Submandibular gland extirpation during neck dissection, is it truly justified?

Background: There is no oncologic basis for the extirpation of the submandibular gland (SMG) in early oral squamous cell carcinomas (OSCC) unless the SMG is truly infiltrated by the tumor. The study aimed at assessing the true involvement of SMG in OSCC and to determine whether the gland extirpation in all cases is justified. Methods: This study prospectively evaluated the pathological involvement of SMG by OSCC in 281 patients, who were diagnosed with OSCC and underwent wide local excision of the primary tumor with simultaneous neck dissection. Results: Among 281 patients, 29 (10%) cases underwent bilateral neck dissection. A total of 310 SMG were evaluated. Involvement of SMG was seen in 5 (1.6%) cases. SMG metastases from Level Ib were seen in 3 (0.9%) of cases, whereas 0.6% showed direct SMG infiltration from the primary tumor. The advanced floor of mouth and lower alveolus cases had a higher tendency to infiltrate SMG. In none of the cases, bilateral or contralateral SMG was involved. Conclusion: The findings of this study show that the extirpation of SMG in all cases is truly irrational. Preserving the SMG is justified in early OSCC with no nodal metastasis. However, SMG preservation is case dependent and is an individual preference. Further studies are required to assess the locoregional control rate and salivary flow rate in postradiotherapy cases where SMG is preserved.

Microsurgical Extirpation of Intracordal Cyst with a Microflap Technique

BACKGROUND AND OBJECTIVES: Microsurgical resection of intracordal cysts is technically difficult and challenging because the wall of cysts may be tightly attached to underlying vocal ligament and/or overlying epithelium, and therefore their thin wall will easily rupture during surgical dissection. We aimed to evaluate the voice outcomes of standard microflap subepithelial resection and the recurrence rate depending on the intraoperative rupturing of the cyst. MATERIALS AND METHODS: Medical records of Samsung Medical Center, Seoul, Korea, were reviewed for sixty-four consecutive patients who received surgical resection of vocal cyst using microflap subepithelial dissection technique between the year 2004 and 2013. Meticulous dissection was performed to completely remove the cyst wall while preserving the mucosa and the lamina propria as much as possible. Voice outcomes and recurrence rates were compared according to the type, size and the intraoperative rupture of cyst. RESULTS: Presence or absence of cyst rupture was clearly described in the operation records of 41 patients. Intraoperative rupture of the cyst occurred in 32 of 41 (78%) patients. The recurrence was detected in 5 of 64 (7.8%) total cases and 4 of 32 (12.5%) cases of ruptured cyst, but not in 9 cases of intact extirpation. Rupture was more common in case of mucous retention cyst compared with epidermoid cyst (p=0.036). Subjective and objective voice parameters were measured at before and 3 months after surgery, which improved regardless of the cyst rupture. CONCLUSION: Although complete microsurgical extirpation of intracordal cyst while keeping the cyst wall intact is technically difficult, meticulous dissection with maximal preservation of surrounding tissue may warrant the improvement of voice outcomes.

Cirugía mínimamente invasiva de la glándula tiroides: Estudio experimental en el perro / Minimally invasive surgery of the thyroid gland: Experimental study in the dog

El objetivo de este estudio fue determinar  si la lobectomía tiroidea video-asistida, realizada en el modelo canino, reduce el tiempo operatorio, el sangramiento, lesiones de las estructuras nerviosas, y mejora los resultados cosméticos de la cicatriz cervical, en comparación con la lobectomía convencional. Se intervinieron 36 perros adultos mestizos sanos, desparasitados, de ambos sexos, procedentes del bioterio del Instituto de Cirugía Experimental de la Universidad Central de Venezuela. Los animales fueron  asignados al azar simple, a dos grupos de estudio: lobectomía tiroidea convencional (LTC) y lobectomía video - asistida (LTVA), sin insuflación de gas. Los resultados estéticos fueron evaluados por los cirujanos de acuerdo a una escala (excelentes, buenos, regulares y malos), observándose los mejores resultados (P<0,05) en el grupo LTVA (promedio ± DE; 9,2 ± 0,5), que en el grupo LTC (promedio ± DE, 5,8±0,7; P<0,001). En el grupo LTVA  el promedio  de tiempo fue 81±3  min mejor que en el LTC 62±4. El sangramiento fue mayor en el LTC (34±5 mL) que en el LTVA (23±5 mL). No se observaron diferencias significativas en cuanto a la paresia o parálisis de los pliegues vocales, o infección de la herida operatoria.  La lobectomía tiroidea video-asistida es una alternativa válida a la cirugía convencional, resultando en un modelo experimental factible y seguro. Se deberían realizar en Medicina humana estudios comparativos y multicéntricos, para determinar la seguridad y eficacia  de estas técnicas.

A study was conducted to determine if the video-assisted lobectomy performed on a canine model, reduces surgical time, bleeding volume, nerve structures injuries; and improves the cosmetic results of the cervical scar, when compared to conventional lobectomy. Thirty-six adult crossbred dogs of either sex from the animal facility of the Institute of Experimental Surgery, Universidad Central de Venezuela were used. The animals were randomly allocated into two experimental groups: Group A: Eighteen dogs who underwent conventional thyroid lobectomy (CTL); Group B: Eighteen dogs who underwent video-assisted thyroid lobectomy (VATL) without gas insulation. Cosmetic results were assessed by surgeons according to a scale, as follows: excellent, good, average, and bad. The results of the experiment show that dogs operated with the VATL technique exhibited significantly (P<0.05) the highest improvements (9.2±0.5), when compared to the CTL technique (5.8±0.7).  Surgical time lasted longer (P<0.001) in dogs under VATL (81±3 min) than in dogs subjected to CTL (62±4 min). Bleeding volume was significantly higher in CTL (34±5 mL) than in VATL (23±5 mL). No statistically significant differences were found regarding paralysis of vocal cords or surgical wound infections. The VATL is a valid alternative in conventional surgery, becoming a feasible and safe experimental model. Comparative and multicentric studies should be carried out in human subjects to determine both safety and efficacy of these techniques.

Nutrition support during stress response period after tumor extirpation in middle-aged and elderly patients with oral and maxillofacial tumors / 中华临床营养杂志

Objective To investigate the nutrition support during stress response period after tumor ex-tirpation in middle-aged and elderly patients with oral and maxillofacial tumors. Methods Sixty patients who had undergone maxillofacial tumor extirpation were randomly divided into nutrition therapy group (n = 35) and control group ( n = 25 ). Patients in nutrition therapy group received enteral nutritional treatment, while patients in control group fed themselves. The nutritional status of the two groups before operations were evaluated with Concise Nutritional Assessment Indicators of human body measurement and biochemistry were used to evaluate the nutritional conditions. The incidence of post-operational complications and recovery time ( from the operation to discharge) were analyzed. Results The weight and arm muscle circumference in the nutrition therapy group significantly decreased after operations (P <0. 05). However, in the control group, all the nutritional indica-tors except the total lymphocyte count were significantly lower than the baseline levels after operations (P < 0. 05 ) ; particularly, of the average body weight decreased by about 6 kg. The incidence of complications in the nutrition therapy group was significantly lower than that in control group (5. 7% vs. 12. 0% , P <0. 05). The recovery time was significantly longer in the control group than that in the nutrition therapy group [ (28. 62± 2.38) vs. (22. 76± 3. 24) d, P < 0. 01 ]. Conclusion The nutritional support during the stress response period can satisfy the demands of high catabolism after maxillofacial tumor extirpation operation in middle-aged and elderly patients.

The Effect of Reoperation in Inferior Oblique Overaction

PURPOSE: To evaluate the efficacy of re-recession or extirpation of inferior oblique (IO) muscle in recurrent or undercorrected IO overaction (IOOA). METHODS: We reviewed the records of 26 patients (33 eyes) with the recurrent or undercorrected IOOA after the graded recession of IO muscle, who underwent re-recession or extirpation of IO muscle, and was followed up for at least 6 months. We performed extirpation of IO muscle overacting larger than +2 after 14 mm recession of IO muscle or larger than +3 after 10 mm recession of IO muscle. In case of +2 IOOA after 10 or 8 mm recession of IO muscle, we carried out 14 mm re-recession of IO muscle. IOOA under +1 was defined as a successful case after re-operation. RESULTS: Thirty one of 33 eyes (93.9%) were corrected successfully after re-operation; 24 eyes with extirpation of IO muscle (96.0%) and 7 eyes with 14 mm re-reccession of IO muscle (87.5%) were successful. CONCLUSIONS: One of the advantages of graded recession of IO muscle is that additional re recession or extirpation of IO muscle can be preformed if needed. Extirpation or 14 mm re-recession of IO muscle was effective re operation procedure to correct a recurred or undercorrected IOOA.

Diagnosis and surgical treatment of subdural-extramedullary tumor / 中国矫形外科杂志

[Objective]To investigate the diagnosis,surgical procedure and clinical effect for the subdural extramedullary tumor. [Methods]Forty-five patients (28 males and 17 females,age ranged from 24-71 years with an average of 45 years ) were treated with tumour extirpation. MRI showed subdural extramedullary tumor before surgery. The spine was exposed through a standard posterior approach,and the dura matter was opened after lamninectomy. The tumor was separated and removed from the dura matter. Pedicle screw fixation was performed to restore the stability of spine. [Results]The patients were followed up from 6 to 42 months with an average of 26.2 months. The postoperative recovery of neurological function was measured with Otani scores. The clinical result was excellent in 11 patients,good in 18 and fair in 12,resulting in 64.44% of good to excellent rate. The good to excellent rate had an advantage in patients (84.62%) operated on within one month after first visit over that of patients (64.29%) who had a misdiagnosis for 1~6 months and the patients (50.00%) for more than 6 months.[Conclusion]Removal is the method of choice for patients with subdural extramedullary tumor. Early diagnosis and removal are key factors to get a good clinical effect.

Giant-cell Tumor of the Lumbar Spine: Case Report

The authors report two cases of giant cell tumor in the lumbar spine. Giant cell tumor in the spine is histologically malignant tumor and recurrence is often even after the surgical excision. Two case of spinal giant cell tumor received total excision of the tumor with wide fixation. We have been following up and observing the two cases of patients with surgically treated giant cell tumor. From the two cases of experience, we could not find any recurrence of the tumor after operation and got the good clinical result with anterior and posterior fixation.

Surgical Treatment of Sensile Entropion

Senile entropion is caused by following pathophysiologic changes ; disinsertion or weakness of lower lid retractor, upward migration and overriding of the preseptal orbicularis oculi muscle over pretarsal orbicularis muscle, horizontal lid laxity, and relative enophthalmos from absorption of orbital fat. There have been numerous procedures to correct senile entropion, but the difficulty of adequate and concurrent correction of all of the underlying defect result in high recurrence rate. Therefore, authors performed a combined procedure including reattachment of disinserted lower lid retractor or tucking of weakened lower tarsus, and the extirpation of overriding preseptal orbicularis oculi muscle. At the same time we performed the correction of the lower lid laxity using lateral tarsal strip procedure of full-thickness wedge resection. Authors performed this method in 21 cases of 17 patients and the cosmetic and functional result were satisfactory.

Huge Sized Intraventricular Teratoma

Teratomas are rare neoplasms, constituting 0.5% to 1.2% of all intracranial tumors;nevertheless, they account for 2% to 4% of intracranial tumor in children. The most common location for these tumor is in the midline pineal region, but teratoma in the lateral ventricle is very rare. A report is presented here of the total extirpation of a huge sized teratoma located in the lateral ventricle of a 4-year old man. This unique tumor is revealed various tissue components, ectodermal and mesodermal derivatives such as skin appendages and neuroglial tissue partially lined by ependmal cells.

The Clinical Study On the Surgical Methods of Synkinetic Ptosis Treatment

Synkinetic ptosis refers to abnormal vertical movement of upper eyelid. This abnormal elevation of the eyelid results from opening or closing of the mouth, chewing, sucking, and movement of jaw outward or toward the contralateral side. A number of other stimuli for the phenomenon have been described. These include smile, sternocleidomastoid contraction or tongue protrusion, inspiraion, and voluntary nystagmus. This type of ptosis was most commonly seen with a congenital Marcus-Gunn jaw-winking syndrome. Usually this movement is thought to be due to a congenital misdirection of some of the 5th cranial nerve fibers into the branch of the 3rd cranial nerve that supplied the levator muscle. We experienced 6 cases of synkinetic ptosis, among them, interesting enough, one was typical elevation of upper lid in smile due to misdirection between the oculomotor and facial nerve fibers. The cosmetic problem was the first purpose of the surgery. So, we performed a levator extirpation with frontalis suspension on 4 cases who had the severe jaw-winking phenomenon and undertook only fron talis suspension on 2 cases and one of whom had poor superior rectus function. In the cases who have undergone levator extirpation with frontalis suspension, synkinetic movement was improved in all. However, in those who underwent the frontalis suspension procedure, the synkinetic phenomenon still remained in spite of acceptable improvement of blepharoptosis in primary position.

Cirsoid Aneurysm of the Scalp: Case Report

The authors report a case of cirsoid aneurysm in which diagnosis is reached by carotid angiography. To clarify the confusion regarding this rare lesion, the definition, origin and pathogenesis of the lesion are discussed.