Mucoepidermoid carcinoma of Stensen's duct: a case report and review of the literature.

BACKGROUND: Mucoepidermoid carcinoma of Stensen's duct is a rare neoplasm, with only five cases reported in the literature. METHODS: We report another case of mucoepidermoid carcinoma of Stensen's duct and review the literature. RESULTS: Stensen's duct neoplasms tend to be symptomatic at an early stage by causing an obstruction of the parotid duct. New imaging techniques such as MR sialography and sialoendoscopy are very helpful in diagnosis and patient management. CONCLUSIONS: Although the rarity of this condition prevents definitive conclusions about the optimal treatment, we propose that Stensen's duct neoplasms should be treated like similar neoplasms occurring in the parotid gland tissue, taking into consideration clinical stage, tumor grade, and surgical margins.

Prediction of outcome in head-and-neck cancer patients using the standardized uptake value of 2-[18F]fluoro-2-deoxy-D-glucose.

PURPOSE: Tumor uptake of 2-[(18)F] fluoro-2-deoxy-D-glucose (FDG) may relate to outcome in cancer patients. Pretreatment FDG uptake was evaluated as a predictor of local control (LC) and disease-free survival (DFS) in patients with head-and-neck cancer managed primarily either by radiotherapy (RT) or surgery. PATIENTS AND METHODS: Tumor FDG uptake using the Standardized Uptake Value (SUV) was measured in 120 patients studied prospectively using positron emission tomography (PET). Treatment consisted of either radical RT with or without chemotherapy (73 patients) or radical surgery with or without postoperative RT (47 patients). Median follow-up of the surviving patients was 48 months. RESULTS: The median SUV was higher in 46 patients who failed treatment than in the remaining controlled patients (5.8 vs. 3.6, p = 0.002). In monovariate analysis, patients with tumors having high FDG uptake (SUV > median, 4.76) had poorer LC (p = 0.003) and DFS (p = 0.005). This difference was also observed when the RT and surgery groups were analyzed separately. In the multivariate analysis T-category (p = 0.005) and SUV (p = 0.046) remained independent adverse factors for LC, whereas N-category (p = 0.004), T-category (p = 0.02) and SUV (p = 0.05) were independent determinants of DFS. CONCLUSION: These results suggest that pretreatment tumor FDG uptake represents an independent prognostic factor in patients with head-and-neck cancers, whatever the primary treatment modality. Tumors having high FDG uptake are at greater risk of failure and should be considered for more aggressive multimodality therapy.

[Videomimicography: a new objective evaluation of facial motor function].

OBJECTIVE: To develop a new method, videomimicography (VMG), to evaluate facial motor function. METHODS: During VMG, 11 landmarks were placed on the face, and 5 movements (forehead lifting, eye closure, nose wrinkling, lip puckering and smiling) with maximal contraction were requested. A digital video film was recorded then fed in a computer to be analyzed. Ten normal subjects were used as normal control. RESULTS: Area measures were found better than distance measures in evaluating facial movements. The best measure for each movement was determined. Then a global index of facial motor function was derived from these measures. This index was found well correlated with the facial paralysis House-Brackmann grade in 48 patients with facial paralysis (r = -0.928). CONCLUSION: VMG is an objective, quantitative, relative simple method. It has good reproducibility. So it can be used in clinic for evaluating facial motor function.

Videomimicography: the standards of normal revised.

BACKGROUND: Studies aiming to objectively evaluate facial movements have focused on the technique of measurement, whereas the most pertinent measurements of basic facial movements have not been well characterized. OBJECTIVE: To determine the best normal measures of 5 basic facial movements in healthy patients. METHODS: In 5 healthy subjects, 11 facial landmarks were placed on the face, and 5 movements (forehead lift, eye closure, nose wrinkling, lip puckering, and smiling) with maximal contraction force were requested. Each subject repeated each movement 3 times, and the entire session was repeated on 4 different days. No specific immobilization of the head was performed. The session was filmed with a digital camera, and the frames with maximal movement were selected. Measurements were performed with Osiris public domain image analysis software. For each measure, the change from rest was computed. Intersubject and intrasubject variability were determined by a multivariate analysis of variance. RESULTS: In all movements, surface changes (mean +/- SD) were higher than distance changes. For forehead lifting and eye closure, the best measure was the eye surface changes of 13% +/- 5% and -32% +/- 9%, respectively. For nasal wrinkling, lip puckering, and smiling, the best measures were the paranasal area (change, -28% +/- 9%), upper lip area (change, -23% +/- 8%), and mouth area (change, 63% +/- 21%), respectively. Most distance changes were below 10%. Same-day repeatability variation was below 15%, and day-to-day repeatability variation was below 7%. In healthy subjects, more than 80% of the total variation was accounted for by the intersubject variability. CONCLUSIONS: Videomimicography is a simple and objective linear measurement system based on facial surface changes. The measures exhibit good reliability.

Occupation and larynx and hypopharynx cancer: an international case-control study in France, Italy, Spain, and Switzerland.

OBJECTIVE: To estimate risks for laryngeal/hypopharyngeal cancer associated with occupational titles and industrial activities. METHODS: A multicentre population-based case-control study was conducted in the early 1980s in six southern European areas. Analyses included 1010 male cases and 2176 controls. Odds ratios (ORs) (adjusted for age, study area, tobacco consumption, and alcohol consumption) were estimated for 156 occupations and 70 industrial activities. RESULTS: An excess risk has been confirmed for categories of construction workers, potters (OR: 5.91, 95% confidence intervals 1.46-24.0), butchers (2.53, 1.22-5.22), barbers (2.33, 1.00-5.40), laborers not otherwise specified (1.52, 1.12-2.06), as well as for men who had been employed in railway transport (1.52, 0.97-2.39), shipbuilding (2.05, 0.89-4.94), and hotels (2.06, 0.89-4.75). An association was also found for shoe finishers (3.23, 0.75-13.9), loggers (2.07, 0.87-4.90), and some groups of metal workers. ORs for loggers, butchers, railway transport workers, laborers, and reinforced concreters increased with duration of employment. The suggestion of a risk for machine operators among woodworkers (3.10, 0.92-10.5) conflicts with previous findings. No significant excess of risk was found for categories previously reported to be associated with laryngeal and hypopharyngeal cancer, such as drivers, mechanics, welders, machinists, and painters. CONCLUSIONS: The present study provides additional evidence to the hypothesis of a risk of cancer of the larynx/ hypopharynx for workers engaged in jobs in the construction, metal, textile, ceramic, and food industries and in railway transport. Loggers were also found at risk; a previously unreported finding.

Standardized uptake value of 2-[(18)F] fluoro-2-deoxy-D-glucose in predicting outcome in head and neck carcinomas treated by radiotherapy with or without chemotherapy.

PURPOSE: In patients with head and neck cancer enrolled onto a prospective study of positron emission tomography (PET), pretreatment 2-[(18)F] fluoro-2- deoxy-D-glucose (FDG) uptake was evaluated as a predictor of local control and disease-free survival (DFS) after treatment by radiotherapy (RT) with or without chemotherapy. PATIENTS AND METHODS: We studied 63 patients with carcinomas of the head and neck who had an FDG-PET scan before radical RT. Tumor FDG uptake was measured with the semiquantitative standardized uptake value (SUV). All patients but one were treated with accelerated or hyperfractionated RT schedules. Thirteen patients received concomitant cisplatin-based chemotherapy. RESULTS: In 25 patients who presented with any component of treatment failure, the SUV was significantly higher than in the remaining patients without any such failure. Patients having tumors with high FDG uptake had a significantly lower 3-year local control (55% v 86%, P =.01) and DFS (42% v 79%, P =.005) compared with patients having low uptake tumors. In the multivariate analysis, the only factor that retained its significance for DFS was SUV category, whereas T category was of borderline significance. For local control, T category remained a significant factor, whereas a lower local control was observed for tumors with a high SUV compared with those with low SUV. CONCLUSION: FDG uptake, as measured by the SUV, has potential value in predicting local control and DFS in head and neck carcinomas treated by RT. High FDG uptake may be a useful parameter for identifying patients requiring more aggressive treatment approaches.

Submandibular diagnostic and interventional sialendoscopy: new procedure for ductal disorders.

We present our initial experience with submandibular sialendoscopy, a new therapeutic approach for disorders of Wharton's duct. We review the sialendoscopes used and discuss their respective merits. We evaluated and treated 129 consecutive patients with suspected ductal disorders. Diagnostic sialendoscopy was used for classifying ductal lesions as sialolithiasis, stenosis, sialodochitis, or polyps. Interventional sialendoscopy was used to treat these disorders. The type of endoscope used, the type of sialolith fragmentation and/or extraction device used, the total number of procedures, the type of anesthesia, and the number and size of the sialoliths removed were the dependent variables. The outcome variable was the endoscopic clearing of the ductal tree and resolution of symptoms. Diagnostic sialendoscopy was possible in 131 of 135 glands (97%), with an average (+/-SD) duration of 28 +/- 15 minutes. Interventional sialendoscopy was attempted in 110 cases, with an average duration of 71 +/- 41 minutes, with a success rate of 82%. Multiple sialendoscopies were necessary in 25% of cases. General anesthesia was used in 12% of cases. Submandibular gland resection was performed in 4%. The average size of the stones was 4.9 +/- 2.9 mm. Multiple sialoliths were found in 31 cases (29%). Sialolith fragmentation was required in 26%. Larger and multiple stones often required longer and multiple procedures and general anesthesia, and more often resulted in failures. Semirigid endoscopes had a higher success rate (85%) than flexible sialendoscopes (54%). Complications were mostly minor, but were encountered in 10% of cases. Diagnostic sialendoscopy is a new technique for evaluating salivary duct disorders that is associated with low morbidity. Interventional sialendoscopy allows the extraction of sialoliths in most patients, thus preventing open gland excision.