Nasal vestibule and columella cancer: a therapeutic and reconstructive conundrum

xlomafota13 shared this article with you from Inoreader Nasal vestibule and columella cancer: a therapeutic and reconstructive conundrum Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Nasal vestibular cancers are rare entities among the head and neck cancers. The treatment options are varied. Although surgical treatment plays an important role, postablative defects are difficult to reconstruct. This review aims to discuss the current views in the management of these cancers and issues related to the reconstruction of the complex surgical defects. Recent findings Nasal vestibular cancers are a distinct rare entity of head and neck cancers. These cancers are staged using the AJCC-TNM system for nonmelanoma cutaneous cancers of head and neck or the Wang classification. Early lesions are best treated by either surgery or radiation giving excellent cure rates. Advanced stages tumours need combined treatment with surgery and adjuvant radiation therapy. Primary radiation therapy can be offered by external beam or interstitial brachytherapy. Surgical treatment varies from endonasal resections, Mohs' chemosurgery to open excisions. Summary Even though the Wang system of classification is used by majority of reports due its clinical utility, it has a drawback of not taking into account the tumour size as done by the AJCC system. Brachytherapy has been reported to be offering excellent cure rates with low morbidity in early tumours. Surgical treatment is also effective in early lesions, but its role is more established in advanced lesions. Reconstruction of the surgical defects is often a challenge, to preserve functional integrity and cosmesis. Various techniques, including skin grafts, local flaps, free flaps and prosthetics, form part of the reconstructive armamentarium. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Treatment of persistent/recurrent nodal disease in nasopharyngeal cancer

xlomafota13 shared this article with you from Inoreader Treatment of persistent/recurrent nodal disease in nasopharyngeal cancer Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Persistent or recurrent disease in the neck lymphatics is an unusual pattern of failure in nasopharyngeal carcinoma (NPC) after definitive radiotherapy or chemoradiotherapy. The purpose of this review is to critically synthesize the current knowledge regarding salvage treatment of this unique form of failure in NPC. Recent findings Surgery in the form of radical neck dissection has been established as the standard salvage treatment with 5-year regional control of 60--86%. Recent shift in paradigm has resulted in the use of modified or selective neck dissection as salvage surgery in some centers. Risk factors for poor survival outcome include recurrent nodal disease, number of involved lymph nodes, extracapsular extension, high lymph node ratio, and positive resection margin. There are no well controlled studies on the role of additional radiotherapy or chemotherapy to improve local control or survival after salvage neck dissection in this group of patients with regional failure. Summary There is limited literature regarding the extent of surgical dissection in treating nodal persistent or recurrent disease. Prospective studies are also needed to determine whether adjuvant therapy improves treatment outcomes. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Imaging-based navigation technologies in head and neck surgery

xlomafota13 shared this article with you from Inoreader Imaging-based navigation technologies in head and neck surgery Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Image guided navigation has had significant impact in head and neck surgery, and has been most prolific in endonasal surgeries. Although conventional image guidance involves static computed tomography (CT) images attained in the preoperative setting, the continual evolution of surgical navigation technologies is fast expanding to incorporate both real-time data and bioinformation that allows for improved precision in surgical guidance. With the rapid advances in technologies, this article allows for a timely review of the current and developing techniques in surgical navigation for head and neck surgery. Recent findings Current advances for cross-sectional-based image-guided surgery include fusion of CT with other imaging modalities (e.g., magnetic resonance imaging and positron emission tomography) as well as the uptake in intraoperative real-time 'on the table' imaging (e.g., cone-beam CT). These advances, together with the integration of virtual/augmented reality, enable potential enhancements in surgical navigation. In addition to the advances in radiological imaging, the development of optical modalities such as fluorescence and spectroscopy techniques further allows the assimilation of biological data to improve navigation particularly for head and neck surgery. Summary The steady development of radiological and optical imaging techniques shows great promise in changing the paradigm of head and neck surgery. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Current indications for adjuvant treatment following transoral laser microsurgery of early intermediate laryngeal cancer

xlomafota13 shared this article with you from Inoreader Current indications for adjuvant treatment following transoral laser microsurgery of early intermediate laryngeal cancer Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review This review summarizes the information in the literature on the indications for adjuvant therapy after transoral laser microsurgery (TLM) for early/intermediate stage laryngeal cancer. Recent findings A high rate of 'nonevaluable' margins after TLM significantly complicates decision-making concerning adjuvant therapy. However, consensus grows that second-look TLM in patients with multiple superficial and deep positive margins is more sensible than sending these patients systematically for adjuvant radiotherapy (RT). Summary The classical adagium: 'Failure to achieve negative margins indicates need for adjuvant RT' does not translate automatically to patients with glottic cancer treated by TLM. Rather, specifically patients with multiple superficial positive margins and positive deep margins after TLM need careful judging what constitutes the best additional adjuvant treatment. Second-look resection is nowadays regarded as the preferred adjuvant treatment for many of these patients whereas RT is reserved for those in whom a second look TLM is judged unlikely to result in 'true negative margins.' Additionally, when the pathology of the re-resection reveals multiple foci of residual disease or suggests again a resection with positive margins, adjuvant postoperative RT is likely to result in a better local control. If this strict selection of patients for adjuvant RT is adhered to carefully, oncological and functional results will be optimal. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Therapeutic challenges in radiation-induced salivary gland cancers

xlomafota13 shared this article with you from Inoreader Therapeutic challenges in radiation-induced salivary gland cancers Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review To give an overview of recent advances in therapeutic approaches of radiation-induced salivary gland cancers (ri-SGCs). Recent findings Reirradiation with protons and carbon ions demonstrated to be feasible, safe and to offer good local control rates, with the possibility of overcoming radioresistance and dosimetric issues in previously irradiated cancer patients. Chromosomal rearrangements, gene fusions and expression profiles are important to identify specific cancer subtypes and can guide tailored systemic therapy. Summary Ri-SGCs are rare and heterogeneous. Patients are often heavily pretreated and at risk of toxicities, and their management remain challenging. A multidisciplinary approach in referral centers is mandatory. Knowledge about SGCs cellular and molecular mechanisms is constantly evolving. In the last years, novel advances in therapeutic approaches, such as carbon ion radiotherapy, are emerging as safe and effective options in active treatment, but further efforts are needed to offer tailored personalized treatments and to improve survival. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A roadmap of six different pathways to improve survival in laryngeal cancer patients

xlomafota13 shared this article with you from Inoreader A roadmap of six different pathways to improve survival in laryngeal cancer patients Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review Laryngeal cancer continues to require improvement in earlier stage diagnosis and better imaging delineation of disease, and hence 'more evidence-based' selection of treatment, as recent evidence suggests that related mortality, in the last decades, has not significantly decreased worldwide. Even though the reasons are not fully understood, there persists an urgency for a review and development of future strategies to embrace such clinical and diagnostic challenges from a political, societal, as well as scientific and clinical points of view. Recent findings This review of the published literature suggests that survival improvement in laryngeal cancer may be achieved by fuelling and combining at least some or all of six targeted agendas: documentation of disease global incidence and national burden monitoring; development and implementation of high-quality cancer registries; education on risk factors and hazardous habits associated with laryngeal cancer for the general population; active modification of proven at-risk population lifestyles; centralization of treatment; and use of machine learning of gathered 'big data' and their integration into approaches for the optimization of prevention and treatments strategies. Summary Laryngeal cancer should be tackled on several fronts, commencing with disease monitoring and prevention, up to treatment optimisation. Available modern resources offer the possibility to generate significant advances in laryngeal cancer management. However, each nation needs to develop a comprehensive approach, which is an essential prerequisite to obtain meaningful improvement on results. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Oral potentially malignant disorders: new insights for future treatment

xlomafota13 shared this article with you from Inoreader Oral potentially malignant disorders: new insights for future treatment Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review The purpose of this review is to define the issues regarding oral potentially malignant disorders (OPMDs) and provide an overview of currently available treatments and ongoing clinical trials for future opportunities. Recent findings Nowadays, the treatment of choice of OPMD is surgery, whose role in preventing malignant transformation is however limited because of the high rate of recurrence and field cancerization. There have been several attempts of combining systemic therapies with surgery to reduce risk of malignant transformation. The identification of biomarkers that could predict malignant transformation is crucial in better tailoring the risk profile and possible therapeutic approaches. Summary Loss of heterozygosity remains the most predictive marker of malignant transformation; however, role of specific microRNA and OPMD immune infiltration are emerging as potential biomarkers. Given the failure of previous trials with various chemopreventive strategies, new strategies should be defined to address the issue of systemic prevention of malignant transformation. Recent updates about immune infiltration and the immune-equilibrium concept for OPMD could shed light into new preventive approaches. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Precision head and neck surgery: robotics and surgical vision technology

xlomafota13 shared this article with you from Inoreader Precision head and neck surgery: robotics and surgical vision technology Via Current Opinion in Otolaryngology & Head and Neck Surgery - Current Issue Purpose of review As the molecular basis of head and neck cancer becomes more clearly defined, precision medicine has gradually refined the multidisciplinary treatment paradigm for patients with oropharyngeal cancer. Although precision medicine is often thought to refer to new molecular diagnostics or unique medical therapy, the recent adoption of robotic surgery has ushered in the era of 'precision' head and neck surgery. Recent findings Surgeons now routinely utilize a virtual reality environment to reduce the morbidity of head and neck surgical care and improve oncologic and functional outcomes. The development and subsequent FDA approval of the da Vinci SP system, a single-arm system with a flexible camera, has allowed for improved visualization and access to the deep oropharynx and larynx. Groups investigating anti-EGFR antibodies tagged with fluorescent dye as well as inherent autofluorescence differences between normal and cancerous mucosal tissues show promise for improving positive surgical margin rates. Summary The evolution of robotics and visualization for oropharyngeal cancer represents a novel and innovative utilization of new technology to improve care. Further advancements in techniques, from refinement of the robotic platform itself, to novel real-time tumour imaging options will be critical to further advance precision care for these patients. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Distinct phenotypic expression levels of macrophages in neonatal lungs

xlomafota13 shared this article with you from Inoreader Distinct phenotypic expression levels of macrophages in neonatal lungs Via Experimental and therapeutic medicine Exp Ther Med. 2021 Apr;21(4):369. doi: 10.3892/etm.2021.9800. Epub 2021 Feb 19. ABSTRACT Alveolar macrophages are the front-line defense against environmental pathogens. However, to the best of our knowledge, differences in function and phenotypic expression levels of macrophages between neonatal and adult lungs have not previously been determined. The present study investigated lung tissues and analyzed blood samples to find cell markers of M1 and M2 macrophages in neonatal and adult rats. Pulmonary sepsis was induced by intrapleural instillation of lipopolysaccharide (LPS; 20 mg/kg) and survival time after administration of LPS was measured. In certain neonates, a selective inducible nitric oxide synthase (iNOS) inhibitor, 1400w, was administered prior to induction of pulmonary sepsis. Compared with adults, fetal and neonatal lung tissues had significantly higher levels of iNOS and CD86 (M1 markers), whereas the expression levels of CD206 and arginase-1 (M2 markers) were lower in the neonatal lung. The circulating cells that co-expressed CD68 (monocytes and macrophages) and CD86 in the blood were also significantly higher in neonates than in adults (25.9±6.6 vs. 11.6±2.2%; P=0.007. At basal unstimulated conditions, lung tissue concentrations of nitrite and nitrate (NOx) were significantly lower in the neonates than in adults (112.1±55.9 vs. 340.9±124.9 µM/g; P<0.001). However, NOx was increased following administration of LPS. Administration of 1400w suppressed lung tissue levels of NOx and improved the survival time in neonatal rats treated with LPS. The present study demonstrated that M1 is the primary macrophage phenotype in the neonatal lung and that higher iNOS expression levels do not have a protective effect against pulmonary endotoxins in neonates. Overproduction of NO by iNOS in neonatal alveolar macrophages may result in detrimental effects during pulmonary inflammation. PMID:33732342 | PMC:PMC7903444 | DOI:10.3892/etm.2021.9800 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Biomechanical evaluation of a customized 3D-printed polyetheretherketone condylar prosthesis

xlomafota13 shared this article with you from Inoreader Biomechanical evaluation of a customized 3D-printed polyetheretherketone condylar prosthesis Via Experimental and therapeutic medicine Exp Ther Med. 2021 Apr;21(4):348. doi: 10.3892/etm.2021.9779. Epub 2021 Feb 11. ABSTRACT The present study aimed to evaluate the biomechanical behavior of a custom 3D-printed polyetheretherketone (PEEK) condylar prosthesis using finite element analysis and mechanical testing. The Mimics software was used to create a 3D model of the mandible, which was then imported into Geomagic Studio software to perform osteotomy of the lesion area. A customized PEEK condyle prosthesis was then designed and the finite element model of the PEEK condyle prosthesis, mandible and fixation screw was established. The maximum stress of the prosthesis and screws, as well as stress and strain of the cortical and cancellous bones in the intercuspal position, incisal clench, left unilateral molar clench and right unilateral molar clench was analyzed. The biomechanical properties of the prosthesis were studied using two models with different lesion ranges. To si mulate the actual clinical situation, a special fixture was designed. The compression performance was tested at 1 mm/min for the condyle prosthesis, prepared by fused deposition modeling (FDM). The results of a finite element analysis suggested that the maximum stress of the condyle was 10.733 MPa and the maximum stress of the screw was 9.7075 MPa; both were far less than the yield strength of the material. The maximum force that the two designed prostheses were able to withstand was 3,814.7±442.6 N (Model A) and 4,245.7±348.3 N (Model B). Overall, the customized PEEK condyle prostheses prepared by FDM exhibited a uniform stress distribution and good mechanical properties, providing a theoretical basis for PEEK as a reconstruction material for repairing the temporomandibular joint. PMID:33732321 | PMC:PMC7903381 | DOI:10.3892/etm.2021.9779 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

18F-fluorodeoxyglucose positron emission tomography for the detection of inflammatory lesions of the arterial vessel walls in Wistar rats

xlomafota13 shared this article with you from Inoreader <sup>18</sup>F-fluorodeoxyglucose positron emission tomography for the detection of inflammatory lesions of the arterial vessel walls in Wistar rats Via Experimental and therapeutic medicine Exp Ther Med. 2021 Apr;21(4):370. doi: 10.3892/etm.2021.9801. Epub 2021 Feb 19. ABSTRACT The present study aimed to evaluate the use of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) for detection of high-fat and high-salt diet-induced inflammatory lesions of the arterial vessel walls in Wistar rats. A total of 20 healthy, 8-week-old, male Wistar rats were randomly assigned to the high-fat diet group and the normal diet group. After 16 and 24 weeks of feeding, Wistar rats in the normal diet group and the high-fat diet group (five rats in each group) were injected with 18F-FDG through the tail vein at a dose of 1 mCi/kg after fasting for 12 h. After 1 h, the rats were anesthetized with 2% isoflurane, followed by micro-PET imaging with a 10-min image capture duration and immunohistochemical staining. The standardized uptake values (SUVs) of 18F-FDG were significantly higher in the iliac artery in the high-fat diet group compared with those in the normal diet group at 16 weeks (1.53±0.08 vs. 1.04±0.03; P<0.05) and at 24 weeks (1.96±0.17 vs. 1.12±0.07; P<0.05). The SUVs of 18F-FDG were also significantly greater in the abdominal aorta in the high-fat diet group compared with those in the normal diet group at 16 weeks (1.35±0.08 vs. 1.02±0.02; P<0.05) and at 24 weeks (1.54±0.09 vs. 1.04±0.02; P<0.05). In addition, the SUVs of 18F-FDG in the iliac artery and abdominal aorta were significantly higher at 24 weeks compared with those at 16 weeks in the high-fat diet group (P<0.05). As determined by immunohistochemistry, the percentage of CD68-positive cells in the total number of cells per unit area in each group was 3.20±1.80% in the 24-week normal diet group, 4.70±2.02% in the 16-week high-fat diet group and 6.94±2.02% in the 24-week high-fat diet group; the percentage of CD68-positive cells in the high-fat d iet group at 24 weeks was significantly higher than that in the high-fat diet group at 16 weeks and in the normal diet group at 24 weeks (P<0.05). In conclusion, 18F-FDG PET is a noninvasive imaging tool that can continuously monitor inflammatory lesions of the arterial vessel walls in Wistar rats. Further improvement of the Wistar rat atherosclerosis model may provide data to support the early assessment of and intervention in atherosclerosis. PMID:33732343 | PMC:PMC7903450 | DOI:10.3892/etm.2021.9801 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.