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PubMed2003

Neck node metastasis after successful brachytherapy for early stage tongue carcinoma.

BACKGROUND AND PURPOSE: The accuracy of factors for predicting lymph node metastasis in patients with early-stage (stage I and II) mobile tongue carcinoma and prognostic factors associated with the clinical and pathological findings of lymph node metastasis were examined. MATERIAL AND METHODS: Between 1971 and 1998, 616 patients with early stage mobile tongue carcinoma were treated by brachytherapy with or without external irradiation. Neck lymph node metastasis occurred in a total of 237 cases, and 191 of them were not associated with primary failure. Neck dissection was performed in 169 of these 191 cases, and 16 cases were treated by radiotherapy. A pathological analysis was possible in 159 of the 169 neck dissection cases. RESULTS: There were 88 tongue cancer recurrences, and the incidence of neck metastasis was 38% (191/528) in the cases of primary controlled early tongue carcinoma, and 25% (38/151) and 41% (153/377), in stage-I and -II carcinoma, respectively. Neck metastasis was diagnosed within 12 months in 80% of cases, and within 24 months in 95%. Macroscopic appearance, tumor thickness and tumor length were identified as significant risk factors by a univariate analysis, but macroscopic appearance was the only significant risk factor identified by a multivariate analysis (P<0.001). The incidence of cervical lymph node metastasis was 62% among the invasive/ulcerative type tongue carcinomas, and was lower among the superficial type and exophytic/nodular type (20 and 35%, respectively). Regional and/or distant failure occurred in 75 of the 169 neck dissection cases (44%). The incidence of regional/distant failure was extremely high (49/68=72%) in the extra-nodal invasion group, and extra-nodal invasion was found even in small metastatic node less than 1 cm in length (20%). CONCLUSIONS: The macroscopic appearance of the primary tongue carcinoma has a major impact on the incidence of lymph node metastasis in patients with early tongue cancer, and extra-nodal invasion was the dominant risk factor for regional and distant failure. Treatment policy for clinically negative neck metastasis in early tongue cancer patients should be determined after considering the possibility of neck metastases and the morbidity associated with elective neck dissection.

Adult↗
PubMed1988

Treatments of choice for early carcinoma of the oral cavity.

The treatment of squamous cell carcinoma of the oral cavity is determined primarily by the stage of the disease. Therapeutic modalities include surgery, radiation therapy, and chemotherapy. For patients with small, localized primary lesions and no metastases (Stages I and II), treatment might include resection of the primary tumor with or without elective neck dissection, radiotherapy to the primary tumor with or without elective neck irradiation, or combination therapy including resection of the primary tumor followed by irradiation of the neck. Patients presenting with clinically negative necks who are initially treated with elective neck dissections show better survival rates than similar patients undergoing later salvage neck dissections.

Combined Modality Therapy↗
PubMed1999

Gustatory sweating: clinical implications and etiologic aspects.

PURPOSE: It was the aim of this study to provide detailed general information on the clinical picture of different kinds of gustatory sweating, including reevaluation of a series of patients who underwent parotidectomy, removal of the submandibular gland, or neck dissection. PATIENTS AND METHODS: This study summarizes the statements of 548 patients questioned about the occurrence of gustatory sweating after parotidectomy (n = 296), extirpation of the submandibular gland (n = 79), and neck dissection (n = 173). RESULTS: After parotidectomy, 45% of the patients had noticed gustatory sweating. In most of them (70%), the symptoms began within 6 months after surgery. Gustatory sweating developed in only one patient with submandibular extirpation (1.5%), and not at all after neck dissection. Most patients (52%) reported that the symptoms occurred independent of the kind of food ingested. These results show that the "masticatory component" is an important trigger for Frey's syndrome. Application of Minor's test localized gustatory sweating mainly in the region of previous parotid lobe removal, but also in other areas deriving their sensory supply from the auriculotemporal, greater auricular, and lesser occipital nerves. The size of the area affected by the sweating was similar after lateral and total parotidectomy. When evaluating clinical symptoms, subjective assessment by the patients seemed to play a major role. After submandibular extirpation and neck dissection, some patients reported gustatory sweating that was not verified by Minor's test. CONCLUSION: There is general agreement that the cause of gustatory sweating is sympathetic or parasympathetic innervation of previously denervated sweat glands, initiated by gustatory triggers. The location of the "erroneous innervation" depends on the type of lesion. In cases after parotidectomy, misdirected parasympathetic regeneration is the model integrating all known factors into a rational concept. For didactic and systematic-pragmatic reasons, a clinically oriented classification of gustatory sweating (types I to III) seems to be useful.

Chi-Square Distribution↗
PubMed2001

[The selection of surgical technique for differentiated thyroid carcinoma].

OBJECTIVE: To evaluate the optimal extent of primary thyroidectomy and neck dissection in the patients with differentiated thyroid carcinoma (DTC). METHOD: Retrospective analysis of 66 cases of DTC. Lobectomy for tumor side plus subtotal lobectomy for another side was performed in 49 cases, lobectomy with isthmectomy was performed in 7 cases, subtotal lobectomy for one side plus partial lobectomy for another side was performed in 6 cases, total thyroidectomy was performed in 4 cases. Unilateral functional neck dissection for another side was performed in 1 case and unilateral traditional neck dissection in 5 cases. RESULT: The 5 and 3 years survival rates were 94% and 96%. All 4 cases operated with total thyroidectomy suffered hypothyroidism and 2 of them had hypoparathyroidism postoperatively. There was no hypothyroidism and hypoparathyroidism for other cases. No recurrent nerve paralysis occurred in this group. CONCLUSION: We recommend lobectomy for tumor side plus subtotal lobectomy for another side for most of DTC. Selective neck dissection is not necessary for N0 cases unless the patient is in high risk group.

Adolescent↗
PubMed1997

Frequency and therapeutic implications of "skip metastases" in the neck from squamous carcinoma of the oral tongue.

BACKGROUND: Supraomohyoid neck dissection is an adequate operation for the elective treatment of the neck for patients with oral cavity cancer. Squamous cell carcinoma of the oral tongue, however, metastasize to clinically negative nodes in 20% to 30% of patients. These nodes usually are located in levels I-III. METHODS: The medical records of 277 previously untreated patients with squamous cell carcinoma of the oral tongue were reviewed between the years 1970 and 1990. All patients had a glossectomy and neck dissection as part of their initial treatment. Patients were evaluated as to the findings in their neck. The following group of patients were included: (1) patients who had level III nodes positive, without disease in levels I and II; (2) patients with disease in level IV; (3) patients with disease in level IIB or IIIB, and; (4) patients who were electively dissected and whose neck did not demonstrate any pathologically involved nodes, but level IV was not included in the dissection and the patient subsequently developed pathologically positive nodes in level IV. RESULTS: Of all patients, 15.8% had either level IV metastasis as the only manifestation of disease in the neck or the level III node was the only node present without disease in level I-II. CONCLUSION: The usual supraomohyoid neck dissection is inadequate for a complete pathologic evaluation of all the nodes at risk for patients with squamous carcinoma of the oral tongue. This may create a dilemma in determining whether postoperative radiotherapy is necessary. Consequently, all patients with squamous cell carcinoma of the oral tongue should have levels I-IV nodes removed if an elective neck dissection is part of their initial therapy.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Adenocarcinoma of the parotid.

All of the consultants considered needle biopsy an integral tool in management of a parotid neoplasm. If the tumor was limited to the superficial lobe of the parotid, they were split between ordering no further tests (Drs. Johnson and Glenn) and proceeding with a CT scan (Dr. Beckford). If frozen section revealed adenocarcinoma, the consultants agreed that a total parotidectomy with preservation of any uninvolved nerve would be in order. If the nerve had to be sacrificed, repair should be with a greater auricular or sural nerve graft. Two consultants (Drs. Beckford and Glenn) would search for a distant primary or metastasis. Controversy regarding management of an N0 neck divided the group into favoring neck dissection (Drs. Beckford and Johnson) and a modified radical neck dissection (Dr. Glenn). In the case of anaplastic carcinoma the consultants differed by suggesting an extended resection (Dr. Beckford), total parotidectomy with nerve preservation (Dr. Johnson), and total parotidectomy with modified radical neck dissection (Dr. Glenn). All the consultants recommended postoperative radiotherapy.

Adenocarcinoma↗
PubMed2005

Management of the neck in salivary gland carcinoma.

Major salivary gland malignancies are rare. Treatment of the primary tumor involves resection with or without postoperative radiation therapy. When there is clinical neck disease, neck dissection is performed to remove gross disease. Treatment of the N0 neck is controversial. Most centers treat the high-risk patient and perform either elective neck dissection or elective neck irradiation to eradicate residual occult disease.

Antineoplastic Agents↗
PubMed1999

[One-stage reconstruction with the pedicle skin flap of forehead for defective tissue of head-neck tumors dissection].

OBJECTIVE: To discuss the feasibility on reconstructing the defective tissue with the pedicle skin flap of forhead after head-neck tumors dissection. METHOD: 14 patients with advanced head-neck tumors were studied, whose defective tissues were reconstructed by their forehead skin flaps. The flap area ranged from 5 cm x 11 cm to 7 cm x 16 cm. RESULT: 2 cases of them were partial necrosis, 3 years and 5 years survival rates were 76.9% and 63.6% respectively. The function of breath through nose or mouth and the function of swallow were satisfactory. CONCLUSION: The forehead skin flap should be a good selection for the reconstruction of defective tissue after basicranial and nasalfacial dissection.

Adolescent↗
PubMed2005

[Transpositional anastomosis of C7 posterior root and spinal accessory nerve to reconstruct the trapezius muscle function].

OBJECTIVE: To introduce a new approach of neurotization to treatment of the shoulder syndrome after the radical neck dissection by using transpositional anastomosis of C7 posterior root and the spinal accessory nerve to reconstruct the function of trapezius muscle. METHODS: From March 1999 to February 2001, 10 patients underwent the neurotization during the radical neck dissection. In the operation, the apo-cranial part of spinal accessory nerve was preserved from the trapezius muscle (> 3. 0 cm in length) and anastomosed to C7 posterior root. Objective physical examinations and electromyography were conducted before and after operation. One, 6 and 12 months after operation the trapezius muscle function after the transpositional anastomosis was evaluated. RESULTS: One, 6 and 12 months after operation, the recovery rates of each part were as follows: 9.8%, 68.9% and 73.5% in upper part; 4.7%, 73.6% and 69.4% in middle part; and 6.2%, 70.5% and 70.3% in lower part. The range of abduction motion of upper arm in 7 cases (70%) exceeded 90 degrees. The mean maximal abduction angle was more than 95 degrees. Evaluation of the shoulder function showed that myoatrophy was mild and the disability of abduction was classified as grade II in 7 cases and grade II in 3 cases. CONCLUSION: Transpositional anastomosis of the C7 posterior root to the spinal accessory nerve after radical neck dissection can well reconstruct the function of trapezius muscle. This approach provides a wide indication in comparison with the functional neck dissection without impairment of arm function after the cutting of C7.

Accessory Nerve↗
PubMed1990

Improving diagnostic accuracy of cervical metastases with computed tomography and magnetic resonance imaging.

Elective neck dissection in patients with head and neck cancer continues to be controversial. The management of these patients would be greatly facilitated by improvements in predicting cervical metastases. Recent investigations have suggested that computed tomography and magnetic resonance imaging are more sensitive in detecting cervical metastases than physical examination. The Department of Otolaryngology at the Ohio State University Hospitals, Columbus, undertook a prospective study to compare the preoperative sensitivities of physical examination, computed tomography, and magnetic resonance imaging with pathologic findings in 27 patients undergoing neck dissections for head and neck cancer. The results indicate that computed tomography and magnetic resonance imaging were more sensitive (84% and 92%, respectively) than physical examination (75%), although the results did not achieve statistical significance. The sensitivity of combined computed tomography and magnetic resonance imaging was 90%.

Head and Neck Neoplasms↗
PubMed1998

[Result of treatment of squamous cell carcinoma of the tongue and floor of the mouth].

A statistical analysis was performed on 40 patients with squamous cell carcinoma of the tongue and mouth floor, which could be followed for 6 months or more after initial treatment in the Department of Otorhinolaryngology, School of Medicine, Keio University during the 14 years from 1983 to 1996. The 5-year survival rate determined by the Kaplan-Meier method for each stage was 100% for Stage I, 77.8% for Stage II, 60.0% for Stage III and 44.4% for Stage IV. Thirteen suffered a relapse after initial treatment and patients with relapses among them have all survived after the subsequent salvage surgery. In contrast, in nine patients with cervical relapse, however, the 5-year survival rate was 11.1% with an unfavorable prognosis. This confirmed that suppressing cervical relapses is important for treating tongue and floor mouth cancers. The treatment strategy in our department is characteristic of positive enforcement of prophylactic neck dissection in the surgery and introduction of neoadjuvant chemotherapy (NAC) in the chemotherapy. Prophylactic neck dissection was performed in the 17 patients and no relapse was observed on the side of prophylactic neck dissection. NAC was performed on 26 patients in consideration of suppressed minute metastases and preserved function and 24 determinable cases were statistically analyzed. Among patients who had received NAC, the oral function was successfully preserved without surgical intervention in six patients both patients who showed complete response (CR) and four out of 14 patients who had a partial response (PR) following NAC. This may indicate that the oral function could be preserved in those patients who exhibited CR following NAC, but that preservation could be difficult in patients who exhibited PR. In addition, concerning the accumulated 5-year survival rate in relation to the effect of NAC, responders (CR + PR) accounted for 90.9% and non-responders (no change + progressive disease following NAC) for 15.0% with a very good outcome noted in the responder group. These figures suggest that responders may have a significantly good prognosis in the multivariant analysis including additional background factors before treatment as well. Accordingly, the present therapeutic measures for non-responders must be reexamined and performed more carefully and accurately as compared with those for responders.

Adult↗
PubMed2001

Surgical treatment of early oral carcinoma-results of a prospective controlled multicenter study.

PURPOSE OF THE STUDY: To assess whether early stage (pT1-2,pN0-1) oral cavity carcinoma is adequately treated by radical surgical resection alone. MATERIAL AND METHODS: Prospective multicenter study. Of 105 patients with cT1-2 cN0-1 oral carcinoma treated in conformity with the study design, 12 had to be excluded because of tumor-positive margins or pN stage > N1. The remaining 93 patients were monitored for at least 2 years. RESULTS: Seventeen patients had local or regional recurrence develop. In 12 of the 17 patients locoregional control was achieved by second treatment. Overall, the 4-year disease-specific survival probability was 94%. Patients treated initially without selective neck dissection had significantly higher recurrence rates than those with neck dissection, although the survival probability was not adversely affected. CONCLUSIONS: Early (pT1-2, pN0-1) squamous cell carcinoma of the oral cavity is adequately treated by surgery alone, provided the resection margins are tumor free. On the basis of the presented data, we would also advocate routine selective neck dissection.

Adult↗
PubMed2005

A case of cervical metastases from temporal bone carcinoid.

BACKGROUND: Carcinoids are neuroendocrine tumors that typically occur in the gastrointestinal tract and lung and less frequently in the head and neck region. Whereas the metastatic potential of laryngeal carcinoid is well documented, only one case of metastasis of temporal bone carcinoid to the cervical lymph nodes has been reported. We present the case of a 55-year-old woman with cervical metastases almost 3 years after a primary diagnosis of temporal bone carcinoid. METHODS: The patient had undergone a subtotal petrosectomy for a temporal bone carcinoid and, 29 months later, revision surgery for a local recurrence. Four months later, multiple laterocervical swelling appeared, and the patient underwent modified radical neck dissection. RESULTS: Histologic examination after the neck dissection was suggestive of lymph node metastases from a carcinoid tumor. Immunohistochemical analysis of the lymph node metastases showed neoplastic cells positive for keratin, vimentin, chromogranin, and neuron-specific enolase and negative for thyroglobulin, calcitonin, S-100, and parathyroid hormone. The patient was treated with intensity-modulated radiation therapy and neck irradiation. CONCLUSIONS: We believe that temporal bone carcinoids have metastatic potential not predictable by histologic features. Surgical excision is the treatment of choice for patients with temporal bone carcinoids, with the approach and technique determined by the extent of the mass. Moreover, before planning surgery and during follow-up, neck node status must be carefully detected.

Carcinoid Tumor↗
PubMed2002

Cervical lymph node metastases from occult squamous cell carcinoma.

Depending on patient and tumor characteristics, reported 5-year actuarial survival rates of patients with cervical nodal metastasis from an unknown primary carcinoma range from 18% to 63%. Prognostic factors for survival include N-stage, number of nodes, grading, extracapsular extension, and performance status. Retrospective studies suggest that neck relapse is more common than are distant metastases or emergence of mucosal primary tumors. The treatment options include neck dissection alone, radiation alone to the neck with or without the putative mucosal origin, and combination unilateral neck dissection plus limited or comprehensive radiotherapy. Combination of nodal dissection with comprehensive bilateral radiotherapy yielded most favorable results in local-regional disease control. However, its impact on the quality of life should be recognized. Also, the confounding effects of patient selection for various treatment modalities on therapeutic outcome cannot be quantified. Retrospective single-institution comparisons between comprehensive and unilateral neck radiotherapy did not show apparent differences in outcome. A randomized trial to compare the therapeutic value of comprehensive versus volume-limited radiotherapy is being planned. No data were found to support the benefit of chemotherapy for the treatment of this disease.

Carcinoma, Squamous Cell↗
PubMed1999

[Experimental study on head and neck hemodynamics after ligation of jugular veins].

OBJECTIVE: To study alteration of neck hemodynamics after ligation of jugular veins during radical neck dissection. METHODS: 4 rhesus monkeys were selected to simulate the human bilateral radical neck dissection. After operation, the jugular veins were ligated or loosen and the blood stream quantities and blood pressure of jugular veins and arteries were measured simultaneously. RESULTS: The hemodynamic index would changed after jugular vein was ligated, the more the jugular veins were ligated, the greater effects the hemodynamics index of jugular veins were occurred, but there was little effect on arteries. CONCLUSION: The external jugular veins have the effect of compensating cerebral venous outflow after removing the internal jugular veins, and the external jugular veins should be conserved when bilateral or unilateral radical neck dissection was done.

Animals↗
PubMed2003

Pre- and intra-operative staging of the neck in a developing world practice.

Most patients with squamous cancer of the head and neck treated at Groote Schuur Hospital are from a poor socio-economic background with a high prevalence of tuberculosis (TB), human immunodeficiency virus (HIV) and other infections that may cause cervical lymphadenopathy resulting in overstaging of the neck. A retrospective review of 186 patients requiring therapeutic and elective neck dissection was undertaken and the sensitivity and specificity of clinical and intra-operative staging of the neck determined. Results showed overall sensitivity of staging at 80.1 per cent. Specificity was 52.2 per cent. Staging of the N(1), N(2b) and N(2c) necks had positive predictive values of 53.2, 65.8 and 68.2 per cent respectively. Occult nodal metastases were present in 32 per cent elective neck dissections (END)s. Specificity of intra-operative staging of the N(0) neck was 33.3 per cent and sensitivity was 72.4 per cent. Conclusions were that our indications for elective neck dissection are appropriate. The high false positive rates for staging of the N(1), N(2b) and N(2c) necks, necessitate a change in management strategy.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Sentinel node biopsy in head and neck cancer.

The purpose of this study was to assess the value of sentinel node (SN) biopsy in oral cancer by means of a lymphoscintigraphic technique and intraoperative detection by blue-dye combined with gamma-ray probe to facilitate identification of the SN. Forty-one T1-T2N0 patients underwent lymphoscintigraphy, SN biopsy, and modified radical neck dissection. An SN was identified in 39 of 41 patients by the combined use of intraoperative blue dye and the probe and was removed. Complete neck dissections were performed and the histological evaluation compared. Thirty-eight SNs in 35 patients were negative at final pathology and correctly predicted the pathological status of the specimens from the full-neck dissections. Five SNs in four patients had micrometastases and were the only metastatic nodes identified. The results of this study on a homogenous series of patients show that SN biopsy is a valuable staging technique in T1 and T2 oral cancer with uninvolved neck, provided that no previous surgery or radiotherapy has altered lymphatic drainage in the oral cavity or in the neck. In a large number of patients, SN biopsy can avoid unnecessary neck dissection and its relevant morphofunctional sequelae.

Carcinoma, Squamous Cell↗
PubMed2000

[Treatment strategy for cervical node metastasis from squamous cell carcinoma of the oropharynx].

The purpose of this study is to ascertain the role of neck surgery and radiation therapy for cervical lymph node metastasis in oropharyngeal cancer patients. We reviewed 217 previously untreated patients with squamous cell carcinoma of the oropharynx who were treated at the Cancer Institute Hospital in Tokyo between 1971 and 1995. The N stage distribution was; N0: 83(38.2%), N1: 42(19.4%), N2a: 23(10.6%), N2b: 27(12.4%), N2c: 33(15.2%), and N3: 9(4.2%). A predominance of cervical node metastases in level II and III was revealed and there were no skip metastases outside of level II and III. The control rate of cervical metastasis for each N stage was; N0: 96.9%, N1: 90.0%, N2a: 76.5%, N2b: 62.5%, N2c: 50.0%, and N3: 0%. Definitive irradiation provided sufficient treatment for small nodes, when the primary tumor growth was well controlled by radiation therapy. Neck dissection was necessary for more advanced neck metastases. Selective limited neck dissection (level II and III) is recommended for N0 and N1 patients, and modified or classical RND is considered to be better for most cases with N2 and N3.

Adult↗