Jeffrey R. Janus

Long-term Functional and Oncologic Results of Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma

OBJECTIVE To examine the long-term functional and oncologic results in patients who underwent transoral robotic surgery (TORS) as primary therapy or as part of combined therapy for oropharyngeal squamous cell carcinoma arising in the tonsil or base of tongue. PATIENTS AND METHODS We reviewed a prospective TORS database of patients with squamous cell carcinoma arising in the tonsil or base of tongue treated between March 2007 and February 2009 to determine oncologic outcomes at 24 months or more of follow-up. The presenting tumor stage, histopathologic factors, surgical margins, and adjuvant treatment extent were evaluated. Functional outcomes included gastrostomy tube dependence and tracheostomy dependence. Oncologic outcomes included local, regional, and distant control and disease-specific and recurrence-free survival. RESULTS A total of 66 TORS patients were followed up for a minimum of 2 years. Most (97.0%; 64 of 66) were able to eat orally within 3 weeks after surgery before starting adjuvant therapy. Long-term gastrostomy tube use was required in 3 of the 66 (4.5%) and long-term tracheotomy in 1 (1.5%). Three-year estimated local control and regional control were 97.0% and 94.0%, respectively. Two-year disease-specific survival and recurrence-free survival were 95.1% and 92.4%, respectively. CONCLUSION With appropriate adjuvant therapy, TORS achieves excellent functional results for patients with oropharyngeal squamous cell carcinoma. Oncologic outcomes are equivalent or superior to results of other surgical and nonsurgical treatments.

Linking expression of FOXM1, CEP55 and HELLS to tumorigenesis in oropharyngeal squamous cell carcinoma†‡

To investigate the relationship between the expression of FOXM1, CEP55, and HELLS in oropharyngeal squamous cell carcinoma to human papillomavirus (HPV), smoking, and tumor stage.

Chordoma and Chondrosarcoma

Chordoma and chondrosarcoma represent 2 fundamentally different and challenging central skull base pathologies. Both are largely surgical diseases with varying outcomes based on completeness of resection. Adjuvant therapy is controversial, although radiation therapy is commonly employed postoperatively, and stereotactic radiosurgery is used either in primary management or treatment of local progression.

Robotic thyroid surgery: Clinical and anatomic considerations.

Robotic thyroid surgery is a relatively new technique that provides the patient with the aesthetic advantage of a surgery without a scar in the anterior cervical region. The use of this technique, however, forces the surgeon to view the anatomy from a different vantage point, concomitantly providing the surgeon with a challenge with respect to dissection and sound oncologic ablation. It is important to note that robotic surgery used in this fashion is not limited access but rather requires a greater surface area of dissection to reach the surgical target. This article will discuss the relevant anatomy, operative goals, robotic technique, and clinical considerations of robotic thyroid surgery. Clin. Anat. 25:40–53, 2012.

The scapular, parascapular, and latissimus dorsi flap as a single osteomyocutaneous flap for repair of complex oral defects

Complex composite defects of the oral cavity are often created due to en bloc resection of malignant tumors. These defects can involve bone, soft tissue, oral mucosa, and external skin, posing a reconstructive challenge to the microvascular surgeon. Though advances have been made in free tissue transfer via piggybacking techniques and double free‐flaps, increases in operative time and morbidity remain limiting factors. Likewise, advancements in single composite flaps (e.g., double‐skin paddle fibular free‐flap) allow for a single donor site, but limit workable tissue. This report describes our experience with the scapular, parascapular, and latissimus dorsi (SPLD) as a combined single unit osteomyocutaneous flap for composite reconstruction of complex oral defects. A case example is subsequently reviewed for clinical correlation. This is an operative techniques article describing the use of the SPLD single multi‐tissue flap for repair of complex oral defects. Cadaveric dissection was performed for instructional purposes. Case example was given for clinical correlation. Relevant history, anatomy, procedural details, and possible complications are presented and subsequently correlated to the case example. A SPLD free‐flap as a single multi‐tissue flap is a viable and beneficial option for reconstruction of complex oral defects. It provides the volume of tissue necessary to fill composite defects and exists as an alternative to multi‐flap procedures, which carry a longer operative time and multiple donor site morbidity. Clin. Anat. 25:120–128, 2012.

Surgical management of giant transdural glomus jugulare tumors with cerebellar and brainstem compression.

Objective The objective of this study is to discuss the management of advanced glomus jugulare tumors (GJTs) presenting with intradural disease and concurrent brainstem compression. Study Design This is a retrospective case series. Results Over the last decade, four patients presented to our institution with large (Fisch D2; Glasscock-Jackson 4) primary or recurrent GJTs resulting in brainstem compression of varying severities. All patients underwent surgical resection through a transtemporal, transcervical approach resulting in adequate brainstem decompression; the average operative time was 12.75 hours and the estimated blood loss was 2.7 L. All four patients received postoperative adjuvant radiotherapy in the form of intensity-modulated radiation therapy or stereotactic radiosurgery. Combined modality treatment permitted tumor control in all patients (range of follow-up 5 to 9 years). Conclusion A small subset of GJTs may present with intracranial transdural extension with aggressive brainstem compression mandating surgical intervention. Surgical resection is extremely challenging; the surgical team must be prepared for extensive operating time and the patient for prolonged aggressive rehabilitation. Newly diagnosed and recurrent large GJTs involving the brainstem may be controlled with a combination of aggressive surgical resection and postoperative radiation.

Surgical management of lateral skull base defects

We sought to analyze key factors that influence the management of lateral skull base defects and implement an algorithm to improve outcomes of reconstruction.

Scapular flap for maxillectomy defect reconstruction and preliminary results using three-dimensional modeling.

Discuss current techniques utilizing the scapular tip and subscapular system for free tissue reconstruction of maxillary defects and highlight the impact of medical modeling on these techniques with a case series.

Human papillomavirus in oropharyngeal squamous cell carcinoma: Assessing virus presence in normal tissue and activity in cervical metastasis

Human papillomavirus (HPV) has been established as an etiologic and prognostic factor in oropharyngeal squamous cell carcinoma (OPSCC). HPV oncogenesis involves expression of E6/E7 oncoproteins, with downstream p53 degradation and pRb inhibition. Although much research has focused on HPVs oncogenic behavior in primary OPSCC, minimal information exists about HPV in adjacent normal and metastatic tissue.

Algorithm for the Repair of Cheek Defects

Defects of the cheek present the reconstructive surgeon with both cosmetic and functional challenges. These defects can range from simple buccal mucosal defects to composite defects of the lips, full thickness cheek, mandible and maxilla, each of which present additional levels of complexity. To best treat these patients, facial reconstructive surgeons should have access to a standardized defect algorithm that can aid in planning and executing reconstruction with successful outcomes.