Treatment of endolymphatic sac tumour (Papillary adenocarcinoma) of the temporal bone.

AIM: To define a better treatment of sporadic endolymphatic sac tumours (ELST) analysing our experience and literature available data. BACKGROUND: ELST can arise as sporadic case (rare) or as a part of von Hippel-Lindau (VHL) disease. It is a low grade malignancy with local spread by continuity. MATERIALS AND METHODS: we described our experience with 7 cases with up to date follow up. RESULTS: Five cases were free of disease after first surgical procedure. One case had recurrence in the temporal lobe after 12 years. One case had two surgical procedures followed by irradiation and died five years after radiotherapy with a slow disease progression. CONCLUSION: With increasing expertise in the skull base surgery, complete tumour excisions are achieved in majority of the more recent cases and appear to be the treatment of choice. External irradiation is also used as palliative measures with doubtful effectiveness. Some recent reports showed encouraging results with gamma knife radiosurgery.

Preservation of palatal mucoperiosteum for oronasal separation after total maxillectomy.

BACKGROUND: Oronasal communication occurs after total maxillectomy for advanced sinonasal cancers. This results in feeding, breathing and cosmetic impairment. Various methods have been described to close off the palatal defect from the oral cavity to improve the function of speech and deglutition. AIMS: The object of this article is to describe our experience of preservation of palatal mucoperiosteum for oronasal separation. MATERIALS AND METHODS: Retrospective review of clinical and operative records of 31 total maxillectomy patients where oronasal separation was achieved by the conventional technique of applying a maxillary obturator. The postoperative complications arising from the use of maxillary obturator for oronasal communication after total maxillectomy in these 31 patients were analysed. To avoid the complications encountered in these 31 patients we preserved and used the ipsilateral palatal mucoperiosteum for oronasal separation. This new technique was applied in 12 patients. The results are presented and compared. RESULTS: A total of 43 patients underwent total maxillectomy for advanced sinonasal tumors. In 31 patients the conventional maxillary obturator was used for oronasal separation. Among these patients, 30 had crustation of the maxillary cavity, nasal regurgitation and cheek skin retraction in 15 each, trismus in eight, infection of skin graft donor site in seven, cheek movement during respiration in five and ill-fitting prosthesis in three. In 12 patients palatal mucoperiosteum was preserved and used for oronasal separation. The complications encountered in oronasal separation by palatal prosthesis were avoided in the modified procedure. CONCLUSIONS: We found that oronasal separation by preservation of palatal mucoperiosteum following total maxillectomy allowed excellent palatal function, prompt rehabilitation and minimal complications without compromising the prognosis.

Total maxillary swing approach to the skull base for advanced intracranial and extracranial nasopharyngeal angiofibroma.

The main objective of surgical approaches to the anterior and anterolateral skull base is to have maximum exposure so injury to important structures is avoided, and surgical complications are reduced. At our institution, we used total maxillary swing (TMS) to approach the anterior and anterolateral skull base for resection of both malignant and benign tumors. We modified some of the techniques described in TMS to avoid complications encountered previously. The purpose of this article was to present the usefulness of TMS for maximum exposure of the anterior and anterolateral skull base using advanced nasopharyngeal angiofibroma (NPA) as the reference disease.We retrospectively reviewed 16 patients who underwent excision of NPA by TMS from 2005 to May 2011. The operative techniques, operative findings, postoperative complications, and follow-up records were reviewed and analyzed.Of the 16 cases of NPA, 5 had intracranial extensions. All had lateral extensions to the pterygopalatine fossa. The pterygoid base was explored in all cases. In 10 cases, the tumors were present in the spongy bone of the pterygoid bases, whereas in 6 cases, the base of the pterygoids was eroded and floating. In all cases, the tumor was completely removed. Complications encountered previously were avoided by the modifications to TMS. Complications encountered because of extensiveness of the tumor were easily managed. No patients had any recurrence until now.Total maxillary swing provides maximum exposure to the anterior and anterolateral skull base for complete removal of the tumors in those areas with minimal complications.