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Castleman’s disease: an approach to diagnosis and management
Otolaryngology– Head and Neck Surgery Volume 129 Number 2
P104 Castleman’s Disease: An Approach to Diagnosis and Management James Lewis Newlon MD (presenter); Joseph A Brennan MD San Antonio TX; Boerne TX
Objectives: Castleman’s disease is a rare benign lymphoproliferative disorder of unproven etiology. Only 70 cases have been reported in the literature for the entire head and neck region. Multiple names have been used in the past to describe this condition such as giant lymph node hyperplasia, angiomatous lymphoid hamartoma, benign giant lymphoma, and follicular lymphoreticuloma. The uncommon occurrence combined with progressively enlarging nature and nonspecific symptoms of Castleman’s disease may not lend itself to an obvious diagnosis. The hypervascular nature of the tumor has not been discussed in the literature to date. This fact raises preoperative management issues. The objective of this paper is to discuss the variable characteristics, differentiating the histological and clinical types, as well as the natural history and treatment of the disease.
P245
Methods: A series of 3 cases will be reviewed. The preoperative management, treatment, and follow-up will all be discussed. Results: Follow-up of 1 to 5 years for the patients in the series revealed that tumors managed by surgical extirpation did not exhibit any recurrent systemic symptoms or local recurrence. Conclusion: The hypervascular nature of the disease poses blood loss issues during surgical extirpation. Preoperative angiography with embolization is recommended. Unfortunately, the diagnostic dilemmas encountered often preclude recognition of the need to embolize. Further study continues in attempt to discover the etiology of the disease and thereby elucidate further treatment options. P105 Pediatric Laryngotracheal Surgery at Hospital S Joa ˜ o, Portugal: A Four-Year Review Jorge E Spratley MD (presenter); Carla Pinto Moura MD; Telma Feliciano MD; Horacio Silva MD PhD; Manuel Pais Clemente MD PhD Porto Portugal; Leca da Palmeira Portugal; Senhora Da Hora Portugal; Porto Portugal; Porto Portugal
Objectives: Treatment of pediatric congenital or acquired subglottic stenosis (SG), in contrast to previous practices, has been performed at our institution since 1998 with either rib cartilage graft laryngotracheoplasty (LTP) or cricotracheal resection (CTR). The purpose was to analyze the recent experience of our pediatric laryngotracheal reconstruction program. Methods: Four-year (1998-2001) retrospective chart review of children with SG consecutively operated by open laryngotracheal reconstruction at the Division of Pediatric Otolaryngology of a tertiary academic referral hospital in the north of Portugal. The main outcome measures were decannulation and return to a non-restrained lifestyle. Results: From 194 diagnostic laryngotracheoscopies performed, 10 patients were operated for the single diagnosis of SG. Ages ranged from 2 to 18 years with 54% girls. Lesions were distributed by Cotton-Myer’s grades II (n ⫽ 2), III (n ⫽ 6), and IV (n ⫽ 3). Types of surgery included single-stage LTP (n ⫽ 3), two-stage LTP (n ⫽ 5), primary CTR (n ⫽ 2), and salvage CTR (n ⫽ 1). All children were successfully decannulated, nine after the first surgery and one following salvage CTR. No recurrent laryngeal nerve lesions occurred. Residual stridor or exertional dyspnea was not registered within a minimum follow-up of 1 year. Voice quality remained good in nine patients. Conclusion: The results support the use of open laryngotracheal surgery for the treatment of pediatric SG. Grade II and III lesions can be capably treated with either single- or two-stage costal cartilage graft LTP. Grade IV stenosis should preferentially be managed by CTR which is also a good
POSTERS
by obliterative and ablative surgical procedures. These obliteration procedures created a nonanatomic situation which often has long-term complications. As experience and technology have evolved, less invasive endoscopic techniques have improved access to the frontal recess. Recreation of the adequate frontal sinus would seem a superior alternative. This paper describes the combined open and endoscopic reconstruction of frontal sinuses in patients who have failed treatment with obliteration or ablation. Methods: Retrospective chart review and critical evaluation of four patients who underwent frontal sinus reconstruction via combined endoscopic and bicoronal approaches. The diseased sinuses were explored and subsequently reconstructed using split-calvarial bone grafts for replacement of the anterior table. Frontal recesses were reopened and functionally reconstructed. The technique, functional and aesthetic results, and the complications of the procedures were reviewed. The authors discuss the advantages and disadvantages of this method of surgical management of recurrent frontal sinus disease. Results: Four patients underwent successful frontal sinus reconstruction. None of the patients had significant complications. All patients have completed reconstruction and have satisfactory aesthetic facial form and frontal sinus function. Conclusion: Frontal sinuses that have recurrent disease or complications following prior obliteration or ablation can sometimes be successfully reconstructed using a combined endoscopic and bicoronal approaches. The split-calvarial bone grafts provide reliable material for reconstruction of the anterior table of the frontal sinuses. This technique should be considered in the revision of frontal sinuses in patients who have complications of obliteration requiring re-exploration.
Scientific Posters
P104 Castleman’s Disease: An Approach to Diagnosis and Management James Lewis Newlon MD (presenter); Joseph A Brennan MD San Antonio TX; Boerne TX
Objectives: Castleman’s disease is a rare benign lymphoproliferative disorder of unproven etiology. Only 70 cases have been reported in the literature for the entire head and neck region. Multiple names have been used in the past to describe this condition such as giant lymph node hyperplasia, angiomatous lymphoid hamartoma, benign giant lymphoma, and follicular lymphoreticuloma. The uncommon occurrence combined with progressively enlarging nature and nonspecific symptoms of Castleman’s disease may not lend itself to an obvious diagnosis. The hypervascular nature of the tumor has not been discussed in the literature to date. This fact raises preoperative management issues. The objective of this paper is to discuss the variable characteristics, differentiating the histological and clinical types, as well as the natural history and treatment of the disease.
P245
Methods: A series of 3 cases will be reviewed. The preoperative management, treatment, and follow-up will all be discussed. Results: Follow-up of 1 to 5 years for the patients in the series revealed that tumors managed by surgical extirpation did not exhibit any recurrent systemic symptoms or local recurrence. Conclusion: The hypervascular nature of the disease poses blood loss issues during surgical extirpation. Preoperative angiography with embolization is recommended. Unfortunately, the diagnostic dilemmas encountered often preclude recognition of the need to embolize. Further study continues in attempt to discover the etiology of the disease and thereby elucidate further treatment options. P105 Pediatric Laryngotracheal Surgery at Hospital S Joa ˜ o, Portugal: A Four-Year Review Jorge E Spratley MD (presenter); Carla Pinto Moura MD; Telma Feliciano MD; Horacio Silva MD PhD; Manuel Pais Clemente MD PhD Porto Portugal; Leca da Palmeira Portugal; Senhora Da Hora Portugal; Porto Portugal; Porto Portugal
Objectives: Treatment of pediatric congenital or acquired subglottic stenosis (SG), in contrast to previous practices, has been performed at our institution since 1998 with either rib cartilage graft laryngotracheoplasty (LTP) or cricotracheal resection (CTR). The purpose was to analyze the recent experience of our pediatric laryngotracheal reconstruction program. Methods: Four-year (1998-2001) retrospective chart review of children with SG consecutively operated by open laryngotracheal reconstruction at the Division of Pediatric Otolaryngology of a tertiary academic referral hospital in the north of Portugal. The main outcome measures were decannulation and return to a non-restrained lifestyle. Results: From 194 diagnostic laryngotracheoscopies performed, 10 patients were operated for the single diagnosis of SG. Ages ranged from 2 to 18 years with 54% girls. Lesions were distributed by Cotton-Myer’s grades II (n ⫽ 2), III (n ⫽ 6), and IV (n ⫽ 3). Types of surgery included single-stage LTP (n ⫽ 3), two-stage LTP (n ⫽ 5), primary CTR (n ⫽ 2), and salvage CTR (n ⫽ 1). All children were successfully decannulated, nine after the first surgery and one following salvage CTR. No recurrent laryngeal nerve lesions occurred. Residual stridor or exertional dyspnea was not registered within a minimum follow-up of 1 year. Voice quality remained good in nine patients. Conclusion: The results support the use of open laryngotracheal surgery for the treatment of pediatric SG. Grade II and III lesions can be capably treated with either single- or two-stage costal cartilage graft LTP. Grade IV stenosis should preferentially be managed by CTR which is also a good
POSTERS
by obliterative and ablative surgical procedures. These obliteration procedures created a nonanatomic situation which often has long-term complications. As experience and technology have evolved, less invasive endoscopic techniques have improved access to the frontal recess. Recreation of the adequate frontal sinus would seem a superior alternative. This paper describes the combined open and endoscopic reconstruction of frontal sinuses in patients who have failed treatment with obliteration or ablation. Methods: Retrospective chart review and critical evaluation of four patients who underwent frontal sinus reconstruction via combined endoscopic and bicoronal approaches. The diseased sinuses were explored and subsequently reconstructed using split-calvarial bone grafts for replacement of the anterior table. Frontal recesses were reopened and functionally reconstructed. The technique, functional and aesthetic results, and the complications of the procedures were reviewed. The authors discuss the advantages and disadvantages of this method of surgical management of recurrent frontal sinus disease. Results: Four patients underwent successful frontal sinus reconstruction. None of the patients had significant complications. All patients have completed reconstruction and have satisfactory aesthetic facial form and frontal sinus function. Conclusion: Frontal sinuses that have recurrent disease or complications following prior obliteration or ablation can sometimes be successfully reconstructed using a combined endoscopic and bicoronal approaches. The split-calvarial bone grafts provide reliable material for reconstruction of the anterior table of the frontal sinuses. This technique should be considered in the revision of frontal sinuses in patients who have complications of obliteration requiring re-exploration.
Scientific Posters