摘要:

AbstractBackground.Reconstruction of tubular defects following pharyngolaryngectomy has required complicated surgery with high perioperative morbidity and mortality. Free jejunal interposition provides an excellent reconstruction with potential for lower immediate complications and better long‐term results than other procedures.Methods.A total of 201 consecutive free jejunal interpositions were performed following pharyngolaryngectomy between 1977 and 1993. Operative details, complications, and outcome were prospectively documented.Results.Perioperative mortality was low (4.5%) and microvascular success rate high (97%), although a small number of late failures were recorded. Average time until swallowing postoperatively was 11 days, and 92% of patients could maintain full nutrition. Voice rehabilitation was mentioned, and increasingly good results are being obtained.Complication rates for the neck (17%) and the abdomen (2.5%) were also low. There were no problems with excess mucus production or reflux. Radiation effect on the jejunal conduit was not detrimental to long‐term patency of the vascular anastomoses or to function as a conduit.Conclusions.Comparison with other published techniques permits the contention that a free jejunal interposition is the reconstruction of choice after pharyngolaryngectomy. © 1995 Jons Wiley&Sons,

ISSN:1043-3074    

DOI:10.1002/hed.2880170202

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Controversy exists regarding the role of a 3‐tiered grading system for mucoepidermoid carcinoma (MEC) of salivary glands in prognosis and survival. This retrospective investigation evaluated a 3‐tiered grading system modified from Healey by Batsakis and Luna and compared various clinical, pathologic, and flow cytometric parameters and overall survival among MECs of differing grades.Methods.Forty‐eight patients with 7 low‐grade (LG), 23 Intermediate‐grade (IG), and 18 high‐grade (HG) MECs of parotid (n= 43) and submandibular (n= 5) glands were studied. Data were analyzed using categorical statistics (Wilcoxon, Kruskal‐Wallis and Chi‐squared tests where appropriate).Results.Mean ages were 42 years for patients with LG tumors; 47 years, IG; and 59 years, HG (p= 0.02). Gender ratio (p<0.001) changed from female predominance in LG (6 F:1 M) and IG (2.1 F:1 M) to male predominance in HG (3.5 M:1 F). Mean tumor stage was 1.4 LG, 2.4 lG, and 3.6 HG (p<0.005). Tumor size increased from 2.1 cm for LG to 3.8 cm for HG (p= 0.01). Margins were involved by tumor in 0% LG, 44% IG, and 61% HG (p<0.001). Lymph node involvement was 0% LG, 22% IG, and 72% HG (p<0.001). DNA aneuploidy (DNA index1.1) was present in 0% LG, 13% IG, and 28% HG (p= 0.05). Proliferative fraction (S + G2M) was 5% LG, 7% IG, and 13% HG (p= 0.008). Radiotherapy was administered in 14% LG, 35% IG, and 61% HG (p= 0.03). Recurrences (local and/or metastatic) occurred in 0% LG, 39% IG, and 61% HG (p= 0.009). Survival was decreased significantly (p<0.0001) with increasing tumor grade (100% LG, 70% IG, and 22% HG).Conclusion.Histologic grading of mucoepidermoid carcinomas of major salivary glands, using the modified Healey 3‐tiered system, correlates well with clinical, pathologic, and flow cytometric factors which influence the prognosis and overall survival in affected individuals. © 1995 Jo

ISSN:1043-3074    

DOI:10.1002/hed.2880170203

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Merkel cell carcinoma is a relatively rare neuroendocrine carcinoma of the skin. It arises in the head and neck region in approximately 50% of cases. Its aggressive behavior predisposes patients to local‐regional recurrence and distant metastases after surgical excision alone. In this article, we describe our experience with Merkel cell carcinoma of the head and neck.Methods.Of 18 patients with Merkel cell carcinoma treated in the Department of Radiation Oncology at the University of Florida, 12 patients who had primary tumors in the head and neck region are reported. Eight patients were treated at initial diagnosis (group A), and four were treated at the time of local‐regional recurrence (group B).Results.Local‐regional control was achieved in seven of eight patients in group A and all four patients in group B. One patient in group A and all patients in group B developed distant metastases and eventually died of their disease. Bone exposure developed in one patient, requiring surgical debridement and hyperbaric oxygen treatment.Conclusion.Patients with Merkel cell carcinoma of the head and neck should be treated aggressively. Our data suggest that local‐regional recurrence is a harbinger of distant metastases. We recommend that these patients receive treatment to both the primary site and draining lymphatics at initial presentation. The role of chemotherapy remains

ISSN:1043-3074    

DOI:10.1002/hed.2880170204

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Paragangliomas of the head and neck are slow‐growing tumors that originate from neural crest cells. Between 7% and 9% of these tumors have a familial occurrence. The suspected gene for familial paragangliomas (FP) is transmitted with an autosomal dominant mode of inheritance with incomplete penetrance, and appears to exhibit genomic imprinting. It has been demonstrated by family studies that individuals who inherit the gene(s) from their father will develop the disease. Through linkage analysis, the gene(s) for FP has been postulated to be located on the long arm of chromosome 11. The discovery of many different genes has been elucidated through the cytogenetic analysis of affected individuals who carry specific chromosome aberrations. This project was designed to look for chromosome abnormalities in several second‐generation family members to further assist in the localization of the gene(s) for FP.Methods.This study involved the cytogenetic evaluation of lymphocytes, fibroblasts, and tumor cells of several second‐generation family members from a three‐generation family with FP of the head and neck to look for chromosome abnormalities generally, and for abnormalities of chromosome 11 specifically. Standard cytogenetic techniques were used for lymphocyte and fibroblast cultures. Tumor cells were cultured in a collagen matrix with F12 medium supplemented with 3% L‐glutamine and 10% fetal calf serum.Results.There were no detectable abnormalities of chromosome 11 in any of the cells. However, nonrandom abnormalities of chromosomes 5 and 7 were seen in some of the tumor cells of one FP patient. To our knowledge, this is the first article which demonstrated the ability to successfully culture FP of the head and neck. © 1995 Jons Wiley

ISSN:1043-3074    

DOI:10.1002/hed.2880170205

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Immunosuppressive prostaglandins may play a role in the biologic behavior of head and neck cancer. Increased levels of prostaglandin E2(PGE2) have been measured in squamous cell carcinoma of the head and neck (SCCHN).Methods.To address this question, tissue levels of PGE2were measured in tumor tissues, normal mucosa, and lymph nodes of 37 patients undergoing tumor resections. Tissue specimens were placed in culture media, and levels of PGE2released into the supernatant were measured by radioimmunoassay.Results.Tissue levels of PGE2were significantly greater in tumor and normal mucosal tissues compared to lymph nodes (p= 0.0003). There was no difference between metastatic and tumor‐free lymph nodes. Although tumor tissue levels of PGE2were not associated with tumor stage, increased levels of PGE2were associated with increased 2‐year disease‐free survival (p= 0.02).Conclusions.Although PGE2may have adverse effects on local immune function in tumor tissues, improved survival of patients with increased local PGE2production may be indicative of an enhanced immunologic response to the tumor which has a favorable impact on outcome. © 1995 Jons Wiley&Son

ISSN:1043-3074    

DOI:10.1002/hed.2880170206

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Nonsquamous cell malignant tumors of the nasal cavity and paranasal sinuses are an uncommon and diverse group of neoplasms. Our goal was to define the relative frequency and distribution of these neoplasms, as well as treatment and outcome.Methods.This retrospective study analyzed 106 patients with nonsquamous cell malignant neoplasms of the nasal cavity and paranasal sinuses treated at our institution between 1966 and 1982.Results.Pathology included: salivary type carcinoma (33 patients); sarcoma (25 patients); melanoma (18 patients); esthesioneuroblastoma (11 patients); lymphoma (11 patients); and anaplastic cancer (9 patients). Most tumors arose in the nasal cavity (50%), followed by the antrum (39%), ethmoidsinus (9%), and frontal sinus (2%). Fifty‐four percent of all patients were treated with surgery alone. Determinate 5‐year and 10‐year cure rates were: esthesioneuroblastoma, 70% and 50%; lymphoma, 45% and 30%; anaplastic, 33% and 25%; salivary, 31% and 18%; sarcoma, 25% and 21%; and melanoma, 19% and 0%.Conclusions.Overall survival for patients with nonsquamous cell malignant neoplasms of the nasal cavity and paranasal sinuses is poor, particularly with follow‐up extended to 10 years. Local recurrence is the major source of treatment failure. We were unable to demonstrate any survival advantage in the group of patients who received surgery and radiotherapy in combination. © 1995 Jons Wiley&S

ISSN:1043-3074    

DOI:10.1002/hed.2880170207

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.A multi‐institutional retrospective study was performed to evaluate the efficacy of the supraomohyoid neck dissection (SOHND) for detection of occult cervical metastasis in squamous cell carcinoma of the oral cavity and oropharynx.Methods.Seventy‐five previously untreated patients with clinically negative necks were studied. Seventeen (23%) neck specimens revealed occult metastatic disease, and 58 (77%) were histologically negative. Postoperative irradiation was received by 94% of the patients with positive specimens and 22% with negative specimens. Patients were followed until recurrence of neck disease, or for a period of 2 years or longer.Results.Cervical metastasis subsequently developed in 25% of treated positive specimen patients, none of the untreated positive specimen patients, 8% of the treated negative specimen patients, and 11% of the untreated negative specimen patients. The sensitivity of SOHND for cervical metastasis was 82%, negative predictive value 91%, and accuracy 94%.Conclusions.The authors conclude that SOHND is a useful procedure for detection of occult cervical metastatic disease in cancer of the oral cavity and oropharynx. © 1995 Jons Wiley&Sons,

ISSN:1043-3074    

DOI:10.1002/hed.2880170208

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Primary parapharyngeal space neoplasms are rare. Tumor distribution characteristics and long‐term outcome have been quite variable in the recent literature. We report the results of a retrospective review of 172 patients with primary parapharyngeal space neoplasms treated surgically from 1960 to 1990 at a large multispecialty clinic and teaching hospital.Methods.Initially, 195 patients seen at our institution were found to have parapharyngeal space neoplasms. Twenty‐three patients previously treated elsewhere were excluded. The remaining 172 patients (96 female and 76 male) were from 11.7 months to 91.5 years of age. All patients were treated surgically; the transparotid‐cervical approach was most widely used.Results.One hundred thirty‐seven tumors (80%) were benign and 35 (20%) were malignant. High‐resolution computed tomography or magnetic resonance imaging was essential in the diagnosis and presurgical planning. Fineneedle aspiration specimens were accurate in the diagnosis of 8 of 9 cases. Pleomorphic adenoma was the most common neoplasm (40%), followed by paraganglioma (20%), neurogenic tumor (14%), malignant salivary gland tumor (13%), miscellaneous malignant tumors (7%), and miscellaneous benign tumors (6%). Mandibulotomy was required for only 6% of all tumors; its use was reserved for malignant lesions and large skull base tumors when risk of tumor rupture was high. Recurrent or persistent disease was recorded in 27 patients with malignant tumors; of these, 24 (89%) are likely to die of disease.Conclusions.The transparotid‐cervical approach is the preferred procedure for most parapharyngeal tumors and can be combined with midline mandibulotomy for large vascular or selected malignant tumors. Recurrence after removal of pleomorphic adenomas is only 4%. Recurrent or persistent malignant disease is nearly always fatal. Perioperative mortality is zero, and morbidity is most often associated with cranial nerve neuropathy. © 1995 Jons Wil

ISSN:1043-3074    

DOI:10.1002/hed.2880170209

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Surgical resection of tumors of the cervicothoracic junction is often problematic due to the limitations imposed by the thoracic cage and adjacent neurovascular structures. The majority of surgical approaches to this region have been designed with the intent of providing adequate exposure for vertebrectomy with tumor resection and vertebral column stabilization. Theses approaches do not provide adequate exposure for a heterogeneous group of tumors which also involve the cervicothoracic junction. We used a combined cervicothoracic surgical approach to determine its efficacy in tumor resection.Method.Seventeen patients with a heterogeneous group of malignancies arising in a variety of soft tissues underwent combined cervicothoracic resection. The approach consisted of anterior cervical access, median sternotomy, and anterior thoracotomy.Results.Complete gross tumor resection was accomplished in all 17 patients, 15 of whom had negative microscopic margins. Extensive reconstruction was employed in 6 patients. Three patients received intraoperative brachytherapy implants and 5 patients received external‐beam postoperative radiotherapy. Local tumor control was obtained in 12 patients, and 10 patients are currently alive, free of disease (median: 12 months; range: 3–47 months). There was no inadvertent sacrifice of neurovascular structures. The sternoclavicular joint was maintained in all patients. There were 4 major complications, and no perioperative mortality associated with the surgical procedure.Conclusion.The combined “trap door” technique provides sufficient exposure for resection of cervicothoracic tumors. Surgery is performed with limited morbidity with the sparing of uninvolved neurovascular structures. The sternoclavicular joint was maintained in all patients. Preliminary results using this approach for resections of tumors of the cervicothoracic junction are encouraging. © 1995 Jons Wiley&S

ISSN:1043-3074    

DOI:10.1002/hed.2880170210

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractBackground.Although the literature has focused on the propensity of uveal melanoma to metastasize to the liver, little attention has been directed to its spread in regional, cervical lymph nodes.Methods.We reviewed records of 77 patients who underwent primary resection of uveal melanoma during a 15‐year period at our institution.Results.A total of only 6.5% of patients developed cervical metastasis. Factors such as age, race, sex, tumor location, and histology were not influential in identifying these patients. Tumor size and local orbital recurrence were, however, associated with a higher risk of cervical lymphadenopathy (p<0.05). Cervical metastases were also associated with the presence of distant metastatic disease.Conclusion.Neck dissection should be reserved for patients with clinically demonstrable lymphadenopathy only after distant disease has been excluded. © 1995 Jons Wiley&Sons, I

ISSN:1043-3074    

DOI:10.1002/hed.2880170211

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY