Synchronous Warthin tumor and papillary oncocytic cystadenoma in the ipsilateral parotid gland: an unreported association.

The occurrence of ipsilateral, synchronous, primary salivary gland tumors of different histological type is rare. In this report, we present the case of a 52-year-old male, established smoker, who showed simultaneously two different benign tumors in the right parotid gland. The patient complained of swelling below the angle of the mandible. Ultrasonography and computed tomography imaging revealed one mass of about 2.8 cm in the right gland. Besides, one small nodule in the left parotid gland was observed. The cytological diagnosis of the right gland was benign tumor, type IVa of the Milan system, consistent with Warthin tumor (WT). The clinical diagnosis was bilateral parotid WT. The histopathological (HP) study of the surgical specimen revealed a WT in combination with a papillary oncocytic cystadenoma (POC) in the right parotid. To our knowledge, this combination of tumors has not been previously reported. In our case, the association of tumors was not detected by imaging or fine-needle aspiration cytology (FNAC). WT and POC are difficult to distinguish by FNAC because their epithelial component is very similar. POC can resemble WT without lymphoid stroma, but the totality of HP features allows the differentiation of both processes. These tumors can be related to a common causal determinant and should not be considered as a result of chance. Both tumors follow favorable courses and are curable by surgical resection.

Response of head and neck epithelial cells to a DNA damage-differentiation checkpoint involving polyploidization.

BACKGROUND: Squamous epithelia of the head and neck undergo continuous cell renewal and are continuously exposed to mutagenic hazard, the main cause of cancer. How they maintain homeostasis upon cell cycle deregulation is unclear. METHODS: To elucidate how head and neck epithelia respond to cell cycle stress, we studied human keratinocytes from various locations (oral mucosa, tonsil, pharynx, larynx, and trachea). We made use of genotoxic or mitotic drugs (doxorubicin [DOXO], paclitaxel, and nocodazole), or chemical inhibitors of the mitotic checkpoint kinases, Aurora B and polo-like-1. We further tested the response to inactivation of p53, ectopic cyclin E, or to the chemical carcinogen 7,12-dimethylbenz[a]anthracene (DMBA). RESULTS: All treatments provoked DNA damage or mitosis impairment and strikingly triggered squamous differentiation and polyploidization, resulting in irreversible loss of clonogenic capacity. CONCLUSION: Keratinocytes from head and neck epithelia share a cell-autonomous squamous DNA damage-differentiation response that is common to the epidermis and might continuously protect them from cancer.

Outcomes following pharyngolaryngectomy with fasciocutaneous free flap reconstruction and salivary bypass tube.

OBJECTIVES/HYPOTHESIS: Reconstruction of the pharyngoesophageal defects is one of the most challenging for head and neck surgeons. We evaluated our experience in the hypopharyngeal reconstruction using a fasciocutaneous free flap in conjunction with a Montgomery salivary bypass tube (MSBT). STUDY DESIGN: Retrospective review. METHODS: The charts of 55 patients who had undergone hypopharynx reconstruction using either a radial forearm free flap (RFFF) (24) or an anterolateral thigh (ALT) flap (31) with MSBT were reviewed. There were 40 circumferential and 15 near-circumferential defects. Outcomes analyzed included fistula and stricture rates and swallowing function. RESULTS: Pharyngocutaneous fistula occurred in 9% of patients (16% using RFFF and 3% using ALT), and strictures occurred in 5% (8% using RFFF and 3% using ALT). Of patients reconstructed with this technique, 95% were able to resume oral alimentation. CONCLUSIONS: The use of fasciocutaneous free flaps in conjunction with the MSBT is a useful tool for pharyngoesophageal reconstruction.

Tratamiento quirúrgico de los condrosarcomas de cabeza y cuello / Surgical treatment of head and neck chondrosarcomas

Introducción: Los condrosarcomas de cabeza y cuello adoptan una gran variedad de localizaciones y comportamientos biológicos. Material y método: Se presenta una serie retrospectiva de 17 casos de condrosarcomas de cabeza y cuello tratados quirúrgicamente en nuestro servicio desde 1977 hasta 2006. Resultados: Los condrosarcomas se localizaron en el área nasosinusal (n=6), laringe (n=5), peñasco (n=3), atlas (n=1), espacio parafaríngeo (n=1) y tráquea (n=1). Todos excepto una paciente se sometieron a cirugía con intención radical. El periodo de seguimiento medio fue de 84 meses (mediana, 71 meses). Se produjo recidiva en 6 pacientes con una latencia media de 10 meses. Dos pacientes fallecieron a causa de la enfermedad y dos permanecieron vivos con enfermedad. Los pacientes con condrosarcomas de grado I presentaron menos recidivas que los grados II y III (17% frente a 80%, p=0,029). La supervivencia media estimada a los 5 años fue del 88% siendo estadísticamente significativa la mayor supervivencia en los pacientes con tumores de grado I (p=0,023). En 2 pacientes con condrosarcomas cricoideos la reconstrucción se llevó a cabo mediante la técnica de Rethi-Ward, encontrándose sin evidencia de la enfermedad a los 71 (decanulado) y 145 meses (no decanulado). Los condrosarcomas de la fosa yugular fueron tratados mediante el abordaje infratemporal tipo A modificado. Conclusiones: Los condrosarcomas de cabeza y cuello de bajo grado presentan un buen pronóstico vital. Los de alto grado, pese al tratamiento radical, tienden a la recidiva (AU)

Introduction: Head and neck chondrosarcomas may adopt different locations and biological behaviour. Material and method: We present a retrospective clinical series of 17 chondrosarcomas surgically treated in our Department from 1977 until 2006. Results: Chondrosarcomas were located in the nasosinusal area (n=6), larynx (n=5), petrous bone (n=3), atlas (n=1), parapharyngeal space (n=1) and trachea (n=1). All patients except for one underwent surgery with radical intention. The mean follow-up period was 84 months (median, 71 months). Six patients developed recurrent disease with a mean latency of 10 months. Two patients died due to the disease and two remained alive with evidence of tumour. Patients with grade I chondrosarcomas presented less recurrent disease than those with grade II or III chondrosarcomas (17% versus 80%, P=0.029). The estimated 5-year survival was 88% with the better survival of patients with grade I chondrosarcomas reaching statistical significance (P=0.023). In 2 patients with cricoid chondrosarcomas, the reconstruction was carried out using the Rethi-Ward technique, and they were without evidence of disease at 71 months (with no cannula) and 145 months (with cannula). Chondrosarcomas of the jugular foramen were treated using a modified infratemporal type A approach. Conclusion: Low grade head and neck chondrosarcomas have a good prognosis while high grade chondrosarcomas tend to recur, despite radical surgical treatment (AU)

Tratamiento de los cordomas de clivus / Surgical treatment of clival chordomas

Introducción: Los cordomas de clivus son neoplasias benignas con una alta tasa de recurrencia y mortalidad. La dificultad para conseguir una resección total y su naturaleza infiltrativa les confieren esta agresividad. Material y método: Se presenta una serie retrospectiva de 8 casos tratados quirúrgicamente en nuestro servicio desde 1993 hasta 2006. Resultados: Los 8 pacientes fueron sometidos a un total de 14 procedimientos quirúrgicos, de los que 6 fueron abordajes anteriores (5 transmandibulares), 2 subtemporales-preauriculares, 2 extremolateral transcondíleos y 2 transcocleares. En 7 pacientes, la intención fue curativa. En 2 casos fue preciso realizar la cirugía de forma secuencial, en dos tiempos. Se consiguió la resección total en el 58% de los procedimientos. El seguimiento medio fue de 40 meses. Dos pacientes fallecieron como consecuencia de recidiva local, un paciente falleció durante el postoperatorio y otro paciente falleció por causas no relacionadas con el tumor. Discusión: La baja incidencia de los cordomas de clivus dificulta la elaboración de estudios randomizados acerca de su manejo. El tratamiento de elección es la cirugía, complementado con radioterapia en casos seleccionados. Preferimos emplear el abordaje transmandibular, combinándolo con extremolateral transcondíleo, en el caso de afectación condilar. Para extensiones laterales, optamos por el abordaje subtemporal-preauricular o vías transpetrosas. Las nuevas modalidades radioterápicas permiten el tratamiento eficaz de los remanentes tumorales. Conclusiones: Los abordajes extradurales implican regiones anatómicas familiares para el otorrinolaringólogo. Es imprescindible conocer las limitaciones de cada abordaje, a fin de evitar morbilidades innecesarias y resecciones incompletas (AU)

Introduction: Clival chordomas are benign neoplastic tumors displaying high morbidity and mortality rates. The difficulties involved in obtaining a total resection and its infiltrative nature explain this aggressiveness. Material and method: We present a retrospective clinical series of 8 surgically treated cases of clival chordomas at our department from 1993 to 2006. Results: All 8 patients underwent a total of 14 surgical procedures, 6 of which were anterior approaches (5 transmandibular), 2 subtemporal-preauricular, 2 from the transcondylar lateral edge and 2 transcochlear. In 7 patients the surgery was performed with curative intent. In 2 cases it was necessary to perform the surgery sequentially, in two steps. Total resection was achieved in 58% of patients. Average follow up was 40 months. Two patients died due to local recurrence, one patient died in the postoperative period and another died due to causes which were not related with the tumor. Discusion: The low incidence of clival chordomas makes it difficult to carry out random clinical studies of its management. The treatment of choice is surgery, supplemented by radiotherapy in selected cases. We prefer to use the transmandibular approach, combined with transcondylar lateral edge approach when the occipital condyle is infiltrated. For lateral extensions, we use the subtemporal-preauricular or transpetrosal approaches. New radiotherapy modalities provide an effective treatment of tumoural residues. Conclusions: Extradural approaches imply anatomical regions which are familiar for otolaryngologists. Specific knowledge about the limitations of each approach is essential in order to avoid unnecessary morbidity and incomplete resections (AU)

Profilaxis antibiótica en cirugía otorrinolaringológica / Antibiotic prophylaxis in otolaryngologic surgery

Desde principios de los años ochenta, numerosos ensayos clínicos han demostrado una reducción significativa en la incidencia de infección en la cirugía limpia-contaminada de la vía aerodigestiva superior debido al uso de antibióticos; sin embargo, no hay consenso sobre las pautas idóneas. Tampoco existe una pauta universalmente aceptada en la reconstrucción con colgajos. En la cirugía otológica, la rinológica, la amigdalectomía, la implantación coclear y la cirugía láser laringofaríngea, el uso de antibióticos perioperatorios depende frecuentemente de preferencias personales e institucionales, y no de la evidencia existente. Revisamos de forma crítica los ensayos clínicos disponibles sobre diversas técnicas quirúrgicas otorrinolaringológicas, evaluando distintos antibióticos, duración del tratamiento o vía de administración. No existen ensayos clínicos sobre la cirugía láser laringofaríngea. Tampoco hay ensayos clínicos sobre implantación coclear y los procedimientos neuroquirúrgicos limpios-contaminados, si bien en estos supuestos se recomienda la profilaxis antibiótica (AU)

Since the beginning of the 80s, numerous clinical trials have shown a significant reduction in the incidence of infections in clean-contaminated upper respiratory tract surgery, due to perioperative use of antibiotics; however, there is no consensus about the best antibiotic protocol. Moreover, there are no universally accepted guidelines about flap reconstructive procedures. In otological and rhinological surgery, tonsillectomy, cochlear implant and laryngo-pharyngeal laser surgery, the use of antibiotics frequently depends on institutional or personal preferences rather than the evidence available. We reviewed clinical trials on different otorhinolaryngological procedures, assessing choice of antibiotic, length of treatment and administration route. There are no clinical trials for laryngo-pharyngeal laser surgery. Nor are there clinical trials on implant cochlear surgery or neurosurgical clean-contaminated procedures, but in these circumstances, antibiotic prophylaxis is recommended (AU)

[Surgical treatment of clival chordomas]. / Tratamiento de los cordomas de clivus.

INTRODUCTION: Clival chordomas are benign neoplastic tumors displaying high morbidity and mortality rates. The difficulties involved in obtaining a total resection and its infiltrative nature explain this aggressiveness. MATERIAL AND METHOD: We present a retrospective clinical series of 8 surgically treated cases of clival chordomas at our department from 1993 to 2006. RESULTS: All 8 patients underwent a total of 14 surgical procedures, 6 of which were anterior approaches (5 transmandibular), 2 subtemporal-preauricular, 2 from the transcondylar lateral edge and 2 transcochlear. In 7 patients the surgery was performed with curative intent. In 2 cases it was necessary to perform the surgery sequentially, in two steps. Total resection was achieved in 58% of patients. Average follow up was 40 months. Two patients died due to local recurrence, one patient died in the postoperative period and another died due to causes which were not related with the tumor. DISCUSSION: The low incidence of clival chordomas makes it difficult to carry out random clinical studies of its management. The treatment of choice is surgery, supplemented by radiotherapy in selected cases. We prefer to use the transmandibular approach, combined with transcondylar lateral edge approach when the occipital condyle is infiltrated. For lateral extensions, we use the subtemporal-preauricular or transpetrosal approaches. New radiotherapy modalities provide an effective treatment of tumoural residues. CONCLUSIONS: Extradural approaches imply anatomical regions which are familiar for otolaryngologists. Specific knowledge about the limitations of each approach is essential in order to avoid unnecessary morbidity and incomplete resections.

[Surgical treatment of head and neck chondrosarcomas]. / Tratamiento quirúrgico de los condrosarcomas de cabeza y cuello.

INTRODUCTION: Head and neck chondrosarcomas may adopt different locations and biological behaviour. MATERIAL AND METHOD: We present a retrospective clinical series of 17 chondrosarcomas surgically treated in our Department from 1977 until 2006. RESULTS: Chondrosarcomas were located in the nasosinusal area (n=6), larynx (n=5), petrous bone (n=3), atlas (n=1), parapharyngeal space (n=1) and trachea (n=1). All patients except for one underwent surgery with radical intention. The mean follow-up period was 84 months (median, 71 months). Six patients developed recurrent disease with a mean latency of 10 months. Two patients died due to the disease and two remained alive with evidence of tumour. Patients with grade I chondrosarcomas presented less recurrent disease than those with grade II or III chondrosarcomas (17% versus 80%, P=0.029). The estimated 5-year survival was 88% with the better survival of patients with grade I chondrosarcomas reaching statistical significance (P=0.023). In 2 patients with cricoid chondrosarcomas, the reconstruction was carried out using the Rethi-Ward technique, and they were without evidence of disease at 71 months (with no cannula) and 145 months (with cannula). Chondrosarcomas of the jugular foramen were treated using a modified infratemporal type A approach. CONCLUSION: Low grade head and neck chondrosarcomas have a good prognosis while high grade chondrosarcomas tend to recur, despite radical surgical treatment.

Antibiotic prophylaxis in otolaryngologic surgery.

Since the beginning of the 80s, numerous clinical trials have shown a significant reduction in the incidence of infections in clean-contaminated upper respiratory tract surgery, due to perioperative use of antibiotics; however, there is no consensus about the best antibiotic protocol. Moreover, there are no universally accepted guidelines about flap reconstructive procedures. In otological and rhinological surgery, tonsillectomy, cochlear implant and laryngo-pharyngeal laser surgery, the use of antibiotics frequently depends on institutional or personal preferences rather than the evidence available. We reviewed clinical trials on different otorhinolaryngological procedures, assessing choice of antibiotic, length of treatment and administration route. There are no clinical trials for laryngo-pharyngeal laser surgery. Nor are there clinical trials on implant cochlear surgery or neurosurgical clean-contaminated procedures, but in these circumstances, antibiotic prophylaxis is recommended.

[Paranasal sinuses mucoceles. Our experience in 72 patients]. / Mucoceles de senos paranasales. Nuestra experiencia en 72 pacientes.

INTRODUCTION: Traditional treatment for paranasal sinuses mucoceles recommended total removal through external approaches. Since the 90s, endoscopic marsupialization has been proposed as optimal surgical treatment. We present our experience in the treatment of this pathology. MATERIAL AND METHOD: A retrospective review of 72 patients treated for paranasal sinuses mucoceles between 1980 and 2006 in our ENT department was performed. We describe clinical features, surgical approaches employed and recurrence of disease. RESULTS: The sample was composed of 72 patients with average follow-up period of 44 months (range 13-214 months). A total of 81 mucoceles were presented, with 44% affecting the frontal sinus or frontoethmoidal cells, followed in frequency by maxillary sinus mucoceles (35%). Twenty-nine percent of the patients did not present predisposing factors; 31% of patients had a history of nasal polyposis, 35% had undergone previous sinus surgery and 14% suffered previous facial fractures; 48 mucoceles patients were treated endoscopically and 33 were treated with external or combined approaches. Recurrence was found in 7 patients, 2 in the endoscopic surgery group and 5 in the external/combined surgery group. CONCLUSIONS: Endoscopic marsupialization is a safe approach with a low rate of recurrence. The endoscopic approach may be unsuitable for frontal lateral sinus mucoceles or those with significant bone blockage.

Mucoceles de senos paranasales. Nuestra experiencia en 72 pacientes / Paranasal sinuses mucoceles. Our experience in 72 patients

Introducción: El tratamiento tradicional de los mucoceles paranasales consistía en la extirpación mediante abordajes externos. Desde los años noventa se ha propuesto la marsupialización endoscópica como tratamiento de elección. Exponemos nuestra experiencia en el tratamiento de estas lesiones. Material y método: Se revisaron retrospectivamente 72 historias clínicas de pacientes intervenidos de mucoceles nasosinusales entre 1980 y 2006 en nuestro centro. Se describen las características clínicas, los abordajes quirúrgicos empleados y la aparición de recidivas. Resultados: La muestra se compone de 72 pacientes con un seguimiento medio de 44 (intervalo, 13–214) meses. Se presentaron un total de 81 mucoceles, de los que el 44% afectaba al seno frontal o las cedillas frontoetmoidales y el 35%, a los senos maxilares. El 29% de los pacientes no presentaban factores predisponentes. El 31% de los pacientes padecían poliposis nasal; el 35%, antecedentes de cirugía nasosinusal, y el 14%, fracturas faciales previas. Se trataron endoscópicamente 48 mucoceles y mediante abordajes externos o mixtos, 33. Apareció recidiva en 7 pacientes, 2 en el grupo de pacientes tratados endoscópicamente y 5 en el grupo de pacientes tratados mediante cirugía abierta o mixta. Conclusiones: La marsupialización endoscópica es una técnica segura y con bajo índice de recidivas que encuentra como limitación relativa los mucoceles frontales laterales o con tabicación ósea significativa (AU)

Introduction: Traditional treatment for paranasal sinuses mucoceles recommended total removal through external approaches. Since the 90s, endoscopic marsupialization has been proposed as optimal surgical treatment. We present our experience in the treatment of this pathology. Material and method: A retrospective review of 72 patients treated for paranasal sinuses mucoceles between 1980 and 2006 in our ENT department was performed. We describe clinical features, surgical approaches employed and recurrence of disease. Results: The sample was composed of 72 patients with average follow-up period of 44 months (range 13–214 months). A total of 81 mucoceles were presented, with 44% affecting the frontal sinus or frontoethmoidal cells, followed in frequency by maxillary sinus mucoceles (35%). Twenty-nine percent of the patients did not present predisposing factors; 31% of patients had a history of nasal polyposis, 35% had undergone previous sinus surgery and 14% suffered previous facial fractures; 48 mucoceles patients were treated endoscopically and 33 were treated with external or combined approaches. Recurrence was found in 7 patients, 2 in the endoscopic surgery group and 5 in the external/combined surgery group. Conclusions: Endoscopic marsupialization is a safe approach with a low rate of recurrence. The endoscopic approach may be unsuitable for frontal lateral sinus mucoceles or those with significant bone blockage (AU)