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SP192 – Transconjunctival en-bloc excision: Orbital rhabdomyosarcoma
CONCLUSIONS: This study has suggested that the PMM flap as a pharyngeal interposition graft is safe and useful for prevention of wound complications in salvage total laryngectomy following CRT. SP158 – Total laryngopharyngectomy Stijn Keereweer (presenter) OBJECTIVES: 1) Review our results of reconstruction surgery with jejunum interposition or gastric pull-up following total laryngopharyngectomy. 2) Be able to compare our results with chemoradiotherpy in subsequent studies. 3) Be able to provide our patients with adequate preoperative counselling. METHODS: This is a retrospective review including patients who underwent a total laryngopharyngectomy reconstructed with either a jejunum interposition or gastric pull-up procedure in the Erasmus Medical Centre between 1990 and 2007. The success rate, postoperative complications and the restoration of the quality of life including speech and swallowing functions were studied. RESULTS: Sixty-three patients were included, in whom 70 reconstructions were performed (51 jejunum interpositions and 19 gastric pull-up procedures). The success rates were 84% and 74%, respectively. The procedures were associated with a high complication rate (63% after jejunum interposition and 89% after gastric pull up), and a lengthy rehabilitation. Surviving patients were found to have a good long-term quality of life. Complete oral intake was achieved in 97%, and speech rehabilitation in 95%. CONCLUSIONS: These procedures are associated with significant morbidity, high complication rates, lengthy rehabilitation but a good long-term quality of life.
P167 moved en-bloc via upper-lid tranconjunctival approach, incisions of Muellers muscle, levator, tarsus, septum, and lid skin were avoided. It was too large and lateral for transcaruncular technique, and transcutaneous would violate the anterior and middle lamella. Chart and literature reviews compared outcomes of transconjunctival technique to transcaruncular, transcutaneous, lateral canthotomy, endoscopic transnasal, and various anterior fossa craniotomies. RESULTS: Preexisting diplopia and proptosis resolved and he showed no decrease in visual acuity early pre-op. Six months status: post chemotherapy and radiation there was trace radiation-induced vision loss (20/40). Our review showed no history of this technique being used for tumor excision from the orbit. Cosmetic and functional outcomes were excellent compared to external techniques. Chart and literature review of upper-lid transconjunctival procedures showed superior cosmesis and no complications, except hemorrhage (⬍5%). External approaches leave scars with higher complication rates that may be avoidable. Transnasal and craniotomy techniques have significant rates of infection (5 to 10%) and CSF leak (7 to 14%). CONCLUSIONS: The upper-lid transconjunctival approach to the orbital vault is a practical technique for the removal of well circumscribed masses superior, posterior, or medial to the globe itself or for tissue diagnosis of less defined lesions. The advantage of no external scar and avoidance of dissection in the anterior and middle lamella of the upper lid affords lower complication and better cosmetic outcomes. The safety record of transconjunctival Muellers muscle resections suggests smaller well-circumscribed tumors of the orbit can be removed with minimal risk. More invasive techniques are more appropriate for diagnosis and/or removal of larger more diffusely infiltrating lesions.
SP192 – Transconjunctival en-bloc excision: Orbital rhabdomyosarcoma Patrick Chase Lay, MD (presenter); Stuart Farris, MD
SP221 – Transoral laser microsurgery for T3 laryngeal tumors Isabel Vilaseca, MD, PhD (presenter); Manuel Bernal-Sprekelsen, MD, PhD; Jose L Blanch
OBJECTIVES: 1) Describe a practical minimally invasive approach to orbital tumors with no external incision. 2) Be able to demonstrate the specific technique used and anatomical considerations in the upper-lid transconjunctival orbitotomy and orbital vault exploration using a thorough series of intraoperative photos. 3) Compare post-op complications and presence of external scars of upper-lid transconjunctival approach against transcutaneous, transcaruncular, lateral canthotomy, endoscopic transnasal, and anterior fossa craniotomy approaches. 4) Show superior cosmetic and functional outcomes for this minimally invasive approach. METHODS: Case report, retrospective review, and literature review from a tertiary care center of an 8-year-old male with proptosis from a 2x3.5cm orbital rhabdomyosarcoma. CT of the orbits revealed a smooth well-demarcated orbital mass between the levator aponeurosis and superior oblique. Re-
OBJECTIVES: Evaluate the oncologic and functional outcomes of transoral laser microsurgery (TLM) radiation therapy in the treatment of T3 laryngeal carcinomas, and to identify prognostic factors for survival and laryngeal preservation according to pT subcategories. METHODS: Retrospective analysis of 147 consecutive T3 laryngeal carcinomas treated with TLM at a single institution. Overall survival, disease-specific survival, laryngectomy-free survival, and function preservation rate were evaluated. RESULTS: Five-year overall, disease-specific, and laryngectomy-free survival was 53.1%, 70.2% and 62.3%, respectively. Disease-specific survival differed between glottic and supraglottic tumors (86.3% vs 61.8%, p ⫽ 0.015). Disease-specific survival was not related to pre-epiglottic involvement, vocal cord fixation, or focal cartilage infiltration in our sample (p ⬎ 0.05). Five-year function preservation was 65.5% in supraglot-
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Program Poster Presentations
P167 moved en-bloc via upper-lid tranconjunctival approach, incisions of Muellers muscle, levator, tarsus, septum, and lid skin were avoided. It was too large and lateral for transcaruncular technique, and transcutaneous would violate the anterior and middle lamella. Chart and literature reviews compared outcomes of transconjunctival technique to transcaruncular, transcutaneous, lateral canthotomy, endoscopic transnasal, and various anterior fossa craniotomies. RESULTS: Preexisting diplopia and proptosis resolved and he showed no decrease in visual acuity early pre-op. Six months status: post chemotherapy and radiation there was trace radiation-induced vision loss (20/40). Our review showed no history of this technique being used for tumor excision from the orbit. Cosmetic and functional outcomes were excellent compared to external techniques. Chart and literature review of upper-lid transconjunctival procedures showed superior cosmesis and no complications, except hemorrhage (⬍5%). External approaches leave scars with higher complication rates that may be avoidable. Transnasal and craniotomy techniques have significant rates of infection (5 to 10%) and CSF leak (7 to 14%). CONCLUSIONS: The upper-lid transconjunctival approach to the orbital vault is a practical technique for the removal of well circumscribed masses superior, posterior, or medial to the globe itself or for tissue diagnosis of less defined lesions. The advantage of no external scar and avoidance of dissection in the anterior and middle lamella of the upper lid affords lower complication and better cosmetic outcomes. The safety record of transconjunctival Muellers muscle resections suggests smaller well-circumscribed tumors of the orbit can be removed with minimal risk. More invasive techniques are more appropriate for diagnosis and/or removal of larger more diffusely infiltrating lesions.
SP192 – Transconjunctival en-bloc excision: Orbital rhabdomyosarcoma Patrick Chase Lay, MD (presenter); Stuart Farris, MD
SP221 – Transoral laser microsurgery for T3 laryngeal tumors Isabel Vilaseca, MD, PhD (presenter); Manuel Bernal-Sprekelsen, MD, PhD; Jose L Blanch
OBJECTIVES: 1) Describe a practical minimally invasive approach to orbital tumors with no external incision. 2) Be able to demonstrate the specific technique used and anatomical considerations in the upper-lid transconjunctival orbitotomy and orbital vault exploration using a thorough series of intraoperative photos. 3) Compare post-op complications and presence of external scars of upper-lid transconjunctival approach against transcutaneous, transcaruncular, lateral canthotomy, endoscopic transnasal, and anterior fossa craniotomy approaches. 4) Show superior cosmetic and functional outcomes for this minimally invasive approach. METHODS: Case report, retrospective review, and literature review from a tertiary care center of an 8-year-old male with proptosis from a 2x3.5cm orbital rhabdomyosarcoma. CT of the orbits revealed a smooth well-demarcated orbital mass between the levator aponeurosis and superior oblique. Re-
OBJECTIVES: Evaluate the oncologic and functional outcomes of transoral laser microsurgery (TLM) radiation therapy in the treatment of T3 laryngeal carcinomas, and to identify prognostic factors for survival and laryngeal preservation according to pT subcategories. METHODS: Retrospective analysis of 147 consecutive T3 laryngeal carcinomas treated with TLM at a single institution. Overall survival, disease-specific survival, laryngectomy-free survival, and function preservation rate were evaluated. RESULTS: Five-year overall, disease-specific, and laryngectomy-free survival was 53.1%, 70.2% and 62.3%, respectively. Disease-specific survival differed between glottic and supraglottic tumors (86.3% vs 61.8%, p ⫽ 0.015). Disease-specific survival was not related to pre-epiglottic involvement, vocal cord fixation, or focal cartilage infiltration in our sample (p ⬎ 0.05). Five-year function preservation was 65.5% in supraglot-
POSTERS
Program Poster Presentations