Treatment of base of tongue cancer, stage III and stage IV with primary surgery: survival and functional outcomes.

This study examines functional outcome (speech and swallowing), survival, and disease control in patients receiving an intensified treatment regimen with primary aggressive surgery, and postoperative radiotherapy or postoperative concomitant chemoradiotherapy, for previously untreated, resectable, stage III and IV squamous cell carcinoma (SCC) of the tongue base. Sixty-six consecutive patients treated from June 1997 to June 2006 were followed prospectively through the Multidisciplinary Head and Neck Surgery Reconstruction Clinic. Speech and swallowing data were gathered at four evaluation times during the first year. Speech assessment was conducted by PERCI, Nasometer, and C-AIDS and swallowing assessment by Modified barium swallow, Diet survey and G-tube. Also, the overall survival, disease-specific survival and loco regional control were measured. The average age of the patients was 56.8, 85 % male and 15 % female. All patients had primary surgical resection and 83 % received postoperative radiotherapy and 17 % chemoradiation therapy. Overall survival at 3 years was 80.3 % and 5 years 52.2 %. Disease-specific survival at 3 years was 86.7 % and 5 years was 77.5 %. Local control was 94 %. Distal metastasis and second primary were found to be 7.5 % each. Primary surgical treatment of advanced BOT cancer offers excellent functional outcome, local control and disease-specific survival.

Corticosteroids in peritonsillar abscess treatment: a blinded placebo-controlled clinical trial.

OBJECTIVES/HYPOTHESIS: Sore throat is a common, benign emergency department (ED) presentation; however, peritonsillar abscess (PTA) is a complication that requires aggressive management. Use of systemic corticosteroids (SCSs) in PTA is occurring without clear evidence of benefit. This study examined the efficacy and safety of SCS treatment for patients with PTA. STUDY DESIGN: Randomized, double-blind, placebo-controlled trial. METHODS: A controlled trial with concealed allocation and double-blinding was conducted at two Canadian EDs. Following written informed consent, eligible patients received 48 hours of intravenous clindamycin and a single dose of the study drug (dexamethasone [DEX] or placebo [PLAC], intravenously [IV]). Follow-up occurred at 24 hours, 48 hours, and 7 days. The primary outcome was pain; other outcomes were side effects and return to normal activities/diet. RESULTS: A total of 182 patients were screened for eligibility; 41 patients were enrolled (21 DEX; 20 PLAC). At 24 hours, those receiving DEX reported lower pain scores (1.4 vs. 5.1; P = .009); however, these differences disappeared by 48 hours (P = .22) and 7 days (P = .4). At 24 hours, more patients receiving DEX returned to normal activities (33% vs. 11%) and dietary intake (38% vs 25%); however, these differences were not significant and disappeared by 48 hours and 7 days. Side effects were rare and did not differ between groups (P > .05). CONCLUSIONS: Combined with PTA drainage and IV antibiotics, 10 mg IV DEX resulted in less pain at 24 hours when compared to PLAC, without any serious side effects. This effect is short-lived, and further research is required on factors associated with PTA treatment success.

Transfusion as a predictor of recurrence and survival in head and neck cancer surgery patients.

OBJECTIVE: There is mixed evidence regarding the association of perioperative blood transfusion to disease recurrence and mortality in head and neck cancer patients. Moreover, few investigations have examined the effects of leukocyte-depleted (leukodepleted) red cell transfusion. The presented study was undertaken to ascertain whether perioperative transfusion of leukodepleted blood is associated with recurrence and survival in head and neck cancer surgery patients. METHODS: The records of all patients having undergone head and neck surgery for malignant disease between October 1996 and October 2002 were reviewed. Hospital, blood bank, and cancer registry database records were reviewed and data were recorded onto a standardized computer spreadsheet. The primary outcome variable was the number of perioperatively transfused units of allogeneic leukodepleted blood. Multivariate analysis and Cox regression methods were employed. RESULTS: Five hundred twenty patients met the criteria for inclusion in the study. Recurrence and mortality rates were significantly different between transfusion and no-transfusion groups, in favour of the no-transfusion group. In addition to age, T stage, and N stage, multivariate analysis revealed leukodepleted blood transfusion to be an independent predictor of both recurrence (odds ratio 1.6) and survival (hazard ratio 1.5). CONCLUSION: Perioperative transfusion of leukodepleted blood is associated with higher recurrence rates and decreased survival in head and neck cancer surgery.

Steel scalpel versus electrocautery blade: comparison of cosmetic and patient satisfaction outcomes of different incision methods.

OBJECTIVE: To determine which method of skin incision has superior cosmetic and patient satisfaction outcomes. METHODS: Consenting patients undergoing bilateral neck dissection who met the inclusion criteria were prospectively enrolled. Each side of the neck was randomly assigned into one of the following two groups: scalpel incision and electrocautery incision. Cosmetic and patient satisfaction outcomes were collected prospectively with patients and outcome assessors blinded to group assignment. Validated self-report questionnaires and objective scar measures were used. RESULTS: Nineteen patients met the criteria for inclusion. Analysis revealed no significant differences between groups in terms of cosmetic or satisfaction outcomes. Use of the steel scalpel was found to result in significantly greater incision-related blood loss compared with use of the electrocautery blade. CONCLUSION: Steel scalpel or electrocautery may be used to incise the skin of patients undergoing bilateral neck dissection with no difference in cosmetic or patient satisfaction outcome. The steel scalpel yields greater incision-related blood loss compared with the electrocautery blade.

Use of anteriorly based pericranial flap in frontal sinus obliteration.

OBJECTIVE: In an era of endoscopic sinus surgery, frontal sinus obliteration continues to remain an important treatment option in chronic frontal sinus disease. Numerous avascular obliterative materials including fat, muscle, cancellous bone, and hydroxyapatite have been used in this procedure. In this article, we describe a vascularized anteriorly based pericranial flap to obliterate frontal sinus. STUDY DESIGN: Retrospective chart review of patients referred to tertiary care hospital between 1996 and 2003. METHODS: Records of the patients who underwent this procedure were reviewed. Demographics, indications, and immediate and late complications were recorded. A phone questionnaire was used to assess patient satisfaction with the outcome. RESULTS: A total of 12 patients underwent frontal sinus obliteration with this technique. Mean follow-up was 40 months. None of the patients developed recurrent frontal sinusitis. All of the patients were pleased with the outcome. CONCLUSION: Pericranial flap is a highly vascularized flap that is easily harvested and is an effective and viable modality for obliterating frontal sinus. EBM RATING: C-4.

Reovirus salvage of positive resection margin: A novel treatment adjunct.

HYPOTHESIS: We hypothesized that the use of reovirus as an intraoperative adjunct would improve local control of positive margins in a human squamous cell carcinoma nude mouse model. PURPOSE: This study was designed to (1) develop a nude mouse human squamous cell carcinoma positive margin model and (2) assess the effect of adjunct intraoperative treatment with reovirus irrigation and injection on local control of resections with positive margins. MATERIALS AND METHODS: We developed a positive margin nude mouse model using the University of Michigan SCC-22B cell line. Established tumours in 39 mice were resected, leaving behind a 1 mm positive margin. The mice were then divided into five treatment groups: (1) no treatment was provided, (2) ultraviolet (UV)-inactivated reovirus was irrigated into the wound bed, (3) UV-inactivated reovirus was injected into the positive margin intratumorally and peritumorally, (4) reovirus was injected into the positive margin intratumorally and peritumorally, and (5) reovirus was irrigated into the wound bed. The mice were followed for 28 weeks and sacrificed. RESULTS: The results of the irrigations showed that tumours recurred in all (100%) of the control groups (no treatment and UV-inactivated virus). The mice irrigated with active reovirus solution had recurrence in 3 of the 14 sites (21%). These findings were statistically significant, with p > .001. The results of the injection showed that tumours recurred in all (100%) of the control groups (no treatment and UV-inactivated virus). The mice injected with reovirus solution had recurrence in 6 of the 16 sites (38%). These findings were statistically significant, with p > .007. CONCLUSIONS: Reovirus adjunctive treatment is a novel, safe, and effective method of improving local control in the positive margin human squamous cell carcinoma mouse model.

Tisseel and its effects on wound drainage post-thyroidectomy: prospective, randomized, blinded, controlled study.

OBJECTIVE: This randomized, blinded, controlled study examines the effects of fibrin sealant (Tisseel, Laboratoire de production Baxter AG, Vienna, Austria) on wound drainage following thyroidectomy. METHODS: Fifty-six consecutive patients were enrolled in the study. Patients were randomized into Tisseel and non-Tisseel treatment groups. Wound drain output was tallied in 8-hour increments by observers blinded to the treatment groups. RESULTS: Fifty-six patients completed the study. Significant decreases in wound drainage were found in the first 8 hours in the Tisseel group. Eight hours postoperatively, wound output in the Tisseel group was reduced by 44% compared with the non-Tisseel group. A significant decrease in the total drainage over the 64-hour time period of 43% was noted between the treatment and control groups. Post-thyroidectomy wound drainage was reduced and trended to earlier drain removal. No significant changes in the length of hospital stay were noted, nor were postoperative complications encountered in either treatment group. CONCLUSIONS: Fibrin sealants offer a unique opportunity to safely decrease post-thyroidectomy wound drainage. This investigation furthers the evidence that fibrin sealants could safely enable the implementation of drain-free thyroidectomies.

Reovirus salvage of squamous cell cancer-contaminated wounds.

PURPOSE: To assess the susceptibility of human squamous cell carcinoma to reovirus infection in vitro and in vivo using a murine model of cancer-contaminated wounds. METHODS: The University of Michigan squamous carcinoma 22B cell line was cultured and inoculated with reovirus in vitro. The effect of the reovirus was assessed with microscopy and a standard 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H tetrazolium bromide (MTT) assay. We used the previously established cancer-contaminated wound SCID mouse model to test saline and reovirus irrigation in vivo. Fifty-five mice were used; 15 were controls, 20 had immediate irrigation, and 20 had delayed irrigation. Surgical sites were assessed for palpable tumour biweekly. RESULTS: The microscopy and MTT assay both showed evidence of reovirus-mediated squamous cancer cell lysis. The control mice grew palpable tumours in 80% of the wounds. Immediate irrigation with saline delayed the onset of palpable tumour and demonstrated a persistent reduction in the rate of development of palpable tumours (p = .004 compared with controls). This effect disappeared when the saline irrigation was delayed, resulting in a tumour development rate that was not significantly different from that of the control. Wounds that were irrigated with reovirus, both immediately and delayed, did not produce palpable tumour (p < .0005 when compared with controls). CONCLUSIONS: (1) The University of Michigan squamous cell carcinoma 22B cell line is susceptible to reovirus in vitro. (2) Immediate irrigation with saline resulted in a significant delay in clinically evident tumour growth and a reduction in the rate of tumour development in the SCID mouse model. (3) The reovirus irrigation resulted in a significant reduction of tumour development in both the immediate and delayed groups in the SCID mouse model. (4) The efficacy of the reovirus irrigation in the delayed group suggests that the major mechanism of action is through a selective and specific targeting of implanted cancer cells.

Functional outcomes after hemiglossectomy and reconstruction with a bilobed radial forearm free flap.

OBJECTIVE: This study examines prospectively the functional outcomes of a cohort of patients who had undergone hemiglossectomy and reconstruction with a bilobed radial forearm free flap (RFFF) for oral tongue squamous cell carcinoma. METHODS: Speech and swallowing data were compiled for patients treated for oral tongue cancer with hemiglossectomy and and reconstruction with a bilobed RFFF. The three evaluation periods were preoperative, postoperatively, and postradiation therapy. RESULTS: Eleven patients were included in the study. A significant difference between preoperative and postoperative single-word intelligibility scores was observed. There was no significant difference across any of the evaluation times for sentence intelligibility. Swallowing analysis revealed fewer instances of laryngeal penetration with liquids postoperatively. No significant differences were found in laryngeal penetration with either the pudding or cookie consistencies across any of the evaluation times. There was no incidence of aspiration at any of the evaluation times. There were no significant differences in the number of problems with the oral or oral preparatory phases across any of the evaluation times. The neurotization status of the RFFF had no significant effect on any of the observed speech or swallowing parameters. CONCLUSIONS: The bilobed RFFF provides functional speech and excellent swallowing outcomes in the reconstruction of hemiglossectomy defects.