The authors stress the importance of the external branch of the superior laryngeal nerve in laryn... more The authors stress the importance of the external branch of the superior laryngeal nerve in laryngeal physiology, by noting the consequences of its section during thyroid surgery. A rigorous anatomical study carried out on 15 fresh cadavers, i.e. 30 superior laryngeal nerves, reproducing the conditions of thyroid surgery, allowed precision of the time during surgery when the external branch is at risk of being damaged, especially during sectioning of the vascular pedicle of the upper pole and at the time of separation of the thyroid pole from the laryngeal axis. The study considers the anatomical variations of the territory of the superior thyroid artery and the various technical problems that are posed in preserving the external branch of the nerve. In the light of their findings, the authors advise that this nerve axis should be identified before ligature of the upper thyroid pedicle; if the advice is not followed then the external branch of the superior laryngeal nerve may be damaged or sectioned in approximately 15% of cases.
The oropharynx belongs to the upper aerodigestive tract including the base of tongue and vallecul... more The oropharynx belongs to the upper aerodigestive tract including the base of tongue and vallecula, the posterior pharyngeal wall, the tonsillar region and lateral oropharyngeal walls, and the soft palate and uvula. Most oropharyngeal cancers are squamous cell carcinoma (OPSCC). Similar to other head and neck cancers, OPSCCs were traditionally more often diagnosed in heavy smokers/heavy drinkers with lower income, lower socioeconomical background and frequent comorbidities related to their lifestyle. However, the last two decades have witnessed an increase in the incidence of OPSCC related to the emergence of human papillomavirus (HPV) -positive tumours mainly observed in high-income countries. [...
Distant metastases from head and neck squamous cell carcinoma (HNSCC), though rare at initial pre... more Distant metastases from head and neck squamous cell carcinoma (HNSCC), though rare at initial presentation, remain an important manifestation of cancer recurrence and mortality. Although generally considered incurable with a dismal prognosis despite palliative therapy, highly selected patients with distant metastases may have a long term survival benefit from aggressive surgery or radiotherapy. Advances in systemic treatments also may improve patient survival. This article reviews the current state of management of HNSCC patients with distant metastases.
Cancer spreads locally through direct infiltration into soft tissues or at distance by invading v... more Cancer spreads locally through direct infiltration into soft tissues or at distance by invading vascular structures, then migrating through the lymphatic or blood flow. Although cancer cells carried in the blood can end in virtually any corner of the body, lymphatic migration is usually stepwise, through successive nodal stops, which can temporarily delay further progression. In radiotherapy, irradiation of lymphatic paths relevant to the localisation of the primary has been common practice for decades. Similarly, excision of cancer is often completed by lymphatic dissection. Both in radiotherapy and in surgery, advanced knowledge of the lymphatic pathways relevant to any tumor location is an important information for treatment preparation and execution. This first part describes the major collecting trunks of the lymphatic system and then the lymphatics of the head and neck providing anatomical bases for the radiological delineation of lymph node areas in the cervical region, it adds to the existing nomenclature of six nodal levels (I-VI), three new areas listed as parotid, buccal and external jugular levels.
Annals of Otology, Rhinology, and Laryngology, Jun 1, 1990
Thirty-nine patients were treated with GAX collagen for vocal fold augmentation. The objective re... more Thirty-nine patients were treated with GAX collagen for vocal fold augmentation. The objective results were evaluated by measurement of the maximum phonation time, the phonatory quotient, vocal frequency analysis, and laryngostroboscopy. These results are as good as those with Zyderm Collagen II (ZCI). Avoidance of useless overcorrection, better resistance to collagenase, and less induced hypersensitivity differentiate GAX from ZCI.
Eighty-three patients (median age, 56 years and Karnofsky performance status greater than or equa... more Eighty-three patients (median age, 56 years and Karnofsky performance status greater than or equal to 70) were treated with carboplatin (Carbo) and fluorouracil (5Fu) for stage III and IV head and neck squamous cell carcinoma (HNSCC). 5Fu (1 g/m2/d) was administered from day 1 to 4 by continuous infusion. Carbo was given on day 1 and, in order to evaluate its maximum-tolerated dose (MTD), the dose level was progressively increased from 250 mg/m2 to 450 mg/m2. The effectiveness of this association and its potential role in local control were also evaluated. Three patients received Carbo at a dose of 250 mg/m2, 13 received 300 mg/m2, one received 330 mg/m2, 12 received 350 mg/m2, six received 375 mg/m2, 26 received 400 mg/m2, 18 received 420 mg/m2, and four received 450 mg/m2. Two (13 of 83) or three courses (64 of 83), repeated every 4 weeks, were administered. The overall (primary tumor and node) response and complete response (CR) rates were 33% and 14%, respectively. For primary tumor, the response rate (RR) was 57% with 32% CR and 18% pathologic complete response (PCR); the RR was higher for patients with oropharyngeal tumor (76%, P = .037) and for patients treated with Carbo greater than or equal to 350 mg/m2 (65%, P = .02); the tumor size (T1 + T2 v T3 + T4) was a good prognostic factor for RR (90% v 46%, P = .001), CR (65% v 20%, P less than .001), and PCR (45% v 8%, P less than .001). For nodes, the RR was 33% with 11% CR. Grade 3-4 neutropenia and thrombocytopenia were experienced by 17% and 28% of the patients treated with 420 mg/m2 of Carbo and by 50% of the patients treated with 450 mg/m2. The MTD can be fixed at 420 mg/m2 and the proposed dose at 400 mg/m2. Thirty-eight patients were treated with surgery plus radiotherapy, 33 with radiotherapy alone, and seven with surgery alone. The median follow-up is 12 months. The 18-month disease-free survival (DFS) is 78% for overall complete responders and 39% for the others (P = .04). There is no primary tumor recurrence among the 12 patients with a primary tumor PCR treated by radiotherapy alone for tumor control (median follow-up, 17.3 months). The association of Carbo-5Fu is a safe induction chemotherapy regimen for HNSCC. The proposed dose of Carbo for future treatment is 400 mg/m2.(ABSTRACT TRUNCATED AT 400 WORDS)
The Head and Neck Cancer Group (HNCG) of the EORTC conducted a quality assurance program in the E... more The Head and Neck Cancer Group (HNCG) of the EORTC conducted a quality assurance program in the EORTC 24954 trial on larynx preservation. In this multicentre study, patients with resectable advanced squamous cell carcinoma of the larynx or hypopharynx were randomly assigned for treatment with sequential or alternating chemoradiation. The need for a quality assurance program is the evaluation and prevention of differences in treatments between centres in this multidisciplinary study. The surgical subcommittee of the HNCG prepared a questionnaire, and clinical records of all patients were verified during audits of independent teams. Data relating institutional practices were collected during a face to face interview with members of the local team. 271 clinical records from the nine main contributing centres were reviewed. The main difference between centres was the time interval between first consultation and treatment initiation, with a mean of 45 days. On the pathology report the nodal involvement was described by level in 36% of the cases according to the American Academy of Otolaryngology-Head and Neck Surgery classification. Extranodal spread was not always described in neck dissection specimens. The EORTC 24954 trial on larynx preservation was the first prospective trial with a quality assurance program in head and neck surgical oncology. The analysis shows similarities in practices, but also points out some important differences between centres. Operation reports were fairly complete, but uniformity in pathology reports should be improved.
Percutaneous tracheotomy (TP) is a standard procedure for airway establishment in selected indica... more Percutaneous tracheotomy (TP) is a standard procedure for airway establishment in selected indications. It is not considered a standard technique for the management of emergency airway situations despite more and more reports high-lighting its use in this setting. In this chapter, we compare TP with other emergency airway access techniques and describe a new approach to manage patients with major airway obstruction leading to "no ventilation, no intubation" situations Under general anaesthesia.
Based on our retrospective data, the optimal tumor thickness cut-off point for prompting prophyla... more Based on our retrospective data, the optimal tumor thickness cut-off point for prompting prophylactic neck dissection is 5 mm. However, larger prospective studies bases on TT measures on preoperative imaging techniques (MRI or US) are needed before to propose a wait-and-see policy.
The authors stress the importance of the external branch of the superior laryngeal nerve in laryn... more The authors stress the importance of the external branch of the superior laryngeal nerve in laryngeal physiology, by noting the consequences of its section during thyroid surgery. A rigorous anatomical study carried out on 15 fresh cadavers, i.e. 30 superior laryngeal nerves, reproducing the conditions of thyroid surgery, allowed precision of the time during surgery when the external branch is at risk of being damaged, especially during sectioning of the vascular pedicle of the upper pole and at the time of separation of the thyroid pole from the laryngeal axis. The study considers the anatomical variations of the territory of the superior thyroid artery and the various technical problems that are posed in preserving the external branch of the nerve. In the light of their findings, the authors advise that this nerve axis should be identified before ligature of the upper thyroid pedicle; if the advice is not followed then the external branch of the superior laryngeal nerve may be damaged or sectioned in approximately 15% of cases.
The oropharynx belongs to the upper aerodigestive tract including the base of tongue and vallecul... more The oropharynx belongs to the upper aerodigestive tract including the base of tongue and vallecula, the posterior pharyngeal wall, the tonsillar region and lateral oropharyngeal walls, and the soft palate and uvula. Most oropharyngeal cancers are squamous cell carcinoma (OPSCC). Similar to other head and neck cancers, OPSCCs were traditionally more often diagnosed in heavy smokers/heavy drinkers with lower income, lower socioeconomical background and frequent comorbidities related to their lifestyle. However, the last two decades have witnessed an increase in the incidence of OPSCC related to the emergence of human papillomavirus (HPV) -positive tumours mainly observed in high-income countries. [...
Distant metastases from head and neck squamous cell carcinoma (HNSCC), though rare at initial pre... more Distant metastases from head and neck squamous cell carcinoma (HNSCC), though rare at initial presentation, remain an important manifestation of cancer recurrence and mortality. Although generally considered incurable with a dismal prognosis despite palliative therapy, highly selected patients with distant metastases may have a long term survival benefit from aggressive surgery or radiotherapy. Advances in systemic treatments also may improve patient survival. This article reviews the current state of management of HNSCC patients with distant metastases.
Cancer spreads locally through direct infiltration into soft tissues or at distance by invading v... more Cancer spreads locally through direct infiltration into soft tissues or at distance by invading vascular structures, then migrating through the lymphatic or blood flow. Although cancer cells carried in the blood can end in virtually any corner of the body, lymphatic migration is usually stepwise, through successive nodal stops, which can temporarily delay further progression. In radiotherapy, irradiation of lymphatic paths relevant to the localisation of the primary has been common practice for decades. Similarly, excision of cancer is often completed by lymphatic dissection. Both in radiotherapy and in surgery, advanced knowledge of the lymphatic pathways relevant to any tumor location is an important information for treatment preparation and execution. This first part describes the major collecting trunks of the lymphatic system and then the lymphatics of the head and neck providing anatomical bases for the radiological delineation of lymph node areas in the cervical region, it adds to the existing nomenclature of six nodal levels (I-VI), three new areas listed as parotid, buccal and external jugular levels.
Annals of Otology, Rhinology, and Laryngology, Jun 1, 1990
Thirty-nine patients were treated with GAX collagen for vocal fold augmentation. The objective re... more Thirty-nine patients were treated with GAX collagen for vocal fold augmentation. The objective results were evaluated by measurement of the maximum phonation time, the phonatory quotient, vocal frequency analysis, and laryngostroboscopy. These results are as good as those with Zyderm Collagen II (ZCI). Avoidance of useless overcorrection, better resistance to collagenase, and less induced hypersensitivity differentiate GAX from ZCI.
Eighty-three patients (median age, 56 years and Karnofsky performance status greater than or equa... more Eighty-three patients (median age, 56 years and Karnofsky performance status greater than or equal to 70) were treated with carboplatin (Carbo) and fluorouracil (5Fu) for stage III and IV head and neck squamous cell carcinoma (HNSCC). 5Fu (1 g/m2/d) was administered from day 1 to 4 by continuous infusion. Carbo was given on day 1 and, in order to evaluate its maximum-tolerated dose (MTD), the dose level was progressively increased from 250 mg/m2 to 450 mg/m2. The effectiveness of this association and its potential role in local control were also evaluated. Three patients received Carbo at a dose of 250 mg/m2, 13 received 300 mg/m2, one received 330 mg/m2, 12 received 350 mg/m2, six received 375 mg/m2, 26 received 400 mg/m2, 18 received 420 mg/m2, and four received 450 mg/m2. Two (13 of 83) or three courses (64 of 83), repeated every 4 weeks, were administered. The overall (primary tumor and node) response and complete response (CR) rates were 33% and 14%, respectively. For primary tumor, the response rate (RR) was 57% with 32% CR and 18% pathologic complete response (PCR); the RR was higher for patients with oropharyngeal tumor (76%, P = .037) and for patients treated with Carbo greater than or equal to 350 mg/m2 (65%, P = .02); the tumor size (T1 + T2 v T3 + T4) was a good prognostic factor for RR (90% v 46%, P = .001), CR (65% v 20%, P less than .001), and PCR (45% v 8%, P less than .001). For nodes, the RR was 33% with 11% CR. Grade 3-4 neutropenia and thrombocytopenia were experienced by 17% and 28% of the patients treated with 420 mg/m2 of Carbo and by 50% of the patients treated with 450 mg/m2. The MTD can be fixed at 420 mg/m2 and the proposed dose at 400 mg/m2. Thirty-eight patients were treated with surgery plus radiotherapy, 33 with radiotherapy alone, and seven with surgery alone. The median follow-up is 12 months. The 18-month disease-free survival (DFS) is 78% for overall complete responders and 39% for the others (P = .04). There is no primary tumor recurrence among the 12 patients with a primary tumor PCR treated by radiotherapy alone for tumor control (median follow-up, 17.3 months). The association of Carbo-5Fu is a safe induction chemotherapy regimen for HNSCC. The proposed dose of Carbo for future treatment is 400 mg/m2.(ABSTRACT TRUNCATED AT 400 WORDS)
The Head and Neck Cancer Group (HNCG) of the EORTC conducted a quality assurance program in the E... more The Head and Neck Cancer Group (HNCG) of the EORTC conducted a quality assurance program in the EORTC 24954 trial on larynx preservation. In this multicentre study, patients with resectable advanced squamous cell carcinoma of the larynx or hypopharynx were randomly assigned for treatment with sequential or alternating chemoradiation. The need for a quality assurance program is the evaluation and prevention of differences in treatments between centres in this multidisciplinary study. The surgical subcommittee of the HNCG prepared a questionnaire, and clinical records of all patients were verified during audits of independent teams. Data relating institutional practices were collected during a face to face interview with members of the local team. 271 clinical records from the nine main contributing centres were reviewed. The main difference between centres was the time interval between first consultation and treatment initiation, with a mean of 45 days. On the pathology report the nodal involvement was described by level in 36% of the cases according to the American Academy of Otolaryngology-Head and Neck Surgery classification. Extranodal spread was not always described in neck dissection specimens. The EORTC 24954 trial on larynx preservation was the first prospective trial with a quality assurance program in head and neck surgical oncology. The analysis shows similarities in practices, but also points out some important differences between centres. Operation reports were fairly complete, but uniformity in pathology reports should be improved.
Percutaneous tracheotomy (TP) is a standard procedure for airway establishment in selected indica... more Percutaneous tracheotomy (TP) is a standard procedure for airway establishment in selected indications. It is not considered a standard technique for the management of emergency airway situations despite more and more reports high-lighting its use in this setting. In this chapter, we compare TP with other emergency airway access techniques and describe a new approach to manage patients with major airway obstruction leading to "no ventilation, no intubation" situations Under general anaesthesia.
Based on our retrospective data, the optimal tumor thickness cut-off point for prompting prophyla... more Based on our retrospective data, the optimal tumor thickness cut-off point for prompting prophylactic neck dissection is 5 mm. However, larger prospective studies bases on TT measures on preoperative imaging techniques (MRI or US) are needed before to propose a wait-and-see policy.
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