SP201 – Extensive poroid hidradenocarcinoma of the head and neck

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Otolaryngology-Head and Neck Surgery, Vol 141, No 3S1, September 2009

occur with recurrent lesions, but basic demographics do not seem to influence rate of facial nerve paralysis. SP179 – Experience with the hairline incision for neck dissection Yoav P Talmi, MD (presenter); Lev Bedrin, MD, PhD; David Talmor, MD OBJECTIVES: 1) Learn the principles of the presented incision and its application. 2) Evaluate the three-year experience with its utilization. METHODS: A prospectively evaluated case series operated on between 2005 and 2008. All patients underwent neck dissection as an isolated or combined procedure in the Sheba tertiary referral center utilizing the extended hairline incision. This is performed by incorporating a single transverse incision as far as the hairline, and then curving it up along the hairline border as high as needed without cosmetic compromise. Access during surgery and cosmetic results were evaluated. RESULTS: Twenty-three cases, 16 with thyroid malignancy, underwent neck dissection with this approach. Access was excellent in all cases. In four patients, the upper limb of the incision had widened up to one cm. This was revised in one case. CONCLUSIONS: While the need for exposure for neck dissection beyond a single transverse incision is uncommon in thyroid surgery, this approach is advantageous when better exposure is needed. This can occur during the procedure while the surgeon is committed to the transverse line or in those cases where a wide approach is needed with the desire to provide a maximally pleasing cosmetic result. Application of this incision is useful in selected cases of non-thyroid cancer requiring neck dissection. SP229 – Expression of oncostatin M in chronic obstructive sialadenitis Hyo Hyun Park, MS (presenter); Heung-Man Lee, MD, PhD; Jeong-Soo Woo, MD OBJECTIVES: We investigated the expression of oncostatin M messenger RNA (mRNA) and protein in normal submandibular glands and those with chronic obstructive sialadenitis and localized the expression of oncostatin M protein. METHODS: Submandibular glands from 10 patients with chronic obstructive sialadenitis as a study group, and 10 normal submandibular glands as a control group, were examined. Oncostatin M mRNA extracted from submandibular gland was used for reverse transcription-polymerase chain reaction and analyzed semiquantitatively. The difference in expression level of oncostatin M protein between the two groups was analyzed through western blot analysis, and oncostatin M protein was localized. RESULTS: The expression levels of oncostatin M mRNA and

protein were significantly increased in the study group. The protein was predominantly localized in ductal epithelia and infiltrating inflammatory cells and was also more strongly expressed in the study group. CONCLUSIONS: Oncostatin M is expressed in both chronic obstructive sialadenitis and normal submandibular gland, and is up-regulated in chronic obstructive sialadenitis. These results suggest that oncostatin M is involved in the pathologic process of chronic obstructive sialadenitis. However, the physiologic role in normal glands, as well as a possible role in the development of chronic obstructive sialadenitis, remains to be elucidated. SP201 – Extensive poroid hidradenocarcinoma of the head and neck Sreekrishna K Donepudi, MD (presenter); Sandeep Samant, MD, FRCS; John Hodges, MD OBJECTIVES: To present a case of extensive poroid hidradenocarcinoma and to review the literature regarding this rare malignant sweat gland tumor. METHODS: A 73-year-old female presented with a massive, ulcerated tumor involving the right side of her face, temporoparietal scalp, and upper neck that had been progressively enlarging for four years. The patient complained of a “cutting, sawing, and tightening” pain in her face as well as difficulty tolerating her oral secretions. She denied dyspnea, dysphagia, and odynophagia. She was otherwise healthy without a significant past medical history. She did have a complete facial palsy on the side of the tumor. Biopsy of the mass showed poroid hidradenocarcinoma. RESULTS: The patient underwent staged partial craniofacial resection extending to the infratemporal fossa and parapharyngeal space, ipsilateral neck dissection, and reconstruction with pectoralis major myocutaneous flap. A second stage procedure was performed two months later by the neurosurgical service to remove residual tumor in the right temporal bone, middle fossa, and infratemporal fossa. The following month, the patient developed an acute right jugular foramen syndrome with multiple lower cranial nerve deficits. Magnetic resonance imaging revealed a recurrence in her right temporal lobe and she underwent another craniectomy. External beam radiation had been recommended but declined by the patient and her family. CONCLUSIONS: Porocarcinomas predominately affect the elderly, originate from eccrine sweat gland ducts, and are locally aggressive with significant risk of metastasis and recurrence after surgical excision. Wide excision with negative margins is the mainstay of treatment as metastasis is often fatal. SP219 – Facial keratoacanthoma: Treatment cost analysis and outcomes Patrick Chase Lay, MD (presenter); WeiWei Dai, DO; James Malone, MD