Neoplastic diseases of the head & neck in children

Pediatric neoplasm is next only to trauma as the most common cause of death. The cervicofacial malignancies presents a unique challenge owing to potential adverse effects of both the disease process and the treatment employed on critical developing head and neck structures. This study comprised of 106 children below 12 years age group conducted during 1999–2003 at JNMC, Aligarh. Of 106 cases 70 were benign neoplasms and 36 malignant neoplasms. Nasopharynx was the commonest site of involvement. Nasopharyngeal angiofibroma was the commonest benign tumour and lymphoma was the commonest malignant neoplasm. Team approach is required for mitigation of the disease process.     

Extranasopharyngeal angiofibroma arising from the infratemporal region

Angiofibroma is a histologically benign but locally invasive tumour of the blood vessels characterized by architecturally irregular vessels set in a fibrous stroma. The commonest site for occurrence of these tumours in the body is the nasopharynx. It is rare to find extranasopharyngeal origin of angiofibromas. The infratemporal fossa is a very rare site of extra nasopharyngeal angiofibroma with only 4 cases reported in the literature. We report here a case of a vascular mass arising from the infratemporal fossa of a 13-year-old boy that was confirmed to be a case of angiofibroma histopathologically. A review is also made of the other reported cases of angiofibroma arising from the infratemporal fossa. The likely theory of origin of the tumour and its management is also discussed.     

Malignant orofacial neoplasms in children and adolescents: a clinicopathologic review of cases in a Nigerian tertiary hospital

OBJECTIVE: The aim of the study was to determine the relative frequency of orofacial malignant neoplasm in children and adolescents. METHODS: A retrospective review of malignant orofacial tumours in children and adolescents 相似文献   

Endoscopic endonasal approach for the treatment of anterior skull base tumours

INTRODUCTION: The increasing expertise of transnasal endoscopic surgery has recently expanded its indications to include the management of tumours affecting the skull base. We report our experience with endoscopic management of these tumours, emphasising the indications and surgical technique used. MATERIAL AND METHOD: A retrospective analysis was performed of patients treated by an endoscopic endonasal approach (EEA) in our department from 2004 until 2011. RESULTS: Sixty-three patients were analysed. We performed an endoscopic craniofacial resection in 32 patients (51%), an expanded EEA in 22 (35%), a transclival approach in 6 (9%) and a transpterygoid approach in 3 (5%). The most frequent benign tumour was nasopharyngeal angiofibroma (24%), while adenocarcinoma (30%) was the most common among malignancies. Mean follow-up was 26 months (range: 6 to 84 months). The complication rate was 5% and resection was complete in 56 cases (89%). The 5-year overall-survival was 71% in patients with malignant tumours and the effectiveness was 100% in benign tumours. CONCLUSION: Our results support that endoscopic surgery, when properly planned, represents a valid alternative to standard surgical approaches for the management of skull base tumours.     

鼻内镜在鼻咽部疾病诊断中的价值

目的探讨鼻内镜在鼻咽部疾病诊断中的价值及作用。方法在表面麻醉下用鼻内镜对1416例门诊病人进行鼻咽部检查。对有新生物或怀疑为恶性肿瘤者在直视下咬取活检送病理。结果192例进行活检,其中发现鼻咽部淋巴组织增生,鼻咽囊肿,鼻咽纤维血管瘤,鼻咽部新生物等病变,确诊为恶性肿瘤107例(占58．75％);对鼻咽淋巴组织有怀疑者予以活检,结果皆为粘膜慢性炎症。结论鼻内镜对鼻咽部疾病的诊断具有较高价值。     

Incidence of salivary gland malignancies in 12 year time period in ENT Department Medical University in Poznan

Neoplasm of salivary gland constitutes about 3% of all tumours of head and neck. Within the category we can differentiate tumours of a very different histological structure. What lies behind such great differences in the changes within the salivary glands is complex embryogenesis of the glands. This work aims at the assessment of the frequency of occurrence of malignant neoplasm in parotid gland and submandibular gland based on the material collected at the ENT Department of the Medical University in Poznan in the years 1995-2006. In the 12-year period, 103 patients suffered from malignant neoplasm. 82 tumours were diagnosed in paroid gland and respectively 21 - in submandibular gland. No neoplasm was identified in sublingual gland. It was concluded, that trends in occurrence of neoplasm of salivary glands, assessed on the basis of the number of patients operated in the years 1995-2006 show that the number of malignant neoplasm cases remains on the same level. The analysis of the epidemiological differences based on the comparison of the groups of patients treated for salivary gland neoplasm in the years 1995-2000 and 2001-2006 has shown that with regard to malignant neoplasm such parameters as sex, age, duration of symptoms, diameter of the tumour and level of advancement have not differed much from each other in the analyzed periods. Epidemiological differences were identified in respective histological structures in the two periods analyzed: adenoid cystic carcinoma was in fact more frequent in the years 1995-2000 than in the years 2001-2006 (58.8% versus 24.1%). On the other hand, metastasis to the salivary glands was less frequent in period I than in period II (11.8% and 27.6% respectively), so was cancer in mixed tumour (2.9% and 17.2%). Facial nerve paralysis was statistically more frequent in highly malignant tumours than in comparison to tumours malignant only to a slight extent.     

Aetiopathology of maxillary swelling—a 3-year prospective study

A wide variety of lesions and not necessarily a malignant tumour can cause maxillary swelling. Non-specificity of clinical and radiological features of these maxillary lesions makes their diagnosis difficult. Review of literature adds a little regarding the aetiopathological distribution of the various lesions causing maxillary swelling. We present our finding regarding the relative distribution of various conditions causing maxillary swelling. The awareness of the spectrum of pathology related to maxillary swelling is essential for correct diagnosis and treatment. Forty-eight patients who presented with a swelling of the maxilla to our hospital between May 1998 and April 2001 were prospectively studied regarding the clinical presentations, radiological features and histological findings. Maxillary swelling was found to be caused by malignant tumours in 54.2%, benign neoplasms in 22.9% and non-neoplastic lesions in 22.9%. Overall squamous cell carcinoma (22.9%) was the commonest lesion, tumour of vascular origin was the commonest benign neoplasm and odontogenic cyst was the commonest among the non-neoplastic lesions.     

Huge nasopharyngeal angiofibroma with intracranial extension: change in the dura mater and choice of surgical management

We aimed to review (1) the imaging changes in the dura mater in cases of huge, lobulated juvenile nasopharyngeal angiofibroma, and (2) the choice of surgical management. Imaging from four cases of juvenile nasopharyngeal angiofibroma showed extrapharyngeal extension of the tumour. The sphenoid sinus, sella turcica and clivus were extensively eroded, and the tumour had spread deep into the cranial fossa. In three cases, intracranial exploration was performed to treat the intracranial tumour lobule. Subsequently, the tumours were removed using extracranial approaches. No perforation of the dura mater was found in these three cases, although the dura mater in the superior orbital fissure was congested, haemorrhagic and solid. Pre-operative imaging for two cases (i.e. the first operation for one and the second operation for the other) revealed no dura mater perforation. A transantral approach via a midfacial degloving incision was used to remove these tumours completely. We conclude that change in the dura mater is a crucial indication for the choice of management. If the dura mater is intact, a transantral approach via a midfacial degloving incision may remove the tumour successfully.     

Histology of submandibular gland tumours, 10 years' experience

Introduction and objectivesThere are few reports focused on neoplasms in the submandibular gland because they are uncommon and are frequently grouped with the other salivary glands tumours. In the classical studies, the proportion of malignancy reported in these cases is around 50%.ObjectivesDetermining the proportion of malignancy, the most frequent histological types, the gender distribution and average age at diagnosis in patients with submandibular gland neoplasms who were treated in our hospital from 2000 year to 2010.MethodsA retrospective review of our department database of the patients who underwent surgery for submandibular gland neoplasm in a ten-year period was performed.ResultsTwenty-two patient records were included, in which 19 (86%) patients presented benign disease and 3 were of a malignant type (adenocarcinoma, well-differentiated epidermoid carcinoma, follicular lymphoma). Two of the 3 cases of malignant neoplasms were in men.ConclusionsA greater proportion of benign neoplasm was found in submandibular tumours. The most frequent benign tumour is the pleomorphic adenoma. Women are more commonly affected (76%). Benign tumours appear in younger patients than do malignant ones.     

Epidemiology of non-malignant salivary gland tumours based on 675 cases

Neoplasm of salivary glands constitutes about 3% of all tumours of head and neck. Within the category we can differentiate tumours of a very different histological structure. What lies behind such great differences in the changes within the salivary glands is complex embryogenesis of the glands. About 80% of all tumours of salivary glands is located in parotid gland, from 10 to 20% - in submandibular gland and several percent in sublingual and small salivary gland. This work aims at the assessment of the frequency of occurrence of non-malignant neoplasm in parotid and submandibular gland based on the material collected at the ENT Department of the Medical University in Poznan in the years 1995-2006. In the 12-year period, 778 patients in total suffered from tumours of large salivary glands. The number of non-malignant neoplasm was 675, and the number of malignant neoplasm was 103. With regard to paroid glands, 586 non-malignant tumours and 82 malignant tumours were identified, with regard to submandibular glands the numbers were respectively: 89 and 21. Main aim of this work has been achieved through the execution of partial steps: the analysis of the trends in occurrence of non-malignant neoplasm in the 12-year period, the analysis of the epidemiological differences: sex, age, place of residence - town or country, duration of symptoms, diameter of the tumour at the time the patient reported for treatment, histological structures that were carried on the basis of the comparison of data collected in the two periods of time: period I--the years 1995-2000 and period II--the years 2001-2006. The frequency of operations on non-malignant tumours of salivary glands (as compared to the total number of operations) was 4.11% in the first period and 4.18% in the second. In both periods the most frequent benign tumour was the mixed tumour (54.9% of all tumours) and constituted 60% and 54% of all tumours in the respective periods analyzed. The next most frequently occurring tumour was Warthin's tumour, identified in 31.2% of the patients, in 23% in period I and 35% in period II. Duration of the symptoms, ranged from 1 month to 20 years, 14 months on average, yet in 263 cases the tumour has been developing developed for over a year. The diameter of the non-malignant tumours undergoing operation ranged from 1 cm to 8 cm, with the average being 3 cm. It was 3 cm with regard to the most frequently occurring tumours: adenoma polymorphum, adenoma monomorphum and cystadenolymphoma.     

鼻咽纤维血管瘤的^99mTc-MIBI显像

目的 :为鼻咽纤维血管瘤寻找无创而有效的术前定性诊断方法。方法 :采用99mTc MIBI对 3例鼻咽纤维血管瘤患者进行头颈部亲肿瘤显像检查。结果 :3例鼻咽纤维血管瘤的早期显像均呈弱阳性 ,延迟显像均表现为放射性分布缺损 ,与恶性肿瘤的阳性显像结果及良性肿瘤的阴性显像结果有明显区别。结论 :99mTc MIBI头颈部亲肿瘤显像对患者无创 ,其显像结果具有一定的特征 ,可作为鼻咽纤维血管瘤术前无创而有效的定性诊断方法。     

Mucosal malignant melanomas of the head and neck with special reference to cases having a prolonged clinical course.

A histological re-examination and re-classification of primary mucosal tumours of the head and neck region, treated at Radiumhemmet and Karolinska Sjukhuset during the period 1927-1970, revealed that 41 tumours were malignant melanomas. All these 41 tumours were located in the nasal cavity, paranasal sinuses and oral cavity and not a single case of primary mucosal malignant melanoma was found in other locations of the head and neck region. In the present study, the long-term prognosis has been analysed. The follow-up period was at least 5 years and ranged up to 48 years. It was found that mucosal malignant melanomas had a very poor prognosis with a five year survival rate of 17% (7 of the total 41 cases) and a ten year survival rate of 7% (3 of the total of 41 cases). The unpredictability of the clinical behaviour of this tumour type is elucidated by cases with a prolonged clinical course despite a primary relatively limited surgery, repeated local recurrences and regional lymph node metastases in an early stage of the disease. Thus, there is always a never-ceasing risk of death in the tumour disease when once a malignant melanoma has occurred. For this reason a meticulous and lifelong follow-up of tumour patients is stressed, and also the value of repeated surgery of local recurrences and regional lymph node metastases.     

Juvenile nasopharyngeal angiofibroma. A report of eighteen cases

Juvenile nasopharyngeal angiofibroma is a disease afflicting mainly adolescent males. The lesion is benign but characterized by local aggressive growth. In advanced cases the tumour may extend intracranially. In this study 18 cases of juvenile nasopharyngeal angiofibroma were investigated. Tumour extension was assessed with the use of angiograms and CT and the individual cases staged in four different categories on the basis of tumour extension. Two cases were staged as I (tumour confined to the nasopharynx), 7 cases as II (tumour extending into nasal cavity and/or sphenoid sinus), 8 as III (tumour extending into one or more of the following: antrum, ethmoid sinus, pterygomaxillary and infratemporal fossae, orbit and/or cheek) and one as IV (tumour extending into the cranial cavity). Preoperative arterial embolization was performed in 8 cases. All patients underwent surgery; none received irradiation. The follow-up period was 6 yrs 4 mo (6 months-17 years). In one case of intracranial extension, tumour recurrence occurred. It is concluded that with the aid of CT and arteriograms to evaluate the extension of the tumour and preoperative embolization, this lesion can be cured in the vast majority of cases, with surgery as the method of choice.     

The use of biopsy in the evaluation of pediatric nasopharyngeal masses

Pediatric nasopharyngeal tumors are rare, and few clinicians possess more than anecdotal experience. The differential diagnosis includes a diverse group of benign and malignant tumors, but can be narrowed further based on the clinical and radiographic appearance of the mass. Nasopharyngeal angiofibroma has such characteristic angiographic and CT imaging that many authors suggest biopsy is not essential in the evaluation of this lesion. We present a case of a pediatric nasopharyngeal neoplasm with angiographic, CT, and clinical findings consistent with angiofibroma. We then discuss the preoperative evaluation of, operative approach to, and postoperative staging and treatment of the biopsy-proven embryonal rhabdomyosarcoma. A review of the literature pertinent to this case is presented, and recommendations made concerning biopsy of lesions resembling juvenile nasopharyngeal angiofibroma. We believe this report reaffirms the use of histologic study whenever possible, in addition to radiographic imaging, in the diagnosis of pediatric nasopharyngeal masses.     

Nasopharyngeal angiofibroma

OBJECTIVE: To study the clinical profile of nasopharyngeal angiofibromas, various surgical approaches, and the outcome of surgery. DESIGN: The retrospective study was carried out in 110 consecutive cases of nasopharyngeal angiofibroma over a period of 25 years. SETTING: A hospital-based study. Methods: In 65 patients, a transpalatal approach was used, and in 38 patients, a lateral rhinotomy approach was used. The tumour was removed by external ethmoidectomy in 2 cases and in by transnasal approach in 3 cases. A modification of the transpalatal approach was also designed. MAIN OUTCOME MEASURES: Patients were regularly followed up for any recurrence for 2 to 5 years. RESULTS: Of 118 operated cases, in 33 patients, recurrence was observed. Four cases had to be operated three times and one case four times. All of the recurrences were observed within 2 years. CONCLUSIONS: Angiofibroma, a disease of adolescent males, arises from either the lateral wall or the roof of the nasopharynx. Patients usually present at the late stage of the disease. Surgery is the treatment of choice. No single approach is applicable to all cases. However, most of the tumours are excisable by a lateral rhinotomy approach, with less chance of recurrence. The modified transpalatal approach provides excellent exposure. Recurrence occurs within 2 years.     

Recent advances in the treatment of juvenile angiofibroma

PURPOSE OF REVIEW: Juvenile nasopharyngeal angiofibroma is a rare vascular tumor almost exclusive to the nasopharynx of adolescent males. Traditionally, juvenile nasopharyngeal angiofibroma has been treated surgically using open surgical approaches and has been associated with frustratingly high recurrence rates. This article reviews recent contributions to the study and treatment of this disease. In particular, advances in minimally invasive endoscopic resection of juvenile nasopharyngeal angiofibroma are evaluated. RECENT FINDINGS: The growth patterns of juvenile nasopharyngeal angiofibroma are evaluated. Young age does not appear to correlate with more aggressive disease. The major recent advance in the treatment of juvenile nasopharyngeal angiofibroma has been the application of endoscopic endonasal surgery to the treatment of select tumors. This article reviews the indications and inclusion criteria recently put forth to help select patients for this minimally invasive approach. In properly selected patients with Radkowski stage I and II lesions, recurrence rates range between 0 and 7%. Advanced lesions continue, in most cases, to require open approaches, some of which are also presented. SUMMARY: With proper patient selection, endoscopic resection of juvenile nasopharyngeal angiofibroma is feasible and may be preferable to traditional open approaches. Results suggest that after endonasal resection, disease recurrence is low. Most larger lesions, especially those with intracranial spread, continue to require open approaches for complete resection.     

Role of radiation therapy for 'juvenile' angiofibroma

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign neoplasm which occurs primarily in male adolescents and is characterized by aggressive local growth. The controversy concerning appropriate treatment for patients with juvenile angiofibroma persists. Radiation therapy and surgical resection have both been reported to be effective to control a high proportion of these tumours. The case reported here demonstrates a locally advanced JNA controlled by radiation therapy.     

Tratamiento quirúrgico del angiofibroma nasofaríngeo juvenil en pacientes pediátricos

Introduction and objectivesThe juvenile nasopharyngeal angiofibroma is a highly vascularised benign neoplasm of complex treatment in its surgical preparation, surgery to be performed, risks and recurrences.The aim of the study was to analyze the management and surgical treatment for the pathology of juvenile nasoangiofibroma.Materials and methodsWe reviewed the clinical histories and images of the patients who underwent surgery with a pathology result of juvenile nasoangiofibroma in the period from January 2008 to December 2016.ResultsSixty-one cases were treated; all of them treated using the same surgical access by means of a Le Fort I osteotomy. All of the patients were male, with an average age of 13.3 years. The Andrew-Fish classification was used for staging the cases, most were staged as grade II and I.ConclusionsThe described approach provided extensive surgical access, which was adequate for the different stages of the tumour. It requires experience to be able to resect the tumour with the least possible bleeding.     

The role of midfacial degloving in modern rhinological practice

The midfacial degloving approach has been available for twenty five years and is slowly increasing in popularity in the management of extensive benign lesions of the sinonasal region, for selected malignancy in this area and to afford access to the nasopharynx and infra-temporal fossa. The advantages, applications and low complication rate are presented in a cohort of 86 patients, ranging from three to 79 years of age with a mean follow-up of 5.5 years. Seventy-seven per cent of the group had benign pathology of which juvenile angiofibroma was the commonest (40 cases). The 20 cases of malignant disease were a heterogeneous group histopathologically including adenoid cystic carcinoma (four cases), malignant schwannoma (two cases), rhabdomyosarcoma (two cases) and squamous cell carcinoma (two cases). Five underwent bilateral radical maxillectomies combined with orbital clearance in one patient. Complications include oro-antral fistula (three cases) and epiphora (three cases) all of which were successfully treated.