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Garefis K, Chatziavramidis A, Konstantinidis I, Pazarli E, Markou K. Transnasal Endoscopic Resection of Torus Tubarius Pleomorphic Adenoma. EAR, NOSE & THROAT JOURNAL 2023; 102:566-568. [PMID: 34056942 DOI: 10.1177/01455613211014113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Konstantinos Garefis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Angelos Chatziavramidis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Iordanis Konstantinidis
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Elisavet Pazarli
- Department of Pathology, Papageorgiou Hospital, Thessaloniki, Greece
| | - Konstantinos Markou
- 2nd Academic ORL, Head and Neck Surgery Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
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2
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Poorna T A, Jr L, Ek J, John B, S N, S S. Extracranial schwannoma of the maxillary nerve misdiagnosed as trigeminal neuralgia in an elderly patient with schizophrenia - A diagnostic dilemma. SPECIAL CARE IN DENTISTRY 2023; 43:276-280. [PMID: 35916362 DOI: 10.1111/scd.12763] [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: 04/22/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 11/27/2022]
Abstract
The present paper discusses the diagnostic challenges we faced in a 60-year-old woman with a history of schizophrenia, presenting with left unilateral facial pain for the past three months. Based on the elaborate clinical examination and diagnostic nerve blocks, the patient was diagnosed with trigeminal neuralgia (TN) and non-surgical therapy commenced. Further investigations with magnetic resonance imaging (MRI) and ultrasound-guided fine needle aspiration cytology (FNAC) revealed the presence of an extracranial schwannoma involving a branch of the maxillary nerve. The patient was symptomatically relieved after surgical excision of the benign tumor under general anesthesia. Hence, we emphasize the need for special care and attention in psychiatric patients presenting with orofacial pain.
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Affiliation(s)
| | - Lokesh Jr
- Government Dental College, Kottayam, Kerala, India
| | - Joshna Ek
- Government Dental College, Kottayam, Kerala, India
| | - Bobby John
- Government Dental College, Kottayam, Kerala, India
| | - Neethu S
- Department of General Pathology, Government Medical College, Kottayam, Kerala, India
| | - Shankar S
- Department of General Pathology, Government Medical College, Kottayam, Kerala, India
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Henry LE, Haugen TW, Rassekh CH, Adappa ND, Weinstein GS, O'Malley BW. A novel transpalatal‐transoral robotic surgery approach to clival chordomas extending into the nasopharynx. Head Neck 2019; 41:E133-E140. [DOI: 10.1002/hed.25747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 03/12/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Laura E. Henry
- University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Thorsen W. Haugen
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of Pennsylvania Health System Philadelphia Pennsylvania
| | - Christopher H. Rassekh
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of Pennsylvania Health System Philadelphia Pennsylvania
| | - Nithin D. Adappa
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of Pennsylvania Health System Philadelphia Pennsylvania
| | - Gregory S. Weinstein
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of Pennsylvania Health System Philadelphia Pennsylvania
| | - Bert W. O'Malley
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of Pennsylvania Health System Philadelphia Pennsylvania
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4
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Coblator-Assisted Endoscopic Transnasal Resection of a Large Nasopharyngeal Pleomorphic Adenoma. Case Rep Otolaryngol 2019; 2019:4654357. [PMID: 30937204 PMCID: PMC6415314 DOI: 10.1155/2019/4654357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/03/2019] [Indexed: 12/17/2022] Open
Abstract
Background Pleomorphic adenomas occurring in the adult nasopharynx are rare, with our literature search identifying only 11 previous English-language reports. We document the unusual case of a large nasopharyngeal pleomorphic adenoma that was resected using radiofrequency coblation via an endoscopic transnasal approach. Methods A 39-year-old male presented with worsening nasal congestion, intermittent otalgia, and a progressive change in voice. Flexible nasendoscopy showed a large homogeneous mass occupying the postnasal space, and computed tomography confirmed a 28 × 31 × 22 mm nasopharyngeal tumour. The biopsy-proven benign tumour was locally dissected using a coblator-assisted transnasal approach. Results Histology confirmed complete excision of a myoepithelial-rich pleomorphic adenoma. The patient was symptom-free postoperatively, and no signs of recurrence were seen at one-year follow-up. Conclusions This is a useful addition to the existing literature on surgical procedures used to treat benign pathology in the nasopharynx. The minimally invasive technique was well tolerated and had favourable patient outcomes.
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Ulu MO, Aydin S, Kayhan A, Ozoner B, Kucukyuruk B, Ugurlar D, Sanus GZ, Tanriover N. Surgical Management of Sphenoid Sinus Lateral Recess Cerebrospinal Fluid Leaks: A Single Neurosurgical Center Analysis of Endoscopic Endonasal Minimal Transpterygoid Approach. World Neurosurg 2018; 118:e473-e482. [PMID: 29981913 DOI: 10.1016/j.wneu.2018.06.219] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To review the results of sphenoid sinus lateral recess (SSLR) cerebrospinal fluid (CSF) leaks treated with the endoscopic endonasal minimal transpterygoid approach (EEMTPA) and to discuss the surgical technique and outcomes. METHODS We performed a retrospective analysis of 13 cases who underwent SSLR CSF leak repair through the EEMTPA in our clinic between September 2008 and December 2017. Demographic and etiological features with reconstruction and surgical outcomes were examined. Mean follow-up time was 6.1 years. RESULTS In regard to etiology, the SSLR CSF leaks included 9 patients with spontaneous, 2 patients with traumatic, and 2 with iatrogenic causes. CSF leak was at the left lateral recess in 8 cases and at right lateral recess in 5 cases. Nine patients had empty sella syndrome, and 11 patients had meningoencephaloceles in addition to SSLR CSF leaks. All patients underwent surgery through the EEMTPA, and a multilayer closure with tissue overlay grafts were used for reconstruction. A pedicled nasoseptal flap and/or pedicled middle turbinate flap were applied to the area of the leak in all cases. One patient had a persistent CSF leak and another had recurrence, both of which required revision surgery. Our overall success rate was 100%. CONCLUSIONS EEMTPA is a safe and effective method that can be used to treat challenging pathologies at the SSLR, including CSF leaks accompanying meningoencephaloceles. Furthermore, the success rate of EEMTPA for SSLR CSF leaks can be increased by applying endoscopic skull base reconstruction techniques such as the pedicled nasoseptal flap and pedicled middle turbinate flap.
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Affiliation(s)
- Mustafa Onur Ulu
- Department of Neurosurgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Seckin Aydin
- Department of Neurosurgery, University of Health Sciences Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Kayhan
- Department of Neurosurgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Baris Ozoner
- Department of Neurosurgery, Erzincan University Medical Faculty, Erzincan, Turkey
| | - Baris Kucukyuruk
- Department of Neurosurgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Doga Ugurlar
- Department of Neurosurgery, University of Health Sciences Haseki Training and Research Hospital, Istanbul, Turkey
| | - Galip Zihni Sanus
- Department of Neurosurgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Necmettin Tanriover
- Department of Neurosurgery, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.
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Carrillo JF, Celis MA, Ramirez-Ortega M, Rivas B, Ochoa FJ. Osteoplastic Maxillotomy for Treatment of Neoplasms of the Nasopharynx and Infratemporal Fossa. Ann Otol Rhinol Laryngol 2016; 114:58-64. [PMID: 15697164 DOI: 10.1177/000348940511400111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Approaches to the infratemporal fossa and nasopharynx are difficult because of the anatomic complexity of these regions. We describe our experience with osteoplastic maxillotomy, with our own modifications, and evaluate oncological outcomes and postoperative quality of life. Ten patients underwent osteoplastic maxillotomy, 3 of whom had a diagnosis of malignancy, and 7 of whom had nasopharyngeal angiofibromas (NPAs). A Weber-Fergusson incision was made to develop facial flaps and preserve the vascularity of the maxilla. Osteotomies were performed through the facial aspects of the maxilla, on the orbital rims, and on the malar eminence for the medial variant of the procedure. The anterolateral variant involved descent of the temporalis muscle with preservation of the facial nerve, and a zygomatic osteotomy. Four craniotomies were done. Two patients had the medial variant of the procedure, and 8 had the anterolateral variant. The complications were transient and mild. The patients who had malignancies are alive with no disease, and there was 1 recurrence among the 7 patients with NPAs. We found excellent aesthetic results in 8 of the 10 patients, and no change in basic functions in 8 patients. Osteoplastic maxillotomy allows resection of massive NPAs with no significant bleeding. Resection of malignant lesions with good results is feasible.
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Affiliation(s)
- Jose F Carrillo
- Head and Neck Department, Instituto Nacional de Cancerología, Mexico City, Mexico
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Douglas WG, Rigual NR, Giese W, Bauer J, Wiseman SM, Loree TR, Schwarz J, Alrawi S, Hicks WL. Advanced Soft Palate Cancer: The Clinical Importance of the Parapharyngeal Space. Otolaryngol Head Neck Surg 2016; 133:66-9. [PMID: 16025055 DOI: 10.1016/j.otohns.2005.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE: To identify the incidence of parapharyngeal space (PPS) recurrences and how they impact survival in advanced-stage soft-palate carcinoma patients. STUDY DESIGN AND SETTING: One hundred thirty-seven patients' charts were reviewed from 1971 to 1996. Inclusion criteria were patients who received a per-oral resection, discontinuous neck dissection, and postoperative adjuvant radiation therapy; 15 patients met criteria for inclusion. The incidence of PPS recurrences, regional failure, and survival were endpoints that were analyzed. RESULTS: There were no local failures in our study. Regional failures excluding the PPS (levels I-V) were 27%, and 40% occurred within the PPS. Cervical adenopathy was associated with 83% of the PPS recurrences. Median survival for PPS recurrences was 26 months, compared with 67 months for levels I-V recurrences (n = ns). CONCLUSIONS: The incidence of PPS recurrences is substantial in advanced-stage soft-palate cancer. PPS recurrences negatively impact survival; without effective salvage techniques for these recurrences or effective adjuvant therapy, poor patient outcomes can be expected.
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Affiliation(s)
- Wade G Douglas
- Department of Head and Neck, Plastics and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
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8
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A giant trigeminal schwannoma of the infratemporal fossa removed by transmandibular approach and coronoidectomy. ORAL AND MAXILLOFACIAL SURGERY CASES 2016. [DOI: 10.1016/j.omsc.2016.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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9
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Nasopharyngeal pleomorphic adenoma presenting as otitis media with effusion: case report and literature review. Am J Otolaryngol 2014; 35:73-6. [PMID: 24051236 DOI: 10.1016/j.amjoto.2013.08.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/11/2013] [Accepted: 08/12/2013] [Indexed: 11/24/2022]
Abstract
Most tumors arising in the nasopharynx are malignant and frequently develop otitis media with effusion (OME). On the contrary, benign nasopharyngeal tumors are very rare, and pleomorphic adenoma, which is a benign mixed tumor of the nasopharynx, is also rarely encountered. We herein report a case of nasopharyngeal pleomorphic adenoma which initially presented as OME. This tumor completely blocked the orifice of the Eustachian tube but was removed by a combination of transnasal and transoral endoscopic resection. A defect in the mucous membrane was covered with polyglycolic acid sheet and fibrin glue. Mucous membrane completely covered the exposed tubal cartilage without adhesion near the tubal orifice. OME and hearing loss completely subsided 3 months after the surgery. She was disease-free 2 years after the surgery. Use of polyglycolic acid sheet could be a feasible mesh for closure of surgical defect without scarring, and it also led to healing of OME.
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Park YM, De Virgilio A, Kim WS, Chung HP, Kim SH. Parapharyngeal space surgery via a transoral approach using a robotic surgical system: transoral robotic surgery. J Laparoendosc Adv Surg Tech A 2013; 23:231-6. [PMID: 23343202 DOI: 10.1089/lap.2012.0197] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE In transoral robotic surgery (TORS), if an endoscopic arm equipped with two integrated cameras is placed close to a lesion, a three-dimensionally magnified view of the operative field can be obtained. More important is that the operation can be performed precisely and bimanually using two instrument arms that can move freely within a limited working space. We performed TORS to treat several diseases that occur in the parapharyngeal space (PPS) and subsequently analyzed the treatment outcomes to confirm the validity of this procedure. PATIENTS AND METHODS Between February 2009 and February 2012, 11 patients who required surgical treatment for the removal of a parapharyngeal lesion were enrolled in this prospective study. Nine patients received TORS for parapharyngeal tumor resection, and 2 patients with stylohyoid syndrome underwent TORS for resection of an elongated styloid process. The average age of the patients included in this study was 42 years. Five patients were male, and 6 patients were female. RESULTS TORS was successfully performed in all 11 patients. The average robotic system docking and operation times were 9.9 minutes (range, 5-24 minutes) and 54.2 minutes (range, 26-150 minutes), respectively. Patients were able to swallow normally the day after the operation. The average blood loss during the robotic operation was minimal (11.8 mL). The average hospital stay was 2.6 days. There were no significant complications in the perioperative or postoperative period. All patients were extremely satisfied with their cosmetic outcomes. CONCLUSIONS PPS surgery via a transoral approach using a robotic surgical system is technically feasible and secures a better cosmetic outcome than the transcervical, transparotid, or transmandibular approach. This new surgical method is safe and effective for benign diseases of the PPS.
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Affiliation(s)
- Young Min Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, Busan, Korea
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11
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Partial maxillary swing approach for removal of the tumors in the retromaxillary area. Auris Nasus Larynx 2009; 36:567-70. [DOI: 10.1016/j.anl.2009.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 01/26/2009] [Indexed: 11/20/2022]
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Bao S, Ni S, Zhang J, Li L, Mo D, Guo C, Zhang J, Yu G, You Y. Treatment of lesions involving both the infratemporal fossa and middle skull base. ACTA ACUST UNITED AC 2006; 66 Suppl 1:S10-7; discussion S17. [PMID: 16904988 DOI: 10.1016/j.surneu.2006.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Accepted: 06/13/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communicating occupying lesions of the intratemporal fossa and mid-cranial fossa represent challenges for neurosurgeons and maxillofacial surgeons. Lesions of the skull base, with complex anatomy, are extremely varied in their histopathology. They often spread via normal anatomic pathways or bony destruction to involve adjacent structures, especially in the case of malignant neoplasms. However, with the development of operative skills and reconstruction techniques, total or near total resection of many such lesions can be accomplished with a low morbidity rate. METHODS The combined frontotemporal-preauricular infratemporal approach, frontotemporal-orbitozygomatic approach, combined frontotemporal and transmandibular approach, transmandibular approach, and transmaxillary approach were used to resect the lesions using microsurgical skills. The plastic reconstruction included reconstruction of the dura defects, osteosynthesis, and obliteration of the operative cavity. RESULTS Thirty-three patients with communicating lesions invading both the infratemporal fossa and the middle skull base underwent microsurgery. Among them, lesions were totally resected in 23, subtotally resected in 6, and partially resected in 4. In 29 patients, clinical status improved significantly. Complications were encountered in 7 cases, and morbidity was not remarkable. CONCLUSION The surgical approach should be selected depending on the size, location, histopathology, and invading extension of the lesion, which can provide excellent visualization and allow for an aggressive and safe resection of lesions involving this region. Familiarity with skull base anatomy, careful microsurgical manipulation, protection of vital structures, reliable plastic reconstruction, intraoperative nerve monitoring, as well as consideration of functional and esthetic outcomes, will all contribute to successful surgery and satisfactory results.
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Affiliation(s)
- Shengde Bao
- Department of Neurosurgery, Peking University First Hospital, Peking University, Beijing 100034, China.
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Roh JL, Jung BJ, Rha KS, Park CI. Endoscopic resection of pleomorphic adenoma arising in the nasopharynx. Acta Otolaryngol 2005; 125:910-12. [PMID: 16158542 DOI: 10.1080/00016480510039003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Pleomorphic adenoma is the commonest benign tumor of the salivary glands. It has rarely been reported arising in the nasopharynx. A pleomorphic adenoma originating from the left lateral wall of the nasopharynx was found in a 61-year-old female who presented with nasal obstruction and intermittent epistaxis. It was successfully removed by combined transnasal and transoral surgery under endoscopic visualization. Endoscope-guided surgery may be helpful for the complete resection of benign nasopharyngeal tumors whilst minimizing injury to the Eustachian tube openings or velopharynx.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otolaryngology--Head and Neck Surgery, Cancer Research Institute, Chungnam National University College of Medicine, Daejeon, South Korea.
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Roh JL. Removal of infratemporal fossa schwannoma via a transmandibular transpterygoid approach. Eur Arch Otorhinolaryngol 2004; 262:428-31. [PMID: 15378317 DOI: 10.1007/s00405-004-0848-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Accepted: 08/06/2004] [Indexed: 10/26/2022]
Abstract
Trigeminal schwannomas are commonly located in the intracranium, and extracranial schwannomas limited to the infratemopral fossa (ITF) are extremely rare. Trigeminal mandibular schwannoma was found in the left ITF of a 48-year-old man who presented with a 1-year history of left facial pain and trismus. The schwannoma was completely removed by a transmandibular transpterygoid approach with no major complications. This case is discussed with a review of the literature on this rare occurrence, focusing on the surgical approach.
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otolaryngology and Head and Neck Surgery, Cancer Research Institute, Chungnam National University College of Medicine, 640 Daesa-Dong Chung-Gu, 301-040 Daejeon, Republic of Korea.
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Kawakami M, Ito K, Tanaka H, Hyo S. Warthin’s tumor of the nasopharynx: a case report. Auris Nasus Larynx 2004; 31:293-8. [PMID: 15364367 DOI: 10.1016/j.anl.2004.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2003] [Revised: 03/22/2004] [Accepted: 05/21/2004] [Indexed: 11/24/2022]
Abstract
Warthin's tumor in the nasopharynx is extremely rare. A 76-year-old man was referred to our hospital for treatment of a nasopharyngeal tumor. Fiberscopic examination, CT and MRI findings showed an oval mass in the right side of the posterior nasopharynx. The tumor was resected surgically using the transpalatal approach. Pathological examination indicated Warthin's tumor. There have not been any signs of recurrence postoperatively.
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Affiliation(s)
- Michiro Kawakami
- Department of Otolaryngology, Osaka National Hospital, Hoenzaka, Chuo, Osaka 540-0004, Japan. auait300@
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Abstract
Nasopharyngeal carcinoma (NPC) is the most common epithelial tumor of the nasopharynx. Radiation therapy is the mainstay of treatment while surgery or chemotherapy is used in selected patients. NPC usually regresses after 3 months of radiation therapy. Nonetheless, a residual mass may be present following treatment and this does not necessarily indicate viable tumor. Imaging studies are often used in conjunction with clinical examination following treatment. While computed tomography (CT) is widely used due to its greater availability, less expensive, and less time consuming, MR imaging is now becoming the preferred modality. MR imaging is more capable than CT for identifying mature scarring, tumor recurrence and postradiation complications. However, MR imaging cannot reliably demonstrate mucosal recurrence or differentiate tumor recurrence from postradiation tissue changes. Familiarity with the imaging findings of various posttreatment changes, tumor recurrence and postradiation complications is essential for management of NPC. Comparison with previous images or imaging-guided biopsy facilitates definitive diagnosis.
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Affiliation(s)
- Shu Hang Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, 222 Mai-Chin Road, Keelung, Taiwan.
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Abstract
OBJECTIVE The objective of this study was to evaluate the oncological outcome and complication rate following surgical treatment of nasopharyngeal salivary gland malignancy. STUDY DESIGN Retrospective case review at tertiary care skull base center. METHODS Pertinent medical records were reviewed from 23 patients presenting with minor salivary gland malignancy. Clinical presentation, prior treatment, histological type and grade, clinical stage, details of surgical treatment, and postoperative adjuvant radiation therapy were studied. Survival and recurrence data were analyzed using the Kaplan-Meier and Cox proportional hazards methods. RESULTS Histological types included 11 adenoid cystic carcinomas, 8 mucoepidermoid carcinomas, and 4 cases of adenocarcinoma not otherwise specified. All patients underwent primary surgical resection, and the lateral infratemporal middle fossa approach was used in 20 patients. Prior radiation therapy had been administered in 6 patients who presented for treatment of recurrent disease, and the remaining 17 patients underwent planned postoperative radiation therapy. Elective neck dissection was undertaken in 15 patients, and occult neck disease was present in 47%. Disease specific survival was 67% at 5 years and 48% at 10 years. High-grade tumors had a significantly poorer outcome (P =.035) with a relative risk of 4.6 compared with low-grade disease. Local control was seen to be 77% at 5 years. CONCLUSIONS Planned combined surgery and radiation therapy achieves survival outcomes and recurrence rates in nasopharyngeal salivary gland malignancy comparable to results reported using the same treatment for minor salivary gland tumors cancer originating elsewhere in the head and neck. Because of the high rate of occult neck metastases, we recommend elective neck dissection as part of the surgical treatment with this disease entity. The lateral infratemporal middle fossa approach provides safe and adequate access to resect the vast majority of these tumors with acceptable complication rates. A reliable form of vascularized reconstruction is necessary to prevent serious postoperative complications, and we currently prefer the gastro-omental free flap.
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MESH Headings
- Actuarial Analysis
- Adenocarcinoma/complications
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adolescent
- Adult
- Aged
- Carcinoma, Adenoid Cystic/complications
- Carcinoma, Adenoid Cystic/mortality
- Carcinoma, Adenoid Cystic/pathology
- Carcinoma, Adenoid Cystic/surgery
- Carcinoma, Mucoepidermoid/complications
- Carcinoma, Mucoepidermoid/mortality
- Carcinoma, Mucoepidermoid/pathology
- Carcinoma, Mucoepidermoid/surgery
- Craniotomy/methods
- Female
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Nasopharyngeal Neoplasms/complications
- Nasopharyngeal Neoplasms/mortality
- Nasopharyngeal Neoplasms/pathology
- Nasopharyngeal Neoplasms/surgery
- Neck Dissection
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging/methods
- Patient Selection
- Proportional Hazards Models
- Radiotherapy, Adjuvant
- Retrospective Studies
- Risk Factors
- Salivary Gland Neoplasms/complications
- Salivary Gland Neoplasms/mortality
- Salivary Gland Neoplasms/pathology
- Salivary Gland Neoplasms/surgery
- Surgical Flaps
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- V L Schramm
- Center for Craniofacial-Skull Base Surgery, Denver, Colorado, USA
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Shu CH, Cheng H, Lirng JF, Chang FC, Chao Y, Chi KH, Yen SH. Salvage surgery for recurrent nasopharyngeal carcinoma. Laryngoscope 2000; 110:1483-8. [PMID: 10983947 DOI: 10.1097/00005537-200009000-00014] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the efficacy of salvage surgery in the treatment of recurrent nasopharyngeal carcinoma (NPC) at the primary site. STUDY DESIGN A retrospective investigation of the outcome of salvage surgery for 28 patients with recurrent NPC after definite radiation therapy. METHODS The nasopharynx was approached anteroposteriorly by the transmaxillary approach (maxillary swing, maxillectomy) or inferior approach (midline mandibulotomy or median labiomandibular glossotomy), or laterally by modified facial translocation or transpterygoid approach; intentional ligation of the internal carotid artery was performed after establishment of extracranial-intracranial (EC-IC) bypass in one patient; postoperative irradiation was given to the patients with positive pathological margins. RESULTS Nine patients lived without disease for 20 to 93 months (mean interval, 52 mo) after surgery; among them, eight patients had T1 tumors that were resected totally by surgery via anteroposterior approaches and the other patient had postoperative irradiation to control the disease. Seven patients had local recurrence 8 to 21 months after treatment. Four patients developed distant metastases, including one patient with a T2b tumor that was totally resected through modified facial translocation approach with ligation of internal carotid artery. Eight patients died of other causes; internal carotid artery blowout was the cause of death in four of these eight patients. CONCLUSIONS In most cases of recurrence, T1 nasopharyngeal tumors can be resected totally by anteroposterior approaches; for T2 or larger tumors, postoperative irradiation is usually necessary. Otherwise, facial translocation offers a better chance to completely resect the tumors. Internal carotid artery is better ligated if patients have received greater than 70 Gy irradiation or if the artery must be exposed during the surgery. We suggest that EC-IC bypass be used to avoid the possible complications (or cerebral ischemic stroke) caused by ligation of internal carotid artery. The transmaxillary approach is favored in the management of nasopharyngeal tumor recurrence with nasal cavity extension, and midline mandibulotomy is more suitable for resection of posterior margin of nasopharyngeal tumor recurrence. Facial translocation offers the widest operative field and is the most versatile approach for radical resection of nasopharyngeal tumor recurrence, but the surgeon should be skilled in the management of the facial nerves to reduce morbidity.
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Affiliation(s)
- C H Shu
- Department of Otolaryngology, Veterans General Hospital, Taipei and National Yang-Ming University School of Medicine, Taiwan
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Guinto G, Abello J, Molina A, Gallegos F, Oviedo A, Nettel B, López R. Zygomatic-transmandibular approach for giant tumors of the infratemporal fossa and parapharyngeal space. Neurosurgery 1999; 45:1385-98. [PMID: 10598707 DOI: 10.1097/00006123-199912000-00025] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The surgical anatomy of the infratemporal fossa and parapharyngeal space is often not properly understood by neurosurgeons, because these areas are more related to other medical disciplines. This article provides a detailed description of the infratemporal fossa and parapharyngeal space anatomy in cadaveric specimens and offers a neurosurgical perspective on a surgical approach that allows wide exposure and complete resection of giant tumors in this location. METHODS Ten cadaveric specimens were prepared for anatomic study. Dissections were performed to emphasize the relationship between bone, muscles, and neurovascular structures and to simultaneously expose the middle cranial fossa, the infratemporal fossa, and the parapharyngeal space. Ten patients with giant lesions in these areas (with maximum tumor diameter >8 cm) were treated via this approach. RESULTS The main obstacles to approaching the infratemporal fossa and the parapharyngeal space are the zygomatic arch, the parotid gland, the facial nerve, and the ascending ramus of the mandible. Thus, by combining a pterional-zygomatic craniotomy with transmandibular access, working up and down the parotid gland, the exposure is wider and safer. Among the 10 patients treated, tumors were totally resected in 7, subtotally resected in 2, and partially resected in 1. Morbidity was unremarkable, and, in 8 patients, clinical status improved dramatically. CONCLUSION The zygomatic-transmandibular approach allows resection of giant lesions in the middle cranial base, when they are invading the infratemporal fossa and parapharyngeal space, with a low morbidity rate.
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Affiliation(s)
- G Guinto
- Department of Neurosurgery, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
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Diaz-Gonzalez FJ, Padrón A, Foncea AM, García de Sola R, Naval L, Rubio P. A new transfacial approach for lesions of the clivus and parapharyngeal space: the partial segmented Le Fort I osteotomy. Plast Reconstr Surg 1999; 103:955-9. [PMID: 10077087 DOI: 10.1097/00006534-199903000-00028] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tumors of the clival and parapharyngeal areas are a challenge because of their location. They used to be considered inaccessible because the aggressive approaches employed caused elevated levels of morbidity. This fact led to more conservative approaches that attempted to preserve the exposure of the lesion. These approaches were a combination of cranial and facial procedures, thus utilizing a combined effort between neurosurgeons and maxillofacial surgeons. We described our experience with a partial segmented Le Fort I osteotomy added to a transmandibular approach to expose a chordoma of the clivus and left parapharyngeal space. A three-dimensional imaging was used as a diagnostic tool and to plan the optimal surgical approach. The operative technique was described in this case study. Some important technical details of the approach are described. The global outcome was favorable.
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Affiliation(s)
- F J Diaz-Gonzalez
- Department of Oral and Maxillofacial Surgery, University Hospital de la Princesa at the Autonoma University of Madrid, School of Medicine, Spain
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Abstract
BACKGROUND The recognition of risk factors for the development of distant metastasis is necessary for identifying high-risk patients who may benefit from systemic therapy. Previous investigations studying possible risk factors have been heterogeneous, with patients having varied forms of therapy. This study is designed to evaluate the clinical and histologic risk factors for the development of distant metastasis (DM) in patients with only advanced-stage head and neck squamous cell carcinoma after surgery and radiotherapy. METHODS Retrospective analysis of a cohort of potentials with-surgically treated stage III and IV squamous cell carcinoma of the hypopharynx, tongue, and supraglottic larynx between 1988-1992. The cohort consisted of 130 patients of which 30 patients developed DM as the initial site of failure. All patients underwent surgical resection of the primary. Neck dissection was performed in 26 of 30 (87%0 patients who developed distant metastasis. Almost all patients received radiation therapy. Patients who initially developed DM (DM group) were compared with patients who did not initially develop DM (no DM group) with respect to certain clinical and histo-pathological factors. RESULTS The majority of patients in the DM group had advanced T stage and clinically palpable cervical lymph nodes (73% and 93% respectively). In the no DM group, most patients had advanced T stage (85%) but 42% of the patients had stage NO necks (p < .05). Eighty-eight percent of patients in the DM group and 60% of patients in the no DM group had histological evidence of extracapsular spread of tumor from cervical lymph nodes (p < .05). Three or more positive lymph nodes were found in 69% of patients who developed DM and in only 35% of patients in the no DM group (p < .05). Age, gender, primary site, history of radiation therapy, perineural invasion and tumor grade were not associated with a higher risk for DM (p > .05). CONCLUSION Patients wit clinically palpable neck disease (N1-3), histological evidence of metastatic nodal disease, extracapsular spread, and three or more positive lymph nodes are at greater risk of developing failure at distant sites. This subset of patients should have an extensive evaluation for distant metastatic disease and should be considered for systemic therapy.
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Affiliation(s)
- A Alvi
- Division of Otolaryngology, Mount Sinai Hospital Medical Center/Chicago Medical School, Illinois 60608, USA
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