Oral mucosal melanoma: conservative treatment including laser surgery

OBJECTIVE

To discuss the convenience of laser surgery as optimal treatment for melanoma of the oral mucosa.

PATIENTS AND METHODS

A retrospective evaluation of four patients with primary oral melanomas treated at a single Cancer Institution in Mexico City.

RESULTS

Two patients were treated with resection of the melanoma with CO2 laser together with extraction of the involved dental organs and curettage of the alveolar walls. These two cases had melanoma in situ with multiple isolated foci. The third patient had a lesion with vertical growth, who was submitted to partial maxillectomy along with selective dissection of bilateral neck levels I-V with a negative report and the fourth patient had a history of oral nodular melanoma and presented with lymph node metastasis. According to follow-up status, there was no distant metastasis in any of the patients reported here.

CONCLUSION

In our experience, conservative management with CO2 laser is adequate for melanomas of the oral mucosa with extraction of the dental organs and curettage of the alveoli to achieve complete surgical resection microscopically without sacrifice of the quality of life. Management of the neck is controversial. We recommend selective therapeutic resection of the neck only if it is found to be clinically positive. Elective dissection has not shown to have an impact in overall survival.

Vertical partial hemilaryngectomy with reconstruction by false cord imbrication

BACKGROUND

To evaluate global survival, disease-free period, complications, evolution and function in vertical partial hemilaryngectomy (VPHL) plus reconstruction with false cord.

METHODS

Descriptive and retrospective study. In aertiary care medical center in Mexico City. Eight patients with early diagnosis of early glottic cancer (T1 and T2), treated with VPHL plus reconstruction with false cord imbrication.

RESULTS

Fifty percent of the patients were clinical stage I, 37.5% stage II and 12.5% stage III. Nasogastric tube was not placed and oral feeding was reinitiated within 3 days on average. Tracheostomy was removed after an average of 2.1 days. Average hospital stay was 3.3 days. Average of the PSS-HNC (Performance Status for Head and Neck Cancer) and Karnofsky Performance Status evaluation was 91 to 97 and 100 at 1 year of evaluation. Voice evaluation demonstrated normal voice in 87.5% of patients. Intensity was below normal with improvement on annual evaluation. Global survival was 100% and disease-free period was 71% at 3 years.

CONCLUSIONS

VPHL with reconstruction by false cord imbrication is an excellent therapeutic option for early glottic cancers. Multiple functional advantages are demonstrated without sacrificing oncological control as well as providing an audible and intelligible voice. In cases of recurrence, various management options are available.

Laser resection of liposarcoma of the hypopharynx

Liposarcomas represent between 15 and 18% of all sarcomas with the most common site being the extremities and retroperitoneum. Liposarcomas of the head and neck are rare, with an estimated incidence representing 3 to 5.6% of all liposarcomas. Liposarcomas most commonly present in the soft tissues of the neck. Primary liposarcoma of the hypopharynx (piriform sinus) is extremely rare. The symptoms presented are principally dysphagia, dyspnea, dysphonia, airway obstruction and sensation of a foreign body. Treatment of choice is surgery, and the literature describes the performance of lateral pharyngotomy, simple excision and even total laryngectomy. We present the case of a 23-year-old patient who was diagnosed 7 years prior with liposarcoma of the piriform sinus. The patient underwent surgery using a cervical approach. The tumor recurred 4 years postoperatively and the patient was again surgically intervened using the same approach. He presented to our Institute with 3 months evolution of dysphonia. Nasofibrolaryngoscopy and imaging studies were performed. Surgical treatment was decided upon with CO2 laser using suspension microlaryngoscopy, obtaining excellent results. Some of the advantages of this approach are low morbidity because of the avoidance of performing a tracheostomy, rapid return to oral feeding without necessity of a feeding tube, and reduction in hospitalization days. Disadvantage includes difficulty in evaluating margins.

[Zenker's diverticulum: laser or stapler treatment]

OBJECTIVE

We undertook this study to report on transoral endoscopic management of Zenker's diverticulum.

METHODS

Four patients with Zenker's diverticulum were treated by transoral microendoscopic surgery, two by stapler and two by laser resection.

RESULTS

All patients were successfully treated, and no complications were noted. Hospital stay was <24 h in all cases. Patients treated by stapler resumed oral feeding 8 h after surgery and those treated by laser required nasogastric tube feeding. Normal oral intake was achieved 5 days later.

CONCLUSIONS

Currently, treatment for Zenker's diverticulum must be done by transoral approach. Technique selection (laser or stapler) depends on surgeon's experience and their access to technology. Both techniques have important advantages when compared to classic open surgery (shorter hospital stay, lower cost, low morbidity and low rate of complications). Open surgery is indicated only when transoral technique is impossible for medical reasons or technical challenges, such as when technological support is not available.