Management of Inoperable Malignant Neoplasms.
Authors: Kiess AP, Quon H
Abstract
For patients with inoperable salivary gland malignancy, radiation therapy has significant limitations but has been the mainstay of treatment. With standard photon radiation (X-rays), the 10-year loco-regional control (LRC) and overall survival rates are only ∼25%. Neutron radiation has potential biological advantages over photon radiation because it causes increased DNA damage, and studies of patients with inoperable salivary gland malignancy have shown improved 6-year LRC and overall survival of ∼60%. However, neutron radiation may also increase the risk of late toxi...
Source: Advances in Oto-Rhino-Laryngology - April 20, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Recurrent Benign Salivary Gland Neoplasms.
Authors: Witt RL, Nicolai P
Abstract
The most important causes of recurrence of benign pleomorphic adenoma are enucleation with intraoperative spillage and incomplete tumor excision in association with characteristic histologic findings for the lesion (incomplete pseudocapsule and the presence of pseudopodia). Most recurrent pleomorphic adenomas (RPAs) are multinodular. MRI is the imaging method of choice for their assessment. Nerve integrity monitoring may reduce morbidity of RPA surgery. Although treatment of RPA must be individualized, total parotidectomy is generally recommended given the multicentrici...
Source: Advances in Oto-Rhino-Laryngology - April 20, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Management of Recurrent Malignant Salivary Neoplasms.
Authors: Merdad M, Richmon JD, Quon H
Abstract
The management of malignant salivary gland neoplasms is based on a surgical paradigm, with intraoperative findings and pathology guiding the role of local-regional adjuvant therapy. Despite high rates of local control, local relapse can be a dominant pattern of recurrence, presenting therapeutic challenges. Although an optimal management approach has not been established, aggressive salvage surgery is favored given the morbidity associated with tumor progression at the skull base and the lack of significant response associated with other available treatment mo...
Source: Advances in Oto-Rhino-Laryngology - April 20, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Prognostic Scoring for Malignant Salivary Gland Neoplasms.
Authors: Vander Poorten V, Guntinas-Lichius O
Abstract
Estimating the prognosis of a patient with a rare disease like salivary gland carcinoma has always been a significant challenge for the clinician. Recent evolution in prognostic research has resulted in systems that summarize the effect of properly weighted, multivariate independent prognostic factors into a scientifically based prognostic estimate. Following external validation and user-friendly translation, these systems constitute an advance in clinical practice and have the ability to influence clinical decision making for the oncologist and the pa...
Source: Advances in Oto-Rhino-Laryngology - April 20, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Salivary Gland Neoplasms in Children and Adolescents.
Authors: Bradley PJ, Eisele DW
Abstract
Salivary gland neoplasms (SGNs) in children are uncommon. Epithelial SGNs (ESGNs) comprise the majority (95%), with the remaining being mesenchymal SGNs (MeSGNs). Pleomorphic adenoma is the most frequently encountered benign neoplasm, mucoepidermoid carcinoma is the most frequent malignant ESGN, and rhabdomyosarcoma is the most frequent malignant MeSGN. ESGN presents in the second decade, whereas MeSGN presents in the first and second decades. Swelling without pain or neurological signs is the main presentation of both benign and malignant neoplasms. Making an accura...
Source: Advances in Oto-Rhino-Laryngology - April 20, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Surgery for Primary Malignant Parotid Neoplasms.
Authors: Deschler DG, Eisele DW
Abstract
The successful treatment of salivary gland malignancies originating in the parotid gland begins with rigorous and thorough surgical management coupled with the directed and appropriate potential adjuvant use of radiation therapy and chemotherapy. The anatomic complexity of the region in relation to the facial nerve and adjoining neurovascular and musculoskeletal structures requires sound surgical planning and decision making based on preoperative and intraoperative findings. The clinical presentation of parotid malignancy is summarized, as well as the further evalua...
Source: Advances in Oto-Rhino-Laryngology - April 20, 2016 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Anatomy and physiology of velopharyngeal closure and insufficiency.
Authors: Raol N, Hartnick CJ
Abstract
The velopharynx is a complex structure that is responsible for separation of the oral and nasal cavities during speech production and swallowing. Incompetence of this mechanism can lead to hypernasality, with nasal air emission and incomprehensible speech, as well as nasopharyngeal regurgitation. There can be a significant social stigma associated with velopharyngeal dysfunction, and surgical treatment can be curative in many cases. Knowledge of the normal anatomy and physiology of the velopharyngeal complex is essential when planning for surgical repair. © 2015 S. Ka...
Source: Advances in Oto-Rhino-Laryngology - March 5, 2015 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Nasometry, Videofluoroscopy, and the Speech Pathologist's Evaluation and Treatment.
Authors: de Stadler M, Hersh C
Abstract
The speech-language pathologist (SLP) plays an important role in the assessment and management of children with velopharyngeal insufficiency (VPI). The SLP assesses speech sound production and oral nasal resonance and identifies the characteristics of nasal air emission to guide the clinical and surgical management of VPI. Clinical resonance evaluations typically include an oral motor exam, identification of nasal air emission, and analysis of the speech sound repertoire. Additional elements include perceptual assessment of intra-oral air pressure, the degree of hype...
Source: Advances in Oto-Rhino-Laryngology - March 5, 2015 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Nasal endoscopy: new tools and technology for accurate assessment.
Authors: Bliss M, Muntz H
Abstract
In this chapter the technique of nasal endoscopy is discussed. Standardized reporting of nasal endoscopy findings is essential in order to allow communication between different surgeons, speech therapists and endoscopists. Representative videos are provided for the normal examination, for coronal and sagittal velopharyngeal closure patterns, as well as for other anatomical variants of interest. Recommendations for tailoring surgical therapy based on the nasopharyngeal closure pattern are given, although the experience of the surgeon is an important factor for success of a...
Source: Advances in Oto-Rhino-Laryngology - March 5, 2015 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
New technology: use of cine MRI for velopharyngeal insufficiency.
Authors: Raol N, Sagar P, Nimkin K, Hartnick CJ
Abstract
Cine magnetic resonance imaging (MRI) has been used since 1999 to evaluate velopharyngeal function. It allows the visualization of articulatory movement of the velopharyngeal port at rest and during speech. In addition, some studies have shown that it can be synched with audio and can define specific anatomic defects. Cine MRI also provides a non-invasive modality by which velopharyngeal closure can be evaluated. In this chapter, the utility and technique of cine MRI will be described. © 2015 S. Karger AG, Basel.
PMID: 25733229 [PubMed - in...
Source: Advances in Oto-Rhino-Laryngology - March 5, 2015 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Validated patient-reported outcome instruments for velopharyngeal insufficiency.
Authors: Skirko JR, Sie KC
Abstract
Velopharyngeal insufficiency (VPI) affects speech, swallowing, and many psychosocial aspects of life in a way best measured by quality-of-life (QOL) instruments. QOL instruments are patient-reported outcome instruments that provide a method of measuring the value that patients place on their health-related experiences. These instruments allow us to quantify patients' QOL during assessment as well as the clinical improvement that we seek with treatment. Two instruments have primarily been used in the VPI population: the Pediatric Voice Outcomes Survey (PVOS) and the VPI E...
Source: Advances in Oto-Rhino-Laryngology - March 5, 2015 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Prosthodontics rehabilitation in velopharyngeal insufficiency.
Authors: Jackson M
Abstract
When surgical correction is less than successful or when children are poor candidates for surgery due to a large gap, a neuromuscular cause of velopharyngeal insufficiency (VPI), a strong gag reflex, or unfavorable anatomy, prosthetic intervention can result in the elimination of VPI. Surgery is ideal and best suited for long-term results; however, if needed, prosthetic correction can resolve VPI and is presented here. Indications for obturators, various designs, and clinical pearls when managing a child with an obturator are discussed. Correction of VPI must always be considere...
Source: Advances in Oto-Rhino-Laryngology - March 5, 2015 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Superiorly based pharyngeal flap.
Authors: Raol N, Hartnick CJ
Abstract
First described in 1875 by Schoenborn as an inferiorly based flap, the pharyngeal flap is the most common surgical procedure performed for velopharyngeal insufficiency. Having undergone numerous modifications since its conception, the pharyngeal flap is now primarily designed as a superiorly based flap and is most effective for patients with good lateral wall motion but limited anterior-posterior motion due to poor palatal excursion. The primary aims of this chapter are to provide the clinician with indications for when to consider utilizing the superiorly based pharyn...
Source: Advances in Oto-Rhino-Laryngology - March 5, 2015 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Sphincter pharyngoplasty.
Authors: Raol N, Hartnick CJ
Abstract
First described in 1950 by Hynes for patients with velopharyngeal insufficiency following cleft palate repair, the sphincter pharyngoplasty is a frequently used procedure for treating velopharyngeal insufficiency that rivals the pharyngeal flap in some centers as the most frequently used procedure. This technique is most effective for patients with good anterior-posterior motion but limited lateral wall motion. The primary aims of this chapter are to provide the clinician with indications for when to consider utilizing the sphincter pharyngoplasty and to give a stepwis...
Source: Advances in Oto-Rhino-Laryngology - March 5, 2015 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Furlow double-opposing z-plasty.
Authors: Raol N, Hartnick CJ
Abstract
First described in 1978 by Furlow for the repair of a cleft soft palate, the double-opposing z-plasty, also known as the Furlow palatoplasty, is an excellent procedure for repairing a submucous cleft. It is also useful in patients with touch closure who simply need lengthening of the soft palate and as an option for patients with anomalous carotid vasculature where pharyngeal flaps and sphincter pharyngoplasty are precarious. The primary aims of this chapter are to provide the clinician with indications for when to consider utilizing the Furlow palatoplasty and to give...
Source: Advances in Oto-Rhino-Laryngology - March 5, 2015 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
