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Telischi J, Nisenbaum E, Nicolli E. Carotid endarterectomy for the management of carotid stenosis occurring concurrently with head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2023; 31:452-456. [PMID: 37916904 DOI: 10.1097/moo.0000000000000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW Currently, most patients with concurrent head and neck cancer (HNC) and carotid stenosis (CS) are treated disjointedly for their oncologic and vascular lesions. The purpose of this review is to evaluate literature exploring a novel approach to these cases that poses several advantages, in which carotid endarterectomy (CEA) is performed simultaneously with surgical resection of HNC. RECENT FINDINGS Carotid stenosis is a common comorbidity of patients presenting with head and neck cancer as these pathologies have overlapping risk factors. Adjuvant oncologic therapy such as radiation therapy to the site of the lesion is known to increase development or progression of carotid stenosis. Performing simultaneous surgical management of CS and HNC decreases total procedures for the patient, provides a less challenging surgical field, and eliminates prioritization of treatment initiation for one pathology over the other. There has been limited reporting of simultaneous CEA with oncologic resection of HNC in the literature. However, of the 21 cases reviewed here, no perioperative strokes were reported with only one perioperative death from myocardial infarction. SUMMARY Available literature supports that simultaneous CEA with oncologic resection of HNC is safe and may offer several advantages, although larger studies are required.
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Affiliation(s)
- Julia Telischi
- Department of Otolaryngology, University of Miami Miller School of Medicine
| | - Eric Nisenbaum
- Department of Otolaryngology, University of Miami Miller School of Medicine
- Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Elizabeth Nicolli
- Department of Otolaryngology, University of Miami Miller School of Medicine
- Sylvester Comprehensive Cancer Center, Miami, Florida, USA
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Depboylu B, Eryilmaz A, Basak HS, Kirbac V, Basal Y, Omurlu IK, Gok M. Comparison of Arterial Stiffness and Strain Measured with Speckle Tracking Carotid Strain Ultrasonography after Radiation and Surgical Treatment for Head and Neck Cancer-A Clinical Trial. Diagnostics (Basel) 2023; 13:3090. [PMID: 37835836 PMCID: PMC10572110 DOI: 10.3390/diagnostics13193090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
This study assessed arterial stiffness in head and neck cancer patients using speckle tracking carotid strain ultrasonography (STCS-US). It investigated the impacts of neck irradiation and neck dissection on the arterial stiffness of these patients by comparing their stiffness parameters with those of healthy controls. A total of 101 participants (67 patients and 34 healthy controls) were enrolled in this study. Fifty-two patients received definitive radiation therapy (TD: 60-72 Gy in 30 days) at least two years ago. Participants were grouped into four according to their states of neck irradiation (IR) and neck dissection (ND): Group (IR+/ND-) had 28 patients, Group (IR+/ND+) had 24 patients, Group (IR-/ND+) had 15 patients, and Group (IR-/ND-) had 34 healthy controls. All the participants underwent STCS-US. Arterial stiffness parameters relating to arterial compliance (AC) and elastic modulus (EM) were significantly changed in Group (IR+/ND-) and Group (IR+/ND+) in the transverse plane (p < 0.001, p < 0.001) and in the longitudinal plane (p < 0.001, p < 0.001); the change in β-stiffness index (β-SI) was more significant in the transverse plane (p = 0.002). Group (IR+/ND+) had significant transverse circumferential (p = 0.001) and radial strain parameters (p = 0.001). The carotid intimal medial thickness (CIMT) significantly changed in Group (IR+/ND+) compared to controls (p = 0.001). Our findings indicate that neck irradiation and neck dissection increase arterial stiffness as single treatments; however, double treatment is associated with a higher increase. Neck irradiation affects strain parameters more than neck dissection alone. The study demonstrated the feasibility and clinical value of the STCS method in assessing arterial stiffness and its potential use in cardiovascular risk assessment for patients with head and neck cancer.
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Affiliation(s)
- Bengu Depboylu
- Department of Radiation Oncology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye;
| | - Aylin Eryilmaz
- Department of Otolaryngology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye; (A.E.); (H.S.B.); (V.K.); (Y.B.)
| | - Hatice Sema Basak
- Department of Otolaryngology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye; (A.E.); (H.S.B.); (V.K.); (Y.B.)
| | - Veli Kirbac
- Department of Otolaryngology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye; (A.E.); (H.S.B.); (V.K.); (Y.B.)
| | - Yesim Basal
- Department of Otolaryngology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye; (A.E.); (H.S.B.); (V.K.); (Y.B.)
| | - Imran Kurt Omurlu
- Department of Biostatistics, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye;
| | - Mustafa Gok
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye
- Department of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
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Incidence of Internal Carotid Artery Stenosis in Oral Squamous Cell Carcinoma Patients After Neck Dissection. J Craniofac Surg 2023; 34:e199-e202. [PMID: 36138543 DOI: 10.1097/scs.0000000000009042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/04/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To determine the incidence of progressive internal carotid artery stenosis (ICAS) by head and neck contrast-enhanced computed tomography (CT) in 45 patients who underwent neck dissection for oral squamous cell carcinoma (OSCC). PATIENTS AND METHODS The study included 45 patients who underwent head and neck contrast-enhanced CT before and after surgery for OSCC by the Hu Yongjie team at the Department of Oral and Maxillofacial-Head & Neck Oncology of Shanghai Ninth People's Hospital in 2016 and were followed up for 5 years. RESULTS Comparison of the current CT with previously obtained head and neck contrast-enhanced CT images revealed progressive ICAS in 3 patients with a mean age of 50.0 years. All 3 patients were male, and their OSCC sites were the tongue in 2 patients and the buccal in 1 patient. Tumor resection and neck dissection were performed for all 3 patients. Two patients underwent radiotherapy. In all 3 patients, the ICAS had occurred on the same side as the tumors. CONCLUSIONS The results of this study suggest that neck dissection with cervical sheath removal might increase the incidence of ICAS, but this result may need the support of a larger sample size study.
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Kuo CY, Chen YT, Sun CK, Hung KC. Ischemic stroke following neck dissection in the elderly. Tzu Chi Med J 2019; 31:177-181. [PMID: 31258294 PMCID: PMC6559032 DOI: 10.4103/tcmj.tcmj_112_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective: Despite the known association of perioperative stroke with perioperative mortality, the prevalence of stroke following neck dissection in elderly patients remains unclear. This study compared the incidence of neck dissection-associated perioperative stroke in elderly and younger patients. Materials and Methods: Totally, 1057 patients receiving neck dissection for head and neck cancers between June 2012 and July 2016 were reviewed at a single center. The patients were divided into elderly (age ≥65 years, n = 177) and younger (age <65 years, n = 880) groups (mean age: 72.3 ± 6.1 and 53.3 ± 7.6, respectively). Patient, anthropometric, and clinical characteristics including diagnoses, comorbidities, length of hospitalization, and incidence of perioperative stroke were compared. Results: Younger patients were more likely to be male (P = 0.001) and to have received radiotherapy (P = 0.013). The prevalence of predisposing factors was higher in the elderly, including history of cerebral vascular accident (P = 0.002), hypertension (P < 0.001), diabetes (P < 0.001), and coronary artery disease (P < 0.001). Elderly patients also had longer hospitalizations (P < 0.001) for which previous radiotherapy was identified as a risk factor (adjusted odds ratio = 3.79, P = 0.0078). Postoperative ischemic stroke was diagnosed in two elderly patients (1.1%), whereas no ischemic strokes occurred in the younger group (P = 0.028). The overall incidence of perioperative stroke was 0.19%. Conclusion: The incidence of perioperative stroke was higher in the elderly than in the younger group. Furthermore, the prevalence of ischemic stroke in elderly patients associated with neck dissection was higher than that previously reported in the aged population after general head and neck operations, highlighting an increased risk of stroke in elderly patients receiving extensive neck surgery.
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Affiliation(s)
- Chuan-Yi Kuo
- Department of Anesthesiology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Yi-Ting Chen
- Department of Anesthesiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
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Cramer JD, Patel UA, Maas MB, Samant S, Smith SS. Is Neck Dissection Associated with an Increased Risk of Postoperative Stroke? Otolaryngol Head Neck Surg 2017; 157:226-232. [PMID: 28417663 DOI: 10.1177/0194599817698414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Prior studies have reported widely disparate rates of postoperative stroke, with conflicting analyses of whether neck dissection is an independent risk factor. Study Design Cohort study. Setting American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2013. Subjects and Methods We compared the 30-day rate of postoperative stroke between patients undergoing complete or modified radical neck dissection and a control cohort composed of those undergoing resections in the oral cavity, oropharynx, larynx, or hypopharynx without neck dissection. Propensity scores and paired statistics were used to compare the groups while adjusting for relevant covariates. Results We identified 9697 patients, including 5827 with neck dissection and 3870 without neck dissection. In the full cohort, the rate of postoperative stroke was greater with neck dissection than without it (0.31% vs 0.11%, P = .052), although the relationship was attenuated by propensity score matching to adjust for comorbidities (0.30% vs 0.13%, P = .18). Among patients with ≥2 risk factors for carotid artery stenosis, neck dissection was associated with an increased rate of postoperative stroke (2.68% with bilateral neck dissection, 0.41% with unilateral neck dissection, and 0.24% without neck dissection, P = .04). The incidence of stroke was strongly associated with 30-day mortality (7.4% vs 0.2%, P < .001). Conclusions Stroke is a rare but highly morbid complication after head and neck surgery. Compared with other head and neck surgery, neck dissection in patients at risk for carotid artery stenosis is associated with an increased risk of postoperative stroke.
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Affiliation(s)
- John D Cramer
- 1 Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Urjeet A Patel
- 1 Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,2 Division of Otolaryngology-Head and Neck Surgery, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Matthew B Maas
- 3 Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sandeep Samant
- 1 Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Stephanie Shintani Smith
- 1 Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,4 Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Sukegawa S, Kanno T, Kanai K, Mandai T, Shibata A, Takahashi Y, Hirata Y, Furuki Y. Perioperative stroke in a patient undergoing surgery for oral cancer: A case report. Oncol Lett 2016; 12:2660-2663. [PMID: 27698839 DOI: 10.3892/ol.2016.5031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/19/2016] [Indexed: 11/05/2022] Open
Abstract
Carotid artery stenosis is a significant risk factor for stroke. In elderly patients with carotid atherosclerosis and stenosis, it is not unusual for oral, head and neck cancer surgery to be performed. The present study describes a case of stroke that occurred during a neck dissection for the treatment of cervical lymph node metastasis of a left maxillary gingival carcinoma. The patient was an 84-year-old female who was considered to be at high risk of a stroke based on pre-operative head and neck computed tomography scans, which detected severe carotid atherosclerosis and stenosis. There was no possible stroke prophylaxis available during the performance of the neck dissection in the present case. However, if patients are evaluated to be high-risk pre-operatively, statin agents should be administered, the surgery should be carefully performed, adequate sedation should be maintained post-operatively and the patient should be followed up, aiming to achieve the early detection of a possible stroke.
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Affiliation(s)
- Shintaro Sukegawa
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Takahiro Kanno
- Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Izumo, Shimane 693-8501, Japan
| | - Kengo Kanai
- Department of Otorhinolaryngology, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan
| | - Toshiko Mandai
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Akane Shibata
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Yuka Takahashi
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Yuji Hirata
- Department of Otorhinolaryngology, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan
| | - Yoshihiko Furuki
- Department of Otorhinolaryngology, Kagawa Prefectural Central Hospital, Kagawa 760-8557, Japan
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Shuman AG, Patel SG, Shah JP, Korc-Grodzicki B. Optimizing perioperative management of geriatric patients with head and neck cancer. Head Neck 2013; 36:743-9. [PMID: 23596001 DOI: 10.1002/hed.23347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 02/01/2013] [Accepted: 04/05/2013] [Indexed: 12/27/2022] Open
Abstract
Given emerging demographic trends, many more elderly patients are being diagnosed with head and neck cancers. The surgical care paradigm for this cohort of patients must take into account specific challenges inherent to geriatric perioperative management. This article attempts to summarize the existing body of literature relevant to the geriatric head and neck cancer population, and to extrapolate relevant data from geriatric perioperative medicine in order to better understand and guide management decisions. The involvement of geriatricians and of patients' primary care providers may be invaluable in assisting in complex perioperative decision-making and in participating in longitudinal management. Preoperative risk stratification and assessment of medical, social, and functional variables are critical for appropriate decision-making in this challenging patient population.
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Affiliation(s)
- Andrew G Shuman
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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Ikawa H, Sato K, Tonogi M, Yamane GY, Kimura M, Tatsuno S, Aoyagi Y, Katakura A. Head and neck contrast-enhanced CT for identification of internal carotid artery stenosis progression on the affected side after treatment for oral squamous cell carcinoma. Oral Radiol 2013; 29:1-5. [PMID: 23293426 PMCID: PMC3532718 DOI: 10.1007/s11282-012-0099-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 06/28/2012] [Indexed: 12/03/2022]
Abstract
Objectives To determine the incidence of progressive internal carotid artery (ICA) stenosis by head and neck contrast-enhanced computed tomography (CT) in 82 patients who underwent surgery, chemotherapy, or combination therapy for oral squamous cell carcinoma (OSCC). Methods The study included 82 patients who underwent head and neck contrast-enhanced CT after surgery alone or combined surgery and chemotherapy for OSCC at the Department of Oral and Maxillofacial Surgery of Ichikawa General Hospital, Tokyo Dental College, or Tokyo Dental College Oral Cancer Center between December 2002 and March 2010. Results Comparison with previously obtained head and neck contrast-enhanced CT images revealed progressive arterial stenosis of the ICA in five patients with a mean age of 62.0 years. All five patients were male, and their OSCC sites were the tongue in two, the floor of the mouth in two, and the mandibular gingiva in one. Tumor resection and neck dissection were performed for four patients and tumor resection alone for one patient. Four patients underwent chemotherapy. ICA stenosis occurred on the same side as the tumor in all five patients. Conclusions The results of this study suggest that, given the possibility of post-treatment vascular events, attention must be paid to subsequent changes in the ICA over time. The results also indicate the usefulness of head and neck contrast-enhanced CT in identifying such problems.
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Affiliation(s)
- Hiroaki Ikawa
- Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
| | - Kazumichi Sato
- Oral Cancer Center, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
| | - Morio Tonogi
- Department of Oral and Maxillofacial Surgery, Nihon University School of Dentistry, 1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8310 Japan
| | - Gen-yuki Yamane
- Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
| | - Masako Kimura
- Department of Radiology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
| | - Satoshi Tatsuno
- Department of Radiology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
| | - Yutaka Aoyagi
- Department of Radiology, Tokyo Dental College, Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
| | - Akira Katakura
- Department of Oral Medicine, Oral and Maxillofacial Surgery, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
- Oral Cancer Center, Tokyo Dental College, 5-11-13 Sugano, Ichikawa, Chiba 272-8513 Japan
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Panoramic Radiographs of Head and Neck Cancer Patients Are Often Evidence of Carotid Artery Atherosclerotic Lesions: A Sign of High-Risk Comorbid Illness. J Oral Maxillofac Surg 2012; 70:1096-101. [DOI: 10.1016/j.joms.2011.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 05/18/2011] [Accepted: 05/19/2011] [Indexed: 01/22/2023]
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Postoperative neurocognitive function and microembolus detection in patients undergoing neck dissection: a pilot study. Eur J Anaesthesiol 2010; 27:417-24. [PMID: 20394111 DOI: 10.1097/eja.0b013e328336c633] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients undergoing oncologic neck dissection may have many of the risk factors for carotid artery stenosis, thus predisposing them to perioperative cerebral ischaemic events. The present study was designed to investigate development of postoperative neurocognitive dysfunction in these patients. METHODS Twenty-six patients were assessed the day before surgery and 48 h and 12 months after surgery using a comprehensive neuropsychological test battery. Cognitive performance was compared with a matched control group to account for the practise effect associated with repeated testing. Doppler ultrasonography was used to detect intraoperative cerebral microembolism. S100beta protein values were evaluated before and immediately after anaesthesia. RESULTS On the second postoperative day, 26.9% of patients undergoing neck dissection had postoperative neurocognitive deficit (POCD), defined as a total deficit score of 2SD worse than the mean performance in the control group. Microemboli were found only in the neck dissection group. S100beta levels were significantly higher after neck dissection (Wilcoxon signed ranked test: P<0.001). After 12 months, the incidence of POCD was similar in both groups. CONCLUSION POCD was detectable only after neck dissection in the early postoperative period accompanied by increased incidence of microembolism and protein S100beta levels, but not 12 months after surgery.
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Brennan PA, Oeppen RS, Bater MC, Khosla N, Davies B, Puxeddu R, Atchley J. CT and duplex scanning: A comparison of imaging techniques for evaluation of the carotid tree in head and neck cancer patients. Oral Oncol 2008; 44:1009-13. [DOI: 10.1016/j.oraloncology.2008.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 02/13/2008] [Accepted: 02/13/2008] [Indexed: 11/26/2022]
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