N C Hyde | PubMed Health

PubMed2003

A new approach to pre-treatment assessment of the N0 neck in oral squamous cell carcinoma: the role of sentinel node biopsy and positron emission tomography.

OBJECTIVES: Pre-operative staging of the clinically N(0) neck in patients with oral squamous cell carcinoma is hindered by the relatively high false negative/positive rates of conventional imaging techniques. The aim of this study is to evaluate the utility of (18)F-fluoro-deoxy-glucose (FDG) positron emission tomography (PET) and sentinel lymph node (SLN) imaging and biopsy to determine the true disease status of the loco-regional lymphatics. METHODS: Nineteen patients with biopsy proven disease without palpable or radiological evidence of neck metastases underwent pre-operative (18)F-FDG PET and SLN imaging. All patients underwent whole-body FDG PET and a single view of the head and neck. SLN technique was performed using four peri-tumoural injections of (99m)Tc labeled albumin colloid each of 10 MBq. Dynamic and static imaging followed in the antero-posterior and lateral projections. At operation 1 ml of 2.5% Patent Blue Dye and a hand held gamma probe (Neoprobe 1500) were used in combination to identify and remove the SLN. Surgery then continued along conventional lines including a neck dissection. Histology of the resultant specimen was correlated with that of the SLN and pre-operative imaging. RESULTS: In all patients SLN harvesting was feasible. In 15/19 patients the SLN(s) and the residual neck dissection were -ve for tumour. In 3/19 patients the SLN(s) were +ve for tumour as were other neck nodes. In 1/19 patients the SLN was -ve but another single tumour +ve node was identified in the neck. This patient occurred early in our series with a SLN close to the primary tumour. (18)F-FDG PET failed to identify nodal disease in all four patients with histologically proven lymph node metastases. The size of these nodes ranged from 12 mm x 10 mm x 3 mm to 25 mm x 15 mm x 10 mm. CONCLUSION: SLN imaging and biopsy with probe and Patent Blue Dye guided harvest is feasible in patients with oral squamous cell carcinoma and can predict cervical nodal status. (18)F-FDG PET may be less useful.

Adult↗

PubMed2000

Hearing loss associated with maxillectomy.

Little has been reported about the effect on auditory tube function of ablative surgery for maxillary neoplasms. Operations on the muscles of the soft palate may cause conductive hearing loss by impairing the opening of the auditory tube, which results in a middle ear effusion. Sensorineural hearing loss may also follow adjuvant radiotherapy. In this retrospective study we aimed to assess hearing status in patients who had undergone maxillary surgery for neoplastic disease between 1987 and 1997. Data recorded included personal details, site and size of lesion, treatment, and histology. Thirty-eight patients were identified, of whom 26 had survived and were contacted. Seventeen of the 26 had had part of the soft palate excised. All patients underwent tympanometry and had a pure tone audiogram. Audiograms showed an air-bone gap of > 10 dB in the ear on the side of the operation in 11 of those 17 patients. All 17 patients who had had soft palate resections had evidence of auditory tube insufficiency on tympanometry. Seven of the nine patients who had had radiotherapy had substantial sensorineural hearing loss. We conclude that conductive hearing loss is dependent on the site of resection; tympanometry is a sensitive test of middle ear function; sensorineural hearing loss may often follow radiotherapy; and audiological assessment is essential both before and after operation in patients having maxillary resections.

Acoustic Impedance Tests↗