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Recurrent respiratory papillomatosis (RRP) is a currently incurable benign neoplasm caused by human papilloma virus (HPV) infection. It usually reduces voice, respiratory, and general quality of life, and is sometimes life-threatening. Patients usually need repeated operations. The use of adjuvant bevacizumab, a monoclonal antibody targeting vascular endothelial growth factor A, has been described in several case reports, with a good efficacy and safety profile. We report the cases of five patients with aggressive RRP who were treated with adjuvant systemic bevacizumab in a single Belgian tertiary center. A complete response was achieved in four patients after a median of 4.5 months, and a partial response in one. In all cases, the number of surgeries was drastically reduced, and quality of life improved. Toxicity was easily managed. Systemic bevacizumab seems to be an effective and safe adjuvant treatment for aggressive RRP.

Spasmodic dysphonia (SD) or laryngeal dystonia is as a rare vocal disorder characterized by involuntary action-induced endolaryngeal contraction. In the last decade, botulin toxin injection has become the standard treatment in adductor spasmodic dysphonia necessitating repetitive injections. The purpose of this study is to analyze retrospectively data from patients treated with the minimal-invasive transoral radiofrequency-induced thermotherapy (RFITT) of the terminal branches of the recurrent nerve. Between 2009 and 2015, 11 patients (six females and five males aged from 32 to 91 years) with adductor SD were treated with RFITT. Pre-operative and post-operative vocal assessments (VHI-30, GRBASI, and acoustic-aerodynamics measurements), number of surgical revisions, delay between procedures, and post-operative complications were recorded. Statistical analyses were carried out on the first vocal assessment performed 2-8 weeks after the first procedure. Based on available data from ten patients, voice handicap index (VHI) showed improvement with a mean value of -17.7 points (p-value (pval) = 0.014, adjusted p-value (adj pval) = 0.21); instability has also revealed improvement in six patients (pval = 0.05, adj pval = 0.31). Four patients underwent only one procedure including one patient showing still long-term beneficial results after 5 years of follow-up. Other patients required one to three new procedures with an average time between procedures of 15.3 months. Over 24 surgeries performed on a total of 11 patients, one definitive treatment-related severe adverse event was reported. Thanks to long-lasting effect, repetitive treatments are less frequent compared to botulin toxin therapy. In our opinion, RFITT is a promising alternative to botulin toxin as a second-step procedure in case of toxin resistance or patient's lack of compliance.

Transoral Robotic Surgery (TORS) is an emerging technique for the treatment of head and neck tumors. The aim of this paper is to describe our experience of perioperative considerations. Indeed, TORS is feasible, safe, and both oncologically and functionally effective. However, this technology has certain perioperative implications. We present the experience of anesthesiologists and surgeons over the past ten years with the Da Vinci Surgical System, and strongly recommend assigning a specific medical and paramedical team to shorten the learning curve and manage this innovative surgical technique with confidence and expertise.

Objective: Medialization thyroplasty using the Montgomery® Implant System (MTIS) is a surgical procedure for the treatment of persistent glottal gaps. In this study, we aimed to analyze postoperative vocal outcomes in patients suffering from unilateral vocal fold paralysis. Methods: A retrospective study was conducted on 30 patients undergoing MTIS medialization thyroplasty for unilateral vocal fold immobility. This series was selected from 68 patients operated on by the same technique between 2009 and 2018. Patients with missing data were excluded. The surgical procedure was performed under local anesthesia and sedation with peroperative fiberoptic examination. A complete vocal assessment was undertaken pre- and postoperatively, including perceptual, aerodynamic, and acoustic parameters and a questionnaire. Shortterm outcomes were analyzed. Results: Postoperative assessment was performed at a median of 33 days (range eight to 216). Absolute median maximum phonation time showed an increase of 4.10 seconds (p < 0.05), whereas the voice handicap index decreased by 36 points (p < 0.05). No significant differences were found between sexes. Conclusion: This retrospective study confirms the excellent immediate vocal results after medialization thyroplasty using MTIS. Further studies with prospective data are needed to evaluate the results according to sex of the patient.

BACKGROUND: To propose a classification of transoral base of tongue (BOT) procedures able to provide uniform terminology in order to better define postoperative results. METHODS: The classification resulted from the consensus of the different authors and is based on anatomical and surgical principles. RESULTS: The classification comprises three types of BOT resections: type 1 is the resection of the entire lingual tonsil to the muscular plane; type 2 is performed by removing the entire lingual tonsil and part of BOT muscles; type 3 is performed by removing the entire lingual tonsil and the entire BOT muscles. Based on the extension of the dissection, we can use the suffix A (contralateral BOT), B (supraglottic larynx), C (lateral oropharynx), and/or D (oral tongue). CONCLUSION: The proposed classification could allow us to easily compare data from different centers.

INTRODUCTION : Since the landmark VA Laryngeal Cancer Study and the RTOG 91–11 trials, non-surgical “organ preservation therapy” for laryngeal cancer has become the standard of care in the United States.This treatment paradigm, some feel, is the reason that laryngeal cancer is the only cancer for which there has been a decrease in survival in the past twenty years. Specifically, large volume T3 tumors of the larynx have demonstrated a lower survival rate when primary nonsurgical organ preservation therapy is chosen. A recent systematic review of treatment outcomes for T3 cancer by treatment type, in fact, demonstrated a lower local control with laryngeal preservation RT as compared to both partial laryngectomy and total laryngectomy. [...]

Transoral robotic surgery (TORS) is an established treatment for many subsites of Head and Neck cancer. With the improved flexibility and access of the single-port (SP) robotic system, tumors within the distal upper aerodigestive tract can now be reached and successfully treated with all the published advantages of transoral endoscopic surgery. Here in we offer the first published surgical technique for SP TORS for resectable hypopharyngeal carcinoma. The video presented demonstrates many important aspects utilizing the enhanced robotic system, including adjustments of the semi-flexible endoscope and use of the third transoral surgical instrumentation. As previously reported, TORS hypopharyngectomy should be considered for resectable tumors to improve upon the deleterious effects of open surgical resection or chemoradiation therapy.