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At least 289 records · Page 16Linked to original sources
PubMed2002

[Sentinel node biopsy in head and neck cancer. Is there an indication for use of this new surgical technique in the treatment of head and neck cancer?].

Management of the clinically N0 neck in head and neck squamous cell carcinoma remains controversial. Since lymph node metastasis reduces the five-year survival by up till 50%, the need for an accurate diagnostic procedure is necessary. The sentinel node, being the initial lymph node to which the primary tumour drains, is believed to be invaded by early metastasis. Identification of the sentinel node by means of a dye or isotope or a combination, and surgical removal followed by histological examination verifies the involvement of the regional glands. At present few and limited materials on head and neck cancers exist, primarily on oral and oropharyngeal cancers. The techniques used are various and not without difficulties. To evaluate the feasibility of the sentinel node biopsy in head and neck cancer, it is proposed to perform a nationwide cohort study that comprises all minor oral and oropharyngeal cancers (T1, T2, N0).

Carcinoma, Squamous Cell↗
PubMedDate not supplied

[Homicide by stab to the neck with subsequent attempted suicide by cut to the neck].

A 37-year-old Turkish woman was fatally injured by her 65-year-old Turkish husband with a stab to the cervical region. After her death he inflicted a deep cut to his own neck, which he survived thanks to immediate medical assistance. To the authors' knowledge this combination of a homicidal stab to the neck and a suicidal cut to the neck has not been described before. Kosher butchering, which is common in the couple's traditional cultural environment, is discussed as possible reason for the choice of the neck as site for applying sharp violence. It may have induced the perpetrator to choose this anatomical region.

Adult↗
PubMed1987

[Unilateral bladder neck incision: endoscopic treatment of bladder neck obstruction. Results in 100 patients].

Endoscopic diathermy unilateral incision of the bladder neck was carried out in 100 consecutive male patients. This procedure was performed for bladder neck obstruction and small benign prostate. The operative details of this technique are given. Follow-up after 2 months revealed excellent symptomatic and urodynamic results. Morbidity was low. Results remain stable after 13 +/- 9 months. One patient needed a transurethral resection of the prostate. Retrograde ejaculation occurred in 5% of the patients. Unilateral bladder neck incision is a simple procedure safe, and easy to learn, with a low risk of retrograde ejaculation. It is the operation of choice for small benign prostate, bladder neck obstruction and young patients.

Adult↗
PubMed1994

Recurrence at the primary site in head and neck cancer and the significance of neck lymph node metastases as a prognostic factor.

BACKGROUND: Biologic aggressiveness of head and neck carcinoma is reflected in its capability to metastasize to regional lymph nodes and its propensity to recur after treatment. METHODS: The authors report on 244 patients treated at the Department of Otolaryngology-Head and Neck Surgery of the Free University Hospital, Amsterdam, The Netherlands, with excision of primary tumor with incontinuity neck dissection with or without postoperative radiation therapy between January 1973 and July 1986. All patients had surgical margins free of tumor. RESULTS: The overall recurrence rate was 12.3%. Stages T3-4 and the presence of more than three positive nodes on histopathologic examination were associated with a 16.2% and 26.2% incidence in recurrence at the primary site, respectively. No prognostic influence arose from primary tumor localization, three or fewer positive nodes, extranodal spread, and postoperative radiation therapy. CONCLUSIONS: Patients with T3-4 disease and those with more than three positive lymph nodes may benefit from novel adjuvant treatment modalities.

Adult↗
PubMedDate not supplied

The use of unilateral deep plane neck lifting to improve the aesthetic appearance of the neck dissection deformity.

The primary concerns of head and neck cancer surgeons are, and should remain, the complete extirpation of tumor and the prevention of tumor recurrence. In recent years, numerous advances have been made in the reconstruction of this patient population, significantly improving their functional and aesthetic outcomes. In this article, with an illustrative case example, we present our technique of unilateral deep plane neck lift that may be considered when one is attempting to achieve better symmetry in patients after radical neck dissection.

Carcinoma, Squamous Cell↗
PubMed1999

[A case of aneurysmal neck clipping following incomplete neck clipping and coil embolization].

We report a case with radical neck clipping following incomplete embolization with coils and imperfect neck clipping. A 43-year-old woman suffered from a subarachnoid hemorrhage (Hunt & Hess Grade IV) due to the rupture of a left paraclinoid internal carotid aneurysm on 28 October, 1996. Neck clipping of the aneurysm was performed at day 1. Follow-up angiogram at 2 weeks after surgery showed however a small residual aneurysm. The second angiogram 1.5 months later showed the growth of the residual aneurysm. The residual part of the aneurysm was then treated with endovascular embolization using interlocking detachable coils (IDC), resulting in incomplete occlusion of the aneurysm. The direct surgical clipping of the residual aneurysm was performed via Dolenc approach. A fenestrated clip was applied to the partial embolized aneurysm, when the aneurysmal wall was ruptured between the occluded part of the aneurysm and the residual dome. The fenestrated clip was then reapplied successfully under temporary occlusion of the parent artery. Because of the stenosis of the parent artery, STA-MCA anastomosis was then performed. Postoperative recovery of the patient was uneventful and postoperative angiogram showed stenosis of the parent artery with patent bypass flow. The patient was discharged without complications. Technical problems in neck clipping following incomplete embolization with coils are discussed.

Adult↗
PubMed2001

[Intentional neck-plastic incomplete clipping followed by coil embolization for broad-necked distal BA aneurysms].

OBJECTIVE: We report three patients with broad-necked distal basilar artery (BA) aneurysms treated with intentional incomplete clipping followed by endovascular occlusion using Guglielmi detachable coils. METHODS: The location of the aneurysms was BA bifurcation in one patient and BA-superior cerebellar artery (SCA) in two. One patient presented with acute subarachnoid hemorrhage and two patients had incidental aneurysms. In two patients, endovascular treatment was thought to be difficult considering the morphology of the aneurysms and surgical treatment was performed as the first choice of treatment. One patient with a BA-SCA aneurysm underwent endovascular treatment using a remodelling technique first. However, it was impossible to place the coil preserving SCA, so surgical treatment was performed. In all patients, the attempt to pursue complete clipping was considered to be accompanied with high risks of morbidity, so neck-plastic incomplete clipping was performed intentionally. One to six days after the surgery, coil embolization was performed. RESULTS: In all patients, complete occlusion of the aneurysms was achieved and all patients had excellent clinical outcomes. CONCLUSION: Intentional neck-plastic incomplete clipping followed by endovascular coiling may be a useful treatment option for patients with broad-necked distal BA aneurysms.

Aged↗
PubMed1986

Parietal occipital nape of neck flap. A myocutaneous flap for selected head and neck reconstruction.

Reconstruction in head and neck surgery has been greatly advanced with the use of the pectoralis major and trapezius myocutaneous flaps. Most surgical defects can be repaired with one of these flaps alone, or in conjunction with cutaneous flaps. Specific problems, however, occur that cannot be successfully reconstructed by these standard flaps. The traditional scalp flaps are cutaneous flaps. Use of these flaps is limited because of their shortened arc of rotation and accompanying forehead deformity. Three patients underwent reconstruction with a parietal occipital nape of neck myocutaneous flap. Its advantages include the following: large segments of hairless skin from the contralateral side of the neck can be used, an extensive arc of rotation and distance can be achieved with excellent vascularity in the overlying skin, and cosmetic results are superior. Angiographic studies were used to demonstrate the vascular pattern and supply to this flap. Cadaver dissections were performed to determine the pattern of distribution of the perforating vessels to the skin from underlying muscle.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Preservation of function by radiotherapy of small primary carcinomas preceded by neck dissection for extensive nodal metastases of the head and neck.

BACKGROUND: When patients are initially seen with a small primary tumor and regional metastases, the question arises whether the primary can be managed by definitive radiotherapy while treating the neck with surgery and postoperative radiation. The advantage of this is least disturbance of the primary site, while still achieving maximal control of the neck disease. METHOD: A retrospective review was conducted over an 8-year period; of the 619 patients seen during this time, 15 were judged suitable for this approach. Small primaries were defined as T1 or T2 lesions or superficial spreading T3 tumors. Extensive neck disease was defined as at least 3 cm in size. RESULTS: There were no regional recurrences and only 3 local recurrences, 2 of which were successfully salvaged. Four patients died of distant metastases. The arguments for and against this unusual approach are discussed. CONCLUSIONS: It is concluded that, in patients conforming to our criteria, this is a sound oncologic approach.

Adult↗
PubMed1991

Elective radical neck dissection in epidermoid cancer of the head and neck. A retrospective analysis of 853 cases of mouth, pharynx, and larynx cancer.

A retrospective analysis of 853 patients with cancer of the mouth, pharynx, and larynx operated on over a 30-year period was performed. Four hundred fifty-seven of them had a radical neck dissection (RND) at some point. Five hundred ninety patients had no clinically positive nodes (N-o) necks at the time of primary treatment; 99 of these had elective neck dissection, whereas 95 others had a delayed RND when nodes became clinically involved. Twenty-three percent of all N-o patients had microscopically involved nodes and less than half of these were among those patients selected for elective RND. Furthermore, 58% of those patients who had elective RND did not have positive nodes. Comparative analysis of elective RND, delayed therapeutic RND after clinical appearance of nodes, and composite operations for patients with N1-N3 disease indicates little difference in disease-free survival when the nodes in the elective RND were positive microscopically for tumors (56%, 49% and 47% respectively). It thus seems that elective RND offers no real advantage over a careful watchful waiting approach in most patients.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Unexpected lymph node pathology in neck dissection for head and neck cancer.

The pathological findings in 62 patients with head and neck cancers who underwent neck dissection during a 12-month period are presented. Histological confirmation of metastatic disease was obtained in 46 cases (74%). In the remaining 16 cases (26%), there was no evidence of metastasis from the primary tumor. In 7 cases (11%), there was unexpected pathology in the cervical lymph nodes which was not related to the primary tumor. Accurate clinical staging of head and neck tumors is made increasingly more difficult in such cases where unrelated or dual lymph node pathology exists.

Aged↗
PubMed2026

Effects of Dynamic Neck Sensorimotor Biofeedback Training in Individuals With Mechanical Neck Pain: A Pilot Randomized Controlled Trial.

Mechanical neck pain (MNP) is commonly accompanied by pain-related functional limitations, sensorimotor disturbances, and fear of movement, which together may contribute to persistent disability. This preliminary randomized controlled trial study investigated the short-term effects of dynamic neck sensorimotor-based biofeedback training in individuals with MNP. 20 MNP patients from outpatient clinics were assigned to a biofeedback training group or a control group. The training group underwent dynamic biofeedback exercises twice weekly for 2&#xa0;weeks, whereas the control group performed repeated cervical movements without biofeedback. Outcomes included cervical kinematics as repositioning errors (RPE), movement units (MU), maximal range of motion (ROM), and subjective measures, including pain intensity, Neck Disability Index (NDI), and Fear-Avoidance Beliefs Questionnaire (FABQ). All participants completed post-intervention assessments; adherence in the training group was 100%, with no missing data and no adverse events reported. Within the biofeedback training group, participants receiving biofeedback training demonstrated greater improvements in cervical repositioning accuracy during flexion (51.95%, p&#xa0;=&#xa0;0.04) and extension (46.67%, p&#xa0;=&#xa0;0.02), along with reductions in fear-avoidance beliefs related to physical activity and work (p&#xa0;<&#xa0;0.05); these changes were less apparent in the active control group. Exploratory regression analyses suggested associations between improvements in repositioning accuracy and pain reduction, and between increased cervical range of motion and improvements in fear-avoidance beliefs related to physical activity. These pilot findings suggest that dynamic sensorimotor biofeedback training may improve proprioceptive acuity and fear-avoidance beliefs in individuals with MNP, supporting further evaluation in an adequately powered randomized trial.

Humans↗
PubMed2005

Determining optimal clinical target volume margins in head-and-neck cancer based on microscopic extracapsular extension of metastatic neck nodes.

PURPOSE: To determine the optimal clinical target volume margins around the gross nodal tumor volume in head-and-neck cancer by assessing microscopic tumor extension beyond cervical lymph node capsules. METHODS AND MATERIALS: Histologic sections of 96 dissected cervical lymph nodes with extracapsular extension (ECE) from 48 patients with head-and-neck squamous cell carcinoma were examined. The maximum linear distance from the external capsule border to the farthest extent of the tumor or tumoral reaction was measured. The trends of ECE as a function of the distance from the capsule and lymph node size were analyzed. RESULTS: The median diameter of all lymph nodes was 11.0 mm (range: 3.0-30.0 mm). The mean and median ECE extent was 2.2 mm and 1.6 mm, respectively (range: 0.4-9.0 mm). The ECE was <5 mm from the capsule in 96% of the nodes. As the distance from the capsule increased, the probability of tumor extension declined. No significant difference between the extent of ECE and lymph node size was observed. CONCLUSION: For N1 nodes that are at high risk for ECE but not grossly infiltrating musculature, 1 cm clinical target volume margins around the nodal gross tumor volume are recommended to cover microscopic nodal extension in head-and-neck cancer.

Adult↗
PubMed2001

Unresectable primary tumor of head and neck: does neck dissection combined with chemoradiotherapy improve survival?

A study regarding patients with primary and previously untreated advanced histologically proven squamous cell carcinoma of the head and neck was performed to compare two treatment modalities: neck dissection followed by chemoradiotherapy (Group I) versus chemoradiotherapy alone (Group II). Fifty-four patients were randomly chosen to receive Group I or II treatment. Our results demonstrate that Group I treatment has a higher and statistically significant disease-specific survival rate. We suggest that an association of neck dissection plus chemoradiotherapy can be useful in the event of unresectable advanced carcinomas.

Adult↗
PubMed2005

Ultrasonographic changes in malignant neck nodes during radiotherapy in head and neck squamous carcinoma.

Limited information is available about the sonomorphological changes in metastatic neck nodes during radiotherapy. The aim of this study was to evaluate the pattern of sonomorphological changes in metastatic neck nodes with radiotherapy. The study population consisted of 16 consecutive patients planned for radical radiotherapy to the head and neck. All patients were subjected to four ultrasound examinations: before therapy, at 46 Gy, at the conclusion of radiation and at first follow up. A total of 59 ultrasound examinations were performed on 16 patients. The difference between the mean number of nodes detected per patient before (10.6) and after (7.8) radiation was significant (P = 0.05). Sixteen nodes were categorized as malignant at first sonography, half of which reverted back to normal by the end of radiation. Changes in the sonomorphology of malignant cervical lymph nodes occur with radiotherapy with more that half demonstrating reversion to normal pattern. Future studies correlating this with histopathology should be considered.

Aged↗
PubMed2003

[Femoral neck morphology differentiates femoral neck from vertebral or hip osteoporotic fracture].

UNLABELLED: Mineral density and bone geometry are the two main biomechanical factors related to bone resistance to stress. OBJECTIVE: In this study we assess whether differences in the proximal femur geometry (PFG) characterize different types of osteoporotic fractures. METHODS: We studied 533 postmenopausal women aged 50 - 85. They were divided into four groups matched for bone mineral density at the femoral neck; without fractures (165), vertebral fractures (139), trochanteric fractures (102), and hip fractures (127). Dual X-Ray absorptiometry (DXA) scans at the spine and at the hip were carried out to measure bone mineral density and the DXA images were used to define the proximal femur geometry parameters of the hip. RESULTS: Age, height, vertebral BMD and PFG parameters (i.e. femoral neck-shaft angle (NSA) and hip axis length (HAL) were different when all four groups were compared by the Anova test. Patients with vertebral fractures were then compared by multivariate analysis to those with trochanteric fractures. The variables that discriminated the two groups were: age, age at menopause, weight, height, and vertebral BMD, but not PFG. Comparing vertebral to hip fractures the distinguishing variables were: vertebral BMD, height, NSA and HAL. We found that hip fractures had longer HAL and wider NSA than vertebral fractures, whereas no statistically significant differences were found between trochanteric fractures and vertebral fractures concerning PFG. CONCLUSIONS: These data indicate that differences in PFG parameters might have a role in predisposing to femoral neck fracture.

Absorptiometry, Photon↗
PubMed1992

Predicting the probability of malignancy of the neck mass with logistic regression model: a statistical analysis of excisional biopsy of neck masses.

One hundred and fifty-six patients with neck lesions were selected into this retrospective study between January, 1989 and December, 1990. All the patients visited OPD with the chief complaint of neck mass without other apparent symptoms and signs after initial work-up. They can be divided into 5 types according to the pathological reports: type a) metastatic lesion, type b) malignant lymphoma, type c) TB lymphadenitis, type d) miscellaneous benign lesion, and type e) inadequate specimen. They represent 24.4%, 12.8%, 9.6%, 52.6%, and 0.6% of the patients respectively. Type a) and type b) were classified as group of malignancy and the other three types were group of benignancy. Chi-square test and t-test were then used to evaluate the significant level of difference in each semiological factor between both groups. Several parameters were found to reach significant level, including tumor fixation, age of the patients, tenderness, location and size of the tumor, and history of cancer. Stepwise logistic regression was utilized to obtain a regression equation to predict the probability of malignancy in OPD patients with neck masses. The accuracy rate of prediction is 83.3%, if the cutpoint value is 0.5. A clinician can therefore avoid untimely excisional biopsy and delay in treatment planning.

Adolescent↗