5530 Background:The best management of lymph node metastasis from unknown primary in the head and neck has not been clearly established. Our objective was to review the outcome in a specific cohort of patients treated uniformly with modified neck dissection followed by concurrent chemoradiation. Methods: We conducted a retrospective evaluation of patients (pts) treated between 1995 and 2002 who had resectable nodal squamous cell cancer (SCC) of unknown primary sites and were treated with modified neck dissection followed by concurrent high-dose cisplatin (CIS) and radiotherapy (RT) using a port inclusive of the nasopharynx. Results: Thirty-six pts were identified (median age of 57; male to female ratio 3:1; African American to White ratio 1: 3; stage distribution: N1 (8%), N2a (20%), N2b (36%), N2c (8%), N3 (16%), unknown (11%); at least 60% of pts had locally advanced disease (>N2b). Chemotherapy was given as cisplatin 100mg/m2 x 3 cycles in 86% or CIS=>carboplatin in 14 %. Concurrent RT was given as follows: potential primary sites (5400 cGy), involved neck (6400 cGy), uninvolved neck (5020 cGy), and supraclavicular/low neck region (5000 cGy). Therapy was not completed in 14% of pts. With median follow-up of 30 months (range 7–101 months), 88 % of pts were disease-free and 12 % failed treatment: loco-regional failure (3%), loco-regional and distant metastasis (3%), and distant metastasis (6%). A second primary (tongue cancer) was seen in one patient and another patient developed colon cancer at 90 months and 18 months, respectively. Among the 36 pts: 86 % were alive with no evidence of disease, 6% were alive with disease and 8% died. Toxicity included mucositis grade (G) 3/4 (43%), neutropenia G 3/4 (14%), and renal toxicity G 3/4 (6%). Conclusions: Neck dissection followed by chemo/RT, using high dose CIS concurrently with nasopharyngeal port RT, is an effective way of treating pts with SCC of neck from an unknown primary. This treatment may confer an improved survival and warrants further prospective testing. No significant financial relationships to disclose.

8:24 a.m. 8:30 a.m. With the use of high-resolution computed tomography (GT) of the chest the number of pulmonary nodules being detected in the follow-up of head and neck cancer patients has significantly increased. A large proportion of these nodules are too small (<1 cm) to make a pathologic diagnoses by needle aspiration. Present data in literature are insufficient to formulate treatment guidelines in these patients. Should we consider these lung nodules benign or malignant? In these cases should the primary head and neck cancer be treated with curative intent? This study was done to find the natural history of these nodules and to find the yield of various diagnostic and therapeutic modalities offered and thus to suggest a treatment guideline for these patients. Medical records of 386 patients with head and neck cancer who had chest CT performed with a follow-up of at least 1 year were reviewed for the presence of small nodules (<1 cm) in the chest CT scan. Of these, 168 (44%) patients had one or more lung nodule that was too small to biopsy. In 73 (43%) patients these nodules were solitary, and in 95 (57%) patients they were multiple. In the solitary nodule group CT-guided needle aspirations were performed in 11 patients, and bronchoscopy was performed in 61 patients with no diagnostic yield. Exploratory thoracotomies were done in 13 patients with three (23%) positive for neoplasm. In subsequent follow-up a total of 6 of 73 patients (8%) with solitary nodules and 17 of 95 (18%) with multiple small nodules were found to have lung neoplasms. Because in our study a significant proportion of chest CT scans done in the follow-up of head neck cancer patients have shown unbiopsiable solitary nodules (19%), with only 8% of the nodules subsequently found to be malignant, we conclude that in the presence of these small, indeterminate solitary nodules, the primary head and neck cancer should be treated with a curative intent, and at the same time a close follow-up of these nodules is suggested with follow-up chest CT scans at 3-month intervals.

Tracheopulmonary aspiration commonly occurs in patients with dysphagia related to head and neck cancer. Scintigraphic studies were performed in 280 patients with head and neck cancer; 33% of these patients had tracheopulmonary aspiration. A subgroup of 18 tracheostomized patients had a tracheostomy tube with a removable obturator, so they could be studied with the tracheostomy open or occluded. When the tracheostomy was occluded the patients aspirated less frequently, and in significantly smaller quantities, than when it was open. When feasible, occluding the tracheostomy tube or permanent surgical closure may reduce or eliminate tracheopulmonary aspiration in these patients. © 1994 John Wiley & Sons, Inc.

Results are presented for repeated videofluoroscopic and scintigraphic examinations of a supraglottic laryngectomy patient, illustrating the successful use and later changes in a compensatory swallow. Issues in patient management are outlined, stressing the importance of interaction between radiologists and dysphagia therapists in the rehabilitation of such patients.

Progress in the treatment of advanced squamous cell cancer (SCC) of the head and neck (H & N) has included the development of combination chemotherapeutic regimens that achieve impressive complete response (CR) rates using two to three courses therapy with minimal toxicity and good patient tolerance. Further improvements in these results will require intensification of induction regimens. Therefore, a five course, alternating combination chemotherapy induction trial was initiated in an attempt to test the feasibility and toxicity of a prolonged, intensive induction regimen in patients with advanced SCC of H & N. Courses 1, 3, and 5 consisted of fluorouracil as a 120-hour infusion (5FU-I) with cisplatin (CACP) as an intravenous (IV) bolus. Courses 2 and 4 consisted of 3 weekly doses of high-dose methotrexate (HDMTX) followed by 5FU (5FU-b) and leucovorin rescue (LR). Forty-six stage IV patients with SCC of H & N (85% T4 and 58% N3) were entered. Thirty-one patients completed the study and 15 did not. Twenty-one of the 46 patients (46%) achieved a CR. Twenty-five of the 46 patients had N3 neck disease, ten of these 25 achieved a CR (40%), and eight did not complete therapy. Of the 15 patients not completing this study, one patient achieved a CR and eight achieved a partial response (PR). Eight of 46 (17%) were removed from study for reasons of toxicity (6% to 13%) or tumor progression (2% to 4%). The remaining seven were removed due to intercurrent medical conditions (four uncomplicated pneumonias and one gun shot wound) or lost to follow-up (2). Myelosuppression, mucositis, and skin toxicity increased in frequency by the end of the trial but were acceptable and reversible. The activity of this five-course regimen is promising given the advanced disease status of patients treated. Consideration of concurrent medical conditions, patient compliance, intensity of medical, nutritional and social support, and levels of acceptable toxicity will be necessary in the design of future, intensive induction trials.

Posttraumatic telecanthus is characterized by a lateral displacement of the medial canthus and a dysfunction of the lacrimal collecting system following injury to the midfacial region.lp3 The condition develops from a high-energy frontal impact, and is often associated with fracture of the nasal, maxillary, lacrimal, ethmoidal, and frontal bones, variable periods of unconsciousness, cerebrospinal fluid leakage, and damage to the globe. Failure to recognize the injury can lead to permanent changes in configuration of the palpebral fissure, distortion of the inner angle, and dacryocystitis.

This paper presents two advances in the evaluation of swallowing function which better define the swallowing processes in the head and neck cancer patient. Videofluoroscopy, improved by computer‐assisted image analysis, provides more accurate information regarding oral and pharyngeal movement of structures. Radionuclide scintigraphy, a complementary technique, quantitatesbolus flow (transit times) and the degree of aspiration. Several cases demonstrate the advantages of the methods and their usefulness in evaluating the effects of cancer treatment. The improved techniques also provide opportunity for designing new strategies of medical and surgical rehabilitation.

Otolaryngology–Head and Neck SurgeryVolume 97, Issue 5 p. 514-516 Case Report Management of Neck Bleeding in Patients with Inhibitors to Factor VIII Paul A. Levine MD, Paul A. Levine MD Case Report EditorSearch for more papers by this authorDr. Muhammad Shurafa MD, Corresponding Author Dr. Muhammad Shurafa MD n/a@dne.dne Department of Medicine, Division of Hematology/Oncology, Harper Hospital, Wayne State University, Detroit, MichiganReprint requests: Muhammad Shurafa, MD, Department of Medicine, c/o Harper Hospital, 3990 John R., Detroit, MI 48201.Search for more papers by this authorDr. Robert Mathog MD, Dr. Robert Mathog MD Department of Otolaryngology, University Health Center, Wayne State University, Detroit, MichiganSearch for more papers by this author Paul A. Levine MD, Paul A. Levine MD Case Report EditorSearch for more papers by this authorDr. Muhammad Shurafa MD, Corresponding Author Dr. Muhammad Shurafa MD n/a@dne.dne Department of Medicine, Division of Hematology/Oncology, Harper Hospital, Wayne State University, Detroit, MichiganReprint requests: Muhammad Shurafa, MD, Department of Medicine, c/o Harper Hospital, 3990 John R., Detroit, MI 48201.Search for more papers by this authorDr. Robert Mathog MD, Dr. Robert Mathog MD Department of Otolaryngology, University Health Center, Wayne State University, Detroit, MichiganSearch for more papers by this author First published: 01 November 1987 https://doi.org/10.1177/019459988709700516Citations: 2AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume97, Issue5November 1987Pages 514-516 RelatedInformation

Seventy-five patients with stage III and IV squamous cell cancer of the head and neck, previously untreated, had two courses of chemotherapy with cis-platinum, Oncovin and bleomycin, followed by radical surgery, radiotherapy or both. Response to chemotherapy (complete and partial) was high (80 percent). In 36 patients radical surgery became possible. The overall survival improved statistically in patients who achieved complete or partial response to chemotherapy compared with those who had minimal or no response. Patients with well to moderately well differentiated cancer, or stage III disease, had a statistically better prognosis than patients with poorly differentiated cancer, or stage IV disease.