At the Roswell Park Memorial Institute, 111 patients were treated for squamous cell carcinoma of the pyriform sinus over a 15-year period. Treatment modalities included surgery, radiation therapy, or a combination of both. A retrospective study was carried out to determine how these treatments, used singly or in combination, affected the cure rate. TNM clinical staging and recurrence patterns were studied, and a high tendency for distant metastases was documented. The five-year survival figure in this study was 29% (28/97).

Aged↗

PubMedDate not supplied

Nonsimultaneous bilateral radical neck dissection.

From January 1963 to December 1977, 63 patients underwent a therapeutic second (staged) neck dissection at our institute. The mean interval between the first neck dissection and the second neck dissection was 13.2 months; 58.7% of the second neck dissections were performed between 6 and 12 months after the first. Forty-six patients had histologically positive and 17 patients had histologically negative nodes in the first neck clearance; 57 patients had histologically positive and 6 patients had histologically negative nodes in the second neck clearance. Forty-two of the 63 patients had bilateral nodal disease, while 2 patients had no disease in either side of the neck. Fifty-four percent of the patients had postoperative complications; 30% developed immediate postoperative edema, and 14% had wound infection. The overall three-year and five-year survival rates were 60% and 38%, respectively. Patients who had bilateral histologically positive nodes had a 16% five-year survival rate, while those who had histologically positive nodes in one side of the neck only had a 26% five-year survival rate.

Adult↗

PubMedDate not supplied

Reconstruction of massive orbito-maxillary-cheek defects.

The problem of soft-tissue reconstruction in patients who must undergo radical resection of the maxilla, orbit, and cheek is discussed. This problem is greatly complicated by previous radiation therapy or by the need for postoperative radiation therapy. Restoration of oral competence is of primary importance and usually cannot be satisfactorily accomplished with prosthetic appliances when a stable support base is lacking. An orderly reconstructive plan with a high success rate is of the utmost help to the surgeon facing this problem. A multistaged procedure utilizing a deltopectoral flap that has been successful in 7 patients is presented.

Cheek↗

PubMedDate not supplied

Radiation and thyroid carcinoma: radiotherapy, head and neck regions, thyroid carcinoma.

Radiotherapy for benign conditions of the head and neck area was first linked to thyroid carcinoma in 1950. All the salivary glands, the parathyroids, and the facial skin can also develop neoplastic lesions in this setting. Thyroid carcinoma is most commonly papillary or mixed papillary and follicular. It is very often multifocal and can be detected by hand palpation, nuclear scanning, high resolution sonography, and needle aspiration. Each test has its limitations and appropriate protocols for screening and detection should be adapted to different medical centers. The surgical management is controversial and ranges from simple lobectomy to total thyroidectomy with adjuvant 131I treatment and thyroid suppression. We prefer total thyroidectomy if it can be performed safely. With adequate treatment the survival should be good. Prevention by administration of iodine at the time of exposure to radiation seems feasible and deserves further clinical trial.

Adenocarcinoma↗

PubMedDate not supplied

Head and neck irradiation in childhood: increased risk of developing thyroid disease.

A nodule of the thyroid in a patient with a history of prior irradiation to the head and neck area in childhood is more likely to be malignant than a nodule in the general population. Thirty-two of 144 such patients (22%) who came to surgery were found to have a carcinoma of the thyroid. A relative short-term (6 mo) trial with suppressive therapy with a thyroactive agent may be helpful in selecting out those nodules that may be malignant. Although considerable controversy continues to exist as to the proper surgical treatment, our current surgical management involves performing a total extracapsular thyroidectomy.

Child↗

PubMedDate not supplied

Cervical node metastases in early squamous cell carcinoma of the floor of the mouth: predictive value of multiple histopathologic parameters.

A semiquantitative assessment of multiple histological parameters was applied retrospectively to 66 patients with stage I and II squamous cell carcinoma of the floor of the mouth to determine if prognostic information relative to cervical node metastases could be obtained. Three parameters relating to the tumor cell population and 5 describing the tumor-host interface were evaluated on a point scale from 1 to 3 with the highest score going to the most threatening characteristic. Twenty of the 66 patients had either occult metastases identified by elective lymphadenectomy (n = 11) or developed metastases to the neck (n = 9). There was no correlation between traditional histological grading as recorded at the time of presentation and the frequency of cervical metastases (p greater than 0.05). Histological reevaluation defined 3 groups of patients with low (less than 14), moderate (14-16), and high scores (greater than 16) with an incidence of cervical metastases of 5/39 (12.8%), 6/17 (35.3%), and 9/10 (90%), respectively (p less than 0.001). The results suggest that microscopic grading could be a useful adjunct to the present TNM staging system in selecting patients likely to benefit from elective treatment of the neck.

Adult↗