The possibilities of surgical treatment of tumours of the head and neck in children

Mirosława Pietniczka¹, Andrzej Kukwa¹, Romuald Krajewski¹, Wojciech Adach¹, Barbara Lisowska², Lechosław P. Chmielik¹

Summary
Background:Treatment of malignant tumours, especially in children, needs a complex procedure. From the initial diagnosis, which as other physicians they derive from the results of histopathology and investigation, the treatment should be settled by a team including the surgeon and specialists in chemo – and radiotherapy. Additionally, the treatment of malignant tumours in children differs considerably from that in adults, which is most often diagnosised empirically. The authors work in co – operation with several Departments of Paediatric Oncology in the country. They confirm on the basis of results from operated patients, the necessity for complex co – operation between oncologists, chemo – and radiotherapists, and surgeons, suggesting that the link between them should be a highly specialised histopathologist.
They discuss the possibility of and methods for surgical procedures and general anaesthesia for neurosurgery.
Methods:52 patients underwent surgery for neck and head tumours under general anaesthesia. There were 74 operative procedures. There were 10 diagnostic biopsies and 64 treatment procedures.
Our material was composed mainly of benign neoplasms, numbering 41, and in 11 cases we had malignant neoplasm. Depending on the size and the location of the tumours, the authors used different types of surgical access.
Results:Observation periods lasted from 2 months to 6 years. All children remained under the control of our Clinic Out – Patient department. We did not observe deaths or any recurrence of illness. Children operated on for RMS, NHL, olfactory neuroblastoma and histiocytosis X were subjected to postoperative chemotherapy. Cosmetic results after the reconstructions were good. Side effects, such as liquorrhoea and otorrhoea, were not recorded in any of the cases.
Conclusion:Treatment of child malignant neoplasm requires complex action and should be effected in close co – operation between the surgeon – oncologist, radio – and chemotherapist. Such treatment significantly increases the child´s chances of cure.
General anaesthesia with controlled ventilation, which is associated with stable blood pressure, adequate ventilation and full muscle relaxation makes it possible to decrease the risk of intraoperative complications and to satisfy the surgeon´s requirements.

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