Parotid metastatic disease from cutaneous squamous cell carcinoma: prognostic role of facial nerve sacrifice, lateral temporal bone resection, immune status and P-stage.

BACKGROUND: Recognized prognostic indicators for metastatic cutaneous squamous cell carcinoma (SCC) of the head and neck include facial nerve involvement, immune status, and "parotid" staging system (P-stage). We sought to examine the impact of lateral temporal bone resection (LTBR) on prognosis. METHODS: We conducted a retrospective analysis of 160 patients with metastatic cutaneous SCC to the parotid. All patients had parotidectomy and neck dissection; 27% had additional LTBR when the tumor was adherent to the temporal bone. RESULTS: Overall 5-year survival was 48%, disease-specific survival 77%, and locoregional control 83%. Corresponding results for immunocompetent versus immunocompromised were 55%, 86%, and 87% versus 12%, 48%, and 64%. On Cox regression analysis, only immunocompromised status (ie, lymphoproliferative disorder, organ-transplant patient) was prognostically significant (p < .001). CONCLUSION: More radical resection that may include LTBR mitigates the poorer prognosis with advanced disease in our series. Treatment must be individualized in immunocompromised patients who have shortened overall survival.

Supraclavicular artery island flap for reconstructing defects in the head and neck region.

PURPOSE OF REVIEW: The supraclavicular artery island flap is a rotation flap that offers a versatile reconstructive option for head and neck defects. Recent anatomical studies have improved our understanding of the vascular supply of the supraclavicular artery island flap. Furthermore, several published large series describe the utility and reliability of this flap. In this article, we review the scientific literature describing the vascular anatomy of the supraclavicular artery island flap, its clinical application, and limitations in reconstructing defects in the head and neck region. RECENT FINDINGS: The vascular anatomy and surface markings, optimal flap design, surgical techniques employed to improve reliability, and aesthetic and functional outcomes of the supraclavicular artery island flap in head and neck reconstruction are well documented in the literature. SUMMARY: The supraclavicular artery island flap offers a versatile and well tolerated option in reconstruction of head and neck defects with several advantages over more traditional regional flaps and distant-free flaps.

Acinic cell carcinoma of the parotid gland: Auckland experience and literature review.

Acinic cell carcinoma is an uncommon malignancy of the salivary glands and as such it has been difficult to accurately delineate its natural history. The aim of this study is to assess the behaviour of acinic cell salivary cancer of the parotid gland presenting to a single head and neck surgical unit in Auckland. The study is a structured review of cases of acinic cell carcinoma of the parotid gland presenting from 2000 to 2006 to the Head and Neck Unit at Auckland Hospital, those identified from the pathology database and the Otobase head and neck database. Case records and pathology reports were reviewed. Fifteen patients were identified, 9 men and 6 women. The mean age was 67.2 years, with range 50-85 years. The mean follow up was 4.4 years and range 1.1-7 years. There was one case of local recurrence during study period and no deaths. Five of 15 patients received postoperative radiotherapy. Postoperative complications consisted of one wound haematoma and two cases of marginal mandibular weakness (one transient and one permanent). Current management strategies are obtaining appropriate rates of recurrence and postoperative complications within the Auckland population.

The use of Monogen in the conservative management of chylous fistula.

BACKGROUND: Chylous fistula is an uncommon complication of lower neck dissection. If untreated, it can lead to severe electrolyte disturbance, fluid, and protein loss and ultimately threaten skin flaps and vital structures. Conservative management aims to decrease chyle volume by replacing long-chain triglycerides (LCTs) with medium-chain triglycerides in the diet or by total parenteral nutrition. METHODS: In 2001, Greenlane Head and Neck unit conducted a prospective 2-year study of all patients with chylous fistula. RESULTS: Eleven patients developed chylous fistula in the period between 2001 and 2003, out of 210 neck dissections. All cases were managed conservatively. The mean time to diagnosis was 1.5 days (1-4), time to closure was 8.1 days (4-26), and mean duration of treatment was 11.5 days (4-35). CONCLUSION: We would recommend conservative management of chylous fistulae with a low LCT diet using Monogen alone to be continued only for the duration of the fistula.

Quality-of-life outcomes in head and neck cancer patients.

Quality-of-life (QL) is a relatively new concept in head and neck oncology outcomes research. It is important to have a clear definition and to use reliable and valid measures in its assessment. QL studies should use patient self-reported data and should account for treatment or disease-related symptoms and the domains of physical and psychosocial functioning, together with a patient-rated global QL score. Within head and neck cancer there are very distinct differences between sites. Oral cancer and laryngeal cancer lead to very different QL outcomes. Care must be used when comparing treatments; organ-preservation techniques do not necessarily lead to better QL outcomes, especially in laryngeal cancer. An assessment of life-utility (QALY) may be helpful in determining how meaningful survival is after treatment, and can be used to provide information to purchasers of health care services in support of better resource allocation for head and neck cancer patients.