Limits of ENT surgery: when a multidisciplinary approach is required in skull base, orbit, dental pathologies and head-neck tumours involving skin

OBJECT Adenoid cystic carcinoma (ACC) is a locally aggressive tumor of salivary gland origin. Little data exist to guide treatment when this tumor extends to involve the structures of the skull base. METHODS Fifty-one patients with a diagnosis of ACC affecting the skull base were identified from a prospective database at MD Anderson Cancer Center (from 1992 to 2010). RESULTS Median follow-up for study patients was 6.75 years. The 5- and 10-year overall survival (OS) rates were 78% and 50%, respectively. Sixty-six percent of patients had progression of their disease. The 5- and 10-year progression-free survival (PFS) rates were 46.7% and 21.0%, respectively. Gross-total resection was achieved in 75% of patients, with 49% having microscopically negative margins at the time of first operation. On univariate analysis, resections with microscopically negative margins were associated with a significant OS advantage (20.1 ± 3.3 years) compared with resections that left residual disease, even if microscopic (10.3 ± 1.6 years, p = 0.035). In patients who underwent reoperation, the effect persisted, with improved OS in those with negative margins (21.4 ± 0.0 vs 16.7 ± 4.0 years, p = 0.06). The use of adjuvant radiotherapy was associated with an OS advantage (16.2 ± 2.5 vs 5.5 ± 2.2 years, p = 0.03) at initial diagnosis and improved PFS (7.8 ± 1.0 vs 2.1 ± 0.62 years, p = 0.005), whereas repeat irradiation provided no benefit. The use of adjuvant chemotherapy at diagnosis or at recurrence was not associated with any significant advantage. Multivariate analysis revealed margin-negative resection at initial operation and at recurrence retained OS significance, even after controlling for age, radiation therapy, and T stage. CONCLUSIONS ACC of the skull base is best treated with a multidisciplinary approach aimed at maximal, safe resection. Adjuvant radiotherapy should be offered, whereas chemotherapy does not confer benefit.

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CSO (Canadian Society of Otolaryngology - Head & Neck Surgery) position paper on rhinologic and skull base surgery during the COVID-19 pandemic

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-020-00476-9 ◽

2020 ◽

Vol 49 (1) ◽

Author(s):

Yvonne Chan ◽

Sarfaraz M. Banglawala ◽

Christopher J. Chin ◽

David W. J. Côté ◽

Dustin Dalgorf ◽

...

Keyword(s):

Skull Base ◽

Skull Base Surgery ◽

Neck Surgery ◽

Healthcare Services ◽

Canadian Society ◽

Upper Aerodigestive Tract ◽

Surgical Services ◽

Operative Care ◽

Head Neck Surgery ◽

Head Neck

AbstractHealthcare services in many countries have been partially or completely disrupted by the Coronavirus (COVID-19) pandemic since its onset in the end of 2019. Amongst the most impacted are the elective medical and surgical services in order to conserve resources to care for COVID-19 patients. As the number of infected patients decrease across Canada, elective surgeries are being restarted in a staged manner. Since Otolaryngologists – Head & Neck Surgeons manage surgical diseases of the upper aerodigestive tract where the highest viral load reside, it is imperative that these surgeries resume in a safe manner. The aim of this document is to compile the current best evidence available and provide expert consensus on the safe restart of rhinologic and skull base surgeries while discussing the pre-operative, intra-operative, and post-operative care and tips. Risk assessment, patient selection, case triage, and pre-operative COVID-19 testing will be analyzed and discussed. These guidelines will also consider the optimal use of personal protective equipment for specific cases, general and specific operative room precautions, and practical tips of intra-operative maneuvers to optimize patient and provider safety. Given that the literature surrounding COVID-19 is rapidly evolving, these recommendations will serve to start our specialty back into elective rhinologic surgeries over the next months and they may change as we learn more about this disease.

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Vascular anatomy of the head, neck, and skull base

Neurointerventional Management: Diagnosis and Treatment 2E ◽

10.3109/9781841848075.001 ◽

2012 ◽

pp. 1-20

Author(s):

Michele H. Johnson ◽

Hjalti M. Thorisson ◽

Michael L. DiLuna

Keyword(s):

Skull Base ◽

Vascular Anatomy ◽

Head Neck

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The Making of a Skull Base Team and the Value of Multidisciplinary Approach in the Management of Sinonasal and Ventral Skull Base Malignancies

Otolaryngologic Clinics of North America ◽

10.1016/j.otc.2016.12.017 ◽

2017 ◽

Vol 50 (2) ◽

pp. 457-465 ◽

Cited By ~ 7

Author(s):

Carl H. Snyderman ◽

Eric W. Wang ◽

Juan C. Fernandez-Miranda ◽

Paul A. Gardner

Keyword(s):

Skull Base ◽

Multidisciplinary Approach ◽

Ventral Skull Base

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Department of Head and Neck Surgery, Queen Mary Hospital, University of Hong Kong, China, and Department of Otolaryngology, Head & Neck and Skull Base Surgery, St Vincent's Hospital, University of New South Wales, Sydney, Australia, December 2008 to June 2009

The Journal of Laryngology & Otology ◽

10.1017/s0022215110001581 ◽

2010 ◽

Vol 124 (9) ◽

pp. 1037-1039

Author(s):

C G L Hobbs

Keyword(s):

Hong Kong ◽

Head And Neck ◽

Skull Base ◽

Skull Base Surgery ◽

New South ◽

Neck Surgery ◽

Queen Mary Hospital ◽

South Wales ◽

Head Neck ◽

Sydney Australia

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Management of head & neck cancer: A multidisciplinary approach

Surgical Oncology ◽

10.1016/0960-7404(94)90010-8 ◽

1994 ◽

Vol 3 (2) ◽

pp. 131

Author(s):

N.D. Stafford

Keyword(s):

Neck Cancer ◽

Multidisciplinary Approach ◽

Head Neck Cancer ◽

Head Neck

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Orbital Surgical Guidelines: Pediatric Considerations

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1722637 ◽

2021 ◽

Vol 82 (01) ◽

pp. 142-148

Author(s):

Ann Q. Tran ◽

Michael Kazim

Keyword(s):

Optic Nerve ◽

Skull Base ◽

Plastic Surgery ◽

Surgical Planning ◽

Multidisciplinary Approach ◽

Skull Base Surgery ◽

Maxillofacial Surgery ◽

Interventional Neuroradiology ◽

Orbital Surgery ◽

Surgical Guidelines

AbstractPediatric orbital and skull base surgery comprises a wide array of tumors. An understanding of the location of the lesion, nature of the disease, and surrounding anatomy is paramount to surgical planning in these small spaces. The goals of pediatric skull base surgery are to avoid injury to the surrounding structures, minimize cosmetic deformities, and remove some or all of the tumors based on anticipated pathology and biologic cost of removal. Safe surgery on many of these tumors requires an understanding of the location of the lesion relative to the optic nerve or orbit. This is particularly challenging because the dimensions of the orbital confines change continuously as one navigates from rostral to caudal. Management of these tumors may require a multidisciplinary approach including orbital surgery, neurosurgery, otolaryngology, oral maxillofacial surgery, plastic surgery, and interventional neuroradiology.

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