Head and neck lymphatic malformation and treatment: Clinical study of 23 cases.

OBJECTIVES: Head and neck lymphatic malformation is a rare benign tumor, mainly affecting children under 1 year of age. Total resection is often difficult, and recurrence is frequent. Functional and esthetic sequelae are a major issue. MATERIALS AND METHODS: A single-center retrospective study recruited patients with head and neck lymphatic malformation managed surgically, with or without associated sclerosis by alcohol, bleomycin or aetoxisclerol, between January 1, 2004 and December 31, 2013. Local control, recurrence and complications rates were analyzed, as were swallowing disorder, tracheostomy and impaired phonation. RESULTS: Twenty-three patients, with a mean age of 15.80 years, were included. Location was suprahyoid in 17 cases (73.91%) and infrahyoid in 6 (26.09%). There were 11 macrocysts (47.82%), 2 microcysts (8.70%) and 10 mixed lesions (43.48%). Three patients showed spontaneous resolution; 12 patients (52.17%) underwent a single surgical procedure, 2 (8.7%) multiple procedures, 2 (8.7%) 1 surgical procedure and 1 sclerosis, 2 (8.7%) 1 surgical procedure and multiple scleroses, and 2 (8.7%) multiple procedures and multiple scleroses. The local control rate was 69.56%. There were 8 recurrences (34.78%), all in suprahyoid microcystic or mixed lesions. There were 2 complications (8.7%): 1 severe upper cervical edema following sclerosis of the floor of the mouth, and 1 postsurgical palsy of the marginal mandibular branch of the facial nerve. In 1 case (4.35%), a nasogastric tube was required for 6 days, without tracheostomy. CONCLUSION: Recurrence was frequent, with non-negligible functional and esthetic impact, especially in case of suprahyoid and microcystic lesion.

Transoral robotic surgery for head and neck cancer: a series of 17 cases.

OBJECTIVES: Transoral robotic surgery (TORS) is an innovative surgical technique indicated for resection of selected head and neck cancers. The authors report their experience and discuss the indications, advantages and disadvantages of this technique. MATERIALS AND METHODS: Seventeen patients were operated by TORS in the Limoges University Hospital ENT department between March 2010 and January 2011. RESULTS: Tumour sites were the aryepiglottic fold (n=3), piriform sinus (n=2), lateral pharyngeal wall (n=3), posterior pharyngeal wall (n=2), base of tongue (n=3), vallecula (n=1), epiglottis (n=2) and arytenoid (n=2). One patient had two primary sites treated by TORS. This series comprised two stage I (11.7%), seven stage II (41.2%), six stage III (35.4%) and two stage IVa tumours (11.7%). Mean TORS set-up and operating times were 20.5 and 39.7 minutes, respectively. No major intraoperative complication was observed. One patient was reoperated on D5 for bleeding. Fifteen patients had clear surgical margins. Swallowing was restored on D2 for nine patients. The mean length of hospital stay was 10 days. Seven patients received adjuvant radiotherapy, seven patients were treated by chemoradiotherapy and three patients were submitted to simple clinical surveillance. CONCLUSION: TORS appears to provide new treatment options for head and neck cancers by extending the indications for endoscopic resection for selected cases of head and neck cancers. It allows effective cancer resection under excellent operating conditions with low morbidity and improved functional recovery. This new treatment modality needs to be evaluated in relation to other open surgery, endoscopic laser and chemoradiotherapy techniques.

Quality of life in chronic venous insufficiency. An Italian pilot study of the Triveneto Region.

AIM: Chronic venous insufficiency (CVI) is a chronic disease, whose disability has not been appreciated clearly, and several treatment costs are not covered by Public Health Service, probably because its any social impact is not well known. The aim of the study was to assess the impact of CVI on quality of life (QoL), and to compare the sensitivity of more diffused instruments for QoL assessment. METHODS: One hundred and four patients with CVI received the Italian version of four QoL assessment instruments (MOS SF-36; CIVIQ-2; Euro-QoL 5D and a visual analogical scale). The poorest QoL was adjusted as 0, the best as 100. After filling the questionnaires, patients underwent a clinical and instrumental examination to assess the diagnosis according to the CEAP classification. RESULTS: The QoL is progressively impaired from CEAP class C1 to class C5-6. The SF-36 showed a normal QoL in patients of CEAP class C1 and C2. Class C3 showed a significant (P<0.0018) reduction of QoL (physical role and bodily pain), and the decline was more significant (P<0.0001) in class C4, involving all physical items and several mental ones. Class C5-6 showed very low scores of physical and social functioning, general health and vitality. Physical and emotional scores were better than C4 patients. CONCLUSIONS: QoL is progressively impaired in CVI, involving primarily the physical items and the emotional role, with worsening of mental items only in advanced stages. This early involvement of physical items underlines how CVI is not an esthetic problem, but, a disease. Its impact on the lifestyle and QoL is similar to that of other chronic diseases (diabetes, cancer, chronic pulmonary disease), reaching in the class C5-6 the poorest level, similar to heart failure.