Organ preservation surgery for laryngeal cancer

The principles of management of the laryngeal cancer have evolved over the recent past with emphasis on organ preservation. These developments have paralleled technological advancements as well as refinement in the surgical technique. The surgeons are able to maintain physiological functions of larynx namely speech, respiration and swallowing without compromising the loco-regional control of cancer in comparison to the more radical treatment modalities. A large number of organ preservation surgeries are available to the surgeon; however, careful assessment of the stage of the cancer and selection of the patient is paramount to a successful outcome. A comprehensive review of various organ preservation techniques in vogue for the management of laryngeal cancer is presented

Temporal bone verrucous carcinoma: outcomes and treatment controversy

Verrucous carcinoma is a rare tumor that presents in the head and neck with the most common sites being the oral cavity and larynx. Fourteen cases of verrucous carcinoma of the temporal bone have been described in literature; this study aims to examine treatment outcomes and discuss the controversy surrounding postoperative radiation. The study design included a literature review along with individual case report in the setting of a tertiary care medical center. Outcome analysis of all cases of verrucous carcinoma of the temporal bone, which are documented in the English literature, and presentation of a single patient report including gross, histologic and radiologic analyses were performed. The longest recorded survival for verrucous carcinoma of the temporal bone occurs in patients treated with surgery alone. Poorer outcomes for patients treated with adjuvant (chemo)radiation may be due to more advanced stage of disease at the time of treatment. Early reports of radiation leading to tumor dedifferentiation or early recurrence are not supported by more recent studies. Whether adjuvant radiation therapy is indicated in verrucous carcinoma of the temporal bone remains controversial

ICAR: endoscopic skull‐base surgery

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Otolaryngological treatments in hagiographical Byzantine texts (324-1453 AD): miracles or reality?

Hagiographical texts of the Byzantine period contain a significant number of miraculous treatments of several diseases of the ear, nose and throat. The comparison of the conservative treatments referred to as well as the often concealed surgical interventions of these texts with those known from the medical texts of the eminent Byzantine physicians, lead the writers to conclude that a series of real treatments were carried out in the churches or in the Xenones (hospitals) of Byzantium

Modified supracricoid partial laryngectomy with cricohyoidopexy: Series report and analysis of results

Aiming to improve voice quality and to facilitate swallowing rehabilitation, we modified the supra-cricoid partial laryngectomy with cricohyoidopexy by preserving the posterior segment of the true vocal cord on the less involved side of the larynx. Between 1983 and 1994, 13 patients with supraglottic cancer were treated with this modified procedure. The possibility of incomplete tumor excision was eliminated by careful patient selection and intraoperative reconfirmation of tumor extent with frozen sections. Our results have been promising, with a 76.9% 3-year survival rate and a 69.2% laryngeal preservation rate. There were 7 recurrences, 3 local (2 at the superior border of the cricoid and 1 at the cricoarytenoid region) and 4 nodal, in 5 patients. Distant metastases developed in another patient. Three patients, 2 with local and nodal recurrence and 1 with distant metastases, died of disease. Functional outcomes were also good, with all patients achieving normal swallowing by the end of the first year, although 5 patients required temporary gastrostomy for transient swallowing impairment, Early decannulation and satisfactory voice quality were achieved in all cases, We believe that with proper patient selection this modified procedure is effective both for tumor control and for preserving a more functional larynx

Protection of the hydroxyphosphinyl function of phosphinic dipeptides by adamantyl. Application to the solid-phase synthesis of phosphinic peptides

To develop solid-phase synthesis of phosphinic peptides, different FmocXaaΦPO(OAd)CH2XaaOH building blocks have been prepared, where Fmoc is (fluorenylmethoxy)carbonyl. In this respect, the protection of the hydroxyphosphinyl function in these phosphinic dipeptides by the adamantyl group turns out to be convenient. The phosphinic adamantyl esters are completely stable in basic conditions and can be removed under relatively mild acidic conditions. Using these building blocks, despite the bulkiness of the adamantyl group, no particular problem of coupling was observed during the solid-phase synthesis of phosphinic peptides by the Fmoc strategy. The developed methodology is of particular interest to facilitate the development of potent inhibitors of zinc-metalloproteases

Aggressive verrucous carcinoma of the paranasal sinuses invading the orbit: Case report and literature review

Introduction: Verrucous carcinoma is a variant of well differentiated squamous cell carcinoma characterised by an exophytic, warty growth which is slowly but locally invasive and which can cause extensive local destruction if left untreated.Case report: We report the first known case of veruccous carcinoma of the paranasal sinuses with rapid orbital invasion. A 58-year-old man presented with right-sided nasal obstruction, a huge right intranasal lesion, intractable dacryocystitis and cutaneous involvement of the nasolacrimal sac region. The tumour was partially removed using an endoscopic transnasal approach. Post-operatively, and while waiting for the histological result, the patient developed signs of rapid invasion of the orbit, with uniocular visual acuity deficit. He underwent combined radiochemotherapy, with a moderate response.Conclusion: Knowledge of the potentially aggressive nature of verrucous carcinoma may be helpful in early management of intraorbital invasion and salvaging of the eye. © 2009 Copyright JLO (1984) Limited

CO2 and KTP-532 laser cordectomy for bilateral vocal fold paralysis

Laryngeal obstruction due to bilateral vocal fold paralysis has been treated in many different ways. The CO2 laser or KTP-532 laser endoscopic cordectomy described in this report is a slight modification of the posterior partial cordectomy proposed by Dennis and Kashima. This technique was used in 18 patients (14 with the CO2 and four with the KTP-532 laser). Prophylactic tracheostomy was performed preoperatively. Post-operative results were excellent in nine cases, good in seven cases and poor in two cases who had to remain with a permanent tracheostomy tube with a speaking valve. The main complications noted were the formation of a granuloma (seven cases) and arytenoid oedema (six cases). Revision surgery was performed in the seven cases with granuloma formation and in the two with persistent oedema. The results and the post-operative findings from the use of the two lasers were similar