Edwin C. Everts

Selective neck dissection and the management of the node-positive neck

OBJECTIVE To assess the oncologic effectiveness of the selective neck dissection (SND) in patients with both clinically and pathologically proven regional metastases. METHODS A 4-year retrospective medical chart review was conducted in an academic tertiary care referral center. Twenty-nine patients with a newly diagnosed upper aerodigestive tract squamous cell carcinoma, and both clinically and histologically proven cervical metastases who underwent 36 SND, had their records reviewed. Minimum follow-up was 2 years. RESULTS Regional metastasis were staged N1 in 13 patients, N2A in 1, N2B in 8, and N2C in 7. Seventeen supraomohyoid and 19 lateral neck dissections were performed. Extracapsular spread of tumor was present in 11 patients. Postoperative radiation therapy was administered to 20 patients. Actuarial disease-specific survival at 4 years was 47% overall, 67% in N1 patients, and 41% in N2 patients. Only 1 failure in the treated neck occurred for a 4-year actuarial regional failure rate of 4%. The actuarial local failure and distant metastasis rate were 36% each. CONCLUSIONS In carefully selected patients with clinically and histologically apparent regional metastases, the selective neck dissection can be an oncologically effective procedure.

Early postoperative calcium levels as predictors of hypocalcemia.

Objective: Early, safe postoperative hospital discharge has become a priority in the current environment of cost containment and managed care. One determinant for this following operations of the thyroid or parathyroid glands is a stable postoperative calcium level. This study sought to determine whether early postoperative calcium levels could safely predict hypocalcemia following operations of the thyroid or parathyroid glands. Study Design: A retrospective chart review of 197 patients undergoing such operations was undertaken. Methods: The study population was divided into patients undergoing parathyroid exploration with removal of one or more glands for parathyroid disease (“parathyroid” group) and patients undergoing bilateral thyroid operations (“nonparathyroid” group). Postoperative calcium levels were plotted as a function of time, and the slope between the first two postoperative calcium levels examined. Results: A positive slope predicted normocalcemia in 100% of “nonparathyroid” and 90% of “parathyroid” surgeries. A negative slope was predictive in its magnitude. The nonparathyroid patients who developed postoperative hypocalcemia had an average slope significantly more negative (‐0.84% change/h) than patients remaining normocalcemic (‐0.49% change/h) (P = .03). Similarly, the parathyroid patients who became hypocalcemic had an average initial slope nearly twice as negative (‐1.4% change/h) as patients remaining normocalcemic (‐0.78% change/h) (P = .005). Conclusions: These results indicate that an initial upsloping postoperative calcium curve based on two early postoperative calcium measurements is strongly predictive of a stable postoperative calcium level, and a steeply downsloping initial calcium curve is worrisome for eventual hypocalcemia.

The relative value of fine-needle aspiration and imaging in the preoperative evaluation of parotid masses.

To establish the sensitivity, specificity, and accuracy of imaging and fine‐needle aspiration (FNA), alone or in combination, in distinguishing benign from malignant histologic findings for parotid lesions.

Genetic polymorphisms in head and neck cancer risk.

To assess whether genetic polymorphisms implicated as risk factors for other tobacco‐associated malignancies are associated with altered risk of head and neck squamous cell carcinoma.

Metallic tracheal stents: complications associated with long-term use in the upper airway.

The use of metallic airway stents for the treatment of benign airway stenosis is increasingly advocated; however, the long-term safety and efficacy of these devices has not been established. Three case studies involving late but significant proximal tracheal stent complications are reported; 1 related to proximal mechanical stent failure and 2 related to obstructing granulation tissue and stenosis at the proximal stent orifice. Placement of these stents in close proximity to the cricotracheal junction is thought to be primarily responsible for these complications as a result of the excess shearing forces created at the stent-mucosal interface by the differential motion of the stent relative to the rigid subglottic airway and the more distensible trachea. Although the use of metallic stents remains appropriate in cases in which there is a defined and relatively short-term end point for treatment, caution is urged in using them in the proximal trachea for long-term management of benign airway disease.

Preoperative Evaluation of Patients With Primary Hyperparathyroidism: Role of High-Resolution Ultrasound†

Unilateral parathyroid exploration with adenoma removal and identification of a normal parathyroid gland is an accepted surgical approach for the treatment of patients with primary hyperparathyroidism. This study prospectively evaluated the ability of high‐resolution sonography to localize adenomas preoperatively and the effect of this localization on operative time and cost in 37 previously untreated patients undergoing surgical treatment for primary hyperparathyroidism. The sensitivity and positive predictive value of the sonographic examination were 84% and 90%, respectively. A true positive sonographic examination decreased surgical time by an average of 40 minutes and reduced operative charges by

Malignant nerve sheath tumors of the head and neck

564, including the cost of the test (

Congenital laryngeal webs: surgical management and clinical embryology

156). In experienced hands high‐resolution sonography can be a cost‐effective means of localizing parathyroid adenomas where unilateral exploration is considered an accepted surgical approach.

Fourth branchial arch sinus : Clinical presentation, diagnostic workup, and surgical treatment

Malignant nerve sheath tumors comprise approximately 5% of all soft tissue sarcomas; only 8% to 15% of these tumors arise in the head and neck. Most tumors appear as a rapidly expanding nonpainful mass in the face or lateral neck. Reported association with Von Recklinghausens disease varies from 26% to 70%. Wide surgical excision is generally the recommended primary treatment. Recently, there has been a trend to include postoperative radiation therapy as a primary modality.

Nodal disease in purely glottic carcinoma: Is elective neck treatment worthwhile?

Laryngeal webs are uncommon congenital anomalies. The formation of a laryngeal web represents anomalous embryologic development of the larynx. The extent of airway involvement varies which ultimately affects surgical management. A series of five congenital laryngeal webs each with subglottic involvement is reported. One patient also had a ventral laryngeal cleft. All patients ultimately required open laryngeal reconstruction, either laryngotracheal reconstruction (LTR) or thyrotomy (laryngofissure) and silastic keel, to correct the defect and all were decannulated. Findings at surgery correlate with recent descriptions of embryonic laryngeal development though the actual mechanism by which webs develop remains unknown. The findings suggest that congenital glottic webs require accurate endoscopic diagnosis and open airway reconstruction for definitive treatment.