Additional diagnostic value of (18)F-FDG PET-CT in detecting retropharyngeal nodal metastases.

OBJECTIVE: This study investigated whether preoperative (18)fluorine-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scanning improved the diagnosis of retropharyngeal lymph node (RPLN) metastasis in patients with head and neck squamous cell carcinoma (HNSCC) relative to conventional imaging alone. STUDY DESIGN: Case series with chart review. SETTING: University hospital cancer center. SUBJECTS AND METHODS: Sixty-three patients with HNSCC underwent RPLN dissection in accordance with our indications and were subsequently divided into two groups: CT/magnetic resonance imaging (MRI) only (group A, n = 33) and CT/MRI with PET-CT (group B, n = 30). The preoperative radiological findings of each group were compared with the RPLN histopathologic findings, which served as the standard of reference. RESULTS: RPLN metastasis was confirmed histopathologically in 17 of 63 patients (27.0%): eight from group A and nine from group B. With the additional use of PET-CT in group B, the sensitivity (88.9%), specificity (85.7%), and accuracy (86.7%) were higher than the respective values in group A (62.5%, 60.0%, and 60.6%). The positive and negative predictive values for group B (72.7% and 94.7%, respectively) were also higher than those for group A (33.3% and 83.3%, respectively). False-positive results were obtained in 10 patients from group A and three patients from B; false-negative findings occurred in three patients from group A and one patient from group B. The predictive power of the radiological findings was statistically significant in group B (P = 0.0017), with an odds ratio of 47.987 (95% confidence interval, 4.3-535.0). CONCLUSION: (18)F-FDG PET-CT, when used in combination with CT/MRI, increases diagnostic efficacy in the detection of RPLN metastases and may therefore be useful in screening high-risk patients.

Necrotizing sialometaplasia accompanied by adenoid cystic carcinoma on the soft palate.

Necrotizing Sialometaplasia (NS) is a benign, self-limiting inflammatory disease of the mucus-secreting glands, and this illness mainly involves the minor salivary glands. The significance of NS resides in its clinical and histopathological resemblance to malignancy. We present here a case of necrotizing sialometaplasia on the soft palate, and this was accompanied by adenoid cystic carcinoma. We report here on this case to draw attention to the difficulty for deciding the extent of resecting a malignancy, and especially when the malignancy is simultaneously accompanied by necrotizing sialometaplasia.

Anatomical variations of the spinal accessory nerve and its relevance to level IIb lymph nodes.

OBJECTIVE: This study was conducted to identify anatomical variations of the spinal accessory nerve (SAN) in the upper neck, the landmark of the anterior and inferior border of level IIb, and to evaluate the nerve's effect on the border and the number of lymph nodes (LNs) in level IIb. STUDY DESIGN AND SETTING: Case series with planned data collection. SUBJECTS AND METHODS: A total of 181 neck dissections (NDs) were prospectively enrolled in this study. The relation between the SAN and adjacent structures (internal jugular vein [IJV], sternocleidomastoid muscle [SCM], cervical plexus) and the number of LNs in level IIb was investigated. RESULTS: The SAN crossed the IJV ventrally in 72 cases (39.8%) and dorsally in 104 cases (57.4%), and passed through the IJV in five cases (2.8%). The SAN ran along the inner surface of the SCM and sent branches to the SCM without penetration of the muscle in 83 cases (45.9%), whereas in 98 cases (54.1%) the nerve sent branches to the SCM by penetration. Cervical plexus contribution to the SAN was seen from C2 in 96 cases (53.1%), C2 and C3 in 69 cases (38.1%), and C3 in 16 cases (8.8%). The mean number of LNs of level IIa and level IIb was 6.5 and 8.2 in cases in which the SAN crossed the IJV ventrally, and 6.8 and 5.4 in dorsally crossing cases. LNs included in the neck level IIb in ventrally crossing SAN cases were significantly larger than the dorsally crossing cases (P < 0.05). CONCLUSIONS: Our results may help to minimize the incidence of injuring the SAN in the upper neck during ND. Neck level IIb would contain more LNs if the course of the nerve leans toward the ventral side.

Functional benefit after modification of radial forearm free flap for soft palate reconstruction.

OBJECTIVES: To compare the velopharyngeal function, swallowing and speech of the conventional and modified radial forearm free flap (RFFF) for soft palate reconstruction. METHODS: Retrospective clinical study. Twenty-eight patients who underwent oropharyngeal reconstruction with RFFF were divided into two groups: 10 patients had conventional folded RFFF and 18 patients underwent modified method. RESULTS: The average speech intelligibility score in modified RFFF group was 8.0+/-2.4, and 6.2+/-2.2 in conventional RFFF group (P<0.05). The nasalance was 27.4+/-7.8% in modified group and 38.6+/-2.7% in conventional group during no nasal passage reading and 43.6+/-7.3% in modified group, 55.2+/-7.6% in conventional group during high nasal passage reading (P<0.05). The subjective swallowing functional score was 2.8 in modified group and 2.1 in conventional group. CONCLUSION: The speech assessment and nasalance demonstrate a more favorable outcome in modified group than conventional group.