http://www.headandneckoncology.org The latest research articles published by Head & Neck Oncology 2012-01-18T00:00:00Z Background: In thyroid surgery vessel division and haemostasis make up an important and time consuming part of the operation. While the presence of the recurrent laryngeal nerve limits the liberal use of diathermia, the many arterial and venous branches to and from the thyroid gland necessitates the use of numerous conventional suture ligatures.This study evaluates the effect of using a vessel sealing system on operation time during thyroid surgery. Methods: A randomized clinical trial was performed between September 2005 and October 2008 in a teaching hospital. Forty patients undergoing total hemithyroidectomy participated in the trial. Twenty were randomized to the intraoperative use of the LigaSure PreciseTM vessel sealing system, and twenty to the use of conventional suture ligatures. Results: The total median operation time was 10 minutes shorter in the LigaSure group (56 versus 66 minutes, P=0.001). No significant differences in complications were noticed. Conclusion: Using an electrothermal vessel sealing system during thyroid surgery is time saving.Trialregistration: This trial was registered in the international standard randomized controlled trials number register (ISRCTNR) under number ISRCTNR82389535. http://www.headandneckoncology.org/content/4/1/2 Anandi Schiphorst Bas Twigt Sjoerd Elias Thijs van Dalen Head & Neck Oncology 2012, null:2 2012-01-18T00:00:00Z doi:10.1186/1758-3284-4-2 /content/figures/1758-3284-4-2-toc.gif Head & Neck Oncology 1758-3284 ${item.volume} 2 2012-01-18T00:00:00Z PDF Oral and pharyngeal cancers are the sixth most common cancers internationally. In the United States, there are about 30,000 new cases of oral and pharyngeal cancers diagnosed each year. Furthermore, survival rates for oral and pharyngeal cancers have not significantly improved over the last three decades. This review examines the scientific literature surrounding the epidemiology of oral and pharyngeal cancers, including but not limited to risk factors, disparities, preventative factors, and the epidemiology in countries outside the United States. The literature review revealed that much of the research in this field has been focused on alcohol, tobacco, and their combined effects on oral and pharyngeal cancers. The literature on oral and pharyngeal cancer disparities among racial groups also appears to be growing. However, less literature is available on the influence of dietary factors on these cancers. Finally, effective interventions for the reduction of oral and pharyngeal cancers are discussed. http://www.headandneckoncology.org/content/4/1/1 Daniel Saman Head & Neck Oncology 2012, null:1 2012-01-13T00:00:00Z doi:10.1186/1758-3284-4-1 /content/figures/1758-3284-4-1-toc.gif Head & Neck Oncology 1758-3284 ${item.volume} 1 2012-01-13T00:00:00Z PDF Background: Taking intraoperative frozen sections (FS) is a widely used procedure in oncologic surgery. However so far no evidence of an association of FS analysis and premalignant changes in the surgical margin exists. Therefore, the aim of this study was to evaluate the impact of FS on different categories of the final margins of squamous cell carcinoma (SCC) of the oral cavity and lips. Methods: FS, pT-stage, grading, and tumor localization of 178 patients with SCC of the oral cavity and lips were compared by uni- and multivariate analysis in patients with positive, dysplastic and negative surgical margin status. Results: Performed on 111 patients (62.4%), intraoperative FS did not have any statistically significant influence on final margin status, independent of whether it was positive (p=0.40), dysplastic (p=0.70), or negative (p=0.70). Positive surgical margins in permanent sections were significantly associated with pT4-tumors (OR 5.61, p=0.001). The chance for negative margins in permanent sections was significantly higher in tumors located in the tongue (OR 4.70, p=0.01). Conclusions: Our data suggests that intraoperative FS in SCC can be useful in selected cases. However it is not advisable as a routine approach. http://www.headandneckoncology.org/content/3/1/56 Stefan Gerber Carole Gengler Klaus Gratz Astrid Kruse Head & Neck Oncology 2011, null:56 2011-12-30T00:00:00Z doi:10.1186/1758-3284-3-56 /content/figures/1758-3284-3-56-toc.gif Head & Neck Oncology 1758-3284 ${item.volume} 56 2011-12-30T00:00:00Z PDF IntroductionVascuologenesis is the de novo establishment of blood vessels and vascular networks from mesoderm-derived endothelial cell precursors (angioblasts). Recently a novel mechanism, by which some genetically deregulated and aggressive tumour cells generate "micro-vascular" channels without the participation of endothelial cells and independent of angiogenesis, has been proposed. This has been termed "vasculogenic mimicry" and has implications beyond angiogenesis and adds another layer of complexity to the current concept for the generation of tumour micro-circulation. We suggest this is common phenomenon in head and neck squamous cell carcinoma (HNSCC) cell lines and other aggressive tumour cell lines. We present experimental evidence of vasculogenic mimicry in HNSCC cell lines and compare them with other tumours and a positive control vascular cell line.Materials and MethodsThe following cell lines were used:- HUVEC ( human umbilical vein endothelial cell line), HN 2a, 2b (primary and metastatic tongue base squamous carcinoma cell line), HCT116 (colonic carcinoma cell line) and DU145 (prostate carcinoma cell line).Pilot experiments were undertaken to assess the growth of a bank of tumour cell lines on (growth factor reduced) matrigel (Sigma) with standard media (DMEM with 10% Fetal Calf Serum).A functional growth assay was also performed by preparing the appropriate cell suspension in serum free medium plated onto either bare plastic or a well pre-coated with growth factor reduced type 4 collagen analogues.Phase contrast photomicrographs were taken at 4 hours and 24 hours. Image analysis was performed; particular features of interest were two dimensional area (surrogate of growth and migration), branch points and end point measurements (surrogate of intercellular complexity). Results: There were observable differences in growth of the cells on laboratory plastic and collagen matrix. Tumour cells formed capillary like networks similar to HUVEC cells. Metastatic HNSCC cells lines were found to have vasculogenic properties similar to HUVEC cell lines when compared to cell lines from their corresponding primary tumour. The endothelial growth factor antibodies used did not inhibit or stimulate cell growth when compared to control but did discourage vascular mimicry. Other tumour cell lines also displayed this property.DiscussionTumour "vasculogenic mimicry" must still be regarded as a controversial issue whose existence is not proven. The clinical importance of this phenomenon however, is that it does explain the lack of complete efficacy of current anti-angiogenic treatments due to the added layer of complexity. It provides a feasible mechanism of early tumour vascular supply which can co-exist and incorporate with later angiogenic mechanisms. We suggest that "vasculogenic mimicry" maybe a common neoplastic phenomena which appears to also be dictated by the cells micro-environment. Its existence also suggests a further process that of the development of tumour mosaic vessels as the neo-vasculature integrates with the existing endothelial lined systems. http://www.headandneckoncology.org/content/3/1/55 Tahwinder Upile Waseem Jerjes Hani Radhi Mohammed Al-Khawalde Panagiotis Kafas Seyed Nouraei Holger Sudhoff Head & Neck Oncology 2011, null:55 2011-12-23T00:00:00Z doi:10.1186/1758-3284-3-55 /content/figures/1758-3284-3-55-toc.gif Head & Neck Oncology 1758-3284 ${item.volume} 55 2011-12-23T00:00:00Z PDF There is a paucity of publications detailing how to deal with the difficult thyroid cancer. When compared to other cancers, it is relatively rare with several histopathological subtypes which run differing clinical courses and respond to different therapies. It is a condition predominately treated by specifically trained General and now ENT surgeons who already have a thorough knowledge of vocal fold assessment and rehabilitation as well as emergency airways management both to avoid and treat common complications should they occur.Good surgery involves a team effort to produce good results consistently. All members of the team are essential to quality service delivery. Communication with the team and the patient is paramount. We describe our approach to the difficult thyroid. http://www.headandneckoncology.org/content/3/1/54 Tahwinder Upile Waseem Jerjes Jaspal Mahil Hitesh Tailor Ramkishan Balakumar Anuja Rao Yassar Qureshi Iain Bowman Suchana Mukhopadhyay Head & Neck Oncology 2011, null:54 2011-12-23T00:00:00Z doi:10.1186/1758-3284-3-54 /content/figures/1758-3284-3-54-toc.gif Head & Neck Oncology 1758-3284 ${item.volume} 54 2011-12-23T00:00:00Z XML Controlling tumour margins in head and neck surgery is of the utmost importance in preventing loco-regional spread and distant metastasis, which will ultimately lead to a significant reduction in morbidity and mortality. We comment on the surgical margins in photodynamic therapy and photochemical internalization. http://www.headandneckoncology.org/content/3/1/53 Waseem Jerjes Tahwinder Upile Hani Radhi Colin Hopper Head & Neck Oncology 2011, null:53 2011-12-22T00:00:00Z doi:10.1186/1758-3284-3-53 /content/figures/1758-3284-3-53-toc.gif Head & Neck Oncology 1758-3284 ${item.volume} 53 2011-12-22T00:00:00Z PDF Traditionally, in the United Kingdom and Europe, the surgeon was generally not troubled by litigation from patients presenting as elective as well as emergency cases, but this aspect of custom has changed. Litigation by patients now significantly affects surgical practice and vicarious liability often affects hospitals. We discuss some fundamental legal definitions, a must to know for a surgeon, and highlight some interesting cases. http://www.headandneckoncology.org/content/3/1/52 Waseem Jerjes Jaspal Mahil Tahwinder Upile Head & Neck Oncology 2011, null:52 2011-12-21T00:00:00Z doi:10.1186/1758-3284-3-52 /content/figures/1758-3284-3-52-toc.gif Head & Neck Oncology 1758-3284 ${item.volume} 52 2011-12-21T00:00:00Z XML Background and purpose: The submental flap is gaining popularity as a simple technique for reconstruction of small to moderate size defects of the oral cavity. However, its role in composite defects involving the jaw is not clearly defined. Indeed, controversy exists about the flap's interference with an oncologically sound neck dissectionPatients and Methods: A total of 21 patients with oral cavity cancers over a three year period were included. All patients underwent surgical resection and immediate reconstruction with submental flap except one patient who had delayed reconstruction with reversed flap. The flap was used for reconstruction of intra-oral soft tissue defect in 13 patients and composite defects in 8 patients. Results: Of 21 patients 12 were males and 9 were females, age ranged from 32 to 83 years. The primary tumor sites included buccal mucosa (7), tongue (4), alveolar margin (3), floor of mouth (5) and lip (2). Eventually in this study, we adopted completing the neck dissection first before flap harvest. Complete flap loss occurred in 2 whereas 3 patients had partial flap loss. Follow up ranged from 3 to 44 months, one patient died from metastatic disease. Four patients developed neck recurrences. Conclusion: The submental flap is a valid option for reconstruction of intra-oral soft tissue as well as composite oral defects particularly in elderly patients. However, oncologically sound neck dissection should be assured. http://www.headandneckoncology.org/content/3/1/51 Ayman Amin Mostafa Sakkary Ashraf Khalil Mohamed Rifaat Sherif Zayed Head & Neck Oncology 2011, null:51 2011-12-20T00:00:00Z doi:10.1186/1758-3284-3-51 /content/figures/1758-3284-3-51-toc.gif Head & Neck Oncology 1758-3284 ${item.volume} 51 2011-12-20T00:00:00Z PDF In this article, we present our experience with a case of myxolipoma of the tongue.Lipoma is a mesenchymal benign tumor occurring with relatively high frequency. However, myxolipoma, one of the histological variant of lipoma characterized by mature adipose tissue and abundant mucoid substances, in the oral cavity is quite rare.The patient was a 52-year-old man who noticed a painless mass on the left border of tongue about 2 years ago. The lesion was noted at a complete medical checkup, and the patient was admitted to our institution for detailed examination. The mass was a palpable, soft and elastic nodule, 15 mm in diameter, covered with normal mucosa in the left inferior aspect of the tongue. The border of the tumor was well-defined, and computed tomography (CT) revealed a fat density within the mass. On the basis of these finding, the tumor was clinically diagnosed as lipoma and was excised under general anesthesia. Histopathologically, the tumor was a well-defined lobulated mass surrounded by a thin fibrous capsule within the muscle of the tongue. The tumor was diagnosed as myxolipoma because it was consisted of solid proliferation of mature adipocytes replaced by abundant mucoid substances. The post operative course was uneventful, and there was no evidence of recurrence 4 years after surgery. http://www.headandneckoncology.org/content/3/1/50 Shigehiro Ono Majeed Rana Masaaki Takechi Ikuko Ogawa Gaku Okui Yoshitsugu Mitani Nils-Claudius Gellrich Nobuyuki Kamata Head & Neck Oncology 2011, null:50 2011-12-20T00:00:00Z doi:10.1186/1758-3284-3-50 /content/figures/1758-3284-3-50-toc.gif Head & Neck Oncology 1758-3284 ${item.volume} 50 2011-12-20T00:00:00Z XML We previously reported on the outcome of 21 patients with stage IV advanced and/or recurrent tongue base carcinoma subjected to mTHPC-PDT. We continue to develop on the previous work by treating more patients with this unforgiving disease. PDT has shown to be a very successful minimally-invasive surgical tool in managing this pathology. Tumour-associated symptoms were reduced significantly. The overall morbidity and mortality following PDT, in this group of patients, were far less when compared with other conventional modalities. http://www.headandneckoncology.org/content/3/1/49 Waseem Jerjes Tahwinder Upile Hani Radhi Colin Hopper Head & Neck Oncology 2011, null:49 2011-12-07T00:00:00Z doi:10.1186/1758-3284-3-49 /content/figures/1758-3284-3-49-toc.gif Head & Neck Oncology 1758-3284 ${item.volume} 49 2011-12-07T00:00:00Z XML