bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary carcinoma involving the petrous temporal bone
Authors: Liu Fei‐Fei , Keane Thomas J. , Davidson Jean
Published: February 2007

Between 1975 and 1985, 29 patients with the diagnosis of carcinoma of the petrous temporal bone were seen at the Princess Margaret Hospital. Twenty‐seven carcinomas were graded: 13 were well‐differentiated; the remaining 14 were either moderately or poorly differentiated tumors. Fifteen patients were managed with a combination of surgery and radiotherapy, 13 were treated with radiotherapy only, and one patient was treated by surgery alone. Median follow‐up time was 6.1 years, and the 5‐year actuarial local control and cause‐specific survival rates for the entire group were 40% and 50%, respectively. Age greater than 60 years, poor grade of tumor, and involvement of the facial nerve were three significant variables associated with poor outcome. A superior 5‐year actuarial local control was achieved with surgery plus postoperative radiotherapy (54%) compared to other treatment approaches. Based on the results from this review, we would continue to recommend a combined modality approach of surgery followed by postoperative radiotherapy in the management of this rare, but life‐threatening disease.
Relative roles of computed tomography and endoscopy for determining the inferior extent of pyriform sinus carcinoma: Correlative histopathologic study
Authors: Saleh Ezzat M. , Mancuso Anthony A. , Stringer Scott P.
Published: February 2007

Ten laryngopharyngectomy specimens were dissected to determine the relative accuracy of computed tomography (CT) and endoscopy under anesthesia for evaluating the inferior extent of pyriform sinus carcinoma. Endoscopic examination failed to detect involvement of the pyriform sinus apex in one patient, and considerably underestimated disease at this level in two others; CT accurately predicted the status of the apex in these three and all other patients. Endoscopy underestimated the inferior extent of tumor in six patients; CT revealed the inferior limit relative to the esophageal verge more accurately in all six of these submucosal extensions. Endoscopy revealed one case of mucosal spread to the esophageal verge not demonstrated by CT. Endoscopy and CT were both correct in revealing the esophageal verge to be involved (one case) and free of disease (two cases). This study also confirmed a common tendency of pyriform fossa cancer to spread through thyrohyoid membrane adjacent to the course of superior laryngeal neurovascular bundle (six cases). High‐resolution CT, in experienced hands, is a useful adjunct to endoscopy for detecting submucosal, inferior extension of pyriform sinus carcinoma. This information can influence the choice of the lower margin of resection and method of pharyngeal reconstruction.
Actinomycosis of the tongue: A diagnostic challenge
Authors: Ficarra Giuseppe , Di Lollo Simonetta , Pierleoni Felicita , Panzoni Enrico
Published: February 2007

Actinomycotic infections of the cervicofacial area are rare and frequently show a confusing clinical picture. We report a case of actinomycosis that mimicked a neoplasm of the tongue. The clinical and pathologic features and the differential diagnosis of this unusual oral infection are discussed.
Metastatic head and neck carcinoma in a percutaneous gastrostomy site
Authors: Meurer Michael F. , Kenady Daniel E.
Published: February 2007

Two unusual cases of metastatic head and neck carcinoma to the exit site of a percutaneous endoscopic gastrostomy (PEG) tube are reported. These patients presented with squamous cell carcinomas of the supraglottic larynx and oropharynx. In both patients, a PEG tube was inserted using the “pull” technique prior to any extirpative measures. Within 9 months after surgical treatment, each patient was diagnosed with metastatic squamous cell carcinoma at the PEG tube exit site. A review of the literature revealed three cases of metastatic head and neck neoplasms to a PEG site and a single case report of spread to the wound of an “open” gastrostomy. The hematogenous route is the probable mechanism of metastasis, but direct implantation cannot be dismissed. Until further data become available, the authors recommend that, when possible, PEG tube placement using the “pull” technique be deferred until after extirpation of head and neck tumors.
Reconstruction of extensive defects of the cranium using free‐tissue transfer
Authors: Potparić Zoran , Starović Borisa
Published: February 2007

Fourteen patients with large tissue deficits in the calvarium and orbits were reconstructed using microvascular free‐tissue transfer (15 flaps). The etiology of these defects was skin neoplasms (seven), osteomyelitis (four), burn (two), and trauma (one). The free flaps used were the latissimus dorsi muscle flap with a split‐thickness skin graft (seven), latissimus dorsi myocutaneous flap (two), rectus abdominis myocutaneous flap (three), radial forearm fasciocutaneous flap (two), and split‐iliac crest flap (one). There was one postoperative death, one flap failure, two recurrences of neoplasm, and one loss of bone grafts and flap from infection. The free flaps can offer good results in patients undergoing wide resection in the cranium and orbits providing immediate repair with acceptable cosmetic result, minimized morbidity, and short hospitalization. However, immediate reconstruction following tumor resection carries a danger of positive margins discovered on permanent histologic sections or the difficulty in detecting recurrence underneath a bulky free flap.
Predictors of neck node control in radically irradiated squamous cell carcinoma of the oropharynx and laryngopharynx
Authors: Varghese Cherian , Sankaranarayanan R. , Nair Balakrishnan , Nair M. Krishnan
Published: February 2007

Cases of squamous cell carcinoma (171) of the oropharynx and laryngopharynx with clinically positive neck nodes, treated primarily by radiotherapy, were used for a multivariate analysis of the factors related to the regional outcome. All patients were staged according to the UICC‐TNM (1982) classification. Lymph node size (P < 0.01), TNM nodal category (P < 0.05), and stage of the disease (P < 0.05) were significant in univariate analysis. Patient‐ and disease‐related factors (age, sex, and histology) and treatment related factors (radiation dose (5000–6000 rads), radiation schedule, and concurrent chemotherapy) did not reach statistical significance. The stepwise logistic regression resulted in a final model with node size as the most important predictor of neck node control (P < 0.01). Patients with neck nodes up to 1 cm can receive radical radiotherapeutic management for treating the primary as well as nodal disease.
Cisplatinum–epirubicin chemotherapy for advanced unresectable squamous cell carcinoma of the head and neck
Authors: Maipang Tanaphon , Watanaarepornchai Somchai , Panjapiyakul Chingyiam , Totemchokchyakarn Piya
Published: February 2007

Twenty‐seven patients with locally advanced unresectable squamous cell carcinoma of the head and neck were offered three courses of cisplatinum and epirubicin. The purpose of this study was to evaluate the effectiveness of this chemotherapy regimen. Subsequent therapy included surgery when feasible and/or radiation therapy. Eighteen patients completed three courses of chemotherapy. Three had a complete response and 14 a partial response. Nine patients refused chemotherapy before treatment was completed. Overall response rate was 63%. Among responding patients, the initial favorable response to chemotherapy was apparent after the first course of chemotherapy. A moderate degree of nausea, vomiting, anorexia, and alopecia were the most common toxicities. Leukopenia grade 3 according to ECOG criteria (WBC 1,000–2,000/mm3) was found in 8(44%) of the 18 patients completing treatment. There was no cardiac toxicity. This regimen appears to be an effective induction chemotherapy for advanced unresectable head and neck cancer with acceptable side effects. Subsequent therapy with surgery and/or radiation can give long‐term local control of disease in some patients. In a selected group of patients with smaller tumors, this treatment should have a better response rate and a favorable effect on survival. Phase III studies using this regimen should be carried out.
Functional facial nerve weakness after surgery for benign parotid tumors: A multivariate statistical analysis
Authors: Mra Zan , Komisar Arnold , Blaugrund Stanley M.
Published: February 2007

A retrospective study was done on 64 patients who underwent superficial or subtotal parotidectomy for a primary benign tumor of the parotid gland. Factors, such as age, sex, smoking, alcohol consumption, type of surgery, duration of surgery, pathology of lesion, and size of lesion, were reviewed in a multivariate statistical analysis to determine if any factors alone or in combination contributed to the development of functional facial nerve weakness postoperatively. Only the age of the patient was found to have a statistically significant causal relation using the Pearson chi‐square method (p = 0.015). The marginal mandibular branch was affected in nine of 10 cases. Different surgical approaches cited in the literature are discussed, along with the possible role of ischemic injury to the facial nerve during parotidectomy.
Surgical strategies for differentiated carcinoma of the thyroid isthmus
Authors: Sugenoya Akira , Shingu Kiyoshi , Kobayashi Shinya , Masuda Hiroyuki , Takahashi Shozo , Shimizu Tadahiro , Onuma Hiroshi , Asanuma Kazuhiko , Ito Nobuo , Iida Futoshi
Published: February 2007

The postoperative outcome (including clinicopathologic features) in 19 patients with differentiated thyroid cancer of the isthmus was investigated to develop more appropriate surgical strategies for these lesions. The extent of thyroidectomy, including neck dissection, tumor size, nodal involvement, and other clinical features were evaluated. The incidence of intraglandular dissemination was about 16% in all patients. Analysis of regional node metastatic distribution revealed no definite metastatic pattern. In addition, there was no apparent correlation between tumor size and nodal involvement. Two of the six patients who underwent total thyroidectomy suffered permanent postoperative hypoparathyroidism. It is thus recommended that isthmusectomy, including an adequate edge of surrounding normal thyroid tissues of each lobe and modified or limited neck dissection when cervical nodes are palpably enlarged is sufficient as an appropriate primary surgical procedure for differentiated carcinoma of the thyroid isthmus.
Retropharyngeal leiomyoma: Case report and review of the literature
Authors: Dharnidharka Vikas R. , Bahl N. K. , Kandoth Pravina W. , Kamath Jayashri R. , Vengsarkar Umesh S.
Published: February 2007

An 8‐year‐old girl was initially seen with dyspnea, drooling of secretions, and loss of weight. A large mass was seen protruding through the posterior pharyngeal wall, which was found to be a leiomyoma after excision. No previous case report exists of a retropharyngeal leiomyoma.
Primary and salvage surgery for cancer of the tonsillar region: A retrospective study of 120 patients
Authors: Gehanno Pierre , Depondt Joël , Guedon Charles , Kebaili Cheidli , Koka Venkata
Published: February 2007

The present series compares results in our head and neck department from primary and salvage surgery for tumors of the tonsillar region from 1978 to 1985. Of 120 consecutively admitted patients, 70 underwent primary surgery followed by irradiation, and 50 underwent salvage surgery after the failure of primary radiotherapy. Follow‐up has been continued for the past 6 years. Musculocutaneous flaps were employed in all patients requiring them after the introduction of this reconstructive technique in 1981. The actuarial survival rate after primary surgery was 58% at 3 years and 46% at 5 years. For salvage surgery the figures were 38% and 24%, respectively. This disappointing survival rate in salvage surgery resulted from a higher postoperative mortality (8% versus 1.4% in primary surgery) and from a higher local failure rate (36% versus 14%). The outcome was invariably unfavorable when tonsillar tumors extended into the base of the tongue.
Olfactory neuroblastoma: The results of modern treatment approaches at the University of Michigan
Authors: Zappia John J. , Carroll William R. , Wolf Gregory T. , Thornton Allan F. , Ho Laurence , Krause Charles J.
Published: February 2007

A retrospective study was undertaken to review patterns of treatment and survival for patients with olfactory neuroblastomas at the University of Michigan since the introduction of craniofacial resection in the late 1970s. Recent results were compared to previous reports. Disease‐free and overall survival for patients with Kadish stage B tumors were unchanged from prior years. Improvement in both disease‐free intervals and overall survival was evident for patients with stage C tumors. Interestingly, in two patients with “unresectable” local disease, complete responses to induction chemotherapy followed by radiotherapy were noted.
Intravenous fluid administration and urine output during radical neck surgery
Authors: Priano Lawrence L. , Smith James D. , Cohen James I. , Everts Edwin E.
Published: February 2007

This study examines perioperative urine output (UO) and hemodynamics in 24 patients who underwent radical head and neck surgery. The hypothesis tested was that “UO was not important in patients with normal renal function as long as hemodynamics were maintained.” Intraoperatively, a “wet” group (13 patients) had generous amounts of intravenous (IV) fluid administered during surgery receiving 1,018 ± 58 mL ± h−1. The other “dry” group (11 patients) had fluids restricted to 426 ± 23 ± h−1. The intraoperative UOs for the wet and dry groups were 1.33 ± 0.27 and 0.39 ± 0.10 mL ± kg−1 ± h−1, respectively (p < 0.05). Postoperatively, the UOs for the wet and dry groups were 1.9 ± 0.3 and 1.1 ± 0.1 mL ± kg−1 ± h−1, respectively (p < 0.05). Perioperatively, there were no statistically significant differences between groups in systemic or pulmonary hemodynamics. Postoperatively, ordinary indices of renal function remained normal in both groups. We conclude that intraoperative oliguria due to moderate fluid restriction is not detrimental to renal outcome as long as systemic hemodynamics are maintained. Furthermore, not only does this relatively “dry” status not compromise hemodynamics, it affords the patient other benefits.
Innervation of the trapezius muscle by the intra‐operative measurement of motor action potentials
Authors: Soo Khee‐Chee , Strong Elliot W. , Spiro Ronald H. , Shah Jatin P. , Nori Subhadra , Green Ronald F.
Published: February 2007

Although the surgical anatomy of the spinal accessory nerve and the cervical plexus has been extensively described, the exact motor innervation of the trapezius has been controversial. Attempts to resolve this question have involved anatomic or electrophysiologic studies in human embryos and animals. Extrapolation of the results to adult humans may not be correct. Accurate identification of muscle innervation is obtainable by intra‐operative measurement of motor action potentials produced by direct stimulation of the accessory nerve and the cervical plexus. The study involved 14 patients undergoing supraomohyoid or modified neck dissections. Under direct vision, stimulating electrodes were placed on the identified nerves and motor action potentials, and latencies were recorded by surface electrodes placed over the three portions of the trapezius. In 13 patients, when the accessory nerve was stimulated, motor action potentials were obtained in 13 of 13 in the first portion, 11 of 13 in the second portion, and 10 of 13 in the third portion of the trapezius. In the last patient, the accessory nerve ended in the sternocleidomastoid muscle, and innervation of the trapezius was via C3 as demonstrated by motor action potentials. Responses when the roots of the cervical plexus were stimulated varied. Three patterns were seen: In the first group (seven patients), motor action potentials were distinct from those recorded when the accessory nerve was stimulated. Additionally, latencies were different from those of the accessory nerve. The second group (four patients) had motor action potentials that were similar to those obtained from stimulation of the accessory nerve, although their corresponding latencies were different. In two patients, no motor action potentials were recorded when the cervical plexus was stimulated. The results suggest that motor innervation of the trapezius is variable. The accessory nerve, when present, provides the most important input to the trapezius. Motor innervation from the cervical plexus is unpredictable, although it appears to be present in the majority of patient studies.
Tumor markers in the diagnosis and follow‐up of head and neck cancer: Role of CEA, CA 19‐9, SCC, TK, and dttpase
Authors: Walther Eberhard K. , Dahlmann Nicolaus , Gorgulla Harald T.
Published: February 2007

The clinical relevance of the carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19‐9, squamous cell carcinoma antigen (SCC), thymidine kinase (TK), and deoxythymidine‐5′‐triphosphatase (dTTPase) as tumor markers in the diagnosis and follow‐up treatment of 26 patients with head and neck cancer is evaluated. Serum levels prior to treatment were found elevated just above the upper limit of normal in 46% (SCC), 15% (CEA), 12% (CA 19‐9), 27% (TK), and 39% (dTTPase) of all patients. If all markers were taken into account, they were elevated in 73% of the untreated patients. However, only in a few cases were the tumor marker values elevated significantly (8%–12%). No significant correlation was detected between serum levels and tumor localization, staging, grading, or performance status for any of the markers. In the follow‐up none of the markers tested revealed any disease‐related information despite therapy variation. Patients with originally elevated marker levels showed decreasing and in some cases increasing values after primary therapy, although no tumor recurrence was detected. Even considering the results as preliminary due to the rather small sample size, they suggest that the routine assessment of CEA, CA 19‐9, SCC, TK, and dTTPase serum levels is of limited practical value.
Basic science reviews: Immunomodulation therapy for squamous cell carcinoma of the head and neck
Authors: Lee Norris K. , Cortesina Giorgio , De Stefani Antonella , Sacchi Manuela , Rosso Stefano , Galeazzi Emanuela
Published: February 2007

The role of the immune system in the pathogenesis and treatment of cancer is currently a popular area of research. An underlying fundamental concept of cancer immunology is the supposition that tumor cells express antigens differently than normal cells, both qualitatively and quantitatively. Understanding tumor–host interactions may suggest opportunities to modify these relationships to obtain antitumor effects. There is growing evidence that the immune system plays an important role in the pathogenesis of squamous cell carcinoma of the head and neck (SCCHN).1‐4 Based on this evidence, trials studying the therapeutic efficacy of biologic response modifiers (BRMs) have been undertaken. These trials have had variable success, but continued efforts incorporating newer cytokines are underway.
Carcinoma of the tonsillar region: A multivariate analysis of 243 patients treated with radical radiotherapy
Authors: Lee W. Robert , Mendenhall William M. , Parsons James T. , Million Rodney R. , Cassisi Nicholas J. , Stringer Scott P.
Published: February 2007

Between October 1964 and June 1990, 243 patients with squamous cell carcinoma of the tonsillar region were treated with continuous‐course radical radiotherapy at the University of Florida. All patients had a minimum 2‐year follow‐up. Patients were staged according to the AJCC system; stage IV was stratified into two subsets: favorable, IVA (T1‐T3 or N2A‐N3A); and unfavorable, IVB (T4 or N3B). The initial and ultimate local control rates (including surgical salvage) according to T stage were as follows: T1, 87% and 100%, T2, 79% and 92%; T3, 71% and 76%; and T4, 44% and 48%. Multivariate analysis demonstrated that anterior extension of the primary tumor (p = .0001) and T stage (p = .014) were the most significant parameters affecting local control after radiotherapy. For T4 lesions, twice‐daily irradiation significantly improved local control (p = .04). The 5‐year absolute and cause‐specific survival rates as a function of modified AJCC stage were as follows: 1, 37% and 100%; 11, 55% and 90%; 111, 55% and 85%; IVA, 35% and 60%; and IVB, 23% and 38%. The probability of a severe complication was 3% for the entire group of patients.
Pretreatment neck node biopsy, distant metastases, and survival in nasopharyngeal carcinom
Authors: Leung S. F. , Teo Peter M. L. , Foo William W. L. , Van Hasselt C. A. , Shiu Wesely C. T. , Ting C. L. , Lau Joseph T. F.
Published: February 2007

Pretreatment neck node biopsy had been performed on 50 of 422 patients who had cervical node metastases from nasopharyngeal carcinoma when initially seen. Multivariate analysis using the Cox proportional hazards model shows that pretreatment node biopsy is not a significant determinant of distant metastases, survival, or recurrence in the neck. Results of similar studies are reviewed and the role of pretreatment node biopsy in nasopharyngeal carcinoma discussed.
Base of tongue carcinoma: Patterns of failure and predictors of recurrence after surgery alone
Authors: Foote Robert L. , Olsen Kerry D. , Davis Dean L. , Buskirk Steven J. , Stanley Robert J. , Kunselman Susan J. , Schaid Daniel J. , Desanto Lawrence W.
Published: February 2007

Between January 1971 and December 1986, 55 patients with squamous cell carcinoma of the tongue base underwent complete surgical resection with curative intent. No preoperative or postoperative adjuvant therapy was administered. The study group consisted of 41 men and 14 women (median age 61 years). All patients were followed until death (39 patients) or for a median of 9.4 years. Local control at 5 years was 74%. No predictors of local recurrence were discovered. Control in the dissected neck at 5 years was 68%. Control of cancer above the clavicles at 5 years was 48%. Distant metastases developed in 14% of the patients by 5 years. Cause‐specific survival at 5 years was 65%. A Cox multivariate regression analysis revealed that pathologic N stage was the only significant independent predictor of recurrence in the dissected neck, recurrence above the clavicles, and cause‐specific survival. The 5‐year overall survival was 55%. Surgical mortality was 4%.
Radical radiotherapy for T4 carcinoma of the skin of the head and neck: A multivariate analysis
Authors: Lee W. Robert , Mendenhall William M. , Parsons James T. , Million Rodney R.
Published: February 2007

Sixty‐seven patients with 68 stage T4 carcinomas of the skin of the head and neck were treated with radical radiotherapy at the University of Florida between October 1964 and November 1989. Thirty‐three lesions were previously untreated and 35 were recurrent. Twenty‐nine lesions were squamous cell carcinomas, 37 were basal cell carcinomas, and 2 were basosquamous carcinomas. Minimum follow‐up was 2 years. The 5‐year local control, local control including surgical salvage, and cause‐specific survival probabilities were 53%, 74%, and 75%, respectively. Local control rates with radiotherapy alone were poorer in patients with recurrent lesions (41% vs. 67%, p = .07) or bone involvement (40% vs. 62%, p = .08).

Results were analyzed by multivariate methods using local control, local control with surgical salvage, and cause‐specific survival as endpoints. The parameters analyzed were histology; size of primary lesion; previous treatment (previously untreated vs. recurrent); involvement of bone, nerve, or cartilage; and skeletal muscle invasion. Three important prognostic factors were identified, each predictive of poorer ultimate local control and cause‐specific survival rates: (a) bone involvement (p < .01); (b) recurrent lesions (p < .01); and (c) nerve involvement (p < .02).

Radiotherapy alone can control advanced carcinomas of the skin of the head and neck, although lesions that have recurred after prior treatment and those with involvement of bone or nerve are associated with a lower likelihood of cure.
Seven‐year follow‐up of vanishing bone disease in a 14‐year‐old girl
Authors: Schiel Harald , Prein Joachim
Published: February 2007

A review of the literature revealed 91 cases of massive osteolysis since the first report by Jackson in 1838, including 31 in the maxillofacial region meeting the Heffez criteria. In seven cases, early irradiation was performed, after which no further progression of bone lysis was observed. The young female patient reported here has been followed up clinically and radiologically for 7 years after radiotherapy, during which time she has remained stable, with no progression of the osteolysis. Our experience with this patient appears to confirm that early radiotherapy with a dose of 30–40 Gy prevents further progression of the disease and can even lead to recalcification. On this basis, and provided the patient remains symptom‐free, reconstructive surgery appears a viable treatment option.
Clinical utility of intraoperative frozen section diagnosis in head and neck surgery: A quality assurance perspective
Authors: Gandour‐Edwards Regina F. , Donald Paul J. , Lie J. T.
Published: February 2007

The technical and professional issues that affect the clinical utility of intraoperative frozen section diagnosis in head and neck surgery are addressed from a quality assurance perspective. The most common reasons for sampling errors and interpretive errors are discussed. We offer several recommendations for head and neck surgeons and pathologists which will optimize the clinical utility of intraoperative frozen section consultation.
Therapeutic lymphadenectomy in melanomas of the head and neck
Authors: Van De Vrie Willem , Eggermont Alexander M. M. , Van Putten Wim L. J. , Wiggers Theo
Published: February 2007

This retrospective study describes patients with locoregionally metastasized melanoma of the head and neck. All patients underwent a therapeutic lymph node dissection. The 3‐year survival rate was 35%. Duration of disease‐free interval, number of lymph nodes involved, and extent of neck dissection proved of no influence on survival rates. Locoregional recurrence occurred in 10 patients and always proved to be a sign of systemic dissemination. Ultimately, 19 patients developed systemic disease. More than 40% developed cerebral metastases and the cerebrum was the second most involved site. As cerebral involvement occurs often in head and neck melanoma, a computed tomography or magnetic resonance imaging scan of the brain is recommended in the routine work‐up before lymph node dissection. Furthermore, because the extent of the surgical procedure had no influence on local recurrence rate and overall survival, a selective approach, preserving functional structures, is advocated.
Multivariate analysis results of radiotherapy for laryngeal cancer
Authors: Cano Elmer , Flickinger John , Johnson Jonas
Published: February 2007

We assess the impact of radiotherapy in the treatment of laryngeal cancer and evaluate the value of the standard dose (linear quadratic plus time model) and other variables to predict tumor control and survival. Between 1972 and 1989, 80 patients with laryngeal cancer received comprehensive radiotherapy. Patients with stage I laryngeal glottic cancer (T1‐NO‐MO) were excluded from this study. Mean follow‐up was 15 months (range 4 to 181). The mean age was 64.8 years (range 40 to 92). Standard dose varied from 32.65 to 81.81 Gy (mean 66.78). The 5‐year overall survival and tumor‐specific survival rates were 44.9 ± 5.8% and 51.4 ± 5.9%, respectively. Five‐year local control and locoregional control rates were 66.4 ± 5.7% and 61.9 ± 5.8%, respectively. Multivariate analysis showed that local control was significantly predicted by T stage (p=.032), but not by standard dose (p=.906). Independently significant factors predicting tumor‐specific survival included stage (p=.006), site (p=.019), and age (p=.001). Local control and survival were significantly predicted by the TNM‐staging classification. The standard dose did not predict local recurrence or survival.
Laryngeal cancer in Colorado
Authors: Harris James A. , Meyers Arlen D. , Smith Chris
Published: February 2007

Previous studies of laryngeal cancer have shown a decrease in the male‐to‐female ratio and that the sex ratio in glottic tumors is higher than that for other laryngeal sites. The purpose of this study was to characterize and identify changes in the demographics, laryngeal site predilection, geographic distribution, trends in tumor stage at diagnosis, and surgical caseload distribution in Colorado. The Colorado Central Cancer Registry for the years 1979 to 1990 was reviewed for cases of laryngeal cancer. The data were analyzed using chi‐square and gradient‐in‐proportions methods. One‐thousand two‐hundred sixty‐five (1265) cases were identified with a male‐to‐female ratio of 4.3:1. There was a significant trend of an increasing proportion of cases attributable to women. Glottic carcinoma accounted for 50.1% of cases, with a male‐to‐female ratio of 7.6:1. The Denver metropolitan area accounted for 57% of all cases, which was not disproportionate to the population. From 1981 to 1990 there was a significant decrease in the proportion of stage I cases and an increase in stage II cases. The teaching hospitals associated with the University of Colorado were responsible for performing 44.5% of all surgery for laryngeal cancer. The results indicate that laryngeal cancer in Colorado shares similar epidemiologic characteristics to those reported in other studies. Of most concern is the increasing proportion of women with laryngeal cancer and the decrease in cases diagnosed at stage I.
Squamous cell carcinoma of the hypopharynx—analysis of treatment results
Authors: Ho Chiu Ming , Lam Kam Hing , Wei William Ignace , Yuen Po Wing , Lam Lai Kun
Published: February 2007

The results of surgical treatment and causes of failure in 109 patients with squamous cell carcinoma of the hypopharynx were analyzed. The 5‐year survival was significantly related to the stage of the disease (stage I, 74%; stage II, 63%; stage III, 32%; and stage IV, 14%) and the preoperative nodal staging (NO, 57%; N1, 28%; N2, 6%; and N3, 0%), but not related to the extent of tumor resection. The local control rate was 86% and the majority of the local recurrences occurred at the upper resection margin. There was no significant difference in the local recurrence rate between those patients who had pharyngolaryngoesophagectomy and those who had pharyngolaryngectomy. However, the resection‐associated complications (bleeding, cardiac arrhythmia, pulmonary complications) were more frequent when total esophagectomy was performed. Reconstruction‐associated complications such as wound infection and anastomotic leakage occurred less often after gastric pull‐up reconstruction as compared with the use of myocutaneous flap, but was associated with more serious outcome after pharyngogastric anastomosis. Thirty‐seven patients (34%) had neck node recurrences and these were significantly related to the preoperative nodal staging (NO, 20%; N1 37%; N2, 48%; and N3, 83%). Additional primary cancers occurred in 17% of the patients and was a significant cause of death in those patients who survived more than 2 years.
Sedimentation rate and serum thymidine kinase activity: Prognostic factors in squamous cell head and neck cancer
Authors: Fontana Xavier , Dassonville Olivier , Néri Joël , Vallicioni Jacques , Santini José , Milano GéRard , Combon Pierre , Lapalus Françoise , Demard François
Published: February 2007

Identification of prognostic factors in squamous cell head and neck cancers involves analysis of highly diverse clinical and biological parameters. This study analyzed the prognostic value of clinical variables (age, sex, tumor site, stage) and biologic parameters (squamous cell carcinoma antigen [SCC], serum thymidine kinase activity [TK], fibrin, sedimentation rate [SR]) at the time of diagnosis of squamous cell carcinoma of the head and neck (oral cavity, oropharynx, hypopharynx) in 189 patients. Among the clinical variables investigated, UICC stage III–IV disease (p < .0002), a hypopharyngeal site (p < .02), and age over 60 years (p < .01) were all associated with a poor prognosis. Similarly, analysis of biological blood variables allowed definition of cut‐off values above which the prognosis was poor: SCC 2.5 ng/mL (p < .01), fibrin 3.5 g/L (p < .01), TK 7 IU/L (p < .0005), and SR 15 mm per first hour (p < .0000). Cox regression analysis of overall survival identified the UICC stage (p < .000), the SR (p < .001), and serum TK (p < .02) as the main independent prognostic factors. A separate study on a small number of head and neck cancer patients revealed higher TK levels in malignant squamous cell carcinoma tissue than in adjacent healthy tissue.
Patterns of spread of squamous cell carcinoma to the ramus of the mandible
Authors: McGregor Alan D. , MacDonald D. G.
Published: February 2007

Patterns of spread of squamous cell carcinoma to the ramus of the mandible have been studied. In nonirradiated mandibles, tumor in the ramus was found to have spread in continuity from tumor within the body. In 22 of 27 specimens (81.5%) with established invasion of the molar region of the body, tumor spread was either confined to the body or to the body and the anterior part of the ramus. The remaining five cases showed extensive spread within the ramus. It was concluded that a more conservative approach to resection of the ramus may be safe on pathologic grounds in the nonirradiated mandible. In postirradiation mandibles, direct invasion through cortical bone was seen in addition to direct spread from the body. Tumor spread to the ramus was seen in nine of 12 specimens (75%), and in each case was both diffuse and extensive. It was concluded that a conservative approach to resection of the ramus is not safe on pathologic grounds after radiotherapy.
Intracranial pressure changes during bilateral radical neck dissections
Authors: Weiss Kevin L. , Wax Mark K. , Haydon Richard C. , Kaufman Howard H. , Hurst Michael K.
Published: February 2007

The management of the contralateral neck in patients with head and neck cancer who have undergone a radical neck dissection (RND) is controversial. A number of these patients will require a second RND. Sacrifice of both internal jugular veins (IJV) has been felt to lead to increased intracranial pressure (ICP) with subsequent neurologic sequelae.

From 1987 to 1991 four patients had staged bilateral RNDs at the West Virginia University. In these patients a subarachnoid bolt was placed to directly monitor ICP. Jugular bulb, mean arterial, pulmonary artery, and central venous pressures were monitored. Electroencephalographic (EEG) monitoring was also performed. All patients demonstrated elevations in ICP immediately on head rotation. Further marked elevations were noted immediately after IJV ligation with a maximum peak at 30 minutes. Pressure levels of greater than 40 mm Hg were observed in three of four patients. Systemic hypertension was observed in response to elevated ICP (Cushing's reflex). All patients studied recovered from surgery without significant sequelae. Within 24 hours the ICP had returned to normal in all patients. Three patients required intraoperative intervention to lower their ICP.

We demonstrate that even in a staged second RND there are significant rises in ICP. These are to a level that suggests emergency medical intervention is required. We feel that when the second IJV is sacrificed an increase in ICP should be anticipated, monitored, and treated accordingly.
Metastatic squamous cell carcinoma to cervical lymph nodes from unknown primary mucosal sites
Authors: Nguyen Cam , Shenouda George , Black Martin J. , Vuong Te , Donath David , Yassa Miriam
Published: February 2007

Between 1978 and 1991, 54 patients with metastatic squamous cell or undifferentiated carcinoma to the cervical lymph nodes, with unknown primary mucosal sites, were treated with curative intent at McGill University teaching hospitals. The median age at diagnosis was 58 years with a male:female ratio of 6:1. All patients presented with a painless neck mass. Five patients (9%) presented with N1 disease, 28 (52%) with N2a disease, four (7%) with N2b disease, three (6%) with N2c disease, and 14 (26%) with N3 disease. Twenty‐four patients (44%) underwent neck dissection, and 30 (56%) had only excisional lymph node biopsy. Fifty‐three patients (98%) were treated with radiotherapy to a median dose of 60 Gy (range 38 to 66 Gy) in 30 fractions. With a median follow‐up time of 49 months, the overall actuarial survival was 63% and 59% at 5 and 10 years, respectively. Three patients were found to have a subsequent primary head and neck tumor. The single most important prognostic factor was the N stage, which influences both neck control and long‐term survival. There was no statistically significance difference in survival or local neck control rates between patients who had neck dissection or excisional lymph node biopsy (p > 0.05). © 1994 John Wiley & Sons, Inc.
Mediastinal dissection and reconstruction for recurrent hürthle cell carcinoma of the thyroid
Authors: Sloan David A. , Vasconez Henry C. , Weeks Julia A.
Published: February 2007

A 69‐year‐old man presented with recurrent Hürthle cell carcinoma of the thyroid. Successful surgical resection of the recurrent tumor included the larynx and trachea; skin, soft tissues, and lymph nodes of the neck; and the tissues of the anterior mediastinum, including upper sternum and clavicular heads. Coverage of the wound was accomplished with an inferiorly based parasternal fasciocutaneous flap and a long pectoralis myocutaneous flap. This represents the first reported case of Hürthle cell carcinoma treated with mediastinal dissection for extensive local disease. Radical surgical resection should be considered for any patient with Hürthle cell carcinoma of the thyroid in view of the ineffectiveness of nonsurgical modalities. © 1994 John Wiley & Sons, Inc.
Oral tongue cancer in young adults less than 40 years of age: Rationale for aggressive therapy
Authors: Sarkaria Jann N. , Harari Paul M.
Published: February 2007

Squamous cell carcinoma (SCC) of the oral tongue in patients less than 40 years old is a rare but aggressive disease. Published reports suggest poor overall treatment results for young patients despite relatively early stage disease presentation. A 25‐year review of the English language literature (1968 to 1993) identifies 14 reports with 3 or more patients younger than 40 years of age with SCC of the oral tongue. Of 152 cases identified, 57% of patients developed locoregional failure and 47% of patients died secondary to their cancer. At the University of Wisconsin Hospital and Clinics, 6 patients under the age of 40 years have received treatment between 1971 and 1991 for SCC of the oral tongue. Despite presentation with relatively early stage disease, 5 of 6 patients have developed locoregional failure and 4 patients have died from their cancer. These results for the younger population reflect a higher locoregional failure and mortality rate than representative reports from the older population. An aggressive therapeutic approach to the young patient with SCC of the oral tongue appears warranted in an attempt to improve locoregional control and ultimate survival. © 1994 John Wiley & Sons, Inc.
Distribution of surviving tumor cells after chemoradiotherapy in tongue and floor of mouth carcinomas
Authors: Osaki Tokio , Hirota Jusui , Yoneda Kazunori , Yamamoto Tetsuya , Ueta Eisaku
Published: February 2007

Background. Conservative surgery according to the clinical response to induction therapy is applied in breast carcinomas but not yet in head and neck carcinomas. The possibility of conservative surgery after induction therapy for preservation of function was examined.

Methods. Forty‐three tongue and 15 floor of mouth carcinomas that had received induction therapy and tumor resection were submitted for a comparative investigation on the clinical effect of induction therapy and cancer cell degeneration, which was examined in semiserial specimens from the bread‐loaf sections of the excised materials, and a classification of the surviving tumor cell distribution in the tissue was proposed. The distribution was divided into four patterns according to the dispersion and volume of the remaining tumor cells (pattern I, no surviving tumor cells; pattern IIA, viable tumor cells in the central superficial region of the original tumor tissue; pattern IIB, viable cells in the superficial portion, but distributed widely; pattern III, massive tumor cell nests in the deep portion, but centrally localized; pattern IVA, sporadical viable cell islands, but not in the periphery; and pattern IVB, diffuse viable cells scattered throughout the original tumor tissue).

Results. The original tumor size did not affect the remaining viable tumor cell distribution pattern, but sporadic distribution patterns (patterns IVA and IVB) were observed in most of the T4 cases. In many cases, especially in tumors of the nondiffuse invasion type (invasion of grade 1 and 2), the tumor remission rate was inversely correlated with the dispersion of the viable tumor cells. However, some cases of grade 3 and 4 invasion exhibited sporadical surviving tumor cells even though a high tumor remission rate was obtained. These tumors, especially those located on the floor of the mouth, recurred with high frequency.

Conclusions. Conservative surgery can be applied to nondiffuse invasion cases, according to the tumor remission rate. In T3 and T4 cases exhibiting grade 3 or 4 invasion, conservative surgery is ill‐advised, even if more than 90% tumor remission is obtained. © 1994 John Wiley & Sons, Inc.
Factors influencing functional outcome in supraglottic laryngectomy
Authors: Beckhardt Russell N. , Murray James G. , Ford Charles N. , Grossman Jeffrey E. , Brandenburg James H.
Published: February 2007

Background. The relationship between preoperative pulmonary function tests (PFTs) and postoperative aspiration and deglutition complications in supraglottic laryngectomy (SL) has not been adequately analyzed. The effects of numerous other variables are either controversial or have not been studied.

Methods. A retrospective chart review was performed on 46 SL patients, analyzing preoperative PFTs and arterial blood gases, demographic factors, stage of disease, extended resections, cricopharyngeal myotomy, hyoid preservation, neck dissection, and postoperative radiotherapy with regards to aspiration and deglutition problems.

Results. Eighteen (39%) patients had no problems, 15 (33%) had moderate problems, and 13 (28%) had severe problems; of these, 39 (85%) were ultimately successful with no further swallowing dysfunction, whereas seven (15%) suffered intractable aspiration difficulties. Decreasing FEV1/ FVC was significantly correlated with a poorer outcome, as was a greater number of pack‐years of smoking. The effect of FEV1/FVC was shown to be independent from pack‐years, whereas the converse was not clearly demonstrated. Extensions of the standard procedure did not correlate significantly with increased problems.

Conclusions. An FEV1/FVC less than 50% signifies a greater risk for severe aspiration and deglutition complications, although it must be regarded as one factor among many in determining operability. With careful attention to reconstruction, extensions of the standard SL procedure can be safely performed. © 1994 John Wiley & Sons, Inc.
Periosteal fasciitis of the mandible
Authors: Mighell Alan J. , High Alec S. , Stassen Leo F. A.
Published: February 2007

Background. Periosteal fasciitis is rare in the head and neck. We believe only two cases of fasciitis‐induced erosion through the mandibular cortical plate have previously been reported.

Results. Management of a case of periosteal fasciitis with bone erosion at the mandibular angle is reported in a 38‐year‐old man.

Conclusions. Misdiagnosis of fasciitis in the past has led to inappropriate management and unnecessary morbidity. The principles of diagnosis and management of this unusual and confusing disorder are highlighted. © 1994 John Wiley & Sons, Inc.
Speech and swallowing function after oral and oropharyngeal resections: One‐year follow‐up
Authors: Pauloski Barbara Roa , Logemann Jerilyn A. , Rademaker Alfred W. , McConnel Fred M. S. , Stein David , Beery Quinter , Johnson Jonas , Heiser Mary Anne , Cardinale Salvatore , Shedd Donald , Graner Darlene , Cook Barbara , Milianti Frank , Collins Sharon , Baker Theresa
Published: February 2007

Background. The purpose of this study was to determine whether the speech and swallowing function of surgically treated oral cancer patients improves between 1 month and 1 year after surgery.

Methods. Speech and swallowing performances were assessed for 28 men and 10 women preoperatively and at 1, 3, 6, and 12 months postoperatively following a standardized protocol. Speech tasks included an audio recording of a brief conversation and of a standard articulation test; swallowing function was examined using videofluoroscopy. Data were also collected on the number and duration of speech/ swallowing therapy sessions, as well as the amount and duration of radiotherapy.

Results. Statistical analyses revealed that the speech and swallowing function of surgically treated oral and oropharyngeal cancer patients did not improve progressively between 1 and 12 months postsurgery; the level of functioning that these patients demonstrated at the 1‐ and 3‐month posthealing evaluations was characteristic of their status at 1 year after surgery.

Conclusion. The lack of improvement between 1 and 12 months postsurgery may be related to the relatively small amount of therapy that these patients received during that period. Several outcome variables worsened significantly at the 6‐month evaluation; the reversal of function at the 6‐month evaluation point could be the effect of postoperative radiotherapy, because irradiated and nonirradiated patients differed in their pattern of recovery on oropharyngeal swallow efficiency and several speech variables. © 1994 John Wiley & Sons, Inc.