Therapeutic, I.

BackgroundCervical nodal status is one of prognostic factors in head and neck squamous cell carcinoma (HNSCC). The objective of this study was to identify prognostic factors of cervical node status including site and size of primary tumors, presence of lymphovascular invasion, and size of cervical node for appropriate further treatment in HNSCC.MethodsA 5-year retrospective review of patients with HNSCC in Phramongkutklao Hospital from 2009 to 2013 was conducted. Histopathologic data on primary tumors and cervical nodes were reviewed. Cervical nodes were divided into five groups: 1–3, 4–6, 7–9, 10–30, and >30 mm. Numbers of positive and negative nodes were compared in different sizes and sites and the presence of extracapsular extension.ResultsIn all, 165 patients and 1,472 nodes were reviewed. The mean age was 52.6 years and 77.58% were male. The most frequent primary site was oral tongue (50.91%). In sum, 52.72% showed lymphovascular invasion. Thirty-five patients (81.40%) in therapeutic neck dissections and 18 patients (69.23%) in prophylactic neck dissections showed nodal metastasis. The mean size of metastatic nodes was 3.89 mm (range, 2–45 mm) and 3.53 mm (range, 2–23 mm), respectively. Significant associations were found between the size of cervical nodes and the site of primary tumor of the oral tongue, lip, base of the tongue, and floor of the mouth (p < 0.05). Metastatic lymph nodes showed extracapsular extension 69.55%. No significance was found between extracapsular extension and clinical staging, size of primary tumor, pathologic differentiation, and size of cervical nodes. Sizes of cervical lymph node of squamous cell carcinoma (SCC) of the oral tongue and lip were statistically significant with the size of tumor and tumor grading (p < 0.05).ConclusionsA statistical significance was found between the size of cervical nodes and the site of primary tumor of the oral tongue and lip. Herein, we recommended performing neck dissection in all cases of SCC of the base of the tongue, floor of the mouth, buccal mucosa, and retromolar trigone.

Background Temporal hollowing is a common complication after pterional craniotomy. Etiologies of hollowing are still in debate and inconclusive. The objective of this study is to determine the etiology and predictive factors of temporal hollowing after pterional craniotomy. Methods A retrospective study of patients who underwent pterional craniotomy was conducted. Inclusion criteria included older than 18 years, having undergone unilateral pterional craniotomy, and with no craniofacial anomaly or temporal defect. Volumes of bone, temporalis muscle, and extratemporalis layer were calculated. Results A total of 51 patients were included. Bone volumes of surgical and nonsurgical sites were 219.12 + 23.02 cm3, and 228.39 + 22.76 cm3, respectively (p = 0.04). Difference of bony volume was 9.10 cm3 (3.99%). Volumes of temporalis muscle in surgical and nonsurgical sites were 12.86 + 3.95 cm3, and 18.10 + 6.08 cm3, respectively (p < 0.005). Difference of muscle volume was 5.08 cm3 (28.32%). Volume of extratemporalis soft tissue in surgical and nonsurgical sites were 11.99 + 5.70 cm3, and 17.31 + 7.76 cm3, respectively (p < 0.005). Difference of soft tissue volume was 5.56 cm3 (31.68%). No statistical significance of the difference of bony, muscle, and soft tissue volumes were found between causes of disease, operative time, and postoperative radiation. Conclusions Hollowing after pterional craniotomy is an unavoidable result. Bone, temporalis muscle, and soft tissues are combined etiologies. No predictive factors including age, sex, causes, operative time, radiation, and surgical technique are demonstrated. Volume of temporal area reduction was 19.74 cm3. Immediate reconstruction is recommended and volume of reconstruction is calculated from preoperative imaging.

Application of topical anesthetics significantly relieved needle-stick pain, especially at sternum and auricular keloids; administration of a lidocaine mixture did not alleviate pain during injection.