A simple classification of cranial-nasal-orbital communicating tumors that facilitate choice of surgical approaches: analysis of a series of 32 cases.

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A simple classification of cranial-nasal-orbital communicating tumors that facilitate choice of surgical approaches: analysis of a series of 32 cases.

Eur Arch Otorhinolaryngol. 2016 Mar 26;

Authors: Deng YF, Lei BX, Zheng MG, Zheng YQ, Chen WL, Lan YQ

Abstract
Cranial-nasal-orbital communicating tumors involving the anterior and middle skull base are among the most challenging to treat surgically, with high rates of incomplete resection and surgical complications. Currently, there is no recognized classification of tumors with regard to the choice of surgical approaches. From January 2004 to January 2014, we classified 32 cranial-nasal-orbital communicating tumors treated in our center into three types according to the tumor body location, scope of extension and direction of invasion: lateral (type I), central (type II) and extensive (type III). This classification considerably facilitated the choice of surgical routes and significantly influenced the surgical time and amount of hemorrhage during operation. In addition, we emphasized the use of transnasal endoscopy for large and extensive tumors, individualized treatment strategies drafted by a group of multidisciplinary collaborators, and careful reconstruction of the skull base defects. Our treatment strategies achieved good surgical outcomes, with a high ratio of total resection (87.5 %, 28/32, including 16 cases of benign tumors and 12 cases of malignant tumors) and a low percentage of surgical complications (18.8 %, 6/32). Original symptoms were alleviated in 29 patients. The average KPS score improved from 81.25 % preoperatively to 91.25 % at 3 months after surgery. No serious perioperative complications occurred. During the follow-up of 3 years on average, four patients with malignant tumors died, including three who had subtotal resections. The 3-year survival rate of patients with malignant tumors was 78.6 %, and the overall 3-year survival rate was 87.5 %. Our data indicate that the simple classification method has practical significance in guiding the choice of surgical approaches for cranial-nasal-orbital communicating tumors and may be extended to other types of skull base tumors.

PMID: 27016919 [PubMed - as supplied by publisher]

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Treatment Efficacy of Voice Therapy for Vocal Fold Polyps and Factors Predictive of Its Efficacy.

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Treatment Efficacy of Voice Therapy for Vocal Fold Polyps and Factors Predictive of Its Efficacy.

J Voice. 2016 Mar 23;

Authors: Lee YS, Lee DH, Jeong GE, Kim JW, Roh JL, Choi SH, Kim SY, Nam SY

Abstract
OBJECTIVES: Vocal fold polyps can be treated with either surgical resection or conservative therapy based on voice therapy. This study was designed to analyze the success rate of voice therapy and identify factors that are predictive of the response to this treatment for vocal fold polyps.
METHODS: This was a retrospective cohort study of 92 consecutive patients who were diagnosed with vocal fold polyp(s) and received voice therapy. We divided the patients into responding and non-responding groups. We analyzed clinical and voice parameters related to the voice results.
RESULTS: After voice therapy, 40 patients showed improved findings and did not undergo surgical treatment. By univariate analysis, female patients (54.9%) and small polyps (56.1%) showed a good response to voice therapy. In multivariate analysis, female sex (odds ratio [OR] = 0.34; confidence interval [CI]: 0.14-0.81, P = 0.01) and small size (OR = 0.15; CI: 0.05-0.47, P <0.01) were significantly related to a successful voice response. In small polyps, the sessile type of polyp was found to be related to a good response rate (OR = 0.24; CI: 0.11-0.95, P = 0.04).
CONCLUSIONS: Voice therapy is more effective for small vocal polyps, particularly the sessile type, in female patients.

PMID: 27017066 [PubMed - as supplied by publisher]

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Enhanced salivary secretion by interferential current stimulation in patients with dry mouth: a pilot study.

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Enhanced salivary secretion by interferential current stimulation in patients with dry mouth: a pilot study.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Feb 13;

Authors: Hasegawa Y, Sugahara K, Sano S, Sakuramoto A, Kishimoto H, Oku Y

Abstract
OBJECTIVE: This pilot study tested the effects of submandibular and sublingual gland stimulation by interferential current stimulation (IFCS), a noninvasive mode of electrical stimulation.
STUDY DESIGN: Three groups were enrolled in this study: 20 young adults, 19 older adults, and 21 patients with dry mouth. Four electrodes were attached to the submandibular area, and the secreted saliva was collected by using Salivette cotton rolls (Sarstedt K. K., Tokyo, Japan) for 15 minutes, either with or without IFCS. Patients were randomly chosen to receive IFCS. Each subject rated pain and discomfort on the Visual Analogue Scale (VAS) after each experiment. Saliva chromogranin A levels were measured as a stress marker. To compare data between conditions with and without IFCS, a two-sample Student t test analysis was performed.
RESULTS: Saliva flow was slightly increased in those in the dry mouth group receiving IFCS compared with those who did not receive IFCS (approximately 130%). However, no such difference was found in the young and older adult groups. There was no significant difference in the VAS values of pain and discomfort or in the stress marker levels between patients who received or did not receive IFCS in the three groups.
CONCLUSIONS: IFCS delivered to submandibular and sublingual glands may promote saliva secretion in persons who suffer from dry mouth in a manner that does not induce pain or physical stress.

PMID: 27017403 [PubMed - as supplied by publisher]

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Iron-labeled adipose stem cells and neovascularization in rabbit calvarial critical-sized defects.

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Iron-labeled adipose stem cells and neovascularization in rabbit calvarial critical-sized defects.

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan 14;

Authors: Lappalainen OP, Haapea M, Serpi R, Lehtonen S, Ylikontiola L, Korpi J, Serlo W, Sándor GK

Abstract
OBJECTIVE: The aim of this study was to evaluate the presence of iron-labeled adipose stem cells at the 2-week time point and vascular changes at the 2-week and 6-week time points using two different types of scaffolds.
STUDY DESIGN: This study included 22 White New Zealand adult male rabbits. In six rabbits, full-thickness calvarial critical-sized defects were filled with autogenous adipose stem cells labeled with iron oxide seeded onto two scaffolds, namely, solid bioactive glass (BAG) or porous tricalcium phosphate granules (TCP) used on reciprocal sides of the skull. Eleven rabbits were implanted with adipose stem cell-seeded scaffolds without iron labeling for analysis of vascular changes. Five defects were left empty as negative control defects. The specimens were analyzed histologically at the 2-week and 6-week time points.
RESULTS: The TCP group showed significantly more vascularity compared with the BAG group. A greater number of labeled stem cells were identified in the TCP group compared with the BAG group, but the difference was not statistically significant.
CONCLUSIONS: This study revealed the differences in stem cell distribution and revascularization of the calvarial defect, which may be biomaterial dependent.

PMID: 27017402 [PubMed - as supplied by publisher]

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High-grade transformation of acinic cell carcinoma: an inadequately treated entity?

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High-grade transformation of acinic cell carcinoma: an inadequately treated entity?

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Jan 21;

Authors: Chintakuntlawar AV, Shon W, Erickson-Johnson M, Bilodeau E, Jenkins SM, Davidson JA, Keeney MG, Rivera M, Price DL, Moore EJ, Olsen KD, Kasperbauer JL, Foote RL, Price KA, García JJ

Abstract
OBJECTIVE: Acinic cell carcinoma (AcCC) is an uncommon salivary gland malignancy. We aim to characterize the clinical and pathologic characteristics of AcCC with and without high-grade transformation (HGT). Importantly, cases of mammary analogue secretory carcinoma, a recently described histologic mimic of AcCC, have been excluded by using cytogenetics and molecular studies.
STUDY DESIGN: Archival surgical pathology material was obtained for patients diagnosed with AcCC at Mayo Clinic Rochester between 1990 and 2010. Tumors harboring the ETV6-NTRK3 fusion transcript were excluded from analysis by using cytogenetics and molecular studies. Tumors with HGT were characterized by areas with an infiltrative growth pattern, nuclear anaplasia, prominent nucleoli, brisk mitotic activity, geographic necrosis, and stromal desmoplasia. Demographic and clinical data were extracted from the medical records.
RESULTS: AcCC with HGT was seen in 8 of 48 cases (17%). Patients with AcCC with HGT were significantly older than patients without HGT (median 69 vs 54 years; P = .04). Angiolymphatic invasion was more common in AcCC with HGT (P = .02). Relapse-free survival and overall survival were significantly worse for cases of AcCC with HGT (hazard ratio 10.4 and 9.3, respectively; P < .0001 for both comparisons). Locoregional recurrence-free survival was not significantly different (P = .12), but distant metastases-free survival was significantly worse in patients with HGT compared with non-HGT patients (P < .0001).
CONCLUSIONS: Prognosis for overall survival and distant relapse for AcCC patients with HGT is significantly worse than that for patients without HGT.

PMID: 27017401 [PubMed - as supplied by publisher]

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[Craniofacial fibrous dysplasia].

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[Craniofacial fibrous dysplasia].

Rev Med Interne. 2016 Mar 23;

Authors: Couturier A, Aumaître O, Mom T, Gilain L, André M

Abstract
Fibrous dysplasia of bone is a benign, uncommon, sporadic, congenital skeletal disorder resulting in deformity. This disease arises from activating somatic mutation in GNAS which encodes the α subunit of the G stimulatory protein associated with proliferation of undifferentiated osteogenic cells resulting in marrow fibrosis, abnormal matrix production, and stimulation of osteoclastic resorption upon overproduction of IL-6 observed in dysplastic cells. Fibrous dysplasia may be monostotic or polyostotic. This mutation affecting many tissues, café au lait skin macules and endocrinopathies (precocious puberty, hyperthyroidism, growth hormone excess, Cushing syndrome) may be associated in McCune-Albright syndrome, but also myxoma in Mazabraud syndrome or phosphate diabetes. Diagnosis of craniofacial fibrous dysplasia should be considered in the presence of headache, neuralgia, sensory disorders (vision, hearing, balance, smelling), functional disorders (nasal obstruction, nasolacrimal duct obstruction, non-matching occlusion), infectious complications (sinusitis, otitis, mastoiditis). Such symptoms should lead to perform craniofacial CT scan completed with MRI. Bone biopsy is not systematic. Surgical treatment is discussed in cases of nervous complication, facial deformity or active lesions. In case of pain resistant to conventional analgesics, intravenous bisphosphonates can be proposed. In non-responder patients, several case reports suggest the efficacy of a monoclonal antibody directed against the IL-6 receptor which requires to be confirmed by randomized studies.

PMID: 27017329 [PubMed - as supplied by publisher]

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Hyperbaric oxygen therapy as an alternative to surgery for non-healing pharyngocutaneous fistula.

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Hyperbaric oxygen therapy as an alternative to surgery for non-healing pharyngocutaneous fistula.

Eur Arch Otorhinolaryngol. 2016 Mar 26;

Authors: Abu Eta R, Eviatar E, Gavriel H

Abstract
The aim of the study is to examine the utilization of hyperbaric oxygen treatment (HBOT) as an alternative to surgical treatment for non-healing postoperative phayngocutaneous fistula (POPCF). A retrospective study was conducted between 2012 and 2014 of referred patients who had failed conservative treatment for POPCF at other medical centers. Reevaluation at our department was followed by therapeutic management including daily HBOT. Eight male patients with a mean age of 62.3 years were included. The average period of conservative treatment was 1 month before admittance to our department. All patients were managed with HBOT and local debridement. Closure of the POPCF was proved by a barium swallow test in seven patients (87.5 %). HBOT is recommended for patients who have failed conservative treatment for POPCF post-laryngectomy, due to a high rate of successful (87.5 %) closure and should be considered as an alternative to surgical treatment.

PMID: 27016920 [PubMed - as supplied by publisher]

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A simple classification of cranial-nasal-orbital communicating tumors that facilitate choice of surgical approaches: analysis of a series of 32 cases.

Related Articles

A simple classification of cranial-nasal-orbital communicating tumors that facilitate choice of surgical approaches: analysis of a series of 32 cases.

Eur Arch Otorhinolaryngol. 2016 Mar 26;

Authors: Deng YF, Lei BX, Zheng MG, Zheng YQ, Chen WL, Lan YQ

Abstract
Cranial-nasal-orbital communicating tumors involving the anterior and middle skull base are among the most challenging to treat surgically, with high rates of incomplete resection and surgical complications. Currently, there is no recognized classification of tumors with regard to the choice of surgical approaches. From January 2004 to January 2014, we classified 32 cranial-nasal-orbital communicating tumors treated in our center into three types according to the tumor body location, scope of extension and direction of invasion: lateral (type I), central (type II) and extensive (type III). This classification considerably facilitated the choice of surgical routes and significantly influenced the surgical time and amount of hemorrhage during operation. In addition, we emphasized the use of transnasal endoscopy for large and extensive tumors, individualized treatment strategies drafted by a group of multidisciplinary collaborators, and careful reconstruction of the skull base defects. Our treatment strategies achieved good surgical outcomes, with a high ratio of total resection (87.5 %, 28/32, including 16 cases of benign tumors and 12 cases of malignant tumors) and a low percentage of surgical complications (18.8 %, 6/32). Original symptoms were alleviated in 29 patients. The average KPS score improved from 81.25 % preoperatively to 91.25 % at 3 months after surgery. No serious perioperative complications occurred. During the follow-up of 3 years on average, four patients with malignant tumors died, including three who had subtotal resections. The 3-year survival rate of patients with malignant tumors was 78.6 %, and the overall 3-year survival rate was 87.5 %. Our data indicate that the simple classification method has practical significance in guiding the choice of surgical approaches for cranial-nasal-orbital communicating tumors and may be extended to other types of skull base tumors.

PMID: 27016919 [PubMed - as supplied by publisher]

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Cervical lymph node metastasis in adenoid cystic carcinoma of oral cavity and oropharynx: A collective international review.

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Cervical lymph node metastasis in adenoid cystic carcinoma of oral cavity and oropharynx: A collective international review.

Auris Nasus Larynx. 2016 Mar 23;

Authors: Suárez C, Barnes L, Silver CE, Rodrigo JP, Shah JP, Triantafyllou A, Rinaldo A, Cardesa A, Pitman KT, Kowalski LP, Robbins KT, Hellquist H, Medina JE, de Bree R, Takes RP, Coca-Pelaz A, Bradley PJ, Gnepp DR, Teymoortash A, Strojan P, Mendenhall WM, Eloy JA, Bishop JA, Devaney KO, Thompson LD, Hamoir M, Slootweg PJ, Vander Poorten V, Williams MD, Wenig BM, Skálová A, Ferlito A

Abstract
The purpose of this study was to suggest general guidelines in the management of the N0 neck of oral cavity and oropharyngeal adenoid cystic carcinoma (AdCC) in order to improve the survival of these patients and/or reduce the risk of neck recurrences. The incidence of cervical node metastasis at diagnosis of head and neck AdCC is variable, and ranges between 3% and 16%. Metastasis to the cervical lymph nodes of intraoral and oropharyngeal AdCC varies from 2% to 43%, with the lower rates pertaining to palatal AdCC and the higher rates to base of the tongue. Neck node recurrence may happen after treatment in 0-14% of AdCC, is highly dependent on the extent of the treatment and is very rare in patients who have been treated with therapeutic or elective neck dissections, or elective neck irradiation. Lymph node involvement with or without extracapsular extension in AdCC has been shown in most reports to be independently associated with decreased overall and cause-specific survival, probably because lymph node involvement is a risk factor for subsequent distant metastasis. The overall rate of occult neck metastasis in patients with head and neck AdCC ranges from 15% to 44%, but occult neck metastasis from oral cavity and/or oropharynx seems to occur more frequently than from other locations, such as the sinonasal tract and major salivary glands. Nevertheless, the benefit of elective neck dissection (END) in AdCC is not comparable to that of squamous cell carcinoma, because the main cause of failure is not related to neck or local recurrence, but rather, to distant failure. Therefore, END should be considered in patients with a cN0 neck with AdCC in some high risk oral and oropharyngeal locations when postoperative RT is not planned, or the rare AdCC-high grade transformation.

PMID: 27017314 [PubMed - as supplied by publisher]

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