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Background: Circulating tumor cells (CTCs) form metastases in distant organs. The purpose of this research was to determine if tumor manipulation could enhance cancer cell release from the primary tumor into the circulatory system., Methods: Nude mice were inoculated with melanoma or breast cancer cells. The implanted tumor underwent compression, biopsy, complete resection, or laser treatment. CTCs were monitored in the bloodstream using in vivo photoacoustic and fluorescence flow cytometry., Results: We discovered that pressure, biopsy, and laser treatment can dramatically increase CTC counts (up to 60-fold), whereas proper tumor resection significantly decrease CTC counts., Conclusion: Standard medical procedures could trigger CTC release that may increase the risk of metastases. This finding suggests the guidance of cancer treatment and likely diagnosis by real-time monitoring of CTC dynamics followed by well-timed treatment to reduce CTCs in the blood. In vivo detection of intervention-amplified CTCs could be used for early diagnosis of a small tumor, which is undetectable with conventional methods., (Copyright © 2013 Wiley Periodicals, Inc.)

Background: First bite syndrome is an unexpected yet relatively common complication of surgeries involving the parapharyngeal space. It can have a significant effect on both the quality of life and physical health of affected patients. This study presents 3 cases of first bite syndrome treated with botulinum toxin and a review of the current literature on available treatment modalities for first bite syndrome., Methods: Three patients with first bite syndrome were injected with 75 units of botulinum toxin into affected parotid glands, focusing on areas of greatest first bite pain., Results: Two of 3 patients experienced complete relief of symptoms for 4 to 6 months. The third patient had significant decrease in pain at 4-month follow-up., Conclusions: Many treatments for first bite syndrome have been attempted including: dietary modification, pharmacological treatments, and surgical treatments. However, few have been successful. Botulinum toxin is a safe and effective treatment for this life altering and difficult to treat first bite syndrome., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: Quality of life (QOL) outcomes become critical for survivors of head and neck cancer. Most QOL studies were based on <5-year outcomes and very few addressed >5-year outcomes. This study focused late complications and >5-year outcomes and also compared the 2 standard treatments., Methods: The long-term problems were identified through mail surveys. The 2 treatment arms were compared for differences., Results: Seventy-three of 234 possible survivors were identified as still living. Forty-seven returned responses were analyzed to determined problems and QOL. Fifty-three percent reported delayed complications which occurred after 5 years. When the 2 treatments were compared, no statistically significant differences were noted. The survivors in the chemoradiotherapy (CRT) group reported greater difficulties with swallowing, sticky saliva, feeding tube, and weight gain. The survivors in the surgery and postoperative radiation therapy (SRT) group reported more problems with trismus., Conclusion: Some complications do not occur until after 5 years. The CRT group tended to have more problems., (Copyright © 2012 Wiley Periodicals, Inc.)

Vascular anomalies are among the most common congenital and neonatal dysmorphogenesis, which are separated into hemangiomas and vascular malformations. They can occur in various areas throughout the body, with 60% being located in the head and neck. The true mechanism of pathogenesis of vascular anomalies is still unclear. Various treatment methods have been reported, and there are still controversies over the selection of different treatment modalities. Based on the clinical and basic research and current literature, the Chinese Division of Oral and Maxillofacial Vascular Anomalies formulated a treatment guideline for hemangiomas and vascular malformations of the head and neck, which will be modified and updated periodically based on new medical evidence and research., (2009 Wiley Periodicals, Inc. Head Neck, 2010.)

Background: The submental island flap (SIF) is a new alternative in the reconstruction of various head and neck defects. We present our preliminary experience in the use of this flap and describe the surgical technique., Methods: Nine patients underwent reconstruction with the SIF between January 1998 and July 1999. The SIF has been used for the reconstruction of the cervical esophageal stenosis in 2 patients, floor of mouth and tongue defects in 6 patients, and a hemilaryngectomy defect in 1 patient., Results: With the exception of one partial flap loss caused by arterial insufficiency, no flap failures were observed. All the donor site defects but one were closed primarily. One patient who underwent reconstruction of a hemilaryngectomy defect underwent revision surgery because of intractable hair growth on the transferred skin paddle. Marginal mandibular nerve function was intact in all the cases., Conclusions: When combined with the reported experience of other surgeons, our preliminary experience showed that the SIF was an excellent alternative in the reconstruction of head and neck defects because of its reliability, versatility, and relative ease of application.

Background: The purpose of this article is to define the outcome of intracranial extension of inverted papilloma and outline a rationale for management of this rare clinical presentation., Methods: A review of patients with intracranial extension of inverted papilloma reported in the literature (18 patients), or treated in our institution (3 patients ) was performed. The data of these 21 patients were consolidated with regard to clinical presentation, treatment, and outcome. Nine patients, including 1 of our cases, had coexisting squamous cell carcinoma and therefore were excluded from the analysis. Twelve patients with "pure" inverted papilloma formed the basis of this study., Results: The majority of patients (83%) with intracranial inverted papilloma had recurrent disease. Patients with extradural disease had a survival rate of 86% with an average follow-up of 4.4 years. Eighty-six percent of these survivors were treated with craniofacial resection. In contrast, 75% of patients with intradural inverted papilloma were dead of disease with an average follow-up of 9.3 months regardless of the treatment modality., Conclusions: Intracranial extension of inverted papilloma is mostly associated with recurrent disease. Intracranial extradural inverted papilloma can be effectively controlled with craniofacial resection. Intracranial intradural involvement of inverted papilloma has a poor prognosis regardless of treatment. Aggressive treatment of intranasal inverted papilloma may be the most important factor in preventing intracranial presentation., (Copyright 1999 John Wiley & Sons, Inc. Head Neck 21: 703-706, 1999.)

Background: This study stems from an encounter with a phrenic nerve paralysis in a patient following doxycycline sclerotherapy for treatment of chylous fistula. The purpose of this study is to identify possible histologic evidence of doxycycline-induced nerve injury., Methods: The femoral nerves of CD rats were used as the in vivo animal model. The nerves were exposed to varying concentrations doxycycline and normal saline was the control. The nerves were studied at several time intervals using two different staining techniques., Results: The results suggest that topical doxycycline induces tissue reactions which are different from normal saline. These reactions include stimulation of a local giant cell inflammatory reaction and disruption of the myelin sheath., Conclusions: Despite the fact that this study does not give physiologic evidence of neurotoxicity, the histologic results suggest that topical doxycycline may cause nerve damage directly or indirectly. We conclude that doxycycline should not be used for sclerotherapy where unprotected nerves are exposed to the agent until further physiologic tests are performed to prove its safety.

In this case, the experts come out of the starting blocks disagreeing. One expert (Dr. Myers) does not routinely use FNA, relying instead on clinical signs to suspect a malignancy. the other physicians (Drs. Robbins and Suen) obtain an FNA for each parotid mass and use the information in counseling patients. MRI is an important preoperative tool for one physician (Dr. Suen). When faced with bilateral tumors, one approach is to stage the operations to avoid possible bilateral facial nerve injury (Dr. Myers). Other approaches include operating on the larger tumor first if both are benign, the malignant tumor first if one is benign and one malignant, and on both sides under the same anesthetic if both are malignant (Dr. Robbins). The other consultant agrees with this latter approach, with the exception being that in the case of bilateral benign tumors, he would operate on the smaller side first (Dr. Suen). Regarding the role for further surgery, one expert would reoperate if there were a suspicion for residual gross tumor on the facial nerve (Dr. Robbins). The others (Drs. Myers and Suen) agree that the positive margin likely reflects microscopic disease and further surgery is not warranted. Radiotherapy is recommended by all the experts. There is no proven role for chemotherapy. There is disagreement regarding whether the facial nerve should have been removed on the left side. Two experts (Drs. Myers and Suen) agree on peeling tumor off the nerve and following with radiotherapy. However, one physician (Dr. Robbins) believes that the facial nerve should have been removed.(ABSTRACT TRUNCATED AT 250 WORDS)

The objective of this study was to determine whether transforming growth factor alpha (TGF alpha) levels could be used as nonspecific tumor markers in patients with advanced squamous cell carcinoma (SCC) of the head and neck. Fourteen patients with epidermoid carcinoma of the head and neck were followed with serial urine TGF alpha levels, and the results were compared with the extent of cancer and the course of the disease. Based on the findings of this study further research is necessary before urine TGF levels can be recommended as a routine screening test for SCC of the head and neck.