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09:02: Quality of Life Following Head and Neck Cancer Treatment
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Otolaryngology-Head and Neck Surgery, Vol 137, No 2S, August 2007
OBJECTIVES: 1. Learn about the clinical utility of sentinel lymph node (SLN) biopsy for accurate staging of oral cavity squamous cell carcinomas (SCC) with clinically and radiologically N0 necks. 2. Discuss SLN biopsy as the only tool to accurately identify early extracapsular spread (ECS). 3. Be able to discuss the potential limitations of selective neck dissection (SND) in the absence of SLN biopsy. METHODS: Retrospective review evaluating 14 consecutive patients with stage I or II oral cavity SCC undergoing SND without evidence of nodal or distant metastatic disease from January 1997 to December 2006. Prior to SND, patients underwent preoperative lymphoscintigraphy and SLN mapping with technetium-99 sulfur colloid. Intraoperatively, SLNs were marked with suture and resected with the en bloc lymphadenectomy specimen. SLNs were subsequently analyzed via standard H&E stains, immunohistochemistry, and serial sectioning for evidence of metastases. RESULTS: Preoperative lymphoscintigraphy showed one or more SLNs in all patients. Three patients had SLNs in two nodal basins and one patient had SLNs in multiple basins. At the conclusion of SND, no SLNs were left in the neck. Three patients had micrometastases and two of these three had ECS in nodes that otherwise appeared normal clinically, grossly, and radiographically. CONCLUSIONS: Combined with standard SND, SLN biopsy may optimize clinical outcomes in patients with oral cavity SCC with clinically negative necks. Microscopic ECS may be missed through routine pathologic analysis of neck dissection specimens for early stage oral cavity cancers. SLN biopsy enables more accurate planning of SND with less likelihood of missing disease-harboring nodal basins.
08:54 Safety of Laryngeal Reinnervation Joel H Blumin, MD (presenter); Albert L Merati, MD OBJECTIVES: 1. Characterize any additional risks and rate of complication associated with laryngeal reinnervation in comparison to traditional laryngeal framework surgery. 2. Identify any patient factors associated with complications in laryngeal reinnervation. METHODS: Retrospective comparison of complication rates between cases with and without laryngeal reinnervation over a five-year period. RESULTS: Sixteen reinnervation procedures were performed to rehabilitate a paralyzed vocal fold. Twelve of the 16 (75%) were combined with arytenoid adduction. Additional laryngeal procedures were performed in 3 cases. One reinnervation was aborted due to presence of scar and vascular malformation in the trachealesophageal groove. There were no major complications (airway obstruction or death). There were no cases of prolonged dysphagia or aspiration pneumonia; there was one wound infection (1/16, 6%), which responded to oral antibiotics. Minor endoscopic find-
ings postoperatively included pharyngeal ecchymoses in three patients (19%), all of whom also had an arytenoid adduction simultaneously performed. There was a similar incidence of minor complications in traditional framework surgery performed without reinnervation (p⬎0.05). CONCLUSIONS: Laryngeal reinnervation, alone or in combination with laryngeal framework surgery, does not appear to add significant perioperative morbidity. This is the first report to document the safety of laryngeal reinnervation by nervenerve anastomosis.
09:02 Quality of Life Following Head and Neck Cancer Treatment Theresa A Gurney, MD (presenter); David W Eisele, MD; Lisa A Orloff, MD; Steven J Wang, MD OBJECTIVES: 1. Analyze various treatment modalities’ impact on quality of life (QOL) following head and neck cancer treatment. 2. Determine clinicopathologic, demographic, and outcome parameters predicting QOL. METHODS: Patients previously treated for head and neck cancer seen at an academic, tertiary head and neck surgery clinic between July 1–October 31, 2006 were asked to participate. The validated University of Michigan Head & Neck Specific Quality of Life Questionnaire was given to patients after obtaining informed consent. Medical records were retrospectively reviewed. RESULTS: Eighty-seven patients were eligible and completed questionnaires. The majority had squamous cell carcinoma (94%), advanced stage disease (53%), and were male (62%). Sixty percent had surgery as a component of their treatment and 53% had radiation. Eighteen percent had a freetissue transfer (fibula flap 8% and radial forearm flap 10%). Neither surgery alone nor concomitant radiation and chemotherapy had a statistically significant impact on QOL. A history of radiation therapy predicted significantly worse QOL in the eating domain. Patients who had both surgery and radiation reported significantly worse QOL in eating and speech. Other predictors of a worse QOL included advanced stage (eating), gastrostomy-tube dependence (eating, speech and emotion), surgical complication (eating, emotion and pain), and posttreatment recurrence (eating, speech and emotion). CONCLUSIONS: Head and neck cancer treatment with radiation therapy or radiation therapy combined with surgery was associated with poorer QOL. In addition, advanced stage, gastrostomy-tube dependence, complication or recurrence also predicted worse QOL.
09:10 Effect of Ciprodex on Graft Healing in Tympanoplasty Ashley Erin Starkweather, BS (presenter); Rick A Friedman, MD, PhD
Otolaryngology-Head and Neck Surgery, Vol 137, No 2S, August 2007
OBJECTIVES: 1. Learn about the clinical utility of sentinel lymph node (SLN) biopsy for accurate staging of oral cavity squamous cell carcinomas (SCC) with clinically and radiologically N0 necks. 2. Discuss SLN biopsy as the only tool to accurately identify early extracapsular spread (ECS). 3. Be able to discuss the potential limitations of selective neck dissection (SND) in the absence of SLN biopsy. METHODS: Retrospective review evaluating 14 consecutive patients with stage I or II oral cavity SCC undergoing SND without evidence of nodal or distant metastatic disease from January 1997 to December 2006. Prior to SND, patients underwent preoperative lymphoscintigraphy and SLN mapping with technetium-99 sulfur colloid. Intraoperatively, SLNs were marked with suture and resected with the en bloc lymphadenectomy specimen. SLNs were subsequently analyzed via standard H&E stains, immunohistochemistry, and serial sectioning for evidence of metastases. RESULTS: Preoperative lymphoscintigraphy showed one or more SLNs in all patients. Three patients had SLNs in two nodal basins and one patient had SLNs in multiple basins. At the conclusion of SND, no SLNs were left in the neck. Three patients had micrometastases and two of these three had ECS in nodes that otherwise appeared normal clinically, grossly, and radiographically. CONCLUSIONS: Combined with standard SND, SLN biopsy may optimize clinical outcomes in patients with oral cavity SCC with clinically negative necks. Microscopic ECS may be missed through routine pathologic analysis of neck dissection specimens for early stage oral cavity cancers. SLN biopsy enables more accurate planning of SND with less likelihood of missing disease-harboring nodal basins.
08:54 Safety of Laryngeal Reinnervation Joel H Blumin, MD (presenter); Albert L Merati, MD OBJECTIVES: 1. Characterize any additional risks and rate of complication associated with laryngeal reinnervation in comparison to traditional laryngeal framework surgery. 2. Identify any patient factors associated with complications in laryngeal reinnervation. METHODS: Retrospective comparison of complication rates between cases with and without laryngeal reinnervation over a five-year period. RESULTS: Sixteen reinnervation procedures were performed to rehabilitate a paralyzed vocal fold. Twelve of the 16 (75%) were combined with arytenoid adduction. Additional laryngeal procedures were performed in 3 cases. One reinnervation was aborted due to presence of scar and vascular malformation in the trachealesophageal groove. There were no major complications (airway obstruction or death). There were no cases of prolonged dysphagia or aspiration pneumonia; there was one wound infection (1/16, 6%), which responded to oral antibiotics. Minor endoscopic find-
ings postoperatively included pharyngeal ecchymoses in three patients (19%), all of whom also had an arytenoid adduction simultaneously performed. There was a similar incidence of minor complications in traditional framework surgery performed without reinnervation (p⬎0.05). CONCLUSIONS: Laryngeal reinnervation, alone or in combination with laryngeal framework surgery, does not appear to add significant perioperative morbidity. This is the first report to document the safety of laryngeal reinnervation by nervenerve anastomosis.
09:02 Quality of Life Following Head and Neck Cancer Treatment Theresa A Gurney, MD (presenter); David W Eisele, MD; Lisa A Orloff, MD; Steven J Wang, MD OBJECTIVES: 1. Analyze various treatment modalities’ impact on quality of life (QOL) following head and neck cancer treatment. 2. Determine clinicopathologic, demographic, and outcome parameters predicting QOL. METHODS: Patients previously treated for head and neck cancer seen at an academic, tertiary head and neck surgery clinic between July 1–October 31, 2006 were asked to participate. The validated University of Michigan Head & Neck Specific Quality of Life Questionnaire was given to patients after obtaining informed consent. Medical records were retrospectively reviewed. RESULTS: Eighty-seven patients were eligible and completed questionnaires. The majority had squamous cell carcinoma (94%), advanced stage disease (53%), and were male (62%). Sixty percent had surgery as a component of their treatment and 53% had radiation. Eighteen percent had a freetissue transfer (fibula flap 8% and radial forearm flap 10%). Neither surgery alone nor concomitant radiation and chemotherapy had a statistically significant impact on QOL. A history of radiation therapy predicted significantly worse QOL in the eating domain. Patients who had both surgery and radiation reported significantly worse QOL in eating and speech. Other predictors of a worse QOL included advanced stage (eating), gastrostomy-tube dependence (eating, speech and emotion), surgical complication (eating, emotion and pain), and posttreatment recurrence (eating, speech and emotion). CONCLUSIONS: Head and neck cancer treatment with radiation therapy or radiation therapy combined with surgery was associated with poorer QOL. In addition, advanced stage, gastrostomy-tube dependence, complication or recurrence also predicted worse QOL.
09:10 Effect of Ciprodex on Graft Healing in Tympanoplasty Ashley Erin Starkweather, BS (presenter); Rick A Friedman, MD, PhD