Surgery Only (surgery + only)

Distribution by Scientific Domains


Selected Abstracts


Prevalence of laryngomalacia in children presenting with sleep-disordered breathing,,§¶

THE LARYNGOSCOPE, Issue 8 2010
Mahilravi Thevasagayam FRCS(Ed) FRCS (ORL-HNS)
Abstract Objective: To determine the prevalence of laryngomalacia among children presenting with symptoms of sleep-disordered breathing (SDB). Method: A retrospective observational study was conducted at a tertiary care paediatric hospital. All children presenting with SDB during a 55-month period were investigated using sleep nasopharyngoscopy (SNP). Patients who had laryngomalacia were identified. Patients who did not present primarily with SDB, or were not examined with SNP were excluded. Data for analysis was collected from a prospectively kept surgical database and medical records. This included patients' demographics, symptoms (including symptoms in infancy), diagnoses, SNP findings, overnight pulse oximetry findings, and treatment. Results: We identified 358 patients with documented primary diagnosis of SDB and who had undergone SNP. Fourteen of these also had a documented diagnosis of laryngomalacia, giving a prevalence rate of 3.9%. Three children were syndromic, and one had cerebral palsy in addition to SDB and laryngomalacia. Three children were obese, and three children had gastroesophageal reflux disease. Seven cases (50%) had symptoms of snoring and/or swallowing dysfunction and/or stridor in infancy. Twelve patients had adenotonsillar surgery. In eight cases symptoms resolved completely with adenotonsillar surgery only. In total, six patients had a supraglottoplasty. There were three failures to supraglottoplasty. Conclusion: The prevalence of laryngomalacia within children presenting with SDB is 3.9%. Our findings support full evaluation of the airway to identify the site of pathology mediating SDB symptoms. Laryngoscope, 2010 [source]


Endoscopic Vertical Partial Laryngectomy,

THE LARYNGOSCOPE, Issue 2 2004
R Kim Davis MD
Abstract Objective: To explain the significant difference between microlaryngoscopy with cordectomy and endoscopic vertical partial laryngectomy (EVPL), to describe the efficacy of EVPL on T1b and T2 glottic squamous cell carcinoma, and to evaluate EVPL with postoperative irradiation in T2 glottic cancer with impaired true vocal cord mobility. Study Design: Retrospective review. Methods: Twenty-six patients seen at the University of Utah Health Science Center between 1987 and 2000 with bilateral T1 (T1b) or T2 squamous cell carcinoma of the glottic larynx underwent EVPL. T2 cancers were classified as follows: a = unilateral disease, b = bilateral disease; i = impaired mobility. T1b and T2a glottic cancer patients received surgery alone, whereas impaired mobility patients (T2ai + T2bi) patients received surgery followed by planned postoperative irradiation. Patients were assessed for primary site control, perioperative and long-term complications, and ultimate cancer control. Results: Survival in the total group was 88.5%, with local control at 92.3%. The two recurrent patients were salvaged by total laryngectomy. For the whole group, anterior commissure involvement was present in 57.7% (15 of 26). Thirteen T2 (5 T2ai + 8 T2bi) carcinoma patients underwent combined therapy, with 8 (61.5%) of these patients having anterior commissure involvement. Two of these patients were upstaged at surgery, one to T3 and one to T4. Local control was 84.5%. Thirteen patients were treated by surgery only, with five of these patients having failed previous irradiation. Survival was 92.3% and local control 100%. This group included two T2bi patients, two patients upstaged to T4 on the basis of extension beyond the subglottis to the anterior wall of the trachea, 3 T2b, and 6 T2a patients. Anterior commissure involvement was seen in 7 (53.8%) of these patients. Conclusions: EVPL alone controlled all T1b and T2a glottic cancer patients, even in the presence of greater than 50% anterior commissure involvement. The significant difference between EVPL and classical microlaryngoscopy with cordectomy was carefully described. EVPL with planned postoperative irradiation resulted in an 85% local control rate in clinically staged T2ai and T2bi cancer patients, including the three upstaged patients. [source]


Clinical and pathologic prognostic features in acinic cell carcinoma of the parotid gland

CANCER, Issue 10 2009
Daniel R. Gomez MD
Abstract BACKGROUND: To the authors' knowledge, the indications for adjuvant treatment in acinic cell carcinoma (AciCC) of the parotid gland have not been elucidated to date. The aim of the current study was to determine patterns of failure and adverse prognostic features. METHODS: Between March of 1989 and August of 2006, 35 patients underwent surgery at Memorial Sloan-Kettering Cancer Center for AciCC of the parotid gland and had their clinical and pathologic features retrospectively analyzed at the primary site. All cases were reviewed by 2 head and neck pathologists. Five-year estimates of survival outcomes were performed, followed by univariate analysis of potential prognostic features. RESULTS: The T classifications were as follows: T1 in 46% of patients, T2 in 23% of patients, T3 in 18% of patients, and T4 in 9% of patients. Three patients had cervical lymph node involvement. All patients underwent surgery as their primary treatment. Approximately 63% of patients (n = 22) received radiation treatment. The median follow-up time for surviving patients was 59.9 months. Five-year estimates of disease-free survival (DFS), overall survival (OS), and local control were 85%, 90%, and 90%, respectively. Of the clinical variables tested, clinical extracapsular extension (ECE), facial nerve sacrifice, and lymph node involvement were found to be significantly associated with a detriment in DFS and OS (P < .05). Positive surgical margins, histologic ECE, >2 mitoses per 10 high-power fields (HPF), atypical mitosis, vascular invasion, perineural invasion, pleomorphism, and necrosis were associated with adverse DFS (P < .05). All of these variables except for vascular invasion (P = .377) and perineural invasion (P = .07) were associated with OS. If high-grade tumors were defined on the basis of high mitotic activity (>2 mitoses/10 HPF) and/or tumor necrosis, high-grade carcinomas had a significantly lower DFS and OS (P = .001). CONCLUSIONS: AciCC had a low treatment failure rate, and a large number of patients could be considered candidates for surgery only. A histologic grading system was devised to help stratify patients for adjuvant treatment. Cancer 2009. © 2009 American Cancer Society. [source]


Therapy of peri-implantitis with resective surgery

CLINICAL ORAL IMPLANTS RESEARCH, Issue 1 2005
A 3-year clinical trial on rough screw-shaped oral implants.
Abstract: The purpose of this randomized clinical trial was to compare the clinical outcome of two different surgical approaches for the treatment of peri-implantitis. Seventeen patients with ITI® implants were included consecutively over a period of 5 years. The patients were randomized with a lottery assignment. Ten patients were treated with resective surgery and modification of surface topography (test group). The remaining seven patients were treated with resective surgery only (control group). Clinical parameters (suppuration, modified plaque index , mPI, modified bleeding index , mBI, probing pocket depth , PPD, pseudopocket , DIM, mucosal recession , REC, probing attachment level , PAL) were recorded at baseline, as well as 6, 12, 24 and 36 months after treatment. The cumulative survival rate for the implants of the test group was 100% after 3 years. After 24 months, two hollow-screw implants of control group were removed because of mobility. Consequently, the cumulative survival rate was 87.5%. The recession index in the control group was significantly lower than in the test group at 24 months (Student's t -value of ,2.14). On the contrary, control group showed higher PPD, PAL and mBI indexes than test group (Student's t -values of +5.5, +2.4 and +9.61, respectively). The PPD and mBI indexes for the implants of the control group were significantly higher at baseline than 24 months later (Student's t -values of +3.18 and +3.33, respectively). Recession and PAL indexes resulted in values significantly lower than baseline (Student's t -values of ,4.62 and ,2.77, respectively). For the implants of the test group PPD and mBI indexes were significantly higher at baseline than 36 months after (Student's t -values of +11.63 and +16.02, respectively). Recession index resulted in values significantly lower at baseline (Student's t -value of ,5.05). No statistically significant differences were found between PAL index measurement at baseline and 36 months later (Student's t -value of +0.89). In conclusion, resective therapy associated with implantoplasty seems to influence positively the survival of oral implants affected by inflammatory processes. Résumé Le but de cet essai clinique randomisé a été de comparer la guérison clinique de deux approches chirurgicales différentes pour le traitement de la paroïmplantite. Dix-sept patients avec des implants ITI® ont été inclus dans cette étude durant une période de cinq années. Les patients étaient répartis au hasard. Dix patients étaient traités avec une chirugie de résection et une modification de la topographie de surface (groupe test). Les derniers sept patients ont été traités avec la chirurgie de résection seulement (groupe contrôle). Des paramètres cliniques [suppuration, indice de plaque modifiée (mPI), indice de saignement modifié (mBI), profondeur de poche au sondage (PPD), pseudo poches (DIM), récession de la muqueuse (Rec), niveau d'attache au sondage (PAL)] ont été mesurés lors de l'examen initial et après six, douze, 24 et 36 mois. Le taux cumulatif pour les implants dans le groupe test était de 100% après trois années. Après 24 mois, deux implants vis creux du groupe contrôle ont été enlevés à cause de la mobilité. En conséquence, le taux de survie cumulatif était de 87,5%. L'indice de récession dans le groupe contrôle était significativement inférieur à celui du groupe test à 24 mois (valeur du test T de Student ,2,14). Par contre le groupe contrôle montrait des indices plus importants de PPD, PAL et mBI que le groupe test (valeurs du test T de Student respectivement de+5,50,+2,40,+9,61). Les indices PPD et mBI pour les implants du groupe contrôle étaient significativement plus importants lors de l'examen initial que 24 mois plus tard (valeurs du test T de Student respectivement de+ 3,18 et+3,33). Les indices de récession et de PAL résultaient en indices significativement inférieures que lors de l'examen initial (valeurs du test T de Student respectivement de ,4,62, ,2,77). Pour les implants du groupe test, les indices PPd et mBI étaient significativement plus importants lors de l'examen initial que 36 mois plus tard (valeurs du test T de Student respectivement de+11,63, 16,02). L'indice de récession résultait en indice significativement inférieur lors de l'examen initial (valeurs du test T de Student ,5,05). Aucune différence significative n'a été trouvée pour la mesure de l'indice PAL entre l'examen initial et 36 mois (valeur du test T de Student de+0,89). En conclusion, le traitement de résection associéà une plastieimplantaire semble influencer de manière positive la survie des implants dentaires affectés par les processus infectieux. Zusammenfassung Das Ziel dieser randomisierten klinischen Studie war, die klinischen Resultate von zwei verschiedenen chirurgischen Behandlungsvarianten der Periimplantitis zu vergleichen. Man nahm während einer Zeitdauer von fünf Jahren 17 Patienten mit ITI®-Implantaten fortlaufend in die Studie auf. Mit einem lotterieartigen System teilte man die Patienten zufällig auf. 10 der Patienten erhielten eine resektive Chirurgie und man modifizierte zusätzlich die Implantatoberfläche (Testgruppe). Bei den übrigen 7 wandte man ausschliesslich die resektive Chirurgie an (Kontrollgruppe). Zu Beginn sowie 6, 12, 24 und 36 Monate nach der Behandlung erhob man folgende klinischen Parameter: Eiterung, modifizierter Plaqueindex , mPI, modifizierter Blutungsindex , mBI, Sondierungstiefe , PPD, Pseudotaschen , DIM, Mukosarezession , Rec, sondierbares Attachmentniveau , PAL. Die kumulative Überlebensrate der Implantate in der Testgruppe betrug nach 3 Jahren 100%. Nach 24 Monaten mussten infolge Mobilität 2 Hohlschraubenimplantate der Kontrollgruppe entfernt werden. Daher betrug die kumulative Überlebensrate hier 87.5%. Der Rezessionsindex nach 24 Monaten war in der Kontrollgruppe signifikant tiefer als in der Testgruppe (T-Student Wert ,2.14). Dagegen zeigte die Kontrollgruppe höhere Indices bei der PPD, dem PAL und beim mBI als die Testgruppe (T-Student Werte von +5.5/+2.4 und +9.61). Die PPD und die mBI-Indices der Implantate aus der Kontrollgruppe waren zu Beginn signifikant höher als 24 Monate später (T-Student Werte von +3.18 und +3.33). Die Rezessions- und PAL-Indices waren dagegen signifikant tiefer als zu Beginn (T-Student Werte von ,4.62 und ,2.77). Bei den Implantaten der Testgruppe waren die PPD- und mBI-Indices zu Beginn signifikant höher als nach 36 Monaten (T-Student Werte von +11.63 und +16.02). Der Rezessionsindex war bei Studienbeginn signifikant tiefer (T-Student Wert von ,5.05). Bei den Messungen des PAL-Index konnte man zwischen den Anfangswerten und denjenigen nach 36 Monaten keine statistisch signifikanten Unterschiede erkennen (T-Student Wert von +0.89). Zusammenfassend kann man feststellen, dass eine resektive Therapie verbunden mit einer Oberflächenveränderung, die Überlebensrate der von einem entzündlichen Prozess betroffenen Implantate positiv zu beeinflussen vermag. Resumen El propósito de este estudio clínico aleatorio fue comparar los resultados clínicos de dos enfoques quirúrgicos diferentes para el tratamiento de periimplantitis. Se incluyeron a diecisiete pacientes consecutivos con implantes ITI® durante un periodo de cinco años. Los pacientes se asignaron aleatoriamente por medio de un sistema de lotería. Se trató a diez pacientes con cirugía resectiva y modificación de la topografía de superficie (grupo de prueba). Los siete pacientes restantes se trataron con cirugía resectiva solamente (grupo de control). Se recogieron parámetros clínicos (supuración, índice de placa modificado , mPI, índice de sangrado modificado , mBI, profundidad de sondaje de la bolsa , PPD, pseudobolsa , DIM, recesión mucosa , REC, nivel de inserción al sondaje , PAL) al inicio, al igual que a los 6, 12, 24 y 36 meses tras el tratamiento. El índice acumulativo de éxito del grupo de prueba tras 3 años fue del 100%. A los 24 meses se retiraron dos implantes huecos roscados del grupo de control debido a movilidad. Consecuentemente el índice acumulado de supervivencia fue del 87.5%. El índice de recesión en el grupo de control fue significativamente más bajo que en el grupo de prueba a los 24 meses (valor T-student de ,2.14). Por el contrario, el grupo de control mostró unos índices PPD, PAL y mBI mas altos que en el grupo de prueba (valores de T-student de +5.5 +2.4 y +9.61 respectivamente). Los índices PPD y mBI para los implantes del grupo de control fueron significativamente mas altos al inicio que 24 meses mas tarde (valores de T-student de +3.18 y +3.33 respectivamente). Los índices de recesión y PAL resultaron significativamente mas bajos que al inicio (valores de T-student de ,4.62 y ,2.77 respectivamente). Para los implantes del grupo de prueba los índices PPD y mBI fueron significativamente mas altos al inicio que tras 36 meses (valores de T-student de +11.63 y +16.02 respectivamente). El índice de recesión resultó ser significativamente más bajo al inicio (valores de T-student de ,5.05). No se encontraron diferencias estadísticamente significativas para las mediciones de índice de PAL al inicio y 36 meses mas tarde (valores de T-student de +0.89). En conclusión, la terapia resectiva asociada con implantoplastia parece influir positivamente sobre la supervivencia de los implantes orales afectados por procesos inflamatorios. [source]