Effect of Microbiology on Prognosis of Deep Neck Infections

Abstract

OBJECTIVE:To determine objective imaging criteria to differentiate benign lateral neck cysts from cystic metastatic adenopathy. METHOD: A retrospective analysis was performed of patients who underwent a contrast enhanced neck CT between July 2003 and July 2009 and were diagnosed with either a branchial cleft cyst (BCC) or oropharyngeal squamous cell cancer. Each CT was reviewed by a radiologist and for each cyst or lymph node(s) the anatomic level in the neck, dimensions, wall thickness, presence of mural nodes, septations, Houndsfields units, homogeneity, extracapsular extension, calcifications, and fat stranding were recorded. T and Chi-squared tests were used to analyze differences between the two groups. RESULTS: 188 patient images were reviewed; 23 patients with BCCs and 38 patients with SCC met inclusion criteria yielding 23 benign cysts and 61 cystic malignant lymph nodes. Significant differences between the two groups were found with regard to size (pϽ0.05 in each dimension), CT density (pϽ0.001), septations (pϭ0.04), homogeneity (pϽ0.001) and extracapsular extension (pϭ0.01). BCCs tended to be larger, less dense, homogeneous, and had no extracapsular extension when compared to the malignant nodes. CONCLUSION: Misdiagnosis of malignant cysts in the neck may lead to delay in diagnosis, a violated neck, and tumor spillage. We found that BCCs and metastatic lymph nodes may be differentiated using CT imaging criteria such as size, CT density, presence of septations, homogeneity, and extracapsular extension. These findings are particularly valuable when a benign lateral neck cyst is inflamed or ruptured. Internal heterogeneity and septations are the most consistent markers present in cystic metastatic adenopathy. Effect of HPV Status on Relative NFkB p65 mRNA ExpressionDaniel Schneider (presenter); Ryan Fader; Beverly Wuertz; Frank Ondrey, MD, PhD OBJECTIVE: 1) Determine HPV-16 status of 40 head and neck squamous cell carcinoma (HNSCC) specimens. 2) Identify relative p65 mRNA expression of above specimens. METHOD: Tumor specimens were obtained from forty patients from the University of Minnesota and paraffinized. Genomic DNA and total RNA was isolated from patient tumor samples via Roche High Pure RNA Paraffin Kit. HPV status was analyzed via PCR of genomic DNA using primer sets for general HPV presence, as well as primer sets specific for HPV-16, followed by agarose gel electrophoresis. NFkB p65 mRNA expression was analyzed via qRT-PCR (Roche Universal Probe Library). RESULTS:Photospectrometry indicated presence, to varying degrees, of DNA/RNA isolates from tumor specimens. Polymerase chain reaction of genomic DNA with various primers specific for HPV and HPV-16, followed by examination of electrophoresed PCR products, showed either presence or absence of band. This indicated the presence or absence of HPV or HPV-16 infection. Quantitative RT-PCR of both the house keeper gene, beta-2 microglobulin, as well as NFB p65 mRNA expression, indicated varying degrees of expression. CONCLUSION: We found there was inc...