bluuebunny/crossref_metadata_2025 huggingface dataset:
Allelotype of head and neck paragangliomas: Allelic imbalance is confined to the long arm of chromosome 11, the site of the predisposing locus PGL
Authors: Devilee Peter , Van Schothorst Evert M. , Bardoel Alfons F. J. , Bonsing Bert , Kulpers‐Dijkshoorn Nel , James Michael R. , Fleuren Gertjan , Van Mey Andel G. L. Der , Cornelisse Cees J.
Published: February 2007

Parangliomas of the head and neck region are usually slow growing, benign tumors. A considerable fraction has a positive family history, and the predisposing locus, PGL, has recently been assigned to 11q22‐q23. The inheritance pattern of the disease suggests that PGL undergoes maternal genomic imprinting. We have investigated 26 tumor samples from 22 patients with head and neck paragangliomas for the occurrence of loss of heterozygosity (LOH) on all non‐acrocentric autosome arms. LOH was found only on chromosome 11, with a marked clustering on the distal half of the q‐arm. However, in many cases the resulting allelic imbalance relative to normal DNA was weak, suggesting that only part of the tumor showed this abnormality. In all eight cases where we were able to determine the parental origin, the allele undergoing loss was maternally derived. Clonality analysis with a polymorphic marker for the X‐chromosome indicated that two of three informative female cases were polyclonal, although a number of tumors carry aneuploid stemlines in DNA flow cytometry. We conclude that either tumor heterogeneity or polyclonality may explain the partial allele loss events seen in certain cases.
Juxtaposition of N‐myc and Igk through a reciprocal t(6;12) translocation in a mouse plasmacytoma
Authors: Axelson Håkan , Wang Yisong , Silva Santiago , Mattei Marie‐Geneniève , Klein George
Published: February 2007

Nearly all mouse plasmacytomas (MPCs) carry an Ig/myc translocation. Any one of the three lg loci may participate, while the myc contribution has been limited to c‐myc, excluding other members of the myc gene family. The same is true for the other two known lg/myc translocation‐carrying tumors, Burkitt's lymphoma and rat immunocytoma. It is believed that the lg/myc juxtaposition plays a decisive, rate limiting role in the genesis of the three tumors, acting through the constitutive activation of myc that makes it refractory to normal regulation. Here we describe the molecular analysis of a unique t(6;12)(CI;B) translocation that we previously identified in an exceptional MPC that expressed N‐myc but not c‐myc. We now show that the translocation led to the juxtaposition of N‐myc and lgx. This is the first case of an lg/myc‐carrying tumor that involves N‐myc rather than c‐myc. These findings suggest that the translocation may already have occurred at the pro‐ or pre‐B cell stage at which N‐myc is open for transcription. According to this interpretation, constitutive activation of N‐myc would suppress the expression of c‐myc, but would not interfere with the differentiation of the pro‐B cell into a fully mature plasma cell. Its tumorigenic influence would become manifest only at the time when the cell would normally be programmed to leave the cycling compartment, in connection with its terminal differentiation.
Acute myelomonocytic leukemia with t(10;11)(p13;q23): Heterogeneity of breakpoints at 11q23 and association with recombinase activation
Authors: Height Susan E. , Dainton Melissa G. , Kearney Lyndal , Swansbury G. John , Matutes Estella , Dyer Martin J. S. , Treleaven Jennie G. , Powles Ray L. , Catovsky Daniel
Published: February 2007

The human trithorax homolog gene (MLL) is directly involved in over 90% of cases of acute leukemia with abnormalities of 11q23. However, involvement of other genes at 11q23 both centromeric and telomeric of MLL has been identified in different subtypes of leukemia and lymphoma. We describe a case of acute myelomonocytic leukemia (AMML; FAB type M4) with t(10;11)(p13;q23) in which the breakpoint at 11q23 was centromeric to the MLL gene and distinct from the breakpoint seen in promyelocytic leukemias with t(11;17)(q23;q22), thus providing further evidence of heterogeneity of breakpoints in 11q23 in acute leukemia. Rearrangements of immunoglobulin (IG) and T‐cell receptor (TCR) genes were also observed, with no immunophenotypic evidence for commitment to the lymphoid lineages, indicating that inappropriate activation of the recombinases may be a feature of this particular variant translocation.
Aneusomy of chromosomes 7 and 17 detected by fish in prostate cancer and the effects of selection in vitro
Authors: Jones Emma , Zhu Xiao Lin , Rohr L. Ralph , Stephenson Robert A. , Brothman Arthur R.
Published: February 2007

Twenty prostate tumor specimens, obtained from radical prostatectomies, and two lymph node metastases were examined by classical and molecular cytogenetic methods. A sample from each tumor was analyzed histologically and used for touch preparations. Adjacent samples were used for preparation of single‐cell suspensions before cell culture (DirFISH) and for establishing cell cultures, which were subsequently harvested for classical G‐banding analysis. Fluorescence in situ hybridization (FISH) was performed on touch preparations, DirFISH, and cells obtained from tissue culture. Biotinylated pericentromeric probes for chromosomes 7 and 17, in addition to a digoxigenin‐labeled X‐chromosome probe, were used in a dual‐color FISH assay. The results indicated that, in uncultured tumor cells, chromosome 17 was lost in 55% of specimens, chromosome 7 was gained in 16% of specimens, and 9% of specimens showed large tetraploid populations. After cell culture, 23% of specimens showed loss of chromosome 17, no specimens showed gain of chromosome 7, and no tetraploid populations were present. This study suggests that loss of chromosome 17 may play an important role in the development of prostate cancer, and that genetic changes observed after selection in vitro may not represent those in the original tumor.
Trisomy 2, trisomy 20, and del(17p) as sole chromosomal abnormalities in three cases of hepatoblastoma
Authors: Tonk Vijay S. , Wilson Kathleen S. , Timmons Charles F. , Schneider Nancy R.
Published: February 2007

Short‐term cultures of three hepatoblastomas were analyzed cytogenetically. Trisomy 2, trisomy 20, and a deletion of 17p were found as the sole abnormalities, yielding the karyotypes 47,XY, + 2; 47,XX, + 20; and 46,XX,del(17)(p12)/46,XX. This is the first reported case of deletion of 17p as the sole chromosomal abnormality in a hepatoblastoma and the first reported case of trisomy 20 without double minute chromosomes as a sole chromosomal abnormality in hepatoblastoma.
Nonrandom loss of human chromosome 3 fragments from mouse‐human microcell hybrids following progressive growth in SCID mice
Authors: Imreh Stephan , Kholodnyuk Irina , Allikmetts Rando , Stanbridge Eric J. , Zabarovsky Eugene R. , Klein George
Published: February 2007

Microcell hybrid lines of A9 mouse fibrosarcoma containing complete or partially deleted human chromosomes 3 (chr. 3) were inoculated into SCID mice. Cell lines derived from the tumors were examined by fluorescent in situ hybridization for the status of the transferred human chromosome and by PCR for marker loss. The SCID tumors arising after the inoculation of 105 cells were passaged serially in vivo and regularly showed loss of four markers; D3S1029 (3p21.3–21.2), AP20R (3p22–21.3.) D3S32 (3p21.3‐p21.2), and THRB (3p24). This regularly deleted region is bordered by markers GNA12 (3p21.1‐p21.3) and VHL (3p25) that were maintained in a fraction of tumors. Fragments derived from the long arm of chromosome 3 and corresponding markers in the 3q26‐q28 region were retained in all tumors. Our findings may be related to the postulated presence of tumor suppressor genes in the 3p24‐p21 region as indicated by the frequent deletion of this region in renal and small cell lung carcinomas and other solid tumors. The technically cumbersome identification of suppressor genes may be supplemented by an “elimination test” based on analogous principles.
Management of attentional resources in within‐modal and cross‐modal divided attention tasks: An fMRI study
Authors: Vohn Rene , Fimm Bruno , Weber Jochen , Schnitker Ralph , Thron Armin , Spijkers Will , Willmes Klaus , Sturm Walter
Published: February 2007

In the present study, we were interested in distinguishing the cortical representations of within‐modal and cross‐modal divided attention tasks by using functional magnetic resonance imaging. Sixteen healthy male subjects aged between 21 and 30 years underwent two within‐modal (auditory/auditory, visual/visual) and one cross‐modal (auditory/visual) divided attention task, as well as related selective attention control conditions. After subtraction of the corresponding control task the three divided attention tasks, irrespective of sensory modality, revealed significant activation in a predominantly right hemisphere network involving the prefrontal cortex, the inferior parietal cortex, and the claustrum. Under the cross‐modal condition, however, the frontal and parietal activation was more extended and more bilateral and there also was stronger right hemisphere activation of the anterior cingulate cortex and the thalamus. In comparison to the within‐modal conditions additional bilateral frontal and left inferior parietal activation was found for the cross‐modal condition. The supplementary fronto‐parietal, anterior cingulate cortex, and thalamus activation in the auditory/visual condition could be argued to reflect an additional demand for coordination of two ongoing cross‐modal cognitive processes. Hum Brain Mapp, 2007. © 2007 Wiley‐Liss, Inc.
Early experience with a hybrid accelerated radiotherapy schedule for locally advanced head and neck cancer
Authors: Nuyts Sandra , Dirix Piet , Hermans Robert , Poorten Vincent Vander , Delaere Pierre , Weltens Caroline , Van den Bogaert Walter
Published: February 2007

Background.

Our aim was to determine feasibility and efficacy of a hybrid radiotherapy schedule in locally advanced head and neck cancer.

Methods.

Seventy‐three patients with locally advanced head and neck cancer were irradiated according to a hybrid accelerated schedule consisting of 20 fractions of 2 Gy (once daily), followed by 20 fractions of 1.6 Gy (twice daily), to a total dose of 72 Gy.

Results.

Locoregional control was 55% after 2 years. Overall survival was 59%, disease‐specific survival was 63%, and disease‐free survival was 46%. Acute toxicity was prospectively scored in all 73 patients: the most frequent toxicities were mucositis (50.7%, grade 3), dysphagia (47.9%, grade 3), and dermatitis (34.5%, grade 3). All patients were treated to full dose, without treatment interruption.

Conclusion.

With this regimen, acceptable locoregional control and survival rates are achieved. Toxicity was well manageable, suggesting that a combination of this schedule with concomitant chemotherapy is possible and could lead to further improvement in the treatment of locally advanced head and neck cancer. © 2007 Wiley Periodicals, Inc. Head Neck, 2007
Bilobed fibula flap for reconstruction of through‐and‐through oromandibular defects
Authors: Said Meena , Heffelfinger Ryan , Sercarz Joel A. , Abemayor Elliot , Head Christian , Blackwell Keith E.
Published: February 2007

Background.

The role of fibula free flaps for reconstruction of through‐and‐through oromandibular defects is examined.

Methods.

Thirty‐four patients underwent reconstruction of through‐and‐through oromandibular defects using fibula free flaps that contain large, bilobed skin paddles for simultaneous reconstruction of intraoral mucosa and external skin. We examined the incidence of wound healing complications, the need for revision reconstructive surgery, and factors affecting the incidence of complications.

Results.

Wound healing complications occurred in 50% of patients. There was a relatively high incidence of partial flap necrosis (26%) and revision surgery (41%). The area of the flap skin paddle was significantly associated with the risk of partial flap necrosis and the need for revision surgery.

Conclusions.

Many through‐and‐through oromandibular defects can be successfully reconstructed using a fibula free flap that contains a large, bilobed skin paddle. However, wound healing complications are increased when the flap skin paddle area exceeds 300 cm2. © 2007 Wiley Periodicals, Inc. Head Neck, 2007.
Ethical dilemmas in head and neck cancer
Authors: Frank Hugh A. , Davidson Terence M.
Published: February 2007

Ethical dilemmas in head and neck cancer daily confront physicians, patients, families, and society at large. For every situation there are potential benefits and real burdens, as well as risks. There are no “right” answers for any given situation, but there are processes for assisting the primary decision makers involved in reaching meaningful and appropriate decisions. This paper asks some pertinent ethical questions and suggests some ways of responding to the issues.
Effect of prior radiotherapy on postsurgical wound infection
Authors: Johnson Jonas T. , Bloomer William D.
Published: February 2007

Radiotherapy causes both epithelial and endothelial damage acutely with the subsequent development of interstitial and perivascular fibrosis. These effects may lead to decreased blood flow, delayed wound healing, and a delay in achieving normal wound tensile strength. In a retrospective study of wound infections that developed in 23 of 354 patients (6%) accrued in a series of prospective, randomized antibiotic trials, the incidence of wound infection in patients receiving prior radiotherapy (7.6%) was not statistically different from the incidence of wound infection observed in patients who had had no prior radiotherapy (6.3%). Wound infection that developed in patients after radiotherapy tended to be associated with increased hospitalization, an increased rate of fistulization, and more frequently required secondary surgical repair. It is concluded that major head and neck procedures can be accomplished without an absolute increase in the incidence of wound infection. However, when postoperative complications occur, it may result in a significant increase in morbidity.
Lateral arm free flap in oral cavity reconstruction: A functional evaluation
Authors: Matloub Hani S. , Larson David L. , Kuhn Joan C. , Yousif N. John , Sanger James R.
Published: February 2007

By use of sophisticated techniques now available from the science of Speech Pathology, we can now document, quantify, and critically analyze the surgeon's reconstructive efforts in the oral cavity. Using these methods, we have evaluated the neurotized lateral arm free flap in six patients receiving oral reconstruction. Two of these are reported in detail. This study has provided a protocol that results in the objective analysis of swallowing, articulation, and range of tongue motion and sensation. All of these tests can be routinely performed by a speech pathologist to document both operative performance as well as patient progress in speech and swallowing. It would appear that we have quantified evidence that the neurotized lateral arm free flap may represent a significant step forward in reducing the morbidity of total and subtotal glossectomy by providing a truly functional reconstruction.
Hereditary carcinoma syndromes associated with benign head and neck tumors
Authors: Smith Dale B. , Arnold James E. , Fox Barbara , Blakeslee Don B.
Published: February 2007

Hereditary forms of carcinoma may be associated with benign head and neck tumors. Many of these hereditary carcinoma syndromes present first to the otolaryngologist. Two unusual cases of Gardner's and Muir‐Torre's syndromes illustrate the hereditary carcinoma syndromes associated with head and neck lesions. We describe the use of new genetic markers and propose a diagnostic algorithm.
Carcinoma of the lip in Auckland, New Zealand, 1969‐1987
Authors: Grover Rosalind , Douglas Richard G. , Shaw James H. F.
Published: February 2007

We have retrospectively reviewed the case notes of 180 pa tients with carcinoma of the lip seen in Auckland between 1969 and 1987. The greater Auckland region is a geographically unique area as it comprises a modest European population (800,000 people) coupled with the largest Maori and Pacific Is lander populations in the world (each of approximately 70,000 people). There were 158 patients with T1 lesions, 20 with T2 lesions, and 1 with T3 disease. Only one patient had nodal me tastases at presentation. Management was primarily surgical in 138 patients, primarily radiotherapy in 25, and 14 patients re ceived adjuvant radiotherapy after surgical excision. Primary surgical excision was associated with a 20% treatment failure rate (local recurrence and/or development of nodal metastases). Radiotherapy alone as primary therapy was followed by an 80% recurrence rate. When adjuvant radiotherapy was used after ex cision the failure rate was 21%. In those patients treated with local excision, the major factor predisposing to disease recur rence was the presence of a positive margin, and recurrence in cervical lymph nodes markedly worsened the prognosis. Over all, 83% of patients were alive and well at the time of the review, 7% were either dead of disease or alive with recurrent disease, and 10% were dead of other causes. We conclude from our data that good results can be achieved after surgery for lip can cer, providing negative margins are obtained, and that positive margins require early re‐excision. Regional nodal disease infre quently follows complete excision of the primary lesion, but when it occurs it has an ominous significance.
Botryomycosis of the oral cavity
Authors: Maves Michael D. , Aguiar Susan W. , Massanari R. Michael , Robinson Robert A.
Published: February 2007

Botryomycosis is a bacterial infection characterized histologically by granules containing bacteria. Usually there is surrounding granulomatous inflammation with occasional extension into muscle or bone. While there are several hypotheses regarding the pathogenesis of botryomycosis, the exact mechanism is unclear. Botryomycosis has been associated with a variety of aerobic and anaerobic bacteria, usually endogenous flora and low virulence organisms. Oral lesions appear to be uncommon despite continuous exposure to endogenous oral flora. Treatment should include surgical excision and antibiotic therapy.
Reversible visual loss due to impacted lateral orbital wall fractures
Authors: Funk Gerry F. , Stanley Robert B. , Becker Terry S.
Published: February 2007

Impaction of the sharp medial edge of the orbital plate of the greater sphenoid wing into the orbital apex is a unique type of lateral orbital wall fracture that can produce a potentially reversible optic neuropathy. Two patients in whom the lateral or temporal approach to the orbit was used to reduce this type of fracture will be presented. In both patients, improvement in vision appeared to be related to removal of a bone fragment compressing the optic nerve in the orbital apex.
Squamous cell carcinoma masquerading as focal myositis of the tongue
Authors: McLendon Christopher L. , Levine Paul A. , Mills Stacey E. , Black William C.
Published: February 2007

The diagnosis of squamous cell carcinoma of the head and neck is not usually a problem for the otolaryngologist/head and neck surgeon. However, we describe a patient whose ultimate diagnosis of squamous cell carcinoma required 16 months and eluded several clinicians, despite an aggressive diagnostic regimen. The diagnostic difficulty was due to the fact that the small, centrally located tumor was surrounded by an intense inflammatory reaction that histologically mimicked a recently described rare entity of the head and neck, focal myositis. Our purpose is to make the otolaryngologist/head and neck surgeon aware of this previously unreported presentation of squamous cell carcinoma of the tongue; to review the pertinent findings associated with focal myositis; and to reinforce the need to maintain a constant vigil for the diagnosis of cancer, in spite of negative pathologic confirmation, when dictated by the clinical situation.
Palliative surgery in patients with bulbar amyotrophic lateral sclerosis
Authors: Short Steven O. , Hillel Allen D.
Published: February 2007

Patients with amyotrophic lateral sclerosis (ALS), a progressive neurodegenerative disorder, commonly develop bulbar symptoms including dysphagia, dysarthria, and defective airway protection. Otolaryngologists/head and neck surgeons are frequently asked to assist in the management of these problems. We reviewed our experience of 13 surgical procedures in 7 patients with advanced bulbar ALS. In spite of technically good surgery, 3 patients died within 1 week of hospitalization. Four patients appeared to benefit from the surgery. Patients with bulbar ALS are a high risk group because of chronic malnutrition and dehydration, covert aspiration and pneumonitis, and diminished ventilation. A team approach to these problems is stressed. Perioperative morbidity can be reduced with careful preoperative preparation and patient selection.
Lateral neck mass as the initial manifestation of thyroid carcinoma
Authors: Park Cheong Soo , Min Jin Sik
Published: February 2007

Of 238 thyroid cancer patients, 24 exhibited a lateral neck mass as the initial presentation. Twenty four (77.4%) of 31 metastatic masses were located at the midjugular and lower jugular lymph chains. The average number of histologically proven metastatic nodes was 6.5. Histologically, 22 cases were diagnosed as papillary carcinoma, 1 as follicular carcinoma, and the remaining case as medullary carcinoma. Fifteen thyroid glands were found to have a single primary focus, while 9 others had multiple foci. The mean diameter of the primary foci was 1.2 cm. The rates of detection of primary foci by thyroid scan and ultrasonography were 60% and 37.5%, respectively. Surgical procedures for the thyroid lesions included total or near‐total thyroidectomy in 18 cases and lobectomy in 6 cases; for metastatic neck nodes, 13 were treated by modified neck dissection, 5 by standard radical neck dissection, and six by partial neck dissection. All 24 patients were followed for a mean duration of 4.5 years with a range of 2.0 to 7.5 years, and all except 1 are still living. In the presence of a lateral neck mass as the initial manifestation of thyroid carcinoma, no matter what size the primary tumor foci, a total or near‐total thyroidectomy appears to be justified in addition to an appropriate neck dissection.
Risk factors for simultaneous carcinoma of the head and neck
Authors: Hsairi Mohamed , Luce Danièle , Point Daniel , Rodriguez Joseph , Brugère Jacques , Leclerc Annette
Published: February 2007

The upper aerodigestive tract is a preferential site for multiple primary cancer. The purpose of this study was to determine the characteristics of patients presenting with at least two simultaneous cancers of the upper aerodigestive tract compared with patients with a single location. Men patients (2,738) with squamous cell carcinoma were enrolled in the study. Of these, 120 (4.4%) presented with at least 2 simultaneous cancers (cancers detected within a 6‐month period). The group of patients with simultaneous cancers was compared with a group presenting with a single location. Two factors (the mean daily alcohol consumption and employment as a “blue‐collar” worker at any time during the working life) seem to be related to the occurrence of simultaneous cancers.
Radiologic assessment of tumor and the carotid artery: Correlation of magnetic resonance imaging, ultrasound, and computed tomography with surgical findings
Authors: Langman Alan W. , Kaplan Michael J. , Dillon William P. , Gooding Gretchen A. W.
Published: February 2007

Carotid artery fixation is an extremely poor prognostic sign in squamous cell carcinoma of the head and neck. Methods more precise than physical exam are necessary to determine whether a neck dissection is sufficient, to exclude patients from surgery, or to plan a carotid artery resection. Thirty‐three patients with a suspicion of carotid wall attachment by physical examination or computed tomography (CT) were further evaluated by magnetic resonance imaging (MRI) and ultrasound (US). The criterion for possible carotid involvement on CT was effacement of greater than 25% of the circumference of the artery. On MRI, the criterion that we proposed was any loss of the fascial plane around the internal or common carotid artery. This was considered effacement of the carotid artery wall. For US, the criterion we used was the loss of the echogeneity along the carotid wall. Histopathological correlation was available in 23 patients (24 necks) who either underwent surgery or necropsy (1 patient); 11 patients were felt not to be surgical candidates or declined surgery, though 1 of these 11 patients did undergo surgical resection after radiotherapy. MRI accurately predicted an uninvolved carotid artery in 13 of 15 cases; US accurately predicted an uninvolved carotid artery in 15 of 20 cases. Demonstration by either MRI or US that the carotid artery is free of tumor had a high degree of reliability. Both US and MRI appear superior to CT and physical examination in assessing the carotid wall in suspicious cases. Individually and in combination, MRI and US offer advantages in selecting patients for possible surgery when the issue of carotid artery fixation is raised.
Dermatofibrosarcoma protuberans with regional lymph node metastasis: A case report
Authors: Hirabayashi Shinichi , Kajikawa Akiyoshi , Kanazawa Kyotaro , Mimoto Koichiro
Published: February 2007

The case of a 21 ‐year‐old man with dermatofibrosarcoma protuberans of the scalp that spread to deep cervical lymph nodes is presented. Available literature is reviewed, and the infrequency of metastasis is discussed. Since cases of metastases almost always involve recurrent lesions, the importance of wide and deep resection in the initial operation cannot be overemphasized.
Chemoprevention of upper aerodigestive tract cancers: A report of the third upper aerodigestive cancer task force workshop
Authors: Lippman Scott M. , Lee Jin S. , Lotan Reuben , Hong Waun K.
Published: February 2007

The National Cancer Institute Organ Systems Program‐sponsored Upper Aerodigestive Cancer Task Force workshops are specifically designed to enhance interactions between basic science and clinical investigators and between academic institutions and the community, and ultimately will contribute to more expeditious clinical advances. The third workshop in this series focused on the rapidly expanding area of chemoprevention of upper aerodigestive epithelial cancers. The first two sessions were devoted to discussion of in vitro and animal‐model data documenting the multistep process of squamous differentiation and carcinogenesis, associated molecular and biochemical alterations, and modulation by chemopreventive agents. Animal‐model studies have identified several promising chernopreventive agents and synergistic combinations for clinical trial. The last two sessions reviewed nutritional epidemiology, major methodologic issues of large intervention studies, and the novel concept of biologic markers as intermediate endpoints for chemoprevention trials.
Analysis of prognostic factors and proposal of a new classification for nasopharyngeal cancer
Authors: Grandi Cesare , Boracchi Patrizia , Mezzanotte Guerrino , Squadrelli Massimo , Marubini Ettore , Molinari Roberto
Published: February 2007

A retrospective analysis was performed on 410 patients with nasopharyngeal carcinoma of squamous or undifferentiated histotype. All patients were classified according to the classification of the American Joint Committee for Cancer Staging and End‐Results Reporting (AJC) and to that of the International Union Against Cancer (UICC, Geneva, 1978). The following prognostic factors were investigated by means of a Weibull multiple regression model: sex, age, histology, primary tumor extent, and nodal metastasis extent. With the exception of sex, all factors significantly influenced survival. With regards to nodal extent, only the level of the involved nodes was a significant variable. Both AJC and UICC classifications, when applied to the entire series of patients, appeared to be unsatisfactory. The authors propose an alternative classification based on a prognostic scoring system directly derived from the Weibull model.
Toxic shock syndrome following submandibular gland excision
Authors: Fornadley John A. , Gomez Patrick J. , Crane Richard T. , Rickman Leland S.
Published: February 2007

Acute toxic shock syndrome (TSS), initially described in association with the use of super absorbent tampons in menstruating women, has complicated a variety of surgical procedures. Recent attention in head and neck surgery has focused on absorbent packing materials, such as those used in postoperative nasal care. It is important to maintain a high index of suspicion in all postoperative patients to fever, hypotension, and erythroderma. We report TSS following submandibular gland excision.
A modified single flap for neck dissection in oral cancer
Authors: Dissanayaka Lakdasa
Published: February 2007

Modification of the single flap for neck dissection is described and illustrated based on experience with 33 cases of squamous cell carcinoma of the oral cavity. The advantages of this modified incision are that there are no three‐point junctions. Hence, it can be used after previous radiotherapy to the neck; the vertical limb is well posterior to the carotid artery, and the horizontal limb can be conveniently extended upward and forward to permit a combined resection of the jaw and/or tongue. To avoid necrosis at the apex of the skin flap, particularly after previous radiotherapy, a margin of about 1 cm can be removed prophylactically from the apex. This incision is recommended particularly for neck dissections in squamous cell carcinomas of the oral cavity in patients who have had previous radiotherapy and/or when resection of the mandible or the tongue is to be done at the same time. The incision is not recommended for bilateral neck dissections, nor for neck dissection combined with total laryngectomy or thyroidectomy.
Thyroid carcinoma presenting as a regional neck mass
Authors: Nussbaum Moses , Bukachevsky Roman
Published: February 2007

During 1978‐1988, we treated 197 patients with thyroid carcinoma. Twenty‐seven patients (14.0%) presented with a regional cervical mass and a clinically normal thyroid gland on initial evaluation. Excisional biopsy proved the diagnosis of metastatic thyroid carcinoma in every patient. Subsequent thyroid scans were 42% sensitive. Only 3 patients underwent fine‐needle aspirations; none showed evidence of malignant cells. Review of surgical specimens showed total involvement of the gland in 13 of 17 cases, with extracapsular spread of tumor in 3 patients. Multicentric disease was present in all but 2 neck specimens. Patient follow‐up from 1 month to 10 years revealed an 11.5% recurrence rate. The results in this group of patients is compared to the larger group of thyroid carcinoma patients, where three recurrences were found in 170 patients presensting with a clinically palpable mass in the thyroid gland. Analysis of our population comparing the subgroup with the larger series of thyroid carcinoma patients suggests that thyroid carcinoma presenting as a regional neck mass is a more aggressive disease.
Intramuscular hemangioma of the sternomastoid muscle
Authors: Jani Piyush , Robb P. , Hanby A. M. , Gleeson M. J.
Published: February 2007

Intramuscular hemangiomas of head and neck are uncommon benign tumors. They arise most frequently in the masseter muscle and may present a diagnostic problem. The clinical presentation is usually that of a slowly enlarging intramuscular mass. The recurrence rate is high following enucleation. A case of a rapidly evolving sternomastoid hemangioma is described which presented in unusual circumstances. The angiographic appearances of this tumor were diagnostic, and the lesion was subsequently resected completely together with a cuff or normal muscle.
Metastatic squamous cell carcinoma of the parotid: A case of an occult primary
Authors: Marvel Jeffrey B. , Schwartz Mary R. , Donovan Donald T.
Published: February 2007

Metastatic squamous cell carcinoma involving an intraparotid lymph node, although uncommon, remains of practical consideration in the differential diagnosis of a parotid mass. This is of particular importance when the primary skin lesion is not readily identifiable, or has been inadequately managed in the past. A representative case is presented, and a review of the literature follows with special emphasis on the anatomy of the parotid lymphatics and the implications for appropriate treatment.
Multiple trichoepithelioma occluding both external auditory canals
Authors: Bibi Carmel O. , Fliss Dan M. , Avinoach Ilana , Brenner Hillel , Tovi Ferrit
Published: February 2007

Multiple trichoepithelioma is an uncommon skin disease with autosomal dominant transmission. It is characterized by multiple, benign facial skin lesions. These lesions constitute a formidable cosmetic and therapeutic problem. Treatment modalities are numerous and varied. In a few rare cases, confluence of the lesions may result in occlusion of the auditory canal, with consequent loss of hearing. In such cases the treatment of choice should be excision and split‐thickness skin grafting.
Quantitative bacteriology of intraoperative wound tissue in contaminated surgery
Authors: Becker Gary D. , Welch William D.
Published: February 2007

This study was designed to evaluate the predictive value of quantitative bacteriology of intraoperative wound tissue in identifying the patient likely to develop wound infection, as well as its subsequent flora. Forty‐one patients undergoing contaminated cancer surgery of the head and neck were studied. Intraoperatively, a sample of wound tissue was cultured and anaerobic and aerobic bacterial isolates quantitated. The wound infection rate was 22% (9 of 41). There was no significant correlation between intraoperative tissue bacterial density and subsequent wound infection, or contaminating and infecting bacteria.
The accuracy and usefulness of frozen‐section diagnosis
Authors: Ikemura Kunio , Ohya Ryoichi
Published: February 2007

A retrospective review of 57 patients, who had received frozensection diagnoses, was performed both to ascertain the accuracy of diagnosis and to evaluate its usefulness in assessing tumor surgery. Except for 2 cases, each with a parotid gland tumor, the frozen‐section diagnoses were consistent with the final diagnoses using permanent paraffin sections. Fifteen cases with either T1 or T2 squamous cell carcinoma of the oral cavity and 2 cases with malignant salivary gland tumor, showing tumor‐free surgical margins by frozen‐section examination, were followed. A local recurrence of the carcinoma was observed in 1 case during the follow‐up period. Prior to neck dissection, lymph node metastases were examined using frozen sections. Ten cases, which were diagnosed as negative for metastasis, showed no subsequent development of cervical node metastasis.
Radiation or surgery for chemodectoma of the temporal bone: A review of local control and complications
Authors: Springate Stephen C. , Weichselbaum Ralph R.
Published: February 2007

For a presentation to the American College of Surgeons in November 1988, we reviewed the literature concerning primary management of glomus tympanicum and jugulare tumors. From the published series, we examined the local control and treatment‐related morbidity for three therapeutic approaches: surgery alone, radiation before or after surgery, and radiation alone. The local control rates were similar, 86%, 90%, and 93%, respectively. Among the surgical series reporting complications, new cranial nerve deficits were common, especially with advanced lesions. Serious sequelae from radiation therapy were rare (2% to 3%). We feel radiation therapy should be considered as primary treatment for glomus jugulare.
Reconstruction of complex maxillectomy defects with the scapular‐free flap
Authors: Granick Mark S. , Ramasastry Sai S. , Newton E. Douglas , Solomon Mark P. , Hanna Dwight C. , Kaltman Steven
Published: February 2007

The defect resulting from partial or complete maxillectomy can often be reconstructed with a skin graft and a prosthesis. In situations where this simple maneuver is unsatisfactory, a more complex reconstructive modality, providing the restoration of composite tissue, is required. The scapular microvascular‐free flap was used in this series of 11 patients, as a cutaneous flap in 3 and as an osteocutaneous flap in 8, to meet the specific reconstructive needs of each patient. Excellent to satisfactory restoration of facial contour and palatal function was achieved in 10 patients. There was 1 flap failure. There were no donor site complications. Selected case histories are presented to demonstrate a spectrum of reconstructive problems. There are clear limitations to its applicability, such as the odd scapular bone contour, the thickness of the cutaneous paddle, the position change required for flap harvesting, and the risk of flap failure. The scapular flap has proven to be useful in restoring bony and soft tissue contour of the face, rigid support for the velum, oronasal separation, support for the orbit, and obliteration of the maxillary sinus. We found the scapular‐free flap to be a useful tool for reconstructing complex and variable maxillectomy defects.
Botulinum a toxin for the treatment of spasmodic torticollis: Dysphagia and regional toxin spread
Authors: Borodic Gary E. , Joseph Michael , Fay Laurie , Cozzolino David , Ferrante Robert J.
Published: February 2007

Chemodenervation of cervical muscles with botulinum A toxin, although useful in treating spasmodic torticollis, has been associated with dysphagia. Retrospective analysis of dose and injection site (sternomastoid vs. posterior cervical muscle groups) in 26 patients (49 injections) suggested that dysphagia was related to the quantity of toxin injected into the sternomastoid muscle: dysphagia, median 150 IU (7 injections); and no dysphagia, median 100 IU (42 injections; p = 0.026 Wilcoxon test). In a prospective study (31 injections to 24 patients), limiting the dose administered to the sternomastoid to 100 IU, substantially reduced the incidence of dysphagia (0 of 31, p = 0.27, Fisher's exact test).

Denervation of human orbicularis muscle fibers, 5 weeks to 4 months after injection of botulinum A toxin for the treatment of blepharospasm, was successfully demonstrated by intense, diffuse acetycholinesterase staining. A weight‐adjusted dose similar to that given for torticollis was injected into longissimus dorsi muscle in 6 albino rabbits. Using the acetylcholinesterase stain as a marker, a diffusion gradient was noted over a distance of 30 to 45 mm from the point of injection and in contralateral muscle 15 to 25 mm from this point. Thus, denervation was demonstrated to occur within a definable area which crossed anatomic barriers, such as fascia and bone. These clinical and laboratory data suggest that dysphagia following botulinum toxin therapy results from toxin spread to pharyngeal musculature from the sternocleidomastoid injection site. Limiting of the injection dose to 100 IU or less to the sternomastoid substantially decreases the incidence of this complication.
Basement membrane type IV collagen in oral squamous cell carcinoma
Authors: Hirota Jyusui , Yoneda Kazunori , Osaki Tokio
Published: February 2007

Biopsied specimens of 82 oral squamous cell carcinomas were immunohistochemically studied for detection of type IV collagen existence in the basement membrane (BM). Immunoreactivity on BM was semiquantitatively evaluated as limited (±), moderate (+), or extensive (++), and matched against clinical and histopathologic features. No clear difference in BM deposition could be found in the tumor sites. The amount of type IV collagen decreased in advanced T stage (T3 and T4) tumors. BM deposition was significantly correlated with lymph node metastasis. In 54 N‐, 32 had extensive deposition, 18 had moderate, and the remaining had limited. Conversely, only 5 of 28 N+ cases showed good type IV collagen immunoreactivity and 14 cases exhibited limited BM deposition. BM existence was also associated with the mode of invasion. BM deposition decreased in order with the grade (i.e., the more limited the BM deposition, the more diffuse the invasion mode). BM deposition was, however, not related with stromal responses, such as cellular infiltrates and fibrosis. We conclude that immunohistochemical examinations of BM deposition on biopsied specimens seem beneficial for cancer treatment.
Histologic differentiation and chemosensitivity of human head and neck squamous cell carcinomas
Authors: Nakashima Tadashi , Maehara Yoshihiko , Kohnoe Shunji , Hayashi Itsuroh , Katsuta Yasaburoh
Published: February 2007

The chemosensitivities of 42 human head and neck squamous cell carcinomas were examined using the in vitro succinate dehydrogenase inhibition (SDI) test. The tumor tissues obtained at surgery or biopsy were exposed to five different antitumor drugs: adriamycin (ADM), cisplatin (CDDP), carboquone (CQ), 5‐fluorouracil (5‐FU), and 1‐hexylcarbamoyl‐5‐fluorouracil (HCFU). The results were analyzed according to the histopathologic degree of differentiation of well, moderately, and poorly differentiated squamous cell carcinoma. The average decrease in succinate dehydrogenase activity was 43.2 /pm 24.9 for ADM, 29.0 /pm 14.2 for CDDP, 32.9 /pm 17.6 for CQ, 64.2 /pm 20.6 for 5‐FU, and 26.8 /pm 16.9 for HCFU. There was a statistically significant difference in the decrease of succinate dehydrogenase activity between well and poorly differentiated squamous cell carcinomas. These data suggest that, for patients with a poorly differentiated squamous cell carcinoma, the response to anticancer drugs may be more satisfactory than in those with a welldifferentiated squamous cell carcinoma.
Accessory parotid glands as a site of metastases from outside the head and neck: Case report
Authors: Goldberg Jay A. , Georgiade Gregory S.
Published: February 2007

Metastases to the salivary glands from outside the head and neck are rare. The world literature reports 53 cases to the parotid, and 25 to the submandibular‐submaxillary gland. This is the first report of a metastasis to the accessory parotid gland.
Sternocleidomastoid flap following parotidectomy
Authors: Bugis Samuel P. , Young J. E. M. , Archibald Stuart D.
Published: February 2007

The sternocleidomastoid (SCM) muscle has been used in various ways for reconstruction following cancer resections in the head and neck. Its use has been restricted because of the presumed precarious nature of its blood supply and its proximity to disease. Patients with large or recurrent benign parotid tumors were the first in our series to have a SCM muscle flap (either superiorly or inferiorly based) used to improve cosmesis. After demonstrating the utility of these flaps, we extended the indications for their use to include patients with primary or recurrent malignant disease. The flaps provide soft tissue contour, coverage of facial nerves and nerve grafts, act as a healthy bed for skin grafts, and help close salivary fistulas. There were no complications attributed to the flaps. This paper discusses 31 patients with benign and malignant parotid disease in whom the SCM flap was used.
Cancer in neck nodes with unknown primary site: Role of mucosal radiotherapy
Authors: Harper Christopher S. , Mendenhall William M. , Parsons James T. , Stringer Scott P. , Cassisi Nicholas J. , Million Rodney R.
Published: February 2007

Sixty‐nine patients with metastatic squamous cell carcinoma in neck nodes with an unknown primary lesion were treated with curative intent between October 1964 and December 1986. Sixty‐five patients received radiotherapy to the neck and at least part of the mucosa of the head and neck, whereas 4 patients received treatment to the neck only. Mucosal doses were approximately 5,000 cGy‐6,000 cGy at 170 cGy‐180 cGy per fraction. Eight patients (12%) subsequently developed mucosal site failures, a figure that did not differ significantly from the incidence of a second metachronous head and neck cancer following definitive irradiation in a series of 393 patients with lesions of the supraglottic larynx, pharyngeal wall, pyriform sinus, or tonsillar area. This suggests that radiotherapy was highly effective in preventing the appearance of cancer at the unknown primary site from which the neck metastasis arose. Absolute and cause‐specific 5‐year survival rates were 48% and 66%, respectively.
Outcome of treatment of 160 patients with squamous cell carcinoma of the neck staged N3a
Authors: Isaacs John H. , Schnitman J. R.
Published: February 2007

One hundred sixty patients with N3a neck disease were studied to evaluate the overall treatment outcome. Of these, 54 recieved palliative radiotherapy and 106 patients were treated with treated with curative intent. Twenty patients (19%) died of inter‐current disease (13 at less than 2 years), and 13 of 93 patients followed for 2 or more years are alive with no evidence of disease. Thus, 73 patients died directly from cancer, with meta‐static disease being the leading cause of death. Almost one third of the patients failed to complete treatment.
Mandibular chloroma demonstrated by magnetic resonance imaging
Authors: Cho June‐Sik , Kim E. Edmund , Ro Jae H. , Pinkel Donald P. , Goepfert Helmuth
Published: February 2007

A case of chloroma or granulocytic sarcoma in the mandible of a young child is presented with magnetic resonance imaging (MRI) features.
Mandibular involvement by squamous cell carcinoma of the lower alveolus: Analysis and comparative study of histologic and radiologic features
Authors: Totsuka Yasunori , Usui Yasuhiro , Tei Kanchu , Fukuda Hiroshi , Shindo Masanobu , Lizuka Tadashi , Amemiya Akira
Published: February 2007

Histologic analysis of squamous cell carcinoma of the lower alveolus shows 2 basic patterns of tumor spread in relation to the mandible: an infiltrative one and an expansive one. While the tumor invades the mandible by destroying the bone or through cortical defects or some spaces in the infiltrative form, the tumor does this only by eroding the bone in the expansive form, in which the degree of bone resorption seems to be proportional to tumor advancement. A comparison between radiologic and histologic features discloses that the radiologically detected bone defects are not necessarily correlated with the patterns of bone involvement. However, most lesions with erosive bone defects show the expansive pattern histologically, and the extent of the radiologically detected bone defect is roughly in accordance with the histologic extent of bone involvement. These results lead us to believe that some squamous carcinoma of the lower alveolus could be treated successfully without sacrificing the continuity of the mandible.
Results and prognosis following surgery for malignant tumors of the skull base
Authors: Jackson Ian T. , Bailey M. Hugh , Marsh W. Richard , Juhasz Peter
Published: February 2007

A series of 155 malignant craniofacial tumors referred to a specialized craniofacial center for surgical treatment are presented. One quarter of these were primary and three quarters recurrent. The statistics of long‐term follow‐up are presented, and it is concluded that this type of surgery for these difficult problems is worthwhile. The increasing experience gained from operating on and following up these patients is presented.
Salmonellosis initially seen as a thyroid abscess
Authors: Gudipati Suhasini , Westblom T. Ulf
Published: February 2007

A case of Salmonella typhimurium thyroid abscess in a 79‐year‐old man is reported. The patient was seen with fever and neck tenderness 2 weeks after a brief episode of diarrhea. Surgical excision combined with 2 weeks of ceftriaxone, 1 g every 12 hours, resulted in complete recovery. This is only the fourth known case of Salmonella thyroid abscess, 3 of which have been caused by S. typhimurium. This organism is rarely found in other focal Salmonella infections and may therefore have a specific affinity for thyroid tissue.