Régis Cauchois

Total conservative parotidectomy for primary benign pleomorphic adenoma of the parotid gland: A 25-year experience with 229 patients

A 25‐year experience with total conservative parotidectomy for primary benign pleomorphic adenoma (PBPA) of the parotid gland in a consecutive series of 229 patients has been reviewed. This study focuses on survival, morbidity, PBPA recurrence, postoperative facial nerve dysfunction, and Freys syndrome. Surgical death was never encountered in this study. The overall incidence for postoperative hemorrhage, hematoma, seroma, skin necrosis, great auricular nerve schwannoma, and keloid scar was 1.7%, 6.1%, 4.8%, 0.9%, 15.7%, and 8.3%, respectively. Five‐, 10‐, 15‐, and 20‐year PBPA control actuarial rate was 99.6%. The overall incidence for temporary facial paresis and paralysis was 64.6% and 5.6%, respectively. Kaplan‐Meier actuarial analysis demonstrated that paresis recovery was noted until the eighteenth postoperative month. The overall incidence for permanent facial paresis and paralysis was 3.9% and 0%, respectively. None of the following variables—sex, age, PBPA size, PBPA location, PBPA contact with the facial nerve, inadvertent PBPA spillage, or surgeons experience— was statistically related to PBPA recurrence and facial nerve dysfunction. The overall incidence for Freys syndrome was 65.9%. Kaplan‐Meier actuarial analysis demonstrated the need for a minimal 5‐year follow‐up to assess Freys syndrome incidence. The mean age was statistically lower in patients presenting with Freys syndrome.

Supracricoid Partial Laryngectomy After Failed Laryngeal Radiation Therapy

Twelve patients managed with supracricoid partial laryngectomies(SCPLs) after failed laryngeal radiation therapy (RT) were evaluated. None of the recurrent tumors were amenable to vertical or horizontal partial laryngectomy. Results were analyzed for tracheostomy decannulation, oral alimentation, morbidity, local control, and survival. Major complications included perichondritis (2 patients), laryngeal stenosis (2 patients), and pneumonia from aspiration (1 patient). Mucocutaneous fistula and cricoarytenoid joint ankylosis were not encountered. Margins of resection were uninvolved in all cases. The Kaplan‐Meier 3‐year actuarial survival and local control estimate was 83.3%. Salvage total laryngectomy allowed for an overall 100% local control rate and a 75% laryngeal preservation rate.

Tracheal resection with end-to-end anastomosis for isolated postintubation cervical trachea stenosis: long-term results.

A 20-year experience with end-to-end tracheal resection and anastomosis for isolated postintubation stenosis of the cervical trachea, in a consecutive series of 32 adult patients, has been reviewed. Surgical death was never encountered. The overall incidences for superficial wound infection, pneumonia, and inferior left laryngeal nerve paralysis were 6.2%, 3.1%, and 3.1%, respectively. One-, 3-and 5-year actuarial anastomosis success rates were 96.7%, 93.3%, and 93.3%, respectively. Successful revision tracheal end-to-end anastomosis was performed once, resulting in an overall 96.9% success rate in our series. None of the following variables — sex, age, cause for intubation, intubation type (laryngotracheal and/or tracheotomy) and duration, delay from initial injury, presence of an open stoma, number of tracheal rings resected, and type of sutures used — were statistically related to the anastomosis success rate or the incidence of complications.

Head and neck pilomatrixoma

Pilomatrixoma, also termed calcifying epithelioma of Malherbe, is an uncommon benign skin neoplasm of hair follicle origin initially described in 1880 by Maherbe and Chenantais.’ Forbis and Helwig2 were the first to advocate the use of the term pilomatrixoma for such tumors. The usual sites involved are the face and upper extremities.3-5 Two head and neck cases are presented together with a review of the medical literature.

Nasal Dermoid Sinus Cyst

Nasal dermoid sinus cyst is one of the diagnoses of midline nasal masses in children. This retrospective study analyzes the various theories regarding the origin of this congenital abnormality, the differential diagnosis, and the value of magnetic resonance imaging, as well as the various surgical options available.

Primary leiomyosarcoma of the mandible

Leiomyosarcoma is a rare lesion of smooth muscle origin that account for 7% of softtissue sarc0mas.l Leiomyosarcomas have been categorized into three main groups: retroperitoneal and intraabdominal leiomyosarcomas; cutaneous and subcutaneous leiomyosarcomas; and leiomyosarcomas of vascular origin.lJ Furthermore, leiomyosarcomas have also been recognized in a number of parenchymal organs (uterus, breast, vagina, scrotum, bone, lung) and in several site in the head and neck area.1,3-5 This report documents a case of a primary mandibular leiomyosarcoma of the mandible. The origin, symptoms, differential diagnosis, treatment, and prognosis of this tumor are discussed together with a review of the medical literature.

Sternocleidomastoid Myofascial Flap for Reconstruction After Composite Resection of Invasive Squamous Cell Carcinoma of the Tonsillar Region: Technique and Outcome

Objective: To present the surgical technique and determine the efficacy of sternocleidomastoid myofascial (SCMF) flap reconstruction after composite resection with intent to cure.