Outcome analysis of patients with craniofacial resection: Hong Kong experience.

BACKGROUND: The aim of this study was to evaluate the clinical outcome of patients who underwent craniofacial resection for tumour in the anterior skull base at the University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong between January 1993 and June 2003. METHODS: A retrospective review was conducted. The duration of follow up ranged from 1.7 to 119 months (median, 41.8 months). The setting was a tertiary referral centre. Thirty-nine patients, 23 males and 16 females, aged 8-79 years were included. Thirty-four patients had malignant tumour and five patients had benign pathology. The tumour pathology was diversified. Nineteen patients had no treatment before the surgery, and the remaining 20 patients had received surgery, radiotherapy or combined treatment before resection. Patients were given postoperative irradiation and/or chemotherapy depending on the pathology of the tumour and the extent of the disease and clearance at the time of surgery. RESULTS: There was no operative mortality. Complications occurred in 10 patients and among them, three required reoperation. The other complications were managed successfully with conservative measures. The 5-year actuarial disease-free survival for patients with benign and malignant pathology was 100 and 77.6%, respectively. For patients with malignant pathology, 5-year actuarial disease-free survival was 90% when the resection margin was negative at surgery. However, the survival dropped to 53.6% when the resection margin was involved macroscopically. CONCLUSION: Craniofacial resection was an appropriate surgical approach with acceptable morbidity in selected patients with tumour located at the anterior skull base. Complete excision of malignant tumour could achieve 90% 5-year disease-free actuarial survival.

"Cystic" parotid swelling on FNA: significance on clinical management.

The clinical significance of a cystic aspirate, defined as an aspirate yielding fluid of any nature, on fine needle aspiration cytology (FNA) of parotid masses was studied. A total of 464 FNA from 236 patients over a 4-year period in a university head and neck department was analyzed. The incidence of cystic aspirates was 17.4%. The gross appearance of the aspirated fluid was consistent between sessions. Aspirated fluids could be blood-related, serous, or purulent, and these were associated with the pathological nature of lesions. Volume and viscosity were not useful features in predicting pathology. Cysts that could be completely emptied may not recur, but the pathology should still be noted. There was no difference in pathology between cystic and noncystic swellings. The incidental finding of fluid on FNA carries very limited clinical implication and parotid masses should be fully worked up and treated as in the noncystic swelling.

Salvage of recurrent head and neck squamous cell carcinoma after primary curative surgery.

PURPOSE: The efficacy of salvage treatment of recurrent head and neck squamous cell carcinomas (HNSCC) after primary curative surgery was evaluated. METHODS: The management outcome of 377 patients who had recurrent squamous cell carcinoma of oral cavity, oropharynx, hypopharynx, and larynx after primary curative surgery was reviewed. RESULTS: The surgical salvage rates of recurrence were 29% local, 30% tracheostomal, 56% unilateral nodal recurrence of previously undissected neck, 32% of unilateral neck recurrence after prior neck dissection, and 11% lung metastasis. The 5-year tumor-free actuarial survival rates of those patients who received surgical salvage was 35% for local recurrence, 32% for unilateral nodal recurrence of the previously undissected neck, and 18% for nodal recurrence of the previously dissected neck. One patient of six with tracheostomal recurrence salvaged with surgery and one patient of six with lung metastasis salvaged with lobectomy survived without tumor at 5 years. There was no 5-year survivor of all patients salvaged with other nonsurgical methods. The mean survival of patients without surgical salvage was 6 months. CONCLUSIONS: There was a moderate chance of cure after surgical salvage of locoregional recurrent HNSCC. Surgical salvage was, however, only feasible for early recurrent tumor. Close follow-up surveillance of early recurrence is essential after primary treatment of patients.

A prospective controlled double-blind trial of great auricular nerve preservation at parotidectomy.

BACKGROUND: Earlier reports of the advantages of preservating the posterior branches of the great auricular nerve (GAN) at parotidectomy were conflicting. This prospective study was aimed at clarifying the controversy. METHODS: Eighty-one patients in a university otolaryngology department were recruited. The posterior branches were preserved whenever initial dissection showed that tumor clearance would not be compromised. Touch-pressure sensation was monitored in predefined territories supplied by the GAN using a Semmes-Weinstein aesthesiometer, preoperatively and postoperatively. Minimal pressure thresholds obtained were compared between the two groups. RESULTS: Preservation of the GAN was achievable in 69% of patients; sensory deficit was transient. With the GAN divided, measurable sensory depression occurred up to 2 years after surgery. The difference is statistically significant. Patients' subjective assessment of numbness also conformed to these trends. Additional time taken for preservation of the GAN was about 10 minutes. CONCLUSIONS: The posterior branches should always be preserved if tumor clearance is not compromised.