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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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Bradley PJ. Pleomorphic salivary adenoma of the parotid gland: which operation to perform? Curr Opin Otolaryngol Head Neck Surg 2004; 12:69-70. [PMID: 15167039 DOI: 10.1097/00020840-200404000-00002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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103
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Genden EM, Rinaldo A, Shaha AR, Bradley PJ, Rhys-Evans PH, Ferlito A. Pharyngocutaneous fistula following laryngectomy. Acta Otolaryngol 2004; 124:117-20. [PMID: 15072411 DOI: 10.1080/00016480310015191] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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104
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Rinaldo A, Shaha AR, Pellitteri PK, Bradley PJ, Ferlito A. Management of malignant sublingual salivary gland tumors. Oral Oncol 2004; 40:2-5. [PMID: 14662408 DOI: 10.1016/s1368-8375(03)00104-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The majority of tumors of the sublingual gland are malignant, with adenoid cystic carcinoma and mucoepidermoid carcinoma being the most frequent. Many other malignant tumor types have also been reported. The sublingual gland anatomically is not a unit organ and while it is described anatomically as being confined to the anterior floor of the mouth, salivary tissue may be located laterally along the submandibular duct and posterior floor of the mouth. Diagnosis should be suspected when any thickening or raised lesion presents in this area and a biopsy performed to confirm malignancy before planning further treatment. Surgery is the treatment of choice, and should include an en-block resection of the anterior floor of mouth as a minimum, and may include a portion of mandible, as well as a supraomohyoid neck dissection. Adjuvant radiotherapy should be considered in most of the patients after surgical excision.
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Bradley PJ, Jones NS, Robertson I. Diagnosis and management of esthesioneuroblastoma. Curr Opin Otolaryngol Head Neck Surg 2003; 11:112-8. [PMID: 14515089 DOI: 10.1097/00020840-200304000-00009] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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%.
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Rinaldo A, Ferlito A, Pellitteri PK, Robbins KT, Shaha AR, Bradley PJ, Kowalski LP, Wei WI. Management of malignant submandibular gland tumors. Acta Otolaryngol 2003; 123:896-904. [PMID: 14606589 DOI: 10.1080/00016480310016406] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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108
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Marshall AH, Quraishi SM, Bradley PJ. Patients' perspectives on the short- and long-term outcomes following surgery for benign parotid neoplasms. J Laryngol Otol 2003; 117:624-9. [PMID: 12956917 DOI: 10.1258/002221503768199960] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
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 during 1988-1997, 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 they had 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.
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Abstract
Chronic parotitis is an insidious inflammatory disorder, which is characterized by a recurrent, often painful, swelling of the gland or glands. Sialography remains the investigation of choice. Diagnostic siladenoscopy may complement or supersede sialography as the diagnostic procedure of choice, as more experience is gained in this technique and its use becomes more widespread. The management options are conservative or surgical, but controversy exists regarding the timing and method of surgical intervention. The surgical methods that have been described include injection of methyl violet - a sclerosing agent, ductal ligation, ductoplasty, tympanic neurectomy, and parotidectomy. Parotidectomy is considered the ultimate surgical option but because of its significant morbidity the exact technique and procedure that should be used remains contentious.
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Abstract
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.
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Bradley PJ, Ferlito A, Lowe J, Devaney KO, Wei WI, Rinaldo A. A head and neck cancer patient dies! Why perform an autopsy: for the relatives, for the clinicians or for the pathologists? Acta Otolaryngol 2003; 123:348-54. [PMID: 12737289 DOI: 10.1080/0036554021000001349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
It is no secret that autopsy rates at most hospitals worldwide--both teaching and community hospitals--have declined precipitously in recent decades, but is this a desirable state of affairs? This article explores this issue from three viewpoints: that of the family members who grant permission for autopsies; that of the clinicians who seek permission for the autopsy to be carried out; and that of the pathologists who actually perform the post-mortem examination. Family concerns about (the sometimes tangential) matter of organ retention following autopsy have recently been highlighted in Europe, with an accompanying negative overall impression of the autopsy being conveyed by many outlets of the popular media. Clinicians will often concede that they feel somewhat distanced from the whole process of autopsy, and so do not hold it in such high esteem as their predecessors once did decades ago. Pathologists at present often perform autopsies as "additional duties" to be fitted in around their central functions, and so do not see them as a primary task to be accomplished. However, there are reasons why this may be detrimental to patient care, including in particular the fact that clinical/radiographic diagnoses are sometimes not confirmed by the results of a complete autopsy. Suggestions for improving the autopsy rate--in particular amongst head and neck cancer patients--are discussed, and include performance of a more rapid limited autopsy and the designation of specialist pathologists in head and neck cancer to carry out autopsies of these patients as an extension of their clinical duties. One conclusion seems inescapable: to increase autopsy rates, the status of the procedure will necessarily have to be upgraded from that of "afterthought/perfunctory task" to that of "consultation", with all of the shifts in attitude such a modification would entail.
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Abstract
While the implementation of multi-modality neoadjuvant therapy for the treatment of head and neck cancer has resulted in an improvement in local regional control, there has been a resultant increase in the reported incidence of distant metastasis. This shift in the pattern of patient treatment failure highlights the importance of identifying patients at high risk of developing metastasis, accurately detecting metastasis, and improving treatment strategies for advanced disease. Currently, metastatic lesions from head and neck primaries portend a poor prognosis; however, molecular biologic techniques offer a promising approach to the diagnosis and treatment of micrometastasis and distant metastatic lesions. The identification of tumor-specific gene mutations and the cell surface antigens may play a key role in the future management of head and neck cancer. The following review outlines just several of the current issues related to the contemporary diagnosis and management of metastatic lesions of the head and neck.
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Abstract
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.
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Harrison LB, Ferlito A, Shaha AR, Bradley PJ, Genden EM, Rinaldo A. Current philosophy on the management of cancer of the base of the tongue. Oral Oncol 2003; 39:101-5. [PMID: 12509962 DOI: 10.1016/s1368-8375(02)00048-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cancer of the base of the tongue is a challenging disease for the head and neck surgeon, radiation oncologist and medical oncologist. However, over the last 10-15 years, improved treatment strategies have evolved which offer patients high probability of loco-regional control, survival, and good quality of life. The ability to offer patients good oncologic and functional outcomes serves as a paradigm for the successful application of multidisciplinary care, and the emphasis on quality of life in head and neck cancer treatment. This review provides an overview of the treatment options that exist, their advantages and disadvantages, and hopefully provides proper guidelines for the current management of this challenging disease.
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Ferlito A, Rogers SN, Shaha AR, Bradley PJ, Rinaldo A. Quality of life in head and neck cancer. Acta Otolaryngol 2003; 123:5-7. [PMID: 12625565 DOI: 10.1080/0036554021000028072] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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116
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Pellitteri PK, Ferlito A, Bradley PJ, Shaha AR, Rinaldo A. Management of sarcomas of the head and neck in adults. Oral Oncol 2003; 39:2-12. [PMID: 12457715 DOI: 10.1016/s1368-8375(02)00032-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Sarcomas account for less than 1% of all malignant neoplasms occurring in the head and neck in adults. These tumors exhibit variable growth and degrees of aggressiveness which are primarily dependent on histologic grade. The pattern of growth demonstrated by sarcomas is generally by local advancement with high-grade tumor exhibiting extensive involvement of adjacent visceral and neurovascular structures. Regional metastasis is uncommon. Etiologic considerations include the tumorigenic effects of prior external beam radiotherapy and the development of second malignancies in the form of sarcomas. The clinical presentation of these neoplasms is variable and dependent on subsite of involvement as well as the aggressiveness of tumor growth. Histologic diagnosis is frequently challenging, often requiring the aid of immunohistochemical staining techniques. Treatment is predominantly surgical, utilizing wide local excision where en-bloc resection is feasible. Radiotherapy, by means of external beam or implant, plays an important adjunctive role in management, especially for tumors where en-bloc resection with margin control is not possible. Chemotherapy regimens are available for soft tissue neoplasms and osteosarcoma and are primarily designed to improve local control. Survival is predicted on the incidence of local recurrence and risk of distant metastasis, both of which are influenced by tumor grade. Low-grade tumors exhibit improved survival over that of less differentiated tumors.
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Brandwein MS, Ferlito A, Bradley PJ, Hille JJ, Rinaldo A. Diagnosis and classification of salivary neoplasms: pathologic challenges and relevance to clinical outcomes. Acta Otolaryngol 2002; 122:758-64. [PMID: 12484654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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118
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Ferlito A, Kowalski LP, Byers RM, Pellitteri PK, Bradley PJ, Rinaldo A, Silver CE, Wei WI, Shaha AR, Medina JE. Is the standard radical neck dissection no longer standard? Acta Otolaryngol 2002; 122:792-5. [PMID: 12484659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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119
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León X, Ferlito A, Myer CM, Saffiotti U, Shaha AR, Bradley PJ, Brandwein MS, Anniko M, Elluru RG, Rinaldo A. Second primary tumors in head and neck cancer patients. Acta Otolaryngol 2002; 122:765-78. [PMID: 12484655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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120
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León X, Ferlito A, III CMM, Saffiotti U, Shaha AR, Bradley PJ, Brandwein MS, Anniko M, Elluru RG, Rinaldo A. Second Primary Tumors in Head and Neck Cancer Patients. Acta Otolaryngol 2002. [DOI: 10.1080/003655402/000028048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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121
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Rucci L, Ferlito A, Bradley PJ, Romagnoli P, Rinaldo A, Anniko M. Can embryology influence clinicians concerning the "best therapy" for glottic cancer? Acta Otolaryngol 2002; 122:796-8. [PMID: 12484660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
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122
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Bradley PJ, Ferlito A, Brandwein MS, Benninger MS, Rinaldo A. Anthrax: what should the otolaryngologist know? Acta Otolaryngol 2002; 122:580-5. [PMID: 12403119 DOI: 10.1080/000164802320396240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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123
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Ferlito A, Pellitteri PK, Robbins KT, Shaha AR, Kowalski LP, Silver CE, Anniko M, Rinaldo A, Medina JE, Bradley PJ, Byers RM. Management of the neck in cancer of the major salivary glands, thyroid and parathyroid glands. Acta Otolaryngol 2002; 122:673-8. [PMID: 12403133 DOI: 10.1080/000164802320396385] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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124
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Abstract
Acute and chronic inflammatory diseases of the major and minor salivary glands constitute the most common clinical syndrome of salivary glands. During the past decade, the use of antibiotics along with fluid hydration and electrolyte management has almost eliminated the development of fulminating acute suppurative parotitis in hospital surgical patients. Although acute bacterial and viral sialadenitis persists, the clinical challenge has changed, with more focus on the chronic inflammatory group of diseases. The pathogenesis of the chronic salivary inflammatory disease spectrum has also changed, with the interplay between sialadenitis, sialectasia, and sialolithiasis. There also exists a heterogeneous group of disorders in chronic inflammatory sialadenitis, which include the group of specific and nonspecific granulomatous diseases.
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Jennings CR, Bradley PJ. Are autopsies useful? Do premorbid findings predict postmortem results in head and neck cancer patients? Ann R Coll Surg Engl 2002; 84:133-6. [PMID: 11995757 PMCID: PMC2503803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
A total of 53 autopsies were analysed in patients with head and neck squamous carcinoma. The discordance rate, that is the proportion of autopsies that revealed new information, was 53%. One-third of patients did not die of cancer. Clinical findings either misdiagnosed or under-diagnosed loco regional disease in 34% of cases, and distant malignant disease in 36% of cases. It appears that the autopsy reveals new and useful information in the head and neck cancer patient, and consent should be sought.
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