Aug 20, 2015 - Objective: Harmonic scalpel (HS) is widely used in thyroidec- tomy because of its multiple advantages. However, there are concerns on thermal ...
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P156
Otolaryngology–Head and Neck Surgery 147(2S)
Results: Thyroid dissection was performed in a total of 10 pigs. Two were “open” procedures to learn the porcine anatomy. Eight were endoscopic procedures. Of them 5 used three 5-mm incisions and 3 used three 2- to 3-mm incisions for surgical tools and a 5-mm incision for the endoscopic camera. In all cases the thyroid was completely dissected with the recurrent laryngeal nerve (RLN) identified and preserved. In 5 cases the thyroid was removed through the floor of the mouth. There was no major bleeding in the live pigs, and all the vital structures were identified and preserved.
Head and Neck Surgery Endoscopic Treatment of Benign Sinonasal Tumors Vic Jankee (presenter); Venkat R. Srinivasan, FRCS; Priya Achar
Conclusion: Endoscopic thyroidectomy using miniature camera and tools in a porcine model seems to be feasible without major complications. The advantages of this approach include minimal scars and improved visualization. We believe that there is room for further development of minimal invasive techniques for thyroid surgery.
Method: We performed a retrospective case note review of patients having endoscopic surgery for benign sinonasal tumors between 2001 to 2010. Our results in terms of success rate and complications were compared with similar studies in the literature. A systematic review was carried out including 5 case series studies and 1 meta-analysis.
Head and Neck Surgery Endoscopic Transnasal Craniectomy for Sinonasal Malignancies Andrea Bolzoni Villaret, MD (presenter); Piero Nicolai, MD; Marco Bottazzoli, MD; Maurizio Bignami, MD; Mario Turri-Zanoni, MD; Paolo Battaglia, MD; Paolo Castelnuovo, MD
Results: Fourteen patients were treated endoscopically (11 inverted papillomas, 1 pleomorphic adenoma, 1 oncocytoma, and 1 schwannoma). Exclusion criteria: Tumors eroding maxillary antrum, and extending into orbit, soft tissue, skull base, or intracranially. There were 9 men and 5 women; average age was 61 years (range, 42-80 years). Minor complications were encountered in 20% of patients. Average follow-up was 46 months (range, 13-120 months). The recurrence rate was 7% (1 patient with inverted papilloma, revised endoscopically). A review of a case series in the literature showed an identical recurrence rate between the 2 types of surgery (9%), and a meta-analysis showed greater difference (endoscopy 12% vs open 19.5%).
Objective: This study reviewed the surgical technique of endoscopic resection with transnasal craniectomy (ERTC), its indications, and morbidity in the management of selected sinonasal malignancies.
Conclusion: Endoscopic excision is an effective treatment modality and beneficial to patients with benign sinonasal tumors as it offers a similar, if not decreased, chance of recurrence with additional benefits of fewer complications and scarring.
Method: From April 1996 to December 2010, 265 patients affected by sinonasal malignant tumors were treated by endoscopic resection at 2 referral university hospitals. From 2004, 126 patients underwent ERTC. Duraplasty was carried out using iliotibial tract and fat tissue. Overall (O), disease-specific (DS), and recurrence-free (RF) survival were calculated. Results: The most frequent histologies were adenocarcinoma (57%) and olfactory neuroblastoma (16%). Eighty-seven (69%) patients were previously untreated. The overall complication rate was 10.6%. Cerebrospinal fluid leak was observed in 9 (7%) cases. The mean hospitalization time was 10.5 days (range, 5-32 days). Overall, 75 (60%) patients received adjuvant treatment. After a mean follow-up of 52.7 months (range, 12-169 months), 100 (79.3%) patients had no evidence of disease, with 5-year OS, DSS, and RFS of 82.6%, 85.7%, and 77.9% respectively. Conclusion: ERTC is a safe procedure with an acceptable complication rate, allowing the ability to perform a wide resection of the dura with a correct assessment of its involvement. Only a few cases of malignancies extending intracranially require combining with an external subfrontal craniotomy.
Objective: 1) To assess the effectiveness of endoscopic surgery in the management of benign sinonasal tumors. 2) To compare our complication and recurrence rates with the literature.
Head and Neck Surgery Evaluating the Safety of Harmonic Scalpel in Thyroidectomy Min Young Seo, MD (presenter); Young-Ik Son, MD, PhD; Chung Hwan Baek, MD, PhD; Ki-Nam Park, MD; Dohun Kim, MD Objective: Harmonic scalpel (HS) is widely used in thyroidectomy because of its multiple advantages. However, there are concerns on thermal damage to the adjacent lateral. This study aimed to compare the incidence of EBSLN or cricothyroid muscle injury, and patterns of voice discomfort between thyroidectomy using HS and classic knot-tie ligation. Method: Thirty-four patients with papillary thyroid microcarcinoma completed the study. Patients were randomly divided into 2 groups; knot-tying group (KT, n = 18) and harmonic scalpel group (HS, n = 16). Results: Subjective voice assessment with questionnaires, acoustical analyses including voice range profile, and
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P157
Poster Presentations
Conclusion: When compared to conventional knot-tying method, using HS does not increase SLN injury, subjective voice discomfort or perturbation parameters of acoustic voice analyses. Regardless of using HS, thyroidectomy may result in subjective voice discomfort until the third month after surgery, which usually recovers to the preoperative level during 6 months.
squamous cell carcinoma (OOSCC) who presented as clinically single lymph node metastasis, nd underwent surgery. 2) To find out a rationale for optimal management in these selected cases. Method: Study design: Retrospective. Year study conducted: 10 years. Disease studied: Oral or oral cavity carcinoma with clinically single lymph node metastasis. Subjects: 54 patients. Setting: Tertiary center. Outcome measurement: Patterns of treatment failure, related clinicopathologic factors.
Head and Neck Surgery Facial Nerve Palsy following Parotidectomy Nikul Amin, MD (presenter); Hannah Dixon; Nicholas Gibbins, MRCS, DOHNS; Simione Lew-Gor, MBChB, MRCS
Results: There was no metastasis in level V as clinical presentation, and only 1 case showed occult metastasis. Among the 15 cases (28%) of treatment failure, recurrence of lymph node metastasis was identified in only 1 case (1.9%). The most common cause of treatment failure or death was distant metastasis, which occurred in 10 patients (18.5%). Clinical (P = .005) and pathologic (P = .003) T stage were risk factors for the distant metastasis.
Objective: To determine the incidence of temporary and permanent facial nerve dysfunction in patients following parotidectomy in a UK teaching hospital.
Conclusion: Nodal recurrence was rare, and distant metastasis was the main cause of failure and death with OOPSCC with single lymph node metastasis. While there is feasibility to save level V in these cases, distant metastasis should be considered in adjuvant therapy and follow up for patients with advanced T stage.
Method: All parotidectomies performed between January 1, 2009, and January 1, 2012, were analyzed using patients’ clinical and operative records. The grade of the surgeon, the operation, and the presence of a facial nerve monitor were recorded. House-Brackmann scores were recorded preoperatively and postoperatively. The length of time until recovery of facial nerve function was recorded. Results: Sixty-five parotidectomies were performed. The indications for surgery included pleomorphic adenoma 31%, warthin 23%, malignant disease 34%, and other 15%. Overall postoperative palsy rate was 43% (28/65). The most commonly affected branch was the marginal mandibular, 25% (16/65 %). Six were permanent and 22 temporary. The rate of facial nerve palsy was 44% for benign disease and 41% for malignant. Of the 6 permanent facial nerve palsies, 4 (67%) facial nerves were sacrificed because of preoperative disease involvement. MM was the branch commonly involved in these cases often due to Level 1 nodal clearance. In patients with temporary facial nerve palsy, mean recovery time was 4.3 months (range, 24 hours-12 months). Conclusion: Facial nerve palsy is a distressing and debilitating complication of parotidectomy, not only functionally but also emotionally and socially. Informed consent is an important part of preoperative assessment and accurate facial nerve palsies incidence rates should be discussed with patients.
Head and Neck Surgery Failure in Oral or Oropharyngeal Cancer with Single-Node Metastasis Yoon Woo Koh, MD (presenter); Hyoung Shin Lee, MD; Won Shik Kim, MD; HyunJun Hong, MD; So-Yoon Lee, MD; Hyun Pil Chung, MD; Eun Chang Choi, MD, PhD Objective: 1) Analyze the oncologic results and related clinicopathologic factors of patients with oral and oropharyngeal
Head and Neck Surgery FAMM FLAP in Head and Neck Surgery Yves Gobel (presenter); Gerald Valette, MD; Ronan Abgral, MD; Jean Rousset; Gael Potard, MD; Remi Marianowski, MD Objective: Facial artery mucosa musclar (FAMM) flap is mainly used in head and neck oncologic surgery for primary reconstruction after resection in oral cavity and in surgical treatment of osteoradionecrosis of the mandible. Some benefits are ease of use, good vitality, and no aesthetic prejudice. Recently, robotic surgery has made removal of the flap inside the mouth cavity easier, thanks to a wider field of view and smaller surgical instruments. Method: Retrospective study. Forty cases were analyzed in ENT and head and neck center of Brest University Hospital, between April 2007 and June 2011, in both indications primary reconstruction and surgical treatment of osteoradionecrosis. Complications such as infection, hematoma, necrosis, time within pedicle weaning, and resumption of feeding were studied. Results: Eighteen cases for primary reconstruction and 22 cases for surgical treatment of osteoradionecrosis were analyzed. After radiotherapy, pedicle weaning was delayed (average of 11 more days) and enteral nutrition period lasted longer (average of 22 days vs 7 days). However, no infection and only 1 case of hematoma (2.5%) and 2 cases of necrosis (5%) were identified. Revision surgery for flap removal was necessary in 1 case (2.5%). After 1 month, oral feeding was possible in 35 cases (85%). Eighty percent of bad results occurred after radiotherapy.
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stroboscopic laryngeal evaluation were performed before and 3 months after surgery.
