OBJECTIVE-No study has evaluated the effect of the multidisciplinary head and neck tumor board on treatment planning. The objective of this study is to determine the efficacy of the multidisciplinary tumor board in altering diagnosis, stage, and treatment plan in patients with head and neck tumors.STUDY DESIGN-Case series with planned data collection.
SETTING-Comprehensive cancer center and tertiary academic hospital.SUBJECTS AND METHODS-A prospective study of the discussions concerning 120 consecutive patients presented at a multidisciplinary head and neck tumor board was performed. As each patient was presented, record was made of the "pre-conference" diagnosis, stage, and treatment plan. After case discussion, the "post-conference" diagnosis, stage, and treatment plan were recorded. Results are compared between malignant and benign tumor cohorts.
RESULTS-The study population was comprised of 120 patients with new presentations of head and neck tumors -84 malignancies and 36 benign tumors. Approximately 27% of patients had some change in tumor diagnosis, stage, or treatment plan. Change in treatment was significantly more common in cases of malignancy, occurring in 24% of patients versus 6% of benign tumors (p = 0.0199). Changes in treatment were also noted to be largely escalations in management (p = 0.0084), adding multi-modality care.CONCLUSION-A multidisciplinary tumor board affects diagnostic and treatment decisions in a significant number of patients with newly diagnosed head and neck tumors. The multidisciplinary approach to patient care may be particularly effective in managing malignant tumors, in which treatment plans are most frequently altered.
Several potential anatomic limits must be considered in pediatric skull base surgery, and these vary according to age. Piriform aperture is likely a limit only in the youngest patients (under 2 years). Sphenoid pneumatization to the planum and sella start at 3 years and complete by age 10 years. Clival intercarotid distances do not change significantly and are not prohibitively narrow in any age group.
Esthesioneuroblastoma is an uncommon tumor that presents in the sinonasal cavity and anterior skull base. Cervical metastases are not frequently found on initial presentation but eventually occur in 20-25% of these patients. This presents the treating physician with the difficult decision as to how and when to treat the neck in this disease. The aims of this study were to provide a comprehensive review of the incidence of N+ disease at presentation, make recommendations about the optimal treatment strategy of patients with N+ disease, explain the role of elective neck treatment in patients with N0 disease, and comment on treatment of patients with late cervical
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. E xternal approaches to the orbit are well established, including the lateral, medial, and inferior orbitotomy. Orbitozygomatic craniotomy can be used for tumors that extend both intracranially and into the orbit and is used for exposure of the optic nerve and canal. 1 Since the 1980s, endoscopic measures have been used to enhance visualization in standard external approaches. 2 Endoscopic endonasal orbital and optic nerve decompressions have become accepted treatments for thyroid eye disease and traumatic optic neuropathy that is unresponsive to steroids. A few case reports of endoscopic decompression, biopsy, and resection of tumors that involve the orbit also have been reported. [3][4][5] The expanded endonasal approach (EEA) has been extended to resection of all types of skull base tumors, including posterior, middle, and anterior fossa masses. In this report, we describe the anatomic principles, indications, technical nuances, and limitations of the medial-inferior intraconal EEA to intraorbital tumor surgery, illustrated through a case series of six patients. This approach is ideally suited to benign soft-tissue masses (hemangioma/lymphangioma) in the medial-inferior quadrant of the orbit that do not extend superolaterally. The use of this technique would avoid the technical difficulties in approaching such masses and limit the dissection to the areas bordering the endonasal corridor.
Our data showed that 77% of physicians who regularly perform EES suffer physical discomfort or symptoms attributable to EES. As expanded endonasal procedures become more prevalent, additional data and ergonomic analysis are necessary to reverse this trend and reduce possible long-term damage for surgeons.
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