Head and Neck Reconstruction in Patients with Polycythemia Vera: Case Series and Literature Review

Abstract Background Polycythemia vera (PV) is a myeloproliferative disease with overproduction of erythrocytes, leukocytes, and platelets causing an increased risk of both thrombosis and hemorrhage. There are limited reports and no established guidelines for managing such patients undergoing reconstructive surgery. Methods We present four patients with PV and head and neck cancer who required reconstruction after resection and provide a review of the current literature. Results Preoperatively, patients on cytoreductive therapy continued with their treatment throughout their hospital course and had hematologic parameters normalized with phlebotomy or transfusions if needed. Two patients who underwent free flap surgery (cases 1 and 2) had postoperative courses complicated by hematoma formation and persistent anemia, requiring multiple transfusions. Cases 3 and 4 (JAK2+ PV and JAK2− PV, respectively) underwent locoregional flap without postoperative complications. Conclusion Concomitant presentation of PV and head and neck cancer is uncommon and presents unique challenges for the reconstructive surgeon. Overall, we recommend that patients should have hematologic parameters optimized prior to surgery, continue ruxolitinib or hydroxyurea, and hold antiplatelet/anticoagulation per established department protocols. It is essential to engage a multidisciplinary team involving hematology, head and neck and reconstructive surgery, anesthesia, and critical care to develop a standardized approach for managing this unique subset of patients.

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Functional Outcomes after Transoral Robotic Surgery for Head and Neck Cancer

Otolaryngology ◽

10.1016/j.otohns.2009.05.014 ◽

2009 ◽

Vol 141 (2) ◽

pp. 166-171 ◽

Cited By ~ 146

Author(s):

Tim A. Iseli ◽

Brian D. Kulbersh ◽

Claire E. Iseli ◽

William R. Carroll ◽

Eben L. Rosenthal ◽

...

Keyword(s):

Head And Neck Cancer ◽

Robotic Surgery ◽

Head And Neck ◽

Neck Cancer ◽

Functional Outcomes ◽

Case Series ◽

Feeding Tube ◽

Transoral Robotic Surgery ◽

T Stage ◽

Increased Risk

OBJECTIVE: To evaluate functional outcomes following transoral robotic surgery for head and neck cancer. STUDY DESIGN: Case series with planned data collection. SETTING: Academic hospital. SUBJECTS AND METHODS: Between March 2007 and December 2008, 54 of 62 candidate patients underwent transoral robotic tumor resection. Outcomes include airway management, swallowing (MD Anderson Dysphagia Inventory), and enterogastric feeding. RESULTS: Tumors were most commonly oropharynx (61%) or larynx (22%) and T1 (35%) or T2 (44%). Many received radiotherapy (22% preoperatively, 41% postoperatively) and chemotherapy (31%). Endotracheal intubation was retained (22%) for up to 48 hours, tracheostomy less frequently (9%), and all were decannulated by 14 days. Most commenced oral intake prior to discharge (69%) or within two weeks (83%). A worse postoperative Dysphagia Inventory score was associated with retained feeding tube ( P = 0.020), age >60 ( P = 0.017), higher T stage ( P = 0.009), laryngeal site ( P = 0.017), and complications ( P = 0.035). At a mean 12 months' follow-up, 17 percent retained a feeding tube (9.5% among primary cases). Retained feeding tube was associated with preoperative tube requirement ( P = 0.017), higher T stage ( P = 0.043), oropharyngeal/laryngeal site ( P = 0.034), and recurrent/second primary tumor ( P = 0.008). Complications including airway edema (9%), aspiration (6%), bleeding (6%), and salivary fistula (2%) were managed without major sequelae. CONCLUSION: Transoral robotic surgery provides an emerging alternative for selected primary and salvage head and neck tumors with low morbidity and acceptable functional outcomes. Patients with advanced T stage, laryngeal or oropharyngeal site, and preoperative enterogastric feeding may be at increased risk of enterogastric feeding and poor swallowing outcomes.

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Controlling MRSA in Surgical Head&Neck Patients: What Works?

Otolaryngology ◽

10.1016/j.otohns.2008.05.117 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P35-P36

Author(s):

Mrinal Supriya ◽

Louise Santangeli ◽

Muhammad Shakeel ◽

Kim Ah-See

Keyword(s):

Risk Factors ◽

Head And Neck Cancer ◽

Hospital Stay ◽

Head And Neck ◽

Cancer Patients ◽

Active Surveillance ◽

Neck Cancer ◽

Case Series ◽

Surveillance Cultures ◽

Increased Risk

Objective Can we control MRSA incidence in head and neck cancer patients by 1) Active surveillance cultures of patients fulfilling Society for Healthcare Epidemiology of America (SHEA) & Scottish Infection Standards and Strategy (SISS) guideline? 2) Cohorting these patients? 3) Restricted Health Care Workers (HCW) access? Methods Prospective case series: July 2007–January 2008. 26 preoperative head and neck cancer patients had a questionnaire filled in to identify known predictors for MRSA as suggested by SISS Group. Intervention: Preoperative nasal swabs, cohorting away from other cases, restricted access. MRSA incidence compared to that over the preceding year(Jan 2006-Jan 2007). Results 26 eligible patients. None of them had known risk factors for MRSA. 17 patients had swabs taken pre-admission. All screened patients were non-carriers of MRSA in their nose and none of them developed MRSA infection during hospital stay. Of remaining 9 patients swabbed after admission, 3 developed MRSA during hospital stay. The incidence of MRSA was 11.5% (3/26) during study period, compared to 28.5% (24/84) the year before implementing these interventions. Conclusions Head and neck cancer patients do not have increased risk factors for MRSA colonization and their active surveillance cultures are unlikely to influence MRSA incidence. Cohorting these patients with restricted HCW access decreased the MRSA rate at our centre.

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Analysing the risk factors in the incidence of Osteoradionecrosis in head and neck cancer patients: A case series

10.26226/morressier.5af5cdae738ab1001baf50e2 ◽

2018 ◽

Author(s):

Zain Iqbal

Keyword(s):

Risk Factors ◽

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Case Series

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Automated Non-Coplanar VMAT for Dose Escalation in Recurrent Head and Neck Cancer Patients

Cancers ◽

10.3390/cancers13081910 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1910

Author(s):

Kaley Woods ◽

Robert K. Chin ◽

Kiri A. Cook ◽

Ke Sheng ◽

Amar U. Kishan ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Dose Escalation ◽

Volumetric Modulated Arc Therapy ◽

Normal Tissue Complication Probability ◽

Tumor Control ◽

Tumor Control Probability ◽

Increased Risk ◽

Recurrent Head

This study evaluates the potential for tumor dose escalation in recurrent head and neck cancer (rHNC) patients with automated non-coplanar volumetric modulated arc therapy (VMAT) stereotactic body radiation therapy (SBRT) planning (HyperArc). Twenty rHNC patients are planned with conventional VMAT SBRT to 40 Gy while minimizing organ-at-risk (OAR) doses. They are then re-planned with the HyperArc technique to match these minimal OAR doses while escalating the target dose as high as possible. Then, we compare the dosimetry, tumor control probability (TCP), and normal tissue complication probability (NTCP) for the two plan types. Our results show that the HyperArc technique significantly increases the mean planning target volume (PTV) and gross tumor volume (GTV) doses by 10.8 ± 4.4 Gy (25%) and 11.5 ± 5.1 Gy (26%) on average, respectively. There are no clinically significant differences in OAR doses, with maximum dose differences of <2 Gy on average. The average TCP is 23% (± 21%) higher for HyperArc than conventional plans, with no significant differences in NTCP for the brainstem, cord, mandible, or larynx. HyperArc can achieve significant tumor dose escalation while maintaining minimal OAR doses in the head and neck—potentially enabling improved local control for rHNC SBRT patients without increased risk of treatment-related toxicities.

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Dental Restrictions to Clinical Practice during the COVID-19 Pandemic: An Australian Perspective

JDR Clinical & Translational Research ◽

10.1177/23800844211000341 ◽

2021 ◽

pp. 238008442110003

Author(s):

T.M. Nguyen ◽

U. Tonmukayakul ◽

H. Calache

Keyword(s):

Head And Neck Cancer ◽

Clinical Practice ◽

Dental Caries ◽

Knowledge Transfer ◽

Head And Neck ◽

Neck Cancer ◽

Dental Care ◽

Oral Diseases ◽

Increased Risk ◽

Dental Profession

The coronavirus disease 2019 (COVID-19) has disrupted essential oral healthcare in Australia. Sources for COVID-19 transmission via dental settings is considered to have high potential due to the production of aerosols and because transmission can occur through the airborne route. However, COVID-19 cases in dentistry is reportedly low. Delayed timely dental care, where severe oral diseases remain undetected, untreated, or asymptomatic such as advanced dental caries, periodontitis, and head and neck cancer, can have detrimental consequences for individuals at increased risk for oral diseases. The dental profession should remain vigilant and advocate for the continuation of essential oral healthcare even in times of uncertainty. Knowledge Transfer Statement: The reportedly low COVID-19 transmission occurring in dental settings highlight achievements made by the dental profession. There are valid reasons to reconsider risk-based essential oral healthcare during the COVID-19 pandemic.

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Outcomes of free flap reconstructive surgery in Head and Neck cancer patients over eighty years old

British Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.bjoms.2021.05.004 ◽

2021 ◽

Author(s):

O. Mitchell ◽

E. Kelly ◽

M. Ethunandan ◽

N. Horlock ◽

S. Sharma ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Free Flap ◽

Reconstructive Surgery

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NF-κB1 intronic region polymorphisms as risk factor for head and neck cancer in HPV-infected population from Pakistan

Current Molecular Medicine ◽

10.2174/1566524021666210302144344 ◽

2021 ◽

Vol 21 ◽

Author(s):

Sumaira Sarwar ◽

Muammad Usman Tareen ◽

Maimoona Sabir ◽

Aneesa Sultan ◽

Salman A Malik

Keyword(s):

Head And Neck Cancer ◽

Lymph Nodes ◽

Head And Neck ◽

Tobacco Use ◽

Neck Cancer ◽

Direct Sequencing ◽

Hpv Infection ◽

Pakistani Population ◽

Specific Pcr ◽

Increased Risk

Background: Head and neck cancer (HNC) developed due to the number of risk factors, including infection of Human Papillomavirus (HPV). The genetic predisposition also plays an important role in deregulating the NF-κB pathway, and certain polymorphisms are reported to affect the pathway genes. Objectives: The present study was conducted for the detection of HPV and polymorphisms in the NF-κB1 gene of HNC patients in the Pakistani population. Methods: Genomic DNA from HNC tumors samples were extracted using the Exgene SV DNA extraction Kit. Allele-specific PCR and direct sequencing were done for analysis of NF-κB1 SNPs, 94ins/del (rs28362491), rs1598858, and rs4648068. Results: The genotypes AG (36.2%/ 12%) of rs1598858, and AG (28.3%/ 12%) and GG (28.3%/ 22%) of rs4648068 were associated with significantly (p≤0.05) increased risk of head and neck cancer in studied population. Furthermore, among the HNC cases, genotypes AGrs1598858 (p≤0.014) and GGrs4648068 (p≤0.001) had increased risk of HPV related cancers. Tobacco use (OR-3.158442; [1.140, 8.754]), lymph nodes involvement (OR 4.05128; [1.854, 8.852]), and poorly differentiated tumors (OR 1.997155; [0.940, 4.245]) were positively associated with HPV induced cancers. Conclusion: It was the first comprehensive study from Pakistan, to evaluate the polymorphic variants of NF-κB1. Genotypes AGrs4648068, GGrs4648068, and AGrs1598858 of NF-κB1 gene are associated with increased risk of head and neck cancers in the Pakistani population. It can be concluded that HPV infection, lymph nodes and tobacco use can act synergetic to each other and add up in modulating HNC when present together with intronic SNPs of NF-κB1 gene.

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