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Extended mid-facial translocation approach for nasopharyngecotmy
Oral Abstract Session 4 PATHOLOGY AND MEDICINE/ORTHOGNATHIC SURGERY/TMJ/ MAXILLOFACIAL RECONSTRUCTION Friday, September 12, 2003, 1:00 pm–5:00 pm
Extended Mid-Facial Translocation Approach for Nasopharyngecotmy
Genomic Profiling of Head and Neck Cancer by cDNA Microarray Analysis
M. Abraham Kuriakose, DDS, MD, Suite 7U, Skirball Building, NYU Medical Center, 530 First Avenue, New York, NY 10016 (Karlis V; Glickman R)
David Hirsch, DDS, MD, NYU College of Dentistry, Department of OMS, 345 E 24th St, New York, NY 10010 (Kuriakose MA; Chen FA; Karlis V; Glickman R)
Introduction: Nasopharyngectomy is emerging as an effective salvage treatment for locally recurrent nasopharyngeal cancer (NPC). The recurrent NPC has a predilection to extend posterolaterally into the paranasopharyngeal and infratemporal fossa region. Surgical procedures which provide exposure of these regions are required for safe and oncologically sound resection of this tumor. In this report we describe the effectiveness of extended facial translocation approach for salvage nasopharyngectomy. Patients and Methods: Four patients with recurrent NPC following radiotherapy underwent extended facial translocation approach for nasopharyngectomy of stage rT2b to rT4 tumors. The inclusion criteria for this procedure consisted of locally recurrent NPC with no evidence of distant metastasis and absence of carotid or dural invasion. The technique consists of translocation of maxilla, zygomatic bone, and nose along with their soft tissue envelope as a composite unit. The surgical defect was reconstructed using temporalis muscle to protect the carotid artery at the skull base. The patients received further radiation by brachytherapy (1,500 to 2,500 cGy). Results: All 4 patients had tumor resection with uninvolved margins. The postoperative complications consisted of a case of palatal fistula and enophthalmos. The patients were followed up for a period ranging from 24 to 48 months (mean 28 months). Local disease control was achieved in all but one patient. Three of the 4 patients remain free of disease. One patient is alive with local recurrance. Conclusions: The extended mid-facial translocation approach provides wide exposure of entire nasopharynx and the ipsilateral infratemporal fossa, enabling oncologically sound resection of recurrent nasopharyngeal cancer with acceptable morbidity.
Objectives: An overwhelming body of evidence suggests that the phenotypic diversity of head and neck squamous cell carcinomas (HNSCC) is preceded or accompanied by corresponding genotypic changes. The objective of this study was to identify the altered gene expression of HNSCC. Methods: Isolated RNA from tumor and corresponding patient’s normal tissues was processed for hybridization to Affymetrix U95A GeneChip, which is a high density Cartesian-coordinate array containing ordered oligo-nucleotides of over 12,000 defined genes and expression sequence tags (ESTs). A total of 15 pairs of samples (30 chips) were investigated. The gene expression data was analyzed by GeneSpring, Excel, and Access software to identify significant differentially expressed genes. Validity of these genes was carried out by RT-PCR and Western blot analysis. Results: A panel of genes with highest potential to be differentially expressed between tumor and normal tissue was identified with the following approaches: Best class predictor (GeneSpring), paired t test (Excel), and Comparison analysis (Access). In combination, 31 probes (27 gene/EST) were selected. These represent known oncogenes, tumor suppressor genes as well as novel genes. Conclusions: The genetic database created provides important insight into modeling gene expression changes implicated in HNSCC and suggests the future potential of identifying novel molecular markers for tumor detection and characterization of phenotypic diversity.
References Ammirati M, Bernando A: Analytical evaluation of complex anterior approaches to the cranial base: An anatomic study. Neurosurgery 4:1398, 1998 Fisch U, Pillsbury HC: Infratemporal fossa approach to lesions of the temporal bone and base of skull. Arch Otolaryngol 105:99, 1979
AAOMS • 2003
References Villaret DB, Wang T, Dillon D, et al: Identification of genes overexpressed in head and neck squamous cell carcinoma using a combination of complementary DNA subtraction and microarrary analysis. Laryngoscope 110:374, 2000 Leethanakul C, Patel V, Gillespie J, et al: Distinct pattern of expression of differentiation and growth-related genes in squamous cell carcinomas of the head and neck revealed by the use of laser capture microdissection and cDNA arrays. Oncogene 19:3220, 2000
Funding Source: George Hall Endowment Fund.
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Extended Mid-Facial Translocation Approach for Nasopharyngecotmy
Genomic Profiling of Head and Neck Cancer by cDNA Microarray Analysis
M. Abraham Kuriakose, DDS, MD, Suite 7U, Skirball Building, NYU Medical Center, 530 First Avenue, New York, NY 10016 (Karlis V; Glickman R)
David Hirsch, DDS, MD, NYU College of Dentistry, Department of OMS, 345 E 24th St, New York, NY 10010 (Kuriakose MA; Chen FA; Karlis V; Glickman R)
Introduction: Nasopharyngectomy is emerging as an effective salvage treatment for locally recurrent nasopharyngeal cancer (NPC). The recurrent NPC has a predilection to extend posterolaterally into the paranasopharyngeal and infratemporal fossa region. Surgical procedures which provide exposure of these regions are required for safe and oncologically sound resection of this tumor. In this report we describe the effectiveness of extended facial translocation approach for salvage nasopharyngectomy. Patients and Methods: Four patients with recurrent NPC following radiotherapy underwent extended facial translocation approach for nasopharyngectomy of stage rT2b to rT4 tumors. The inclusion criteria for this procedure consisted of locally recurrent NPC with no evidence of distant metastasis and absence of carotid or dural invasion. The technique consists of translocation of maxilla, zygomatic bone, and nose along with their soft tissue envelope as a composite unit. The surgical defect was reconstructed using temporalis muscle to protect the carotid artery at the skull base. The patients received further radiation by brachytherapy (1,500 to 2,500 cGy). Results: All 4 patients had tumor resection with uninvolved margins. The postoperative complications consisted of a case of palatal fistula and enophthalmos. The patients were followed up for a period ranging from 24 to 48 months (mean 28 months). Local disease control was achieved in all but one patient. Three of the 4 patients remain free of disease. One patient is alive with local recurrance. Conclusions: The extended mid-facial translocation approach provides wide exposure of entire nasopharynx and the ipsilateral infratemporal fossa, enabling oncologically sound resection of recurrent nasopharyngeal cancer with acceptable morbidity.
Objectives: An overwhelming body of evidence suggests that the phenotypic diversity of head and neck squamous cell carcinomas (HNSCC) is preceded or accompanied by corresponding genotypic changes. The objective of this study was to identify the altered gene expression of HNSCC. Methods: Isolated RNA from tumor and corresponding patient’s normal tissues was processed for hybridization to Affymetrix U95A GeneChip, which is a high density Cartesian-coordinate array containing ordered oligo-nucleotides of over 12,000 defined genes and expression sequence tags (ESTs). A total of 15 pairs of samples (30 chips) were investigated. The gene expression data was analyzed by GeneSpring, Excel, and Access software to identify significant differentially expressed genes. Validity of these genes was carried out by RT-PCR and Western blot analysis. Results: A panel of genes with highest potential to be differentially expressed between tumor and normal tissue was identified with the following approaches: Best class predictor (GeneSpring), paired t test (Excel), and Comparison analysis (Access). In combination, 31 probes (27 gene/EST) were selected. These represent known oncogenes, tumor suppressor genes as well as novel genes. Conclusions: The genetic database created provides important insight into modeling gene expression changes implicated in HNSCC and suggests the future potential of identifying novel molecular markers for tumor detection and characterization of phenotypic diversity.
References Ammirati M, Bernando A: Analytical evaluation of complex anterior approaches to the cranial base: An anatomic study. Neurosurgery 4:1398, 1998 Fisch U, Pillsbury HC: Infratemporal fossa approach to lesions of the temporal bone and base of skull. Arch Otolaryngol 105:99, 1979
AAOMS • 2003
References Villaret DB, Wang T, Dillon D, et al: Identification of genes overexpressed in head and neck squamous cell carcinoma using a combination of complementary DNA subtraction and microarrary analysis. Laryngoscope 110:374, 2000 Leethanakul C, Patel V, Gillespie J, et al: Distinct pattern of expression of differentiation and growth-related genes in squamous cell carcinomas of the head and neck revealed by the use of laser capture microdissection and cDNA arrays. Oncogene 19:3220, 2000
Funding Source: George Hall Endowment Fund.
59