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Lopez F, Agaimy A, Franchi A, Suárez C, Vander Poorten V, Mäkitie AA, Homma A, Eisbruch A, Olsen KD, Saba NF, Nuyts S, Snyderman C, Beitler JJ, Corry J, Hanna E, Hellquist H, Rinaldo A, Ferlito A. Update on olfactory neuroblastoma. Virchows Arch 2024; 484:567-585. [PMID: 38386106 DOI: 10.1007/s00428-024-03758-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/18/2024] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
Olfactory neuroblastomas are uncommon malignancies that arise from olfactory receptor cells located high in the nasal cavity. Accurate diagnosis plays a crucial role in determining clinical results and guiding treatment decisions. Diagnosis can be a major challenge for pathologists, especially when dealing with tumours with poor differentiation. The discovery of several molecular and immunohistochemical markers would help to overcome classification difficulties. Due to the paucity of large-scale studies, standardisation of diagnosis, treatment and prediction of outcome remains a challenge. Surgical resection by endoscopic techniques with the addition of postoperative irradiation is the treatment of choice. In addition, it is advisable to consider elective neck irradiation to minimise the risk of nodal recurrence. Molecular characterisation will help not only to make more accurate diagnoses but also to identify specific molecular targets that can be used to develop personalised treatment options tailored to each patient. The present review aims to summarise the current state of knowledge on histopathological diagnosis, the molecular biology and management of this disease.
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Affiliation(s)
- Fernando Lopez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Avenida de Roma, S/N, 33011, Oviedo, Asturias, Spain.
| | - Abbas Agaimy
- Institut Für Pathologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alessandro Franchi
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, 56126, Pisa, Italy
| | | | - Vincent Vander Poorten
- Department of Otorhinolaryngology, Head and Neck Surgery, Department of Oncology, Section of Head and Neck Oncology, KU Leuven, and Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, Research Program in Systems Oncology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Akihiro Homma
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Kerry D Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Sandra Nuyts
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven-University of Leuven, 3000, Leuven, Belgium
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - June Corry
- Division of Radiation Oncology, GenesisCare Radiation Oncology, St. Vincent's Hospital, Melbourne, VIC, 3065, Australia
| | - Ehab Hanna
- Department of Head & Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Henrik Hellquist
- Faculty of Medicine and Biomedical Sciences (FMCB), University of Algarve, Algarve Biomedical Center Research Institute (ABC-RI), 8005-139, Faro, Portugal
- Department of Cellular Pathology, Northern Lincolnshire and Goole NHS Foundation Trust, Lincoln, LN2 5QY, UK
| | | | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, Padua, Italy
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Bhardwaj A, Priya M, Malhotra M, Varshney S, Tyagi AK, Singh A. Novel Modifications to Total Maxillary Swing Approach in Extensive Nasopharyngeal Angiofibroma to Minimize Complications. Indian J Otolaryngol Head Neck Surg 2022; 74:1120-1127. [PMID: 36452589 PMCID: PMC9702321 DOI: 10.1007/s12070-020-02181-5] [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: 08/20/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022] Open
Abstract
Maxillary swing approaches provide excellent exposure of the anterior, mid, and anterolateral skull base offering a wide window to approach nasopharyngeal neoplasms; however, they are also associated with complications. The present study aimed to evaluate the results of a modified total maxillary swing (TMS) approach developed to minimize postoperative complications. The modified TMS approach was used to treat five patients who had extensive juvenile nasopharyngeal angiofibromas between March and October 2019 at our tertiary care center. Surgical technique, preoperative image findings, and intra-operative findings were recorded. In the postoperative follow-up, patients were examined to rule out all possible complications associated with the procedure according to the literature. A retrospective analysis was performed to assess tumor extensions, surgical modifications, and postoperative complications. All tumors had orbital and infratemporal (lateral limit) involvement while four had intracranial involvement. No per-operative complications were reported, and postoperative clinical and endoscopic evaluation was performed at 1, 2, and 3 months. There was no evidence of complications including residue, recurrence, maxillary necrosis, ophthalmoplegia, epiphora, palatal fistula, or jaw malocclusion. Besides, minor complications such as infraorbital margin skin retraction, infraorbital serous collection, maxillo-zygomatic abscess, and unsightly scar were also not seen. Only one case presented with maxillary osteomyelitis which was resolved with mini-plate removal and antibiotics. A modified TMS approach is a prudent option to ensure complete removal of juvenile nasopharyngeal angiofibromas with negligible complications.
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Affiliation(s)
- Abhishek Bhardwaj
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 India
| | - Madhu Priya
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 India
| | - Manu Malhotra
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 India
| | - Saurabh Varshney
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 India
| | - Amit Kumar Tyagi
- Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rishikesh, 249203 India
| | - Arpana Singh
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, India
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Chaudhary N, Jaitly S, Verma RK, Gupta S. The Maxillary Swing: An Efficacious Approach to Surgical Management of Advanced Stage Juvenile Nasopharyngeal Angiofibroma. Indian J Otolaryngol Head Neck Surg 2022; 74:1496-1501. [PMID: 36452751 PMCID: PMC9702283 DOI: 10.1007/s12070-021-02600-1] [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: 10/05/2020] [Accepted: 04/26/2021] [Indexed: 10/21/2022] Open
Abstract
The objective of this study was to evaluate the efficacy and outcome using the maxillary swing approach for the management of extensive nasopharyngeal angiofibroma. A retrospective case series analysis in a tertiary care centre revealed eighteen cases with extensive nasal angiofibroma operated using the maxillary swing approach between 2011 and 2017. All patients had tumour extension to the lateral most portions of the infratemporal fossa with complete occupation and destruction of the lateral wall of the sphenoid sinus causing abutment to the cavernous sinus and complete involvement of the pterygopalatine fossa and pterygoid base. One patient displayed full occupancy of the maxillary sinus as a consequence of erosion of the posterior and medial walls of the maxillary sinus. All patients underwent tumour excision using the maxillary swing approach. Patients were followed up for a minimum period of 1 year after surgery. The maxillary swing approach gave optimal exposure of the entire central skull base including the infratemporal fossa and its extreme lateral and superior aspects. Adequate tumour exposure and vascular control could be achieved in all cases resulting in complete tumour excision. The mean operative time was 3 h 15 min. Post-operative healing was satisfactory with palatal fistula formation in four cases and all patients remaining disease-free up to the present time. One had minimal misalignment of the halves of the upper jaw and two had epiphora, of which one required dacryocystorhinostomy. The maxillary swing is an effective approach in the management of extensive nasopharyngeal angiofibroma and leads to optimal anatomical exposure with minimal morbidity.
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Affiliation(s)
- Neena Chaudhary
- Department of Otorhinolaryngology, VMMC and Safdarjung Hospital, New Delhi, 110029 India
| | - Shweta Jaitly
- Department of Otorhinolaryngology, VMMC and Safdarjung Hospital, New Delhi, 110029 India
| | - Rajeev Kumar Verma
- Department of Otorhinolaryngology, VMMC and Safdarjung Hospital, New Delhi, 110029 India
- Srimadhopur, Siker, Rajasthan India
| | - Shashank Gupta
- Department of Otorhinolaryngology, VMMC and Safdarjung Hospital, New Delhi, 110029 India
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Suárez C, López F, Mendenhall WM, Andreasen S, Mikkelsen LH, Langendijk JA, Bondi S, Rodrigo JP, Bäck L, Mäkitie AA, Fernández-Alvarez V, Coca-Pelaz A, Smee R, Rinaldo A, Ferlito A. Trends in the Management of Non-Vestibular Skull Base and Intracranial Schwannomas. Cancer Manag Res 2021; 13:463-478. [PMID: 33500660 PMCID: PMC7822088 DOI: 10.2147/cmar.s287410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/30/2020] [Indexed: 01/18/2023] Open
Abstract
The aim of this review is to analyze the latest trends in the management of non-vestibular skull base and intracranial schwannomas in order to optimize tumor control and quality of life. Non-vestibular cranial nerve schwannomas are rare lesions, representing 5–10% of cranial nerve schwannomas. Management decisions should be individualized depending on tumor size, location and associated functional deficits. Generally, large sized schwannomas exerting significant mass effect with increased intracranial pressure are treated surgically. In some cases, even after optimal skull base resection, it is not possible to achieve a gross total resection because tumor location and extent and/or to reduce morbidity. Thus, subtotal resection followed by stereotactic radiosurgery or fractioned radiotherapy offers an alternative approach. In certain cases, stereotactic radiosurgery or radiotherapy alone achieves good tumor control rates and less morbidity to gross total resection. Finally, given the slow growth rate of most of these tumors, observation with periodic radiographic follow-up approach is also a reasonable alternative for small tumors with few, if any, symptoms.
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Affiliation(s)
- Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain
| | - Fernando López
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain.,Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Simon Andreasen
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark.,Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.,Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lauge Hjorth Mikkelsen
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Stefano Bondi
- Department of Otorhinolaryngology-Head and Neck Surgery, San Raffaele Hospital, Vita-Salute University, Milan, Italy
| | - Juan P Rodrigo
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain.,Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Leif Bäck
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden
| | | | - Andrés Coca-Pelaz
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad of Oviedo, Oviedo, Spain.,Department of Otorhinolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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5
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Llorente JL, López F. The endoscopic endonasal approach for the treatment of juvenile angiofibromas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 70:136-144. [PMID: 29764608 DOI: 10.1016/j.otorri.2018.01.004] [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: 12/31/2017] [Accepted: 01/13/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Juvenile angiofibroma (JA) is a benign tumour, for which the treatment of choice is surgery. It may be associated with significant morbidity because of its anatomical location and its locally destructive growth pattern. Severe haemorrhage constitutes a high risk in JA and its surgical management can be complex. The management of JA remains a challenge. The objective of this study was to review a series of patients with JA treated via the endonasal/endoscopic approach. MATERIAL AND METHODS Medical records of patients operated for JA were reviewed. MAIN OUTCOME MEASURES tumour stage, intraoperative blood loss, complications and persistence/recurrence rates. RESULTS A total of 30 male patients and one female were included. The mean age was 17 years. Using the Radkowski classification, one JA was classified as stage I, 5 stage IIA, 9 stage IIB, 4 stage IIC, 10 stage IIIA and 2 stage IIIB. Thirty-nine percent of the JA was classified as advanced stage JA (IIIA and IIIB). The mean blood loss was 1.156mL Except in one case, no significant complications were observed. Tumour persistence/recurrence was observed in 2 JA (6%), at the end of the follow-up. Mean postoperative follow-up time was 86 months. CONCLUSIONS This retrospective study supports the notion that endonasal endoscopic approaches for a JA are a feasible option associated with good long-term results.
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Affiliation(s)
- José Luis Llorente
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España.
| | - Fernando López
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
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6
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The Endoscopic Endonasal Approach for the Treatment of Juvenile Angiofibromas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kim SM, Paek SH, Lee JH. Infratemporal fossa approach: the modified zygomatico-transmandibular approach. Maxillofac Plast Reconstr Surg 2019; 41:3. [PMID: 30687683 PMCID: PMC6331346 DOI: 10.1186/s40902-018-0185-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 12/18/2018] [Indexed: 11/28/2022] Open
Abstract
Background The infratemporal fossa (ITF) is an anatomical lateral skull base space composed by the zygoma, temporal, and the greater wing of the sphenoid bone. Due to its difficult approach, surgical intervention at the ITF has remained a heavy burden to surgeons. The aim of this article is to review basic skull base approaches and ITF structures and to avoid severe complications based on the accurate surgical knowledge. Methods A search of the recent literature using MEDLINE (PubMed), Embase, Cochrane Library, and other online tools was executed using the following keyword combinations: infratemporal fossa, subtemporal fossa, transzygomatic approach, orbitozygomatic approach, transmaxillary approach, facial translocation approach, midface degloving, zygomatico-transmandibular approach, and lateral skull base. Aside from our Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) trial, there have been very few randomized controlled trials. The search data for this review are summarized based on the authors’ diverse clinical experiences. Results We divided our results based on representative skull base approaches and the anatomy of the ITF. Basic approaches to the ITF include endoscopic endonasal, transzygomatic, orbitozygomatic, zygomatico-transmandibular, transmaxillary, facial translocation, and the midfacial degloving approach. The borders and inner structures of the ITF (with basic lateral skull base dissection schemes) are summarized, and the modified zygomatico-transmandibular approach (ZTMA) is described in detail. Conclusions An anatomical basic knowledge would be required for the appropriate management of the ITF pathology for diverse specialized doctors, including maxillofacial, plastic, and vascular surgeons. The ITF approach, in conjunction with the application of microsurgical techniques and improved perioperative care, has permitted significant advances and successful curative outcomes for patients having malignancy in ITF.
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Affiliation(s)
- Soung Min Kim
- 1Oral and Maxillofacial Microvascular Reconstruction LAB, Ghana Health Service, Regional Hospital Sunyani, P.O. Box 27, Sunyani, Brong Ahafo Ghana.,2Department of Oral and Maxillofacial Surgery, Dental Research Institute, Clinical Trial Center and Oral Cancer Center, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Sun Ha Paek
- 3Department of Neurosurgery, Hypoxia Ischemia Hypoxia Disease Institute, Cancer Research Institute, Seoul National University Medical College, Seoul, South Korea
| | - Jong Ho Lee
- 2Department of Oral and Maxillofacial Surgery, Dental Research Institute, Clinical Trial Center and Oral Cancer Center, School of Dentistry, Seoul National University, Seoul, South Korea
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8
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Salvage Surgery in the Treatment of Local Recurrences of Nasopharyngeal Carcinomas. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Cirugía de rescate en las recidivas locales del carcinoma de nasofaringe. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 69:339-344. [DOI: 10.1016/j.otorri.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/16/2017] [Accepted: 11/21/2017] [Indexed: 11/19/2022]
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10
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Kalra GS, Midya M, Bedi M. Access to the Skull Base - Maxillary Swing Procedure - Long Term Analysis. Ann Maxillofac Surg 2018; 8:86-90. [PMID: 29963431 PMCID: PMC6018278 DOI: 10.4103/ams.ams_5_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Skull base is difficult to approach surgically due to its complex anatomy. A number of procedures that is endoscopic, microscopic, and open approaches have been used. The maxillary swing approach provides a wide exposure to the surgeon for better oncological clearance. Patients and Methods: A total of 62 patients with varied etiologies involving the skull base region were operated with maxillary swing procedure over a period of 15 years from 2001 to 2016 in plastic surgery department at a single institution. Results: There was no recurrence in the follow-up period. One patient had palatal fistula and one patient had mild nasal mucosal atrophy. None of the patients had malocclusion in the postoperative period. The minimum follow-up period was 24 months. Conclusion: Maxillary swing procedure provides excellent exposure to skull base, and most of the tumors involving this region can be effectively excised with minimal morbidity to the patient.
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Affiliation(s)
- Gurudayal Singh Kalra
- Department of Burns, Plastic and Reconstructive Surgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Manojit Midya
- Department of Burns, Plastic and Reconstructive Surgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Mitesh Bedi
- Department of Burns, Plastic and Reconstructive Surgery, SMS Medical College, Jaipur, Rajasthan, India
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11
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López F, Triantafyllou A, Snyderman CH, Hunt JL, Suárez C, Lund VJ, Strojan P, Saba NF, Nixon IJ, Devaney KO, Alobid I, Bernal-Sprekelsen M, Hanna EY, Rinaldo A, Ferlito A. Nasal juvenile angiofibroma: Current perspectives with emphasis on management. Head Neck 2017; 39:1033-1045. [PMID: 28199045 DOI: 10.1002/hed.24696] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/03/2016] [Accepted: 12/06/2016] [Indexed: 12/12/2022] Open
Abstract
Juvenile angiofibroma is an uncommon, benign, locally aggressive vascular tumor. It is found almost exclusively in young men. Common presenting symptoms include nasal obstruction and epistaxis. More advanced tumors may present with facial swelling and visual or neurological disturbances. The evaluation of patients with juvenile angiofibroma relies on diagnostic imaging. Preoperative biopsy is not recommended. The mainstay of treatment is resection combined with preoperative embolization. Endoscopic surgery is the approach of choice in early stages, whereas, in advanced stages, open or endoscopic approaches are feasible in expert hands. Postoperative radiotherapy (RT) or stereotactic radiosurgery seem valuable in long-term control of juvenile angiofibroma, particularly those that extend to anatomically critical areas unsuitable for complete resection. Chemotherapy and hormone therapy are ineffective. The purpose of the present review was to update current aspects of knowledge related to this rare and challenging disease. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1033-1045, 2017.
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Affiliation(s)
- Fernando López
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, Spain
| | - Asterios Triantafyllou
- Pathology Department, Liverpool Clinical Laboratories, Liverpool, UK.,School of Dentistry, University of Liverpool, Liverpool, UK
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jennifer L Hunt
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Carlos Suárez
- Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, Spain
| | - Valerie J Lund
- Professorial Unit, Ear Institute, University College London, London, UK
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Iain J Nixon
- Departments of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, UK
| | | | - Isam Alobid
- Department of Otolaryngology, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain
| | - Manuel Bernal-Sprekelsen
- Department of Otolaryngology, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
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12
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Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It provides recommendations on the work up and management of lateral skull base cancer based on the existing evidence base for this rare condition.
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13
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Zuzukin V, Ducic Y. Aggressive maxillofacial disassembly in skull base surgery. Otolaryngol Head Neck Surg 2016; 135:303-11. [PMID: 16890088 DOI: 10.1016/j.otohns.2006.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Indexed: 10/24/2022]
Abstract
Objective To review our favorable experience with maxillofacial disassembly for exposure and resection of tumors of the skull base. Patients and Methods This is a retrospective review of 31 patients from 1997 to 2005 treated by maxillofacial disassembly and includes 22 patients with midface disassembly and 9 patients with mandible with or without midface disassembly. Results Follow-up ranges from 2 weeks to 7 years: 23 of 31 patients are alive and disease free; 3 patients are alive with disease; 3 patients have died of distant metastasis. There were 14 complications in 12 (38.7%) patients; 13 of 14 complications were minor. One major complication (cardiovascular accident) resulted in the single postoperative mortality in this series. Conclusion Our technique of maxillofacial disassembly allows for tailored exposure of all regions of the anterolateral skull base with acceptable perioperative morbidity in appropriately selected patients. EBM rating: C-4
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Affiliation(s)
- Vladimir Zuzukin
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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14
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Modified Facial Translocation Approach in a One-Month Old With a Skullbase Tumor. J Craniofac Surg 2016; 27:718-20. [PMID: 27092923 DOI: 10.1097/scs.0000000000002586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The authors present a patient of a neonate with a skull base extragonadal germ cell tumor requiring a modified facial translocation approach for resection. A 1-week-old female presented with right proptosis, eyelid edema, and nasal obstruction. Imaging revealed a 3-cm right-sided skull base mass involving the right maxillary, ethmoid, sphenoid sinuses, orbit, infratemporal fossa, and cavernous sinus via skull base erosion. The lesion was refractory to chemotherapy and required surgical excision. A modified facial translocation approach with preservation of anterior maxillary bone vascularization was used to remove the tumor, which was found to be teratoma with yolk-sac features. The patient tolerated surgery well and was noted to have minimally affected facial skeleton growth at 2-year follow-up. This modified facial translocation approach allowed safe access to this anterior skull base tumor with acceptable morbidity and mild facial growth effects so far.
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15
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Shen X, Li Y, Zhang Y, Kong J, Li Y. An analysis of brachytherapy with computed tomography-guided permanent implantation of Iodine-125 seeds for recurrent nonkeratin nasopharyngeal carcinoma. Onco Targets Ther 2015; 8:991-7. [PMID: 25999732 PMCID: PMC4427452 DOI: 10.2147/ott.s83140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background 125I seed implantation is a new method in treatment of nasopharyngeal carcinoma (NPC), and it is worthwhile to evaluate its feasibility. In this study, we performed brachytherapy with computed tomography (CT)-guided permanent implantation of 125I seeds in the treatment of patients with the recurrence of NPC. Methods A total 30 patients (20 male and ten female) at the median age of 55 (range 25–80) years were diagnosed with recurrent nonkeratin NPC, with a total 38 lesions and a short disease-free interval (mediañ11 months) after primary radiotherapy alone or combined with chemotherapy. Patients received CT scan, starting from 2 months after the treatment. Follow-up was conducted for ~2–38 months to observe the local control rate and overall survival rate. We also analyzed the possible correlation between survival periods and the status of recurrent tumors. Results The local control rates at 6, 12, 24, 30, and 36 months after the procedure of 125I seed implantation were 86.8%, 73.7%, 26.3%, 15.8%, and 5.3%, respectively. The overall 1-, 2-, and 3-year survival rates were 80.0% (24/30), 30.0% (9/30), and 6.7% (2/30), respectively, with a median survival period of 18 months (17.6±8.6 months). Interestingly, the survival periods of the patients who had primary radiotherapy with or without chemotherapy were 15.8±7.9 and 24.3±7.9 months, respectively. Kaplan–Meier survival analysis demonstrated that χ2 (log rank) was 7.555, with very significant difference (P<0.01). The survival periods of patients in tumor stages I, II, III, and IV were 25.4±8.7, 19.8±9.4, 16.1±4.5, and 12.8±7.8 months, respectively, with significant differences (P<0.05). Conclusion Our data suggest that the survival period of recurrent NPC patients after 125I seed implantation is inversely related to the tumor stages of the recurrence but not to chemotherapy after the primary radiotherapy. Therefore, CT-guided 125I seed implantation can be set for treatment of recurrent NPC, for better survival rate with minimal damage.
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Affiliation(s)
- Xinying Shen
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China ; Department of Interventional Radiology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, People's Republic of China
| | - Yong Li
- Department of Interventional Radiology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, People's Republic of China
| | - Yanfang Zhang
- Department of Interventional Radiology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, People's Republic of China
| | - Jian Kong
- Department of Interventional Radiology, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, People's Republic of China
| | - Yanhao Li
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
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Modified midfacial translocation for access to ventral skull base tumours. The Journal of Laryngology & Otology 2014; 128:803-9. [PMID: 25171215 DOI: 10.1017/s0022215114001881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To describe our technical modifications of midfacial translocation for access to the nasopharynx, and anterior, central and lateral skull base. DESIGN Retrospective chart review of a prospective case series. SETTING Department of Otolaryngology-Head and Neck Surgery, Aberdeen Royal Infirmary, Scotland, UK. METHODS Along with demographics, other parameters studied were adequacy of exposure, completeness of resection, aesthetic outcome and complications. Our main outcome measures included adequacy of exposure, partial or total resection of tumour, aesthetic outcome, and complications related to surgical technique. RESULTS A total of 48 patients underwent modified midfacial translocation at our institution for nasopharyngeal, parapharyngeal, and anterior, central and lateral skull base tumours. In all cases, the exposure was deemed to be adequate. Two patients developed wound dehiscence in previously irradiated fields. Other incisions healed very well and the aesthetic outcome was regarded as satisfactory. CONCLUSION Modified midfacial translocation is based on the principle of temporary craniofacial disassembly for access to the skull base. Our modifications offer adequate access and a better aesthetic outcome. All incisions are placed through the aesthetic sub units of the nose with preservation of the lip. Preservation of the bony piriform aperture prevents airway compromise.
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Mathur NN, Vashishth A. Extensive nasopharyngeal angiofibromas: the maxillary swing approach. Eur Arch Otorhinolaryngol 2014; 271:3035-40. [PMID: 24389983 DOI: 10.1007/s00405-013-2804-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/29/2013] [Indexed: 10/25/2022]
Abstract
The objective of this study was to evaluate the efficacy and outcome using the maxillary swing approach for the management of extensive nasopharyngeal angiofibromas. A retrospective analysis in a tertiary care center revealed five cases with extensive nasal angiofibromas operated using the maxillary swing approach between 2010 and 2012. All patients had tumor extension to the lateral-most portions of the infratemporal fossa with complete occupation and destruction of the lateral wall of the sphenoid sinus causing abutment to the cavernous sinus and complete involvement of the pterygopalatine fossa and pterygoid base. One patient displayed full occupancy of the maxillary sinus as a consequence of erosion of the posterior and medial walls of the maxillary sinus, while another had severe temporal lobe compression through the roof of the infratemporal fossa. All patients underwent tumor excision using the maxillary swing approach. Patients were followed up for a minimum period of 1 year after surgery. The maxillary swing approach gave optimal exposure of the entire central skull base including the infratemporal fossa and its extreme lateral and superior aspects. Adequate tumor exposure and vascular control could be achieved in all cases resulting in complete tumor excision. The mean operative time was 4.5 h. Post-operative healing was satisfactory with palatal fistula formation in two cases and all patients remaining disease-free up to the present time. One had minimal misalignment of the halves of the upper jaw and two had epiphora, of which one required dacryocystorhinostomy. The maxillary swing is an effective approach in the management of extensive nasopharyngeal angiofibromas and leads to optimal anatomical exposure with minimal morbidity.
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Affiliation(s)
- Neeraj Narayan Mathur
- Department of ENT and Head and Neck Surgery, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India,
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López F, Suárez V, Costales M, Rodrigo JP, Suárez C, Llorente JL. Endoscopic Endonasal Approach for the Treatment of Anterior Skull Base Tumours. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012. [DOI: 10.1016/j.otoeng.2012.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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López F, Suárez V, Costales M, Rodrigo JP, Suárez C, Llorente JL. Endoscopic endonasal approach for the treatment of anterior skull base tumours. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2012; 63:339-47. [PMID: 22498372 DOI: 10.1016/j.otorri.2012.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 02/21/2012] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The increasing expertise of transnasal endoscopic surgery has recently expanded its indications to include the management of tumours affecting the skull base. We report our experience with endoscopic management of these tumours, emphasising the indications and surgical technique used. MATERIAL AND METHOD A retrospective analysis was performed of patients treated by an endoscopic endonasal approach (EEA) in our department from 2004 until 2011. RESULTS Sixty-three patients were analysed. We performed an endoscopic craniofacial resection in 32 patients (51%), an expanded EEA in 22 (35%), a transclival approach in 6 (9%) and a transpterygoid approach in 3 (5%). The most frequent benign tumour was nasopharyngeal angiofibroma (24%), while adenocarcinoma (30%) was the most common among malignancies. Mean follow-up was 26 months (range: 6 to 84 months). The complication rate was 5% and resection was complete in 56 cases (89%). The 5-year overall-survival was 71% in patients with malignant tumours and the effectiveness was 100% in benign tumours. CONCLUSION Our results support that endoscopic surgery, when properly planned, represents a valid alternative to standard surgical approaches for the management of skull base tumours.
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Affiliation(s)
- Fernando López
- Servicio de Otorrinolaringología, Unidad de Base de Cráneo, Instituto Universitario de Oncología del Principado de Asturias, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Kekatpure VD, Rajan GP, Patel D, Trivedi NP, Arun P, Iyer S, Kuriakose MA. Morbidity profile and functional outcome of modified facial translocation approaches for skull base tumors. Skull Base 2012; 21:255-60. [PMID: 22470269 DOI: 10.1055/s-0031-1280680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The primary objective of this study was to evaluate morbidity associated with facial translocation approaches for skull base and results of various technical modifications. Forty consecutive patients who underwent facial translocation approaches for accessing skull base tumors from July 2005 to June 2010 were included in this study. There were 25 patients who underwent standard facial translocation, 4 patients medial mini, and 11 patients underwent extended facial translocation. Thirteen patients had benign disease and 27 patients had malignant disease. Resection was R0 in 36 and R1 in 4 patients. Most patients had acceptable cosmetic results. None of the patients had problems related to occlusion or speech and swallowing. The commonest complication observed was nasal crusting in 16 patients. Grade 2 trismus and exposure of mini plate was seen in three patients. Two patients developed necrosis of translocated bone. Three patients developed palatal fistula before modification of palatal incision. Facial translocation provides a satisfactory access for adequate clearance of skull base tumors with satisfactory aesthetic and functional results. With modifications of the surgical technique and implementation of new surgical tools, the morbidity of facial translocation approaches will continue to decrease.
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Total maxillary swing approach to the skull base for advanced intracranial and extracranial nasopharyngeal angiofibroma. J Craniofac Surg 2011; 22:1671-6. [PMID: 21959410 DOI: 10.1097/scs.0b013e31822f3c96] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The main objective of surgical approaches to the anterior and anterolateral skull base is to have maximum exposure so injury to important structures is avoided, and surgical complications are reduced. At our institution, we used total maxillary swing (TMS) to approach the anterior and anterolateral skull base for resection of both malignant and benign tumors. We modified some of the techniques described in TMS to avoid complications encountered previously. The purpose of this article was to present the usefulness of TMS for maximum exposure of the anterior and anterolateral skull base using advanced nasopharyngeal angiofibroma (NPA) as the reference disease.We retrospectively reviewed 16 patients who underwent excision of NPA by TMS from 2005 to May 2011. The operative techniques, operative findings, postoperative complications, and follow-up records were reviewed and analyzed.Of the 16 cases of NPA, 5 had intracranial extensions. All had lateral extensions to the pterygopalatine fossa. The pterygoid base was explored in all cases. In 10 cases, the tumors were present in the spongy bone of the pterygoid bases, whereas in 6 cases, the base of the pterygoids was eroded and floating. In all cases, the tumor was completely removed. Complications encountered previously were avoided by the modifications to TMS. Complications encountered because of extensiveness of the tumor were easily managed. No patients had any recurrence until now.Total maxillary swing provides maximum exposure to the anterior and anterolateral skull base for complete removal of the tumors in those areas with minimal complications.
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Mattei TA, Nogueira GF, Ramina R. Juvenile nasopharyngeal angiofibroma with intracranial extension. Otolaryngol Head Neck Surg 2011; 145:498-504. [PMID: 21572079 DOI: 10.1177/0194599811408694] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide a critical evaluation of the historical evolution of the surgical treatment of juvenile nasopharyngeal angiofibroma (JNA) with intracranial extension. STUDY DESIGN Case series with chart review. SETTING Skull base multidisciplinary group at the Instituto de Neurologia de Curitiba, Brazil. SUBJECTS AND METHODS From 1988 to 2000, the multidisciplinary skull base group surgically treated 67 adolescent boys with JNA, 20 of whom presented with intracranial extension. All patients presented involvement of the cavernous sinus, and 5 of them spread into the orbit. Before 2008, the authors combined microscopic-endoscopic techniques. After this period, the surgical approach used was facial degloving, associated with purely endoscopic technique patients. RESULTS Total tumor removal was achieved in 17 cases in the first surgery. In this series, the intracranial extension was extradural in all cases. There was only 1 case of cerebrospinal fluid leakage, which was promptly identified and treated. There was no mortality or permanent morbidity. CONCLUSION Radical removal of large JNA may be difficult because of its extreme vascularity and extension to the cavernous sinus, orbit, middle and anterior fossa. Nevertheless, most of JNA with intracranial extension can be resected in the first operation with minimal morbidity through a facial degloving and further combination of expanded endoscopic endonasal approaches.
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Xu F, Sun X, Hu L, Wang J, Wang D, Pasic TR, Kern RC. Endoscopic surgical treatment of neurogenic tumor in pterygopalatine and infratemporal fossae via extended medial maxillectomy. Acta Otolaryngol 2011; 131:161-5. [PMID: 21047192 DOI: 10.3109/00016489.2010.522594] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The endoscopic extended medial maxillectomy approach for the management of lesions of the pterygopalatine and infratemporal fossa provides excellent exposure and results with good hemostasis and low morbidity. This approach is a viable alternative to the open approaches to these areas. OBJECTIVES To describe an endoscopic extended medial maxillectomy approach for the treatment of nonmalignant tumors in the pterygopalatine and infratemporal fossa. METHODS From January 2004 to June 2007, five patients who had tumors in the pterygopalatine fossa and/or infratemporal fossa, and underwent surgical resection of the tumors with the endoscopic extended medial maxillectomy approach, were reviewed regarding demographics, preoperative images, tumor cell type, surgical techniques, and outcomes. RESULTS Five patients underwent the procedure mentioned above; three females and two males with a mean age of 38 and a range of 21-58 years. All patients had adequate exposure and total tumor resection with the endoscopic extended medial maxillectomy approach. None of the patients required an external approach for tumor extirpation. There were no major postoperative complications. No evidence of tumor recurrence was noted after follow-up for 12-78 months.
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Affiliation(s)
- Feng Xu
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, PR China
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Ohno K, Tsunoda A, Shirakura S, Takahashi N, Kishimoto S. The approaches and outcomes of skull base surgery for pediatric sarcoma after initial therapy. Auris Nasus Larynx 2010; 38:208-14. [PMID: 21055890 DOI: 10.1016/j.anl.2010.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2010] [Revised: 07/31/2010] [Accepted: 08/13/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Surgical removal of the residual pediatric sarcoma after initial therapy is common; however, that in the skull base area still presents a formidable challenge. We reviewed the approaches and outcomes of skull base surgery for pediatric sarcoma. METHODS Thirteen patients with pediatric sarcoma who received skull base surgery were reviewed retrospectively. Tumor sites, surgical approach, complications, regional recurrence after surgery, and survival rate were analyzed. RESULTS The residual tumor sites were the infratemporal fossa (8), nasal cavity and paranasal sinus (4) and orbit with anterior skull base invasion (1). Coronal skin incision (1), that with preauricular skin incision (7) and facial dismasking flap (5) were applied to patients as the skin preparation. Following skin preparations, anterior skull base surgery with frontal craniotomy (3), infratemporal fossa approach with temporal craniotomy (5), and anterior-lateral skull base with front-temporal craniotomy (1) were performed. Tumors were removed with a sufficient surgical field in all patients. Facial nerve palsy (9), facial deformity (4), orbital complications (diplopia, decreased visual acuity, narrowing of visual field) (2) and occlusal imbalance (1) occurred. However, facial palsy, diplopia and occlusal imbalance subsided gradually. Local recurrence occurred in 6 cases and distant metastasis was observed in 4 cases. The overall 5-years survival rate was 51.9% (Kaplan-Meier method). CONCLUSION These tumors were safely removed with minimum morbidity. Skull base surgery is recommended to remove residual pediatric sarcoma after the initial treatment.
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Affiliation(s)
- Kazuchika Ohno
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
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Suárez C, Rodrigo JP, Rinaldo A, Langendijk JA, Shaha AR, Ferlito A. Current treatment options for recurrent nasopharyngeal cancer. Eur Arch Otorhinolaryngol 2010; 267:1811-24. [PMID: 20865269 PMCID: PMC2966947 DOI: 10.1007/s00405-010-1385-x] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 08/27/2010] [Indexed: 11/28/2022]
Abstract
Loco-regional control rate of nasopharyngeal carcinoma (NPC) has improved significantly in the past decade. However, local recurrence still represents a major cause of mortality and morbidity in advanced stages, and management of local failure remains a challenging issue in NPC. The best salvage treatment for local recurrent NPC remains to be determined. The options include brachytherapy, external radiotherapy, stereotactic radiosurgery, and nasopharyngectomy, either alone or in different combinations. In this article we will discuss the different options for salvage of locally recurrent NPC. Retreatment of locally recurrent NPC using radiotherapy, alone or in combination with other treatment modalities, as well as surgery, can result in long-term local control and survival in a substantial proportion of patients. For small-volume recurrent tumors (T1–T2) treated with external radiotherapy, brachytherapy or stereotactic radiosurgery, comparable results to those obtained with surgery have been reported. In contrast, treatment results of advanced-stage locally recurrent NPC are generally more satisfactory with surgery (with or without postoperative radiotherapy) than with reirradiation.
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Affiliation(s)
- Carlos Suárez
- Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
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Koda H, Tsunoda A, Iida H, Akita K, Kishimoto S. Facial Dismasking Flap for Removal of Tumors in the Craniofacial Region. Laryngoscope 2007; 117:1533-8. [PMID: 17632424 DOI: 10.1097/mlg.0b013e31806dd040] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study was aimed at estimating the usefulness of the facial dismasking flap for craniofacial surgery. STUDY DESIGN Anatomical study and retrospective case study. MATERIALS AND METHODS The facial dismasking flap is a combination of a coronal skin incision and a circumpalpebral incision. By adding a circumpalpebral incision, the skin can be detached from the orbital structures and the coronal skin flap can be elevated more inferiorly together with the facial nerves and muscles. We retrospectively reviewed patients who underwent the facial dismasking flap with regard to the extent of the surgical field and resectability under this flap. Postoperative facial scarring and movements were also evaluated. Facial palsy was estimated according to the House-Brackmann grading system. RESULT Twenty-three patients with tumors in various locations, such as, the nasal cavity, paranasal sinus, zygoma, and infratemporal fossa, who had undergone a facial dismasking flap, were studied. Sufficient surgical fields were obtained for removal of the tumor in all patients. Tumors were totally resected in 21 patients and were subtotally resected in two patients to avoid optic nerve damage. Facial nerves were anatomically preserved and facial scarring was minimal in all patients. No facial palsy remained in any patients except one who showed a deterioration of the facial palsy (House-Brackmann grade V-VI). CONCLUSION This flap allows the surgeon to obtain wide exposure of the upper two-thirds of the facial skull. Moreover, damage to the facial skin is minimal and facial movements are well preserved. This technique is not well known to head and neck surgeons, and this is the first comprehensive report of this technique applied to removal of craniofacial lesions.
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Affiliation(s)
- Hiroko Koda
- Department of Otolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
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Kuriakose MA, Salins P. S332. J Oral Maxillofac Surg 2006. [DOI: 10.1016/j.joms.2006.06.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cabanillas R, Llorente JL, Estelrrich PM, Martínez-Cassati ME, Franco V, Suárez C. [Functional and oncologic results of the surgical salvage in the management of recurrent nasopharyngeal carcinomas]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2006; 56:416-22. [PMID: 16353788 DOI: 10.1016/s0001-6519(05)78640-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the indications and results of the surgical salvage in the treatment of recurrent nasopharyngeal carcinoma at the primary site. MATERIAL AND METHOD Twelve patients with biopsy-proven recurrent nasopharyngeal cancer were managed with the subtemporal-preauricular and facial translocation approaches. One patient was staged as having recurrent T stage (rT1) 1 disease; 3 patients, rT2; 2 patients, rT3; and 6 patients rT4. RESULTS With a mean follow-up of 3 years, the 3-year actuarial survival rate was 42%. Survival for recurrent T stage was as follows: rT1, 100%; rT2, 67%; rT3, 50%; rT4, 17%. Survival rates for patiens with rT3 and rT4 disease without intracranial disease are 40%. CONCLUSIONS Facial translocation and subtemporal-preauricular approaches are versatile surgical techniques for radical resection of nasopharyngeal recurrences with an acceptable morbidity. The long term survival results are encouraging for rT1-rT3 tumors and also for rT4 without intracranial extension of the disease.
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Affiliation(s)
- R Cabanillas
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Universidad de Oviedo, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Asturias.
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Kuriakose MA, Salins PC. New Considerations in Skull Base Surgery. J Oral Maxillofac Surg 2005. [DOI: 10.1016/j.joms.2005.05.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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