EXTRACAPSULAR DISSECTION AND LIMITED PAROTIDECTOMY

Publication date: Available online 3 July 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): David Myssiorek
Parotid surgery has evolved over the last century. Many of the long-held principles have been questioned and consequently modified. The basic tenets of parotid surgery for benign disease have been identifying and preserving the facial nerve and complete excision of the tumor with an adequate cuff of normal tissue. This can be safely accomplished by extracapsular dissection or limited/partial parotidectomy. Extracapsular dissection implies no attempt at finding the facial nerve, while limited or partial parotidectomy includes finding one (or more) branch of the facial nerve and then dissecting that branch in a retrograde fashion.Indications for extracapsular dissection or limited parotidectomy are similar to superficial parotidectomy. There is some evidence that this technique can be used safely without compromising oncological principles with low-grade cancers. Extracapsular dissection or limited parotidectomy should not be performed for large tumors, anatomically difficult to reach tumors and high-grade cancers.When compared to superficial parotidectomy, extracapsular dissection had similar recurrence rates. Extracapsular dissection had lower transient and permanent facial paralysis rates. Frey syndrome was also reported less frequently following extracapsular dissection. Sialoceles may be more frequent postoperatively but are easily treated and rarely last longer than three weeks.



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Neck dissection for salivary gland malignancies

Publication date: Available online 3 July 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Serena Byrd, Luc G.T. Morris
Salivary gland carcinomas are diverse, and their biological behavior and surgical management are also variable and somewhat controversial. Cervical lymph node status is an important prognostic variable for salivary gland malignancies. Neck dissection should be undertaken if there is clinical or radiographic evidence of associated nodal metastasis in the neck. However, indications for elective neck dissections in a clinically N0 neck remains a controversial topic. This article describes indications for elective neck dissection in salivary gland malignancies, provides a detailed review of the neck dissection technique, and discusses postoperative management of these patients.



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Sublingual Gland

Publication date: Available online 4 July 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Patrick J Bradley
It is infrequent for surgery to be necessary for the sublingual salivary gland. As such the anatomy of the floor of mouth is not well taught or understood to medical graduates and head and neck surgeons. Three diseases or conditions require surgical management: the ranula, neoplasm and sialolithiasis. In the benign conditions, the lingual nerve and submandibular duct must be identified and preserved to avoid patient morbidity. Malignant salivary gland neoplasms are rare, and hence an inaccurate diagnosis frequently delayed commencement of correct treatment. Most cases present at an advanced stage of disease. Surgical excision with a "safe margin" is required, and thus removal of the lingual nerve and submandibular gland are sequelae of the treatment rather than a complication.



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Potentiation of PD-L1 blockade with a potency-matched dual cytokine–antibody fusion protein leads to cancer eradication in BALB/c-derived tumors but not in other mouse strains

Abstract

We have recently described a novel therapeutic antibody product (IL2–F8–TNF^mut), featuring the simultaneous fusion of murine IL2 and of a TNF mutant with scFv(F8), an antibody specific to the alternatively-spliced extra domain A of fibronectin (EDA). Here, we report on the in vivo characterization of the anti-cancer activity of IL2–F8–TNF^mut in four immunocompetent murine models of cancer, CT26, WEHI-164, F9 teratocarcinoma and Lewis lung carcinoma (LLC), using the product alone or in combination with a monoclonal antibody specific to murine PD-L1. All four models exhibited a strong expression of EDA-fibronectin, which was confined to vascular structures for F9 tumors, while the other three malignancies exhibited a more stromal pattern of staining. A complete and long-lasting tumor eradication of CT26 and WEHI-164 tumors was observed in BALB/c mice when IL2–F8–TNF^mut was used in combination with PD-L1 blockade. The combination treatment led to improved tumor growth inhibition in 129/SvEv mice bearing murine teratocarcinoma or in C57BL/6 mice bearing murine LLC, but those cancer cures were difficult to achieve in those models. A microscopic analysis of tumor sections, obtained 24 h after pharmacological treatment, revealed that the PD-L1 antibody had homogenously reached tumor cells in vivo and that the combination of PD-L1 blockade with IL2–F8–TNF^mut stimulated an influx of NK cells and of T cells into the neoplastic mass. These data indicate that potency-matched dual-cytokine fusion proteins may be ideally suited to potentiate the therapeutic activity of immune check-point inhibitors.

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The volatilome – investigation of volatile organic metabolites (VOM) as potential tumor markers in patients with head and neck squamous cell carcinoma (HNSCC)

Different organisms such as bacteria, molds and humans produce and release a relative unknown class of metabolites which are responsible for the individual olfactory pattern. These volatile organic metabolites...

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The 678 Hz acoustic immittance probe tone: a more definitive indicator of PET than the traditional 226 Hz method

The accurate diagnosis of Eustachian tube (ET) dysfunction can be very difficult. Our aim is to determine whether a 678 Hz probe tone is a more accurate indicator of Patulous ET (PET) than the 226 Hz probe ton...

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Endoscopic endonasal transmaxillary ligation of a feeding artery and coblation plasma technology enables en bloc resection of advanced juvenile nasopharyngeal angiofibroma without preoperative embolization

Juvenile nasopharyngeal angiofibroma (JNA) is a hypervascular tumor and uncontrolled hemorrhage makes its removal very difficult. Although preoperative intravascular embolization of a feeding artery is recommended, serious complications such as iatrogenic thrombosis in the brain and insufficient decrease in blood flow to the tumor are concerns. Recently, coblation plasma technology has been reported to be useful for tumor removal with minimum hemorrhage under a clear surgical field. Here we report successful removal of advanced JNA without preoperative embolization, using intraoperative ligation of the maxillary artery and coblation plasma technology.

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