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Head & Neck

Christopher E Fundakowski, Nathan W Hales, Nishant Agarwal, Marcin Barczyński, Pauline M Camacho, Dana M Hartl, Emad Kandil, Whitney E Liddy, Travis J McKenzie, John C Morris, John A Ridge, Rick Schneider, Jonathan Serpell, Catherine F Sinclair, Samuel K Snyder, David J Terris, R Michael Tuttle, Che-Wei Wu, Richard J Wong, Mark Zafereo, Gregory W Randolph
"I have noticed in operations of this kind, which I have seen performed by others upon the living, and in a number of excisions, which I have myself performed on the dead body, that most of the difficulty in the separation of the tumor has occurred in the region of these ligaments…. This difficulty, I believe, to be a very frequent source of that accident, which so commonly occurs in removal of goiter, I mean division of the recurrent laryngeal nerve." Sir James Berry (1887).
February 20, 2018: Head & Neck
Ethan Frank, Daniela Ale-Salvo, Joshua Park, Yuan Liu, Alfred Simental, Jared C Inman
BACKGROUND: Thyroid disease occurs more frequently in patients with hyperparathyroidism than the general population and hinders parathyroid localization. Identifying thyroid pathology before operating improves management and avoids the risks of reoperation in the neck. This review assesses imaging studies in patients with hyperparathyroidism and thyroid pathology to identify the ideal imaging methodology for patients with multigland disease. METHODS: Systematic review of original articles reporting sensitivity or positive predictive value (PPV) for one or more imaging modalities in patients with hyperparathyroidism and thyroid disease...
February 20, 2018: Head & Neck
Megan Morisada, Michael Chamberlin, Clint Allen
BACKGROUND: The ability of radiation to enhance antitumor immunity under specific experimental conditions is well established. Here, we explore preclinical data and the rationale for combining different radiation doses and fractions with immune checkpoint blockade immunotherapy. METHODS: We conducted a review of the literature. RESULTS: The ability of high-dose or hypofractionated radiation to enhance antitumor immunity resulting in additive or synergistic tumor control when combined with checkpoint blockade is well studied...
February 20, 2018: Head & Neck
Virginia Wedell Osborn, Babak Givi, Justin Rineer, Dylan Roden, Niki Sheth, Ariel Lederman, Evangelia Katsoulakis, Kenneth Hu, David Schreiber
BACKGROUND: Postoperative chemoradiotherapy (CRT) is considered standard of care in patients with locally advanced head and neck cancer with positive margins and/or extracapsular extension (ECE). METHODS: The National Cancer Data Base (NCDB) was queried to identify patients with squamous cell carcinoma of the head and neck with stages III to IVB disease or with positive margins and/or ECE diagnosed between 2004 and 2012 receiving postoperative radiotherapy (RT)...
February 16, 2018: Head & Neck
Martial Guillaud, Calum E MacAulay, Kenneth W Berean, Martin Bullock, Kelly Guggisberg, Hagen Klieb, Lakshmi Puttagunta, Carla Penner, Keith Kwan, Miriam P Rosin, Catherine F Poh
BACKGROUND: The purpose of this study was to use quantitative tissue phenotype (QTP) to assess the surgical margins to examine if a fluorescence visualization-guided surgical approach produces a shift in the surgical field by sparing normal tissue while catching high-risk tissue. METHODS: Using our QTP to calculate the degree of nuclear chromatin abnormalities, Nuclear Phenotypic Score (NPS), we analyzed 1290 biopsy specimens taken from surgical samples of 248 patients enrolled in the Efficacy of Optically-guided Surgery in the Management of Early-staged Oral Cancer (COOLS) trial...
February 16, 2018: Head & Neck
Sze Ling Chan, Li Shia Ng, Xueying Goh, Chor Hiang Siow, Han Lee Goh, Boon Cher Goh, Timothy Cheo, Kwok Seng Loh, Liam R Brunham
BACKGROUND: The purpose of this study was to characterize the clinical course of hearing loss in patients with nasopharyngeal carcinoma (NPC) and the clinical factors affecting its severity. METHODS: The time course of hearing loss in patients with NPC was assessed using threshold shift from baseline and Common Terminology Criteria for Adverse Events (CTCAE) grade. RESULTS: In the chemoradiotherapy (CRT) groups, the threshold shift was significantly higher from 3 months at 4 kHz (P = 2...
February 16, 2018: Head & Neck
Martin Kauke, Ali-Farid Safi, Andrea Grandoch, Hans-Joachim Nickenig, Joachim Zöller, Matthias Kreppel
BACKGROUND: Sinonasal sarcomas are rare and heterogeneous in nature. Continuously collecting data influencing the prognosis is fundamental for optimizing therapeutic assessment of this highly destructive neoplasm. METHODS: We conducted a single-institution retrospective cohort study considering 27 patients with sinonasal sarcoma. RESULTS: The overall survival (OS) rates for 1 year and 5 years were calculated as 74% and 36%, respectively. Extent of the primary tumor (P = ...
February 14, 2018: Head & Neck
Shuang Bai, Zhi-Qiang Zhang, Zhi-Qiang Wang, Zhong-Fei Xu, Wei-Yi Duan, Fa-Yu Liu, Xue-Xin Tan, Chang-Fu Sun
BACKGROUND: The anterolateral thigh (ALT) free flap has been an extremely versatile flap. The purpose of this study was to propose comprehensive functional assessments of the donor site. METHODS: A total of 33 ALT flaps were enrolled prospectively. Objective assessments included isokinetic testing of the knee, and electromyographic examination of the lateral femoral cutaneous nerve (LFCN). The Patient and Observer Scar Assessment Scale (POSAS) was used to subjectively assess the donor-site scar...
February 14, 2018: Head & Neck
Morgan A Gingerich, Joshua D Smith, Nicole L Michmerhuizen, Megan Ludwig, Samantha Devenport, Chloe Matovina, Chad Brenner, Steven B Chinn
BACKGROUND: The past 2 decades have seen an increased incidence of head and neck squamous cell carcinoma (HNSCC) in a nontraditional, low-risk patient population (ie, ≤45 years of age, no substance use history), owing to a combination of human papillomavirus (HPV) infection and individual genetic variation. METHODS: Articles positing genetic variants as contributing factors in HNSCC incidence in low-risk, nontraditional patients were identified using a PubMed search, reviewed in detail, and concisely summarized herein...
February 10, 2018: Head & Neck
Emi J Yoshida, Michael Luu, John M David, Sungjin Kim, Alain Mita, Kevin Scher, Stephen L Shiao, Mourad Tighiouart, Allen S Ho, Zachary S Zumsteg
BACKGROUND: Postoperative concomitant chemoradiotherapy (CRT) improves outcomes for younger adults with head and neck squamous cell carcinoma (HNSCC) and positive margins or extranodal extension (ENE), but its benefit for older adults is not well established. METHODS: Patients from the National Cancer Data Base (NCDB) with HNSCC undergoing curative-intent resection, neck dissection, and postoperative radiation with positive margins or ENE were identified. RESULTS: This analysis included 1199 patients aged ≥ 70 years with median follow-up of 42...
February 8, 2018: Head & Neck
Diana N Kirke, Muhammad M Qureshi, Sophia C Kamran, Waleed Ezzat, Scharukh Jalisi, Andrew Salama, Peter C Everett, Minh Tam Truong
BACKGROUND: The purpose of this study was to evaluate the role of postoperative adjuvant radiotherapy (surgery + adjuvant RT) versus adjuvant chemoradiotherapy (surgery + adjuvant CRT) in patients with T4N0M0, stage IV head and neck squamous cell carcinoma (HNSCC). METHODS: Between 1998 and 2011, 3518 and 885 patients were treated with surgery + adjuvant RT and surgery + adjuvant CRT, respectively. Three-year overall survival (OS) rates were determined and crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed...
February 8, 2018: Head & Neck
Daniel Clasen, Judith Keszte, Andreas Dietz, Jens Oeken, Eberhard F Meister, Orlando Guntinas-Lichius, Friedemann Pabst, Jens Büntzel, Eva-Maria Jenzewski, Susanne Singer, Alexandra Meyer
BACKGROUND: This prospective study was conducted to assess changes in quality of life (QOL) of patients who undergo a partial laryngectomy. METHODS: The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires Core and Head and Neck (EORTC-QLQ-C30, QLQ-H&N35) were used preprocedure (n = 218), 1 week (n = 159), 3 months (n = 122), and 1 year after partial laryngectomy (n = 88). Changes over time were analyzed with the Wilcoxon signed rank test and the Holm-Bonferroni method, and interpreted regarding clinical relevance...
February 8, 2018: Head & Neck
Samskruthi P Murthy, Deepak Balasubramanian, Narayana Subramaniam, Gopalakrishnan Nair, Misha J C Babu, Priyank V Rathod, Krishnakumar Thankappan, Subramania Iyer, Smitha Nalumackal Vijayan, Chaya Prasad, Vasantha Nair
BACKGROUND: The American Thyroid Association (ATA) recommends thyroid lobectomy for 1 to 4 cm tumors without adverse features. We studied the prevalence of adverse pathological features in patients eligible for unilateral lobectomy. METHODS: We conducted a retrospective study of patients who underwent total thyroidectomy. Patients with differentiated thyroid cancer (DTC) with tumors measuring 1 to 4 cm with no known preoperative adverse features were included in this study...
February 8, 2018: Head & Neck
David Goldenberg, Robert L Ferris, Maisie L Shindo, Ashok Shaha, Brendan Stack, Ralph P Tufano
BACKGROUND: Morbid obesity is a chronic condition that may be challenging to treat. Gastric bypass surgery is used to treat morbid obesity and its complications. Hypocalcemia, a known complication after thyroidectomy, is usually transient and treatable. There is a growing body of literature indicating that patients with previous gastric bypass surgery are at an increased risk for recalcitrant, symptomatic hypocalcemia after thyroidectomy. The management of hypocalcemia in patients with prior gastric bypass surgery may be exceedingly difficult...
February 8, 2018: Head & Neck
Stephen F Hall, Rebecca J Griffiths
BACKGROUND: Supraglottic laryngeal carcinoma has an entirely different etiology, clinical presentation, and prognosis compared to glottis cancer but the only evidence for the use of concurrent chemotherapy with radiotherapy (CRT) is the 5.4% 5-year improvement in overall survival (OS) for the combined laryngeal site. METHOD: We conducted a retrospective population-based study using administrative data to compare OS, disease-specific survival (DSS), laryngectomy-free survival, and laryngoesophageal dysfunction-free survival over time and by treatment for all patients with supraglottic laryngeal carcinoma diagnosed between January 1, 1990, and December 31, 2014, in Ontario, Canada...
February 7, 2018: Head & Neck
Stephen Y Kang, Antoine Eskander, Ralph Abi Hachem, Enver Ozer, Theodoros N Teknos, Matthew O Old, Daniel M Prevedello, Ricardo L Carrau
BACKGROUND: When locoregional flaps fail to reconstruct the skull base, the microvascular surgeon faces several reconstructive challenges. We present our technique and results of salvage anterior skull base reconstruction utilizing the vastus lateralis free tissue transfer (VLFTT). METHODS: Four patients with anterior skull base defects after previous locoregional flap failure underwent free tissue transfer reconstruction with VLFTT. RESULTS: The success rate of free tissue transfer was 100%...
February 6, 2018: Head & Neck
Leif J J Bäck, Katri Aro, Laura Tapiovaara, Pirkka Vikatmaa, Remco de Bree, Verónica Fernández-Álvarez, Luiz P Kowalski, Iain J Nixon, Alessandra Rinaldo, Juan P Rodrigo, K Thomas Robbins, Carl E Silver, Carl H Snyderman, Carlos Suárez, Robert P Takes, Alfio Ferlito
BACKGROUND: Sacrifice and reconstruction of the carotid artery in cases of head and neck carcinoma with invasion of the common or internal carotid artery is debated. METHODS: We conducted a systematic search of electronic databases and provide a review and meta-analysis. RESULTS: Of the 72 articles identified, 24 met the inclusion criteria resulting in the inclusion of 357 patients. The overall perioperative 30-day mortality was 3.6% (13/357)...
February 5, 2018: Head & Neck
Shawn T Joseph, Jose Tharayil, Mohan T Mihir, B S Naveen
BACKGROUND: Very few cases of conservative laryngectomy in recurrent carcinoma of subglottis postradiotherapy have been reported. Technical aspects of conservative resection and reconstruction in subglottic carcinoma have not been well described. METHODS: Herein, we present a case of recurrent carcinoma of subglottis for which conservative resection with adequate margins was done with endoscope assistance and defect reconstructed by buccal mucosa, conchal cartilage, and temporoparietal free flap...
February 5, 2018: Head & Neck
David M Guttmann, Julie Kobie, Surbhi Grover, Alexander Lin, John N Lukens, Nandita Mitra, Karin V Rhodes, Weiwei Feng, Samuel Swisher-McClure
BACKGROUND: The purpose of this study was to determine national disparities in head and neck cancer treatment package time (the time interval from surgery through the completion of radiation) and the associated impact on survival. METHODS: We conducted an observational cohort study using the National Cancer Database of 15 234 patients with resected head and neck cancer who underwent adjuvant radiotherapy from 2004-2012. Predictors of prolonged package time were identified by multivariable linear regression...
February 2, 2018: Head & Neck
Christopher P Haskins, Sommer Nurkic, Kristianna M Fredenburg, Peter T Dziegielewski, William M Mendenhall
BACKGROUND: We report on a patient with human immunodeficiency virus (HIV)-positive disease with a primary orbital melanoma treated with surgery and adjuvant radiation. METHODS: A 53-year-old woman with HIV-positive disease presented with left-sided progressive ipsilateral vision loss and proptosis. An MRI scan revealed a mass-enhancing lesion measuring 2.1 × 2.6 × 2.5 cm abutting the optic nerve. The patient underwent left orbital exenteration with temporalis flap reconstruction, pathology revealing malignant melanoma, stage T1N0M0...
February 2, 2018: Head & Neck
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