Hypothyroidism in patients treated with radiotherapy for head and neck carcinoma: standardised long-term follow-up study.

OBJECTIVE: Hypothyroidism is a common complication when radiotherapy is part of the treatment for head and neck tumours. This study aimed to show the incidence of hypothyroidism and possible risk factors in these patients. METHODS: Factors related to the population, tumour, treatment and occurrence of hypothyroidism were analysed in 241 patients diagnosed with head and neck carcinoma. RESULTS: Approximately 53 per cent of patients were diagnosed with radiation-induced hypothyroidism. Its occurrence was related to: tumour location, laryngeal surgery type, neck dissection type, post-operative complications, cervical radiotherapy and radiotherapy unit type (linear particle accelerator or telecobalt therapy technology). CONCLUSION: Control of thyroid function should be standardised for several years after treatment, particularly in patients with risk factors, such as those treated with telecobalt therapy, those with post-operative complications and for whom the thyroid parenchyma is included in the irradiated area (laryngeal or pharyngeal location and bilateral cervical radiation).

Pathological examination of cordectomy specimens: analysis of negative resection.

OBJECTIVE: Occasionally, after performing a cordectomy to treat a T1 glottic tumor, the pathologist does not detect carcinomatous cells in the surgical specimen. This study determined how often this happens and analyzed these cases to identify related variables. METHODS: Forty-six patients were studied. Data on patient age and gender, tumor T stage and macroscopic surface extension, device used (laser vs. microelectrode dissection (ME)), and presence/absence of a negative cordectomy were compiled. We performed excisional biopsies as a diagnostic procedure. RESULTS: Tumor stage was carcinoma in situ (Cis; 11 cases), T1a (28 cases), or T1b (7 cases). Nineteen tumors were limited, and 27 were extensive. Twenty-one patients underwent laser surgery, and 25 had ME. There were 12, 21, 4, and 9 types II to V cordectomies, respectively. The pathologist reported 15 negative cordectomies (32.6%). Only tumor extension was significantly associated with a negative cordectomy (p=0.047). CONCLUSION: In 32.6% of our cases, the excisional biopsy was diagnostic and therapeutic. This percentage rose to 52.6% in the cases of limited tumors. We recommend performing an excisional biopsy and limited resection of the surgical bed with ME or laser surgery. A pathologist can examine the margins to determine whether the resection should be extended. When choosing radiotherapy, it is better to first perform an incisional biopsy to obtain a diagnosis of carcinoma.

Oropharyngectomy without mandibulotomy in advanced stage (T3-T4) oropharyngeal cancer.

CONCLUSIONS: The postoperative course was excellent for this type of surgery, and the functional recovery was comparable to that obtained with much more laborious techniques. OBJECTIVES: To compare the advantages and disadvantages of the described technique and oropharyngectomy with labial mandibulotomy. PATIENTS AND METHODS: A total of 46 patients underwent surgery by means of an oropharyngectomy without mandibulotomy. The pharynx was reconstructed using a plasty made of four regional flaps. RESULTS: In addition to obvious esthetic benefits, complications of the osteotomy were absent and surgical time was reduced. Some patients undergoing pull-through oropharyngectomy also underwent a marginal mandibulectomy, markedly reducing the frequency of radionecrosis compared with other statistics of techniques using mandibulotomy.

Hipotiroidismo primario posradioterapia en pacientes con cáncer de cabeza y cuello / Primary hypothyroidism after radiotherapy in patients with head and neck cancer

Introducción: El tratamiento con radioterapia en el cáncer de cabeza y cuello es una causa de hipotiroidismo. Nos proponemos estudiar el desarrollo de hipofunción tiroidea en estos pacientes. Pacientes y métodos: Se realizó un análisis retrospectivo de 194 pacientes tratados con radioterapia por cáncer de cabeza y cuello. Se determinó la tirotropina (TSH) y la tiroxina (T4) libre a los 3, los 6 y los 12 meses después de la radioterapia y anualmente durante el seguimiento. El hipotiroidismo se clasificó como subclínico (aumento de la TSH y la T4 libre normal) y clínico (aumento de la TSH y disminución de la T4 libre). Se analizó la relación del hipotiroidismo con edad, sexo, estirpe histológica del tumor, dosis de radiación y el uso de quimioterapia. Resultados: Con una media de seguimiento de 4,2 años, 56 pacientes presentaron elevación de la TSH (39 pacientes subclínico y 17 clínico). El tiempo medio para el diagnóstico fue de 3,0 ± 1,8 años (subclínico 2,6 ± 1,5 años, clínico 4 ± 1,9 años; p < 0,05). El 80% de los pacientes fueron diagnosticados entre el segundo y el sexto año desde la radioterapia. La edad, la histología del tumor, la dosis de radiación y el uso de quimioterapia no modificaron la probabilidad de desarrollar hipotiroidismo. El sexo demostró un valor predictor (un 66,6 frente a un 25,8% en mujeres y varones, respectivamente; p < 0,05). Conclusiones: La tasa de incidencia de hipotiroidismo después de radioterapia en pacientes con cáncer de cabeza y cuello es elevada. Es importante determinar la TSH durante un largo período de tiempo después de la radioterapia (AU)

Introduction: Radiotherapy in the treatment of cancer of the head and neck can cause hypothyroidism. Our aim was to study the development of thyroid hypofunction in these patients. Patients and methods: We performed a retrospective analysis of 194 patients who underwent radiotherapy for head and neck cancer. Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels were determined at 3, 6 and 12 months after radiotherapy and then annually during follow-up. Hypothyroidism was classified as subclinical (SHT) (an increase of TSG and normal FT4 levels) and clinical (CHT) (an increase of TSH and a decrease of FT4). The association between hypothyroidism and age, sex, histological type of the tumor, radiation dose and use of chemotherapy was analyzed. Results: With a mean follow-up of 4.2 years, 56 patients showed elevated TSH levels (SHT in 39 patients and CHT in 17). The mean time to diagnosis was 3.0 ± 1.8 years (SHT 2.6 ± 1.5 years, CHT 4 ± 1.9 years; p < 0.05). Eighty percent of the patients were diagnosed between the second and the sixth year after radiotherapy. Age, histological type, radiation dose and use of chemotherapy did not affect the probability of developing hypothyroidism. Sex had a predictive value (66.6% in women versus 25.8% in men; p < 0.05). Conclusions: The incidence rate of hypothyroidism after radiotherapy in patients with cancer of the head and neck is high. Prolonged follow-up of TSH levels should be performed in these patients after radiotherapy (AU)

[Influence of the nasogastric tube in the pathology of the maxillary sinus]. / Influencia de la sonda nasoesofágica en la patología del seno maxilar.

INTRODUCTION: Nasoesophageal tube (NT) is very often used by the ear, nose and throat specialists in head and neck oncological surgery. It is well known the irritative effect that it has on the nasosinusal mucosa. The aim of this study is to analyze the relationship between the use of the NT and the pathology of the maxillary sinuses. MATERIAL AND METHOD: The study was carried out in 25 patients treated in our department who had been fed by NT, after surgery. A plain sinus X-ray was performed in the pre-operatory period and a control radiograph in the post-operatory period, and the results have been analyzed. RESULTS AND CONCLUSIONS: No sinusitis had been observed whatever length of time the NT remained in situ.

[Intranasal approaches for pituitary area tumors. Our experience]. / Abordajes transnasales para los tumores de región hipofisaria. Nuestra experiencia.

Transsphenoidal approach is the most commonly employed surgical technique for the resection of pituitary tumors. We present our experience in the transnasal-transsphenoidal approach in 30 patients undergoing pituitary surgery from 1998 to 2002. Ten patients underwent surgery via a sublabial-transeptal-transsphenoidal approach, 15 patients via a transeptal-transsphenoidal approach and 5 patients via a pure endoscopic transnasal-transsphenoidal. The pathological study showed 29 pituitary adenomas and 1 Rathe's cleft cyst. We conclude that the pure endoscopic transnasal-transsphenoidal approach guided by a navigator-system is safest and more effective approach. We reserved the transeptal-transsphenoidal approach for cases with obstructive septal deflection and poor pneumatized sphenoid sinuses. We do not recommend the use of the sublabial-trans-sphenoidal approach.

Upper lateral cartilage transposition in the surgical management of nasal valve incompetence.

INTRODUCTION: The treatment of nasal valve dysfunction is very controversial and many otorhinolaryngologists do not always take surgery into consideration. The purpose of this paper is to present the author's surgical technique and the description of 13 patients on which it may work. MATERIAL AND METHOD: Thirteen cases presenting with nasal obstruction secondary to nasal valve dysfunction are reviewed. All of the patients presented with internal valvulary incompetence and in three of them an alar collapse was associated. Diagnosis was achieved by means of the clinical findings and physical examination. An open rhinoplasty approach was employed. The surgical technique consisted in a transposition of the upper lateral cartilage over the alar cartilage. In the three patients with alar collapse a fixation graft from the septal cartilage was also employed. RESULTS: Nasal obstruction and valvular incompetence seemed improved in all of the cases. CONCLUSION: Upper lateral cartilage transposition seems to be an adequate method to solve the nasal valve incompetence.

Inverted papilloma of the sphenoid sinus.

Inverted nasosinusal papilloma is a benign tumor accounting for less than 4% of all nasal masses. The lesion originates in the mucosa lining the nasal cavities, the locations in decreasing order of frequency being the lateral wall of the nasal fossa, ethmoid sinus, and maxillary sinus; the sphenoid sinus is only rarely affected. Despite its benign histology, the tumor shows aggressive behavior and can be associated to carcinomas. Surgery is therefore indicated in such cases.

[Intelligent system to perform a diagnostic protocol for lymphatic invasion in laryngeal cancer]. / Sistema inteligente para protocolizar el diagnóstico de invasión ganglionar en el cáncer de laringe.

Laryngeal carcinoma is the most frequent malignant tumour in head and neck. Node invasion is known to be one of the most important prognostic factors. The aim of this study has been to design an intelligent system to perform a diagnostic algorithm of metastasic neck nodes. 122 clinical reports of patients diagnosed of laryngeal carcinoma in our department have been reviewed. The compiled data have been: tumor site, T stage, N stage (clinical, after CT scan and post-surgery). The method used to design the intelligent system has been the ID3, which is able to generate a minimal decision tree. Palpation has been the variable that has given more information about node invasion. CT has proved to be more efficient in supraglottic tumours. ID3 method has shown to be useful in performing diagnostic algorithms, specially when the number of cases and diagnostic tests are high.

Arteriovenous haemangioma of the pterygoid process. Report of a case.

Arteriovenous haemangioma is a benign tumor which in ear, nose and throat practice is generally found in the soft tissues of the oral cavity. Bone involvement is very uncommon. These lesions typically manifest themselves in infancy, with a tendency towards spontaneous resolution. The management options comprise simple observation, embolization or surgical removal--depending on the location of the tumour and its symptoms. A correct diagnosis is essential to ensure the adoption of adequate measures during surgery. The present case describes an exceptional location of arteriovenous hemangioma of the pterygoid process, and discusses the associated diagnostic and treatment problems.

[Our management protocol and surgical technique in cerebrospinal fluid rhinorrhea treated with an endonasal approach]. / Nuestro protocolo de actuación y técnica quirúrgica en las rinolicuorreas tratadas por vía endonasal.

Five patients with cerebrospinal fluid fistula (CFF) have been treated with intratecal fluoresceine, 2 cc at 2%, and endoscopic nasal surgery. In 3 patients CFF was postraumatic; one case spontaneous and another case iatrogenic. In all the cases CFF have been solved in the first time. Postoperatory follow-up vary from 8 to 14 months, and no recurrence was observed. Fluorescein must be managed adequately for prevent neural complications.