Salvage surgery for locoregional recurrences of advanced pharyngolaryngeal squamous cell carcinoma after organ preservation failure.

Organ preservation treatment for advanced head and neck squamous cell carcinoma is associated with poor outcomes due to locoregional recurrences. Salvage surgery is the main therapeutic option for some of these patients. The aim of this study was to analyse the results of salvage surgery for advanced pharyngolaryngeal squamous cell carcinoma previously treated with radiochemotherapy. We performed a retrospective study on 38 patients (36 men, 2 women). The median age at diagnosis was 60 years with a mean follow-up period of 49.8 months. Recurrences were diagnosed at a mean of 395 days after finalising organ preservation treatment. Patients went under different salvage surgeries, including 22 total laryngectomies, 6 partial laryngectomies (3 transoral laser surgeries and 3 opened surgeries), 8 functional neck dissections and 2 tongue base surgeries. Nineteen patients had no postoperative complications after a mean hospital stay of 2 weeks. However, 5 patients died of significant recurrent bleedings. There were 4 salivary fistulas that responded to conservative management, while 7 patients had important pharyngostomas that required reconstruction with either regional or free flaps. The mean hospital stay was of 61.60 days for all patients. Five-year overall survival from diagnosis, overall survival after salvage surgery and survival after salvage surgery were 44.20, 37.90 and 45.70%, respectively. In summary, we conclude that salvage surgery is an optimal treatment for pharyngolaryngeal and regional recurrences and provides improvement in locoregional control and survival, despite the severe complications.

[Primitive neuroectodermal tumor/extraosseus Ewing sarcoma of the temporal bone]. / Tumor neuroectodérmico primitivo periférico/sarcoma de Ewing extraóseo del hueso temporal.

The term primitive neuroectodermal tumor (PNET) should be included in the differential diagnosis of small round blue cell tumors, which come from the neural crest and explain their neuroectodermal character. This is one of the most indifferentiated histological types of malignant tumors. In the PNET family, we high light the Ewing's Sarcoma, that is frecuently located in bony sites and has a less frequent localization in soft tissues. We focus on one atypic case of PNET/Extraosseus Ewing's Sarcoma that involves the external auditory canal and infiltrates the temporal bone. Surgery followed by postoperative chemotherapy and radiation offers the best local control of the disease.

Tumor neuroectodérmico primitivo periférico/ sarcoma de Ewing extraóseo del hueso temporal / Primitive neuroectodermal tumor/Extraosseus Ewing Sarcoma of the temporal bone

El término tumor neuroectodérmico primitivo (PNET) se incluye dentro de un grupo de neoplasias formado por "células redondas azules de pequeño tamaño" que derivan de la cresta neural y de ahí su carácter neuroectodérmico. Es uno de los tipos histológicos más indiferenciados de tumores malignos. Dentro de esta familia de tumores destaca el Sarcoma de Ewing, que aparece fundamentalmente en estructuras óseas, disminuyendo su probabilidad en estructuras extraóseas. Presentamos un caso atípico de pPNET/Sarcoma de Ewing extraóseo que ocupaba el CAE e infiltraba el hueso temporal. Para el control de la enfermedad, el enfoque preferido es la cirugía más radioquimioterapia

The term primitive neuroectodermal tumor (PNET) should be included in the differential diagnosis of small round blue cell tumors, which come from the neural crest and explain their neuroectodermal character. This is one of the most indifferentiated histological types of malignant tumors. In the PNET family, we high light the Ewing´s Sarcoma, that is frecuently located in bony sites and has a less frequent localization in soft tissues. We focus on one atypic case of PNET/ Extraosseus Ewing´s Sarcoma that involves the external auditory canal and infiltrates the temporal bone. Surgery followed by postoperative chemotherapy and radiation offers the best local control of the disease

Tumores malignos del conducto auditivo externo y oído medio / Malignant tumours of the external auditory canal and of the middle ear

Objetivos: Revisar la experiencia de nuestro Centro en el tratamiento de una patología tan poco frecuente como son los tumores del CAE y oído medio. Material y métodos: Se realiza una revisión de 36 pacientes con tumores malignos del oído medio y CAE tratados en el servicio de nuestro hospital en el período de 1977-2000, excluyendo los tumores de pabellón, tumores metastásicos y sarcomas. El sistema de estadiaje utilizado es el propuesto por el M.D. Anderson. Resultados: El tipo histológico más frecuente en nuestra serie es el carcinoma epidermoide, presentándose en el 100 por ciento de los casos con otorrea y dolor como primer síntoma en el momento de la consulta. La combinación de cirugía y radioterapia obtuvo una tasa de supervivencia a los 5 años del 41 por ciento. Conclusiones: Esta patología precisa para la realización de un diagnóstico precoz un alto índice de sospecha clínica. El correcto estadiaje clínico tiene un importante valor pronóstico (AU)

OBJECTIVES: To review our experience and results in the treatment of a low incidence pathology such as the malignant ear tumors. METHODS: The study reviewed 36 patients with malignant tumors of the EAC and middle ear treated between 1977 and 2000 in our hospital, excluding cancer of the pinna, metastatic tumours and sarcomas. It was used the staging system proposed by the M.D. Anderson. RESULTS: The most common histological type in our series is the squamous cell carcinoma, and the otorrhea and pain are the primary symptoms in 100% of patients. Surgery combined with radiotherapy obtained a 41% 5-year survival rate. CONCLUSIONS: The staging system is an important prognostic factor and it is important an early diagnosis to achieve a better therapeutical result (AU)

[Geniculate ganglion tumors. Therapeutic and reconstructive management]. / Tumores del ganglio geniculado. Manejo terapéutico y reconstructivo.

We present five cases of patients diagnosed of a facial nerve tumoral lesion localised at the Geniculate Ganglion and all of which underwent surgical resection. The initial symptoms were in four cases of peripheral facial nerve paralysis and in the fifth case facial paresis. Two trans-mastoid extralabyrinthine approaches were performed and one through a combined path (middle fossa and trans-mastoid) with reconstruction of the facial nerve through a termino-terminal graft. In the fourth case, an approach through fossa media was done, and did not include nerve reconstruction but palliative treatment with a palpebral gold plaque. In the fifth case, a modified trans-labyrinthine approach with facial-hypoglossus termino-terminal anastomosis. Histological diagnosis was 3 neurinomas and 2 hemangiomas. Of the termino-terminal grafts two managed a functional Grade III of the House-Brackmann classification. The third one sustained a Grade VI and therefore a suspension with temporal muscle was carried out. The patient with facial-hypoglossus anastomosis is in a functional Grade IV. Geniculate ganglion tumors are in their majority benign and their treatment is the total resection of the tumor. Nerve reconstruction can be primary or deferred with the aid of a nerve graft or anastomosis, being necessary palliative techniques when resection is not possible.

Tumores del ganglio geniculado. Manejo terapéutico y reconstructivo / Geniculate ganglion tumors. Therapeutic and reconstructive management

Presentamos cinco casos de pacientes diagnosticados de una lesión tumoral del nervio facial localizada en la región del ganglio geniculado a los cuales se practicó cirugía de exéresis. La clínica inicial fue en cuatro de los casos parálisis facial periférica de larga evolución y en el quinto paresia facial. Se realizaron dos abordajes transmastoideos extralaberínticos y uno por vía combinada (fosa media y transmastoidea) con reconstrucción del nervio facial mediante injerto termino-terminal. En el cuarto caso, un abordaje por fosa media, no se incluyó reconstrucción nerviosa sino tratamiento paliativo con placa de oro palpebral. En el quinto, un abordaje translaberíntico modificado, se hizo anastomosis termino-lateral hipogloso-facial. El diagnóstico histológico fue de 3 neurinomas y 2 hemangiomas. Funcionalmente 2 de los injertos termino-terminales lograron grado III de la clasificación de House-Brackmann. El tercero mantuvo grado VI por lo que se realizó suspensión con músculo temporal. El paciente con anastomosis hipoglosofacial está en grado funcional IV. Los tumores del ganglio geniculado son en su mayoría de histología benigna y su tratamiento es la exéresis completa. La reconstrucción nerviosa puede ser primaria o diferida ayudándose de injerto nervioso o anastomosis, siendo necesarias las técnicas paliativas cuando ésta no es posible (AU)

We present five cases of patients diagnosed of a facial nerve tumoral lesion localised at the Geniculate Ganglion and all of which underwent surgical resection. The initial symptoms were in four cases of peripheral facial nerve paralysis and in the fifth case facial paresis. Two trans-mastoid extralabyrinthine approaches were performed and one through a combined path (middle fossa and trans-mastoid) with reconstruction of the facial nerve through a termino-terminal graft. In the fourth case, an approach through fossa media was done, and did not include nerve reconstruction but palliative treatment with a palpebral gold plaque. In the fifth case, a modified trans-labyrinthine approach with facial-hypoglossus termino-terminal anastomosis. Histological diagnosis was 3 neurinomas and 2 hemangiomas. Of the termino-terminal grafts two managed a functional Grade III of the House-Brackmann classification. The third one sustained a Grade VI and therefore a suspension with temporal muscle was carried out. The patient with facial-hypoglossus anastomosis is in a functional Grade IV. Geniculate ganglion tumors are in their majority benign and their treatment is the total resection of the tumor. Nerve reconstruction can be primary or deferred with the aid of a nerve graft or anastomosis, being necessary palliative techniques when resection is not possible (AU)

[Malignant tumours of the external auditory canal and of the middle ear]. / Tumores malignos del conducto auditivo externo y oído medio.

OBJECTIVES: To review our experience and results in the treatment of a low incidence pathology such as the malignant ear tumors. METHODS: The study reviewed 36 patients with malignant tumors of the EAC and middle ear treated between 1977 and 2000 in our hospital, excluding cancer of the pinna, metastatic tumours and sarcomas. It was used the staging system proposed by the M.D. Anderson. RESULTS: The most common histological type in our series is the squamous cell carcinoma, and the otorrhea and pain are the primary symptoms in 100% of patients. Surgery combined with radiotherapy obtained a 41% 5-year survival rate. CONCLUSIONS: The staging system is an important prognostic factor and it is important an early diagnosis to achieve a better therapeutical result.