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Watson AL, Hurrell M, Howes D, Leinkram D, Low THH, Dunn M, Clark JR. Surgical and health related quality of life outcomes following treatment with zygomatic implant perforated (ZIP) flaps. ANZ J Surg 2024; 94:846-853. [PMID: 38149753 DOI: 10.1111/ans.18832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/09/2023] [Accepted: 12/11/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND The zygomatic implant perforated (ZIP) flap is a novel approach to the challenge of reconstructing the maxilla. We report on our experience using the ZIP flap technique for patients undergoing infrastructure maxillectomy at Chris O'Brien Lifehouse, Sydney, Australia. METHODS Thirteen patients who underwent a ZIP flap reconstruction between August 2019 and August 2021 were identified. Demographic, surgical, and histopathological information was collected. Health Related Quality of Life (HRQOL) was assessed using the FACE-Q Head and Neck Cancer module, the M.D. Anderson Dysphagia Inventory, and the Speech Handicap Index. RESULTS A total of 44 zygomatic implants were placed, of which 42 (95%) survived. The median time from surgery to dental rehabilitation was 35 days. HRQOL data was available for nine patients over 24 months, demonstrating improved speech and swallowing outcomes over the follow up period. CONCLUSIONS The ZIP flap is a reproducible surgical technique that facilitates rapid dental rehabilitation post infrastructure maxillectomy.
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Affiliation(s)
- Antonia L Watson
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Michael Hurrell
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Maxillofacial Surgery Unit, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Southport, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Dale Howes
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - David Leinkram
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Masako Dunn
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
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Noor A, Mair MD, Gupta R, Elliott MS, Wykes J, Palme CE, Clark JR, Low THH. When should patients with T1N0 oral squamous cell carcinoma be considered for elective neck dissection? ANZ J Surg 2024; 94:854-860. [PMID: 38291013 DOI: 10.1111/ans.18884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 01/03/2024] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
AIMS To identify adverse pathological features (APF) predicting nodal failure in clinically node negative T1 oral squamous cell carcinoma (OSCC). METHODOLOGY This study evaluated patients with T1N0 (≤5 mm depth of invasion (DOI) and ≤2 cm diameter) oral cancers from a prospectively maintained database between 1988 and 2020. All patients underwent surgical excision of the primary lesion without neck dissection. Patients underwent three monthly clinical surveillance and salvage neck dissection was performed if nodal relapse was diagnosed. RESULTS Overall, 141 patients were included. Nodal relapse was reported in 16/141 (11.3%) patients. Factors impacting regional recurrence-free survival were DOI ≥3 mm (HR: 2.4, P < 0.001), maximum tumour diameter ≥12 mm (HR: 1.1, P = 0.009), perineural invasion (PNI) (HR 7.5, P = 0.002) and poor differentiation (HR 5.3, P = 0.01). Rates of nodal relapse increased from 2% amongst patients with no APFs to 100% for those with four APFs. Patients with two or more APFs had significantly poorer 5-year regional recurrence-free survival (94.8% vs. 56.3%, P < 0.001). CONCLUSION Patients with T1N0 OSCC with two or more APFs (DOI ≥3 mm, diameter ≥12 mm, PNI or poor differentiations) should be considered for elective neck dissection.
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Affiliation(s)
- Anthony Noor
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Manish D Mair
- Department of Head and Neck Surgery, University Hospital of Leicester NHS trust, Leicester, UK
| | - Ruta Gupta
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology, NSW Health Pathology, Camperdown, Australia
| | - Michael S Elliott
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - James Wykes
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Carsten E Palme
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Medicine, Sydney Local Health District, Syndey, New South Wales, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Medicine, Sydney Local Health District, Syndey, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Balgobind S, Cheung VKY, Luk P, Low THH, Wykes J, Wu R, Lee J, Ch'ng S, Palme CE, Clark JR, Gupta R. Prognostic and predictive biomarkers in head and neck cancer: something old, something new, something borrowed, something blue and a sixpence in your shoe. Pathology 2024; 56:170-185. [PMID: 38218691 DOI: 10.1016/j.pathol.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 01/15/2024]
Abstract
A biomarker is a measurable indicator of biological or pathological processes or the response to an exposure or intervention and is used to guide management decisions. In head and neck pathology, biomarkers are assessed by histological criteria and immunohistochemical and molecular studies. Surgical resection remains the mainstay of management of many head and neck malignancies. Adjuvant radiotherapy and/or systemic therapy may be administered depending on the presence of adverse prognostic factors identified on histopathological or immunohistochemical examination. In this review, we outline the clinically relevant prognostic and predictive factors in head and neck malignancies including conventionally recognised factors such as tumour size, depth of invasion, lymphovascular and perineural invasion and margin status as well as novel evolving factors such as recurrent genetic rearrangements and assessment of immune checkpoints. Practical issues are discussed to assist with recognising and reporting of these factors. A summary of useful tools such as structured pathology report formats is also included to assist with comprehensive reporting of all clinically relevant parameters, minimise risk and improve workflow efficiencies.
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Affiliation(s)
- Sapna Balgobind
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia.
| | - Veronica K Y Cheung
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia
| | - Peter Luk
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Tsu-Hui Hubert Low
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Raymond Wu
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Jenny Lee
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Melanoma Institute Australia, University of Sydney, Sydney, NSW, Australia; Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Sydney Ch'ng
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Carsten E Palme
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Jonathan R Clark
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, NSW, Australia; Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
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de Almeida JR, Su JS, Kolarski MM, Truong T, Weinreb I, Perez-Ordonez B, Smith SM, Hosni A, Patel S, Valero C, Xu B, Ghossein R, Katabi N, Clark J, Low THH, Gupta R, Graboyes EM, Davies J, Richardson M, Pasham V, Jester R, Goldstein DP, Huang SH, Xu W, O'Sullivan B. Development and validation of a novel TNM staging N-classification of oral cavity squamous cell carcinoma. Cancer 2024; 130:410-420. [PMID: 37751180 DOI: 10.1002/cncr.35020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND For oral cavity squamous cell carcinoma (OSCC), extent of extranodal extension (ENE) (minor, ≤2 mm; major, >2 mm) is differentially prognostic, whereas limitations exist with the 8th edition of American Joint Committee on Cancer/International Union Against Cancer TNM N-classification (TNM-8-N). METHODS Resected OSCC patients at four centers were included and extent of ENE was recorded. Thresholds for optimal overall survival (OS) discrimination of lymph node (LN) features were established. After dividing into training and validation sets, two new N-classifications were created using 1) recursive partitioning analysis (RPA), and 2) adjusted hazard ratios (aHRs) and were ranked against TNM-8-N and two published proposals. RESULTS A total of 1460 patients were included (pN0: 696; pN+: 764). Of the pN+ cases, 135 (18%) had bilateral/contralateral LNs; 126 (17%) and 244 (32%) had minor and major ENE, and two (0.3%) had LN(s) >6 cm without ENE (N3a). LN number (1 and >1 vs. 0: aHRs, 1.92 [95% confidence interval (CI), 1.44-2.55] and 3.21 [95% CI, 2.44-4.22]), size (>3 vs. ≤3 cm: aHR, 1.88 [95% CI, 1.44-2.45]), and ENE extent (major vs. minor: aHR, 1.40 [95% CI, 1.05-1.87]) were associated with OS, whereas presence of contralateral LNs was not (aHR, 1.05 [95% CI, 0.81-1.36]). The aHR proposal provided optimal performance with these changes to TNM-8-N: 1) stratification of ENE extent, 2) elimination of N2c and 6-cm threshold, and 3) stratification of N2b by 3 cm threshold. CONCLUSION A new N-classification improved staging performance compared to TNM-8-N, by stratifying by ENE extent, eliminating the old N2c category and the 6 cm threshold, and by stratifying multiple nodes by size.
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Affiliation(s)
- John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jie Susie Su
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Mirko Manojlovic Kolarski
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, Health Sciences North, Sudbury, Ontario, Canada
| | - Tra Truong
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Ilan Weinreb
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | | | - Stephen M Smith
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Snehal Patel
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cristina Valero
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Bin Xu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ronald Ghossein
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nora Katabi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jonathan Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, the University of Sydney, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health Sciences, the University of Sydney, Sydney, New South Wales, Australia
| | - Ruta Gupta
- Sydney Medical School, Faculty of Medicine and Health Sciences, the University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Joel Davies
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Otolaryngology-Head and Neck Surgery, Sinai Health Systems, Toronto, Ontario, Canada
| | - Mary Richardson
- Department of Pathology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Vishu Pasham
- Department of Pathology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Rachel Jester
- Department of Pathology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
- Department of Radiation Oncology, Centre Hospitalier de L'University de Montreal, Montreal, Quebec, Canada
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Subramaniam N, Heller G, Clark JR, Gupta R, Goldstein D, de Almeida JR, Hosni A, Balasubramanian D, Thankappan K, Iyer S, Batstone M, Iyer NG, Smee RI, Chandrasekhar NH, Pillai V, Shetty V, Rangappa V, Veness M, Low THH. Improving accuracy in nodal staging of oral cancer: Proposal of a new system. Surg Oncol 2024; 52:102033. [PMID: 38211447 DOI: 10.1016/j.suronc.2024.102033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 09/16/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Despite introduction of extranodal extension (ENE) into the AJCC 8th edition of oral cancer staging, previous criticisms persist, such as limited discrimination between sub-stages and doubtful prognostic value of contralateral nodal disease. The purpose of this study was to compare our novel nodal staging system, based on the number of positive nodes and ENE, to the AJCC staging system in surgically treated patients. METHODS Retrospective analysis of 4710 patients with oral squamous cell carcinoma (OSCC) treated with surgery±adjuvant therapy in 8 institutions in Australia, North America and Asia. With overall survival (OS) and disease specific survival (DSS) as endpoint, the prognostic performance of AJCC 8th and 7th editions were compared using hazard consistency, hazard discrimination, likelihood difference and balance. RESULTS Our new nodal staging system (PN) a progressive and linear increase in hazard ratio (HR) from pN0 to pN3, with good separation of Kaplan Meier curves. Using the predetermined criteria for evaluation of a staging system, our proposed staging model outperformed AJCC 8th and 7th editions in prediction of OS and DSS. CONCLUSION PN was the lymph node staging system that provided the most accurate prediction of OS and DSS for patients in our cohort of OSCC. Additionally, it can be easily adopted, addresses the shortcomings of the existing systems and should be considered for future editions of the TNM staging system.
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Affiliation(s)
| | - Gillian Heller
- NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Jonathan Robert Clark
- Head and Neck Oncology, Chris O'Brien Lifehouse Hospital and Central Clinical School, University of Sydney, Australia
| | - Ruta Gupta
- Tissue Pathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - David Goldstein
- Head and Neck Oncology, Princess Margaret Cancer Center, University of Toronto, Canada
| | - John R de Almeida
- Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Canada
| | - Ali Hosni
- Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Canada
| | - Deepak Balasubramanian
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, India
| | - Subramania Iyer
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, India
| | - Martin Batstone
- Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - N Gopal Iyer
- Surgical Oncology, National Cancer Centre, Singapore
| | - Robert I Smee
- Nelune Comprehensive Cancer Centre, Randwick and Faculty of Medicine, University of New South Wales, Australia
| | | | - Vijay Pillai
- Head and Neck Oncology, Mazumdar Shaw Medical Center, Bangalore, India
| | - Vivek Shetty
- Head and Neck Oncology, Mazumdar Shaw Medical Center, Bangalore, India
| | | | - Michael Veness
- Radiation Oncology, Westmead Cancer Care Centre, Westmead and Westmead Clinical School, University of Sydney, Australia
| | - Tsu-Hui Hubert Low
- Head and Neck Oncology, Chris O'Brien Lifehouse Hospital Sydney, Australia
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Charters E, Cheng K, Dunn M, Wu R, Palme C, Howes D, Low THH, Heng C, Ricketts V, Kneebone K, Loy J, Clark JR. A pilot study of intensive intervention using a novel trismus device. Int J Speech Lang Pathol 2023; 25:813-820. [PMID: 36511636 DOI: 10.1080/17549507.2022.2130429] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Trismus secondary to head and neck neoplasm treatment impacts upon quality of life, nutrition, oral hygiene, and dentition. Current treatment options for trismus apply unquantified force to the jaw, and in many cases, the device costs are prohibitive. This study aimed to prospectively evaluate the impact of a novel trismus device. METHOD This single arm cohort study prospectively evaluated the impact of a novel trismus device on maximal incisal opening (MIO), trismus-related function and quality of life scores. Seventeen patients diagnosed with trismus were recruited to undergo a 10-week program using a novel device. The effect of the intervention was assessed by comparing pre- vs post-intervention validated measures. RESULT A significant improvement in MIO was observed post the 10-week intervention period (12.6 mm). This was associated with an improvement in patient reported trismus symptomology including quality of life, swallowing, speech, and jaw pain. CONCLUSIONS This pilot study demonstrates the feasibility of a novel device in the treatment of trismus. Further evaluation of this device is warranted to assess efficacy, safety, and cost-effectiveness in a larger cohort with appropriate controls.
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Affiliation(s)
- Emma Charters
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
| | - Kai Cheng
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Masako Dunn
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
| | - Raymond Wu
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Carsten Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Dale Howes
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
- Sydney Dental School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Caleb Heng
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
| | - Virginia Ricketts
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
| | - Karri Kneebone
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
| | - Jamie Loy
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Charters E, Low THH. Improving the oral function of patients with upper and lower lip tensor fascia lata slings for patients with flaccid facial nerve palsy. Oral Oncol 2023; 147:106601. [PMID: 37925897 DOI: 10.1016/j.oraloncology.2023.106601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Facial nerve paralysis (FNP) often causes decreased quality of life and may lead to significant facial dysfunction. Oral competence is frequently raised as a concern by patients as it impacts nutrition, hydration, social participation, and mental health. This can result in social isolation and reduced capacity to return to vocational roles. Despite its prevalence, it is incompletely understood and rarely described. This study prospectively evaluated the impact that facial nerve static and dynamic reanimation has on oral competence, with a specific focus on speech intelligibility and the oral phase of the swallow. MATERIALS AND METHODS Patients who had a static or dynamic facial reanimation at Chris O'Brien Lifehouse due to facial nerve paralysis were recruited consecutively between September 2020 and October 2022. Their speech and swallow were analysed using patient reported outcome measures including the speech handicap index and the oral competence questionnaire, and speech intelligibility rated by the patient and their speech pathologist at baseline (up to 2-weeks prior to surgery), then at 6- and 12- months post-surgery. Outcomes were evaluated firstly by a paired analysis (pre- compared to post-operative oral competence outcomes), and secondly by a cohort analysis of static, compared to dynamic reanimation. RESULTS 19 participants underwent a facial nerve reconstruction (10 static, 9 dynamic and static) due to pre-operative facial nerve paralysis. At 12-months improvements in both the oral competence questionnaire (OCQ) and the speech handicap index (SHI) (score reduced at a rate of 0.3 points per week and the 0.2 points respectively) and that this change met statistical significance (OCQ; p = p < 0.003, SHI; p < 0.001). Patient rated intelligibility increased 0.3 and clinician rated intelligibility increased 0.2 points per week which also significantly improved (p = 0.001 and p < 0.001 respectively). CONCLUSIONS Both static and dynamic facial reanimation procedures significantly improved both speech and swallowing measures for oral competence at 6- and 12- months post-procedure. There was not a significant difference found between static and dynamic procedures.
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Affiliation(s)
- Emma Charters
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; Sydney Facial Nerve Clinic, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia.
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; Sydney Facial Nerve Clinic, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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8
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Manzie TGH, Clark JR, Wykes J, Low THH. How to prevent excessive fluid within the surgical field during microvascular anastomosis: early neck drain placement as a continuous suction device. Br J Oral Maxillofac Surg 2023; 61:631-633. [PMID: 37690876 DOI: 10.1016/j.bjoms.2023.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Timothy G H Manzie
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia.
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia; Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Hayler R, Charters E, Coulson S, Hubert Low TH. Gender differences in perceived speech intelligibility in patients with facial nerve palsy. Int J Speech Lang Pathol 2023:1-6. [PMID: 37907077 DOI: 10.1080/17549507.2023.2259136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
PURPOSE Facial nerve palsy (FNP) affects physical and social function, including speech. There exists discrepancy between professional and patient perception of appearance following FNP; however, speech differences remain unknown. We aimed to compare ratings of speech intelligibility by different listeners. METHOD Patients were identified through the Sydney Facial Nerve Service. FNP related scoring was obtained using the Sunnybrook Facial Grading System, Sydney Facial Grading Score, Facial Disability Index, and Speech Handicap Index. Intelligibility was scored by a speech-language pathologist, member of the public, and patient using a standardised passage. FNP scoring and intelligibility were compared using interclass coefficients (ICC). RESULT Forty patients were recruited (females = 20). There was no difference in FNP scoring, nor between the frequency or types of phonemic errors. Observers' rating of intelligibility had an ICC of 0.807, compared with 0.266 and 0.344 for patients compared to the member of the public and speech-language pathologist respectively. Observers rated males and females intelligibility similar (p > 0.05), but females rated their intelligibility lower than males (74.5 ± 12.8 vs. 82.5 ± 8.4, p = 0.025). CONCLUSION Patients, particularly females, perceive their speech to be less intelligible than observers. Clinicians should be aware of this discrepancy, which does not correlate with physical function.
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Affiliation(s)
- Raymond Hayler
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- Department of Medicine, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, Macquarie University, Sydney, Australia
| | - Emma Charters
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- Head and Neck Department, Chris O'Brien Lifehouse, Sydney, Australia
| | - Susan Coulson
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- School of Physiotherapy, and
| | - Tsu-Hui Hubert Low
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, Australia
- Faculty of Medicine and Health, Macquarie University, Sydney, Australia
- Head and Neck Department, Chris O'Brien Lifehouse, Sydney, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
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10
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Zhang M, Phung D, Gupta R, Wykes J, Wu R, Lee J, Elliott M, Palme CE, Clark J, Low THH. Persisting facial nerve palsy or trigeminal neuralgia - red flags for perineural spread of head and neck cutaneous squamous cell carcinoma (HNcSCC). ANZ J Surg 2023; 93:2394-2401. [PMID: 37485776 DOI: 10.1111/ans.18625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Perineural spread (PNS) of head and neck cutaneous squamous cell carcinoma (HNcSCC) is a unique diagnostic challenge, presenting with insidious trigeminal (CN V) or facial nerve (CN VII) neuropathies without clinically discernible primary masses. These patients are often sub-optimally investigated and misdiagnosed as Bell's palsy or trigeminal neuralgia. This case series highlights the red flags in history and pitfalls that lead to delays to diagnosis and treatment. METHODS A retrospective case series of 19 consecutive patients with complete clinical histories with HNcSCC PNS without an obvious cutaneous primary lesion at time of presentation to a quaternary head and neck centre in Australia were identified and included for analysis. RESULTS Fifteen had CN VII PNS, 17 had CN V PNS, and 13 had both. The overall median symptom-to-diagnosis time was 12-months (IQR-15 months). Eight patients had CN VII PNS and described progressive segmental facial nerve palsy with a median symptom-to-diagnosis time of 9-months (IQR-11.75 months). Eleven patients had primary CN V PNS and described well localized parathesia, formication or neuralgia with a median symptom-to-diagnosis time of 19-months (IQR 27.5 months). CONCLUSION PNS is often mistaken for benign cranial nerve dysfunction with delays in diagnosis worsening prognosis. Red flags such as progressive CN VII palsy or persistent CN V paraesthesia, numbness, formication or pain, particularly in the presence of immuno-compromise and/or a history of facial actinopathy should raise suspicion for PNS. Gadolinium-enhanced MR Neurography should be obtained expediently in patients with persistent/progressive CN V/CN VII palsies in patients with red flags, with low threshold for referral to a Head and Neck Surgeon.
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Affiliation(s)
- Michael Zhang
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Daniel Phung
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Ruta Gupta
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - James Wykes
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Raymond Wu
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jenny Lee
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael Elliott
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Otolaryngology, Head and Neck Surgery, Macquarie Medical School, Macquarie University, Sydney, New South Wales, Australia
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11
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Hasmat S, Heller G, Cook L, Gupta R, Clark JR, Ooi EH, Low THH. The impact of multifocal perineural invasion in predicting survival in patients with oral squamous cell carcinoma: A multicenter investigation. Head Neck 2023; 45:2605-2612. [PMID: 37563878 DOI: 10.1002/hed.27485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/14/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Perineural invasion (PNI) in oral squamous cell carcinoma (OSCC) does not contribute to the current American Joint Committee on Cancer 8th edition (AJCC8) staging manual. This study seeks to validate the effect of multifocal PNI in a large cohort of patients. METHODS Patients undergoing primary surgical treatment of OSCC with curative intent between 1995 and 2022 was retrieved from two Australian head and neck databases. PNI was categorized as a single focus or multiple foci. Study end points included disease-specific survival (DSS) and overall survival (OS). RESULTS Complete data for survival analysis was available in 993 patients. Multifocal PNI was associated with a 61% increased risk of death due to OSCC (HR 1.61, 95% CI 1.11-2.33, p = 0.014) and a 32% increased risk of death from any cause (HR 1.32, 95% CI 1.01-1.73, p = 0.045). CONCLUSIONS Multifocal PNI is a significant predictor of survival in OSCC.
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Affiliation(s)
- Shaheen Hasmat
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Gillian Heller
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Lachlan Cook
- Department of Otolaryngology - Head and Neck Surgery, Flinders Medical Centre and Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Ruta Gupta
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Eng H Ooi
- Department of Otolaryngology - Head and Neck Surgery, Flinders Medical Centre and Royal Adelaide Hospital, Adelaide, South Australia, Australia
- Department of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Tsu-Hui Hubert Low
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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12
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Gupta R, Strbenac D, Satgunaseelan L, Cheung VKY, Narayanappa H, Ashford B, Mitchell J, Thind A, Palme CE, Ch'ng S, Low THH, Wykes J, Willet CE, Chew T, Yang J, Ranson M, Clark JR. Comparing Genomic Landscapes of Oral and Cutaneous Squamous Cell Carcinoma of the Head and Neck: Quest for Novel Diagnostic Markers. Mod Pathol 2023; 36:100190. [PMID: 37080394 DOI: 10.1016/j.modpat.2023.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/01/2023] [Accepted: 04/05/2023] [Indexed: 04/22/2023]
Abstract
Squamous cell carcinoma is the most common head and neck malignancy arising from the oral mucosa and the skin. The histologic and immunohistochemical features of oral squamous cell carcinoma (OSCC) and head and neck cutaneous squamous cell carcinoma (HNcSCC) are similar, making it difficult to identify the primary site in cases of metastases. With the advent of immunotherapy, reliable distinction of OSCC and HNcSCC at metastatic sites has important treatment and prognostic implications. Here, we investigate and compare the genomic landscape of OSCC and HNcSCC to identify diagnostically useful biomarkers. Whole-genome sequencing data from 57 OSCC and 41 HNcSCC patients were obtained for tumor and matched normal samples. Tumor mutation burden (TMB), Catalogue of Somatic Mutations in Cancer (COSMIC) mutational signatures, frequent chromosomal alterations, somatic single nucleotide, and copy number variations were analyzed. The median TMB of 3.75 in primary OSCC was significantly lower (P < .001) than that of 147.51 mutations/Mb in primary HNcSCC. The COSMIC mutation signatures were significantly different (P < .001) between OSCC and HNcSCC. OSCC showed COSMIC single-base substitution (SBS) mutation signature 1 and AID/APOBEC activity-associated signature 2 and/or 13. All except 1 HNcSCC from hair-bearing scalp showed UV damage-associated COSMIC SBS mutation signature 7. Both OSCC and HNcSCC demonstrated a predominance of tumor suppressor gene mutations, predominantly TP53. The most frequently mutated oncogenes were PIK3CA and MUC4 in OSCC and HNcSCC, respectively. The metastases of OSCC and HNcSCC demonstrated TMB and COSMIC SBS mutation signatures similar to their primary counterparts. The combination of high TMB and UV signature in a metastatic keratinizing squamous cell carcinoma suggests HNcSCC as the primary site and may also facilitate decisions regarding immunotherapy. HNcSCC and OSCC show distinct genomic profiles despite histologic and immunohistochemical similarities. Their genomic characteristics may underlie differences in behavior and guide treatment decisions in recurrent and metastatic settings.
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Affiliation(s)
- Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.
| | - Dario Strbenac
- School of Mathematics and Statistics, The University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Laveniya Satgunaseelan
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Veronica Ka-Yan Cheung
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Harini Narayanappa
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Bruce Ashford
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia; Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Jenny Mitchell
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia; Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Amarinder Thind
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Carsten E Palme
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia; Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Sydney Ch'ng
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia; Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Department of Plastic and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, New South Wales, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia; Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Cali E Willet
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia; Sydney Informatics Hub, Core Research Facilities, The University of Sydney, Sydney, New South Wales, Australia
| | - Tracy Chew
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia; Sydney Informatics Hub, Core Research Facilities, The University of Sydney, Sydney, New South Wales, Australia
| | - Jean Yang
- School of Mathematics and Statistics, The University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Marie Ranson
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia; Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia; School of Chemistry and Molecular Bioscience, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jonathan R Clark
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia; Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
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13
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Hasmat S, Lovell NH, Low THH, Clark JR. Development of an implantable bionic for dynamic eye closure in facial nerve paralysis: Evolution of the design. Med Eng Phys 2023; 115:103977. [PMID: 37120171 DOI: 10.1016/j.medengphy.2023.103977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 01/03/2023] [Accepted: 04/06/2023] [Indexed: 05/01/2023]
Abstract
Facial nerve paralysis (FNP) presents with a constellation of clinical problems but its most concerning consequence is corneal exposure from lack of blinking. Bionic lid implant for natural closure (BLINC) is an implantable solution for dynamic eye closure in FNP. It uses an electromagnetic actuator to mobilise the dysfunctional eyelid by means of an eyelid sling. This study highlights issues relating to device biocompatibility and describes its evolution to overcome some of these issues. The essential components of the device are the actuator, the electronics including energy storage, and an induction link for wireless power transfer. Effective arrangement of these components within the anatomical confines and their integration is achieved through a series of prototypes. The response of each prototype is tested in a synthetic or cadaveric model for eye closure with the final prototype designed for acute and chronic animal trials.
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Affiliation(s)
- Shaheen Hasmat
- Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW 2006, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia.
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, UNSW Sydney, NSW 2052, Australia
| | - Tsu-Hui Hubert Low
- Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW 2006, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Jonathan R Clark
- Faculty of Medicine and Health, the University of Sydney, Camperdown, NSW 2006, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
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14
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Liu TPJ, David M, Clark JR, Low THH, Batstone MD. Prediction nomogram development and validation for postoperative radiotherapy in the management of oral squamous cell carcinoma. Head Neck 2023; 45:1503-1510. [PMID: 37019874 DOI: 10.1002/hed.27363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/11/2023] [Accepted: 03/24/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Predictive nomograms are useful tools to guide clinicians in estimating disease course. Oral squamous cell carcinoma (OSCC) patients would benefit from an interactive prediction calculator that defines their levels of survival-risk specific to their tumors to guide the use of postoperative radiotherapy (PORT). METHODS Patients with OSCC surgically treated with curative intent at four Head and Neck Cancer Centres were recruited retrospectively for development and validation of nomograms. Predictor variables include PORT, age, T and N classification, surgical margins, perineural invasion, and lymphovascular invasion. Outcomes were disease-free, disease-specific, and overall survivals over 5 years. RESULTS 1296 patients with OSCC were in training cohort for nomogram analysis. Algorithms were developed to show relative benefit of PORT in survivals for higher-risk patients. External validation on 1212 patients found the nomogram to be robust with favorable discrimination and calibration. CONCLUSION The proposed calculator can assist clinicians and patients in the decision-making process for PORT.
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Affiliation(s)
- Timothy P J Liu
- Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Bowen Bridge Road & Butterfield Street, Herston, Queensland, Australia
- Faculty of Medicine, University of Queensland, Level 2, Mayne Medical Building, 288 Herston Road, Herston, Queensland, Australia
| | - Michael David
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
- The Daffodil Centre, University of Sydney (A Joint Venture With Cancer Council), Kings Cross, New South Wales, Australia
| | - Jonathan R Clark
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, New South Wales, Australia
| | - Martin D Batstone
- Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Bowen Bridge Road & Butterfield Street, Herston, Queensland, Australia
- Faculty of Medicine, University of Queensland, Level 2, Mayne Medical Building, 288 Herston Road, Herston, Queensland, Australia
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15
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Shein G, Lee JWY, Coulson S, Low THH. Outcomes of immediate facial nerve reanimation with nerve transfer for facial nerve neoplasm-induced paralysis: a retrospective review. ANZ J Surg 2023. [PMID: 36978256 DOI: 10.1111/ans.18336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/14/2022] [Accepted: 02/06/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the outcomes of our polyneural, zone-based reanimation approach for patients with neoplasm-induced facial paralysis. METHODS A retrospective review of consecutive patients who underwent facial reanimation surgery using multiple donor nerve transfers was undertaken. In each case, the selection of donor nerves was based on the availability of donor nerve and the viability of the motor endplate on the affected side. Sources of the neural inputs utilized included the remnant facial nerve stump, masseteric nerve, partial hypoglossal nerve, and branches of the contralateral facial nerve. Clinical outcomes were scored by expert raters. Ratings were undertaken using the modified House-Brackmann, eFACE and MEEI FACEgram scoring systems. RESULTS Between 2017 and 2020, 12 patients were included in the study (mean age 60 years; range 26-81 years). Eight patients (67%) achieved a grade III outcome on the modified House-Brackmann grading scale. Mean eFACE static and dynamic scores were 76 and 57 respectively, reflecting a high degree of symmetry at rest and moderate restoration of dynamic movement. Mean time to movement was 5.4 months (SD 1.9). Objective FACE-gram measurements confirmed restoration of midface movement with an average improvement in smile excursion and mouth angle excursion of 3.19 mm (SD 3.18) and 4.81° (SD 2.90) respectively. CONCLUSION Facial reanimation using multiple nerve transfers is effective in achieving improvements in facial function and symmetry.
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Affiliation(s)
- Gregory Shein
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jennifer W Y Lee
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Susan Coulson
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Sydney Facial Nerve Service, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Head and Neck Department, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
- Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Tadi S, Ka-Yan Cheung V, Lee CS, Nguyen K, Luk PP, Low THH, Palme C, Clark J, Gupta R. MYB RNA detection by in situ hybridisation has high sensitivity and specificity for the diagnosis of adenoid cystic carcinoma. Pathology 2023; 55:456-465. [PMID: 37055331 DOI: 10.1016/j.pathol.2023.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/11/2022] [Accepted: 01/20/2023] [Indexed: 04/15/2023]
Abstract
Adenoid cystic carcinoma (ACC) is one of the most common primary salivary gland cancers. ACC has several benign and malignant mimics amongst salivary gland neoplasms. An accurate diagnosis of ACC is essential for optimal management of the patients and their follow-up. Upregulation of MYB has been described in 85-90% of ACC, but not in other salivary gland neoplasms. In ACC, MYB upregulation can occur as a result of a genetic rearrangement t(6;9) (q22-23;p23-24), MYB copy number variation (CNV), or enhancer hijacking of MYB. All mechanisms of MYB upregulation result in increased RNA transcription that can be detected using RNA in situ hybridisation (ISH) methods. In this study, utilising 138 primary salivary gland neoplasms including 78 ACC, we evaluate the diagnostic utility of MYB RNA ISH for distinguishing ACC from other primary salivary gland neoplasms with a prominent cribriform architecture including pleomorphic adenoma, basal cell adenoma, basal cell adenocarcinoma, epithelial myoepithelial carcinoma, and polymorphous adenocarcinoma. Fluorescent in situ hybridisation and next generation sequencing were also performed to evaluate the sensitivity and specificity of RNA ISH for detecting increased MYB RNA when MYB gene alterations were present. Detection of MYB RNA has 92.3% sensitivity and 98.2% specificity for a diagnosis of ACC amongst salivary gland neoplasms. The sensitivity of MYB RNA detection by ISH (92.3%) is significantly higher than that of the FISH MYB break-apart probe (42%) for ACC. Next generation sequencing did not demonstrate MYB alterations in cases that lacked MYB RNA overexpression indicating high sensitivity of MYB RNA ISH for detecting MYB gene alterations. The possibility that the sensitivity may be higher in clinical practice with contemporary samples as compared with older retrospective tissue samples with RNA degradation is not entirely excluded. In addition to the high sensitivity and specificity, MYB RNA testing can be performed using standard IHC platforms and protocols and evaluated using brightfield microscopy making it a time and cost-efficient diagnostic tool in routine clinical practice.
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Affiliation(s)
- Sahithi Tadi
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Veronica Ka-Yan Cheung
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - C Soon Lee
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Discipline of Pathology, School of Medicine, Western Sydney University, Campbelltown, NSW, Australia; Department of Anatomical Pathology, Liverpool Hospital, Liverpool, NSW, Australia; Cancer Pathology Laboratory, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; CONCERT Biobank, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, NSW, Australia
| | - Kevin Nguyen
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Peter P Luk
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW, Australia
| | - Carsten Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jonathan Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, NSW, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
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17
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Fung YY, Chung D, Clark JR, Low THH, Palme CE, Wykes J, Elliott MS. Comparative analysis of pre-operative ultrasound and histopathology in small papillary thyroid carcinoma in the era of active surveillance. ANZ J Surg 2023; 93:902-906. [PMID: 36852861 DOI: 10.1111/ans.18353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/19/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Contemporary management of small papillary thyroid carcinomas (PTC) includes active surveillance (AS) as a number of these tumours are indolent. Overseas studies have reported AS in tumours up to 15 mm. This study aims to look at an Australian cohort of patients who have had surgery for non-incidental PTCs and analyse their pre-operative ultrasound and histopathology data to investigate potential issues that might arise in the era of AS. METHODS Retrospective review of 82 patients who had surgical removal of PTCs ≤15 mm in diameter. Pre-operative ultrasound imaging was reviewed by an experienced sonologist and histopathology data was obtained from medical records. The AS risk stratification framework by Brito et al. was used to determine those who were feasible for AS based on ultrasound findings. RESULTS Review of pre-operative ultrasounds demonstrated there were 68 (82.9%) patients who were shown to be either appropriate or ideal for AS. On review of histopathology, 49 (69%) patients had at least one adverse pathological risk factor. This is more than half of the patients that were originally identified as candidates for AS. CONCLUSION Our study has revealed a large proportion were suitable for AS but when compared with histopathological guidelines there was a high incidence of adverse pathological features found. This discrepancy indicates that although the guidelines are important, there are unknown pathological variables that need to be considered in patients selected for AS.
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Affiliation(s)
- Yuen Yin Fung
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - David Chung
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia
| | - James Wykes
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia
| | - Michael S Elliott
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia
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18
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Charters E, Low THH, Coulson S. Utility of an oral competence questionnaire for patients with facial nerve paralysis. J Plast Reconstr Aesthet Surg 2023; 77:201-208. [PMID: 36587474 DOI: 10.1016/j.bjps.2022.11.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 10/27/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the utility of a patient-reported outcome measure that evaluates oral competence; speech and swallowing functions after facial nerve paralysis (FNP). METHODS The Oral Competence Questionnaire (OCQ) covers 16 questions from known, validated patient-reported outcome measures. The OCQ was completed by 40 patients with facial nerve paralysis (FNP) and 40 healthy controls. The sensitivity of the questionnaire was tested against other validated questionnaires for oral function, speech/swallowing functions, and facial nerve-related disability. Normative data were obtained by administering the OCQ to a group of healthy volunteers. RESULTS A total of 80 participants completed the OCQ (40 FNP and 40 healthy controls). Strong linear relationships (Spearman correlation coefficients >0.8) were observed between speech intelligibility ratings, objective speech outcomes, and the OCQ. Linear correlations were also noted between OCQ and FDI (Spearman correlation coefficient >0.4). The mean OCQ score for participants with FNP was 28.8 and 0.0 for healthy controls. CONCLUSIONS This succinct, 16-item questionnaire demonstrated good sensitivity for testing oral competence and oral function for patients with FNP, and the ability to discriminate between patients with FNP from patients with normal facial nerve function.
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Affiliation(s)
- Emma Charters
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia; Central Clinical School, The University of Sydney, Sydney, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney Australia
| | - Susan Coulson
- School of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Camperdown, NSW, Australia
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19
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Papanikolas MJ, Hurrell MJL, Clark JR, Low THH, Ch'ng S, Elliott MS, Palme CE, Wykes J. Anterolateral thigh, radial forearm and superficial circumflex iliac perforator flaps in oral reconstruction: a comparative analysis. ANZ J Surg 2023; 93:1335-1340. [PMID: 36629132 DOI: 10.1111/ans.18239] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Anterolateral thigh (ALT) and Radial forearm free flaps (RFFF) are historically the most common methods of oral reconstruction. The Superficial circumflex iliac artery perforator flap (SCIP) is an alternative providing a donor site that can be readily closed primarily with improved cosmesis in younger patients, due to its concealability. METHODS We reviewed 135 patients who received ALT, RFFF or SCIP flaps for oral reconstruction in our institution. Our aim was to compare operative and perioperative outcomes between each cohort. ANOVA and χ2 test were used for statistical analysis. RESULTS There were 37 ALT, 64 RFFF and 35 SCIP reconstructions. Patients reconstructed with SCIP flaps had smaller resection volumes (P < 0.001) and earlier T and N classifications (P = 0.001, P = 0.008), and consequently reduced tracheostomy rates (P < 0.001), reduced need for enteral feeding at discharge (P < 0.001) and shorter length of stay and perioperative times (P < 0.001). SCIP flaps were more common in younger patients (P < 0.01). ALT flaps were used for more advanced disease (P = 0.001) and had larger resection volumes (P < 0.001) and increased need for assisted enteral feeding (P < 0.001). There were no significant differences in flap or donor site outcomes. There were two flap failures, both RFFF. CONCLUSION Each flap plays an important role in the reconstruction of oral defects, with larger defects preferentially reconstructed with ALT flaps. SCIP appears to be a reliable alternative in small defects with excellent perioperative and postoperative outcomes.
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Affiliation(s)
- Michael John Papanikolas
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Michael James Leslie Hurrell
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Sydney Ch'ng
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael S Elliott
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - James Wykes
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
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20
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Manzie T, Howes D, Leinkram D, Fleming S, Clark JR, Dunn M, Elliott M, Low THH. Virtual surgical planning for combined nasal, dental and maxillary reconstruction with the prefabricated fibula flap. Oral Oncol 2023; 136:106264. [PMID: 36455515 DOI: 10.1016/j.oraloncology.2022.106264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 11/19/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Timothy Manzie
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
| | - Dale Howes
- Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia; Sydney Dental School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - David Leinkram
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Sophie Fleming
- Prosthetic Art Technology, Alstonville, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Masako Dunn
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Michael Elliott
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia; Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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21
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Hasmat S, Low THH, Dusseldorp JR, Mukherjee P, Clark JR. Facial nerve palsy: Narrative review on the importance of the eye and its assessment. Head Neck 2022; 44:2600-2607. [PMID: 35894515 DOI: 10.1002/hed.27151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/25/2022] [Accepted: 07/07/2022] [Indexed: 11/12/2022] Open
Abstract
New solutions are emerging that address specific facial regions in facial nerve palsy (FNP). However the most dreaded consequence of FNP is paralytic lagophthalmos threatening the eye. A way to prioritize these regions is thus required. A review of the literature is conduced to capture the current concepts in evaluating FNP. Overall, patients are assessed from three perspectives: from the clinician's perspective using validated clinician-based grading instruments, from patient's perspective based on FNP-specific patient-reported outcome measures, and from the perspective of the layperson. The existing tools however provide limited information regarding the relative importance of different regions of the face. The eye appears to be an area of great concern for the patient where most surgical therapies are directed at. Addressing ocular problems in FNP carry a high priority but this is not clearly reflected by the standard systems.
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Affiliation(s)
- Shaheen Hasmat
- Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Joseph R Dusseldorp
- Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Payal Mukherjee
- Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Jonathan R Clark
- Faculty of Medicine, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
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22
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Phung D, Ahmadi N, Gupta R, Clark JR, Wykes J, Ch'ng S, Elliott MS, Palme CE, Shannon K, Wu R, Lee JH, Low THH. Survival outcomes of perineural spread in head and neck cutaneous squamous cell carcinoma. ANZ J Surg 2022; 92:2299-2304. [PMID: 35866314 DOI: 10.1111/ans.17908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 06/06/2022] [Accepted: 06/25/2022] [Indexed: 11/28/2022]
Abstract
AIM To present an institution's experience and survival outcomes for patients with head and neck cutaneous squamous cell carcinoma (HNcSCC) and perineural spread (PNS). METHOD Retrospective study of patients with HNcSCC and PNS treated between January 2010 and August 2020 from the Sydney Head and Neck Cancer Institute database, Sydney, Australia; a high-volume, tertiary, academic head and neck centre. Patient demographics, primary site, involved cranial nerves, treatment modality, loco-regional failure and survival data were obtained. RESULTS Forty-five patients were identified, of which 32 patients were male (71%). Mean age at diagnosis was 68.7 years (range 43-90). Median follow-up was 16.1 months (range 1-107). The trigeminal nerve was most frequently involved (n = 30, 66.6%) followed by facial nerve (n = 13, 28.9%). Most patients underwent surgery followed by radiotherapy (n = 33, 73%) and eight received definitive radiotherapy. The median overall survival (OS) was 4.5 years (95% CI 3.71-5.38), median disease-specific survival 5.1 years (95% CI 4.21-5.97) and median disease-free survival (DFS) was 1.7 years (95% CI 1.11-2.22). The estimated 5-year OS and DFS were 45% and 25%, respectively. Patients treated with surgery and adjuvant radiotherapy with a clear proximal nerve margin had favourable DFS (P = 0.035) and trended towards better OS (P = 0.134) compared with patients with an involved nerve margin. Patients treated surgically with involved proximal nerve margins had similar outcomes compared with patients with treated definitive radiotherapy (HR 0.80, 95% CI 0.29-2.22, P = 0.664). CONCLUSION The likelihood of achieving a clear proximal nerve margin should be a strong consideration in the selection of appropriate patients for primary surgery.
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Affiliation(s)
- Daniel Phung
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Navid Ahmadi
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ruta Gupta
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Department of Head and Neck Surgery, Wollongong Hospital, New South Wales, Australia
| | - Sydney Ch'ng
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael S Elliott
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kerwin Shannon
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Raymond Wu
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jenny H Lee
- Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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23
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Cleary JD, Kekesi O, Hasmat S, Low THH, Lovell NH, Clark JR, Suaning GJ. Overcoming Facial Paralysis with an Implantable Actuator for Restoration of Blink. Annu Int Conf IEEE Eng Med Biol Soc 2022; 2022:1498-1501. [PMID: 36085991 DOI: 10.1109/embc48229.2022.9871833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The loss of the ability to blink the eyelid is considered the most severe effect of facial nerve paralysis. The delicate homeostasis of the eye is disrupted, and without frequent intervention, the cornea can become damaged, ultimately resulting in blindness. The psychosocial impact is also significant, with individuals withdrawing from society to hide what they perceive to be a disfigurement. Surgical and engineering interventions have been devised to reanimate blink, however, a solution has yet to be designed which addresses both functional and aesthetic concerns. Here we describe an implantable electromagnetic actuator to restore the capacity to blink. Triggered synchronously with the contralateral eye, and externally modifiable to tailor treatment post-operatively to the individual, this implant restores complete blinking and a natural appearance. Cadaver studies (N=12) have been used to validate the device design, including the form factor and force required to elicit a blink, while a passive in vivo study (N=1) has verified the surgical protocol and recovery.
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24
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Cheung VKY, Hulme K, Schifter M, Palme C, Low THH, Clark J, Gupta R. Oral Epithelial Dysplasia: A Review of Diagnostic Criteria for Anatomic Pathologists. Adv Anat Pathol 2022; 29:227-240. [PMID: 35435865 DOI: 10.1097/pap.0000000000000343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Oral epithelial dysplasia (OED) represents a spectrum of histologic changes in the oral cavity mucosa that has the potential to transform into oral squamous cell carcinoma. Predicting the risk of malignant transformation is predominantly based on clinicopathologic correlation, histologic examination and grading. OED often poses a diagnostic challenge, primarily due to its histologic mimics and a large number of terminologies used in the literature. The grading system for OED is also fraught with significant interobserver variability. This review summarizes the essential clinical and histopathologic features of OED and its mimics. Practical preanalytical, analytical, and postanalytical considerations for anatomic pathologists are discussed to improve the diagnostic accuracy and increase the reproducibility in the grading of OED.
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Affiliation(s)
- Veronica K Y Cheung
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital
- Faculty of Medicine and Health, Sydney Medical School
| | - Katherine Hulme
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital
| | - Mark Schifter
- Westmead Centre for Oral Health, Westmead Hospital, a Teaching Hospital of the Sydney Dental School, Faculty of Medicine and Health, University of Sydney
- The Skin Hospital, Darlinghurst (Sydney)
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse
| | - Carsten Palme
- Faculty of Medicine and Health, Sydney Medical School
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse
| | - Tsu-Hui Hubert Low
- Faculty of Medicine and Health, Sydney Medical School
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse
- Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University
| | - Jonathan Clark
- Faculty of Medicine and Health, Sydney Medical School
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital
- Faculty of Medicine and Health, Sydney Medical School
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25
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Irawati N, Moghadam A, Abdul-Razak M, Strach M, Elliott M, Ch'ng S, Shannon K, Palme CE, Clark J, Wykes J, Low THH. Outcomes after definitive treatment for head and neck angiosarcoma. ANZ J Surg 2022; 92:1407-1414. [PMID: 35531880 DOI: 10.1111/ans.17695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Head and neck angiosarcoma (HN-AS) is a rare and aggressive, representing <1% of all head and neck malignancies. It is characterized by a high rate of local recurrence and poor 5-year survival (10-54%). Australian data in this rare disease is lacking. We aim review the clinical outcomes of HN-AS from two high volume head and neck cancer units in Australia. METHODS Retrospective chart review. RESULTS A total 26 patients were identified, consist of predominantly male patients (81%) with a mean age of 77 year old. Most of the HN-AS arises from the scalp (62%). The 5-year overall survival (OS) and disease free survival (DFS) were 41% and 15%, respectively. Patients treated with upfront surgery with adjuvant therapy has better OS and DFS compared with patients receiving upfront chemoradiotherapy (median OS 3.63 vs. 0.53 years, P = 0.011 and median DFS 1.19 vs. 0.33 years, P = 0.001). There is no difference in OS or DFS for the sites of HN-AS or age of patients. Recurrences were noted in 15 patients (57.7%). For those with metastatic disease, the most common site was the lung (80%) with a median time to development of distant disease of 2.7 years (range 1.8-3.6 years). In patients who underwent salvage treatment, the median survival (post-salvage) was 1.3 years (0-2.8 years). CONCLUSION This is the first Australian report of treatment patterns and outcomes of patients with HN-AS. Our cohort confirms that HN-AS is a slowly progressive disease with poor survival. Patients treated with surgery and adjuvant radiotherapy in this series had better outcomes compared with those treated with chemoradiotherapy alone. The role of neoadjuvant chemotherapy is an area of ongoing research.
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Affiliation(s)
- Nina Irawati
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
| | | | | | - Madeleine Strach
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
| | - Michael Elliott
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Sydney Ch'ng
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Kerwin Shannon
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Carsten E Palme
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Jonathan Clark
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - James Wykes
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia.,Department of Otolaryngology-Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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26
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Yung AE, Wong G, Pillinger N, Wykes J, Haddad R, McInnes S, Palme CE, Hubert Low TH, Clark JR, Sanders R, Ch'ng S. Validation of a risk prediction calculator in Australian patients undergoing head and neck microsurgery reconstruction. J Plast Reconstr Aesthet Surg 2022; 75:3323-3329. [PMID: 35768291 DOI: 10.1016/j.bjps.2022.04.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/16/2022] [Accepted: 04/26/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) surgical risk calculator (SRC) is an open access calculator predicting patients' risk of postoperative complications. This study aims to assess the validity of the SRC in patients undergoing microsurgical free flap reconstruction at an Australian tertiary referral centre. METHODS This is a retrospective cohort study of 200 consecutive patients treated up to November 2020. SRC-predicted rates of postoperative complications and hospital length of stay (LOS) were compared to those observed for the ablative and reconstructive components of the procedure. The performance of the SRC was assessed using Brier scores, area under the receiver operating characteristic (ROC) curve (AUC), and the Hosmer-Lemeshow test. RESULTS For both ablative and reconstructive components, the SRC discriminates well for pneumonia and urinary tract infection, and it is calibrated well for readmission and sepsis, but it does not discriminate and calibrate well for any single outcome. SRC-predicted hospital LOS and actual LOS did not correlate well for the reconstructive component, but they correlated strongly for the ablative component. CONCLUSIONS The SRC is a poor predictor of postoperative complication rates and hospital LOS in patients undergoing head and neck microsurgical reconstruction.
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Affiliation(s)
- Amanda E Yung
- The University of Sydney Sydney Medical School, Sydney, Australia; The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia
| | - Gerald Wong
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Neil Pillinger
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia
| | - Roger Haddad
- Department of Plastics and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Stephanie McInnes
- Department of Anaesthetics, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia
| | - Carsten E Palme
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia
| | - Tsu-Hui Hubert Low
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia
| | - Jonathan R Clark
- The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Head and Neck Surgery, Chris O'Brien Lifehouse Cancer Centre, Sydney, Australia
| | - Robert Sanders
- The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Sydney Ch'ng
- The Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health Distrinct, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Department of Plastics and Reconstructive Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Melanoma Institute of Australia, Sydney, Australia.
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Petrides GA, Dunn M, Charters E, Venchiarutti R, Cheng K, Froggatt C, Mukherjee P, Wallace C, Howes D, Leinkram D, Singh J, Nguyen K, Hubert Low TH, Ch'ng S, Wykes J, Clark JR. Health-related quality of life in maxillectomy patients undergoing dentoalveolar rehabilitation. Oral Oncol 2022; 126:105757. [PMID: 35121398 DOI: 10.1016/j.oraloncology.2022.105757] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Surgical resection of the maxilla impairs aesthetics, speech, swallowing, and mastication. Maxillary reconstruction is increasingly performed with virtual surgical planning (VSP) to enhance functional dental rehabilitation with a conventional denture or osseointegrated implants. The aim of this study was to determine whether dental status and VSP is associated with health-related quality of life (HRQOL) and function in patients who have undergone maxillectomy. MATERIALS AND METHODS A cross-sectional study was conducted among patients who underwent free flap reconstruction or obturation of the maxilla between July 2009 and December 2020. The FACE-Q Head and Neck Cancer (FACE-Q) module, M.D. Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI) were used to evaluate HRQOL. RESULTS Forty-three patients (response rate 59%) completed questionnaires and 48% underwent dental rehabilitation. In Okay Class II and III defects, adjusting for the effect of radiotherapy and time from surgery, there was a positive association between denture status and FACE-Q smiling (p = 0.020), eating (p = 0.012), smiling (p = 0.015), and MDADI global (p = 0.015), emotional (p = 0.027), functional (p = 0.028), and composite (p = 0.029) scores. VSP was associated with FACE-Q swallowing (p = 0.005), drooling (p = 0.030), eating (p = 0.008), smiling (p = 0.021), MDADI global (p = 0.017), emotional (p = 0.041), functional (p = 0.040), composite (p = 0.038), and SHI total scores (p = 0.042). CONCLUSIONS Dentoalveolar rehabilitation and VSP were associated with higher HRQOL scores relating to eating and drinking, smiling, and speaking.
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Affiliation(s)
- George A Petrides
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Masako Dunn
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Emma Charters
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Rebecca Venchiarutti
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Kai Cheng
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Catriona Froggatt
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Payal Mukherjee
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Christine Wallace
- Department of Oral Restorative Sciences, Westmead Centre for Oral Health, Corner of Hawkesbury Road and, Darcy Road, Westmead NSW 2145, Australia
| | - Dale Howes
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; School of Dentistry, Faculty of Medicine and Health, University of Sydney, 2 Chalmers St, Surry Hills, NSW 2010, Australia
| | - David Leinkram
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Jasvir Singh
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Kevin Nguyen
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Anderson Stuart Building, The University of Sydney, Camperdown, NSW 2050, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Sydney Ch'ng
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Anderson Stuart Building, The University of Sydney, Camperdown, NSW 2050, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW 2050, Australia; Department of Plastic Surgery, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW 2050, Australia
| | - James Wykes
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Anderson Stuart Building, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Anderson Stuart Building, The University of Sydney, Camperdown, NSW 2050, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW 2050, Australia.
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Anning R, Huang J, Ronan A, de Malmanche J, Asher R, Low THH. Improvement in epistaxis management: the experience of a dedicated hereditary haemorrhagic telangiectasia clinic. ANZ J Surg 2021; 92:499-504. [PMID: 34724318 DOI: 10.1111/ans.17322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/28/2021] [Accepted: 10/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hereditary haemorrhagic telangiectasia (HHT) is a rare genetic vascular disorder which is characterised by the development of arteriovenous malformations and telangiectasias. A key clinical manifestation is recurrent epistaxis. This study examined the impact of a dedicated HHT clinic in a major Australian tertiary hospital on epistaxis symptoms and subjective quality of life. METHODS A multidisciplinary HHT clinic was established in 2015. All patients satisfied either genetic diagnosis or fulfilled Curacao criteria. A protocol based clinical assessment was performed and a standardised treatment regimen was implemented. Patients completed quality of life and epistaxis severity score (ESS) questionnaires at each review. RESULTS Participants of the dedicated clinic included 21 females (58.3%) and 15 males (41.7%), with a mean age of 49.0 ± 24.0 years. The ACVRL1 variant was the most common (n = 20, 55.6%). A statistically significant reduction in epistaxis severity was noted between the baseline and second review (P = 0.02) and was maintained to the third visit (P = 0.015). Patients older than 50 years demonstrate a consistently higher ESS than those less than 50 years old (P = 0.03). This trend is noted throughout the follow up period with the dedicated clinic. CONCLUSION The introduction of a multidisciplinary, dedicated HHT clinic to provide enhanced assessment, monitored treatment regimen and greater access to care, resulted in improvement in the management of epistaxis and quality of life in these patients.
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Affiliation(s)
- Rebecca Anning
- Department of Otolaryngology Head and Neck Surgery, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - Johnson Huang
- Department of Otolaryngology Head and Neck Surgery, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - Anne Ronan
- General Genetics Service, Hunter Genetics, Waratah, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jillian de Malmanche
- Hunter Haematology Unit, Calvary Mater Hospital, Waratah, New South Wales, Australia
| | - Rebecca Asher
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology Head and Neck Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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29
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Petrides GA, Hicks G, Dunn M, Froggatt C, Wallace C, Howes D, Leinkram D, Low THH, Ch'ng S, Wykes J, Palme CE, Clark JR. Dentoalveolar outcomes in maxillary reconstruction: A retrospective review of 85 maxillectomy reconstructions. ANZ J Surg 2021; 91:1472-1479. [PMID: 34124825 DOI: 10.1111/ans.17001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/23/2021] [Accepted: 05/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although microvascular free flaps are often used to reconstruct maxillary defects, dentoalveolar rehabilitation is arguably less common despite its importance to midface function and aesthetics. The aim of this study is to review the contemporary management of maxillary defects in a single quaternary referral institution to identify factors that assist or impede dentoalveolar rehabilitation. METHODS A retrospective review of maxillary reconstructions performed between February 2017 and December 2020 was performed. Patient characteristics, defect classification, operative techniques, complications and dentoalveolar outcomes were recorded. RESULTS A total of 85 maxillary reconstructions were performed in 73 patients. Of the 64 patients where dental rehabilitation was required, 31 received a functional denture (48%) with 24 (38%) being implant-retained. Significant predictors of successful rehabilitation included the use of virtual surgical planning (VSP; 86% vs. 25%, p < 0.001), preoperative prosthodontic assessment (82% vs. 21%, p < 0.001), prefabrication (100% vs. 40%, p = 0.002) and use of the zygomatic implant perforator flap technique (100% vs. 39%, p = 0.001). Preoperative prosthodontic consultation was associated with 21-fold increase in the odds of rehabilitation (odds ratio 20.9, 95% confidence interval 6.54-66.66, p < 0.005). CONCLUSION Preoperative prosthodontic evaluation, VSP and reconstructive techniques developed to facilitate implant placement are associated with increased dental rehabilitation rates. Despite using an institutional algorithm, functional dentures are frequently prevented by factors including soft tissue constraints, disease recurrence and patient motivation.
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Affiliation(s)
- George A Petrides
- Faculty of Medicine and Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Gabrielle Hicks
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Masako Dunn
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Catriona Froggatt
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Christine Wallace
- Department of Oral Restorative Sciences, Westmead Centre for Oral Health, NSW Health, Sydney, New South Wales, Australia
| | - Dale Howes
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,School of Dentistry, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Leinkram
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sydney Ch'ng
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia.,Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
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30
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Mooney CP, Clark JR, Shannon K, Palme CE, Ebrahimi A, Gao K, Ch'ng S, Elliott M, Gupta R, Low THH. The significance of regional metastasis location in head and neck cutaneous squamous cell carcinoma. Head Neck 2021; 43:2705-2711. [PMID: 34019319 DOI: 10.1002/hed.26744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 04/21/2021] [Accepted: 05/04/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Regional metastasis of head and neck cutaneous squamous cell carcinoma (HNcSCC) can be seen in either parotid and/or cervical lymph nodes. The aim of this study was to assess whether there was a difference in prognosis between parotid and cervical nodal metastases. METHODS Patients with regional metastasis from HNcSCC were identified from an institutional database. Disease-specific (DSS) and overall survival (OS) were calculated using the Kaplan-Meier method and Cox proportional hazards models. RESULTS Five hundred and thirty-five patients were identified with median follow-up of 26.4 months (3-255 months). Two hundred and thirty-five patients had parotid metastasis, 96 patients had neck metastasis, and 204 patients had both. On multivariable analysis, any regional metastasis to the neck when compared to parotid alone conferred worse DSS (HR 1.8, p = 0.007) and OS (HR 1.3, p = 0.024). CONCLUSION Regional metastasis of HNcSCC to the neck confers worse outcomes compared to metastasis to the parotid alone.
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Affiliation(s)
- Craig P Mooney
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kerwin Shannon
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Ardalan Ebrahimi
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kan Gao
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Sydney Ch'ng
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Michael Elliott
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Ruta Gupta
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia
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Subramaniam N, Palme CE, Low THH. Combined approach for malignant tumours of the deep lobe of the parotid involving the stylomandibular tunnel and parapharyngeal space. Oral Oncol 2021; 119:105283. [PMID: 33910782 DOI: 10.1016/j.oraloncology.2021.105283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Narayana Subramaniam
- Head and Neck Oncology, Chris O'Brien Lifehouse, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Carsten E Palme
- Head and Neck Oncology, Chris O'Brien Lifehouse, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Head and Neck Oncology, Chris O'Brien Lifehouse, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
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Mirian C, Gerds TA, Pedersen MM, de Ridder M, Balm A, Mattavelli D, Piazza C, Jensen LR, Balasubramanian D, Subramaniam N, Dokhe Y, Thankappan K, Iyer S, Karam SD, Wiegand S, Feeley L, Milross C, Gao K, Palme CE, Low THH, Gupta R, Freudlsperger C, Moratin J, Sheahan P, Clark J, Ovesen T. Metrics of pN-staging in oral squamous cell carcinoma: An analysis of 1,905 patients. Eur J Cancer 2021; 150:33-41. [PMID: 33887515 DOI: 10.1016/j.ejca.2021.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/20/2021] [Accepted: 03/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND We aimed to compare the predictive performance of pN-categories in oral squamous cell carcinoma (OSCC) encompassing the most recent 8th edition (TNM8), its predecessor (TNM7), and a newly proposed algorithm (pN-N+), which classifies patients according to the number of positive lymph nodes and extranodal extension. METHODS Consecutive, primary OSCC patients from seven previously published cohorts were included and classified according to the three pN-classifications: TNM7, TNM8 and pN-N+. Overall survival probabilities were summarised with the Kaplan-Meier method. We added each of the three metrics to a Cox regression adjusted for pT-category, lymph nodal yield, age, sex, radiotherapy and chemotherapy, and trained these models in one institution. We evaluated the predictive performance in the remaining six institutions and assessed the predicted 5-year risk of death using the area under the receiver operating characteristics curve (AUC) and Brier scores. RESULTS All 1,905 included patients were classified according to TNM7 and pN-N+. A subset of 1,575 patients was additionally classified according to TNM8, leading to upstaging in 27.0%. The pN-N+ ranked overall best determined by the obtained AUC and Brier scores. In contrast to pN-N+, TNM7 and TNM8 both suffered from disproportionate patient distribution across pN-categories and poor pN-categorial discrimination on overall survival. CONCLUSIONS The TNM8 pN-classification designates a larger subset to more advanced disease stages but failed to show improvement of its predictive performance compared to TNM7. The pN-categories of TNM7/8 are disproportionate and inconsistently discriminated. The pN-N+ conveyed the best measures of prognosis and should be considered in future TNM iterations.
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Affiliation(s)
- Christian Mirian
- Department of Otorhinolaryngology, Region Hospital West Jutland, Holstebro, Denmark.
| | - Thomas A Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Maria M Pedersen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Mischa de Ridder
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Alfons Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Lasse R Jensen
- Department of Otorhinolaryngology, Region Hospital West Jutland, Holstebro, Denmark
| | - Deepak Balasubramanian
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Narayana Subramaniam
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Yogesh Dokhe
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Subramania Iyer
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Sana D Karam
- Department of Radiation Oncology, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Susanne Wiegand
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Linda Feeley
- Department of Pathology, Cork University Hospital, Cork, Ireland; ENTO Research Unit, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Chris Milross
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Kan Gao
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia
| | - Carsten E Palme
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Tsu-Hui Hubert Low
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Ruta Gupta
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Sydney, Australia
| | - Christian Freudlsperger
- Department of Oral and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Julius Moratin
- Department of Oral and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick Sheahan
- ENTO Research Unit, College of Medicine and Health, University College Cork, Cork, Ireland; Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria, University Hospital, Cork, Ireland; Department of Surgery, University College Cork, Cork, Ireland
| | - Jonathan Clark
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Therese Ovesen
- Department of Otorhinolaryngology, Region Hospital West Jutland, Holstebro, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
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Every J, Subramaniam N, Dawson R, Ch'ng S, Low THH, Palme CE, Clark J, Wykes J. Microvascular reconstruction of head and neck defects in the elderly. ANZ J Surg 2021; 91:969-974. [PMID: 33825309 DOI: 10.1111/ans.16771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/26/2021] [Accepted: 02/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Microvascular free-flap reconstruction of the head and neck is a common technique utilized across many ages. The purpose of this study was to identify if advanced age or comorbidity was associated with worse post-operative outcomes in patients undergoing free-flap reconstruction. METHODS A retrospective analysis was performed on 344 consecutive patients undergoing free-flap surgery of the head and neck. Demographic, clinical and pathological factors were considered along with Charlson Comorbidity Index (CCI) scores and American Society of Anesthesiologists (ASA) status. Logistic regression analysis was used to investigate the association of age, CCI or ASA with post-operative complications. RESULTS Elderly patients (≥75 years) had a higher overall complication rate (odds ratio (OR) 1.7, P = 0.04) that was restricted to medical complications (OR 2.1, P = 0.05) and not surgical complications (OR 1.4, P = 0.14). Reconstructions of defects from cutaneous malignancy predominated in the elderly cohort (48% versus 29%, P < 0.01), but there was no difference in complication rate when cutaneous or mucosal subgroups were separated by age. ASA IV status was weakly associated with surgical complications (OR 3.89, P = 0.053), but CCI and elderly age were not associated with any outcome. Median length of stay was similar between age groups. CONCLUSION Free-flap reconstruction in older patients was associated with increased medical complications, and surgical complications were weakly associated with ASA status. Advanced age or comorbidity should not preclude microvascular reconstruction, but comorbid status should be optimized pre-operatively and factors predisposing to medical complications minimized where possible.
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Affiliation(s)
- James Every
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Narayana Subramaniam
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia
| | - Rebecca Dawson
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia
| | - Sydney Ch'ng
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia
| | - Jonathan Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney Head and Neck Cancer Institute, Sydney, New South Wales, Australia
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Hasmat S, Cleary J, Suaning GJ, Lovell NH, Low THH, Clark JR. Dynamic facial reanimation using active implantable prosthesis: Restoring blink. J Plast Reconstr Aesthet Surg 2021; 74:1633-1701. [PMID: 33593711 DOI: 10.1016/j.bjps.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/02/2020] [Accepted: 01/23/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Shaheen Hasmat
- Faculty of Medicine, University of Sydney, Camperdown, NSW 2006, Australia; Department of Head and Neck Surgery, The Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia; Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia.
| | - Jacinta Cleary
- School of Aerospace Mechanical & Mechatronic Engineering, University of Sydney, Camperdown, NSW 2006, Australia
| | - Gregg J Suaning
- School of Aerospace Mechanical & Mechatronic Engineering, University of Sydney, Camperdown, NSW 2006, Australia
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, UNSW Sydney, NSW 2052, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, The Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia; Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Jonathan R Clark
- Faculty of Medicine, University of Sydney, Camperdown, NSW 2006, Australia; Department of Head and Neck Surgery, The Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia; Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
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Subramaniam N, Clark JR, Goldstein D, de Almeida J, Abdalaty AHA, Balasubramanian D, Thankappan K, Iyer S, Batstone M, Iyer NG, Smee RI, Chandrasekhar NH, Pillai V, Shetty V, Rangappa V, Veness M, Low THH. Geographical heterogeneity in the American Joint committee on Cancer oral cancer staging and prognostic implications. Oral Oncol 2020; 113:105122. [PMID: 33352532 DOI: 10.1016/j.oraloncology.2020.105122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 11/19/2020] [Accepted: 11/26/2020] [Indexed: 12/09/2022]
Abstract
OBJECTIVES The AJCC 8th edition (AJCC 8) has introduced depth of invasion (DOI) and extranodal extension (ENE) into staging for oral squamous cell carcinoma (OSCC). Although validations have been performed on institutional datasets have shown a good performance, particularly in early OSCC, there have been no studies on diverse patient populations that determine the impact on prognostic heterogeneity. MATERIALS AND METHODS Retrospective analysis of 4710 patients with oral squamous cell carcinoma (OSCC) treated with surgery +/- adjuvant therapy in 8 institutions in Australia, North America and Asia. With overall survival (OS) as endpoint, the prognostic performance of AJCC 7th and 8th editions were compared using Akaike Information Criterion (AIC), Bayesian Information Criteria (BIC), Harrell's concordance index (C-index). RESULTS When comparing AJCC 8 to AJCC 7, the heterogeneity in prediction of OS increased for T-category and N-category while remaining unchanged for TNM staging, suggesting AJCC 8 increased complexity with no improvement in predictive value. There were significant differences in median DOI and incidence of ENE between geographical regions, resulting in dissimilar rates of stage-migration when adopting AJCC 8. CONCLUSION In an attempt to improve prognostic performance, AJCC 8 introduced more variables; however heterogeneity in these results in significant geographical differences in model discrimination and performance. Caution should be applied as this may result in inaccurate and unreliable prognostic predictions that may impact treatment recommendations.
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Affiliation(s)
- Narayana Subramaniam
- Fellow, Head and Neck Oncology, Chris O'Brien Lifehouse Hospital, Sydney, Australia.
| | - Jonathan Robert Clark
- Head and Neck Oncology, Chris O'Brien Lifehouse Hospital and Central Clinical School, University of Sydney, Australia
| | - David Goldstein
- Head and Neck Oncology, Princess Margaret Cancer Center, University of Toronto, Canada
| | - John de Almeida
- Head and Neck Oncology, Princess Margaret Cancer Center, University of Toronto, Canada
| | | | - Deepak Balasubramanian
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, India
| | - Subramania Iyer
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, India
| | - Martin Batstone
- Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - N Gopal Iyer
- Surgical Oncology, National Cancer Centre, Singapore
| | - Robert I Smee
- Nelune Comprehensive Cancer Centre, Randwick and Faculty of Medicine, University of New South Wales, Australia
| | | | - Vijay Pillai
- Head and Neck Oncology, Mazumdar Shaw Medical Center, Bangalore, India
| | - Vivek Shetty
- Head and Neck Oncology, Mazumdar Shaw Medical Center, Bangalore, India
| | | | - Michael Veness
- Radiation Oncology, Westmead Cancer Care Centre, Westmead and Westmead Clinical School, University of Sydney, Australia
| | - Tsu-Hui Hubert Low
- Fellow, Head and Neck Oncology, Chris O'Brien Lifehouse Hospital, Sydney, Australia
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Hayler R, Low THH, Fung K, Nichols AC, MacNeil SD, Yoo J. Implantable Doppler Ultrasound Monitoring in Head and Neck Free Flaps: Balancing the Pros and Cons. Laryngoscope 2020; 131:E1854-E1859. [PMID: 33141464 DOI: 10.1002/lary.29247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/29/2020] [Accepted: 10/23/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES/HYPOTHESIS Free flap transfer offers a versatile option for reconstruction in head and neck surgery, with success rates over 95%. There remains a substantial re-exploration rate of roughly 5% to 15%, with early recognition of compromise essential to flap survival. Monitoring techniques are highly desirable, with the gold standard being clinical monitoring. The Cook-Swartz Doppler (CSD) probe utilizes Doppler technology to inform clinicians about real-time flow. We aim to describe our adoption of this technology in 100 consecutive free flaps. STUDY DESIGN Prospective case series. METHODS Prospective data were collected from July 2014 to June 2015 on 100 consecutive free flaps performed at a head and neck unit in London, Ontario. All patients had a CSD inserted for arterial and venous monitoring. RESULTS A total of 100 free flaps were performed on 99 patients. Sensitivity was 87.1% and specificity was 85.7%. Positive predictive value was 98.8% and negative predictive value was 33.3%. False-negative and false-positive rate were 1.0% and 12.0%, respectively. The exploration rate was 12%, with no flap loss and two partial debridements. The CSD was helpful in management in 9% of cases and was clinically unhelpful in 11% of cases, with 10 of 11 abnormal signals ignored. There were three unique CSD complications; one retained wire, one pedicle laceration during extraction, and one clot around the probe interrupting signal. CONCLUSIONS The CSD is a helpful adjunct to clinical monitoring but has unique complications, which were not previously described. Pros and cons must be considered for new centers adopting this technology. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1854-E1859, 2021.
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Affiliation(s)
- Raymond Hayler
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Head and Neck Department, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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Smithers FAE, Haymerle G, Palme CE, Low THH, Froggatt C, Gupta R, Clark JR. A prospective study of intraoperative assessment of mucosal squamous cell carcinoma margins in the head and neck. Head Neck 2020; 43:590-600. [PMID: 33098251 DOI: 10.1002/hed.26517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In head and neck cancers, tumor margin assessment has important prognostic and therapeutic implications. Frozen section control of margins is commonly employed intraoperatively. However, this is not without limitations. The aim of this study is to determine whether intraoperative slicing of the whole specimen is feasible and what impact this may have on tumor margin assessment and the requirement for postoperative radiotherapy. METHODS From September 2016 to August 2018, we recruited 22 patients as a pilot study looking at both the practicalities and the clinical relevance of whole margin tumor analysis intraoperatively. Our project is a prospective single arm study with historical controls. RESULTS Forty-one percent of our patients required further intraoperative resection for close or involved margins. Seven of these patients who otherwise would have required adjuvant radiotherapy due to their margin status did not, after our intervention. CONCLUSIONS We found that although requiring resources, this process was feasible without unduly increasing operative times and with potential patient benefit including reduced incidence of adjuvant radiotherapy.
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Affiliation(s)
- Fiona A E Smithers
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Department of Plastic, Reconstructive and Burns Surgery, Hutt Valley Hospital, Lower Hutt, New Zealand
| | - Georg Haymerle
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Department of Otorhinolaryngology - Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Carsten E Palme
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Catriona Froggatt
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Ruta Gupta
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Department of Anatomical Pathology, Royal Prince Albert Hospital, Sydney, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Department of Surgery, Royal Prince Albert Hospital, Sydney, New South Wales, Australia
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Liu TPJ, Fisher BM, Chua B, Clark JR, Low THH, Batstone MD. Survival outcomes following modern multidisciplinary management of oral squamous cell carcinoma in Australia. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:92-98. [PMID: 33187950 DOI: 10.1016/j.oooo.2020.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/23/2020] [Accepted: 09/30/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Oral squamous cell carcinoma (SCC) has been traditionally described as a highly lethal disease. This study aims to provide updated multi-institutional data on the survival of patients with oral SCC in Australia. STUDY DESIGN Retrospective survival analysis was performed between 2008 and 2016. All new patients with oral SCC treated with curative intent were recruited from 2 high-volume Australian head and neck oncology centers. Outcomes were measured in overall survival (OS), disease-specific survival (DSS), disease-free survival, and salvage rates for recurrences. RESULTS Survival analysis included 771 patients with oral SCC. Five-year OS and DSS were 66.1% and 79.7%, respectively. Stage I and II oral SCC had significantly better survival than higher stages. Five-year OS and DSS for patients with stage I SCC were 79.7% and 93.4%, respectively, and for patients with stage IVB they were 37.9% and 54.3%, respectively. Two hundred forty-nine patients had disease recurrence (32.3%), with 66 patients (26.5% remaining disease free post salvage treatment. CONCLUSION Survival outcomes for oral SCC among Australian patients have improved, possibly due to advances in multidisciplinary care. Early detection of oral SCC leads to highly favorable prognosis; there is therefore an opportunity for routine oral cancer screening to be performed by community health practitioners with the aim of improving survival from oral SCC.
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Affiliation(s)
- Timothy P J Liu
- Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.
| | - Bradley M Fisher
- Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Benjamin Chua
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia; Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Jonathan R Clark
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney; Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District
| | - Tsu-Hui Hubert Low
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney; Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District
| | - Martin D Batstone
- Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
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Mooney CP, Gao K, Clark JR, Gupta R, Shannon K, Palme CE, Ebrahimi A, Ch'ng S, Low THH. Soft Tissue Metastases in Head and Neck Cutaneous Squamous Cell Carcinoma. Laryngoscope 2020; 131:E1209-E1213. [PMID: 32926433 DOI: 10.1002/lary.29064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/26/2020] [Accepted: 08/11/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Soft tissue metastases (STM) in head and neck cutaneous squamous cell carcinoma (HNcSCC) are non-nodal based metastases to the parotid and cervical soft tissues of the head and neck. This is a unique subgroup of regional metastases amongst patients with cSCC and have been shown to be associated with poor prognosis. Detailed studies of this subgroup are lacking in the literature. A retrospective cohort analysis was performed to characterize the prognostic significance of STM in HNcSCC based on individual clinicopathological features. METHODS Patients with HNcSCC with STM were identified from the Sydney Head and Neck Cancer Institute database. Clinicopathological characteristics were extracted from the histopathological reports. Recurrence and follow-up data were analyzed to determine disease-free and overall survival using the Kaplan-Meier method and Cox proportional hazards models. RESULTS After excluding all patients with lymph node metastasis with no STM, there were 200 patients identified (161 parotid, 32 cervical, and seven with concurrent parotid and cervical STM) with a 5-year overall survival of 36%. In univariable analysis, age of patients, size of the deposits, location of the deposits, and patients that were not offered adjuvant radiotherapy have worse overall survival. However, on multivariable analysis, age and the number of STM deposits were independent factors that predict for worse survival. CONCLUSION The presence of STM in patients with HNcSCC is associated with poor prognosis. Increasing number of STM deposits, as well as involved margin of the regional excision, negatively impacted on the overall prognosis. LEVEL OF EVIDENCE Level III - retrospective cohort study. Laryngoscope, 131:E1209-E1213, 2021.
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Affiliation(s)
- Craig P Mooney
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kan Gao
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia.,Central Clinical School, University of Sydney, Sydney, Australia.,Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Ruta Gupta
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia.,Central Clinical School, University of Sydney, Sydney, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, NSW Health Pathology, Sydney, Australia
| | - Kerwin Shannon
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia
| | - Carsten E Palme
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia.,Central Clinical School, University of Sydney, Sydney, Australia
| | - Ardalan Ebrahimi
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia.,Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Sydney Ch'ng
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia.,Central Clinical School, University of Sydney, Sydney, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia.,Central Clinical School, University of Sydney, Sydney, Australia
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Ebrahimi A, Gupta R, Luk P, Low THH, McDowell L, Magarey MJR, Smith PN, Perriman DM, Schulte KM, Veness M, Porceddu SV, Clark JR. Number of nodal metastases and the American Joint Committee on cancer staging of head and neck cutaneous squamous cell carcinoma: A multicenter study. Oral Oncol 2020; 111:104855. [PMID: 32835932 DOI: 10.1016/j.oraloncology.2020.104855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/27/2020] [Accepted: 06/07/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We aimed to determine if the number of nodal metastases is an independent predictor of survival in HNcSCC, whether it provides additional prognostic information to the AJCC N and TNM stage and identify optimal cut-points for risk stratification. MATERIALS AND METHODS Retrospective multi-institutional cohort study of patients with parotid and/or cervical nodal metastases from HNcSCC treated with curative intent by surgery ± adjuvant therapy. The impact of number of nodal metastases on disease-specific and overall survival was assessed using multivariate Cox regression. Optimal cut-points for prognostic discrimination modelled using the AIC, BIC, C-index and PVE. RESULTS The study cohort included 1128 patients, with 962 (85.3%) males, median age of 72.9 years (range: 18-100 years) and median follow-up 3.4 years. Adjuvant radiotherapy was administered to 946 (83.9%) patients. Based on objective measures of model performance, number of nodal metastases was classified as 1-2 (N = 816), 3-4 (N = 162) and ≥5 (N = 150) nodes. In multivariate analyses, the risk of disease-specific mortality progressively increased with 3-4 nodes (HR, 1.58; 95% CI: 1.03-2.42; p = 0.036) and ≥5 nodes (HR, 2.91; 95% CI: 1.99-4.25; p < 0.001) with similar results for all-cause mortality. This simple categorical variable provided superior prognostic information to the TNM stage. CONCLUSION Increasing number of nodal metastases is an independent predictor of mortality in HNcSCC, with categorization as 1-2, 3-4 and ≥5 nodes optimizing risk stratification and providing superior prognostic information to TNM stage. These findings may aid in the development of future staging systems as well as identification of high-risk patients in clinical trials.
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Affiliation(s)
- Ardalan Ebrahimi
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia; Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Department of Head and Neck Surgery, The Canberra Hospital, Canberra, Australia.
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Peter Luk
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Matthew J R Magarey
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Paul N Smith
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Diana M Perriman
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Klaus-Martin Schulte
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Michael Veness
- Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Radiation Oncology, Westmead Hospital, Sydney, Australia
| | - Sandro V Porceddu
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; Radiation Oncology Department, Princess Alexandria Hospital, Brisbane, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
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Subramaniam N, Gao K, Gupta R, Clark JR, Low THH. Trends in parotidectomy over 30 years in an Australian tertiary care center. Head Neck 2020; 42:2905-2911. [PMID: 32618071 DOI: 10.1002/hed.26335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 05/10/2020] [Accepted: 05/30/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Nomenclature, classification, and management of parotid tumors are constantly evolving; this study was performed to identify temporal trends in histology and facial nerve sacrifice in parotidectomy during a 30-year period (1987-2018). METHODS Retrospective analysis of patients treated in a single tertiary-care institution during this time period was performed with analysis of temporal trends. RESULTS Two thousand eight hundred and fifty-seven parotidectomies were performed; pleomorphic adenoma was the most common histology (34.3%), followed by skin cancer metastases (32.3%). Significant trends noted were increasing age (P < .001), fewer parotidectomies for inflammatory lesions (P < .001), reduced incidence of mucoepidermoid carcinoma (P = .048), increasing incidence of parotidectomy for cutaneous malignancies (P < .001), and reduced facial nerve sacrifice (P = .034). CONCLUSION In this contemporary series of parotid pathology, metastatic cutaneous malignancies accounted for a third of cases. Despite reducing facial nerve sacrifice in parotid disease, it is still required in approximately 15% of malignancy and needs to be discussed with all patients preoperatively.
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Affiliation(s)
- Narayana Subramaniam
- Head and Neck Oncology, Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kan Gao
- Head and Neck Oncology, Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Ruta Gupta
- Pathology, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Jonathan Robert Clark
- Head and Neck Oncology, Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Pathology, Royal Prince Alfred Hospital and Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Tsu-Hui Hubert Low
- Head and Neck Oncology, Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, NSW, Australia
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Subramaniam N, Clark JR, Goldstein D, de Almeida J, Ali Abdalaty AH, Balasubramanian D, Thankappan K, Iyer S, Batstone M, Gopal Iyer N, Smee RI, Chandrasekhar NH, Pillai V, Shetty V, Rangappa V, Veness M, Hubert Low TH. Stage pN3a in oral cancer: A redundant entity? Oral Oncol 2020; 110:104815. [PMID: 32467072 DOI: 10.1016/j.oraloncology.2020.104815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/20/2020] [Indexed: 11/25/2022]
Affiliation(s)
| | - Jonathan Robert Clark
- Head and Neck Oncology, Chris O'Brien Lifehouse Hospital and Central Clinical School, University of Sydney, Australia
| | - David Goldstein
- Head and Neck Oncology, Princess Margaret Cancer Center, University of Toronto, Canada
| | - John de Almeida
- Head and Neck Oncology, Princess Margaret Cancer Center, University of Toronto, Canada
| | | | - Deepak Balasubramanian
- Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, India
| | - Krishnakumar Thankappan
- Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, India
| | - Subramania Iyer
- Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, India
| | - Martin Batstone
- Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - N Gopal Iyer
- Surgical Oncology, National Cancer Centre, Singapore
| | - Robert I Smee
- Nelune Comprehensive Cancer Centre, Randwick and Faculty of Medicine, University of New South Wales, Australia
| | | | - Vijay Pillai
- Head and Neck Oncology, Mazumdar Shaw Medical Center, Bangalore, India
| | - Vivek Shetty
- Head and Neck Oncology, Mazumdar Shaw Medical Center, Bangalore, India
| | | | - Michael Veness
- Radiation Oncology, Westmead Cancer Care Centre, Westmead and Westmead Clinical School, University of Sydney, Australia
| | - Tsu-Hui Hubert Low
- Head and Neck Oncology, Chris O'Brien Lifehouse Hospital, Sydney, Australia
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Hasmat S, McPherson S, Suaning GJ, Lovell NH, Hubert Low TH, Clark JR. Recreation of eyelid mechanics using the sling concept ✰. J Plast Reconstr Aesthet Surg 2020; 73:942-950. [PMID: 32081580 DOI: 10.1016/j.bjps.2019.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/01/2019] [Accepted: 12/30/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Paralytic lagophthalmos causes major functional, aesthetic and psychological problems in patients with facial paralysis. The Bionic Lid Implant for Natural Closure (BLINC) project aims to restore eyelid function using an implanted electromagnetic actuator combined with an eyelid sling. The authors performed a preliminary study using cadaveric heads to investigate the optimal application of an eyelid sling in various configurations around the orbit. METHODS The sling was tested in a cadaveric sheep head using 2 medial anchor points and 4 lateral ostectomy points. An impulse was generated using gravitational force to test each combination of medial and lateral sling insertion sites using weights between 10 and 50 g. Each generated blink was recorded and analysed. The final result was validated in a human cadaveric model. RESULTS The maximum amount of eye closure and closure speed displayed in sheep were 83.7 ± 9.4% of total closure and 70.6 ± 6.9 mm/s at a maximum force of 490 mN, respectively. The 2 inferior lateral attachments performed better at displacing the eyelid than the superior attachments. The position with the highest degree of eye-closure (improvement of 21.6%, p < 0.001) and speed (improvement of 30.4 mm/s, p < 0.001) was the combination of a posterior medial attachment and an inferior-posterior lateral attachment, which resulted in a near physiological closure in human cadaver. CONCLUSION Closure improved with an inferior lateral position due to increased force acting in the direction of closure. Posterior positioning increases force acting radially, towards the centre of eyelid movement. The latter directs the closure force to effectively move the eyelid around the curved globe.
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Affiliation(s)
- Shaheen Hasmat
- Faculty of Medicine, University of Sydney, Camperdown, New South Wales 2006, Australia; Department of Head and Neck Surgery, The Chris O'Brien Lifehouse, Camperdown, New South Wales 2050, Australia; Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales 2050, Australia.
| | - Shaun McPherson
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia
| | - Gregg J Suaning
- School of Aerospace Mechanical & Mechatronic Engineering, University of Sydney, Camperdown, New South Wales 2006, Australia
| | - Nigel H Lovell
- Graduate School of Biomedical Engineering, UNSW Sydney, New South Wales 2052, Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, The Chris O'Brien Lifehouse, Camperdown, New South Wales 2050, Australia; Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales 2050, Australia; Central Clinical School, University of Sydney; Sydney, Camperdown, New South Wales 2050, Australia
| | - Jonathan R Clark
- Faculty of Medicine, University of Sydney, Camperdown, New South Wales 2006, Australia; Department of Head and Neck Surgery, The Chris O'Brien Lifehouse, Camperdown, New South Wales 2050, Australia; Sydney Facial Nerve Service, The Chris O'Brien Lifehouse, Camperdown, New South Wales 2050, Australia; Central Clinical School, University of Sydney; Sydney, Camperdown, New South Wales 2050, Australia
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Patel KB, Low THH, Partridge A, Nichols AC, MacNeil SD, Yoo J, Fung K. Assessment of shoulder function following scapular free flap. Head Neck 2019; 42:224-229. [PMID: 31657104 DOI: 10.1002/hed.25992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 09/22/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The scapular system free flap has been increasing in popularity to reconstruct short segment mandibular bony defects. It is important to assess donor site morbidities systematically. METHODS Prospective cohort study using objective measures of range of motion (ROM) and shoulder strength were measured. Subjective disability was evaluated with validated questionnaires-Neck Disability Impairment Index and Shoulder Pain and Disability Index. RESULTS Twenty-six patients were recruited-19 with scapular tip and 7 with lateral border scapular free flap. Decreased ROM on the operated side was noted for shoulder abduction, shoulder flexion, and external rotation. No significant difference was noted for shoulder extension. Strength was reduced for shoulder flexion, shoulder abduction, and external rotation. Subjective measurements did not indicate significant shoulder function disruption. CONCLUSION Patients with scapular free flap reconstruction did not experience significant shoulder morbidity. Measures of shoulder ROM and power were objectively affected; however, subjective measures of shoulder disability were not significantly affected.
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Affiliation(s)
- Krupal B Patel
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Tsu-Hui Hubert Low
- Head and Neck Department, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Allison Partridge
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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Vasan K, Satgunaseelan L, Anand S, Asher R, Selinger C, Low THH, Palme CE, Clark JR, Gupta R. Tumour mismatch repair protein loss is associated with advanced stage in oral cavity squamous cell carcinoma. Pathology 2019; 51:688-695. [PMID: 31630878 DOI: 10.1016/j.pathol.2019.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 08/07/2019] [Accepted: 08/19/2019] [Indexed: 01/05/2023]
Abstract
An unexplained increase in the incidence of oral cavity squamous cell carcinoma (oSCC) has been observed despite decreasing smoking rates, particularly in younger patients. Links to defects in the DNA mismatch repair (MMR) system are well established in early onset colorectal, urothelial and gynaecological malignancies. MMR deficient patients treated with immune checkpoint inhibitors have demonstrated improved response rates. Studies exploring MMR status in head and neck squamous cell carcinoma (HNSCC) demonstrate conflicting results. This study explores the incidence of MMR protein loss and its association with clinicopathological features and outcome in oSCC. Immunohistochemical staining using tissue microarrays to assess the expression of MMR proteins (hMLH1, hMSH2, hMSH6, and hPMS2) was performed on 285 consecutive oSCC cases between 2000 and 2016. Data on smoking, alcohol and metachronous malignancies were retrospectively collected. Proportional hazards regression models were used to compare survival in MMR intact and deficient patients. MMR deficiency was seen in 21 patients (7.4%). MMR deficient tumours were associated with bone invasion (52% vs 32%, p=0.05), higher pT stage (pT4 in 57% vs 35%, p<0.001) and a higher number of metachronous malignancies (p=0.05). MMR deficiency was not associated with younger age at presentation or absence of smoking or alcohol. There was no significant association between MMR status and survival (overall survival hazard ratio 1.36; p=0.32). The incidence of MMR loss in oSCC is low and is not associated with young age at presentation. MMR deficiency in oSCC is associated with an increase in the number of metachronous malignancies and more advanced primary tumours.
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Affiliation(s)
- Kartik Vasan
- Central Clinical School, University of Sydney, Sydney, NSW, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia.
| | - Laveniya Satgunaseelan
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Sunaina Anand
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rebecca Asher
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Christina Selinger
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Carsten E Palme
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Jonathan R Clark
- Central Clinical School, University of Sydney, Sydney, NSW, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Ruta Gupta
- Central Clinical School, University of Sydney, Sydney, NSW, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Hasmat S, Ebrahimi A, Gao K, Low THH, Palme C, Gupta R, Clark J. Multifocal perineural invasion is a better prognosticator than depth of invasion in oral squamous cell carcinoma. Head Neck 2019; 41:3992-3999. [PMID: 31487105 DOI: 10.1002/hed.25940] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/24/2019] [Accepted: 08/15/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Prognostic significance of perineural invasion (PNI) in oral squamous cell carcinoma (OSCC) characterized as unifocal and multifocal was compared to depth of invasion (DOI) and extranodal extension (ENE). MATERIALS AND METHODS Univariable and multivariable analyses of 861 consecutive patients with OSCC undergoing treatment between 1995 and 2018 were performed, with local failure (LF) and disease-specific mortality (DSS) as the primary endpoints. RESULTS After adjusting for other adverse histopathological factors and adjuvant therapy, multifocal PNI was associated with a greater risk of LF (P = .01) and DSS (P = 0.02) compared to DOI. The effect of multifocal PNI was comparable to the effect of nodal metastases without ENE (P = 0.02). LF and DSS were not improved by the administration of adjuvant radiotherapy within unifocal or multifocal PNI groups. CONCLUSION Multifocal PNI is associated with a greater risk of death in OSCC than DOI. Its effect is comparable to that of nodal metastases (without ENE).
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Affiliation(s)
- Shaheen Hasmat
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Ardalan Ebrahimi
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Medical School College of Health and Medicine, Australian National University, Canberra, Australia
| | - Kan Gao
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | | | - Ruta Gupta
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jonathan Clark
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
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Zilberg C, Lee MW, Kraitsek S, Ashford B, Ranson M, Shannon K, Iyer NG, Ch'ng S, Low THH, Palme C, Clark J, Gupta R, Yu B. Is high-risk cutaneous squamous cell carcinoma of the head and neck a suitable candidate for current targeted therapies? J Clin Pathol 2019; 73:17-22. [PMID: 31300530 DOI: 10.1136/jclinpath-2019-206038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cutaneous squamous cell carcinoma (cSCC) is the second most common malignancy, most frequently affecting the head and neck. Treatment often requires surgery and can have significant functional morbidity. Research into disease pathogenesis and second line medical management of cSCC is limited. We assess genetic mutations in high-risk, primary head and neck cutaneous squamous cell carcinomas (HNcSCC) that may hinder or be beneficial for use of targeted therapy in disease management. METHODS Genetic alterations and variant allele frequencies (VAFs) were analysed using a clinically relevant 48 gene panel in 10 primary high-risk non-metastatic treatment-naïve HNcSCC to evaluate applicability of targeted therapeutics. Variants present at all VAFs were evaluated for pathogenicity. Somatic mutation patterns of individual tumours were analysed. RESULTS High-risk HNcSCC showed a high proportion (82%) of C to T transitions in keeping with ultraviolet-mediated damage. There was significant intratumour genetic heterogeneity in this cohort (MATH scores 20-89) with the two patients <45 years of age showing highest intratumour heterogeneity. TP53 was altered at VAF >22% in all cases, and mutations with highest VAF were observed in tumour suppressor genes in 80%. 70% of cases demonstrated at least one mutation associated with treatment resistance (KIT S821F, KIT T670I, RAS mutations at codons 12 and 13). CONCLUSION We demonstrate high proportion tumour suppressor loss of function mutations, high intratumour genetic heterogeneity, and presence of well recognised resistance mutations in treatment naïve primary HNcSCC. These factors pose challenges for successful utilisation of targeted therapies.
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Affiliation(s)
- Catherine Zilberg
- Medicine, Gosford Hospital, Gosford, New South Wales, Australia .,Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Spiridoula Kraitsek
- Medical Genomics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Bruce Ashford
- Biological Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Marie Ranson
- Biological Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Kerwin Shannon
- The Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - N Gopalakrishna Iyer
- Sinnghealth/Duke-NUS Head and Neck Centre, National Cancer Centre Singapore, Singapore, Singapore
| | - Sydney Ch'ng
- The Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Central Clinical School Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- The Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Central Clinical School Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Carsten Palme
- The Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.,Central Clinical School Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Clark
- The Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Ruta Gupta
- Anatomic Pathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Bing Yu
- Molecular and Clinical Genetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Mazzola F, Gupta R, Luk PP, Palme C, Clark JR, Low THH. The Milan System for Reporting Salivary Gland Cytopathology-Proposed modifications to improve clinical utility. Head Neck 2019; 41:2566-2573. [DOI: 10.1002/hed.25732] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/19/2019] [Accepted: 02/19/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Francesco Mazzola
- Department of Otorhinolaryngology and Head and Neck Surgery; IRCCS Ospedale Policlinico San Martino; Genoa Italy
- Department of Head and Neck Surgery; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse; Sydney Australia
| | - Ruta Gupta
- Central Clinical School, University of Sydney; Sydney Australia
- Department of Tissue Pathology and Diagnostic Oncology; Royal Prince Alfred Hospital; Sydney Australia
| | - Peter P. Luk
- Central Clinical School, University of Sydney; Sydney Australia
| | - Carsten Palme
- Department of Head and Neck Surgery; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse; Sydney Australia
- Central Clinical School, University of Sydney; Sydney Australia
| | - Jonathan R. Clark
- Department of Head and Neck Surgery; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse; Sydney Australia
- Central Clinical School, University of Sydney; Sydney Australia
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse; Sydney Australia
- Central Clinical School, University of Sydney; Sydney Australia
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Murthy S, Low THH, Subramaniam N, Balasubramanian D, Sivakumaran V, Anand A, Vijayan SN, Nambiar A, Thankappan K, Iyer S. Validation of the eighth edition AJCC staging system in early T1 to T2 oral squamous cell carcinoma. J Surg Oncol 2018; 119:449-454. [PMID: 30575027 DOI: 10.1002/jso.25348] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 12/06/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND To validate the newly proposed American Joint Committee on Cancer (AJCC) eighth edition staging in early T1 and T2 oral cavity cancers and its effect in predicting tumour control. METHODS Retrospective analysis of treatment outcomes of 441 T1 to T2 oral squamous cell carcinoma (OSCC). Overall survival (OS), disease-specific survival (DSS), and tumour control were calculated and compared between the AJCC 7 and 8 staging systems. RESULTS The 5-year OS was 78% and 61% for T1 and T2 tumours, respetively (P < 0.001) (AJCC 7) vs 87% and 67% (P < 0.001) (AJCC 8). The 5-year DSS was 78% and 61% for T1 and T2, respectively (P < 0.001) (AJCC 7) vs 89% and 71% (P < 0.001) (AJCC 8). For stages I and II tumours the 5-year OS was 81% and 76%, respectively (P < 0.302) (AJCC 7) vs 87% and 73% (P < 0.017) (AJCC 8). The 5-year DSS was 83% and 82% (P < 0.222) vs 89% and 77% (P < 0.016). With the AJCC eighth edition the 5-year local, regional, and distant control rates for T1 vs T2 tumours were 85% vs 74% (P = 0.003), 95% vs 77% (P = 0.001), and 95% vs 80% (P = 0.014), respectively. CONCLUSION The AJCC 8th staging system provided for more accurate prediction of OS, DSS, and disease control in early oral cavity cancers.
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Affiliation(s)
- Samskruthi Murthy
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Narayana Subramaniam
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Deepak Balasubramanian
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Vidhyadharan Sivakumaran
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Adharsh Anand
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Smitha Nalumackal Vijayan
- Department of Pathology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Ajit Nambiar
- Department of Pathology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Subramania Iyer
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
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Subramaniam N, Balasubramanian D, Low THH, Murthy S, Anand A, Prasad C, Vijayan SN, Thankappan K, Iyer S. Role of adverse pathological features in surgically treated early oral cavity carcinomas with adequate margins and the development of a scoring system to predict local control. Head Neck 2018; 40:2329-2333. [DOI: 10.1002/hed.25163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/03/2017] [Accepted: 02/08/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Narayana Subramaniam
- Department of Head and Neck Oncology; Amrita Institute of Medical Sciences; Kerala India
| | - Deepak Balasubramanian
- Department of Head and Neck Oncology; Amrita Institute of Medical Sciences; Kerala India
| | | | - Samskruthi Murthy
- Department of Head and Neck Oncology; Amrita Institute of Medical Sciences; Kerala India
| | - Adharsh Anand
- Department of Head and Neck Oncology; Amrita Institute of Medical Sciences; Kerala India
| | - Chaya Prasad
- Department of Pathology; Amrita Institute of Medical Sciences; Kerala India
| | - Smitha N. Vijayan
- Department of Pathology; Amrita Institute of Medical Sciences; Kerala India
| | | | - Subramania Iyer
- Department of Head and Neck Oncology; Amrita Institute of Medical Sciences; Kerala India
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