Michael Bublik

50 LASER-INDUCED THERMAL THERAPY FOR RECURRENT HEAD AND NECK CANCER: A COMPREHENSIVE REVIEW.

Squamous cell carcinoma of the head and neck occurs frequently worldwide, with more than 500,000 new cases projected annually. Once recurrent after primary treatment, survival rates for head and neck cancers are very poor. Management of recurrent head and neck cancer is a seldom reported but a common clinical dilemma. Only a small subset of patients are candidates for potentially curative surgery. Chemotherapy alone provides only limited palliation with no long-term survivors, and reirradiation in most cases is unfeasible because of local toxicity. Experience is accumulating using laser-induced thermal therapy (LITT) for treatment of recurrent, unresectable head and neck cancers leading to favorable results and apparent long-term efficacy in some cases. In this study, we review our results on 104 patients with recurrent head and neck cancer who were treated by LITT. Best results were seen in oral cavity tumors where average survival was 20.3 months (10.7-30 months; 95% CI) compared to neck (average = 14.4 months, 7.5-20.7 months; 95% CI) and other tumor sites (average = 18 months, 13.8-22.3 months; 95% CI). Tumor regrowth was not seen after treatment for an average of 47 days, with significant palliation of symptoms observed in most of these patients. Therapy response was inversely related to initial tumor volume and was dependent on both histology and growth rate. Smaller slow-growing tumors and more differentiated tumors were palliated successfully with a better local therapy response rate than poorly differentiated and rapidly dividing malignancies. The results of LITT in recurrent head and neck cancer and the prognostic factors predicting outcome in this patient population are also reviewed.

S289 – Effect of Pterygopalatine Injection on EBL in Sinus Surgery

Objectives We compare estimated blood loss (EBL) during functional endoscopic sinus surgery between patients receiving transoral pterygopalatine fossa and transnasal infiltration (combined) to patients receiving only transnasal infiltration. Variables such as CT-stage, revision surgery, presence of polyps, and operative time are considered. Methods Injection with 1% lidocaine with 1:100,000 epinephrine was performed through the greater palatine foramen and transnasally in the “combined” study group (20 patients) and only transnasally in the control group (22 patients). Charts, operative reports, and CT scans were reviewed and demographic data as well as pertinent information were collected. Patients were followed up and all additional procedures and events were recorded. Results 12 females and 8 males, average age of 48, underwent combined injections; 16 males and 6 females (average age of 50) were in the control group. Using the Wilcoxon/ Kruskal-Wallis Tests (Rank Sums), mean EBL calculated for the combined injection group was 347ml and 493ml for the transnasal injection group (CI 0.95, p=0.093). Average ratio of EBL over OR time was 2.89 ml/min for the combined group and 4.11 ml/min for the control group. We also compare EBL between groups in patients with polyps, endoscopic and CT stage, and revision cases. No complications were reported. Conclusions Combined injection of the pterygopalatine fossa and nasal cavity appears to be a safe and relatively simple method to decrease EBL during sinus surgery, but initial data analysis shows that the difference did not reach statistical significance.

S191 – Unilateral Vocal Fold Paralysis: Medialization Results:

Objectives Management of glottal insufficiency due to unilateral vocal fold paralysis (UVFP) has evolved from trans-oral injection to external thyroplasty to revisited injections (transoral or transcutaneous). Currently, preference is given to the less invasive injection medialization. Multiple injectable materials have been utilized with newer ones being introduced to manage concerns over permanency and vocal fold vibratory patterns. The purpose of this study is to evaluate the long-term results of injection medialization for UVFP in terms of stability of glottal closure and voice outcome vs. need for reinjection. Methods All patients with UVFP that underwent injection medialization and had follow-up studies more than 6 months were eligible for inclusion. Parameters studied included demographic data (age, gender), side of paralysis, etiology, degree of pre-injection glottal insufficiency, length of follow-up, degree of post-injection glottal closure, mucosal wave resolution, and Voice Handicap Index. Results 146 patients were identified with a mean age of 61.7 years (17–94); males (55%) and females (45%). Etiology was idiopathic (56%); iatrogenic (48%); tumor-related (9%); trauma (3%); and neurologic (2%). Degree of glottal insufficiency was mild (21%); moderate (29%); and severe (50%). Material injected was Cymetra in 80 patients and Radiesse in 66 patients. 45 (33%) patients underwent more than 1 injection. Details of patients requiring repeat injections with regards to the material injected and the other parameters will be presented. Conclusions Injection medialization via a transcutaneous approach has long-lasting results making it an appropriate minimally-invasive option for long-term medialization for UVFP.