Egbert J. de Vries

A new method to predict safe resection of the internal carotid artery

A patent internal carotid artery (ICA) is essential in most patients. Management of skull base lesions often requires translocation, Balloon embolization, or resection of this vessel. Preoperative tests to assess the availability of collateral flow have not been uniformly accurate. A new test that significantly increases the safety of surgical removal of the ICA is described.

Hypopharyngeal reconstruction: A comparison of two alternatives

Gastric pull‐up or free jejunal interposition was used for reconstruction after total laryngopharyngectomy in 31 patients. Complications and functional outcomes of the two methods are compared. Primary swallowing was achieved in 86% of patients after gastric pull‐up and in 82% of patients after jejunal interposition. Patients who underwent jejunal interposition were able to swallow sooner and had a shorter hospital stay than patients who underwent gastric pull‐up. Esophageal tumor recurrence after jejunal interposition was not observed. Hepatic failure occurred in two gastric pull‐up patients, leading to perioperative death in one. Flap necrosis occurred in two jejunal interposition patients and one gastric pull‐up patient. Two additional fistulas occurred in jejunal interposition patients as a result of microvascular complications. Stricture developed in four jejunal interposition patients, requiring revision surgery in two. Minor complications were more common in the gastric pull‐up group. Long‐term speech and swallowing function are compared. Our current choice of jejunal interposition or gastric pull‐up for reconstruction after total laryngopharyngectomy primarily depends on the location of the tumor.

Elective resection of the internal carotid artery without reconstruction

Curability of skull base tumors is related to the ability to achieve a complete resection. Resection of the internal carotid artery with the tumor puts the patient at risk for catastrophic cerebral injury. Autogenous vein grafting is not always technically or physiologically possible.

Jejunal Interposition for Repair of Stricture or Fistula after Laryngectomy

Complications following total laryngectomy may include pharyngocutaneous fistula or pharyngeal stricture. Traditional techniques of repair of fistula and stricture with local or regional flaps lead to a high rate of failure. In this study, we report 18 patients treated by secondary jejunal interposition (JI) to rehabilitate swallowing following recalcitrant postlaryngectomy stricture or fistula. All patients had undergone total laryngectomy with or without partial pharyngectomy for treatment of squamous cell carcinoma of the larynx (8) or hypopharynx (10). Four were stage II; 5, stage III; and 9, stage IV. Thirteen patients (72%) regained swallowing function. Complications of secondary JI included perioperative death (2), flap loss (1), and persistent fistulas (3). Jejunal interposition may be the best modality in the rehabilitation of swallowing in patients with persistent fistula or stricture that fails to respond to traditional management.

Salivary Gland Lymphoproliferative Disease in Acquired Immune Disease

Persistent generalized lymphadenopathy is a nonspecific symptom of acquired immune deficiency syndrome (AIDS). The histopathology of the lymphadenopathy in homosexual men is complex and varied.‘ It includes a spectrum of morphologic changes, from lymphoid hyperplasia to lymphoid depletion. The development of lymphomas in populations at risk for AIDS often follows persistent lymphadenopathy.’ We describe two patients with lymphoproliferative disease of the salivary gland associated with acquired immune disease. The first case is a malignant lymphoma that manifested as a salivary gland tumor in a patient with AIDS, and the second case is a benign lymphoepithelial lesion and florid reactive follicular hyperplasia of the parotid gland in a patient with hemophilia with AIDS-related complex (ARC).

Avascular Carotid Body Tumor

Paragangliomas of the carotid body are slow-growing hypervascular tumors of the neural crest paraganglion cells that innervate the carotid bulb.’ Symptoms include a neck mass, dysphagia, and fullness in the throat. Signs include a neck mass near the angle of the mandible and a fullness in the parapharyngeal space. Owing to their hypervascular nature and their location in the poststyloid parapharyngeal space, carotid body tumors are virtually always diagnosed preoperatively with various imaging modalities. Angiography confirms the diagnosis by showing the highly vascular nature of the mass that often separates the internal and external carotid arteri e ~ . ’ ~ Computed tomography (CT) will shown an enhancing mass. Intense enhancement is also seen during the arterial phase on dynamic CT.4 Magnetic resonance imaging (MRI) will often suggest the diagnosis by demonstrating numerous flow-voids present within the tumor mass, indicative of large feeding and draining vessel^.^^^-^ To our knowledge we present the first case report of a carotid body tumor that did not demonstrate the typical vascular nature of this lesion, despite extensive preoperative imaging evaluation including, CT, MRI, and angiography.

Nasopharyngeal teratoma involving the temporal bone

Teratoma is the most common nasopharyngeal tumor in neonates. The tumor is usually limited to the oropharynx and is manifest by stridor and respiratory distress. Complete excision affects a cure. An unusual case of nasopharyngeal teratoma extending into the temporal bone, causing facial paralysis and conductive hearing loss, in addition to stridor, is presented. Stridor was relieved by transoral partial excision shortly after birth. Complete removal of the tumor by way of a subtemporal and infratemporal fossa approach was performed at 14 months of age. The defect was filled with a rectus abdominis muscle graft with microvascular anastomoses. The facial nerve was reconstructed secondarily with a sural nerve graft. The patient has no recurrence tumor and has good facial function at 30 months. This case demonstrates the first known case of facial paralysis due to nasopharyngeal teratoma. The surgical approach for tumor removal: lateral infratemporal fossa dissection, and the method of reconstruction: free rectus abdominis muscle flap with microvascular anastomoses, had so far not been described in a patient this young.