An additional challenge for head and neck radiologists: anatomic variants posing a surgical risk – a pictorial review

AbstractAnatomic variants in the head and neck are quite numerous and occur frequently: a minority of them increase the risk of complications during surgical procedures and may be visualized on cross-sectional images. As some of these complications are potentially fatal, awareness (and accurate reporting) of such variants is a basic responsibility of radiologists, particularly when surgery in the pertinent anatomic area is under consideration.

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Radiology of acute mastoiditis and its complications: a pictorial review and interpretation checklist

The Journal of Laryngology & Otology ◽

10.1017/s0022215119001609 ◽

2019 ◽

Vol 133 (10) ◽

pp. 856-861

Author(s):

M W Mather ◽

P D Yates ◽

J Powell ◽

I Zammit-Maempel

Keyword(s):

Head And Neck ◽

Surgical Planning ◽

Systematic Approach ◽

Acute Mastoiditis ◽

Cross Sectional ◽

Imaging Technology ◽

Radiological Features ◽

Pictorial Review ◽

Cross Sectional Imaging ◽

Sectional Imaging

AbstractBackgroundMastoiditis is an otological emergency, and cross-sectional imaging has a role in the diagnosis of complications and surgical planning. Advances in imaging technology are becoming increasingly sophisticated and, by the same token, the ability to accurately interpret findings is essential.MethodsThis paper reviews common and rare complications of mastoiditis using case-led examples. A radiologist-derived systematic checklist is proposed, to assist the ENT surgeon with interpreting cross-sectional imaging in emergency mastoiditis cases when the opinion of a head and neck radiologist may be difficult to obtain.ResultsA 16-point checklist (the ‘mastoid 16’) was used on a case-led basis to review the radiological features of both common and rare complications of mastoiditis; this is complemented with imaging examples.ConclusionAcute mastoiditis has a range of serious complications that may be amenable to treatment, once diagnosed using appropriate imaging. The proposed checklist provides a systematic approach to identifying complications of mastoiditis.

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Hubungan ekspresi p53, Bcl-2, c-Myc dan MMP-9 dengan gambaran klinikopatologi karsinoma sel skuamosa kepala-leher

Oto Rhino Laryngologica Indonesiana ◽

10.32637/orli.v46i1.147 ◽

2016 ◽

Vol 46 (1) ◽

pp. 53

Author(s):

Azwar Azwar ◽

Sofia Mubarika ◽

Agus Surono

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Tumor Location ◽

Neck Squamous Cell Carcinoma ◽

Second Primary ◽

Cross Sectional ◽

P53 Expression ◽

Local Metastasis

Latar belakang: Karsinoma sel skuamosa kepala dan leher merupakan salah satu kanker terseringdi seluruh dunia. Pendekatan pengobatan agresif dan multidisiplin telah dilakukan, namun belum adapeningkatan yang signifikan dalam kelangsungan hidup 5 tahun, selama 20 tahun terakhir. Kegagalanpengobatan terjadi dalam bentuk kekambuhan lokoregional, metastasis jauh, dan/atau tumor primer kedua.Berbagai penanda molekular tumor telah diteliti untuk mengetahui potensinya dalam memprediksi hasilpenyakit atau respon terhadap terapi.Tujuan: Mengetahui hubungan ekspresi protein p53, Bcl-2, c-Myc,dan MMP-9 berdasarkan gambaran klinikopatologis karsinoma sel skuamosa kepala dan leher di RumahSakit dr. Zainoel Abidin.Metode: Studi menggunakan desain cross sectional. Sampel terdiri dari 60blok parafin karsinoma sel skuamosa kepala dan leher. Prosedur pewarnaan imunohistokimia dilakukandengan menggunakan antibodi monoklonal terhadap p53, Bcl-2, c-Myc, dan MMP-9. Ekspresi proteinp53, Bcl-2, c-Myc, dan MMP-9 dianalisis secara imunohistokimia pada karsinoma sel skuamosa kepaladan leher kemudian hasilnya dihubungkan dengan parameter klinikopatologis seperti usia, jenis kelamin,lokasi tumor, diferensiasi tumor, metastasis kelenjar getah bening dan stadium tumor, kemudian dianalisisstatistik dengan Chi square.Hasil: Hasil penelitian menunjukkan terdapat hubungan bermakna tingkatekspresi p53 dengan metastasis lokal (p=0,021) dan ada hubungan bermakna tingkat ekspresi MMP-9dengan lokasi tumor (p=0,026). Tidak terdapat hubungan ekspresi p53, Bcl-2, cMyc, dan MMP-9 terhadapusia, jenis kelamin, stadium tumor, diferensiasi histologi, tingkat T, N, dan metastasis jauh.Kesimpulan:Ada hubungan ekpresi p53 dengan metastasis kelenjar limfe regional dan ekspresi MMP-9 dengan lokasitumor pada karsinoma sel skuamosa kepala dan leher. Kata kunci: Karsinoma sel skuamosa kepala dan leher, p53, Bcl-2, c-Myc, MMP-9 ABSTRACTBackground: Head and neck squamous cell carcinoma (HNSCC) is one of the most commoncancers world wide. Although aggressive and multidisciplinary approach to the treatment has been done,there is no significant improvement in 5-year survival in the last 20 years. Treatment failure occurredin the form of locoregional recurrence, distant metastasis, and/or a second primary tumor. A variety oftumor molecular markers have been studied to determine their potential in predicting disease outcome orresponse to the therapy. Purpose: To investigate correlation p53, Bcl-2, c-Myc, and MMP-9 expressionto clinicopathologic parameter in head and neck squamous cell carcinoma patient in dr. Zainoel Abidinhospital. Methods: Cross sectional design study. The sample was consisted of 60 paraffin blocks ofhead and neck squamous cell carcinoma. Procedure of immunohistochemical staining used monoclonalantibodies against p53, Bcl-2, c-Myc, and MMP-9. Expression of p53 protein, Bcl-2, c-Myc, and MMP-9were analyzed by immunohistochemistry in head and neck squamous cell carcinoma. Then, the results were linked to clinicopathologic parameters such as age, sex, tumor location, tumor differentiation,lymph node metastasis and tumor stage, and statistically analyzed with Chi square. Results: The resultsshowed there were significant correlation between p53 expression level with local metastasis (p=0,021)and significant correlation of MMP-9 expression levels with tumor location (p=0,026). There were norelationship of p53, Bcl-2, cMyc and MMP-9 expressions based on age, sex, stage tumor, histologicdifferentiation, level of T, N, and distant metastases. Conclusion: There were relationships between p53expression with local metastasis and MMP-9 expression with tumor location in head and neck squamouscell carcinoma. Keywords: Head and neck squamous cell carcinoma, p53, Bcl-2, c-Myc, MMP-9

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Acceptance and adoption of transoral robotic surgery in Germany

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06623-w ◽

2021 ◽

Author(s):

Magis Mandapathil ◽

Jens E. Meyer

Keyword(s):

Robotic Surgery ◽

Head And Neck ◽

Neck Surgery ◽

Transoral Robotic Surgery ◽

Head And Neck Surgery ◽

University Hospitals ◽

Cross Sectional ◽

Adoption Rate ◽

Decision Making Processes ◽

Sectional Analysis

Abstract Purpose Since its introduction over a decade ago, the use of robotic surgery (RS) in head and neck surgery has widely spread around the globe, with very differential adoption of this novel surgical technique in different parts of the world. In this study, we analyze the acceptance and adoption of robotic surgery in the head and neck in Germany. Materials and methods A cross-sectional analysis using a questionnaire evaluating the acceptance and adoption of RS was performed. Questionnaires were distributed to all chairmen /-women of Otorhinolaryngology, Head and Neck Surgery Departments in Germany. Results A total of 107 respondents completed the questionnaire (65.2%). At university hospitals, 71.4% of the respondents indicated that a robotic system was available, and 21.4% responded that robotic surgery was performed at their institution; 22.7% and 0.04%, respectively, at non-university hospitals. The overall adoption rate was 0.8%. The most common cases performed were TORS resection in the oropharynx. Main reasons for not adopting this technique were costs, lack of interest and available co-operations. Conclusion This study provides evidence of the extent of adoption of TORS in Germany; main perceived barriers to adoption are costs with lack of cost-covering reimbursement and insufficient co-operations with other disciplines as well as hospital administration resulting in a very low adoption rate of this technique over the past decade. Results from this study may assist in decision-making processes on adopting this technique in the future.

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Feel the Burn! Fireworks-related Otolaryngologic Trauma

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211008100 ◽

2021 ◽

pp. 000348942110081

Author(s):

Alexander J. Straughan ◽

Luke J. Pasick ◽

Vrinda Gupta ◽

Daniel A. Benito ◽

Joseph F. Goodman ◽

...

Keyword(s):

United States ◽

Head And Neck ◽

Emergency Departments ◽

Closed Head Injury ◽

Penetrating Trauma ◽

The United States ◽

Neck Injuries ◽

Chi Square ◽

Injury Surveillance System ◽

Cross Sectional

Objectives: Fireworks are used commonly for celebrations in the United States, but can lead to severe injury to the head and neck. We aim to assess the incidence, types, and mechanisms of head and neck injuries associated with fireworks use from 2010 to 2019. Methods: A retrospective cross-sectional study, using data from the National Electronic Injury Surveillance System, of individuals presenting to United States Emergency Departments with head and neck injuries caused by fireworks and flares from 2010 to 2019. Incidence, types, and mechanisms of injury related to fireworks use in the US population were assessed. Results: A total of 541 patients (349 [64.5%] male, and 294 [54%] under 18 years of age) presented to emergency departments with fireworks-related head and neck injuries; the estimated national total was 20 584 patients (13 279 male, 9170 white, and 11 186 under 18 years of age). The most common injury diagnoses were burns (44.7% of injuries), laceration/avulsion/penetrating trauma (21.1%), and otologic injury (15.2%), which included hearing loss, otalgia, tinnitus, unspecified acoustic trauma, and tympanic membrane perforation. The remaining 19% of injuries were a mix, including contusion, abrasion, hematoma, fracture, and closed head injury. Associations between fireworks type and injury diagnosis (chi-square P < .001), as well as fireworks type by age group (chi-square P < .001) were found. Similarly, associations were found between age groups and injury diagnoses (chi-square P < .001); these included children 5 years and younger and adults older than 30 years. Conclusions: Fireworks-related head and neck injuries are more likely to occur in young, white, and male individuals. Burns are the most common injury, while otologic injury is a significant contributor. Annual rates of fireworks-related head and neck injuries have not changed or improved significantly in the United States in the past decade, suggesting efforts to identify and prevent these injuries are insufficient.

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Clinical utility of a functional lumen imaging probe in management of dysphagia following head and neck cancer therapies

Endoscopy ◽

10.1055/s-0043-110670 ◽

2017 ◽

Vol 49 (09) ◽

pp. 848-854 ◽

Cited By ~ 9

Author(s):

Peter Wu ◽

Michal Szczesniak ◽

Julia Maclean ◽

Lennart Choo ◽

Harry Quon ◽

...

Keyword(s):

Head And Neck Cancer ◽

Diagnostic Accuracy ◽

Head And Neck ◽

Neck Cancer ◽

Characteristic Curve ◽

Diagnostic Tools ◽

Cross Sectional ◽

Imaging Probe ◽

Functional Lumen Imaging Probe ◽

Dysphagic Patients

Abstract Background and aims Chemoradiotherapy for head and neck cancer (HNC) with/without laryngectomy commonly causes dysphagia. Pharyngoesophageal junction (PEJ) stricturing is an important contributor. We aimed to validate a functional lumen imaging probe (the EndoFLIP system) as a tool for quantitating pretreatment PEJ distensibility and treatment-related changes in HNC survivors with dysphagia and to evaluate the diagnostic accuracy of EndoFLIP-derived distensibility in detecting PEJ strictures. Methods We studied 34 consecutive HNC survivors with long-term (> 12 months) dysphagia who underwent endoscopic dilation for suspected strictures. Twenty non-dysphagic patients undergoing routine endoscopy served as controls. PEJ distensibility was measured at endoscopy with the EndoFLIP system pre- and post-dilation. PEJ stricture was defined as the presence of a mucosal tear post-dilation. Results PEJ stricture was confirmed in 22/34 HNC patients (65 %). During distension up to 60 mmHg, the mean EndoFLIP-derived narrowest cross-sectional area (nCSA) in HNC patients with strictures, without strictures, and in controls were 58 mm2 (95 % confidence interval [CI] 22 to 118), 195 mm2 (95 %CI 129 to 334), and 227 mm2 (95 %CI 168 to 316), respectively. A cutoff of 114 mm2 for the nCSA at the PEJ had perfect diagnostic accuracy in detecting strictures (area under the receiver operating characteristic curve = 1). In patients with strictures, a single session of dilation increased the nCSA by 29 mm2 (95 %CI 20 to 37; P < 0.001). In patients with no strictures, dilation caused no change in the nCSA (mean difference 13 mm2 [95 %CI −4 to 30]; P = 0.13). Conclusions EndoFLIP is a highly accurate technique for the detection of PEJ strictures. EndoFLIP may complement conventional diagnostic tools in the detection of pharyngeal outflow obstruction.

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Surgical Morbidity of Neck Dissection after Chemoradiotherapy in Advanced Head and Neck Cancer

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949710600205 ◽

1997 ◽

Vol 106 (2) ◽

pp. 117-122 ◽

Cited By ~ 38

Author(s):

James P. Newman ◽

Willard E. Fee ◽

David J. Terris ◽

Richard L. Goode ◽

Harlan A. Pinto ◽

...

Keyword(s):

Head And Neck ◽

Surgical Procedures ◽

Complication Rate ◽

Organ Preservation ◽

Surgical Complication ◽

Control Group ◽

Surgical Morbidity ◽

Significant Difference ◽

Duration Of Surgery ◽

Lower Complication

The use of chemotherapy and irradiation for organ preservation attempts to eliminate the need for extensive surgery in patients with advanced squamous cell carcinoma of the head and neck (SCCHN). We sought to characterize the morbidity of surgery in patients who needed surgery after treatment with induction chemotherapy followed by simultaneous chemotherapy and radiotherapy (chemoradiotherapy). The surgical morbidity within the first 30 postoperative days of 17 patients treated in an organ preservation approach between July 1991 and December 1994 was compared with a control group of patients undergoing similar surgical procedures during the same period. The organ preservation study patients underwent surgical procedures consisting of 18 neck dissections and 5 resections of the primary site. Six patients in the organ preservation study group experienced 8 surgical complications within the first 30 postoperative days, and most complications were minor. There was no significant difference in the duration of surgery or length of hospitalization between study patients and matched controls. Our surgical complication rate (35.3%) was higher but not statistically different from that of the control group, and compared favorably to reports of surgical morbidity (44% to 61%) in the literature on patients treated with chemoradiotherapy. The lower complication rate seen in this study may be a reflection of early surgical intervention as part of our organ preservation study scheme, the preponderance of neck dissections performed, and the limited number of pharyngeal procedures performed.

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Periaortic air in native and post-operative aorta on computed tomography

British Journal of Radiology ◽

10.1259/bjr.20210878 ◽

2021 ◽

Author(s):

Mansi Verma ◽

Amit Ajit Deshpande ◽

Niraj Nirmal Pandey ◽

Sanjeev Kumar

Keyword(s):

Computed Tomography ◽

Clinical Laboratory ◽

Radical Surgery ◽

Imaging Finding ◽

Radiological Findings ◽

Catastrophic Event ◽

Cross Sectional ◽

Pictorial Review ◽

Cross Sectional Imaging ◽

Indispensable Tool

Periaortic air can be seen in various conditions which can be a benign imaging finding or harbinger of a catastrophic event. The causes vary in native aorta and post-operative aorta. A radiologist has an important part in the management process of these patients, as the treatment varies from conservative to radical surgery based on the aetiology. The presence of periaortic air seen in the light of various clinical, laboratory and radiological findings can guide the radiologist towards a particular aetiology. Cross-sectional imaging, mainly computed tomography, is an indispensable tool in recognising ectopic periaortic air and to identify the associated findings and eventually make an accurate diagnosis. We present a pictorial review of various causes of the periaortic air in native and postoperative aorta, the salient features and management of the described conditions.

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A pictorial review of the helpfulness of diffusion weighted imaging sequences in head and neck pathology

10.26226/morressier.60dc80855d86378f03b41088 ◽

2021 ◽

Author(s):

Nirav Kaneria ◽

Hannah Marsh

Keyword(s):

Head And Neck ◽

Diffusion Weighted Imaging ◽

Diffusion Weighted ◽

Pictorial Review ◽

Head And Neck Pathology

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Enhanced Morbidity of Pectoralis Major Myocutaneous Flap Used for Salvage after Previously Failed Oncological Treatment and Unsuccessful Reconstructive Head and Neck Surgery

The Scientific World JOURNAL ◽

10.1100/2012/384179 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 5

Author(s):

Christiana Maria Ribeiro Salles Vanni ◽

Leandro Luongo de Matos ◽

Mário Paulo Faro Junior ◽

Jossi Ledo Kanda ◽

Cláudio Roberto Cernea ◽

...

Keyword(s):

Radiation Therapy ◽

Head And Neck ◽

Myocutaneous Flap ◽

Neck Surgery ◽

Cross Sectional Study ◽

Pectoralis Major ◽

Pectoralis Major Myocutaneous Flap ◽

Cross Sectional ◽

Oncological Treatment ◽

Major Complications

Introduction. The reconstruction of complex cervicofacial defects arising from surgical treatment for cancer is a real challenge for head and neck surgeons, especially in salvage reconstruction surgery and/or failed previous reconstruction. The pectoralis major myocutaneous flap (PMMF) has been widely used in these specific situations due to its reliability and low rate of failure or complications.Objectives. Identify factors that determine complications and influence the final outcome of the reconstructions with PMMF in salvage cancer surgery or in salvage reconstruction.Methods. A cross-sectional study design was used to evaluate a sample including 17 surgical patients treated over a period of ten years that met the inclusion criteria.Results. Reconstruction was successful in 13 cases (76.5%), with two cases of partial flap loss and no case of total loss. Complications occurred in 13 cases (76.5%) and were specifically related to the flap in nine instances (52.9%). An association was identified between the development of major complications and reconstruction of the hypopharynx () as well as in patients submitted to surgery in association with radiation therapy as a previous cancer treatment (). The former condition is also associated with major reconstruction failure (). An even lower incidence of major complications was noted in patients under the age of 53 ().Conclusion. Older patients, with hypopharyngeal defects and submitted to previous surgery plus radiation therapy, presented a higher risk of complications and reconstruction failure with PMMF.

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