Evaluation and Treatment of Acute Bleeding from the Head and Neck

Acute bleeding in the head and neck area occurs due to various causes and often is a life-threatening situation. Head and neck cancers can be a cause of intractable hemorrhage from local tumour irradiation or spontaneous tumourbleeding1. In addition to tumour-related bleeding, iatrogenic bleeding related to surgical procedures or trauma, can also lead to intractable, life-threatening bleeding1. A pseudoaneurysm is an extravascular hematoma that communicates with the intravascular space. This rare lesion receives its name from the fact that its vascular wall is composed of fibrous connective tissue (pseudo-capsule) that develops after rupture of the endothelium2. Pseudoaneurysms occur when there is a partial disruption in the wall of a blood vessel, causing a hematoma that is either contained by the vessel adventitia or the perivascular soft tissue3.

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Acute haemorrhage in patients with advanced head and neck cancer: value of endovascular therapy as palliative treatment option

The Journal of Laryngology & Otology ◽

10.1017/s0022215105003178 ◽

2005 ◽

Vol 120 (2) ◽

pp. 117-124 ◽

Cited By ~ 18

Author(s):

Andreas M Sesterhenn ◽

Joanna Iwinska-Zelder ◽

Carsten V Dalchow ◽

Siegfried Bien ◽

Jochen A Werner

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Endovascular Therapy ◽

Treatment Options ◽

Neurological Complication ◽

Advanced Head ◽

Emergency Procedure ◽

Acute Bleeding ◽

Acute Haemorrhage

Aims: Acute or subacute haemorrhage is one of the most frightening complications in patients suffering from advanced head and neck cancer. Few articles report experience with superselective endovascular therapy for this purpose. Is endovascular therapy underestimated in the field of palliative head and neck cancer therapy? This study set out to investigate this question.Patients and methods: A review was undertaken of the clinical courses of seven patients (six men, one woman) suffering from incurable, advanced head and neck cancer (four pharyngeal, two laryngeal, one neck) and treated with superselective endovascular strategies as an emergency procedure for acute bleeding.Results: All patients were successfully treated without evidence of neurological complication. Patients reached a median survival of 20 weeks (range eight–168 weeks). Following endovascular treatment all patients were discharged from the hospital within several days. Three patients survived almost free of symptoms for several weeks and were able to stay at home with their families until their death.Conclusion: We conclude that in the field of palliative care, superselective endovascular therapy deserves to be considered alongside standard treatment options for the management of acute haemorrhage from advanced head and neck cancer.

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Bleeding In Head And Neck Malignancy : Institution Based Management And Review

10.21203/rs.3.rs-237519/v1 ◽

2021 ◽

Author(s):

Elroy Saldanha ◽

Amar Jain ◽

Dhruv Patel ◽

Bonny Joseph ◽

Sandeep Ghosh ◽

...

Keyword(s):

Head And Neck ◽

Medical Personnel ◽

External Carotid Artery ◽

Neurological Deficits ◽

External Carotid ◽

Acute Bleeding ◽

Universal Precautions ◽

Oncological Emergency ◽

Post Surgery ◽

Bleeding Episodes

Abstract Introduction:Squamous cell carcinoma constitutes for >90% of head and neck cancers. Acute rupture of irradiated, large vessels is life-threatening complication. The distribution of bleeding foci is diverse and can range from internal or common carotid arteries to branches of the external carotid artery. We intend to assess the management of patients presented in our institution with such acute bleeding episodes and also review the management of carotid blowout syndrome which is an oncological emergency.Methods:Retrospective observational study of 27 cases presented in our institution with acute bleeding due to head and neck cancer for period of two years. After resuscitation and necessary consents, emergency open tracheostomy was done with universal precautions. ECA/CCA ligation was done. All the patients were started on low molecular weight heparin 8 hours post surgery. Therapeutic outcomes were assessed based on simple frequencies and proportions.Results:Of the 27 cases presented in our institution, 19 of them underwent ECA ligation while 8 of them CCA ligation for the control of active bleeding. 12 of 27 patients were receiving definitive chemoradiation of which 7 of them were ongoing. Remaining 15 patients were receiving adjuvant radiotherapy following surgery.19 patients who underwent ECA ligation, had no further bleeding episodes. 8 patients who underwent CCA ligation, had only wound related complications and none of them had neurological deficits. 11 patients were operated during covid-19 period. 4 patients turned out covid positive. None of the medical personnel contacted the infection.Conclusion:Radiotherapy is one the major contributor for CBS. Endovascular procedures can be used for local tumour bleed, threatened, impending and stable acute CBS. Surgical CCA ligation done in bleeds unsuccessful by endovascular procedure and in acute unstable CBS. ECA ligation is safe and effective method to control local tumor bleed. Surgical finesse, careful planning, adherence to universal precautions and institutional protocol can reduce Covid-19 transmission to medical personnel in this testing times.

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Acute Bleeding in the Head and Neck: Angiographic Findings and Endovascular Management

American Journal of Neuroradiology ◽

10.3174/ajnr.a3761 ◽

2013 ◽

Vol 35 (2) ◽

pp. 360-366 ◽

Cited By ~ 14

Author(s):

L.- B. Zhao ◽

H. B. Shi ◽

S. Park ◽

D. g. Lee ◽

J. H. Shim ◽

...

Keyword(s):

Head And Neck ◽

Endovascular Management ◽

Acute Bleeding ◽

Angiographic Findings

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Implications for clinical staging of metastatic cutaneous squamous carcinoma of the head and neck based on a multicenter study of treatment outcomes

The Journal of Laryngology & Otology ◽

10.1017/s0022215106002891 ◽

2005 ◽

pp. 1

Keyword(s):

Head And Neck ◽

Treatment Outcomes ◽

Multicenter Study ◽

Squamous Carcinoma ◽

Clinical Staging

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[Triple-combined therapy of malignant cancer of the head and neck-maxillary cancer]

Journal of Dental Education ◽

10.1002/j.0022-0337.1969.33.4.tb00237.x ◽

1969 ◽

Vol 33 (4) ◽

pp. 596-598

Author(s):

Y Sato

Keyword(s):

Head And Neck ◽

Combined Therapy ◽

Maxillary Cancer

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Copper-dependent ATP7B up-regulation drives the resistance of TMEM16A-overexpressing head-and-neck cancer models to platinum toxicity

Biochemical Journal ◽

10.1042/bcj20190591 ◽

2019 ◽

Vol 476 (24) ◽

pp. 3705-3719 ◽

Cited By ~ 2

Author(s):

Avani Vyas ◽

Umamaheswar Duvvuri ◽

Kirill Kiselyov

Keyword(s):

Oxidative Stress ◽

Head And Neck ◽

Transcriptional Activation ◽

Platinum Resistance ◽

Mrna Levels ◽

Strong Positive Correlation ◽

Platinum Compounds ◽

Copper Chelation ◽

Novel Approach ◽

Cancer Models

Platinum-containing drugs such as cisplatin and carboplatin are routinely used for the treatment of many solid tumors including squamous cell carcinoma of the head and neck (SCCHN). However, SCCHN resistance to platinum compounds is well documented. The resistance to platinum has been linked to the activity of divalent transporter ATP7B, which pumps platinum from the cytoplasm into lysosomes, decreasing its concentration in the cytoplasm. Several cancer models show increased expression of ATP7B; however, the reason for such an increase is not known. Here we show a strong positive correlation between mRNA levels of TMEM16A and ATP7B in human SCCHN tumors. TMEM16A overexpression and depletion in SCCHN cell lines caused parallel changes in the ATP7B mRNA levels. The ATP7B increase in TMEM16A-overexpressing cells was reversed by suppression of NADPH oxidase 2 (NOX2), by the antioxidant N-Acetyl-Cysteine (NAC) and by copper chelation using cuprizone and bathocuproine sulphonate (BCS). Pretreatment with either chelator significantly increased cisplatin's sensitivity, particularly in the context of TMEM16A overexpression. We propose that increased oxidative stress in TMEM16A-overexpressing cells liberates the chelated copper in the cytoplasm, leading to the transcriptional activation of ATP7B expression. This, in turn, decreases the efficacy of platinum compounds by promoting their vesicular sequestration. We think that such a new explanation of the mechanism of SCCHN tumors’ platinum resistance identifies novel approach to treating these tumors.

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