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Transoral surgery of the oropharynx has seen an important evolution in recent years, expanding the surgical options available (TORS, TOUSS, TOLS). The capacity to resect increasingly extensive lesions and the number of patients who benefit from them. This fact has led to an evolution in the reconstruction of surgical defects after transoral surgery. This article aims to review the possible reconstructive techniques, indications and factors to be taken into account prior to surgery, proposing a protocol to assess the need for transoral reconstruction based on the depth of the defect, the staging, and previous treatment., (Copyright © 2018 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Goals: There has been a very significant increase in the use of minimally invasive surgery has in the last decade. In order to provide a common language after transoral surgery of the oropharynx, a system for classifying resections has been created in this area, regardless of the instrumentation used., Methods: From the Oncology Working Group of the Catalan Society of Otorhinolaryngology, a proposal for classification based on a topographical division of the different areas of the oropharynx is presented, as also based on the invasion of the related structures according to the anatomical routes of extension of these tumours., Results: The classification starts using the letter D or I according to laterality either right (D) or left (I). The number of the resected area is then placed. This numbering defines the zones beginning at the cranial level where area I would be the soft palate, lateral area II in the tonsillar area, area III in the tongue base, area IV in the glossoepiglottic folds, epiglottis and pharyngoepiglottic folds, area V posterior oropharyngeal wall and VI the retromolar trigone. The suffix p is added if the resection deeply affects the submucosal plane of the compromised area. The different proposed areas would, in theory, have different functional implications., Conclusions: Proposal for a system of classification by area to definedifferent types of transoral surgery of the oropharynx, and enable as sharing of results and helps in teaching this type of technique., (Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.)

Introduction and Objectives: HSP-90 is an intracellular protein that protects the cell from environmental stress situations. The overexpression of HSP-90 isoforms could serve as a mechanism of resistance to radiotherapy for tumour cells. We studied this effect in a sample of head and neck tumours., Methods: We included 87 patients diagnosed with oral cavity, oropharynx, larynx and hypopharynx tumours. We studied the expression of the HSP-90 isoforms by real-time PCR on pre-treatment biopsy samples. We analysed the relationship between HSP-90 expression levels and local relapse of the tumour with CRT decision trees., Results: The expression levels of the inducible citosolic isoform (HSP90AA) allowed the definition of 2 groups of patients with different rates of local relapse. The group with a low expression level showed a 2.9% local relapse rate, while the group with a high expression level showed a 38.2% rate. Survival curves showed differences in time to local relapse for both groups of patients. These differences did not reach statistical significance., Conclusions: Radiotherapy response was related to expression levels of HSP-90 in a sample of head and neck cancer patients. This result could prove useful in the selection of treatments for this group of patients., (Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.)

Introduction and Objectives: The aim of our study was to evaluate outcomes of a minimally invasive approach, using transoral surgery (TOS) as the primary treatment for oropharyngeal carcinoma., Methods: We reviewed 43 previously untreated patients with oropharyngeal carcinoma, who were treated with TOS. Distribution of the primary tumor site was: tonsil (52%), soft palate (23%), base of the tongue (21%) and posterior wall (4%). Eight patients had a stage I disease, 9 had a stage II disease, 7 had a stage III disease, 16 had a stage IVA, and 3 had stage IVB disease. Eighteen patients underwent postoperative radiotherapy. Records of these patients were reviewed to obtain measures such as local and regional control, overall and disease-specific survival, and speech and swallowing function., Results: The overall recurrence rate was 44%, and the local recurrence rate was 18%. The 5-year overall survival and disease-specific survival rates were 55% and 66%, respectively. Five-year disease-specific survival rates by site were as follows: 100%, 85%, 44%, and 30% for posterior wall, tonsil, soft palate and base of the tongue, respectively. Five-year estimates for local control were 100%, 90%, and 0% for palate, tonsil and for base of the tongue tumors, respectively. All of the patients preserved the larynx and live without tracheotomy and oral alimentation was successfully without feeding tube., Conclusions: TOS as the primary treatment approach offers a surgical alternative for treatment of the primary oropharyngeal tumor, in the era of chemoradiation therapy. This approach confers a good local control and functional outcomes., (Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.)

Introduction and Objectives: Squamous cell carcinomas of the oropharynx are aggressive tumours usually diagnosed at advanced stage. Their optimal treatment has not been established. The aim of this study was to compare the oncological and functional outcomes in patients with carcinomas of the oropharynx treated by radiotherapy (with chemotherapy in advanced stages) vs surgery (with radiotherapy in advanced stages)., Methods: A retrospective study on 50 patients with squamous cell cancer of the oropharynx treated by radiotherapy (with or without chemotherapy) at our institution between 1998 and 2008 was carried out. The oncological and functional results were compared with patients with same cancer location and stage treated by surgery (with or without radiotherapy). In both groups, the patients were classified as follows: 10% Stage I, 12% Stage II, 16% Stage III, 48% Stage IVa and 14% Stage IVb., Results: The 5-year disease-specific survival was 33% in the radiotherapy group and 52% in the surgical group (P=.17). Five-year disease-specific survival for Stage I and II patients was 82% in the radiotherapy group and 70% in the surgical group. In Stage III and IV disease, 5-year disease-specific survival was higher in the surgical group (47% vs 17%). The functional results were similar; anatomical and functional preservation of the larynx was higher in the radiotherapy group but the successful return to oral food intake was higher in the surgical group., Conclusions: The prognosis of squamous cell carcinoma of the oropharynx is poor. Oncological results in Stages I and II were similar for radiotherapy and surgical treatments. In advanced stages, the prognosis was better in patients treated by surgery with or without radiotherapy. Functional results were similar in both treatment modalities., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Introduction: The assessment of quality of life in patients with head and neck cancer is dependent on many variables., Objective: The aim of this study was to evaluate the differences in quality of life among patients treated with conservative or radical surgery for laryngeal, oropharyngeal or hypopharyngeal cancer, evaluated before and at 3 and 6 months after definitive therapy., Material and Method: Prospective study between November 2008 and June 2009 on 53 patients diagnosed and treated for head and neck carcinoma with surgery: partial (n=32) and radical (n=21). Quality of life was evaluated using the European Organization of Research and Treatment of Cancer (EORTC) general questionnaire EORTC QLQ-C30 and its specific head and neck EORTC QLQ-H&N35 before treatment, and at 3 and 6 months afterwards., Results: No significant differences were found in overall health. Patients experienced the greatest changes in functional scale. There were no changes in swallowing problems or feeling of disease, while evident phonation problems were present in both groups., Discussion and Conclusions: The routine application of quality of life questionnaires in cancer patients improves information regarding how and to what extent patients feel that treatment and its sequelae modify it, making it possible to adapt rehabilitation and support programs to their real needs. This data helps in choosing between different options depending on the results, delivering improved care to patients., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Introduction and Objectives: Oropharyngeal and hypopharyngeal reconstructions require significant human and technical resources. This study analysed our reconstruction program over the last 13 years., Material and Methods: Retrospective study in a tertiary reference centre., Results: Forty-three reconstruction procedures, of which 67.4 % (29/43) were microvascular (radial forearm 17, rectus abdominis 10, scapular 1, jejunum 1) and 42.6% (14/43) myocutaneous (pectoralis major 13, latissimus dorsi 1). Of these reconstructions, 83% (37/43) were for oropharyngeal defects and 17% (6/43) for hypopharyngeal defects, with 70% Stage iv (30/43), 26% Stage iii (11/43) and 4% (2/43) Stage ii. Mean Hospital stay was 54 days. Complications were present in 74.4% (32/43), salivary fistula being the most frequent (62.5%; 20/32). Ischemic necrosis was present in 20% (6/29) of the microvascular flaps. One microvascular flap was performed every 5.5 months, and one myocutaneous every 11.1 months. Previous radiotherapy and salvage surgery did not significantly increase the rate of complications., Conclusions: Reconstruction of pharyngeal defects is a challenging and demanding task, one that is great when everything runs perfectly and disastrous when failure takes place, mainly for the patient. Disciplines related with head and neck reconstruction should create multidisciplinary teams to increase experience, particularly in centres where the number of patients available makes it difficult to get the expertise and confidence this surgery demands for accomplishing the objectives of patient satisfaction and functional restoration., (Copyright 2009 Elsevier España, S.L. All rights reserved.)

The kaposiform hemangioendothelioma is a very infrequent tumor proceeding from the endothelial-derived spindle cells, more often found on the limbs, although peritoneal, retroperitoneal and sacrum locations are also prevailing. Head and neck are exceptional locations. The kaposiform hemangioendothelioma is almost exclusively found in children and early adolescents, and it is highly associated with the Kasabach-Merritt syndrome and lymphangiomatosis. The main treatment is the tumor surgical removal, including wide margins, plus supporting therapy when Kasabach-Merritt syndrome is linked. We report an isolated oropharyngeal kaposiform hemangioendothelioma 9-10-year old male case.

The ex-utero intrapartum treatment (EXIT) procedure is a technique designed to allow partial foetal delivery via caesarean section with establishment of a safe foetal airway by either intubation, bronchoscopy, or tracheostomy while foetal oxygenation is maintained through utero-placental circulation. The most common indication for the EXIT procedure is the presence of foetal airway obstruction, which is usually caused by a prenatal diagnosed neck mass. We report three cases of head and neck tumours with airway obstruction treated by means of EXIT and with different solutions in the management of the airway. With the involvement of Paediatric Otolaryngologists in EXIT, new indications and select variations from the standard EXIT protocol should be considered.

An ex utero intrapartum treatment (EXIT) procedure provides sufficient time to gain control of the potentially obstructed fetal upper airway while uterine placental circulation is maintained during cesarean section. We report 2 cases in which fetal congenital upper airway obstruction was managed without complications during EXIT procedures. We also discuss general considerations concerning the obstetric patient and the performance of intramuscular fetal anesthesia. Before the hysterotomy, sevoflurane at 1.5 minimum alveolar concentration was administered to assure sufficient uterine relaxation during EXIT. The 2 parturients remained hemodynamically stable during the procedure and uterine and placental perfusion was adequate. Nasotracheal intubation was possible in 1 fetus after a cervical mass was dissected. In the other, a tracheostomy was created. After the umbilical cord was clamped, the concentration of sevoflurane anesthetic gas was reduced and oxytocin and methylergometrine were administered to induce adequate uterine contractions within a few minutes. Both neonates survived the EXIT procedure with no complications.

The rabdomiosarcoma (RMS) are infrequent tumors. They are principally described in infancy and located in 35% of the cases in head and neck. The nasopharynx localisation is relatively rare, being in these cases the tongue, palate and oral mucosa the preferent places of establishment. Classically the patient presented very low standard healing with surgery and radiotherapy. The introduction in the middle 70 of systematic chimiotherapy as complementary treatment, improved the survival rate in large scale. In this article the case of an adolescent patient, who presented a RMS at the level of the soft palate, the diagnostic procedure and the therapeutic decision adopted, after revision of the last studies at this respect, are described.

Introduction: The effect of the wide long-wave CO2 laser is the thermal vaporization of the tissues, getting a maximum energy concentration with a minimum of tissue penetration. In oral surgery, it is generally used for the treatment of oral and oropharyngeal small mucous tumors, due to the scarce morbidity that takes place and the absence of reconstructive necessity., Objective: To analyze the postoperative evolution, in the patients treated by oral and oropharyngeal epidermoid carcinomas, after CO2 laser resection. To compare it with that of the patients treated by means of conventional surgical methods, achieving the reconstruction through direct suture or the employment of local, regional or distance flaps., Methods: A prospective study was designed including 70 patients treated by oral and oropharyngeal epidermoid carcinomas. Thirty-five patients were treated by means of CO2 laser, in 10 cases direct wound-closure was realized, and in the remaining 25 patients some local, regional or distance flap were used. There were analysed the presence of postoperative pain, the degree of cicatricial retraction, and the speech and swallowing functional results., Results: We obtained a smaller painful degree and postoperative cicatricial retraction by the employment of CO2 laser. It permits minimizing the functional speech sequels (better words articulation) and swallowing (effective and precocious functional recovery)., Conclusion: CO2 laser resection has become the elective treatment for small oral and oropharyngeal epidermoid carcinomas. The reasons are the absence of reconstructive surgery necessity, the scarce cicatricial retraction, and the excellent postoperative evolution.

Objective: To evaluate the results of an induction chemotherapy protocol with Vinorelbine, UFT and Cisplatin (UFTVP)., Methods: 93 patients with laryngo-pharyngeal squamous cell carcinoma in stage III or IV were prospectively entered into a protocol to receive four cycles of UFTVP. Responders followed definitive radiation therapy. Nonresponders underwent conventional surgery with postoperative radiation., Results: Following chemotherapy nodal response (complete in 28% and partial in 33%) was less than that the primary site (complete in 60% and partial in 30%), p = 0.002. With a median follow-up of 62 months, the Kaplan-Meier 5-year survival was 45%. Successful larynx preservation was achieved in 50% of patients with laryngeal cancer and in 29% of patients with hypopharyngeal cancer. Lymph node metastases and pharyngeal localization were found to be significant negative factors with regards to survival., Conclusions: UFTVP is an active regime of chemotherapy in advanced squamous cell carcinoma of the pharynx and larynx. Results differ according to the localization, having significantly better rates of survival and organ preservation in the laryngeal cancers that in those of the pharynx.

We present the consequences corresponding to a bilateral section of the main trunk of vagus nerve at cervical level in a patient with an oropharyngeal carcinoma with bilateral neck nodes. As a consequence of the bilateral resection of both vagus nerves during neck dissections, as well as motor and sensitive damage of the larynx and pharynx, we could observe affection of the normal tone of the oesophagus, stomach and duodenum which forced to enteral nutrition by direct jejunal access, and a disorder of the cardiac rhythm due to loss of the parasympathetic innervation appeared.

A retrospective series of 76 pedicled pectoralis major musculocutaneus flaps is presented. We used this technique in reconstruction after head and neck tumours resections and in complications of oncological surgery such as pharyngostomes or orostomes. Most of these flaps were used in reconstruction of oral cavity and in postradiotherapy salvaje surgery cases. We also analyse the presence of complications at the donor and receiver sites and its correlation with different parameters like protein levels, haemoglobin, administration of radiotherapy and its dose, previous quimiotherapy and the influence of systemic diseases.

The lateral arm flap, is a fasciocutaneous flap with great versatility, but underused in head and neck reconstruction. Its qualities include a intermediate thickness between the radial forearm flap and the pectoralis major, ideal to reconstruct oropharyngeal defect, a consistent vascular pedicle, a pliable soft tissue and a low donor site morbidity. Use of this flap does not require the sacrificing of a major feeding vessel to the arm. We have chosen this technique to reconstruct four cases with surgical defects in oral cavity and oropharynx. The anatomic and functional results have been satisfactory and the complications rate is comparable to other microvascular techniques. We think that the lateral arm free flap is a useful reconstructive technique in specific areas of head and neck.

In a study of 79 patients diagnosed as squamous cell carcinoma of the oropharynx and oral cavity, we compared the results obtained with two different types of initial treatment (surgery versus irradiation). Patients were grouped by tumor size: small tumors (T1 and T2) and bigger tumors (T3 and T4). Thirty-one patients had T1-T2 tumors:17 treated surgically with an 83% cure rate, 14 treated by irradiation with a 71% cure rate. Forty-three patients had T3-T4 tumors: 38 treated by irradiation with an 32.5% cure rate and 5 treated by surgery, with a 25% cure rate.

The free radial forearm flap has become the most common used flap in recreative head and neck. The tolerable complications rate and also the achievements rate offers one of the best choices in pharynx repair.

Solitary or multiple extramedullary plasmacytoma is and odd condition. We report one case of multiple extramedullary plasmacytoma of pharyngolaryngeal site, stressing the importance of the area covered in order to rule out the most frequent systemic disease, that is the multiple myeloma. Comments about pathological anatomy features of the diagnosis and elective treatment as well.

Synovial sarcoma is a malignant growth of the soft parts of young people, scarcely of the head and neck. The tumor classic is two-phase composed by epithelial and spindle cells. The AA. report a new case of synovial sarcoma located in the oropharynx and the treatment followed, and discuss as well the histology and the origin of these tumors.

The accuracy of computed tomography (CT) in detecting cervical lymph node metastases was studied. Twenty patients with squamous carcinoma of the head and neck were selected. The results obtained by cervical palpation, CT and postoperative histological study were compared. Palpation had a sensitivity of 64% and specificity of 100%. CT had a sensitivity of 71% and specificity of 100%. The small gain in sensitivity does not justify the systematic use of CT to study cervical lymph nodes in head and neck squamous carcinoma.

The present paper shows the results of a randomized, prospective trial carried out on 170 patients undergoing elective surgery for oropharyngeal cancer. These patients were distributed in two groups that received a prophylactic therapy with amoxicillin and clavulanic acid, for 24 hours and 5 days, respectively. Comparing results of short-term and long-term prophylaxis. Among patients undergoing only total or partial laryngectomies, no differences between both groups were found. Among patients who already had a tracheostomy, the rate of local infection was higher in the short-time group. Duration of prophylaxis in high-risk surgery, such as that requiring flap reconstruction, needs further investigation.

A study was carried out about the general features of myocutaneous flap taken from the pectoralis major muscle. This flap is employed in the reconstructive step after ablative surgery for carcinomata of the oropharynx, tongue, floor of the mouth, hypopharynx and other growths of the neck with skin involvement. The AA. review their 31 cases results, both cosmetic and functionally, and consider that the end-condition is favorable and hopeful in the whole.