头颈部淋巴水肿的诊治进展

头颈部淋巴水肿(HNL)多继发于头颈肿瘤治疗后，症状、体征缺乏特异性，相较于乳腺癌、宫颈癌治疗后继发性淋巴水肿的肿胀程度稍轻。然而，由于头颈部解剖位置的特殊性，其对患者外观、感觉、运动，乃至心理的长期影响较为严重。目前，临床医生对HNL关注较少，缺乏足够的认识，诊治手段及流程尚不规范，且没有完善的诊疗指南用于指导医疗工作，有待学界进一步探究。本文就近年国内外对HNL的诊治进展进行综述，旨在进一步明确HNL的诊治方式。     

Leiomyosarcoma of the head and neck: a review of the literature and report of two cases.

Two cases of leiomyosarcoma involving structures of the head and neck area are added to the 29 cases recorded in the English literature since 1950. Review of the diagnosis, histological appearance, behavior and management of the tumor suggests that wide local excision is the therapy of choice. Radical neck dissection is indicated for metastatic nodal disease.     

Three-dimensional high-resolution volume rendering (HRVR) of computed tomography data: Applications to otolaryngology—head and neck surgery

Conventional computed tomographic display formats are not optimal for demonstrating three-dimensional anatomic relationships. In otolaryngology—head and neck surgery these critical relationships are often highly complex, and their complete understanding is essential to a successful surgical outcome. A new computer-generated image display format, high-resolution volume rendering (HRVR), facilitates the understanding of these critical anatomic relationships by transforming conventional imaging data into clinically relevant 3-D images. Unlike many other 3-D reconstruction algorithms, HRVR suffers minimal data loss in the conversion process, which in turn provides for superior image resolution. This better allows the application of 3-D technology to small or complicated anatomic structures such as those frequently encountered in otolaryngology—head and neck surgery. Advances in computer-controlled manipulations that further enhance the evaluation of desired pathologic features have been achieved. This pilot study contains representative clinical cases chosen to illustrate the potential utility of HRVR in otolaryngology—head and neck surgery. The authors believe HRVR images will enhance the surgeon's understanding of the 3-D anatomic relationships that exist between critical pathologic features and surrounding vital structures.     

Regional anesthesia and invasive techniques to manage head and neck pain

Regional anesthesia of the head and neck is an effective method of obtaining surgical anesthesia for various procedures. Diagnostic and therapeutic head and neck blocks can also assist with the diagnosis and management of many chronic pain conditions, including headache, postherpetic neuralgia, and cancer pain in this region. Gamma knife surgery offers a unique approach to the management of refractory trigeminal neuralgia. Because of the proximity of so many critical structures adjacent to these nerves, a solid understanding of the anatomical basis of these nerve blocks is necessary. Appropriate patient selection, monitoring, proper injection technique, knowledge of the pharmacokinetics and pharmacodynamics of local anesthetics and vasoconstrictors, possible drug interactions, and recommended doses will ensure safe and successful application of head and neck nerve blockade.     

Head drop syndrome secondary to multimodality treatments for head and neck cancer

Five patients under follow‐up for head and neck squamous cell carcinoma (SCC) at Southern General Hospital Glasgow presented with a fixed flexion deformity of the neck. These cases are characterized by the onset of severe weakness and atrophy of the neck extensor muscles and anterior fibrosis forcing the mandible to the chest wall. This causes considerable morbidity with communication, feeding, and appearance. This is a rare complication with no curative treatments that has not been reported previously by a UK center and is likely to become important with the increased use of multimodality treatments for head and neck SCC.     

Management of head and neck burns.

Successful treatment of acute head/neck burns requires assessment and protection of the airway, prevention of further injury to damaged surface structures, and timely and diligent debridement and wound closure. Rehabilitation methods and modalities help to preserve function and control scarring. Reconstructive surgery should be designed to improve function and appearance, primarily by correction of the skin/tissue defect which healed by scar contracture. Thoughtful timing and application of logical surgical principles offer the opportunity of recovery to a level better than merely acceptable.     

Liposarcoma of the tongue: case report and review of the literature

Liposarcoma is the most common soft-tissue malignancy in adults, but the appearance of a liposarcoma in the head and neck region is distinctly unusual. Intraoral liposarcomas represent a particularly interesting subset of this tumor in that (1) they are exceedingly rare and (2) affected patients tend to have a better prognosis than do patients with a similar lesion located elsewhere in the head and neck. An understanding of the histologic subtypes and corresponding clinical behavior of liposarcomas will assist physicians in appropriately managing these patients. Most of these tumors can be effectively treated with conservative surgery. We report the rare case of a well-differentiated liposarcoma arising in the tongue of a 55-year-old man. We also discuss the typical pathologic findings in these malignancies and review the diagnosis, associated controversies, management, and prognosis.     

Head and neck teratomas in children: a case series

Teratomas of the head and neck due to their obscure origin, bizarre microscopic appearance, unpredictable behaviour and often dramatic clinical presentation are a clinical surprise. This article focuses on pediatric head and neck teratomas and on their diversity and rarity and also reviews the recent terminology of this group of tumours.     

Psychosocial aspects of head and neck cancer–a review of the literature

Review: Psychosocial aspects of head and neck cancer–a review of the literature This study is a systematic analysis of the literature on psychosocial aspects in head and neck cancer patients. Patients with head and neck cancer experience a variety of physical as well as psychosocial problems. Physical problems include swallowing or chewing, speech and physical appearance. Psychosocial problems include anxiety, depression, loss of self-esteem and uncertainty about the future. Because of these problems, isolation from friends typically occurs, re-employment is difficult, and there are social and sexual tensions within families. Information and support by professionals, partners and/or fellow patients are related to positive rehabilitation outcomes such as the acquisition of speech, increases in constructive social functioning and decreases in depression.     

Opioids and their proper use as analgesics in the management of head and neck cancer patients

Opioid analgesics play an important part in the interdisciplinary management of head and neck cancer patients. Acute pain during the initial treatment period and chronic pain after treatment may be undertreated by head and neck surgeons because of unwarranted fear of the opioid side effects and toxicities. Properly used, opioid analgesics are among the safest and most effective medications in the armamentarium of the head and neck surgeon. Knowledge of opioid pharmacology can help surgeons treat pain aggressively in patients while managing side effects and toxicities. This understanding can also address the unique problems in pain management presented in head and neck cancer patients attributable to the involvement by the disease of the aerodigestive tract, which interferes with the oral route of administration of opioid analgesics. Significant difficulties in the use of opioid analgesics arise when the patient is a substance abuser. This article discusses the basic principles of opioid pharmacology, discusses opioid use in head and neck cancer patients, and provides guidelines on the use of opioids in the substance abuser.     

Fracture of the clavicle following radical neck dissection and postoperative radiotherapy: a case report and review of the literature

The treatment of head and neck cancer with radiotherapy and radical neck dissection has many recognized complications. Radiotherapy in therapeutic doses can produce devascularization and weakening of bone. Radical neck dissection results in altered mechanics of the shoulder girdle and a disruption of normally balanced forces acting on the clavicle. An unusual case of clavicle fracture which is considered to have resulted from an interaction of the effects of these therapies is discussed. An approach for recognizing and distinguishing this entity by its time course, and radiographic and nuclide bone scan appearance is presented.     

Occupation and cancer of the oral cavity, pharynx and larynx

There is increasing evidence of an association between occupational factors and head and neck cancer. The present paper reviews the most relevant epidemiological studies published within the last 30 years. Generally these studies indicate an increased cancer risk for "blue collar workers" exposed to dust or inhaled organic and inorganic agents. Moreover, the increased risk of head and neck cancer in most studies persists after adjustment for alcohol and tobacco consumption. More detailed, clinically orientated studies are necessary to provide a better understanding of the role of occupational factors in head and neck cancer.     

A new method of 3-dimensional reconstruction of the head and neck

In the past decades the development of MRI has significantly increased the importance of diagnostic imaging of head and neck lesions. The standard imaging method is based on two-dimensional slices. The present study was performed to evaluate the diagnostic value of 3D MRI-reconstructions for head and neck lesions. The 3D reconstruction method and the results of the 3D-reconstructed images are presented. Important aspects of the interesting structures can be evaluated much more easily with reconstructed images than by mentally reconstructing two-dimensional slices. In the light of the present results, 3D reconstruction promises to be an accurate method for the diagnosis of head and neck lesions and might be of clinical importance in the future.     

Muscle flaps in the head and neck.

Muscle flaps about the head and neck have signficant application in reconstruction and rehabilitation following radical ablative surgery. Nine such flaps are reviewed and the uses, advantages, and disadvantages in three major muscle falps cited. Their main applications include: 1) augmentation of a regional deficiency and preparation of a bed for skin grafting; 2) rehabilitation of the paralyzed face and so improved appearance in repose and animation; 3) protection for vital vascular structures such as the carotid or innominate artery; and 4) assistance in mastication and deglutition when transposed to a paralytic or deficient area.     

The psychosocial care needs of patients with HPV-related head and neck cancer

Patients with head and neck cancer (HNC) suffer disproportionate psychosocial distress because of the nature of the tumor site, the possible impact on facial appearance and function, and the symptom burden resulting from treatment. Unmet psychosocial needs can negatively impact many aspects of care, from compliance to successful survivorship. This article reviews the challenges that patients with HNC confront throughout the disease trajectory from diagnosis to treatment, recovery, and long-term survivorship. It also provides a framework for understanding psychosocial adjustment and quality of life both for the general population of patients with HNC, and those with human papillomavirus-related diagnoses.     

Psychosocial aspects of head and neck cancer--a review of the literature

This study is a systematic analysis of the literature on psychosocial aspects in head and neck cancer patients. Patients with head and neck cancer experience a variety of physical as well as psychosocial problems. Physical problems include swallowing or chewing, speech and physical appearance. Psychosocial problems include anxiety, depression, loss of self-esteem and uncertainty about the future. Because of these problems, isolation from friends typically occurs, re-employment is difficult, and there are social and sexual tensions within families. Information and support by professionals, partners and/or fellow patients are related to positive rehabilitation outcomes such as the acquisition of speech, increases in constructive social functioning and decreases in depression.     

Chemodectomas of the head and neck.

Chemodectomas of the head and neck are reviewed. Their clinical picture, frequent multicentric origin, microscopie and macroscopic picture are discussed as well as their roentgenologic appearance. The role of angiography in their diagnosis is emphasized.     

Hemangiopericytoma of the head and neck

PURPOSE: To report a series of patients with hemangiopericytoma (HP) of the head and neck, to review pathological features of these tumors, and to discuss management options. MATERIALS AND METHODS: A retrospective review of the medical records at the University of California, Los Angeles (UCLA) Medical Center in Los Angeles, CA, was done in order to identify those patients with primary HP of the head and neck, including soft tissue and mucosal sites. RESULTS: Ten patients with HP of the head and neck were identified. There was an equal sex distribution and an average age of 36 (range 10-65). Seven of the tumors arose from soft tissue sites in the head and neck, and the remaining 3 arose from the mucosa. All patients underwent wide excision of the primary lesion with a local recurrence rate of 40%. Thirty percent of patients developed metastatic lung disease 0 to 8 years after initial diagnosis. Each patient who developed metastatic disease had abundant mitoses on pathological review compared with rare or absent mitoses in the lesions that took a more benign course. CONCLUSIONS: Pathological appearance of resected HP is predictive of later metastatic potential. Long-term follow-up is necessary in patients even after radical resection because recurrence or metastasis may be delayed by many years.     

Immunohistochemical localization of keratin in head and neck neoplasms and normal tissues

Immunohistochemical localization of keratin antigens using keratin antisera and the immunoperoxidase technique have been shown to be helpful in identifying certain epithelial cells. Our study was designed to evaluate the application of this technique to head and neck neoplasms and normal tissues using two keratin antibody preparations. Our data indicate that the keratin antibodies stained normal epithelial structures in the head and neck except for cells with active secretory functions such as mucus, cerumen, or salivary secretion. Neoplasms of the head and neck showed keratin antibody staining for epithelial neoplasms and negative staining for mesenchymal neoplasms. The immunohistologic demonstration of keratin is useful in distinguishing undifferentiated or poorly differentiated epithelial malignancies from sarcomas or lymphomas and demonstrating myo-epithelial cells in salivary neoplasms.     

Head and neck cancer: causes,prevention and treatment

Although head and neck carcinoma ranks fifth among cancer types, patient survival rates have not changed significantly over the past years.ObjectiveTo determine the risk factors, causes, therapies, and prevention measures for head and neck cancer.MethodRisk factors, causes, therapies, and preventive measures for this disease were searched on databases PUBMED, MEDLINE, and SciELO.ResultsAlcohol and tobacco are still atop risk factors. Other factors may influence the development of head and neck carcinoma. Surgery is the main treatment option, and the addition of radiotherapy following surgery is frequent for patients in the early stages of the disease. Other therapies target specific genetic molecular components connected to tumor development. Disease preventive measures include smoking cessation, limiting alcohol intake, preventing exposure to tobacco smoke and environmental carcinogenic agents, early detection of infection by HPV, maintaining oral health, good eating habits, and managing stress.ConclusionAdditional research is needed for a more thorough understanding of the development of head and neck carcinomas and to shed light on new ways to improve therapeutic approaches and interventions.