Search

Background: Massive oropharyngeal bleeding post-chemoradiotherapy is a life-threatening condition that requires emergent management., Methods: This retrospective case series included 11 patients with oropharyngeal squamous cell carcinoma who suffered from massive bleeding during or following treatment with definitive chemoradiotherapy. Details of acute and definitive management of oropharyngeal bleeding are reported., Results: Nine of 11 hemorrhagic events occurred a mean (SD) of 88.6 days (53.6) after radiotherapy. Airway intubation and embolization were performed in 10 of 11 patients, followed by surgery in 7 of 11 patients. The most commonly embolized vessels were the external carotid and lingual arteries. At the time of discharge, 3 of 11 patients had a tracheostomy, and 7 of 11 continued to use a gastrostomy tube. Four patients died., Conclusions: Hemorrhagic complications in oropharyngeal cancer treatment require emergent responses. Developing a workflow for coordination between multidisciplinary teams can maximize probability of survival and decrease morbidity., (© 2024 Wiley Periodicals LLC.)

Background: The purpose of this study was to compare long-term functional and quality of life (QOL) outcomes after total laryngectomy with primary closure and those who underwent reconstruction with noncircumferential radial free forearm tissue transfer (RFFTT)., Methods: Sixty-seven patients were identified by chart review and underwent long-term follow-up using QOL surveys and standardized interviews., Results: The RFFTT group had significantly higher rates of chemotherapy, gastric tube (G-tube) at surgery, and postoperative stricture. At follow-up, most patients (88%) had a tracheoesophageal prosthesis (TEP) and were using it as their primary communication method. Diet and swallowing outcomes were comparable and no one had a G-tube. Device life and TEP complications did not differ significantly. Only voice-related QOL differed significantly between the RFFTT group and those who had undergone total laryngectomy without adjuvant treatment., Conclusion: Despite more extensive treatment, the reconstructed group achieved comparable outcomes to those who had undergone total laryngectomy with adjuvant treatment., (© 2017 Wiley Periodicals, Inc.)

Background: Assessment of the retropharyngeal lymph nodes is essential in the treatment for oropharyngeal squamous cell carcinoma (SCC). Transoral robotic retropharyngeal lymph node dissection (RPLND) may provide valuable staging information and guide selection of adjuvant therapy in a transoral robotic surgery (TORS) treatment paradigm., Methods: Outcomes were compared between 30 patients with oropharyngeal SCC with tonsillar primaries undergoing RPLND and 37 stage-matched cases without RPLND., Results: Retropharyngeal metastasis was confirmed in 6 patients undergoing RPLND. Compared with 37 stage-matched controls, there were no differences in length of stay, length of feeding tube dependence, net change in perioperative weight, or rates of hemorrhage and postoperative complications. RPLND altered adjuvant treatment recommendations in 1 of 30 patients., Conclusion: RPLND is technically feasible by a purely transoral robotic approach. Its performance is not associated with worse swallowing outcomes or rates of complication. In select patients, RPLND may provide valuable staging information and guide the selection of adjuvant therapy., (© 2017 Wiley Periodicals, Inc.)

Background: Rheumatoid nodules are a common manifestation of rheumatoid arthritis but buccal rheumatoid nodules are extremely rare. The purpose of this study was to report a rare case of a rheumatoid buccal nodule and a review of the literature., Methods and Results: This case is about a 79-year-old woman with rheumatoid arthritis who was taking methotrexate and hydroxychloroquine, presenting with an enlarging left buccal submucosal mass. An incisional biopsy showed features consistent with that of a rheumatoid nodule. The mass was managed expectantly and the patient was taken off methotrexate with a marked reduction in the size of the nodule., Conclusion: Submucosal rheumatoid nodules of the oral cavity are an extremely rare manifestation of rheumatoid arthritis but should be considered in the differential diagnosis in patients with a history of rheumatoid arthritis presenting with submucosal masses. © 2016 Wiley Periodicals, Head Neck 39: E12-E14, 2017., (© 2016 Wiley Periodicals, Inc.)

Background: Nasopharyngeal angiofibromas are typically considered benign vascular neoplasms, with descriptions of high-grade sarcomatous change found only in lesions with prior radiotherapy., Methods and Results: We describe the first reported case of high-grade malignant change in a nasopharyngeal angiofibroma naive to radiation. A 45-year-old man presented with left-sided nasal congestion and fullness and was found to have a left-sided nasopharyngeal mass with intracranial extension on CT scan. A biopsy of the mass revealed nasopharyngeal angiofibroma. The patient opted for MRI surveillance, which revealed interval growth 3 years later. Decompression surgery revealed only angiofibroma, but resection 9 months later demonstrated high-grade sarcoma and concomitant angiofibroma. The patient had residual disease which progressed through chemoradiation, and is now pursuing clinical trial enrollment., Conclusion: Malignant transformation of nasopharyngeal angiofibroma is extremely rare. As highlighted by this report, high-grade undifferentiated lesions may arise in tumors without previous radiation. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2425-E2427, 2016., (© 2016 Wiley Periodicals, Inc.)

Background: Surgical access to metastases in the retropharyngeal lymph nodes (RPLNs) could be difficult. Transoral robotic surgery (TORS) can be utilized to access RPLNs. The purpose of this study was to describe a TORS approach to RPLN dissection., Methods: A case series of patients undergoing RPLN dissection by TORS was conducted and compared to matched controls (1:2)., Results: Twelve patients underwent robotic RPLN dissection. Median age was 63 years (range, 43-73 years). Pathology was oropharyngeal squamous cell carcinoma (SCC) in 9 patients and papillary thyroid cancer (PTC) in 3 patients. The feeding tube dependence duration was 12 days (range, 1-46 days) on average. Complications occurred in 8 patients (66%); most commonly, aspiration pneumonitis in 6 patients. In comparison to the matched controls (24), there was no difference in length of stay or feeding tube dependence. Complications were higher in patients with oropharyngeal SCC., Conclusion: TORS is feasible for accessing RPLNs. The procedure is well tolerated in patients with PTC; whereas patients with oropharyngeal SCC are at increased risk of complications. © 2015 Wiley Periodicals, Inc. Head Neck 38: E981-E986, 2016., (© 2015 Wiley Periodicals, Inc.)

Background: Osteoradionecrosis (ORN) of the hyoid bone is a rare but reported complication of head and neck irradiation. Here we describe 2 cases in which carotid rupture was associated with hyoid ORN., Methods: This study was conducted through a retrospective chart review and case reports of 2 patients., Results: Both patients had a history of radiation therapy for head and neck cancer; 1 patient had undergone previous surgical resection. Both patients had a history of painful swelling in the neck preceding presentation with hemorrhage. Acute hemorrhage was controlled in all patients using a combination of techniques including embolization, stent grafting, and vessel ligation., Conclusion: ORN of the hyoid can be associated with life-threatening carotid rupture. In patients with a history of head and neck irradiation who present with painful swelling in the region of the hyoid, this entity should be considered. Early intervention may prevent subsequent rupture of the carotid artery and hemorrhage., (Copyright © 2011 Wiley Periodicals, Inc.)

Background: The purpose of this study was to report the incidence of venous thromboembolism (VTE) in patients with head and neck cancer after surgery., Methods: This was a single-institution, retrospective cohort: 134 patients underwent resection and simultaneous microvascular reconstruction. The primary endpoint was identification of confirmed or suspicious VTE within 30 days of surgery., Results: Two subjects (1.4%) with confirmed VTE (1 pulmonary embolism, 1 deep venous thrombosis) and 6 subjects (4.4%) with suspicious VTE (1 acute respiratory failure, 1 sudden cardiac arrest, and 4 cases of leg edema without imaging) were identified. The strongest predictors of possible VTE were prior VTE (p = .004; odds ratio [OR], 25.11; 95% confidence interval [CI], 1.13-556.40), red cell transfusion (p = .009; OR, 1.80; 95% CI, 1.16-2.80), high body mass index (p = .015, OR, 1.29, 95% CI, 1.05-1.58), and older age (p = .046; OR, 1.10; 95% CI, 1.00-1.19)., Conclusion: The incidence of VTE in patients with head and neck cancer after resection and microvascular reconstruction ranged from 1.4% to 5.8%., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: There is a paucity of outcomes data for patients with lymph node metastasis from cutaneous squamous cell carcinoma of head and neck (SCCHN)., Methods: Patients from a tertiary care center with cutaneous SCCHN metastatic to parotid and or cervical lymph nodes were identified. Data were abstracted and analyzed using COX multivariate analysis., Results: Fifty-one patients (47 men, and 4 women) with a median age of 73 years were identified. Eight patients (16%) had recurrent disease and 11 (22%) were immunosuppressed. Forty patients (71%) received adjuvant radiation therapy. Median overall survival was 23 months (range, 3-148 months). Recurrent disease was associated with higher risk of death (hazard ratio [HR], 2.7; 95% confidence interval [CI] 1.1-6.9) and radiation therapy with reduced risk (HR, 0.18; 95% CI, 0.06-0.54)., Conclusion: Lymph node metastases from cutaneous SCCHN is associated with poor survival., (Copyright © 2011 Wiley Periodicals, Inc.)

Background: Esophageal dilation by rendezvous is a useful technique for the treatment of complicated esophageal strictures., Methods and Results: We present a case of a 74-year-old man with chronic dysphagia caused by a complete cervical esophageal stricture that developed after external beam radiotherapy for treatment of papillary thyroid carcinoma. During attempted dilation using the rendezvous technique, the patient suffered a fatal pulmonary air embolism. The technique of esophageal dilation by rendezvous, complications, and risk factors for development of venous air embolism are discussed., Conclusion: To the best of our knowledge, this is the first report in the literature of fatal venous air embolism after dilation by rendezvous., (Copyright © 2009 Wiley Periodicals, Inc.)

Background: Atelectasis is commonly encountered in patients undergoing rectus abdominus tissue transfer. Primary closure of the anterior rectus sheath may contribute to this process. Augmentation of the closure with mesh may decrease the incidence of Atelectasis., Methods: In this retrospective review 32 patients with preoperative and postoperative augmentation were compared to 23 who had primary closure of the anterior rectus sheath., Results: Augmentation consisted of acellular dermis (25) or mesh (7). Postoperative atelectasis was radiographically detected in: 91% (n=29) of augmented patients versus 83% (n=19) of primary closure patients. Major atelectasis in 41% (n=13) of augmented patients versus 61% (n=14) of primary closure patients p<.05. The incidence of atelectasis was independent of skin flap size and operative times., Conclusions: The use of acellular dermis or mesh to augment the abdominal wall appears to reduce the high incidence of postoperative atelectasis following rectus-free flap harvest., (Copyright (c) 2008 Wiley Periodicals, Inc. Head Neck 2008.)

Background: Glutathione S-transferase T1 detoxifies some environmental carcinogens while activating others and is deleted in 15% to 38% of humans. We sought to determine whether GSTT1 genotype and genotypes of several related genes are associated with risk of squamous cell carcinoma of the head and neck (HNSCC)., Methods: Somatic genotypes for GSTT1, GSTM1, GSTP1, and CYP1A1 were determined in 283 individuals with HNSCC and 208 population-based controls., Results: The OR for presence of GSTT1 was 1.6 (CI, 1.1-2.5, p = 0.03). HNSCC risk was not associated with GSTM1 null genotype, the presence of the GSTP1 Val/Val genotype, or the Val/Val homozygous genotype for CYP1A1. Stratified analysis revealed disparate ORs for women (OR, 3.0; CI, 1.5-6.3) and men (OR, 1.2; CI, 0.7-2.1) for the presence of GSTT1., Conclusions: In this population, the presence of GSTT1 gene was associated with a significant increase in the risk of HNSCC. This association was particularly robust in women., (Copyright 2004 Wiley Periodicals, Inc.)

Cricopharyngeal spasm and Zenker's diverticulum represent disorders of the pharyngoesophageal junction for which a unifying theory of etiology has yet to be established. There is, however, a large body of evidence that supports an association with gastroesophageal reflux. Cricopharyngeal myotomy is the key to successful management of both disorders. Newer transoral endoscopic techniques of management have a lower overall morbidity than traditional open approaches in appropriately selected patients and are therefore gaining popularity as the preferred method of treatment., (Copyright 2003 Wiley Periodicals, Inc.)

Introduction: First bite syndrome (FBS) is the development of pain in the parotid region after the first bite of each meal and can be seen after surgery of the parapharyngeal space. The cause is not clear but has been proposed to involve a loss of sympathetic nerve function to the parotid, causing a denervation supersensitivity of salivary gland myoepithelial cells. The purpose of this study was to review the records of 12 patients with FBS to determine any common features of the operations performed that would support this theory of parotid "sympathectomy" as an etiologic factor of FBS., Methods: Retrospective review of 12 patients with FBS managed at two tertiary care centers., Results: Twelve patients were diagnosed with FBS after surgery involving the parapharyngeal space. All patients had most of their parotid gland preserved. Six patients exhibited a postoperative Horner's syndrome, suggesting sympathetic chain interruption. The six patients without Horner's syndrome were found to have undergone external carotid artery ligation inferior to the parotid gland, suggesting an interruption of sympathetic innervation to the parotid gland itself., Conclusions: Preservation of parotid gland tissue and a loss of its sympathetic nerve supply, whether by disruption of the cervical sympathetic chain as evidenced by a Horner's syndrome or more selective denervation by ligation of the external carotid artery with its accompanying sympathetic nerve plexus, were common features of all patients. This series supports the concept of parotid "sympathectomy" as an etiologic factor in FBS., (Copyright 2002 Wiley Periodicals, Inc.)

Background: This work was done to determine whether the slope of change between preoperative and early postoperative (2 hr and 8 hr) ionized calcium levels (ciCa) could predict significant postoperative hypocalcemia., Methods: We did a retrospective chart review of 79 patients undergoing thyroid (n = 56) or parathyroid surgery (n = 23) where overall parathyroid function was felt to be at risk. Results/Conclusions A positive slope between the preoperative ciCa and any postoperative ciCa or the first two postoperative ciCa's predicted normocalcemia in 100% of patients. For the thyroid group, the difference in the slope of the change from preoperative ciCa to first (<2 hours) postoperative ciCa (-15.940%/hours vs -9.375%/hours, p =.082) did not differentiate patients who developed hypocalcemia (n = 11) and those who remained normocalcemic (n = 45). By contrast the slope of change from preoperative ciCa to the second postoperative (8 hr) ciCa (-1.671%/ hour vs -0.849%/hours, p =.006) and first to second postoperative ciCa (-1.022%/hour vs -0.473%/hour, p =.001) did. For the parathyroid group, none of the differences in similar comparisons between the normocalcemic (n = 20) and hypocalcemic patients (n = 3) approached statistical significance. The relatively small number of patients who became hypocalcemic in this study precluded definition of an absolute slope of calcium level change above which normocalcemia can be assured., (Copyright 2002 John Wiley & Sons, Inc.)

Background: To establish the sensitivity, specificity, and accuracy of imaging and fine-needle aspiration (FNA), alone or in combination, in distinguishing benign from malignant histologic findings for parotid lesions., Methods: Retrospective blinded review of preoperative imaging and FNA studies of parotid masses and comparison with histologic findings after excision., Results: Forty-eight patients were identified (13 with CT, 35 with MRI); 23 (48%) of the lesions were malignant, 25 (52%) were benign. MRI, CT, and FNA misclassified 17%, 46%, and 21% of the lesions, respectively. The sensitivity/specificity/accuracy of these tests for detecting malignant lesions were as follows: MRI (88%,77%,83%), CT (100%,42%, 69%), and FNA (83%,86%,85%) and were not significantly different. Combinations of imaging and FNA were not significantly better in detecting malignancy., Conclusions: Imaging and FNA are comparable in their ability to correctly identify malignant parotid lesions preoperatively. Combining these two modalities yields no advantage in terms of specificity, sensitivity, or accuracy of a malignant diagnosis.

Objective: To assess whether genetic polymorphisms implicated as risk factors for other tobacco-associated malignancies are associated with altered risk of head and neck squamous cell carcinoma., Design: Case-control study., Subjects: One hundred sixty patients with head and neck squamous cell carcinoma recruited from a university-based head and neck oncology clinic and 149 population-based controls., Methods: Genotyping of the CYP1A1 (Ile462Val), GSTM1 (null), GSTP1 (Ile105Val), GSTT1 (null), and P53 (Arg72Pro) genes was performed by polymerase chain reaction-based techniques on DNA prepared from peripheral blood. In addition, a questionnaire was used to collect demographic information from each subject., Results: Cases were significantly older (p <.0001) and had significantly greater tobacco use (p <.0001) and were more likely to be male (p <.0001) than were control subjects, thus confirming known risk factors for this disease. When cases and controls were compared by simple chi-square analysis, only the frequency of CYP1A1 (Ile462Val) polymorphism was significantly different between cases and controls (OR =.42; 95% CI =.18-.99; p <.04). However, with a logistic regression model to control for known risk factors, we were unable to demonstrate a significant association with head and neck cancer for any of the polymorphisms tested, including CYP1A1., Conclusions: This population fails to identify a relationship between the above-mentioned polymorphisms and head and neck cancer.