RESUMEN
The objective of the study was to analyze the incidence, treatment, and prevention of early and late respiratory complications in a series of patients who had supracricoid partial laryngectomies with either cricohyoidoepiglottopexy or cricohyoidopexy. From medical charts, we retrospectively reviewed 101 patients who underwent supracricoid partial laryngectomies, from 1980 to 2006, for laryngeal squamous cell carcinoma, and recorded the various postoperative complications and the time of decannulation. The mortality rate was 3.96%. Early complications included broncho-pulmonary infections and laryngeal stenoses which occurred in 9.9%. Univariate analysis showed a statistically significant relationship between the pulmonary complications and neck dissections (p < 0.04). Later, they were due to laryngeal obstruction (neolaryngeal mucosal flap, residual false vocal cord fold or arytenoid edema). The median decannulation time was 8 days, and there was a significant relationship between the decannulation delay and the pulmonary complications. Only two patients had a later definitive tracheotomy. Respiratory complications after supracricoid partial laryngectomy are frequent, but can be easily managed in most cases. A preoperative pulmonary assessment is necessary to select patients. During surgery, a precise impaction of the hyoid bone with the cricoid cartilage and a repositioning of an arytenoid can avoid some postoperative stenoses.
Asunto(s)
Obstrucción de las Vías Aéreas/epidemiología , Carcinoma de Células Escamosas/cirugía , Cartílago Cricoides/cirugía , Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Obstrucción de las Vías Aéreas/prevención & control , Obstrucción de las Vías Aéreas/cirugía , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/radioterapia , Terapia Combinada , Femenino , Humanos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/radioterapia , Terapia por Láser , Masculino , Persona de Mediana Edad , Disección del Cuello , Estadificación de Neoplasias , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/cirugía , Radioterapia Adyuvante , Reoperación , Estudios Retrospectivos , TraqueotomíaRESUMEN
BACKGROUND: Primary involvement of the sphenoid sinus occurs in 2% of all paranasal sinus tumors and is associated with dismal prognosis. Optimal management remains debatable. METHODS: A total of 23 patients were treated for a primary cancer of the sphenoid sinus from 1988 to 2004. Charts were reviewed for patient-, tumor-, and treatment-related parameters. Univariate and multivariate analyses were conducted to identify prognostic factors for locoregional control and survival. RESULTS: Cranial neuropathies were present in 12 patients. Pathologic findings included adenoid cystic carcinoma, adenocarcinoma, lymphoma, squamous cell carcinoma, sarcoma, neuroendocrine carcinoma, melanoma, and malignant hemangiopericytoma. All but 2 patients had stages III to IV cancer. Radiotherapy was performed in 18 patients and chemotherapy in 12. Of 10 patients undergoing surgery, total excision with grossly negative margins was achieved in 4 patients and subtotal resection in 6. Median locoregional control and overall survival were 12 and 41 months, respectively. On multivariate analysis, cranial neuropathy was associated with worse locoregional control and survival. Surgery was rarely complete because of advanced stages at presentation, but it yielded better outcomes than other treatments without surgery in non lymphoma-cases. CONCLUSION: Early CT and MRI should be performed when facing aspecific, rhinological, or neuro-ophtalmological symptoms. Cranial neuropathies indicate a worse prognosis. Surgery, including debulking surgery, may be preferred to combined modality treatments without surgery. Its apparently favorable impact on prognosis would need to be tested in homogenous histological groups of patients, which is impossible because of the rarity of the disease. Highly conformal radiotherapy (adjuvant or definitive) should be encouraged and optimized with concurrent chemotherapy in advanced stages. Aggressive multidisciplinary management including surgery, chemotherapy, and radiotherapy should be encouraged and adapted on histology and tumor extensions. Progress is still warranted to improve outcomes.
Asunto(s)
Neoplasias de los Senos Paranasales/mortalidad , Neoplasias de los Senos Paranasales/terapia , Seno Esfenoidal/patología , Adulto , Anciano , Carcinoma/mortalidad , Carcinoma/patología , Carcinoma/terapia , Quimioterapia Adyuvante , Enfermedades de los Nervios Craneales/complicaciones , Diagnóstico por Imagen , Femenino , Humanos , Linfoma de Células B/mortalidad , Linfoma de Células B/patología , Linfoma de Células B/terapia , Masculino , Melanoma/mortalidad , Melanoma/patología , Melanoma/terapia , Meningioma/mortalidad , Meningioma/patología , Meningioma/terapia , Persona de Mediana Edad , Análisis Multivariante , Neoplasias de los Senos Paranasales/patología , Plasmacitoma/mortalidad , Plasmacitoma/patología , Plasmacitoma/terapia , Cuidados Preoperatorios , Radioterapia Adyuvante , Radioterapia Conformacional , Seno Esfenoidal/cirugíaRESUMEN
Schizophyllum commune, a basidiomycete fungus, is a rare cause of mycotic disease. We report here a case of sinusitis in a 35-year-old woman that underscores the value of molecular biology for the diagnosis of this fungal infection.
Asunto(s)
Sinusitis del Etmoides/diagnóstico , Sinusitis del Etmoides/microbiología , Micosis/diagnóstico , Micosis/microbiología , Schizophyllum/aislamiento & purificación , Adulto , Sinusitis del Etmoides/patología , Sinusitis del Etmoides/cirugía , Femenino , Humanos , Senos Paranasales/diagnóstico por imagen , Radiografía , Schizophyllum/genética , Análisis de Secuencia de ADNRESUMEN
Paranasal sinus mucocele is a benign pseudocystic lesion, which may originate from any of the sinus cavities. Although the diagnosis may be suggested by the clinical presentation, CT is necessary to accurately analyze the regional anatomy and extent of the lesion. MRI is helpful in defining the limited unusual lesions occurring in critical areas. Standard treatment is surgical marsupialization, through endonasal sinus surgery, which offers a conservative, minimally invasive approach, and respects the sinus architecture and natural drainage. Our long-term experience with the endonasal endoscopic approach for the treatment of mucoceles led us to subsequently expand our indications to include most mucoceles, either as the sole approach or associated with an external approach. Comprising the surgical experience of two collaborating universities, this paper describes the indications for the endonasal surgical approach and the long-term postoperative followup.