Characterization of CD44v3-containing isoforms in head and neck cancer.

Head and neck squamous cell carcinoma (HNSCC) is a debilitating and deadly disease that is only cured 50% of the time. A better understanding of the molecular mechanisms involved in HNSCC progression may lead to earlier detection and improved cure rates. CD44 is a ubiquitous transmembrane glycoprotein comprising a family of alternatively spliced isoforms involved in cell migration and cell proliferation. CD44 isoforms containing the variant 3 (v3) exon include a growth factor binding site and may be involved in tumor progression. To characterize CD44v3-containing isoforms expression in HNSCC we purified RNA from four HNSCC cell lines and performed RT-PCR using junction primer strategies followed by gel elecrophoresis. Cloning and sequencing of HNSCC cell line PCR products revealed two isoforms. One of these, CD44v3-10, has been previously described. The other isoform, CD44v3, has not been characterized in HNSCC tissues. To further study this isoform, we purified RNA from 19 HNSCC tissues, 7 normal margin tissues and 5 true normal tissues. Following reverse-transcription, we performed quantitative PCR using junction primers specific for CD44v3. Results show that HNSCC tumor tissues expressed mean CD44v3 levels that were elevated 4.5 times more than true normal tissues (p < 0.01). Mean CD44v3 values for HNSCC tumors were 0.43 +/- 0.44 while mean levels for true normal tissues were 0.10 +/- 0.11. Levels in tumor tissue did not vary significantly with tumor characteristics such as site, stage, prior treatment, or nodal status. In addition, to characterize the role of this molecule plays in tumor progression, we overexpressed CD44v3 in a HNSCC cell line. Our results indicate that although higher levels of CD44v3 did not affect the rate of proliferation, a significant increase in migration was observed. CD44v3 may provide a target for future diagnostic and therapeutic interventions for HNSCC.

Periorbital emphysema as a complication of functional endoscopic sinus surgery.

Clinically significant periorbital emphysema is an unusual complication of functional endoscopic sinus surgery (FESS). In most instances, it resolves spontaneously without any serious sequelae. Rarely, it can progress rapidly and become severe enough to cause irreversible blindness. We present and discuss the management of 2 cases of periorbital emphysema after FESS.

Prone positioning for head and neck reconstructive surgery.

Certain head and neck surgical cases require the patient to be positioned prone. Such positioning carries with it an attendant subset of risks and complications not otherwise encountered in more traditional supine positioning. Gaining awareness of these risks and complications, and developing proactive positioning strategies, will enable the surgical team to position the patient optimally for the procedure and provide for every consideration of patient safety. This article consists of a specific literature review of those issues directly related to the anatomical and physiological concerns arising from prone positioning. Particular attention is paid to the cardiopulmonary, renal, ophthalmologic, and neurological vulnerabilities unique to this position. Proper planning by the surgical team and utilization of the correct equipment are a necessity. A tailored approach to the needs of the individual patient and an intimate awareness of the potential pitfalls will contribute to better outcomes when using the prone position.

Parotid surgery using Nd:YAG laser contact tips: clinical assessment of perioperative facial nerve function.

OBJECTIVE: The objective of this paper is to review 51 consecutive contact Nd:YAG laser parotidectomies to determine perioperative outcomes and complications related to the facial nerve and the use of the laser tips. BACKGROUND DATA: Parotid surgery is mostly performed with scalpel or scissors, techniques that may put the facial nerve at risk for injury due to brisk bleeding and imprecise dissection. Even though previous experiences with Nd:YAG lasers in surgery had raised concerns of energy dispersion, the contact sapphire tips used in this series allowed accurate precise dissection and hemostasis, limiting complications. MATERIALS AND METHODS: Close facial nerve dissection was done at 8-12 watts, for an average total of 8,000-12,000 joules per case. RESULTS: No significant or permanent facial nerve complications resulted from the use of the laser tips, except for expected transient and reversible postoperative ipsilateral marginal mandibular nerve paresis observed in 43% of the patients-less than the generally quoted 50% expected after uneventful lateral lobe parotidectomy. CONCLUSION: This review concludes that the contact Nd:YAG laser may offer significant technical and safety advantages, and no direct associated complications in the dissection and preservation of the facial nerve in parotidectomy.

Surgical treatment of parotid tumors in the general community hospital.

We reviewed 51 consecutive parotidectomies done at a general community hospital and gathered data on age and sex of the patients, length of stay in the hospital, perioperative outcome, complications, and surgical pathology. Statistical method included logistic regression and ANOVA to determine relationship and dependence of the variables. There were 24 male and 27 female patients. Thirty-six (70.6%) of the parotid tumors were benign. There were no major complications. Treatment of parotid tumors in the community hospital is feasible and safe if basic guidelines are implemented. The epidemiology of parotid tumors in the relatively smaller hospital should resemble that reported in the literature. Our data suggest that parotid malignancy may occur more frequently in elderly men and that length of stay in the hospital may be longer for patients having surgery for malignant than for benign parotid tumors.