Sentinel lymphadenectomy correctly identified the stage of metastatic disease in 97% of patients in cases in which up to three sentinel nodes were identified. If only the lymph node with the highest tracer activity had been excised, 39% of cancer-positive necks would have been missed. Selective ND identified metastatic disease in the additional 3% of patients.

The early postoperative hypopharyngeal anatomy of 37 consecutive patients undergoing total laryngectomy at the Boston Veteran's Administration Hospital between July 1977 and April 1980 was studied by barium swallow radiographs and correlated with the technique of closure. The "pseudoepiglottis," a structure radiographically resembling a normal epiglottis, was seen arising from the anterior hypopharynx near the base of the tongue in 21 of 28 evaluable patients. It occurred in all patients with vertical closures vs. 67% of patients with a "T" shaped closure. The average length in the "T" closure group was 9.6 mm (range 0-35) vs. 18.4 mm (6-40) in the vertical group, a statistically significant difference (p less than 0.05). Radiologic strictures occurred in 39% of all patients, dysphagia in 29%, fistulae in 18%, and sinus tracts in 14%. All complications occurred more frequently in the vertical closure group. Patients who received preoperative cis-platinum bleomycin chemotherapy and postoperative irradiation had 50% dysphagia and 67% stricture rates. The average ratio of the width of the retropharyngeal space to that of C4 was 0.48 in stricture patients vs. 0.29 in non-stricture patients (statistically significant at the p less than 0.01 level). This ratio taken in the early postoperative period may help predict which patients will develop strictures.

Transoral excision of supraglottic and hypopharynx cancer as a single modality is effective when lesions are selected for small size and endoscopic accessibility. Excisional biopsy with clear margins of larger supraglottic tumors in combination with postoperative radiotherapy provides an excellent treatment alternative for selected lesions in patients who are not candidates for open surgery. In this preliminary report, 45 cases using this minimally invasive approach are reviewed outlining oncologic rationale and functional advantages. A large bore tubed laryngoscope or the adjustable bivalve supraglottiscope was used along with a carbon dioxide laser in all cases. In 22 of the 45 patients (mostly TI), local en bloc excision of the primary cancer was performed as sole treatment on selected lesions of the supraglottis and hypopharynx. There were no local recurrences, however, 1 patient developed a neck recurrence and was salvaged by neck dissection. Twenty‐three of the 45 patients had more extensive primaries (mostly T2, T3) and N0 necks. Transoral excisional biopsy was followed by full‐course radiation therapy to the primary site and both necks. All 23 were followed a minimum of 2 years, and the median follow‐up period was 58 months. Clear margins were obtained in 16 of 23, and there were no recurrences in the larynx. Two of 16 did fail in the neck and died despite neck dissection. Seven of 23 patients had positive margins and, despite full‐course radiotherapy to the primary site and both necks, 5 of 7 failed locally or regionally. Two of the 7 died of their disease despite open salvage surgery. Therefore, 4 of 23 patients who underwent transoral excision of larger lesions followed by full‐course radiotherapy died of recurrent cancer.

Ectopic vein grafts with primarily arm vein are an acceptable alternative for infrainguinal reconstruction in the absence of suitable ipsilateral greater saphenous vein.

Sixty-eight consecutive patients with infiltrating squamous cell carcinoma of the supraglottic larynx were referred to the senior author (R.K.D.) from January 1987 through December 1999. Forty-six patients (clinically staged T2) were selected to undergo endoscopic carbon dioxide laser supraglottic laryngectomy. Thirty-eight of these patients underwent planned postoperative irradiation. The other 8 patients were treated by surgery only, either because they had previously undergone irradiation or because they had refused postoperative irradiation. Eighteen cases (39%) were restaged from T2 to T3 on the basis of preepiglottic space invasion demonstrated on final pathology review. Primary site control was maintained in 97% of the combined-therapy patients and in all of the surgery-only patients without any salvage procedures. Regional control was attained in 96% of NO patients treated with irradiation alone, and 91% of N+ patients treated with modified radical neck dissection and postoperative irradiation. The combined-therapy group had only a 3% gastrostomy dependency rate, no tracheotomy dependency, a 5% aspiration pneumonia rate, and an average onset of independent swallowing at less than 2 weeks.

\s=b\Forty patients with head and neck cancer had a computed tomographic (CT) scan followed by lymphadenectomy and pathologic confirmation. The overall accuracy of clinical examination of the neck was 70% vs 93% by CT. The CT correctly "upstaged" the neck in nine patients. One was upstaged from NO to N1, and four each from NO to N2 and N1 to N2. It correctly "downstaged" the neck in one patient (from N2 to N1). Eight patients had extranodal disease on CT confirmed by pathology. The CT findings were correct in ten of 11 previously treated patients. Because CT is more accurate than the clinical examination, it should be included in the staging of not only the primary tumor but also nodal disease of the neck. It can have an important role in the management of head and neck cancer. (Arch Otolaryngol 1985;111:735-739) Si nce 1981, computed tomography (CT) has been used in the evalua¬ tion of patients with head and neck cancer at the University of Utah affil¬ iated hospitals in Salt Lake City. Pre¬ vious reports have indicated the value of CT scanning in primary tumor staging, assessment of tumor re¬ sponse to therapy, diagnosis of tumor recurrence in the neck that has been treated, the search for an unknown primary tumor, and the evaluation of other diseases in the head and neck.114 Clinical examination, which is the basis for staging metastatic cancer in reports to have a significant degree of error in both clinically abnormal and clinically normal necks.15 Although CT scanning has been shown to decrease the amount of error,1618 its use in evaluating cervical lymphadenopathy has not gained widespread acceptance.19 Because the presence of cervical métastases has a great influ¬ ence on the type of treatment and the eventual prognosis of the patient, this study was done to provide additional information regarding the correlation of CT scans with clinical and patho¬ logic findings. In addition to examin¬ ing the use of CT in the untreated neck, the value of this modality as a follow-up tool in previously treated necks was also assessed, since clinical examination of these patients is often difficult. PATIENTS AND METHODSForty patients with head and neck can¬ cer underwent a prospective evaluation of the clinical, radiologie (CT), and pathologic nodal staging. The criteria for inclusion in this study included having had a clinical examination of the head and neck followed by a CT scan. A lymphadenectomy was then done. No intervening therapy was given to the neck between the time of the CT scan and the surgery. Pathologic con¬ firmation was obtained for all patients.Most patients were examined with a CT scanner (Siemens Somatom II) using a magnification, high milliampere seconds package. Several CT scans were obtained on another scanning unit (Philips 300).Axial scans with 4-mm section thickness and 10-s scan time were obtained. In the primary lesion and regional nodal areas, contiguous 4-mm sections were obtained.The remainder of the neck was then scanned in 8-mm increments. The patient remained in a supine position wi...

Objective: To study the reliability of the sentinel node technique (SNT) in the management of the N0 neck in patients with supraglottic laryngeal cancer. Methods: Patients presenting to our department, between 2001 and 2004, with T1–T3 supraglottic cancer and N0 neck, clinically and radiologically, were included in the study. All patients underwent sentinel lymph node detection, using the hand‐held gamma probe followed by bilateral modified radical neck dissection (MRND) and resection of the primary tumor. We compared the results of the SNT with those of the gold standard MRND for the staging of the neck. The histologic examination was performed after fixation for both the products of SNT and MRND. Results: Twenty‐nine patients were included in the study. Twenty‐one had T2, 2 had T1, and 6 had T3 tumors. Patients had transoral CO2 laser‐assisted resection of the primary tumor. All the patients underwent bilateral neck dissection immediately after the sentinel node biopsy. Of the 95 sentinel lymph nodes harvested, 22 were positive for lymph node metastasis. The mean number of sentinel node per patient was 3. Of the 58 modified neck dissections (2 neck sides/patient), there was 1 additional positive lymph node, in the prelaryngeal area, and the patient had already positive sentinel lymph nodes. The SNT allowed the identification of node metastasis in 100% of the cases with a sensitivity of 100 (48–100), specificity of 78 (64–88), negative predictive value of 100 (91–100). Conclusions: SNT is reliable in the staging of the clinically N0 neck in patients with supraglottic cancer. Laryngoscope, 2010

The results suggest the following trends: 1) Adjuvant radiation therapy was associated with poorer outcomes for voice, speech, and swallowing and may be associated with more impairment than surgery alone and 2) poorer outcomes on voice and swallowing were observed for the glottic and supraglottic cancer groups, respectively. To bolster these preliminary findings, additional outcomes studies in patients treated with conservation therapy are needed.