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Subtotal reconstructive laryngectomy
Otolaryngology Head and Neck Surgery Volume 117 Number 2
after laryngectomy and a 73-year-old female patient who suffered from neuromuscular dystrophia. Her swallowing disorder was caused by an increased tone of the cricopharyngeal muscle compared with the surrounding muscular tissue. Diagnosis was made by clinical findings and barium swallows. No CT scans or angiographies to exclude aberrant vessels in the tissue bridge had to be performed. The power of the CO 2 laser was set at 1-2 Watt, cwmode with a focal diameter of 0.25 mm, working distance being 400 mm. Results: Exposure of the tissue bridge was improved through the spreadable diverticuloscope. Employing the low power setting of the CO 2 laser reduced the fume production significantly, rendering excellent vision to the operating field, magnified by the microscope. Blood vessels could thus be identified easily. Although the mediastinum was always opened, no case of putrid mediastinitis could be observed, whereas a lot of patients developed a high fever for 24 hours, which was interpreted as a short-lasting mediastinal inflammation requiring no specific therapy. All but one patient were relieved from their symptoms, regardless of what the underlying disease was. In five patients treatment had to be repeated for a relapse due to incomplete dissection of the tissue bridge in the first session. No recurrent nerve paralysis was seen. Conclusion: The endoscopic tissue bridge dissection with the CO 2 laser at a low power setting seems to be a recommendable method for the treatment of obstructed deglutition caused by hypopharyngeal tissue bridges of various etiologies. There is no risk for recurrent nerve paralysis and it is easy to learn, cheap, repeatable, and requires only short hospitalization of the patients. 109
Subtotal Reconstructive Laryngectomy ALP DEMIRELLER, MD, MUSTAFA SAATCI, MD, and YUCEL AKBAS, MD, Ankara, Turkey
Objective: Subtotal reconstructive laryngectomy (SRL) is an alternative technique described for extensive tumors of the larynx that are behind the limits of classical conservative partial laryngectomies and otherwise should be treated by total laryngectomy. Method: Twenty-six patients with laryngeal carcinoma underwent SRL between 1991 and 1996. The median age was 53.8. Twenty-five patients were primary admissions, and one had recurrent disease previously treated by irridiation. In 15 cases SRL type Ia was performed, in 10 cases type Ib was performed, and in one case type II was performed. In supraglottic carcinomas bilateral elective neck dissection was performed. In glottic carcinomas neck dissection was performed in the presence of clinically positive lymph node. None of patients were treated by postoperative irradiation. Results: As oncologic result: one patient who is still alive had local recurrence and was treated by total laryngectomy. No distant metastases were seen. Functional results of SRL
Scientific Pesters
P 195
are that 25 patients were successfully decannulated; one patient treated by SRL type II c o u l d n ' t tolerate decannulation. In one patient aspiration pneumonia occurred as a result of swallowing impairment. In none of the patients temporary or permanent gastrostomy was needed. Conclusions: Although prolonged hospital stay and delayed physiological functions can be termed as disadvantages of SRL, the operation is reliable and oncologically valid procedure in selected cases of patients with laryngeal carcinoma who otherwise would be treated by total laryngectomy. 110
Prognostic Significance of BCL-2 Expression in Tumor of A d v a n c e d Squamous Cell Carcinoma of the Head and Neck MICHAEL FRIEDMAN, MD, FACS, DAVID CALDARELLI, MD, JOSEPH ALLEGREI-fi, MD, BRUCE HUDKINS, MD, and HASAN TANYERI, MD, Chicago, III.
The BCL-2 genes have an important role in regulating programmed cell death (apoptosis). Previously we found a high correlation between BCL-2 overexpression in laryngeal cancers and a poor response to surgical or radiation treatment. Based on these results, we expanded our study to evaluate the prognostic significance of BCL-2 overexpression in the center and the margins of advanced squamous cell carcinoma. We studied specimens with immunohistochemistry and polymerase chain reaction techniques to identify the BCL-2 family (BCL-1, BAX, BCL-X, MCL-1) in primary recurrent tumors. We found a positive trend toward overexpression of several of these gene markers, including BCL-2 itself, in patients with recurrence. The BCL-2 gene family may play a role in the future guiding adequate tumor resections and in postoperative surveillance for recurrence. 111
Accuracy of Parotid Tumor Fine-needle Aspiration and Its Effect on Histologic Diagnosis MONTAGUE CARR, MD, GREG LICAMELI, MD, ROBERT DOLAN, MD, GERARD DOMANOSWSKI, MD, and NABIL FULEIHAN, MD, Boston, Mass.
Objective: This study was performed to assess the accuracy of preoperative parotid fine-needle aspiration (FNA) at our institution and to determine if the performance of FNA on the parotid gland, which produces tissue lytic enzymes, complicates histologic diagnosis of parotid tumors. Methods: We reviewed and compared 42 cases of parotid FNA with the results of tumor histologic over an 11-year period from June 1983 to June 1994 from 41 patients. Histologic sections of parotid tumors that had undergone FNA were studied to assess if any architectural changes were present and if these were believed to complicate diagnosis. Results: Overall sensitivity for benign verses malignant parotid neoplasms was 85.7%. Fine-needle aspiration was more sensitive in diagnosing benign disease (32 of 34)
after laryngectomy and a 73-year-old female patient who suffered from neuromuscular dystrophia. Her swallowing disorder was caused by an increased tone of the cricopharyngeal muscle compared with the surrounding muscular tissue. Diagnosis was made by clinical findings and barium swallows. No CT scans or angiographies to exclude aberrant vessels in the tissue bridge had to be performed. The power of the CO 2 laser was set at 1-2 Watt, cwmode with a focal diameter of 0.25 mm, working distance being 400 mm. Results: Exposure of the tissue bridge was improved through the spreadable diverticuloscope. Employing the low power setting of the CO 2 laser reduced the fume production significantly, rendering excellent vision to the operating field, magnified by the microscope. Blood vessels could thus be identified easily. Although the mediastinum was always opened, no case of putrid mediastinitis could be observed, whereas a lot of patients developed a high fever for 24 hours, which was interpreted as a short-lasting mediastinal inflammation requiring no specific therapy. All but one patient were relieved from their symptoms, regardless of what the underlying disease was. In five patients treatment had to be repeated for a relapse due to incomplete dissection of the tissue bridge in the first session. No recurrent nerve paralysis was seen. Conclusion: The endoscopic tissue bridge dissection with the CO 2 laser at a low power setting seems to be a recommendable method for the treatment of obstructed deglutition caused by hypopharyngeal tissue bridges of various etiologies. There is no risk for recurrent nerve paralysis and it is easy to learn, cheap, repeatable, and requires only short hospitalization of the patients. 109
Subtotal Reconstructive Laryngectomy ALP DEMIRELLER, MD, MUSTAFA SAATCI, MD, and YUCEL AKBAS, MD, Ankara, Turkey
Objective: Subtotal reconstructive laryngectomy (SRL) is an alternative technique described for extensive tumors of the larynx that are behind the limits of classical conservative partial laryngectomies and otherwise should be treated by total laryngectomy. Method: Twenty-six patients with laryngeal carcinoma underwent SRL between 1991 and 1996. The median age was 53.8. Twenty-five patients were primary admissions, and one had recurrent disease previously treated by irridiation. In 15 cases SRL type Ia was performed, in 10 cases type Ib was performed, and in one case type II was performed. In supraglottic carcinomas bilateral elective neck dissection was performed. In glottic carcinomas neck dissection was performed in the presence of clinically positive lymph node. None of patients were treated by postoperative irradiation. Results: As oncologic result: one patient who is still alive had local recurrence and was treated by total laryngectomy. No distant metastases were seen. Functional results of SRL
Scientific Pesters
P 195
are that 25 patients were successfully decannulated; one patient treated by SRL type II c o u l d n ' t tolerate decannulation. In one patient aspiration pneumonia occurred as a result of swallowing impairment. In none of the patients temporary or permanent gastrostomy was needed. Conclusions: Although prolonged hospital stay and delayed physiological functions can be termed as disadvantages of SRL, the operation is reliable and oncologically valid procedure in selected cases of patients with laryngeal carcinoma who otherwise would be treated by total laryngectomy. 110
Prognostic Significance of BCL-2 Expression in Tumor of A d v a n c e d Squamous Cell Carcinoma of the Head and Neck MICHAEL FRIEDMAN, MD, FACS, DAVID CALDARELLI, MD, JOSEPH ALLEGREI-fi, MD, BRUCE HUDKINS, MD, and HASAN TANYERI, MD, Chicago, III.
The BCL-2 genes have an important role in regulating programmed cell death (apoptosis). Previously we found a high correlation between BCL-2 overexpression in laryngeal cancers and a poor response to surgical or radiation treatment. Based on these results, we expanded our study to evaluate the prognostic significance of BCL-2 overexpression in the center and the margins of advanced squamous cell carcinoma. We studied specimens with immunohistochemistry and polymerase chain reaction techniques to identify the BCL-2 family (BCL-1, BAX, BCL-X, MCL-1) in primary recurrent tumors. We found a positive trend toward overexpression of several of these gene markers, including BCL-2 itself, in patients with recurrence. The BCL-2 gene family may play a role in the future guiding adequate tumor resections and in postoperative surveillance for recurrence. 111
Accuracy of Parotid Tumor Fine-needle Aspiration and Its Effect on Histologic Diagnosis MONTAGUE CARR, MD, GREG LICAMELI, MD, ROBERT DOLAN, MD, GERARD DOMANOSWSKI, MD, and NABIL FULEIHAN, MD, Boston, Mass.
Objective: This study was performed to assess the accuracy of preoperative parotid fine-needle aspiration (FNA) at our institution and to determine if the performance of FNA on the parotid gland, which produces tissue lytic enzymes, complicates histologic diagnosis of parotid tumors. Methods: We reviewed and compared 42 cases of parotid FNA with the results of tumor histologic over an 11-year period from June 1983 to June 1994 from 41 patients. Histologic sections of parotid tumors that had undergone FNA were studied to assess if any architectural changes were present and if these were believed to complicate diagnosis. Results: Overall sensitivity for benign verses malignant parotid neoplasms was 85.7%. Fine-needle aspiration was more sensitive in diagnosing benign disease (32 of 34)