John R. Salassa

Oral dantrolene sodium for tonsillectomy pain: a double-blind study.

Tonsillectomy in adults and older children is typically accompanied by 7 to 14 days of pain. On the basis of clinical observations of patients treated perioperatively with dantrolene sodium for malignant hyperthermia, we hypothesized that pharyngeal muscle spasms are a major factor in tonsillectomy pain. We entered 113 patients, 11 years of age and older, into a double-blind, placebo-controlled study to evaluate the effectiveness of dantrolene sodium in reduction of tonsillectomy pain. Patients were randomly assigned either dantrolene (1.5 mg/kg per day) or placebo orally four times a day for 5 days postoperatively. On a standardized questionnaire, the patient recorded pain, diet, activity level, analgesics, and side effects, daily for 2 weeks. Also, alkaline phosphatase (alk phos) and serum aspartate aminotransferase (SGOT) levels were determined before the operation and 2 weeks after. Patients who received dantrolene had no significant differences in subjective pain, diet, or activity level scores from those of patients who received placebo. Dantrolene patients did, however, require significantly less analgesic use than placebo patients (p = 0.034, 0.015, and 0.005 for postoperative days 2, 3, and 4, respectively). There was no significant difference in side effects or changes in liver enzyme between the dantrolene and placebo groups. We conclude that dantrolene sodium, given in the dosage noted, is effective in reduction of analgesic requirements after tonsillectomy.

Transoral Laser Microresection of Advanced Laryngeal Tumors

• Transoral laser microsurgery (TLM) permits both small and large laryngeal tumors to be resected. The limits of resectability are based on access and functional consequences and not on extent or T stage. • Piecemeal resection of cancer permits precise tumor mapping and may improve local control over traditional “en bloc” resections. It further permits larger tumors to be removed through endoscopes that could otherwise not accommodate the physical volume. • TLM offers numerous functional advantages including fewer tracheostomies, no fistulas, earlier swallowing, and sensation. • TLM can replace traditional conservation laryngeal operations. • TLM can fit well into multimodality therapy strategies.

S141 – Total Laryngectomy in Patients with Advanced Bulbar ALS

Objectives 1) Identify patients with Amyotrophic Lateral Sclerosis (ALS) who would benefit from a total laryngectomy (TL) and outline specific surgical indications. 2) Educate physicians about the surgical procedure, perioperative course, and benefits from having a TL. 3) Review the clinical course and results of patients with ALS who had a TL. Methods From January 1999 to January 2008, charts from the Mayo Clinic in Jacksonville, FL, were retrospectively reviewed. 3 patients who underwent TL for advanced bulbar symptoms related to ALS were identified and their clinical course reviewed. Results At the time of surgery, all patients were aphonic with a multitude of symptoms including: dysphagia, drooling, respiratory insufficiency, aspiration pneumonia, choking and coughing. Average surgical time was 103 minutes. No intraoperative complications occurred. 2 patients with pre-existing respiratory insufficiency experienced postoperative pulmonary complications, resulting in a prolonged hospital course, median stay 17 days (range 6–29 days). One patient was lost to follow-up postoperatively. The other 2 and their caregivers were pleased with the results of TL. Benefits reported were: elimination of choking spells, improved comfort with mechanical ventilation, safe and easy tracheostomy tube changing and cleaning, less traumatic tracheobronchial suctioning, increased oral intake, reduced anxiety of aspiration, and less coughing. Conclusions TL is a relatively safe, quick, and uncomplicated surgery that should be considered earlier and more frequently in the treatment plan of patients with advanced bulbar symptoms of ALS. Patients with preoperative respiratory insufficiency may experience prolonged recovery times.

08:02: Recurrent Laryngeal and Pharyngeal Cancer Salvaged with TLM

OBJECTIVES: 1. Understand the role of Transoral Laser Microsurgery in the management of recurrent cancer of the larynx and pharynx. 2. Describe the outcomes and complications following salvage TLM for recurrent larynx and pharynx cancer. METHODS: Study Design and Setting: A two-center prospective case series analysis. Patients: One hundred and sixty-four patients undergoing salvage Transoral Laser Microsurgery (TLM) for previously treated laryngeal or pharyngeal squamous cell carcinoma between 1996 and 2006. Interventions: TLM in 164 patients, neck dissection in 35 and adjuvant radiotherapy in 17 patients. Outcome measures: End points analyzed included overall survival, disease-free survival, local control, locoregional control, duration of hospital stay and complications. RESULTS: One hundred and nine patients (67%) had salvage TLM for recurrent primary tumors while 55 patients (33%) had salvage TLM for new primary tumors occurring within a previously treated region. The average follow-up period was 26 months. The distribution of tumor location was oropharynx 75 (46%), glottic and subglottic larynx 57 (35%), supraglottic larynx 19 (12%), pyriform hypopharynx 11 (7%), hypopharynx and cervical esophagus 2 (1%). Overall two-year local and locoregional control estimates were 75% and 72%, respectively. Two-year disease-free and overall survival estimates were both 70%. The 5-year Kaplan-Meier estimates were: local control, 71%; locoregional control, 68%; disease-free survival 63% and overall survival 59%. The average duration of hospitalization for all patients was two days. Five patients (3%) suffered significant postoperative bleeding. CONCLUSIONS: Transoral Laser Microsurgery offers select patients an attractive salvage surgical therapy to the recurrent tumor site. 08:10 Racial Patterns of Thyroid Cancer Incidence in the U.S. Luc GT Morris, MD (presenter); Andrew Sikora, MD, PhD; Daniel Jethanamest, MD; Mark D DeLacure, MD