Neurosurgery: Skull Base Craniofacial Trauma.

Much of craniofacial trauma involves the frontal sinuses. Because of its response to injury, the frontal sinus mucosa has an innate ability to develop mucoceles, and if infected, mucopyocoeles. This article presents a therapeutic algorithm for all forms of craniofacial trauma with concentration on the most severe injury-the through and through fracture and its surgical remediation.

Evaluating risk factors and predicting complications in head and neck reconstructive surgery.

Purpose Of Review: Complications in head and neck reconstructive surgery can have devastating effects. There is a tremendous body of literature examining risk factors that may predict complications in this patient population, thereby minimizing or avoiding adverse outcomes.

Recent Findings: Rotational thromboelastometry may provide a mechanism to predict coagulopathy in patients undergoing microvascular reconstruction.

Combined Balloon Test Occlusion and SPECT Analysis for Carotid Sacrifice: Angiographic Predictors for Success or Failure?

Objectives To evaluate angiographic patterns that may predict the success or failure of carotid artery balloon test occlusion (BTO) and single-photon emission computed tomography (SPECT) analysis for carotid sacrifice. Study Design This is a retrospective nonrandomized study. Study Setting Conducted at the University of California Davis Medical Center, Sacramento, California.

Level IB nodal involvement in oropharyngeal carcinoma: implications for submandibular gland-sparing intensity-modulated radiotherapy.

Objectives/hypothesis: Submandibular gland-sparing intensity-modulated radiotherapy (SMG-sparing IMRT) has been proposed to reduce xerostomia following head and neck irradiation. However, the safety of this practice has been questioned. Data from a large surgical series of oropharyngeal carcinoma patients were extracted to identify clinicopathological correlates for submandibular involvement and to create a risk stratification scheme to guide decision making to refine selection guidelines for SMG-sparing IMRT.

Widefield optical imaging of changes in uptake of glucose and tissue extracellular pH in head and neck cancer.

The overall objective of this study was to develop an optical imaging approach to simultaneously measure altered cell metabolism and changes in tissue extracellular pH with the progression of cancer using clinically isolated biopsies. In this study, 19 pairs of clinically normal and abnormal biopsies were obtained from consenting patients with head and neck cancer at University of California, Davis Medical Center. Fluorescence intensity of tissue biopsies before and after topical delivery of 2-NBDG (2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-yl)amino]-2-deoxy-D-glucose) and Alexa 647-pHLIP [pH (low) insertion peptide] was measured noninvasively by widefield imaging, and correlated with pathologic diagnosis.

Comparison of functional outcomes and quality of life between transoral surgery and definitive chemoradiotherapy for oropharyngeal cancer.

Background: The purpose of this study was to compare patient-reported outcomes between patients treated by initial transoral resection versus definitive chemoradiotherapy for oropharyngeal cancer.

Methods: Thirty-one patients with oropharyngeal cancer treated by initial transoral CO2 laser microsurgery (n = 16) or robotic surgery (n = 15) followed by postoperative radiotherapy were identified. Each patient was matched to 1 control patient treated by definitive chemoradiotherapy.

Patterns of nodal involvement for clinically N0 salivary gland carcinoma: refining the role of elective neck irradiation.

Background: The purpose of this study was to analyze the pattern of occult cervical lymph node metastasis among patients with clinically N0 salivary gland carcinoma.

Methods: One hundred nineteen patients underwent primary surgery and ipsilateral neck dissection for clinically N0 carcinomas of the major and minor salivary glands. Eighty patients (67%) had parotid tumors.

Tobacco use among long-term survivors of head and neck cancer treated with radiation therapy.

Purpose: The objective of this study is to determine the prevalence of tobacco consumption (i.e., cigarette use) among survivors of head and neck cancer after treatment with radiation therapy (RT).

Improved clinical outcomes with multi-modality therapy for sinonasal undifferentiated carcinoma of the head and neck.

Objective: To examine outcomes among patients treated for sinonasal undifferentiated carcinoma (SNUC) of the head and neck.

Study Design: Retrospective review.

Methods: The records of 16 consecutive patients with newly diagnosed, non-metastatic SNUC were analyzed.

Feasibility and toxicity of concurrent chemoradiation for elderly patients with head and neck cancer.

Objectives: Although concurrent chemoradiation is increasingly used for patients with locally advanced head and neck cancer, many elderly patients receive radiation alone due to toxicity concerns. We evaluate acute and late toxicity among patients age ≥ 65 who received concurrent chemoradiation for head and neck cancer.

Design: Retrospective review.

Depression among long-term survivors of head and neck cancer treated with radiation therapy.

Importance: The diagnosis and subsequent treatment of head and neck cancer can have a potentially devastating impact on psychosocial functioning. Although the long-term physical adverse effects of radiation therapy (RT) for head and neck cancer have been well described, relatively few studies have evaluated psychosocial functioning after treatment.

Objective: To determine the prevalence of self-reported depression among survivors of head and neck cancer returning for follow-up after being treated with RT.

Mucoepidermoid carcinoma of the parotid gland treated by surgery and postoperative radiation therapy: clinicopathologic correlates of outcome.

Objectives/hypothesis: To determine clinical and pathological correlates of outcome among patients treated by surgery and postoperative radiation therapy for mucoepidermoid carcinoma of the parotid gland.

Study Design: Retrospective review.

Methods: The medical records of 61 patients treated by surgery and postoperative radiation therapy for localized mucoepidermoid carcinoma of the parotid gland were retrospectively reviewed in an attempt to identify clinicopathologic correlates of overall survival.

High-resolution optical molecular imaging of changes in choline metabolism in oral neoplasia.

This study was aimed at developing an optical molecular imaging approach to measure differences in uptake and intracellular retention of choline in clinically isolated tissue biopsies from head and neck cancer patients. An optically detectable analogue of choline (propargyl choline) was synthesized and evaluated in 2D and 3D models and clinically isolated paired biopsies (n = 22 biopsies). Fluorescence contrast between clinically abnormal and normal tissues based on uptake and intracellular retention of propargyl choline was measured and correlated with pathologic diagnosis.

Optical molecular imaging detects changes in extracellular pH with the development of head and neck cancer.

Noninvasive localized measurement of extracellular pH in cancer tissues can have a significant impact on the management of cancer. Despite its significance, there are limited approaches for rapid and noninvasive measurement of local pH in a clinical environment. In this study, we demonstrate the potential of noninvasive topical delivery of Alexa-647 labeled pHLIP (pH responsive peptide conjugated with Alexa Fluor(®) 647) to image changes in extracellular pH associated with head and neck squamous cell carcinoma using widefield and high resolution imaging.

Skull base surgery for the management of deeply invasive scalp cancer.

Skin cancer involving the scalp is a common malignancy in the "sun belt areas of the United States." Most early lesions are well managed by primary care physicians and dermatologists. Occasionally we encounter basal cell, squamous cell, and rarely Merkel cell carcinomas that have failed local therapy and present with large tumors invading full thickness scalp, calvarium, and even underlying dura.

Utility of daily image guidance with intensity-modulated radiotherapy for tumors of the base of skull.

Background: This study was carried out to report our experience using intensity-modulated radiotherapy (IMRT) with daily image-guided radiotherapy (IGRT) for tumors involving the base of skull.

Methods: In all, 100 patients were prospectively treated with IMRT to a median dose of 64 Gy (range, 45-70 Gy). Daily helical megavoltage computed tomography (MVCT) scans were obtained as part of an IGRT registration protocol for patient alignment.

Radiation therapy in the management of head-and-neck cancer of unknown primary origin: how does the addition of concurrent chemotherapy affect the therapeutic ratio?

Purpose: To determine how the addition of cisplatin-based concurrent chemotherapy to radiation therapy influences outcomes among a cohort of patients treated for head-and-neck cancer of unknown primary origin.

Methods And Materials: The medical records of 60 consecutive patients treated by radiation therapy for squamous cell carcinoma of the head and neck presenting as cervical lymph node metastasis of occult primary origin were reviewed. Thirty-two patients (53%) were treated by concurrent chemoradiation, and 28 patients (47%) were treated by radiation therapy alone.

Evaluation of the planning target volume in the treatment of head and neck cancer with intensity-modulated radiotherapy: what is the appropriate expansion margin in the setting of daily image guidance?

Purpose: To compare patterns of disease failure among patients treated with intensity-modulated radiotherapy (IMRT) in conjunction with daily image-guided radiotherapy (IGRT) for head and neck cancer, according to the margins used to expand the clinical target volume (CTV) to create a planning target volume (PTV).

Methods And Materials: Two-hundred and twenty-five patients were treated with IMRT for squamous cell carcinoma of the head and neck. Daily IGRT scans were acquired using either kilovoltage or megavoltage volumetric imaging prior to each delivered fraction.

Prospective trial of high-dose reirradiation using daily image guidance with intensity-modulated radiotherapy for recurrent and second primary head-and-neck cancer.

Purpose: To report a single-institutional experience using intensity-modulated radiotherapy with daily image-guided radiotherapy for the reirradiation of recurrent and second cancers of the head and neck.

Methods And Materials: Twenty-one consecutive patients were prospectively treated with intensity-modulated radiotherapy from February 2006 to March 2009 to a median dose of 66 Gy (range, 60-70 Gy). None of these patients received concurrent chemotherapy.

Sinonasal undifferentiated carcinoma with intracranial extension.

Aim: To report our experience in the management of sinonasal undifferentiated carcinoma (SNUC) over a period of 15 years.

Study Design: A retrospective case review of 13 patients with SNUC treated at the University of California, Davis, Medical Center (UCDMC) Center for Skull Base Surgery, over the past 15 years.

Results: Most tumors arose in the ethmoid sinuses.

Current trends in the diagnosis and management of head and neck paragangliomas.

Purpose Of Review: The purpose of this review is to provide an overview of the diagnosis and management of head and neck paragangliomas.

Recent Findings: The review will focus on three main areas of interest: genetics, newer imaging modalities, and management with radiation therapy.

Summary: The succinate dehydrogenase enzyme complex is important in the pathogenesis of paragangliomas.