A prospective study of parotid metastases from head and neck cancer

A prospective study of eighty-eight patients with cutaneous head and neck cancer was undertaken to define patients at high risk for parotid lymph node metastases. Over a three year period, twenty-one patients with highly malignant primary melanoma or squamous carcinoma of the eyelid, frontal, temporal, posterior cheek, or anterior ear skin underwent either initial wide primary excision and superficial parotidectomy with radical neck dissection (16 patients) or secondary parotidectomy after initial treatment elsewhere (5 patients).     

A prospective study of endotracheal tube cytology in head and neck cancer patients

A prospective study was undertaken to determine the incidence of endotracheal tube contamination by malignant cells in patients with head and neck cancer undergoing bronchoscopy. In 67 consecutive patients, bronchoscopy was performed with a flexible instrument, through or beside the endotracheal tube. Following the procedure, the inside and outside of the tube were washed and the specimens examined cytologically. Fifteen positive (class III to V) cytologic specimens were obtained, all from the outside of the tube. All washings from inside the tube were negative (class I and II). Twelve of the positive cytologic specimens were found in patients with hypopharyngeal and laryngeal carcinoma, two with carcinoma in the tongue base, and the other primary site was unknown. Two patients with normal chest roentgenograms had positive bronchial and endotracheal tube washings. In both the bronchoscope was passed beside the endotracheal tube. This study provides additional evidence that contamination of the bronchoscope can occur when it is passed directly over a carcinoma of the head and neck.     

Desmoid tumor of the head and neck

BACKGROUND: [corrected] Desmoid tumors are rare benign tumors but have a tendency toward local recurrence after resection because of their infiltrative growth and frequent entrapment of vital structures in the head and neck region. We report 24 desmoid tumors of the head and neck and propose a reasonable approach in the management of such cases. METHODS: Twenty-four patients (9 male and 15 female; median age, 33 years; range, 0-66 years) with a desmoid tumor of the head and neck (neck, 15 patients; head, 9 patients) treated from 1990 to 2004 were retrospectively analyzed. The size ranged from 0.5 to 13 cm in diameter (mean, 3.6 cm). In the neck, 8 tumors were around the superficial layer of deep cervical fascia, whereas 4 tumors of the neck involved the prevertebral fascia and 2 involved brachial plexus. RESULTS: Twenty patients received complete resection of the tumor, but the section margin was positive in 8 patients, of which 6 patients remained free of disease in a period of 13 to 105 months. Three patients, including 2 with positive section margin and 1 with negative margin, developed recurrences, which were successfully removed again. Two patients underwent partial resection of the tumor because of brachial plexus involvement. One of them achieved regression after postoperative radiotherapy and the other had spontaneous regression. The hypopharygneal tumor in a newborn had spontaneously complete regression, and tracheostomy was closed at the age of 6 years. One patient remained with stable disease for 14 months after biopsy of the tumor without excision. CONCLUSION: The overall prognosis is still good despite frequent incomplete resection. Surgical resection of the tumor with close observation is suggested even if the section margin is positive. If a desmoid tumor cannot be removed grossly, regression or arrested growth of the remaining tumor is expected. Radiotherapy might be reserved for a growing tumor.     

A prospective, longitudinal study of pain in head and neck cancer patients.

BACKGROUND: Little is known about the epidemiology of pain in head and neck cancer, the effects of curative treatment on this pain, and the impact that pain experience may have on patients' quality of life (QL). METHOD: The prevalence and severity of pain was studied in 93 patients who were first seen with a diagnosis of head and neck cancer, were treated, and remained disease free at two years. QL assessment utilised the life-satisfaction scale and the General Health Questionnaire as specific measures. Pain was assessed by a linear analogue scale anchored by words and numbers. RESULTS: Forty-eight percent had head and neck pain when first seen, whereas only 25% and 26% had such pain at 12 and 24 months. Approximately 8% of patients rated the pain as "severe" when first seen, whereas 3% had severe pain at 12 months and 4% at 2 years. The prevalence of shoulder and arm pain increased from 14% at diagnosis to 37% at a year and 26% at 24 months, but the percentage of patients with severe pain at any stage postoperatively was only 5% and 2%, respectively. Any pain (pain in either in the head and neck or shoulder and arm or both) at 2 years was strongly predicted by earlier posttreatment pain (at 3 months or at 12 months.) Shoulder and arm pain at 2 years was strongly correlated with surgical treatment of the neck, although no difference in pain experience was noted between those who had radical neck dissections and those who had more conservative procedures. There was no correlation between radiotherapy to the neck and subsequent shoulder and arm pain. Pain had an adverse effect on the general well-being and psychological distress of head and neck cancer patients who were free of disease. CONCLUSIONS: Pain is common among those presenting with curable head and neck cancer. Pain can be reduced by curative treatment but neck dissection may cause increased shoulder and arm pain. Ongoing pain is predictable and impacts adversely on patients QL.     

A prospective study on the impact of the renal biopsy in clinical management

A three year prospective study involving 80 patients was conducted to assess the impact of renal biopsy on clinical management. Pre-biopsy predicted histologic diagnosis was changed in 35 (44%) of the patients as a result of the biopsy. Prognosis changed in 45 (57%) of the patients. Therapy changed in 25 (31%) of the patients. These results suggest that, overall, renal biopsy had a marked effect on management. However, we identified subgroups of patients who were unlikely to have their management changed as a result of the biopsy: of 16 patients with a pre-biopsy diagnosis of IgA nephropathy, 1 (6%) had treatment changed because of the biopsy; and of the 50 patients without heavy proteinuria (greater than 3 g/24 h), 10 (20%) had treatment changed because of the biopsy. Although our overall results suggest an important role for renal biopsy in clinical management, renal biopsy has the least apparent impact in patients with a pre-biopsy diagnosis of IgA nephropathy or without heavy proteinuria.     

Health impact of head and neck cancer

A multidimensional Head and Neck Quality of Life (HNQOL) instrument and a general health status measure were administered to 397 patients with head and neck cancer. Scores for the 4 domains of the HNQOL (communication, eating, pain, and emotional well-being) were calculated. Patient demographics, comorbidities, clinical characteristics, treatment data, disability status, and a global "overall bother" score were assessed. When compared with the US population aged 55 to 64 years, the group had significantly worse scores in the 8 health domains of the SF-36. Patients' overall bother scores from the head and neck cancer treatment correlated best with the HNQOL emotion domain (r = 0.71) and the HNQOL pain domain (r = 0.63), and least with the patients' perception of their response to treatment (r = 0.39). Pain, eating, emotion, physical component summary score, age, and an interaction term between eating and emotion were significant predictors for overall bother. Of the 217 patients who were working before the diagnosis of cancer, 74 (34. 1%) reported that they had become disabled. Patients who had more than 1 type of treatment were 5.9 times more likely to report themselves as disabled (odds ratio [OR] = 5.94, P < 0.01), even after adjusting for age, emotion score, and physical component summary score, which were other factors that predicted disability.     

Risk factors for wound infection in head and neck cancer surgery: a prospective study

BACKGROUND: The goal of this prospective study is to determine risk factors for wound infections (WI) for patients with head and neck cancer who underwent surgical procedure with opening of upper aerodigestive tract mucosa. METHODS: One hundred sixty-five consecutive surgical procedures were studied at Oscar Lambret Cancer Center within a 24-month interval. Twenty-five variables were recorded for each patient. Statistical evaluation used Chi2 test analysis (categorical data) and Mann-Whitney test (continuous variables). RESULTS: The overall rate of WI was 41.8%. Univariate analysis indicated that five variables were significantly related to the likelihood of WI: tumor stage (p =.044), previous chemotherapy (p =.008), duration of preoperative hospital stay (p = 022), permanent tracheostomy (p =.00008), and hypopharyngeal and laryngeal cancers (p =.008). CONCLUSIONS: Despite antibiotic prophylaxis, WI occurrence is high. These data inform the head and neck surgeon, when a patient is at risk for WI and may help to design future prospective studies.     

Experience with percutaneous titanium implants in the head and neck: a clinical and histological study

Percutaneous implants have been associated with numerous problems. However, by using skin-penetrating, bone-anchored titanium implants, developed by Professor Br?nemark at the Department of Anatomy, University of G?teborg, good long-term results have been observed. These implants have been in clinical use for anchorage of bone-conducting hearing aids and facial prostheses since 1977 and 1979, respectively. The total number of implants is approximately 700. Less than 4% of the observations have shown significant irritation. Biopsies from 33 patients were collected for histological studies. In the irritated skin there was an increased number of inflammatory cells, mainly polymorphonuclear cells, B-cells, and plasma cells but not T-cells. This suggests a response directed against exogenous agents rather than an allergic reaction against the implant per se.