1,720,979 research outputs found
Neck Metastasis From Burned-Out Tumor of the Testis: Diagnostic Pitfall for the Head and Neck Surgeon
Full text linkGerm cell neoplasms are relatively uncommon but highly curable when recognized and treated properly. They most commonly present as a testicular mass and have high tendency to hematogenous spread; thus, more than 70% of patients have metastases at the time of diagnosis. Usually they develop retroperitoneal lymph node metastasis, then spread into the thoracic region and reach the cervical region finally
In response to "In reference to: Neck Abscess: An Unusual clinical presentation of immunoglobulin G4-related disease"
No full textIn response to "In Reference to: Neck abscess: An unusual Clinical Presentation of Immunoglobulin G4-Related diseas
Neck abscess: An unusual clinical presentation of immunoglobulin G4 related disease
No full textImmunoglobulin G4 related disease (IgG4-RD) is a systemic fibroinflammatory disease that can affect almost any organ. Only a few cases of IgG4-RD have been reported to present with cervical lymphadenopathy and none with neck abscesses. We report a case in a patient with bilateral neck mass and bilateral neck abscesses. The patient underwent bilateral neck incision for drainage of the abscesses on two occasions, followed by a neck dissection after a third recurrence. Immunohistochemistry of the specimen revealed IgG4-RD. Although surgery is not the recommended firstline approach for IgG4-RD, only a neck dissection enabled clinical resolution of the lesions in our patient
Transoral surgery (TOS) in oropharyngeal cancer: Different tools, a single mini-invasive philosophy
No full textSurgery with or without adjust therapy and radiotherapy with or without chemotherapy have traditionally represented the possible treatment option for oropharyngeal cancer- The adverse effects of non surgical treatment and recent technical innovations have prompted a new interest in the surgical approach. However parallel to the possibility of achieving radical cancer clearance, we should remember the impact that the traditional open surgery has on the patient's cosmoses, functionality and quality of life. As a result, transoral surgery is an attractive option for oropharyngeal tumors. The therm transoral surgery only indicates that the tumor is accessed and resected via the oral cavity, but the surgeon can choose among different resection methods such as transoral laser microsurgery, transoral robotic surgery, transoral videolaryngoscopic surgery, endoscopic larynx-pharingeal surgery, and ultrasound transoral surgery. The aim of this paper is to review the recent literature on the transoral treatment of oropharyngeal cancer to standardize the terminology of transoral procedures analyzing the common aspects, main difference and future perspectives of the various forms of transoral surgery
Liberatory vertigo: A new prognostic factor for repositioning maneuvers
No full textOBJECTIVE:
This study suggests the new concept of liberatory vertigo to facilitate emergency department treatment of benign paroxysmal positional vertigo.
METHODS:
The present prospective nonrandomized study enrolled 535 patients with typical forms of positional vertigo, who were treated following clinical practice guidelines. We observed the onset of liberatory vertigo during the maneuver as a prognostic factor, and we tested the correlation between that symptom and therapeutic effectiveness. A subjective evaluation of vertigo was made by way of a questionnaire. Data analysis was performed that made use of statistical software.
RESULTS:
Complete recovery occurred in 287 patients (76.5%) with posterior semicircular canal positional vertigo and in 67 patients (80%) with horizontal semicircular canal positional vertigo; liberatory vertigo occurred in 195 (67.9%) and 59 (88%) of those cases, respectively. Differences in terms of recovery probability resulted regardless of the canal involved. Positive predictive value ranged from 93% to 97%.
CONCLUSIONS:
In our sample, liberatory vertigo could predict the effectiveness of the maneuver regardless of the canal involved
Is there a role for ultrasonic surgery in transoral laryngeal cancer resections?
No full textMinimally invasive surgery for laryngeal cancer is nowadays the goal of all larynx surgeons. Transoral laser microsurgery is a widespread and standardized technique that has made it possible to reduce surgical morbidities and hospitalization and to spare laryngeal function. Nonetheless, it has some limitations, which may be exceeded by using new optical and cutting devices as in TransOral UltraSonic Surgery. Areas covered: The aim of this paper is to identify current knowledge about ultrasonic scalpel (US) application in transoral laryngeal surgery and to deduce reasonable indications and contraindications of the tool. Expert opinion: Transoral laryngeal surgery with US is feasible and allows for 'angulated' dissections with higher hemostatic capacity than the CO2 laser. When coupled with an endoscope, surgeons have the possibility to angulate the laryngeal exposure from the inside, reducing blind areas. Nonetheless, US blades are quite bulky, thermal damage is higher than that produced by CO2 laser, and its use should be avoided where the functional result is more closely related to the amount of resected tissue. Tumors limited to the suprahyoid larynx are the current indications for US surgery
What’s behind Margin Status in Oral Cancer?
Full text linkIn the 2nd century AD, Galen argued that the failure to remove any single ‘root’ of a malignant tumor could result in a local relapse. After nearly 2 millennia, this problem appears to be even more challenging due to our increased understanding of the complexity of tumor formation and spread. Pathological analysis of tumor margins under a microscope remains the primary and only accepted method for confirming the complete tumor removal. However, this method is not an all-or-nothing test, and it can be compromised by various intrinsic and extrinsic limitations. Among the intrinsic limitations of pathological analysis we recall the pathologist handling, tissue shrinkage, the detection of minimal residual disease and the persistence of a precancerous field. Extrinsic limitations relate to surgical tools and their thermal damage, the different kinds of surgical resections and frozen sections collection. Surgeons, as well as oncologists and radiotherapists, should be well aware of and deeply understand these limitations to avoid misinterpretation of margin status, which can have serious consequences. Meanwhile, new technologies such as Narrow band imaging have shown promising results in assisting with the achievement of clear superficial resection margins. More recently, emerging techniques like Raman spectroscopy and near-infrared fluorescence have shown potential as real-time guides for surgical resection.
The aim of this narrative review is to provide valuable insights into the complex process of margin analysis and underscore the importance of interdisciplinary collaboration between pathologists, surgeons, oncologists, and radiotherapists to optimize patient outcomes in oral cancer surgery
Charcoal Suspension Tattoo: A New Technique for Intraoperative Detection of Small Tumors of the Parotid Gland
No full textAbstract
OBJECTIVE:
The current surgical trend in the treatment of pleomorphic adenomas of the parotid gland is to limit the extent of resection. This raises the need to correctly identify the mass within the normal parenchyma so as to avoid dissecting the entire superficial lobe of the gland. We describe ultrasound-guided tattooing as a technique to facilitate identification and excision of parotid pleomorphic adenomas.
METHODS:
We reviewed 23 consecutive patients with pleomorphic adenoma of the parotid gland. All patients underwent ultrasound-guided tattooing of the lesions with a charcoal suspension. Baseline tumor and patients' characteristics, major and minor complications, and subjective tolerance to the procedure were recorded. We assessed the number of intralesionally marked masses and the percentage of intraoperatively detected marked lesions.
RESULTS:
The injection was well tolerated. No major complications were recorded. In 2 cases (9%), a transient increase in lesion size was observed. No other minor complications were encountered. Charcoal was found inside the tumor in 19 cases (83%). In 4 cases (17%), it was found in the tissues above the lesion. Twenty-three lesions were intraoperatively detected (100%) and dissected.
CONCLUSION:
Charcoal suspension tattooing is safe and well tolerated for the detection of small pleomorphic adenomas during parotid surgery
The CO2 waveguide laser with flexible fiber in transoral resection of oral and oropharyngeal cancers: a retrospective cohort study on postoperative and quality of life outcomes
No full textThe aim of this study was to evaluate the CO2 waveguide laser (WG CO2 laser) with flexible fiber (Lumenis Ltd., Yokneam, Israel) in the treatment of oral and oropharyngeal cancers, specifically focusing on postoperative outcomes, pain, and quality of life (QoL). Eighty-one patients, 43 women and 38 men, with oral or oropharyngeal cancer who consecutively underwent transoral resection by WG CO2 laser from August 2015 to April 2020 were retrospectively enrolled. Resections were performed in super pulsed mode with a power setting ranging between 3 and 10 W. Data about frozen sections, reconstruction, complication rate, length of hospital stay, tracheostomy rate and time to decannulation, nasogastric feeding tube rate and time to oral feeding, pain, and QoL were reviewed. Continuous variables were presented as mean and standard deviation. Concordance between intraoperative frozen section examination and definitive histology was calculated using Cohen's K test of agreement. The mean length of hospital stay was 13 days. The feeding tube rate was 81%; the tracheostomy rate was 35%; the feeding tube was left in place for 8 days on average, and the time to decannulation was 9 days. The only complication was a postoperative bleeding in 4 patients. The median postoperative pain score measured by the Numeric Pain Rating Scale on postoperative days 1, 3, and 5 was 0 and there was a constant decrease in painkiller use over the days. The overall mean composite QoL score was 77 ± 14, with excellent results in saliva, taste, pain, and speech domains. Frozen section evaluation had a specificity of 99% and a negative predictive value of 98%. WG CO2 laser is a good and safe tool for transoral tailored resection of oral and oropharyngeal cancers. It ensures a good overall QoL and guarantees fast recovery and a very low postoperative pain
MRI and frozen section evaluation of mylohyoid muscle in determining surgical approach for T2-T3 floor of the mouth cancer
Full text linkPurpose: The choice of surgical approach for floor of the mouth (FOM) cancer, particularly for intermediate-stage tumors (cT2-cT3), remains controversial. This study aims to evaluate a method considering mylohyoid muscle (MM) invasion as a determinant for surgical approach selection, utilizing magnetic resonance imaging (MRI) preoperatively and frozen section (FS) analysis intraoperatively. Methods: This observational retrospective cohort study analyzed patients undergoing surgical resection of cT2 and cT3 FOM squamous cell carcinoma (SCC) between January 2013 and June 2023. MM infiltration assessed by preoperative MRI determined the surgical approach: clear infiltration led to compartmental surgery (CS), while doubtful or absent infiltration led to transoral surgery (TOS). Conversion from TOS to CS occurred intraoperatively based on macroscopic evidence or positive FS. Data collected included demographic, clinical, surgical, and pathological variables. Survival analysis was conducted using Kaplan-Meier method. Results: Among 44 patients included, majority had cT2 tumors (59.1%). MM resection was necessary in 22.7% of cases. Overall survival (OS) and progression-free survival (PFS) did not significantly differ between TOS and CS groups. Radiological depth of invasion (rDOI) 10 mm is correlated with MM resection only in 23.8% of cases. Pathological depth of invasion (pDOI) discrepancies were observed in the two groups: in CS group is shown a higher pDOI (> 10 mm) confirmation (90%). Surgical complications and functional outcomes differed between TOS and CS groups. Conclusion: Considering MM invasion for surgical approach selection in cT2-cT3 FOM tumors appears oncologically safe, with better functional outcomes in muscle preservation. Preoperative MRI for MM assessment combined with intraoperative FS analysis provides reliable guidance for surgical decision-making
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