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Bradley PJ, Rinaldo A, Suárez C, Shaha AR, Leemans CR, Langendijk JA, Patel SG, Ferlito A. Primary treatment of the anterior vocal commissure squamous carcinoma. Eur Arch Otorhinolaryngol 2006; 263:879-88. [PMID: 16909217 DOI: 10.1007/s00405-006-0138-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 06/19/2006] [Indexed: 11/24/2022]
Abstract
Squamous cell carcinoma may involve the anterior commissure (AC) area of the laryngeal glottis, and can be grouped morphologically into four groups; (1) tumor confined to the AC, (2) tumor involving one cord and the AC, (3) tumor involving the AC and a portion of both vocal cords, and (4) tumor involving a greater part of one cord and crossing over to involve a variable length of the other cord. Some of these patients when evaluated by imaging, either CT and/or MRI, may demonstrate thyroid cartilage erosion or involvement, thereby upstaging a T1a, T1b into a T3 or a T4 glottic cancer. The majority of patients treated by radiotherapy have only been staged clinically, and hence a failure or recurrence rate of 15%. In patients treated surgically by endoscopic or external surgery, the local recurrence rates are similar at 15%. Therefore, future reporting of patients treated with AC involvement should be staged radiologically, to include CT or MRI, and documentation of the treatment results be reported in subgroups, according to whether there is no cartilage involvement, inner-table cartilage erosion, or through-and-through cartilage invasion. Should endoscopic cordectomy be used, then the type of surgery performed should be based on the classification as suggested by the European Laryngological Society. The use of the above recommendations would allow for more meaningful results to be reported and for cause specific analysis of failure of treatment techniques applied.
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Bradley PJ, Ferlito A, Suárez C, Werner JA, Genden EM, Shaha AR, Leemans CR, Langendijk JA, Rinaldo A. Options for salvage after failed initial treatment of anterior vocal commissure squamous carcinoma. Eur Arch Otorhinolaryngol 2006; 263:889-94. [PMID: 16909218 DOI: 10.1007/s00405-006-0137-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 07/17/2006] [Indexed: 11/27/2022]
Abstract
Persistence or recurrent cancer in the anterior commissure (AC) after primary radiotherapy may remain localized to its pretreatment anatomical site. If so, endoscopic CO(2) laser excision, in experienced hands, may achieve complete tumor excision and result in cure for many patients. Occasionally, second and third recurrences may be similarly salvaged by further endoscopic surgery. The use of the vertical hemilaryngectomy is an alternative treatment for similar localized lesions, with a higher first time surgical tumor eradication rate, but with a more protracted hospitalization and a less satisfactory voice and swallowing outcome. In both types of such surgical salvage, CT scanning must demonstrate no evidence of cartilage invasion or destruction. When there is evidence of minimal thyroid cartilage invasion, then the supracricoid partial laryngectomy is an alternative conservation option, and is likely to result in a cure, with the retention of a voicing larynx without a stoma. When the tumor has increased in size from the original pretreatment dimension and/or site, then imaging must be used to identify possible cartilage invasion, in which case the likelihood of tumor eradication by endoscopic or external vertical partial laryngectomy is highly unlikely. The indications for the routine use of total laryngectomy for the treatment of recurrent or persistent cancer involving the AC must be reviewed; there is current evidence that cure can be achieved by a less radical procedure. However, total laryngectomy may remain the only treatment option for advanced or aggressive first time recurrence, or in patients who develop subsequent recurrence following previous less aggressive surgery (endoscopic or external).
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Abstract
Parapharyngeal space (PPS) tumours are uncommon and can be a diagnostic challenge as the presenting symptoms are often vague and non-specific. Most of the PPS tumours are salivary tumours (pleomorphic adenoma being the most frequent diagnosis), and are thought to originate from minor salivary glands or the deep lobe of the parotid gland. Warthin's tumour, another benign salivary tumour involving the PPS has been rarely reported. A case of bilateral, metachronous Warthin's tumour involving the PPS is reported here. PPS Warthin's tumour is a very rare condition that if undiagnosed may result in considerable morbidity.
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Bradley PJ, Zutshi B, Nutting CM. An audit of clinical resources available for the care of head and neck cancer patients in England. The Journal of Laryngology & Otology 2006; 119:620-6. [PMID: 16102217 DOI: 10.1258/0022215054516214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: To undertake a postal survey of cancer networks to define the services available for the diagnosis, treatment and support of patients with head and neck cancer in England.Findings: Thirty-four cancer networks are now responsible for the delivery of head and neck cancer services in England and 52 cancer units responded to our questionnaire. Multidisciplinary team working was evident in all centres. However such team working was not always fully staffed, especially in areas of national staff shortages such as pathology, radiology, dietetics and speech therapy. Rapid referral pathways were present for initial assessment of patients but clinically significant delays were identified in the provision of complex investigations, in access to intensive care beds and for oncological care – especially radiotherapy.Conclusions: Major changes in service configuration are likely to be required if the current national targets of time to diagnosis and treatment are to be met.
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Ferlito A, Bradley PJ, Rinaldo A. What is the treatment of choice for Tl squamous cell carcinoma of the larynx? The Journal of Laryngology & Otology 2006; 118:747-9. [PMID: 15550178 DOI: 10.1258/0022215042450760] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Rinaldo A, Bradley PJ, Ferlito A. Tularemia in otolaryngology: a forgotten but not gone disease and a possible sign of bio-terrorism. The Journal of Laryngology & Otology 2006; 118:257-9. [PMID: 15117460 DOI: 10.1258/002221504323011969] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Motamed M, Laccourreye O, Bradley PJ. Salvage Conservation Laryngeal Surgery after Irradiation Failure for Early Laryngeal Cancer. Laryngoscope 2006; 116:451-5. [PMID: 16540908 DOI: 10.1097/01.mlg.0000199591.92336.06] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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. STUDY DESIGN Review article. METHODS A computerized literature search of the Medline database from 1985 to 2005 was performed using the following search strategy: laryngeal neoplasm/AND salvage therapy/. Studies with a sample size less than 10 and an average follow-up of less than 24 months were excluded from analysis. The oncologic outcome, functional outcome, length of hospitalization, and the frequency of complications were recorded. RESULTS The average reported local control rate for recurrent early glottic cancer after radiotherapy salvaged by using the external or the endolaryngeal laser approach is 77% and 65%, respectively. The average reported overall local control rate, including cases that subsequently required total laryngectomy, is 90% and 83%, respectively. The endolaryngeal approach when compared with the extralaryngeal approach does have the advantage of reduced complications, lesser requirement for tracheostomy and nasogastric feeding, and shortened hospitalization time. CONCLUSIONS Conservation laryngeal surgery is a safe and effective treatment for recurrent localized disease after radiotherapy for early stage glottic cancer. Local control may be achieved without the sacrifice of laryngeal function, and total laryngectomy may be held in reserve as the ultimate option for salvage without compromising ultimate survival significantly.
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Genden EM, Rinaldo A, Bradley PJ, Lowry J, Suárez C, Shaha AR, Scully C, Ferlito A. Referral guidelines for suspected cancer of the head and neck. Auris Nasus Larynx 2006; 33:1-5. [PMID: 16298505 DOI: 10.1016/j.anl.2005.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2005] [Accepted: 09/16/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To identify the impact of referral guidelines for head and neck cancer on the economics and effectiveness of the delivery of care. METHODS A retrospective review of the literature was performed to examine the current referral guidelines and referral models that have impacted the delivery of care. RESULTS Advances in technology and changes in the diagnostic work up of head and neck cancer require that common symptoms and presentations of head and neck cancer are made available to primary care physicians to improve the expeditious referral of head and neck cancer patients. CONCLUSION Physician awareness and symptom guidelines may prove effective in expediting the care of patients with head and neck cancer.
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Bradley PJ. Head and neck cancer, England, UK—action is getting faster, have you not noticed? Br J Oral Maxillofac Surg 2005; 43:481-3. [PMID: 15993521 DOI: 10.1016/j.bjoms.2005.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Accepted: 06/04/2005] [Indexed: 11/25/2022]
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Mordekar SR, Bradley PJ, Whitehouse WP, Goddard AJP. Occult carotid pseudoaneurysm following streptococcal throat infection. J Paediatr Child Health 2005; 41:682-4. [PMID: 16398875 DOI: 10.1111/j.1440-1754.2005.00759.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Pseudoaneurysm of the internal carotid artery (PAICA) is a rare complication of neck space infection. An 8-year-old girl presented with odynophagia (painful swallowing), trismus and left peritonsillar swelling. Abscess was suspected, but aspiration was dry. The PAICA was diagnosed on computed tomography. The aneurysm and involved left internal carotid artery were occluded endovascularly. She has made an uneventful recovery.
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Bradley PJ, Zutshi B, Nutting CM. An Audit of Clinical Resources Available for the Care of Head and Neck Cancer Patients in England. Clin Oncol (R Coll Radiol) 2005; 17:604-9. [PMID: 16372485 DOI: 10.1016/j.clon.2005.07.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIMS Thirty-four cancer networks are now responsible for the delivery of head and neck cancer services in England. A survey of all cancer networks was carried out to define the services available for the diagnosis, treatment and support of patients with head and neck cancer. MATERIALS AND METHODS Fifty-two cancer units were identified in England from the Cancer Services Collaborative 'Improvement Partnership', and approached through a variety of methods. One questionnaire was circulated to all 34 network leads to establish the services and resources in each network. A second questionnaire was circulated to all known head and neck teams in the UK. RESULTS Multidisciplinary team (MDT) working was evident in all centres, although frequently the MDT was not fully staffed, especially in areas of national staff shortages, such as in pathology, radiology, dietetics and speech therapy. Rapid referral pathways were present for initial assessment of patients, but clinically significant delays were identified in complex investigations, access to intensive care beds and oncological care, especially radiotherapy. CONCLUSION Major changes in service configuration are likely to be required if the current national targets of time to diagnosis and treatment are to be met.
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Bradley PJ. 'Metastasizing pleomorphic salivary adenoma' should now be considered a low-grade malignancy with a lethal potential. Curr Opin Otolaryngol Head Neck Surg 2005; 13:123-6. [PMID: 15761289 DOI: 10.1097/01.moo.0000153450.87288.2a] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW To review the current knowledge on the clinical entity of metastasizing pleomorphic adenoma. RECENT FINDINGS Using case studies, the literature continues to explore the potential to identify a chromosomal abnormality that might explain the clinical entity, and may constitute a submicroscopic malignant transformation with molecular genetic alterations. Presently there are no agreed histopathological parameters that can identify or confirm a difference in behavior between the 'common' pleomorphic adenoma from the metastasizing pleomorphic adenoma. SUMMARY The evidence supports that metastasizing pleomorphic adenoma is most likely to be an unrecognized and as yet unclassified malignant neoplasm and as such must be considered a low-grade, potentially lethal malignant disease when it presents, which may constitute a submicroscopic malignant transformation with molecular genetic alterations. Further research is required to answer the many questions.
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Wei WI, Ferlito A, Rinaldo A, Gourin CG, Lowry J, Ho WK, Leemans CR, Shaha AR, Suárez C, Clayman GL, Robbins KT, Bradley PJ, Silver CE. Management of the N0 neck--reference or preference. Oral Oncol 2005; 42:115-22. [PMID: 15979931 DOI: 10.1016/j.oraloncology.2005.04.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Accepted: 04/11/2005] [Indexed: 10/25/2022]
Abstract
For patients with squamous cell carcinoma of the upper aerodigestive tract, appropriate management of the regional lymph nodes is an important and often controversial issue that has significant influence on survival. Over the years radical treatment either by surgery or radiotherapy contributed to improvement in prognosis. Recently, a more conservative approach has achieved a similar level of cancer control with less morbidity. This review considers the issues of selection of patients for treatment of the neck, choice of modality and extent of therapy, treatment of the contralateral neck, management of recurrence and influence of the site and status of the primary lesion.
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Vaghela HM, Bradley PJ. Nasal dermoid sinus cysts in adults. The Journal of Laryngology & Otology 2005; 118:955-62. [PMID: 15667683 DOI: 10.1258/0022215042790565] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Nasal dermoid sinus cysts (NDSC) are rare congenital lesions that most frequently present in children, but have been reported in adults. This article reviews adult (more than 16 years of age) nasal dermoid sinus cysts as they present, their radiological investigation, surgical approach and outcome. Thirty-eight previously published cases are reviewed, to which a further six cases are added. All 44 cases are tabulated and reviewed. The risk of intracranial extension is 27.5 per cent, especially men with a dermal sinus. Recurrences are likely if the NDSC is not completely excised. Curative treatment is surgical. It is recommended that all adults who present with a dermal cyst and/or sinus in the region of the nasal dorsum should be investigated by computed tomography (CT) and/or magnetic resonance (MRI). This is to delineate deep tissue involvement and to exclude a possible associated intracranial extension, prior to recommending surgical excision.
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Goddard AJP, Lenthall RK, Bradley PJ. Endovascular management of infected carotid artery pseudoaneurysm complicating pharyngolaryngectomy: complete occlusion followed by early recurrence and rebleeding. The Journal of Laryngology & Otology 2005; 118:991-5. [PMID: 15667692 DOI: 10.1258/0022215042790574] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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.
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Genden EM, Rinaldo A, Suárez C, Wei WI, Bradley PJ, Ferlito A. Complications of free flap transfers for head and neck reconstruction following cancer resection. Oral Oncol 2005; 40:979-84. [PMID: 15509488 DOI: 10.1016/j.oraloncology.2004.01.012] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2003] [Accepted: 01/07/2004] [Indexed: 11/29/2022]
Abstract
The reported success rate of microvascular free flap reconstruction ranges between 95% and 97%. However when complications occur, they must be identified early and managed efficiently because there is a narrow window of opportunity to salvage potential flap failure. While technical advances in instrumentation and magnification have improved overall success rates, the rare complication may prove devastating for the patient, his/her hospital stay, and the optimum rehabilitation. Complications of microvascular free tissue transfer may occur at the recipient site or at the donor site. Complications occurring at the recipient site are largely a result of vessel thrombosis while complications occurring at the donor site may result from many causes, ranging from infection to those related to the harvesting of the flap. Irrespective of the site of the complication, it is essential that complications be recognized and addressed early in their course to prevent or minimize devastating consequences.
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Rodrigo JP, Ferlito A, Suárez C, Shaha AR, Silver CE, Devaney KO, Bradley PJ, Bocker JM, McLaren KM, Grénman R, Rinaldo A. New molecular diagnostic methods in head and neck cancer. Head Neck 2005; 27:995-1003. [PMID: 16200629 DOI: 10.1002/hed.20257] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Initial cancer evaluation includes assessment of histologic appearance, tumor grading, assessment of lymph node status, and presence of metastasis. However, traditional diagnostic methods such as histopathology and radiology are not sensitive enough to detect small numbers of cancer cells and are limited in their ability to predict response to treatment. Recently, there has been considerable progress in molecular diagnostics in these areas. Using molecular-based technologies, it is now possible to detect cancer early in asymptomatic individuals, identify minimal residual disease at histopathologic normal surgical margins, more precisely assess tumor burden in cancer patients, and more accurately assess the prognosis of the patients. Examples of these applications in the evaluation of head and neck cancer are reviewed here. However, despite the great promise of these new molecular approaches for cancer detection, much of the current technology limits their implementation into routine clinical use.
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Robbins KT, Ferlito A, Suárez C, Brizel DM, Bradley PJ, Pellitteri PK, Clayman GL, Kowalski LP, Genden EM, Rinaldo A. Is there a role for selective neck dissection after chemoradiation for head and neck cancer? J Am Coll Surg 2004; 199:913-6. [PMID: 15555975 DOI: 10.1016/j.jamcollsurg.2004.08.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Pellitteri PK, Rinaldo A, Myssiorek D, Gary Jackson C, Bradley PJ, Devaney KO, Shaha AR, Netterville JL, Manni JJ, Ferlito A. Paragangliomas of the head and neck. Oral Oncol 2004; 40:563-75. [PMID: 15063383 DOI: 10.1016/j.oraloncology.2003.09.004] [Citation(s) in RCA: 199] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2003] [Accepted: 09/10/2003] [Indexed: 10/26/2022]
Abstract
Paragangliomas are neuroendocrine tumors derived from the extra-adrenal paraganglia of the autonomic nervous system. Within the head and neck, they are generally defined and named according to their site of origin, and may be found frequently neighboring vascular structures. Physiologic activity is rare in these neoplasms and they may exhibit patterns of inheritance which predispose their occurrence in families, often with multicentricity. These tumors generally exhibit a slow rate of growth, most often presenting asymptomatically as a space occupying mass lesion noted clinically or radiographically. The most common paraganglioma of the head and neck is the carotid body tumor followed by the jugulo-tympanic and vagal varieties. Other rare sites where this tumor may occur include; the larynx, sinonasal chambers and orbit. Diagnosis is generally made through a combination of clinical findings and radiographic studies. Magnetic resonance represents the most important imaging modality for the evaluation and characterization of suspected head and neck paraganglioma. Definitive management for these lesions should be carefully considered in relation to both tumor and patient-oriented factors, especially in regard to the potential morbidity of treatment. Surgery and radiation therapy represent the main treatment modalities for paraganglioma. The selection of treatment depends on the size, location, and biologic activity of the tumor as well as the overall fitness of the patient. Although radiotherapy may be effective in arresting growth of these tumors, rarely is the neoplasm eliminated without surgical resection. Surgery may be associated with significant morbidity, primarily as a consequence of incurring major cranial nerve injury. Patient selection (relative to age and medical condition) should be carefully considered prior to recommending aggressive surgery for paragangliomas of head and neck, especially in those patients at risk for disabling surgical morbidity.
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Abstract
PURPOSE OF REVIEW This purpose of this article is to review and provide an update of current publications on the evaluation and management of adenoid cystic carcinoma. RECENT FINDINGS Adenoid cystic carcinoma is an uncommon salivary gland malignancy that presents insidiously and is generally advanced when diagnosed. Current effective treatment modalities include surgery and irradiation, but locoregional recurrences are frequent and may present as early as 2 years. Patients survive with recurrent and metastatic disease for several years despite not being offered any treatment. Molecular analysis of the tumors is being undertaken, with optimistic results capable of selecting high-risk patients who may benefit from adjuvant treatment such as chemotherapy SUMMARY Little progress has been made in advancing "curative" treatment of adenoid cystic carcinoma of the head and neck. The disease is said to have a fatal outcome. The time is now opportune for a multicenter, randomized, controlled trial to identify patients who would benefit from adjuvant radiotherapy and/or chemotherapy in the control of locoregional recurrences and the prevention of distant metastases.
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Paleri V, Orvidas LJ, Wight RG, Bradley PJ. Verrucous carcinoma of the paranasal sinuses: case report and clinical update. Head Neck 2004; 26:184-9. [PMID: 14762888 DOI: 10.1002/hed.10230] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS Verrucous carcinoma of the paranasal sinuses is a rare but potentially curable disease. Treatment is surgical, and prognosis is good with early intervention.
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Devaney KO, Rinaldo A, Zeitels SM, Bradley PJ, Ferlito A. Laryngeal Dysplasia and Other Epithelial Changes on Endoscopic Biopsy: What Does It All Mean to the Individual Patient? ORL J Otorhinolaryngol Relat Spec 2004; 66:1-4. [PMID: 15103193 DOI: 10.1159/000077225] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2003] [Accepted: 01/09/2004] [Indexed: 11/19/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to document the information reported on cancers presenting in the head and neck area during pregnancy. RECENT FINDINGS Accidents and cancer account for most deaths during the reproductive years. Cancer complicates approximately 0.1% of all pregnancies and, in order of frequency, the incidence of cancers by site are breast, melanoma, thyroid, cervix, lymphoma, and ovary. Some of these cancers may present in the head and neck region, as well as more uncommon cancers such as mucosal squamous cell carcinoma. SUMMARY It is recognized that with the dramatic rise in births among "reproductively" older women and with the changing epidemiology of squamous cell carcinoma of the head and neck in nonsmoking and nonalcohol-drinking women, there is to be expected an increased incidence and presentation. Management of such patients must consider the gestational age of the pregnancy and must include alternatives to current treatments to accommodate the individual's wishes regarding her pregnancy.
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Bradley PJ, Ferlito A, Devaney KO, Rinaldo A. Crohn's disease manifesting in the head and neck. Acta Otolaryngol 2004; 124:237-41. [PMID: 15141749 DOI: 10.1080/00016480310015326] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Crohn's disease may present to the head and neck surgeon with symptoms and signs attributed to the disease. Many clinical presentations, both specific and non-specific, have been recorded in the oral cavity, nose and larynx. Some of these clinical manifestations have been found to be consistent with Crohn's disease, but most have been attributed to Crohn's disease without histologic confirmation of the presence of non-caseating granulomas, which is pathognomonic of Crohn's disease. Lesions, when present without an associated diagnosis of Crohn's disease, should be ascribed the diagnosis of orofacial granulomatosis, until a diagnosis of intestinal Crohn's disease has been confirmed.
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