Long-Term Outcomes of Breast Cancer Patients Who Underwent Selective Neck Dissection for Metachronous Isolated Supraclavicular Nodal Metastasis

We retrospectively enrolled 139 patients who developed metachronous isolated supraclavicular lymph node metastasis (miSLNM) from 8129 consecutive patients who underwent primary surgery between 1990 and 2008 at a single medical center. The median age was 47 years. The median follow-up time from date of primary tumor surgery was 73.1 months, and the median time to the date of neck relapse was 43.9 months in this study. Sixty-one (43.9%) patients underwent selective neck dissection (SND). The 5-year distant metastasis-free survival (DMFS), post-recurrence survival, and overall survival (OS) rates in the SND group were 31.1%, 40.3%, and 68.9%, respectively, whereas those of the no-SND group were 9.7%, 32.9%, and 57.7%, respectively (p = 0.001). No SND and time interval from primary tumor surgery to neck relapse ≤24 months were the only significant risk factors in the multivariate analysis of DMFS (hazard ratio (HR), 1.77; 95% confidence interval (CI), 1.23–2.56; p = 0.002 and HR, 1.76, 95% CI, 1.23–2.52; p = 0.002, respectively) and OS (HR, 1.77; 95% CI, 1.22–2.55; p = 0.003 and HR, 3.54, 95% CI, 2.44–5.16; p < 0.0001, respectively). Multimodal therapy, including neck dissection, significantly improved the DMFS and OS of miSLNM. Survival improvement after miSLNM control by intensive surgical treatment suggests that miSLNM is not distant metastasis.

A Case of Primary Squamous Cell Carcinoma of The Thyroid Gland

Primary squamous cell carcinoma of thyroid is a very rare malignant tumor with poor prognosis. It is usually diagnosed as an advanced disease infiltrating adjacent organs, and characterized by aggressive clinical course with an average postoperative survival time of less than 1 year. Recently, we had a 79- year-old woman with a painful neck mass who was diagnosed as primary squamous cell carcinoma of thyroid gland. She underwent total thyroidectomy and selective neck dissection(level Ⅲ, Ⅵ) with no further postoperative managements such as radiation therapy or chemotherapy; she died of poor general condition and pneumonia resulting from rapid progression of the lesion on the 38th day after surgery. We report this case with a review of relevant literatures.

Endoscopic Cervical Lymph Node Dissection Using the Extra-cervical Anterior Chest Wall Approach: A New Technique

Introduction This study aims to demonstrate the safety, surgical feasibility, and esthetic features of total endoscopic neck dissection (END) through anterior chest wall approach (ACWA) without creation of any neck incisions. Resection of their primary tumors followed by selective total END through ACWA using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). Methods From January 2020 to August 2020, 6 patients with a biopsy proven head and neck carcinoma underwent resection of their primary tumors followed by selective total END through ACWA using 3 ports (one 10-mm port for the camera and two 5-mm ports for the working instruments). Results The selective neck dissection was successfully performed endoscopically in all cases with no conversion to open approach and with good visualization of the major neurovascular structures. The operative time for the END ranged from 120 to 170 minutes, with 10–50 mL estimated blood loss. No significant perioperative complications were encountered. The mean total number of cervical LN retrieved was 13.67 + 2.42, and the mean LNR was .01 + .13. All patients were discharged in the third postoperative day, and they were satisfied with the cosmetic outcome. Conclusion Selective total END through ACWA is technically feasible and safe with satisfactory cosmetic results. The absence of neck scars and magnification of the important neurovascular structures are the most obvious advantages of this innovative technique. It may be a valid alternative to conventional surgery when performed in selected patients. However, further research with longer follow up is needed to clarify the oncological safety and the real benefits of END in head and neck cancer patients.

Role of Selective Neck Dissection in Primary T1, T2, N0 Neck Oral Tongue Carcinoma

Background: Oral tongue is one of the common site for carcinoma. 22% to 39% of oral cancer develops at this site. The high incidence of cervical lymph node metastasis, occult cervical metastasis, Provide a logical basis for treatment of the neck. The aim of this is study was to find out the importance of selective neck dissection in primary T1, T2, N0 Neck Oral Tongue Carcinoma. Methods: This cross-sectional study was conducted in the Department of Otolaryngology- Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka Medical College Hospital and National Institute of ENT, Dhaka. Thirty cases of primary T1, T2, N0 Neck Oral Tongue Carcinoma with inclusion criteria was enrolled as a study sample. Patients were evaluated by a complete clinical head and neck examination as well as Imaging (MRI) of the primary tumor and neck. All the data were compiled and sorted properly and the numerical data were analyzed statistically. The results were expressed as percentage and mean ± SD. Chi-square (x2) test or Fisher’s Exact test was done for comparison of data presented in categorical value and p value <0.05 was considered as the level of significance. Among the patients 23(76.7%) were T1 lesion and remaining 7(23.33%) were T2 lesion. Extended Supraomohyoid Selective Neck Dissection (SOSD) (I-IV) was done in all patients. Following histopathological examination, 8(26.67%) patients of N0 neck became positive for nodal metastasis. Results: The study showed that most commonly (50%) involved group of occult metastasis was upper deep cervical lymph node in submandibular area (level-I). Occult nodal metastasis was significantly common 87.5% among male patients than females (p=0.039) and also common 87.5% among <50 years age group (p=0.023). Neck node positive was significantly more 62.5% in T2 lesion (p=0.002) of oral tongue carcinoma. Conclusion: In this study, we found that a number of patients had been histopathologicallly detected micro-metastases in regional neck nodes in clinically N0 patients.So, Extended Supraomohyoid Selective neck dissection (I-IV) was appropriate in T1,T2, N0 Neck Oral Tongue Carcinoma. Bangladesh J Otorhinolaryngol 2021; 27(2): 130-138

Lymphoepithelial carcinoma of the larynx: an extremely rare tumour in a patient of Chinese descent

Lymphoepithelial carcinoma (LEC) of the larynx is an extremely rare tumour which, unlike its nasopharyngeal counterpart, has shown a propensity to affect elderly Caucasian men and is not commonly associated with Epstein-Barr virus. We present a 70-year-old Chinese man who complained of hoarseness and dysphagia. Nasoendoscopy revealed a left supraglottic tumour. Preoperative MRI (in particular Diffusion Weighted Imaging) showed the possibility of two distinct components within a tumour. The patient underwent total pharyngolaryngectomy and bilateral selective neck dissection. The final histology report confirmed the presence of a tumour with two distinct components: predominant LEC with a smaller conventional (keratinising) squamous cell carcinoma component. The patient recovered well after surgery and subsequently underwent adjuvant radiotherapy. Final staging was pT3 N2c M0 (AJCC stage IVA). Follow-up over 2 years revealed no tumour recurrence.

Choice of Levels in Selective Neck Dissection and Its Impact On Regional Control and Survival in 661 Patients With Head and Neck Squamous Cell Carcinoma

Background: Selective Neck Dissection (SND) is the surgical treatment of choice in suspected or manifest nodal positive squamous cell carcinoma of the head and neck (HNSCC). For SND to be successful, treated levels should be selected accordingly. Aim of this study was to identify neck dissection levels that had an impact on the individual prognosis.Methods: We conducted a retrospective review of SND as part of primary treatment of HNSCC. Overall survival (OS) and regional control rates (RCR) were calculated for all patients.Results: 661 patients with HNSCC were included, 644 underwent ipsilateral and 319 contralateral SND. Average follow up was 78.9 ± 106.4 months. 67 (10.1%) patients eventually developed nodal recurrence. Tumor sites were oral cavity (135), oropharynx (179), hypopharynx (118) and larynx (229). Tumor categories pT1 – pT4a, and all clinical and pathological nodal categories were included. Multivariate analysis indicated improved OS rates for patients undergoing SND in ipsilateral levels I and V as well as level III contralaterally. Analysis for tumor origin showed that SND in ipsilateral level I showed a significantly improved OS in HNSCC of the oral cavity.Conclusion: In HNSCC of the oral cavity, ipsilateral level I needs to be included when performing SND.

53 A Rare Malignant Lesion of the Jaws

Introduction Primary intraosseous carcinoma (PIOC) of the jaw is an incredibly rare lesion with approximately 200 cases reported in the literature. PIOC are mostly asymptomatic incidental radiographic findings and present as poorly-defined, non-corticated radiolucencies often with root resorption and cortical perforation. Prognosis is considered poor and best predicted by histological grade. Case report A gentleman in his 50s presented to his dentist with a draining sinus from his LR6 tooth. A radiograph revealed a non-corticated radiolucency localised to the distal root of the LR6. 7 months later, he returned with pain and mobility of the LR7. Another radiograph revealed a non-corticated radiolucency from around the distal root of the LR6 extending to the LR8. Urgent biopsy of the mandibular bone was arranged by the oral and maxillofacial surgery team. Histopathology revealed the lesion was likely a benign squamous odontogenic tumour. However, it was not possible to exclude a well-differentiated squamous cell carcinoma. Correlation of clinical findings, imaging and multidisciplinary team discussion was recommended. Following the MDT meeting, excision of the bony lesion was undertaken. Histopathology this time returned as primary intraosseous carcinoma NOS T4N0M0, thought to have arisen from a radicular cyst associated with the LR6/7. The treatment was right segmental mandibulectomy, fibular free flap, selective neck dissection (I-III) and adjuvant radiotherapy. Conclusions This case highlights how subtle radiographic features can represent malignancy in lesions appearing cystic at first. Although rare, clinicians should be aware of PIOC as a differential diagnosis when presented with radiographic features which could represent malignancy.

Correlación clínico patológica de los ganglios cervicales en pacientes con cáncer de cabeza y cuello

Objective: To correlate the clinical lymph node classification with the pathological result of neck dissections performed in patients with head and neck cancer at the Otorhinolaryngology Department of the Hospital Universitario de Caracas from January 1, 2011 to December 31, 2016. Method: Descriptive, quantitative and retrospective study, which evaluated 27 patients, who underwent classical radical, modified radical and selective neck dissection. Results: average age 56 years, 77.8% male. The most frequent histological type was squamous carcinoma 81.5%. The most used type of dissection was selective 53.3%, followed by the classical radical 26.7% and the modified radical 20.0%, of these 36% presented local or cervical recurrence. Of the 16 patients with positive lymph nodes, 13 had patology confirmation, and all the negative nodes also had negative patology confirmation; regarding cervical recurrence, of the 7 cases where it was present, all positive nodes, and in the 11 patients negative nodes, all negative cervical recurrence. Conclusion: The relationship between the pathological and clinical classification, as well as the presence of positive lymph nodes in cervical recurrences are statistically significant and are related to the decrease in survival. Neck palpation continues to be a useful tool in therapeutic decision making, which has shown higher than average sensitivity and specificity.

Distribution of Metastases in Ent Area – Comparison of Theory and Practice

In head and neck cancers the occurrence of nodal metastases is the most important prognostic factor. Their early diagnosis is crucial for proper treatment. Detection of early metastases is still very difficult. Predictive diagnostic methods such as the sentinel lymph node detection is limited by the occurrence of skip metastases. At our Clinic we prefer a selective neck dissection based on a surgical treatment of predilected lymphatic spread area for each type of head and neck tumor with a preservation of non-lymphatic structures of the neck. The main objective of this article is to analyze the distribution of neck metastases and to study the frequency of skip metastases in head and neck cancer.

POST-SURGICAL SHOULDER REHABILITATION OF SELECTIVE NECK DISSECTION WITH PECTORALIS MAJOR MYOCUTANEOUS FLAP RECONSTRUCTION IN “SICK” SYNDROME PATIENTS

Selective neck dissection (SND) is a surgical procedure developed to remove cervical lymph nodes at the risk of invasion metastasis. It is distinguished from radical neck dissections wherein there is the retention of one or more groups of lymph nodes. In this case, a 45-year-old male shopkeeper diagnosed with malignancy of lower anterior alveolus from 45-36 region (stage IVA –T4a N2Cm0) underwent SND, segmental mandibulectomy, and reconstruction with pectoralis major myocutaneous flap (PMMC flap) on the left side. On assessment, before the SND, Scapular mal positioning, inferior medial border prominence, coracoid pain, and dyskinesia of scapular movement (SICK) were identified. The patient was referred for physiotherapy with the complaint of inability to maintain saturation, difficulty in decannulation, and shoulder dysfunction on postoperative day 3 (POD-3). Chest physiotherapy comprising of breathing and suctioning techniques aided early decannulation. Furthermore, a prompt shoulder rehabilitation program for six months had a positive impact on the overall functioning and quality of life of the patient.