Table of Contents  
EXPERT COMMENT
Year : 2019  |  Volume : 6  |  Issue : 4  |  Page : 302

Expert comments on “extending the boundaries of carotid body tumor excision with a maxillofacial surgeon”


Consultant Vascular Surgeon, Royal Victoria Hospital, Belfast Trust, Belfast, Northern Ireland

Date of Submission29-Nov-2019
Date of Acceptance29-Nov-2019
Date of Web Publication20-Dec-2019

Correspondence Address:
Mr. Paul Blair
Consultant Vascular Surgeon, Royal Victoria Hospital, Belfast Trust, Belfast
Northern Ireland
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_100_19

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How to cite this article:
Blair P. Expert comments on “extending the boundaries of carotid body tumor excision with a maxillofacial surgeon”. Indian J Vasc Endovasc Surg 2019;6:302

How to cite this URL:
Blair P. Expert comments on “extending the boundaries of carotid body tumor excision with a maxillofacial surgeon”. Indian J Vasc Endovasc Surg [serial online] 2019 [cited 2020 Sep 27];6:302. Available from: http://www.indjvascsurg.org/text.asp?2019/6/4/302/273584



The surgical resection of a carotid body tumor (CBT) can be difficult when distal extension to the base of the skull can limit exposure significantly and increase the risk of cranial nerve damage. Daniel Sathiya et al.[1] in their paper “Extending the boundaries of Carotid Body excision with a Maxillofacial Surgeon” have reported the advantages of additional surgical exposure gained by the use of a mandibular swing or mandibular subluxation. The remarkably low incidence of cranial nerve injury they have recorded may well be a consequence of the avoidance of excessive retraction as a result of the exposure technique they describe.

The decision to remove a CBT requires careful assessment of the patient, high-quality imaging to ensure accuracy of diagnosis, and also knowledge of the likely etiology, particularly with regard to genetic profiling. The majority of CBTs are benign, slow-growing, and asymptomatic making the decision to intervene quite difficult, particularly in older patients. Involvement of a multidisciplinary team such as described by Daniel Sathiya et al.[1] during assessment and treatment is important, and joint operating with colleagues from other surgical specialties can improve outcomes. Selective embolization in the immediate preoperative period can reduce bleeding and facilitate surgical resection in larger tumors. Selective targeted radiotherapy can also be considered in cases deemed too high risk for surgery as a result of the high probability of disabling cranial nerve injury.

The benefits of high-volume centers on surgical outcomes for vascular index cases have been well documented, and intuitively, one would assume that the complex surgery and additional interventions associated with the treatment of patients with head-and-neck paragangliomas should be concentrated in a number of regional centers. A range of surgical specialties are currently involved in the management of these patients, and our knowledge of the role of genetics and hypoxia on the development of these rare tumors is improving. A national registry of such cases is required combined with a national audit of outcomes. We would then be in a position to advise patients appropriately on their diagnosis and the best form of treatment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Daniel Sathiya SS, Stephen E, Kota AA, Samuel V, Premkumar P, Selvaraj D, et al. Extending the boundaries of carotid body tumor excision with a maxillofacial surgeon. IJVES 2019;6:298-301.  Back to cited text no. 1
    




 

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