Patency and caliber of the internal jugular vein after neck dissection

OBJECTIVE: To determine the incidence of thrombosis and change in caliber of the internal jugular vein after neck dissection. PATIENTS AND METHODS: Between September 1999 and December 2000, we studied 68 patients who underwent 76 neck dissection that spared the internal jugular vein. Thrombosis of the internal jugular vein was determined using duplex Doppler scans. The examination was performed about 10 days after the operation. Preoperative and postoperative imaging was available for 28 patients who underwent 32 neck dissections after April 2000. These 28 patients were divided into three groups. Group 1 consisted of 5 internal jugular veins which were treated with supraomohyoid neck dissection. Group 2 included 17 internal jugular veins which were treated with functional neck dissection. For group 3, ten patients underwent simultaneous bilateral neck dissections that spared the ipsilateral internal jugular vein with concurrent contralateral radical neck dissection. For each group, the mean ratio of the post- to pre-operative caliber of the internal jugular vein was calculated. Measurements were planned for 7 days, 1 month, and 3 months postoperatively. RESULTS: The overall patency of the 76 internal jugular veins after neck dissection was 100%. In all groups, the mean ratio of the post- to pre-operative caliber of the internal jugular vein was lowest during the early postoperative period, and gradually increased within 3 months after surgery. CONCLUSION: The caliber of the internal jugular veins decreased the most during the early postoperative period; however, internal jugular vein thrombosis is uncommon.     

Merkel cell carcinoma of the auricle

Merkel cell carcinoma is a rare, although increasingly recognized, malignant tumor of the skin. The most common site of occurrence is the head and neck (50%). Only five cases of this tumor on the auricle have been reported previously. We present a further such case. The incidence, clinical features, diagnosis, prognosis, and treatment of the Merkel cell carcinoma are discussed. Received: 21 August 2000 / Accepted: 18 September 2000     

Castleman’s disease (giant lymph node hyperplasia) of the neck: a case report

Castleman’s disease (giant lymph node hyperplasia) is an uncommon cause of neck mass. Its cause and pathogenesis are still unknown. Giant lymph node hyperplasia (GLH) usually presents as an asymptomatic solitary mass and can occur anywhere in the head and neck. Diagnostic test results are always inconclusive. Excision and histopathological evaluation are the only ways to make a definitive diagnosis. The disease is curable by surgical excision. A case of GLH presenting as a solitary neck mass in a 68-year-old man is reported. There has been no recurrence during about 7 months. Received: 25 May 1999 / Accepted: 7 September 2000     

头颈部非霍奇金淋巴瘤25例临床分析

目的：探讨25例头颈部非霍奇金淋巴瘤(NHL)的临床表现、分期、分型及治疗方法。方法：对我院2000年3月-2004年4月间治疗的25例头颈部NHL进行回顾性分析。结果：25例中,首犯咽淋巴环11例,鼻腔8例,鼻窦1例,颈淋巴结4例,腮腺1例。鼻腔、鼻窦已有3例死亡。结论：根据头颈部NHL的首犯部位、肿瘤分期、组织学分型进行恰当的治疗,可提高治愈率。     

In the case of "difficult" tracheotomy

Difficulties from open surgical procedures are common. The severity and frequency of these occurences depends on several factors: anatomic, physiologic, kind of local patology and skills and experience of operator. The incidents of undesires outcomes during tracheostomy can not be exactly predictet because interactions of the above issues. This paper consider some of difficulties observed in our department from January 2000 to July 2007. Tracheotomy is usssually a safe procedure, but complication ranging could be high in the following conditions: morbid obesy, a short and thick neck, cervical stiffness, tumors and infiltrantions of the neck, thyroid gland tumors.     

Treatment of neck nodes after induction chemotherapy in patients with primary advanced tumours

Responsiveness of neck nodes to induction chemotherapy often differs from that of the primary tumour. We have conducted a retrospective study to evaluate the results of treating the neck in a cohort of 350 patients with locally advanced (T3–4) head and neck carcinomas treated with radiation therapy at the primary location of the tumour after induction chemotherapy. One hundred and thirty-nine patients (40%) did not have neck nodes on diagnosis (N0). The treatment of the neck included surgery in 65 patients. Neck dissections were carried out before radiotherapy in 37 patients and after radiotherapy in 28 patients. The frequency of neck treatment failure was 24%. There was a tendency to better neck control when treatment included neck dissection, independently of the neck stage or response to chemotherapy. This tendency was statistically significant in patients with an advanced regional tumour (N2–3) who did not achieve a complete regional response after chemotherapy. In a multivariate analysis the variables that were related to the regional failure were the relapse of the tumour at the primary site, the neck stage (N), the type of treatment used in the neck, and the grade of regional response after induction chemotherapy. Our results lead us to suggest that after induction chemotherapy neck surgery is advisable in all cases with advanced regional disease (N2–3), independently of the grade of response achieved after induction chemotherapy, and is also advisable in N1 patients in whom induction chemotherapy does not achieve a complete response. Received: 27 December 1999 / Accepted: 6 June 2000     

Sentinel node biopsy for oral and oropharyngeal squamous cell carcinoma of the head and neck

OBJECTIVES: The aims were to assess the technical feasibility of sentinel node biopsy (SNB), to validate SNB against elective neck dissection, and to report the results of the clinical application of the SNB concept for early oral and oropharyngeal squamous cell carcinoma. STUDY DESIGN: Prospective consecutive cohort analysis. METHODS: Between 2000 and 2006, a total of 79 patients were included. Lymphatic mapping consisted of preoperative lymphoscintigraphy and intraoperative use of a hand-held gammaprobe. Twenty-eight patients were assessed for feasibility and validation; the SNB was done in context with an elective neck dissection. Fifty-one patients were evaluated in an observational trial; elective neck dissection was performed only in case of positive SNB. RESULTS: Validation revealed a sentinel node detection rate by lymphoscintigraphy of 93%, with the gammaprobe of 100%. The negative predictive value of a negative SNB was 100%. During the observational trial 40% of the patients were upstaged as a result of a positive SNB. Intraoperative frozen section analysis showed a negative predictive value of 83%. Two patients (6%) with negative SNB experienced a neck recurrence, the negative predictive value of SNB was therefore 94%. Patients with positive SNB were treated successfully with elective neck dissection. CONCLUSIONS: SNB is technically feasible and reproducible with a high sentinel node detection rate. Validation against elective neck dissection revealed a negative predictive value of 100%. Application of the SNB concept in clinical practice was very successful. The recurrence rate within the neck was very low and the morbidity and cost of an elective neck dissection could be spared to 60% of the patients.     

Head and neck pilomatricoma in the pediatric age group: a retrospective study and literature review

OBJECTIVE: To discuss the clinical course and management of pilomatricoma involving the head and neck in the pediatric age group and to review the literature. METHODS: Retrospective analysis of the author's case files between the years of 1996 and 2000, revealed seven cases of head and neck pilomatricoma involving children. A literature review was employed to compare this study to others. RESULTS: In all cases, the presenting sign was a superficially located rock-hard mass in the head and neck. The mean duration the mass was present at the initial otolaryngologic evaluation was 11 months. There was a total of seven patients of which five (71%) were female while two (29%) were male. Each patient presented with a single pilomatricoma. Five (71%) occurred in the neck while two (29%) occurred in the face. All were treated with surgical excision. There were no recurrences. CONCLUSION: Pilomatricoma is a rare, benign, skin neoplasm that is superficially located and most commonly occurs in the head and neck, thus otolaryngologists should be aware of its clinical presentation. Although malignant transformation has been described, it is exceedingly rare. Diagnosis is usually suspected based on palpation of a superficial, rock-hard mass and confirmed by histopathologic examination. Since this neoplasm doesn't spontaneously regress, surgical excision is both curative and the treatment of choice. Recurrence is rare.     

Pleomorphic adenoma of the pterygopalatine fossa: a case report

Pleomorphic adenoma (PA) is the most common benign tumor of the major salivary glands. It can also occur in the minor salivary glands, mainly in the oral cavity, and in other sites in the head and neck region. We present a very rare case of PA in the pterygopalatine fossa. Surgical resection of the tumor was performed via the transmaxillary approach. The patient has experienced neither surgical complications nor recurrence in the past 3 years. This case suggests that a localized benign tumor in the pterygopalatine fossa can be removed safely and efficaciously via a transmaxillary approach. Received: 8 February 2000 / Accepted: 18 May 2000     

吻合血管的双游离瓣技术在大型头颈部缺损修复中的应用

目的 分析双游离瓣技术在大型头颈部缺损修复中的应用价值。方法 对2000年3月～2002年1月期间完成的33例利用双游离瓣行大型头颈部缺损修复的病例作回顾性研究，分析所采用游离瓣的类型、受区血管、游离瓣成活情况及术后并发症的发生情况，并分析有可能影响游离瓣成活的各种因素。结果 33例患者中23例采用腓骨瓣 前臂瓣，6例采用腓骨瓣 腹直肌皮瓣，4例采用前臂瓣 腹直肌皮瓣；除1例采用串联瓣的形式外，其余32例患者的两块游离瓣均采用不同的受区血管，其中14块游离瓣采用了对侧颈部的受区血管；66块游离瓣中，1块腓骨瓣和1块腹直肌皮瓣因静脉栓塞而失败，其余的64块瓣均成活；受区和供区总的并发症发生率为39．4％(13／33)，但大多数并发症均不严重，没有造成严重的后果。结论 大型头颈部缺损的双游离瓣修复安全可靠，能较好地恢复患者的外形和功能，提高了患者的生存质量。     

Effectiveness and pitfalls of elective neck dissection in N0 laryngeal cancer

The aim of the study was to evaluate the efficacy and potential pitfalls of selective neck dissection of levels II-IV in controlling occult neck disease in clinically negative neck (cN0) of patients with laryngeal squamous cell carcinoma. Charts of 96 consecutive cN0 laryngeal cancer patients undergoing 122 neck dissections at the University of Florence from January 2000 to December 2004 were reviewed. N0 neck was defined with contrast enhanced computed tomography scan. Occult neck disease rate was 12.5%, involvement per level was: 47.6% at level II, 38.1% at level III, 9.5% at level IV. Six patients developed neck recurrence (6.25%) after selective neck dissection of levels II-IV within the first two years after treatment. In conclusion, selective neck dissection of levels II-IV is effective in N0 laryngeal squamous cell carcinoma; posterior limits of surgical resection are missing therefore if post-operative radiation is required, the field should be extended beyond the dissected levels. The low incidence of occult neck disease indicates the need to refine treatment strategy, restricting elective neck dissection only to supraglottic T2 with epilaryngeal involvement, supraglottic T3-4 and glottic T4 tumours, and considering a "wait and see" protocol implemented with imaging techniques and cytological assessments for other lesions.     

Deep neck infection with dental origin: analysis of 85 consecutive cases (2000-2006)

CONCLUSIONS: Diagnostic work-up should include contrast-enhanced computed tomography (CT) and mandible orthopantogram. When a dental origin of deep neck infection is suspected, the intravenous antibiotic regimen has to be active against gram-positive bacteria, both aerobes and anaerobes. Surgical exploration and drainage may be mandatory at presentation, or in cases not responding to medical therapy within the first 24 h. OBJECTIVES: Deep neck infections are still associated with significant morbidity and mortality rates when complications occur. Despite worldwide improvement in dental care and oral hygiene, a significant prevalence of deep neck infections caused by dental infections has been described recently (> 40%). PATIENTS AND METHODS: We analysed retrospectively 85 cases of deep neck infection with dental origin out of 206 consecutive cases of deep neck infection diagnosed in our institution between 2000 and 2006. RESULTS: The most frequent dental source was a periapical infection of the first mandibular molar, followed by second and third molar, respectively. Submandibular space infection involvement was diagnosed in 73 of 85 patients (85.9%), masticatory space infection in 28 (32.9%); in 56 patients (65.9%) the infection involved more than one space. Twenty-four patients (28.2%) were treated only with intravenous antibiotic therapy; 61 patients (71.8%) required both medical and surgical procedures.     

Management pathways and the surgical diagnosis of tuberculous lymphadenitis: can they be improved? The Bradford experience

OBJECTIVE: To study the diagnostic pathway for tuberculous lymphadenitis from initial referral to the commencement of antituberculous therapy with the object of identifying potentially avoidable delays. DESIGN: Retrospective case series study. SETTING: District General Hospital, England, UK. SUBJECTS: Thirty-four patients with head and neck tuberculous lymphadenitis diagnosed by a positive histological specimen over the 3-year period 1998-2000. RESULTS: There were no clear pathways for referral and management. There were substantial variations in the management between different specialties and even sometimes within the same specialty. There was evidence of poor communication between various teams. CONCLUSIONS: The study shows that for the management of head and neck tuberculous lymphadenitis, there is a need for a 'hospital' or 'trust' approach. It also reinforces the arguments for a dedicated 'neck lump clinic' with easy access both from the general practitioners and from other specialties within the hospital and for a protocol for handling biopsy specimens from nodes.     

Interest of the cervical gland dissection after radiotherapy with or without chemotherapy

OBJECTIVES: The aim of this study was to evaluate the necessity and morbidity of neck dissection after radiation therapy within organ preservation treatment. PATIENTS AND METHODS: We present a retrospective study of 64 patients, treated initially by radiotherapy with or without chemotherapy for squamous cell carcinoma of head and neck with cervical metastases (> 2 cm), who underwent post-radiation neck dissection between January 1992 and August 2000. Eight (13%) patients were classified T1, nineteen (30%) T2, twenty (31%) T3, eleven (17%) T4 and six (9%) Tx. Eleven patients had N1 neck disease (17%), fifteen patients N2a (24%), eleven patients N2b (17%) and twenty-seven patients N3 (42%). RESULTS: Follow-up ranged from 3 to 86 months with a mean of 39 months. The average length of time between neck dissection and the end of treatment was 60 days. Complications were recorded in 21 patients (33%). Forty-four (68%) of 64 patients had microscopic residual disease. Eight (72%) of 11 patients with N1 neck disease and 17 (63%) of 27 patients with N3 neck disease had pathology. Initial N status was not a predictive factor of microscopic residual disease (p = 0.51). There was no significant relationship between clinical residual adenopathy and microscopic residual disease (p = 0.53). Fourteen patients are still alive without recurrent disease. Eight (57%) of these 14 patients had a positive pathology at the time of neck dissection. The mean follow-up time of these patients is 32.6 months, with a follow up longer than 2 years for half of them (n = 7). CONCLUSION: Neck dissection after radiation was planned for all patients with an initial node > 2 cm in diameter regardless of clinical response in the neck. We confirm that neck dissection appears to be safe after radiotherapy and is necessary because it improves quality of life and prevents fatal evolution with uncontrollable neck disease.     

Incidental association of thyroid carcinoma and squamous cell carcinoma of head and neck

PURPOSE: This study was carried out to address the dilemma of managing incidentally associated squamous cell carcinoma of the head and neck and thyroid carcinoma. MATERIALS AND METHODS: The patient group consists of 229 consecutive cases of squamous cell carcinoma of the head and neck and who were treated surgically at the Uludag University School of Medicine Department of Otolaryngology over a four-year period between 1997 and 2000. RESULTS: Among these patients, 3 had additional thyroid papillary carcinoma metastases (1.3%, 3/229) within the surgical specimens of the surgical procedures performed for squamous cell carcinoma of the head and neck. Complementary thyroidectomy was recommended but could not be performed in one of three cases because of the patient's refusal, and the primary focus of thyroid carcinoma could be found in only one of these two cases who had undergone complementary thyroidectomy. All three patients received postoperative radioactive iodine and thyroid hormone suppression, and all are free of disease after 49, 46, and 19 months of follow-up, respectively. CONCLUSIONS: Management of thyroid carcinoma found incidentally during treatment of squamous cell carcinoma of the head and neck is still debatable, and all patients must be evaluated individually with regard to its benefit. Our limited experience suggests that total thyroidectomy may not be regarded as mandatory in managing these patients.     

Role of planned postchemoradiotherapy selective neck dissection in the multimodality management of head and neck cancer

OBJECTIVE/HYPOTHESIS: To assess the oncologic efficacy and functional outcome of selective postchemoradiotherapy neck dissection for stage IV head and neck squamous cell carcinoma. METHODS: Retrospective review of patients with N2-3 cervical metastases at presentation who underwent planned neck dissection after complete biopsy-proven clearance of primary site mucosal disease with chemoradiotherapy between 2000 and 2006. RESULTS: There were 31 males and 10 females. The average age at presentation was 57 +/- 9 years. The oropharynx was the most common primary site (n = 23; 56%). Forty-nine hemineck dissections were performed, including six bilateral and two revision procedures. Sixteen (39%) patients had residual viable postchemoradiotherapy neck disease. Patient weight did not deteriorate after neck dissection (P > .4). Two patients had persistently worsened postoperative swallowing. Ten patients required shoulder physiotherapy, of whom eight were treated with conservative measures. Five-year hemineck disease control and disease-specific survival rates were 92% and 64%, respectively. Presence of viable postchemoradiotherapy neck disease was the only independent predictor of regional control (P < .001; hazard ratio 0.00; 0.00-0.40) and disease-specific survival (P < .02; hazard ratio 0.23; 0.04-0.55). Surgery was twice more likely to confer therapeutic benefit than to cause a significant, albeit in most cases, transitory, complication. CONCLUSIONS: Neck dissection is a safe and effective procedure and a necessary component of the multimodality management of all head and neck cancer patients with N2-3 disease. It should be performed soon after satisfactory demonstration of primary site disease clearance. Universal deployment of radical surgery appears unnecessary and should, when possible, be abandoned in favor of more selective procedures to lessen morbidity.     

Risk of coronary artery disease is not linked to head and neck cancers: a population‐based retrospective cohort study

Clin. Otolaryngol. 2012, 37 , 369–375 Objectives: To explore the possible association between the risk of coronary artery disease and head or neck cancer based on some possible shared risk factors and/or treatment‐related complications. Design and setting: A population‐based retrospective cohort study. Participants: All new 729 patients with head and neck cancer diagnosed between 2000 and 2003 were followed up till 2009, and the risk of subsequent coronary artery disease was calculated. For each patient, the risk was calculated in 4 age‐and sex‐matched population controls. Matching was not possible for factors including socio‐economic group and smoking. Main outcome measures: Cox’s proportional hazard regression analysis was conducted to estimate the relationship between head or neck cancer and risk of coronary artery disease. Results: For patients with head or neck cancer, the overall risk for developing coronary artery disease was almost the same as that of the control group [adjusted hazard ratio (but without control for some lifestyle factors): 0.95; 95% confidence interval: 0.65–1.35]. Overall, we found no increased risk of coronary artery disease for patients with head or neck cancer when the data were categorised either by treatment methods or by cancer subsites. Conclusions: This population‐based study indicated that patients with head or neck cancer were at no higher risk of developing coronary artery disease than was the general population over a 6‐ to 9‐year period; however, we cannot exclude the risk over a longer period of time.     

Sarcomatoid carcinoma of the pyriform sinus with brain and subcutaneous metastases: an unusual metastatic spread pattern

A 63-year-old man presented a polypoid tumor in the laryngeal space involving the right pyriform fossa. The patient underwent a total laryngectomy with bilateral functional neck dissection, and the diagnosis of sarcomatoid carcinoma with malignant fibrous histiocytoma-like stroma was established. The tumor showed an uncommon behavior, with distant metastases to the brain and to the subcutaneous tissue of the abdominal wall. The patient died 1 year after the development of the metastases. Despite its polypoid pattern of growth, sarcomatoid carcinoma of the larynx may behave very aggressively. It is important for clinicians to be aware of the possibility of distant subcutaneous and brain metastases in sarcomatoid tumors of the laryngeal space. If such metastases develop, the prognosis is ominous, with an average life expectancy of 3 months. Received: 3 March 2000 / Accepted: 6 April 2000     

Synovial cell sarcoma: diagnosis,treatment, and outcomes

OBJECTIVES/HYPOTHESIS: Synovial cell sarcoma is a mesenchymal tumor predominantly of the lower extremities. Three percent of cases arise in the head and neck region. It is thought that head and neck synovial sarcoma has a better prognosis than tumors of the extremities. Our experience has demonstrated aggressive behavior of this neoplasm in the head and neck. This compelled us to compare our experience with other studies. STUDY DESIGN: Retrospective chart review. METHODS: We obtained the records of patients diagnosed with head and neck synovial sarcoma from the Tumor Registry of the University of Louisville School of Medicine (Louisville, KY) and affiliated hospitals for data compiled between January 1990 and December 2000. Data on patient demographics, clinical findings and symptoms, histological findings, treatment, extent of disease, recurrence, and survival were recorded. The literature was reviewed identifying reports of synovial cell sarcoma. RESULTS: Five consecutive patients with synovial cell sarcoma were assessed at our facility. The median patient age was 28.2 years. All of the patients underwent an aggressive primary surgical excision followed by irradiation. All patients received chemotherapy after recurrence. Four of the five patients had local recurrence, and all five of the patients developed distant metastases. Three of the patients have died, and two are alive with evidence of disease. Novel sites are reported including the ethmoid sinus and the parotid gland. This group demonstrated a 40% 5-year overall survival, which was lower than the 60% 5-year survival reported in the literature for all sites. CONCLUSIONS: Synovial cell sarcoma of the head and neck is a disease of young people and carries a poor prognosis. The aggressive nature of the disease may require modification of accepted treatment modalities and sequence.