Factors affecting lymph node yield and density in neck dissection.

BACKGROUND: Studies suggest that neck dissections with a minimum of 16-18 yielded nodes are associated with better overall survival compared to neck dissections with lower yields. AIMS: We aimed to identify factors affecting the lymph node yield and density in patients with oral cavity cancer undergoing elective neck dissection levels 1-3. MATERIALS AND METHODS: Using prospectively registered data, we conducted a population-based cohort study on all patients surgically treated for oral cavity cancer including levels 1-3 neck dissection at our institution from 2018 to 2022. Uni and multivariate analyses were performed to identify factors associated with lymph node yields. RESULTS: In total, 221 patients were included. The mean lymph nodes yield and density were 19 (95%CI 18-20) and 0.12 (95%CI 0.09-0.16), respectively. In multivariate analysis, increasing body weight (p = .034) was positively and previous radiotherapy (p = .006) were negatively correlated with the number of yielded lymph nodes. Lymph node density was positively correlated with body weight (p = .011) and body mass index (p = .032) in univariate analysis. CONCLUSIONS AND SIGNIFICANCE: Increasing body weight was positively and previous radiotherapy was negatively correlated to lymph node yield. These factors should be taken into consideration when interpreting the lymph node yield as an indicator of neck dissection quality.

Oncological results and morbidity following intended curative resection and free jejunal graft reconstruction of cervical esophageal cancer: a retrospective Danish consecutive cohort study.

BACKGROUND: The role of surgery in treatment of locally advanced cervical esophageal cancer (CEC) remains debated. In the European and American treatment guidelines, definitive chemoradiotherapy (dCRT) is preferred over surgery, while in the Danish guidelines, the two treatment modalities are equally recommended. Surgical treatment of CEC is centralized at our center in Denmark. We present our outcomes following neoadjuvant chemoradiotherapy (nCRT) when possible and resection as first-line therapy for CEC and compare with recent published dCRT results. METHOD: We retrospectively reviewed the medical charts of patients treated for cervical esophageal cancer at Aarhus University Hospital from 2001-2018 with nCRT when possible and pharyngolaryngectomy followed by reconstruction with a free jejunal graft. RESULTS: Forty consecutive patients were included. About, 45% received nCRT. The median survival was 21 months. The overall, disease-specific and disease-free 5-year survival was 43.6%, 53.2%, and 47.4%, respectively. The rate of microscopically radical resection was 85%. The recurrence rate was 47% and 81% of recurrences were locoregional. The in-hospital and 30-day mortality rate was 0%. Major complications occurred in 27.9%. Anastomotic leakage, graft failure, fistulas and strictures occurred in 10%, 7.5%, 30%, and 30%, respectively. CONCLUSION: Our treatment offers equal oncological results compared to the best internationally published results for dCRT for CEC. Results vary considerably between dCRT studies. Morbidity appears more pronounced following surgery. Future studies are warranted to investigate the Danish national outcomes following dCRT as first-line treatment for curable locally advanced CEC.

Hyperbaric oxygen may only be optional in head and neck necrotizing fasciitis: a retrospective analysis of 43 cases and review of the literature.

BACKGROUND: Necrotizing fasciitis in the head and neck (NF-HN) is a rare and potentially life-threatening condition. The use of hyperbaric oxygen therapy (HBOT) in the acute regimen is disputed and there is a lack of evidence of therapeutic effect. This study aims to describe a retrospective cohort of patients with NF-HN and investigate the use of HBOT and consequences thereof. METHODS: All patients treated for NF-HN at Aarhus University Hospital (AUH) between 2002 and 2014 were included in this retrospective cohort. Data regarding demographics, treatment and a one-year follow-up was registered. A review of the literature on NF-HN and HBOT was performed. RESULTS: Forty-three patients were consecutively treated for NF-HN during the period. All patients were treated in accordance with current guidelines with HBOT as a variable. Thirty patients received HBOT, and 13 patients were omitted from HBOT for different reasons. In the HBOT group were no mortalities vs. three mortalities in the non-HBOT group two late deaths due to precursory underlying cancer of the head and neck, and one early death shortly after admittance. We found higher rates of complications (63% vs. 25%) and sequelae (77% vs. 40%) among the HBOT group compared to the non-HBOT group. CONCLUSIONS: Our findings suggest that HBOT for NF-HN may only be optional and that the decision relies on an individual assessment of each patient. Further research is needed concerning the evidence of HBOT and towards selecting the patients benefitting from HBOT.

Deep head and neck infection causing pathological fracture of the mandibular condyle.

We report an unusual case of a 46-year-old male with a severe deep head and neck infection after extraction of two mandibular molars that led to a potentially life-threatening condition and caused pathological fracture of the mandibular condyle. This is the first published spontaneous pathological fracture of the mandibular condyle caused by an infection spread from a lower molar tooth. Based on CT scan we discuss the pathways of infection of odontogenic origin and the reflections of treatment. This case report illustrates an unusual presentation of a spontaneous pathological condylar fracture caused by a severe life-threatening infection after tooth extraction. It details the examination and management of the patient and reflections about the treatment.

High expression of organic cation transporter 3 in human BAT-like adipocytes. Implications for extraneuronal norepinephrine uptake.

Brown adipose tissue (BAT) is activated by extracellular norepinephrine (NE) released by the sympathetic nervous system. The extracellular concentration of NE is additionally regulated by the disappearance/degradation of NE. Recent studies have introduced the organic cation transporter 3 (OCT3) as a possible contributor in the regulation of NE in adipose tissue. In the present study we set out to investigate the presence of OCT3 in human neck adipose tissue (AT), which is the primary localization of BAT in humans. Moreover, we wanted to assess the possible function and correlation of the transporter with known markers of thermogenic function, e.g. UCP1. When examining neck AT biopsies from 57 individuals we found that OCT3 was expressed at 2.5 ± 0.16 fold higher level in the deep-neck AT compared with subcutaneous AT. UCP1 was found extensively expressed in the deep-neck AT depot and the correlation between UCP1 and OCT3 within the deep-neck AT was found highly significant (r2 = 0.4012, P-value < 0.0001). Lastly, we were able to reduce NE uptake in isolated brown adipocytes in an in vitro culture by adding corticosterone which is a known OCT3-blocker. In conclusion, we found that OCT3 may be a regulator of the concentration of NE in AT and by this mechanism a possible regulator of BAT function and a potential target for pharmacological intervention.

Thyroid malignancy markers on sonography are common in patients with benign thyroid disease and previous iodine deficiency.

OBJECTIVES: The purpose of this study was to evaluate the characteristics of benign thyroid nodules on sonography and ultrasound elastography in a population exposed to iodine deficiency. METHODS: We conducted a prospective systematic evaluation of preoperative thyroid sonography and elastography in patients assigned for surgical excision of benign thyroid nodules. Two experienced sonographers performed all sonographic and elastographic examinations. Thyroid nodules were evaluated by 7 generally accepted sonographic malignancy risk markers and assigned an elasticity score on elastography. The final diagnosis of a benign thyroid nodule was based on histopathologic analysis of resected thyroid gland tissue. RESULTS: We evaluated 232 thyroid nodules in 105 patients (86 women and 19 men). In total, 57% of the examined nodules had 1 or 2 malignancy risk markers present, and 24% did not have any markers present. A solid nodule larger than 15 mm was the most common malignancy risk marker observed (63%), followed by low elasticity (33%), microcalcifications (26%), and hypoechogenicity (15%). In an analysis stratified according to the number of nodules (solitary versus multiple), low elasticity was described more frequently in solitary nodules (61.9% versus 30.4%; P= .004). A large nodular volume was a predictor (P < .05) of microcalcifications and intranodular vascularization, whereas an absent halo sign and a solid nodule were found less frequently in nodules with larger volumes. CONCLUSIONS: Our results show that routine preoperative malignancy risk evaluation of presumably benign thyroid nodules is of little value when performed on patients exposed to iodine deficiency.

Prevalence of human papillomavirus and other risk factors in Lithuanian patients with head and neck cancer.

OBJECTIVE: Head and neck squamous cell carcinoma (HNSCC) is a disease attributed to exposure to tobacco and alcohol. However, many epidemiological and molecular data suggest that human papillomavirus (HPV) infection may promote head and neck carcinogenesis. The objective of our study was to evaluate the prevalence of HPV and its various types in fresh HNSCC tumor samples using the polymerase chain reaction (PCR). METHODS: 48 patients with primary diagnosed HNSCC carcinoma were investigated. HPV DNA was detected using PCR. HPV-positive samples were additionally tested for HPV16 and 18. RESULTS: Of the 48 patients, 13 (27.1%) had detectable HPV. After HPV typing, HPV16 was found in only 4 cases (30.1%). CONCLUSIONS: Our study demonstrated a HPV detection rate of 27.1% in Lithuanian HNSCC patients; 30.1% of them harbored HPV16. There were no differences regarding the other risk factors (smoking, alcohol consumption and occupational history) between HPV-positive and HPV-negative patients with head and neck cancer in our study.