Combined Transcranial and Endoscopic Endonasal Approach for Resection of a Complex Sinonasal Squamous Cell Carcinoma: Two-Dimensional Operative Video

Sinonasal squamous cell carcinoma (SCC) is a rare head-and-neck neoplasm that has a propensity to locally invade vital structures. Currently, the combination of surgical resection and radiation remains the optimal treatment.1 However, the extent of disease burden and involvement of surrounding anatomy may make these inoperable. Here, we demonstrate the successful application of multidisciplinary approach for surgical resection of a large, complex SCC lesion centered at the superior nasal cavity with extension into the eye orbits and brain. A two-step approach was performed; transcribiform, endoscopic piecemeal resection with reconstruction of the skull base, followed by a bifrontal craniotomy. Reconstruction was achieved using an inlay of DuraMatrix allograft (Stryker Inc., Kalamzoo, Michigan, United States) followed by an inlay of AlloDerm (Allergan Inc., Irvine, California, United States), anchored anteriorly and posteriorly with wide wings placed over the respective orbital roofs. Major steps include (1) a summary of the patient presentation and preoperative imaging, (2) resection of the tumor endonasally, (3) resection of the tumor intracranially from a bifrontal craniotomy, and (4) a review of the postoperative imaging. The patient tolerated the procedure (Fig. 1) well, returned to his baseline with no new neurologic deficits, and was placed on 6-week antibiotics regimen for osteomyelitis discovered during the operation. Approximately, 2 months after discharge, the patient unfortunately returned with altered mental status, was found to have sepsis, and expired shortly thereafter. This operative video illustrates the technical steps and capabilities of surgical treatment, achieving near-complete gross total resection of a complex SCC lesion using a multidisciplinary approach.The link to the video can be found at: https://youtu.be/8ffckKIuBzM.

Epidemiology and Outcomes of Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma (NPC) is a rare head and neck neoplasm worldwide. It is common among the southern Chinese with significant geographical variation with the highest incidence being in Southeast Asia up to 6.4/100,000 males and 2.4/100,000 females in these regions and the Epstein Barr virus (EBV) is associated closely with NPC. This disease has peculiarities in its etiopathogenesis, presentation, risk of nodal and distant metastasis, response to therapy and overall survival (OS) outcomes that stand out as compared to other head and neck cancer subsites. NPC is mainly treated by RT and is profoundly radiosensitive and radiotherapy treatment is the spine of treatment for all stages of NPC without far off metastases. Many advances in RT techniques and schedules are attempted to improve outcomes of the disease starting from intracavitary brachytherapy, intensity modulated RT to simultaneous modulated accelerated RT, all showing some promise with most significant benefit seen with addition of chemotherapy, especially in intermediate (Stage II) and advanced (Stage III, IVA, IVB) cases. At a time when modern radiation treatment like intensity-modulated radiotherapy (IMRT) are accomplishing great good local control, distant metastases are getting to be the transcendent design of treatment failure, particularly in patients with locally progressed illness. There are numerous results from clinical trials looking at combined radiation treatment (RT) and chemotherapy for NPC. Survival rates significantly differ between NPC patients according to stages of disease.

Profile of parotid tumors visiting tertiary health care facility in North India

<p class="abstract"><strong>Background:</strong> Neoplastic lesions of head and neck presenting in a tertiary care facility were analyzed. This study is proposed to examine the epidemiological pattern of parotid tumors, histopathology correlations and relation of facial nerve with the parotid tumors.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective study of patients with head and neck neoplasms who presented to the ENT tumour clinic of Dayanand Medical College and Hospital over a period of 2 years i.e., from January 2018 to December 2019. Patients’ demographic profile, histopathological reports and pre-operative fine needle aspiration cytology reports were studied. </p><p class="abstract"><strong>Results:</strong> Total number of cases of head and neck neoplasms were 273 over a period of 2 years. Parotid tumours constituted 9.1% of the total head and neck neoplasm. Predominant age group in case of benign parotid tumors was 40-50 years, whereas in case of malignant neoplasms was 50-60 years. Posterior belly of digastric along with tragal pointer are the most consistent and reliable landmarks for Identification of facial nerve.</p><p><strong>Conclusions:</strong> Identification of trunk of facial nerve using anatomical landmarks is the keystone for parotid surgery. Posterior belly of digastric along with tragal pointer are the most consistent and reliable landmarks for Identification of facial nerve. </p>

Adenoma Pleomorfo de Parótida, Manejo Quirúrgico: A Propósito de un caso

BACKGROUND: Pleomorphic adenoma is the most common benign tumor of the salivary glands, particularly of the parotid gland. The main characteristic of this benign tumor is its slow growth, causing the noticeable presence of facial or cervical mass. The treatment is surgery, with the main risk of postoperative facial paralysis. We present a case report, resolved surgically with a partial pa-rotidectomy, which involves dissection of the facial nerve. CASE REPORTS: A 34 year old female patient, seeking medical attention due to a slow-growing mass in the right parotid region. Patient denied associated symptoms. After CT and Fine needle puncture, the patient was diagnosed of a pleomorphic adenoma of the parotid gland, and treated with right partial parotidectomy. EVOlUTION: The surgical technique used is described on literature, with a variant in the incision type. We used modified Blair incision. The whole tumor was removed. After surgery patient presented with facial paralysis, she was treated with corticoids. Patient was discharged with a House Brackmann 1 score. CONClUSIONS: Accordingly with literature, the resolution of this pathology is surgical, paratidectomy is the only treatment that avoids the mass causing damage to adjacent structures, like the facial nerve. The proper identification and dissection of this nerve, is one of the main concerns of the procedure. KEY WORDS: PAROTID GLAND, PLEOMORPHIC ADENOMA, HEAD AND NECK NEOPLASM, FACIAL PARALYSIS