Malignant tumours of the parotid gland: management of the neck (including the clinically negative neck) and a literature review.

Major salivary gland malignancies are rare, constituting 1%-3% of head-neck tumours. The surgical management of the clinically negative neck (cN0) does not have a univocal consensus yet. We have carried out a retrospective study on 119 cases of malignant parotid tumours that were surgically treated between January 1999 and January 2014. Our aim was to analyse preoperative findings (cytotype, cTNM) and to correlate these with postoperative results (grading, histotype, occult neck metastasis) in patients with parotid tumours to obtain an appropriate indication for neck management. In cN0 patients with a T1, T2 low-grade cancer a wait-and-see approach is preferred. Instead, in cNO patients with high-grade or low-grade T3, T4 tumours an elective neck dissection (END) is always planned. Levels II, III and IV, at least, must be dissected. The decision to dissect level V or I depends on the location of the primary tumour. In the cN0 group 19 of 58 (32.7%) patients who underwent an END had occult metastases. In clinically positive neck (cN+) patients a Modified Radical Neck Dissection (MRND), at least, must be performed. The criteria to add adjuvant radiotherapy (PORT) include deep lobe parotid tumours, advanced lesions (T3-T4), microscopic (R2) or macroscopic (R1) residual disease after surgery, high grade tumours, perineural diffusion, lymph node metastasis, capsular rupture, and local recurrence after previous surgery. Kaplan-Meier analyses have shown a reduction in the overall survival (OS) from 100% to 91% and in disease-free survival (DFS) from 100% to 95.5% for the NO-PORT and PORT group, respectively. In our study, the cN0 pN+ patients had a higher degree of DFS compared to the cN+.

Use of suborbicularis oculi fat flap to cover peri-orbital bone exposure.

Wide resection of recurrent basal cell carcinoma (BCC) in the peri-orbital-infraorbital-nasal area may include periosteum resection with maxillary or nasal bone exposure. The absence of vascularized periosteum makes the defect ungraftable and local flaps are often required. As an alternative to a large single flap or a combination of flaps, it is possible to turn the ungraftable portion of the defect into a graftable one. The suborbicularis oculi fat (SOOF) flap is an advancement flap that is used in aesthetic surgery for midface rejuvenation. The use of the SOOF flap along with a full-thickness skin graft, as an alternative to the use of other standardized flaps to cover defects in the peri-orbital-infraorbital-nasal area with avascularized tissue or noble structure exposure, is reported herein. As an immediate single-stage reconstruction, this procedure leaves other flap options intact in the event of re-operation for a recurrent tumour.

Semiautomatic regional segmentation to measure orbital fat volumes in thyroid-associated ophthalmopathy. A validation study.

This study was designed to validate a novel semi-automated segmentation method to measure regional intra-orbital fat tissue volume in Graves' ophthalmopathy. Twenty-four orbits from 12 patients with Graves' ophthalmopathy, 24 orbits from 12 controls, ten orbits from five MRI study simulations and two orbits from a digital model were used. Following manual region of interest definition of the orbital volumes performed by two operators with different levels of expertise, an automated procedure calculated intra-orbital fat tissue volumes (global and regional, with automated definition of four quadrants). In patients with Graves' disease, clinical activity score and degree of exophthalmos were measured and correlated with intra-orbital fat volumes. Operator performance was evaluated and statistical analysis of the measurements was performed. Accurate intra-orbital fat volume measurements were obtained with coefficients of variation below 5%. The mean operator difference in total fat volume measurements was 0.56%. Patients had significantly higher intra-orbital fat volumes than controls (p<0.001 using Student's t test). Fat volumes and clinical score were significantly correlated (p<0.001). The semi-automated method described here can provide accurate, reproducible intra-orbital fat measurements with low inter-operator variation and good correlation with clinical data.

[A chart for low visual acuities: experience in a center for low vision and rehabilitation]. / Intérêt de mesurer les acuités visuelles très basses dans un centre de réadaptation pour déficients visuels.

INTRODUCTION: Commonly used visual test charts can be used to measure 1-m minimal visual acuities (VA) of 20/1000 (Snellen chart) and 1/40 (Early Treatment of Diabetic Retinopathy Study [ETDRS] charts). METHODS: In a prospective study, we considered all patients who visited in a Low Vision and Rehabilitation Center between September 2007 and January 2009. Distance best corrected VA (DBCVA) was evaluated with the ETDRS LogMAR 4-m chart and a customized ETDRS 1-m chart, while near best corrected VA (NBCVA) was measured with the LogMAR conversion of the Parinaud 30-cm chart. RESULTS: One hundred and sixteen eyes (58 patients; 34 males and 24 females with a mean age of 69+/-19.4 [19-94] years) were included in the study. Mean DBCVA was 0.97+/-0.58 LogMAR, mean NBCVA was 0.28+/-0.2 LogMAR. In 52 eyes (44.8%), distance VA was less than 1/20 (DBCVA 1.86+/-0.5 LogMAR, NBCVA 0.08+/-0.05 LogMAR). Among the 58 best seeing eyes, DBCVA was 0.87+/-0.6 LogMAR, while NBCVA was 0.34+/-0.2 LogMAR. In 18 of 58 cases (31%), distance VA was less than 1/20 (DBCVA 1.86+/-0.59 and NBCVA 1.51+/-0.42). CONCLUSION: In a center for low vision and visual rehabilitation, a customized chart was necessary in 31% of cases for evaluation of VA. A fine measurement of low VA is useful for baseline assessment and for evaluation of changes during rehabilitation.

Unilateral exophthalmos associated with ipsilateral mucosal turbinate hypertrophy: benign exophthalmos syndrome (BES). A description of a new clinical condition.

PURPOSE: To report the clinical and radiologic characteristics of a group of patients who experienced unilateral exophthalmos associated with ipsilateral mucosal turbinate hypertrophy. The clinical features of these patients are presented and a hypothesis proposed to explain this condition for which the authors introduce the term benign exophthalmos syndrome (BES). METHODS: Retrospective, noncomparative case series. PARTICIPANTS: Four patients experienced slow progressive unilateral exophthalmos associated with ipsilateral mucosal turbinate hypertrophy, with no evidence of orbital mass or extraocular muscles involvement. INTERVENTION: Main Outcome Measures. Symptomatic outcome and measurement of the degree of relative exophthalmos. RESULTS: The onset of exophthalmos was associated with clinical and radiologic features that resemble BES. In all patients, radiologic examination demonstrated an ipsilateral mucosal turbinate hypertrophy and not the presence of orbital disease or expanding lesions of paranasal sinus. After daily intranasal spray of steroid, in three of the four cases the globe returned to within 1 mm of exophthalmometry of the contralateral eye. CONCLUSIONS: The relationship between the feature of paranasal sinus disease and the development of ipsilateral exophthalmos has been described in the literature. The four cases described herein appear peculiar for the slow progressive onset of the exophthalmos, without inflammatory and mass effect signs. This condition associated in all cases with ipsilateral hypertrophy of the nasal mucosa provides a guide to a hypothetical mechanism for BES. According to these hypothesis, the therapy should be devoted to the nasal disease more than the orbital.