Hypoglossal schwannoma masquerading as a carotid body tumor.

Study Objective. To describe the clinical presentation, evaluation, and treatment of a hypoglossal schwannoma. Methods. We report an unusual case of a hypoglossal schwannoma presenting as a pulsatile level II neck mass at the bifurcation of the external and internal carotid arteries, mimicking a carotid body tumor. Radiologic findings are reviewed in detail. Results. A 59-year-old female presented to a tertiary care medical center with complaints of a pulsatile right-sided neck mass. An MRA of the neck was obtained demonstrating a 5 cm mass located at the carotid artery bifurcation and causing splaying of the internal and external carotids. Based on clinical presentation and imaging, a diagnosis of a carotid body tumor was conferred and the patient scheduled for excision. Intraoperatively, the mass was noted to arise from the hypoglossal nerve, remaining independent of the carotid artery. On histopathologic analysis, the mass was determined to be consistent with hypoglossal schwannoma. Conclusion. Though rare, the hypoglossal schwannoma should remain a consideration in the evaluation of a parapharyngeal space mass. As this report demonstrates, the clinical and radiologic presentation of a hypoglossal schwannoma may closely mimic that of the more common carotid body tumor

Vocal Fold Cancer Transoral Laser Microsurgery Following European Laryngological Society Laser Cordectomy Classification

BackgroundThe surgical treatment of glottic, or vocal cord, cancer has seen considerable progression over the past several decades. Specifically, there has been a stark transition from open partial laryngectomy surgery to endoscopic laser microsurgical techniques which have been inspired in large part by two landmark studies: Professor Wolfgang Steiner’s original case series describing transoral laser microsurgery for glottic cancer (1993) and the European Laryngological Society’s (ELS) classification scheme (2000). We performed a comprehensive review of published literature to characterize the pattern of this novel modality as compared with two landmark studies over the past four decades.MethodsAn English literature search was conducted on PubMed for available original investigations on surgical treatment of glottic laryngeal cancer published over the past 40 years. Our Boolean criteria included the following terms: cancer, glottic, laryngeal, surgery, endoscopic, and laser. The publication rates were calculated as annual compound growth as well as corrected growth rates as defined by the Fisher equation for inflation effects.ResultsOur review identified 13,372 studies covering larynx cancer and 3,557 studies covering glottic cancer original studies. Among these, we analyzed the compound annual growth rates and correct growth rates for three distinct publication periods or epochs, prior to 1993, 1993–1999, and 2000–2017. For all but two of the search term groups covering both glottic cancer as well as larynx cancer, there was a substantial growth improvement in the time period following the ELS classification scheme as compared with the growth rate of the time period following Steiner’s case series.ConclusionThe progress toward minimally invasive treatment of glottic cancer has progressed steadily over the past several decades. Analysis of publication show increased growth during the time period following the ELS classification scheme over the time period following Steiner’s landmark study. A mistake would be concluding any diminished importance of Professor Steiner’s work, instead, our analysis demonstrates the wide-spread adoption of the endoscopic laser cordectomy procedure following the ELS classification system. Complex surgical techniques such as transoral laser microsurgery are optimally disseminated within well-defined classification schemes, though further validation is warranted

Hypoglossal Schwannoma Masquerading as a Carotid Body Tumor

Study Objective. To describe the clinical presentation, evaluation, and treatment of a hypoglossal schwannoma. Methods. We report an unusual case of a hypoglossal schwannoma presenting as a pulsatile level II neck mass at the bifurcation of the external and internal carotid arteries, mimicking a carotid body tumor. Radiologic findings are reviewed in detail. Results. A 59-year-old female presented to a tertiary care medical center with complaints of a pulsatile right-sided neck mass. An MRA of the neck was obtained demonstrating a 5 cm mass located at the carotid artery bifurcation and causing splaying of the internal and external carotids. Based on clinical presentation and imaging, a diagnosis of a carotid body tumor was conferred and the patient scheduled for excision. Intraoperatively, the mass was noted to arise from the hypoglossal nerve, remaining independent of the carotid artery. On histopathologic analysis, the mass was determined to be consistent with hypoglossal schwannoma. Conclusion. Though rare, the hypoglossal schwannoma should remain a consideration in the evaluation of a parapharyngeal space mass. As this report demonstrates, the clinical and radiologic presentation of a hypoglossal schwannoma may closely mimic that of the more common carotid body tumor

Transoral robotic assisted resection of the parapharyngeal space.

BackgroundPreliminary case series have reported clinical feasibility and safety of a transoral minimally invasive technique to approach parapharyngeal space masses. With the assistance of the surgical robotic system, tumors within the parapharyngeal space can now be excised safely without neck incisions. A detailed technical description is included.MethodsAfter developing compressive symptoms from a parapharyngeal space lipomatous tumor, the patient was referred by his primary otolaryngologist because of poor open surgical access to the nasopharyngeal component of the tumor.ResultsTransoral robotic assisted resection of a 54- × 46-mm parapharyngeal space mass was performed, utilizing 97 minutes of robotic surgical time. Pictorial demonstration of the robotic resection is provided.ConclusionParapharyngeal space tumors have traditionally been approached via transcervical skin incisions, typically including blunt dissection from tactile feedback. The transoral robotic approach offers magnified 3D visualization of the parapharyngeal space that allows for complete and safe resection

Transoral robotic surgery for laryngeal cancer.

PURPOSE OF REVIEW: Transoral robotic surgery (TORS) has seen substantial surge since its introduction in around 2007. Although initially described for cancer of the oropharynx, advances in robotic instrumentation and endoscopy have allowed for application of TORS toward laryngeal cancer. This review discusses the recent published experience of TORS for laryngeal cancer. RECENT FINDINGS: TORS supraglottic laryngectomy continues to be the most frequent application of robotic surgery for laryngeal cancer. A number of case series have described the positive experience with TORS supraglottic laryngectomy with both oncologic and functional outcomes rivaling alternative therapy options. TORS total laryngectomy also continues to be applied in selective cases for laryngeal cancer. The objectives of TORS total laryngectomy is to reduce the size of the resultant pharyngotomy and to limit the lateral exposure of the cervical vessels. Although limited in numbers, TORS total laryngectomy appears to be a technique of increasing application. TORS approach for primary glottic cancer has also been described in limited case series. Although the majority of patients demonstrated positive outcomes following TORS glottic cordectomy, this technique may still require additional advancement of robotic technology before widespread application is seen. SUMMARY: A TORS approach for laryngeal cancer is increasing in application and utility. The major surgical procedures described to date include supraglottic laryngectomy, total laryngectomy, and glottic cordectomy with promising results

Single-port transoral robotic surgery hypopharyngectomy.

Transoral robotic surgery (TORS) is an established treatment for many subsites of Head and Neck cancer. With the improved flexibility and access of the single-port (SP) robotic system, tumors within the distal upper aerodigestive tract can now be reached and successfully treated with all the published advantages of transoral endoscopic surgery. Here in we offer the first published surgical technique for SP TORS for resectable hypopharyngeal carcinoma. The video presented demonstrates many important aspects utilizing the enhanced robotic system, including adjustments of the semi-flexible endoscope and use of the third transoral surgical instrumentation. As previously reported, TORS hypopharyngectomy should be considered for resectable tumors to improve upon the deleterious effects of open surgical resection or chemoradiation therapy

Laryngeal Preservation in Glottic Cancer: A Comparison of Hospital Charges and Morbidity among Treatment Options.

ObjectiveWhen total laryngectomy is not required, organ preservation surgery or radiotherapy is considered the standard of care for primary glottic cancer. These accepted treatment options are available for early and advanced glottic cancers due to equivalent locoregional control and survival rates. However, in today's climate of accountable care, the financial burden of treatment choices continues to increase in significance. We therefore compared hospital charges and treatment-related morbidity between organ-preserving surgery and radiation with or without chemotherapy-herein, (chemo)radiation-in the primary treatment of glottic cancer.Study designNationwide Inpatient Sample Database was analyzed to assess clinical and financial information.SettingPopulation-based analysis.SubjectsPatients (N = 5499) with primary glottic cancer undergoing treatment with laryngeal preservation strategies.MethodsPatients were subdivided by ICD-9 codes into 3 treatment groups: endoscopic resection, open partial laryngectomy, and (chemo)radiation. Treatment-related outcomes, charges, and length of hospitalization were analyzed among treatment groups.ResultsWhen adjusting for sex, age, race, comorbidity, and primary payer, (chemo)radiotherapy was associated with increased direct charges (P &lt; .001; coefficient, $23,658.99; 95$10,227.15-37,090.84) and length of hospitalization (P < .001; hazard ratio, 0.593; 95% CI: 0.502-0.702) when compared with endoscopic surgery. As compared with open surgery, endoscopic surgery was associated with reduced hospital charges (P = .012; coefficient, 11,967.01; 95% CI: $2,784.17-$21,249.85) and duration of hospitalization (P &lt; .001; hazard ratio, 0.749; 95% CI: 0.641-0.876).ConclusionsThis analysis suggests that increased utilization of endoscopic surgery in patients with primary glottic cancer not requiring total laryngectomy may lead to reduced financial burden and duration of hospitalization when compared with open surgery or (chemo)radiation therapy