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Swallowing disorders due to oro-pharyngo-laryngeal cancer, or due to the consequences of surgical resection and radiotherapy, should be accurately evaluated to manage properly both nutritional therapy and dysphagia rehabilitation techniques. The site, size, and local spread of such tumors and, especially, the nature and extent of surgical resection and reconstruction, are important factors which are closely related to the functional disorders of deglutition. The aim of this paper is to demonstrate video-fluoroscopy capability to evaluate the incidence, type, and severity of such functional disorders. For this purpose we studied by means of dynamic radiology 23 patients with oral cancer and 33 patients with pharyngeal-laryngeal cancer, most of them after surgical and/or radiological treatment. Eighty-four per cent of the patients had swallowing disorders such as poor oral processing (25%), retention of the bolus in the pharynx (41%), penetration (41%) or aspiration (37%) of the bolus in the airway, dysmotility of upper esophageal sphincter (9%), and structural lesions (61%). The association of these functional disorders was closely related to the pathological background of each patient. In conclusion, a dynamic radiological study is recommended for both pre and postoperative evaluation of these patients, to choose the appropriate nutritional therapy and dysphagia rehabilitation technique.
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Primary parapharyngeal space tumours are exceedingly rare. We present a series of 114 parapharyngeal space tumours, the second largest in the literature. The most frequent benign tumours were pleomorphic adenoma (34) and paraganglioma (33); the commonest malignancies were of salivary gland origin (12). The 5- and 10-year survival for benign tumours was 100%. The 5- and 10-year survival for malignancies was 93% and 57% respectively. The importance of long-term follow-up is evidently crucial.
To achieve cryodestruction of neoplastic tissues or preliminary freezing tumours for reducing bleedings cryogenic technique was employed in the treatment of 60 patients with buccal and pharyngeal neoplasms. Cryogenic action on the buccal and pharyngeal newgrowths is a promising method of therapy, and for it most suitable is cryoprobe. Recommendations for further improvement of cryogenic instruments are given.
The aim of this prospective study was to compare the diagnostic value of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of tumors of the nasopharynx, oropharynx and hypopharynx. For this reason, we performed CT and MRI in a total of 473 patients with neoplasms of the nasopharynx [116], oropharynx [282] and hypopharynx [39]. Furthermore, the MR imaging protocol had to be optimized including 2D and 3D gradient echo sequences. We compared the use of conventional and fast spin echo and 3D gradient echo sequences for the evaluation of tumors of the nasopharynx and the skull base, and we evaluated 2D fast and ultrafast MR sequences for the detection and delineation of tumors of the oropharynx and hypopharynx. MRI yielded better results than CT in the detection of pharyngeal neoplasms. The differentiation of tumor and inflammatory tissue was best achieved using MRI. Contrast-enhanced 3D GE sequences improved the diagnostic value of MRI of the nasopharynx. Fast and ultrafast 2D MR sequences increased the contrast between orofacial tumors and surrounding tissues. Functional MR images (phonation studies, Valsalva's maneuver) were attainable using ultrafast sequences thus enhancing the diagnostic value of MRI in the case of tumors of the hypopharynx. T2-weighted turbo (fast) spin echo sequences with relatively short acquisition times proved to be superior to conventional T2-weighted spin echo sequences. In conclusion, MRI is the imaging modality of choice in the evaluation of pharyngeal neoplasms. Conventional T2-weighted SE should be substituted by fast T2-weighted SE sequences. 3D GE sequences should be integrated in the MR imaging protocol of the nasopharynx. Fast and ultrafast 2D GE sequences should be applied in the evaluation of tumors of the oropharynx and hypopharynx.
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