[Diagnosis of lymph node metastasis of head-neck carcinomas].
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Carcinoma, Squamous Cell↗
Biomedical subjects
R M Tiwari
Publications and source records attributed to R M Tiwari.
Partial vertical laryngectomy for recurrent glottic carcinoma.
Partial vertical laryngectomy for recurrent glottic carcinoma was performed in 61 patients according to stringent criteria. The great majority of the recurrent tumours appeared within 2 years of radiotherapy (80%). The mean follow-up after surgery was 79 months. At 5 years 85% of the patients were free of local recurrence. Nine patients (15%) developed a local recurrence; eight of them underwent total laryngectomy; one patient refused the operation and died. Seven patients died of other causes. The actuarial overall survival rate was 88% at 5 years. Post-operative complications were seen in 12 patients (20%); nine of these patients developed airway problems. One patient underwent total laryngectomy for severe aspiration, the others finally were decannulated. The results of this study indicate that partial vertical hemilaryngectomy for irradiation failures is a safe procedure with good results without undue morbidity.
Adult↗
Castleman's disease as a uncommon cause of a neck mass.
Castleman's disease is an uncommon cause of a neck mass; in only 6% of the cases reported in the literature was the disease located in the neck. We present the case of a 21-year-old woman who developed a swelling in the left side of her neck that was subsequently diagnosed as Castleman's disease. The different forms of the disease and its histopathology are discussed.
Adult↗
Free vascularized jejunum interposition for pharyngoesophageal reconstruction after total laryngopharyngectomy.
The records of 28 patients who underwent free jejunal graft reconstruction after resection for cancer involving the pharynx were analysed. Seven patients had a T3 carcinoma, 15 patients T4 and six patients recurrence after laryngectomy. Ten patients had received radiotherapy in the past. Post-operatively, 15 patients (54%) had complications and two patients (7%) died. No significant difference was observed in the complication rate between the group that received radiotherapy in the past and those who did not. Nineteen patients received post-operative radiotherapy. Nine patients had no radiotherapy on the basis of complete resection or because of serious complications. For the whole group the 2-year recurrence free period and survival were 42% and 51% respectively. The post-operative radiotherapy group had a significantly better survival (73%) and recurrence free period (63%) than the group without post-operative radiotherapy (0%). Thus, post-operative radiotherapy seems indicated irrespective of resection margins.
Adult↗
Surgery and postoperative radiotherapy and radiotherapy alone in T3-T4 cancers of the pyriform sinus. Treatment results and patterns of failure.
Fifty-four patients with T3-T4 squamous cell carcinomas of the pyriform sinus were treated between 1976 and 1990. Surgery with postoperative radiotherapy (n = 32) was the treatment of choice. Radical radiotherapy was used in patients with contraindications for surgery or with inoperable tumors and in patients who refused surgery. The local control rate was significantly higher in the combined treatment group (31/32; 97%) than in the group treated with radical radiotherapy (14/22; 64%) which consisted of more advanced cases. In patients who received radical radiotherapy, the highest local control rates were recorded with doses of 70 Gy and above and with the use of 2 fractions per day. There was no significant difference in regional control and survival rates between the treatment groups. New approaches are indicated to improve the prognosis of hypopharyngeal cancer.
Adult↗
Articulation after total glossectomy: a clinical study of speech in six patients.
In this study we investigated the speech of six patients after total glossectomy. After rehabilitation a reasonable function of speech was possible, as a result of compensatory mechanisms. Suggestions to improve the results of speech and language therapy are given.
Aged↗
[Neck lymph node dissection in squamous cell carcinoma originating in the head-and-neck area; the significance for the prognosis].
Neck dissection has a therapeutical as well as a prognostic relevance with respect to regional recurrence and distant metastases. Between January 1973 and July 1986 576 neck dissections in 511 patients (396 men, 115 women, among whom 486 with squamous cell carcinoma of the head and neck, and 14 with neck metastases of an unknown primary tumour) were performed at the department of Otolaryngology-Head and Neck Surgery of the Free University Hospital, Amsterdam. Patients with tumour at the margins were excluded. Recurrence-free curves were calculated according to Kaplan-Meier and the log rank test was used to test the differences. All patients underwent a comprehensive neck dissection and were irradiated postoperatively when three or more tumour-positive nodes or extranodal spread were reported by the pathologist. Endpoint for analysis was occurrence of an ipsilateral neck recurrence or of a distant metastasis. Figures were corrected for a simultaneous recurrence at a higher level. A total of 29 neck recurrences (7.2%; n = 523) and 26 distant metastases (10.7%; n = 281) were demonstrated in the 5-year follow-up period. The number of positive nodes was of prognostic significance for both events (p = 0.039 and p = 0.0027). Extranodal spread was shown only to increase the incidence of distant metastases (p = 0.017), whereas its prognostic value with regard to recurrence in the neck was nullified by the strict institution of postoperative radiotherapy. It is recommended to give radiotherapy to patients with two positive nodes and possibly to every patient with a histopathologically positive neck.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Atypical leiomyoma of the choana.
Leiomyomas of the nose, nasopharynx and paranasal sinuses are rare. So far only two atypical leiomyomas at these sites have been reported in the English literature. A new case is presented and the literature on the subject is reviewed.
Aged↗
[Masseter muscle flaps and buccal mucosa transposition flaps in the reconstruction of the dorsal oral cavity and the oropharynx].
The m. masseter crossover flap according to Tiwari combined with a buccal mucosa transposition flap represents an excellent technique for a primary two-layered closure of defects due to surgical removal of T2- and small T3-tumors of the posterior part of the lateral floor of the mouth, the posterior edge of the tongue, the retromolar trigone, the soft palate and the tonsilar region. Especially advantageous are the low postoperative morbidity, the low rate of postoperative complications, and good functional and cosmetic results. The surgical expenditure is little and recommends the use of this technique also in patients with reduced operability.
Head and Neck Neoplasms↗
Malignant adenolymphoma of the parotid gland: report of carcinomatous transformation.
Malignant transformation of an adenolymphoma (Warthin's tumour) is a rare event. This paper presents a case of carcinoma arising in an adenolymphoma of the parotid gland.
Adenocarcinoma↗
Role of masseter crossover flap in oropharyngeal reconstruction.
Oropharyngeal reconstruction especially after surgery for medially located lesions of moderate dimensions presents a challenge. The risk of using well vascularized, but insensitive tissues close to the airway has led to the development of several measures to overcome the difficulties involved. The transposition of masseter muscle which has been put forward in recent years provides successfully primary closure with preservation of function.
Aged↗
Adenoid cystic carcinoma of the salivary glands: clinicopathological survey of 51 patients.
A clinicopathological study of 51 cases of adenoid cystic carcinoma in the head and neck region seen over a period of 20 years is presented. The correlation between various histological features and their impact on the results is attempted. Longterm results with respect to loco-regional recurrences, distant metastases and survival with various modalities of therapy are presented. Although this is a small series, radical surgery in keeping with the aim of avoiding undue mutilation, thus preserving the quality of life, followed by a full course of radiotherapy has been the mainstay of treatment and the results here presented justify this approach.
Adult↗
Total glossectomy: reconstruction and rehabilitation.
Patients with carcinoma of the tongue including the base of the tongue who underwent total glossectomy in a period of just over ten years since January 1979 have been reviewed. Total glossectomy may be indicated as salvage surgery or as a primary procedure. The larynx may be preserved or may have to be sacrificed depending upon the site of the lesion. When the larynx is preserved the use of laryngeal suspension facilitates early rehabilitation and preserves the quality of life to a large extent. Cricopharyngeal myotomy seems unnecessary.
Aged↗
Primary radiotherapy with surgery in reserve for advanced laryngeal carcinoma. Results and complications.
A retrospective study of a selected group of 58 patients with T3 and T4 squamous cell carcinomas of the larynx presenting between 1974 and 1984 was undertaken. These patients were treated primarily with radical radiotherapy and salvage surgery in reserve. The aim of this study was to examine survival, recurrence rate and the complications after salvage surgery. In 30 patients the tumor was classified as a T3 and in 28 as a T4. In 14 patients (24%) nodal disease in the neck was present prior to the radiotherapy. Follow-up in all patients continued for at least 3 years or until death. Nineteen patients (33%) developed locally recurrent tumor and five (9%) developed nodal metastases to the neck. The recurrence in almost every patient was detected within 2 years after completion of the irradiation. Thirty patients (52%) are alive of whom 29 have no evidence of disease. Of these 30 patients 22 (73%) have their larynx intact and functioning. The 5-year adjusted acturial survival for the whole group of patients is 73%, for the T3N0 group 87% and for the T4N0 group 75%. Patients with nodal disease responded poorly. After salvage surgery severe postoperative complications developed in 37% of the patients. There were no deaths following salvage surgery.
Adult↗
Heterogeneity of stage II glottic carcinoma and its therapeutic implications.
The heterogeneity of glottic carcinoma results in variable loco-regional control probabilities from 40 to 80%. These widely different results may be due to two prognostic parameters of the tumor: the mobility of the vocal cord and the volume of the tumor. On the other hand radiation dose and technique may influence the treatment results. Stringent work-up has been prospectively undertaken in 156 patients with Stage II glottic carcinoma since 1974 through 1983 in the Academic Hospital of the Free University in Amsterdam. Several subgroups were defined from the beginning to indicate one or both of these prognostic factors. All were treated with a high quality accurate radiation therapy program delivering high dose to all patients with worse prognostic factors and even higher dosages to voluminous tumors with impaired mobility of a cord or slowly regressing tumors. The latter was individually judged for each patient towards the end of the treatment period. The loco-regional control probability of around 80% for all the subgroups irrespective of the prognostic factors indicate that the heterogeneity of Stage II glottic cancer may be influenced by high dosages of quality controlled radiotherapy. Thus results hitherto reported in literature may be further improved by the dose-schedules outlined here.
Adult↗
Cartilagenous tumours of the larynx.
A brief review of the literature on cartilagenous tumours of the larynx is presented and their pathology, clinical features and treatment is discussed: Chondromas are rare; Chondrosarcomas can be potentially fatal. Conservative surgical therapy and close follow up is the essential line of treatment for tumours of the cricoid cartilage. Three new cases are presented.
Adult↗
Acoustic and aerodynamic parameters of speech after laryngectomy and the Staffieri procedure.
The voice obtained with the Staffieri method of surgical voice rehabilitation after total laryngectomy was studied in 20 subjects and objectively described in terms of selected acoustic and aerodynamic parameters. Intensity and frequency, pressure and airflow were studied during sustained phonation of the vowel 'a'. Simultaneous recordings showed a relationship between intensity and between fundamental frequency, pressure and airflow in most of the subjects. As the subjects in the present study were not able to produce a vowel at target intensities and frequencies, the data were interpolated to 65 dB (A) intensity level for comparison purposes. We found no indication that from an acoustical and aerodynamical point of view, the Staffieri procedure should be preferred over other alaryngeal voice production methods.
Adult↗
The role of the upper oesophageal sphincter in voice rehabilitation after laryngectomy and Staffieri's procedure.
The Staffieri method was used for voice rehabilitation after total laryngectomy in our patients. Leakage of saliva has been a problem in some. It has been suggested that aspiration could be due to specific pressure relations in the pharynx, upper oesophageal sphincter and cervical oesophagus during deglutition (Mann et al., 1980). Regarding voice production, the upper oesophageal sphincter is probably the main sound source, functioning in essentially the same way as in oesophageal speech. Intraluminal pressure recordings at rest and during swallowing were used in 16 Staffieri speakers and 9 oesophageal speakers. Upper oesophageal sphincter dysfunction was seen more often in Staffieri speakers with aspiration problems than in Staffieri speakers without aspiration problems, but the relation is not clearly understood. A definite relation could be established between upper oesophageal sphincter function in terms of relaxation and coordination and aerodynamic pressure measured in the tracheostoma, necessary to sustain phonation. After dilatation of the oesophagus, produced by the inflow of air, a reflex rise in the upper oesophageal sphincter pressure is thought to occur. The pressure necessary to sustain phonation probably depends on the extent to which this reflex mechanism occurs and on the ability of the patient to induce a relaxation of the upper oesophageal sphincter before air expulsion. Selective myotomy will possibly lower the necessary pressure and enhance vocal rehabilitation. Whether this will solve a part of the aspiration problems in Staffieri speakers is completely unpredictable, as the relation of the motor function of the upper oesophageal sphincter and the aspiration problems is not well understood.
Adult↗