Showing papers in "Head and Neck-journal for The Sciences and Specialties of The Head and Neck in 1991"
TL;DR: According to a cutoff EGFR value of 100 fmol/mg protein, EGFR‐positive tumors had a greater probability of complete response to chemotherapy than EG FR‐negative tumors; other tumor characteristics, such as the degree of tumoral differentiation, tumor size, or stage, were unable to operate such a discrimination in the response of chemotherapy.
Abstract: Epidermal growth factor (EGF) stimulates the growth of several types of epithelial tissues and possesses a strong mitogenic activity that is mediated through its cell surface receptor (EGFR). The aim of this study was to characterize EGFR and measure its levels in head and neck tumors biopsies (70 patients); use of a simplified competition technique with a radiolabeled ligand allowed evaluation of functional EGFR. Five samples (4 tumors and 1 control) were used to characterize EGF binding. Graphic representation identified a single family of binding sites. Kd values revealed high affinity for EGF binding: mean Kd, 0.156 +/- 0.108 nM (0.095-0.347 nM). EGF-binding characteristics (Kd) were similar in nontumoral tissue samples (controls) and in tumor material. In 59 of 60 cases, EGFR levels were higher in the tumor than in the corresponding controls. A significant correlation was found between EGFR levels and tumor size and stage. Controls exhibited a trend toward higher EGFR levels in elevated sizes and stages. According to a cutoff EGFR value of 100 fmol/mg protein, which separated all controls from tumors, EGFR-positive tumors (greater than 100 fmol/mg protein) had a greater probability of complete response to chemotherapy than EGFR-negative tumors; other tumor characteristics, such as the degree of tumoral differentiation, tumor size, or stage, were unable to operate such a discrimination in the response to chemotherapy. EGFR may thus be an interesting biological marker for head and neck cancer.
253 citations
TL;DR: Tumors in the nasopharynx and the paranasopha ryngeal space can be adequately resected and tubings for after loading brachytherapy can be positioned accurately during surgery.
Abstract: A new approach to expose the nasopharynx and the parana sopharyngeal space is described. The maxilla, severed from its bony connections, is swung laterally to provide exposure of the nasopharynx. Tumors in the nasopharynx and the paranasopha ryngeal space can be adequately resected and tubings for after loading brachytherapy can be positioned accurately during surgery. The blood supply of the maxilla is from the attached cheek flap and masseter muscle. Three illustrative cases are presented. The wounds in all of them healed primarily with minimal morbidity. The only disadvantage is the development of mild trismus, which responded to conservative treatment.
182 citations
TL;DR: The data indicate that prolonged survival is possible with mucosal melanoma of the head and neck; however, recurrence or metastasis remain possible many years after the initial diagnosis.
Abstract: Forty-two patients with mucosal melanoma of the head and neck were treated at the M. D. Anderson Cancer Center from 1944-1989. Their records were evaluated regarding: location of the primary, stage of the disease at presentation, type of treatment, location of recurrences, and overall survival. These patients received the majority of their therapy at M. D. Anderson Cancer Center. The treatment consisted of surgery, radiotherapy, chemotherapy, immunotherapy, or a combination of these. The 5-year survival rate was 40%. Twenty-four of 27 patients who died with metastatic melanoma had local or regional disease concomitantly. Forty percent of patients were free of disease at 5 years; however, only 26% had long-term survival. Although the majority of patients eventually succumbed to their disease, local and regional control was obtained initially in 92% of the group. These data indicate that prolonged survival is possible with mucosal melanoma of the head and neck; however, recurrence or metastasis remain possible many years after the initial diagnosis.
148 citations
TL;DR: It is concluded that by using specific selection criteria, thyroid lobECTomies and subtotal thyroidectomies can be performed safely in an ambulatory surgery setting without increase in morbidity or mortality.
Abstract: With the realization that simple thyroid procedures had a very low rate of complication and that patients often seemed well enough to go home from the recovery room, we began performing them in an ambulatory surgery setting. We review here 134 consecutive thyroid procedures performed at Columbia Presbyterian Medical Center between July 1987 and July 1989. Patients undergoing reoperation, neck dissection, sternal splits, or other concomitant procedures were excluded. There were 105 women and 29 men with an average age of 47 years. Fifty percent of the operations were performed for benign disease, although the most common diagnosis was papillary cancer (44%). Twenty-one operations (16%) were performed under local anesthesia. Most patients underwent surgery in our ambulatory surgery unit and 76 were discharged the day of surgery. Of these patients, 21 underwent total thyroidectomy, 13 subtotal thyroidectomy, and 42 simple thyroid lobectomy. Of the 58 patients who were admitted, 53 were discharged on the day following surgery. The average length of stay was 0.49 days. Extensive pre- and postoperative teaching was given regarding the signs and symptoms associated with the complications of thyroid surgery. All patients were felt to be reliable and capable of understanding the procedure and of complying with the postoperative plans. Postoperative complications included 8 patients (6%) with transient hypocalcemia and 1 patient (0.75%) with permanent unilateral recurrent laryngeal nerve paralysis. All complications occurred in patients who underwent total thyroidectomies. No patient had a postoperative complication requiring reoperation or readmission. We conclude that by using specific selection criteria, thyroid lobectomies and subtotal thyroidectomies can be performed safely in an ambulatory surgery setting without increase in morbidity or mortality.
115 citations
TL;DR: Clinical evaluation was the most accurate, both to determine bone invasion and to decide the type of mandibular resection necessary in association with the primary tumor.
Abstract: Preoperative evaluation of the mandible for invasion by tumor has always been a difficult problem. Various methods have been used, including clinical evaluation, panoramic x-rays, dental films, routine mandible films, bone scans, computed tomographic (CT) scans, and magnetic resonance imaging (MRI) scans. The diagnostic accuracy of these methods has not been totally satisfactory from the clinical standpoint. We compared the diagnostic effectiveness of clinical evaluation, panorex films, and CT scans in 60 patients with carcinoma of the floor of mouth. The relative value of these tests was studied in relation to marginal or segmental mandibulectomy. Our data showed that CT scanning was not very helpful, mainly because of the presence of irregular dental sockets and artifacts. Clinical evaluation was the most accurate, both to determine bone invasion and to decide the type of mandibular resection necessary in association with the primary tumor.
Panoramic films were helpful in evaluating the gross extent of mandibular invasion. However, they were not of any help in determining minimal bony invasion or cortical invasion. Even though CT scanning has made a tremendous impact in other areas of head and neck surgery, it is not of much help in making the critical decisions in the type of mandible resection, marginal or segmental, in patients with carcinoma of the floor of mouth. Our experience demonstrates that clinical evaluation is superior in preoperative evaluation of the mandible, and especially in deciding the type of mandible resection.
108 citations
TL;DR: Results lead us to believe that some squamous carcinoma of the lower alveolus could be treated successfully without sacrificing the continuity of the mandible.
Abstract: Histologic analysis of squamous cell carcinoma of the lower alveolus shows 2 basic patterns of tumor spread in relation to the mandible: an infiltrative one and an expansive one While the tumor invades the mandible by destroying the bone or through cortical defects of some spaces in the infiltrative form, the tumor does this only by eroding the bone in the expansive form, in which the degree of bone resorption seems to be proportional to tumor advancement A comparison between radiologic and histologic features discloses that the radiologically detected bone defects are not necessarily correlated with the patterns of bone involvement However, most lesions with erosive bone defects show the expansive pattern histologically, and the extent of the radiologically detected bone defect is roughly in accordance with the histologic extent of bone involvement These results lead us to believe that some squamous carcinoma of the lower alveolus could be treated successfully without sacrificing the continuity of the mandible
99 citations
TL;DR: Although the T stage and the paranasopharyngeal extension were individually found to be well correlated with local tumor control, the prognostic value of paranasophileal extension remained significant among subgroups of patients with T3 and T4 disease.
Abstract: The local tumor control of 262 patients with nasopharyngeal carcinoma (NPC) at median follow-up of 27 months was studied with reference to the paranasopharyngeal and other aspects of extranasopharyngeal extension of tumor, as well as to other possible prognostic factors. Only cranial nerve palsy, oropharyngeal involvement, and paranasopharyngeal extension of tumor were found to be significant in a multivariate analysis using Cox model for factors influencing local tumor control. Other factors and other parameters of extranasopharyngeal extension of tumor, namely, erosion of the base of skull, intracranial extension, and involvement of nasal fossa, were found not to be significant. The degree of paranasopharyngeal extension in each side was correlated with scales measuring extranasopharyngeal extension of tumor in other directions (p = 0.001). Although the T stage and the paranasopharyngeal extension were individually found to be well correlated with local tumor control, the prognostic value of paranasopharyngeal extension remained significant among subgroups of patients with T3 and T4 disease (p = 0.1044 and 0.0010, respectively).
95 citations
TL;DR: Recent evidence indicates that even cases with only mild or moderate epithelial dysplasias are at increased risk for malignant transformation, with the highest rates occurring in patients with more severe dysplasia or carcinoma in situ.
Abstract: Laryngeal keratosis (LK) is a precancerous mucosal change with great similarity to oral leukoplakia. Its malignant transformation rate varies from 1% to 40%, with the highest rates being found in patients microscopically diagnosed as "keratosis with atypia" (KWA). Recent evidence indicates that even cases with only mild or moderate epithelial dysplasias are at increased risk for malignant transformation, with the highest rates occurring in patients with more severe dysplasia or carcinoma in situ. Approximately 81% of LK patients are men and the average age at diagnosis is 50 years, a decade younger than that for laryngeal carcinoma patients. A high proportion of LK patients are tobacco smokers (84%) and alcohol abusers (at least 35%). LK is almost always found on the true vocal cords and is usually bilateral (67%). Clinical signs of high risk include, in decreasing order of importance: erythroplakia, surface granularity, increased keratin thickness, increased size, recurrence after conservative removal, and long duration. The annual incidence of LK in the United States is 10.2 and 2.1 lesions per 100,000 males and females, respectively.
86 citations
TL;DR: In this paper, an analysis of 508 patients with head and neck squamous cell carcinoma and clinically positive neck nodes who were treated with radiotherapy alone to the primary lesion (with or without a neck dissection) was conducted to determine if open neck-node biopsy before definitive treatment adversely affected the probability of control of neck disease, the risk of distant metastasis, or the cause-specific survival rate.
Abstract: An analysis of 508 patients (660 heminecks) with head and neck squamous cell carcinoma and clinically positive neck nodes who were treated with radiotherapy alone to the primary lesion (with or without a neck dissection) was conducted to determine if open neck-node biopsy before definitive treatment adversely affected the probability of control of neck disease, the risk of distant metastasis, or the cause-specific survival rate. The prognostic factors analyzed included biopsy status of the neck, N stage, neck treatment, node mobility, node location, T stage, primary site, and control of disease above the clavicles. Sixty-six patients who had undergone an open neck-node biopsy before definitive radiotherapy were compared with a control group of 442 patients who did not undergo a neck-node biopsy; no detrimental effect of the biopsy on neck control, distant metastasis, or cause-specific survival was demonstrated. We conclude that the potential adverse effect of violating the neck before definitive treatment cannot be demonstrated if radiotherapy is the next step in the patient's management.
81 citations
TL;DR: Most of the mandibulotomy patients had an uncomplicated recovery, but osteotomy‐related compliations occurred in 20%.
Abstract: Median mandibulotomy (mandibular "swing") has supplanted mandibular resection for access to oral and oropharyngeal tumors when there is intervening grossly normal tissue between the tumor and bone. It has also proved useful for exposure in selected patients with deep lobe parotid or parapharyngeal space tumors. We have reviewed our experience with 313 mandibulotomies performed between 1959 and 1988 with emphasis on indications, complications, and modifications in technique. Most of our mandibulotomy patients had an uncomplicated recovery, but osteotomy-related complications occurred in 20%. These complications were usually minor and no instances of nonunion were recorded. There was no apparent relationship to antecedent or postoperative radiotherapy. Dental splints were used only in selected patients (40%). The technique of osteotomy has been evolving in recent years. Paramedian, rather than median mandibulotomy, minimizes trauma to the genioglossus, geniohyoid, and digastric muscles. Miniplates offer a useful alternative to conventional wire fixation. Preoperative dental assessment has facilitated better occlusion postoperatively in dentulous patients.
80 citations
TL;DR: A multivariate analysis showed that the combination of malignancy score and nodal status were the strongest predictors for survival, whereas in NO patients only malignancies score was related to prognosis.
Abstract: Histopathologic malignancy score and DNA ploidy were investigated as prognostic factors for 72 cases of squamous cell carcinoma of the head and neck (HNSCC). The malignancy grading was based upon four different morphologic characteristics for the tumor cell population and four characteristics for the tumor-host relationship. DNA ploidy was determined through flow cytometry on fresh-frozen tumor samples. The median malignancy score was 20, with 71% of the tumors scoring less than 20 being diploid and 68% of the tumors scoring greater than or equal to 20 being nondiploid (p = 0.003). Univariate analysis revealed that tumors scoring less than 20 and diploid tumors had a significantly higher proportion of complete response and better survival as compared to tumors scoring greater than or equal to 20 and nondiploid tumors, respectively. There was a tendency toward better survival among patients without regional metastasis (N0) as compared with patients with regional spread (N+), whereas the other single factors, patient age, clinical stage, histologic grade, and tumor size did not correlate with prognosis. In N+ patients both malignancy score and DNA ploidy were predictive for survival, whereas in N0 patients only malignancy score was related to prognosis. A multivariate analysis showed that the combination of malignancy score and nodal status were the strongest predictors for survival. DNA ploidy did not contribute further information in this test, due to its close relation with the histopathologic malignancy score.
TL;DR: A review of the literature since 1966 revealed an unexpectedly high incidence of neck failure, and of the 21 of 110 patients with neck failures that were identified through the literature, there were 6 subsequent deaths.
Abstract: A retrospective review of the Memorial Sloan Kettering Cancer Center experience (MSKCC) with esthesioneuroblastoma was performed. From 1975 to 1985 14 cases were identified. Overall 5- and 10-year survival was 86% and 70%, respectively. Four local failures were observed and 4 neck failures were observed. A review of the literature since 1966 revealed an unexpectedly high incidence of neck failure, and of the 21 of 110 patients with neck failures that were identified through the literature, there were 6 subsequent deaths.
TL;DR: The data suggest that the treatment of choice for AC cancers is conservation surgery, particularly frontolateral laryngectomy, rather than radiotherapy, particularly radiotherapy recurrences.
Abstract: A retrospective review of 182 patients with glottic cancer involving the anterior commissure (AC) is presented. Of these, 123 patients were first treated with conservative surgery and 59 underwent radiotherapy. Patients were staged according to the AJCC system and by the modality of neoplastic involvement of AC (pure AC cancer, glottic cancer involving AC up to the midline, and beyond the midline). Our results indicate a higher rate of local control and of specific-disease survival in the group of patients first treated with surgery than those treated with radiotherapy (86% vs 74% and 97.5% vs 84%, respectively) (p less than 0.05). For pure AC cancers, our results show better local control with primary radiotherapy than with conservation surgery (82% vs 76.5%), but surgical failures have been more successfully salvaged than have radiotherapy recurrences (ultimate local control, 97.5% vs 82%, respectively). These data suggest that the treatment of choice for AC cancers is conservation surgery, particularly frontolateral laryngectomy.
TL;DR: Indium‐labeled white blood cell (WBC) scan, a new imaging modality, appears to play a role in complementing computed tomographic findings, demonstrating early extension of disease, and following therapeutic efficacy in this disease of high‐potential mortality.
Abstract: Mediastinal and thoracic extension of head and neck infections are rare but occur even in the modern antibiotic era. Early intervention is paramount to successful clinical outcome. 111Indium-labeled white blood cell (WBC) scan, a new imaging modality, appears to play a role in complementing computed tomographic (CT) findings, demonstrating early extension of disease, and following therapeutic efficacy. Together, the CT scan and WBC scan aid in directing early intervention and extent of surgery in this disease of high-potential mortality. We report 3 cases of deep head and neck infection complicated by mediastinal extension, including mediastinitis, pericardial effusion, and tampon-ade, empyema, and respiratory failure. Early surgical intervention included neck drainage, tracheostomy, thoracotomy, and pericardiotomy. While usually associated with greater than 50% mortality, all of the patients in this series survived. Based on our experience, we recommend prompt aggressive surgical debride-ment in treating mediastinal complications resulting from head and neck infections.
TL;DR: The time from the end of radiotherapy to diagnosis of a primary recurrence was the most significant predictor of survival, both from initial presentation and from the date of recurrence, suggesting that large recurrences are multicentric.
Abstract: A personal series of 3,215 patients with proven squamous cell carcinoma of the mucosal surfaces of the upper aerodigestive tract is presented. Of these patients, 515 suffered a recurrence of their primary tumor after a course of radiotherapy. The time from the end of radiotherapy to diagnosis of a primary recurrence was not related to any known host factors, nor to tumor factors except site. However, it was the most significant predictor of survival, both from initial presentation and from the date of recurrence. The time to recurrence did not relate to the size of the tumor at recurrence, suggesting that large recurrences are multicentric. The time to recurrence also predicted response and survival of 67 patients with end-stage disease treated by chemotherapy. The response and survival were better in tumors with a time to recurrence longer than the median; the increased survival was not significant, but the increased response was.
TL;DR: Although most injuries were due to either retraction or edema of cranial nerves, long‐term follow‐up regarding recovery of function is very important and proper clinical evaluation of these patients should be routinely done preoperatively in order to document possible preexisting cranial nerve deficits.
Abstract: Cranial nerve injuries may result from carotid endarterectomy. From January 1984 to December 1987, a total of 336 carotid endarterectomies were performed at University Hospitals of Cleveland and Cleveland Veterans Administration Hospital. Forty-five cranial nerve injuries were documented (13.5%). Twenty patients (6%) had documented unilateral vocal cord paralysis, 16 (4.8%) had hypoglossal injuries, 8 (2.4%) had facial nerve paresis, and 1 (0.3%) had an injury to the spinal accessory nerve. Although most injuries were due to either retraction or edema of cranial nerves, long-term follow-up regarding recovery of function is very important. We feel that proper clinical evaluation of these patients should be routinely done preoperatively in order to document possible preexisting cranial nerve deficits. Postoperatively, if symptoms of possible cranial nerve abnormalities occur, these patients should have a thorough head and neck evaluation in order to identify possible lesions and institute further treatment to improve their quality of life.
TL;DR: Twenty patients with recurrent, inoperable head and neck squamous cell carcinoma received perilymphatic injections of natural interleukin‐2 (nlL‐2) for 10 days, and despite these marked responses, the tumor always relapsed, and subsequent IL‐2 courses were poorly effective.
Abstract: Twenty patients with recurrent, inoperable head and neck squamous cell carcinoma received perilymphatic injections of natural interleukin-2 (nIL-2) for 10 days. Ten patients received 200 units (U) of nIL-2; five 1,000 U; and five 5,000 U. Irrespective of the location of the recurrence, the injections were always performed 1.5 cm below the insertion of the sternocleidomastoid muscle on the mastoid. When the ipsilateral lymphatic chain was still present, they were performed on the same side as the tumor site, whereas when it had been stripped as a result of previous surgery, they were contralateral. Patients who had undergone bilateral neck dissection were injected on the tumor side. Whenever possible, the treatment was repeated after 45-day intervals. In 13 patients (65%) with bilateral or contralateral lymph nodes, complete or partial disappearance of the lesion was observed. Despite these marked responses, the tumor always relapsed, and subsequent IL-2 courses were poorly effective. There were no systemic disturbances during or after treatment, but only moderate local swelling and pain.
TL;DR: While representing distinct clinical entities, these neoplasms demonstrate similar ultrastructural and histochemical features and should be classified as neuroendocrine tumors of the larynx (NETL).
Abstract: A review of the international literature has revealed 68 paragangliomas, 42 large cell, and 74 small cell tumors of the larynx. Paragangliomas are usually benign, although malignant cases have been reported. Large cell tumors are malignancies associated with a high incidence of early cervical metastasis. Small cell tumors are aggressive cancers characterized by early, diffuse metastatic disease. All three neoplasms demonstrate a propensity for the supraglottic larynx. While surgery remains the treatment of choice for paragangliomas and large cell cancers, small cell cancers are best treated by radiotherapy and chemotherapy. The determinate 5-year survival for patients with paragangliomas, large cell, and small cell cancers is 60%, 34%, and 14%, respectively. While representing distinct clinical entities, these neoplasms demonstrate similar ultrastructural and histochemical features and should be classified as neuroendocrine tumors of the larynx (NETL). A comprehensive analysis of these laryngeal tumors is presented herein. Their clinical behavior and management options are reviewed and a scheme for their nomenclature and classification is proposed.
TL;DR: Analysis of the records of 53 patients treated surgically for squamous cell carcinoma of the lower alveolar ridge disclosed that marginal resection was effective in controlling lower gingival cancers, with and without apparent bone involvement.
Abstract: The records of 53 patients treated surgically for squamous cell carcinoma of the lower alveolar ridge were reviewed and the results of segmental and marginal resections of the mandible were compared. Analysis of these 2 treatment modalities disclosed that marginal resection was effective in controlling lower gingival cancers, with and without apparent bone involvement, if erosive bone defects that did not extend beyond the inferior alveolar canal, or invasive bone defects confined to a superficial area of the alveolar bone, were detected radiologically.
TL;DR: It is concluded that radiotherapy remains the treatment of choice for patients with stage T1‐T2 carcinoma of the tonsillar fossa and in selected T3‐T4 cases a combination of surgery and postoperative irradiation appears to offer better tumor control, but the possibility of greater morbidity must be considered.
Abstract: The results of therapy are reported in 296 patients with histologically proven epidermoid carcinoma of the tonsillar fossa; 127 were treated with irradiation alone (5,500 to 7,000 cGy), 133 with preoperative radiotherapy (2,000 to 3,000 cGy) or were initially planned for preoperative irradiation but treated with radiotherapy alone, and 36 with postoperative irradiation (5,000 to 6,000 cGy). The operation in all but 4 patients consisted of an en bloc radical tonsillectomy with ipsilateral lymph node dissection. Actuarial 5-year no evidence of disease (NED) was as follows: survival rates for patients with T1 tumors, 76%; T2, 54%; T3, 45%; and T4, 20%. Patients with no cervical lymphadenopathy or with a small metastatic lymph node (N1) had better relapse-free survival (60% to 70% at 5 years) than those with large or fixed lymph nodes (30% to 40%). Primary tumor recurrence rate in the T1-T2 groups was about 20% in patients treated with irradiation and surgery and 30% for those treated with irradiation alone (difference not statistically significant), 30% in patients with stage T3 lesions in all treatment groups, and 33% in patients with T4 disease treated with surgery and postoperative irradiation compared to 52% with irradiation alone (p = 0.03). The overall recurrence rate in the neck was about 20% for the N0 patients, 25% for N1, and 30% for those with N2 and N3 cervical lymph nodes in the 4 treatment groups. The incidence of contralateral neck recurrences was about 8% with the various treatment modalities.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: The dose of radiotherapy used and the performance of hemithyroidectomy were related to the development of elevated TSH levels and the performances of radical neck dissection, gender, hyperfractionated radiotherapy, and the use of chemotherapy were not related.
Abstract: Sixty-eight patients were studied prospectively with serial thyroid-stimulating hormone (TSH) levels after radiotherapy for head and neck neoplasms. Overall, 57% of the patients developed elevated TSH levels. Excluding patients with less than 2 years follow-up, 85% developed an elevated TSH. Ninety-two percent of patients treated with partial thyroidectomy and radiotherapy developed an elevated TSH. Most TSH elevations occurred within 1 year of treatment. The dose of radiotherapy used and the performance of hemithyroidectomy were related to the development of elevated TSH levels (p less than 0.05). The performance of radical neck dissection, gender, hyperfractionated radiotherapy and the use of chemotherapy were not related to the development of an elevated TSH (p greater than 0.05).
TL;DR: In this paper, the authors investigated whether the added time required to perform free flap reconstructions increases the risk of medical complications to the patient, and 20 consecutive free flap patients were compared to 20 age-, site-, and histology-matched controls.
Abstract: Free tissue transfer has become an important adjunct in the reconstruction of head and neck cancer patients. Despite the success, the added time required to perform free flap reconstructions continues to be a concern for some head and neck surgeons. In order to investigate whether this added time increases the risk of medical complications to the patient, 20 consecutive free flap patients were compared to 20 age-, site-, and histology-matched controls. These patients were analyzed for demographic data, American Society of Anesthetic risk scores, stage, tumor site, and pre- and postoperative medical problems. The mean occurrence of medical problems preoperatively was 1.1 occurrences per patient for the flap group and 1.5 occurrences per patient for the control group. Postoperatively, there were 0.75 occurrences per flap group and 0.9 occurrences for the control group. Neither of these was statistically significant. The length of hospitalization was 13.5 days for the control group and 15.9 days for the flap group. Again, this was not statistically significant. The only significant statistic difference was the length of the procedure: 6.95 hours for the control group and 11.0 hours for the flap group, which had a p value of less than 0.001. In conclusion, this study indicates that length of procedure alone should not be a determining factor in deciding whether or not to use immediate microvascular reconstruction in head and neck cancer patients.
TL;DR: It is concluded that low‐dose cyclic IFN is well‐tolerated in patients with recurrent SCCHN and has potential antitumor activity.
Abstract: Fourteen patients with recurrent squamous cell carcinoma of the head and neck (SCCHN) were treated with 10 x 10(6) U of nonrecombinant interferon alpha (IFN) intramuscularly (IM) daily for 3 days every 28 days. There were 11 men and 3 women, with ages ranging from 48 to 74 years. Patients had previously been treated with surgery (9 patients), radiotherapy (13 patients), or chemotherapy (8 patients). All patients had measurable disease by physical exam and radiologic evaluation and a performance status of less than or equal to 2 (ECOG). Patients were treated for a minimum of 3 months and continued on therapy until disease progression. The dose and treatment schedule of IFN was well-tolerated. Toxicities included low-grade fever, mild anorexia, and malaise. Treatment was stopped in 1 patient due to the development of atrial fibrillation. One death occurred as a complication of aspiration pneumonia 2 weeks following the onset of therapy and was not felt to be related to IFN therapy. Of the 14 patients treated, there was 1 complete response (30+ months) of a base of tongue primary. Two patients had stabilization of disease (SD, 8 and 12 months). One patient had a mixed response with resolution of subcutaneous nodules. The remaining 10 patients died of progressive disease. Immunological assessment was performed on 8 patients. The 1 patient who had a complete response was noted to have markedly low pretreatment natural killer (NK) cell activity and a subsequent sharp rise in activity after initial treatment. We conclude that low-dose cyclic IFN is well-tolerated in patients with recurrent SCCHN and has potential antitumor activity.
TL;DR: The role of perioperative antibiotic prophylaxis was investigated in 95 patients undergoing 100 clean‐contaminated cranial base surgeries, and the surgical approach, type of reconstruction, duration of surgery, and use of drains were not significantly correlated with wound infection.
Abstract: The role of perioperative antibiotic prophylaxis was investigated in 95 patients undergoing 100 clean-contaminated cranial base surgeries. A variety of antibiotic regimens were employed. Potential risk factors for local infection were analyzed. Seven patients (7%) developed infections at the surgical site (meningitis, intracranial abscess, cellulitis/abscess, and osteomyelitis). Antibiotic prophylaxis for 24 hours or less was associated with a significantly increased risk of infection (p less than 0.04). Prolonged antibiotic prophylaxis (greater than 48 hours) was not more efficacious than prophylaxis for 48 hours. The surgical approach, type of reconstruction, duration of surgery, and use of drains were not significantly correlated with wound infection. The risk of intracranial infection following cranial base surgery is low despite the presence of bacterial contamination intraoperatively. Broad-spectrum coverage of gram-positive and gram-negative organisms for at least 48 hours is recommended. Attention to surgical technique is important in preventing infectious complications.
TL;DR: It can be concluded that flaps harvested from skin previously expanded have an improved survival rate compared to similar flaps developed in nonexpanded skin.
Abstract: The relatively recent advent of tissue expansion for medical purposes precludes the availability of extensive knowledge concerning the physiologic and histologic changes that occur during controlled expansion of the skin. This paper reviews the basic science and clinical research that has been conducted to investigate the changes and summarizes the findings. It can be concluded that flaps harvested from skin previously expanded have an improved survival rate compared to similar flaps developed in nonexpanded skin. Increased vascularity to either the skin, the capsule that forms around the expander, or both probably in some way accounts for the improved survival. Controlled expansion of the skin results in the creation of additional new skin at the expense of thinning the dermis and subcutis. This thinning is associated with an overall decrease in tensile strength of the expanded skin. The increase in surface area gained from skin expansion probably varies according to the type of skin expanded and the underlying tissues that serve as a foundation for the expander.
TL;DR: Methods of graft contouring and the application of rigid internal fixation are described in detail and unusual situations in which the tumor extends through the buccal cortex of the mandible, and when condylar replacement is necessary, are presented.
Abstract: Experience in over 65 cases of microvascular mandibular reconstruction has resulted in the development of reliable techniques for bone fixation and contouring to achieve the best functional results. Methods of graft contouring and the application of rigid internal fixation are described in detail. Unusual situations in which the tumor extends through the buccal cortex of the mandible, and when condylar replacement is necessary, are presented. The options for managing these situations are discussed.
TL;DR: Thirteen patients were identified with isolated sphenoid sinus disease who were successfully managed with sublabial transseptal sphenoidsotomy at Allegheny General Hospital for Pittsburgh between January 1985 and July 1989, and this approach allows maximal visualization and safety with minimal morbidity.
Abstract: Isolated sphenoid sinus disease is an unusual entity that is encountered infrequently. With advances in antibiotic therapy and imaging techniques, the nature of isolated sphenoid sinus disease has significantly changed. More tumors and less inflamrnatory disorders are being encountered. We have retrospectively reviewed the medical records of patients who had undergone sublabial transseptal sphenoidotomy for isolated sphenoid sinus disease at Allegheny General Hospital for Pittsburgh between January 1985 and July 1989. Thirteen patients were identified with isolated sphenoid sinus disease who were successfully managed with sublabial transseptal sphenoidotomy. This approach allows maximal visualization and safety with minimal morbidity.
TL;DR: Four patients were seen with neurilemmoma which arose in the cervical vagus nerve, and it would appear that an intracapsular enucleation may be advisable for clearance of this kind of tumor.
Abstract: Four patients were seen with neurilemmoma which arose in the cervical vagus nerve. Three tumors arose in the upper third of the lateral neck, and the remaining one in the lower third. Lateral neck mass was a prominent symptom in 3 patients, and parapharyngeal mass in the remaining one. The parapharyngeal mass bulged into the oropharynx in the tonsillar and retrotonsillar region and caused mild swallowing difficulty. Complete surgical extirpation by means of intracapsular enucleation was possible in all 4 patients. All patients remained free of disease for periods ranging from 15 to 75 months following surgery. It would appear that an intracapsular enucleation may be advisable for clearance of this kind of tumor.
TL;DR: A nonsurgical management protocol is proposed which includes CT scan and needle aspiration with tissue for cytology and fluid for amylase level if possible, and watchful observation is advised for cystic pathology.
Abstract: In this study of 13 patients with cystic lesions of the parotid gland, 9 patients were known to be antibody positive for the human immunodeficiency virus (HIV) and 4 were subsequently tested to be positive. All patients had computed tomographic (CT) confirmation of parotid gland cysts. Five patients had fluid aspirates showing high amylase levels. All cystic lesions had lymphoepithelial features and lymphoid histology similar to those seen in HIV infection. This study includes a review of 148 HIV patients reported in the literature, as well as our experience. Of all the reported cases, when gross pathology suggested cystic lesions, the incidence of malignancy was close to 1%. The incidence of malignancy for a solid mass, however, was close to 40%. We propose a nonsurgical management protocol which includes CT scan and needle aspiration with tissue for cytology and fluid for amylase level if possible. Watchful observation is advised for cystic pathology.
TL;DR: This study demonstrates that partial glossectomy for early carcinomas of the tongue can be performed with minimal, if any, permanent speech impairment.
Abstract: To determine the type and extent of speech impairment to be expected following partial glossectomy, pre- and postoperative speech evaluations were performed on 10 patients undergoing surgery for carcinomas of the mobile tongue less than 3 cm in size. In addition, audiotapes of standardized speech samples were made at each evaluation. Preoperative speech evaluation revealed normal rates of verbal diadochokinesis without distortion in all 10 patients. Phonologic analysis was also normal in 9 of these patients. Postoperative evaluation revealed normal rates of verbal diadochokinesis in 6 patients and mild lingual distortion in 4. At 3 weeks postoperatively 1 patient had sibilant distortion and 1 patient overall slurring of speech. Evaluation of both of these patients at 6 months revealed that speech had returned to normal. Blinded comparison of the pre- and postoperative audiotapes revealed no change in 8 patients. In 2 patients the early postoperative tape was thought to "sound different" but the final postoperative tapes in all patients were judged to be normal. This study demonstrates that partial glossectomy for early carcinomas of the tongue can be performed with minimal, if any, permanent speech impairment.