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Manual of Head and Neck Surgical Oncology
Nicholas Stafford
1:
Head and neck cancer: etiology and epidemiology
Simon Carr
Etiology
Tobacco and alcohol
Viruses
Dietary factors
Occupational factors
Laryngopharyngeal reflux
Molecular and genetic factors
Epidemiology
2:
Imaging head and neck cancer
Imaging modalities
Ultrasound
Advantages
Disadvantages
CT
Advantages
Disadvantages
MRI
Advantages
Disadvantages
PET–CT
Advantages
Disadvantages
Safety issues
Ultrasound
CT
MRI
PET–CT
Staging the primary tumor
Imaging technique
MRI
CT
Larynx
Hypopharynx
Sinonasal tumors
Nasopharynx
Oropharynx
Oral cavity
Staging neck disease
Staging distant metastases
Lungs
Chest radiograph
CT chest
Liver
Bone
PET–CT
Unknown (occult) primary tumors
Post-treatment imaging
Early postoperative period
Post-treatment ‘baseline’ imaging
Expected post-treatment changes
Post-treatment ‘follow-up’ imaging
Imaging of treatment complications
Problems with swallowing
Initial investigation with barium swallow
Problems with voice production after surgical voice restoration
Osteoradionecrosis
Recurrent disease
Primary site
Neck
Distant
Second primary tumors
Synchronous head and neck tumors
Synchronous lung tumors
Metachronous head and neck tumors
Metachronous lung tumors
3:
Therapy requirements in head and neck oncology
Nutritional therapy
What is a dietician?
What is a head and neck dietician?
Nutritional effects of treatment
Nutritional requirements
Summary
Speech and language therapy
What is a speech and language therapist (SLT)?
Communication
Eating, drinking and swallowing
Head and neck cancer – its impact on communication and swallowing
The multi-disciplinary team (MDT) and speech and language therapy
Key points of speech and language therapy involvement in the pathway
Clinical evaluation of communication
Communication and the total laryngectomy
Prosthetic SVR
Artificial larynx (electrolarynx)
Esophageal voice
Assessment for heat moisture exchanger systems
Assessment for hands-free speech
Clinical evaluation of swallowing
Compensatory strategies
Texture modification of food and fluid
Videofluoroscopic evaluation of oropharyngeal swallowing disorders
Fiberoptic endoscopic evaluation of swallowing
Evaluation of SLT service provision
MDT collaboration in SLT referral
4:
Systemic therapy in head and neck cancer
Platinum agents: cisplatin and carboplatin
5-Fluorouracil (5FU)
Taxanes
Targeted biological agents
Acute oncology – management of toxicities
Bleeding and bruising
Diarrhea
Mucositis
Nausea and vomiting
Neutropenic sepsis
Chemotherapy in practice
Induction chemotherapy
Concurrent chemotherapy with radiotherapy
Adjuvant chemoradiotherapy
Palliative chemotherapy
EGFR inhibition
Summary
5:
Radiotherapy principles
Radiotherapy in practice
Radiotherapy treatment planning
Preplanning
Dentition
Nutrition
Audiometry
Smoking cessation
Immobilization
Localization
Planning
Verification
Radiotherapy techniques
3D conformal radiotherapy
Intensity-modulated radiotherapy
Image-guided radiotherapy
Indications for radiotherapy in head and neck cancer
Radical curative radiotherapy (alone or in combination with chemotherapy)
Postoperative radiotherapy (alone or in combination with chemotherapy)
Tumor factors
Nodal factors
Brachytherapy
Palliative radiotherapy
Toxicity of radiotherapy
Acute
Late
Care of the head and neck patient
Summary
6:
Radical neck dissection
Neck levels
Preoperative considerations
Consent for surgery
Antibiotics
Incisions
Operative technique
Exposure
The inferior dissection
The superior dissection
Postoperative complications
Immediate
Early
Late
Specific features of modified radical and selective neck dissections
7:
Total laryngectomy
Preoperative considerations
Antibiotics
Incision
Operative technique
Raise skin flaps
Isolation of larynx
Excision of the larynx
Surgical voice restoration
Postoperative care
8:
Tonsil and soft palate surgery
Assessment and diagnosis of oropharyngeal tumors
Treatment options for soft palate and tonsil tumors
Soft palate surgery
Complications
Tonsil and lateral oropharyngeal wall surgery
Lip split mandibulotomy approach to the oropharynx
Operative technique
Closure
Postoperative care
Complications of lip split mandibulotomy
T4 lateral oropharyngeal tumors involving mandibular bone
Reconstruction
Summary
9:
Tongue base surgery
Diagnostic surgery for tongue base lesions
Surgical resection of tongue base tumors
Operative technique of visor approach with chin-point osteotomy
Closure
Possible complications
Lateral pharyngotomy approach to the tongue base
Reconstruction of tongue base defects
Future developments
Summary
10:
Medial maxillectomy via a lateral rhinotomy approach
Preoperative considerations
Surgical anatomy
Consent
The operation
Incision
Operative technique
11:
Maxillectomy
Introduction
Preoperative considerations
Staging
Antibiotics
Anesthetic considerations
Operative technique
Postoperative care
Orbital extenteration
Medial wall maxillectomy
12:
Anterior skull base (including pituitary fossa) tumors
Common tumors of the anterior skull base
Classification of lesions of the anterior skull base
Evaluation of the patient
Detailed history
Intraoperative monitoring
Planning of surgery
Subspecialty team work planning
Reconstruction plan
Postoperative care
Frontobasal approach
Indications
Advantages
Limitations
Technique
Combined approaches
Fronto-orbito zygomatic osteotomy approach
Indications
Advantages
Limitations
Technique
Craniofacial approach
Indications
Advantages
Disadvantages
Technique
Midface degloving approach
Indications
Advantages
Disadvantages
Technique
Approach to the sella and upper clivus
Transnasal approach (Figure 12.1)
Indications
Advantages
Disadvantages
Technique
Endoscopic endonasal approach to anterior skull base and sella (Figure 12.1)
Indications
Advantages
Disadvantages
Preoperative planning
Technique
Management of a CSF leak
Antibiotic policy
13:
Application of endoscopic sinus surgery in head and neck oncology
Preoperative considerations
Consent for surgery
Anesthetic considerations
Endoscopic medial maxillectomy
Operative technique
Endoscopic frontoethmoidal approaches
Operative technique (modified Lothrop procedure)
Endoscopic posterior approach for juvenile angiofibromas
Operative technique
Exposure
Removal of tumor
Extended endoscopic approaches for malignant lesions
Operative technique
Postoperative care
14:
Glossectomy
Preoperative considerations
Staging
Partial glossectomy
The anterior tongue
Tumors of the lateral border
Tumors of the tongue tip or midline dorsum
Surgical approach to larger tumors
15:
Management of the mandible in squamous cell carcinoma of the oral cavity
Staging and workup
Surgical technique
Ablation
Reconstruction
Rehabilitation
Complications
16:
Parotid cancer
Staging
Clinical presentation
Diagnosis
Clinical examination
Ultrasound-guided fine needle aspiration cytology
Preoperative investigation
Treatment options
Consent to surgical treatment
Incisions
Operative technique
Preparation
Exposing the facial nerve
Facial nerve dissection
Post-resection
Postoperative complications
17:
Surgery of the infratemporal fossa and adjacent skull base
Anatomy of the infratemporal fossa
Principles of infratemporal fossa and skull base surgery
Preoperative assessment
Anterior approaches
Lateral approach
Endoscopic approach
Consent for surgery and operability
Operative technique
The postauricular transtemporal approach
Incision
Closure of the external auditory meatus
Facial nerve exposure
Neck dissection
Bone exposure/mobilization
Facial nerve transposition (may not be necessary)
Labyrinthectomy (may not be necessary)
Obliteration of the sigmoid sinus and jugular fossa dissection
Distal control of the ICA
Infratemporal fossa dissection
The preauricular infratemporal approach (type D)
Temporal bone cancers
Complications
CSF leaks
Neurological damage
Neurovascular damage
Wound-related complications
Trismus
Cosmetic complications
18:
Thyroid cancer
Differentiated thyroid cancer
Presentation
Investigations
Treatment
Medullary thyroid cancer
Anaplastic thyroid cancer
Thyroid lymphoma
Management of thyroid cancer
Surgery for thyroid cancer
Thyroid lobectomy
Level 6–7 dissection
Adjuvant therapy
Follow-up
19:
Head and neck skin cancer
Non-melanoma skin cancer
Diagnosis and staging
Basal cell carcinoma
Destructive surgical treatments
Excisional surgical treatments
Non-surgical treatments
Squamous cell carcinoma
Other non-melanoma skin cancer
Staging of SCCs and BCCs
Nodes (N)
Metastasis (M)
Malignant melanoma
Etiology and risk factors
Diagnosis
Staging
Primary tumor
Nodes
Metastasis
Sentinel lymph node biopsy
Other staging investigations
Treatment
Wide local excision
Neck dissection
Adjuvant treatment
Summary
20:
Surgical reconstruction in the head and neck
The reconstructive ladder
Skin and soft tissue defects
Scalp and calvarial defects
Maxillary defects
Mandibular defects
Defects of floor of mouth and oral tongue
Defects of the oropharynx
Reconstruction of the hypopharynx
Summary
INDEX
TOC
Index
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