Search

Background:Larynx preservation surgery (LPS) combined with multimodal adjuvant therapy (MAT) is re-emerging as treatment option for hypopharyngeal cancer (HPC). This study aims to explore the survival and functional outcome of this combined approach. Methods:This is a retrospective cohort study. Selected patients with primary HPC treated by LPS and MAT at two large Beijing medical centers between 2005 and 2019 were included. In addition to LPS, patients received one or more of the following treatments: preoperative induction chemotherapy, postoperative intensity-modulated radiotherapy, chemotherapy, or targeted therapy. Results:In total, 64 patients were included (62 were men, and median age was 57.5 years). The disease in most patients was in stage III (28.1%) or IV (56.3%), or in stage T2 (34.4%) or T3 (45.3%), based on the TNM scale. Across all patients, the rate of overall survival (OS) was 60.7% at 3 yr and 47.3% at 5 yr. OS was significantly higher for patients with stage I or II disease than for those with stage III or IV disease (HR 8.64, 95% CI 3.69–20.2, log-rank P= .010). Decannulation was successful in 55 patients (85.9%), and swallowing function was satisfactory (stage 0–III, on Functional Outcome Swallowing Scale) for 50 (78.1%). Median Voice Handicap Index-10 score on voice performance was 19 (range 4–40), and median Functional Assessment of Cancer Therapy-General Questionnaire score for QoL was 75 (range 16–105). Conclusions:LPS and MAT can provide satisfactory oncologic control and good functional outcomes for selected patients with HPC, especially those with stage I or II disease.

Objective Under current standards of treating highly aggressive hypopharyngeal cancer (HPC), oncological control and functional outcome are still unsatisfactory worldwide. This study explored the surgery-oriented comprehensive treatment approach based on 15 years of practice.Methods A retrospective cohort of HPC patients treated by the senior author at Chinese PLA General Hospital between Nov 2005 and Aug 2012 and Capital Medical University Beijing Friendship Hospital between May 2014 and Nov 2019 was studied. Oncological control, swallowing function, and quality of life (QoL) were assessed.Results In total, 122 patients were included in this study, with 11 (9.0%) cases in the early stage and 111 (91.0%) cases in the advanced stage. Five-year overall survival (OS) and disease-free survival (DFS) were 40.0% and 36.1%, respectively. The swallowing outcome was satisfactory in 90 (73.8%) patients. Tracheostomy-free survival was achieved in 55 (45.1%) patients. Multivariate cox regression analysis showed that the size of the surgical defect, local-regional recurrence, and distant metastasis were independent impact factors for OS and DFS (P< .05). Multivariate analysis showed that the logistic regression coefficients (standard error) of pharyngo-cutaneous fistula and local-regional recurrence on swallowing function were 1.274 (.532) and 1.283 (.496), respectively (P< .05). In addition, the logistic regression coefficients (standard error) of the clinical stage, local-regional recurrence, decannulation, and feeding tube on QoL were −7.803 (3.593), −7.699 (3.151), 13.853 (3.494), and −20.243 (3.696), respectively (P< .05).Conclusions Surgery-oriented comprehensive treatment can give rise to good swallowing function without jeopardizing oncological control. The size of the surgical defect, local-regional recurrence, and distant metastasis were independent factors impacting OS and DFS. Pharyngo-cutaneous fistula and local-regional recurrence were independent factors impacting swallowing function. Clinical stage, local-regional recurrence, decannulation, and feeding tube were independent factors impacting QoL.

Tumor-associated tissue eosinophilia (TATE) has been previously reported to be associated with a favorable prognosis for a variety of carcinomas, including head and neck cancer. We have examined this relationship in a series of 104 patients with laryngeal cancer who were observed for 5 years or more. Patients were followed up for a minimum of 5 years or until death. The original laryngeal biopsy histologic slides were examined and graded for TATE. Tumor-associated tissue eosinophilia was absent in 73 of the 104 biopsy specimens, and 25 of these, 73 patients died directly of laryngeal carcinoma within 5 years. In all, 31 patients had TATE and only 3 subsequently died of laryngeal carcinoma within 5 years (P = 0.009, chi-square test). It appears, therefore, that TATE is associated with a good long-term prognosis for laryngeal carcinoma.

It is infrequent for surgery to be necessary for the sublingual salivary gland. As such the anatomy of the floor of mouth is not well taught or understood to medical graduates and head and neck surgeons. Three diseases or conditions require surgical management: the ranula, neoplasm, and sialolithiasis. In the benign conditions, the lingual nerve and submandibular duct must be identified and preserved to avoid patient morbidity. Malignant salivary gland neoplasms are rare, and hence an inaccurate diagnosis frequently delayed commencement of correct treatment. Most cases present at an advanced stage of disease. Surgical excision with a "safe margin" is required, and thus removal of the lingual nerve and submandibular gland are sequelae of the treatment rather than a complication. [ABSTRACT FROM AUTHOR]

This article presents a summary of the recent publications on the diagnosis and management of primary malignant parotid epithelial neoplasm, with special emphasis on evaluation and treatment of nodal metastases.

The public demands that ‘all modes of treatment’ should be offered to patients who present with head and neck cancer. Up to 40 of patients present with advanced stage disease, of whom some 10 have metastatic disease and are currently deemed incurable. This review summarizes the current role and philosophy of surgical interventions in the palliation of head and neck cancer.

With the recent changes in the cause of head and neck cancer and the association of cystic metastatic neck squamous cell carcinoma with human papilloma virus (HPV), patients who are diagnosed with a cystic lesion in their upper neck need thorough investigation before commencing any treatment.

This review aims at unravelling the medical literature which has reported on the treatment of ‘larynx preserving’ chemoradiotherapy strategies and separating the treatment sites, larynx and hypopharynx, from each other and reporting on the adverse effects and functional outcomes of patients with hypopharyngeal cancer.

Parapharyngeal space (PPSp) tumours are uncommon and hence the ‘generalist expertise’ for diagnosis and treatment is limited. Recent improvements in radiology and cytopathology mean the likely diagnosis is more certain and hence the recommended surgical treatment can be more definitive.

As treatment changes in the management of head and neck cancer, patients are reportedly living longer; therefore, their death may be due to comorbidity, metastatic disease or the development of a metachronous second primary tumour (MSPT). This review describes recent developments in the identification of MSPTs of head and neck cancer, oesophagus and lung, and suggests/recommends an ‘ideal surveillance protocol’.

The history of the surgical treatment of cervical lymph node metastases began in the 19th century, and, unfortunately, the initial attempts at surgical treatment of neck metastases were disastrous. Although some European surgeons reported few cases of radical en bloc dissection, the first successful surgical procedure was performed and described in detail by Franciszek Jawdyński, a Polish surgeon, in 1888. George Washington Crile popularized and illustrated radical en bloc neck dissection in the early 20th century.

The majority of inverted nasal papilloma are benign and treatment is by complete local surgical removal. There is an associated real, but small risk of malignancy, which may coexist at the time of presentation or develop at a later time. This article reviews some of the recent publications addressing the association of inverted papilloma with malignancy.

To look at the current published literature on squamous-cell carcinoma of the head and neck, at the microscopic level, and the implications of molecular and genetic research.

Surgery remains a mainstay of treatment for head and neck cancer. Patients have significant comorbidities, and protracted surgery is associated with complications and may require a high-dependency nursing environment such as an intensive care or high-dependency unit postoperatively. The literature is reviewed to document the current evidence for early postoperative nursing care.

AbstractAdvanced juvenile nasopharyngeal angiofibroma (JNA) (i.e. disease with intracranial extension) is reportedly uncommon. The optimum management form of such a clinical situation currently remains controversial. This review, of the recent English published literature, discusses the common JNA classification systems advocated, shows the advantages and disadvantages of surgical approaches used (both open, endoscopic or combined), and re-evaluates the current role of radiotherapy (for initial management or treatment of residual/recurrent disease). We also discuss the typical presentation of these patients, the role of pre-operative embolization, as well as surgical techniques to minimize recurrence, and advocate a post-treatment follow-up protocol.Copyright © 2006 S. Karger AG, Basel

Primary malignant melanoma of the head and neck is an uncommon disease associated with a very poor prognosis, and an unpredictable natural disease process. Most patients, when diagnosed, pose a major dilemma to their treating clinicians as to what is the most appropriate current management options available with their likely short-term or long-term results.

Objectives:One third of recurrences after radiotherapy for early laryngeal cancer remain localized. Salvage conservation laryngeal surgery, with total laryngectomy held as reserve, is a surgical management option that is arguably underused. The aim of this review is to report the oncologic and functional results of salvage conservation laryngeal surgery, using the external or the endolaryngeal laser approach.

To review the current knowledge on the clinical entity of metastasizing pleomorphic adenoma.

Hypopharyngeal cancer presents major problems for the patient and the clinician regarding how best to treat both the disabling symptoms and to offer patients the likelihood of cure. The majority of patients present with squamous cell carcinoma at a clinically advanced disease stage, with cervical nodal disease, and frequently have multiple comorbidities. Options for treatment include surgery, radiotherapy, chemoradiotherapy, or a combination. Many surgical options have been described and range from partial pharyngeal surgery with or without partial laryngectomy in localized early disease, to a more radical approach in advanced disease, including total laryngectomy with partial pharyngectomy or extended pharyngolaryngectomy. The physical consequences of a radical surgical approach are a significant alteration or loss of voice and swallowing function. Rehabilitation of the swallowing function is difficult, and, currently, there is no satisfactory pharyngeal replacement when a circumferential hypopharyngeal segment is resected. Complications, such as fistula and stenosis, are common, and patients may require further surgery if they survive. [Copyright &y& Elsevier]

Carotid artery pseudoaneurysms are rare lesions and are increasingly treated by endovascular means. This paper reports the case of a patient presenting with haemorrhage due to a left external carotid artery pseudoaneurysm seven weeks after total laryngectomy for carcinoma. The lesion recurred and rebled after technically successful emergency endovascular occlusion. Subsequent aneurysmectomy and carotid sacrifice resulted in fatal hemispheric infarction. The aneurysm was demonstrated to be infected on white cell study and subsequent histopathology. We propose that infection within the aneurysm itself was a significant factor in its recurrence and rebleeding after endovascular occlusion. If infection is proven or suspected then consideration should be given to early surgical rather than endovascular intervention.

This purpose of this article is to review and provide an update of current publications on the evaluation and management of adenoid cystic carcinoma.

The purpose of this review is to document the information reported on cancers presenting in the head and neck area during pregnancy.

Verrucous carcinoma is a low-grade malignancy that has been reported to occur in all anatomic sites of the head and neck. Fourteen cases of verrucous carcinoma of paranasal sinus origin have been reported to date in the English literature. Case report and retrospective review of all cases of verrucous carcinoma of the paranasal sinuses in the English literature. All authors were contacted to provide missing data and long-term follow-up. Five of the eight authors contacted responded, and the most current data from all 15 cases was compiled. Eleven of the 15 patients (73%) were men and ranged in age from 35 to 81 years (median, 68 years). The maxillary sinus is the most common paranasal sinus involved (93%). Presentation often occurred late, with 12 of 15 (80%) initially being seen at stage T3 or higher. Surgical excision was the treatment of choice, and median disease-free survival was 54 months. Verrucous carcinoma of the paranasal sinuses is a rare but potentially curable disease. Treatment is surgical, and prognosis is good with early intervention. © 2003 Wiley Periodicals, Inc. Head Neck 26: 184–189, 2004

Surgery for benign parotid gland salivary neoplasms is associated with sequelae: scar and divot defect and complications, facial nerve paresis/paralysis and Frey’s syndrome. These potential sequelae and complications are discussed with all patients prior to operation. We contacted 212 patients who had undergone surgery for benign parotid disease during1988–1997, by postal questionnaire. We enquired about their perception and recollection of the information they had received pre-operatively and to document and comment upon what problems they had experienced in the early and late post-operative period. The usable return rate was 75.5 per cent (173/212). Most patients (90 per cent) were satisfied with the information theyhad received pre-operatively. The complication and/or sequelae rates for facial nerve palsy (temporary 26.3 per cent, permanent 1.9 per cent), Frey’s syndrome (12.5 per cent) and sensory deficit about the cheek and ear (30.6 per cent), are comparable to other published studies.

Management options for patients with advanced neck node metastasis from head and neck cancer are controversial. Typically, N3 disease suggests a poor outcome because of difficulty with regional control and the high likelihood of distant metastases. Patients who are treated for cure are treated with aggressive multimodality treatment. Therefore, a critical assessment of the potential for cure or measurable palliation, patient comorbidity, and the risk of complications when considering treatment for patients with N3 disease figures prominently in treatment planning. The pretreatment evaluation and contemporary management of patients with N3 disease are discussed in this review.

An adult older than 40 years present with a cystic lump in the upper neck should be considered at risk of having an underlying malignancy of the head and neck—a mucosal squamous cell carcinoma or a papillary thyroid carcinoma. Although the likelihood of malignancy is small, should the diagnosis of malignancy be confirmed pathologically, this consequential diagnosis will result in devastating physical and psychologic upset to the patient and their caretakers, the treating surgeons, and possibly many other clinical groups. It is therefore recommended that all such patients be investigated by radiologic imaging—CT/MRI and fine needle aspiration cytology, followed by panendoscopy of the head and neck, which includes an ipsilateral tonsillectomy biopsy and an excision biopsy of the cystic neck lesion. Should the lesion prove to be an isolated cystic metastatic squamous cell carcinoma, a neck dissection should be performed with or without adjuvant radiotherapy. Should the lesion prove to be a metastatic papillary thyroid carcinoma, a total thyroidectomy and neck dissection should be performed. In general, patients with cystic metastasis have a better prognosis than patients who present with a noncystic neck mass.

Esthesioneuroblastoma is an uncommon malignant neoplasm of the nasal vault that in the past was considered benign or low-grade malignant. Surgical approaches in the main were transnasal, with a high recurrence rate and ultimate patient death. With the modern imaging of CT and MRI, should the patient be willing and fit enough, esthesioneuroblastoma currently should be approached using a craniofacial resection. Large tumors should be considered for preoperative chemotherapy and postoperative radiotherapy. Local tumor recurrence is not uncommon and is generally related to the attention to local anatomic dissection. Neck metastases, when they present, should be excised using a modified neck dissection. Distant metastases may present at any time during the course of the disease, generally within 36 months, and may respond to local radiotherapy or systemic chemotherapy. Five-year survival currently appears to be optimized by surgery followed by postoperative radiotherapy and is approximately 65.

Tracheostomal stenosis is reported to be present in 4 to 44 of patients who have had total laryngectomy. Numerous contributory factors to this stenosis have been cited. This paper reviews the evidence surrounding these factors. Surgical techniques that use a skin flap inserted into the circumference of the tracheostoma have a lower incidence of stenosis than other methods (0–13). Female sex and postoperative stomal infection are associated with an increased incidence of stenosis. Numerous techniques have been described to treat established tracheostomal stenosis. The underlying surgical theme is to interrupt the circumferential scar by inserting new tissue in a manner similar to the techniques described for construction of the primary stoma. No single method is reported to be superior to the others.

Ionizing radiation is an established curative therapeutic modality in the management of neoplasms. However, it is well recognized that radiation is also carcinogenic to bone and soft tissues. In the head and neck, radiation-induced tumors are uncommon despite the large numbers of patients treated by primary or adjunctive radiotherapy. However, with patients living longer, the risk of radiation inducing a tumor in previously irradiated areas is increasingly possible. Because of the case reports and the increasing numbers of patients who are surviving many years, clinicians must be conscious of changes in patients treated with radiation, and may suggest a thorough work-up to exclude a new tumor. The possibility of a second squamous cell carcinoma tumor arising after several years in a previously irradiated squamous cell carcinoma site, such as the larynx, must be considered a metachronous carcinoma not related to previous irradiation. The use of radiotherapy for the treatment of patients with benign head and neck neoplasms should be recommended with caution, and complications of such treatments should be documented in the literature when they arise.

AbstractPatients who present with malignant salivary glands should at their initial assessment have an X-ray of the chest to exclude the possibility of distant metastases. Patients who have other symptoms, bone pain etc., should be appropriately investigated. The likelihood of patients developing distant metastases is associated with high-grade tumors, most commonly adenoid cystic carcinoma, high-grade mucoepidermoid carcinoma, salivary duct carcinoma and tumors sited in the submandibular gland, posterior tongue and pharyngeal tumors. Patients who have had a high-grade tumor treated and survived without locoregional recurrence have the same risk of developing distant metastases as those patients who have locoregional recurrence. Other histological types of salivary tumors are associated with a lower risk of developing distant metastases but a real risk remains lifelong. It is recommended that all patients who have a malignant salivary gland tumor treated, any histology, should be followed up and clinically assessed at least once every 12 months for life.Copyright © 2001 S. Karger AG, Basel

The formation of the chylous fistula is a potentially serious complication of surgery in the neck. This is especially true of the left side of the neck, where 75 of cases occur. Overall, the reported incidence following surgery to the neck is of the order of 1 to 2.5 of cases. Exactly when this situation, if it arises, should be managed is controversial. This paper is a review of the current literature and recommends current best practice. The basic science of chyle, the important decisions of clinical management regarding conservative “watch and wait” versus surgical intervention, the timing of such surgical interventions, and the aggressiveness of these interventions are discussed.

Recurrence of salivary pleomorphic adenoma is an uncommon event, if the primary surgery has been performed meticulously and the tumor has been completely excised. The parotid gland is the most frequent site for recurrence followed by the minor salivary gland (oral cavity) and then the submandibular gland. Recurrences are classified as uninodular or multinodular. The uninodular recurrences are more easily treated by “completion” surgery and removal of the remaining glandular structure. Multinodular recurrence is more diffuse and hence surgery is likely to be more extensive, with risk of resultant permanent facial nerve paralysis, the possibility of further tumor recurrence, and the long-term risk of malignant degeneration. The use of radiotherapy remains controversial in the management of benign recurrent disease; although its use may minimize the surgical complications, the risk of malignant degeneration persists and complications are associated with radiotherapy.

The majority of head and neck cancer patients are malnourished and in need of nutritional support at the time of presentation. This support should commence when it is suspected that the diagnosis is likely to be a malignancy. Patients who have lost more than 10 of their body weight during the previous 6 months are described as severely malnourished. The current agreed upon six nutritional parameters are a poor correlation with nutritional status (> 10 body weight). The finding of decreased HLA-DR expression on blood monocytes with weight loss is exciting and should be investigated further. The introduction of percutaneous endoscopic gastrostomy has made enteral nutritional support for all head and neck cancer patients a reality, with acceptable mortality and minimal morbidity. The introduction of an immune-enhancing formula has shown a significant impact in reducing the incidence of infectious complications when compared with standard formula.

Patients with head and neck cancer are at high risk of developing a second primary malignancy at a rate of 4 to 7 per annum. This poses an important issue of long-term follow-up in patients with head and neck cancer. In order to improve both the early detection and appropriate treatment of second primary malignancies, it is important to better define the patient group with high susceptibility and to develop new strategies of screening. Biomarkers such as mutagen sensitivity, chromosomal deletions, p53mutations, cyclin D1gene amplification, nuclear retinoid acid receptor expression, and epidermal growth factor receptor expression all may have a place in identifying patients at increased risk of developing a second primary malignancy. The high incidence of second primary malignancies after treatment of early head and neck cancer makes this disease a good model for chemoprevention. Retinoids used alone or in combination with other antitumor agents such as interferon show much promise for biochemoprevention of head and neck cancers.

Squamous cell carcinoma is the most common malignant tumor of the oropharyngeal region of the head and neck, although it is infrequently encountered in the Western world. Early tumors are uncommon and are effectively treated either by primary surgery or external beam radiotherapy. Advanced disease, the most frequent stage of disease at presentation (75), requires thoughtful, structured, and well-planned treatment strategies if patients are to experience relief of symptoms, preservation of quality of life, and realistic expectation for cure.

The treatment of a patient with imminent airway obstruction caused by a malignant tumor of the larynx is an uncommon clinical problem. These cases need to be evaluated, diagnosed, and managed with care, skill, speed, and above all, appropriateness of intervention. Three methods are available to control the airway: tracheostomy, emergency laryngectomy, and controlled tracheal intubation with or without tumor debulking. Two groups of patients had their airways managed either by tracheostomy and delayed elective surgery or by emergency laryngectomy. There was no survival advantage between the groups, and no increased risk of stomal recurrence was demonstrated. If time permits, the patient is considered suitable, and adequate anesthetic and surgical instrumentation is available, it is currently recommended that the obstructing laryngeal tumor be debulked by cold-steel or, preferably, CO2laser and that the emergency situation be stabilized and the definitive treatment of the patient be converted to an elective procedure without the need to create a tracheostomy.

The House-Brackmann is the most widely accepted system for the clinical assessment of facial nerve function. It is, however, being subjective and discontinuous, prone to interobserver variation. The need for an objective system persists. The Nottingham System is described and compared to the Burres-Fisch system in a study of 29 subjects with varying degrees of facial nerve function, ranging from normal to total paralysis. Within-group component of variance analysis was 7% for the Nottingham System compared to 26% for the Burres-Fisch system. Bland and Altmans' analysis showed the Burres-Fisch system to be biased, overestimating small percentage scores, and underestimating large ones. The Nottingham System proved unbiased. The Nottingham System is recommended as an accurate objective continuous grading system for the rapid assessment of facial nerve function in the clinic.

Since 1983, we have treated advanced (UICC stages 111 and IV) squamous carcinomas of the larynx by primary radiotherapy, using three small fractions a day, 3–4h interfraction interval, 5 days per week. The early patients received doses per fraction of 1.5 Gy, and a total dose of approximately 70 Gy, given as a split-course over 6 to 7 weeks. While overall tumor control and laryngeal preservation was good, a number of severe late radiation reactions were seen. The schedule was then modified, with a reduction in the fraction size to 1.1 Gy, the total dose to 60 Gy, and the overall time to 4 weeks, with omission of the mid-treatment “split.” Since 1986, we have treated 26 patients in this way. Acute reactions are brisk, but rapidly healing. loco-regional control was achieved in 22 patients, only one of whom has relapsed to date, in a solitary node, salvaged by radical neck dissection. Four have died of uncontrolled loco-regional malignancy, and three of intercurrent disease while in clinical remission. No serious late morbidity has been observed in surviving patients, and vocal quality is good in the majority. These results suggest that this hyperfractionated and accelerated radiotherapy schedule may offer an acceptable nonsurgical, voice-preserving treatment for advanced laryngeal carcinoma; it can be used in a normally working radiotherapy department.

Fiberoptic endoscopy has made a notable impact in rhinology over the last decade, mainly in the diagnosis and treatment of paranasal sinus inflammatory disease. The aim of this article is to review, discuss, and illustrate the role of endoscopy in the management of nasal neoplasia. We have reviewed our own experience and illustrate this with four cases. We discuss the role of endoscopy in the diagnosis, biopsy, resection, post-therapeutic surveillance, and palliation of these tumors.