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Head And Neck (head + and_neck)
Terms modified by Head And Neck Selected AbstractsENDOSCOPIC DIAGNOSIS OF INTRAEPITHELIAL SQUAMOUS NEOPLASIA IN HEAD AND NECK AND ESOPHAGEAL MUCOSAL SITESDIGESTIVE ENDOSCOPY, Issue 2006Manabu Muto In the multistep process of squamous epithelial carcinogenesis, squamous epithelial dysplasia has been considered to be a preinvasive stage of squamous cell carcinoma. If we could distinguish a dysplasia at high risk, such lesions could be targets for local treatment such as endoscopic mucosal resection to avoid the transformation to invasive carcinoma. Narrow-band imaging, a new optical technology, is useful to identify the cancerous lesion compared to conventional white light image. In addition, narrow-band imaging combined with magnifying endoscopy makes it possible to visualize the changes of microvascular architecture occurring in the epithelium. To evaluate whether these endoscopic findings are reliable to diagnose a dysplasia at high risk, a prospective study on the basis of the standards for reporting diagnostic accuracy initiative is needed. If endoscopic assessment of intraepithelial squamous neoplasia is reliable, it would be of benefit to the patients' outcome and improve cost effectiveness of care because of the avoidance of developing invasive carcinoma and the reduction of unnecessary biopsies. [source] The expression of key cell cycle markers and presence of human papillomavirus in squamous cell carcinoma of the tonsilHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2004Wei Li MMed Abstract Background. Chemical carcinogens induce squamous cell carcinoma (SCC) of the head and neck by targeting the p53 and the retinoblastoma (pRb) pathways. Human papillomavirus (HPV) might have an etiologic role in these cancers at particular sites. Few studies have compared cell cycle protein expression in HPV-positive and HPV-negative tumors in this region. Methods. Fifty tonsil SCCs were analyzed for HPV by PCR and for expression of cell cycle proteins (p53, pRb, p16INK4A, p21CIP1/WAF1, p27KIP1, and cyclinD1) by immunohistochemistry. Results. HPV was present in 42%; almost all were type 16. There were statistical associations between HPV positivity and reduced expression of pRb and cyclinD1, overexpression of p16, and younger patient age. Tumor with down-regulated p27 tended to have down-regulated pRb and p21. Conclusions. HPV-positive tonsil SCCs have distinct molecular pathways. Their association with younger patient age suggests that they are biologically distinct from HPV-negative tumors. © 2004 Wiley Periodicals, Inc. Head and Neck 26: 1,9, 2004 [source] Rim versus sagittal mandibulectomy for the treatment of squamous cell carcinoma: Two types of mandibular preservationHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 12 2003Mario Fernando Muñoz Guerra MD Abstract Background. The role of conservative mandibulectomy for patients with bone invasion from squamous cell carcinoma remains poorly defined. However, marginal mandibular resection is biomechanically secure in its design while maintaining the mandibular continuity. This procedure has proven to be a successful method of treating squamous cell carcinoma with limited mandibular involvement. Purpose. The purpose of this study was to analyze our results after the use of a marginal technique for the treatment of oral and oropharyngeal cancer and to compare two types of mandibular conservative procedures: rim resection versus sagittal inner mandibulectomy. Methods. A retrospective review of a cohort of 50 patients (global group) who underwent mandibular conservative resection for previously untreated squamous cell carcinoma was performed. Two subgroups were considered: rim group (n = 37) and sagittal group (n = 13). Clinical evaluation and preoperative radiologic studies were the means used to evaluate bony invasion and to decide on the extent of mandibulectomy. The treatment outcome after these two types of mandibular resection was calculated and compared using analysis by the Pearson ,2 test, logistic regression model for multivariate analysis, and the Kaplan-Meier method to determine survival. Results. In the sagittal group, specimens from 2 patients (11.7%) demonstrated tumor invasion on decalcified histologic examination, whereas the rim group showed 11 cases (29.7%) with bone invasion. Local recurrence was observed in the follow-up of 10 patients. No statistical relationship was found between the presence of histologic bone invasion and the risk of local recurrence. The size of bone resection >4 cm (p = .002) and tumor invasion of surgical margins (p = .039) were found to be associated with increased local recurrence rates. In multivariate analysis, lymph node affectation significantly correlated with histologic mandibular involvement (p = .02). In the global group, the 5-year observed survival rate was 56.97%. Overall survival and rate of recurrence were comparable in both groups. In the global group, tumor infiltration beyond the surgical margin was statistically related with poor survival (p = .01). Conclusions. Analysis of this series disclosed that marginal mandibulectomy is effective in the control of squamous cell carcinomas that are close to or involving the mandible. In carefully selected patients, sagittal bone resection seems to be as appropriate as rim resection in the local control of these tumors. © 2003 Wiley Periodicals, Inc. Head and Neck 25: 000,000, 2003 [source] Benign metastasizing pleomorphic adenoma of the parotid gland: A clinicopathologic puzzleHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 12 2003Gino Marioni MD Abstract Background. Pleomorphic adenoma constitutes the most common benign parotid gland tumor. Local recurrence after surgical treatment (lateral or total parotidectomy) has been described in 1% to 5% of cases. Malignant degeneration has been reported in 2% to 9% of cases of pleomorphic adenoma of salivary gland origin. Metastasizing pleomorphic adenomas without histologic evidence of malignancy have rarely been reported. Metastatic lesions have been discovered in bone, lymph nodes, the lung, oral cavity, pharynx, skin, liver, retroperitoneum, kidney, calvarium, and central nervous system. To the best of our knowledge, we hereby report the first case of pleomorphic adenoma of the parotid gland metastasizing to the ipsilateral maxilla. Methods. We simultaneously examined apoptosis-related protein expression and markers of cell-proliferation activity in our case of benign pleomorphic adenoma metastasis and compared outcome with a control group of primary parotid pleomorphic adenomas. Results. Analysis of p53, Bcl-2, MIB1, CD 105, p27, and p21 expression did not reveal significant differences between metastasizing pleomorphic adenoma of the salivary gland and the control group of primary parotid pleomorphic adenomas. Conclusions. Clinical rather than pathologic evidence seems to justify inclusion of metastasizing salivary pleomorphic adenoma in the group of low-grade malignant salivary tumors. © 2003 Wiley Periodicals, Inc. Head and Neck 25: 000,000, 2003 [source] Maxillary obturators: The relationship between patient satisfaction and speech outcomeHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2003Jana M. Rieger PhD Abstract Background. Patient satisfaction with a maxillary obturator has been studied in relation to extent of surgical defect, sociodemographic characteristics, scores on mental health inventories, and psychosocial adjustment to illness scales. However, review of the literature reveals limited study of the relationship between patient satisfaction with an obturator and clinical speech outcome measures. The purpose of this study is to relate patient satisfaction scores obtained by questionnaire with those obtained by means of clinical speech measurements. Methods. Acoustical, aeromechanical, and perceptual measurements of speech were collected for 20 patients after receiving a definitive obturator. Patient satisfaction with their obturator was later measured with the Obturator Functioning Scale (OFS). Results. Results reveal that poorer aeromechanical speech results were associated with patient-reported avoidance of social events, whereas lower speech intelligibility outcomes were related to overall poorer perception of speech function on the OFS. Several background patient characteristics were significantly related to several responses on the OFS and to the aeromechanical assessment outcomes. Conclusions. Results from instrumental assessments of speech seem to be informative regarding not only speech outcome but also a patient's satisfaction with the obturator. Consideration of background patient characteristics is important when interpreting both clinically obtained and patient-perceived outcomes. © 2003 Wiley Periodicals, Inc. Head and Neck 25: 000,000, 2003 [source] Basaloid in contrast to nonbasaloid head and neck squamous cell carcinomas display aberrations especially in cell cycle control genesHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2003Micaela Poetsch PhD Abstract Background. At present, the differences between head and neck basaloid squamous cell carcinoma (BSCC) and nonbasaloid squamous cell carcinoma (SCC) are mostly on the basis of histologic and immunohistologic findings. Methods. In this study, we investigated 8 BSCCs and 59 SCCs for loss of heterozygosity (LOH) at chromosomes 5q, 9p, 9q, 10q, 11q, 13p, 17p, and 18q. In addition, we analyzed p16, PTEN, and CCND1 (cyclin D1) and investigated the HPV status. Immunohistochemically, the expression of MIB-1, p16, p53, and cyclin D1 was determined. Results. Aberrations in the BSCCs were especially frequent at 9p and in the CCND1 gene. In contrast, alterations at 10q occurred almost exclusively in conventional SCCs. Obvious differences could be determined concerning the HPV status: HPV-DNA was detected in all BSCCs but only in 17% of conventional SCCs. Conclusions. Although the number of investigated BSCCs is rather low and did not allow statistical conclusions, our results focus on certain differences between the molecular pathogenesis of BSCCs and SCCs. © 2003 Wiley Periodicals, Inc. Head and Neck 25: 000,000, 2003 [source] Who merits a neck dissection after definitive chemoradiotherapy for N2,N3 squamous cell head and neck cancer?HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2003Scott A. McHam DO Abstract Background. The role of neck dissection (ND) after definitive chemoradiotherapy for squamous cell head and neck cancer is incompletely defined. We retrospectively reviewed 109 patients with N2,N3 disease treated with chemoradiotherapy to identify predictors of a clinical complete response in the neck (CCR-neck), pathologic complete response after ND (PCR-neck), and regional failure. Method. All patients were given 4-day continuous infusions of 5-fluorouracil (1000 mg/m2/d) and cisplatin (20 mg/m2/d) during the first and fourth weeks of either once daily (n = 68) or twice daily (n = 41) radiation therapy. ND was considered for all patients after completion of chemoradiotherapy and was performed in 32 of the 65 patients achieving a CCR-neck after chemoradiotherapy and in all 44 patients with residual clinical evidence of neck disease. CCR-neck, PCR-neck, and regional failure were then correlated with potential predictors, including T, N, largest lymph node size (<3 cm, ,3 cm), primary tumor site, and radiation fractionation schedule. Results. Achievement of a CCR-neck was predicted by N, N2 vs N3 (53 of 80 vs 12 of 29, p = .019) and by largest lymph node size, <3 cm vs ,3 cm (19 of 25 vs 46 of 84, p = .06). Achievement of a PCR-neck could not be predicted by any clinical parameter. Regional failure occurred both in patients undergoing ND and those not dissected (5 of 76 vs 4 of 33, p = .33) and proved more likely only in the ND patients with residual positive pathology compared with those achieving a PCR-neck (5 of 25 vs 0 of 51, p < .001). Primary site was not a useful predictor of CCR-neck, PCR-neck, or regional failure. Most importantly, CCR-neck (vs Assessment of parathyroid autotransplantation for preservation of parathyroid function after total thyroidectomyHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2003Magdy I. El-Sharaky MD Abstract Background. Hypoparathyroidism with permanent hypocalcemia is a well-recognized complication after thyroid surgery. Aim. This study was conducted to assess the role of immediate parathyroid autotransplantation in the preservation of parathyroid function after total thyroidectomy. Patients and Methods. Twenty-eight patients had autotransplantation of parathyroid glands resected or devascularized during total thyroidectomy. Data were collected prospectively regarding demographics, indication for surgery, operative procedure, pathologic diagnosis, number of glands transplanted, and subsequent course. Thyroid nodules were evaluated by ultrasonography, radionuclide scanning, and/or fine-needle aspiration cytology. All patients had serum ionized calcium, phosphorus, and intact parathyroid hormone (PTH) levels measured preoperatively and monitored regularly postoperatively for a period of 14 weeks and again at 6 months after operation. Patients were categorized into three groups according to the number of glands transplanted: one (group 1, n = 6), two (group 2, n = 14), or three glands (group 3, n = 8). In three other volunteers, one parathyroid gland was transplanted in the brachioradialis and subjected to electron microscopy 1, 2, and 4 weeks after transplantation. Results. Total thyroidectomy was performed for malignant disease in 16 patients (57.1%) and for benign disease in 12 (42.9%) patients. All patients reverted to asymptomatic normocalcemia without the need for any medications within 4 to 14 weeks. Normal levels of serum markers were regained slower when one gland was transplanted compared with two or three glands (P < .01). Electron microscopic examination showed evidence of ischemic degeneration in the transplanted tissues 1 week postoperatively. Regeneration started by the second week and coincided with normalization of PTH levels. Optimum resting and nearly normal status of parathyroid tissue was achieved by the fourth week. Conclusions. This study showed that active PTH production coincides with regeneration of parathyroid cells and that autotransplantation of at least two resected or devascularized glands during total thyroidectomy nearly eliminates permanent postoperative hypoparathyroidism, thus improving the safety of total thyroidectomy performed for malignant or benign disease. © 2003 Wiley Periodicals, Inc. Head and Neck 25: 799,807, 2003 [source] Prognostic significance of tumor angiogenesis, Ki 67, p53 oncoprotein, epidermal growth factor receptor and HER2 receptor protein expression in undifferentiated nasopharyngeal carcinoma,a prospective study,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2003Brigette B. Y. Ma FRACP Abstract Background. This study prospectively examines the prognostic role of p53 oncoprotein (p53), Ki67-antigen (Ki67), tumor angiogenesis (MVD), epidermal growth factor receptor (EGFR), and HER2 receptor protein (HER2) expression in Chinese with undifferentiated nasopharyngeal carcinoma (NPC). Methods. Seventy-eight Chinese were recruited from October 1995 to July 1997 at the Prince of Wales Hospital, Hong Kong. Pretreatment immunohistochemical preparations of the primary tumor were made, and clinical data were collected prospectively until October 30, 2000. The markers were correlated with overall survival (OS), disease-free survival (DFS), time to progression (TTP), and UICC stage. Results. On univariate analysis, EGFR expression correlated with poorer OS (p = .0001), DFS (p = .01), shorter TTP (p = .0001), and advanced T stage (p = .036). Strong EGFR expression, when compared with weak or moderate, was associated with poorer OS (p = .04) and shorter TTP in a subgroup of patients with UICC stage III,IV disease. HER2 expression was associated with advanced UICC stage (p = .006). The presence of p53 expression correlated with poorer DFS (p = .01) and a trend toward shorter TTP (p = .06). No correlation was found with Ki67-antigen or MVD. On multivariate analysis, only EGFR expression was significantly linked to shorter OS and TTP. Conclusions. EGFR expression in undifferentiated NPC is associated with a poor clinical outcome. A prognostic role of p53 and HER2 expression is suggestive but not consistently defined in this study. The relatively high prevalence of positive staining for EGFR supports the use of molecular targeted therapy in this disease. © 2003 Wiley Periodicals, Inc. Head and Neck 25: 864,872, 2003 [source] Pocket Radiologist: Head and Neck , Top 100 DiagnosesJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2003Andy Whyte No abstract is available for this article. [source] A ChemoSensory Questionnaire for Patients Treated for Cancer of the Head and Neck,THE LARYNGOSCOPE, Issue 12 2005Andrew N. Goldberg MD, MSCE Abstract Objectives: To investigate primary chemosensory issues experienced by patients who undergo treatment for cancer of the head and neck and to develop and assess a ChemoSensory Questionnaire (CSQ). Design: Cross sectional survey for questionnaire development and testing. Methods: Literature, expert opinion, and focus group methodology were used to identify aspects of smell and taste affecting patients before, during, and after therapy for cancer of the head and neck. A draft instrument was compiled, reviewed, and revised. The revised instrument was administered along with a demographic and clinical form, the SF-12, the Performance Status Survey, and the University of Michigan Head and Neck Quality of Life Questionnaire (HRQOL) to a sample of patients. After item and scale analyses and reductions, a final instrument was assembled. Construct validity and test-retest reliability were assessed. Results: Two hundred six patients were included in the study. The final survey instrument consisted of eight items, four on smell and four on taste. Cronbach's alpha was 0.89 for the smell scale and 0.78 for the taste scale. Correlations with other HRQOL scales ranged from 0.20 to 0.64 for the taste scale and from 0.10 to 0.33 for the smell scale. Good construct validity of the CSQ scores was demonstrated. Conclusions: Treatment for head and neck cancer negatively impacts smell and taste. A survey instrument was developed to evaluate chemosensory function that is simple to administer and is brief. This instrument will be of value in identifying factors that contribute to chemosensory disturbance and may serve as a guide for planning treatment regimens that minimize such disturbance. [source] Current use of 18F-Fluorodeoxyglucose Positron Emission Tomography and Combined Positron Emission Tomography and Computed Tomography in Squamous Cell Carcinoma of the Head and NeckTHE LARYNGOSCOPE, Issue 11 2005Lee A. Zimmer The history and physical examination, computed tomography (CT) and magnetic resonance imaging are the cornerstones for identifying new and recurrent cancers of the head and neck. The advent of positron emission tomography (PET) and combined PET/CT imaging technology is a promising development. These modalities have the potential to help stage patients presenting with head and neck cancer, identify responses to nonsurgical therapy, and allow earlier detection of recurrence in the hope of improving survival. The following paper provides a brief history of PET and PET/CT imaging. The current PET and PET/CT literature for squamous cell carcinoma of the head and neck is reviewed, and specific recommendations for its use are provided. [source] Outcome Analysis of Patients with Squamous Cell Carcinoma of the Head and Neck and Hepatitis C Virus,THE LARYNGOSCOPE, Issue 10 2005Jason Hunt MD Abstract Objective/Hypothesis: Infection with the hepatitis C virus (HCV) is a global problem with over 170 million people infected. Recently, we have noticed that a large number of patients diagnosed with squamous cell carcinoma of the head and neck (SCCHN) have also been diagnosed with HCV. A review of the literature reveals little information concerning this patient population. The objective of this study was to compare the outcome of SCCHN patients who have been exposed to HCV with naïve SCCHN patients. Study Design: Retrospective chart review. Methods: A retrospective chart review from June 1991 through December 2002 was performed to identify patients diagnosed with SCCHN who were screened for HCV. Patients were stratified into two groups (HCV positive and HCV negative). Data were recorded on patients for status of disease at last clinic visit, pretreatment serum albumin and hematocrit levels, and RNA quantities of HCV. Statistical analysis was performed using paired t test to compare serum albumin and hematocrit levels. Kaplan-Meier survival curves were used to compare outcomes. The log-rank test was used to determine significance. Cox regression was used to examine the association of prognostic predictor variables with overall survival and disease-free survival. Results: There was no difference noted in 5 year survival between hepatitis C positive and hepatitis C negative groups in overall outcomes (66.7% vs. 67.9%, P = 1.000) or 5 year disease-free survival (90.5% vs. 80.8%, P = .514). The two groups, HCV positive versus HCV negative, also had similar serum albumin levels (3.62 g/dL vs. 3.72 g/dL, P = .37) as well as serum hematocrit levels (42.9% vs. 41.0%, P = .12). Serum levels of hepatitis C RNA were obtained in seven patients, with only one being undetectable. The only prognostic predictor variable that was significantly associated with overall survival was age. None of the predictor variables were significantly associated with disease-free survival. Conclusion: Co-infection with HCV, although prevalent in the Veterans Administration Hospital population, did not affect patient outcome as defined by disease-free survival. Patients who were seropositive for HCV had comparable serum albumin levels as well as serum hematocrit when compared with HCV negative patients. [source] Craniofacial Resection for Nonmelanoma Skin Cancer of the Head and Neck,THE LARYNGOSCOPE, Issue 6 2005Douglas D. Backous MD Abstract Objectives/Hypothesis: We reviewed our experience with craniofacial resection for advanced, nonmelanoma skin cancer of the head and neck to determine prognostic factors, local control rate, disease free survival, morbidity, and mortality. Study Design: Retrospective review of consecutive patients treated at a tertiary referral center from 1982 to 1993. Methods: Charts of patients having craniofacial resection for aggressive nonmelanoma cutaneous malignancies were reviewed and living patients followed for 10 additional years. Demographics, histology, previous interventions, treatment, surgical pathology, reconstructions, and complications were examined. The product-limit method was used to calculate survival functions, and the log-rank test was used to compare survival distributions. Results: Thirty-five patients, mean age 66.7 years, received treatment at our facility. Follow-up ranged from 2 to 191 (mean 47.4) months. Histology included 20 squamous cell carcinomas (SCC) and 15 basal cell carcinomas (BCC). Sixty percent had craniofacial resection alone, and 28.6% also had postoperative radiotherapy. There were two perioperative deaths, and 37.1% suffered early and 14.3% late surgical complications. Two- and five- year survival was significantly better (P = .02) with BCC (92% and 76%) than with SCC (54% and 24%). Long-term disease-specific survival was 20%, and 11.4% of our subjects were living with disease. Intracranial extension (P = .02), perineural invasion (P = .049), and prior radiotherapy significantly decreased 5-year survival. Conclusions: Acceptable mortality and morbidity is possible using craniofacial resection to treat advanced nonmelanoma skin cancer. Although disease-specific survival remains poor, positive trends were noted in local control beginning at 2 years of follow-up. Because patients often have few remaining options for cure, craniofacial resection is justified when technically feasible. [source] Effectiveness of Chemotherapy and Radiotherapy in Sterilizing Cervical Nodal Disease in Squamous Cell Carcinoma of the Head and Neck,THE LARYNGOSCOPE, Issue 4 2005Michael G. Moore MD Abstract Objective: Determine effects of chemoradiotherapy on nodal disease in head and neck squamous cell carcinoma (SCCA). Study Design: Matched case-control study. Methods: A series of neck dissections (ND) performed for SCCA of the head and neck was retrospectively reviewed. Three groups were identified: 1) planned ND after chemoradiotherapy, 2) ND after radiotherapy alone, and 3) ND before adjuvant therapy (control group). Demographic data, tumor-node-metastasis stage, and pathology were reviewed. Total number of nodes recovered, number of positive nodes, and extracapsular spread (ECS) were recorded. To each patient in the chemoradiotherapy group, a randomly matched dissection in the control group was identified, matching for preoperative N stage and ND type (comprehensive, supraomohyoid, or selective). Comparisons were conducted for total nodes, presence of positive nodes, and ECS. Similar matched comparisons were conducted for ND after radiotherapy alone versus the control group. Results: Ninety-seven NDs (N0 = 10 cases, N1 = 9, N2 = 69, and N3 = 9) were matched to control NDs without previous therapy. Total nodal yield was not statistically different between chemoradiotherapy and control groups (23.5 vs. 23.0 nodes, respectively, P = .77). Positive nodal yield was significantly lower for chemoradiotherapy versus control dissections (0.76 vs. 3.0, P < .001). The percent of chemoradiotherapy dissections recovered as positive nodes was 24.7% versus 68.0% of the control group (P < .001). ECS was identified in 13.4% of the chemoradiotherapy group versus 32.0% of the control group (P = .002). Radiotherapy alone produced less pronounced nodal reductions. Conclusions: Chemoradiotherapy substantially decreases nodal disease and ECS in SCCA. However, a significant percentage of necks contain positive nodes after therapy, meriting consideration for ND. [source] Role for Postoperative Radiation Therapy in Adenoid Cystic Carcinoma of the Head and Neck,THE LARYNGOSCOPE, Issue 7 2004Damon A. Silverman MD Objective: Clarify the role for postoperative radiation for adenoid cystic carcinoma (ACC) of the head and neck as it relates to tumor site, T-stage, and surgical margin status. Study Design: Retrospective cohort study at an academic tertiary care hospital. Methods: A review of 129 patients with biopsy-proven ACC was performed. Previous treatment failures and nonoperative candidates were excluded, with 75 patients considered eligible for further study. Patients were grouped according to treatment modality and Kaplan-Meier estimates of overall survival, locoregional control, and distant control were compared using log-rank tests. Patients were also stratified according to tumor site, T-stage, and surgical margin status, and pair-wise comparisons of treatment outcome within each group were performed using Wald tests from Cox proportional hazards models. Results: Twenty-five patients were treated with surgery alone, and 50 were treated with surgery and postoperative radiation. There was no significant difference in outcome between treatment groups when correlated with tumor site (P = .89). However, postoperative radiation was associated with improved overall survival for advanced T-stage (T4) tumors (P = .019) and greater locoregional control for patients with microscopically positive margins (P = .018). There was no demonstrated benefit of postoperative radiation for patients with microscopically negative margins (P = .93). Conclusions: The findings of this study suggest that advanced T-stage and positive microscopic margins are important factors in determining the necessity for postoperative radiation therapy for ACC of the head and neck and that radiation therapy may not be necessary for patients with early T-stage tumors and negative surgical margins. [source] Vascular Leiomyoma of the Head and NeckTHE LARYNGOSCOPE, Issue 4 2004Cheng-Ping Wang MD Abstract Objectives/Hypothesis Vascular leiomyoma, a benign tumor composed of smooth muscle cell and vascular endothelium, is rare in the head and neck region. The authors report their experience with 21 patients. Study Design Retrospective review. Methods From 1988 to 2001, the clinical records of 21 patients with vascular leiomyoma of the head and neck were reviewed. The pathological material of each tumor was reviewed again for confirmation of the diagnosis and histological classification proposed by Morimoto. Results Twelve male and 9 female patients were studied. The mean age was 48 years. The locations and numbers of cases of the tumors were as follows: auricle, five; nasal cavity, three; external nose, 3; neck, 3; lip, 3; inner canthus, 2; forehead, 1; and hard palate, 1. All tumors were painless, and most were less than 2 cm in diameter. Three vascular leiomyomas of the neck were larger than 2 cm. Two of the three tumors originating in the nasal cavity presented with nasal obstruction or epistaxis. Regarding histological subtype, 14 of 21 (67%) tumors were solid type; 6 (28%) were cavernous type, and only one (5%) was venous type. Only one tumor (5%) recurred after excision. Conclusion Vascular leiomyoma usually presents as a small, painless mass. Auricle, nose, lip, and neck are the most common sites of occurrence. Unusually large vascular leiomyomas are developed in the deep space of the neck. Imaging study or cytological examination is not helpful for diagnosis. Histological classification is not necessary. Simple excision yields excellent results. [source] Candidate's Thesis: The Application of Sentinel Node Radiolocalization to Solid Tumors of the Head and Neck: A 10-Year Experience,THE LARYNGOSCOPE, Issue 1 2004James C. Alex MD Abstract Objectives/Hypothesis The goals of the research study were to develop an easily mastered, accurate, minimally invasive technique of sentinel node radiolocalization with biopsy (SNRLB) in the feline model; to compare it with blue-dye mapping techniques; and to test the applicability of sentinel node radiolocalization biopsy in three head and neck tumor types: N0 malignant melanoma, N0 Merkel cell carcinoma, and N0 squamous cell carcinoma. Study Design Prospective consecutive series studies were performed in the feline model and in three head and neck tumor types: N0 malignant melanoma (43 patients), N0 Merkel cell carcinoma (8 patients), and N0 squamous cell carcinoma (20 patients). Methods The technique of sentinel node radiolocalization with biopsy was analyzed in eight felines and compared with blue-dye mapping. Patterns of sentinel node gamma emissions were recorded. Localization success rates were determined for blue dye and sentinel node with radiolocalization biopsy. In the human studies, all patients had sentinel node radiolocalization biopsy performed in a similar manner. On the morning of surgery, each patient had sentinel node radiolocalization biopsy of the sentinel lymph node performed using an intradermal or peritumoral injection of technetium Tc 99m sulfur colloid. Sentinel nodes were localized on the skin surface using a handheld gamma detector. Gamma count measurements were obtained for the following: 1) the "hot" spot/node in vivo before incision, 2) the hot spot/node in vivo during dissection, 3) the hot spot/node ex vivo, 4) the lymphatic bed after hot spot/node removal, and 5) the background in the operating room. The first draining lymph node(s) was identified, and biopsy of the node was performed. The radioactive sentinel lymph node(s) was submitted separately for routine histopathological evaluation. Preoperative lymphoscintigrams were performed in patients with melanoma and patients with Merkel cell carcinoma. In patients with head and neck squamous cell carcinoma, the relationship between the sentinel node and the remaining lymphatic basin was studied and all patients received complete neck dissections. The accuracy of sentinel node radiolocalization with biopsy, the micrometastatic rate, the false-negative rate, and long-term recurrence rates were reported for each of the head and neck tumor types. In the melanoma study, the success of sentinel node localization was compared for sentinel node radiolocalization biopsy, blue-dye mapping, and lymphoscintigraphy. In the Merkel cell carcinoma study, localization rates were evaluated for sentinel node radiolocalization biopsy and lymphoscintigraphy. In the head and neck squamous cell carcinoma study, the localization rate of sentinel node radiolocalization biopsy and the predictive value of the sentinel node relative to the remaining lymphatic bed were determined. All results were analyzed statistically. Results Across the different head and neck tumor types studied, sentinel node radiolocalization biopsy had a success rate approaching 95%. Sentinel node radiolocalization biopsy was more successful than blue-dye mapping or lymphoscintigraphy at identifying the sentinel node, although all three techniques were complementary. There was no instance of a sentinel node-negative patient developing regional lymphatic recurrence. In the head and neck squamous cell carcinoma study, there was no instance in which the sentinel node was negative and the remaining lymphadenectomy specimen was positive. Conclusion In head and neck tumors that spread via the lymphatics, it appears that sentinel node radiolocalization biopsy can be performed with a high success rate. This technique has a low false-negative rate and can be performed through a small incision. In head and neck squamous cell carcinoma, the histological appearance of the sentinel node does appear to reflect the regional nodal status of the patient. [source] Metastatic Renal Cell Carcinoma to the Head and Neck,THE LARYNGOSCOPE, Issue 9 2002Keith M. Pritchyk MD Abstract Objectives The objectives of the study were to present four cases of renal cell carcinoma (RCC) metastatic to the head and neck, to recognize the appearance on radiographic studies, to understand the importance of preoperative embolization, and to review the results of treatment. Study Design Retrospective review of patients diagnosed with metastatic RCC to the head and neck. Methods The records of four patients diagnosed with metastatic RCC at a tertiary medical center over a 5-year period from 1996 to 2001 were reviewed and analyzed for demographic and outcomes data. Results Metastatic RCC to the head and neck was seen in the following locations: nasal cavity, lower lip, hard palate, tongue, and maxillary sinus. Presenting signs were loose upper molars, dysphagia, nasal obstruction, lower lip lesion, recurrent epistaxis, and foul nasal drainage. Histological studies confirmed metastasis of RCC in all four patients. Treatment consisted of preoperative radiation therapy, embolization, and local excision with adjunct chemotherapy. Conclusions Metastatic RCC to the head and neck is rare but can have serious consequences if not recognized before biopsy. We present several treatment options with local excision as the primary mode of treatment. [source] Melanoma of the Head and Neck: Current Concepts in Diagnosis and ManagementTHE LARYNGOSCOPE, Issue 7 2001Eric J. Lentsch MD First page of article [source] Surgical Pathology of the Head and Neck,THE LARYNGOSCOPE, Issue 9 2000Karen H. Calhoun MD No abstract is available for this article. [source] Neural Cell Adhesion Molecule Expression in Adenoid Cystic Carcinoma of the Head and Neck,THE LARYNGOSCOPE, Issue 6 2000James A. Hutcheson MD Abstract Objective To investigate whether there is a correlation between neural cell adhesion molecule (NCAM) expression and perineural spread in patients with adenoid cystic carcinoma of the head and neck (ACCHN). Study Design Retrospective review of medical records and immunohistochemical staining of specimens from 37 patients treated at the University of Arkansas in Little Rock from 1987 to 1997. Methods Sections from paraffin-embedded specimens were e-amined for the presence of NCAM using monoclonal anti-NCAM antibody by avidin-biotin-pero-idase immunohistochemical staining. NCAM staining was scored in each specimen and correlated with the data obtained from patient charts. Results Twenty-five of 37 specimens (68%) showed histopathological evidence of perineural spread. All 37 specimens (100%) stained positive for NCAM, regardless of perineural spread status. Conclusion Our results suggested that the use of NCAM expression as a predictor of perineural spread is highly unlikely. [source] Nordic rattle: the hoarse vocalization and the inflatable laryngeal air sac of reindeer (Rangifer tarandus)JOURNAL OF ANATOMY, Issue 2 2007Roland Frey Abstract Laryngeal air sacs have evolved convergently in diverse mammalian lineages including insectivores, bats, rodents, pinnipeds, ungulates and primates, but their precise function has remained elusive. Among cervids, the vocal tract of reindeer has evolved an unpaired inflatable ventrorostral laryngeal air sac. This air sac is not present at birth but emerges during ontogenetic development. It protrudes from the laryngeal vestibulum via a short duct between the epiglottis and the thyroid cartilage. In the female the growth of the air sac stops at the age of 2,3 years, whereas in males it continues to grow up to the age of about 6 years, leading to a pronounced sexual dimorphism of the air sac. In adult females it is of moderate size (about 100 cm3), whereas in adult males it is large (3000,4000 cm3) and becomes asymmetric extending either to the left or to the right side of the neck. In both adult females and males the ventral air sac walls touch the integument. In the adult male the air sac is laterally covered by the mandibular portion of the sternocephalic muscle and the skin. Both sexes of reindeer have a double stylohyoid muscle and a thyroepiglottic muscle. Possibly these muscles assist in inflation of the air sac. Head-and-neck specimens were subjected to macroscopic anatomical dissection, computer tomographic analysis and skeletonization. In addition, isolated larynges were studied for comparison. Acoustic recordings were made during an autumn round-up of semi-domestic reindeer in Finland and in a small zoo herd. Male reindeer adopt a specific posture when emitting their serial hoarse rutting calls. Head and neck are kept low and the throat region is extended. In the ventral neck region, roughly corresponding to the position of the large air sac, there is a mane of longer hairs. Neck swelling and mane spreading during vocalization may act as an optical signal to other males and females. The air sac, as a side branch of the vocal tract, can be considered as an additional acoustic filter. Individual acoustic recognition may have been the primary function in the evolution of a size-variable air sac, and this function is retained in mother,young communication. In males sexual selection seems to have favoured a considerable size increase of the air sac and a switch to call series instead of single calls. Vocalization became restricted to the rutting period serving the attraction of females. We propose two possibilities for the acoustic function of the air sac in vocalization that do not exclude each other. The first assumes a coupling between air sac and the environment, resulting in an acoustic output that is a combination of the vocal tract resonance frequencies emitted via mouth and nostrils and the resonance frequencies of the air sac transmitted via the neck skin. The second assumes a weak coupling so that resonance frequencies of the air sac are lost to surrounding tissues by dissipation. In this case the resonance frequencies of the air sac solely influence the signal that is further filtered by the remaining vocal tract. According to our results one acoustic effect of the air sac in adult reindeer might be to mask formants of the vocal tract proper. In other cervid species, however, formants of rutting calls convey essential information on the quality of the sender, related to its potential reproductive success, to conspecifics. Further studies are required to solve this inconsistency. [source] Longstanding malformation of right sided pinna in an elderly manCONGENITAL ANOMALIES, Issue 1 2010Deeke Yolmo ABSTRACT The pinna is the second most common site for external ear vascular malformation in the head and neck. These malformations are relatively uncommon in adults and can pose difficult therapeutic challenges. We hereby present a case of a 69-year-old man with a congenital lesion in the right pinna consistent with an arteriovenous malformation. The lesion was complicated by ulceration and bleeding for 6 months prior to presentation. Resection of pinna was carried out, and satisfactory functional and esthetic results were obtained. There was no recurrence at 22 months of regular follow up. [source] Head and neck cancer in the UK: what is expected of cytopathology?CYTOPATHOLOGY, Issue 2 2009G. Kocjan Objective:, This review highlights the role of cytopathology in cancer management within UK Head and Neck Cancer Networks and informs on the issues raised by recent UK Department of Health documents and other UK professional guidance. UK guidance requires the formal involvement of cytopathologists within multidisciplinary cancer teams, with medical and non-medical cytopathology staff setting up and running rapid access lump clinics, and support for image-guided fine needle aspiration cytology (FNAC) services. UK guidance also makes recommendations for training, resources and quality control. This review also highlights the resource gap between best practice evidence-based guidance for head and neck (HN) cancer services and existing UK provision for cytopathology, as evidenced by lack of availability of experienced staff and adequacy of training and quality control (QC). Finally, it stresses the importance in the UK of the Royal College of Pathologists' guidance, which defines the need for training, the experience needed for new consultants, the requirements for audit and QC. The implications for the additional resources required for HN cancer cytopathology services are discussed. Recent professional guidance specifying the provision of HN cancer services in the UK includes a cytopathology service for cancer networks, such as rapid access FNAC clinics. Although these clinics already operate in some institutions, there are many institutions where they do not and where the provision of cytopathology services would have to be restructured. This would need the support of local cancer networks and their acceptance of the detailed requirements for cytopathology, including resources, training and QC. The standards are not defined locally, as Strategic Health Authorities and Primary Care Trusts have been instructed by the Department of Health to support, invest and implement them. [source] Cystic lesions of the head and neck: cytohistological correlation in 63 casesCYTOPATHOLOGY, Issue 3 2007P. Firat Objective:, To investigate the accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of cystic masses of the head and neck (H&N), excluding thyroid lesions. Methods:, A total of 198 cases, 63 of whom had consequent surgical specimens, were retrieved from the files of two university hospitals and reviewed. Results:, FNAC correctly diagnosed 25 of 36 neoplasms with a cystic component. Five Warthin's tumours, two squamous cell carcinomas, two mucoepidermoid carcinomas and two schwannomas yielded non-representative aspirates. Four of the missed Warthin's tumours and two mucoepidermoid carcinomas which were misdiagnosed as benign cysts were aspirated by their clinician. One branchial cleft cyst was cytologically interpreted as highly suspicious for carcinoma. Conclusions:, Disparate entities may present with similar cytological findings in the H&N region. A detailed description of differential diagnosis should be given in the cytology report in suspicious cases. Repeated aspirations from different sites of the lesion may reduce the false-negative rate. [source] Good practice in head and neck fine needle aspiration cytology as assessed by CUSUMCYTOPATHOLOGY, Issue 6 2002I. A. Robinson Providing data as evidence of good practice is becoming imperative to meet the demands of professional revalidation and clinical governance. Sensitivity and specificity are common performance measures in fine needle aspiration (FNA) but are vulnerable to discordant analytical methods. We introduce a CUSUM technique and show how it may be used to show attainment and maintenance of proficiency in head and neck (H&N) FNA. In addition, we show how it can be used to compare practices and demonstrate different performance for FNAs from different tissues; a fact that must be recognized by anyone devising minimum performance values. [source] High-Risk Cutaneous Squamous Cell Carcinoma without Palpable Lymphadenopathy: Is There a Therapeutic Role for Elective Neck Dissection?DERMATOLOGIC SURGERY, Issue 4 2007JUAN-CARLOS MARTINEZ MD PURPOSE The beneficial role of elective neck dissection (END) in the management of high-risk cutaneous squamous cell carcinoma (CSCC) of the head and neck remains unproven. Some surgical specialists suggest that END may be beneficial for patients with clinically node-negative (N0) high-risk CSCC, but there are few data to support this claim. We reviewed the available literature regarding the use of END in the management of both CSCC and head and neck SCC (HNSCC). METHODOLOGY The available medical literature pertaining to END in both CSCC and HNSCC was reviewed using PubMed and Ovid Medline searches. RESULTS Many surgical specialists recommend that END be routinely performed in patients with N0 HNSCC when the risk of occult metastases is estimated to exceed 20%; however, patients who undergo END have no proven survival benefit over those who are initially staged as N0 and undergo therapeutic neck dissection (TND) after the development of apparent regional disease. There is a lack of data regarding the proper management of regional nodal basins in patients with N0 CSCC. In the absence of evidence-based data, the cutaneous surgeon must rely on clinical judgment to guide the management of patients with N0 high-risk CSCC of the head and neck. CONCLUSIONS Appropriate work-up for occult nodal disease may occasionally be warranted in patients with high-risk CSCC. END may play a role in only a very limited number of patients with high-risk CSCC. [source] Pilomatrix Carcinoma of the Back Treated by Mohs Micrographic SurgeryDERMATOLOGIC SURGERY, Issue 8 2004David Sable MD Background. Pilomatrix carcinoma (synonyms, matrical carcinoma or malignant pilomatrixoma) is a rare malignant neoplasm derived from the hair matrix first described in 1980. This neoplasm can exhibit local aggressive behavior and distant metastasis. Most pilomatrix carcinomas occur on the head and neck of elderly individuals with a predilection for males (M:F 5:1). Pilomatrix carcinoma is often clinically misdiagnosed as a sebaceous cyst and histologic difficulty can occur in differentiating this entity from the benign entity pilomatrixoma. Objective. The objective was to describe a case of pilomatrix carcinoma encountered in a Mohs micrographic surgery practice. We present the first case of this lesion treated by Mohs surgery. Methods. A case report and literature review are presented. Conclusion. Pilomatrix carcinoma is a rare malignant variant of pilomatrixoma. Given the rarity of this lesion there are no well-defined standards for surgical management. Wide local excision has been recommended given the high rate of reoccurrence. Mohs micrographic surgery may provide optimal treatment of this neoplasm given the ability to have 100% margin control. [source] Familial Eccrine Spiradenoma: A Case Report and Review of the LiteratureDERMATOLOGIC SURGERY, Issue 4 2003Maryanna C. Ter Poorten MD BACKGROUND Familial eccrine spiradenoma is a rare autosomal dominant condition that is characterized by slow-growing, benign adnexal tumors. OBJECTIVE We investigated a case of familial eccrine spiradenoma displaying an autosomal dominant inheritance pattern. To our knowledge, only two previously reported cases of familial eccrine spiradenoma exist in the literature. METHODS A case report and review of the literature are given. RESULTS We report a case of familial eccrine spiradenoma in a mother and daughter and present successful treatment using surgical extirpation and CO2 laser ablation. CONCLUSION Familial eccrine spiradenoma is a benign autosomal dominantly inherited condition that is characterized by tender, slow-growing, adnexal tumors of the head and neck. Surgical tumor extirpation and CO2 laser ablation offer both an effective symptomatic and cosmetically elegant treatment option. [source]
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