This article presents our experience with the management and outcomes of patients with sporadic glomus jugular tumors using a tailored surgical approach. We conducted a retrospective study of 49 patients with sporadic jugular paragangliomas. Thirty-eight patients (78%) were treated using the transmastoid-infralabyrinthine (TM-IL) approach, and 11 (22%) were treated with the infratemporal fossa type A (IFT-A) approach. Mean follow-up period was 8.2 years. Surgical cure was achieved in all but 6 patients using the TM-IL approach (84%) and in 8 of 11 patients with the IFT-A approach (73%). A House-Brackmann grade of I or II facial nerve function was obtained postoperatively in 84% of TM-IL cases and in 56% of the IFT-A cases. The incidence of other complications-meningitis and transient cerebrospinal fluid leak-was higher in the TM-IL group (8% and 13%, respectively) compared with the IFT-A group (0% and 9%, respectively). We concluded that the TM-IL approach with individually tailored management of the facial nerve fulfills the long-term requirements of both keeping good postoperative facial function and obtaining adequate tumor resection.
The main goal of our dynamic 3D computer-assisted reconstruction of a metallic retrobulbar foreign body following orbital injury with ethmoid bone involvement was to use 3D-information obtained from standard computed tomography (CT) data to explore and evaluate the nasal cavity, ethmoidal sinuses, retrobulbar region, and the foreign body itself by simulated dynamic computed visualization of the human head. A foreign body, 10 x 30 mm in size, partially protruded into the posterior ethmoidal cells and partially into the orbit, causing dislocation and compression of the medial rectus muscle and inferior rectus muscle. The other muscles and the optic nerve were intact. Various steps were taken to further the ultimate diagnosis and surgery. Thin CT sections of the nasal cavity, orbit and paranasal sinuses were made on a conventional CT device at a regional medical center, CT scans were transmitted via a computer network to different locations, and special views very similar to those seen on standard endoscopy were created. Special software for 3D modeling, specially designed and modified for 3D C-FESS purposes, was used, as well as a 3D-digitizer connected to the computer and multimedia navigation through the computer during 3D C-FESS. Our approach achieves the visualization of very delicate anatomical structures within the orbit in unconventional (non-standard) sections and angles of viewing, which cannot be obtained by standard endoscopy or 2D CT scanning. Finally, virtual endoscopy (VE) or a 'computed journey' through the anatomical spaces of the paranasal sinuses and orbit substantially improves the 3D C-FESS procedure by simulating the surgical procedure prior to real surgery.
OBJECTIVE:Although PET-CT has been shown to have diagnostic and staging value for the head and neck carcinoma, it still has deficiencies to give an optimal level of sensitivity and specificity. High levels of false positivity continue to be the biggest clinical challenge. This study evaluates the impact of major clinicopathologic factors on PET-CT findings in the primary and lymph node metastatic head and neck carcinoma. METHOD: Retrospective chart review of a case series at Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute: 243 oral cavity (OC) and laryngopharyngeal carcinoma patients who underwent PET CT and neck dissections in the 3 consecutive years were included in the study. Major primary site was OC followed by oropharynx (OP), larynx and hypoharynx (HP) and carcinoma of unknown primary (CUP). RESULTS: Oral cavity and OP were the two major primary sites (70.3%, nϭ171), followed by larynx, CUP, and HP. 111 patients (45.6 %) were determined to be clinically Nϩ at the time of preoperative evaluation, while pathological Nϩ was detected in 36.2% of patients. Correlation of the PET CT SUV value and the clinicopathologic factors like the size of the largest lymph node, number of positive lymph nodes, extracapsular spread, tumor grade, primary site, size and depth of infiltration of the primary tumor, lymphatic and perineural invasion are all compared; correlation was found with the size and depth of infiltration of the tumor, and number of positive lymph node. Perineural (pϭ0.013) and lymphatic invasion (pϭ0.0093), and extracapsular spread (pϽ0.0001) was significantly altering the SUV value. CONCLUSION: Most of the adverse features of the current pathologic staging system are shown to have significant impact on the PET CT findings. Complication Rates in Stapled vs Suture Closure LaryngectomyLarry Myers, MD (presenter); Deborah Larrison, MD OBJECTIVE: Surgical technique, or fear of increased risk of complications including infection and fistula. The purpose of this study was to examine complication rates with the use of the linear stapling device compared with traditional suture techniques during laryngectomy in a matched cohort of patients. METHOD: This investigation was a retrospective, matched cohort design. The records of all patients undergoing total laryngectomy by the senior author were reviewed from 2002 to 2007. Criteria for inclusion in the study were as follows: Patients must have undergone total laryngectomy within the study period. Only patients with endolaryngeal disease or disease amenable to primary closure were included in the study cohort. This resulted in a total of 42 patients being included in the study. Of these, 26 patients underwent traditional suture closure of the pharynx and 16 patients underwent closure with the linear stapling device. Demographic data, clinical data, treatment data, and outcome data were retrospectively collected and stored in an Excel v12.2 database (Microsoft). Data were analyzed using SPSS v16.0 statistical softwa...
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