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PubMed1985

Modified radical neck dissection and postoperative radiotherapy in squamous cell head and neck cancer.

Between 1978 and 1982, 41 patients with clinically staged N1, N2, or N3b disease underwent unilateral or bilateral modified radical neck dissection. Five patients died free from their original disease with less than 24 months follow-up. Twenty-four patients with histologically positive nodes received postoperative radiotherapy with 2 (8 percent) neck recurrences. Another four patients with histologically positive nodes refused postoperative radiotherapy and had two (50 percent) neck recurrences. Three patients did not respond to radiotherapy at the time of their surgery and had no neck recurrences. The final five patients had histologically negative nodes, did not receive radiotherapy, and had no neck recurrences. These results suggest that modified radical neck dissection can be used in lieu of the classical radical dissection in many patients with clinically positive nodes who have squamous cell head and neck cancer without compromising survival.

Carcinoma, Squamous Cell↗
PubMed1998

Management of the neck in patients with head and neck cancer treated by concurrent chemotherapy and radiation.

The current high level of interest in organ preservation strategies for patients with advanced squamous cell carcinoma of the head and neck undoubtedly will result in increasing numbers of patients managed initially with chemotherapy and radiation, either sequentially or concurrently. In some protocols, surgery, and neck dissection in particular, will either be mandatory or offered based on the degree of response to treatment and initial stage of neck disease. Head and neck oncologic surgeons need to be involved and at the forefront of such trials, to allow meaningful data regarding pathologic response to treatment to be obtained, as well as to define the role of surgery in such patients. Although present data is limited, it would appear that in patients achieving a complete response to chemoradiation, the role of neck dissection may be more limited than in the past, even for patients with N2 to N3 neck disease at presentation. Surgical complications may be increased in this heavily treated patient population, and subsequent surgery should be designed to minimize the risk of wound complications, especially if performed before the patient has made a full recovery from the metabolic and immunologic derangements associated with chemoradiation. Head and neck surgeons need to play an active role in the design and conduct of chemoradiation trials so that these and other relevant questions will be answered by the data generated.

Antineoplastic Agents↗
PubMed2003

Recent advances in therapeutic exercise for the neck: implications for patients with head and neck pain.

There have been recent advances in the rehabilitation of the muscles that control the head and neck. These advances are based on evidence of specific neck muscle dysfunction in individuals with persistent head and neck pain. Traditional rehabilitation strategies have focused predominantly on muscle strength and endurance under high loads. New evidence suggests that in people with neck pain there are underlying neuromuscular problems that may require more immediate attention and may not be adequately addressed by simple strength and high-load endurance retraining. Evidence of altered coordination between the deep and superficial neck muscles, greater neck muscle fatigue under sustained low loads, and deficits in kinaesthetic sense have been identified in symptomatic individuals. There is evidence to indicate that addressing these muscle control problems, with specific gentle exercise strategies, results in a reduction in neck pain and associated symptoms.

Exercise Therapy↗
PubMed1999

Radiotherapy followed by neck dissection for small head and neck cancers with advanced cervical metastases.

Patients with small or occult primary carcinomas of the head and neck with advanced cervical metastases present a difficult problem for the otolaryngologist. A retrospective review was performed of patients who presented to UCLA Medical Center between January 1986 and June 1996 with small or occult primary tumors of the head and neck with advanced cervical metastases. The treatment algorithm consisted of initial radiotherapy to the primary site and the neck, followed in 6 to 8 weeks with endoscopy and biopsy of the primary tumor site. As long as the repeat biopsy of the primary tumor site was negative by frozen section, an immediate neck dissection was performed, even if no residual neck disease was present. Almost 40% of patients with no clinical evidence of neck disease following radiotherapy had evidence of metastatic cancer on histopathologic examination. While some would consider a watchful waiting policy when there is no clinically detectable neck disease following radiotherapy, we believe it is preferable to perform immediate surgery in such patients, in light of the high incidence of microscopic metastatic disease.

Carcinoma, Squamous Cell↗
PubMed1997

Postural stability, neck proprioception and tension neck.

We examined whether tension neck (TN) may due to inadequate proprioceptive and vestibular activation of the cervico-collic reflex (CCR). CCR and vestibulospinal responses (VSRs) were recorded from 106 forest workers by stimulating the neck, lumbar or calf proprioceptors by vibration. The VSRs were recorded with posturography. TN occurred in 27 out of 106 subjects. The subjects with TN (48.5 years) were older than those without TN (43.1). The mean body sway during quiet stance was the same in both groups during the neck stimulation. In subjects with tension neck stimulation of neck or lumbar proprioceptors caused excessive, unpredictable body excursion in the lateral and anteroposterior direction that continued after stimulation. Results from stimulation of lower limb proprioceptors did not significantly differ between the 2 groups. In logistic regression analysis a model to predict TN consisting of perstimulatory postural stability (odds ratio 1.4) and poststimulatory postural stability (odds ratio 1.8) turned out to be statistically significant. The anatomical findings of CCR in the medulla oblongata suggest that neck muscle afferents control the posture and muscle activity of the neck. The erroneus facilitation of proprioception in TN subjects indicate that TN may be raised by inadequate facilitation of CCR.

Adult↗
PubMed1999

Management of the neck after alternating chemoradiotherapy for advanced head and neck cancer.

BACKGROUND: To investigate neck control probability and the value of nodal response at completion of alternating chemoradiotherapy, a group of 43 patients was reviewed. METHODS: Patients were treated with 60 Gy alternated with four cycles of cisplatin and fluorouracil. All patients had lymph nodes positive for squamous cell carcinoma from various primary sites, underwent computed tomography (CT) for staging and evaluation of response, and were treated at a single institution. Patients with bilateral lymph nodes (N2c) were further staged according to the side of dominant neck disease. RESULTS: After chemoradiotherapy alone, 2-year neck control probabilities (NCP) are 86+/-13%, 58+/-10%, and 0 for N1, N2a/b, and N3 neck stages, respectively (p = .038). Two-year NCP for 25 complete responders is 85+/-8%, whereas, at the same time interval, it is 17+/-9% for 18 partial responses (p<.0001). Within patients with N1-2a/b neck disease, 21 complete responders had a 2-year NCP of 92+/-8%. Five (11%) heminecks in four patients developed severe (Radiation Therapy Oncology Group [RTOG] grade > 2) subcutaneous late reactions. CONCLUSIONS: For patients with N1-2a/b neck disease, response at the end of treatment as evaluated by both physical exam and CT is a reliable criterion to select patients for complementary surgery even after chemoradiotherapy. For N3 disease, planned neck dissection regardless of response seems warranted.

Adult↗
PubMed1991

Supraomohyoid neck dissection with frozen section biopsy as a staging procedure in the clinically node-negative neck in carcinoma of the oral cavity.

A retrospective analysis was performed to evaluate the efficacy of elective supraomohyoid neck dissection in 57 newly diagnosed patients with squamous cell carcinoma of the oral cavity. The protocol included sampling of both the most suspicious and the largest node in the jugulodigastric region (if present) and the most distal jugulo-omohyoid lymph node (if present) for frozen section examination. In 10 cases, frozen section biopsy revealed metastatic disease, and surgery was continued using standard or modified radical neck dissection en bloc with the primary tumor. In another 10 cases, histologic examination of the supraomohyoid neck dissection specimens revealed occult nodal disease at other sites. In the histologically proven absence of metastatic disease in the supraomohyoid neck dissection specimens, disease recurrence in the neck occurred in only three cases (7%), all in the presence of local failure. The results of our analysis support the conclusion that elective supraomohyoid neck dissection with frozen section biopsy appears to be a valid staging procedure and a valuable approach to the management of the clinically node-negative neck in squamous cell carcinoma of the oral cavity.

Biopsy↗
PubMed1989

EMG activities of neck muscles underlying lateral flexion of the neck during head-turning induced by electrical stimulation of the caudate nucleus in cats.

Patterns of EMG activities of neck muscles underlying the initiation of head-turning, induced by stimulation of the caudate nucleus, were analyzed with special reference to temporal relations between the onset of head-turning and that of changes in EMG activities. These patterns were compared with those associated with the initiation of lateral flexion of the neck which occurred without electrical stimulation of the caudate nucleus in order to examine whether the caudate-induced head-turning was initiated via the same muscular system as that used in non-caudate-induced head movements. Experiments were carried out using 5 awake, unrestrained cats which were trained to stand still with one limb on each of 4 footplates. Trains of stimulating current pulses were applied to several stimulation points in the caudate nucleus while the animal maintained a stable standing posture with its neck extended. Head movements in the horizontal plane and EMGs of 6 neck muscles (splenius, longissimus cervicis, obliquus capitis caudalis, biventer cervicis, complexus and cervical multifidus) were recorded. Patterns of EMG activities of neck muscles around the onset of the caudate-induced head-turning were characterized by an increase in activity of the splenius, the longissimus cervicis and the obliquus capitis caudalis muscles, and by a decrease in activity of the complexus, the biventer cervicis and the cervical multifidus on the side of flexion. It is suggested that an increase in activity of the splenius, the longissimus cervicis and the obliques capitis caudalis muscles was responsible for the initiation of this evoked response. In non-caudate-induced lateral flexion of the neck, patterns of activities of neck muscles were similar to those in caudate-induced head-turning. It is therefore concluded that the caudate-induced head-turning as an evoked behavioral response was initiated through a muscular system similar to that utilized for similar head movements occurring without electrical stimulation of the caudate nucleus, although the pathways involved are thought to be different.

Animals↗
PubMed1989

Multiple primary cancer in patients with cancer of the head and neck: second cancer of the head and neck, esophagus, and lung.

Squamous cell carcinoma of the head and neck is complicated by a second primary carcinoma of the head and neck, esophagus (the upper aerodigestive tract, or UADT), or lung in 10-40% of patients. Routine panendoscopy will identify a simultaneous second primary in 9-14% of the patients. Metachronous second cancers most often involve the esophagus or lung, whereas synchronous second cancers are more common in the head and neck as occult lesions. For the highest-risk subgroups, second primary cancers occur in 4% of patients per year. In cancer of the floor of the mouth the excess mortality rate is 5-6% per year. Risk is independent of stage of the first primary and the survival impact is the greatest in groups of patients with early-stage disease. Head and neck cancer almost always results from the heavy use of tobacco for many years, either with or without the concomitant heavy use of alcohol, and these same agents are directly responsible for the second cancers of the UADT and lung. All head and neck cancer patients should be advised to avoid these agents. The clinician must diagnose and treat second cancers to extend the survival of patients with a good prognosis for control of the initial head and neck cancer. We need further progress in eliminating the use of known carcinogens in these patients, paradigms for cost-effective diagnosis and treatment of second primary cancers, effective treatment of the head and neck primary cancer devoid of long-lasting tissue toxicities, effective chemopreventive agents to retard established processes of carcinogenesis that place the patient at continued risk after cigarette and alcohol use has been eliminated, and continued efforts to control the medical illnesses to which these patients are susceptible.

Carcinoma, Squamous Cell↗
PubMed1995

Parotid and neck metastases from cutaneous squamous cell carcinoma of the head and neck.

BACKGROUND: Approximately 5% of cutaneous squamous cell carcinomas (SCC) metastasize to regional nodes. Nodal involvement may be more common for cutaneous squamous cell carcinomas of the head and neck, but few large series have reported clinical outcome after treatment of parotid gland and neck metastases from these cancers. PATIENTS AND METHODS: A combined retrospective/prospective study of patients treated between 1983 and 1994 was performed. There were 69 men and 6 women, with a median age of 67 years. Twenty-nine patients had neck metastases, and 33 had parotid gland metastases, while 13 patients had involvement at both sites. Of the 75 patients, 68 were treated surgically and 50 received postoperative radiotherapy. RESULTS: The facial nerve was sacrificed totally in 6 patients and partially in 9. Histologic extranodal spread was present in 48 (71%) of all surgically treated patients. Among 61 patients followed up to recurrence, or for greater than 12 months, 26 (43%) developed recurrence--12 in the parotid gland, 7 in the neck, and 7 in both sites. Multiple recurrences were common and occurred at a median of 8 months after surgery. Positive surgical margins were associated with poorer local disease control (P < 0.05). Cumulative survival at 5 years was 61%, but only 15 of 70 evaluable patients (21%) were eligible for follow-up at this time. Neck involvement with or without parotid gland disease was associated with an increased risk of distant metastases, but this was not statistically significant. Postoperative radiotherapy was not associated with improved disease control. CONCLUSION: Cutaneous, metastatic SCC involving the parotid gland and neck is an aggressive disease with a tendency to an infiltrative growth pattern and multiple recurrences. More aggressive surgery may be justified to reduce the incidence of regional failure after parotidectomy and neck dissection.

Adult↗
PubMed2000

Postural stability using different neck positions in normal subjects and patients with neck trauma.

Subjects with neck problems, such as whiplash injuries, often complain of disturbed equilibrium and, in some instances, provocation of the neck position can elicit such problems. The importance of neck proprioceptors for maintaining balance is gaining increased interest, moreover the function or malfunction of the otoliths may disturb equilibrium in certain head positions. The aim of the study was to create a reference material for postural control and its dependence on head position in healthy subjects and to compare this with a set of patients with known neck problems and associated vertiginous problems. A total of 32 healthy subjects (16 men, 16 women, age range 21-58 years) as well as 10 patients age range 27-62 years (mean 44 years) with neck problems and associated balance problems since a whiplash injury were tested for postural control using the EquiTest dynamic posturographic model. The normal subjects were initially split into four age groups in order to estimate the effects of age on performance. The postural stability was evaluated for dependence of support surface conditions (stable or sway-referenced), visual input (eyes open or closed) and head position (neutral, left rotated, right rotated, extended backwards or flexed forward) using analysis of variance (ANOVA) with Tukey's post hoc test in case of a significant factor effect. As expected, visual cues as well as stable support surface improve postural stability (p < 0.001). Postural stability is statistically different in the head extended backwards condition compared with the other four head positions (p < 0.001 in all cases) in both patients and controls. Eliminating this test condition from the analysis, only a slight (p < 0.05) difference between head forwards and head turned left remained. This pattern of results remained if the normal subjects were only split into two age groups instead of four. Finally, the patient group exhibited significantly lower postural performance than all the groups of normal subjects (p <0.01), but none of the normal groups differed significantly from each other. It is concluded that the postural control system is significantly challenged in the head extended backwards condition in both normal subjects and patients with previous whiplash injury and persistent neck problems. The patient group differed statistically from all groups of normal subjects. This suggests that neck problems impair postural control, and that the head extended position is a more challenging task for the postural system to adapt to. Whether this is due to utricular malpositioning, central integrative functions or cervical proprioceptive afferents is not within the scope of this study to answer.

Adult↗
PubMed1996

The incidence of micrometastases in neck dissection specimens obtained from elective neck dissections.

Although modern imaging techniques become more accurate for the assessment of lymph node metastases in the neck as criteria and technology evolve, micrometastases remain occult with any technique. Even the routine histopathological examination of neck dissection specimens is unable to detect all micrometastases. Because knowledge on the incidence of micrometastases in the clinically NO neck might be of importance for decision making regarding elective treatment, a retrospective study on 96 elective neck dissections was conducted. Meticulous histopathological examination of the neck dissection specimens yielded 3092 lymph nodes of which 67 (2.2%) were tumor-positive. Twenty-six of these 67 lymph node metastases were micrometastases. Of the 36 tumor-positive neck dissection specimens, 21 contained micrometastases. In 9 tumor-positive specimens only micrometastases were found. This high incidence of micrometastases has important implications for the diagnostic work-up, the treatment, and histopathological examination of the NO neck.

Carcinoma, Squamous Cell↗
PubMed2006

Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Neck Disability Index and Neck Pain and Disability Scale.

STUDY DESIGN: This study's design was a cross-cultural validation of the Neck Disability Index and Neck Pain and Disability Scale. OBJECTIVES: This study's objective was to translate, culturally adapt, and validate a Brazilian Portuguese version of the Neck Disability Index (NDI-BR) and the Neck Pain and Disability Scale (NPDS-BR). SUMMARY OF BACKGROUND DATA: Although several valid measures exist for measurement of neck pain and functional impairment, these measures have yet been validated in Brazilian Portuguese. Successful linguistic and cultural translation may allow appropriate cross-cultural comparison for clinical and laboratory research analysis. METHODS: The NDI-BR and NPAD-BR were culturally and linguistically translated from English into Brazilian Portuguese. The translated version of the instrument was administered to 203 patients at a midsize hospital in southern Brazil. Psychometric evaluation included factor analysis, internal reliability measures, test-retest reliability at 1 and 7 days, and criterion validity comparison with the Brazilian version of the SF-36. RESULTS: Factor analyses demonstrated a single-factor subscale for the NDI-BR and three subscales for the NPDS-BR. An item analysis showed a high degree of internal consistency for the NDI-BR (r = 0.74) and the three subscales of the NPDS-BR (subscale 1, r = 0.89; subscale 2, r = 0.81; subscale 3, r = 0.72). Test-retest reliability was also acceptable at for the NDI-BR (0.98 at baseline and 0.48 at 7 days) and subset one (0.96 at baseline and 0.91 at 7 days), subset 2 (0.96 at baseline and 0.62 at 7 days), and subset 3 (0.52 at baseline and 0.45 at 7 days) of the NPDS-BR. Construct validity was established during comparison of the Brazilian version of the SF-36. Only items associated with physical role, bodily pain, and emotional role failed significant correlation. CONCLUSIONS: A reliable and valid Portuguese version of the Neck Disability Index and Neck Pain and DisabilityScale was developed, which will facilitate the examination of functional performance within a large patient population, as well as cross-cultural comparisons.

Adult↗
PubMed2004

Neck dissection findings in primary head and neck high-grade adenocarcinoma.

Primary salivary adenocarcinoma of the head and neck is rare. In cases where cervical metastases are evident or suspected, neck dissection is likely to play a role in management. However, there is little data in the literature regarding the findings and outcome of neck dissection in these patients. The present study comprised a review of 12 patients with high-grade salivary adenocarcinoma (salivary ductal carcinoma or adenocarcinoma, not otherwise specified (NOS). Eight underwent neck dissection (four modified radical, four selective). Histological examination showed evidence of cervical metastases in five. The prevalence of occult metastases in the N(0) neck was 40 per cent. Computed tomography (CT) and magnetic resonance imaging (MRI) were not useful in detecting occult neck disease. Five patients had no evidence of disease at the most recent follow up. Neck dissection is indicated in patients with high-grade salivary adenocarcinoma, and may provide information for planning adjuvant treatment.

Adenocarcinoma↗
PubMedDate not supplied

Endovascular treatment of experimental wide neck aneurysms: comparison of results using coils or cyanoacrylate with the assistance of an aneurysm neck bridge device.

BACKGROUND AND PURPOSE: Endovascular treatment of wide neck aneurysms often results in incomplete occlusion or aneurysm recurrence. The two goals of the present study were to compare results of coil embolization with or without the assistance of an aneurysm neck bridge device (ANBD) and to explore the use of this instrument to control cyanoacrylate embolization. METHODS: Wide necked bifurcation aneurysms were constructed in 28 dogs. Coil embolization of the aneurysms was performed 2 to 4 weeks later, with (n = 11) or without (n = 10) ANBD assistance. In seven other animals, embolization was performed with cyanoacrylate, injected under the protection of ANBDs. Angiographic results were compared immediately after and at 3 and 12 weeks. Neointima formation at the neck was also compared between groups at 12 weeks. RESULTS: Initial angiographic results and recurrences at 12 weeks were not significantly different in aneurysms coiled with or without ANBDs. Neointimal scores were also similar. The use of one ANBD at the neck was not sufficient to safely deliver cyanoacrylate into aneurysms. Cyanoacrylate embolization led to improved angiographic results (P =.05) and to better neointimal sealing of the neck of the aneurysms at 12 weeks (P =.004). CONCLUSION: ANBDs did not prevent recanalization and recurrences after coil embolization of wide neck aneurysms in this animal study. ANBD-assisted cyanoacrylate embolization was unsafe but could decrease recurrences at 12 weeks.

Animals↗
PubMed1992

Work-related chronic neck impairment. Neck motion analysis in female traverse crane operators.

Twenty-one female steel industry traverse crane operators with long-term sick-leave (3 (1-8) years) due to chronic neck disability underwent careful analysis of case history, physical status and electrogoniometric three-dimensional recordings of active neck motion. Results were compared with those from working female crane operators having identical work posture and tasks and, further, with a group of working female clerks. The sick-listed crane operators had previous frequent contacts with the primary health care because of complaints from the neck and back. In comparison with the reference groups, the sick-listed crane operators showed tenderness of the trapezius and levator scapulae muscles and a short neck stature in combination with impaired active neck motion range with reduced motion speed. The motion pattern was however unchanged. The findings are consistent with the clinical picture of chronic neck myalgia that persisted despite long-term absence from the previous exposure to high static work load upon the neck-shoulders.

Adult↗
PubMed2005

[Application of supraomohyoid neck dissection in oral squamous cell carcinoma with clinically N0 neck].

OBJECTIVES: The value of supraomohyoid neck dissection used in treating oral squamous cell carcinoma was discussed. METHODS: Twenty-seven cN0 patients with oral squamous cell carcinoma were entered into the study. Supraomohyoid neck dissection was performed to remove the lymphatic tissue of level I, II, and III. The operation duration and shoulder function were recorded. RESULTS: The average operation duration was (1.6 +/- 0.2) h. Nineteen percent (5/27) of the cN0 neck were proved positive pathologically which included two cases in level I and four in level II (one case had both level I and II metastases). Shoulder function recovered in three months after operation. All patients were followed up from two years to four years and none of them had local or neck recurrence. CONCLUSIONS: Supraomohyoid neck dissection is a right choice for cN0 patients with oral squamous cell carcinoma with its advantages in both curing neck lymphatic metastases and preserving neck and shoulder contours and functions.

Adult↗