Rammohan Tiwari

Management of cervical lymph nodes in patients with head and neck cancer.

SummaryThe status of the cervical lymph nodes is the single most important prognostic factor in head and neck cancer. Unfortunately, clinical assessment of the neck is not very accurate, although newer imaging techniques such as CT, MRI and ultrasound-guided fine needle aspiration cytology can be used to improve upon the results of clinical palpation alone. While diagnostic techniques remain less than 100% accurate, the risk of occult disease in the neck will remain. If this occurrence is judged to be greater than 15–20%, elective treatment to the neck may then be justified. When the neck is treated surgically, histological information can be gained which has both prognostic and therapeutic implications. Indications for the use of surgery and radiotherapy for the elective and therapeutic management of the neck and the results of such treatment are discussed.

Adenoid cystic carcinoma of the salivary glands: clinicopathological survey of 51 patients.

A clinicopathological study of 51 cases of adenoid cystic carcinoma in the head and neck region seen over a period of 20 years is presented. The correlation between various histological features and their impact on the results is attempted. Longterm results with respect to loco-regional recurrences, distant metastases and survival with various modalities of therapy are presented. Although this is a small series, radical surgery in keeping with the aim of avoiding undue mutilation, thus preserving the quality of life, followed by a full course of radiotherapy has been the mainstay of treatment and the results here presented justify this approach.

Positive surgical margins in neck dissection specimens in patients with head and neck squamous cell carcinoma and the effect of radiotherapy

To evaluate the outcome after surgery and radiotherapy for extensive nodal disease in patients with primary head and neck cancer.

The surgical management of recurrent or residual pleomorphic adenomas of the parotid gland. Analysis and results in 40 patients

From 1974 to 1995, 40 patients were treated surgically at the University Hospital Vrije, Universiteit Amsterdam for recurrent or residual pleomorphic adenomas of the parotid gland after previous surgery. The median interval between the initial procedure and surgery for the recurrence was 122 months. Eleven patients had one or more attempts to resect tumor recurrences prior to referral. During reoperation at this institution it was decided to refrain from tumor resection in three patients. Tumor control in two of these patients was achieved using radiotherapy. In the third patient a “wait-and-see” policy was adopted. The other 37 patients underwent en bloc surgical excisions of their tumor and/or previously incised tissues. Among the 36 patients operated for histopathologically benign disease, 16 received postoperative radiotherapy (to 6500 cGy). None developed a further recurrence, the median follow-up being 106 months. Only one of these patients experienced permanent segmental facial nerve paralysis. Malignant transformation of tumor occurred in two patients. One of these patients died of locoregional disease after surgery and radiotherapy. Radical tumor resection was deferred in the other patient, with tumor control achieved using radiotherapy (7000 cGy). However, since recurrent disease tends to be multifocal in origin, prolonged routine follow-up is required.

Neck Dissection for Advanced Lymph Node Metastasis Before Definitive Radiotherapy for Primary Carcinoma of the Head and Neck

Objective To evaluate the outcome of neck dissection for advanced metastasis and subsequent planned radiotherapy to the neck and primary tumor.

LONG-TERM RESULTS OF ORGAN PRESERVATION IN CHONDROSARCOMA OF THE CRICOID

Abstract Chondrosarcoma of the larynx is rare. The posterolateral lamina of the cricoid cartilage is the site most commonly involved. Although the symptomology, radiological and histopathological diagnostic features are well known, the condition continues to be diagnosed late and recurrences after excision are common. In general, radical surgical excision can result in long-term remission, although prognosis is related to the histopathological grade of the tumor. While a conservative surgical approach in low-grade tumors is justified, unexplained hoarseness, unilateral vocal cord paralysis and dyspnea requires CT scan examination.

Malignant adenolymphoma of the parotid gland: report of carcinomatous transformation.

Malignant transformation of an adenolymphoma (Warthins tumour) is a rare event. This paper presents a case of carcinoma arising in an adenolymphoma of the parotid gland.

Local radiation dose, fixation, and non-union of mandibulotomies

Non‐union of mandibulotomies is a serious complication but risk factors are unclear. No data are available on the effect of the specific dose of irradiation at the osteotomy site.

Laryngeal Reconstruction With Free Nonvascularized Grafts From the Buccal Mucosa

PURPOSE This study was designed to investigate the suitability of nonvascularized healthy buccal mucosal graft in reconstruction of subglottic defects. PATIENTS AND METHODS The study was conducted over an 11-year period from 1985 to 1995. Seven nonvascularized healthy buccal mucosal grafts were used to provide coverage for subglottic defects. The indications for surgery included chondrosarcoma of the cricoid including two recurrent tumors and one patient with recurrent subglottic benign laryngeal stenosis. No stenting was used. Period of follow-up ranged from 1 to 10 years. RESULTS Graft take was successful in all cases without complications. CONCLUSION Healthy nonvascularized buccal mucosal graft is suitable for reconstruction of subglottic defects. Stenting is not required.