Hakan Coskun

SHOULDER FUNCTION AFTER ACCESSORY NERVE-SPARING NECK DISSECTIONS

This study was designed to observe the effect of preserving the spinal accessory nerve (SAN) during neck dissection (ND) and adjuvant radiotherapy (ART) after ND on shoulder function.

NECK TREATMENT AND SHOULDER MORBIDITY: STILL A CHALLENGE

Shoulder complaints and functional impairment are common sequelae of neck dissection. This is often attributed to injury of the spinal accessory nerve by dissection or direct trauma. Nevertheless, shoulder morbidity may also occur in cases in which the spinal accessory nerve has been preserved. In this article, the physiology and pathophysiology of the shoulder are discussed, followed by a consideration of the impact of neck dissection on shoulder complaints, functional impairment, and quality of life. Finally, rehabilitation will be considered.

Factors Affecting Wound Infection Rates in Head and Neck Surgery

PURPOSE: This study was planned with 2 goals in mind: to evaluate the efficacy of prolonged and 1-day antibiotic regimens for prophylaxis and to evaluate the effect of various factors such as neck dissection, localization and stage of tumor, type of laryngectomy, and history of prior radiotherapy, tracheotomy, and diabetes mellitus on postoperative wound infection rates. METHODS AND MATERIAL: In this study, 408 head and neck procedures (201 clean and 207 clean-contaminated) performed at our institution were retrospectively reviewed. RESULTS: Prolonged and 1-day antibiotic regimens for both clean and clean-contaminated procedures were similar in efficacy (7% vs 3% for clean procedures [P = 0.165] and 30% vs 28% for clean-contaminated procedures [P = 0.777]). The wound infection rate was higher (13%) after clean radical neck dissections versus other clean procedures (1%) (P = 0.001). For clean-contaminated procedures, factors affecting postoperative wound infection rates were performance of bilateral neck dissections (P = 0.014), disease stage (P = 0.002), type of laryngectomy (P = 0.002), and history of prior tracheotomy (P = 0.006).

Selective neck dissection for clinically N0 neck in laryngeal cancer: Is dissection of level IIb necessary?

The most common morbidity associated with selective neck dissection (SND; II–IV) is spinal accessory nerve dysfunction and related shoulder disability. Nerve dysfunction is usually attributed to stretching of the nerve during clearance of lymph nodes lying posterior and superior to the spinal accessory nerve (level IIb). If these lymph nodes were left in place and not removed, stretching of the spinal accessory nerve during neck dissection and postoperative shoulder disability could be avoided. 113 SNDs (II–IV) performed on clinically N0 necks of patients with laryngeal carcinoma were enrolled in this prospective study. During SND, level IIb was separately removed and processed. Mean number of lymph nodes in level IIb was 6.26 (range, 0-19). In none of the 113 SND (II-IV) specimens did level IIb contain metastases, thus providing an oncological basis that leaving these lymph nodes in place is an oncologically safe approach, probably avoiding postoperative shoulder disability.

Proposal for A Rational Classification of Neck Dissections

Alfio Ferlito, MD, DLO, DPath, FRCSEd ad hominem, FRCS (Eng, Glasg, Ir) ad eundem, FDSRCS ad eundem, FHKCORL, FRCPath, FASCP, IFCAP, K. Thomas Robbins, MD, FRCSC, Jatin P. Shah, MD, PhD (Hon), MS, FRCSEd (Hon), FRACS (Hon), FDSRCS, Jesus E. Medina, MD, Carl E. Silver, MD, Shawkat Al-Tamimi, MD, Johannes J. Fagan, MBChB, FCS (SA) MMed, Vinidh Paleri, MS, FRCS (ORL-HNS), Robert P. Takes, MD, PhD, Carol R. Bradford, MD, Kenneth O. Devaney, MD, JD, FCAP, Sandro J. Stoeckli, MD, Randal S. Weber, MD, Patrick J. Bradley, MB, BCh, BAO, DCH, MBA, FRCS (Ed, Eng, Ir), FHKCORL, FRCSLT (Hon), FRACS (Hon), Carlos Suarez, MD, PhD, C. Rene Leemans, MD, PhD, H. Hakan Coskun, MD, Karen T. Pitman, MD, Ashok R. Shaha, MD, Remco de Bree, MD, PhD, Dana M. Hartl, MD, PhD, Missak Haigentz, Jr, MD, Juan P. Rodrigo, MD, PhD, Marc Hamoir, MD, Avi Khafif, MD, Johannes A. Langendijk, MD, PhD, Randall P. Owen, MD, MS, Alvaro Sanabria, MD, MSc, PhD, Primož Strojan, MD, PhD, Vincent Vander Poorten, MD, PhD, Jochen A. Werner, MD, Stanislaw Bien, MD, PhD, Julia A. Woolgar, FRCPath, PhD, Peter Zbaren, MD, Jan Betka, MD, PhD, FCMA, Benedikt J. Folz, MD, Eric M. Genden, MD, Yoav P. Talmi, MD, Marshall Strome, MD, MS, Jesus Herranz Gonzalez Botas, MD, Jan Olofsson, MD, Luiz P. Kowalski, MD, PhD, Jon D. Holmes, DMD, MD, Yasuo Hisa, MD, PhD, Alessandra Rinaldo, MD, FRCSEd ad hominem, FRCS (Eng, Ir) ad eundem, FRCSGlasg

Acute invasive fungal rhinosinusitis: evaluation of 26 patients treated with endonasal or open surgical procedures.

OBJECTIVE Acute invasive fungal rhinosinusitis (AIFRS) is a serious disease with a high mortality and morbidity rate, which almost always affects immunocompromised patients and/or patients with diabetes mellitus. Our purpose was to present the diagnostic and therapeutic management and outcome of these patients. STUDY DESIGN Case series with chart review. SETTING Tertiary care university hospital. SUBJECTS AND METHODS Twenty-six patients, who were operated on because of AIFRS between September 1999 and June 2009, were retrospectively evaluated in this study. Endoscopic surgery was used in 19 patients, and open surgical debridement was performed in seven patients. RESULTS Overall survival rate of the patients in the open surgery group (4 of 7; 57.1%) was similar to that of the endoscopically treated group (9 of 19; 47.3%). Thirteen patients (50%) died of complications related to the underlying disease (9 of 13; 69.2%) and AIFRS (4 of 13; 30.7%). AIFRS-specific survival rate is 76.5 percent; 90 percent (9 of 10) and 57.1 percent (4 of 7) for endoscopic and open surgery groups, respectively. Four patients who died had pathological diagnosis of mucormycosis (P = 0.52). CONCLUSION AIFRS can be successfully treated with a combination of endonasal surgical debridement and antifungal medications. Endonasal approach is suitable for patients diagnosed in the early stages of the disease and provides a less traumatic option in those patients who already have a poor health status. Open surgery should be preferred in the presence of intraorbital extension, palatinal, and/or intracerebral involvement. Reversing the underlying disease process and immunosuppression is as important as the surgical and antifungal treatment.

ACCESSORY NERVE FUNCTION AFTER LEVEL 2B-PRESERVING SELECTIVE NECK DISSECTION

The aim of this prospective study was to evaluate the relationship between accessory nerve functions and level 2b–preserving selective neck dissection.

Protective Effect of Amifostine Against Toxicity of Paclitaxel and Carboplatin in Non-small Cell Lung Cancer

AbstractAim: In this study we determined the protective role of amifostine against the side effects of the combination of paclitaxel and carboplatin in patients with non-small cell lung cancer (NSCLC). Patients and Methods: Chemo-naive patients with NSCLC were eligible. Thirty-eight patients were randomized to receive paclitaxel 175 mg/m2 and carboplatin AUC=6 with amifostine 910 mg/m2 (group B) or chemotherapy alone (group A). The occurrences of hematologic, neurologic, cardiologic toxicities, and ototoxicity were evaluated. Results: All patients completed the six scheduled cycles of therapy. A total of 114 cycles of chemotherapy was given in both groups. Neutropenia grade 3–4 was observed in 11 cycles (9.6%) in group A and 19 cycles (16.6%) in group B (p=0.16). Paresthesia grade 1 or 2 was observed in 18 of 19 patients of group A and in 8 of 19 patients of group B, following the sixth cycle of chemotherapy (p=0.018). Two patients of group B and nine patients of group A suffered from sensory motor impairment grade 2 (p=0.029). There was no clinical evidence in any patient for deterioration in cardiac function. Asymptomatic and transient sinus bradycardia or ventricular premature beats developed in four patients. None of the patients reported vertigo, tinnitus, or hearing loss. Conclusion: The addition of the amifostine to the combination of paclitaxel and carboplatin may prevent or reduce the incidence of neurotoxicity in the treatment of NSCLC. Amifostine does not appear to have a preventive role in neutropenia.

Basaloid squamous cell carcinoma of the larynx: A report of four new cases

Objectives: This study is designed to report the clinical and pathologic features and outcome of cases of basaloid squamous cell carcinoma (BSCC) of the larynx treated in our clinic.

Objective and early diagnosis of chylous fistula in the postoperative period.

OBJECTIVE : The study goal was to evaluate whether quantitative analysis of neck drainage contents is an important parameter of objective and early diagnosis of chylous fistula (CF) in the postoperative period. STUDY DESIGN AND SETTING : We prospectively evaluated 103 consecutive neck dissections during a 2-year period at a tertiary academic referral center. Six of the patients (5.8%) had CF. The data obtained from the patients with CF were matched with normal data obtained from patients without CF. RESULTS : A statistically significant difference was found between total drainage volumes of the patients with and those without CF (P < 0.05). In almost all patients with CF, drainage levels of triglycerides and cholesterol on postoperative day 1 were higher than serum levels. The difference between the drainage levels of triglycerides and cholesterol of the patients with and without CF was highly significant (P < 0.001). CONCLUSIONS : Serum and drainage levels of triglycerides and cholesterol on postoperative day 1 can be used as objective and early predictive parameters of CF.