BACKGROUND: Little is known about the rehabilitation outcomes of long-term survivors following treatment for head and neck cancer. There are, for example, no studies on physical and psychosocial rehabilitation outcomes of T1 glottic larynx carcinoma, despite the fact that these form the majority of head and neck cancer sites. Thus, this investigation afforded a unique opportunity for examining similarities and differences among T1 glottic larynx patients, laryngectomy patients, and those who had surgery for cancer of the oral cavity and/or oropharynx along a variety of physical and psychosocial dimensions. METHODS: To describe the impact of these three types of head and neck cancer and their treatment on the physical and psychosocial functioning of long-term survivors, a self-report questionnaire was completed by 110 patients treated between 2 and 6 years previously in a major cancer center. RESULTS: Data indicate that a higher percentage of patients treated with laryngectomy or commando procedures still experience severe psychosocial distress between 2 and 6 years after their last treatment than do patients treated with radiotherapy for a T1 carcinoma of the glottic larynx. Psychosocial and physical complaints are still reported by many laryngectomy patients, apparently the result of problems in effective communication with others. Many commando procedure patients experience problems with respect to food intake, and with disfigurement and its consequences. T1 larynx patients mainly experience a considerable number of physical complaints. The greater the time that had elapsed since treatment, the fewer the psychosocial problems associated with head and neck tumors. Open discussion of the illness in the family, social support, and perceptions of adequate information from the specialist are the most important predictors of positive rehabilitation outcomes. CONCLUSIONS: This study indicates that T1 larynx patients report many physical complaints even though several years had elapsed since treatment. Also, laryngectomy patients may need psychosocial guidance for a longer posttreatment period and that health care personnel must involve the partner as much as possible in all communications. Commando procedure patients in particular feel hindered by their disfigurement and its consequences. Future research with respect to validation of the specific head and neck modules is needed.

Adaptation, Psychological↗

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Computed tomography of the human developing anterior skull base.

The ossification of the anterior skull base, especially the lamina cribrosa, has been studied by computed tomography and histopathology. Sixteen human fetuses, (referred to our laboratory for pathological examination after spontaneous abortion between 18 and 32 weeks of gestation) and three infants, (1, 2 and 6 years of age, respectively) were examined. The cartilaginous preformation of the anterior skull base creates a 'pseudo-defect' on CT in the coronal plane, even with ultra thin sections and high resolution CT. By the age of 6 years of life this 'artefact' is no longer, as the present ossification of the lamina cribrosa is, by that time, complete.

Embryonic and Fetal Development↗

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Assessment of cervical metastatic disease.

Ultrasound of the neck is, when combined with ultrasound-guided fine-needle aspiration biopsy (UGFNAB), an accurate test for nodal disease in patients with head and neck squamous cell cancer (HNSCC). The combined procedure is characterized by high sensitivity and specificity. Therefore, the technique is suited for demonstrating, detecting and excluding cervical metastatic disease. This paper will discuss how to interpret the diagnostic information supplied by US-UGFNAB. It is concluded that US-UGFNAB is a promising concept of methodic use of both an imaging technique and cytopathologic examination in the evaluation of patients with HNSCC. Application of the combined procedure may produce a more accurate classification of these patients and may change indications for therapeutic and elective neck treatment. In addition, US-UGFNAB may prove to be valuable during follow-up of patients with HNSCC, in the accurate preoperative assessment of the carotid artery in patients with metastatic neck disease, and the detection of lymph nodes in patients with malignancies other than HNSCC.

Biopsy, Needle↗

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Ultrasound in the diagnosis of laryngoceles.

Clinical and anatomical features of laryngoceles are reviewed. Furthermore, the ultrasound characteristics of 8 patients with laryngoceles are outlined. Internal laryngoceles appeared to be echo-free, well-defined structures inside the thyroid cartilage. Combined laryngoceles had an additional cystic mass outside the laryngeal skeleton, at the thyrohyoid membrane. Characteristically, this cystic mass was connected through the thyrohyoid membrane to the intra-laryngeal mass. Finally, the value of ultrasound examination in the diagnostic work-up of patients with laryngoceles is appreciated and compared to the respective values of ENT examination, conventional tomography and CT.

Diagnosis, Differential↗

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Evaluation of branchiogenic cysts by ultrasound.

Ultrasound and palpation findings of 17 patients with branchiogenic cysts were studied. Results were compared with operative and histopathologic findings in 13 patients, and to fistulography, cytologic examination and/or CT in 4 patients. Ultrasound findings (appearance, location and extension) were characteristic in 15 of 17 cases. Palpation proved to be incorrect or inconclusive in more than half of the patients. It is concluded that ultrasound examination of the neck may contribute to the correct presurgery diagnosis of branchiogenic cysts.

Biopsy, Needle↗

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Ultrasound characteristics of thyroglossal duct anomalies.

The purpose of this study was to determine the value of ultrasound examination in the diagnosis of thyroglossal duct anomalies. The ultrasound and palpation findings in 24 patients with a thyroglossal duct anomaly were reviewed. Cysts, tracts and ectopic thyroid tissue appeared to produce a characteristic ultrasound pattern in most cases. This study includes 5 patients with non-symptomatic lesions which were detected at ultrasound examination. The necessity of performing a radionuclide scan prior to surgery for a thyroglossal duct anomaly is reconsidered in view of the diagnostic power of ultrasound in thyroid disease.

Biopsy, Needle↗

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Reconstruction of the anterior laryngeal wall with a composite graft of demineralized bovine bone matrix and autogenous perichondrium. An experimental study in adult rabbits.

In this study the feasibility to reconstruct the anterior laryngeal wall in adult rabbits with a composite graft of demineralized bovine bone matrix and autogenous perichondrium was investigated. It is demonstrated that demineralized bovine bone, which is a porous biomaterial, is completely transformed into autologous cartilage, once it is implanted in a vascularized perichondrial pocket. It appeared to be possible to reconstruct the anterior laryngeal wall in adult rabbits with this newly formed cartilage. As the biomaterial has been transformed into autologous tissue it is entirely incorporated at the recipient site giving rise to solid connections (cartilaginous and/or fibrous) with the surrounding tissues.

Animals↗

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Induction in vivo of cartilage grafts for craniofacial reconstruction.

In the craniofacial region, defects of cartilage structures are preferably reconstructed with autologous cartilage. Donor-site morbidity related to the creation of a new defect elsewhere, and a lack of growth potential of the graft--mandatory in children--have stimulated investigators to find other ways to generate new "extra" cartilage. Several biomaterials have been tested as a matrix for the ingrowth of (peri)chondroblasts in experimental animals. In young (growing) rabbits we have developed a process of heterotopic cartilage induction with the use of a demineralized (bovine) bone matrix which is enfolded in a pedicled flap of ear perichondrium for at least three weeks. During this period the demineralized matrix is colonized by macrophages and polymorphonuclear cells which start a process of complete biodegradation of the material. Simultaneously, the collagen matrix is invaded by mesenchymal cells, originating from the perichondrium and differentiating into chondroblasts and later, into chondrocytes forming the intercellular substance. The developing, very young cartilage could be demonstrated as collagen type II, thus, hyaline cartilage. When applied with its adherent perichondrium as a graft, it merges easily with the more matured host cartilage and even appears to be capable of further growth. Therefore, it seems suitable for the reconstruction of a cartilaginous defect in growing cartilaginous structures like the nasal septum or the larynx.

Animals↗

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Skulls with facial clefts. Experimental surgery on the facial skeleton.

Skulls of adult, unoperated patients with facial clefts show additional anomalies specific for the type of cleft. In an experimental study we demonstrated that similar anomalies develop in rabbits with clefts that are artificially made in the fourth week after birth. Some surgical methods (Veau, primary osteoplasty) for correction of facial clefts are compared with regard to their effect upon later growth of the skull of young rabbits. The importance of experimental surgery preceding the introduction of new surgical techniques on the growing skull and its facial skeleton in particular is stressed.

Abnormalities, Multiple↗

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Growth mechanisms in skulls with facial clefts. Descriptive and experimental studies on the facial skeleton.

During postnatal growth, skulls of patients with untreated unilateral clefts of the alveolus and palate develop additional anomalies of the facial skeleton. Similar anomalies--a deviation of the upper jaw to the non-cleft side and retropositioning of the maxilla on the cleft side--develop in rabbits with the same type of cleft, surgically produced in the fourth week after birth. Based on a quantitative study of the postnatal growth of the rabbit skull under normal and various experimental conditions, a mechanisms is proposed for the late developement of anomalies of the facial skeleton in cleft-affected skulls.

Abnormalities, Multiple↗

PubMedDate not supplied

Otic placode and cephalic neural crest.

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Animals↗

PubMedDate not supplied

Stress and woundhealing of the cartilaginous nasal septum.

In the cartilaginous nasal septum of growing rabbits a stress is demonstrated, released by an incision perpendicular to the antero-posterior axis and rebuilt within a period of 3 weeks when the mechanical continuity of the septum is restored. The latter is the result of a process of woundhealing establishing a firm perichondrial side-to-side connection between the stumps.

Animals↗

PubMedDate not supplied

Porous hydroxylapatite-perichondrium graft in cricoid reconstruction.

Composite grafts of hydroxylapatite-perichondrium were used for reconstructing defects in the cricoid of young rabbits. The alloplastic material showed no signs of resorption; it was firmly attached to the surrounding tissues by ingrowing connective tissue; only a moderate foreign body reaction was observed. The perichondrium formed new cartilage around the hydroxylapatite.

Animals↗