ABSTRACT
BACKGROUND: Germ cell tumors (GCTs) of the head and neck region are rare but may pose significant problems for perinatal management as well as surgical and adjuvant therapy. PROCEDURE: Thirty-two prospectively reported patients from the German MAKEI studies (Maligne Keimzelltumoren) were analyzed with regard to perinatal management and long-term survival. RESULTS: Twenty-three tumors were diagnosed around birth and four during the first 3 months of life. All were primarily diagnosed as teratomas, but in two tumors, yolk sac tumor (YST) foci were identified. Another pure teratoma was diagnosed at 12 months. Four tumors were diagnosed after the first year of life and showed YST as leading histology. Most neonates presented with huge tumors causing external airway obstruction. All tumors were resected (complete resection, 16/26 patients with complete surgical information; incomplete resection, 10/26 patients). Eight tumors including five of six YSTs were treated with chemotherapy. In total, six patients relapsed. Relapse rate was higher after incomplete (5/10 patients) than after complete resection (1/16 patients). Accordingly, more relapses were observed in pharyngeal than in neck tumors due to incomplete resection. Nevertheless, half of the patients with incomplete resection remained in remission. One patient with YST died after multiple relapses. CONCLUSIONS: GCTs of the head and neck region require a multidisciplinary approach in specialized centers. Most patients with antenatal tumor growth are identified by ultrasound and delivered preterm by cesarian section. After delivery, immediate intubation and ventilation aim for respiratory stabilization, followed by elective resection. With this approach, outcome was favorable.
Subject(s)
Head and Neck Neoplasms/diagnosis , Head and Neck Neoplasms/therapy , Neoplasms, Germ Cell and Embryonal/diagnosis , Neoplasms, Germ Cell and Embryonal/therapy , Endodermal Sinus Tumor/diagnosis , Endodermal Sinus Tumor/therapy , Head and Neck Neoplasms/surgery , Humans , Infant , Infant, Newborn , Neoplasms, Germ Cell and Embryonal/surgery , Perinatal Care , Prospective Studies , Recurrence , Remission Induction , Survival Rate , Teratoma/diagnosis , Teratoma/therapy , Treatment OutcomeABSTRACT
PURPOSE: In this article, the question of whether adjuvant hyperbaric oxygen therapy (HBO) has a positive effect when treating chronically recurrent mandibular osteomyelitis in children and adolescents is discussed. PATIENTS AND METHODS: Over a period of 5 years, 4 cases were observed, 3 of which were submitted to adjuvant HBO. Details on the modalities of this type of treatment and the simultaneous intravenous administration of high doses of antibiotics are reported. RESULTS: All 3 patients have been free of any symptoms from 20 to 74 months (mean, 41 months) and therefore may most likely be regarded as healed. CONCLUSION: The small number of cases does not allow a final statement on the extent to which HBO contributed to the positive outcome. However, in our opinion, HBO is a most promising therapeutic option. Finally, the problems involved in prospective randomized studies of this rare disease are discussed in detail.
