摘要:

AbstractThe technical and professional issues that affect the clinical utility of intraoperative frozen section diagnosis in head and neck surgery are addressed from a quality assurance perspective. The most common reasons for sampling errors and interpretive errors are discussed. We offer several recommendations for head and neck surgeons and pathologists which will optimize the clinical utility of intraoperative frozen section consultation.

ISSN:1043-3074    

DOI:10.1002/hed.2880150502

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

年代:1993

数据来源: WILEY

摘要:

AbstractThis retrospective study describes patients with locoregionally metastasized melanoma of the head and neck. All patients underwent a therapeutic lymph node dissection. The 3‐year survival rate was 35%. Duration of disease‐free interval, number of lymph nodes involved, and extent of neck dissection proved of no influence on survival rates. Locoregional recurrence occurred in 10 patients and always proved to be a sign of systemic dissemination. Ultimately, 19 patients developed systemic disease. More than 40% developed cerebral metastases and the cerebrum was the second most involved site. As cerebral involvement occurs often in head and neck melanoma, a computed tomography or magnetic resonance imaging scan of the brain is recommended in the routine work‐up before lymph node dissection. Furthermore, because the extent of the surgical procedure had no influence on local recurrence rate and overall survival, a selective approach, preserving functional structures, is advo

ISSN:1043-3074    

DOI:10.1002/hed.2880150503

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

年代:1993

数据来源: WILEY

摘要:

AbstractWe assess the impact of radiotherapy in the treatment of laryngeal cancer and evaluate the value of the standard dose (linear quadratic plus time model) and other variables to predict tumor control and survival. Between 1972 and 1989, 80 patients with laryngeal cancer received comprehensive radiotherapy. Patients with stage I laryngeal glottic cancer (T1‐NO‐MO) were excluded from this study. Mean follow‐up was 15 months (range 4 to 181). The mean age was 64.8 years (range 40 to 92). Standard dose varied from 32.65 to 81.81 Gy (mean 66.78). The 5‐year overall survival and tumor‐specific survival rates were 44.9 ± 5.8% and 51.4 ± 5.9%, respectively. Five‐year local control and locoregional control rates were 66.4 ± 5.7% and 61.9 ± 5.8%, respectively. Multivariate analysis showed that local control was significantly predicted by T stage (p=.032), but not by standard dose (p=.906). Independently significant factors predicting tumor‐specific survival included stage (p=.006), site (p=.019), and age (p=.001). Local control and survival were significantly predicted by the TNM‐staging classification. The standard dose did not predict local rec

ISSN:1043-3074    

DOI:10.1002/hed.2880150504

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

年代:1993

数据来源: WILEY

摘要:

AbstractBetween 1978 and 1991, 56 microvascular composite flaps were used for oromandibular reconstructions: 15 for primary total and subtotal tongue reconstruction and five for secondary major tongue reconstruction. The delayed reconstructions were performed to improve the oral and pharyngeal phases of swallowing. Using a floor of the mouth composite bone grafting technique to reposition the tongue and obliterate the oral dead space intraoral food transport was improved (three of five patients), but aspiration persisted (three of four patients). When compared with 10 patients evaluated for primary total and subtotal tongue reconstruction the primary reconstruction group showed superior swallowing (eight dynamic oral transport, no aspiration) and speech results. The poor results of secondary reconstruction are attributed to scarring and irreversible damage to remaining functional muscles involved in protecting the laryngeal aditus.

ISSN:1043-3074    

DOI:10.1002/hed.2880150505

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

年代:1993

数据来源: WILEY

摘要:

AbstractPrevious studies of laryngeal cancer have shown a decrease in the male‐to‐female ratio and that the sex ratio in glottic tumors is higher than that for other laryngeal sites. The purpose of this study was to characterize and identify changes in the demographics, laryngeal site predilection, geographic distribution, trends in tumor stage at diagnosis, and surgical caseload distribution in Colorado. The Colorado Central Cancer Registry for the years 1979 to 1990 was reviewed for cases of laryngeal cancer. The data were analyzed using chi‐square and gradient‐in‐proportions methods. One‐thousand two‐hundred sixty‐five (1265) cases were identified with a male‐to‐female ratio of 4.3:1. There was a significant trend of an increasing proportion of cases attributable to women. Glottic carcinoma accounted for 50.1% of cases, with a male‐to‐female ratio of 7.6:1. The Denver metropolitan area accounted for 57% of all cases, which was not disproportionate to the population. From 1981 to 1990 there was a significant decrease in the proportion of stage I cases and an increase in stage II cases. The teaching hospitals associated with the University of Colorado were responsible for performing 44.5% of all surgery for laryngeal cancer. The results indicate that laryngeal cancer in Colorado shares similar epidemiologic characteristics to those reported in other studies. Of most concern is the increasing proportion of women with laryngeal cancer and the decrease in cas

ISSN:1043-3074    

DOI:10.1002/hed.2880150506

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

年代:1993

数据来源: WILEY

摘要:

AbstractThe results of surgical treatment and causes of failure in 109 patients with squamous cell carcinoma of the hypopharynx were analyzed. The 5‐year survival was significantly related to the stage of the disease (stage I, 74%; stage II, 63%; stage III, 32%; and stage IV, 14%) and the preoperative nodal staging (NO, 57%; N1, 28%; N2, 6%; and N3, 0%), but not related to the extent of tumor resection. The local control rate was 86% and the majority of the local recurrences occurred at the upper resection margin. There was no significant difference in the local recurrence rate between those patients who had pharyngolaryngoesophagectomy and those who had pharyngolaryngectomy. However, the resection‐associated complications (bleeding, cardiac arrhythmia, pulmonary complications) were more frequent when total esophagectomy was performed. Reconstruction‐associated complications such as wound infection and anastomotic leakage occurred less often after gastric pull‐up reconstruction as compared with the use of myocutaneous flap, but was associated with more serious outcome after pharyngogastric anastomosis. Thirty‐seven patients (34%) had neck node recurrences and these were significantly related to the preoperative nodal staging (NO, 20%; N1 37%; N2, 48%; and N3, 83%). Additional primary cancers occurred in 17% of the patients and was a significant cause of death in those patients who survived more tha

ISSN:1043-3074    

DOI:10.1002/hed.2880150507

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

年代:1993

数据来源: WILEY

摘要:

AbstractA phase II clinical trial was initiated in 1987 to evaluate a new induction regimen ofcis‐platinum, 5‐fluorouracil, and leucovorin (PFL) for patients with stages III–IV squamous cell carcinoma of the head and neck. Ninety patients were treated and followed for a median duration of 18 months. The median age was 55 and 87% of the patients had stage IV disease. The rates of complete and overall clinical response following three cycles of PFL were 57% and 80%, respectively; the rate of complete response at the primary site was 72%. Eighty‐four percent of patients were treated to the primary site with radiation alone (median dose 68 Gy in daily 1.8‐Gy fractions) irrespective of the location of the primary site or initial T‐stage. The acute tolerance to full‐course radiation following PFL was acceptable. The actuarial rate of primary site control for patients treated, with radiation was 67% at 36 months. An important prognostic indicator for primary site control was a complete clinical response to induction PFL. For patients who achieved a complete response, radiation or surgery followed by radiation controlled primary site disease equally well at 70%. Patients with a partial response did less well. For these patients, surgery and radiation appeared slightly better than ra

ISSN:1043-3074    

DOI:10.1002/hed.2880150508

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

年代:1993

数据来源: WILEY

摘要:

AbstractThis study examined the effects of three swallow maneuvers: (1) the supraglottic swallow (voluntary closure of the vocal folds prior to the swallow); (2) the super‐supraglottic swallow (airway closure at the level of the arytenoid to base of epiglottis); and (3) the Mendelsohn maneuver (voluntary prolongation of laryngeal elevation and cricopharyngeal opening during swallow) on swallow functioning in a 47‐year‐old patient who underwent right composite resection for a squamous cell carcinoma of the right retromolar trigone. All maneuvers were employed during the same videofluorographic (VFG) swallow study conducted 6 months after the patient's surgery. Biomechanical analysis of 3‐mL swallows defined the extent and timing of tongue base retraction to the posterior pharyngeal wall, laryngeal elevation, laryngeal closure and cricopharyngeal opening during swallows with and without maneuvers. Airway closure duration was prolonged during supraglottic and super‐supraglottic swallows, but aspiration was not eliminated. Use of the Mendelsohn maneuver improved coordination and timing of pharyngeal swallow events, including timing of posterior movement of the tongue base to the pharyngeal wall in relation to airway closure and cricopharyngeal opening, with elimination of aspiration. The Mendelsohn maneuver compensated for anatomic and physiologic changes in the oropharyngeal swallow and enabled reinstatement of safe oral intake in this surgically treated head and neck cancer patient who was previously unable to take nutriti

ISSN:1043-3074    

DOI:10.1002/hed.2880150509

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

年代:1993

数据来源: WILEY

摘要:

AbstractIdentification of prognostic factors in squamous cell head and neck cancers involves analysis of highly diverse clinical and biological parameters. This study analyzed the prognostic value of clinical variables (age, sex, tumor site, stage) and biologic parameters (squamous cell carcinoma antigen [SCC], serum thymidine kinase activity [TK], fibrin, sedimentation rate [SR]) at the time of diagnosis of squamous cell carcinoma of the head and neck (oral cavity, oropharynx, hypopharynx) in 189 patients. Among the clinical variables investigated, UICC stage III–IV disease (p<.0002), a hypopharyngeal site (p<.02), and age over 60 years (p<.01) were all associated with a poor prognosis. Similarly, analysis of biological blood variables allowed definition of cut‐off values above which the prognosis was poor: SCC 2.5 ng/mL (p<.01), fibrin 3.5 g/L (p<.01), TK 7 IU/L (p<.0005), and SR 15 mm per first hour (p<.0000). Cox regression analysis of overall survival identified the UICC stage (p<.000), the SR (p<.001), and serum TK (p<.02) as the main independent prognostic factors. A separate study on a small number of head and neck cancer patients revealed higher TK levels in malignant squamous cell carcinoma tissue than in adjacent healthy tis

ISSN:1043-3074    

DOI:10.1002/hed.2880150510

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

年代:1993

数据来源: WILEY

摘要:

AbstractSquamous cell carcinoma is the fourth most common neoplasm in cats. As in man, local resective surgery of stage III and IV carcinoma often results in recurrence related to compromised margins. Radical resective procedures may be performed when reconstructive techniques are available to restore cosmesis and function. A platysma myocutaneous flap that was based on a cutaneous branch of the caudal auricular artery and vein was developed to fulfill this requirement. Control flaps, which included ligation and division of the caudal auricular artery and vein, were similarly developed on the contralateral aspect of the neck. Mean survival of all platysma myocutaneous flaps (86.7%), compared with control flaps (62.9%), was significantly different (p<.05). Flaps grouped in lengths of 6, 9, and 12 cm had mean survival lengths of 93.8%, 81.9%, and 84.4%, respectively. The mean survival length of flaps measuring 12 cm in length was significantly different (p<.05) compared with flaps measuring 6 and 9 cm. On the basis of the results of this study, the platysma myocutaneous flap based on a cutaneous branch of the caudal auricular artery and vein may be a source of tissue for reconstructive procedures of the head and neck in cats.

ISSN:1043-3074    

DOI:10.1002/hed.2880150511

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

年代:1993

数据来源: WILEY