Oropharyngectomy without mandibulotomy in advanced stage (T3-T4) oropharyngeal cancer

CONCLUSIONS

The postoperative course was excellent for this type of surgery, and the functional recovery was comparable to that obtained with much more laborious techniques.

OBJECTIVES

To compare the advantages and disadvantages of the described technique and oropharyngectomy with labial mandibulotomy.

PATIENTS AND METHODS

A total of 46 patients underwent surgery by means of an oropharyngectomy without mandibulotomy. The pharynx was reconstructed using a plasty made of four regional flaps.

RESULTS

In addition to obvious esthetic benefits, complications of the osteotomy were absent and surgical time was reduced. Some patients undergoing pull-through oropharyngectomy also underwent a marginal mandibulectomy, markedly reducing the frequency of radionecrosis compared with other statistics of techniques using mandibulotomy.

[Influence of the nasogastric tube in the pathology of the maxillary sinus]

INTRODUCTION

Nasoesophageal tube (NT) is very often used by the ear, nose and throat specialists in head and neck oncological surgery. It is well known the irritative effect that it has on the nasosinusal mucosa. The aim of this study is to analyze the relationship between the use of the NT and the pathology of the maxillary sinuses.

MATERIAL AND METHOD

The study was carried out in 25 patients treated in our department who had been fed by NT, after surgery. A plain sinus X-ray was performed in the pre-operatory period and a control radiograph in the post-operatory period, and the results have been analyzed.

RESULTS AND CONCLUSIONS

No sinusitis had been observed whatever length of time the NT remained in situ.

[Intranasal approaches for pituitary area tumors. Our experience]

Transsphenoidal approach is the most commonly employed surgical technique for the resection of pituitary tumors. We present our experience in the transnasal-transsphenoidal approach in 30 patients undergoing pituitary surgery from 1998 to 2002. Ten patients underwent surgery via a sublabial-transeptal-transsphenoidal approach, 15 patients via a transeptal-transsphenoidal approach and 5 patients via a pure endoscopic transnasal-transsphenoidal. The pathological study showed 29 pituitary adenomas and 1 Rathe's cleft cyst. We conclude that the pure endoscopic transnasal-transsphenoidal approach guided by a navigator-system is safest and more effective approach. We reserved the transeptal-transsphenoidal approach for cases with obstructive septal deflection and poor pneumatized sphenoid sinuses. We do not recommend the use of the sublabial-trans-sphenoidal approach.

Arteriovenous haemangioma of the pterygoid process. Report of a case

Arteriovenous haemangioma is a benign tumor which in ear, nose and throat practice is generally found in the soft tissues of the oral cavity. Bone involvement is very uncommon. These lesions typically manifest themselves in infancy, with a tendency towards spontaneous resolution. The management options comprise simple observation, embolization or surgical removal--depending on the location of the tumour and its symptoms. A correct diagnosis is essential to ensure the adoption of adequate measures during surgery. The present case describes an exceptional location of arteriovenous hemangioma of the pterygoid process, and discusses the associated diagnostic and treatment problems.

Upper lateral cartilage transposition in the surgical management of nasal valve incompetence

INTRODUCTION

The treatment of nasal valve dysfunction is very controversial and many otorhinolaryngologists do not always take surgery into consideration. The purpose of this paper is to present the author's surgical technique and the description of 13 patients on which it may work.

MATERIAL AND METHOD

Thirteen cases presenting with nasal obstruction secondary to nasal valve dysfunction are reviewed. All of the patients presented with internal valvulary incompetence and in three of them an alar collapse was associated. Diagnosis was achieved by means of the clinical findings and physical examination. An open rhinoplasty approach was employed. The surgical technique consisted in a transposition of the upper lateral cartilage over the alar cartilage. In the three patients with alar collapse a fixation graft from the septal cartilage was also employed.

RESULTS

Nasal obstruction and valvular incompetence seemed improved in all of the cases.

CONCLUSION

Upper lateral cartilage transposition seems to be an adequate method to solve the nasal valve incompetence.

Inverted papilloma of the sphenoid sinus

Inverted nasosinusal papilloma is a benign tumor accounting for less than 4% of all nasal masses. The lesion originates in the mucosa lining the nasal cavities, the locations in decreasing order of frequency being the lateral wall of the nasal fossa, ethmoid sinus, and maxillary sinus; the sphenoid sinus is only rarely affected. Despite its benign histology, the tumor shows aggressive behavior and can be associated to carcinomas. Surgery is therefore indicated in such cases.

[Intelligent system to perform a diagnostic protocol for lymphatic invasion in laryngeal cancer]

Laryngeal carcinoma is the most frequent malignant tumour in head and neck. Node invasion is known to be one of the most important prognostic factors. The aim of this study has been to design an intelligent system to perform a diagnostic algorithm of metastasic neck nodes. 122 clinical reports of patients diagnosed of laryngeal carcinoma in our department have been reviewed. The compiled data have been: tumor site, T stage, N stage (clinical, after CT scan and post-surgery). The method used to design the intelligent system has been the ID3, which is able to generate a minimal decision tree. Palpation has been the variable that has given more information about node invasion. CT has proved to be more efficient in supraglottic tumours. ID3 method has shown to be useful in performing diagnostic algorithms, specially when the number of cases and diagnostic tests are high.

[Our management protocol and surgical technique in cerebrospinal fluid rhinorrhea treated with an endonasal approach]

Five patients with cerebrospinal fluid fistula (CFF) have been treated with intratecal fluoresceine, 2 cc at 2%, and endoscopic nasal surgery. In 3 patients CFF was postraumatic; one case spontaneous and another case iatrogenic. In all the cases CFF have been solved in the first time. Postoperatory follow-up vary from 8 to 14 months, and no recurrence was observed. Fluorescein must be managed adequately for prevent neural complications.