Parotidectomy is performed for benign or malignant tumors and for selected benign inflammatory and autoimmune conditions. Possible associated complications include facial nerve paralysis, pain, loss of sensation, gustatory sweating, and facial scarring. Global quality of life in patients undergoing parotidectomy has not been reported. The implications of facial surgery with the catastrophic potential of facial nerve paralysis may severely affect quality of life. A quality-of-life study was conducted in patients undergoing parotidectomy for benign and malignant diseases to define the significance of associated morbidity and its impact on quality of life. A quality-of-life instrument was specifically created, based on the principles of the University of Washington Quality of Life questionnaire, and mailed to the patients. Questions addressed recognized complications of parotidectomy. Patient group results were compared for age above and below 45 years, sex, benign versus malignant disease, presence or absence of Frey syndrome, and presence or absence of benign pleomorphic adenoma. Forty-six percent of 125 patients meeting the study criteria fully replied to the questionnaire. The global health score was 3.5, corresponding with "good" to "very good." Except for local sensation, which had a score of 50, all other domains scored above 76. Change in appearance, gustatory sweating, and pain were reported by 70 percent, 57 percent, and 30 percent, respectively. Importance attributed to all domains except facial function was low. Pain was encountered significantly less in patients younger than 45 years of age, and scores for appearance were also highly significant in this age group. Postoperative sequelae were noted in the majority of patients. The dominant sequelae were altered sensation, change in appearance, Frey syndrome, and pain. A degree of permanent postoperative facial nerve impairment was reported by 10 patients. Nevertheless, overall, parotidectomy does not seem to severely affect quality of life.

Margin status, a major prognostic parameter in oral cancer, was analyzed vis-à -vis the histopathologic parameters of risk scores and stromal myofibroblasts. Specimens of tongue carcinoma (n = 50) were submitted to a risk score assignment consisting of the worst pattern of invasion, lymphocytic infiltration, and perineural invasion. Frequency of stromal myofibroblasts (alphasmooth muscle actin stain) was assessed. A triple immunostaining assay with E-cadherin, Ki-67 and alpha-smooth muscle actin was used to identify carcinoma cells undergoing epithelial-mesenchymal transition. Margins were considered 'clean' if the tumor was ‡5 mm away from them. Patients £60 years were considered as 'young'. Kaplan-Meier survival analysis with univariate and Cox multivariate regression model with stepwise forward selection, and Fisher's exact tests were used. Abundant myofibroblasts were found in 27 (54%) cases. Carcinoma cells devoid of E-cadherin but amalgamated with the stromal myofibroblasts were identified in 18 (36%) cases. Local recurrence and overall survival were negatively influenced by abundance of stromal myofibroblasts (P = 0.004 and P = 0.008, respectively). High-risk scores (P = 0.011), positive margins, and 'young' age (P = 0.027, each) had an unfavorable impact on recurrence. Multivariate analysis revealed that only abundance of stromal myofibroblasts had an independent adverse effect on local recurrence (hazard ratio [HR] 4.369; P = 0.014; 95% confidence interval [CI], 1.356-14.074). It seems that abundant stromal myofibroblasts (camouflaging some malignant cells) and high-risk scores have an unfavorable impact on the risk of recurrence in particular in 'young' patients. Therefore, the treatment concept should be adjusted accordingly and target concomitantly the epithelial malignancy and its allied stroma. (Cancer Sci 2010; 101: 274-280)

The thyroid gland is the second most common site for malignancy in the head and neck region. Quality of life (QOL) of thyroid cancer patients has not been studied directly. The QOL of long-term thyroid carcinoma patients was investigated. A standardized set of questions based on the University of Washington QOL questionnaire for head and neck cancer with specific domains associated with thyroid disease was created. This questionnaire was mailed to patients who underwent total thyroidectomy for well-differentiated cancer in the department of Otolaryngology--Head and Neck surgery at the Chaim Sheba Medical Centre in Israel between the years 1994-2000. Seventy-eight patients undergoing total thyroidectomy were identified. Forty-eight patients were excluded and 20 out of the 30 remaining patients responded to the questionnaires. Six were male and 14 female, 12 were under the age of 45 (these 12 patients were staged as stage 1). Eleven patients underwent neck dissection. General health and QOL were significantly better for the younger age group and so was the calcium balance score. General health and QOL were significantly better for patients undergoing neck dissection. The overall QOL score was 3.8 conforming with 'good' in the questionnaire. Surgery and initial radioiodine treatment scored 6.75 and 6.9 respectively in the distressing scale (0-10 range: 10 = most distressing). The highest distress was encountered during withdrawal from thyroid hormone. Women rated the importance of proper replacement therapy significantly higher than men. Global low scores were found for employment and for effective L-thyroxine replacement therapy. Overall, QOL in these patients was good although lower than expected when compared with other forms of cancer. Age and gender-related differences were noted. Better QOL in neck dissection patients is probably associated with age under 45 years. High distress scores for hormone withdrawal during periodical imaging correspond with former reports and supports use of Thyrogen. Better hormone balance is warranted for this group.

This is the first large series that focuses on the clinical behavior, complications, and treatment of ISS.

In the current study, patients with NPC reported ear problems, difficulties in chewing, and dry mouth but their overall QOL appeared to be good. Ear problems such as secretory otitis media should be recognized at the time of presentation and treated. Conformal radiotherapy techniques sparing the salivary glands and temporal bone most likely will be useful in reducing the morbidity associated with treatment.

A protocol was created for prospective margin status evaluation of patients with Oral SCC. Margins are evaluated intra- and post-operatively during three stages. Patients were divided into three groups: group 1 in which one margins were sampled randomly, group 2 with frozen sections taken from the surgical bed and 3 in which they were taken from the tumor specimen itself. Patients in group 3 showed the best correlation with final margin status and survival.

The histopathologic RS can serve to identify a subgroup of patients <60 years who have a high recurrence rate of oral tongue cancer, irrespective of the margin status.

The advantages of mechanical sutures with the closed stapling technique are simple and rapid application, watertight closure with good hemostasis, prevention of field contamination, good speech and deglutition, no increase in fistula rate, and low local recurrence rates. Operating room expenses may also be significantly reduced, rendering this method cost-effective as well.