Matthew H. Rigby

Endoscopic treatment of Cis-T2 glottic cancer with a CO2 laser : Preliminary results from a canadian centre

In Canada, endoscopic resection using a CO(2) laser has been generally ignored as a treatment option. In this article, we present an introductory analysis of our clinical experience with the CO(2) laser at the QEII Health Sciences Centre in Halifax, Nova Scotia. Outcomes from a cohort of 36 patients with glottic cancer staged as Cis-T2 (7 Cis, 17 T1, 12 T2) who underwent endoscopic resection using a CO(2) laser between January 2002 and June 2005 were studied retrospectively. The mean follow-up was 16.2 months (range 0-41 months). At the time of the study, no patient had died of laryngeal disease, one patient had died of another disease, and one patient was lost to follow-up. There had been three recurrences in the cohort: two local recurrences and one recurrence in a regional lymph node. After salvage, all patients with recurrences were disease free at the time of the study. There were three postoperative complications in the cohort: one postoperative myocardial infarction, one case of respiratory distress postextubation, and one case of subcutaneous emphysema. The average time for the procedure was 0.97 hours (range 0.25-2.75 hours). The average postoperative length of stay was 1.2 days (range 0-12 days). Of 35 cases with follow-up, 60% had no reported problems with voice in their last visit and 11% reported consistent hoarseness or weakness. Although our oncologic results do require more follow-up, based on our positive experience thus far, we believe that endoscopic management of glottic cancer is a treatment option that may be underused in the Canadian health care system.

Fat graft pedicle stabilization in head and neck microvascular reconstruction.

The three-dimensional nature of free flap inset is a key concept in head and neck reconstructive surgery. The orientation and placement of the pedicle are vitally important for flap survival, as venous congestion caused by unfavorable pedicle geometry may adversely affect flap success. Various techniques including microsutures and fibrin glue have been described to protect the pedicle from destabilizing mechanical forces.1,2 We report on the successful use of fat grafts to stabilize the pedicle in the head and neck. These grafts represent a reliable, safe, easy, and costeffective way of stabilizing the pedicle.

Pigmented Villonodular Synovitis of the Temporomandibular Joint: A Unique Presentation

Summary: Pigmented villonodular synovitis (PVNS) is a rare and benign proliferative disorder of synovium with potentially locally aggressive growth and invasion of the bone. Occurring within the joints, tendon sheaths, and bursae, it is most commonly a monoarticular disease affecting large joints. In particular, most cases of PVNS occur in the knee. PVNS of the temporomandibular joint (TMJ) is a highly rare disorder, with approximately 60 cases reported. Herein, we present a unique case of an elderly male presenting with ear pain and subsequently diagnosed with PVNS of the TMJ with a history of trauma to the area. Initial imaging of the TMJ and the surrounding region looked concerning for invasive and/or malignant disease, but an open biopsy confirmed PVNS.

The histologic risk model is a useful and inexpensive tool to assess risk of recurrence and death in stage I or II squamous cell carcinoma of tongue and floor of mouth

Surgery is the mainstay of treatment for low-stage (stage I/II, ie, T1N0/T2N0) squamous cell carcinoma of oral cavity. However, a significant percentage of low-stage squamous cell carcinoma of oral cavity will develop local recurrence and disease-related mortality. In this study, we stratified 64 patients with low-stage of oral tongue and floor of mouth patients into high-, intermediate- and low-risk categories based on existing histologic risk model. The classification of these risk categories was based on presence or absence of perineural invasion and evaluation of tumor–host junction for worst pattern of invasion and lymphocytic host response. We correlated risk category and other variables with recurrence and death. In a univariate model, high-risk category tumors had a significantly higher rate of recurrence and death due to recurrence compared with low/intermediate-risk categories (P=0.000 and P=0.047, respectively). Controlling for margin status and T-stage, high-risk category had a 12.4 odds ratio of later recurrence when compared with low/intermediate-risk categories, with a P-value of 0.001. In conclusion, we found low-stage oral cavity squamous cell carcinoma patients with high-risk category have a significantly higher risk for recurrence when compared with patients in the low- or intermediate-risk category, even when controlling for margin status and T-stage. These patients may be suitable candidates for adjuvant treatment to decrease morbidity and mortality associated with a recurrence. Our results indicate that the histologic risk model is a useful and simple tool to assess risk of recurrence in stage I or II squamous cell carcinoma of oral cavity.

Report of metastatic ileal neuroendocrine tumor to the submandibular gland

Highlights • The differential diagnosis for neck masses is broad and includes neoplastic, infectious, and anatomic considerations.• Bronchopulmonary neuroendocrine tumors are known to metastasize to the head and neck.• This report is the first of ileal neuroendocrine tumor metastasis to the submandibular gland.

Absence of Ulnar Artery Inflow Detected by Allen’s Test Prior to Radial Forearm Free Flap

Summary: Radial forearm free flaps are commonly used for soft-tissue reconstruction after resection of head and neck cancer. It is perfused by the radial artery, leaving the ulnar artery for perfusion of the hand and digits. The absence of distal ulnar artery and associated superficial palmar arch, however, has not been reported in cadaveric dissection. We report a case of unilateral ulnar artery flow absence, detected by Allen’s test, during preoperative preparation for a radial forearm free flap. Based on the simplicity, safety, and ease, we recommend Allen’s test to be performed preoperatively on every patient for whom such a flap is a consideration.

Atypical Presentation of a Cellular Neurothekeoma On the Nasal Vestibule of a Pregnant Woman

Neurothekeomas are rare benign solitary tumours of the skin, most commonly manifesting in the head and neck and upper extremities of adults within the second to third decade of life, more often appearing in females at a 2:1 ratio. The authors describe a case of an immunohistochemical diagnosis of a cellular neurothekeoma on the nasal vestibule of a pregnant woman, and discuss the curative ability of surgical excision in these patient cohorts.

Myxoid neurothekeoma of the caudal nasal septum and tip.

Myxoid Neurothekeoma of the Caudal Nasal Septum and Tip Otolaryngology– Head and Neck Surgery 146(5) 868–869 American Academy of Otolaryngology—Head and Neck Surgery Foundation 2012 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0194599811429245 http://otojournal.org John Robert Scott, Martin Joseph Bullock, MD, FRCPC, Matthew Hall Rigby, MD, and S. Mark Taylor, MD, FRCSC