ISSN:8756-0437    

DOI:10.1002/ssu.2980110302

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractChoosing the best initial therapy for squamous carcinoma of the oral cavity depends on patient factors as well as tumor factors. The patient factors which influence the decision include the dental and nutritional status, associated diseases, use of alcohol and tobacco, distance from the hospital, and the reliability, lifestyle, occupation, and choice of the patient. The important tumor factors include size, site, histology, biologic behavior, and type of biopsy. With experience and judgment the treatment team (surgeons, radiotherapists, dentists, and medical oncologists) can use these patient and tumor factors to tailor the therapy to each individual so that not only is the cancer optimally treated, but important aspects of function and cosmesis are preserved. ©copy; 1995 Wiley‐Liss, I

ISSN:8756-0437    

DOI:10.1002/ssu.2980110303

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractModern head and neck surgery has focused on patient rehabilitation and restoration of form and function in the treatment of oral cancers. An important aspect of that process has been the conservation of the mandible in tumor ablation and the reconstruction of the mandible if segmental resection is indicated. This article outlines the science and clinical data behind rim mandibulectomy and the mandibular osteotomy and “swing” to gain access to tumors of the posterior tongues and pharynx. Additionally, the various methods of reconstruction of the mandible in use today as well as the advantages and disadvantages of each are addressed. © 1995 Wiley‐Lis

ISSN:8756-0437    

DOI:10.1002/ssu.2980110304

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractOsseointegrated implants can be used to facilitate rentention stability and support for facial and intraoral prostheses used to restore head and neck defects. Preliminary studies indicate that in nonirradiated maxillectomy patients the success rates are about 75%. In the reconstructed mandible the results appear to be more favorable—over 90% for implants placed in free nonvascularized bone grafts and over 90% for free revascularized bone grafts. Similar high success rates have been observed for most sites used to support facial prostheses. Success rates for auricular sites exceed 95% and for floor of nose sites success rates exceed 90%. Success rates have been lower (77%) for implants placed in the frontal bone for retention of orbital prostheses. Success rates for irradiated bone sites have been lower and range from 60.4% in the maxilla to 68.6% in facial bone sites. Of greater concern is that most implants placed in irradiated sites are beginning to show signs of impending failure. © 1995 Wiley‐Liss,

ISSN:8756-0437    

DOI:10.1002/ssu.2980110305

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractThe recent twenty years have brought major advances in reconstruction of pharyngoesophageal defects. Early dependence on multiple staged procedures initially were replaced by colon interposition and gastric pull‐up. Subsequent elucidation of the musculocutaneous concept has added useful techniques such as the sternocleidomastoid and pectoralis major musculocutaneous flaps. Increasing experience with microsurgical reconstruction and a larger number of flaps available have made free tissue transfer a common and reliable method of reconstruction of significant defects.The choice of reconstruction depends to greatest degree on the oncologic needs of the situation. If the entire esophagus or significant part of the thoracic esophagus is involved by tumor then total esopha‐gectomy and gastric pull‐up or colon interposition is indicated. For most hypopharyngeal and laryngopharyngeal tumors, and a significant number of cervical esophageal tumors, segmental resection of the area with the appropriate node dissection and replacement with a jejunal free autograft or radial forearm free flap gives a high likelihood of success. Thoracic musculocutaneous flaps may be useful if proper precautions are observed in the reconstructive technique. This article presents the accumulated experience with these techniques and management of the subsequent problems. © 1995 Wiley‐L

ISSN:8756-0437    

DOI:10.1002/ssu.2980110306

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractCranial base surgery is a young field of head and neck and neuro‐oncology. It deals with solid tumors at the skull base which were not previously treated with surgery. The development of new cranial base approaches incorporating intracranial exposure and new reconstructive techniques now enable an “en bloc” resection of most of these difficult tumors.In order to analyze the evolution of cranial base surgery and its contribution to the treatment of carcinomas and sarcomas, we reviewed the results reported in the literature over the past 40 years. We have designated three periods of time that reflect the advances and impact of skull base surgery and have summarized the outcomes of the major contributors in each era. The pioneers of the first period (1960s‐1970s) achieved 3‐ and 5‐year survivals of 52 and 49% while attempting resection of tumors without intracranial or pytergopalatine extension. In the second period (1970s‐1980s), improved surgical techniques allowed resection of more extensive tumors, including intracranial invasion, and 3‐year survivals rose to 57–59% with limited reports of 5‐year survivals in the range of 49%. The third period of cranial base surgery (1980s‐1990s) brought further refinement of techniques, introduced the concept of a coordinated multispecialty approach, and resulted in increased 5‐year survivals to 56–70

ISSN:8756-0437    

DOI:10.1002/ssu.2980110307

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractDue to the overwhelming prognostic significance of regional metas‐tases, proper management of cervical lymph nodes in cases of squa‐mous cell carcinoma of the head and neck is essential for an optimal outcome. Better understanding of the predictability of incidence and patterns of metastases of these tumors in recent years has led us away from the radical neck dissection as the only surgical therapeutic or staging procedure done on the neck. Recent studies suggest that selective removal of lymph node groups at risk in clinically negative necks, or modified neck dissections that save important structures, like the jugular vein, XI nerve, and sternocleidomastoid muscle, in clinically positive necks, are appropriate in many patients. Careful selection of the type of neck dissection and judicious use of postoperative radiation therapy can optimize cure rates as well as functional and cosmetic results. © 1995 Wiley‐Lis

ISSN:8756-0437    

DOI:10.1002/ssu.2980110308

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractFine‐needle aspiration biopsy (FNAB) and computed tomography (CT) or magnetic resonance imaging (MRI) are useful in the evaluation of salivary gland tumors, but they are not essential for treatment planning in every patient. The mainstay of therapy is a well‐planned and carefully executed surgical procedure which adequately excises the tumor. Disease‐free survival is very likely in patients with early stage malignant tumors. When treatment is delayed until the tumor is extensive (Stage 3,4), local recurrence and distant metastases are common and survival rates are low. Adjunctive postoperative radiation therapy can enhance locoregional control in the latter patients, but does not invariably lead to better survival. No consistently effective chemotherapy agents or combinations are presently available. Early diagnosis and consistent, high quality treatment offer the best hope for improved survival. © 1995 Wiley‐L

ISSN:8756-0437    

DOI:10.1002/ssu.2980110309

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractDifferentiated thyroid carcinoma is a relatively indolent disease. Despite the usually favorable prognosis, differentiated thyroid cancer is fatal in some patients. In the past, treatment strategies were often based upon incomplete knowledge or inaccurate assumptions regarding the significance of the presenting characteristics of the tumor and patient. More recently, several large retrospective reviews have analyzed various presenting factors and have identified those that have prognostic significance and those that do not. Significant prognostic factors are age, primary tumor size, histology, grade, local tumor extension, and M stage. N stage appears to be a significant factor in older patients but not in younger patients. Gender, focality, and a history of prior irradiation are not significant prognostic factors. Using this knowledge, patients can be grouped into low, intermediate, and high risk groups.Prognostic factor and risk group analysis has facilitated the development of more rational treatment algorithms. Low risk patients can usually be treated with lobectomy and suppression therapy. For high risk patients, total thyroidectomy and adjuvant radioiodine is advocated. Treatment for patients in the intermediate risk group should be individualized. Prognostic factor and risk group analysis makes a selective approach to differentiated thyroid cancer possible. Such an approach can spare many patients the morbidity and expense of unnecessarily aggressive treatment without compromising outcome. © 1995 Wiley‐Liss, I

ISSN:8756-0437    

DOI:10.1002/ssu.2980110310

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY

摘要:

AbstractSelected advances in radiotherapy for treatment of head and neck cancer are reviewed. These include the role of postoperative radiotherapy, planned postirradiation neck dissection, altered fractiona‐tion, neoadjuvant chemotherapy and radiotherapy for laryngeal preservation, three‐dimensional conformal treatment planning, charged particle irradiation for skull base tumors, and stereotactic radiosur‐gery. © 1995 Wiley‐L

ISSN:8756-0437    

DOI:10.1002/ssu.2980110311

出版商:John Wiley&Sons, Inc.    

年代:1995

数据来源: WILEY