Transoral robotic surgery of parapharyngeal space tumours: a series of four cases

Tumours arising from the parapharyngeal space (PPS) represent less than 1% of all head and neck tumours. Salivary gland tumours account for 40–50% of PPS lesions and are located in the pre-styloid parapharyngeal space. Pleomorphic adenomas represent 80–90% of salivary tumours in the PPS. Recently, transoral robotic surgery (TORS) has become common in head and neck surgery as a minimally invasive procedure. Four cases of benign PPS tumour treated with TORS are presented here. Preoperative diagnosis was conducted by fine needle aspiration biopsy and magnetic resonance imaging, and the results were used to plan the correct surgical approach. One case required a change of approach to conventional transoral blunt dissection. Patients required pain control and reported dysphagia symptoms for a period of weeks, but no nasogastric tube was needed at any time. This case series indicates that TORS is a safe surgical procedure for the excision of benign tumours of the PPS in selected cases.     

Midfacial tumours: a review of 72 cases

We review 72 midfacial tumours managed during the 10-year period between 1985 and 1995. We describe presenting features, sites of lesions and histology, treatment regimens and outcomes, as well as the various surgical approaches for the resection of midfacial tumours, and their indications and contraindications. The choice of approach should be based on type of tumour, its site, and extent.     

44例颞下咽旁间隙肿瘤的临床和治疗

颞下咽旁间隙肿瘤患者４４例。良性肿瘤３１例，起源最多是腮腺深叶，其次是神经鞘膜；恶性肿瘤１３例，种类繁多。临床主要表现为咽侧壁膨隆；大多数病人是一种多样化、无痛性肿胀，少数病人出现发音改变和吞咽困难。全部病例获手术治疗。其中４１例获随访结果，随访时间最长２０年，作者就颞下咽旁间隙肿瘤的临床表现、诊断和手术等问题进行了讨论。     

Primary impaction of primary teeth: a review and report of three cases

Primary impaction of primary teeth is rare. Only ten cases have been found in the world literature. It affects almost always second molars and the finding is usually occasional. Three cases of this abnormality, two of the upper jaw and one of the mandible, are presented. The analysis of the characteristics of these cases and the cases in the literature, suggests that ankylosis has probably a leading role in the etiopathogenesis. The following criteria for a correct diagnosis is presented: 1) deep retention into the bone; 2) absence of caries, restorations and resorptions; 3) frequent passing of the corresponding permanent premolar; and possible retention of the corresponding adjacent tooth. More attention is recommended in the study of the lesion for the future.     

Surgical treatment of benign parapharyngeal space tumours. Presentation of two clinical cases and revision of the literature

Parapharyngeal space (PPS) tumours, most of them benign, account for some 0.5% of tumours of the head and neck. The importance of these tumours lies mainly in two aspects: on the one hand, the difficulty of early diagnosis, due to the lack of symptoms in the initial stages and, on the other, the extreme complications of performing surgery in the parapharyngeal region. This article discusses two clinical cases of parapharyngeal space tumours: a 45 year old man and a 60 year old woman. We revise the scientific literature and analyse the diagnostic and therapeutic procedures used, placing special emphasis on describing the different surgical approaches to the parapharyngeal space: transcervical, transcervical-transparotid, transpalatal or transoral, transmandibular and orbitozygomatic, all of which, used alone or combined with others, allow for complete resection of these tumours with minimum morbidity.     

Extracapsular dissection of the parapharyngeal space for a pleomorphic adenoma: a 10-year review

Pleomorphic adenomas of the parapharyngeal space are difficult to remove with a margin of normal tissue. We reviewed 29 cases of extracapsular dissection of a parapharyngeal pleomorphic adenoma and found that extracapsular dissection does not increase the probability of recurrence of the tumour.     

Stylomandibular tenotomy in the transcervical removal of large benign parapharyngeal tumours

We used a simple modification of the transcervical approach in a selected group of nine patients with large benign parapharyngeal space tumours, all of whom met the following inclusion criteria: The tumour was benign on fine needle aspiration, the encapsulated tumour was not attached to skull base or great vessels in the parapharyngeal space on imaging. Adequate exposure was achieved by just dividing the stylomandibular ligament and retracting the mandible anteriorly. It was possible to remove the tumours successfully and safely in all nine patients without the need for mandibulotomy or superficial parotidectomy. In seven cases, the tumour crossed the midline. There were no major perioperative neurological or vascular complications. On subsequent follow up, there were no clinical or radiological signs of residual or recurrent tumour.     

Impact of indocyanine green fluorescent image-guided surgery for parapharyngeal space tumours

In parapharyngeal space dissection, significant complications such as dysphagia and carotid artery rupture have been reported. In order to resect tumours safely in narrow parapharyngeal space, we propose indocyanine green (ICG) florescence image for navigation surgery.ObjectiveTo evaluate the usefulness of ICG fluorescent image-guided surgery for parapharyngeal space tumours.Methods0.5 mg/kg of ICG was injected via the cephalic vein. Observation of the fluorescent image was performed with HEMS (HyperEye Medical System) at 10–30 min after injection. At first, the position of the tumour was marked over pharyngeal mucosa according to ICG fluorescence imaging with HEMS. We also confirmed submucosal tumours hidden under fascia using HEMS imaging again and resected them.ResultsAll tumours displayed bright fluorescence emissions which clearly contrasted with the normal structures. Even with the submucosal tumour covered with and obscured by fasciae, we could observe the tumour clearly under HEMS imaging. Tumours behind the carotid artery and lower cranial nerves also were displayed bright fluorescence emissions and were clearly detected. As a result, we could completely remove the tumour safely and noninvasively to preserve pharyngeal functions.ConclusionICG fluorescence imaging is effective for the detection and resection of the parapharyngeal space tumours with preserving functions.     

Double mandibular osteotomy with coronoidectomy for tumours in the parapharyngeal space

Removal of deep-lobe parotid tumours from the parapharyngeal space is often difficult because of limited surgical access and the critical vascular and neurologic structures nearby. Mandibulotomy, when necessary, is useful for improving wider visibility and control of the vascular bundle and facial nerve, but may cause damage to the inferior dental and lingual nerves. The double mandibular osteotomy with coronoidectomy gives excellent access and avoids damage to these nerves.     

Treatments of tenosynovial giant cell tumours of the temperomandibular joint: a report of three cases and a review of literature

Tenosynovial giant cell tumours (TGCTs) are benign lesions affecting synovial joints. The classified subtypes are localized and diffuse. They seldom occur in the temporomandibular joint (TMJ). The aim of this study is to report on three new cases and to review the literature.One patient had surgical debulking with adjuvant external beam radiation therapy (EBRT). After 1 year of follow-up, no evidence of disease was presented. The second patient was misdiagnosed and treated with denosumab. Debulking with adjuvant EBRT followed. Ten months postoperatively, no disease progression was seen. The third patient received systemic nilotinib and remained stable for over 5 years.The literature review included 106 cases of which 95 had diffuse subtype. Most patients, had surgical excision. Thirteen (14%) patients received adjuvant EBRT. Eleven (14%) recurrences were identified. After 1-, 5- and 10 years of follow-up, an overall progression-free survival (PFS) of 99% (95% confidence interval (CI) 0.96–1), 80% (95% CI 0.68–0.94), 67% (95% CI 0.51–0.90) was calculated, respectively. Treatments for diffuse-TGCT-TMJ should be individualized depending on age, severity of symptoms, extent of disease and progression, expected mutilation of surgical interference, and current systemic treatment options. In stable disease a ‘wait and see’ policy, is a viable option. Additional treatments should be reserved for symptomatic, irresectable tumours or residual disease after surgical treatment with persistent complaints.     

Primary hemihypertrophy of the face: review and report of two cases

Two patients who underwent surgical correction for facial hemihypertrophy are presented with a one year follow-up. The aid of computerized tomography in planning the procedures and assessing the stability of the result is discussed.     

A modified surgical approach for parapharyngeal space tumours: use of the inverted 'L' osteotomy.

Removal of tumours from the parapharyngeal space is often difficult because of limited surgical access. Mandibulotomy has proved useful for improving access but may cause damage to the inferior dental and lingual nerves. Use of the inverted 'L' osteotomy provides excellent access avoiding damage to the nerves and the technique is illustrated with three surgical cases.     

Primary malignant neoplasms of orofacial origin: a retrospective review of 256 cases in a Nigerian tertiary hospital

A retrospective review of cases histologically diagnosed as malignant lesions of the orofacial region in 1992-2003 from the records of the Department of Oral Pathology and Biology, Lagos University Teaching Hospital, Nigeria was carried out. All cases were subjected to analysis of age, gender, site distribution and histologic types. Malignant tumours constituted 18% of all the biopsies of orofacial lesions seen within the period. The mean age of patients was 42.2+/-21.5 years (range: 2.5-85). There were 177 (69%) epithelial tumours of which squamous cell carcinoma was predominant, 47 (18%) sarcomas and 32 (13%) lymphomas. Squamous cell carcinoma (44%) was the most common malignant orofacial tumour. Osteosarcoma (32%) and Burkitt's lymphoma (56%) was the predominant sarcoma and lymphoma, respectively. Patients with a histologic diagnosis of carcinoma were older than those with sarcomas and lymphomas (P<0.01), and those with a histologic diagnosis of malignant lymphoma were significantly younger than those with sarcomas (P<0.01). Almost 25% of patients with carcinomas were below the age of 40 years. Malignant orofacial tumours are not uncommon in the studied environment, with a sizable proportion of carcinomas occurring before the age of 40 years.     

Odontogenic tumours: 240 cases diagnosed over 31 years at a Brazilian university and a review of international literature

This study describes the epidemiology and clinical presentation of odontogenic tumours (OT) seen at a regional Brazilian oral and maxillofacial pathology service; to assess the quantitative impact of the most recent World Health Organization (WHO) classification of these lesions; and to compare this series with others available in international databases. The study was carried out by retrospectively analysing 240 cases diagnosed from 1978 to 2009, followed by a comprehensive review of the literature. The patients’ mean age was 29 years, with a male to female ratio of 1:1.1. Benign lesions comprised 97.9% of the cases (mostly keratocystic odontogenic tumours (KCOT), odontomas and ameloblastomas) with the remaining tumours depicting a prevalence of less than 5%. Adenomatoid OT were less frequent than in most previous studies, while malignant OT were strikingly numerous. Most OT in children and in the anterior maxilla were odontomas, while maxillary ameloblastomas were rare. Lack of swelling was more frequent in KCOT than in ameloblastomas. The present study confirms the relative impact of KCOT in the epidemiology of OT and identifies more similarities between the present series with reports from the United States and Europe than with African and Asian populations.     

Odontogenic tumours: a retrospective study of 1642 cases in a Chinese population

A total of 1642 odontogenic tumour cases retrieved from the files of the College of Stomatology, Sichuan University, China were retrospectively analyzed for gender, age, tumour site and relative frequency of various types, and the data compared with that of previous reports. The final diagnosis in each case was based on the WHO 2005 histopathological classification of odontogenic tumours. Of these tumours 1592 (97.0%) were benign and 50 (3.0%) were malignant. Ameloblastoma (40.3%) was the most frequent type, followed by keratocystic odontogenic tumour (35.8%), odontoma (4.7%) and odontogenic myxoma (4.6%). The mean age of the patients was 32.1, with a wide range (3-84 years). The male-female ratio and maxilla-mandible ratio were 1.4:1 and 1:4.0, respectively. Ameloblastoma and keratocystic odontogenic tumours, important indications of extensive surgical procedures, are not considered rare in this Chinese population, whereas odontoma is uncommon.     

Oral malignant tumours: a report on 728 cases in Chile

The objective of this study was to describe the main clinical characteristics and the relative frequency of each type of oral malignancies received at the Oral Pathology Reference Institute (IREPO) of the Faculty of Odontology; University of Chile, since 1975 to 2006. Studies were performed of 728 cases of biopsies recorded in the IREPO data base with a diagnosis corresponding to some type of Oral Malignant Tumour (OMT) and which counted with all required clinical and demographic data. Histological sections were observed by two oral pathologists with the purpose of confirming the original diagnosis. 61.6% of OMTs were observed in males and 38.4% in females. Patients average age was 65.3 years, and the most frequent localization was the alveolar/gums ridge (20% of the cases) being the squamous cell carcinoma (SCC) the most frequent pathology (58.4%) These results are similar to the frequencies of oral malignancies reported for other countries as to distribution per gender, age, histological diagnosis. Nevertheless, frequency distribution of each of the OMTs is different to that indicated in most publications.