Management and prognostic factors of recurrent pleomorphic adenoma of the parotid gland: personal experience and review of the literature.
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The aim of this study was to investigate the management and prognostic determinants of recurrent pleomorphic adenoma (RPA). A retrospective analysis was performed to examine the clinical features, the prevalence of surgical complications, and new recurrences of RPA. Tumor recurrence rate was estimated by the Kaplan-Meier method, and the prognostic value of some of the variables was tested by univariate analysis using the log rank test. The study focused on 33 patients, 18 female (54.5%) and 15 male (45.5%), aged 12-71 years (median 41). A total or extended total parotidectomy was performed in 16 cases (48.5%), a superficial parotidectomy in 10 cases (30.3%), and a local excision in 7 cases (21.2%). In ten patients (30.3%), a branch or the trunk of the facial nerve was deliberately sacrificed. Major complications included one unexpected definitive paralysis of the marginal mandibular branch of the facial nerve and 14 cases of Frey syndrome. Follow-up varied from 2 to 25 years (median 10.5 years), and there were 11 new recurrences (33.3%) within a period varying from 1 to 16 years (median 6 years). The estimated tumor recurrence rates were 14.1+/-6.6% at 5 years, 31.4+/-9.4% at 10 years, 43.0+/-10.8% at 15 years, and 57.2+/-14.8% at 20 years. Presence of a multinodular lesion and the type of intervention performed were significantly associated with a higher probability of recurrence. RPAs are prone to new recurrences, especially when multinodular and treated with a local excision. Surgical treatment should include facial nerve resection in selected cases. Follow-up for the patient's lifetime is warranted. (+info)
A 5-year audit of rhinology procedures carried out in a district general hospital.
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INTRODUCTION: Although there has been many studies quoting ENT and rhinology complications, there have been none looking at the complication rates of one department with a single specialist rhinologist over a 5-year period. PATIENTS AND METHODS: Over a 5-year period between 1998 and 2002, the number of operative procedures undertaken in the ENT department in a busy district general hospital was collected in a prospective manner. RESULTS: A total of 10,768 ENT procedures were undertaken in the department which comprised four consultants and associated junior staff (SpRs/SASs/SHOs); 2507 of these procedures were rhinology cases. There were 39 recorded complications following nasal surgery, giving an overall rhinology complication rate of 1.56%. This included 12 postoperative nose bleeds (0.48%), 5 cases of infection following septal surgery (0.56%), 7 cases of septal perforation (0.75%) and various minor functional endoscopic sinus surgery (FESS) complications (2.17%). These figures are either below or within the quoted literature rates. There were no major complications or deaths recorded following nasal surgery. CONCLUSIONS: These results compare favourably with those of other studies. (+info)
Recurrent respiratory papillomatosis: an overview of current thinking and treatment.
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Human papillomaviruses (HPV) infection in benign laryngeal papillomas is well established. The vast majority of recurrent respiratory papillomatosis lesions are due to HPV types 6 and 11. Human papillomaviruses are small non-enveloped viruses (>8 kb), that replicate within the nuclei of infected host cells. Infected host basal cell keratinocytes and papillomas arise from the disordered proliferation of these differentiating keratinocytes. Surgical debulking of papillomas is currently the treatment of choice; newer surgical approaches utilizing microdebriders are replacing laser ablation. Surgery aims to secure an adequate airway and improve and maintain an acceptable quality of voice. Adjuvant treatments currently used include cidofovir, indole-3-carbinol, ribavirin, mumps vaccine, and photodynamic therapy. The recent licensing of prophylactic HPV vaccines is a most interesting development. The low incidence of RRP does pose significant problems in recruitment of sufficient numbers to show statistical significance. Large multi-centre collaborative clinical trials are therefore required. Even so, sufficient clinical follow-up data would take several years. (+info)
Comparison of outcomes of velopharyngeal surgery between the inferiorly and superiorly based pharyngeal flaps.
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BACKGROUND: Pharyngeal flaps have been widely used for the correction of velopharyngeal incompetence. The aim of this study was to compare the outcomes of velopharyngeal surgery between those who received the superiorly and inferiorly based pharyngeal flaps. METHODS: A retrospective review of medical records of patients with cleft palates who received pharyngeal flap surgery for the correction of velopharyngeal incompetence at one craniofacial center was performed. The superiorly based flaps were elevated and inset using the fish-mouth method. The inferiorly based flaps were sutured to the soft palate where a distally based mucosa flap was turned over to cover the raw surface of the flap pedicle. The velopharyngeal functions were categorized as adequate, marginal, or inadequate. Complications associated with the operation were documented. Statistical comparisons between the two groups were made. RESULTS: There were 65 patients in each group. No statistically significant differences were found for sex distribution and age at operation. The outcomes of the velopharyngeal surgery were better in the group of patients who received the inferiorly based pharyngeal flaps (p = 0.030). The complications were not significantly different between the two groups, and were all relatively mild. CONCLUSION: The inferiorly based pharyngeal flap was more effective than the superiorly based pharyngeal flap for the correction of velopharyngeal incompetence. A probable explanation may be the fibrotic changes and scar contracture occurring in the pedicle of the superiorly based pharyngeal flap that may have impaired the velopharyngeal closure. (+info)
Endoscopic polipectomy with middle meatal antrostomy for antrochoanal polyp treatment.
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Antrochoanal polyp (ACP) or Killian polyp is a benign nonatopic lesion of the maxillary sinus. Patients usually present nasal obstruction. Many surgical options for the treatment of ACPs have been suggested to minimize postoperative recurrence. The endoscopic nasal approach is a surgical option for maxillary intrasinusal resection of the polyp implantation through the maxillary ostium or middle meatal antrostomy, with lower morbidity when compared to other surgical approaches. AIM: To evaluate the rate of endoscopic antrochoanal polypectomy with middle meatotomy in the treatment of ACP. MATERIALS AND METHODS: Were evaluated by means of a retrospective study, 29 patients, who were diagnosed based on history, physical examination, computed tomography, and histological findings, treated between 1997 and 2004. The surgical approach was endoscopic polypectomy with middle meatotomy. RESULTS: Twenty-nine patients with ACP, 17(58.6%) were females and 12(41.4%) males, age range, 7-75 years (average of 27.55 years) were included in this study. The main symptom were nasal obstruction 24(82%), oral breathing 11(37.9%), snoring nine (31%), rhinorrhea 5(17%), epistaxis 2(6.9%), headache 2(6.9%), and drip one (3.4%). The association with atopy was found in nine (31%). The mean follow-up period was 17 months (3-63 months). Only two patients (6.9%) presented recurrence. CONCLUSION: The rate of recurrence obtained in our study is no different from literature data, even when compared with former and gold standard procedures. (+info)
Anatomical reconstruction from endoscopic images: toward quantitative endoscopy.
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ENT assessment in the integrated management of candidate for (maxillary) sinus lift.
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As stated at the 1996 Consensus Conference at Babson College, a (maxillary) sinus lift is a "safe and predictable" procedure for increasing alveolar bone height in the postero-superior alveolar regions in order to allow oral rehabilitation and restore masticatory function by means of the insertion of a dental implant even in the case of an atrophic maxilla. However, the procedure has a well-known impact on the delicate homeostasis of the maxillary sinus: the concomitant presence of systemic, naso-sinusal or maxillary sinus disease may favour the development of post-operative complications (particularly maxillary rhino-sinusitis), which can compromise a good surgical outcome. On the basis of these considerations, the management of sinus lift candidates should include the careful identification of any situations contraindicating the procedure and, if naso-sinusal disease is suspected, a clinical assessment by an ear, nose and throat specialist, which should include nasal endoscopy and, if necessary, a computed tomography scan of the maxillofacial district, particularly the ostio-meatal complex. This first preventive-diagnostic step should be dedicated to detect presumably irreversible and potentially reversible contraindications to a sinus lift, whereas the second (preventive-therapeutic) step is aimed at correcting (mainly with the aid of endoscopic surgery) such potentially reversible ear, nose and throat contraindications as middle-meatal anatomical structural impairments, phlogistic-infective diseases and benign naso-sinusal neoplasms the removal of which achieves naso-sinusal homeostasis recovery, in order to restore the physiological drainage and ventilation of the maxillary sinus. The third (diagnostic-therapeutic) step is only required if mainly infective and sinusal complications arise after sinus lift surgery, and is aimed at ensuring early diagnosis and prompt treatment of maxillary rhino-sinusitis in order to avoid, if possible, implant loss and, in particular, the related major complications. The purpose of this report is to describe these three steps in detail within the context of a multidisciplinary management of sinus lift in which otorhinolaryngological factors may be the key to a successful outcome. (+info)
Reliability of surgical skills scores in otolaryngology residents: analysis using generalizability theory.
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