TLM as a primary treatment for advanced oropharyngeal malignancy confers excellent survival and swallowing proficiency.

Objectives/Hypothesis Document survival, prognostic variables, and functional outcomes of patients with AJCC stage III or IV oropharyngeal cancer, treated with transoral laser microsurgery (TLM) ± adjuvant therapy. Study Design Analysis of prospectively assembled data pertaining to the above-described patient cohort. Methods Patients treated with TLM for AJCC stage III or IV oropharyngeal cancer at Washington University School of Medicine from 1996 to 2006 were followed for a minimum of 2 years. Recurrence, survival, functional, and human papilloma virus data were analyzed. Results Eighty-four patients met inclusion criteria. Mean follow-up was 52.6 months. Overall AJCC stages were: III 15% and IV 85%. T stages were T1–2, 74%; T3–4, 26%. Eighty-three patients underwent neck dissection, 50 received adjuvant radiotherapy, and 28 received adjuvant chemoradiotherapy. Overall survival at 2 and 5 years was 94% and 88%, respectively. Disease-specific survival at 2 and 5 years was 96% and 92%, respectively. Six patients recurred (7%): locally (one), regionally (four), and distant (five). T stage, positive margins, and p16 status significantly impacted survival. The addition of adjuvant chemo-therapy in high-risk patients did not significantly impact survival. Five patients (6%) had major surgical complications, but without mortality. Eighty-one percent of patients had acceptable swallowing function at last follow-up. Immediately postoperatively, 17% required G-tubes, which dropped to 3.4% of living patients at 3 years. Conclusions In this population, our findings validate TLM ± adjuvant therapy as a highly effective strategy for survival, locoregional control, and swallowing recovery in AJCC stage III and IV oropharyngeal cancer. Our finding also show that p16 positivity improves survival.

Symptomatic salivary stones in the middle or proximal parotid duct have traditionally been treated by gland excision, which is associated with a 3% to 27% risk to the facial nerve in the pediatric population. Minimally invasive approaches to the management of salivary duct calculi have been introduced over the last several years. Fluoroscopically guided basket retrieval, lithotripsy, and intraoral stone removal under general anesthesia have found favor with many surgeons. Our patient had extracorporeal lithotripsy to his parotid gland with complete disintegration of the stone. He has had no evidence of stone recurrence or further bouts of parotitis. Extracorporeal shock wave lithotripsy with or without duct dilation is an efficient technique for the therapy of sialolithiasis in selected patients, especially patients who are at higher risk from a surgical standpoint.

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