280例颈根部周围神经肿瘤临床治疗的回顾性分析

目的探讨颈根部周围神经肿瘤的临床手术入路及手术适应证的选择。方法回顾性总结分析湖南省肿瘤医院头颈外科1995年1月～2009年1月诊治的280例颈根部周围神经肿瘤的手术治疗及临床疗效。结果 280例颈根部周围神经肿瘤被顺利整体切除,术后随访3年。良性肿瘤221例,复发10例,其中1例椎管复发致死亡。恶性肿瘤59例,其中16例神经纤维肉瘤出现局部复发及远处转移,予以放化疗缓解。术后280例患者中,8例患者因肿块巨大一侧喉返神经受损术后出现声嘶,5例患者出现Horner’s综合征,11例患者出现血气胸、淋巴瘘等并发症。结论通过对280例颈根部周围神经手术入路和结果分析,良、恶性颈根部周围神经肿瘤手术治疗均有良好效果。     

Parotid gland tumors: a retrospective study of 154 patients

IntroductionBenign tumors of the parotid gland comprise the majority of salivary gland tumors.ObjectiveTo review the clinical characteristics of parotid gland tumors submitted to surgical treatment by the same surgeon.MethodsRetrospective study with 154 patients who had parotid gland tumors. Clinical and histological data, type of surgery, and complications were assessed and described.ResultsThe main manifestation was a mass with a median evolution of 12 months for benign tumors and five months for malignant tumors. Ultrasonography was the most frequent complementary exam. Pleomorphic adenoma was the most common of the benign tumors, and mucoepidermoid carcinoma was the most frequent malignant tumor. Superficial parotidectomy with preservation of the facial nerve was the most common surgical procedure and reversible paresis of branches of the facial nerve was the most common complication.ConclusionsPleomorphic adenoma is the most common parotid gland tumor and superficial parotidectomy with preservation of the facial nerve is the most common and appropriate treatment for most low-morbidity tumors.     

Facial Nerve Function After Petrosectomy

Objectives: Evaluation of facial nerve function after petrosectomy in a patient series with facial nerve denudation-decompression, forward or backward rerouting, and facial nerve suture and grafting. Study Design: Fifty-six patients with petrosectomies performed for 24 benign and 9 malignant tumors of the petrous bone, 13 malignant tumors of the parotid gland or of the infratemporal spaces with infiltration of the petrous bone, 8 traumatic facial nerve disruptions, and 2 osteoradionecroses were retrospectively evaluated with respect to facial nerve function. Sixteen cases involved a partial, 25 a subtotal, and 15 an extended subtotal petrosectomy. Methods: The treatment of the facial nerve included 15 denudation-compressions, 23 denudation-compressions with rerouting, 4 primary sutures, and 14 nerve grafts. The House-Brackmann grading system was used for facial nerve evaluation. Results: Normal or nearly normal facial nerve function was obtained in facial nerve denudation-decompression with and without rerouting (House-Brackmann Grade I or II) except in cases of malignant tumors and osteoradionecrosis, where preoperative impaired function remained. Satisfactory results were obtained with nerve suturing and nerve grafting after petrous bone fracture (Grade III or IV, in one case practically Grade II) except in a case of late repair 3 years after the trauma (Grade V). Variable results were obtained with nerve grafting in cases with tumor infiltration: Satisfactory results (5 of Grade III or IV) were obtained when the tumor was healed and also when postoperative radiotherapy was applied; poor results were obtained in the case of tumor recurrence (6 of Grade V or VI). Conclusions: Our results show that petrosectomy with denudation-decompression of the facial nerve with or without rerouting usually results in a normal mimic of the face. When the facial nerve is disrupted by trauma or when the nerve is infiltrated by tumor, early reconstruction with nerve suture or grafting mostly leads to a partial and quite acceptable reinnervation of the face.     

Recurrent benign pleomorphic adenoma of the parotid gland: Facial nerve identification and risk factors for facial nerve paralysis at re-operation

ObjectiveSurgery for recurrent pleomorphic adenoma of the parotid gland is challenging since there is a considerable risk of facial nerve injury and a high re-recurrence rate. We investigated surgery for recurrent pleomorphic adenoma, focusing on management of the facial nerve.MethodsWe reviewed 29 patients who underwent surgery for recurrent benign pleomorphic adenoma of the parotid gland at our department between 1999 and 2018. We examined clinicopathologic features and risk factors for facial nerve injury during reoperation.ResultsFactors associated with difficulty in identifying the main trunk of the facial nerve during surgery were bilobar tumors, multiple tumors, and use of an S-shaped skin incision at the previous operation. When the facial nerve was identified intraoperatively, it could be preserved in 2/3 of patients, while the nerve was only preserved in 1/3 of patients when it was not identified. Factors related to permanent postoperative paralysis included recurrence in the deep lobe or both lobes and multiple tumors.ConclusionThe probability of successfully preserving the facial nerve is relatively high if the nerve can be identified during surgery for recurrent pleomorphic adenoma, although intentional resection is necessary in some patients. Factors associated with difficulty in identifying the facial nerve are similar to those related to permanent postoperative paralysis, including bilobar tumors and multiple tumors. In patients with recurrent pleomorphic adenoma, preservation of the facial nerve is difficult, when they may have undergone previous extensive resection or have multiple tumors requiring subtotal or more extensive resection.     

The distribution of parotid gland neoplasms in a veteran population

ObjectiveSalivary gland tumors account for 6%–8% of head and neck neoplasms with the parotid gland as the most common primary site. Pleomorphic adenomas (PA) are considered the most common benign parotid gland neoplasms, followed by Warthin tumors (WT). The goal of this study was to investigate the distribution of parotid gland neoplasms among a United States veteran population.DesignRetrospective chart review.SettingWashington DC Veterans Affairs Medical Center.ParticipantsVeterans who underwent fine needle aspiration (FNA) for a parotid gland mass from 2000 to 2018 were included. Medical records were reviewed for gender, age, tobacco use, surgery date, and pathology results.Main outcome measuresChanges in the distribution of parotid neoplasms and tobacco use over an 18-year period.ResultsOf 141 patients with parotid gland masses, 86.5% (n = 122) were benign, 9.9% (n = 14) were malignant, and 3.5% (n = 5) were indeterminate. Of benign tumors, WT accounted for the majority at 51.6%, followed by PA at 40.2%. When stratified by decade (2000–2009 and 2010–2018), the proportion of WT compared to all other benign and malignant neoplasms increased from 31.6% to 53.6%, whereas the proportion of PA decreased from 36.8% to 33.3%. The rate of tobacco use was unchanged at approximately 32.0% among our cohort from 2000 to 2018.ConclusionAmong our cohort of veteran patients, WT was the most common benign parotid tumor and has increased in incidence over the last two decades despite an unchanged smoking rate.     

Comparative analysis of benign and malignant parotid gland tumors: A retrospective study of 992 patients

ObjectiveWe analyzed and compared the clinical characteristics of benign and malignant parotid gland tumors.Patients and methodsA total of 992 patients who underwent surgical treatment for parotid gland tumors from January 2010 to December 2020 were included in this study. This study population was subdivided into benign (n = 812, 81.9 %) and malignant parotid gland tumors (n = 180, 18.1 %).ResultsPleomorphic adenoma is the most common benign tumor and mucoepidermoid carcinoma is the most common malignant tumor. The patients with malignant parotid gland tumors were older than the patients with benign lesions. The duration of symptoms was longer in patients with benign parotid gland tumors compared to those with malignant lesions. The size of the malignant tumors was larger than that of the benign lesions. Preoperative fine-needle aspiration cytology had a diagnostic sensitivity of 50.3 %, diagnostic specificity of 98.7 %, a positive predictive value of 89.5 %, a negative predictive value of 89.9 %, and accuracy of 89.9 % for diagnosing malignant parotid gland tumors. For benign parotid gland tumors, superficial parotidectomy was most frequently performed, and for malignant parotid gland tumors, total parotidectomy was most frequently performed. Facial palsy was observed in 19.4 % of the patients with malignant parotid gland tumors compared to 5.4 % of those with benign tumors.ConclusionThe clinical features of benign and malignant parotid gland tumors showed differences in age, symptoms, duration of symptoms, size and site of the parotid tumors, surgical procedures, and postoperative facial nerve palsy.     

腭部肿瘤61例临床分析

目的 探讨腭部肿瘤的临床特征和治疗原则。方法 腭部肿瘤患者61 例行手术治疗,良性肿瘤44 例,其中腺源性良性肿瘤28例;恶性肿瘤17例, 腺源性恶性肿瘤11 例。良性肿瘤进行了局部切除,恶性肿瘤进行了局部扩大切除,部分使用局部或者颈部的组织瓣和脱细胞真皮基质进行修复,术后2例鳞状细胞癌患者进行放疗。结果 良性肿瘤44例未见复发;恶性肿瘤11例中1例混合瘤恶变,术后2年局部复发;1例鳞状细胞癌术后1年出现肺部转移。结论 腭部肿瘤以良性肿瘤为主,恶性肿瘤应根据情况进行放射治疗,并修复软腭的功能。     

Positive predictive values of MRI and ultrasound-guided fine-needle aspiration biopsy for isolated parotid swelling in adults: A STARD comparative analysis

ObjectivesTo evaluate positive predictive values (PPVs) of magnetic resonance imaging (MRI) and ultrasound-guided fine-needle aspiration biopsy (UFNAB) in patients with isolated parotid swelling.Material and methodsObservational study following the STARD guideline, based on a cohort of 212 patients from 18 to 93 years of age, with isolated parotid swelling (malignant: 16.9%; benign: 83.1%), consecutively operated on between 2015 and 2020, after work-up including MRI and UFNAB in an otorhinolaryngology department of a university hospital. The main endpoint was PPV for diagnosis of benign tumor, malignant tumor and the most frequent etiology. Secondary endpoints were correlations between PPVs and clinical factors for malignancy, and the impact on PPV of various situations: dynamic analysis on MRI; diagnostic disagreement between MRI and UFNAB; and UFNAB PPV according to MRI diagnosis.ResultsPPVs for MRI and UFNAB were respectively 45.4% and 88.8% for malignant tumor, 89.6% and 46.9% for benign tumor, and 88.1% and 85.2% for pleomorphic adenoma (the most frequent etiology). Tumor fixation and history of head and neck radiation therapy PPVs were the only one higher than the MRI one for malignant tumor. MRI PPV did not differ between groups with or without dynamic analysis. PPV for malignant tumor, benign tumor and pleomorphic adenoma on MRI and UFNAB was respectively 42.8% and 33.3%, 42.8% and 100%, and 36.3% and 50% in case of diagnostic discordance. When MRI suggested malignant tumor, UFNAB PPV was 51.8% for malignant tumor, 67.7% for benign tumor, and 37.5% for pleomorphic adenoma; when MRI suggested benign tumor, it was 32.2% for malignant tumor, 91.5% for benign tumor, and 88.5% for pleomorphic adenoma; and, when MRI suggested pleomorphic adenoma, it was 23.5% for malignant tumor, 93.9% for benign tumor, and 92% for pleomorphic adenoma.ConclusionSystematic association of UFNAB to MRI did not fundamentally improve diagnostic accuracy. UFNAB appeared most valuable in case of history of radiation therapy, in case of tumor fixation, and when MRI diagnosis was uncertain and/or suggested malignant tumor and/or the apparent diffusion coefficient (ADC) was low. The contribution of UFNAB when MRI suggested benign tumor or especially pleomorphic adenoma was more limited.     

A rare case of canalicular adenoma in the parotid gland: Highlighting diagnostic limitations of fine-needle aspiration

BackgroundCanalicular adenoma is a rare, benign tumor of primarily salivary gland origin that presents mostly in the upper lip. However, there are only six reports in the English literature detailing canalicular adenoma of the parotid gland, none of which discuss discrepancy between preoperative cytology and surgical pathology. In this report, we present a rare case of parotid gland canalicular adenoma where preoperative ultrasound-guided fine-needle aspiration (USFNA) suggested malignancy. The patient was treated with deep lobe parotidectomy due to the FNA results and her multiple comorbidities. However, her tumor may have been treated with observation alone if canalicular adenoma had been suspected prior to surgery.Main findingsA 59-year-old female with a history of heart and lung disease presented with a 1.6 cm well defined, enhancing lesion involving the superficial portion of the right parotid gland. This lesion was incidentally noted on CT angiography (CTA) of the neck and chest. The well-defined characteristics of this lesion on CT imaging suggested benign neoplasm. However, USFNA results were suggestive of a malignant parotid lesion. The patient subsequently underwent right deep lobe parotidectomy with facial nerve dissection and superficial musculoaponeurotic system (SMAS) rotational flap reconstruction. Surgical pathology and immunohistochemistry yielded a final diagnosis of benign canalicular adenoma.ConclusionsUSFNA diagnosis of CA is extremely difficult due to its low-grade neoplastic cells mimicking neoplastic cells in other benign and malignant tumors of the head and neck. FNA remains a useful tool for assessing malignancy risk, but the results always have some level of uncertainty and do not provide sufficient detail. Therefore, FNA results should be interpreted in concert with imaging and patients' medical history. Cytopathologists can also report salivary gland FNA results in a more uniform and detailed manner by utilizing the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC).     

腔镜下耳后发际线径路面神经顺行解剖后腮腺良性肿瘤切除术的临床分析

目的 探讨腔镜辅助下耳后发际线径路面神经顺行解剖后腮腺肿瘤切除手术的临床效果。方法 选择2022年7月—2022年9月诊治的3例腮腺肿瘤位于浅叶并且直径小于3cm患者，采用发际线径路，在全腔镜下顺行解剖面神经后，行腮腺肿瘤和部分浅叶切除治疗。结果 3例患者均顺利完成手术，均无术后出血、涎瘘及面瘫，收到良好的美容效果。结论 腔镜下耳后发际线径路面神经顺行解剖后腮腺良性肿物切除术是一种安全可行、有良好美容效果的手术方式。     

The role of fine needle aspiration biopsy in deep lobe parotid tumors: Comparison of preoperative cytology and postoperative histopathologic results

PurposeMajor salivary gland tumors constitute almost 3% of head and neck tumors. Tumors located exclusively in the deep lobe are not common and 20% of parotid gland tumors originate from deep lobe under the branches of the facial nerve. Accuracy of fine needle aspiration biopsy (FNAB) procedure in salivary gland tumors have been studied extensively, however there isn't any data regarding usefulness of FNAB in tumors located exclusively in deep lobe of parotid gland. In this study we aimed to assess the use of FNAB in deep lobe parotid tumors.Materials and methodsWe retrospectively analyzed 51 patients with deep lobe parotid tumors who underwent surgery in our clinic between January 2013–December 2018. Characteristics of patients were recorded. Preoperative FNAB results and postoperative final histopathologic diagnosis were compared. Statistical analysis was performed using SPSS 24.0 was used for statistical analysis.ResultsThe number of patients that met the inclusion criteria was 51. The mean age of patients were 49.2(14–86). In 40 (78.4) of the patients, tumor was reported as benign and in 11 (21.6) patients FNAB diagnosis was suspicious for malignancy, malignant or non-diagnostic. In final histopathologic diagnosis, 42 of the tumors were benign and 9 were malignant. The most common benign tumor type was pleomorphic adenoma which constitutes 27 of the cases (52.9%). Regarding detection of malignant disease, the sensitivity of FNAB was 90.4%, specificity was 77.7%, positive predictive value was 95%, negative predictive value was 63.6%. There was a substantial agreement between FNAB and final histopathologic diagnosis(kappa = 0,628).ConclusionsFNAB is a safe and reliable tool to evaluate deep lobe parotid tumors. It is an important part of preoperative surgical planning and can help the surgeon in patient counseling. FNAB with ultrasound guidance is recommended for deep lobe tumors.     

咽旁间隙恶性副神经节细胞瘤的临床分析

目的 总结咽旁间隙恶性副神经节细胞瘤的临床特点，探讨其诊断及治疗方法。方法 回顾性分析解放军总医院耳鼻咽喉头颈外科自2010年1月—2021年12月收治并经病理确诊的咽旁间隙恶性副神经节细胞瘤8例的临床资料，其中男3例，女5例，年龄21~57岁。患者的临床症状无特异性，所有患者术前均行增强CT/MRI及数字减影血管造影(DSA)等影像学检查，其特点是咽旁间隙富血供病变，与颈部大血管关系密切。结果 所有患者均经颈外入路或颅颈联合入路肿瘤切除术及区域性淋巴结清扫术，其中5例患者行1次手术，2例患者行2次手术，1例患者行3次手术。所有患者均无脑血管损伤并发症。7例患者发生局部淋巴结转移，1例患者发生远处转移。1例患者术后行放射治疗，1例行术后化疗。所有患者均无死亡。结论 咽旁间隙恶性副神经节细胞瘤发病少，其治疗是以手术为主，同时需结合肿瘤特点及患者具体情况制定综合治疗方案。     

Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy

IntroductionFine needle aspiration biopsy is a valuable tool in preoperative evaluation of head and neck tumors. However, its accuracy in management of salivary gland tumors is debatable.ObjectiveWe aimed to investigate the efficacy and the accuracy of fine needle aspiration biopsy in parotid gland tumors.MethodsPatients who underwent parotidectomy between January 2008 and June 2017 due to parotid gland tumor were examined retrospectively. Patients with both preoperative fine needle aspiration biopsy and postoperative surgical pathologies were included. Preoperative fine needle aspiration biopsy was categorized as benign, malignant or suspicious for malignancy. Surgical pathology was grouped as benign or malignant. Surgical pathology was compared with fine needle aspiration biopsy, and sensitivity, specificity, accuracy and agreement between both tests were investigated.Results217 cases were evaluated and 23 cases were excluded because the fine needle aspiration biopsy diagnosis was non-diagnostic or unavailable. 194 cases were included. The mean age of the patients was 47.5 ± 15.88 (7–82). There were 157 benign, 37 malignant cases in fine needle aspiration biopsy, 165 benign and 29 malignant cases in surgical pathology. The most common benign tumor was pleomorphic adenoma (43.3%), and malignant tumor was mucoepidermoid carcinoma (4.13%). The diagnostic accuracy for fine needle aspiration biopsy when detecting malignancy was 86.52%. Sensitivity and specificity were 68.96% and 89.63% respectively. Positive predictive value was 54.05% and negative predictive value was 94.23%. There was moderate agreement between fine needle aspiration biopsy and surgical pathology (κ = 0.52). The sensitivity was 54.54% in tumors less than 2 cm while 77.77% in larger tumors. In tumors extending to the deep lobe, sensitivity was 80%.ConclusionFine needle aspiration biopsy is an important diagnostic tool for evaluating parotid gland tumors. It is more accurate in detecting benign tumors. In tumors greater than 2 cm and extending to the deep lobe, the sensitivity of fine needle aspiration biopsy is high. The use of fine needle aspiration biopsy in conjunction with clinical and radiological evaluation may help to reduce false positive and false negative results.     

Leczenie nowotworów złośliwych przewodu słuchowego zewnętrznego i kości skroniowej w materiale Kliniki Otolaryngologii i Onkologii Laryngologicznej CM UMK w Bydgoszczy

Introduction, material and methods, aim of the studyEvaluation of the methods and results of treatment of 19 cases of malignant tumors of the external auditory meatus and/or temporal bone was performed.ResultsIn 10 cases planoepithelial carcinoma was diagnosed; in 7 cases basocellulare carcinoma; in 1 case rhabdomyosarcoma; and in 1 case malignant peripheral nerve sheath tumor were histopathologically established. In stage T1 were 8 cases, in T2 – 7, in T3 – 1 and in T4 3 patients were stated based upon clinical and radiological (HRCT and MRI) examination. Three patients in T4 stage were qualified to palliative therapy. In 2 cases radical mastoidectomy was performed, 8 patients underwent partial temporal bone resection. In 6 cases removal of cartilaginous and osseous external auditory meatus was done. In 9 cases local recurrence of tumor was observed during 2 years after surgery. The last 7 cases are under oncological observation.ConclusionsIn conclusion we stressed that patients with malignant tumors of this region are treated in late stages of the disease; it is a main cause of poor diagnosis.     

头皮冠状切口在耳鼻喉科前颅底手术中的应用

对鼻腔、鼻窦肿瘤侵及颅底的7例（恶性4例，良性3例）采用头皮冠状切口施行前颅底手术，除1例巨大骨化纤维瘤未予完全切除外，余6例均完全切除病灶。4例恶性肿瘤中2例硬脑膜因肿瘤侵犯予以切除，3例良性肿瘤因硬脑膜变薄致术中撕裂，缺损的硬脑膜及颅底骨板均用帽状腱膜下层一颅骨膜瓣、颞肌筋膜瓣修补，大的颅底缺损用额肌肌皮瓣加固。良性肿瘤3例中，未完全切除的1例随访1年半病情稳定，另2例随访8年和6年无复发。4例恶性肿瘤中，3例分别随访6年、4年、17月无复发，1例术后18个月颅内复发死亡。所有病例未发生术后并发症。文中对该术式的优缺点以及颅底、硬脑膜的切除和修复问题进行了讨论。     

Masson tumor as a neck mass

IntroductionA Masson's tumor is a benign, intravascular tumor, typically located in the fingers. Histologically, a Masson's tumor is characterized by an intravascular endothelial papillary projection associated with thrombi, without atypia or necrosis. The CD 31 and CD 34 stains are the most efficient immunohistological markers to identify the vascular origin.Case summaryA 54-year-old man presented with a right lateral neck mass for 3 weeks. The CT scan of the neck showed an oval, well-circumscribed cystic mass, measuring 20 mm × 9 mm, situated over the right sternocleidomastoid muscle, with a peripheral vessel draining into the right anterior jugular vein. The mass was excised surgically, and a pathological report indicated a thrombosed material inside the lumen of a small vein with a differentiated papillary structure; neither nuclear atypia nor necrosis were seen. The patient had an uncomplicated recovery and completed 8 months of follow-up appointments without any evidence of recurrence.DiscussionIntravascular papillary endothelial hyperplasia (IPEH) can be differentiated from angiosarcoma by lack of extension to the perivascular tissue and absence of necrosis and atypia. The pathogenesis is still unknown; surgical excision is the method of treatment. This is an extremely rare presentation of Masson's tumor.     

咽旁间隙恶性肿瘤的诊断与治疗

目的 探讨咽旁间隙恶性肿瘤的临床特征、诊断和治疗方法。方法 回顾性分析5例咽旁间隙恶性肿瘤患者的临床资料,均行颈部B超及CT扫描,3例行增强MRI检查;均行颈侧入路切除肿瘤,其中2例同期行同侧功能性颈淋巴结清扫术,3例术后行放射治疗;术中快速病理、术后常规病理及免疫组织化学检查,明确诊断。结果 5例中恶性神经纤维瘤1例,恶性神经鞘膜瘤1例,腮裂癌1例,未分化癌1例,滑膜肉瘤1例;术前B超、CT、增强MRI检查可以明确肿瘤的位置、大小、形态、边界及与周边结构的关系,有助于手术入路及手术方式的选择;5例术后随访,3例随访1年内无复发,1例随访3年后死亡,1例半年后失访。结论 咽旁间隙恶性肿瘤组织类型复杂多样,预后差,颈部B超、CT扫描、增强MRI检查对肿瘤的诊断有帮助,选择合适入路肿瘤切除术是首选的治疗方法,综合治疗对患者的预后很关键。     

Clinicopathologic analysis of 2736 salivary gland cases over a 11-year period in Southwest China

Objective: To investigate the epidemiological and clinicopathological characteristics of salivary gland tumors in southwest China in order to provide data for clinical diagnosis and other similar research.

Methods: Between March 2007 and December 2017, 2736 patients with salivary gland tumors were recruited, the clinical and pathological data were retrospectively analyzed.

Results: A total of 2736 patients had a ratio of males to females of about 1.02:1. The ratio of benign to malignant tumors was 3.46:1. Pleomorphic adenoma and adenoid cystic carcinoma had 50.8% and 7.2%, respectively. About 65.4% tumors occurred in the parotid gland. There was no significant difference between the tumor in the left or right parotid and the use of cell phones. There were significant differences between gender and both the characteristics and locations of salivary gland tumors (p?p?Conclusions: The salivary gland benign and malignant tumors were more common in pleomorphic adenoma and adenoid cystic carcinoma, most occurred in the parotid gland. The minor gland tumors are lower than other parts of China. The incidence of parotid gland tumors is not related to the use of cell phones.     

Aggressive fibromatosis of the head and neck in the pediatric population

Background

Aggressive fibromatosis, previously referred to as desmoid tumor, is a rare tumor. It is classified as benign, however, has a high potential for local invasion and recurrence. It is most commonly found in the abdomen, with an origin in the head and neck accounting for less than a quarter of the total cases.

Methods

Literature review using PubMed and OVID and a combination of the words, “desmoid”, “fibromatosis”, “pediatric”, “children”, and “head and neck”.

Results

Annual occurrence is 0.2 – 0.4 per 100,000, with origins in the head and neck accounting for 10–25%. Since 1954, 97 cases of pediatric head and neck fibromatosis were reported. The age range was from birth to 16 years, with the average being 4 years and 5 months old. The overwhelming majority of tumors were of the mandible (38%). 74% patients underwent a large resection as the primary treatment modality. The most common treatment complication was tumor recurrence (16%).

Conclusions

Fibromatosis is a rare tumor of muscoloaponeurotic origin. Surgery is the mainstay of treatment; however recurrence rates are high, even despite negative surgical margins.     

Parálisis unilateral de cuerda vocal de causa extralaríngea: etiología y pronóstico

Introduction and methodologyUnilateral vocal cord paralysis without laryngeal lesions is a relatively frequent entity. It can be the manifestation of numerous diseases from the thorax, neck, skull or systemic. The objective is to study the extralaryngeal etiology of unilateral vocal cord paralysis, its prognosis and the relationship of both with different clinical variables. Retrospective study of 116 patients with complete unilateral vocal cord paralysis without laryngeal lesions. The patients underwent cervical-thoracic CT +/– evaluation by Neurology with brain MRI to establish the etiology and follow-up for at least 1 year.ResultsThe most common extralaryngeal cause of vocal cord paralysis was cervical surgery (46.5%), followed by tumor (24.1%). Idiopathic paralysis were 15.5%. An association was obtained between sex and etiology (p <0.01), men in relation to malignant pathology and women to iatrogenic disease. Cardiovascular, cerebrovascular, tumor and idiopathic etiology predominate in elderly patients; while in younger patients the surgical one (p <0.01). 18.1% recovered vocal cord mobility. The female sex was related to its recovery (p <0.01). Tobacco and malignant etiology were related to its persistence (p <0.01).ConclusionsThe first extralaryngeal cause of unilateral CV paralysis is surgical followed by lung and thyroid neoplasms. There is a great diversity of lesions that can cause it, in many cases it involves the diagnosis of malignant tumors. Its recovery is more frequent in female patients, non-smokers and with benign pathology.