New predictors of complications in carotid body tumor resection

Objective

This study examined the relationship between two new variables, tumor distance to base of skull (DTBOS) and tumor volume, with complications of carotid body tumor (CBT) resection, including bleeding and cranial nerve injury.

Macroglossia caused by adenoid cystic carcinoma. Case report

A 33-year-old woman sought medical care at our institution for macroglossia. She had been treated before with tracheostomy and gastrostomy due to an adenoid cystic carcinoma (ACC) of the mobile tongue, in clinical stage IVC. She was subjected to total glossectomy with larynx preservation, modified radical dissection of the right neck and of the left supraomohyoid muscle, as well as reconstruction using a free flap from the rectus abdominus. The histological report described a 15x11 cm solid type ACC of the mobile tongue (grade III), with infiltration to adjacent soft tissues, vascular and lymphatic vessels, as well as two metastatic lymph nodes in the right neck dissection. One month after surgery, bone and bilateral pulmonary tumor activity became evident. In advanced-stage tumors, treatment must be individualized, and when accompanied by severe deterioration of the quality of life, surgery is recommended independently from the extension, provided that a good reconstruction is accomplished.     

Upper lip malignant neoplasms. A study of 59 cases

Objectives: To present the demographic data, clinico-pathologic features and therapeutic outcome of a series of upper lip malignancies. Study Design: Retrospective study at a single Cancer Institution in Mexico City during a 14-year period. Results: There were 59 cases, (30 males and 29 females); age range: 14 to 106 years (mean: 73 yr.). Antecedents of ultraviolet light and tobacco exposure were found in 20 (33.9%) and 16 cases (27%) respectively. There were 35 squamous cell carcinomas (59.3%), 19 basal cell carcinomas (32.2%) and one case each (1.7%) of adenocarcinoma NOS, adenoid cystic carcinoma, angiosarcoma, Merkel cell carcinoma and melanoma. There were 14 cases in stage I (23.7%), 14 in stage II (23.7%), 3 in stage III (5.1%) 14 in stage IV (23.7%) and 14 were not classified (23.7%). There were no significant differences with respect to the overall survival curve and the disease-free survival curve among surgical treatment and radiotherapy. In addition, there was not statistically significant difference in the overall survival and disease-free survival among squamous cell carcinoma and basal cell carcinoma cases with respect to the type of treatment. Conclusions: Upper lip malignant neoplasms are infrequent lesions. The present series describes the main clinico-pathological features in a hospital-based population in Mexico city and demonstrates some differences with respect to those found in the lower lip. Key words:Upper lip, neoplasms, basal cell carcinoma, squamous cell carcinoma, melanoma.     

Synovial sarcomas of the head and neck: Comparative analysis with synovial sarcoma of the extremities

Objective

This study analyzed synovial sarcoma (SS) of the head and neck in order to identify features associated with survival improvement and compared them with the survival of SS of limbs.

Methods

Clinical charts and histopathologic material with analysis for SYT/SSX gene rearrangement of 16 patients were reviewed. The clinicopathologic features and their association with survival were analyzed and compared with 174 SS of limbs.

Results

The average age was 24.2 years (range 21–86). Eight cases occurred in each sex. The most frequent site was the parapharyngeal space (PPS). The mean tumor size was 5.38 cm. Sixty-nine percent occurred in Stages II–III and 9% in Stage IV. Fifteen cases were excised: R0 resection in seven (46.7%) cases and R1 resection in eight (53.3%) cases. No patient with R0 resection has recurred, and three patients (37.5%) with R1 resection have recurred (p = 0.035). Patients with R0 surgery had better survival rates compared to those who received other treatments (p = 0.045). SS of head and neck showed a 5-year survival rate of 58% compared to 44.6% of the limbs (p = 0.450).

Conclusion

The most prevalent location was the PPS. Surgical resection with clear margins correlated with low recurrence. Head and neck sarcomas had similar survival rates compared to sarcomas of limbs.     

Functional evaluation after reconstruction of the anterior floor of the mouth with free flaps in patients with head and neck cancer

The aim of this study was to evaluate functional results in two type of free flaps applied in a series of patients with cancer of the the anterior floor of the mouth. From 1992 to 1997, 15 patients with a diagnosis of squamous cell carcinoma of the anterior floor of the mouth were submitted to surgical excision and primary reconstruction with free fascio-cutaneous or osteo-myocutaneous flaps. Functional assessment of each patient included application of the Performance Status Scale for Head and Neck Cancer (PSS-HNC), Karnofsky scale, articulation test and flouroscopy. Ten patients received a free radial forearm flap and one of them required an additional non-vascularized free iliac crest graft. Five patients received a free iliac crest flap. Dental implants were inserted in eight cases. A functional evaluation was performed on nine patients: PSS-HNC median score for diet was 80 (range: 50–100), for speech was 75 (range: 50–100) and for «eating in public» category, it was 75 (range: 75–100); Karnofsky scale median score was 90. All patients showed good communication skills by evaluation. Eight patients had articulation errors of the type tip-tonge consonants /t,d,n,s,z,l/ and/or posterior-tongue consonants /k,g,r/; physical and social activities were normal for all patients. Flouroscopy showed anatomical and physiological alterations following large resections of soft tissue. The type of reconstruction selected for each patient must be individualised. The quality of functional rehabilitation achieved in the floor of the mouth is inversely proportional to the degree of the soft tissue resection, mostly that of the tongue.