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Sataloff’s Comprehensive Textbook of Otolaryngology: Head & Neck Surgery (Head and Neck Surgery) - Volume 5
Robert T Sataloff, Patrick J Gullane, David P Goldstein
CHAPTER 1:
The Molecular Biology of Head and Neck Cancer
INTRODUCTION
MOLECULAR CHANGES ASSOCIATED WITH HISTOLOGICAL CHANGES IN SQUAMOUS EPITHELIUM
Terminology: Oncogenes, Tumor Suppressor Genes, and Mutations
Cell Proliferation (p53, Rb, CDKN2A, CCND1)
Cell Signaling (EGFR, RAS, PI3KCA, TGFBR2, SMAD4)
Cell Differentiation (NOTCH, TP63)
Cell Death (CASP8)
HPV-Associated Viral Molecular Mechanisms of HNSCC
TARGETED DRUG THERAPY IN HNSCC
Target: EGFR Pathway
Target: PI3CA-AKT-mTOR Pathways
CONCLUSION
ACKNOWLEDGMENT
CHAPTER 2:
Principles of Radiation Oncology
INTRODUCTION
PRINCIPLES OF RADIATION PHYSICS
Types of Radiation
Electromagnetic Radiation
Particle Radiation
PRINCIPLES OF RADIOBIOLOGY
Fate of Irradiated Cells
Primary Target Is DNA
Interaction with Ionizing Radiation
Radiation Effects on Normal Tissues
Radiation Cell Killing
Radiation Effects on Cell Kinetics
Cell Survival and Radiation Dose-Response Curves
Linear-Quadratic Model
Fractionation
Factors Affecting Radiation Sensitivity
Type of Radiation and Linear Energy Transfer
Oxygen Status
Cell Cycle Age
Biologic Basis of Dose Fractionation (Fractionation and the 4 Rs)
Repair of Sublethal Damage
Reassortment
Repopulation
Reoxygenation
ADVANCES IN RADIATION ONCOLOGY
Altered Fractionation
HIGH-PRECISION RADIATION THERAPY
Conformal Radiotherapy
Intensity-Modulated Radiotherapy
IMRT Delivery
Adaptive Radiotherapy
Combination Chemotherapy with Radiotherapy
Induction Chemotherapy
Adjuvant Radiation and Chemotherapy
Altered Fractionation and Concurrent Chemotherapy
Combining Systemic Targeted Agents with Radiation
RECENT ADVANCES IN HEAD AND NECK CANCER
Biomarkers
Circulating EBV DNA Titers in Nasopharyngeal Carcinoma
HPV and Oropharyngeal Carcinoma
EGFR Expression in Head and Neck Tumors
PALLIATIVE RADIOTHERAPY
SUMMARY
CHAPTER 3:
Principles of Medical Oncology
INTRODUCTION
THE MOLECULAR BASIS FOR SYSTEMIC THERAPY
GENERAL PRINCIPLES IN SYSTEMIC THERAPY ADMINISTRATION
Defining Treatment Goals
Chemotherapy Administration
Efficacy Measurement
CHEMOTHERAPY AGENTS
Platinum Compounds
Methotrexate
5-Fluorouracil
Taxanes
MOLECULAR TARGETING
INTEGRATION OF SYSTEMIC THERAPY INTO CURATIVE INTENT TREATMENT
SYSTEMIC THERAPY FOR PALLIATION
FUTURE DIRECTIONS
CHAPTER 4:
Immunobiology and Immunotherapy in Head and Neck Cancer
CANCER AND THE IMMUNE SYSTEM
ANTITUMOR IMMUNITY
THE MECHANISM OF ANTITUMOR IMMUNITY
The Innate Immune System
The Adaptive Immune System
T-Cell Exhaustion
Regulatory T cells (Tregs)
Myeloid-Derived Suppressor Cells (MDSCs)
Tumor Stroma
HEAD AND NECK CANCER AND THE IMMUNE SYSTEM
Tumor-Infiltrating Lymphocytes and HNSCC
Tregs and HNSCC
MDSCs and HNSCC
Stroma and HNSCC
HUMAN PAPILLOMAVIRUS
IMMUNOTHERAPY
Monoclonal Antibodies
Immunostimulatory Antibodies
Vaccines
Tumor Cell Vaccines
Protein/Peptide Vaccines
Dendritic Cell Vaccine
Vectored Vaccines
Adoptive T-Cell Transfer
Small Molecule Modulators and Adjuvants
Improving Immunotherapy Outcomes
CHAPTER 5:
Head and Neck Imaging
INTRODUCTION
IMAGING MODALITIES
Radiography
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Positron Emission Tomography
PARANASAL SINUSES AND NASAL CAVITY
Anatomy
Malignancy
Nonsquamous Cell Cancers
NASOPHARYNX
Anatomy
Malignancy
Nonsquamous Cell Cancers
OROPHARYNX
Anatomy
Malignancy
Tonsillar Carcinoma
Tongue Base Carcinoma
Soft Palate Carcinoma
Posterior Pharyngeal Wall Carcinoma
Nonsquamous Cell Cancers
ORAL CAVITY
Anatomy
Malignancy
Oral Tongue
Floor of Mouth
Buccal Region
Retromolar Trigone and Hard Palate
Nonsquamous Cell Cancers
LARYNX
Anatomy
Benign Tumors
Malignancy
Supraglottic Carcinoma
Glottic Carcinoma
Subglottic Carcinoma
Cartilage Invasion
Extralaryngeal Soft Tissue Infiltration
Nodal Metastasis
Distant Metastasis
Post-Treatment Surveillance
HYPOPHARYNX
Anatomy
Malignancy
Nodal and Distant Metastasis
MAJOR SALIVARY GLANDS
Anatomy
Imaging
Salivary Gland Tumors
PERINEURAL TUMOR SPREAD
CERVICAL LYMPHADENOPATHY
Anatomy
Features of Metastatic Nodal Disease
POST-THERAPY AND SURVEILLANCE IMAGING
CHAPTER 6:
Sentinel Node Biopsy in Head and Neck Cancer
OVERVIEW OF ROLE AND INDICATIONS FOR SENTINEL NODE BIOPSY
THEORY AND BACKGROUND
TECHNIQUE
Imaging and Radiolocalization
Histopathological Workup
IMPACT AND OUTCOME
CHAPTER 7:
Non-melanoma Skin Cancers of the Head and Neck
BASAL CELL CARCINOMA AND SQUAMOUS CELL CARCINOMA
Definition
Etiology
Solar Radiation
Immunosuppression
Human Papilloma Virus
Chronic Wounds and Scars
Chemicals
Gorlin's Syndrome and the Sonic Hedgehog Pathway in BCC
Xeroderma Pigmentosum
Epidermodysplasia Verruciformis
Clinical Presentations
Diagnosis
Differential Diagnosis
Treatment
Surgery
Radiotherapy
Chemotherapy and EGFR TKI
Topical Therapy
Hedgehog Inhibitor
Chemoprevention
Miscellaneous Treatment Options
Prognosis
Staging
Survival Outcome
Epidemiology
CHAPTER 8:
Melanoma
EPIDEMIOLOGY
ETIOLOGY
ENVIRONMENT
Ultraviolet Radiation and DNA/RNA Damage
Indoor Tanning
Sunscreens
PRECURSOR LESIONS AND GENETICS
HISTOPATHOLOGY
Immunocytochemistry
DIAGNOSTIC EVALUATION
History
Examination
Biopsy
Imaging
The Primary Tumor
The Regional Lymph Nodes
Distant Metastases
PROGNOSTIC FACTORS
Thickness
Mitotic Rate
Ulceration
Location of the Primary Melanoma
Lymph Node Metastases
Biomarkers
STAGING
TREATMENT
Primary Melanoma
Mohs Surgery
Frozen Section
THE REGIONAL LYMPH NODES
Clinically Negative (N0) Regional Lymph Nodes
Elective Node Dissection vs Observation
Sentinel Node Biopsy
Technique
Indications
Elective Neck Irradiation
Management of the Clinically Positive Neck
Location of the Primary Melanoma
Extent of the Tumor in the Lymph Nodes
Location of the Positive Lymph Nodes
Adjuvant Radiation Therapy
Adjuvant Chemotherapy and Immunotherapy
Targeted Therapy
CHAPTER 9:
Pathology of Cutaneous Malignancies of the Head and Neck
INTRODUCTION
INTRODUCTION
Risk Factors
Biopsy
Lentigo Maligna
Clinical Presentation
Histology
Lentigo Maligna Melanoma
Desmoplastic Melanoma
Superficial Spreading Melanoma
Clinical Presentation
Histological Findings
Nodular Melanoma
Clinical Presentation
Histological Findings
Melanoma Prognostic Factors
Primary Tumor Thickness
Primary Tumor Ulceration
Primary Mitotic Rate
Clark/Anatomic Level of Invasion
Ancillary Studies
PART A REFERENCES
OVERVIEW
Ultraviolet Radiation
Immune Status
Human Papilloma Virus and NMSC
Sampling Technique and Pitfalls for NMSC
Synoptic Report in NMSC
BASAL CELL CARCINOMA
Introduction
Clinical Presentation
Pathophysiology
Histology
Ancillary Studies
Metastasis and Recurrence
SQUAMOUS CELL CARCINOMA
Introduction
Pathogenesis
Histology
Ancillary Studies
High-Risk SCC
MERKEL CELL CARCINOMA
Background
Clinical Presentation
Pathogenesis
Histology
Ancillary Studies
Differential Diagnosis
Prognosis
MALIGNANT ADNEXAL TUMORS OF THE HEAD AND NECK
Introduction
Tumors of the Follicular Epithelium
Trichilemmal Carcinoma
Trichoblastic Carcinoma
Malignant Proliferating Pilar (Trichilemmal) Tumor
Sebaceous Carcinoma
Tumors of the Cutaneous Sweat Glands
Microcystic Adnexal Carcinoma
Adenoid Cystic Carcinoma
Syringoid Eccrine Carcinoma
Apocrine Carcinoma
Other Malignant Adnexal Tumors
PART B REFERENCES
Merkel Cell Carcinoma
Malignant Adnexal Tumors of the Head and Neck
INTRODUCTION
DERMATOFIBROSARCOMA PROTUBERANS
Clinical Background
Histologic Features
Ancillary Studies
Differential Diagnosis
Prognosis
ANGIOSARCOMA
Clinical Background
Histologic Findings
Ancillary Studies
Differential Diagnosis
Prognosis
ATYPICAL FIBROXANTHOMA
Clinical Background
Histologic Findings
Ancillary Studies
Differential Diagnosis
Prognosis
KAPOSI SARCOMA
Clinical Background
Histologic Features
Ancillary Studies
Differential Diagnosis
Prognosis
ATYPICAL INTRADERMAL SMOOTH MUSCLE NEOPLASM
Clinical Background
Histology and Ancillary Studies Features
Differential Diagnosis
Prognosis
Radiation-Induced Leiomyosarcoma
PART C REFERENCES
Angiosarcoma
Atypical Fibroxanthoma
Kaposi Sarcoma
Atypical Intradermal Smooth Muscle Neoplasm
CHAPTER 10:
Merkel Cell Carcinoma and Other Rare Skin Cancers
MERKEL CELL CARCINOMA
Definition
Etiology
Clinical Presentation
Diagnosis
Differential Diagnosis
Treatment
Prognosis
Staging
Survival Outcome
Epidemiology
SEBACEOUS CARCINOMA
Definition
Etiology
Clinical Presentation
Diagnosis
Differential Diagnosis
Treatment
Prognosis
Epidemiology
ECCRINE CARCINOMA
Definition
Etiology
Clinical Presentation
Diagnosis
Differential Diagnosis
Treatment
Prognosis
Epidemiology
DERMATOFIBROSARCOMA PROTUBERANS
Definition
Etiology
Clinical Presentation
Diagnosis
Differential Diagnosis
Treatment
Prognosis
Epidemiology
ATYPICAL FIBROXANTHOMA
Definition
Etiology
Clinical Presentation
Diagnosis
Differential Diagnosis
Treatment
Prognosis
Epidemiology
CUTANEOUS ANGIOSARCOMA
Definition
Etiology
Clinical Presentation
Diagnosis
Differential Diagnosis
Treatment
Prognosis
Epidemiology
KAPOSI SARCOMA
Definition
Etiology
Clinical Presentation
Diagnosis
Differential Diagnosis
Treatment
Prognosis
Epidemiology
CHAPTER 11:
Surgical Anatomy and Embryology of the Thyroid and Parathyroid Glands
INTRODUCTION
THYROID EMBRYOLOGY
PARATHYROID EMBRYOLOGY
THYROID ANATOMY
General Appearance
Arterial Blood Supply
Venous Drainage
NERVE ANATOMY
PARATHYROID ANATOMY
Location
CHAPTER 12:
Pathology of Thyroid and Parathyroid Neoplasms
THYROID PATHOLOGY
CLASSIFICATION OF THYROID PATHOLOGY
Congenital Lesions
Thyroglossal Duct Cyst
Benign Follicular Epithelial Proliferations
Follicular Nodular Disease
Follicular Adenomas
Malignant Thyroid Neoplasms of Follicular Epithelium
Well-Differentiated Carcinoma of Follicular Epithelium
Variants of Differentiated Thyroid Carcinomas
Poorly Differentiated Carcinoma of Follicular Epithelium
Anaplastic Thyroid Carcinoma
Primary Neuroendocrine Neoplasms of the Thyroid Gland
Medullary Thyroid Carcinoma
Mixed Follicular-C Cell Lesions
Intrathyroidal Paragangliomas
Intrathyroidal Parathyroid Lesions
Other Intrathyroidal Primary Neoplasms
Salivary Gland Tumors
Thymic Tumors
Squamous Cell Carcinoma
Hematolymphoid Neoplasms
Mesenchymal Neoplasms
Teratoma
Metastatic Malignancy
PARATHYROID PATHOLOGY
Classification of Parathyroid Pathology
Parathyroid Adenoma
Parathyroid Hyperplasia
Parathyroid Carcinoma
Other Lesions of Parathyroids
CHAPTER 13:
Diagnosis and Management of the Thyroid Nodule
INTRODUCTION
EVALUATION
History and Physical Examination
Laboratory Evaluation
Imaging
THYROID ULTRASOUND EVALUATION
Technique
Thyroid Nodule Ultrasonography Assessment
FINE-NEEDLE ASPIRATION BIOPSY
FNAB Cytopathology Interpretation
Nondiagnostic
Benign
Indeterminate or Suspicious for Neoplasm
Malignant
FNAB for Multinodular Goiter
MANAGEMENT
THYROID NODULE FOLLOW-UP
SPECIAL CONSIDERATIONS
RED FLAGS FOR MALIGNANCY
SUMMARY
CHAPTER 14:
Management of Well-Differentiated Thyroid Cancer
INTRODUCTION
EPIDEMIOLOGY
INVESTIGATION OF A PATIENT WITH A THYROID NODULE SUSPICIOUS FOR WELL-DIFFERENTIATED THYROID CANCER
Prognosis and Risk Stratifications
SURGICAL MANAGEMENT OF WELL-DIFFERENTIATED THYROID CANCER
ADJUVANT THERAPY FOR WELL-DIFFERENTIATED THYROID CANCER
FOLLOW-UP
Salvage of Recurrent Disease
CONCLUSION
CHAPTER 15:
Medullary Thyroid Cancer
EPIDEMIOLOGY
TUMOR BEHAVIOR AND HISTOLOGY
MOLECULAR PATHWAYS IN MTC
CLINICAL PRESENTATION
DIAGNOSTIC EVALUATION OF SPORADIC OR INDEX CASE OF MTC
Germ Line RET Testing
STAGING AND PROGNOSIS
SURGICAL MANAGEMENT OF MTC
Prophylactic Thyroidectomy
Surgery in the Setting of Locoregional Disease
Surgery in Setting of Distant Metastasis
ROLE OF RADIATION THERAPY
SYSTEMIC THERAPY FOR MTC
POSTOPERATIVE FOLLOW-UP/ LONG-TERM SURVEILLANCE
Postoperative Follow-up
Long-Term Surveillance
CHAPTER 16:
Anaplastic Thyroid Cancer
OVERVIEW
EPIDEMIOLOGY
PROGNOSTIC AND PREDICTIVE FACTORS
INVESTIGATIONS
STAGING
MANAGEMENT
Surgery
Radiation Therapy
Technical Planning and Delivery of Radiation Therapy
Chemotherapy
Clinical Outcomes
Follow-up
Management Summary Table
CONCLUSION
CHAPTER 17:
Principles and Technique of Thyroidectomy
INTRODUCTION
INDICATIONS FOR THYROID SURGERY
PREOPERATIVE EVALUATION
SURGICAL TECHNIQUE
Conventional Thyroidectomy
Minimally Invasive Nonendoscopic Thyroidectomy
Minimally Invasive Video-Assisted Thyroidectomy
Remote Access/Robotic Thyroidectomy
COMPLICATIONS OF THYROID SURGERY
LARYNGEAL NERVE MONITORING
CONCLUSION
CHAPTER 18:
Management of Advanced Thyroid Cancer
INTRODUCTION
ANATOMY AND SYMPTOMS
DIAGNOSTIC EVALUATION
Endoscopy
Cross-Sectional Anatomic Imaging
MANAGEMENT
Philosophy of Surgical Resection for Advanced Thyroid Cancer
Extent of Surgical Resection Based on Anatomic Findings
Muscles
Laryngeal Nerves
Trachea
Larynx
Pharynx
Esophagus
Other Regional Anatomy
Radiation Therapy
CONCLUSION
CHAPTER 19:
Management of Recurrent Thyroid Cancer
INTRODUCTION
IMPACT OF RECURRENT THYROID CANCER
LOCATIONS FOR RECURRENT DISEASE
DETECTION OF RECURRENT DISEASE
TREATMENT OPTIONS
NOVEL TREATMENT OPTIONS
DEFINITION OF SUCCESSFUL TREATMENT
REVISION CENTRAL NECK DISSECTION
Step 1. Division of the Strap Muscles and Exposure of the Thyroid Bed
Step 2. Dissection of the Carotid Arteries
Step 3. Identification of the Recurrent Laryngeal Nerves
Step 4. Dissection of the Parathyroid-Thymic Tissue
Step 5. Dissection of the Pretracheal and Upper Mediastinal Lymph Nodes
SUMMARY
CHAPTER 20:
Hyperthyroidism: Graves' Disease, Toxic Multinodular Goiter, and Solitary Toxic Nodule
INTRODUCTION
ETIOLOGIES
Graves' Disease
TOXIC MULTINODULAR GOITER
SOLITARY TOXIC NODULE
MANAGEMENT
Antithyroid Medical Therapy: Thionamides, Beta-blockers, and Corticosteroids
Radioactive Iodine-131 Ablation
Surgical Resection of Thyroid
CHAPTER 21:
Surgical Management of Goiter
DEFINITION OF GOITER—CERVICAL AND SUBSTERNAL
Definition of Goiter
Definition of Cervical and Substernal Goiters
ETIOLOGY OF GOITER
WORKUP OF THE BENIGN GOITER
History
Dyspnea
Dysphagia
Dysphonia
Other Symptoms
Physical Examination
Palpable Cervical Mass
Tracheal Deviation
Dilated Head and Neck Vessels
Other Clinical Findings
Laryngeal Examination
Vocal Cord Function
Tracheal Lumen
Investigations
Thyroid Function Tests and Other Laboratory Tests
Imaging Tests
Thyroid Radionucleotide Scan
Fine Needle Aspiration
Flow-Volume Loop
MEDICAL MANAGEMENT OF GOITER
Iodine Supplementation
Thyroid Hormone
Radioactive Iodine
Medical Versus Surgical Management
INDICATIONS FOR SURGERY
Symptomatic
Dyspnea
Dysphagia
Dysphonia
Tracheal Compression on CT Scan
Interval Growth on CT Scan
Suspected Malignancy
Cosmetic Deformity
SURGICAL MANAGEMENT
Preoperative Thoracic Consultation
Airway Management
Intubation
Extubation
Recurrent Laryngeal Nerve (RLN) Monitoring
Surgical Technique
Equipment and Preparation
Technique
Identification and Preservation of Parathyroid Glands
Identification and Preservation of the RLN
Delivery of Goiter
Extent of Thyroidectomy
COMPLICATIONS OF SURGERY
RLN Paralysis
Hypoparathyroidism
Hematoma
Recurrence
Tracheostomy
Other
CONCLUSION
CHAPTER 22:
Management of Primary and Secondary Hyperparathyroidism
INTRODUCTION
CALCIUM HEMOSTASIS AND PARATHYROID HORMONE REGULATION
PARATHYROID GLAND EMBRYOLOGY, ANATOMY, AND NORMAL HISTOLOGY
HYPERPARATHYROIDISM
Etiology/Pathogenesis
Incidence
Primary Versus Secondary Hyperparathyroidism
Presentation
Evaluation
Localization Studies
Noninvasive Methods
Invasive Methods
Intraoperative Adjuncts
Familial HPT and MEN
Histopathology of the Parathyroid Glands
Parathyroid Adenoma
Parathyroid Gland Hyperplasia
Parathyroid Carcinoma
SURGICAL MANAGEMENT
Indication for Exploration
Surgical Technique
Focused Surgery
Neck Exploration
Surgery for Secondary Hyperparathyroidism
Mediastinal Exploration
POSTOPERATIVE MANAGEMENT
CHAPTER 23:
Management of Recurrent Hyperparathyroidism
INTRODUCTION
CAUSES OF FAILED PRIMARY EXPLORATION
INDICATIONS FOR REOPERATION
PREOPERATIVE ASSESSMENT AND CONFIRMATION OF HYPERPARATHYROIDISM
LOCALIZATION STUDIES
NONINVASIVE PREOPERATIVE LOCALIZATION METHODS
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
SPECT/CT Fusion
INVASIVE PREOPERATIVE METHODS
Fine-Needle Aspiration Biopsy
Selective Arteriography
Selective Venous Sampling
INTRAOPERATIVE ADJUNCTS
Intraoperative Ultrasound
Methylene Blue
Radioguided Parathyroid Gland Identification
Frozen Section
Intraoperative PTH Monitoring
SURGICAL STRATEGY
RADIOGUIDED EXPLORATION
Unsuccessful Re-exploration
Postoperative Care
CHAPTER 24:
Paragangliomas of the Head and Neck
INTRODUCTION AND PHYSIOLOGY OF PARAGANGLIA
HISTOPATHOLOGY OF PARAGANGLIOMAS
NOMENCLATURE
GENETICS OF PARAGANGLIOMAS
GENERAL CONSIDERATIONS IN WORKUP OF HEAD AND NECK PARAGANGLIOMAS
History and Physical Examination
Functional Head and Neck Paragangliomas
Malignant Paragangliomas
Diagnostic Evaluation of Head and Neck Paragangliomas
Biopsy
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Digital Subtraction Angiography
Carotid Artery Occlusion Studies
Preoperative Embolization
Octreotide Scintigraphy
MIBG Scintigraphy
Miscellaneous Tests
GENERAL TREATMENT PRINCIPLES OF HEAD AND NECK PARAGANGLIOMAS
Comparing Surgery and Radiation Therapy
Conventional Fractionated Radiation Therapy
Stereotactic Radiosurgery
Surgery
Observation
Salvage Therapy
CAROTID BODY PARAGANGLIOMAS
Routes of Spread of Carotid Body Paragangliomas
Treatment of Carotid Body Paragangliomas
Management of Bilateral Carotid Body Paragangliomas
VAGAL PARAGANGLIOMAS
Routes of Spread of Vagal Paragangliomas
Treatment of Vagal Paragangliomas
JUGULOTYMPANIC PARAGANGLIOMAS
Routes of Spread
Treatment of Tympanic Paragangliomas
Treatment of Jugular Paragangliomas
MISCELLANEOUS PARAGANGLIOMA SITES
Laryngeal Paragangliomas
Thyroid Paragangliomas
Sinonasal Paragangliomas
CONCLUSION
CHAPTER 25:
Anatomy, Physiology, and Non-neoplastic Disorders of the Salivary Glands
INTRODUCTION
ANATOMY
Parotid Gland
Submandibular (Submaxillary) Gland
Sublingual Gland
Minor Salivary Glands
Salivary Gland Secretory Unit
Acinus
Secretory Duct
Collecting Duct
PHYSIOLOGY
Saliva Production
Saliva Secretion
Neural Control and Regulation
Functions of Saliva
Lubrication
Taste and Digestion
Acid Neutralization
Dentition
Antibacterial Activity
NON-NEOPLASTIC DISORDERS
Evaluation
History
Physical Examination
Imaging Studies
Laboratory Studies
Fine-Needle Aspiration Biopsy
Diagnostic Gland Biopsy
Inflammatory Disorders
Acute Sialadenitis
Viral sialadenitis
Bacterial Sialadenitis
Radiation Sialadenitis
Chronic Sialadenitis
Granulomatous Disease
Autoimmune Disorders (Sjögren's Syndrome)
HIV-associated Cystic Sialadenitis
Noninflammatory Disorders
Acute Disorders
Chronic Disorders
CONCLUSION
CHAPTER 26:
Pathology of Salivary Gland Neoplasms
INTRODUCTION AND GENERAL CONSIDERATIONS
Histology of Normal Salivary Glands
Overview of Salivary Gland Neoplasms
Histological Grading of Malignant Salivary Gland Tumors
Utilities of Diagnostic Molecular Pathology in Salivary Gland Neoplasms
BENIGN EPITHELIAL TUMORS
Pleomorphic Adenoma6
Synonyms
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Myoepithelioma7
Synonyms
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Basal Cell Adenoma
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Warthin Tumor8
Synonyms
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Oncocytoma
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Canalicular Adenoma
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Sebaceous Adenoma and Lymphadenoma
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Ductal Papillomas
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Cystadenoma
Synonyms
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
MALIGNANT EPITHELIAL TUMORS
Acinic Cell Carcinoma3,4,9
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis and Prognostic Factors
Mucoepidermoid Carcinoma3,10–15
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis and Prognostic Factors
Adenoid Cystic Carcinoma3,4,16,17
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis and Prognostic Factors
Polymorphous Low-Grade Adenocarcinoma4,7,18
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis and Prognostic Factors
Epithelial-Myoepithelial Carcinoma4,19
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis and Prognostic Factors
Hyalinizing Clear Cell Carcinoma20,21
Synonyms
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Basal Cell Adenocarcinoma22
Synonyms
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Malignant Sebaceous Tumors: Sebaceous Carcinoma and Sebaceous Lymphadenocarcinoma
Cystadenocarcinoma
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Low-Grade Cribriform Cystadenocarcinoma23
Synonyms
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis and Prognostic Factors
Mucinous Adenocarcinoma
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Oncocytic Carcinoma24,25
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Salivary Duct Carcinoma7,26
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Adenocarcinoma, Not Otherwise Specified
Myoepithelial Carcinoma7,27
Synonym
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Carcinoma ex Pleomorphic Adenoma7,28–30
Synonyms
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Carcinosarcoma
Metastasizing Pleomorphic Adenoma
Squamous Cell Carcinoma
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Small Cell Carcinoma31,32
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Large Cell Carcinoma
Synonym
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Lymphoepithelial Carcinoma
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
Sialoblastoma
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis and Prognostic Factors
Mammary Analog Secretory Carcinoma33–35
Definition
Clinical and Epidemiological Features
Pathological Findings
Prognosis
CHAPTER 27:
Salivary Gland Neoplasms
INTRODUCTION
INCIDENCE
ETIOLOGY
HISTOLOGIC CLASSIFICATION
BENIGN TUMORS
Pleomorphic Adenoma
Warthin's Tumor (Papillary Cystadenoma Lymphomatosum, Adenolymphoma)
Oncocytoma
Monomorphic Adenomas
MALIGNANT TUMORS
Mucoepidermoid Carcinoma
Adenoid Cystic Carcinoma
Adenocarcinoma, Not Otherwise Specified
Salivary Duct Carcinoma
Carcinoma Ex Pleomorphic Adenoma
Acinic Cell Carcinoma
Grading of Malignant Salivary Gland Neoplasms
CLINICAL PRESENTATION AND EVALUATION
History
Physical Findings
Diagnostic Imaging
Fine-Needle Aspiration Cytology
Staging
Molecular Alterations in Salivary Malignancy
OVERVIEW OF PAROTID AND SUBMANDIBULAR GLAND SURGERY AND COMPLICATIONS
Complications of Parotidectomy
Complications of Submandibular Gland Resection
Treatment: Surgery
Benign Lesions
Recurrent Benign Lesions
Malignant Lesions: Parotid Gland
Malignant Lesions: Submandibular Gland
Malignant Lesions: Minor Salivary Glands
Malignant Lesions: Neck Dissection
Malignant Lesions: Intraoperative Frozen Section Analysis
Malignant Lesions: Results of Surgical Treatment
Treatment: Radiation Therapy
Treatment: Chemotherapy
PROGNOSTIC FACTORS
CHAPTER 28:
Tumors of the Parapharyngeal Space
INTRODUCTION
ANATOMY
Anterior
Posterior
Medial
Lateral
Inferior
CONTENTS
Prestyloid
Poststyloid
PRESENTATION AND EVALUATION
PATHOLOGY
SALIVARY GLAND NEOPLASMS
NEUROGENIC TUMORS
OTHER PATHOLOGIES
PREOPERATIVE PREPARATION
SURGICAL APPROACHES
COMPLICATIONS
CHAPTER 29:
Soft Tissue Sarcomas of the Head and Neck
INTRODUCTION
ETIOLOGY
PRESENTATION
EVALUATION
Initial Assessment
Imaging Local Disease
Evaluation of Metastasis
PATHOLOGY AND GRADING
Classification
Grading of STS
Staging Classifications
Overview of Treatment and Prognosis of STS
Surgery for STS
Radiotherapy
Adjuvant Chemotherapy
MANAGEMENT OF METASTATIC DISEASE
DIAGNOSIS AND MANAGEMENT OF SPECIFIC STS
Angiosarcoma
Rhabdomyosarcoma
Dermatofibrosarcoma Protuberans
Synovial Sarcoma
Liposarcoma
Malignant Fibrous Histiocytoma
Aggressive Fibromatosis
Hemangiopericytoma
Kaposi's Sarcoma
KEY POINTS
CHAPTER 30:
Bone Sarcomas of the Head and Neck
INTRODUCTION
ETIOLOGY
PRESENTATION
EVALUATION
Imaging
PATHOLOGY AND GRADING
Classification
Grading Bone Sarcomas
Staging Classifications
OVERVIEW OF TREATMENT AND PROGNOSIS OF BONE SARCOMA
Osteosarcoma
Treatment
Chemotherapy
Chondrosarcoma
Treatment
Chondrosarcoma of the Larynx
Skull Base Chondrosarcomas
Ewing's Sarcoma
Metastatic Disease
CHAPTER 31:
Overview of Head and Neck Lymphomas
INTRODUCTION
CLASSIFICATION
CLINICAL FEATURES
General
NHL
HL
Transformed Disease
Nodal Head and Neck Presentation
Extranodal Head and Neck Presentation
RISK FACTORS
Infection
Autoimmune Disease
Immunosuppression
DIAGNOSIS
WORKUP
Staging
Other Investigations
THERAPY
Treatment Principles
Chemotherapy
Radiotherapy
Surgery
SPECIFIC HEAD AND NECK SITES
PRIMARY EXTRANODAL LYMPHOMAS
Waldeyer's Ring
Parotid
Thyroid
Extranodal Nasal-Type Natural Killer/T-Cell Lymphoma (ENKTL)
Laryngeal
Ocular Adnexa
Sinonasal
OTHER HEMATOLOGICAL NEOPLASMS
Plasmacytomas
Myeloid Sarcomas
POST-THERAPY MONITORING
Monitoring for Relapse
Long-Term Side Effect of Therapy
SUMMARY
ACKNOWLEDGMENTS
CHAPTER 32:
Nasal Cavity and Paranasal Sinus Malignancies
INTRODUCTION
EPIDEMIOLOGY
RISK FACTORS
RELEVANT ANATOMY (FIGS. 32.1 A TO C)
CLASSIFICATION OF DIFFERENT MALIGNANCIES
Squamous Cell Carcinoma
Adenoid Cystic Carcinoma
Adenocarcinoma
Olfactory Neuroblastoma (Esthesioneuroblastoma)
Sinonasal Undifferentiated Carcinoma
Mucosal Melanoma
Sarcomas
Metastatic Tumors
DIAGNOSIS
STAGING
SURGERY
Open Approaches Versus Endoscopic Approaches
OPEN APPROACHES (FIGS. 32.6A TO E)
Bicoronal
Lateral Rhinotomy
Weber-Ferguson Approach
Midfacial Degloving
Palatal
Infratemporal Fossa Approaches
TYPES OF RESECTION
Medial Maxillectomy (Fig. 32.7A)
Infrastructure Maxillectomy (Fig. 32.7B)
Total Maxillectomy (Fig. 32.7C)
Orbital Exenteration (Fig. 32.7D)
Craniofacial Resection (Fig. 32.7E)
ENDOSCOPIC APPROACHES
Endoscopic Anterior Craniofacial Resection (See Figs. 32.10A to F)
Endoscopic Lateral Approaches
NECK DISEASE
RECONSTRUCTION
Maxillary Reconstruction (See Figs. 32.8A to G and 32.9A to F)
Skull Base Reconstruction (See Figs. 32.10A to F)
SURGICAL COMPLICATIONS
RADIOTHERAPY
CHEMOTHERAPY
ONCOLOGIC OUTCOMES AND PROGNOSIS
QUALITY OF LIFE
FOLLOW-UP SURVEILLANCE
CHAPTER 33:
Benign and Premalignant Oral Lesions
INTRODUCTION
WHITE LESIONS
Developmental White Lesions
Hyperkeratotic Lesions
Candidiasis
ULCERATIVE LESIONS
Primary Solitary Acute Ulcers
Primary Solitary Chronic Ulcers
Solitary Chronic Ulcers of Infectious Origin
Primary Multiple Acute Ulcers
Infectious Oral Ulcers
Erythema Multiforme
Multiple Acute Recurrent Ulcers
Recurrent Aphthous Stomatitis
Recurrent HSV Ulcers
Multiple Recurrent Chronic Ulcers
RED, BLUE, AND PIGMENTED LESIONS
PAPILLARY/VERRUCOID LESIONS
Human Papilloma Virus-Induced Benign Oral Lesions
SUBMUCOSAL NODULES AND MASSES
ORAL PREMALIGNANT LESIONS
Oral Lichen Planus
Smokeless Tobacco Keratosis (Snuff Dippers Pouch)
Oral Submucous Fibrosis
Leukoplakia and Erythroplakia
Management of OPLs
SUMMARY
CHAPTER 34:
Lesions of the Jaw/Dental-Related Lesions
INTRODUCTION
EMBRYOLOGY AND ANATOMY OF THE TOOTH, GUMS, AND ALVEOLAR PROCESS
GENERAL GUIDELINES IN DIAGNOSIS AND MANAGEMENT
BENIGN
Odontogenic Cysts
Dentigerous Cyst (Synonym: Follicular Cyst)
Eruption Cyst
Periapical Cyst (Synonyms: Apical Periapical Cyst, Radicular Cyst)
Paradental Cyst
Botryoid Odontogenic Cyst
Glandular Odontogenic Cyst (Synonym: Sialo-Odontogenic Cyst)
Gingival Cyst of the Adult
Benign Fibro-Osseous Lesions
Odontogenic Tumors
Calcifying Epithelial Odontogenic Tumor (CEOT)
Adenomatoid Odontogenic Tumor (AOT)
Squamous Odontogenic Tumor (SOT)
Odontoma
Ameloblastic Fibroma (AF) and Ameloblastic Fibro-Odontoma (AFO)
Calcifying Odontogenic Cyst (Synonym: Gorlin Cyst)
Osseous Tumors
Osteoblastoma/Osteoid Osteoma/Cementoblastoma
Cementoblastoma (Synonym: True Cementoma)
Osteoma
Other
Aneurysmal Bone Cyst (ABC)
Simple Bone Cyst (SBC) (Synonyms: Traumatic Bone Cyst, Solitary Bone Cyst, Hemorrhagic Bone Cyst, and Idiopathic Bone Cavity)
Stafne Bone Cavity (Synonyms: Stafne's Bone Defect, Static Bone Cyst)
BENIGN LESIONS WITH AGGRESSIVE POTENTIAL
Central Giant Cell Granuloma (Synonym: Giant Cell Reparative Granuloma)
Ossifying Fibroma (Synonyms: Central Ossifying Fibroma, Cemento-Ossifying Fibroma)
Familial Gigantiform Cementoma
Juvenile Ossifying Fibroma (Synonym: Juvenile Active Ossifying Fibroma)
Ameloblastoma
Odontogenic Myxoma
Keratocystic Odontogenic Tumor (Synonyms: Odontogenic Keratocyst)
Gorham's Disease (Synonyms: Gorham Vanishing Bone Disease, Hemangiomata with Osteolysis, Massive Osteolysis, Osteolysis and Angiomatous Nevi, Phantom Bone Disease, Breschet-Gorham-Stout Syndrome, Cystic Angiomatosis of Bone)
MALIGNANT LESIONS
Malignant Ameloblastoma (Synonyms: Metastasizing Ameloblastoma, Atypical Ameloblastoma)
Ameloblastic Carcinoma
Clear-Cell Odontogenic Carcinoma
Ameloblastic Fibrosarcoma
Central Mucoepidermoid Carcinoma
Primary Intraosseous Carcinoma (Synonym: Primary Intraosseous Squamous Cell Carcinoma)
CHAPTER 35:
Oral Cavity Cancer
INTRODUCTION
ANATOMY OF THE ORAL CAVITY
EPIDEMIOLOGY
ETIOLOGY
Tobacco and Alcohol
Alcohol
Other Factors
PATHOLOGY
Epithelial Tumors
Benign
Premalignant
Malignant
Nonepithelial Tumors
Salivary Gland Tumors
Soft Tissue Tumors
Lymphoma
Mucosal Malignant Melanoma
Bone Tumors
Secondary Metastases
ORAL CARCINOGENESIS
Diagnosis
History
Physical Examination
Investigations
Staging
Treatment
General Principles
Surgical Management
Radiotherapy and Chemotherapy
Treatment of Premalignant Lesions and Chemoprevention of Oral Cancer
Chemoprevention
Results of Treatment
Complications of Treatment
POST-TREATMENT CONSIDERATIONS
Rehabilitation
Follow-up
CONCLUSION
CHAPTER 36:
Nasopharyngeal Carcinoma
ANATOMY
EPIDEMIOLOGY
RISK/PREDISPOSING FACTORS
Salt-Preserved Fish
Epstein-Barr Virus (EBV)
Genetic Factor
PATHOLOGIES
HISTOLOGIC FEATURES
DIAGNOSIS
Symptoms and Signs
CLINICAL
SEROLOGY/SERUM DNA
CYTOLOGY
IMAGING
STAGING
TREATMENT OF NASOPHARYNGEAL CARCINOMA
RADIOTHERAPY
Techniques
Intensity-Modulated Radiotherapy
Combined Chemoradiotherapy
SALVAGE OF RESIDUAL OR RECURRENT TUMOR
Incidence and Diagnosis
TREATMENT OF RESIDUAL OR RECURRENT DISEASE
Metastatic Cervical Lymph Node
Localized Disease in the Nasopharynx
RADIOTHERAPY
External Beam Reirradiation
Stereotactic Radiosurgery
Brachytherapy
SALVAGE SURGERY
Endoscopic Resection
Maxillary Swing Nasopharyngectomy
CHAPTER 37:
Oropharyngeal Cancer
INTRODUCTION
ANATOMY
Boundaries
Innervation
Vasculature
Lymphatics
EPIDEMIOLOGY AND RISK FACTORS
PATHOLOGY
Non-HPV-Related Squamous Cell Carcinoma
HPV-Related OPSCC
Minor Salivary Gland
DIAGNOSIS
History
Physical Examination
Diagnostic Imaging
Staging Endoscopy and Biopsy
Laboratory Diagnosis of HPV-Related Tumors
TREATMENT
Surgical Approaches
Transoral Surgery
Lateral and Suprahyoid Pharyngotomy
Mandibulotomy
Transoral Robotic Surgery
TRANSORAL LASER MICROSURGERY
Radiation Therapy
Chemotherapy
Induction
Concurrent Chemoradiation
Adjuvant Chemotherapy
Management of the Neck
BIOMARKERS AND RISK STRATIFICATION
SUMMARY
CHAPTER 38:
Current Concepts in Transoral Approaches to Cancers of the Oropharynx and Oral Cavity
INTRODUCTION
HISTORY OF TRANSORAL SURGERY
TRANSORAL SURGERY BASIC PRINCIPLES AND TECHNIQUES
Access
Margin Control
Transoral Anatomy
TOS for Lateral Oropharyngectomy
TOS for Base of Tongue Resection
TOS for Oral Cavity
Management of the Unknown Primary
Neck Dissection
Cost
FUNCTIONAL OUTCOMES FOLLOWING TOS
COMPLICATIONS OF TOS
ONCOLOGIC OUTCOMES
Oropharynx
Oral Cavity
Unknown Primary
TOS as a Salvage Treatment
CONCLUSION
CHAPTER 39:
Early Larynx Cancer
ANATOMY
EPIDEMIOLOGY
PATHOLOGY
WORKUP AND STAGING
TREATMENT GUIDELINES
Glottic
Supraglottic
Endoscopic Partial Laryngectomy
Surgical Technique
Transoral Robotic Surgery
Open Partial Laryngeal Surgery
Vertical Partial Laryngectomy
Supraglottic Partial Laryngectomy
Supracricoid Partial Laryngectomy
Salvage Surgery for Early Glottic Cancer
CONCLUSION
CHAPTER 40:
Advanced Laryngeal Cancer
INTRODUCTION
EPIDEMIOLOGY
RISK FACTORS
ANATOMY
STAGING
ASSESSMENT
History and Physical Examination
Imaging Studies
Operative Endoscopy and Biopsy
Histopathology
Additional Evaluation
TREATMENT
Radiotherapy
Chemotherapy
Complications of Nonsurgical Treatments
Optimizing Outcomes-Radiation Versus Surgical Treatments
Surgical Treatment
Transoral Laser Microsurgery (TLM)
Vertical Hemilaryngectomy
Supraglottic Laryngectomy
Supracricoid Laryngectomy
Total Laryngectomy
Management of the Neck
Complications of Surgical Treatment
Post-treatment Surveillance
CHAPTER 41:
Tracheal Stenosis and Tracheal Neoplasms
INTRODUCTION
ANATOMY OF THE TRACHEA
TRACHEAL STENOSIS
Historical Perspective
Etiologies
Evaluation
History
Physical Examination
Pulmonary Function Testing
Imaging
Direct Laryngoscopy and Bronchoscopy
Management
Anesthetic Considerations
Endoscopic Procedures
Open Procedures
Cricotracheal Resection
Tracheal Resection
Complications
Future Directions
Conclusion
TRACHEAL NEOPLASMS
Introduction
Classification
Primary
Squamous Cell Carcinoma
Adenoid Cystic Carcinoma
Other Malignant Neoplasms
Secondary
Evaluation
History
Physical Examination
Imaging
Endoscopic Examination
Staging
Treatment
CONCLUSION
CHAPTER 42:
Hypopharynx Cancer
INTRODUCTION
SURGICAL ANATOMY
Pyriform Sinus
Posterior Pharyngeal Wall
Postcricoid Space
Neurovascular Supply
Lymphatic Network
EPIDEMIOLOGY
ETIOLOGY
Tobacco and Alcohol
Human Papilloma Virus, Plummer-Vinson Syndrome, and Other Factors
PATHOLOGY AND STAGING
Macroscopic Pathology
Microscopic Pathology
Molecular Pathology
Pathology of Nodal Metastases
Pathology of Distant Metastases
Synchronous and Metachronous Lesions
Staging, Classification, and Prognosis
PATIENT EVALUATION
Presenting Symptoms
Clinical Evaluation
Panendoscopy and Biopsy
Imaging
TREATMENT APPROACH
PRIMARY SURGERY
Radical Open Surgery
Open Partial Laryngectomy and Pharyngectomy
Transoral Surgery
RADIATION THERAPY
CHEMORADIATION
Induction Chemotherapy
Concurrent Chemoradiation
SUMMARY
CHAPTER 43:
Cervical Esophageal Cancer
DEFINITION AND ANATOMY OF THE CERVICAL ESOPHAGUS
INCIDENCE, EPIDEMIOLOGY, AND HISTOLOGY OF CERVICAL ESOPHAGEAL CANCER
SYMPTOMS
DIAGNOSTIC AND STAGING INVESTIGATIONS
Esophagogastroscopy
Bronchoscopy
Barium Swallow
EUS
CT
PET-CT
MRI
Approach to Diagnosis and Staging
TNM Staging
Blood Analysis
Functional Assessment
TREATMENT
Curative Intent
Primary Surgery
Salvage Surgery for Persistent or Recurrent Disease
Induction Therapy Followed by Surgery
Surgery: Resection and Reconstructive Techniques
Nonsurgical Therapy
Palliation
Brachytherapy for Palliation
Endoscopic Dilation
Stenting
Laser
Photodynamic Therapy
Combined Modalities
Complications
Tracheoesophageal Fistula
Complications After Chemotherapy
Complications After Surgery
Complications After Radiotherapy
Complications After Stents
Oncological Outcome
Functional Outcome
CONCLUSION
CHAPTER 44:
Voice Rehabilitation after Laryngectomy
INTRODUCTION
FUNCTIONAL CHANGES AFTER TOTAL LARYNGECTOMY
HISTORY OF VOICE RESTORATION AFTER TOTAL LARYNGECTOMY
CURRENT OPTIONS FOR ALARYNGEAL VOICE RESTORATION
Electrolarynx
Esophageal Speech
Tracheoesophageal Puncture
EVALUATION FOR TEP
Insufflation
Videofluoroscopy
CHARACTERISTICS OF TE SPEECH
BASIC STEPS OF REHABILITATION AFTER TEP
TE SPEECH FAILURE
Voice Prosthesis as Source of TE Speech Failure
Vibratory Segment as Source of TE Speech Failure
Tracheostoma as Source of TE Speech Failure
TEP COMPLICATIONS
Complications: Early Leakage Through the Voice Prosthesis
Complications: Leakage Around the Voice Prosthesis
CONCLUSION
CHAPTER 45:
Neck Dissection
INTRODUCTION
HISTORICAL PERSPECTIVE
CLASSIFICATION
TYPES OF NECK DISSECTION
SURGICAL STEPS
Radical Neck Dissection
Position
Incision
Flap Elevation
Dissection
Modified Radical Neck Dissection
Selective Neck Dissection (SND) for Oral Cavity Tumors
Technique
SND for Oropharyngeal, Laryngeal, and Hypopharyngeal Cancers
Technique
Central Compartment Dissection
Technique
Posterolateral Neck Dissection
Technique
COMPLICATIONS OF NECK DISSECTION
Intraoperative Complications
Injury to Carotid Artery
Injury to IJV
Nerve Injury
Chyle Leak
Bradycardia
Postoperative Complications
Bleeding
Chylous Fistula
Edema
Blindness
Seroma
Wound Dehiscence and Infection
FUTURE DIRECTIONS
CHAPTER 46:
Unknown Primary Carcinoma
APPROACH TO THE ADULT WITH A NECK MASS
FINE-NEEDLE ASPIRATION
OPEN BIOPSY
MANAGEMENT OF THE MALIGNANT NECK MASS
PET/CT
Endoscopy
Staging and Prognosis
TREATMENT GUIDELINES
Primary Surgery
Primary Radiation
Chemotherapy
CONCLUSION
CHAPTER 47:
Deep Neck Space Infections
PREDISPOSING FACTORS
Upper Aerodigestive Tract Infections
Dental and Periodontal Disease
Sialolithiasis and Sialadenitis
Diabetes Mellitus
Age
Immunocompromise
Intravenous Drug Use
Congenital Anatomic Abnormalities
OTHER FACTORS
Microbiology
PERTINENT ANATOMY
Fascial Divisions of the Neck
Deep Cervical Fascia
Anatomical Classification
Parapharyngeal Space
Submandibular Space
Sublingual Space
Peritonsillar Space
Danger Space
Retropharyngeal Space
Prevertebral Space
Masticator Space
Parotid Space
Carotid Space
Pretracheal Space
CLINICAL PRESENTATION
Peritonsillar Abscess
Parapharyngeal Abscess
Retropharyngeal Abscess
Sublingual and Submandibular Space Abscess
Parotid Space Abscess
INITIAL ASSESSMENT AND AIRWAY MANAGEMENT
Airway Assessment and Role of Flexible Fiberoptic Laryngoscopy
Airway Management Strategies
Tracheostomy
CLINICAL EVALUATION
Physical Examination
Laboratory Studies
Head and Neck Malignancy
IMAGING STUDIES
Ultrasound
Plain Film X-Ray
Computerized Tomography
Magnetic Resonance Imaging
MEDICAL MANAGEMENT
Medical Management without Surgical Intervention
Fluid Resuscitation
Analgesics
Corticosteroids
Empiric Antimicrobial Therapy
Targeted Antimicrobial Therapy
Antimicrobial Oral Rinses
SURGICAL MANAGEMENT
Indications for Surgical Intervention
Needle Aspiration
Goals of Surgery
Transoral Drainage
Transcervical Drainage
Quinsy Tonsillectomy
Concurrent Versus Delayed Dental Extraction
COMPLICATIONS
Airway Compromise
Mediastinitis
Necrotizing Fasciitis
Lemierre's Syndrome
Complications Involving the Carotid Artery
CHAPTER 48:
Complications of Head and Neck Surgery
INTRODUCTION
SALIVARY GLAND SURGERY
Parotidectomy
Early Surgical Complications
Late Surgical Complications
Medical Complications
Submandibular Gland
Early Surgical Complications
Late Surgical Complications
Medical Complications
Sublingual Gland and Ranula
Early Surgical Complications
Late Surgical Complications
Medical Complications
LARYNGECTOMY
Early Surgical Complications
Vascular and Lymphatic
Dysphagia, Aspiration, and Dysphonia
Late Surgical Complications
Pharyngocutaneous Fistula
Stenosis
Medical Complications
Infection
Endocrine
Cardiac and Respiratory
NECK SURGERY
Early Surgical Complications
Nerve Injury
Vascular
Late Surgical Complications
Chylous Fistula
Flap Necrosis
Edema
Neuroma
Medical Complications
COMPLICATIONS AND MANAGEMENT OF THE HOSTILE WOUND
Radiation
Infection
Steroids
Medical Conditions
CONCLUSION
CHAPTER 49:
Salvage Surgery for Recurrent Head and Neck Cancer
INTRODUCTION
SURVEILLANCE
MANAGEMENT
LARYNGEAL RECURRENCE
ORAL CAVITY RECURRENCE
OROPHARYNGEAL RECURRENCE
HYPOPHARYNGEAL RECURRENCE
REGIONAL RECURRENCE
CONCLUSION
CHAPTER 50:
Perioperative Assessment in Elderly Patients Undergoing Head and Neck Surgery
INTRODUCTION
PREOPERATIVE ASSESSMENT
COUNSELLING AND DECISION-MAKING CAPACITY
COGNITIVE IMPAIRMENT, DEMENTIA, AND POSTOPERATIVE DELIRIUM
PSYCHIATRIC RISK ASSESSMENT
FRAILTY AND FUNCTIONAL STATUS
CARDIOVASCULAR RISK ASSESSMENT
PULMONARY RISK ASSESSMENT
MEDICAL MANAGEMENT AND MEDICATION
PREOPERATIVE TESTING
HIGHLIGHTS
CHAPTER 51:
Overview of Regional Flaps in Head and Neck Cancer
INTRODUCTION
REGIONAL FLAPS
RECONSTRUCTIVE DECISION MAKING
FASCIOCUTANEOUS AND OTHER THIN FLAPS
Melolabial
Paramedian Forehead and Pericranial
Platysma
Sternocleidomastoid
Submental Island
Supraclavicular
Temporoparietal and Temporalis
MUCOSAL
Buccinator Myomucosal
Facial Artery Myomucosal
Nasoseptal
THICK FLAPS
Pectoralis Major
Deltopectoral
Latissimus Dorsi
Trapezius
CONCLUSION
CHAPTER 52:
Overview of Free Flaps Used in Head and Neck Reconstruction
INTRODUCTION
HISTORY
FASCIAL AND FASCIOCUTANEOUS FREE FLAPS
TEMPOROPARIETAL FASCIAL FREE FLAP
RADIAL FOREARM FREE FLAP
LATERAL ARM FREE FLAP
ANTEROLATERAL THIGH FREE FLAP
MUSCULOCUTANEOUS FREE FLAPS
LATISSIMUS DORSI FREE FLAP
RECTUS ABDOMINUS FREE FLAP
SERRATUS FREE FLAP
OSSEOUS AND OSTEOCUTANEOUS FLAP
Overview
Osteocutaneous Radial Forearm Flap (OCRFF)
FIBULA OSSEOUS AND OSTEOCUTANEOUS FLAP (FFF)
Subscapular System Osseous Flaps
Serratus-Rib Flap
Scapular Osteocutaneous (or Osteomuscular) Flap
Iliac Crest Osteocutaneous Flap
MONITORING
ANTICOAGULATION
SUMMARY
CHAPTER 53:
Functional Oropharyngeal Reconstruction: An Evidence-Based Approach
INTRODUCTION
ANATOMY
PHYSIOLOGY AND PATHOPHYSIOLOGY
Breathing
Swallowing
Speech Production
DEFECT CLASSIFICATION
PRINCIPLES OF FUNCTIONAL RECONSTRUCTION
SURGICAL APPROACHES AND THEIR RECONSTRUCTIVE IMPLICATIONS
Transoral Approach
Transoral Transcervical Approach (Mandibular Lingual Release)
Transpharyngeal Approaches
Suprahyoid Pharyngotomy
Lateral Pharyngotomy
Transmandibular Approaches
Lip-Splitting Mandibulotomy
Midline Labioglossal Mandibulotomy
Mandibulectomy or Composite Resection
RECONSTRUCTIVE TECHNIQUES AND OUTCOMES
Reconstruction of the Soft Palate
Defects Less Than Quarter of the Soft Palate (SP1)
Defects Greater Than Quarter But Less Than Half of the Soft Palate (SP2)
Functional Outcomes of SP2 Reconstructions
Defects Equal to or Greater Than Half of the Soft Palate (SP3)
Functional Outcomes of SP3 Reconstructions
Prosthetic Soft Palate Rehabilitation
Reconstruction of the Pharyngeal Walls
Reconstruction of the Base of the Tongue
Defects Less Than a Quarter of the Volume of the Base of Tongue (BOT1)
Defects Greater Than a Quarter of the Volume of the Base of Tongue (BOT2, BOT3)
Surgical Technique for BOT2 and BOT3
Functional Outcomes for BOT2 and BOT3
Reconstruction of Defects that Involve Multiple Sites
Mandibular Reconstruction
Nerve Reconstruction and Neurotization
SALIVARY PRESERVATION
FUNCTIONAL ASSESSMENT
COMPLICATIONS
CONCLUSION
CHAPTER 54:
Reconstruction of the Oral Cavity
INTRODUCTION
GENERAL CONSIDERATIONS
MANDIBULAR RECONSTRUCTION
Fibular Flap
Deep Circumflex Iliac Artery (DCIA) Flap
Scapular Flap
Osteocutaneous Radial Forearm Flap
MAXILLARY RECONSTRUCTION
Fibular Free Flap
Deep Circumflex Iliac Artery (DCIA) Flap
Scapular Flap
Radial Forearm Flap/Osteocutaneous Flap
Plating/Graft Fixation
Computer-Generated Virtual Planning and Modeling
Prosthetic/Dental Rehabilitation
OSTEONECROSIS
TONGUE RECONSTRUCTION
Local Flap Reconstruction
Radial Forearm Flap
Anterior Lateral Thigh (ALT) Flap
CHEEK/BUCCAL MUCOSA RECONSTRUCTION
Local Flap Reconstruction
Radial Forearm Flap
Anterior Lateral Thigh (ALT) Flap
Osteocutaneous Flap Reconstruction
Microvascular Surgery
Diagnostic/Monitoring
FUTURE DIRECTIONS
Tissue Engineering
Transplantation
CONCLUSION
CHAPTER 55:
Reconstruction of the Hypopharynx and Larynx
HYPOPHARYNX
Goals of Reconstruction and Preoperative Considerations
After Laryngectomy or Laryngopharyngectomy
Primary Closure
Regional Flap
Fasciocutaneous Free Flap
Enteric Free Flaps
Operative Technique and Perioperative Considerations
Management of Complications
Pharyngectomy with Larynx Preservation
Open Partial Pharyngectomy
Transoral Robotic Hypopharyngectomy
LARYNX
CHAPTER 56:
Reconstruction of Maxilla and Skull Base Defects
INTRODUCTION
SKULL BASE: BASIC CONCEPTS
CLASSIFICATION OF SKULL BASE DEFECTS
Anterior Defects: Foveocranial
Foveocranial Reconstructive Option: Nasoseptal Flap
Foveocranial Surgical Decision Making: Nasoseptal Flap
Foveocranial Reconstructive Option: Pericranial Flap
Foveocranial Surgical Decision Making: Pericranial Flap
Foveocranial Reconstructive Option: Transpterygoid Temporoparietal Fascia Flap
Foveocranial Surgical Decision Making: Transpterygoid Temporoparietal Fascia Flap
Anterior Defects: Frontocranial
Frontocranial Reconstructive Option: Pericranial Flap with Bone Graft
Frontocranial Surgical Decision Making: Pericranial Flap with Bone Graft
Frontocranial Reconstructive Option: Soft Tissue Transfer—Radial Forearm, Anterolateral Thigh, Rectus Abdominis, Latissimus Dorsi
Frontocranial Surgical Decision Making: Soft Tissue Transfer-Radial Forearm, Anterolateral Thigh, Rectus Abdominis, Latissimus Dorsi
Frontocranial Reconstructive Option: Osseocutaneous Autogenous Transplant
Frontocranial Surgical Decision Making: Osseocutaneous Autogenous Transplant
Anterior Defects: Orbitocranial
Orbitocranial Reconstructive Option: Prosthesis for Orbitocranial Defect Types I, II, and III with Orbital Exenteration
Orbitocranial Surgical Decision Making: Prosthesis for Orbitocranial Defect Types I, II, and III with Orbital Exenteration
Orbitocranial Reconstructive Option and Surgical Decision Making: Fasciocutaneous Radial Forearm and Perforator Based Fasciocutaneous Autogenous Transplant for Type I Orbital Defects
Orbitocranial Reconstructive Option and Surgical Decision Making: Perforator-Based Fasciocutaneous Autogenous Transplant for Types II and III Orbital Defects with Orbital Exenteration
Orbitocranial Reconstructive Option and Surgical Decision Making: Osseocutaneous Radial Forearm for Type II Orbital Defects with Orbital Exenteration
Orbitocranial Reconstructive Option and Surgical Decision Making: Osseocutaneous Thoracodorsal Artery Scapular Tip Artery (TDAST) for Types II and III Orbital Defects with or without Orbital Exenteration
Anterior Defects: Orbitomaxillocranial
Orbitomaxillocranial Reconstructive Option and Surgical Decision Making: Prosthesis
Orbitomaxillocranial Reconstructive Option and Surgical Decision Making: Soft Tissue Autogenous Transplant-Rectus Abdominis, ALT, Latissimus Dorsi
Orbitomaxillocranial Reconstructive Option and Surgical Decision Making: Thoracodorsal Artery Scapular Tip (TDAST)
Lateral Skull Base
Lateral Skull Base Reconstructive Option and Surgical Decision Making: Skin Grafts
Lateral Skull Base Reconstructive Option and Surgical Decision Making: Cervicofacial Rotational Flap
Lateral Skull Base Reconstructive Option and Surgical Decision Making: Pedicled Flaps-Latissimus Dorsi, Trapezius, Pectoralis
Lateral Skull Base Reconstructive Option and Surgical Decision Making: Autogenous Transplant
Adjunctive Materials
RECONSTRUCTION OF THE MAXILLA: BASIC CONCEPTS
CLASSIFICATION OF MAXILLARY DEFECTS
Class I
Class IIA
Class IIA Maxilla Defect Option and Surgical Decision Making: Palatal Island Rotation Flap
Class IIA Maxilla Defect Option and Surgical Decision Making: Forearm Flap for Central Palate
Class IIB
Class IIB Maxilla Defect Option and Surgical Decision Making: Horizontal Myo-osseous DCIA
Class IIB Maxilla Defect Option and Surgical Decision Making: The Osseocutaneous Free Fibular Transfer
Class IIB Maxilla Defect Option and Surgical Decision Making: Osseocutaneous Thoracodorsal Artery Scapular Tip Artery (TDAST)
Class IIC
Class IID
Class IIIB, Class IIIC, Class IIID
Class IIIB, C, D Maxilla Defect Option and Surgical Decision Making: Vertically Positioned DCIA with Internal Oblique
Class IIIB, C, D Maxilla Defect Option and Surgical Decision Making: Osseocutaneous Fibular Flap
Class IIIB, C, D Maxilla Defect Option and Surgical Decision Making: Osseocutaneous Thoracodorsal Artery Scapular Tip Artery (TDAST)
CONCLUSION
CHAPTER 57:
Reconstruction of Parotidectomy Defects and Facial Nerve Paralysis
INTRODUCTION
CONTOUR DEFORMITIES
Limited Parotidectomy
Fat Grafting and Dermal Fat Grafting
Alloplastic Material
SMAS Flap
Sternocleidomastoid Muscle Rotation Flap
Contour Restoration and FS
Personal Approach
Total, Radical, and Extended Parotidectomy Defects
Pedicled Regional Flaps
Free Tissue Transfer
Anterolateral Thigh Free Flap
Scapular Free Flap
Lateral Arm Free Flap
Radial Forearm Free Flap
Personal Approach
Defects Involving Extensive External Skin Removal
Personal Approach
Summary
FACIAL NERVE
Potential for Facial Nerve Recovery
Direct Facial Nerve Repair Techniques
Distal Facial Nerve Powered by Another Motor Nerve
Irreversible Facial Paralysis
Procedures to Address the Eye
Procedures to Address the Midface and Smile
Summary—Facial Nerve
VIDEO LEGENDS
CHAPTER 58:
Reconstruction of the Scalp
INTRODUCTION
ANATOMY
DEFECT CLASSIFICATION
Partial-Thickness Soft Tissue Defects
Full-Thickness Soft Tissue Defects
Calvarial Defects
Transcranial Defects
RECONSTRUCTIVE OPTIONS
Split-Thickness and Full-Thickness Skin Grafts
Tissue Expansion
Local Flaps (Scalping, Orticochea, Pericranial)
Regional Flaps (Trapezius Pedicled Myocutaneous Flap, Latissimus Pedicled Flap)
Free Tissue Transfer
RECONSTRUCTIVE ALGORITHM FOR COMPLEX DEFECT RECONSTRUCTION
SUMMARY
CHAPTER 59:
Facial Transplantation
KEY POINTS
LIMITATIONS OF CONVENTIONAL RECONSTRUCTION
THE IMPORTANCE OF THE CENTRAL FACE
THE RATIONALE FOR FACIAL TRANSPLANTATION
MEDICAL RISKS
ETHICAL CONSIDERATIONS
SURGICAL INDICATIONS FOR TRANSPLANTATION
ALLOGRAFT DESIGN AND CLASSIFICATION SCHEMES
CLINICAL EXPERIENCE
CASE ONE
Indication
Anatomical Design and Flap Procurement
Outcomes
CASE TWO
Indication
Anatomical Design and Flap Procurement
Outcomes
CONCLUSION
INDEX
TOC
Index
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