Computed tomography of head and neck malignancies

This article briefly describes the clinical features of the most common malignant neoplasms of the head and neck region. The diagnostic approach and contribution of computed tomography is discussed. CT is presently considered the method of choice in noninvasive evaluation of these neoplasms.     

Clinical Spectrum of Trauma at a University Hospital in Nigeria

Background and Objectives: Data on trauma in Nigeria requires updating just as trauma care needs coordination and organization. This study was done to examine the clinical spectrum of trauma and to propose measures for organization of trauma care. Patients and Methods: A 2-year prospective report of an ongoing trauma research is presented. Data obtained from September 1999 to December 2000) include name, age, sex, presenting diagnosis at the accident and emergency (A and E) unit, injury-arrival time, ode of transportation of patients to the hosptial, and the outcome of care. Results: Trauma patients comprised 2,913 of the 4,164 (70.0%) surgical patients seen in the A and E but 129 of 171 deaths (75.4%). Types of trauma were lacerations (585 patients, 20.1%), fractures (542, 18.7%), head injury (250, 8.6%), multiple injuries (249, 8.6%), burns (159, 5.5%), and others. Road traffic accidents (RTA) occurred in 1,816 patients (62.3%), falls in 308, assaults in 258, burns in 159, home accidents in 122, gunshot injuries in 107, industrial accidents in 73, and foreign body injuries in 70. There was no pre-hospital care. Transport to the A and E was done by relations, the police and a few Good Samaritans. Most of the patients reached the hospital in < 6 h. Common mortalities were from head injury (37 patients, 28.7%), multiple injuries (35, 27.1%), fractures (12, 9.3%), and burns (9, 7.0%). Of 106 deaths with timed records, 22 (20.7%), 56 (53.0%) and 28 (26.3%) occurred in 0–1 h, > 1–24 h and > 24 h, respectively. Conclusions: The spectrum of trauma is predominantly RTA-related, hence, trauma care organization would include prevention of RTA, organization of pre-hospital care aimed at transport time of < 2h, training volunteers from the populace and the police as emergency medical services technicians for resuscitation during transport and getting patients to hospital in optimal state, and an enhanced in-hospital care by designation and categorization of hospitals. These strategies, including continuous trauma research and funding, would go a long way in reducing mortalities from trauma, especially from RTA. Received: May 24, 2002; revision accepted: October 23, 2002 Correspondence Address Babatunde A. Solagberu, MD, MB, FWACS (Ortho), FICS, P. O. Box 4377, 240001 Ilorin, Nigeria, Phone (+234/31) 22-6474, -2067, ext. 168, 241, Fax -0020, e-mail: basolagberu@yahoo.com     

Skin malignancy of the head and neck in Calabar, Southern Nigeria

Squamous cell carcinoma (SCC) is the most common malignant skin tumour in sub-Saharan Africa in contrast to Caucasians in whom basal cell carcinoma (BCC) is most frequent. We evaluated all patients with a histologic diagnosis of skin malignancy of the head and neck presenting to the University of Calabar Teaching Hospital, Calabar from January 2005 through December 2008. This was compared with total skin malignancy during the same period. Seventy patients presented with skin malignancy during the study period. The 15 patients with lesions located on the head and neck accounted for 21% of skin malignancy seen during the same period. SCC 7 (46%) ranked first while the second was Kaposi sarcoma (KS), 4 (27%), all human immunodeficiency virus seropositive. Others were BCC 3 (20%) and dermatofibrosarcoma protuberans in one patient. They ranged in age from 21–65 years (mean 33.3 years) with seven males and eight females. The seven albinos (SCC-6, BCC-1) accounted for 47% of skin malignancy. Albinism no solar radiation, immunosuppression (KS) were identified risk factors. Implementation of public education strategies such as prevention, early identification, and treatment would improve prognosis.     

Retropharyngeal lymph node metastases in head and neck malignancies

Retropharyngeal lymph node (RPLN) metastasis of primary head and neck cancer often receives less consideration than lymph node metastasis in the neck. With improvements in imaging techniques and reports of surgical pathology, there is an improved understanding of the risk and subsequently the need for treatment of RPLNs. The rates of RPLN metastasis from carcinomas of the nasopharynx, oropharynx, hypopharynx, postcricoid region, maxillary sinus, and cervical esophagus are sufficiently high to warrant routine treatment, either electively or therapeutically, of this region. Through improved diagnostic techniques and heightened awareness of RPLN metastasis, patients at risk of having these metastases can be treated more effectively. © 2010 Wiley Periodicals, Inc. Head Neck, 2010     

Nutritional concepts in the treatment of head and neck malignancies

Cancer cachexia should no longer be a contraindication to adequate antineoplastic treatment. Current methods of nutritional assessment allow one to identify malnutrition and to follow the nutritional status of the patient throughout the cancer-management program. Enteral nutritional repletion and maintenance remain the ideal course of action, but the gastrointestinal tract is not always readily available or advisable for use; in such circumstances, intravenous hyperalimentation (IVH) may be indicated. The properly nourished patient better tolerates cancer therapy, experiences fewer complications of malnutrition (e.g., sepsis and poor wound healing), and has a better-functioning immune system than does his malnourished counterpart. This article reviews methods of nutritional assessment, delineates indications and techniques for nutritional repletion, and summarizes the results obtained.     

Percutaneous endoscopic gastrostomy in patients with head and neck malignancies

One hundred thirty-six percutaneous endoscopic gastrostomies (PEGs) were placed in 126 patients with head and neck malignancies. PEG was performed by the "push" technique described by Russell. There were 140 PEG attempts, with 136 successful placements (97%). Seven complications occurred related to tube placement (5% of placements). Complications encountered were prolonged ileus in one patient (1%), local skin wound infection in one patient (1%), and early tube dislodgment in five patients (4%). Three patients required laparotomy (2%). There were no episodes of aspiration and no deaths. Patients were followed up for an average of 11 months, with a mean duration of PEG tube placement of 6 1/2 months. Patients continued PEG feedings throughout the postoperative radiotherapy period and until oral intake was satisfactory. Acceptance of PEG feedings has been high. No patient required rehospitalization for nutritional support.     

Testicular cancer in children and adolescents in Ibadan,Nigeria

Thirty-five testicular neoplasms diagnosed over a twenty-year period in Nigerian children up to the age of twenty years were analyzed. Burkitt lymphoma was the most common cause of testicular neoplasm, while germ cell tumors formed the bulk of non-Burkitt neoplasia (72 per cent). Shortage of testicular germ cell tumors in adult males may account for the over-all low frequency of tumors of the testis in Nigerian Africans.     

Nutrition management of patients with malignancies of the head and neck

The importance of nutrition and the prognostic impact of malnutrition in patients with head and neck cancer are not fully appreciated in the surgical world where a pervasive attitude exists that weight loss during treatment is inevitable and nutritional expertise or intervention may be dismissed out of ignorance. In this article, the authors explore the nutritional requirements of these patients and the impact of a multidisciplinary therapeutic approach to head, neck, and skull base cancer care.     

Radiofrequency coblation for the resection of head and neck malignancies.

OBJECTIVE: To review the safety and efficacy of the use of radiofrequency coblation for endoscopic resection of upper aerodigestive tract malignancies and to compare length of procedures using coblation with CO(2) laser surgery. STUDY DESIGN AND SETTING: A retrospective case-note review of 40 adult patients with endoscopically treated mucosal squamous cell carcinoma of the head and neck, 20 having undergone resection using radiofrequency coblation and being case-matched to 20 treated with CO(2) laser. RESULTS: Coblation proved to be an effective method for resection of selected head and neck malignancies. It allows for much faster resection times than the CO(2) laser (P = 0.017) especially in the oropharynx (P = 0.007), but the large probes currently available can cause problems in assessment of adequate resection margins. CONCLUSIONS: Although current probe design limits the potential for resection of some tumors, radiofrequency coblation appears to be an attractive evolving technique for the endoscopic resection of selected upper aerodigestive tract malignancies.     

Indications for hyperalimentation in the treatment of head and neck malignancies

Patients with cancer of the head and neck are often malnourished when first seen by the treating physician. Often, oncologic therapeutic techniques of surgical intervention or radiotherapy or chemotherapy (or combinations thereof) compound this poor nutritional state. Proper evaluation of the patient's nutritional status and the anticipated metabolic stress of the treatment chosen can allow the physician to select the optimal method of nutritional repletion.