Parapharyngeal Space Tumor: Submandibular Approach Without Mandibulotomy

Abstract

Purpose/Objective(s): Malnutrition is a common complication for head and neck cancer (HNC) patients receiving radiation therapy (RT) or chemoradiation therapy (CRT). The Academy of Nutrition and Dietetics (AND) and the American Society of Parenteral and Enteral Nutrition (ASPEN) define moderate and severe malnutrition as the presence of 2 or more of the following: inadequate energy intake, weight loss, loss of body fat, loss of muscle mass, fluid accumulation, or reduced grip strength. In malnutrition, decreased muscle function may respond more quickly to nutritional deprivation than changes in weight. Research suggests that grip strength is a feasible tool for the bedside assessment of muscle function. The purpose of this study was to implement grip strength assessment as part of the nutrition assessment for HNC patients receiving RT or CRT and to investigate the relationship between grip strength and weight loss before and after 7 weeks of RT. Materials/Methods: Grip strength, assessed by dynamometry, and weight were recorded the first and last week of RT. Each hand was measured 3 times and the average was calculated. Hand dominance was noted. Subjects were classified as malnourished if they met the AND/ASPEN malnutrition criteria for weight loss and reduced grip strength. Reduced grip strength was defined as a grip strength 2 standard deviations (SD) below the normative standards provided with the dynamometer. Descriptive statistics were used to describe the subject population, changes in grip strength, and changes in weight. Correlation between change in grip strength and change in weight was performed using the Pearson correlation. Results: Eleven subjects, with a median age of 59 years (53-74), received RT (nZ4) or CRT (nZ7). Mean change in grip strength for the left hand was-1.0AE3.8 kg (SD) and for the right hand was-0.7AE5.6 kg (SD). The mean weight loss was 6.6AE6.4 kg (SD). Decreased grip strength correlated weakly with weight loss for both the left (rZ0.248, 90% confidence interval [CI]-0.205-0.501, PZ.462), and right hand (rZ0.180, 90% CI-0.396-0.686, PZ.596). Two subjects (18%) at the initial treatment visit and 1 subject (9%) at the last treatment visit qualified as malnourished. Conclusion: Although this study found no statistical correlation between weight loss and grip strength in the small series of HNC patients receiving RT or CRT, collecting data on grip strength using the dynamometer proved feasible. To more accurately diagnose malnutrition using the criteria of reduced grip strength, further research is needed to establish grip strength reference ranges.

Endoscopy-Aided Combined Intraoral and Cervical Approach for a Huge Parapharyngeal Benign Tumor

“…Therefore, the mandibular swing approach is done for huge tumors; however, surgery itself is invasive to the patient, and malocclusion may occur. [12][13][14] The transoral approach is less invasive for the extirpation of tumors in the PS, and an assistance of endoscopy facilitates the surgery. 15 The use of an angle widener, formerly used in the dental clinic, facilitates the surgical procedure.…”