舌骨咽切开术治疗舌根癌

目的 探讨舌根癌外科治疗的最佳进路和方法。方法通过舌骨咽切开术治疗11例舌根癌,同期行会厌切除者4例,喉水平部分切除者1例。选择性颈清扫术1例,单侧功能性颈清扫术2例,双侧功能性颈清扫术1例,单侧根治性颈清扫术6例,一侧根治性和另一侧功能性颈清扫术1例。结果鳞状细胞癌10例,胚胎性横纹肌肉瘤1例;术后出现咽漏1例,进食流质轻度呛咳1例,上切缘阳性者1例,淋巴结转移者7例;术后拔管率100％;2、3、5年生存率分别为81.8％,77.8％,33.3％。结论 舌骨咽切开进路可清晰暴露舌根、会厌、下咽及喉部,适用于这些部位的肿瘤切除,并发症少。     

Hyalinizing clear cell carcinoma arising from the base of the tongue

Hyalinizing clear cell carcinoma is a low-grade indolent and rare salivary gland tumor originally described by Milchgrub et al. in 1994. We herein report a case of this tumor of the base of the tongue. A 66-year-old Japanese woman presented with a large painless mass in the throat. Computed tomography and magnetic resonance imaging revealed a 40×30-mm well-defined ovoid tumor arising from the base of the tongue. She underwent tracheostomy followed by a resection of the tumor via the transmandibular approach combined with a right-sided supra-omohyoid neck dissection. Because the tumor invasion of the surrounding tissue was limited, the surgical defect at the base of the tongue was relatively small, and no reconstructive procedure needed to be performed. The tumor was histopathologically diagnosed as hyalinizing clear cell carcinoma of the minor salivary gland. Her postoperative clinical course was uneventful. No aspiration or difficulty upon deglutition was recognized when she started transoral ingestion on the eighth postoperative day. The patient is currently free from disease 21 months after surgery. The pathology, clinical characteristics, and treatment of hyalinizing clear cell carcinoma are bibliographically reviewed.     

Radiofrequency tongue reduction through a cervical approach: a pilot study

OBJECTIVE/HYPOTHESIS: The objective of this prospective cohort study was to determine the feasibility, safety, and efficacy of radiofrequency tongue base reduction through a cervical approach in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Patients with moderate to severe OSAS and predominant tongue base obstruction by physical examination were included at our institution from 1999 to 2003. A sonogram was obtained to identify the lingual arteries, and an electrode was inserted through the neck and into the tongue under fluoroscopic guidance. Adverse events were recorded as well as efficacy on snoring (visual analog scale), daytime sleepiness (Epworth score), and polysomnography. RESULTS: The 10 patients received a mean of 14,288 +/- 3,251 J per session. No cases of tongue palsy or infection occurred. During the first 7 days, mean pain score (0-10 scale) was 1.3 +/- 1.5. Snoring volume (0-10 scale) decreased from 6.2 +/- 2.3 to 3.9 +/- 2.6 (P = .017) and sleepiness (0-24 scale) from 8.7 +/- 5.6 to 4.7 +/- 3.3 (P = .011). The respiratory disturbance index (events/hour) decreased from 52.0 +/- 19.6 to 33.6 +/- 24.4 (P = .016). Mean minimal oxygen saturation (%) increased from 64.2 +/- 13.0 to 75.8 +/- 10.3 (P = .003). Sleep architecture improved although not significantly. CONCLUSION: Radiofrequency tongue base reduction through a cervical approach proved feasible and safe despite the large energy doses used. Fluoroscopic guidance enables to place the electrode at the desired site of treatment. Although OSAS improved in nine of 10 patients, greater efficacy might be achieved in patients with less severe OSAS at baseline. Studies are needed to correlate objective clinical efficacy with the dose per lesion site and the number of lesion sites per session.     

低温等离子刀切除舌根增生性肿物40例报告

目的 探讨低温等离子刀切除舌根增生性肿物的效果。 方法 选取应用低温等离子刀舌根良性增生性肿物切除术40例,分别对患者术前及术后2周、术后6个月的咽部异物感、吞咽梗阻感、咽部疼痛感等主观症状应用VAS量表评分。 结果 所有患者术中仅少量出血或无出血,术后创面无出血。术前患者咽部异物感、吞咽阻挡感、咽部疼痛感等主观症状VAS评分为(38.8±5.94)分,术后2周患者VAS评分为(7.50±2.96)分,差异有统计学意义。6个月随访,舌根部创面光滑,无复发。患者咽部异物感、吞咽阻挡感、咽部疼痛感等主观症状VAS评分为(7.25±2.67)分,与术后2周VAS评分差异无统计学意义。 结论 低温等离子刀治疗舌根增生性肿物疗效显著,具有出血量少、术后疼痛轻、术后并发症少等优点。     

Analysis of treatment results for base of tongue cancer

OBJECTIVE: The study reported the results of treatment for base of tongue cancer with five different treatment modalities with long-term follow-up. STUDY DESIGN: This was a retrospective study of 262 patients with base of tongue cancer treated in the Departments of Otolaryngology-Head and Neck Surgery and Radiation Therapy at Washington University School of Medicine (St. Louis, MO) from July 1955 to January 1998. METHODS: The study population included previously untreated patients with biopsy-proven squamous cell carcinoma of the base of tongue who were treated with curative intent by one of five modalities and were all eligible for 5-year follow-up. The treatment modalities included local resection alone, composite resection alone, radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow-up parameters were studied using standard statistical analysis to determine statistical significance. RESULTS: The overall 5-year disease-specific survival (DSS) was 49.6% with death due to tumor in 50.4%. The 5-year cumulative disease-specific survival probability (CDSS) was 0.526 (Kaplan-Meier) with a mean of 7.8 years and a median of 5.6 years. Patients with early disease had significantly improved DSS compared with patients with more advanced disease (stages I and II; TN stages T1N0, T2N0, and T2N1; and T stages T1 and T2.). Patients with N0 had better DSS than patients with positive lymph nodes (P =.010). The DSS for all stages by treatment modality included local resection (70.0%), composite resection (47.6%), radiation therapy (40.4%), local resection and radiation therapy (50.0%), and composite resection with radiation therapy (51.5%). Overall and within the stages there was no significant difference in either DSS or CDSS by treatment modality. Local-regional recurrence occurred in 26% of patients, and overall salvage was 10.5%. Patients with clear resection margins did better than patients with close or involved margins (DSS and CDSS). Patients treated with radiation therapy alone had improved capacity to swallow (P =.001), speak (P =.01), and work (P =.001) compared with patients treated with the other modalities. CONCLUSIONS: Cancer of the base of tongue is a lethal disease, and its treatment results in significant disability. No treatment produced a significantly improved survival advantage. Focus on improving local-regional control might improve overall survival. All treatment modalities were associated with major treatment-related complications. Radiation alone produced significantly improved post-treatment function and quality of life compared with the other modalities. Because of the recurrence rates at the primary and neck sites and the high rates of development of distant metastasis and second primary cancers, patients should be monitored for a minimum of at least 4 years.     

Transoral robotic surgery (TORS) for base of tongue neoplasms

OBJECTIVE: To develop a minimally invasive surgical technique for the treatment of base of tongue neoplasms using the optical and technical advantages of robotic surgical instrumentation. STUDY DESIGN: Ten experimental procedures including tongue base exposure and dissections were performed on three cadavers and two mongrel dogs. Transoral robotic surgery (TORS) was then performed on three human patients with tongue base cancers in a prospective human trial. METHODS: Using the da Vinci Surgical Robot (Intuitive Surgical, Inc., Sunnyvale, CA), we performed a total of 10 base of tongue resections on edentulous and dentate cadavers as well as live mongrel dogs. In the cadaver models, exposure was evaluated using three different retractors, the Dingman, Crowe Davis, and FK retractors. The three human patients underwent TORS surgery of their tongue base cancers under an institutional review board approved prospective clinical trial. The ability to identify and preserve or resect key anatomic structures such as the glossopharyngeal, hypoglossal, and lingual nerves as well as techniques for identifying the lingual artery and achieving hemostasis were developed. RESULTS: The da Vinci Surgical Robot provided excellent visualization and enabled removal of the posterior one third to one half of the oral tongue in cadavers, dogs, and human patients. Among the three retractors evaluated, the FK retractor offered the greatest versatility and overall exposure for robotic instrument maneuverability. Complete resection to negative surgical margins with excellent hemostasis and no complications was achieved in the live patient surgeries. CONCLUSIONS: TORS provided excellent three-dimensional visualization and instrument access that allowed successful surgical resections from cadaver models to human patients. TORS is a novel and minimally invasive approach to tongue neoplasms that has significant advantages over classic open surgery or endoscopic transoral laser surgery.     

Base of the tongue metastatic cancer from hepatocellular carcinoma: a case report

Although hepatocellular carcinoma (HCC) is a common malignancy in Taiwan, metastasis to the head and neck area is extremely rare. In this report, we document a case of HCC metastasis to the base of the tongue. The patient involved had been treated for HCC with chemoembolization and radiotherapy 3 years prior to being diagnosed with tongue base metastasis. Symptoms of the metastasis included frequent oozing from the tongue base tumor. The patient died 3 months after a palliative resection of the tongue. To our knowledge, this is the first clinical presentation of HCC metastasis to the tongue base documented in the English language. We also believe that this particular case is important because we predict that the advancement in HCC treatment modalities will allow enough survival time in patients to cause occult extrahepatic metastatic lesion to develop into a field of clinical significance.     

Complications of supraglottic laryngectomy for carcinomas of the supraglottis and the base of the tongue

The medical records of patients with either a supraglottic carcinoma (n = 193) or a base of tongue carcinoma (n = 56) who underwent a supraglottic laryngectomy were studied. Because of aspiration total laryngectomy was required in 9.8% and 21.4% of patients with supraglottic and base of tongue carcinomas, respectively, being related to locally advanced stage of disease in the base of tongue and to an age older than 65 years in the case of supraglottic carcinomas. The non-decannulation rates were 23.8% and 50% in supraglottic and base of tongue tumours respectively. Post-operative radiotherapy did not influence the decannulation rate. but advanced local disease and age did. Post-operative mortality in the first month after the operation was 2.6% in supraglottic tumours and 3.6% in base of tongue tumours.     

Staging and prognostic factors in carcinoma of the base of the tongue

During the period 1966-1985, 66 patients were submitted for curative treatment of a carcinoma of the base of the tongue in the Netherlands Cancer Institute. Treatment consisted of radiotherapy (59 patients), surgery and post-operative radiotherapy (4 patients) and surgery alone (3 patients). Patients were staged according to the UICC (1982) and UICC (1987)/AJCC (1988) criteria. Regrouping by the latter system caused enlargement of the N2-group and of stage IV. The crude 5-year survival was 22%, the 5-year tumour control was 36% and the locoregional control was 47%. The most important prognostic factors for the tumour-free interval are the T-category (P = 0.01) and stage grouping (UICC 1982) (P = 0.022). The same factors predict the locoregional control (P = 0.005 and 002 respectively). Crude survival is lower in smokers, and in patients in poor general condition (P = 0.04 and 0.007 respectively).     

内镜辅助耳前颞下窝入路颞下窝良性肿瘤切除术

目的探讨内镜辅助经耳前颞下窝入路切除颞下窝良性肿瘤的可行性及疗效。方法采用内镜辅助经耳前颞下窝入路切除颞下窝良性肿瘤5例,男1例,女4例;年龄41～59岁,平均51岁。主要症状是咀嚼不适感4例,患侧头痛3例,患侧听力下降2例。主要体征为患侧颞颧部膨隆3例,其余2例无明显阳性体征。结果手术均在1.5～3.0 h内顺利完成,肿瘤完全切除。患者术后感觉患侧咀嚼无力、闭合力稍差、张口受限、术区肿胀,约2个月后基本正常。随访6～26个月,平均18个月,未发生面瘫、无颞下颌关节错位咬合、无慢性疼痛等并发症,其中1例术后12个月,仍感觉患侧下颌部麻木。切口均甲级愈合。术后病理2例为巨细胞修复性肉芽肿,2例为骨巨细胞瘤,1例为磷酸盐尿性间叶组织肿瘤。所有患者随访至今均无复发。结论内镜辅助经耳前颞下窝入路可以彻底切除翼外板、翼外肌下头外侧区域颞下窝上部关节区附近的一些良性肿瘤,是安全、有效、微创的,值得临床推广应用。     

Extended supraglottic laryngectomy for primary base of tongue carcinomas

A retrospective review of 56 patients with a primary base of tongue carcinoma was undertaken to determine the value of supraglottic laryngectomy. All the patients had a supraglottic laryngectomy and a total of 77 neck dissections. Forty-three (76.8%) patients received post-operative radiotherapy. The incidence of local recurrence was 23.2%, neck relapse being seen in 16.1% of patients. The 3 year survival was 47%. The overall survival of the whole series and by stage was not improved by combined therapy compared with surgery alone.     

Combined radiofrequency surgery of the tongue base and soft palate in obstructive sleep apnoea

Objective To investigate the safety and efficacy of combined temperature-controlled radiofrequency volumetric tissue reduction of the tongue base and soft palate in obstructive sleep apnoea.

Material and methods A total of 20 patients with obstructive sleep apnoea and combined palatal and retrolingual obstruction were included in a non-randomized clinical trial and 51 combined treatments were performed under local anaesthesia. Postoperative pain was assessed using visual analogue scales. Functional parameters, daytime sleepiness and quality of life were assessed using questionnaires (Epworth Sleepiness Scale, Short Form-36) before and 12 weeks after the last treatment session. Concurrently, polysomnography was performed on two consecutive nights.

Results The mean postoperative pain score dropped from 5.6 at Day 1 to 0.6 at Day 7. Painkillers were taken for a mean of 3.3 days. There were no postoperative complications or changes in functional parameters. Daytime sleepiness improved significantly (p<0.05). The mean respiratory disturbance index was reduced from 25.3±11.4 to 16.7±15.3 (p<0.05). Six out of 18 (33%) patients were cured after a mean of 2.7 treatment sessions.

Conclusion Combined radiofrequency volumetric tissue reduction of the tongue base and soft palate is a safe and effective treatment for obstructive sleep apnoea.     

累及舌根晚期咽喉恶性肿瘤的手术及舌根重建

目的 探讨累及舌根恶性肿瘤的手术及功能重建。方法 对手术治疗的57例原发舌根及咽喉部累及舌根的恶性肿瘤病人进行总结，其中舌根癌7例，软腭癌累及舌根6例，扁桃体癌累及舌根14例，声门上区喉癌累及舌根30例，分别实施经口、咽侧、舌骨区、下颌骨正中裂开外旋入路切除肿瘤，术后行切除舌根的修复及舌功能重建，应用颈阔肌皮瓣、胸骨舌骨肌肌筋膜(皮)瓣、颞肌肌筋膜瓣、胸大肌肌皮瓣、喉气管瓣及局部拉拢缝合喉体上提修复缺损。结果 全部病人术后经锻炼逐步恢复了饮食功能；除行喉气管瓣修复5例外，全部恢复了言语功能；3年、5年生存率分别为40／57(70．18％)、33／57(57．89％)。结论 术前对肿瘤原发部位及范围的准确评估是选择合适的手术进路、修复方式及彻底切除肿瘤的重要前提；适合的手术入路及修复方式，在彻底切除肿瘤的同时得以功能重建，提高了生活质量，可以获得较为理想的治疗效果：对这类肿瘤府采取积极有效的综合治疗措施。     

Submandibular approach for excision of a large schwannoma in the base of the tongue

A 24-year-old Turkish woman is described, who gradually developed progressive swallowing problems over 6 months due to a tumor in the base of the tongue. Magnetic resonance imaging showed a large well-circumscribed solid mass. Histopathological examination of an incisional biopsy showed a schwannoma. The tumor was completely removed through a submandibular approach. The postoperative course was uneventful and her complaints disappeared. The submandibular approach used gave an excellent exposure of the base of tongue with a less obvious scar than a lip-splitting incision. Received: 16 June 1999 / Accepted: 22 July 1999     

额鼻眶筛入路显微镜下一次性切除11例前颅底沟通瘤

目的 对11例前颅底沟通瘤行额鼻眶筛入路显微手术一次性切除疗效分析。方法 对手术治疗的11例前颅底沟通瘤进行回顾性分析。所有患者术前均行CT或MR检查。均经额鼻眶筛入路与相关科室配合运用显微外科技术一次性切除颅内外肿瘤。结果 全切除9例，次全切2例，手术效果好，无手术死亡及严重并发症。结论 额鼻眶筛入路手术治疗前颅底沟通瘤有利于肿瘤的广泛暴露和切除，多学科联合与显微外科技术对一次性切除颅内外肿瘤有帮助。术中颅底重建是手术的关键步骤之一。     

Pseudoaneurysm of the lingual artery after temperature-controlled radiofrequency tongue base reduction: a severe complication

Temperature-controlled radiofrequency reduction (TCRF) of the tongue base has been developed as an alternative option for the treatment of patients with obstructive sleep apnea syndrome. The technique is propagated as an easy and safe surgical method. The case of a 34-year-old male patient with obstructive sleep apnea syndrome who underwent TCRF is reported. Fourteen days after surgery was performed, heavy bleeding at the base of the tongue occurred. Computed tomography and digital subtraction angiography imaging revealed a pseudoaneurysm of the lingual artery, which was treated endovascularly by detachable and free platinum coils during the same session. The article reports the first case of pseudoaneurysm under TCRF of the tongue base and discusses the diagnostic and therapeutic procedure to handle and avoid life-threatening complications under this method of treatment.