Intraoperative verification of resection margins of maxillary malignancies by cone-beam computed tomography.

Resection of maxillary cancer often results in incomplete excision because of the tumour's proximity to important structures such as the orbit. To deal with this problem we prospectively investigated the feasibility of intraoperative imaging during maxillectomy to verify the planned resection margins. In total, six patients diagnosed with maxillary cancer listed for maxillectomy were included, irrespective of the histological type of tumour. Before resection, an accurate intended resection volume was delineated on diagnostic images. At the end of the operation we took a cone-beam computed tomographic (CT) scan of the treated maxilla, after which the accuracy of the resection was quantitatively evaluated by comparing the preoperative resection plan and the images acquired intraoperatively, based on the anatomy. Further resection was then done if necessary and quantitatively evaluated with a second cone-beam CT scan. Postoperatively we compared the results of the scan with those of the histological examination. Of the six, two resections were reported pathologically as less than radical, each of which was detected by intraoperative CT and resulted in extensions of the original resections. The mean (SD) distance between the planned and the actual resection was 1.49 (2.78)mm. This suggests that intraoperative cone-beam CT imaging is a promising way to make an adequate intraoperative assessment of planned surgical margins of maxillary tumours. This allows for intraoperative resection margins to be improved, possibly leading to a better prognosis for the patient.

Rhabdomyoma of the pyriform sinus: case report and review of the literature.

OBJECTIVE: Adult rhabdomyoma is a rare benign tumour that arises from skeletal muscle. It is mostly found in the head and neck region, and it should be included in the differential diagnosis of benign lesions. METHODS: A 62-year-old man presented with dysphagia, and flexible endoscopy revealed a submucosal mass obliterating the right pyriform sinus. Computed tomography imaging revealed that the mass was hyperattenuated and extended from the right pyriform sinus to the true vocal cord. The mass was excised transorally under general anesthesia with a carbon dioxide laser. Microscopically, the tumour demonstrated features of adult-type rhabdomyoma. RESULTS: One year after surgery, the patient had no signs of recurrence. CONCLUSIONS: Rhabdomyoma is a rare neoplasm of the pyriform sinus. This entity should be considered in the differential diagnosis of tumours in this region.

Molecular pathways of lymphangiogenesis and lymph node metastasis in head and neck cancer.

Metastasis to regional lymph nodes constitutes the main route toward progression and dissemination of head and neck carcinoma; at the same time it is the most significant adverse prognostic indicator for this disease. In recent years, significant focus has been given on the molecular mechanisms behind lymph node metastasis of head and neck cancer. The aim of this study is to assess the role of growth factor expression and function in association with lymph node metastasis and overall prognosis of head and neck cancer. Current literature, searching for experimental data regarding the molecular pathways of lymph node dissemination of head and neck cancer, is reviewed giving special emphasis on the expression and prognostic significance of specific growth factors. Members of the vascular endothelial growth factor (VEGF), mostly VEGF-C and VEGF-D, with their action through the receptors VEGFR-3 and VEGFR-2, constitute the most extensively studied growth factors associated with lymphangiogenesis so far. High expression of these as well as other molecules, including angiopoietins, insulin-like growth factor, and fibroblast growth factor, has been associated with lymph node metastasis and poor prognosis in head and neck squamous cell carcinoma. Numerous growth factors seem to play an important role regarding the lymph node metastatic potential of head and neck cancer. Further research is necessary in order to further clarify the molecular pathways and introduce novel therapeutic options.

Herpes zoster laryngitis and Ramsay-Hunt syndrome in a patient with chronic renal failure.

OBJECTIVE: We report on a clinical case of simultaneous and unilateral involvement of the facial and superior laryngeal nerve in a patient with chronic renal disease undergoing haemodialysis. METHOD: A 75-year-old man with chronic renal failure was referred to our department suffering from severe odynophagia. During flexible endoscopy, vesicles were found on the mucosa of his right supraglottic larynx. Two days later, peripheral facial nerve palsy with a mild auricular rash appeared in the patient. RESULTS: The clinical presentation suggested varicella-zoster virus reactivation, which was confirmed serologically, and appropriate treatment was administered. CONCLUSIONS: Involvement of more than one cranial nerve in herpes zoster infection is possible, especially in vulnerable patients such as those with chronic renal failure. It is also important to suspect involvement of the superior laryngeal nerve in cases of odynophagia and throat pain, even when hoarseness is absent.

Maxillary sinusitis of dental origin due to oroantral fistula, treated by endoscopic sinus surgery and primary fistula closure.

AIM: To present the current treatment approach for oroantral fistula causing maxillary sinusitis. DESIGN: Case series. Four cases of oroantral fistula (diameters: 6, 9, 11 and 13 mm) due to chronic maxillary sinusitis were treated by excision of all diseased oroantral fistula tissue, followed by endoscopic creation of a large middle antrostomy and closure of the fistula using buccal flaps. A synthetic surgical glue and local alveolar bone were used. RESULTS: Patients were followed up for six months to three years; all were considered cured. CONCLUSION: Most surgeons use buccal or palatal flaps, combined with the Caldwell-Luc procedure, to treat chronic odontogenic sinusitis and to repair fistulae more than 5 mm in diameter. This study supports the hypothesis that an endoscopic technique could be successfully used in patients with oroantral fistula causing chronic maxillary sinusitis of dental origin, instead of the Caldwell-Luc procedure, at least in patients with a small to medium-sized oroantral fistula.