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At least 217 records · Page 12Linked to original sources
PubMed2005

The nodal neck level of sentinel lymph nodes in mucosal head and neck cancer.

Sentinel node biopsy is emerging as a successful means of identifying subclinical lymph node disease in mucosal head and neck cancer. Sentinel node studies in melanoma and breast cancer have identified sentinel nodes at unusual sites and the technique is redefining our understanding of dynamic lymphatic flow. In this study, the sentinel nodes in mucosal head and neck malignancies were mapped according to their site within the neck and this was correlated with tumour site within the oral cavity. Fifty-two necks were explored for sentinel nodes from tumours located in the tongue (23 cases), floor of mouth (12 cases), palate (six cases), retromolar trigone (five cases), alveolus (three cases), buccal mucosa (two cases), tonsil (two cases) and lip (one case). In total, 124 sentinel nodes were found in levels I-V. Two hot spots were found in the tonsils and were not excised, two nodes were located in level IIB, four nodes were found in level IV, three in the contralateral neck and one in level V. The sentinel nodes located at unusual sites would not have been excised in a supraomohyoid neck dissection and the study has improved our understanding of dynamic lymph flow from tumours.

Head and Neck Neoplasms↗
PubMed2006

Selective neck dissection (I-III) for node negative and node positive necks.

Selective neck dissection (I-III) for oral cancers offers similar regional control rates with less morbidity as compared with modified radical neck dissection. Charts of 414 patients with oral cancer, who underwent selective neck dissection (I-III) during 1994-2001, were analysed retrospectively. Seventy nine percent of the patients had a primary tumour in the gingivo-buccal complex. Cancer of tongue showed a trend towards higher regional failure (12.3%) as compared to gingivo-buccal cancers (6.5%). Primary tumour was staged as T1-8%, T2-47%, T3-19% and T4-26%. Sixty five percent of the patients were clinically node negative. Isolated neck failure was observed in 4.8% of patients at 2 years and in 5.8% at 5 years. De-differentiation of primary tumour and perineural spread were associated with regional failures. Eighty three percent of the neck recurrences were in the ipsilateral neck and only 16% of these were at levels IV or V. In all, 30% of all regional failures were outside the field of dissection.

Adult↗
PubMed1998

Results of a prospective trial on elective modified radical classical versus supraomohyoid neck dissection in the management of oral squamous carcinoma. Brazilian Head and Neck Cancer Study Group.

BACKGROUND: Elective treatment of the neck in oral squamous cell carcinoma has changed over the last 20 years. The main object of this report is to present the results of a multi-institutional prospective study designed to compare standard treatment with modified radical classical neck dissection (MRND) to supraomohyoid neck dissection (SOH) in the management of the clinically negative neck in oral cancer patients. PATIENTS AND METHODS: A total of 148 patients were included in the trial. All patients had previously untreated T2 to T4 N0 squamous cell carcinoma of the oral tongue (62 cases), floor of the mouth (49 cases), inferior gingiva (12 cases), or retromolar trigone (25 cases). Tumor stages were T2, 91; T3, 27; and T4, 30. There were no significant imbalances between groups. RESULTS: The false-negative rate was 28%, and most positive nodes were sited at level II and III. Complications were seen in 41% of MRND patients and in 25% of SOH patients (P = 0.043). Median total duration of hospitalization was 9 days in MRND patients and 7 days in the SOH group. To date, 19 and 16 patients presented with local and neck recurrences, respectively. The 60-month actuarial survival rates were 63% in the MRND group and 67% in the SOH group (P = 0.7150). CONCLUSIONS: This study demonstrates that the recurrence and survival rates were similar in both groups. SOH neck dissection can be recommended as standard elective treatment for patients with T2-T4 oral squamous cell carcinomas.

Adult↗
PubMed1987

Prevention of post-prostatectomy vesical neck contracture by prophylactic vesical neck incision.

Most vesical neck contractures occur after resection of adenomas weighing less than 20 gm. This complication is believed to be secondary to excessive resection or fulguration of an undilated bladder neck. Prophylactic bladder neck incision was performed in conjunction with transurethral resection of the prostate on 114 patients with prostatic adenomas weighing less than 20 gm. Vesical neck contracture occurred in 1 patient (0.87 per cent), compared to 12 contractures in 161 patients who underwent transurethral resection of the prostate alone (7.5 per cent). Increasing bladder neck diameter by incision appears to be protective against formation of vesical neck contractures in patients with small obstructing prostatic adenomas.

Contracture↗
PubMed2006

Effect of regression of enlarged neck lymph nodes on radiation doses received by parotid glands during intensity-modulated radiotherapy for head and neck cancer.

OBJECTIVES: The regression of enlarged neck lymph nodes during intensity-modulated radiotherapy (IMRT) may increase actual radiation doses to the parotid glands of patients with head-and-neck cancer. We investigated the changes in the lymph nodes volume during IMRT and the effect of these changes to the parotid gland doses. METHODS: Ten head and neck cancer patients with enlarged neck lymph nodes were enrolled in this study. Computed tomography (CT) imaging was repeated to evaluate the change in lymph nodes volume after initial 45 Gy, and the second part of IMRT (21 Gy) was then replanned to reflect the change of nodal tumor volume. The dosimetric benefit of parotid sparing with replanning was compared with that of no replanning. RESULTS: The enlarged neck lymph nodes in all patients pushed the parotid glands outward in pretreatment CT images. After 45 Gy of IMRT, nodal regression caused the parotid glands to shift inward into the high-dose area. When compared with those without replanning, we found modification of IMRT plan after 45 Gy significantly reduced radiation dose to parotid glands (mean reduction of 2.95 +/- 1.10 Gy to the left and 3.23 +/- 1.37 Gy to the right, respectively; P < 0.001). CONCLUSIONS: Excessive parotid gland doses secondary to the regression of enlarged neck nodes could be mitigated by replanning after 45 Gy. However, recontouring of large lymph nodes that regress during therapy has a risk of under-dosing extracapsular extension of lymph node metastases. Therefore, recontouring should be done with extreme caution.

Adult↗
PubMed2004

Incidence of perioperative stroke after neck dissection for head and neck cancer: a regional outcome analysis.

OBJECTIVE: To determine the incidence of perioperative stroke in patients undergoing a neck dissection. SUMMARY BACKGROUND DATA: The incidence of perioperative stroke in non-head and neck surgery is between 0.08 and 0.2%. In contrast, a critical review of the literature identified 2 studies stating the incidence of perioperative stroke in head and neck surgery to be 3.2% and 4.8%. The implications of these results are significant because they suggest a potential need for preoperative screening and/or intervention for carotid artery pathology. METHODS: This historical cohort study was conducted using discharge data for all neck dissections performed in a geographically-defined health region in Alberta, Canada, from 1994 to 2002. Subjects were selected for study if they had an assigned ICD-9CM procedure code for a neck dissection at one of the region's 3 adult-care hospitals. Our main outcome measure was perioperative stroke. RESULTS: Patients (n = 499) were identified as having had a neck dissection (mean age 56.5 +/- 15.3 SD, 65.3% male). Seven patients had ICD-9CM codes for postoperative central nervous system complications (incidence of 1.4%). However, on chart review, only one had had a true perioperative stroke corresponding to an incidence of 0.2% (95% confidence interval 0.01, 1.12). No missed strokes were found in a confirmatory random review of 10% of charts. CONCLUSIONS: The incidence of perioperative stroke in this study is significantly lower than that previously stated in the literature. This suggests that preoperative screening and/or intervention for carotid artery disease may not be necessary in this patient population.

Female↗
PubMed2002

Value of neck dissection in patients with cancer of the parotid gland and a clinical NO neck.

Cervical lymph node metastases in patients with parotid gland carcinoma are not rare. Regional metastases have a significant influence on the prognosis of these patients. In spite of the clinical relevance of lymphogenous metastases, the indications for elective treatment of the neck are not well defined. In the present review the controversies and therapeutical strategies of ipsilateral neck lymph nodes and their extension in patients with potential occult lymph node metastases are discussed. On the basis of the published data, in consideration of the direction of lymphogenous metastatic spread of parotid gland carcinomas, an elective neck dissection is recommended in carcinomas with high percentage of lymphatic spread also in the N0 neck. Consideration of additional parameters (> T2, lymphangiosis carcinomatosa) is appropriate to perform also a neck dissection in carcinomas with low risk for lymphogenous metastases. An elective neck dissection should include levels I, II, III and upper V.

Humans↗
PubMed1999

[The influence of dorsal neck proprioceptive inputs on vestibular compensation--by three-dimensional analysis of neck-induced nystagmus].

The influence of dorsal neck proprioceptive inputs on vestibular compensation was investigated in 21 patients with unilateral vestibular dysfunction. Subjects neither had history of spontaneous nystagmus nor of disequilibrium, indicating that they were in a good compensated stage. However, marked nystagmus was induced by applying vibratory stimulation to the dorsal neck of the patients, using a vibrator with a frequency of 110 Hz. The nystagmus was three-dimensional as analyzed by applying computerized eye movement analysis system. Twelve of 21 patients (57%) demonstrated three components of eye movement. All subjects showed a horizontal component directed towards the contralateral side of the vestibular lesion. Vertical and torsional components of the nystagmus were exhibited by 18 and 14 subjects, respectively. The average percentages of slow phase velocity of the horizontal, vertical and torsional components were 57%, 23% and 20%, respectively. No tendency towards any of the three components was observed. Furthermore, in order to investigate the relation between dorsal neck proprioceptive inputs and vestibular outputs, especially semicircular canal outputs, the author compared the direction of the nystagmus with the orientation of the semicircular canals. Normalized average velocity vectors of the nystagmus were calculated. In most subjects, the velocity vectors of the nystagmus were related to the horizontal semicircular canal. These results suggest that by controlling the neck proprioceptive inputs, neck vibration can cause discompensation in vestibularly well-compensated subjects with unilateral dysfunction secondary to vestibular lesion, and that neck proprioceptive inputs have a great influence on the horizontal vestibulo-ocular reflex pathways. However, in a few subjects the average vectors of the nystagmus were related to the vertical semicircular canals. This suggests that the proprioceptive inputs may also be related to the vertical vestibulo-ocular reflex pathways.

Adult↗
PubMed2005

CT angiography in penetrating neck trauma reduces the need for operative neck exploration.

The evaluation of penetrating neck injury has evolved dramatically from mandatory operative exploration of Zone II injuries that penetrate the platysma to selective management based on physical examination and adjunctive studies. More recently, CT angiography has emerged as an efficient, noninvasive method of evaluating penetrating neck injury. We retrospectively reviewed our experience over 10 years with the management of penetrating neck injury. One hundred thirty cases were reviewed with 34 undergoing CT angiogram (Group CTA) and 96 with no CT angiogram (Group nCTA). Group CTA had significantly fewer neck explorations, 1 (3%) versus 32 (33%), P < 0.001. Negative explorations were significantly higher in nCTA as well, with a rate of 22 per cent versus 0 in CTA (P < 0.01). The use of angiogram and esophagram was also significantly lower in CTA versus nCTA (P = 0.02 and P = 0.04). Of the 34 patients in CTA, 4 (12%) also underwent angiography and 4 (12%) received a contrast esophagram. Of the 64 patients in nCTA who did not undergo a neck exploration, 19 (29%) underwent angiography, and 17 (26%) received a contrast esophagram. The use of CT angiogram increased over time with a concomitant decrease in the rate of neck explorations.

Adolescent↗
PubMed1977

Treatment of the neck in patients with squamous cell carcinoma of the head and neck.

A retrospective study of 702 patients with clinically positive nodes associated with squamous cell carcinoma of the oral cavity, supraglottic larynx, and hypopharynx observed from 1954 to 1968 was done. The policies of treatment for the neck were not standardized during those years. Three hundred eleven patients who survived 24 months with the primary lesion controlled were divided into two groups: 1) those whose neck was treated by surgery alone; and 2) those who had combined radiation therapy and surgery to the neck, to test the efficacy of the two forms of treatment. For the three sites, the recurrence rate in the necks for the surgically treated group was 14% for stage N1, 26% for N2 and 34% N3. Rates for the group receiving combined treatment were 2%, 11% and 25% respectively. Results of the study also showed that elective irradiation, 5,000 rads in five weeks, will prevent metastasis from occurring in the NO staged neck.

Carcinoma, Squamous Cell↗
PubMed2001

Evaluation of the TriSpan neck bridge device for the treatment of wide-necked aneurysms: an experimental study in canines.

BACKGROUND AND PURPOSE: Many wide-necked aneurysms are difficult or impossible to treat with the Guglielmi detachable coil (GDC). The purpose of this study was to evaluate the use of a neck bridging device, the TriSpan coil, in combination with standard GDCs for the treatment of wide-necked aneurysms in an experimental canine aneurysm model. METHODS: Of 24 experimental aneurysms in 12 animals, 19 (7 lateral and 12 terminal) were treated with the TriSpan coil in conjunction with standard GDCs. Digital subtraction angiography (DSA) was performed on all animals immediately after treatment. In 6 animals, follow-up DSA and histological evaluation were performed 4 weeks after treatment. In the remaining 6, DSA was done at both 90 and 180 days after treatment. Histological evaluation was done immediately after the 180-day angiographic evaluation. RESULTS: The TriSpan was easy to use in conjunction with the standard GDC. Because of their geometry, some lateral aneurysms were difficult or impossible to treat with this device. Greater than 90% aneurysm occlusion was obtained in all 19 aneurysms. In no instance was there evidence of coil migration, herniation, or aneurysm recanalization. Histological evaluation of the tissue surrounding the TriSpan coil showed tissue responses similar to that seen with standard GDCs. CONCLUSIONS: These results show that the TriSpan coil in conjunction with standard GDCs can be used safely and effectively for the treatment of wide-necked aneurysms in this canine model. Positioning and deployment of the neck bridge in aneurysms having an acute angle with the long axis of their parent artery are difficult or impossible. It is likely that this device, used in conjunction with the standard GDC, will allow treatment of some wide-necked aneurysms that are not treatable with the GDC alone.

Aneurysm↗
PubMed1993

Supraomohyoid neck dissection in the treatment of head and neck tumors. Survival results in 212 cases.

Elective supraomohyoid neck dissection is considered part of standard treatment of oral and oropharyngeal cancer in most institutions, but its role in the treatment of clinically positive neck cancer remains a subject of controversy. The main object of this study is to report the results of 212 consecutive patients who underwent supraomohyoid neck dissections from 1954 to 1990. Most patients had squamous cell carcinoma of the oral cavity. Eighty-six patients (40.6%) had histologically positive lymph nodes in the surgical specimen (sensitivity, 0.55; specificity, 0.53). At the study closing date there were 58.8% actuarial 10-year overall survival rates. Forty-five patients (21.2%) had 50 tumor recurrences (32 local, 13 regional, five distant), and in 40 patients (18.8%) a second primary tumor was diagnosed. A multivariate regression technique based on Cox's proportional hazards model was used, and age (65 years or younger vs older than 65 years) represented the variable with the highest predictive strength with respect to overall survival (relative risk, 2.3). Tumor site, sex, and histologically proved metastasis were also associated with overall survival rates. The same variables were also related to the risk of recurrence. In conclusion, the death rate is mainly related to the control of the primary site tumor and the occurrence of a second primary tumor rather than to neck recurrences. It confirms that supraomohyoid neck dissection is an adequate elective procedure and possibly sufficient in the treatment of a selected group of patients with lip cancer with positive nodes at level 1.

Adolescent↗
PubMed2005

Treatment of the N0 neck during salvage surgery after radiotherapy of head and neck squamous cell carcinoma.

BACKGROUND: The morbidity and mortality rates of salvage surgery in patients with local recurrence of head and neck squamous cell carcinoma (HNSCC) after radiotherapy are high. The aim of this study was to determine the rate of occult neck node metastasis and the surgical morbidity of patients after salvage surgery for local relapse after definitive radiotherapy. METHODS: Thirty patients who underwent salvage surgery with a simultaneous neck node dissection for a local relapse after definitive radiotherapy for HNSCC between 1992 and 2000 were included in this study. The primary tumor sites were oral cavity in six patients, oropharynx in 17, supraglottic larynx in three, and hypopharynx in four. Initially, seven patients had T2 disease, eight had T3, and 15 had T4. RESULTS: Twelve patients (40%) experienced postoperative complications, including two deaths. There was no cervical lymph node metastasis (pN0) in 29 of the 30 patients. Fifteen patients (50%) had a recurrence after salvage surgery, including 11 new local recurrences and four patients with distant metastasis. CONCLUSIONS: The risk of neck node metastasis during salvage surgery for local recurrence in patients treated initially with radiation for N0 HNSCC is low. Neck dissection should be performed in only limited area, depending on the surgical procedure used for tumor resection.

Adult↗
PubMed1977

Influence of initial neck node biopsy on the incidence of recurrence in the neck and survival in patients who subsequently undergo curative resectional surgery.

During a period of 23 years, 57 patients who had an initial neck node biopsy elsewhere, with the diagnosis of metastatic squamous cell carcinoma established, underwent curative resection by our department after the site of head and neck primary was found. Ten patients free of disease died of other causes, leaving 47 patients who were eligible for at least 3 years of follow-up. Ninteen patients are alive after 3 or more years. The incidence of recurrence in the neck was 57% (27/47). The 3-year survival in this group of Stage III was 40% (19/47) and 5-year survival was 34% (16/47). Compared with historical data, it appears from the present study that a previous biopsy of a neck node did not adversely affect the incidence either of neck recurrence or survival when appropriate surgery is performed.

Biopsy↗
PubMed1997

[Volume changes to the neck lymph node metastases in head-neck tumors. The evaluation of radiotherapeutic treatment success].

AIM: This work is engaged with the volume change of neck lymph node metastasis of malignant tumors in the head-neck region during radiotherapy. PATIENTS AND METHOD: In 54 patients with head and neck tumors, the volume of neck lymph nodes before and after radiation was measured. The volumetry was done with CT planimetry. The total dose was 66 Gy (2 Gy/d) telecobalt from 2 lateral opponated fields. The time of volume change could be defined with measuring of the half-time and the doubling-time by the help of Schwartz formula. RESULTS: After 10 Gy the volume diminution was about 20% and half-time 24 to 26 days. Afterwards the time of volume diminution picked up speed and finally achieved 60 to 72%. Meanwhile the half-time decreased to the half value. The result was independent of the site of primary tumor, the patient's sex and age. CONCLUSION: In our opinion the effectivity of radiotherapy can best be judged with defining of the volume change of lymph nodes of the neck.

Adult↗
PubMed2003

Extent of surgical intervention in case of N0 neck in head and neck cancer patients: an analysis of data collection of 39 hospitals.

In the discussion on the treatment of the clinical N0 neck in head and neck cancer, the sentinel lymphonodectomy is gaining more and more in significance. Prior to a multicentre study on the value of sentinel lymphonodectomy, it seemed to be desirable to collect data on the current practice of neck dissection in German ENT departments. First a standardised questionnaire was sent to 50 hospitals in Germany. It contained questions on the respective therapeutic concepts (uni- or bilateral modified radical neck dissection versus selective neck dissection, wait-and-see policy) in histologically proven squamous cell carcinoma (G2) and defined localisation of the primary tumour (T1-T2 carcinoma of the oral cavity, the oropharynx and hypopharynx as well as larynx). Summing up the evaluation of 39 anonymously answered questionnaires, it can be stated that no uniform therapeutic concept for the treatment of the cervical lymph nodes in carcinomas of the upper aerodigestive tract based on the stage of lymphatic metastatic disease exists. It seems to be essential to elaborate such a concept in order to be able to compete in the international context. Likewise, a widespread uniform therapeutic strategy would be the basic prerequisite for the initiation and realisation of multicentric therapy studies.

Aged↗
PubMed1986

Elective neck irradiation for squamous cell carcinoma of the head and neck: analysis of time-dose factors and causes of failure.

This is an analysis of 190 patients who were treated with radiation therapy alone at the University of Florida, between October 1964 and December 1982, for T1-4 N0 squamous cell carcinoma of the head and neck; in all patients, the primary lesion was permanently controlled and the neck was evaluable for at least 2 years following radiation therapy. The control of neck node disease is analyzed as a function of elective neck irradiation, the dose of radiation delivered to the first-echelon lymph nodes, and the likelihood that occult disease was present in the neck prior to treatment.

Carcinoma, Squamous Cell↗