Planned postradiotherapy neck dissection: Rationale and clinical outcomes.

OBJECTIVES: In this study, we examine pathology results and clinical outcome for patients with locoregionally advanced squamous cell carcinoma of the head and neck (SCCHN) who present with advanced neck disease and undergo planned postradiotherapy neck dissection. STUDY DESIGN: Review of all patients with SCCHN treated with primary radiation (or chemoradiation) and postradiotherapy neck dissection at the University of Wisconsin between 1992 to 2005 was performed. One hundred seven neck dissections were identified in 93 patients, 79 unilateral and 14 bilateral. All major treatment and outcome parameters were examined with particular emphasis on the postradiotherapy neck dissection. RESULTS: Thirty of 107 neck dissection specimens (28%) showed evidence of residual carcinoma on pathologic review. The mean number of lymph nodes identified at neck dissection for the entire cohort was 21 per specimen (range, 1-60) with 1.3 nodes per positive neck dissection demonstrating residual carcinoma. No correlation was found between the type of neck dissection performed and the presence of residual nodal disease. Eighty-two evaluated patients (93%) remain free of regional disease recurrence, whereas six patients have subsequently manifested neck recurrence. Four of the six patients who developed regional recurrence showed residual carcinoma in their neck dissection specimen. Five of these patients underwent comprehensive neck dissection (levels I-V); one underwent selective neck dissection (

Clinical evaluation of Parkinson's-related dysphonia.

OBJECTIVES: Nearly one third of patients with idiopathic Parkinson's disease (IPD) cite dysphonia, characterized subjectively as causing a harsh and breathy voice, as their most debilitating deficit. Medical or behavioral treatments may lead to voice improvement. The purpose of this study was 1) to determine whether vocal fold injection of Cymetra (micronized form of collagen, elastin, proteoglycans; Lifecell Co.) is associated with changes in dysphonic voice characteristics in subjects with IPD, as judged perceptually using a standard instrument Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and (2) which acoustic and aerodynamic measurements of voice are most reflective of any observed perceptual changes in voice. STUDY DESIGN: Prospective clinical evaluation of patients with Parkinson's-related dysphonia (PRD). METHODS: Six patients with PRD were evaluated before treatment for the presence of dysphonia and glottal gap. All subjects underwent transoral vocal fold collagen injection using topical anesthesia in the otolaryngology clinic as part of their clinical care. At the initial clinic visit, and 10 to14 days after vocal fold collagen injection, patients were asked to complete the Voice Handicap Index (VHI), a questionnaire concerning voice-related quality of life, and perceptual analyses of voice quality were performed. In addition, patients underwent acoustic (pitch/loudness range, maximum phonation time [MPT], and aerodynamic phonation threshold pressure [PTP]) voice analysis. RESULTS: Five of six subjects had self-perceived improvements in voice after treatment, as determined by the VHI (range, +8 to -24). All five subjects who completed testing demonstrated decreased PTP (range, -1.3 to -2.7, P = .002). Five of six subjects demonstrated statistically significant improvements in MPT (range, -2-16 s, P = .05). Five of six subjects had improved pitch range (-26-343 Hz), whereas all subjects had increased intensity range (0.6-23 db) after injection. CONCLUSIONS: Transoral collagen injection in patients with PRD is safe, well tolerated, and is an effective temporary method of subjectively improving voice and speech in selected patients with IPD. Reduction of glottal gap with collagen improves MPT and subglottal PTP. The resulting gain of vocal efficiency may reduce vocal fatigue and provide a useful adjunct to voice therapy for PRD.

Comparison of resorbable poly-L-lactic acid-polyglycolic acid and internal Palmaz stents for the surgical correction of severe tracheomalacia.

Tracheomalacia (TM) is associated with expiratory airway collapse and potentially fatal respiratory distress. Internal and external tracheal stents and, recently, resorbable biopolymers have been used to treat this condition. In this study, the efficacy and biocompatibility of internal Palmaz stents and external poly-L-lactic acid-polyglycolic acid (PLPG) stents were compared in a model of severe TM induced in piglets. The tracheas were repaired with one of two stenting methods, and the animals survived for up to 16 weeks. Weight gain, adverse respiratory signs and symptoms, tracheal or lung histopathologic changes, and internal and external tracheal diameters were measured. The animals in the PLPG group uniformly were free of respiratory distress and tracheal stenosis or inflammation, whereas all animals in the Palmaz group developed respiratory distress as a result of pneumonia or tracheal stenosis caused by intraluminal granulation tissue. In conclusion, superior efficacy of external, resorbable PLPG stents was found relative to internal Palmaz stents for the surgical repair of severe TM.

Effect of topical mitomycin on skin wound contraction.

OBJECTIVE: To evaluate the effect of different dosing regimens of mitomycin on skin wound contraction. METHODS: Full-thickness skin wounds were created in 5 groups of hairless mice, which represented different dosing regimens or a sterile water control: A, control; B, mitomycin (0.5 mg/mL) applied immediately after creation of the lesion (day 1); C, mitomycin (1.0 mg/mL) applied on day 1; D, mitomycin (0.5 mg/mL) applied on days 1 and 3; and E, mitomycin (1.0 mg/mL) applied on days 1 and 3. Wound surface area was measured immediately after drug application (day 1), and thereafter every 3 to 5 days until day 29 by means of computer-assisted image analysis. RESULTS: All dosing regimens of mitomycin application resulted in an initially exponential rate of wound contraction that was significantly slower than in the sterile water control group, with a significantly larger wound surface area on day 29. Wound area in the control group contracted approximately 9 times more rapidly than in the treatment groups. No difference was observed among the different dosing regimens. CONCLUSION: Application of mitomycin, at the lowest dose and frequency of application used in this study, resulted in improved outcomes with regard to contraction of full-thickness skin wounds.

Neuromuscular junction changes in aged rat thyroarytenoid muscle.

Dynamic remodeling of neuromuscular junction (NMJ) structure is postulated as a cause of age-related muscular atrophy. Direct study of NMJ morphology in laryngeal muscles is important to our understanding of age-related decrements in voice and swallowing. The morphology of NMJs was studied in a rat model to compare young and old specimens of thyroarytenoid muscle--a muscle critical to airway protection and phonation. Fluorescent, triple-label immunohistochemical analysis and confocal microscopic visualization were used to analyze the structure of NMJs. We found that laryngeal NMJs underwent significant changes that were similar to those observed after denervation. Specifically, the axon terminal area was significantly reduced, there were a number of postsynaptic acetylcholine receptor areas unoccupied by nerve terminals, and there was increased variability in end plate architecture in the old muscles. The results of this study increase our understanding of the age-related morphological changes in the larynx, and may serve as a baseline to test the effectiveness of future interventions.