A 3-year study of supraomohyoid neck dissection and modified radical neck dissection type I in oral cancer: with special reference to involvement of level IV node metastasis

The present study was undertaken to determine the pattern and incidence of predictable lymphatic spread and skip metastasis in oral cancer and analyze the prognostic implications of different therapeutic modalities in the neck metastases. The study includes 81 patients with squamous cell carcinoma of oral cavity with T1-2N0M0 and T1-3N1-3M0 who were admitted to the Department of ENT and Head and Neck Surgery, SMS Medical College and Hospital, Jaipur, from June 2006 to May 2008. After complete diagnostic evaluation (imaging, FNAC), all these patients were operated (wide primary excision with SOHND/Extended SOHND/MRD-I) and followed up periodically till date. Occult metastasis was found in 26% of the patients. Level I, II, III was most commonly involved. We did not find any metastasis or recurrence at level IV in N0 cases. Involvement of level IV node in N0 and N+ neck were 0 and 9%, respectively. We did not find any “skip metastasis” at level IV in oral cancers. We concluded that SOHND for N0 and MRND type I for N+ neck for oral cancers is an appropriate treatment.     

借鉴分区性颈清扫操作技术切除颈部非肿瘤病变13例

目的探讨分区性颈清扫技术在颈部非肿瘤病例中的应用。方法借鉴分区性颈清扫技术对颈部非肿瘤病变进行切除,其中有脓肿型或溃疡型颈淋巴结核5例、复发鳃裂瘘管7例、颈部肿物经切取活检后形成囊肿1例。所有病例均采取整块切除病变组织。结果颈清扫技术有利于彻底清除与周围组织粘连紧密、分界欠清、范围较广、并且常规治疗效果欠佳的病变。本组病例未出现副神经和喉返神经损伤、切口愈合不良等并发症。术后随访5个月至2年均未见复发。结论参照分区性颈清术的手术技术处理复发型第2、3鳃裂瘘管和有脓肿（≥3cm）或瘘管形成的颈淋巴结核,可取得较好的临床疗效。     

Manifestation of malignant lymphoma of the head and neck with special reference to the salivary glands

We found that thirteen per cent of all head and neck malignomas are malignant lymphomas. In 75% of these cases the Non-Hodgkin type could be found. The major salivary glands were involved by the lymphoma in 55% out of 104 patients. Paraglandular lymph nodes of the parotid gland were affected as well as intraglandular lymph nodes and the lymphoid tissue within the gland proper. The submandibular gland normally shows an involvement only with its paraglandular lymph nodes. Two thirds of the Non-Hodgkin lymphomas located in the salivary glands were low-grade. In case of clinical suspicion of a malignant lymphoma, fine needle biopsy is required for cytological diagnosis. However, surgery is mandatory for histological diagnosis, not as a therapeutic measure.     

Simple laryngeal suspension procedure by suturing the digastric muscle to the periosteum of the mandible in neck dissection for tongue cancer

Purpose

In this article, a simple, new laryngeal suspension procedure is described. The effect of hyoid bone suspension by suturing the digastric muscle to the periosteum of the mandible is analyzed.

The conservation neck dissection

This study compares the neck tumor recurrence rate between patients treated with radical neck dissection and those treated with conservation neck dissection. A standard radical neck dissection modified by sparing at least the internal jugular vein or the spinal accessory nerve is defined as a conservation dissection. Six hundred ninety-one neck dissections performed on 631 patients in the Department of Otolaryngology-Head and Neck Surgery of the University of Illinois College of Medicine at Chicago were reviewed retrospectively. All patients had been followed postoperatively for at least 24 months. Group I consisted of 422 radical neck dissections. Group II contained 269 conservation neck dissections. We found no statistically significant difference in the rate of neck recurrence between the group of patients who underwent radical neck dissection and the group who underwent conservation neck dissection.     

Subacute hypoglossal nerve paresis with internal carotid artery dissection

OBJECTIVES: To describe a case of an isolated hypoglossal nerve palsy in a patient with a spontaneous internal carotid artery dissection (ICAD). This condition is a well-recognized cause of cerebral ischemic stroke in patients younger than 45 years of age. Isolated cranial nerve neuropathy is a rare presentation. More common manifestations include incomplete hemiparesis, hemicrania, Horner syndrome, cervical bruit, pulsatile tinnitus, and multiple cranial nerve palsies. METHODS: A comprehensive literature search (Ovid, MEDLINE) for the presentation, diagnostic evaluation, treatment, and outcome of patients with internal carotid artery dissection was performed. RESULTS: A 43-year-old man presented with a 3-week history of mild dysarthria. There was no history of craniocervical trauma. The physical examination revealed an isolated left hypoglossal nerve paresis. Magnetic resonance imaging and angiography findings were consistent with a left skull base ICAD. The patient was successfully treated with anticoagulation therapy. The current rate of cranial nerve involvement is estimated at 10% of all ICADs. This is the second report of isolated hypoglossal nerve palsy without hemicrania in a case of atraumatic ICAD. CONCLUSIONS: Patients with an ICAD infrequently present to the otolaryngologist because of its head and neck manifestations. It is crucial to recognize atypical findings and to perform an accurate and prompt diagnostic evaluation. The foundation of treatment is aggressive anticoagulation, with surgical or radiologic intervention reserved for cases demonstrating life-threatening progression.     

Quality of life of patients with malignant tumors of the head and neck area with special reference to laryngectomy patients

BACKGROUND: Quality of life is an important factor for patients with cancer in the head and neck region. This factor has not often been investigated in such patients. METHODS: A series of 201 patients with head and neck cancer answered a questionnaire concerning quality of life in general. In addition various parameters of quality of life were rated by an observer such as the Karnofsky scale, the WHO-status and the Spitzer quality of life index. RESULTS: The patients were subdivided into 3 groups, 101 patients with laryngeal cancer, 70 with pharyngeal cancer and 30 others ENT-cancer patients. Patients with cancer of the pharynx had more physical problems. In addition the patients were in different stages of their tumor disease. The patients with cancer in UICC I/II had a better health and quality of life than UICC III/IV. 75% of the whole population spoke about their quality of life as good and better. A similar tendency of quality of life was found in the groups of laryngeal cancer. The indices for health and quality of life in the patients were strongly correlated to the Karnofsky scale, the WHO-status and the Spitzer quality of life index. CONCLUSIONS: The study suggests that it is necessary to measure quality of life variables in head and neck cancer patients. All of the different methods are important for the measurement of quality of life.     

Mucosal malignant melanomas of the head and neck with special reference to cases having a prolonged clinical course.

A histological re-examination and re-classification of primary mucosal tumours of the head and neck region, treated at Radiumhemmet and Karolinska Sjukhuset during the period 1927-1970, revealed that 41 tumours were malignant melanomas. All these 41 tumours were located in the nasal cavity, paranasal sinuses and oral cavity and not a single case of primary mucosal malignant melanoma was found in other locations of the head and neck region. In the present study, the long-term prognosis has been analysed. The follow-up period was at least 5 years and ranged up to 48 years. It was found that mucosal malignant melanomas had a very poor prognosis with a five year survival rate of 17% (7 of the total 41 cases) and a ten year survival rate of 7% (3 of the total of 41 cases). The unpredictability of the clinical behaviour of this tumour type is elucidated by cases with a prolonged clinical course despite a primary relatively limited surgery, repeated local recurrences and regional lymph node metastases in an early stage of the disease. Thus, there is always a never-ceasing risk of death in the tumour disease when once a malignant melanoma has occurred. For this reason a meticulous and lifelong follow-up of tumour patients is stressed, and also the value of repeated surgery of local recurrences and regional lymph node metastases.     

Isolated hypoglossal nerve palsy due to internal carotid artery dissection

A case of an isolated hypoglossal nerve palsy is reported. The differential diagnosis is discussed, in the context of the requirement for careful scrutiny of the entire course of the hypoglossal nerve on imaging, to detect underlying pathology remote from the tongue, and to avoid unnecessary invasive diagnostic procedures prompted by the appearance of a 'pseudomass' of the weak tongue both clinically and radiologically.