Naresh Jha

Effect of Exercise on Upper Extremity Pain and Dysfunction in Head and Neck Cancer Survivors A Randomized Controlled Trial

Shoulder pain and disability are well recognized complications associated with surgery for head and neck cancer. This study was designed to examine the effects of progressive resistance exercise training (PRET) on upper extremity pain and dysfunction in postsurgical head and neck cancer survivors.

Functional Outcomes After Primary Oropharyngeal Cancer Resection and Reconstruction With the Radial Forearm Free Flap

Objective To report prospectively collected aeromechanical, acoustical, and perceptual speech outcomes, as well as preliminary swallowing data, in patients having reconstruction with radial forearm free flaps after primary resection for oropharyngeal cancer.

Prevention of radiation induced xerostomia by surgical transfer of submandibular salivary gland into the submental space.

BACKGROUND AND PURPOSE Xerostomia is a significant morbidity of radiation treatment in the management of head and neck cancers. We hypothesized that the surgical transfer of one submandibular salivary gland to the submental space, where it can be shielded from radiation treatment (XRT), would prevent xerostomia. MATERIALS AND METHODS We conducted a prospective Phase II clinical trial and the patients were followed clinically with salivary flow studies and the University of Washington Quality of Life questionnaire. RESULTS We report the results on 76 evaluable patients. The salivary gland transfer was done in 60 patients. Nine patients (of 60) did not have postoperative XRT and in eight patients (of 60) the transferred gland was not shielded from XRT due to proximity of disease. The median follow up is 14 months. Of the 43 patients with the salivary gland transfer and post-operative XRT with protection of the transferred gland, 81% have none or minimal xerostomia, and 19% developed moderate to severe xerostomia. Three patients (6.9%) developed local recurrence, five patients (11.6%) developed distant metastases and five patients (11.6%) have died. There were no complications attributed to the surgical procedure. CONCLUSION Surgical transfer of a submandibular salivary gland to the submental space preserves its function and prevents the development of radiation induced xerostomia.

Nutrition impact symptoms: Key determinants of reduced dietary intake, weight loss, and reduced functional capacity of patients with head and neck cancer before treatment

Our aim was to evaluate the prevalence and relationship of symptoms with reduced dietary intake, weight, and functional capacity in patients with head and neck cancer.

Submandibular salivary gland transfer prevents radiation-induced xerostomia

BACKGROUND Xerostomia is a significant morbidity of radiation therapy in the management of head and neck cancers. We hypothesized that the surgical transfer of one submandibular salivary gland to submental space, outside the proposed radiation field, prior to starting radiation treatment, would prevent xerostomia. METHODS We are conducting a prospective clinical trial where the submandibular gland is transferred as part of the surgical intervention. The patients are followed clinically, with salivary flow studies and University of Washington quality of life questionnaire. RESULTS We report early results of 16 patients who have undergone this procedure. Seven patients have finished and 2 patients are currently undergoing radiation treatment. In 2 patients, no postoperative radiation treatment was indicated. Two patients are waiting to start radiation treatment and 2 patients refused treatment after surgery. The surgical transfer was abandoned in 1 patient. All of the transferred salivary glands were positioned outside the proposed radiation fields and were functional. The patients did not complain of any xerostomia and developed only minimal oral mucositis. There were no surgical complications. CONCLUSIONS Surgical transfer of a submandibular salivary gland to the submental space (outside the radiation field) preserves its function and prevents the development of radiation-induced xerostomia.

Understanding the human salivary metabolome.

Saliva is a readily accessible biofluid that is important for the overall health, aiding in the chewing, swallowing, and tasting of food as well as the regulation mouth flora. As a first step to determining and understanding the human saliva metabolome, we have measured salivary metabolite concentrations under a variety of conditions in a healthy population with reasonably good oral hygiene. Using 1H NMR spectroscopy, metabolite concentrations were measured in resting (basal) and stimulated saliva from the same subject and compared in a cohort of healthy male non‐smoking subjects (n = 62). Almost all metabolites were higher in the unstimulated saliva when compared to the stimulated saliva. Comparison of the salivary metabolite profile of male smokers and non‐smokers (n = 46) revealed citrate, lactate, pyruvate, and sucrose to be higher and formate to be lower in concentration in smokers compared with non‐smokers (p < 0.05). Gender differences were also investigated (n = 40), and acetate, formate, glycine, lactate, methanol, propionate, propylene glycol, pyruvate, succinate, and taurine were significantly higher in concentration in male saliva compared to female saliva (p < 0.05). These results show that differences between male and female, stimulated and unstimulated, as well as smoking status may be observed in the salivary metabolome. Copyright

A pilot study of a randomized controlled trial to evaluate the effects of progressive resistance exercise training on shoulder dysfunction caused by spinal accessory neurapraxia/neurectomy in head and neck cancer survivors

Shoulder dysfunction remains a frequent complication after neck dissection procedures for head and neck cancer.

Submandibular gland transfer : A new method of preventing radiation-induced xerostomia

Objective Radiation‐induced xerostomia is a significant morbidity of radiation therapy in the management of patients with head and neck cancers. We have recently reported a method of transfer of one submandibular gland to the submental space in a small pilot series of eligible surgical patients. The submental space was shielded during postoperative radiation therapy. The transferred gland continued to function after the completion of radiation therapy and none of the patients developed xerostomia. The purpose of this article is to present the technique of submandibular gland transfer in detail and to evaluate the postoperative survival and function of the transferred submandibular glands.

Does radiotherapy have a role in hemangiopericytoma management? Report of 14 new cases and a review of the literature

From 1948 to 1984, 14 adult patients received radiation therapy as a part of their treatment for hemangiopericytoma at the University of Texas M.D. Anderson Hospital and Tumor Institute at Houston. In addition to radiation therapy 11 patients were treated with surgery, with or without chemotherapy--5 as primary management and 6 after recurrence following surgical excision. Although 9 of these 11 patients had macroscopic and 1 had definite microscopic disease at the time of irradiation, none suffered local recurrence and 9 have survived from 3.5 years to 20 years free of disease. Two of the 11 patients died of distant metastases. Two patients completed treatment for palliation and 1 of them survived for 2 years after treatment. The results suggest that postoperative radiation therapy should be considered as an integral part of the primary treatment of hemangiopericytoma.

Phase III randomized study: Oral pilocarpine versus submandibular salivary gland transfer protocol for the management of radiation-induced xerostomia

Xerostomia is a serious morbidity of radiation treatment in head and neck cancer.