgery 2016; 37:479-486. [PMID: 27501201 DOI: 10.1002/micr.30086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Radical tumor ablation in the periauricular area often results in extensive soft tissue defects, including facial nerve sacrifice, bone and/or dura defects. Reconstruction of these defects should aim at restoring facial reanimation, wound closure, and facial and neck contours. We present our experience using free anterolateral thigh flap (ALT) in combination with masseter nerve to facial nerve transfer in managing complex defects in the periauricular area. METHODS Between 2011 and 2015 six patients underwent a combined procedure of ALT flap reconstruction and masseter nerve transfer, to reconstruct extensive, post tumor resection, periauricular defects. The ALT flap was customized according to the defect. For smile restoration, the masseter nerve was transferred to the buccal branch of the facial nerve. If the facial nerve stump was preserved, interposition of nerve grafts to the zygomatic and frontal branches was performed to provide separate eye closure. The outcomes were analyzed by assessing wound closure, contour deformity, symmetry of the face, and facial nerve function. RESULTS There were no partial or total flap losses. Stable wound closure and adequate volume replacement in the neck was achieved in all cases, as well as good facial tonus and symmetry. The mean follow-up time of clinical outcomes was 16.8 months. Smile restoration was graded as good or excellent in four cases, moderate in one and fair in one. CONCLUSION Extensive periauricular defects following oncologic resection could be adequately reconstructed in a combined procedure of free ALT flap and masseter nerve transfer to the facial nerve for smile restoration.
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Affiliation(s)
- Lara Cristóbal
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Sora Linder
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Beatriz Lopez
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Maria Mani
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
| | - Andres Rodríguez-Lorenzo
- Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital and Department of Surgical Sciences, Uppsala University, Sweden
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Intracranial Facial Nerve Grafting in the Setting of Skull Base Tumors: Global and Regional Facial Function Analysis and Possible Implications for Facial Reanimation Surgery. Plast Reconstr Surg 2016; 137:267-278. [PMID: 26710031 DOI: 10.1097/prs.0000000000001881] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Reconstructive surgeons may encounter patients presenting after intracranial facial nerve resection and grafting in the setting of skull base tumors, who inquire regarding progression, final facial function, and need for future operations. Study goals were to analyze global and regional facial function using established grading systems and videography, while examine variables possibly affecting outcomes. METHODS Between 1997 and 2012, 28 patients underwent intracranial nerve grafting. Fifteen were prospectively evaluated by three facial nerve physical therapists with the Facial Nerve Grading System 2.0 and the Sunnybrook Facial Grading Score for function and the Facial Disability Index for quality of life. Still photographs and videography were used to assess quality of motion and tone, while demographic and medical variables were analyzed regarding their effect on end results. RESULTS Average patient age was 41.9 years (range, 22 to 66 years), and there were 10 women and five men. Average time interval between nerve grafting and evaluations was 42.9 months (range, 12 to 146 months). Both grading scores demonstrated best outcomes in the periorbita and worst outcomes in the brow. Buccinator muscle tone also improved. The average total Facial Disability Index was 67.5 percent. Although not statistically significant, the data suggest that nerve gap length affected total resting symmetry and voluntary movement, whereas preoperative palsy and age may affect total resting symmetry. Perioperative radiation therapy, tumor type, donor nerve, and coaptation technique were not found to affect outcomes. CONCLUSIONS Intracranial facial nerve grafting largely provides better resting tone and facial symmetry, potentially improving end results of future intervention; however, overall voluntary facial motion is poor. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Sánchez-Burgos R, Otero TG, Lassaletta L, Arias Gallo J, Cuellar IN, García MB. Facial nerve reconstruction following radical parotidectomy and subtotal petrosectomy for advanced malignant parotid neoplasms. Ann Maxillofac Surg 2016; 5:203-7. [PMID: 26981471 PMCID: PMC4772561 DOI: 10.4103/2231-0746.175747] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction: To describe the oncological management and functional outcome of patients with advanced parotid malignant tumors undergoing facial nerve reconstruction after radical parotidectomy and subtotal petrosectomy. Materials and Methods: A combined approach was used to treat advanced stage parotid malignancies with intrapetrous involvement of the facial nerve main trunk or abutment on the stylomastoid foramen. Patients underwent facial nerve rehabilitation with cable graft reconstruction or with static techniques. Results: Six patients were included. All patients had Stage IV disease and underwent surgical treatment using a combined approach. Three patients underwent facial-nerve cable graft technique and three patients underwent static techniques to rehabilitate facial nerve function. Five patients received adjuvant treatment with radiotherapy and/or chemotherapy. The mean follow-up was 27.5 months, with a minimum of 7 months and a maximum of 8 years. Four patients remain disease-free, with an overall survival rate of 66%. Among the patients undergoing dynamic reconstruction, first signs of recovery were established at 6 months of follow-up. All patients achieved a House-Brackmann score of III-IV within the first two postoperative years. Conclusions: When possible, facial nerve grafting is the preferred method of facial nerve rehabilitation in an advanced stage parotid tumors. A multidisciplinary approach allows better functional and oncological outcomes.
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Affiliation(s)
- Rocío Sánchez-Burgos
- Department of Oral and Maxillofacial Surgery, University Hospital of the Canary Islands, Tenerife, Spain
| | - Teresa Gonzalez Otero
- Department of Oral and Maxillofacial Surgery, La Paz University Hospital, Madrid, Spain
| | - Luis Lassaletta
- Department of Otorhinolaryngology, La Paz University Hospital, Madrid, Spain
| | - Javier Arias Gallo
- Department of Oral and Maxillofacial Surgery, La Moraleja Hospital, Madrid, Spain
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Mazzoni A, Zanoletti E, Marioni G, Martini A. En bloc temporal bone resections in squamous cell carcinoma of the ear. Technique, principles, and limits. Acta Otolaryngol 2016; 136:425-32. [PMID: 26824405 DOI: 10.3109/00016489.2015.1126352] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSIONS En bloc resection should always be primarily considered in ear carcinoma, also in advanced tumors growing beyond the walls of the external auditory canal, because it achieves a full specimen for histopathological evaluation and allows a correlation between clinical, pathological features, and outcomes. OBJECTIVE AND METHODS Dismal outcome of surgical and radiotherapic therapies for advanced ear carcinoma required a critical discussion of the oncological principles of treatment. Our analysis involved preliminarily a detailed description of surgical technique including the contribution of modern skull base microsurgery. RESULTS Evident limits in diagnostic protocols, surgical treatment and outcome evaluation modalities pointed to the need of a new approach towards an accurate definition of pre-operative tumor location, size, and behavior. En bloc resection achieved a specimen for a final pathological evaluation and an adjunctive piecemeal excision was necessary only whenever resection was not felt falling in safe, tumor-free tissue. Chemotherapy and radiotherapy should be considered in selected cases for adjuvant treatment.
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Affiliation(s)
- Antonio Mazzoni
- a Department of Neurosciences DNS, Otolaryngology Section , Padova University , Padova , Italy
- b Formerly Neurosciences Department, Otolaryngology , Ospedali Riuniti , Bergamo , Italy
| | - Elisabetta Zanoletti
- a Department of Neurosciences DNS, Otolaryngology Section , Padova University , Padova , Italy
| | - Gino Marioni
- a Department of Neurosciences DNS, Otolaryngology Section , Padova University , Padova , Italy
| | - Alessandro Martini
- a Department of Neurosciences DNS, Otolaryngology Section , Padova University , Padova , Italy
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Renkonen S, Sayed F, Keski-Säntti H, Ylä-Kotola T, Bäck L, Suominen S, Kanerva M, Mäkitie AA. Reconstruction of facial nerve after radical parotidectomy. Acta Otolaryngol 2015; 135:1065-9. [PMID: 26061795 DOI: 10.3109/00016489.2015.1050604] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Most patients benefitted from immediate facial nerve grafting after radical parotidectomy. Even weak movement is valuable and can be augmented with secondary static operations. Post-operative radiotherapy does not seem to affect the final outcome of facial function. OBJECTIVES During radical parotidectomy, the sacrifice of the facial nerve results in severe disfigurement of the face. Data on the principles and outcome of facial nerve reconstruction and reanimation after radical parotidectomy are limited and no consensus exists on the best practice. METHOD This study retrospectively reviewed all patients having undergone radical parotidectomy and immediate facial nerve reconstruction with a free, non-vascularized nerve graft at the Helsinki University Hospital, Helsinki, Finland during the years 1990-2010. There were 31 patients (18 male; mean age = 54.7 years; range = 30-82) and 23 of them had a sufficient follow-up time. RESULTS Facial nerve function recovery was seen in 18 (78%) of the 23 patients with a minimum of 2-year follow-up and adequate reporting available. Only slight facial movement was observed in five (22%), moderate or good movement in nine (39%), and excellent movement in four (17%) patients. Twenty-two (74%) patients received post-operative radiotherapy and 16 (70%) of them had some recovery of facial nerve function. Nineteen (61%) patients needed secondary static reanimation of the face.
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Affiliation(s)
- Suvi Renkonen
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital , Stockholm , Sweden
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Leong SC, Lesser TH. Long-Term Outcomes of Facial Nerve Function in Irradiated and Nonirradiated Nerve Grafts. Ann Otol Rhinol Laryngol 2013; 122:695-700. [DOI: 10.1177/000348941312201106] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: We reviewed the long-term results of facial nerve repair in a tertiary head and neck institution in the north of England. Methods: We performed a case notes review of patients who had facial nerve repair over a 10-year period and had completed 24 months of follow-up. Results: The study population comprised 18 female patients and 24 male patients, with an overall mean age of 53.2 years (range, 16 to 80 years). Of the 24 patients who had a cable nerve graft, the greater auricular nerve was used in 15 cases. The sural nerve was used as the donor in a cross-facial nerve graft in 9 patients. Sixteen patients had transposition nerve repair: Hypoglossal and ansa cervicalis in 7 and 9 cases, respectively. Two patients had primary anastomosis after surgery for extensive malignant tumors. In this series, no patients achieved a House-Brackmann (HB) grade of II. Overall, the HB grades III, IV, and V were the best postoperative facial nerve functions achieved in 11.9%, 33.3%, and 26.2% of patients, respectively. Failure (HB grade VI) was observed in 28.6% of patients. More than half of patients (62.5%) who had either a sural nerve cable graft or a faciohypoglossal transposition had a good outcome (HB grade III or IV). Conclusions: In the present series, 45% of patients had an HB grade of III or IV at long-term follow-up. The best outcome (HB grade III) was observed after cross-facial grafting with the sural nerve.
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Effect of postoperative brachytherapy and external beam radiotherapy on functional outcomes of immediate facial nerve repair after radical parotidectomy. Head Neck 2013; 36:113-9. [DOI: 10.1002/hed.23276] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 11/07/2022] Open
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Tay G, Tan HK, Thiagarajan A, Soo KC, Iyer NG. Squamous cell carcinoma of the ear arising in patients after radiotherapy for nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2013; 271:149-56. [DOI: 10.1007/s00405-013-2495-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/10/2013] [Indexed: 11/27/2022]
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Abstract
Primary temporal bone tumors are rare. Suspicious lesions of the ear canal should be biopsied for diagnosis. Surgical resection to achieve negative margins is the mainstay of treatment. Small tumors can be treated with lateral temporal bone resection. Parotidectomy and neck dissection are added for disease extension and proper staging. Higher staged tumors generally require subtotal temporal bone resection or total temporal bone resection. Adjuvant postoperative radiotherapy has shown improved survival for some patients. Chemotherapy has an emerging role for advanced stage disease. Evaluation and management by a multidisciplinary team are the best approach for patients with these tumors.
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Affiliation(s)
- Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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38
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Hanasono MM, Silva AK, Yu P, Skoracki RJ, Sturgis EM, Gidley PW. Comprehensive management of temporal bone defects after oncologic resection. Laryngoscope 2012; 122:2663-9. [PMID: 23070792 DOI: 10.1002/lary.23528] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 04/25/2012] [Accepted: 05/29/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate reconstructive outcomes following oncologic temporal bone resection. STUDY DESIGN Retrospective review. METHODS Subjects consisted of 117 patients undergoing temporal bone resection and reconstruction between 2000 and 2010. Reconstructive outcomes, including results following facial nerve repair, were analyzed. RESULTS Reconstruction was performed with a regional flap in 27 patients and a microvascular free flap in 90 patients. Operative time was shorter for cases involving reconstruction with regional flaps compared to free flaps (6.9 vs. 11.2 hours, P < .0001), as were intensive care unit and hospital stays (0.4 vs. 3.4 days, P < .0001 and 4.1 vs. 8.6 days, P < .0001, respectively). Overall complication rates were similar for regional and free flap cases (22.2% vs. 23.3%, P = 1.00), although donor site complications were more common with free flaps (0% vs. 13.3%, P = .07). Facial nerve repairs were performed in 19 patients. Of 14 patients with more than 12 months of follow-up, 71.4% demonstrated signs of reinnervation and 42.9% achieved a House-Brackmann score of 3 or better. The mean time to reinnervation was 7.9 months. Recovery was not significantly affected by preoperative nerve function, postoperative radiation, or advanced age (P = 1.00 in each case). CONCLUSIONS We recommend regional flaps for small defects based on minimal donor site morbidity, and shorter operative times, intensive care unit, and hospital stays. For extensive defects and in cases involving prior surgery or radiation, free flaps are preferred. Facial nerve repair should be attempted whenever feasible, even in the setting of preoperative weakness, planned postoperative radiation, and advanced age.
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Affiliation(s)
- Matthew M Hanasono
- Department of Plastic Surgery, The University of Texas M D Anderson Cancer Center, Houston, Texas, USA.
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Revenaugh PC, Knott PD, Scharpf J, Fritz MA. Simultaneous Anterolateral Thigh Flap and Temporalis Tendon Transfer to
Optimize Facial Form and Function After Radical Parotidectomy. ACTA ACUST UNITED AC 2012. [DOI: 10.1001/archfaci.2011.1263] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Peter C. Revenaugh
- Authors Affiliations: Head and Neck Institute, Department of Otolaryngology–Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio (Drs Revenaugh, Scharpf, and Fritz); and Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco (Dr Knott)
| | - P. Daniel Knott
- Authors Affiliations: Head and Neck Institute, Department of Otolaryngology–Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio (Drs Revenaugh, Scharpf, and Fritz); and Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco (Dr Knott)
| | - Joseph Scharpf
- Authors Affiliations: Head and Neck Institute, Department of Otolaryngology–Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio (Drs Revenaugh, Scharpf, and Fritz); and Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco (Dr Knott)
| | - Michael A. Fritz
- Authors Affiliations: Head and Neck Institute, Department of Otolaryngology–Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio (Drs Revenaugh, Scharpf, and Fritz); and Department of Otolaryngology–Head and Neck Surgery, University of California, San Francisco (Dr Knott)
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Gidley PW, Thompson CR, Roberts DB, DeMonte F, Hanna EY. The oncology of otology. Laryngoscope 2012; 122:393-400. [PMID: 22252464 DOI: 10.1002/lary.22402] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 09/01/2011] [Accepted: 09/07/2011] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS To describe the population of patients with malignancy affecting the ear canal and temporal bone. STUDY DESIGN Retrospective review. METHODS The charts of 157 patients with temporal bone cancer were reviewed for clinical outcomes. RESULTS Between 1999 and 2009, 157 patients underwent temporal bone surgery for cancer involving the ear canal (n = 25), external ear with ear canal involvement (n = 26), periauricular skin (n = 40), parotid gland (n = 40), temporal bone (n = 13), and lateral skull base (n = 13). All surgeries involved one or more otologic approaches: mastoidectomy (28.0%), lateral temporal bone resection (TBR) (59.2%), subtotal TBR (2.5%), total TBR (3.2%), transtemporal approach (TTA) to the jugular foramen (8.2%), TTA to the middle fossa (5.7%), and TTA to the infratemporal fossa (3.2%). Cancers of the cartilaginous ear canal were managed with wide local excision of canal skin and cartilage in nine patients (5.7%). A combination of approaches was performed in 32 patients (20.4%). The 5-year overall survival rate was 58.0%. Patients whose disease was limited to the ear canal had significantly better overall survival than did patients who had skull base primaries (P = .02989), periauricular skin cancer (P = .00138), or temporal bone tumors (P = .02598). Patients with parotid tumors also had better overall survival than did those with periauricular skin tumors (P = .02357). CONCLUSIONS Otologic surgery plays an important role in managing cancers that involve the ear canal, temporal bone, or lateral skull base. The specialty of otologic oncology is emerging as a defined area of practice.
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Affiliation(s)
- Paul W Gidley
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
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Gidley PW, Thompson CR, Roberts DB, Weber RS. The results of temporal bone surgery for advanced or recurrent tumors of the parotid gland. Laryngoscope 2011; 121:1702-7. [PMID: 21792957 DOI: 10.1002/lary.21867] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS To describe the results of temporal bone surgery in managing advanced or recurrent tumors of the parotid gland. STUDY DESIGN Retrospective review. METHODS Patients with advanced or recurrent tumors involving the parotid gland who underwent either mastoidectomy or temporal bone resection were reviewed for treatment outcomes. RESULTS Forty-nine patients were identified who required either mastoidectomy (n = 33) or temporal bone resection (n = 16) for malignancies involving the parotid gland. Facial nerve sacrifice was required in 35 patients (71.4%). Perineural invasion was found in 51.1% of patients; and negative margins were achieved in 78.2% patients. Six of 10 patients presenting with normal facial function (House-Brackmann I) and recurrent tumors maintained normal facial function following salvage surgery. Trismus, tumors larger than 4 cm, and the need for mandibulectomy were significantly correlated with higher recurrence rates (P = .025, P = .004, and P = .002, respectively). Patients with preoperative House-Brackmann I or II had a lower risk for recurrence (P = .035) and more favorable survival at 3 years (P = .024). Patients who required parapharyngeal space dissection and those with metastatic neck disease had the poorest survival rates. The overall survival at 3 years was 72.4%. CONCLUSIONS Mastoidectomy and temporal bone resection permit preservation of the facial nerve when oncologically safe; they may help to achieve negative margins, and they allow facial nerve grafting when nerve sacrifice is required. Despite the poor prognostic indicators of facial paralysis, recurrent tumors, and perineural invasion, a significant number of patients can be salvaged successfully when a temporal bone procedure is combined with parotidectomy.
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Affiliation(s)
- Paul W Gidley
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
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