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Optimal surgery for pleomorphic adenoma of the parotid is controversial. In the present review, we discuss the advantages and disadvantages of the various approaches after addressing the surgical pathology of the parotid pleomorphic adenoma capsule and its influence on surgery. PubMed literature searches were performed to identify original studies. Almost all pleomorphic adenomas can be effectively treated by formal parotidectomy, but the procedure is not mandatory. Extracapsular dissection is a minimal margin surgery; therefore, in the hands of a novice or occasional parotid surgeon, it may result in higher rates of recurrence. Partial superficial parotidectomy may be a good compromise. The tumor is removed with a greater cuff of healthy parotid tissue than in extracapsular dissection. This may minimize the recurrence rate. On the other hand, the removal of healthy parotid tissue compared with formal parotidectomy is limited, thus minimizing complications such as facial nerve dysfunction and Frey syndrome.

Surgery of recurrent pleomorphic adenoma presents an increased risk of facial nerve injury and a considerable re-recurrence rate. A series of 33 patients with first recurrence of pleomorphic adenoma of the parotid gland was analyzed. The data were derived from medical records as well as from interviews and clinical examinations of all living patients. Histologic material of the initial and recurrent tumor were reviewed. Multifocal recurrence and carcinoma in pleomorphic adenoma were observed in 73% and 9% of patients, respectively. The incidence of permanent partial facial nerve injury after surgery was 23% in patients with initial enucleation and 14% in those with initial superficial parotidectomy (including 1 patient with facial nerve resection and 1 patient with a partial facial paresis before recurrence surgery). A subsequent recurrence occurred in 6 patients, all with initial enucleation after a mean time interval of 9 years. The preservation of the facial nerve was possible in all but 1 patient treated for the first recurrence with a relatively low rate of permanent partial facial paresis because of the use of the operating microscope and facial nerve monitor. To evaluate the re-recurrence rate, a follow-up of at least 10 years is necessary.

The low incidence and heterogeneity of histiotypes of primary parotid carcinomas makes these tumors histologically and epidemiologically difficult to evaluate. The present study reviews a single institution’s experience in the treatment of primary parotid carcinomas during the last 10 years. The charts of 98 consecutive patients who had a primary parotid carcinoma and who received primary curative treatment were analyzed retrospectively. The tumors were grouped into high-grade and low-grade malignancies. The effect of treatment modalities on locoregional control, the incidence of locoregional recurrences and distant metastases, and survival rates are evaluated and compared between high- and low-grade malignancies. High- and low-grade malignant tumors were observed in 50 and 48 cases, respectively. Lymph node metastases were detected in 25 of 98 (25%) patients, of whom 8 of 22 (22%) clinically NO staged patients underwent elective neck dissection. In 24 of 26 resected facial nerves, a histologic tumor infiltration was confirmed, in 14 high-grade and 10 low-grade tumors. Local recurrence developed in 13 patients and was associated in 7 with high-grade and in 6 with low-grade tumors. All but 1 of the low-grade malignancies with local recurrence did not receive postoperative irradiation. Regional recurrence developed in 11 patients and distant metastases developed in 10, 3 in combination with a neck recurrence and 1 with a local recurrence. The survival rate at 5 years for low- and high-grade carcinomas was 87% and 56% and the disease-free survival rate 72% and 48%, respectively. The incidence of occult metastases in clinically N0-elective neck dissection was 22%. A routine elective neck dissection in all N0 parotid carcinomas is suggested. There is no statistically significant difference between low- and high-grade tumors as for the rate of local recurrence and, as all except one of the low-grade malignancies with local recurrence did not receive postoperative irradiation, postoperative irradiation is not only suggested for high-grade carcinomas but also for T2 to T4 low-grade carcinomas.

Objective 3-dimensional biomechanical changes of the shoulder at rest or during arm elevation were measured by means of a new specific method using an optoelectronic detection system that was developed for computer-aided surgery. Additionally, the shoulder syndrome following neck dissection was evaluated by the recognized orthopedic shoulder Constant score. The statistical evaluation encompassed 12 patients with unilateral radical neck dissection (RND), 12 patients with unilateral modified radical neck dissection (MRND) with preservation of the accessory nerve, and 10 healthy subjects. The healthy shoulders showed normal kinematic behavior, the so-called “scapulohumeral rhythm” (SHR). After MRND, the static scapular position and SHR showed no significant 3-dimensional variations. In contrast, RND produced a highly significant scapular displacement at rest (p < .01) and a near-total abolition of SHR. The Constant scores were significantly lower after RND than after MRND (p < .01). Three-dimensional evaluation of the shoulder syndrome supports the Constant score, quantifying what can be measured objectively.

In a retrospective study, clinical, histopathological and immunohistochemical findings of basaloid squamous cell carcinoma (BSCC) of the hypopharynx are analyzed and compared with the literature. Among 196 patients treated for hypopharyngeal carcinoma between January 1993 and December 2000, 6 patients fulfilled the morphological and immunohistochemical criteria of a BSCC. Three primary tumors were initially classified as T 3 and 3 as T 1 , 3 presented with lymph node metastases. In no case was the BSCC associated with another primary neoplasm. Two patients developed distant metastases during the follow-up and died from the disease at 26 and 35 months. Four patients are alive with no evidence of disease at 27, 29, 61 and 87 months. We observed a contrast in the clinical behavior between the cases reported in the literature and our cases, as our BSCC of the hypopharynx were not detected at a more advanced stage than were the SCC and were in no case associated with another second primary tumor. However, the number of our cases is too small to draw reliable conclusions.

Supraomohyoid neck dissection (SOHND) is currently performed in patients with carcinoma of the oral cavity with clinically negative neck. Most investigators consider SOHND as a staging procedure. Records of 100 patients with cancer of the oral cavity and clinically negative neck undergoing SOHND were reviewed. The rate and significance of occult metastases are evaluated, the neck recurrences are analyzed and the indication of adjuvant radiation of pN+ necks is discussed. In 34 of 1814 of analyzed lymph nodes, metastatic disease was detected as follows: 30 macrometastases and 4 micrometastases. In 13 of 34 metastases (38%), extracapsular spread was observed. Twenty of 100 patients (20%) had to be upstaged. In 9 of 87 (10%) patients without local recurrence and with a minimal follow-up of 24 months, 5 ipsilateral (4 within the dissection field) and 5 contralateral neck recurrences were observed. Regional recurrence developed in 4% and 35% of patients with pN0 and pN+ necks, respectively. In 20% of patients with oral cavity tumors and pN0 neck, occult metastases were disclosed. Neck recurrences developed significantly more often in patients with pN+ than in those with pN0 necks. To evaluate the exact indication for an adjuvant treatment of patients with cN0/pN+ necks, prospective studies should be performed.

Invasion of the larynx by differentiated thyroid gland carcinoma is uncommon but causes serious morbidity and mortality when present. The clinicopathologic characteristics of 5 patients in which a total laryngectomy had to be performed for differentiated thyroid carcinoma are analyzed. Special reference is paid to the histologic intralaryngeal tumor spread, which is evaluated on whole-organ section. All patients presented with hoarseness and/or dyspnea. Two patients are alive at 44 and 115 months. One patient died of intercurrent disease 2 months and 2 patients with disease 6 and 14 months after surgery. In all cases, intralaryngeal tumor spread was observed. Invasion of the larynx occurs by direct extension or by posterior tumor growth around the edge of the thyroid cartilage. In rare cases, differentiated thyroid carcinoma can widely infiltrate the larynx, making total laryngectomy unavoidable. The diagnosis of intralaryngeal tumor spread is done by imaging and endoscopy.

Stage IV circular hypopharyngeal cancer is a disease with poor long‐term survival, and the only means of cure—surgery—is associated with high morbidity. All patients admitted with circular hypopharyngeal cancer and extension to the esophagus were enrolled in a multidisciplinary treatment protocol, including circular laryngopharyngoesophagectomy with tracheostomy, neck dissection, and pull‐up of a fundus rotation gastric tube that was anastomosed to the oropharynx. Five weeks postoperatively high‐dose radiotherapy (60 Gy) was given to the cervical region. Altogether, 18 qualifying patients were explored cervically, were found to have resectable lesions (i.e., without carotid artery infiltration), and were included in the protocol. After laryngopharyngoesophagectomy, an elongated gastric tube was pulled up to the oropharynx. The average distance bridged with the tube was 32±4 cm. No anastomotic leaks were found on postoperative Gastrografin swallow, and oral feeding was started between days 5 and 8. Patients were discharged with normal oral feeding on day 21 (±17 days). Diarrhea, postprandial fullness, and reflux resolved within 6 months postoperatively. Five patients died during the follow‐up period of 42 months (range 3–63 months): three due to cardiac events 18 and 38 months postoperatively and two within 12 months with residual disease and tumor recurrence, respectively. The estimated 5‐year survival was 60%. We concluded that an aggressive multidisciplinary approach including circular laryngopharyngoesophagectomy, neck dissection, and high‐dose radiotherapy ascertains good long‐term survival and good functional results in patients with advanced hypopharyngeal cancer when the intestinal continuity is reconstructed with a fundus rotation gastroplasty. Résumé En cas de cancer circonférentiel de l’hypopharynx stade IV, la survie est médiocre. Le seul moyen de cure possible, la chirurgie, est grevé d’une morbidité élevée. Tous les patients admis pour cancer circonférentiel de l’hypopharynx avec envahissement de l’œsophage ont été enregistrés dans un protocole de traitement multidisciplinaire, comprenant une laryngopharyngo‐oesphagectomie avec trachéostomie, une lymphadénectomie cervicale et une gastroplastie tubulisée au dépens du fundus gastrique anastomosé à l’oropharynx. Cinq semaines après, une radiothérapie à haute dose (de 60 Gy) a été délivrée à la région cervicale. Dix‐huit patients remplissant ces conditions ont eu une exploration cervicale et ont été considérés comme potentiellement résecables (c’est‐à‐dire sans infiltration de l’artère carotide). Après laryngo‐pharyngo‐esophagectomie, un tube gastrique a été monté à l’oropharynx. La distance moyenne du tube a été de 32±4 cm. Aucune fistule anastomotique n’a été retrouvée sur l’examen postopératoire à la gastrografine et on a pu commencer l’alimentation orale entre les jours postopératoires 5 et 8. Les patients ont pu quitter l’hôpital s’alimentant normalement au jour 21 (±17 jours). En ce qui concerne la morbidité postopératoire, diarrhée, sensation de plénitude postprandiale et reflux se sont résolus en moins de six mois après l’opération. Cinq patients sont décédés pendant la période de suivi de 42 mois (extrêmes 3–63 mois), trois, d’événements cardiaques, 18 et 38 mois postopératoire et deux patients, respectivement, de maladie résiduelle et de récidive tumorale, en moins de 12 mois. La survie à 5 ans a été de 60%. Chez les patients atteints de cancer de l’hypopharynx avancé, une approche multidisciplinaire agressive comprenant une laryngo‐pharyngoesophagectomie circulaire, la lymphadénectomie cervicale et la radiothérapie à haute dose, assurent une bonne survie à long terme et de bons résultats fonctionnels lorsque la continuité intestinale est rétablie par une gastroplastie de rotation fundique. Resumen El cáncer hipofaríngeo de los pliegues circulares, estadio IV, es una afección con escasa supervivencia a largo plazo y cuya curación, exclusivamente quirúrgica cursa con elevada morbilidad. Todos los pacientes con dicho tipo de cáncer que además, se propaga al esófago, fueron incluidos en un protocolo de tratamiento multidisciplinario consistente en una laringo‐faringo‐esofagectomía circular con traqueostomía y vaciamiento ganglionar del cuello, anastomosándose un tubo del fundus gástrico rotado a la orofaringe. Transcurridas 5 semanas de la intervención se aplicó sobre la región cervical, radioterapia, a dosis altas: 60 Gy. En 18 pacientes en los que la cervicotomía exploradora demostró la resecabilidad (i.e., sin infiltración de la arteria carótida) se incluyeron en el mencionado protocolo. Tras la laringo‐faringoesofagectomía un elongado tubo gástrico se ascendió para anastomosarlo a la orofaringe. La deglución de gastrografin no reveló ninguna dehiscencia anastomótica y la alimentación oral se instauró entre los días 5 y 8 del postoperatorio. Los pacientes fueron dados de alta con alimentación oral normal a los 21 días (±17 días). Diarreas, pesadez postprandial y reflujo desaparecieron a lo largo de los primeros seis meses del postoperatorio. 5 pacientes fallecieron durante el seguimiento, superior a 42 meses (rango 3–63 meses); tres, a los 18 y 38 meses de la intervención por problemas cardiacos; los otros dos murieron antes de 12 meses por enfermedad residual o recidivante. La supervivencia estimada a los 5 años fue del 60%. En pacientes con cáncer hipofaríngeo avanzado un tratamiento agresivo multidisciplinario que incluye no sólo la resección laringo‐faringo‐esofágica sino también el vaciamiento ganglionar del cuello y radioterapia postoperatoria a dosis altas permite un elevado porcentaje de supervivencia a largo plazo con buenos resultados funcionales, cuando la continuidad del tubo digestivo se restablece con una gastroplastia de rotación fúndica.