Primary Surgical Therapy for Locally Limited Oral Tongue Cancer

Objectives. The aim of this study was to assess the efficacy of primary surgical treatment in the management of locally limited oral tongue carcinoma. Methods. A retrospective evaluation was carried out for all patients treated with primary surgery for pT1-pT2 oral tongue carcinomas at a tertiary referral center between 1980 and 2005. All cases were assessed for disease-specific survival and local control rates in relation to T classification, N classification, infiltration depth of the primary tumor, and decision making on neck management and adjuvant therapy. The cases were additionally evaluated for the incidence of major complications and tracheotomies. Results. 263 cases were assessed. The 5-year disease-specific survival rate was 75.2%. Positive neck disease was shown to be a significant negative prognostic factor. The occult metastasis rate was 20.2%. Conclusions. Primary surgical treatment is a very effective modality against T1-T2 oral tongue carcinoma, and a low rate of complications can be anticipated

Early Stage Oropharyngeal Carcinomas: Comparing Quality of Life for Different Treatment Modalities

Objective. To compare long-term quality of life outcomes after treating early stage oropharyngeal carcinoma either with surgery, surgery combined with radiotherapy, or surgery combined with chemoradiotherapy. Methods. Questionnaire based method: 111 eligible patients agreed to fill out a quality of life questionnaire. Results. Of the 32 scales contained in the EORTC's combined QLQ-C30 and HN35, 11 scales show significantly better results for the surgery-only treatment group when compared to either surgery combined with radiotherapy or surgery combined with any type of adjuvant therapy. These eleven scales are role function (P = 0.019/0.008), social function (P = 0.01/0.034), nausea (P = 0.017/0.025), pain (P = 0.014/0.023), financial problems (P = 0.030/0.012), speech (P = 0.02/0.015), social eating (P = 0.003/<0.001), mouth opening (P = 0.033/0.016), sticky saliva (P = 0.001/<0.001), swallowing (P < 0.001/<0.001), and dry mouth (P < 0.001/0.001). Conclusion. Treatment of early stage oropharyngeal carcinoma with surgery alone has definite advantages over treatments including any form of adjuvant therapy when considering quality of life. Advantages manifest themselves especially in functional aspects of the head and neck realm; however general health aspects as well as psychosocial aspects show improvements as well. This study does not show any indication of QOL-related drawbacks of surgery-only treatment approaches

Treatment of Salivary Gland Diseases: Established Knowledge, Current Challenges and New Insights

In the last two decades, a change in paradigm has taken place in the management of salivary gland diseases [...

Paradigm shift in surgery for benign parotid tumors: 19 years of experience with almost 3000 cases

Objectives The aim of this study was to explore the changes in philosophy in the surgical therapy of benign parotid tumors over a period of 19 years. Methods The records of all patients treated for benign parotid tumors between 2000 and 2018 were evaluated. Data were analyzed with respect to the number of procedures carried out per year of the study according to each of the different surgical modalities and the incidence of postoperative complications. Statistical analysis was performed using the x2 test. A P value of <.05 was considered statistically significant. Results A total of 2988 patients were included in this study. Our analysis showed that the increasing performance of extracapsular dissection was associated with a progressive reduction in the incidence of temporary facial nerve palsy and Frey's syndrome, while the rate of permanent facial nerve palsy remained consistently low. Conclusion One of the most controversial issues in head and neck surgery is which therapeutic approach is best in patients with benign parotid tumors. Our analysis demonstrated that a change of strategy towards reducing invasiveness was possible, with exceptional functional results. Avoidance of facial nerve dissection is feasible in more than two‐thirds of cases with benign tumors. Level of Evidence 4b Laryngoscope, 130: 1941–1946, 202

Unexpected Detection of Parotid Gland Malignancy during Primary Extracapsular Dissection

Objective To evaluate the oncologic and functional outcome in cases in which a false preoperative working hypothesis “benign parotid tumor” led to a primary extracapsular dissection being performed rather than a traditional, more radical surgical modality. Study Design Case series with chart review. Setting Academic tertiary referral center. Subjects and Methods The records of all patients treated for malignant tumors of the parotid gland between 2006 and 2012 were retrospectively studied. Patients were excluded from our study sample for insufficient data or if their histories indicated manifestation of malignant tumors without primary parotid origin (squamous cell carcinomas, lymphomas, melanomas), revision surgery, as well as concomitant or past malignant tumors. Consequently, a total of 29 patients with 30 primary malignant tumors of the parotid gland formed our study sample (14 men, 15 women; male:female ratio, 0.93:1; mean age, 55.4 years; range, 14-85 years). Results Of 30 cases, 22 had low-grade tumors. Further tumor cells were detected in only the histology specimens of the parotid in 3 of the 25 cases treated subsequently with completion parotidectomy. Five patients received adjuvant radiation. Five-year disease-specific survival was 100%; local disease control was 96.6%. Of 30 cases, 28 had House-Brackmann I after tumor treatment; the other 2 cases had a slight paralysis (House-Brackmann II). Conclusion Beginning with the “false” working hypothesis and performing an extracapsular dissection in unsuspected cases seems to have no adverse impact on patients’ survival and postoperative quality of life in cases in which definitive histology reveals malignancy

Cartilaginous bending spring for preventing tympanic membrane graft medialisation in anterior or subtotal tympanic membrane perforations—how I do it

Background!#!The reconstruction of anterior or subtotal tympanic membrane perforations is critical due to the risk of anterior graft medialisation and retraction or recurrent perforation.!##!Method!#!After reconstruction of the tympanic membrane by means of grafting, a rectangular cartilage strut (length 6 mm, breadth 2 mm, thickness 0.1 mm) is prepared using a cartilage knife and scalpel. This strut graft is placed between the cartilage graft and the promontory in the anterior inferior part of the middle ear cavity.!##!Conclusion!#!Our experience shows that using a U-shaped cartilage strut to sustain the tympanic reconstruction effectively prevents the medialisation of the graft and recurrent perforations