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6 results

  • Well-differentiated liposarcoma arising in the parapharyngeal space: a case report and review of the literature

  • N Kikuchi, T Nakashima, J Fukushima, K Nariyama, S Komune
  • Journal:
    The Journal of Laryngology & Otology / Volume 129 / Issue S2 / March 2015
    Published online by Cambridge University Press:
    23 February 2015, pp. S86-S90
    Print publication:
    March 2015
  • Background:

    Liposarcomas rarely occur in the parapharyngeal space and only a few case reports exist. For curative therapy of liposarcoma, surgical excision remains the dominant modality. Although a wide surgical margin is important to prevent local recurrence, wide excision is often difficult in the head and neck region.

    Case report:

    We report a case of a 19-year-old female with a well-differentiated liposarcoma arising in the parapharyngeal space. We removed the tumour surgically utilising a cervical–parotid approach. The histological diagnosis was well-differentiated sclerosing liposarcoma. There is no recurrence after five years and nine months of follow up.

    Conclusion:

    The patient's age and the tumour site made it difficult for us to make a quantitative diagnosis before the operation. Well-differentiated liposarcoma rarely develop distant metastasis, but often recur locally. The benefit of adjuvant radiotherapy for well-differentiated liposarcoma is still not clear and careful and long-term follow up is necessary.

  • Modified midfacial translocation for access to ventral skull base tumours

  • A Hussain, M Shakeel, V Vallamkondu, M Kamel
  • Journal:
    The Journal of Laryngology & Otology / Volume 128 / Issue 9 / September 2014
    Published online by Cambridge University Press:
    29 August 2014, pp. 803-809
    Print publication:
    September 2014
  • Objective:

    To describe our technical modifications of midfacial translocation for access to the nasopharynx, and anterior, central and lateral skull base.

    Design:

    Retrospective chart review of a prospective case series.

    Setting:

    Department of Otolaryngology-Head and Neck Surgery, Aberdeen Royal Infirmary, Scotland, UK.

    Methods:

    Along with demographics, other parameters studied were adequacy of exposure, completeness of resection, aesthetic outcome and complications. Our main outcome measures included adequacy of exposure, partial or total resection of tumour, aesthetic outcome, and complications related to surgical technique.

    Results:

    A total of 48 patients underwent modified midfacial translocation at our institution for nasopharyngeal, parapharyngeal, and anterior, central and lateral skull base tumours. In all cases, the exposure was deemed to be adequate. Two patients developed wound dehiscence in previously irradiated fields. Other incisions healed very well and the aesthetic outcome was regarded as satisfactory.

    Conclusion:

    Modified midfacial translocation is based on the principle of temporary craniofacial disassembly for access to the skull base. Our modifications offer adequate access and a better aesthetic outcome. All incisions are placed through the aesthetic sub units of the nose with preservation of the lip. Preservation of the bony piriform aperture prevents airway compromise.

  • Chapter 42 - Conclusions

  • from Section 8 - The transplant service
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 355-356

  • Summary

    The most common surgical approach used for cadaveric donor nephrectomy is the en bloc technique through a large abdominal incision. Transplantation using organs from cadaveric donors is always performed with the over-riding need to minimize the cold ischemic time of the organ. There are a number of techniques for anastomosing the ureter to the bladder. These include the Leadbetter-Politano or a direct vesico-ureteric anastomosis. Many patients with renal failure have significant atherosclerosis, with calcification resulting in noncompressible solid arteries that cannot be clamped. Careful preoperative assessment by computed tomography scanning should allow identification of calcified arteries before listing for transplantation. The preferred donor procedure is a laparoscopic nephrectomy, with mobilization of the kidney assisted by the use of a hand port, usually through a small infra-umbilical midline incision through which the kidney is removed. Late vascular complications are usually stenosis of the arterial anastomosis.

  • Clinical study of parapharyngeal space tumours

  • H Chijiwa, T Mihoki, B Shin, K Sakamoto, H Umeno, T Nakashima
  • Journal:
    The Journal of Laryngology & Otology / Volume 123 / Issue S31 / May 2009
    Published online by Cambridge University Press:
    22 May 2009, pp. 100-103
    Print publication:
    May 2009

  • This study reviewed 24 cases of parapharyngeal space tumour treated at Kurume University Hospital between 1990 and 2007. Histological diagnoses were generally obtained from the excised tumour (22/24). Seventy-seven per cent of the parapharyngeal space tumours were benign and 23 per cent were malignant. Thirty-eight per cent (eight of 22) of these tumours were pleomorphic adenomas and 23 per cent (five of 22) were schwannomas. A transparotidectomy and transcervical approach were used in 88 per cent (15/17) of benign tumours. A mandibular swing approach was used for one malignant tumour. Post-operative complications were identified in 16 of 22 patients. The most common complication, facial nerve paralysis, was identified in eight patients, and seven of these patients demonstrated first bite syndrome. In consideration of the high incidence of post-operative complications, the surgical approach should therefore be carefully selected when treating patients with parapharyngeal space tumours.

  • The midfacial degloving approach to sinonasal disease

  • David J. Howard, Valerie J. Lund
  • Journal:
    The Journal of Laryngology & Otology / Volume 106 / Issue 12 / December 1992
    Published online by Cambridge University Press:
    29 June 2007, pp. 1059-1062
    Print publication:
    December 1992

  • The midfacial degloving approach was first described by Casson et al. in 1974 but despite a number of papers in the American literature advocating its use, it has not gained popularity in Europe. The advantages and application of the technique are presented in 36 patients, ranging from 7–78 years of age. The approach is ideally suited for extensive benign lesions in the nasal cavity, ethmoid and sphenoid sinuses and enables access to the nasopharynx and infratemporal fossa whilst avoiding an external incision. These lesions have included angiofibroma (13 cases), inverted papilloma (five cases), a variety of cysts (three cases) and six miscellaneous cases of benign pathology. Malignant lesions which have not breached the anterior cranial fossa may also be removed, up to and including bilateral maxillectomy (nine cases) and this can be combined with orbital clearance. The approach may be repeated if necessary and is associated with few significant complications though vestibular stenosis, oro-antral fistula, nasolacrimal damage and upward rotation of the nasal tip may occur. Strategies to avoid these problems can be undertaken and long-term cosmetic results are excellent.