Combined preoperative SLN identification and intraoperative radio- and fluorescence guidance during SLN biopsies for oral cavity cancer proved feasible using ICG-(99m)Tc-nanocolloid. The addition of fluorescence imaging was shown to be of particular value when SLNs were located in close proximity to the primary tumour.

The consistent use of indwelling voice prostheses shows a high success rate of prosthetic vocal rehabilitation, in terms of the percentage of long-term users (95%), and of a fair-to-excellent voice quality (88% of patients).

Previous studies have demonstrated the positive effect of a heat and moisture exchanger (HME) on the respiratory system in patients after laryngectomy. However, patient compliance with these devices was reduced by device-related problems and troublesome combination with a voice prosthesis. Recently a more specialized device has become available. This is an HME combined with a valve for easy digital occlusion of the stoma (Provox Stomafilter; Hörby, Sweden). In the authors' initial study of this revised device, a clear improvement in short-term compliance was demonstrated. To investigate long-term compliance, 69 consecutive patients were interviewed by means of a structured questionnaire. The results show that all patients expressed their satisfaction with the valve used for digital occlusion of the stoma. Sixty-three percent of the patients reported that voicing was facilitated. Subjective intelligibility improved in 55% of the patients. Previous problems with other devices (e.g., plaster adherence, skin irritation, and handling) were clearly diminished, increasing the long-term compliance of the patients to 78%. This new HME can be considered as a beneficial pulmonary rehabilitation tool for laryngectomized patients.

This new voice prosthesis, the Provox ActiValve, represents a solution for patients who have the problem of requiring very frequent voice prosthesis replacements due to excessive Candida growth and/or inadvertent opening of the valve by swallowing and inhalation-related underpressure in the esophagus.

The test results obtained with this new device show that its advanced features (obligatory HME and multi-magnet valve systems) offer additional benefits for further improving vocal and pulmonary rehabilitation after total laryngectomy.

The new Provox Vega 22.5 and 20 Fr prostheses have a device life comparable to Provox2, whereas voicing is better than (with the 22.5 Fr version) or comparable (with the 20 Fr version) to Provox2. The Smart Inserter, after a short learning curve, turns out to be a further improvement of the anterograde replacement of these indwelling devices.

BACKGROUND.Validation of the prognostic indices for the recurrence-free interval of patients with parotid carcinoma, the development of which was described in a previous report, is needed to be confident of their generalizability and justified prospective use. METHODS. The DutchCooperative Group on Head and Neck Cancer database contains 231 patients with parotid carcinoma from six tertiary referral centers who were seen between 1985-1994. This database was used to validate the predictive value of the prognostic indices, PS1 (pretreatment index predicting recurrence) and PS2 (posttreatment index predicting recurrence), in patients with parotid carcinoma. Validation methods included calculation of both indices for each patient, comparison of coefficients, construction of survival curves using the published cutoff points, and calculation of concordance measure C. Wald tests for optimization of scale and weights of the contributing variables, and for possible score improvement by including other variables, were also performed. RESULTS.The 5-year disease-free rate was 62% (standard error ϭ 4% ). PS1 was calculated for 183 patients. The previously set cutoff points resulted in 5-year diseasefree rates that ranged from 92% (PS1 ϭ 1) to 42% for the least favorable group (PS1 ϭ 4). Concordance measure C was 0.74. The postoperative score, PS2, was calculated for 171 patients. Previous cutoff points resulted in 5-year disease-free rates that ranged from 90% (PS2 ϭ 1) to 40% (PS2 ϭ 4). Concordance measure C was 0.71. Both PS1 and PS2 did not improve using the findings in this independent material. CONCLUSIONS. The prognostic indices performed adequately in this validationsample. This finding demonstrates that the prognosis of a parotid carcinoma patient can be quantified by using a weighted combination of the parameters of age, pain, clinical T (cT) classification, clinical N (cN) classification, skin invasion, facial nerve dysfunction, perineural growth, and involved surgical margins. A quantified prognosis, in terms of the recurrence-free interval, can be used to provide information to the patient, to perform clinical trials, and eventually to make clinical decisions. A user-friendly translation and computerized calculation of the indices should be the next step toward generalized prospective use and repetitive evaluation of the indices.

Objectives: Assessment of the immediate results and long-term clinical effects of a thin silicone washer placed behind the tracheal flange of voice prostheses to treat periprosthetic leakage.Patients and Methods: Three year retrospective analysis of 32 laryngectomized patients with 107 periprosthetic leakage events (PLEs). Custom-made silicone washers (outer diameter 18 mm, inner diameter 7.5 mm, thickness 0.5 mm) were placed behind the tracheal flange either in combination with prosthesis replacement or later.Results: There was immediate resolution of periprosthetic leakage in 88 PLEs (median, 38 d; mean, 53 d; range, 8 -330 d) and in 6 PLEs with the washer still in situ at the date of analysis (median, 75; mean, 97 d; range, 38 -240 d). There was no resolution for periprosthetic leakage in 13 PLEs. Thus, in total, 94 of 107 PLEs (88%) were successfully resolved. In 29 of 32 (91%) patients, the washer resolved the problem at least in one PLE successfully. Twelve of 32 patients, including all 3 with washer failures, also required other interventions to ultimately solve the problem. The vast majority of patients (80%) did not consider placement of the washer to be inconvenient.Conclusions: In consideration of the high success rate and limited inconvenience for patients, this simple thin silicon washer application provides a good first option for the treatment of periprosthetic leakage.