bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation of clinical, surgical, pathologic, and MR fat suppression results for head and neck cancer
Authors: Tien Robert D. , Robbins K. Thomas
Published: February 2007

Magnetic resonance (MR) imaging provides superior soft tissue delineation of head and neck tumors compared to previous radiologic studies. Further refinements using fat suppression and gadolinium (Gd‐DTPA) enhancement have added to these improved images. We performed MR studies of 16 patients with head and neck tumors with detailed clinical, surgical, and pathologic information. MR studies included standard spin‐echo T1‐weighted images (T1WI) with and without fat suppression and T2‐weighted images (T2WI) with fat suppression. Gadolinium was also administered with fat suppression. Conventional and paired fat suppression MR images were compared by a grading system. Post‐Gd‐DTPA fat suppression T1WI, and T2WI with fat suppression, showed superior sensitivity for tumor delineation when compared to conventional T1WI. Fat suppression T2WI was the best technique to delineate squamous cell carcinoma both in the primary site and regional lymph nodes. Clinical, surgical, and pathologic results correlated perfectly with imaging findings. These refinements in MR imaging represent a significant advance in the radiologic evaluation of head and neck tumors. © 1992 John Wiley & Sons, Inc.
Bone and gallium scans in postradiotherapy osteonecrosis of the jaw
Authors: Epstein Joel B. , Wong Frances L. , Dickens Alan , Szasz Ivan , Lepawsky Michael
Published: February 2007

The role of radiographic and nuclear imaging in evaluation of postradiotherapy osteonecrosis of the jaw was studied. Patients who had received imaging at diagnosis and following hyperbaric oxygen therapy were studied. Radiographic changes did not correlate with the clinical status of patients. All bone scans were abnormal at the time of diagnosis of osteonecrosis, but remained abnormal following changes in the clinical status of patients. Thus, the bone scan may aid in the detection of osteonecrosis. Gallium uptake did not aid i diagnosis, but did correlate with clinical findings following treatment. Persisting positive gallium scans may indicate the need for surgery following hyperbaric oxygen therapy. © 1992 John Wiley & Sons, Inc.
Epidermoid cysts of the cranial bones
Authors: Wax Mark K. , Briant T. David R.
Published: February 2007

Ectodermally derived tissue in ectopic sites is seen in the head and neck. Extracranial dermoid and epidermoid tumors are relatively rare. While most otolaryngologists are familiar with the cholesteatoma of the otic area, not very many are exposed to this lesion in other sites. Those of the cranial bones are even rarer still. These tumors may expand (1) laterally in the cranial bones, (2) externally to present as masses in the scalp or facial region, or (3) internally to involve the intracranial contents. A patient with a frontal bone epidermoid, whose tumor had expanded in all three directions to erode both inner and outer cortex of cranium and laterally to rupture into the frontal sinus, is discussed. The literature is reviewed and the management of these rare masses is discussed. © John Wiley & Sons, Inc.
Papillary adenocarcinoma in thyroid hemiagenesis
Authors: Khatri Vijay P. , Espinosa Manuel H. , Harada William A.
Published: February 2007

Variation in the gross anatomy of the thyroid gland is relatively common. Although thyroid hemiagenesis is felt to be a rare anomaly, its incidence is probably underestimated as the diagnosis is usually incidental. The case of a 41‐year‐old woman with right thyroid hemiagenesis associated with papillary adenocarcinoma is presented. The diagnosis of hemiagenesis was established by isotope imaging and surgical exploration for a benign nodule. Seven years later she was seen with a recurrent neck mass, and an isotope scan revealed it to be a cold thyroid nodule. As she was diagnosed to have papillary adenocarci‐noma, total thyroid lobectomy was performed and at present she remains disease‐free. © 1992 John Wiley & Sons, Inc.
Occult lymph node metastasis in small oral tongue cancers
Authors: Ho Chiu M. , Lam Kam H. , Wei William I. , Lau Sai K. , Lam Lai K.
Published: February 2007

The need to treat the neck in patients with a small primary cancer in the tongue remains controversial. Twenty‐eight patients with stage I or II oral tongue squamous carcinomas were retrospectively reviewed. They had not received previous treatment. The tongue primary was excised via the transoral route and the neck was observed closely during follow‐up. Thirteen patients developed ipsilateral nodal metastases during follow‐up, three of whom also had simultaneous recurrence at the primary site. An additional patient had recurrence at the primary site alone. The incidence of occult neck metastasis was 42% (10 of 24). No tumor‐related death occurred in the group without nodal metastasis. The salvage rate after appearance of nodal metastasis was 30%. In oral tongue cancers, elective neck treatment should be considered regardless of a small primary and negative neck examination because of the high incidence of occult nodal metastasis and the poor outcome after salvage treatment. © 1992 John Wiley & Sons, Inc.
Rapid superselective high‐dose cisplatin infusion for advanced head and neck malignancies
Authors: Robbins K. Thomas , Storniolo A. M. , Kerber Charles , Seagren Stephen , Berson Anthony , Howell Stephen B.
Published: February 2007

Advances in vascular radiology techniques for superselective arterial infusions and methods to overcome systemic toxicity from high‐dose cisplatin chemotherapy encouraged us to re‐evaluate the effects of rapid regional cisplatin infusion for patients with head and neck malignancies. Twenty patients (17 carcinomas, three sarcomas) received high‐dose cisplatin (100‐200 mg/m2) by this method. Fifteen of the 17 patients with upper aerodigestive tract carcinoma are part of an ongoing phase I dose escalation of cisplatin with sodium thiosulfate neutralization. Three additional patients with sarcomas were treated with intra‐arterial (IA) cisplatin and systemic Adriamycin. Fifty‐three IA infusions were performed without any complications. Only minimal toxicity related to the chemotherapy was observed. The overall response rate for previously untreated patients was nine of 10 (90%) [complete response (CR) 67%; partial response (PR) 33%]. The response rate for patients with recurrent disease was five of eight (63%) (CR 20%, PR 80%). The average length of follow‐up is 9.5 months and the actuarial survival rate is 56%. Superselective rapid infusion of high‐dose cisplatin for patients with advanced head and neck malignancies is feasible, relatively nontoxic, and may have important applications in multimodality therapy, particularly for patients with bulky primary disease. © 1992 John Wiley & Sons, Inc.
Embolization of a life‐threatening mandibular vascular malformation by direct percutaneous transmandibular puncture
Authors: Resnick Scott A. , Russell Eric J. , Hanson David H. , Pecaro Bernard C.
Published: February 2007

Vascular malformations of the mandible are uncommon, but often present with significant hemorrhage. Transarterial vessel occlusion has become a valuable primary or adjunctive treatment for such lesions, as well as for most other symptomatic congenital and acquired head and neck vascular anomalies. Permanent embolic obliteration of the malformation requires placement of occlusive material directly into the nidus (core) of the lesion. Prohibitively complex proximal vasculature may prevent successful catheter positioning and lead to failure of traditional embolotherapy. Even optimal placement of arterial embolic material may fail to fully obliterate the nidus, allowing eventual restoration of flow to the lesion due to arterial recanalization. Under such circumstances it may be possible to obliterate the malformation and control lesional hemorrhage by occlusion of the malformation or its venous drainage by direct percutaneous mandibular puncture. In our case, multiple transarterial embolizations failed to sufficiently manage a symptomatic vascular malformation. Successful embolotherapy was performed via direct puncture of the venous side of the malformation through the mandibular cortex. Venous thrombosis induced concomitant occlusion of abnormal arteriovenous shunts, resulting in long‐term control of life‐threatening oral hemorrhage. © 1992 John Wiley & Sons, Inc.
Surgical anatomy of the external branch of the superior laryngeal nerve
Authors: Cernea Claudio R. , Ferraz Alberto R. , Nishio Sunao , Dutra Augusto , Hojaij Flavio C. , Dos Santos Luiz R. Medina
Published: February 2007

Iatrogenic lesions of the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomies are not infrequent due to the possibility of anatomic variations of the relationships of this nerve with the superior thyroid vessels. Therefore, based on an anatomic analysis of 30 superior thyroid poles from 15 fresh cadavers, a new classification of the EBSLN was proposed, considering the jeopardy during a thyroidectomy. Thirty‐seven percent of the nerves were type 2, ie, crossing the superior thyroid pedicle less than 1 cm above the superior thyroid pole. It is notable that 20% were type 2b, ie, crossing the vessels below the upper border of the pole, having been considered “high risk.” This incidence was comparable with other series, which found dangerous anatomic variations of the EBSLN in the range of 15% to 68%, confirming that a significant proportion of these nerves might be at risk during surgery on the superior thyroid pole. © 1992 John Wiley & Sons, Inc.
Overexpression of P53 in head and neck cancer
Authors: Watling David L. , Gown Allen M. , Coltrera Marc D.
Published: February 2007

The putative tumor suppressor gene p53 plays a key role in the regulation of cell proliferation. Functional loss of p53 protein through mutation or viral oncogene‐complexing can result in p53 protein overexpression detectable by immunocytochemistry, which in turn has been associated with markers of poor prognosis in some cancers. We report here an analysis of p53 overexpression in fixed, embedded specimens from 81 prospectively collected head and neck tumors, both benign and malignant, including 55 squamous cell carcinomas, using monoclonal pAb1801. Sixty‐two percent of the squamous cell carcinomas from the head and neck region overexpressed p53, whereas none of the benign tumors or adjacent normal tissues overexpressed p53. Overexpression of p53 was strongly associated (p < 0.01, two‐tailed chi‐square) with a histologic malignancy grading scale previously shown to have prognostic capabilities. We conclude that p53 overexpression is one of the most common abnormalities identified in head and neck cancer, and may be a useful marker in the study of multistep progression of tumori‐genesis. © 1992 John Wiley & Sons, Inc.
DNA ploidy analysis of squamous cell head and neck cancer to identify distant metastasis from second primary
Authors: Slootweg Pieter J. , Rutgers Derk H. , Wils Iris S.
Published: February 2007

We conducted an investigation by flow cytometry to determine whether lung cancer in eight patients with oral cancer represented a metastasis or a second primary. One patient had the same aneuploid cell population at both sites which indicated the lung lesion to be a metastasis. Two patients had a diploid lesion at both sites. In these patients, a second primary could not be distinguished from a distant metastasis because (notwithstanding both lesions being diploid) the tumors may have a different DNA content but at a level too low for flow cytometric detection. Five cases had differing DNA indices, which could represent a second primary as well as the emergence of a new clone during tumor progression and metastasis. It appears that DNA flow cytometry can identify tumors that are the same if both have the same aneuploid pattern, but it cannot prove that they are different. © 1992 John Wiley & Sons, Inc.
Pathogenesis and surgical treatment of migraine and neurovascular headaches with rhinogenic trigger
Authors: Novak V. Josef , Makek Miro
Published: February 2007

Patients (299) with various types of headaches (migraines, cluster headaches, and so‐called idiopathic headaches) were operated on between 1973 and 1991. Septal correction, resection of the middle concha, ethmoidectomy, and sphenoidectomy on the corresponding headache side or occasionally on both sides were carried out. Most patients (235; 78.5%) were totally asymptomatic postoperatively; 34 (11.5%) had a sensation of pressure in the head on rare occasions but no further migraines, and 30 (11%) continued to experience headaches that occurred only rarely and were mild and of short duration. © 1992 John Wiley & Sons, Inc.
Thoracic duct cyst: An unusual supraclavicular mass
Authors: Wax Mark K. , Treloar Murray E.
Published: February 2007

Lesions of the thoracic duct may occur either in the neck or the mediastinum. The majority of lesions that present in the neck consist of chylous fistulae and are secondary to neck surgery. Cysts of the thoracic duct are very rare and are usually reported as a disease entity of the mediastinum. There are only two reported cases in the literature of thoracic duct cysts occurring in the neck. The third case of a thoracic duct cyst located primarily in the neck is reported. Thoracic duct cysts in the neck must be differentiated from other cysts of the neck, because not recognizing the inferior attachment to the thoracic duct, may result in the disastrous consequence of a chylothorax. Diagnosis can easily be made by fine‐needle aspiration with biochemical analysis. Computerized axial tomography (CAT) is useful in defining the anatomic boundaries. A weakness in the wall of the thoracic duct, either on a congenital or degenerative basis, has been postulated as the etiology. The natural history of these lesions remains unknown. Smaller lesions may be followed at routine intervals. Larger lesions should be surgically removed because of the possible complications that may ensue as a result of traumatic rupture or inflammation. © 1992 John Wiley & Sons, Inc.
Cytokeratin expression in normal and (pre)malignant head and neck epithelia: An overview
Authors: Van Der Velden Lilly‐Ann , Schaafsma H. Ewout , Manni Johannes J. , Ramaekers Frans C. S. , Kuijpers Wim
Published: February 2007

Intermediate filament proteins (IFPs) are important markers of tissue differentiation and have been receiving increasing interest, in particular, through their applicability in the characterization of malignant tumors. Cytokeratins (Cks) are a family of IFPs that are typically specific for epithelial cells. They are expressed in certain combinations depending on the type of epithelium and the degree of differentiation. This review presents a critical analysis of the available data on Ck expression in normal and (pre) neoplastic epithelia of the head and neck region. Special attention is paid to technical and cell biologic pitfalls, which can lead to false‐negative or false‐positive data. It appears that only a limited fraction of the reported data contributes substantially to our knowledge of IFP expression in head and neck cancer because of the use of ill‐defined, often formalin‐fixed and paraffinembedded, tissue specimens, and the application of limited panels of monoclonal antibodies. It is concluded that the use of immunocytohistochemistry is promising for the differential diagnosis of head and neck tumors and contributes to our knowledge on their biologic behavior. However, documentations of more complete Ck expression patterns of normal and (pre)malignant epithelium are required, together with their correlation to clinical parameters.
Combined approach for excision of cervical nerve tumors with dural extension
Authors: Komisar Arnold , Blaugrund Stanley M. , Camins Martin , Mangiardi John
Published: February 2007

Tumors of the cervical plexus are rare. Often these tumors are found on routine exam as asymptomatic masses. We present our experience in managing four patients with tumors with dural extension. Three of these lesions were neurilemomas and one was a meningioma. Symptoms and signs included weakness and hypoesthesia. Evaluation included complete neurologic examination with electromyography (EMG). Magnetic resonance imaging (MRI) was the best diagnostic tool to see tumor extent into the epidural and intradural space. Computed tumography (CT) or plain x‐rays were used to evalute the degree of destruction of the cervical spine. The surgical removal of these tumors was performed by a two‐team approach. A posterior laminectomy was xcombined with an anterior neck exploration. Follow‐up shows persistent upper extremity weakness in two patients, hypesthesia in three patients, and anesthesia of the anterior chest wall in two patients. Patients with these lesions should be informed of the potential neurologic consequences of removal.
Correlation between nodal density in contrasted scans and response to cisplatin‐based chemotherapy in head and neck squamous cell cancer: A prospective validation
Authors: Janot François , Cvitkovic Esteban , Piekarski Jean Daniel , Sigal Robert , Armand Jean Pierre , Bensmaine Amine , Luboinski Bernard
Published: February 2007

This prospective study was done to validate an earlier retrospective study demonstrating a relationship between complete response to chemotherapy and nodal density as estimated in contrasted computed tumorgraphy (CT scans) in head and neck squamous cell carcinoma (HNSCC). CT scans of 36 patients were evaluated by two radiologists blinded to therapeutic outcome. The density of the largest node (>2 cm) was compared to that of nuchal muscles. A node was classified as hypodense if more than 33% of the nodal surface area consisted of hypodense zones. Density and nodal staging were related: 67% (10 of 15) of patients with N3 disease but only 29% (six of 21) with N1–N2 exhibited isodensity, p < 0.05. Complete response to chemotherapy was noted in 63% (10 of 16) of the isodense group but only in 15% (three of 20) of the hypodense group, p < 0.01. We believe that nodal density can be used for therapeutic decision‐making in high nodal volume HNSCC.
Hyperbaric oxygen therapy and squamous cell carcinoma cell line growth
Authors: Sklizovic Davor , Sanger James R. , Kindwall Eric P. , Fink John G. , Grunert Brad K. , Campbell Bruce H.
Published: February 2007

Hyperbaric oxygen (HBO) promotes tissue healing by increasing oxygenation. Therefore, HBO therapy is clinically useful for some patients who have undergone major cancer resection and/or radiotherapy to the head and neck. For individual patients, however, there might be undetected viable tumor present at the time of therapy. This study was performed to determine if increased tissue oxygen had a measurable effect on the growth of squamous carcinoma xenotransplants which had been derived from head and neck cancers. After the successful growth of two well‐established human squamous cell carcinoma cell lines (183 and 1483), each tumor was transplanted into 20 mice. Every mouse received four transplants of 106 cells. Ten mice with 40 xenotransplants in each group were treated with HBO daily for 90 minutes at a pressure of 2 atm, whereas the other 10 formed the control group. The mice transplanted with cell line 1483 were treated for 21 days; mice transplanted with cell line 183 were treated for 28 days. The tumor weight, volume, and histology were evaluated. No significant difference was found between experimental groups. This study suggests that increased tissue oxygen neither significantly increases nor decreases the growth of squamous cell carcinoma.
Neoplastic seeding of squamous cell carcinoma of the oropharynx
Authors: Clayman Gary , Cohen James I. , Adams George L.
Published: February 2007

Neoplastic seeding is a concept of mechanical disruption and spread of tumor into normal tissues. It is well‐documented and accepted as an explanation for unusual patterns of tumor recurrence at multiple sites in the body. Neoplastic seeding is often invoked as an explanation for stomal recurrences following treatment of laryngeal carcinoma. However, it is impossible to discern whether these recurrences represent peritracheal lymph nodes, persistent or recurrent local disease, or neoplastic seeding of tumor. The purpose of this article is to report two cases of tracheostomy site recurrences after treatment of oropharyngeal squamous carcinoma, in which neoplastic seeding is the most plausible explanation of recurrence. The rarity of this phenomenon appears strikingly small despite significant experimental evidence supporting the possibility of its occurrence. Although specific recommendations for prevention cannot be made, it appears prudent to avoid re‐use of instruments that come into direct contact with squamous cell carcinoma tumor surface.
Manifestations of metastatic breast carcinoma to the head and neck
Authors: Wanamaker John R. , Kraus Dennis H. , Eliachar Isaac , Lavertu Pierre
Published: February 2007

Although metastatic neoplasms in the head and neck are rare compared to primary head and neck neoplasms, metastatic breast carcinoma has been described at numerous sites in the head and neck region. Two cases of breast carcinoma metastatic to sites in the head and neck are reported. In one case a laryngeal metastasis represented the first manifestation of recurrent breast cancer. The second case, a nasal metastasis, was unsuspected and was treated as cellulitis. The presentation of metastatic breast carcinoma to the head and neck may in fact be atypical, posing a diagnostic dilemma. These cases illustrate the importance of past medical history and the high index of suspicion in patients with a history of prior malignancy.
Treatment of stage I and II oral tongue cancer
Authors: Lydiatt Daniel D. , Robbins K. Thomas , Byers Robert M. , Wolf Patricia F.
Published: February 2007

We reviewed 156 previously untreated patients with squamous cell carcinoma of the oral tongue staged T1 and T2 to determine the incidence of nodal metastasis, and if elective neck dissection affected local/regional control or survival. Patients were divided into two nonrandomized groups: group 1, intraoral glossectomy only (102 patients); and group 2, intraoral glossectomy plus neck dissection (54 patients). Analysis revealed no significant differences for tumor location, histologic differentiation, status of margins, or clinical appearance; however, perineural invasion significantly adversely affected survival and local/regional control. In group 1 patients, 16.5% subsequently developed cervical metastasis, and 20.4% of patients in group 2 had occult nodal disease. The survival and local/regional control for group 1 patients subsequently developing nodes was 33% and 50%, respectively. The survival and local/regional control for group 2 patients with occult metastasis was 55% and 91%, respectively. We believe elective neck dissection is indicated for early staged oral tongue cancer.
Effects of maneuvers on swallowing function in a dysphagic oral cancer patient
Authors: Lazarus Cathy , Logemann Jeri A. , Gibbons Patricia
Published: February 2007

This study examined the effects of three swallow maneuvers: (1) the supraglottic swallow (voluntary closure of the vocal folds prior to the swallow); (2) the super‐supraglottic swallow (airway closure at the level of the arytenoid to base of epiglottis); and (3) the Mendelsohn maneuver (voluntary prolongation of laryngeal elevation and cricopharyngeal opening during swallow) on swallow functioning in a 47‐year‐old patient who underwent right composite resection for a squamous cell carcinoma of the right retromolar trigone. All maneuvers were employed during the same videofluorographic (VFG) swallow study conducted 6 months after the patient's surgery. Biomechanical analysis of 3‐mL swallows defined the extent and timing of tongue base retraction to the posterior pharyngeal wall, laryngeal elevation, laryngeal closure and cricopharyngeal opening during swallows with and without maneuvers. Airway closure duration was prolonged during supraglottic and super‐supraglottic swallows, but aspiration was not eliminated. Use of the Mendelsohn maneuver improved coordination and timing of pharyngeal swallow events, including timing of posterior movement of the tongue base to the pharyngeal wall in relation to airway closure and cricopharyngeal opening, with elimination of aspiration. The Mendelsohn maneuver compensated for anatomic and physiologic changes in the oropharyngeal swallow and enabled reinstatement of safe oral intake in this surgically treated head and neck cancer patient who was previously unable to take nutrition orally.
Platysma myocutaneous flap for head and neck reconstruction in cats
Authors: Smith Mark M. , Shults Stacey , Waldron Don R. , Moon Martha L.
Published: February 2007

Squamous cell carcinoma is the fourth most common neoplasm in cats. As in man, local resective surgery of stage III and IV carcinoma often results in recurrence related to compromised margins. Radical resective procedures may be performed when reconstructive techniques are available to restore cosmesis and function. A platysma myocutaneous flap that was based on a cutaneous branch of the caudal auricular artery and vein was developed to fulfill this requirement. Control flaps, which included ligation and division of the caudal auricular artery and vein, were similarly developed on the contralateral aspect of the neck. Mean survival of all platysma myocutaneous flaps (86.7%), compared with control flaps (62.9%), was significantly different (p< .05). Flaps grouped in lengths of 6, 9, and 12 cm had mean survival lengths of 93.8%, 81.9%, and 84.4%, respectively. The mean survival length of flaps measuring 12 cm in length was significantly different (p< .05) compared with flaps measuring 6 and 9 cm. On the basis of the results of this study, the platysma myocutaneous flap based on a cutaneous branch of the caudal auricular artery and vein may be a source of tissue for reconstructive procedures of the head and neck in cats.
Mesenchymal chondrosarcoma of the jaw—report of a case and review of 41 cases in the literature
Authors: Takahashi Kikuo , Sato Kenichi , Kanazawa Harusachi , Wang Xiao‐Li , Kimura Takayuki
Published: February 2007

A case of mesenchymal chondrosarcoma in the mandible of a 35‐year‐old woman is presented. In a thorough survey of the world literature, 41 cases of mesenchymal chondrosarcoma occurring the jaw are reviewed.
Controversies: Carcinoma of the tonsil
Authors: Snyderman Nancy L. , Strome Marshall , Ward Paul , Johnson Jonas , Goepfert Helmuth
Published: February 2007

Editor's note: One of the most interesting aspects of this job is that the contributors never fail to surprise me. When I submit what I consider a straightforward case, I commonly receive quite complex and circuitous answers. Conversely, cases that could be treated in a variety of ways may come back with a consensus. Responses in this case lived up to my unexpected expectations. Health care costs in the United States are skyrocketing. Health care providers now grapple with economic decisions that in years past would have been inconceivable. We also face the stark realization that health care in this country is now rationed. Not everyone gets it. In the opinion of this editor, as we attempt to deal with health care costs in the future, harder decisions will have to be made. If a patient develops cancer after years of smoking or cirrhosis after years of abusing alcohol, who should be responsible for the costs of treatment? Does secondhand smoke play a role in the genesis of head and neck cancers? Should a patient's home life alter treatment plans? Should economics be considered? Who will make the decisions? The answers are complex. What I thought would be long and conflicting thoughts from the experts turned out to be short and to the point–another surprise.
Assessment of quality of life in head and neck cancer patients
Authors: Hassan Sammy J. , Weymuller Ernest A.
Published: February 2007

Seventy‐five consecutive patients were selected to evaluate a disease‐specific quality‐of‐life questionnaire (UW QOL). The new test was compared to two established equality of life evaluation tools, the Karnofsky scale and the Sickness Impact Profile (SIP). Each test was administered on three separate occasions: (1) several days preoperatively; (2) immediately postoperatively; and (3) 3 months postoperatively.

The Karnofsky scale is relatively crude and lacks the ability to measure subtle changes. The SIP is a detailed questionnaire that is quite sensitive to change. However, due to its length, the SIP is inefficient and expensive to administer, and patient noncompliance is often a problem.

The three questionnaires were compared according to the following factors: Acceptability: 97% of the patients favored the UW QOL scale compared with the SIP because it was more concise and easier to complete. Validity: Validity indicates the ability of the test under investigation to measure what it was intended to measure. Using the SIP as a gold standard, the UW QOL scale demonstrated an average criterion validity of 0.849, whereas the Karnofsky average criterion validity was 0.826. Reliability: Reliability is a measurement of the reproducibility of the data. The UW QOL questionnaire scored >0.90 on reliability coefficients versus 0.80 for the Karnofsky and 0.87 for the SIP scale. Responsiveness: Responsiveness is the ability of the test to measure clinical change. The UW QOL scale faired better than the Karnofsky and the SIP scale in detecting change.

The UW QOL scale is comparable to the Karnofsky and SIP scales when tested for validity and reliability. It was the preferred test format of 97% of patients and provided the greatest responsiveness to clinical change.
Comparison of the addition of T and N integer scores with TNM stage groups in head and neck cancer
Authors: Jones Glenn W. , Browman George , Goodyear Michael , Marcellus D. , Hodson D. Ian
Published: February 2007

The 1987 TNM classification system modified T and N definitions for squamous cell carcinomas of the head and neck. It did not change stage groupings (I through IV). The primary purpose of clinical staging is to divide patients into prognostically meaningful groups. The 1987 changes to the TNM T and N descriptions may not have removed the previously established heterogeneity within stage groups III and IV which existed before 1987. The development of a stage grouping system called TANIS (the T And N Integer Score), which is formed by adding the integer values of the T and N classifications, is reported herein.

We compared the prognostic performance of T, N, TNM stage group, and TANIS stage for radiotherapy response and survival using data from 86 patients with newly diagnosed, measurable TNM II (oral cavity), and localized TNM III‐IV squamous cell carcinomas of the head and neck, excluding nasopharynx, who were randomized to test 5‐fluorouracil‐methotrexate sequencing. The sequencing of chemotherapy was shown to make no difference to prognosis. All patients received 60 Gy of radiotherapy in 6 weeks.

As compared to T, N, and the TNM stage group system, TANIS was the single best predictor for a complete response to radiotherapy (p = 0.0005). TANIS was also the single best predictor for survival from randomization (p = 5 × 10−6). With the 86 patients divided into three groups (TANIS 2 to 3, 4, and 5 to 7), TANIS provided a better prognostic discrimination than did the TNM stage grouping method (TNM II, III, and IV). TANIS is a single index that combines T and N information in a simple way which was more strongly associated with radiotherapy response and survival than the traditional TNM stage groups.
Infrahyoid myocutaneous flap in head and neck reconstruction
Authors: Magrin Jose , Kowalski Luiz P. , Santo Gilmar E. , Waksmann Gilson , Dipaula Rafael A.
Published: February 2007

Infrahyoid myocutaneous flap is one of the alternatives to be considered for the reconstruction of moderate defects following resection of the oral cavity, oropharynx, or hypopharynx cancers. The flap is based on the uni‐or bilateral superior thyroid pedicle; its major limitations are due to small flap volume and arc of rotation. The authors reviewed a series of 15 consecutive patients with carcinomas of the oral cavity or pharynx who underwent radical surgical resections followed by immediate reconstruction using an infrahyoid myocutaneous flap. Four of five cases with prior irradiation presented complications. The incidence of flap necrosis in this series (47%) was higher than that reported by others (10%). We consider the presence of massive neck metastasis and prior irradiation contraindications to the use of this flap.
Symptom‐directed selective endoscopy and cost containment for evaluation of head and neck cancer
Authors: Benninger Michael S. , Enrique Ronel R. , Nichols Richard D.
Published: February 2007

Panendoscopy is commonly used for diagnosing synchronous primary neoplasms of the head and neck, although the yield and cost effectiveness has been questioned. To compare symptom‐directed selective endoscopy to panendoscopy, 100 consecutive patients with newly diagnosed and untreated squamous cell carcinoma were prospectively evaluated. Symptoms were used to select which studies might have been performed to discover synchronous primary lesions. All patients were subsequently evaluated with chest x‐ray, barium esophagram, direct pharyngolaryngoscopy, esophagoscopy, and bronchoscopy with bronchial washings. Seven synchronous primary neoplasms were discovered in six patients with one patient having three separate tumors. There were five synchronous pharyngeal and one oral cavity neoplasms with two of the pharyngeal tumors being asymptomatic. Two primary cervical esophageal tumors and one synchronous esophageal tumor were found in three patients all of whom had symptoms of dysphagia and odynophagia. Two pulmonary metastasis were discovered by chest x‐ray in patients with normal bronchoscopies with bronchial washings. Selective symptomatic evaluations would have resulted in one‐third savings in total cost and would have minimized excessive procedures and potential morbidity. Direct pharyngolaryngoscopy and chest x‐rays are recommended for patients with squamous cell carcinoma of the head and neck but esophagoscopy, esophagogram, and bronchoscopy might be reserved for patients with associated symptoms. Bronchial washings are not recommended.
Relative effect of surgery and radiotherapy on the internal jugular vein following functional neck dissection
Authors: Docherty James G. , Carter Rosamund , Sheldon Christopher D. , Falconer J. Stuart , Bainbridge L. Christopher , Robertson A. Gerard , Soutar David S.
Published: February 2007

We examined the internal jugular veins in three groups of patients who had undergone (1) a functional neck dissection and radiotherapy, (2) a functional neck dissection alone, or (3) radiotherapy alone, using a noninvasive color Doppler ultrasound scan. The internal jugular veins were ultrasonically bilaterally normal in 18% of patients who had undergone a functional neck dissection and radiotherapy, in 88% of patients who had undergone a functional neck dissection alone, and in 57% of patients who had undergone radiotherapy alone. The combination of a functional neck dissection and radiotherapy significantly affected the internal jugular vein when compared with a functional neck dissection alone.
Professional burnout among head and neck surgeons: Results of a survey
Authors: Johnson Jonas T. , Wagner Robin L. , Rueger Robert M. , Goepfert Helmuth
Published: February 2007

Burnout may develop in highly productive, hard‐working individuals from all walks of life. Extending working hours under stressful circumstances may produce a sense of frustration resulting in emotional exhaustion, loss of empathy for patients, and a decreased sense of personal accomplishment.

The membership of the American Society of Head and Neck Surgery and the Society of Head and Neck Surgeons was surveyed by mail relative to burnout. A total of 395 head and neck surgeons responded. Mean age was 48 years. The average individual worked an average of 66 hours per week. More than 70% of work was devoted to patient care of which 30% to 50% was devoted to the management of head and neck cancer. A total of 128 (34%) individuals responded that they felt “burned out.” Only 27%, however, indicated frustration with disease, whereas 67% indicated frustration by government and 58% indicated frustration by the economics of medical practice.

Most respondents enjoy their work, nevertheless, the stress of extending working hours dealing with severely ill patients, and the increased need to deal with government and economic issues is of concern to the community of physicians practicing head and neck surgery. Discussion about and confrontation with these issues are appropriate to facilitate and enhance an individual's ability to continue to function productively in this environment.
Scintigraphic assessment of aspiration in head and neck cancer patients with tracheostomy
Authors: Muz Jaroslaw , Hamlet Sandra , Mathog Robert , Farris Ronnie
Published: February 2007

Tracheopulmonary aspiration commonly occurs in patients with dysphagia related to head and neck cancer. Scintigraphic studies were performed in 280 patients with head and neck cancer; 33% of these patients had tracheopulmonary aspiration. A subgroup of 18 tracheostomized patients had a tracheostomy tube with a removable obturator, so they could be studied with the tracheostomy open or occluded. When the tracheostomy was occluded the patients aspirated less frequently, and in significantly smaller quantities, than when it was open. When feasible, occluding the tracheostomy tube or permanent surgical closure may reduce or eliminate tracheopulmonary aspiration in these patients. © 1994 John Wiley & Sons, Inc.
Laryngeal preservation by induction chemotherapy plus radiotherapy in locally advanced head and neck cancer: The M. D. Anderson cancer center experience
Authors: Shirinian Mihran H. , Weber Randal S. , Lippman Scott M. , Dimery Isaiah W. , Earley Charles L. , Garden Adam S. , Michaelson Jacqueline , Morrison William H. , Kramer Alan , Byers Robert , Peters Lester , Hong Waun Ki , Goepfert Helmuth
Published: February 2007

Standard treatment of locally advanced laryngeal, hypopharyngeal, and some oropharyngeal cancers includes total laryngectomy. In an attempt to preserve the larynx through induction chemotherapy, we conducted two consecutive phase II studies. From March 1986 to February 1991, 64 patients with advanced untreated but resectable head and neck cancer who would require total laryngectomy were enrolled on one of two cisplatin‐based induction regimens: cisplatin‐bleomycin‐5‐fluorouracil (PBF) in 31 patients and cisplatin‐5‐fluorouracil (PF) in 33; all received definitive radiotherapy. Surgery was reserved for patients who achieved less than a partial response to chemotherapy and patients with residual or recurrent disease after sequential chemotherapy plus radiotherapy. Overall complete plus partial response rates to both cisplatin‐based regimens were comparable. The combined PF and PBF overall response rates were 75% for laryngeal cancer, 78% for hypopharyngeal cancer, and 75% for oropharyngeal cancer. Complete response rates after radiotherapy were 88%, 83%, and 50%, respectively. Neutropenia (<1,000 cells/mm3) was the most common hematologic toxic effect: it occurred in 44% of patients who received PF and 16% of those who received PBF. Grade ≥3 mucositis occurred in 50% of patients who received PF and 4% who received PBF. The data suggest that laryngeal preservation was feasible in all three primary‐site subgroups. With followup of 15+ to 54+ months, 44% of patients with laryngeal cancer, 28% with hypopharyngeal cancer, and 22% with oropharyngeal cancer are alive with laryngeal preservation. The overall 2‐year survival rates for patients with cancer of the larynx, hypopharynx, and oropharynx were 71%, 46%, and 38%, respectively. © 1994 John Wiley & Sons, Inc.
Free vascularized fascial flap in oral cavity reconstruction
Authors: Martin Ian C. , Brown Andrew E.
Published: February 2007

Our experience with the free vascularized fascial flap based on the radial artery used for intraoral reconstruction is described. Thirteen patients underwent primary or secondary reconstruction following major resections for malignant disease. The osseofascial flap incorporating radial bone proved to be ideal when reconstruction of composite mandibular or maxillary defects was undertaken. The flaps rapidly underwent surface epithelialization, and submucosal fibrosis provided the ideal attached mucosal lining for prosthetic rehabilitation. © 1994 John Wiley & Sons, Inc.
Immunohistologic distribution of basement membrane in oral squamous cell carcinoma
Authors: Kumagai Shigehiro , Kojima Shinya , Imai Kazushi , Nakagawa Kiyomasa , Yamamoto Etsuhide , Kawahara Ei , Nakanishi Isao
Published: February 2007

The distribution pattern of the basement membrane (BM) around tumor cells was determined in 72 oral squamous cell carcinomas by immunohistochemical staining with antibodies against human type IV collagen, laminin, and heparan sulfate proteoglycan. An intact continuous BM was found in 29 cases, whereas partial or widespread loss of the BM was detected in the other 43 cases (59.7%). Statistical analysis showed that the degree of BM loss was correlated with the degree of differentiation of tumor cells, but not with tumor size, and, most significantly, with the mode of cancer invasion and the incidence of lymph node metastasis. Carcinoma with a well‐defined tumor‐stromal boundary generally expressed an intact continuous BM. In contrast, the majority of diffusely invasive carcinomas lacked a continuous BM. Carcinomas with a widespread loss of BM structures showed a high frequency of regional lymph node metastasis (16 of 18 cases, 88.9%). © 1994 John Wiley & Sons, Inc.
Superior vena cava syndrome and tracheal obstruction due to multinodular goiter
Authors: McKellar Daniel P. , Verazin Gary T. , Lim K. M. , Spiegel Jerome C. , Block Blaine L.
Published: February 2007

Tracheal obstruction and superior vena cava (SVC) syndrome are rare complications of retrosternal goiter. These two conditions present a difficult diagnostic and therapeutic challenge. Malignancy is the most common cause of SVC syndrome. Determining whether SVC syndrome is due to a benign or malignant process is imperative before instituting treatment, but this determination may be difficult. We present a case of a patient presenting with upper airway obstruction and SVC syndrome with a large mediastinal mass. The mass was determined to be a multinodular goiter. The patient was managed by surgical removal of the goiter with complete resolution of symptoms. This case illustrates the need for careful preoperative evaluation and the importance of establishing a histologic diagnosis prior to initiating treatment for SVC syndrome. © 1994 John Wiley & Sons, Inc.
Basic science reviews: Biology of interleukin‐1 (IL‐1), with respect to otorhinolaryngology‐head and neck surgery
Authors: Wustrow Thomas P. U.
Published: February 2007

Interleukin‐1 (IL‐1) has a number of fundamental immunoregulatory, hematologic, metabolic, and physiologic effects and thus is instrumental in the coordination of tissue interactions, such as wound healing, inflammation, and host tumor response. IL‐1 stimulates the activation and differentiation of pre‐B cells and T cells, chemotaxis of neutrophils, recruitment of bone marrow stem cells, stimulation of arachidonic acid metabolism, degradation of proteoglycans, and increase in basal body temperature. Altered production of IL‐1 or IL‐1 regulatory factors may have profound clinical consequences, such as seen in AIDS, other viral and malignant diseases, and in uncontrolled inflammatory processes. A variety of positive and negative feedback mechanisms for regulation of IL‐1 production have been found; therapeutic interventions are aimed at these regulatory pathways. Through approaches interfering with the signal transduction or processing of IL‐1, especially by interleukin‐1‐receptor antagonists (IL‐1RA), future treatment modalities are on the horizon. © 1994 John Wiley & Sons, Inc.
Predictors of carcinomatous invasion of the mandible
Authors: Tsue Terance T. , McCulloch Timothy M. , Girod Douglas A. , Couper David J. , Weymuller Ernest A. , Glenn Michael G.
Published: February 2007

The preoperative assessment of mandibular invasion by oral or oropharyngeal squamous cell carcinoma poses a challenge for the head and neck surgeon. A study of 64 composite resection patients was performed to determine which variables in the patient's history, physical exam, and diagnostic workup had a predictive association with carcinomatous mandibular invasion. Four postoperative variables were included in this analysis. Thirty‐nine percent of the mandibular specimens demonstrated cancerous involvement.

A multivariate recursive partitioning statistical analysis was performed to create a decision tree. Branching was based on the two statistically predictive variables: computed tomographic (CT) scan results and primary tumor location. The guide provides improved predictive accuracy with a 100% negative predictive value (NPV) and a 46% positive predictive value (PPV). This decision guide should help the surgeon provide accurate patient counseling, anticipate reconstructive needs, and maximize surgical oncologic effectiveness. © 1994 John Wiley & Sons, Inc.
Analysis of recurrence, complications, and functional results with free jejunal flaps
Authors: Bradford Carol R. , Esclamado Ramon M. , Carroll William R. , Sullivan Michael J.
Published: February 2007

The medical records of 20 patients undergoing revascularized jejunal flap reconstruction of hypopharyngeal defects were retrospectively reviewed to analyze the incidence of distal marginal recurrence, complication rates, and success of early functional restoration. This report is one of few in the literature to address distal marginal recurrence in patients undergoing jejunal free flap reconstruction of hypopharyngeal defects. In 15 evaluable patients, two (13%) developed distal marginal recurrences. Both patients had tumor involving the hypopharynx at the junction of the cervical esophagus. The major complication rate was five of 20 patients (25%) and included three flap failures, one death, and one intra‐abdominal hemorrhage. The minor complication rate was 35%. The median hospital stay was 15.5 days and the median time to successful swallowing was 14.5 days. The functional success rate for swallowing was 58%. Because of the aggressive nature of this disease, we feel partial esophagectomy with jejunal flap reconstruction is warranted to achieve early functional restoration in a select group of patients when a 2‐cm distal margin can be obtained above the cervical esophagus with frozen‐section control, and the distal esophagus is normal. © 1994 John Wiley & Sons, Inc.