Levent Erisen

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.

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.

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.

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.

P53 gene mutations in surgical margins and primary tumor tissues of patients with squamous cell carcinoma of the head and neck.

Aims and Background The frequency of p53 mutations in primary tumors, the effect of the mutations on some clinical and pathological features of head and neck squamous cell carcinoma, and the impact of p53 mutations in the surgical margins on local recurrence were determined. Material and Methods We investigated the presence of p53 mutations in primary tumor samples and in the surgical margins of 34 patients with head and neck cancer using single strand conformational polymorphism and sequencing analysis. Results The p53 mutations (codons 175addAT, 175delGC, 206G→A, and 248delC) were found in the primary tumor samples of 15 of 34 patients (44.12%) and in the surgical margins of 5 of the 15 tumors (33.33%) with p53 mutations. Conclusions We found no statistically significant association between the presence of p53 mutations in the primary tumor, the clinical and pathological features, or outcome of head and neck squamous cell carcinoma in this study. Furthermore, the presence of p53 mutations in the surgical margins may not increase the risk of local-regional recurrence, but probably increases the risk of developing distant metastases or second primary tumors.

Quantitative analysis of the drainage after neck dissection

The goals of this study are to determine the normal volume and lipid values of the drainage after neck dissection (ND) and to evaluate the changes of these values according to the type and side of the ND. Ninety-seven uncomplicated NDs involving zones I through IV were evaluated prospectively in this study. The most important result of the analysis of the drainage is that levels of triglyceride and cholesterol in the drainage were lower than serum levels in all but 1 case (P < 0.001). When matched for the type and side of the dissection, only mean total drainage volume was significantly higher in radical NDs than in selective NDs (P = 0.001). The normal volume and lipid values of neck drainage are reported in this study. Being aware of the changes in these values may help early diagnosis of some pathologic conditions.