Limitations and Opportunities in Open Laryngeal Organ Preservation Surgery: Current Role of OPHLs

The current trend for treatment of intermediate-early advanced laryngeal cancer is essentially oriented toward preservation of organ and laryngeal function, and with a good potential for treating the disease. This goal can be achieved by adopting open laryngeal organ preservation surgery (OLOPS), at present mainly represented by open partial horizontal laryngectomies (OPHLs). An approach using rigorous selection criteria based on both the general condition of the patient and the local and regional extent of the disease gives excellent oncological and functional results in untreated patients. Similar outcomes, albeit slightly worse, are also obtainable in radio-recurrent and laser-recurrent patients. Troublesome postoperative management and the inconsistency of functional recovery are the main limitations for extensive application of this therapeutic strategy. The future direction is represented by simplification of the indications identifying iso-prognostic sub-categories within the T-stage, wider consensus on rehabilitation protocols, hybrid approaches to the larynx, and open minimally invasive access

Non-human immunodeficiency virus-related Kaposi's sarcoma of the oropharynx: a case report and review of the literature.

INTRODUCTION: Kaposi’s sarcoma is a malignant, slowly progressing, mesenchymal neoplasm characterized by a proliferation of connective tissue and capillaries. Clinical presentation is usually as nodules and red-purple plaques. This case report not only represents an uncommon presentation of Kaposi’s sarcoma in a non-immunocompromised patient, but also supports the role of viral infection in the pathogenesis of this disease. It provides some interesting information about this rare disease, particularly in patients who are human immunodeficiency virus negative. CASE PRESENTATION: A 48-year-old Caucasian man presented with a sensation of a foreign body in his throat, accompanied by stomatolalia. Maxillofacial and neck magnetic resonance imaging confirmed the presence of a voluminous solid mass at the base of his tongue with oropharyngeal space reduction. Histological analysis indicated that the lesion was compatible with ulcerated Kaposi’s sarcoma of the oropharynx. Results of serological tests for human immunodeficiency virus infection were negative as was the result of the human herpesvirus-8 test, but the cytomegalovirus test result was positive. CONCLUSIONS: This case is unusual because the patient had only oropharyngeal localization of disease, without evidence of immunosuppression or the typical background or risk factors suggesting the classic or endemic form of Kaposi’s sarcoma. Isolated cases of Kaposi’s sarcoma with oropharyngeal manifestations not associated with human immunodeficiency virus infection are rare, and only 15 cases have been reported to date. At present, its localization, microscopic and histological characteristics, and patterns of progression are the main tools used for differential diagnosis of Kaposi’s sarcoma from other vascular neoplasms

A Rare Nasopharyngeal Presentation of Amyloidosis

Amyloidosis is a heterogeneous group of diseases characterized by the extracellular deposition of insoluble proteins whose pathogenesis is not yet fully understood. The deposition of amyloid proteins can be systemic or localized, idiopathic or related to systemic diseases, mostly multiple myeloma or chronic inflammatory diseases. Localized head and neck amyloidosis is a rare entity, mainly involving the larynx. Given the rarity of the disease and the absence of a lasting follow-up protocol, there is no standard treatment defined for localized amyloidosis. We report a rare case of localized nasopharyngeal amyloidosis, treated with complete transoral resection and confirmed by histological examination

Pharyngo-jugular fistula after "salvage" total laryngectomy: A case report

INTRODUCTION: We present a rare case of pharyngo-jugular fistula in a patient who underwent salvage total laryngectomy after organ-sparing radiochemotherapy. CASE PRESENTATION: A 77-year-old Caucasian man underwent total laryngectomy and bilateral neck dissection as salvage surgery after the failure of radiochemotherapy at another hospital. Thirty-five days after surgery, he was admitted to our emergency room for fever and massive oral bleeding during meals. Videopanendoscopy showed the presence of a large clot at the base of his tongue, while a neck computed tomography scan showed a pharyngo-jugular fistula with the presence of air in the left internal jugular vein. Cervicotomy was performed: the internal jugular vein was ligated and sectioned, and the pharyngeal defect was repaired with a pectoralis major myocutaneous flap. The postoperative period was uneventful. Twenty-five days post surgery, videofluorography showed the fistula had disappeared. Our patient then began oral feeding without complications and was discharged. At present, 5 years after the operation, our patient is alive and shows no evidence of disease. CONCLUSIONS: Pharyngo-jugular fistula is an uncommon complication after total laryngectomy, especially in the chemoradiation era, which is potentially fatal if not promptly treated