Head & neck
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The plunging ranula is a relatively uncommon phenomenon which represents a mucus escape reaction occurring from disruption of the sublingual salivary gland. We present a series of 20 patients managed at Green Lane Hospital (Auckland, New Zealand) over a 9-year period. ⋯ Plunging ranulas appear to occur with greater incidence in the Maori and Pacific Island Polynesian populations. The precise etiology of their predisposition is unknown, although local trauma or inherent mylohyoid dehiscences may play important roles. Removal of the sublingual gland via either a cervical or intraoral approach is important in the management of this condition. Excision of the pseudocyst is probably unnecessary and places surrounding structures at risk of damage, but a biopsy of the pseudocyst wall is important to confirm the diagnosis.
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Multicenter Study
Impact of comorbidity on outcome of young patients with head and neck squamous cell carcinoma.
Comorbid conditions have a significant impact on the actuarial survival of patients with head and neck cancer. However, no studies have evaluated the impact of comorbidity on tumor- and treatment-specific outcomes. This study was performed to evaluate the impact of comorbidity, graded by the Kaplan-Feinstein comorbidity index (KFI) on the incidence and severity of complications, disease-free interval, and tumor-specific survival in patients undergoing curative treatment for head and neck cancer. ⋯ The presence of comorbid conditions has a significant impact on tumor- and treatment-specific outcomes. Although the presence of advanced comorbid conditions is not associated with an increase in the rate of treatment-associated complications, complications tend to be more severe in this population. More importantly, advanced comorbidity has a detrimental effect on the disease-free interval and tumor-specific survival in patients with head and neck cancer, independent of other factors. This suggests that comorbidity may impact on tumor behavior, presumably by altering the host's response to cancer. Accordingly, to be more predictive and reliable, the current staging system for head and neck cancer should include a description of the patient's comorbidity.
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Comparative Study
Baseline and post-treatment assessment of the general health status of head and neck cancer patients compared with United States population norms.
It is a common perception that the overall health of patients with head and neck cancer (HNC) is likely to be poor compared with the general population. This project was undertaken to investigate the pre- and post-treatment, global health status of HNC patients in comparison with age-matched, U.S. population norms using a self-administered general health status survey. ⋯ This work provides objective support for the perception that many HNC patients are initially seen for treatment with baseline health status functioning significantly below their age-matched contemporaries in the general population. An educated evaluation of global health outcomes following treatment in the HNC patient population must begin with an accurate pretreatment assessment of these parameters. Self-reported health-status assessment (HSA) is a useful means of evaluating global health status in this patient population.
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Comparative Study
Development of distant metastasis after treatment of advanced-stage head and neck cancer.
The recognition of risk factors for the development of distant metastasis is necessary for identifying high-risk patients who may benefit from systemic therapy. Previous investigations studying possible risk factors have been heterogeneous, with patients having varied forms of therapy. This study is designed to evaluate the clinical and histologic risk factors for the development of distant metastasis (DM) in patients with only advanced-stage head and neck squamous cell carcinoma after surgery and radiotherapy. ⋯ Patients wit clinically palpable neck disease (N1-3), histological evidence of metastatic nodal disease, extracapsular spread, and three or more positive lymph nodes are at greater risk of developing failure at distant sites. This subset of patients should have an extensive evaluation for distant metastatic disease and should be considered for systemic therapy.