Stuart Archibald

Postlaryngectomy quality-of-life dimensions identified by patients and health care professionals**†

We compared the quality-of-life (QOL) dimensions after laryngectomy in patients with advanced larynx or pharynx cancer that were elicited from 20 consecutive laryngectomy patients and 20 health care professionals working in the Regional Head and Neck Oncology Service. Subjects in both groups were asked to identify important QOL items after recovery from laryngectomy and to rank and rate each on a vertical visual analogue scale. Health care professionals ranked impaired communication and self-image/self-esteem as the two most important QOL dimensions, whereas patients ranked the physical consequences of surgery, e.g., tracheal mucous production, and interference with social activities as the two most important items. The results indicate that the responses of health care professionals do not fully correlate with patient priorities. These findings are relevant to researchers developing treatment-specific QOL measures and to health care professionals when presenting treatment options to patients.

Needle aspiration cytologic biopsy in head and neck masses

Over 500 fine (no. 22) needle aspiration biopsies were done on head and neck lesions. The total accuracy for the series was 94.5 percent. The accuracy rates for thyroid, salivary and metastatic or benign lymph node lesions were similar: approximately 95 percent. Only lymphomatous lesions gave a lower accuracy rate: 75 percent. This method of evaluating masses in the head and neck is simple, rapid, inexpensive, well-tolerated and harmless, and is very accurate when there is close cooperation between the clinician and the cytopathologist.

Surgical patterns of venous drainage of the free forearm flap in head and neck reconstruction.

A retrospective review of 40 consecutive free forearm flaps used in head and neck reconstruction in our Head and Neck Service identified five different patterns of venous drainage. In type 1, the cephalic vein and two venae comitantes join into a larger median cubital vein, which itself splits into two sizable branches (n = 8, two anastomoses). In type 2, a median cubital vein drains both the cephalic vein and the two venae comitantes (n = 17, single anastomosis). In type 3, the cephalic vein and the confluence of two venae comitantes are drained separately (n = 1, two anastomoses). In type 4, the cephalic vein and each of two venae comitantes are anastomosed separately (n = 2, three separate anastomoses). In type 5, the cephalic vein and the larger of the two venae comitantes are drained separately (n = 6, two anastomoses). Understanding these possible venous drainage patterns substantially expedites the raising of the free forearm flap. The selection of patterns 1 and 2, when possible, with the large-caliber veins ensures the safety of the flap. Long vascular pedicles permit anastomoses to contralateral neck recipient vessels, obviating vein grafts, and permit safe full head and neck mobility. (Plast. Reconstr. Surg. 93: 54, 1994.)

Sebaceous carcinoma of the face following irradiation

Malignant neoplasms of sebaceous glands are uncommon but generally occur about the head and neck, where these glands are concentrated. The sites of most frequent occurrence are the ocular adnexae, where sebaceous carcinoma presents as an infiltrating malignancy with a poor prognosis. Cutaneous sebaceous carcinoma is rare at other sites but has a better prognosis. We have located eight cases in the literature of sebaceous carcinoma arising in a previously irradiated field: five in the ocular adnexae and three elsewhere on the face. We here report a fourth case of recurrent sebaceous carcinoma with metastases that occurred on the face of an 82-year-old woman who had received radiation to the area for cosmetic epilation 35 years previously.

Mucoepidermoid Carcinoma of the Parotid Gland: A Rare Presentation in a Young Child

Although mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland neoplasm in childhood and adolescence, it is rarely found in children under the age of 10. A 6-year-old girl had an asymptomatic neck mass for 5 months. Clinical examination findings showed a 1.5-cm smooth and firm but mobile nontender mass located in the upper left anterior cervical triangle, clinically separate from the parotid gland. Ultrasound examination findings showed a vascular mass, with a cystic component, possibly within the tail of the parotid gland. An excisional biopsy was performed and frozen section showed a low-grade MEC. A left superficial parotidectomy was then performed. Final histopathologic examination showed one positive resection margin. Subsequently, reexcision of the surgical site and an upper modified neck dissection was undertaken. This unusual presentation of MEC as a neck mass in one of the youngest reported patients illustrates that the anatomic region for parotid tumors is large. Possibly some of these tumors may arise from heterotopic or accessory parotid tissue.

The free vascularized anterior rib graft.

The free vascularized anterior rib graft, one of the earliest free osseous transfers to the head and neck,has not gained widespread acceptance, perhaps due to early reservations concerning the adequacy of the periosteal circulation. The authors present further laboratory evidence, with clincal cases, attesting to the adequacy of the periosteal circulation alone. Our surgical technique varies from other reports in that a substantially greater length of the internal mammary vessels is harvested and includes the dual periosteal supply by means of the supracostal and intercostal vessels, both branches of the internal mammary vessels. This modification is based on anatomic and angiographic findings. The incorporation of both branches enhances the margin of safety in raising this free bone graft.

The Role of the Randomized Controlled Trial in Plastic Surgery

This article discusses the role of the randomized controlled trial (RCT) in plastic surgery. There are unique challenges in the execution of an RCT in plastic surgery, including: (1) surgical equipoise, (2) the surgical learning curve, (3) differential care, (4) randomization, (5) concealment, (6) expertise-based design, (7) blinding, (8) intention-to-treat analysis, (9) loss to follow-up, and (10) treatment effect and implications for sample size calculations. The RCTs conducted in plastic surgery to date are generally of poor quality in design and reporting, are fraught with bias, and have small sample sizes, thus this article attempts to help future investigators perform better quality RCTs.

Association of Marijuana Use With Psychosocial and Quality of Life Outcomes Among Patients With Head and Neck Cancer

Importance Cannabis sativa, the most widely used illicit substance in Canada, has a unique ability to facilitate relaxation and relieve anxiety while reducing pain. However, no study to date has examined quality of life (QOL) and psychosocial issues in relation to the use of this drug among patients with newly diagnosed head and neck cancer (HNC). Objective To examine the differences in QOL and psychosocial outcomes between marijuana users and nonusers with newly diagnosed HNC. Design, Setting, and Participants This prospective cohort study was conducted at a tertiary care cancer center. Patients were enrolled consecutively and prospectively at the time of HNC diagnosis from January 1, 2011, to January 1, 2015. Seventy-four patients who were current marijuana users were case matched to 74 nonusers in a 1:1 scheme based on age, sex, and tumor subsite. All patient demographic and QOL data were collected prospectively, and data analysis was conducted from November 1 to December 1, 2017. Main Outcomes and Measure The QOL outcome was assessed using the EuroQol-5D (EQ5D) and the Edmonton Symptom Assessment System (ESAS) questionnaires. Results A total of 148 patients were included in this study: 74 in the marijuana user group (mean [SD] age, 62.3 [10.3] years; male sex, 61 patients [82%]) and 74 in the marijuana nonuser group (mean age, 62.2 years; male sex, 63 patients [85%]). There was no statistically significant difference in age, sex, tumor subsite, clinical TNM staging, treatment modality, or mean Karnofsky score between the 2 groups. On univariate analysis, there was no statistically significant difference in the mobility, self-care, and usual activities domains of the EQ5D. Marijuana users had significantly lower scores in the anxiety/depression (difference, 0.74; 95% CI, 0.557-0.930) and pain/discomfort (difference, 0.29; 95% CI, 0.037-1.541) domains. Wilcoxon rank sum test confirmed the results of the EQ5D with improvements in the pain/discomfort (z score, −2.60) and anxiety/depression (z score, −6.71) domains. Marijuana users had less pain, were less tired, were less depressed, were less anxious, had more appetite, were less drowsy, and had better general well-being according to the ESAS. A Wilcoxon rank sum test confirmed a statistically significant improvement in ESAS scores within the domains of anxiety (z score, −10.04), pain (z score, −2.36), tiredness (z score, −5.02), depression (z score, −5.96), drowsiness (z score, −5.51), appetite (z score, −4.17), and general well-being (z score, −4.43). Conclusions and Relevance This prospective case-matched study suggests that there may be significant QOL benefits, including decreased anxiety, pain, and depression and increased appetite and generalized feelings of well-being, associated with marijuana use among patients with newly diagnosed HNC.