Retropharyngeal lipoma with parapharyngeal extension: is transoral excision possible?

Retropharyngeal lipomas are rare tumours that are usually asymptomatic until they reach a large size. The definitive treatment is surgical excision. Since the tumours are typically large at the time of presentation, extensive surgery for complete clearance of the lipoma from the retropharyngeal and parapharyngeal regions is to be expected. Transoral excision is typically indicated for small retropharyngeal tumours, as this approach does not give good access to the parapharyngeal area laterally. Herein, we present the case of a patient who underwent transoral excision of a huge retropharyngeal lipoma, which extended into the right parapharyngeal space. The surgical technique used and the insights gained are described in this report. Even with parapharyngeal extension, transoral resection of a huge retropharyngeal lipoma can be performed. More invasive surgery, which may involve a neck incision, mandibulotomy or pharyngotomy, is not necessary. While huge retropharyngeal lipomas are usually symptomatic and require surgical intervention, transoral resection can be adequate and safe for treatment.

Minimally invasive surgery for head and neck cancer.

Minimally invasive surgery has been adopted in many areas of surgery to reduce patient morbidity during surgical resection. To achieve this, endoscopic instrumentation coupled with improved imaging and localisation techniques have been developed, to enable adequate resection of tumours with minimum damage to surrounding tissues. We review two emerging technologies, robotic assisted surgery and intraoperative imaging. We also discuss two fields of head and neck surgery, skull-base tumour resection and thyroidectomy, where the application of minimally invasive endoscopic techniques has been widely applied, and review their results.

LIF promotes neurogenesis and maintains neural precursors in cell populations derived from spiral ganglion stem cells.

BACKGROUND: Stem cells with the ability to form clonal floating colonies (spheres) were recently isolated from the neonatal murine spiral ganglion. To further examine the features of inner ear-derived neural stem cells and their derivatives, we investigated the effects of leukemia inhibitory factor (LIF), a neurokine that has been shown to promote self-renewal of other neural stem cells and to affect neural and glial cell differentiation. RESULTS: LIF-treatment led to a dose-dependent increase of the number of neurons and glial cells in cultures of sphere-derived cells. Based on the detection of developmental and progenitor cell markers that are maintained in LIF-treated cultures and the increase of cycling nestin-positive progenitors, we propose that LIF maintains a pool of neural progenitor cells. We further provide evidence that LIF increases the number of nestin-positive progenitor cells directly in a cell cycle-independent fashion, which we interpret as an acceleration of neurogenesis in sphere-derived progenitors. This effect is further enhanced by an anti-apoptotic action of LIF. Finally, LIF and the neurotrophins BDNF and NT3 additively promote survival of stem cell-derived neurons. CONCLUSION: Our results implicate LIF as a powerful tool to control neural differentiation and maintenance of stem cell-derived murine spiral ganglion neuron precursors. This finding could be relevant in cell replacement studies with animal models featuring spiral ganglion neuron degeneration. The additive effect of the combination of LIF and BDNF/NT3 on stem cell-derived neuronal survival is similar to their effect on primary spiral ganglion neurons, which puts forward spiral ganglion-derived neurospheres as an in vitro model system to study aspects of auditory neuron development.