Analysis of Treatment Results for Floor‐of‐Mouth Cancer

Objective This study reports the results of treating floor‐of‐mouth cancer with five different treatment modalities with long‐term follow‐up. Study Design Retrospective study of 280 patients with floor‐of‐mouth cancer treated in the Department of Otolaryngology—Head and Neck Surgery at Washington University Medical School (St. Louis, MO) from 1960 to 1994. Methods Patients with biopsy‐proven squamous cell carcinoma of the floor of mouth who were previously untreated were treated with curative intent by one of five modalities and were all eligible for 5‐year follow‐up. The treatment modalities included local resection alone, composite resection alone (with neck dissection), radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow‐up parameters were studied using standard statistical analysis to determine statistical significance. Results The overall 5‐year disease‐specific survival (DSS) was 56% with death due to tumor in 44% of patients. The 5‐year cumulative disease‐specific survival (CDSS) was 0.61 (Kaplan‐Meier probability) with a mean of 8.3 years and a median of 9.7 years. The DSS by treatment modality included local resection (76%), composite resection (63%), radiation therapy (43%), local resection with radiation therapy (61%), and composite resection with radiation therapy (55%). Overall, there was no significant difference in DSS by treatment modality. Recurrence at the primary site (41%) was the most common site of treatment failure. Nineteen percent of patients had recurrence in the neck. Eighty‐eight percent of initial recurrences occurred within 60 months after the onset of treatment. Metastasis to a distant site occurred in 30% of patients. Twenty percent of these patients had second primary cancers, and 53% of these patients died of their second primary cancers. Conclusions Significantly improved 5‐year DSS was seen in the patients with clear margins, early clinical tumor stage, and negative nodes. Significantly decreased 5‐year survival was seen in the patients with involved margins, advanced clinical tumor stage, positive nodes, and tumor recurrence. Patients with no clinically positive nodes (cN0) can be observed safely for regional nodal disease and subsequent positive nodes can be treated as they occur with no adverse affect on survival. Because of high recurrence rates at the primary site and neck, and an increased rate of both distant metastasis and the development of second primary cancers, patients should be monitored closely for a minimum of at least 5 years.     

Sudden deafness: long‐term follow‐up and recurrence

We examined the long‐term outcome for patients with idiopathic sudden sensorineural hearing loss (sudden deafness), including the incidence of recurrence of sudden deafness. The subjects were 1798 individuals who came to Nagoya University hospital within 2 weeks of the onset of unilateral sudden deafness. Only 14 of the patients had a history of being diagnosed with sudden deafness. After their visit to our hospital, one patient had a recurrence in the ipsilateral ear and four patients experienced sudden deafness in the contralateral ear. We performed hearing examinations on 88 patients who revisited our hospital more than 10 years after unilateral sudden deafness. Of these patients, there was one with a recurrence in the ipsilateral ear and one with sudden deafness in the contralateral ear. Thus, in this series the recurrence of sudden deafness was rare.     

Detection of paranasal ectopic adrenocorticotropic hormone‐secreting pituitary adenoma by Ga‐68‐DOTANOC positron‐emission tomography–computed tomography

Ectopic adrenocorticotropic hormone (ACTH)‐secreting tumors account for approximately 10% of Cushing's syndrome (CS). We present an extremely rare case of a patient with CS caused by an ectopic ACTH‐secreting pituitary adenoma (EAPA) of the ethmoid sinus. The tumor was identified by positron‐emission tomography–computed tomography (PET/CT) using the somatostatin receptor analogue Ga‐68‐DOTANOC. Transnasal endoscopic resection was performed and the patient showed significant clinical improvement with normalization of the endocrine pituitary axis. Immunostaining showed a somatostatin receptor 2 and 5‐positive ACTH‐producing adenoma. In patients with ectopic ACTH secretion, Ga‐68‐DOTANOC‐PET/CT may play an important role in the localization of EAPA. Transnasal endoscopic resection is the therapy of choice.     

HLA‐DRB1, ‐DQA1, and ‐DQB1 Genotypes in Patients With Nasal Polyposis

Objectives/Hypothesis Genetic etiology is suspected in the development of nasal polyposis on the basis of familial aggregation. This study investigated whether there is an association between HLA‐DRB1, ‐DQA1, and ‐DQB1 alleles and developing nasal polyposis. Study Design Data from 50 polypectomized patients were compared with data from 50 healthy randomly selected controls. Polyp score, possible asthma, aspirin sensitivity, and ASA triad were also recorded. Methods Genotyping of HLA‐DRB1 alleles was carried out with the Dynal RELI SSO HLA‐DRB, a direct DNA probe test that utilizes a polymerase chain reaction (PCR) and nucleic acid hybridization for the differentiation of 70 HLA‐DRB alleles and 9 supertypes. For DQA1* genotyping PCR‐RFLP (restriction fragment length polymorphism) was used, differentiating eight alleles. The DQB1* typing was carried out using a INNO‐LiPA DQB PCR‐reverse hybridization kit, allowing the discrimination of 30 alleles. Results People carrying the HLA‐DR7‐DQA1*0201, and ‐DQB1*0202 haplotype were found to have a two to three times higher odds ratios (ORs) for developing the disease, compared with controls. Patients with ASA triad carried the above‐mentioned DR7 allele with the linked alleles significantly more often (P < .001). Subjects carrying HLA‐DR5 allele and the linked alleles had lower odds ratio values. Conclusion These results underline that allergy is not conditional for the formation of nasal polyps as thought before. Nasal polyposis associated with asthma and aspirin sensitivity is probably a unique form of nasal polyps. The authors plan further investigations in this field.     

Comparison of two T‐classification systems for sino‐nasal carcinoma

It is often difficult to determine the actual site of origin of tumours originating in the sino‐nasal region, and a uniform classification system that covers all tumours in this area is warranted. A retrospective series of 165 consecutive patients with sino‐nasal carcinoma, treated and followed at the Aarhus University Hospital between 1963 and 1991, was evaluated and T‐staged according to the Lederman classification. The 80 maxillary antrum carcinomas were also staged according to the UICC 1997 system. In univariate analysis, the UICC T‐classification was prognostic for locoregional tumour control and disease‐specific survival. However, when adjusted for covariates (gender and nodal involvement) in a multivariate analysis, the UICC classification was not a significant independent prognostic parameter. In contrast, the Lederman T‐classification was prognostic both in univariate and multivariate analysis. The Lederman T‐classification was more prognostic for locoregional control and disease‐specific survival than the UICC TNM classification. In addition, the Lederman classification is easy to use and has a broader applicability as it covers all sites in the sino‐nasal area.     

End‐to‐Side Venous Anastomosis With an Anastomotic Coupling Device for Microvascular Free‐Tissue Transfer in Head and Neck Reconstruction

Objective: The purpose of this study is to demonstrate the success rate of using a coupling device for end‐to‐side venous anastomosis in patients undergoing free‐tissue transfer (FTT) in head and neck reconstruction. Methods and Measures: Retrospective data were collected in consecutive series of 134 patients undergoing surgical resection of head and neck tumors followed by FTT. All microvascular FTTs were performed at Yale‐New Haven Hospital between November 2001 and August 2007. The Unilink coupling device was used to perform arterial and venous anastomosis in this case series. Flap survival and thrombosis of the venous anastomoses were determined. Results: One hundred thirty‐four consecutive patients underwent a total of 137 microvascular FTTs using a coupling device. In our series, a total of 173 end‐to‐side anastomoses were completed in 96 patients. Of these, 77 patients had both venous anastomoses, 17 underwent one end‐to‐side and one end‐to‐end anastomoses, and two patients had one venous anastomosis per patient performed in end‐to‐side fashion. Reconstruction included 76 radial forearm, 17 fibula, and three rectus abdominis free flaps. There were three vascular insufficiency related complications of which two were salvageable. There was one case of flap failure (1%), resulting in a free flap survival rate of 99%. Conclusion: This largest reported series of end‐to‐side venous anastomoses with an anastomotic coupling device demonstrates feasibility and efficacy of this technique in head and neck reconstruction.