Bilateral Selective Neck Dissection Research Articles

Synchronous Carcinoma in Thyroglossal Cyst: A Rare Occurrence.

A Thyroglossal cyst is a commonly encountered clinical entity resulting due to the persistence of the thyroglossal duct and the transformation of a few embryonic cells into a cyst. The incidence of malignant change in the thyroglossal cyst is reported as between 1 to 1.8 percent. Here we present a case report of a male who presented with swelling in the neck, on ultrasonography (USG) found to be a thyroglossal cyst, fine needle aspiration cytology (FNAC) suggested a papillary carcinoma within the thyroglossal cyst. Total thyroidectomy with bilateral selective neck dissection, central compartment clearance, and sistrunk operation were done. The histopathological report revealed papillary carcinoma of the thyroid within a thyroglossal cyst with neck nodal metastasis.

Feasibility of dpFAMM flap in tongue reconstruction after facial vessel ligation and radiotherapy\u2014case presentation

BackgroundSalvage surgery with reconstruction of the second and next primary tongue cancer remains difficult, especially after earlier neck dissection and radiotherapy. In the current report, we describe the feasibility of the extended, double-pedicled facial artery musculomucosal (dpFAMM) flap in the reconstruction of the patient with second primary tongue squamous cell carcinoma, after facial vessel ligation and radiotherapy.Case presentationAn 81-year-old female patient was operated on due to tongue squamous cell carcinoma (SCC) on the left side T3N1M0 in 2019. Bilateral selective neck dissection with tongue reconstruction was performed by island FAMM flap. The patient also suffered from synchronous mucinous breast carcinoma treated with tamoxifen. The second primary SCC of the tongue on the opposite (right) side was detected in 2020. The patient did not agree to surgical treatment; therefore, radiotherapy was performed. The local recurrence of the tongue cancer of the right side was treated surgically in 2021. Salvage surgery comprised hemiglossectomy and dpFAMM flap reconstruction with uneventful postoperative follow-up.ConclusionsThis case presentation proved that dpFAMM flap can be used in salvage surgery and reconstruction even in patients after ligation of facial vessels, irradiation, and in the course of hormone therapy. The flap is easy to handle, has good vascularity, and comprises a predictable method of reconstruction, especially for patients with severe comorbidities.

Elective Neck Dissection during Salvage Total Laryngectomy: Personal Experience.

The role of elective neck dissection during salvage surgery in patients with a clinically negative neck (cN0) is still discussed. The main objective of this work was to estimate the prevalence and predictive factors of occult neck nodes metastasis; we therefore aimed to evaluate the survival rate and the main oncologic outcomes of cN0 patients who underwent salvage total laryngectomy and elective bilateral neck dissection. In this retrospective observational study, we enrolled 80 cN0 patients affected by recurrent laryngeal cancer and who underwent salvage total laryngectomy and bilateral selective elective neck dissection. Several parameters were collected in order to find prognostic factors; finally, postoperative complications were reviewed and survival analysis was performed. Occult lymph node metastases were reported in 18 out of 80 patients (22.5%). Significant statistical correlation between lymphovascular invasion (p = 0.007), perineural invasion (p = 0.025) and occult nodal metastasis was found. Other variables (glottic subsite of recurrence, clinical T, pathological T, previous chemotherapy) were not significantly predictive of occult nodal metastasis. The 5-year OS, DSS, and RFS were 50.4%, 64.7%, and 63.4%, respectively. In conclusion, our single-institution data on a large cohort of patients, suggest performing routinely elective selective bilateral neck dissection during salvage total laryngectomy in cN0 patients due to the biological attitude of the tumor to spread to cervical nodes, considering an acceptable complications rate.

Factors predicting contralateral nodal spread in papillary carcinoma of thyroid.

Lymph node metastasis (LNM) is evident in about 20-50% of cases at presentation in papillary carcinoma thyroid (PTC). There are no clear recommendations for the need and extent of lateral and central compartment dissection in PTC. A total of 83 patients who underwent total thyroidectomy and bilateral selective neck dissection for diagnosed PTC from September 2011 to October 2017 were retrospectively analyzed. Tumor site was bilobar or involving isthmus in 40 patients. Contralateral LNM was seen in 42 patients. Both radiological (median size 2.6 cm, P = 0.051) and pathological (median size 3.65 cm, P = 0.015) size of tumor, tumor involving isthmus or bilateral lobes (P = 0.006), and lymphovascular invasion (LVI) (P = 0.026) had significant correlation with contralateral LNM. Size and site of tumor, ipsilateral lateral compartment nodes involvement, and LVI status of tumor significantly increases the probability of contralateral LNM in patients of PTC.

Malignant Transformation of Ossifying Fibroma to Juvenile Aggressive Ossifying Fibroma to Fibroblastic Osteosarcoma: A Case Report

AbstractThe researchers present a case of mandibular juvenile ossifying fibroma (JOF) undergoing malignant transformation to fibroblastic osteosarcoma (FOS) and propose to use this unique case report. In contrast to extragnathic OS (osteosarcoma), comprehensive genomic studies of gnathic OS are lacking and, hence, there are no validated diagnostic and therapeutic molecular targets for gnathic OS. Distinguishing fibroblastic OS of the jaws from its close mimics, such as ossifying fibroma (OF) and fibromatosis of the jaws, poses major challenge for pathologists. Identification of genomic aberrations of gnathic OS is an unmet clinical need that is critical for diagnosis and therapeutic targeting of these rare malignant tumors of the head and neck. PurposeThe purpose of this article to present a rare case of pathologic transformation from OF to JOF to a FOS. MethodsHistopathology was completed at each stage of biopsy. A thorough review of the literature was completed to identify other cases of this phenomenon, along with a search of genetic heterogeneity and clonal evolution during JOF recurrence and malignant transformation. ResultsA 62 -year-old female presented with a JOF of the right mandible and was treated with curettage. This tumor recurred in 2016, and the patient underwent surgical resection of the recurrent tumor. In 2019, this patient presented with large rapidly growing tumor at the same site with paresthesia suspicious for malignancy. The patient underwent right hemi-mandibulectomy with bilateral selective neck dissection. Evaluation of the histopathology revealed evidence of transformation from a benign fibro-osseous lesion to a fibroblastic osteosarcoma. ConclusionTo the researchers' knowledge, there have not been any previously published reports of malignant progression of JOF to FOS, and this case series offers a unique opportunity to explore the genetic heterogeneity and clonal evolution during JOF recurrence and malignant transformation.

Papillary Thyroid Carcinoma Associated with Caseating Granulomatous Inflammation: A Case Report from United Arab Emirates

The study presents the case of a 37-year-old female expatriate who was referred with a neck swelling and was managed further in Tawam Hospital, Al Ain. Initial ultrasonography and fine needle aspiration cytology from the right thyroid nodule confirmed papillary carcinoma of thyroid Bethesda type 6 and fine needle aspiration cytology from the right mid jugular lymph node proved metastasis from the primary. Further evaluation by CT scan neck with contrast and a total thyroidectomy and bilateral selective neck dissection was done.

Common Peroneal Nerve Palsy Associated With Intraoperative Hypotension Following Total Thyroidectomy

Perioperative peroneal neuropathy is an uncommon complication following surgeries performed with patients positioned supine. It may be caused by various factors aside from intraoperative compression. The authors report a case of common peroneal nerve palsy in a patient who underwent total thyroidectomy with central and bilateral selective neck dissection. The patient’s body mass index was 31.3 kg/m2. She was positioned supine and the operative time was 7-h. During surgery, her mean arterial pressure intermittently dropped to 50-60 mmHg for 55 min and 61-70 mmHg for 195 min. She developed common peroneal nerve palsy on postoperative day 1. Nevertheless, the patient fully recovered without any complications within 3 weeks.

Rational surgical neck management in total laryngectomy for advanced stage laryngeal squamous cell carcinomas

PurposeControversies exist in regard to surgical neck management in total laryngectomies (TL). International guidelines do not sufficiently discriminate neck sides and sublevels, or minimal neck-dissection nodal yield (NY).MethodsThirty-seven consecutive primary TL cases from 2009 to 2019 were retrospectively analyzed in terms of local tumor growth using a previously established imaging scheme, metastatic neck involvement, and NY impact on survival.ResultsThere was no case of level IIB involvement on any side. For type A and B tumor midline involvement, no positive contralateral lymph nodes were found. Craniocaudal tumor extension correlated with contralateral neck involvement (OR: 1.098, p = 0.0493) and showed increased involvement when extending 33 mm (p = 0.0134). Using a bilateral NY of ≥ 24 for 5-year overall survival (OS) and ≥ 26 for 5-year disease-free survival (DFS) gave significantly increased rate advantages of 64 and 56%, respectively (both p < 0.0001).ConclusionsThis work sheds light on regional metastatic distribution pattern and its influence on TL cases. An NY of n ≥ 26 can be considered a desirable benchmark for bilateral selective neck dissections as it leads to improved OS and DFS. Therefore, an omission of distinct neck levels cannot be promoted at this time.

Primary Intraosseous Carcinoma of the Mandible: A Case Report

ABSTRACT&#x0D; Objective: To present a rare case of primary intraosseous carcinoma arising from the mandible and to discuss the ensuing course and the management of the patient.&#x0D; Methods: &#x0D; Design: Case Report&#x0D; Setting: General Tertiary Government Training Hospital&#x0D; Patient: One&#x0D; Result: A 56-year-old man consulted for a right mandibular mass of 4 months that started as a small bony swelling which gradually increased to its present size of 8 x 6 cm. Incisional biopsy revealed invasive squamous cell carcinoma and the patient underwent segmental mandibulectomy and bilateral selective neck dissection (levels 1 to 3). Final histopathologic findings revealed squamous cell carcinoma.&#x0D; Conclusion: Primary intraosseous carcinoma of the mandible was diagnosed since there was no overlying mucosal ulceration, other types of odontogenic carcinoma were ruled out, and no other distant primary tumor was noted from the time of examination until six months post-treatment.&#x0D; Keywords: primary intraosseous carcinoma; squamous cell carcinoma; odontogenic tumor; epithelial rest of Malassez; dental lamina

Techniques in the Safe Use of Polycaprolactone in Structural Rhinoplasty

ABSTRACT&#x0D; &#x0D; Objective: To present a rare case of primary intraosseous carcinoma arising from the mandible and to discuss the ensuing course and the management of the patient.&#x0D; &#x0D; Methods:&#x0D; Design: Case Report&#x0D; Setting: General Tertiary Government Training Hospital&#x0D; Patient: One&#x0D; &#x0D; Result: A 56-year-old man consulted for a right mandibular mass of 4 months that started&#x0D; as a small bony swelling which gradually increased to its present size of 8 x 6 cm. Incisional&#x0D; biopsy revealed invasive squamous cell carcinoma and the patient underwent segmental&#x0D; mandibulectomy and bilateral selective neck dissection (levels 1 to 3). Final histopathologic&#x0D; findings revealed squamous cell carcinoma.&#x0D; &#x0D; Conclusion: Primary intraosseous carcinoma of the mandible was diagnosed since there was no overlying mucosal ulceration, other types of odontogenic carcinoma were ruled out, and no other distant primary tumor was noted from the time of examination until six months post-treatment.&#x0D; &#x0D; Keywords: primary intraosseous carcinoma; squamous cell carcinoma; odontogenic tumor;&#x0D; epithelial rest of Malassez; dental lamina

Marginal mandibular nerve injury during neck dissection of level IIa, and the influence of different types of dissection: diathermy versus cold knife.

Post-operative injury of the marginal mandibular branch of the facial nerve is consider a complication in neck dissection and can be related to different factors including traction, devascularisation or the conduction block due to diathermy. Prospective, crossover study including patients treated bilateral selective neck dissection of level IIa during a 12 months-period, was performed to evaluate the efficacy of the Hayes-Martin manoeuvre to prevent nerve injury during the use of cold or monopolar diathermy dissection. 20 patients met the inclusion criteria (40 neck dissections). Just one case of a right temporal MMN weakness in the post-operative period was observed (1/40 = 2,5%). There were no cases of permanent marginal mandibular nerve weakness using the Hayes-Martin manoeuvre Conclusion: The Hayes-Martin manoeuvre is a safe way to preserve MMN during neck dissection of level IIa, regardless of the type of dissection.

Contralateral neck metastases in lateralised, resectable advanced stage oropharyngeal squamous cell carcinoma-Results of 57 patients undergoing bilateral selective neck dissection.

Contralateral neck metastases in lateralised, resectable advanced stage oropharyngeal squamous cell carcinoma-Results of 57 patients undergoing bilateral selective neck dissection.

Results of Total Laryngectomy as Treatment for Locally Advanced Hypopharyngeal Cancer

Introduction and objectivesTotal laryngectomy (TL), with eventual postoperative radiotherapy, has proven to be effective in treating cases of locally advanced hypopharyngeal cancer. The aim of this study was to analyse the oncological outcomes of this procedure in patients with hypopharyngeal cancer classified T3 and T4. MethodsWe studied 59 patients (33 T3 and 26 T4a) with primary squamous cell carcinoma of the hypopharynx treated with TL from 1998 to 2012. ResultsMean age was 61 years with a male predominance (96.6%). All the patients were smokers and 96% consumed alcohol. Unilateral selective neck dissection (ND) was performed in 12 patients, unilateral radical ND in 11 patients, bilateral selective ND in 20 patients and radical ND plus selective ND in 14 patients. Sixty-six percentage of the patients received postoperative radiotherapy. Lymph node metastases occurred in 81% of the patients and extranodal invasion in 56% of them. Twenty-nine percentage of the patients had loco-regional recurrence, 17% developed distant metastases, and 25% a second primary tumour. The 5-year disease-specific survival was 46%. ConclusionsTL extended to pharynx (with eventual postoperative radiotherapy) offers good oncological results in terms of loco-regional control and survival in locally advanced hypopharyngeal cancer, so organ preservation protocols should achieve similar oncological results to those shown by TL.

Resultados de la laringectomía total en carcinomas localmente avanzados de hipofaringe

Introduction and objectivesTotal laryngectomy (TL), with eventual postoperative radiotherapy, has proven to be effective in treating cases of locally advanced hypopharyngeal cancer. The aim of this study was to analyse the oncological outcomes of this procedure in patients with hypopharyngeal cancer classified T3 and T4. MethodsWe studied 59 patients (33 T3 and 26 T4a) with primary squamous cell carcinoma of the hypopharynx treated with TL from 1998 to 2012. ResultsMean age was 61 years with a male predominance (96.6%). All the patients were smokers and 96% consumed alcohol. Unilateral selective neck dissection (ND) was performed in 12 patients, unilateral radical ND in 11 patients, bilateral selective ND in 20 patients and radical ND plus selective ND in 14 patients. 66% of the patients received postoperative radiotherapy. Lymph node metastases occurred in 81% of the patients and extranodal invasion in 56% of them. 29% of the patients had loco-regional recurrence, 17% developed distant metastases, and 25% a second primary tumour. The 5-year disease-specific survival was 46%. ConclusionsTL extended to pharynx (with eventual postoperative radiotherapy) offers good oncological results in terms of loco-regional control and survival in locally advanced hypopharyngeal cancer, so organ preservation protocols should achieve similar oncological results to those shown by TL.

Prospective case-control study of efficacy of bilateral selective neck dissection in primary surgical treatment of supraglottic laryngeal cancers with clinically negative cervical findings (N0).

To evaluate the efficacy of bilateral selective neck dissection of levels II-IV in elective and therapeutic management of the neck as a part of primary surgical treatment of patients with supraglottic laryngeal cancer and clinically negative cervical findings (N0). Institutional, observational, case-control study with historic control of patients who underwent primary supraglottic tumour surgery, and a prospective cohort of patient, who underwent, besides the operation of primary tumour, bilateral selective neck dissection (level II-IV). University, tertiary level hospital, national referral centre. The study included 193 patients with supraglottic cancer and without palpable or ultrasound positive cervical findings who were surgically treated from 1988 to 2005. Besides the operation of primary tumour, all patients in the study group underwent bilateral selective neck dissection (level II-IV). Patients in the control group (N = 51) underwent primary tumour operation only and were followed up regularly. In cases with postoperative regional recurrences, the radical neck dissection was performed. All patients with histopathological confirmation of occult metastases were administered radiotherapy treatment (60 Gy) in the postoperative period. Five-year overall survival rate. Occult cervical metastases were found in 18% of patients. They were present in level II in 77.5%, in level III in 20% of cases and in one patient in level IV (2.5%); the extracapsular spread was observed in 20% of cases. Postoperative regional metastases were found in 4.15% of cases in the study group, and in 11.8% in the control group, which proved to be significantly higher. The five-year overall survival rate showed no significant difference between the study group and the control group. The incidence of postoperative regional recurrences could be reduced by performing bilateral selective neck dissection simultaneously with primary tumour operation, but with no influence on the survival rate.

Spilt Milk

We report a case of bilateral chylothorax without evidence of chylous fistula in a 62-year-old man following total laryngectomy and bilateral selective neck dissection for laryngeal cancer. Chylous fistulae, a well-known complication of neck dissection, occurs following 1% to 2% of these surgeries. On rare occasions, the chyle leak may communicate with the pleural space, resulting in chylothorax. This is a rare but potentially life-threatening complication. Bilateral chylothorax following neck dissection is even rarer, with less than 25 cases reported in the literature. Early diagnosis is essential to prevent complications. Physicians should have a high index of suspicion, especially when the postoperative effusions do not respond to diuretics. Though no evidence-based treatment guidelines exist, expert opinion recommends conservative management as first-line therapy. Our patient was effectively treated by conservative management. We postulate a mechanism whereby bilateral chylothorax occurred in our patient without a chylous fistula.

Selective Neck Dissection (IIa, III): A Rational Replacement for Extended Supraomohyoid Neck Dissection in Patients with N0 Supraglottic and Glottic Squamous Cell Carcinoma.

OBJECTIVESTo evaluate the effectiveness of selective neck dissection of sublevel IIa and level III in cases of glottis and supraglottic laryngeal carcinoma in the absence of lymph node metastasis and to show if there is value in dissecting the sublevel IIb or level IV in these cases.PATIENTS AND METHODSTwenty-five patients with N0 glottic or supraglottic cancer were subjected to unilateral or bilateral selective neck dissection according to the site and the extent of the tumor, and the specimens were histopathologically examined for metastasis.RESULTSTwenty-five patients (23 males and 2 females) with mean age of 55.72 years were included in the study. Lymph node metastasis to sublevel IIa and level III was found in 6/25 (24%) cases with glottic or supraglottic carcinoma, while to sublevel IIb and level IV was found in 1/25 (4%) with P-value of 0.05, which is statistically significant.CONCLUSIONSelective neck dissection of level IIb is not required in cases of the supraglottic laryngeal cancer. Dissection of sublevel IIa and level III takes less time and is effective. Dissection of level IV is not needed in the case of supraglottic cancer.

Refractory hypocalcemia and hypomagnesemia associated with the use of an oral proton-pump inhibitor in a patient with hypoparathyroidism

The human body physiologically requires gastric acid for efficient absorption of calcium through the small intestine. A proton-pump inhibitor reduces acidity in the stomach, and impairs the absorption of food and therapeutic preparations of calcium salts in the small intestine. Hypomagnesemia is a rare adverse effect of a proton-pump inhibitor. We report a 64-year-old man with a malignant neoplasm of the hypopharynx. After a total pharyngolaryngectomy, bilateral selective neck dissection (levels II, III, and IV), and right thyroidectomy, he developed hypocalcemia, hypomagnesemia, and hypoparathyroidism. After the administration of calcium and magnesium supplements, the patient's serum calcium and magnesium levels were still abnormal. The patient was later found to be taking an oral proton-pump inhibitor (esomeprazole) to treat a peptic ulcer. After discontinuing the oral proton-pump inhibitor, the patient was found to have normal serum calcium and magnesium levels under supplementation with oral calcium and 1,25-dihydroxyvitamin D.

Transoral robotic supraglottic laryngectomy: Surgical considerations

Transoral robotic surgery (TORS) has emerged as a novel, safe, and feasible procedure for the resection of supraglottic laryngeal cancers. The purpose of this study was to demonstrate the surgical technique for TORS supraglottic laryngectomy (SGL). A patient with a T2N0M0 laryngeal cancer limited to the supraglottic larynx was selected for TORS. En bloc tumor resection was accomplished with negative surgical margins together with bilateral selective neck dissection. There was no perioperative or early postoperative complication. The patient was extubated immediately after surgery. Oral supraglottic diet was initiated within the first 24 hours. No gastrostomy or tracheostomy tube placement was required. A video demonstration of the surgical technique is included on Head & Neck's website. TORS SGL is a safe and feasible procedure for the resection of selected supraglottic tumors.

Pathology Quiz Case 1

A 57-YEAR-OLD WOMAN PRESENTED WITH A 2-year history of chronic cough. Onset was associated with flulike symptoms. Her cough worsened, and she started to have difficulty in airway functioning and dysphagia. She denied any hoarseness. A physical examination showed that she was in no apparent distress. Her voice was normal. Flexible fiber-optic laryngoscopy showed a large, posterior, broadly based interarytenoid mass significantly obstructing the posterior glottis, splaying open the arytenoids (Figure 1). The vocal cords were mobile. Computed tomographic imaging of the neck showed a soft-tissue lesion in the larynx obstructing the airway and bilateral level II and III lymphadenopathy. Computed tomographic imaging of the abdomen and pelvis showed hypodense liver lesions. A biopsy of the mass was performed under local anesthesia. Hematoxylin-eosin staining at low (original magnification 40) (Figure 2) and higher (original magnification 200) (Figure 3) magnifications is shown. Immunohistochemical staining was positive for c-Kit (CD117) and DOG1 (discovered on GIST), and negative for pancytokeratin, CD34, CD45, melan-A, S100, and CD68. Gomori methenamine silver stain demonstrated focal fungal organisms, and the acid-fast bacilli stain was negative for organisms. The patient then underwent an awake tracheotomy, endoscopic transoral laser partial laryngectomy, and bilateral selective neck dissections. A rubbery mass originating from the right arytenoids, growing over the interarytenoid area and extending to the left arytenoid, was discovered. The left arytenoid itself was free of tumor. Infiltrating portions of the tumor were not completely removed. The postcricoid area, esophageal inlet, and bilateral true cords were free of tumor. The final pathologic findings showed a spindle cell tumor measuring 2.7 1.2 1.7 cm in size with 5 mitoses per 50 high-power fields (HPFs). Twenty of 30 lymph nodes were positive for metastatic disease. What is your diagnosis?