Preliminary report--near total laryngectomy for SCC larynx

A retrospective analysis was performed on patients subjected to near-total laryngectomy at Aga Khan University Hospital Karachi from September 2006 and May 2010, to evaluate the functional outcome of Near Total Laryngectomy and its effect on disease control. In all of these advanced stage laryngeal-hypopharyngeal squamous cancer patients, the disease was limited to one side of the larynx-hypopharynx. Four patients were staged as T3 and rest were T4; near total laryngectomy was done in all 07 patients. Post operative adjuvant radiotherapy was given to 06 patients. All of these patients are on regular oral diet and maintaining their body weight. Six patients are using their preserved hemi larynx effectively. Mean follow up of these patients was 15 months. Three patients developed regional recurrence whereas the remaining four patients were well till their last follow-up. Near total laryngectomy is a safe surgical option even for advanced laryngeal-hypopharyngeal cancer without compromising oncological clearance. It gives patients their own physiological voice that does not require maintenance but at the expense of permanent tracheostomy

Olfactory neuroblastoma: a case report and review of the literature

Malignant tumors of the nasal cavity are rare. We report the case of an elderly woman who consulted us with a 4-year history of progressive nasal obstruction, occasional epistaxis, facial pain, and watering of the eyes. A diagnosis of olfactory neuroblastoma was established by histopathology and confirmed by immunohistochemistry. On staging, the mass was classified as a Kadish stage B tumor. The mass was excised via a lateral rhinotomy approach, and the tumor was peeled away completely from the cribriform plate with endoscopes. The patient underwent postoperative radiation, and she was free of recurrence at follow-up 15 months later

Incorporating endoscope in middle ear surgery

We conducted a study to evaluate the use of a pediatric rigid otoendoscope for determining the extent of middle ear disease and for assessing ossicular integrity and mobility during tympanoplasty. Our study population was made up of 132 patients who were undergoing surgery for the treatment of chronic suppurative otitis media; of this group, 41 patients underwent otoendoscopy and 91 underwent scutum lowering for purposes of visualization. In the otoendoscopy group, the ossicles were successfully visualized and their mobility assessed in 34 patients; the remaining 7 patients subsequently underwent scutum lowering. A 30° endoscope allowed for complete visualization of the middle ear in almost all of the 34 cases. The mean duration of surgery for the 34 patients in the otoendoscopy group was 62.85 minutes (±15.57), which was significantly shorter than the duration of surgery (71.23 ± 15.65 min) for the 98 patients who underwent scutum lowering (p \u3c 0.005). A total of 50 patients required less than 60 minutes of surgical time-26 of 34 (76.5%) in the endoscopy group and 24 of 98 (24.5%) in the scutum-lowering group. Statistical analysis revealed that the possibility of completing a procedure in less than 60 minutes was 73.65% (±12.56%) when endoscopy was used and 58.62% (±12.60%) when scutum lowering was used-again, a statistically significant difference (p \u3c 0.005). We conclude that incorporation of an angled otoendoscope into middle ear surgery is a worthwhile alternative to scutum lowering

Adenoid cystic carcinoma of the external auditory canal

This is a rare case of a young male with biopsy proven adenoid cystic carcinoma of the external auditory canal who underwent excision of the lesion with superficial parotidectomy sparing the facial nerve. Histopathology showed perineural invasion, which is a diagnostic hallmark of adenoid cystic carcinoma. Clinical examination, chest X-ray and CT scan showed no signs of recurrence or metastasis 2 years postoperatively

Neuronavigation assisted endoscopic sinus surgery

In the past two decades, endoscopic sinus surgeries (ESS) have been widely advocated as a safe and effective treatment for disorders of paranasal sinuses that are refractory to medical therapy. ESS caters surgeons with two-dimensional visualization of the anatomical structures; however in scenarios where there is a close anatomical relation between the disease and delicate intracranial or intraorbital structures drastic complications can occur. Hence, endoscopic procedures had to be converted into open surgical procedures if the extent of the disease could not be visualized or cleared thoroughly. Recently however; neuronavigation systems have been combined with ESS to yield better results and facilitate this procedure. The implementation of these systems with ESS has aided surgeons in difficult approaches. We recently decided to use the neuronavigation system of our Neurosurgical department to help aid eradicate various nasal and sinus pathologies in a series of patients

Comparison of outcomes of enteral feeding via nasogastric versus gastrostomy tubes in post operative patients with a principle diagnosis of squamous cell carcinoma of the oral cavity

OBJECTIVES: Squamous cell carcinoma of the oral cavity has a profound impact on a patient\u27s nutritional intake, 40-50% of head and neck cancer patients have a markedly impaired nutritional status at the time of their initial presentation. Studies show that patients who have better nutritional status have fewer complications and a better survival rate. Therefore, enteral nutritional support plays an important part in their management. Due to the lack of relevant data, surgeons help patients make informed decisions regarding their mode of nutritional support and perform gastrostomy or place nasogastric tube depending on the patient\u27s preference. This study addresses the need for scientific data regarding the impact and psychosocial acceptance of both these modalities in our population. METHODS: A retrospective review of patient\u27s charts with a principle diagnosis of squamous cell carcinoma of the oral cavity, receiving surgery +/- adjuvant radiotherapy was carried out. Patients were also questioned regarding their experience with the mode of nutrition and its impact on their life during their regular follow up consultations. Post therapy change in weight, psychosocial acceptance and quality of life were considered as measures of outcome. RESULTS: A mean weight loss of 5.43 +/- 3.4 kg (p = 0.025) was noticed in 15 patients on nasogastric feeding. On the other hand, significantly less weight loss of 1.25 +/- 5.12 kg (p = 0.025) was noticed in the patients receiving nutrition via gastrostomy tubes; nine patients had a mean weight gain of 2.89 +/- 1.95 kg and the rest had similar weight loss of 5.427 +/- 3.4 kg. CONCLUSION: The authors of the study recommend that gastrostomies should be considered for patients requiring long term post operative enteral nutritional support in patients of head and neck cancers

Association between tumour volume and recurrence of squamous cell carcinoma of the head and neck

Objective: To evaluate the prognostic significance of computerized tomography derived tumour volume for squamous cell cancers of the head and neck, treated primarily by surgery.Methods: The retrospective review study comprised 72 patients with head and neck malignancies who were treated primarily by surgery at Aga Khan University Hospital, Karachi, with/without adjuvant. It was done from May 2007 to November 2008. Each patient was followed up for a minimum of one year to check for recurrence. For statistical analysis SPSS 17 was used. Frequencies, cross-tabulations with chi square tests to find associations, binary logistic regression analysis, Cox regression analysis and receiver operating characteristic curve tests were run on the data.Results: Overall, the median tumour volume for patients with recurrent disease was 52cm3 compared to 22cm3 for those who did not have a recurrence. It was found that large tumour volume was associated with a significantly higher chance of recurrence (p = 0.009). Laryngeal cancers with volumes greater than 46cm3 and oral cancers with volumes greater than 23.1cm3 were associated with poor prognosis.CONCLUSIONS: The primary tumour volume can represent an important prognostic factor for treatment outcome. Patients with larger primary tumour volumes should be treated more aggressively

Two cases of primary laryngeal amyloidosis

The larynx is a rare site of involvement of amyloidosis. We report two cases of laryngeal amyloidosis. Both patients were middle aged females with history of persistent hoarseness. Fibreoptic laryngoscopy used for diagnosis in both and debulking of the tumour was performed. Histopathological examination confirmed the diagnosis of amyloidosis. Appropriate follow up is an important part of the long-term management of the disease

Mucoepidermoid carcinoma of the base of tongue

Mucoepidermoid carcinomas are thought to arise from the reserve cells of salivary gland ducts. Minor salivary glands are located all around the oral cavity and base of the tongue; however few cases of MEC of the base of the tongue have been reported in literature and no guidelines are available for its management. Here we would like to present the case of a 71 year old male with mucoepidermoid carcinoma of the base of the tongue successfully treated with surgical excision and neck dissection. Regular clinical follow up showed no signs of recurrence at 9 months post excision

Comparison of different treatment modalities in advanced laryngeal hypopharyngeal squamous cell carcinoma

OBJECTIVE: To compare outcome of patients with advanced laryngeal hypopharyngeal squamous cell carcinoma treated surgically or with chemotherapy and/or radiotherapy. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 2000 to December 2005. METHODOLOGY: Medical records of already treated stage-III and IV squamous cell carcinoma of larynx/hypopharynx patients were reviewed. Group-A comprised of patients treated with surgery +/- adjuvant therapy whereas non-surgically managed patients were labeled as group-B. One hundred and nineteen out of 275 met the inclusion criteria. Kaplan Meier technique was used to estimate mean recurrence time with standard errors. Cox proportional hazard regression was used to estimate the hazard ratio with 95 percent confidence interval for gender, age and tumour location. RESULTS: Sixty two percent of group-A and 49% patients of group-B were stage-III. In group-A, 40% patients received postoperative adjuvant therapy while in group-B, 45% received concomitant chemoradiation. Mean follow-up duration was 18.3 months. Mean recurrence time was 1369+193 days. In group-A, mean recurrence time was 2097+277 days. It was 399+/-68 days for group-B patients (p \u3c 0.001). The hazard ratio of recurrence in hypopharyngeal tumours was 1.5 times (95% CI 0.68, 3.30) as compared to tumours of larynx. The hazard ratio of recurrence was 1.98 times (95% CI 0.99, 3.95) when both larynx and hypopharynx were involved as compared to when tumour was localized to larynx only. No residual disease was noted at the completion of treatment in surgical group-A while 62% patients of the group-B had residual disease at the completion of treatment. Larynx was retained in only 25% patients in group-B. CONCLUSION: Statistically significant difference was noted in disease free outcome when stage-III and IV larynx hypopharynx cancer was managed surgically as compared to non-surgical management. Chances of retaining larynx are only 25% when managed non-surgically