A review of 23 patients with tuberculosis of the head and neck

Objective: to review the clinical features and management of tuberculosis of the head and neck and to identify those features which may aid diagnosis. Design: retrospective study. Setting: teaching hospital, England, UK. Subjects: Twenty-three patients with tuberculosis of the head and neck diagnosed by culture of specimens obtained by fine needle biopsy (n = 8) or by open biopsy of the lumps in the neck (n = 15) who presented between 1990 and 1993. Main outcome measures: methods of diagnosis and management. Results: thirteen of the 23 patients (57%) presented with either a fluctuant mass or a discharging sinus in the neck. Nine (39%) had uncomplicated enlarged lymph nodes and 12 (55%) had systemic symptoms. The supraclavicular region was the most common site (n =11) and 8 of these 11 had abnormalities in the chest radiograph. In 3 patients the disease was resistant to treatment with standard antituberculous treatment. Conclusions: atypical mycobacterial lymphadenitis is usually resistant to standard antituberculous treatment, so it is essential to obtain a microbiological diagnosis. Excision is usually the treatment of choice for such patients.     

A re-evaluation of the importance of disc position in temporomandibular disorders

During the 1970s there was a resurgence of interest in disc displacement as being central to the pathology of internal derangement. Since then it has been proposed that a displaced disc can result in pain, mandibular dysfunction, degenerative joint disease and mandibular growth disturbances. Two decades later, and with the introduction of sophisticated investigations and treatment modalities, doubts have emerged as to true pathological significance of disc position. Evidence derived from clinical observations, autopsy material, imaging studies and surgical findings has failed to establish strong support for the central role of disc displacement in internal derangement of the temporomandibular joint.     

Aggressive variants of papillary thyroid carcinoma

A number of histologic variants of well‐differentiated papillary carcinoma have been found to be associated with more aggressive tumor behavior. Tall cell, columnar cell, diffuse sclerosing, solid/trabecular, and insular variants of well‐differentiated papillary thyroid cancer are all potentially more aggressive than conventional papillary thyroid cancer. When subjected to multivariate analysis, however, evidence that the histologic subtype of tumor is an independent predictor of outcome is weak. Rather, the aggressive variants tend to present with features recognized by other staging systems as associated with a worse prognosis, including higher histologic grade, extracapsular spread, large tumor size, and the presence of distant metastases. Prognosis is directly related to the presence of these features. The state of our knowledge is limited by the relatively small number of cases that have been studied. The presence of an aggressive variant of papillary carcinoma should alert the surgeon that he is dealing with a potentially aggressive tumor. Clinical treatment decisions should be based on the stage of the disease, influenced by the knowledge that the aggressive variants tend to be associated with higher risk factors. The surgeon must be prepared to perform at the first, or second stage, a total thyroidectomy, central compartment neck dissection, additional lymphadenectomy, and/or resection of invaded surrounding structures, and search for distant metastasis. Postoperative radioactive iodine should generally be administered for these variants as they will generally be intermediate to advanced tumors. The tall cell variant is often refractory to such treatment but may be susceptible to treatment targeted against BRAF mutation. External beam irradiation may be used in cases of incomplete resection. © 2010 Wiley Periodicals, Inc. Head Neck, 2011     

Central compartment dissection in laryngeal cancer

We report here a review of the literature intended to clarify the nomenclature and boundaries of the nodes in the “central compartment” of the neck, the frequency with which tumors from the different laryngeal sites metastasize to these nodes, and the indications for central compartment node dissection in the treatment of cancers of the larynx. From this review, we conclude that, until consensus is reached about grouping of the lymph nodes in this area, it is best to refer to these nodes by their anatomic location, ie, prelaryngeal, pretracheal, or paratracheal lymph nodes. It is also advisable to describe dissection of these nodes as selective neck dissection (SND) with an annotation about the specific lymph node groups removed. Metastases in prelaryngeal and paratracheal lymph nodes in patients with squamous cell carcinoma of the larynx are associated with increased tumor recurrence, more frequent metastases in lymph nodes of the lateral compartment of the neck, and decreased survival. If untreated, they may lead to the development of peristomal recurrence. Therefore, elective treatment of level VI nodes is recommended in patients with squamous cell carcinomas of the subglottic region, advanced glottis carcinomas with subglottic extension, and in certain advanced carcinomas of the supraglottic region. © 2010 Wiley Periodicals, Inc. Head Neck, 2011     

Recent advances in head and neck surgical oncology

In recent years, the field of head and neck oncology has witnessed a remarkable transformation with unprecedented advances that have revolutionized the management of complex tumors in this region. As an intricate subspecialty within oncology, head and neck surgical procedures demand detailed knowledge of the complex anatomy meticulous precision in surgical technique, and expertise to preserve vital functions while ensuring optimal oncological outcomes. With the relentless pursuit of improved patient outcomes, the integration of innovative technologies has significantly enhanced the surgical armamentarium. Robotics, endoscopic platforms, and image-guided navigation have revolutionized the surgical approach, enabling precise tumor resection and sparing healthy tissues. Furthermore, the application of advanced imaging modalities and molecular biomarker profiling has opened new avenues for personalized treatment strategies. From targeted therapies and immunotherapies to adaptive radiation techniques, clinicians are now equipped with an array of tailored options, ushering in a new era of personalized care for patients with head and neck malignancies. This article delves into the unfolding narratives of clinical triumphs, exploring the transformative potential of emerging therapies and the collaborative efforts propelling head and neck surgical oncology toward a future of hope and healing.