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Topical Fluorides for Head and Neck Cancer Patients Subjected to Surgical Resection and Radiation Therapy in Resource Restraint Settings.
Sheikh, A, Khan, FR, Tabassum, S
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 2020;(2):205-209
Abstract
Patients undergoing surgical resection and ionizing radiations for the treatment of head and cancer may lead a challenging life even after the cure of the disease; because these procedures can adversely affect the oral mucosa, salivary gland, bone, masticatory musculature, and the dentition. Especially, if major salivary glands are exposed to high dose radiation, an irreversible xerostomia may occur that can lead to rampant dental caries. Treatment of these complications demands high cost and time; and is often unaffordable for the patients in the resource constraint setting rendering them to compromise on their quality of life. The healthcare providers should work together in a team to prevent or manage these complications and improve the lives of the patients. This review paper focuses on the significance of low cost fluoride treatment for salvaging the dentition among patients who have had developed head and neck carcinoma and later got subjected to surgical resection and radiation therapy.
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2.
Electrochemotherapy in the head and neck area: an addition to the treatment armamentarium.
de Bree, R, Wessel, I
Current opinion in otolaryngology & head and neck surgery. 2020;(2):112-117
Abstract
PURPOSE OF REVIEW Electrochemotherapy (ECT) is increasingly used in different settings in head and neck cancer patients when conventional treatment options are not available. RECENT FINDINGS Recent improvements of electroporation and ECT include new advanced electrode probes, the combination with intratumorally injected supraphysiological doses of calcium and an update of the standard operating procedures. SUMMARY ECT is a treatment modality that combines administration of a chemotherapeutic drug, for example, bleomycin, with electroporation therapy (EPT). EPT uses brief, high-intensity, pulsed electrical currents to enhance the uptake of cytotoxic drugs by producing a transient increase in cell wall permeability. ECT increases the effect of cytostatic drugs, is independent on histology of the lesion, enables treatment to previously treated areas, preserves healthy tissue, has no significant side effects (low-dose chemotherapy) and enables repeated treatments. ECT can be combined with other treatment modalities and is an addition to the current treatment options of head and neck cancer. ECT is not only able to palliate symptoms but can also provide complete responses and curation.
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3.
Magnetic Resonance Spectroscopy of the Head and Neck: Principles, Applications, and Challenges.
Fujima, N, Carlota Andreu-Arasa, V, Barest, GD, Srinivasan, A, Sakai, O
Neuroimaging clinics of North America. 2020;(3):283-293
Abstract
Several investigations have revealed the utility of magnetic resonance spectroscopy (MRS) as an adjunct in the evaluation of lesions of the head and neck. This technique remains a challenge in the head and neck because of its low signal-to-noise ratio and long acquisition times. In this review article, the basics of image acquisition technique and reported clinical utilities of head and neck MRS are presented.
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4.
Anesthesia and Enhanced Recovery After Head and Neck Surgery.
Worrall, DM, Tanella, A, DeMaria, S, Miles, BA
Otolaryngologic clinics of North America. 2019;(6):1095-1114
Abstract
Enhanced recovery protocols have been developed from gastrointestinal, colorectal, and thoracic surgery populations. The basic tenets of head and neck enhanced recovery are: a multidisciplinary team working around the patient, preoperative carbohydrate loading, multimodal analgesia, early mobilization and oral feeding, and frequent reassessment and auditing of protocols to improve patient outcomes. The implementation of enhanced recovery protocols across surgical populations appear to decrease length of stay, reduce cost, and improve patient satisfaction without sacrificing patient quality of care or changing readmission rates. This article examines evidence-based enhanced recovery interventions and tailors them to a major head and neck surgery population.
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5.
Quality assurance in head and neck cancer surgery: where are we, and where are we going?
Simon, C, Dietz, A, Leemans, CR
Current opinion in otolaryngology & head and neck surgery. 2019;(2):151-156
Abstract
PURPOSE OF REVIEW The scope of this review is to summarize current efforts in quality assurance for head and neck cancer surgery. National and international initiatives are summarized and progress in terms of identification of process indicators and outcome indicators delineated. RECENT FINDINGS Massive efforts have been made in order to improve quality of head and neck cancer surgery. New guidelines for quality assurance of head and neck cancer surgery in clinical trials have recently been proposed by EORTC. SUMMARY Quality assurance programs can be tested within the clearly defined environment of prospective clinical trials. If positive, such programs could be rolled out within national healthcare systems, if feasible. Testing quality programs in clinical trials could be a versatile tool to help head neck cancer patients benefit from such initiatives on a global level.
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6.
Tracheostomies and PEGs: When Are They Really Indicated?
Hoffman, MR
The Surgical clinics of North America. 2019;(5):955-965
Abstract
Surgeons are often asked to perform tracheostomies and percutaneous endoscopic gastrostomies for a wide variety of patients. As consultants, surgeons are tasked with honoring the relationship between the referring provider and the patient while also assessing whether the consult is appropriate given the patient's prognosis and goals of care. This article discusses the most common conditions for which these procedures are requested and reviews the evidence supporting either the placement or avoidance of these tubes in each condition. It provides a framework for surgeons to use when discussing these procedures in the context of goals of care.
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7.
Nutrition and Perioperative Care for the Patient with Head and Neck Cancer.
Gill, A, Farwell, DG, Moore, MG
Oral and maxillofacial surgery clinics of North America. 2018;(4):411-420
Abstract
Recovery after major head and neck cancer surgery is a complex process. In addition to perioperative sequelae such as pain, wound infections, venous thromboembolism (VTE), and pneumonia, these patients frequently suffer from malnutrition. We provide a contemporary evidence-based approach to common aspects of perioperative care to guide the clinician in the optimal management of patients. Particular emphasis is placed on the preoperative education of patients and the identification and management of malnutrition around the time of surgery. This article discusses recommendations for perioperative antibiotics, pain management, and prophylaxis against VTE and pneumonia in this patient population.
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8.
Head and Neck Cancer Tumor Seeding at the Percutaneous Endoscopic Gastrostomy Site.
Greaves, JR
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2018;(1):73-80
Abstract
The National Institutes of Health National Cancer Institute estimates that over 13,000 new cases of head and neck cancer (HNC) will be diagnosed in 2017. Patients with HNC often require enteral nutrition (EN) via gastrostomy tube to provide nutrition support and hydration because of tumor obstruction of the oropharynx and/or cumulative effects of chemoradiation therapy. The percutaneous endoscopic gastrostomy (PEG) tube has become the preferred technique for EN access because placement is considered a minimally invasive procedure. There are 3 methods of PEG placement: Gauderer-Ponsky "pull," Sachs-Vine "push," and Russell "push" method. The Gauderer-Ponsky "pull" method has become the preferred method of PEG placement. It has been previously reported that the rate of stomal metastasis can be 0.5%-1% of those undergone the Gauderer-Ponsky "pull" method that is consistent with HNC morphology. Other researchers believe the rate may be as high as 0.5%-3%. This article reviews the 3 methods of PEG placement, as well as all potential complications, including metastatic seeding at the PEG site. In addition, 1 additional case of tumor seeding at the PEG site will be reviewed. Consideration for avoidance of the Gauderer-Ponsky pull method of PEG placement or other methods of feeding tube placement where the gastrostomy tube has to pass through the oral cavity before exiting the abdominal wall in patients with squamous cell carcinoma of the head and neck should be considered.
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9.
Photodynamic treatment outcomes of potentially-malignant lesions and malignancies of the head and neck region: A systematic review.
Gondivkar, SM, Gadbail, AR, Choudhary, MG, Vedpathak, PR, Likhitkar, MS
Journal of investigative and clinical dentistry. 2018;(1)
Abstract
AIM: The aim of the present study was to systematically review the efficacy of photodynamic therapy (PDT) in the management of oral potentially-malignant disorders (PMDS) and head and neck squamous cell carcinoma (HNSCC). METHODS From 1985 to 2015, PubMed/Medline, Google Scholar, EMBASE, and ISI Web of Knowledge were searched using different combinations of the following key words: PDT, oral precancer, leukoplakia, erythroplakia, erythroleukoplakia, verrucous hyperplasia, oral submucous fibrosis, and HNSCC. Review articles, experimental studies, case reports, commentaries, letters to the editor, unpublished articles, and articles published in languages other than English were excluded. RESULTS Twenty-six studies were included in the present study. The number of patients ranged from 2 to 147, with a mean age of 50-67 years. The reported numbers of PMDS and HNSCC ranged between 5 and 225. Photosensitizers used were aminolevulinic acid, meta-tetrahydroxyphenylchlorin, Foscan, hematoporphyrin derivatives, Photofrin, Photosan, and chlorine-e6. Laser wavelength, power density, irradiation duration were 585-652 nm, 50-500 mW/cm2 , and 1-143 minutes, respectively. Complete, partial, and no response to PDT was found in 22.58%-100%, 4%-66%, and 0%-38.70% of PMDS, respectively, and 16%-100% of complete response in HNSCC patients. CONCLUSION PDT is effective in the management of PMDS and HNSCC.
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10.
Free Flap Head and Neck Reconstruction with an Emphasis on Postoperative Care.
van Gijn, DR, D'Souza, J, King, W, Bater, M
Facial plastic surgery : FPS. 2018;(6):597-604
Abstract
Microsurgical free tissue transfer represents the mainstay of care in both ablative locoregional management and the simultaneous reconstruction of a defect. Advances in microsurgical techniques have helped balance the restoration of both form and function-decreasing the significant morbidity once associated with large ablative, traumatic, or congenital defects-while providing immediate reconstruction enabling early aesthetic and functional rehabilitation. There are a multitude of perioperative measures and considerations that aim to maximize the success of free tissue transfer. These include nutritional support, tight glycemic control, acknowledgment of psychological and psychiatric factors, intraoperative surgical technique, and close postoperative monitoring of the patients' hemodynamic physiology. While the success rates of free tissue transfer in experienced hands are comparable to alternative options, the consequences of flap failure are catastrophic-with the potential for significant patient morbidity, prolonged hospital stay (and associated increased financial implications), and increasingly limited options for further reconstruction. Success is entirely dependent on a continuous arterial inflow and venous outflow until neovascularization occurs. Flap failure is multifactorial and represents a dynamic process from the potentially reversible failing flap to the necrotic irreversibly failed flap-necessitating debridement, prolonged wound care, and ultimately decisions concerned with future reconstruction. The overriding goal of free flap monitoring is therefore the detection of microvascular complications prior to permanent injury occurring-identifying and intervening within that critical period between the failing flap and the failed flap-maximizing the potential for salvage. With continued technique refinement, microvascular free flap reconstruction offers patients the chance for both reliable functional and aesthetic restoration in the face of significant ablative defects. The caveat to this optimism is the requirement for considered perioperative care and the optimization of those factors that may offer the difference between success and failure.