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SP160 – Intraoral removal of deep stone of the submandibular gland
P156
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
(NACT) followed by concomitant chemoradiotherapy (CRT) in a non-endemic population affected by advanced nasopharyngeal carcinoma (NPC). METHODS: From 2004 to 2008, 40 consecutive patients with NPC were treated with three cycles of induction chemotherapy (CHT) with cisplatin (100 mg/m2) plus epirubicin (90 mg/m2), followed by cisplatin (100 mg/m2 on days 1-22-43) and concomitant radiotherapy, consisted of 70 Gy in 35 fractions. All patients completed the protocol. Objective responses and toxicity were recorded. Statistical analysis was performed using SPSS 16.0 version. RESULTS: After induction CHT plus CRT we observed the following objective response rates: 90% (95%CI 76.1%97.6%) and 100% (95%CI 85.1%-100%) respectively. No severe toxicity was recorded. The 3- and 5-year disease-free survival was 75% (95%CI 5281) and 65.4% (95%CI 55-78) respectively and the 3 and 5 year overall survival was 84% (95%CI 69-92) and 77.5% (95%CI 62-87) respectively (median follow-up 54.5 months). Three and five years loco-regional control was 82.4% (95%CI 72-91) and 70.3% (95%CI 59-83) respectively and five years distant metastases free survival was 75% (95%CI 62-87). CONCLUSIONS: NACT with cisplatin and epirubicin followed by concomitant CRT represents a feasible and efficient treatment for patients affected by advanced NPC. This regimen ensures an excellent locoregional disease control and overall survival with a low incidence of distant metastases. SP186 – Inflammatory pseudotumor of the carotid sheath Vivian Renee Tran, MD (presenter); Bevan Yueh, MD, MPH OBJECTIVES: To demonstrate that surgical resection is a treatment option for cases of inflammatory pseudotumor of the carotid sheath refractory to steroids. METHODS: A case report of a 42-year-old female diagnosed with a right-sided carotid inflammatory pseudotumor that did not respond to medical management. The patient passed a balloon test occlusion (BTO) pre-operatively. The involved portion of the common carotid artery was resected via an extended vertical carotid endarterectomy approach. Reconstruction consisted of a polytetrafluorethylene (PTFE) interposition graft. Electroencephalograms (EEG) and somatosensory evoked potentials (SEP) were monitored intra-operatively. RESULTS: The patient underwent successful resection of the involved portion of the carotid artery. The ipsilateral vagus nerve was sacrificed due to involvement. A thyroplasty was performed three months later to improve voicing. Post-operatively the patient had resolvement of her presenting symptoms of syncope and neck tenderness. Her only complaint was of first bite syndrome, or pain in the parotid region during the first few bites of a meal. This is likely secondary to injury to her sympathetic chain.
CONCLUSIONS: Inflammatory pseudotumor (IP) is a benign fibro inflammatory process most commonly seen in the lungs, but in the head and neck, it most commonly involves the orbit. IP of the carotid sheath is a rare etiology that should be on the differential for neck masses. The mainstay of treatment for IP has been systemic steroids. For refractory cases of inflammatory pseudotumor of the carotid sheath, surgical resection is a treatment option. SP160 – Intraoral removal of deep stone of the submandibular gland KiHwan Hong, MD (presenter); YunSu Yang, MD OBJECTIVES: Most head and neck surgeons believe that if a stone is located in the deep region and there are signs of obstruction or inflammation, the submandibular gland will be irreparably damaged and should be excised. In this study, we introduce new surgical techniques for the deep stones. METHODS: In total, 123 cases of the deep stones (hilum or parenchyma itself) of the submandibular gland were included in this study. They were all applied to remove the stone intraorally carried out in a recent four-year period. The surgical techniques can be classified as type I: stone removal only: type II: stone and sublingual gland removal; and type III: stone and sublingual gland removal with duct marsupialization. The age, sex, post-operative complications, and long-term morbidity were reviewed. RESULTS: All patients received follow-up care for the recurrence of the stone or duct stenosis. Two patients showed duct stenosis and stone recurrence. In the duct stenosis, the patient was tolerable and simply followed up at clinic. All patients were satisfied because of the avoidance of an external scar. CONCLUSIONS: We recommend the stone removal without excision of the submandibular gland in the deep stone of the submandibular duct. Although the surgical exposure may be difficult due to narrow surgical field, the stone lies in the hilum of the duct or in the parenchyma of the gland itself could be removed intraorally. SP218 – Intravascular lipoma of the left internal jugular vein Dev P Kamdar, MD (presenter); Shamit Chopra; Ho-Sheng Lin, MD; Corey Treadway, MD OBJECTIVES: 1) To present the first-ever reported case of an intravascular lipoma arising in the internal jugular vein. 2) To review the relevant radio logic and pathologic findings of such a lesion. METHODS: Case report. RESULTS: N/A CONCLUSIONS: Intravascular lipomas are quite rare. There have been very few cases reported in literature, and all of those have been of lipomas arising in the venae cavae and the
Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009
(NACT) followed by concomitant chemoradiotherapy (CRT) in a non-endemic population affected by advanced nasopharyngeal carcinoma (NPC). METHODS: From 2004 to 2008, 40 consecutive patients with NPC were treated with three cycles of induction chemotherapy (CHT) with cisplatin (100 mg/m2) plus epirubicin (90 mg/m2), followed by cisplatin (100 mg/m2 on days 1-22-43) and concomitant radiotherapy, consisted of 70 Gy in 35 fractions. All patients completed the protocol. Objective responses and toxicity were recorded. Statistical analysis was performed using SPSS 16.0 version. RESULTS: After induction CHT plus CRT we observed the following objective response rates: 90% (95%CI 76.1%97.6%) and 100% (95%CI 85.1%-100%) respectively. No severe toxicity was recorded. The 3- and 5-year disease-free survival was 75% (95%CI 5281) and 65.4% (95%CI 55-78) respectively and the 3 and 5 year overall survival was 84% (95%CI 69-92) and 77.5% (95%CI 62-87) respectively (median follow-up 54.5 months). Three and five years loco-regional control was 82.4% (95%CI 72-91) and 70.3% (95%CI 59-83) respectively and five years distant metastases free survival was 75% (95%CI 62-87). CONCLUSIONS: NACT with cisplatin and epirubicin followed by concomitant CRT represents a feasible and efficient treatment for patients affected by advanced NPC. This regimen ensures an excellent locoregional disease control and overall survival with a low incidence of distant metastases. SP186 – Inflammatory pseudotumor of the carotid sheath Vivian Renee Tran, MD (presenter); Bevan Yueh, MD, MPH OBJECTIVES: To demonstrate that surgical resection is a treatment option for cases of inflammatory pseudotumor of the carotid sheath refractory to steroids. METHODS: A case report of a 42-year-old female diagnosed with a right-sided carotid inflammatory pseudotumor that did not respond to medical management. The patient passed a balloon test occlusion (BTO) pre-operatively. The involved portion of the common carotid artery was resected via an extended vertical carotid endarterectomy approach. Reconstruction consisted of a polytetrafluorethylene (PTFE) interposition graft. Electroencephalograms (EEG) and somatosensory evoked potentials (SEP) were monitored intra-operatively. RESULTS: The patient underwent successful resection of the involved portion of the carotid artery. The ipsilateral vagus nerve was sacrificed due to involvement. A thyroplasty was performed three months later to improve voicing. Post-operatively the patient had resolvement of her presenting symptoms of syncope and neck tenderness. Her only complaint was of first bite syndrome, or pain in the parotid region during the first few bites of a meal. This is likely secondary to injury to her sympathetic chain.
CONCLUSIONS: Inflammatory pseudotumor (IP) is a benign fibro inflammatory process most commonly seen in the lungs, but in the head and neck, it most commonly involves the orbit. IP of the carotid sheath is a rare etiology that should be on the differential for neck masses. The mainstay of treatment for IP has been systemic steroids. For refractory cases of inflammatory pseudotumor of the carotid sheath, surgical resection is a treatment option. SP160 – Intraoral removal of deep stone of the submandibular gland KiHwan Hong, MD (presenter); YunSu Yang, MD OBJECTIVES: Most head and neck surgeons believe that if a stone is located in the deep region and there are signs of obstruction or inflammation, the submandibular gland will be irreparably damaged and should be excised. In this study, we introduce new surgical techniques for the deep stones. METHODS: In total, 123 cases of the deep stones (hilum or parenchyma itself) of the submandibular gland were included in this study. They were all applied to remove the stone intraorally carried out in a recent four-year period. The surgical techniques can be classified as type I: stone removal only: type II: stone and sublingual gland removal; and type III: stone and sublingual gland removal with duct marsupialization. The age, sex, post-operative complications, and long-term morbidity were reviewed. RESULTS: All patients received follow-up care for the recurrence of the stone or duct stenosis. Two patients showed duct stenosis and stone recurrence. In the duct stenosis, the patient was tolerable and simply followed up at clinic. All patients were satisfied because of the avoidance of an external scar. CONCLUSIONS: We recommend the stone removal without excision of the submandibular gland in the deep stone of the submandibular duct. Although the surgical exposure may be difficult due to narrow surgical field, the stone lies in the hilum of the duct or in the parenchyma of the gland itself could be removed intraorally. SP218 – Intravascular lipoma of the left internal jugular vein Dev P Kamdar, MD (presenter); Shamit Chopra; Ho-Sheng Lin, MD; Corey Treadway, MD OBJECTIVES: 1) To present the first-ever reported case of an intravascular lipoma arising in the internal jugular vein. 2) To review the relevant radio logic and pathologic findings of such a lesion. METHODS: Case report. RESULTS: N/A CONCLUSIONS: Intravascular lipomas are quite rare. There have been very few cases reported in literature, and all of those have been of lipomas arising in the venae cavae and the