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At least 163 records · Page 9Linked to original sources
PubMed2005

Transurethral incision of bladder neck in treatment of bladder neck obstruction in women.

OBJECTIVES: To report our preliminary experience with transurethral incision of the bladder neck in the treatment of female voiding dysfunction due to bladder neck obstruction. Bladder neck obstruction in women is an infrequently diagnosed urologic condition. METHODS: Bladder neck obstruction was diagnosed in 11 women 41 to 80 years of age, who presented with difficult micturition or urinary retention. Preoperative investigations included a full urodynamic examination and urethrocystoscopy. Transurethral bladder neck incision was performed in all patients. Urodynamic results and clinical improvement in voiding symptoms were assessed. RESULTS: Of the 11 patients, 5 had chronic urinary retention and 6 had difficult micturition; 3 also had recurrent urinary tract infection or upper urinary tract deterioration. The most frequent findings on video-urodynamic study were a high voiding pressure plus low flow rate and a narrow bladder neck during voiding on cinefluoroscopy. After treatment, the lower urinary tract symptoms were resolved or improved in all patients. Ten patients resumed spontaneous voiding with a small postvoid residual urine volume; the remaining patient was able to void by abdominal straining after adjuvant urethral botulinum A toxin injection. Urodynamic study revealed a decreased voiding pressure and postvoid residual urine volume and an increased maximal flow rate. The overall satisfactory rate was 91%. CONCLUSIONS: Transurethral incision of the bladder neck is effective in relieving voiding difficulty owing to anatomic or functional bladder neck obstruction in women. A full video-urodynamic evaluation is essential in making the correct diagnosis and formulating a treatment plan.

Adult↗
PubMed2005

Localized amyloid deposition in the nasopharynx and neck, mimicking nasopharyngeal carcinoma with neck metastasis.

Amyloidosis results from the deposition of amyloid proteins in organs and tissues. Clinically, it can be classified into systemic and localized forms. Here, we report a case of localized amyloidosis of the nasopharynx and neck. The initial presentation was a nasopharyngeal mass, and bilateral neck masses, mimicking nasopharyngeal carcinoma with neck metastasis. Computed tomographic scans of the neck revealed asymmetry between the bilateral nasopharyngeal walls, and multiple radio-opaque masses in both sides of the neck. A nasopharyngeal biopsy was performed and confirmed amyloid deposition. Subsequent neck-mass excision biopsies confirmed that the neck masses were also amyloid deposits. Further laboratory examinations revealed no systemic involvement. There was no disease progression after local excision. Localized amyloidosis in the head and neck is rare, but can have various manifestations that may sometimes mimic neoplasms.

Aged↗
PubMedDate not supplied

Squamous cell carcinoma metastatic to the neck from an unknown head and neck primary site.

Squamous cell carcinoma metastatic to the neck from an unknown head and neck primary site is relatively uncommon and presents a challenging diagnostic and therapeutic dilemma. Diagnostic evaluation includes fine-needle aspiration of the neck mass, chest roentgenography, computed tomography, and/or magnetic resonance imaging of the head and neck, followed by panendoscopy and biopsies. The primary tumor will be detected in approximately 40% of patients; approximately 80% of cancers are located in the base of the tongue or tonsillar fossa. Management options include treatment of the neck alone or both sides of the neck and the potential head and neck primary sites. The latter approach is associated with better long-term control above the clavicles. The 5-year survival rate is approximately 50% after treatment and is influenced by the extent of neck disease. In this article, we review the pertinent literature.

Biopsy, Needle↗
PubMedDate not supplied

Planned postradiotherapy bilateral neck dissection for head and neck cancer.

PURPOSE: This is a retrospective analysis of 50 patients with squamous cell carcinoma of the head and neck treated with radiotherapy (RT) to the primary site and bilateral neck followed by a planned bilateral neck dissection approximately 4 to 6 weeks after completion of RT. PATIENTS AND METHODS: Between November 1964 and March 1997, 50 patients underwent bilateral neck dissections after RT, with minimum 2-year follow-up. Forty-eight patients had bilateral positive neck nodes. RESULTS: At 5 years, the rates of neck disease control, local-regional control, and cause-specific survival were 76%, 70%, and 39%, respectively. Five severe complications developed after surgery, and 1 developed after RT. CONCLUSIONS: Radiotherapy followed by a planned bilateral neck dissection resulted in a high rate of local-regional control with acceptable morbidity. The likelihood of severe complications after simultaneous (as opposed to staged) neck dissection was not significantly different (P =.24).

Carcinoma, Squamous Cell↗
PubMed2006

Does clinical and radiological response predict complete tumor control in N2-N3 squamous cell head and neck cancer after non-operative management of the neck?

CONCLUSION: A complete clinical and radiological response observed following chemotherapy and radiotherapy is not predictive of the absence of residual disease. Moreover, salvage neck surgery does not always seem to be an effective strategy. Consequently, early neck dissection should be advised for patients with complete clinical and radiological response (CCRR) after chemoradiotherapy for tumors with N2-N3 disease. BACKGROUND: We retrospectively reviewed the outcome of 28 patients with N2-N3 disease treated initially with chemotherapy and radiotherapy. PATIENTS AND METHODS: A neck dissection was performed for all patients with residual disease in the neck. RESULTS: A CCRR in the neck was achieved in 25 of 28 patients. The remaining three patients with residual neck mass underwent a salvage neck dissection: the pathological examination confirmed the persistence of tumoral disease. No regional failure was observed in these three patients. In 25 patients considered to have CCRR in the neck, 5 patients (20%) developed regional recurrence. Successful salvage approach was not possible for any of these patients.

Adult↗
PubMed1998

Observations on control of N2 and N3 neck disease in squamous cell carcinoma of the head and neck by intra-arterial chemoradiation.

Patients with head and neck squamous cell cancer with N2 and N3 neck disease have a poor prognosis and are at risk to fail regionally despite combined surgery and radiation. Twenty-two patients with N2 and N3 neck disease (and T3-4 primaries) were treated with intra-arterial, high-dose cisplatin (CDDP), 150 mg/m2 per week for 4 weeks, and concurrent radiation. All patients were followed for at least 2 years or until death from any cause. Twenty patients had a complete response at the primary site. Two of the 20 with a complete response later had a neck recurrence and died. Five patients with palpable nodes after treatment underwent fine-needle aspiration (FNA), one of which was positive and two suggestive of cancer. Six neck dissections were performed in this group, only two of which had positive nodes. This chemoradiation protocol may offer reasonable control of N2 and N3 neck disease in advanced head and neck squamous cell cancer. Neck dissection appeared to be necessary in only those patients with nodes 8 weeks after treatment in whom FNA was positive or suggestive of cancer. Because of the relatively small size of this series, additional accrual and monitoring of such patients is planned.

Adolescent↗
PubMed1984

Tonic neck reflex of the decerebrate cat: response of spinal interneurons to natural stimulation of neck and vestibular receptors.

In order to investigate the neural basis of the tonic neck reflex, we studied the response of neurons in the cervical spinal cord of decerebrate, paralyzed cats to neck rotation about the longitudinal axis (roll), to vestibular stimulation produced by roll tilt, and to a combination of these stimuli. Most neurons were outside the motoneuron nuclei and were arbitrarily classified as interneurons. Three types of preparation were used--one with intact labyrinths, one acutely labyrinthectomized, and one with acute spinal transection. The activity of 115 neurons recorded extracellularly was modulated by sinusoidal neck rotation in the range 0.02-4 Hz; their behavior was sufficiently linear for sinusoidal analysis. The phase and gain of the responses of neurons in all three preparations were similar except that the absolute gain in cats with intact labyrinths was higher than that of the others. The location of neurons in segments C4-C8 was mainly in laminae 7-8. Some neurons were excited by rotation of the chin to the ipsilateral side (type I) and others by contralateral chin rotation (type II). The dynamic behavior of type I and type II neurons was the same; phase was flat over most of the frequency range and close to the phase of peak neck rotation, while gain enhancement occurred at higher frequencies. This behavior was similar to that of the neckforelimb reflex evoked in unparalyzed intact-labyrinth and labyrinthectomized cats. In cats with intact labyrinths, vestibular input to neurons whose activity was modulated by the neck stimulus was studied using whole-body roll tilt. Many neurons received otolith input; some received canal input. Neck and vestibular inputs to spinal neurons always had opposite polarities (complementary inputs). Thus, type I neurons were always excited by tilt to the ipsilateral side (ipsilateral ear down) while type II neurons were excited by tilt to the contralateral side. Combined neck and vestibular stimulation indicated that the dynamic behavior of neurons was determined by a linear summation of the responses to these stimuli. Interaction of neck and vestibular input at the neuron level was similar to that observed previously at the reflex level in forelimb extensor muscles.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2006

Spatially fractionated GRID radiation treatment of advanced neck disease associated with head and neck cancer.

Advanced nodal disease associated with head and neck cancer warrants aggressive, often multi-modality therapy to maximize local-regional control. The expansion of a novel treatment paradigm developed by our institution includes the addition of a single-fraction of high dose spatially-fractionated radiation (GRID) to a conventional course of treatment. Between 1995 and 2002 a series of 27 patients (median age 65) with bulky N2-3 disease were treated. Median nodal tumor size was 7 cm. Two groups of patients were evaluated. Group 1 (N=14) patients received a median neck dose 69 Gy (range 54-79 Gy) plus GRID treatment. Group 2 (N=13) patients received a median neck dose of 59 Gy (range 54-72 Gy) plus GRID treatment followed by planned neck dissection. Patients were evaluated for local-regional control, pathological response, survival, and morbidity. Median time to follow-up for Group 1 was 10 months (range 3-44 months). Neck control was 93%. Disease specific survival was 50%. Morbidity was limited to soft-tissue related damage and was mild. Median time to follow-up for Group 2 was 38 months (range 5-116 months). Pathologic complete response rate was 85%. Overall neck control rate was 92%. Disease specific survival was 85%. Surgical morbidity was limited to three wound healing complications. GRID treatment may be safely added to conventional treatment management of locally advanced neck disease related to cancer with acceptable morbidity. It may improve pathologic complete response rates in those patients who undergo planned neck dissection, possibly leading to improved survival. In patients with inoperable bulky disease, addition of GRID enhances local-regional control.

Adult↗
PubMed2003

Is neck ultrasound necessary for early stage oral tongue carcinoma with clinically N0 neck?

OBJECTIVES: To define the necessity of neck ultrasound for investigation of T1 and T2 oral tongue carcinoma with N0 neck. METHODS: The medical records of all patients with early stage (T1-2 N0) oral tongue cancer treated surgically between January 1985 and December 2000 were reviewed. Patients with 30 neck dissections were identified for analysis. The result of neck ultrasound examination was correlated with the histological examination. RESULTS: The sensitivity, specificity and overall accuracy of ultrasound examination were found to be 47%, 93% and 70%, respectively. The implication of ultrasound examination with respect to elective neck treatment was discussed in the management of the N0 neck. CONCLUSIONS: It is concluded that ultrasound alone is inadequate for making decisions regarding neck management of patients with T1 and T2 N0 carcinoma of the tongue and cannot replace a policy of elective neck dissection.

Carcinoma↗
PubMed1987

The management of a neck mass: presenting feature of an asymptomatic head and neck primary malignancy?

Malignancy of the upper aerodigestive tract is not always associated with obvious localizing symptoms. Presentation may then only be prompted by the appearance of a hard mass in the neck, a metastasis to a cervical lymph node. Neck exploration without a prior diligent search for an occult head and neck primary tumour is to be avoided as it compromises subsequent treatment. The diagnostic investigation of 112 patients complaining solely of a painless and enlarging neck swelling is reviewed. An otolaryngologic examination identified an asymptomatic malignancy of the head and neck in 72 patients (64%). Excision biopsy of the neck mass was required to achieve a diagnosis in only 29 (29%) of those patients who had not already undergone surgery. These results are presented to emphasize the need for a specialist examination of the head and neck prior to embarking on excision of any suspicious neck mass.

Carcinoma, Squamous Cell↗
PubMed1994

Evaluation of short neck: new neck length percentiles and linear correlations with height and sitting height.

Qualitative impressions of neck length are often used as aids to dysmorphology in syndromes like Turner, Noonan, Klippel-Feil and in craniovertebral anomalies, some of which have serious neurological implications. There are no national or international standards for neck length. The present study attempted to create standards and percentile charts for Indian children and compute age-independent correlations of neck length with linear measurements such as standing and sitting height. A total of 2724 children of both sexes between 3 and 15 years, whose heights and weights conformed to ICMR standards were inducted. Neck length was measured by a modified two-point discriminator between two fixed bony points-inion and spinous process of C7 with the head held in neutral position. Percentiles (5th-95th) were constructed for both sexes. Growth was rapid from 3 to 6 years. Neck length formed a mean of 12.7 +/- 4.58% of height and 20.1 +/- 6.73% of sitting height. Age independent linear regression equations: Neck length = 10 + (0.035 x height) and Neck length = 9.65 + (0.07 x sitting height) were highly significant (p < 0.001). Neck length relationships of 30 randomly selected normal children clustered around the regression lines and 16 with genetic syndromes fell below the regression lines.

Adolescent↗
PubMed1998

Dose-response relationship for elective neck irradiation of head and neck cancer--facts and controversies.

The aim of this study is to assign dose-response relationship for subclinical neck metastases of squamous cell head and neck cancer based on extensive survey of 24 data sets collected from the literature. Neck relapse rates (NRR) without and after elective (ENI) or preoperative irradiation were estimated for each site and stage of primary tumor and the reduction in neck relapse rate was calculated. An average NRR without ENI was 22% (12-35%) and only 2.5% (0-10%) after the ENI with total dose of 46-50 Gy which gives high reduction rate in the risk of neck recurrences being on the average 89% and 42% (0-46%) after preoperative irradiation using 22-30 Gy. Dose response curve for elective and preoperative irradiation have shown that 50 Gy in 2 Gy fraction reduces the incidence of neck relapses in the N0 patients by more than 90% and only by less than 50% after total doses lower than 30 Gy. No correlation between the risk of neck metastases without ENI and the reduction in neck relapses after ENI was found.

Carcinoma, Squamous Cell↗
PubMed1999

A conservation approach to pharyngeal carcinoma with advanced neck disease: optimizing neck management.

BACKGROUND: Surgical management of advanced neck disease remains controversial when a conservative approach based on radiotherapy is retained for primary tumors. The objective of this study was to evaluate retrospectively treatment results in pharyngeal cancers presenting with N2-N3 neck disease, using neck dissection followed by radical locoregional radiotherapy (RT) and to compare these results with those obtained in patients treated by radical RT alone. METHODS: From August 1991 to November 1996, 41 patients with carcinomas of the oro- or hypopharynx were staged as T1-T3 N2-N3 M0 (American Joint Committee on Cancer [AJCC] stage IV). Twenty-four patients were treated with neck dissection followed by RT (group 1) and 17 patients with radical RT (group 2) using a progressively accelerated concomitant boost schedule. Chemotherapy was delivered to 6 patients in group 1 and 8 in group 2 partially concomitantly with RT. RESULTS: Three-year actuarial locoregional control was 73% and 55% for groups 1 and 2, respectively (p = .52). The corresponding 3-year actuarial overall survival rates were 37% and 50% (p = .42). Severe postoperative complications were observed after neck dissection in four patients (16%). Acute toxicity during RT was similar in the two groups. Late toxicities were also similar, except for two patients in group 1 who developed severe laryngeal edema. CONCLUSIONS: Neck dissection followed by radical RT to the primary tumor and neck represents a valid treatment option in this subset of patients, allowing good control of advanced neck disease, while at the same time conserving pharyngolaryngeal function. However, for patients who are at high risk of severe postoperative complications, radical RT can be considered a worthy alternative, particularly for oropharyngeal carcinomas.

Carcinoma, Squamous Cell↗
PubMed2001

Selective neck dissection in treatment of node-positive neck cases.

Surgical management of patients with cervical metastases of laryngeal and hypolaryngeal cancer has remained a challenge ever since Dr. Crile described the radical neck dissection. The evolution of neck dissection technique confirms this statement. The modification of the radical neck dissection is justified by the severe cosmetic and functional losses related to it and by the fact that despite the comprehensiveness, the recurrences in the neck are still a significant problem. Applying selective neck dissection in node positive cases seems to be justifiable. Expanding the indications for this operation is justified, because in the absence of factors that have destructive effect on fascial compartments of the neck or disrupt the lymphatic flow, such as gross adenopathy or significant extracapsular spread, the principles on which the selective neck dissection is based are still valid. In this paper we report our experience with 10 patients with N1 and N2 who underwent supraomohyoid and lateral neck dissections with follow-up of at least 2 years.

Adult↗
PubMed1999

Efficacy of targeted chemoradiation and planned selective neck dissection to control bulky nodal disease in advanced head and neck cancer.

PURPOSE: To determine the efficacy of targeted chemoradiation with the radiation plus platinum (RADPLAT) protocol and planned selective neck dissection in patients with N2 to N3 nodal disease associated with upper aerodigestive tract carcinoma. METHODS: Analysis of 52 patients with N2a, N2b, or N3 disease involving 60 heminecks treated with intraarterial cisplatin, 150 mg/m2, and intravenous sodium thiosulfate, 9 g/m2, on days 1, 8, 15, and 22; radiation therapy, 180 to 200 cGy per fraction for 35 fractions (total dose, 68-74 Gy); and planned neck dissection (33 of 35 procedures were selective). RESULTS: Of the 56 evaluable heminecks, a clinical complete response was achieved in 33 (59%). Within this group, 16 neck dissections were performed, none of which yielded disease on pathological examination. A clinical partial response was obtained in 21 heminecks, of which 18 subsequently had a neck dissection, yielding disease on pathological examination in 14. In all cases, it was possible to completely excise all adenopathy with clear margins on pathological examination. The rate of regional disease control among the 56 evaluable heminecks was 91% (51/56) (median follow-up, 36 months). Four failures were associated with uncontrolled disease at other sites, and 1 was an isolated neck recurrence. CONCLUSION: Selective neck dissection appears to be an effective adjunct to targeted chemoradiation in controlling N2 to N3 neck disease.

Adult↗
PubMed2004

Soft tissue deposits in neck dissections of patients with head and neck squamous cell carcinoma: prospective analysis of prevalence, survival, and its implications.

BACKGROUND: Soft tissue deposits of squamous cell carcinoma in the necks of patients with squamous cell carcinoma of the upper aerodigestive tract may represent either total effacement of a lymph node by carcinoma or extralymphatic deposits of carcinoma. There are few reports of their clinical or prognostic significance. METHODS: Data from 215 neck dissections from 155 patients with squamous cell carcinoma of the upper aerodigestive tract were studied prospectively to assess the prevalence of soft tissue deposits within the neck. The case notes of these patients were subsequently reviewed to analyze the effect on both the overall survival and recurrence-free survival. RESULTS: The prevalence rate for soft tissue deposits occurring alone was 10.3%; the prevalence rate for soft tissue deposits occurring with extracapsular spread was 13.5%. The overall prevalence rate for soft tissue deposits was 23.9%. There was a statistically significant reduction in actuarial and recurrence-free survival in patients with soft tissue deposits compared with patients with pathologically node-negative necks (P=.001), and in patients with soft tissue deposits compared with those with pathologically node-positive necks without extracapsular spread (P=.001). No statistically significant differences were found between patients with soft tissue deposits and patients with pathologically node-positive necks with extracapsular spread, for actuarial survival or recurrence-free survival. CONCLUSIONS: In this series, soft tissue deposits were associated with an aggressive clinical course and poor survival. It is therefore important that histopathologists agree on a uniform terminology when reporting soft tissue deposits and actively look for their presence when examining neck dissection specimens.

Head and Neck Neoplasms↗
PubMed2006

Internal mammary artery and vein: recipient vessels for free tissue transfer to the head and neck in the vessel-depleted neck.

BACKGROUND: Microvascular free tissue transfer is a standard reconstructive option for postablative defects of the head and neck. However, the success of this surgery requires suitable recipient vessels in the cervical region. This form of reconstruction can be particularly challenging in the vessel-depleted neck. While the internal mammary artery and vein (IMA/V) have been used extensively in breast reconstruction, there are few reports describing their use in head and neck reconstruction. We report the first case series of the use of the internal mammary vessels for head and neck microvascular reconstruction. METHODS: We reviewed 5 cases of free tissue transfers to the head and neck in which extensive prior treatment precluded the use of more traditional recipient vessels in the neck or upper chest. RESULTS: A variety of free flaps were transferred for different reconstructive problems which included: chin/lower lip (n = 2), closure of widely patent tracheoesophageal puncture sites (n = 2), and pharyngoesophageal reconstruction following staged repair of a severe stenosis (n = 1). The radial forearm free flap was transferred in 4 patients and the rectus abdominus free flap in 1 patient. The IMA/V on the right side was prepared in all cases. All free flaps were successfully revascularized without the need for vein grafts and without the need for any microvascular revision procedures. CONCLUSION: The internal mammary artery and vein provide reliable, easily accessible recipient vessels for microvascular reconstruction in the vessel-depleted neck. The selection of free flap donor sites with long donor vessels facilitates the microvascular repair.

Cervicoplasty↗
PubMed2002

Number and location of radiolabeled, intraoperatively identified sentinel nodes in 48 head and neck cancer patients with clinically staged N0 and N1 neck.

The value of sentinel node (SN) biopsy for squamous cell carcinoma of the head and neck (HNSCC) has not been determined yet. A critical evaluation of this concept seems to be mandatory with regard to the increasing acceptance of SN biopsy in other tumor entities. Against the background of the results of 48 previously untreated patients, a reproducible technique for SN biopsy in the head and neck level, which has been adjusted to the special topographic conditions of this anatomic region, is presented. Methods included intraoperative SN biopsy, which was performed in 48 previously untreated patients suffering from squamous cell carcinoma (2x lower lip, 8x oral cavity, 20x oropharynx, 15x larynx, 3x hypopharynx). Using ultrasound imaging, 43 patients were staged as N0 necks, and 5 patients were staged as N1 necks. Fine-needle aspiration cytology (FNAC) was performed in cases of doubt. Surgery on the neck was carried out according to the suspected stage of lymphogenic spread once the SN1 as well as one or two further hot nodes (SN2, SN3) had been identified. Numbers and distribution of the intraoperatively excised nodes SN1-3 were documented according to their relation to the tumor location. Post-operatively, the histologic results of the intraoperatively excised nodes SN1-3 were compared to the histologies of the neck dissection specimen. Results showed that in all 48 patients, a SN1 could be identified intraoperatively. In 20 cases an additional SN2 and in 6 cases a SN3 was diagnosed. In carcinomas of the lower lip and oral cavity, the SN1 was found in 4 cases in level I (2x lower lip, 2x floor of the mouth) and in 6 cases in level II (6x lateral tongue). In carcinomas of the oropharynx, the respective nodes were found in 17 of 20 cases in level II (carcinomas of the tonsil) and in 3 cases in level III (carcinomas of the base of the tongue). In supraglottic carcinomas the SN1 was identified in 8 of 10 cases in level II and in 2/5 patients with glottic carcinomas, while in 3/5 glottic carcinomas as well as in all hypopharyngeal carcinomas, the SN1 was found in level III. In relation to the predictiveness of the detected SN, it has to be remarked that in 38 patients a SN1 free of tumor was representative for the regional lymph node status (pN0). An isolated metastasis (pN1) was diagnosed in the SN (9x SN1, 1x SN2) in 10 patients. In conclusion, the results of a SN biopsy modified to a strictly intraoperative method of detection are encouraging. Critical indications showed that a thorough and standardized technical performance of the injection as well as a mandatory, so far unchanged, neck dissection form the basis for the development of a SN concept for SCCs of the upper aerodigestive tract. The value of the SN concept, however, currently remains unclear for patients suffering from HNSCC.

Adult↗