Head and Neck
Công bố khoa học tiêu biểu
* Dữ liệu chỉ mang tính chất tham khảo
We performed a systematic review and meta‐analysis to determine whether diabetic patients have an increased rate of postoperative complications compared to nondiabetic patients after head and neck free flap reconstruction. A systematic review of PubMed Database between 1966 and 2012 was performed. RevMan 5.0 was used for meta‐analysis. A retrospective medical chart review of 7890 patients to identify those who had a failed microsurgical reconstruction of the head and neck region at Chang Gung Memorial Hospital was also carried out. The result revealed that patients with diabetes mellitus have a 1.76 increased risk of complications (odds ratio [OR] = 1.76; 95% confidence interval [CI] = 1.11–2.79) with minimal heterogeneity (
We analyzed the variability and accuracy of sentinel lymph node (SLN) identification by lymphoscintigraphy performed preoperatively and repeated on the day of operation in patients with melanoma or Merkel cell cancer.
Twenty‐five prospectively studied patients had lymphoscintigraphy prior to and on the day of operation. Discordance between lymphoscintograms was defined as change in location of SLN or failure to identify a SLN by one of the studies.
In 22 of 24 assessable cases (92%), SLNs were excised. Preoperative lymphoscintigraphy was correct in 19 of 22 (86%) cases. Day of operation lymphoscintigraphy was correct in 20 of 22 (91%) cases. SLN location was as classically described in 24 of 25 (96%) cases. Discordance between lymphoscintigraphy studies was 32% (8/25 patients). Half with discordant migration (8%) yielded metastases in basins not identified by day of operation lymphoscintigraphy but demonstrated by preoperative lymphoscintigraphy.
Head and neck lymphatic drainage patterns not only vary between patients but also can vary with time for a single patient. © 2007 Wiley Periodicals, Inc. Head Neck 2007
Có nhiều lựa chọn điều trị khác nhau cho bệnh ung thư biểu mô tế bào vảy tại thanh quản T1a (SCC). Xạ trị (RT) thường được ưu tiên hơn phẫu thuật cắt bỏ. Tuy nhiên, điều này đã bị thách thức bởi phẫu thuật vi phẫu bằng laser qua miệng (TLM) cho thấy tỷ lệ bệnh lý thấp và kết quả chức năng tốt.
Một cuộc khảo sát hồ sơ hồi cứu đã được thực hiện. Các bệnh nhân bị ung thư SCC thanh quản T1a chưa được điều trị đã được đưa vào nghiên cứu. Các mục tiêu của nghiên cứu bao gồm kiểm soát tại chỗ và vùng, tỷ lệ sống sót tổng quát, tỷ lệ sống sót đặc hiệu với bệnh và tỷ lệ bảo tồn thanh quản tuyệt đối.
Bốn trăm bốn bệnh nhân đã được đưa vào nghiên cứu này. Các ước lượng Kaplan-Meier cho 5 năm như sau: kiểm soát tại chỗ 86.8%, tỷ lệ sống sót tổng quát 87.8%, tỷ lệ sống sót đặc hiệu với bệnh 98.0%, tỷ lệ sống mà không tái phát 76.1%, và tỷ lệ bảo tồn thanh quản 97.3%. Tỷ lệ biến chứng chỉ ở mức 1%; phần lớn bệnh nhân có giọng nói bình thường hoặc chỉ bị khàn nhẹ.
Tỷ lệ biến chứng thấp, kết quả chức năng xuất sắc và tỷ lệ bảo tồn cơ quan cao cho thấy TLM là lựa chọn ưu tiên. Nhất trí với tài liệu hiện có, TLM nên là phương pháp điều trị lựa chọn cho các bệnh nhân mắc ung thư SCC thanh quản T1a.
Transoral CO2 laser surgery has been accepted as a valuable therapeutic option for glottic cancer.
This was a retrospective analysis of 595 patients. Five‐year overall and disease‐specific survivals, local control with laser, locoregional, regional control, and organ preservation rates were calculated. The impact of different variables was calculated by univariate analysis.
Overall, disease‐specific and disease‐free survivals, local control with laser, locoregional, regional control, and organ preservation rates were 87.5%, 99%, 81.3%, 92.7%, 98.9%, 98.2%, and 97.1%, respectively. Univariate analysis showed a significant impact of pT category on local control with laser, organ preservation, locoregional and regional control, of endoscopic re‐treatment for positive deep surgical margins on local control with laser and organ preservation, and recurrence after endoscopic re‐treatment on local control with laser and organ preservation.
This series confirms the good oncologic outcomes of endoscopic laser surgery for Tis, T1, and selected T2 and T3 glottic tumors. © 2009 Wiley Periodicals, Inc. Head Neck, 2010
The oncologic impact of surgical margins after transoral laser microsurgery (TLM) for T1 and T2 glottic carcinoma is controversial. The purpose of this study was to assess the prognostic value of margin status in terms of local control.
Records of 266 patients treated from 1990 to 2013 were evaluated. Patients with previous cordectomy or without preoperative CT scan were excluded from the study.
A total 110 patients (85 T1a, 8 T1b, and 17 T2) were enrolled. A local recurrence was observed in 23 patients. Five‐year disease‐free survival was significantly impaired in patients with positive margins (
The present study shows that invaded margin is a factor of poor local control even though laser vaporization was systematically applied after resection. In case of deep vocal fold involvement, TLM should be extended beyond the vocal muscle to improve local control. © 2016 Wiley Periodicals, Inc.
The spread pattern of 14 cases of primary subglottic cancer, as seen on computed tomography (CT), is analyzed. Cricoid cartilage invasion was present in nine cases. Tracheal invasion was definite in four cases and questionable in three. Extralaryngeal soft tissue spread was present in nine cases; all but one had cartilage destruction. The patterns of spread seen accurately reflect reports in previous whole‐organ section studies, and suggest that the elastic cone has a primary role in directing the spread of tumor.
Anticipating spread to areas described above with CT and/or magnetic resonance imaging (MRI) can be used to try to improve treatment planning and perhaps outcome by: (1) avoiding placement of urgent tracheostomies close to the tumor; (2) helping to modify standard surgical approaches by suggesting lower‐than‐usual tracheostomies, or more extensive‐than‐usual thyroid gland resection; and (3) avoiding delay in diagnosis by strongly suggesting rebiopsy when imaging indicates a tumor is present, and initial endoscopy and biopsy cannot confirm the imaging findings.
The purpose of this review is to address the issue of unnecessary irradiation of the normal larynx.
We performed a literature review and dosimetry evaluation of intensity modulated radiotheraphy (IMRT) techniques.
Data suggest that matching conventional parallel opposed photon fields through adenopathy is a reasonable alternative to the common practice of unnecessarily irradiating the normal larynx to high doses. The dosimetry evaluation demonstrates that the laryngeal dose is much higher when the entire neck is included in the IMRT field as opposed to using a standard anterior low‐neck field below the level of the thyroid notch.
Lateral opposed fields should not be extended to include the larynx to avoid matching fields through adenopathy. IMRT fields should not include the normal larynx when the laryngeal dose would be substantially lower with a technique that shields the larynx in an anterior low‐neck field. © 2004 Wiley Periodicals, Inc.
The osteomyocutaneous peroneal artery‐based combined (OPAC) flap is a refinement of fibula osteoseptocutaneous flap, with the inclusion of partial soleus muscle based on an independent myocutaneous perforator.
Seventeen men underwent composite oromandibular reconstruction using an OPAC flap. Flaps were raised with 1 or 2 skin paddles and 2 to 3 bone segments. In 8 cases, a portion of soleus muscle was included.
All flaps survived, but partial failure occurred in 2 cases (11.7%). At a mean follow‐up of 25.3 ± 19.4 months, 6 of 12 patients tolerated a regular diet, 5 a soft diet, and 1 a liquid diet. Speech was normal in 2 patients, intelligible in 4, and slurred in 6.
Advantages of the OPAC flap include a single donor site, 1 pair of recipient vessels, versatile 3‐dimensional inset, adequate soft tissue augmentation, and better aesthetic and functional outcomes. © 2008 Wiley Periodicals, Inc. Head Neck, 2009
The aim of this prospective cohort study was to determine whether an immediate postoperative period of deep sedation and artificial respiration in an intensive care unit (ICU) leads to fewer complications and a reduced failure rate of microvascular flaps compared with a situation in which patients are allowed to breathe spontaneously without sedation in a recovery room.
Each group comprised 50 patients. General medical complications and flap donor and recipient site complications were documented.
Significantly, more patients had problems with weaning from ventilation in the ICU group (
Admission to an ICU did not reduce complications after microvascular reconstruction and, therefore, has only to be considered for selected cases. © 2009 Wiley Periodicals, Inc. Head Neck, 2009
Cuniculatum carcinoma is a well‐differentiated form of squamous cell carcinoma that shares histologic characteristics with papillary squamous cell carcinoma and verrucous carcinoma. Cuniculatum carcinoma usually occurs on the plantar region, and only 16 cases involving the oral cavity have been described in the literature.
The authors have reported 3 cases of mandibular cuniculatum carcinoma. All of the patients were in a great deal of pain. Histologic diagnosis was difficult due to the presence of few cellular atypies. Clinical criteria, osseous lysis, and the coexistence of multiple intraosseous well‐differentiated, hyperkeratotic papillomatous lesions with few cellular atypies sign the diagnosis.
No local recurrence has been reported after treatment with radical surgery alone.
The diagnosis is often delayed. Although cuniculatum carcinoma displays aggressive behavior locally, lymph node infiltration and metastasis are rare. The therapy of choice is surgical removal with free margins, after which the prognosis is excellent. © 2010 Wiley Periodicals, Inc. Head Neck, 2012
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