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    • Patients with endophytic tumors had a fold higher rate

    2019-06-28

    Patients with endophytic tumors had a 2.6-fold higher rate of local recurrence than those with exophytic tumors. The 5-year local control rates were 64% and 95% in those with endophytic and exophytic lesions, respectively. The correlation of tumor morphology with local recurrence in patients with early glottic cancer who underwent TLM has rarely been reported. Franchin et al. analyzed the prognostic factors of 412 patients with T1–T2 glottic cancer treated with RT, and found X-Gal borderline significance of local control in patients with exophytic lesions versus infiltrative lesions (hazard ratio, 2.2; p = 0.07). In other sub-sites of the head and neck area, Spiro et al. found that endophytic tumors were significantly more likely to recur locally than exophytic tumors in patients with oral tongue cancer (32% vs. 10%, p < 0.04). In our experience, it X-Gal is more difficult during TLM to identify deep margin in patients with endophytic tumors than in those with exophytic tumors. The piecemeal method with transection of the tumor may help delineate the tumor and healthy tissue interface and identify the depth of tumor invasion.
    Acknowledgments This study was sponsored by the National Science Council (grant number 100-2314-B-075-017-MY3) and Taipei Veterans General Hospital (grant number V98C1-135).
    Introduction Consecutive horizontal deviation occurs when ocular misalignment surgery overcorrects for misalignment in the absence of exogenous mechanical factors or an acquired paralytic component. Patients originally with inward deviation (esotropia) can have subsequent outward deviation (exotropia), This scenario, called consecutive exotropia, occurs in 2–8% of esotropia cases treated with surgery. Similarly, consecutive esotropia through overcorrection of an original exotropia has been reported to occur in as high as 6–20% of surgical cases. Small-angle vertical deviations can be concomitantly present in patients with consecutive horizontal deviation. There are few studies devoted to management of associated vertical tropia in patients with consecutive horizontal deviations. Treatment for associated vertical ocular deviations mostly consists of vertically offsetting the horizontal rectus muscles during surgery that is primarily aimed at correcting the horizontal deviation. ‘Clinically significant’ vertical deviations are defined as those with a magnitude of 5 prism diopters (PD) or greater in primary position, regardless of the magnitude of deviation in other fields of gaze. This article focuses on the spontaneous resolution of small-angle vertical tropia, unrelated to oblique muscle dysfunction, manifest or latent dissociated vertical deviation, or extraocular muscle palsy.
    Methods
    Results Twenty-three cases met the inclusion criteria for this study, including 12 with consecutive esotropia and 11 with consecutive exotropia. Of the 12 patients with consecutive esotropia, 9 (75%) underwent reversal of the lateral rectus recession, 1 (8.3%) had medial rectus recession, and 2 (16.7%) required reversal of the lateral rectus recession and recession of the medial rectus. Of the 11 patients with consecutive exotropia, 4 (36.4%) underwent reversal of the medial rectus recession, 2 (18.2%) had lateral rectus recession, and 5 (45.5%) required reversal of the medial rectus recession and recession of the lateral rectus. The average age at surgery was 20 ± 9 years (range 5–39 years). The mean preoperation vertical deviation was 7.6 ± 2.3 PD for distance and 7.3 ± 2.3 PD for near. Measurements for preoperative and postoperative hypertropia at near and distance are shown in Table 1. Preoperatively, no patients experienced vertical diplopia with prism correction for horizontal deviation alone. No patients had objective torsion or compensatory head posturing or tilting. Postoperatively, no patient manifested hypertropia or intermittent hypertropia in any field of gaze at 6 months follow-up. All patients showed orthophoria (<5 PD) at the final follow-up visit. In this series, none of the patients experienced postoperative complications.