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Objectives/Hypothesis To determine the feasibility and the preliminary oncological results of transoral robotic surgery (TORS) for the treatment of early stage laryngeal tumors. Study Design Retrospective single center study. Methods We reviewed the medical records of 23 patients who underwent TORS for the treatment of T1 or T2 laryngeal squamous cell carcinoma between August 2009 and March 2012. Results Laryngeal tumors were involving the glottis (13 cases) and the supraglottis (10 cases). They were classified T1 N0 in 16 cases, T2 N0 in four cases, and T2 N+ in three cases. The median TORS operative time was 60 minutes (ranging from 30 to 118 minutes). The median hospitalization time was 7.5 days. Histopathological examination of the resected tumors confirmed 14 cases in which the margins were clear, four cases in which the surgical margins were close (less than 1 mm), one case in which the margins were microscopically positive, and in four cases margins status were not able to be recorded. A tracheostomy was carried out for three patients, and 11 patients got a nasogastric feeding tube postoperatively. The local recurrence rate was 8.7% (2/ 23 cases), and in both cases the recurrence occurred in the anterior commissure area only. The overall larynx preservation rate was 95,7% (22/ 23 cases). Conclusion In this preliminary study, we demonstrated that laryngeal TORS is feasible and may result in oncological results comparable with other treatment strategies, including laser CO2 surgery. This innovative approach needs to be evaluated through randomized multi-institutional trial. Level of Evidence 4. Laryngoscope, 123:2485-2490, 2013 [ABSTRACT FROM AUTHOR]

Background Robot-assisted endoscopic transaxillary thyroidectomy is an emerging surgical technique. Despite promising results it presents some limitations and remains controversial in terms of usefulness and validity. We developed an alternative robotic technique using a gasless infraclavicular approach. Methods We tested this approach using cadaveric dissection, then we performed the technique on a series of 21 patients from October 2009 to July 2010. Results Sixteen patients underwent total thyroidectomy and 5 patients underwent lobectomies. Mean total operative time was 197 minutes. We observed postoperative complications in 4 patients. Pathologic diagnoses included: benign follicular adenoma (19 patients) and single papillary carcinoma <1 cm in diameter pT1a (2 patients). Conclusions The infraclavicular approach for robotic thyroidectomy is feasible, but is not safe enough to be recommended, based on our experience and on the technical difficulties encountered. The use of 2 robotic arms instead of 3 is a major limitation for this technique. © 2011 Wiley Periodicals, Inc. Head Neck, 2012 [ABSTRACT FROM AUTHOR]

Background. To date, more than 60 gene expression profiling (GEP) studies have been published in the field of head and neck squamous cell carcinoma (HNSCC) with variable objectives, methods, and results. Methods. The purpose of this study was to present a state-of-the-art review of GEP in HNSCC focusing on the current advances and perspectives for clinical applications. Results. Gene expression signatures have been developed to identify screening and diagnostic molecular markers, to improve tumor staging (cervical lymph node and distant metastasis prediction), to differentiate lung metastasis of HNSCC from primary lung squamous cell carcinoma, to predict tumor response to chemoradiotherapy, and to provide outcome predictors. Conclusion. Some transcriptional signatures that could improve HNSCC management have been identified, but further analyses are required to properly validate and to precisely evaluate their clinical relevance. After an exploratory phase, the completion of large scale projects with stringent methodology is now necessary to transfer GEP from bench to bedside. [ABSTRACT FROM AUTHOR]

Conclusion. This update will enable us to precisely address the involvement pattern of level VI and to standardize treatment procedures in order to refine their indications and eventually improve their results and avoid treatment morbidity. Background. The neck level classification is being used worldwide to describe the lymph nodes status of the neck. It provides standardized data to properly evaluate and then improve our protocols for the management of neck metastasis in an evidence-based medical manner. Although level VI treatment is challenging in cancer of the larynx, pharynx, trachea, esophagus, and thyroid, our knowledge about its involvement relies on few non-standardized data, due to the inadequate definition of this region. Method. We propose an updated radiological and surgical definition of level VI, with the introduction of two sublevels which fulfill surgical, radiotherapy, radiological, and pathological concerns. Results. Level VIa encompasses prelaryngeal, intercricothyroidal, pretracheal, and perithyroidal nodes. Level VIb encompasses inferior laryngeal nodes. Within the traditional limits of level VI, all lymph nodes lying between the inferior border of the hyoid bone and the inferior border of the cricoid cartilage belong to level VIa. Between the inferior border of the cricoid cartilage and the top of the suprasternal notch, lymph nodes lying in front of the posterior face of the thyroid gland belong to level VIa; those lying behind this boundary belong to level VIb. We also discuss the definition of the superior mediastinal lymph nodes, which should not be mistaken for level VI. [ABSTRACT FROM AUTHOR]

Redundant length of the internal carotid artery causes the abnormal course of this vessel and changes its anatomic relationships. The frequency of these usually bilateral variations is said to lie between 10 and 40% of the population, without sex difference. Nonetheless, because of an intricate relationship between the carotid artery and pharynx, the presence of a pharyngeal beating mass and, more exceptionally, of an acute hemorrhagic incident during a pharyngeal surgical procedure may lead to diagnosis. A 55-year-old North African woman was referred to our otolaryngology department for current investigations of severe chronic renal failure. The overlying mucosa was normal, no cervical lymphadenopathy was detected and physical examination revealed no other abnormality.