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Radiotherapy is an integral part of the therapy for cancer of the head and neck. Unfortunately, not all cancers are equally susceptible to the effects of radiation, and many such cancers recur after radiation treatment. Researchers have speculated that some cancers are more resistant to irradiation because of purely physical factors such as their size and location. Other factors, such as the ulceration of a tumor and its stage of development, also seem to be important. A key factor seems to be the adequacy of the blood supply of the tumor; tumors which are poorly supplied with oxygen may have a greater chance of surviving radiation than those which are well oxygenated. However, two tumors which appear to be the same are often entirely different in their susceptibility to radiation. Some researchers have suggested that this is due to differences in the ability of the cancer cells themselves to repair the damage which is inflicted by the radiation. One way to approach this problem is to obtain cells from the cancers of human patients and grow them in tissue culture dishes, where there are no differences in oxygen supply. In this way, the response of cells to radiation may be studied without the influence of such variables. For this reason, cells were cultured from tumor specimens removed from 20 patients with cancer of the head and neck. Some of the cell lines which were established were found to be resistant to radiation, and others were radiosensitive. Radioresistant cells were obtained both from patients who had previously received radiation treatment and patients who had not. Similarly, radiosensitive cells were obtained even from patients whose cancer had recurred after radiotherapy. However, when only the radioresistant cells were compared, the amount of radiation required to kill a specified proportion of the cells from the previously irradiated patients was significantly higher than the radiation dose required to kill a similar fraction of cells from the other patients. These results indicate that resistance to radiation appears to be, at least in part, an intrinsic characteristic of the cancer cells themselves, and is not due entirely to the physical characteristics of the patient's original tumor. The physiological basis for this radiation resistance has not yet been identified, however. (Consumer Summary produced by Reliance Medical Information, Inc.)

Appropriate early treatment can make a difference in the patient's quality of life and chances for survival. You may be the first to see a neck mass; here are guidelines [...]

The definitive diagnosis of a lump in the neck requires a thorough evaluation before biopsy. Are you up-to-date on the endoscopic and imaging procedures of choice? The initial evaluation of [...]

Age: A clue in neck mass diagnosis When an older adult has a lump, malignancy should be at the top of the differential--but even the young child can have cancer. [...]

From the Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minn. (Dr. Strome); the Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor (Drs. Robey, [...]

The Hemovac drainage system was required postoperatively for 156 patients who had undergone major head and neck surgical treatment. This study distinguishes infectious complications from noninfectious complications by the aerobic and anaerobic cultures that were taken from the Hemovac line drainage and any subsequent complications. The 33% complication rate included only those of the head and neck and excluded general medical complications. Of the 52 patients having complications, 19 had infectious, 24 had noninfectious, and nine had both infectious and noninfectious complications.

• Three hundred forty-two cases of laryngeal cancer were treated at the University of Michigan, Ann Arbor. One hundred ten supraglottic cancers and 150 glottic cancers were studied in depth. Conservation surgery was performed on 63 patients. Determinate two-year disease-free survival for glottic cancer was 90% in those irradiated primarily, 83% for those treated with vertical hemilaryngectomy, and 58% in the group that had total laryngectomy. Supraglottic cancers had a determinate survival rate at two years of 62% for those irradiated primarily, 80% for those treated with a supraglottic laryngectomy, and 62% when total laryngectomy was required. The cost of preserving the respiratory and sphincteric functions of the larynx in some cases amounted to the morbidity associated with a protracted hospital stay, altered deglutition, instances of a weak but functional voice, and the possibility of a permanent tracheostomy. Despite high recurrence rates of 30% to 40%, the overall determinate survival with salvage was an acceptable 80% for the conservation surgery group.(Arch Otolaryngol 1985;111:361-365)

• A free flap has been defined as an island flap that has been completely detached from the body and transferred to a distant recipient site, where microvascular anastomoses are done to reestablish its essential intravascular circulation.The groin flap, based on its superficial circumflex iliac artery and venae comitantes, was utilized as a free flap to close large intraoral defects in six patients following ablative cancer operations. All patients received preoperative or postoperative irradiation therapy. Four of the six free groin flap operations were clinically successful. One flap became necrotic unexpectedly after 3½ weeks. Infection played a major part in necrosis of the other flap.The use of the free flap in oral cavity reconstruction offers certain advantages over regional vascular flaps but definite limitations exist.(Arch Otolaryngol 103:78-83, 1977)

• The records of 508 patients who had undergone radical neck dissection were reviewed. Twenty-eight of these patients (5.5%) were found to have tumor attached to the carotid arterial system. Twenty-four patients (86%) died with tumor, the mean survival time being 16.9 months. Local recurrence of tumor in the neck occurred in 46% of the patients and distant metastases in 67%. Eighteen percent of those who developed local recurrence did so in the absence of distant metastases and might have benefited from a more aggressive approach toward the tumor.(Arch Otolaryngol 103:70-73, 1977)

• This study represents a retrospective evaluation of 145 implants of irradiated homologous costal cartilage used over a three-year period for facial contour restoration in a variety of anatomic sites. In this series, the immediate complication rate was 5.5%, the late complication rate was 2.1%, and the partial resorption rate was 1.4%. The infection rate for the implants inserted intraorally onto the face of the maxilla did not have a statistically significant difference from the infection rate for the entire series, thus demonstrating that this implant is not easily infected. These results establish irradiated homologous costal cartilage as a valid implant material.(Arch Otolaryngol 103:12-15, 1977)

• The effectiveness of elective en bloc, therapeutic en bloc, and secondary radical neck dissections is evaluated in patients whose primary tumor remained controlled following initial treatment (surgery, irradiation, or combined therapy). Pathologically documented cervical involvement following elective en bloc, therapeutic en bloc, and secondary radical neck dissections occurred in 80 (27%) of 295, 158 (67%) of 237, and 77 (75%) of 102 of the patients, respectively.Patient survival is greater if cervical metastases are surgically removed while occult, rather than if they are resected after they are clinically suspected. Patients who have a 15% to 20% or greater likelihood of having occult cervical metastases will have an increased probability for survival if the surgical management includes an elective en bloc radical neck dissection.(Arch Otolaryngol 101:656-659, 1975)

• Recurrent pleomorphic adenomas of the parotid gland warrant consideration because of the potential for facial nerve injury occurring with surgical treatment and the risk of malignant conversion. Forty-eight cases of recurrent pleomorphic adenoma treated at the University of Michigan, Ann Arbor, between 1935 and 1975 were retrospectively analyzed. The results of surgical procedures for recurrence were determined with respect to tumor control and resultant facial nerve function. Malignant conversion developed in three (6%) of 48 cases. The results of this study underscore the importance of adequate surgical excision of initial recurrences as well as primary tumors to prevent tumor recidivism. Tumor control rates and facial nerve preservation are enhanced with formal parotidectomy for recurrent tumor when feasible. In cases in which facial nerve identification and dissection is not possible, en bloc total parotidectomy offers effective, though not absolute, control of extensive recurrence.(Arch Otolaryngol Head Neck Surg 1986;112:1180-1184)

• The management of osteoradionecrosis of the mandible remains controversial. Involvement of large areas of the mandible or the entire mandible with osteoradionecrosis may result in severe functional disability and cosmetic deformity. Pain, trismus, difficulty with speech and eating, and a malodorous wound are all problems that must be corrected. Local forms of therapy may be inadequate in the treatment of extensive osteoradionecrosis, and more aggressive surgical management is required. The extent of surgical intervention depends on the individual case. However, preservation of function and avoidance of disfigurement are important goals in the treatment plan. From both a functional and cosmetic standpoint, surgical management can be effective in achieving satisfactory rehabilitation goals.(Arch Otolaryngol 1982;108:179-183)

• Squamous cell carcinoma is the most common of human cancers, and yet because it is poorly represented by cultured cell lines, little is known about the characteristic cell biology and the cellsurface antigenic phenotypes of such tumors. To develop a continuously available source of squamous cell carcinoma for repeated and reproducible serologic analysis and for better understanding of its biologic characteristics, tissue culture methods and nude mice were used to establish new cell lines of squamous carcinoma. Special media, serum supplements from several sources, and methods of handling fresh tissue specimens were all examined as a means of improving the survival of tumor cell lines. Several new cell lines were established. Features characteristic of a squamous cell origin, eg, microvilli, desmosomes, tonofilaments, and the squamous cell differentiation antigen (pemphigus antigen), were found. The clinical course of disease in individual donor patients has been examined.(Arch Otolaryngol 1981;107:703-710)

• Thin-needle aspiration cytology is a well-known minimally invasive technique that is used in the diagnosis of neoplastic disease. The same biopsy technique provides a means for immediate identification of actinomycosis. Aspiration specimens may be used for morphologic studies, as well as for microbiologic isolation. The diagnostic histologic feature of sulfur granules remains intact with this cytologic aspiration technique. This technique is a safe, simple, and rapid means of diagnosing actinomycosis and appears to have value in the diagnosis of other infectious diseases as well.(Arch Otolaryngol 104:491-494, 1978)

• Three groups of rats were studied. Group 1 rats received 6,000 R of irradiation, group 2 rats received 4,000 R, and group 3 rats acted as a control. Four weeks following irradiation, the femoral artery of each rat was cut and reapproximated using microvascular surgical techniques. Four weeks after surgery, the same femoral artery was evaluated for patency. There was no notable effect of irradiation on the patency of subsequently performed anastomosis of these small (1 mm in diameter) muscular arteries. Radiation effects were obvious on histological examination, but the anatomical and physiological alterations apparently were not severe enough to cause early thrombosis after microsurgical manipulation of these vessels.(Arch Otolaryngol 104:103-107, 1978)