This study identifies significant prognostic factors in squamous cell carcinomas of the anterior tongue and floor of mouth. It is clear that the TMN staging system does not account for other important variables that affect tumor prognosis. Tumor thickness and the presence of perineural invasion and intralymphatic tumor emboli should be examined in all resected tumors. Tumor thickness, tumor size, and perineural invasion all have an impact on survival and must be considered in treatment plans. Tumors measuring between 2 mm and 3 mm may or may not have metastases and further evaluation of this group needs to be done. Most importantly, the data in this study supports a multiinstitutional prospective evaluation of pathology specimens. Precise guidelines must be established for handling of the specimen, which must then be evaluated for the variables mentioned above. In this way, more definitive conclusions can be reached in the management of tumors of the anterior tongue and floor of mouth.
The use of antibiotic prophylaxis does not prevent all postoperative wound infections. The records of 245 patients undergoing major head and neck surgery were reviewed to determine the cause of wound infection which developed in 17 patients. Patients with Stage IV tumors had an increased infection rate as compared to lesser stages (p less than .01). Reconstruction with a myocutaneous flap was associated with an increased infection rate when compared to primary closure or split-thickness skin graft reconstruction (p less than .001). Probable errors in surgical technique were identified in 10 of 17 infected patients. Neither weight loss, diabetes mellitus, prior radiation therapy, nor prior tracheotomy were found to increase the risk of wound infection (p greater than .05). This study lends insight into factors that may potentiate the development of wound infection despite antibiotic prophylaxis. A strategy to minimize postoperative infection is offered.
Although pulmonary lymphangitic carcinomatosis (PLC) is not uncommon for breast, bronchial, and stomach cancers, it is rarely associated with head and neck malignancy. A case of PLC is reported with the primary lesion being an adenosquamous carcinoma of the hypopharynx. A literature review is discussed, highlighting the varied radiographic picture of PLC, the possible diagnostic modalities, the proposed pathogenesis, and the treatment options. The prognosis even if antemortum diagnosis and treatment are given remains fatal, although with temporary improved quality of life and lengthened survival. There is hope that with greater awareness of the disease process an increased incidence of diagnosis may allow progress to be made in therapeutic interventions.
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