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Jugular paraganglioma resection without facial transposition
P160
Otolaryngology Head and Neck Surgery August 1995
Scientific Sessions- - Wednesday
11:23 A.M.
11:31 A.M.
Jugular Paraganglioma Resection Without Facial Transposition
Clinical Applications of the Island Pedicled Nasolabial Musculocutaneous Flap
OSWALDO L. M. CRUZ, MD, PHD (presenter), LUIZROBERTO MEDINA DOSSANTOS, MD, PHD, MARIe GILBERTOSIQUEIRA, MD, and HELDERTEDESCHI, MD, See Paulo, Brazil
GREG R. LICAMELI, MD (presenter), and ROBERTDOLAN, MD, Boston, Mass.
The classic surgery for grade II, III, or iV jugular paragangliomas involves the transposition of the facial nerve for a better visualization of the tumor and its most mobile relationship. This "rernuting" can be troublesome because it is technically difficult and time consuming and the manipulation of the nerve leads to an unpredictable result regarding the preservation of its function. To minimize these inconveniences we have modified our surgical approach in cases of grade II and III paraganglioma, which involves a dissection of the lateral aspects of tumor and jugular foramen, preserving the facial nerve on its natural position, protected with a eggshell layer of bone. The technique encompasses the initial standard steps of the lateral transtemporal approach: isolation of the main vascular and neural structures in the neck; large mastoidectomy with skeletonization of sigmoid sinus, posterior and middle fossa dura and identification of the mastoid and tympanic segments of the facial nerve. The next steps are the dissection of the retrofacial air cells, taking down the posterior auditory canal wall and drilling out of the tympanic portion of the temporal bone. In so doing we are able to create a wide communication among the space formerly being the external auditory canal, the mastoid region, and retrofacial cells. The facial nerve lies, therefore, on its natural position, like a bridge over the space just described. Removing the mastoid osseous tip, we can dissect the entire course of the facial nerve, opening the stylomastoid foramen and communicating the previously dissected extratemporal segment with the tympanomastoid segment. The resection of the tumor can be easily and safely accomplished working anterior and posterior to the nerve with only minimal changes in the surgical microscope position. This minimal technical annoyance is greatly compensated, with the best results regarding facial nerve function preservation. Among our series of jugular paraganglioma operated on, we have introduced this technical modification in the last two cases, with complete preservation of the facial nerve function (Grade I-House) even in the immediate postoperative period. Technical details will be presented. In conclusion, according to these initial results, the maintenance of the facial nerve on its natural position is a feasible and rewarding procedure in the surgery of most grade II and III jugular paragangliomas.
The island pedicled musculocutaneous naolabial flap (MNLF) represents a new generation of nasolabial flaps that address the problems of a bulky and immobile pedicle. The intention of this paper is to present our experience with the MNLF for reconstruction of large nasal defects involving the columella, septum, and nasal ala. The charts and clinical photographs of eight patients who underwent nasal reconstruction using the MNLF were reviewed. There were no flap failures or partial necroses. All patients were noted to have a symmetric facial appearance at rest and with expression postoperatively. With use of the MNLF, it is possible to reconstruct the entire columeUa and more extensive defects, which may also include the membranous and cartilaginous septum, in a single stage. Repair of these defects was previously beyond the capabilities of the nasolabial flap. 11:39 A.M.
Discussion 11:45 A.M. Alteration of the p53 Gene: An Early Step in Oral Cavity Cancer? HELENA ROWLEY, MB, FRCSI (presenter), P. SHERRINGTON, PHD, A. KINSELLA, PHD, and PROF. A.S. JONES, MD, FRCS, Liverpool, England
Objective: p53 is a tumor suppressor gene. p53 mutation and p53 protein overexpression occur in many tumors and may be of prognostic value. The aim of this study was to identify evidence of p53 mutation or overexpression in malignant squamous tumors of the oral cavity and see if these alterations were detectable in dysplastic oral lesions in the same patients. Methods: Sections of dysplasia and carcinoma were obtained from 14 patients with squamous cell carcinoma of the oral cavity. With use of a monoclonal antibody (DO-7), we analyzed these specimens for p53 overexpression using immunohistochemistry. We microdissected dysplastic and carcinoma specimens from nine patients and, after DNA extraction and polymerase chain reaction, we analyzed exons 5-8 with use of direct sequencing. Results: Nuclear staining indicating overexpression of p53 did not occur in histologically normal epithelium in these patients. Overexpression of the p53 protein did occur, however, in a high percentage (>80%) of squamous cell carcinomas, and when present in the carcinoma specimen it was invariably present in the dysplastic specimen from the same patient. After direct sequencing of exons 5-8 we also found a variety of mutations. Conclusions: We found overexpression of the p53 protein in dysplastic and malignant oral cavity lesions, which
Otolaryngology Head and Neck Surgery August 1995
Scientific Sessions- - Wednesday
11:23 A.M.
11:31 A.M.
Jugular Paraganglioma Resection Without Facial Transposition
Clinical Applications of the Island Pedicled Nasolabial Musculocutaneous Flap
OSWALDO L. M. CRUZ, MD, PHD (presenter), LUIZROBERTO MEDINA DOSSANTOS, MD, PHD, MARIe GILBERTOSIQUEIRA, MD, and HELDERTEDESCHI, MD, See Paulo, Brazil
GREG R. LICAMELI, MD (presenter), and ROBERTDOLAN, MD, Boston, Mass.
The classic surgery for grade II, III, or iV jugular paragangliomas involves the transposition of the facial nerve for a better visualization of the tumor and its most mobile relationship. This "rernuting" can be troublesome because it is technically difficult and time consuming and the manipulation of the nerve leads to an unpredictable result regarding the preservation of its function. To minimize these inconveniences we have modified our surgical approach in cases of grade II and III paraganglioma, which involves a dissection of the lateral aspects of tumor and jugular foramen, preserving the facial nerve on its natural position, protected with a eggshell layer of bone. The technique encompasses the initial standard steps of the lateral transtemporal approach: isolation of the main vascular and neural structures in the neck; large mastoidectomy with skeletonization of sigmoid sinus, posterior and middle fossa dura and identification of the mastoid and tympanic segments of the facial nerve. The next steps are the dissection of the retrofacial air cells, taking down the posterior auditory canal wall and drilling out of the tympanic portion of the temporal bone. In so doing we are able to create a wide communication among the space formerly being the external auditory canal, the mastoid region, and retrofacial cells. The facial nerve lies, therefore, on its natural position, like a bridge over the space just described. Removing the mastoid osseous tip, we can dissect the entire course of the facial nerve, opening the stylomastoid foramen and communicating the previously dissected extratemporal segment with the tympanomastoid segment. The resection of the tumor can be easily and safely accomplished working anterior and posterior to the nerve with only minimal changes in the surgical microscope position. This minimal technical annoyance is greatly compensated, with the best results regarding facial nerve function preservation. Among our series of jugular paraganglioma operated on, we have introduced this technical modification in the last two cases, with complete preservation of the facial nerve function (Grade I-House) even in the immediate postoperative period. Technical details will be presented. In conclusion, according to these initial results, the maintenance of the facial nerve on its natural position is a feasible and rewarding procedure in the surgery of most grade II and III jugular paragangliomas.
The island pedicled musculocutaneous naolabial flap (MNLF) represents a new generation of nasolabial flaps that address the problems of a bulky and immobile pedicle. The intention of this paper is to present our experience with the MNLF for reconstruction of large nasal defects involving the columella, septum, and nasal ala. The charts and clinical photographs of eight patients who underwent nasal reconstruction using the MNLF were reviewed. There were no flap failures or partial necroses. All patients were noted to have a symmetric facial appearance at rest and with expression postoperatively. With use of the MNLF, it is possible to reconstruct the entire columeUa and more extensive defects, which may also include the membranous and cartilaginous septum, in a single stage. Repair of these defects was previously beyond the capabilities of the nasolabial flap. 11:39 A.M.
Discussion 11:45 A.M. Alteration of the p53 Gene: An Early Step in Oral Cavity Cancer? HELENA ROWLEY, MB, FRCSI (presenter), P. SHERRINGTON, PHD, A. KINSELLA, PHD, and PROF. A.S. JONES, MD, FRCS, Liverpool, England
Objective: p53 is a tumor suppressor gene. p53 mutation and p53 protein overexpression occur in many tumors and may be of prognostic value. The aim of this study was to identify evidence of p53 mutation or overexpression in malignant squamous tumors of the oral cavity and see if these alterations were detectable in dysplastic oral lesions in the same patients. Methods: Sections of dysplasia and carcinoma were obtained from 14 patients with squamous cell carcinoma of the oral cavity. With use of a monoclonal antibody (DO-7), we analyzed these specimens for p53 overexpression using immunohistochemistry. We microdissected dysplastic and carcinoma specimens from nine patients and, after DNA extraction and polymerase chain reaction, we analyzed exons 5-8 with use of direct sequencing. Results: Nuclear staining indicating overexpression of p53 did not occur in histologically normal epithelium in these patients. Overexpression of the p53 protein did occur, however, in a high percentage (>80%) of squamous cell carcinomas, and when present in the carcinoma specimen it was invariably present in the dysplastic specimen from the same patient. After direct sequencing of exons 5-8 we also found a variety of mutations. Conclusions: We found overexpression of the p53 protein in dysplastic and malignant oral cavity lesions, which