Head and neck cancer management and reconstruction

phẫu thuật tạo hình Head and neck cancer management and reconstructionHead and neck cancer management and reconstruction Head and neck cancer management and reconstruction Head and neck cancer management and reconstruction Head and neck cancer management and reconstruction

To access the additional media content available with this e-book via Thieme MedOne, please use the code and follow the instructions provided at the back of the e-book TPS 23 x 31 - | 25.07.19 - 09:17 TPS 23 x 31 - | 25.07.19 - 09:17 TPS 23 x 31 - | 25.07.19 - 09:17 Head and Neck Cancer Management and Reconstruction Second Edition Eric M Genden, MD, MHA, FACS Isidore Friesner Professor and Chairman Department of Otolaryngology–Head and Neck Surgery The Icahn School of Medicine at Mount Sinai New York, New York Thieme New York • Stuttgart • Delhi • Rio de Janeiro TPS 23 x 31 - | 25.07.19 - 09:17 Thieme Medical Publishers, Inc 333 Seventh Avenue New York, New York 10001 Executive Editor: Timothy Y Hiscock Managing Editor: J Owen Zurhellen Director, Editorial Services: Mary Jo Casey Production Editor: Sean Woznicki International Production Director: Andreas Schabert Editorial Director: Sue Hodgson International Marketing Director: Fiona Henderson International Sales Director: Louisa Turrell Director of Institutional Sales: Adam Bernacki Senior Vice President and Chief Operating Officer: Sarah Vanderbilt President: Brian D Scanlan Library of Congress Cataloging-in-Publication Data Names: Genden, Eric M., editor Title: Head and neck cancer : management and reconstruction / [edited by] Eric M Genden Other titles: Head and neck cancer (Genden) Description: Second edition | New York : Thieme, [2019] | "Head and neck cancer: management and reconstruction is a combination and thorough update of two prior texts, Reconstruction of the head and neck: a defect-oriented approach, and Head and neck cancer: an evidence-based team approach"–ECIP galley | Includes bibliographical references and index Identifiers: LCCN 2018051856| ISBN 9781626232310 (hardcover : alk paper) | ISBN 9781626232327 (eISBN) Subjects: | MESH: Head and Neck Neoplasms–therapy | Head and Neck Neoplasms–diagnosis | Reconstructive Surgical Procedures–methods | Head–surgery | Neck–surgery Classification: LCC RC280.H4 | NLM WE 707 | DDC 616.99/491–dc23 LC record available at https://lccn.loc.gov/2018051856 Important note: Medicine is an ever-changing science undergoing continual development Research and clinical experience are continually expanding our knowledge, in particular our knowledge of proper treatment and drug therapy Insofar as this book mentions any dosage or application, readers may rest assured that the authors, editors, and publishers have made every effort to ensure that such references are in accordance with the state of knowledge at the time of production of the book Nevertheless, this does not involve, imply, or express any guarantee or responsibility on the part of the publishers in respect to any dosage instructions and forms of applications stated in the book Every user is requested to examine carefully the manufacturers’ leaflets accompanying each drug and to check, if necessary in consultation with a physician or specialist, whether the dosage schedules mentioned therein or the contraindications stated by the manufacturers differ from the statements made in the present book Such examination is particularly important with drugs that are either rarely used or have been newly released on the market Every dosage schedule or every form of application used is entirely at the user’s own risk and responsibility The authors and publishers request every user to report to the publishers any discrepancies or inaccuracies noticed If errors in this work are found after publication, errata will be posted at www.thieme.com on the product description page Some of the product names, patents, and registered designs referred to in this book are in fact registered trademarks or proprietary names even though specific reference to this fact is not always made in the text Therefore, the appearance of a name without designation as proprietary is not to be construed as a representation by the publisher that it is in the public domain Copyright © 2020 by Thieme Medical Publishers, Inc Thieme Publishers New York 333 Seventh Avenue, New York, NY 10001 USA +1 800 782 3488, customerservice@thieme.com Thieme Publishers Stuttgart Rüdigerstrasse 14, 70469 Stuttgart, Germany +49 [0]711 8931 421, customerservice@thieme.de Thieme Publishers Delhi A-12, Second Floor, Sector-2, Noida-201301 Uttar Pradesh, India +91 120 45 566 00, customerservice@thieme.in Thieme Publishers Rio de Janeiro, Thieme Publicaỗừes Ltda Edifớcio Rodolpho de Paoli, 25 andar Av Nilo Peỗanha, 50 Sala 2508, Rio de Janeiro 20020-906 Brasil +55 21 3172-2297 / +55 21 3172-1896 www.thiemerevinter.com.br Cover design: Thieme Publishing Group Typesetting by Thomson Digital, India Printed in the United States of America by King Printing ISBN 978-1-62623-231-0 Also available as an e-book: eISBN 978-1-62623-232-7 54321 This book, including all parts thereof, is legally protected by copyright Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher’s consent, is illegal and liable to prosecution This applies in particular to photostat reproduction, copying, mimeographing, preparation of microfilms, and electronic data processing and storage TPS 23 x 31 - | 25.07.19 - 09:17 I could not have completed this second edition without the support of my loving family: Audrey, Eric Jr., Sophie, and Isabelle TPS 23 x 31 - | 25.07.19 - 09:17 Head and Neck Cancer | 25.07.19 - 09:27 Contents Video Contents ix Preface x Acknowledgments xi Contributors xii Carcinoma of the Oral Tongue and Floor of Mouth Evan M Graboyes and Brian Nussenbaum Reconstruction of the Oral Tongue and Floor of Mouth 19 Rodrigo Bayon and Nitin A Pagedar Carcinoma of the Buccal Mucosa 31 Jason E Thuener, Akina Tamaki, Andrew P Stein, and Nicole M Fowler Reconstruction of Buccal Defects 43 Stephen Y Kang, Theodoros N Teknos, and Matthew O Old Carcinoma of the Palate and Maxilla 52 Jamal Ahmed, Deepa Danan, Giovana Thomas, Jason M Leibowitz, and Francisco J Civantos Reconstruction of the Palate and Maxilla 65 Neal D Futran Management of Carcinoma of the Lateral Pharynx and Soft Palate 84 Ashley M Nassiri, Krystle A Lang Kuhs, and Alexander Langerman Reconstruction of the Lateral Pharynx and Soft Palate 102 Steven B Cannady Carcinoma Involving the Mandibular Alveolus and Retromolar Trigone 117 Tjoson Tjoa and Derrick T Lin 10 Reconstruction of the Mandible and Composite Defect 130 Shawn Li and Rod P Rezaee 11 Open Management of Carcinoma of the Oropharynx 141 Robert H Lindau, Andrew M Coughlin, Erin R S Hamersley, and Dana K Petersen 12 Transoral Robotic Management of the Oropharynx 154 Ross W Green and Brett A Miles 13 Reconstruction of the Oropharynx 169 Tamer A Ghanem and Zaahir Turfe 14 Carcinoma of the Hypopharynx 180 Matthew Mifsud, John R de Almeida, Meredith Giuliani, Aaron R Hansen, and David P Goldstein vii Head and Neck Cancer | 25.07.19 - 09:27 Contents 15 Carcinoma of the Larynx 203 Moustafa W Mourad, Sami P Moubayed, and Raymond L Chai 16 Reconstruction of Laryngeal and Hypopharyngeal Defects 217 Han Zhang, David P Goldstein, and John R de Almeida 17 Carcinoma of the Thyroid 230 Seth Kay, William S Duke, and David J Terris 18 Carcinoma of the Salivary Glands 252 Mark K Wax and Savannah Gelesko 19 Reconstruction of the Parotid Defect 270 Stephen Y Kang, Matthew O Old, and Theodoros N Teknos 20 Carcinoma of the Nasal Cavity and Anterior Skull Base 278 Jean Anderson Eloy, Peter F Svider, Michael J Pfisterer, Suat Kilic, Soly Baredes, and James K Liu 21 Reconstruction of the Anterior Skull Base 304 Anthony G Del Signore, Zhong Zheng, Alfred Marc C Iloreta Jr., Brett A Miles, and Satish Govindaraj 22 Carcinoma of the Nasopharynx 324 Carcinoma of the Skin of the Head, Face, and Neck 347 Raymond K Tsang and William I Wei 23 David Z Cai, Brian A Moore, Merrill S Kies, and Randal S Weber 24 Scalp Reconstruction 377 Eric M Genden 25 Reconstruction of the Cheek and Face 383 Edward I Chang and Matthew M Hanasono 26 Carcinoma of Unknown Primary 397 Umamaheswar Duvvuri and Michael J Persky 27 Surveillance of the Patient 404 Peter M Som and Eric M Genden 28 Drug Development in the 21st Century: Monoclonal Antibodies and Immunotherapy 413 Viginie Achim and Daniel Clayburgh 29 The Vessel-Depleted Neck: Microvascular Reconstruction 423 Salvage Surgery: Minimizing Wound Complications 435 Scott A Roof and Marita S Teng 30 Daniel I Kwon and Eric M Genden Index viii 442 Head and Neck Cancer | 19.07.19 - 12:08 Salvage Surgery: Minimizing Wound Complications Table 30.2 Wound healing complications Wound healing complications Minor Major Cellulitis Free flap failure Seroma Salivary fistula (requiring surgery) Low-flow chyle leak High-flow chyle leak Skin edge necrosis/dehiscence Salivary fistula (amenable to wound care) 30.1.2 Wound Complications in Salvage Surgery Fig 30.1 Typical salvage surgery case with large recurrent cancer requiring surgical treatment Pictured is a malnourished patient with significant scarring from previous surgery as well as neck fibrosis and contracture secondary to radiation treatment endothelial cells that are vacuolized Similarly, the tunica media and adventitia show fibrosis, hyalinosis, and loss of smooth muscle cells and fibroblasts Normal extracellular matrix is reduced and replaced by calcifications.9,10 These changes are initially acute but become chronic with abnormal collagen deposition without appropriate remodeling Similar to blood vessel changes, surrounding connective tissue and lymphatic systems are affected as well.11 The resultant fibrotic tissue is chronically hypoxic and hypocellular Blood vessels are sparse and diminished in diameter and less responsive to angiogenic or vasodilatory mediators.1 Ultimately, tissue treated with radiation and chemotherapy is poorly equipped to react to new injury and thus more prone to developing wound complications The specific role of chemotherapy to local tissue has not been well studied Studies have drawn statistically significant associations with prior chemotherapy to wound complications.12 However, chemotherapy is most commonly associated with radiotherapy and it is difficult to delineate its specific impact As a sensitizer, chemotherapy likely compounds the cellular effects of radiation leading to impaired healing Additionally, chemotherapy may have a profound negative effect on the systemic medical condition of the patients With the emerging role of neoadjuvant chemotherapy in head and neck cancer, further understanding of the tissue effects of chemotherapy is required.13 436 Patients undergoing salvage surgery are at high risk for woundrelated complications such as infection, bleeding, osteoradionecrosis, wound dehiscence, flap failure, and fistula (▶ Table 30.2) Wound complications may be delineated into minor versus major complications Most studies define major wound complications by the need for prolonged hospitalization, reoperation, or life-threatening complications Wound complication-related mortality is most common from sepsis or carotid blowout Most of the literature on salvage head and neck surgery is found in laryngeal cancer Following the paradigm shift toward organ preservation and primary chemoradiotherapy for the treatment of advanced laryngeal cancer, associated salvage total laryngectomy became more prevalent These patients undergoing salvage laryngectomy were found to have major wound complications in approximately 60% of cases, reaching up to 80% in some series.14,15 Specifically examining pharyngocutaneous fistula rates reported incidences vary widely from specific studies ranging from to 75% However, pooled results show a significantly higher rate of fistula in salvage laryngectomy (~30%) versus primary laryngectomy (~10%).16,17 Furthermore, the effect of radiation on fistula rates has been found to be dose dependent with high-dose radiation being associated with significantly higher fistula formation.15,16 Finally, when present, fistula in the setting of previous radiation results in longer healing times and higher rates of reoperation.17 Note Wound complication-related mortality is most common from sepsis or carotid blowout and the effect of radiation on fistula rates has been found to be dose dependent with high-dose radiation being associated with significantly higher fistula formation Rates for wound complications in salvage head and neck surgery have improved from previously reported rates due to increased experience by surgeons operating on irradiated tissue Vascularized tissue reconstruction has been the mainstay of combating impaired wound healing in salvage surgery Locoregional flaps that were recognized have conferred a reduction in wound breakdowns when compared to primary reconstruction early in the usage of radiotherapy.18,19 Microvascular free tissue transfer has expanded this principle greatly with an array of donor options and the ability to reconstruct Head and Neck Cancer | 19.07.19 - 12:08 Salvage Surgery: Minimizing Wound Complications ever more complex defects With increased experience and refined techniques, microvascular free tissue transfer has been able to combat many of the healing difficulties that salvage surgery poses Usage of free flap reconstruction in salvage laryngectomy has shown to confer a 43% decrease in risk of fistula formation in a recent meta-analysis The pooled rate of pharyngocutaneous fistula has shown to be 31% in primary closure versus 22% with a vascularized flap in meta-analyses.20,21 Note Free flap reconstruction is associated with a 43% decrease in risk of fistula formation following salvage laryngectomy Despite the clear advantages of using free transfer of nonradiated tissue, poor healing in the salvage surgery is still a practical challenge Many series have failed to show any difference in free flap outcomes and wound despite the well-known vascular changes and prothrombotic states that irradiated tissues pose complications between irradiated versus nonirradiated patients.22,23 Despite these encouraging statistics, most individual studies, even from high-volume centers, represent relatively small cohorts of heterogeneously treated patients Additionally, many studies investigating free flap outcomes focus on free flap failure or anastomotic failure, a relatively rare event, as their primary outcome factors Other wound complications such as partial necrosis, dehiscence, and salivary leak may be underreported or are inconsistently recorded However, when systematically reviewed, previous radiation has been shown to have statistically worse free flap survival, secondary wound complications, and fistulas compared to nonirradiated patients on meta-analysis.24 These wound and flap complications, as with laryngectomy fistula rates, have been shown to be radiation dose dependent.25 30.1.3 Strategies for Management of Salvage Surgery Patients Preoperative Patients with head and neck cancer requiring salvage surgery invariably have multiple barriers to wound healing A comprehensive approach is necessary to optimize outcomes and avoid complications Preoperative planning with appropriate imaging, multidisciplinary discussion, ablative and reconstructive plans are important to select the appropriate intervention Treatment should ideally be given at a high-volume tertiary care center with experienced inpatient care teams The operating surgeon should have a clear plan preoperatively with expertise in a variety of free flaps as well as vessel harvest with backup reconstructive options The patient should be well educated and have realistic expectations regarding postoperative course and the possibility of additional treatment, reoperation, and wound care Note Preoperatively, the operating surgeon should have a clear plan and possess an expertise in a variety of free flaps as well as backup reconstructive options As discussed previously, there are many patient health risk factors for poor wound healing that have been associated with worse outcomes in head and neck cancer surgery and salvage surgery.3,26 Some predispositions to poor wound healing are innate, but certain factors such as nutrition, blood sugar control, smoking, and alcohol abuse can be optimized prior to surgery Tobacco and alcohol cessation counseling should be provided While nonsmokers have been shown to have improved healing outcomes after surgery when compared to smokers, even short-term perioperative tobacco cessation is associated with lower postoperative infection rates.27 Nutrition referral or encouragement of maximizing nutrition should be routine In some patients, preoperative gastrostomy tube may be prudent Finally, the consultation or communication with other medical providers is important to optimize the patient’s medical condition Controlling blood sugar, managing immunosuppressant medications, optimizing thyroid levels, improving pulmonary function are all important factors for preoperative planning as well as for promoting healing postoperatively Note Tobacco use is a clear risk for wound complications and even short-term perioperative tobacco cessation is associated with a decrease in postoperative infection rates Antibiotics Perioperative antibiotics should be given, especially considering head and neck surgery typically involves a clean-contaminated field Methicillin-resistant Staphylococcus aureus (MRSA) infections have been linked to postoperative infections and fistula in head and neck surgery.28 Studies have shown that a short perioperative antibiotic course is as effective as prolonged antibiotics in primary head and neck surgery in preventing surgical site infections, with prolonged courses being associated with additional risk.29 Studies looking specifically at free flap reconstruction have supported the evidence favoring short-term antibiotics versus long term.30,31 However, in salvage surgery, an optimal prophylactic antibiotic length is unclear A recent study comparing 24-hour antibiotic prophylaxis with a prolonged course showed a high rate of postoperative infections in the short-term course but did not achieve statistical significance.32 Ultimately, salvage surgery encompasses a range of infection risk and antibiotics should be used judiciously by the clinician’s discretion when deviated from standard perioperative recommendations Note Short perioperative antibiotic course is as effective as prolonged antibiotics in primary head and neck surgery in preventing surgical site infections, with prolonged courses being associated with additional risk General principles of optimal operative technique remain especially important in salvage surgery Each surgical decision from 437 Head and Neck Cancer | 19.07.19 - 12:08 Salvage Surgery: Minimizing Wound Complications 438 skin incision design to suture placement becomes more significant to the overall outcome Poor skin incision planning or a high-tension closure may result in skin breakdown and exposure of underlying structures such as the carotid artery Modifications of the MacFee or apron incision have been shown to largely avoid issues of skin flap necrosis that were problematic with other incisions used in the past.33,34 Plating and implant use should be used with caution due to high rates of extrusion and infection.35 These risks are especially high if hardware is placed under areas of thin soft tissue coverage, exposed to saliva, or is prone to biofilm formation of the body for the past two decades Its adoption in the treatment of head and neck wounds has been more recent but has been shown to be similarly safe and effective.52,53 Local Wound Care Hyperbaric Oxygen Treatment The general principles of local wound healing involve decontamination, preventing further trauma, and optimizing the local environment Chronic wounds often exhibit colonization of bacteria and bacterial count has been associated with delayed wound healing.36 In head and neck surgery, contamination with saliva or mucus is a frequent problem Every effort to separate wounds from contamination should be done In cases of large salivary contamination due to dehiscence or fistula, catheterization with T-tube or Malecot or surgical formalization may be used to divert saliva until delayed closure Wounds should be thoroughly washed to reduce bacterial load A variety of topical treatments and dressings have been described to decrease colonization including Dakin’s hypochlorite solution, topical antibiotics, and silver-based dressings.37,38,39 Qualitative wound cultures may be done to differentiate between inflammation and infection Systemic antibiotics may be used in the presence of local infection but have not been shown to aid in local wound healing and should not be used in the absence of active infection.40 Several topical treatments to optimize the local tissue environment have been described Topical therapies including hydrocolloids, alginates, and other foams and gels have shown to be helpful in promoting a moist environment that promotes healing and reduces pain.41 Occlusive dressings are often used in chronic wounds to similarly prevent desiccation but should be used with caution due to high rates of contamination in the head and neck Several active topical agents such as bioflavonoids and growth factors are being studied that have shown to upregulate the cellular mechanisms for healing in vitro and in animal models.42,43 Similarly, mesenchymal stem cell injection into radiation-related wounds are being studied in various experimental models and show promise.44,45,46,47 Traditionally, wet-to-dry dressing changes have been used for debridement of nonviable tissue and are still frequently used by surgeons to promote granulation tissue.48 Negative pressure wound therapy (NPWT) and enzymatic topical treatments are modern alternatives to remove nonviable tissue and exudates Studies have shown them to speed up granulation and reduce patient discomfort with more frequent dressing changes While there is a lack of randomized controlled data to demonstrate a clear healing advantage over traditional wound care,49,50,51 NPWT has been shown to decrease hospitalization stay, speed wound closure, and decrease associated morbidity compared with traditional wound care The benefits of NPWT are well studied and have been commonly used in other parts Hypoxia and hypoperfusion are some of the primary underlying etiologies of poor wound healing in salvage surgery Hyperbaric oxygen (HBO) therapy increases tissue oxygen tension and has been shown to promote angiogenesis, collagen formation, has antimicrobial properties.54 HBO has been used for a variety of acute and chronic wounds including radiation-associated wounds and proven to be efficacious in randomized controlled trials.55,56,57,58 One of the most common applications in head and neck irradiated patients is for osteoradionecrosis (ORN) where it has been shown to be effective when local treatment has failed.59 HBO is primarily indicated as an adjunct to conservative wound care strategies and can work synergistically with local wound therapy to obviate the need for more aggressive treatment.60 Recently, its application alongside vascularized flaps to improve outcomes has been an area of interest with promising results in animal models but lacks clinical evidence.61 Note The use of NPWT has been shown to decrease hospitalization stay, speed wound closure, and decrease associated morbidity compared with traditional wound care Surgical Reconstruction It is well established that reconstruction in salvage surgery, whether primary after resection or secondary for the treatment of chronic wounds, should be done with a vascularized flap A variety of pedicle and free flaps have been described for various defects of the head and neck There are no randomized controlled studies to help determine flap selection in salvage surgery reconstruction Instead, flap selection is largely dependent on the particular defect, functional and aesthetic goals, and surgeon experience Pedicle flaps have traditionally been the workhorse of head and neck reconstruction due to their reliability and technical simplicity The deltopectoral and pectoralis major free flaps have been well tried for the past several decades and have proven effective in a variety of applications.20,62,63,64 Other regional flaps such as the submental island and supraclavicular flap have also been used However, pedicle soft tissue flaps have limited utility for complex head and neck defects and the donor sites may be included in the previous radiation field With increasingly widespread expertise in microvascular free tissue transfer, pedicle flaps should only be used in selected cases Free tissue transfer is the gold standard for salvage surgery reconstruction and its application continues to be refined Their use has been well described even in cases of multiple courses of radiation or recipient vessel depletion.7,65 In general, donor tissue selection should be appropriate to the defect and goals of Head and Neck Cancer | 19.07.19 - 12:08 Salvage Surgery: Minimizing Wound Complications reconstruction However, additional considerations should be taken by the reconstructive surgeon in regard to vessel size, pedicle length, and vascularity of the tissue to help guide donor sites The use of muscle coverage has been shown to promote wound healing with its high vascularity, conforming ability to close dead space, and expressions of growth factors.66 Reconstruction with free flaps with significant muscle bulk includes the rectus abdominus, serratus, latissimus, or vastus lateralis These sites may be harvested as a composite flap with skin and bone or as free muscle and fascia (▶ Fig 30.2,▶ Fig 30.3) Note The use of muscle coverage has been shown to promote wound healing with its high vascularity, conforming ability to close dead space, and expressions of growth factors The gastro-omental free flap is uniquely ideal for repair of highrisk wounds and has enjoyed a resurgence of interest due to the widespread use of chemoradiation and salvage surgery This is primarily due to the rich supply of fibroblasts and progenitor stem cells from the omentum as well as the advantage of a highly vascular pliable tissue layer Used in the past primarily for pharyngeal mucosal repair, the protective qualities of the omentum were recognized when they were used to help protect the carotid arteries in the era of routine radical neck dissections67 (▶ Fig 30.4) However, its popularity decreased in favor of less morbid donor sites Recent series have reaffirmed its benefit in salvage surgery involving pharyngeal defects The omental tissue can be used to bolster pharyngeal closures, acting as a protective overlay.68,69 The fibroblast-rich omentum has the capability of walling off salivary leaks with fibrous adhesions that can form within hours.70 Additionally, the mucus secretions of the distal gastric mucosa help combat xerostomia, improving swallowing outcomes Finally, the rich vascularity of the omentum allows for skin grafting to cover cutaneous defects (▶ Fig 30.5) Ultimately, the advantages of free tissue transfer in aiding wound healing and reconstruction after salvage surgery is contingent on appropriate donor-site selection and inset design Special consideration should be given to prioritize factors that will improve healing The association of increased free flap anastomotic failure with previously irradiated patients, as well as timing and dose dependence, should be considered in planning.24 Fig 30.2 The scapular composite free flap The scapula free flap provides a vascularized bone flap and a vascularized muscle flap This is an excellent donor site for the compromised wound bed Fig 30.4 Gastro-omental free flap The gastro-omental free flap can be used as a patch graft or as a tube designed The omentum promotes healing and is ideal for the compromised wound Fig 30.3 An inset scapular composite free flap The muscle flap can be placed in the neck to promote healing and protect the great vessels 439 Head and Neck Cancer | 19.07.19 - 12:08 Salvage Surgery: Minimizing Wound Complications Fig 30.5 The omentum can be covered with a skin graft 30.2 Conclusion For a variety of reasons, major ablative surgery after previous radiotherapy or chemoradiotherapy is required in a significant population of head and neck cancer patients Salvage surgery is often necessary as the last remaining curative treatment option or simply to alleviate the morbidity of uncontrolled recurrence but is associated with significant wound healing complications This is due to a multitude of factors that create conditions averse to the normal wound healing mechanism Wound healing problems in salvage surgery represent a heterogeneous population with multiple codependent factors Thus, there is a paucity of data to clearly guide specific treatment planning However, the mechanisms of wound healing, tissue changes after irradiation, and chronic wound care outcomes are fairly well described By utilizing a comprehensive approach to patient optimization and surgical planning, the barriers to wound healing may be overcome with favorable outcomes References [1] Paderno A, Piazza C, Bresciani L, Vella R, Nicolai P Microvascular head and neck reconstruction after (chemo)radiation: facts and prejudices Curr Opin Otolaryngol Head Neck Surg 2016; 24(2):83–90 440 [2] Broughton G, II, Janis JE, Attinger CE The basic science of wound healing Plast Reconstr Surg 2006; 117(7) Suppl:S:12–S–34 [3] Schwartz SR, Yueh B, Maynard C, Daley J, Henderson W, Khuri SF Predictors of wound complications after laryngectomy: a study of over 2000 patients Otolaryngol Head Neck Surg 2004; 131(1):61–68 [4] Chaukar DA, Deshmukh AD, Majeed T, Chaturvedi P, Pai P, D’cruz AK Factors affecting wound complications in head and neck surgery: a prospective study Indian J Med Paediatr Oncol 2013; 34(4):247–251 [5] Mücke T, Rau A, Weitz J, et al Influence of irradiation and oncologic surgery on head and neck microsurgical reconstructions Oral Oncol 2012; 48(4): 367–371 [6] Wong KK, Higgins KM, Enepekides DJ Microvascular reconstruction in the vessel-depleted neck Curr Opin Otolaryngol Head Neck Surg 2010; 18(4): 223–226 [7] Jacobson AS, Eloy JA, Park E, Roman B, Genden EM Vessel-depleted neck: techniques for achieving microvascular reconstruction Head Neck 2008; 30 (2):201–207 [8] Schultze-Mosgau S, Grabenbauer GG, Radespiel-Tröger M, et al Vascularization in the transition area between free grafted soft tissues and pre-irradiated graft bed tissues following preoperative radiotherapy in the head and neck region Head Neck 2002; 24(1):42–51 [9] De Wilde R, Boeckx W, Van Der Schueren E, Guelinckx P, Gruwez J A scanning electron microscopic study of microvascular anastomoses on irradiated vessels: short-term effect of irradiation Microsurgery 1983; 4(3):193–200 [10] De Wilde RL, Donders G Scanning electron microscopic study of microvascular anastomoses on irradiated vessels: long-term effect of irradiation Microsurgery 1986; 7(4):156–157 [11] Martin M, Lefaix J, Delanian S TGF-beta1 and radiation fibrosis: a master switch and a specific therapeutic target? Int J Radiat Oncol Biol Phys 2000; 47(2):277–290 [12] Penel N, Lefebvre D, Fournier C, Sarini J, Kara A, Lefebvre JL Risk factors for wound infection in head and neck cancer surgery: a prospective study Head Neck 2001; 23(6):447–455 [13] Beauvillain C, Mahé M, Bourdin S, et al Final results of a randomized trial comparing chemotherapy plus radiotherapy with chemotherapy plus surgery plus radiotherapy in locally advanced resectable hypopharyngeal carcinomas Laryngoscope 1997; 107(5):648–653 [14] Sassler AM, Esclamado RM, Wolf GT Surgery after organ preservation therapy Analysis of wound complications Arch Otolaryngol Head Neck Surg 1995; 121(2):162–165 [15] Weber RS, Berkey BA, Forastiere A, et al Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91–11 Arch Otolaryngol Head Neck Surg 2003; 129(1):44–49 [16] Dirven R, Swinson BD, Gao K, Clark JR The assessment of pharyngocutaneous fistula rate in patients treated primarily with definitive radiotherapy followed by salvage surgery of the larynx and hypopharynx Laryngoscope 2009; 119(9):1691–1695 [17] Cavalot AL, Gervasio CF, Nazionale G, et al Pharyngocutaneous fistula as a complication of total laryngectomy: review of the literature and analysis of case records Otolaryngol Head Neck Surg 2000; 123(5):587–592 [18] Stafford N, Dearnaley D Treatment of ‘inoperable’ neck nodes using surgical clearance and postoperative interstitial irradiation Br J Surg 1988; 75(1):62–64 [19] Cornes PGS, Cox HJ, Rhys-Evans PR, Breach NM, Henk JM Salvage treatment for inoperable neck nodes in head and neck cancer using combined iridium192 brachytherapy and surgical reconstruction Br J Surg 1996; 83(11): 1620–1622 [20] Paleri V, Drinnan M, van den Brekel MW, et al Vascularized tissue to reduce fistula following salvage total laryngectomy: a systematic review Laryngoscope 2014; 124(8):1848–1853 [21] Hasan Z, Dwivedi RC, Gunaratne DA, Virk SA, Palme CE, Riffat F Systematic review and meta-analysis of the complications of salvage total laryngectomy Eur J Surg Oncol 2017; 43(1):42–51 [22] Choi S, Schwartz DL, Farwell DG, Austin-Seymour M, Futran N Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer Arch Otolaryngol Head Neck Surg 2004; 130 (11):1308–1312 [23] Bengtson BP, Schusterman MA, Baldwin BJ, et al Influence of prior radiotherapy on the development of postoperative complications and success of free tissue transfers in head and neck cancer reconstruction Am J Surg 1993; 166 (4):326–330 [24] Herle P, Shukla L, Morrison WA, Shayan R Preoperative radiation and free flap outcomes for head and neck reconstruction: a systematic review and meta-analysis ANZ J Surg 2015; 85(3):121–127 Head and Neck Cancer | 19.07.19 - 12:09 Salvage Surgery: Minimizing Wound Complications [25] Benatar MJ, Dassonville O, Chamorey E, et al Impact of preoperative radiotherapy on head and neck free flap reconstruction: a report on 429 cases J Plast Reconstr Aesthet Surg 2013; 66(4):478–482 [26] Ganly I, Patel S, Matsuo J, et al Postoperative complications of salvage total laryngectomy Cancer 2005; 103(10):2073–2081 [27] Sørensen LT Wound healing and infection in surgery The clinical impact of smoking and smoking cessation: a systematic review and meta-analysis Arch Surg 2012; 147(4):373–383 [28] Jeannon J-P, Orabi A, Manganaris A, Simo R Methicillin resistant Staphylococcus aureus infection as a causative agent of fistula formation following total laryngectomy for advanced head & neck cancer Head Neck Oncol 2010; 2:14 [29] Simo R, French G The use of prophylactic antibiotics in head and neck oncological surgery Curr Opin Otolaryngol Head Neck Surg 2006; 14(2):55–61 [30] Mitchell RM, Mendez E, Schmitt NC, Bhrany AD, Futran ND Antibiotic prophylaxis in patients undergoing head and neck free flap reconstruction JAMA Otolaryngol Head Neck Surg 2015; 141(12):1096–1103 [31] Khariwala SS, Le B, Pierce BH, Vogel RI, Chipman JG Antibiotic use after free tissue reconstruction of head and neck defects: short course vs long course Surg Infect (Larchmt) 2016; 17(1):100–105 [32] Yang SF, Nadimi S, Eggerstedt M, et al Antibiotic prophylaxis and postoperative wound infection rates in salvage surgery for head and neck cancer Head Neck Cancer Res 2016; 1:2 [33] Daniell CH, Fee WE, Jr MacFee incisions: dispelling the myth of cervical flap vascular inadequacy Head Neck Surg 1987; 9(3):167–171 [34] Yii N-W, Patel SG, Williamson P, Breach NM Use of apron flap incision for neck dissection Plast Reconstr Surg 1999; 103(6):1655–1660 [35] Tan BK, Por YC, Chen HC Complications of head and neck reconstruction and their treatment Semin Plast Surg 2010; 24(3):288–298 [36] Edwards R, Harding KG Bacteria and wound healing Curr Opin Infect Dis 2004; 17(2):91–96 [37] Giovinco NA, Bui TD, Fisher T, Mills JL, Armstrong DG Wound chemotherapy by the use of negative pressure wound therapy and infusion Eplasty 2010; 10:e9 [38] Lin YH, Hsu WS, Chung WY, Ko TH, Lin JH Silver-based wound dressings reduce bacterial burden and promote wound healing Int Wound J 2016; 13 (4):505–511 [39] Dire DJ, Coppola M, Dwyer DA, Lorette JJ, Karr JL Prospective evaluation of topical antibiotics for preventing infections in uncomplicated soft-tissue wounds repaired in the ED Acad Emerg Med 1995; 2(1):4–10 [40] Singer AJ, Dagum AB Current management of acute cutaneous wounds N Engl J Med 2008; 359(10):1037–1046 [41] Yao K, Bae L, Yew WP Post-operative wound management Aust Fam Physician 2013; 42(12):867–870 [42] Khanna S, Roy S, Bagchi D, Bagchi M, Sen CK Upregulation of oxidant-induced VEGF expression in cultured keratinocytes by a grape seed proanthocyanidin extract Free Radic Biol Med 2001; 31(1):38–42 [43] Philipp K, Riedel F, Germann G, Hörmann K, Sauerbier M TGF-beta antisense oligonucleotides reduce mRNA expression of matrix metalloproteinases in cultured wound-healing-related cells Int J Mol Med 2005; 15(2):299–303 [44] Hadad I, Johnstone BH, Brabham JG, et al Development of a porcine delayed wound-healing model and its use in testing a novel cell-based therapy Int J Radiat Oncol Biol Phys 2010; 78(3):888–896 [45] Chunmeng S, Tianmin C, Yongping S, et al Effects of dermal multipotent cell transplantation on skin wound healing J Surg Res 2004; 121(1):13–19 [46] Kim JH, Jung M, Kim HS, Kim YM, Choi EH Adipose-derived stem cells as a new therapeutic modality for ageing skin Exp Dermatol 2011; 20(5):383–387 [47] Lee SH, Jin SY, Song JS, Seo KK, Cho KH Paracrine effects of adipose-derived stem cells on keratinocytes and dermal fibroblasts Ann Dermatol 2012; 24 (2):136–143 [48] Hom DB, Adams G, Koreis M, Maisel R Choosing the optimal wound dressing for irradiated soft tissue wounds Otolaryngol Head Neck Surg 1999; 121(5): 591–598 [49] Dumville JC, Owens GL, Crosbie EJ, Peinemann F, Liu Z Negative pressure wound therapy for treating surgical wounds healing by secondary intention Cochrane Database Syst Rev 2015(6):CD011278 [50] Norman G, Dumville JC, Mohapatra DP, Owens GL, Crosbie EJ Antibiotics and antiseptics for surgical wounds healing by secondary intention Cochrane Database Syst Rev 2016; 3:CD011712 [51] Hurd T, Rossington A, Trueman P, Smith J A retrospective comparison of the performance of two negative pressure wound therapy systems in the management of wounds of mixed etiology Adv Wound Care (New Rochelle) 2017; 6(1):33–37 [52] Dhir K, Reino AJ, Lipana J Vacuum-assisted closure therapy in the management of head and neck wounds Laryngoscope 2009; 119(1):54–61 [53] Satteson ES, Crantford JC, Wood J, David LR Outcomes of vacuum-assisted therapy in the treatment of head and neck wounds J Craniofac Surg 2015; 26(7):e599–e602 [54] Borab Z, Mirmanesh MD, Gantz M, Cusano A, Pu LL Systematic review of hyperbaric oxygen therapy for the treatment of radiation-induced skin necrosis J Plast Reconstr Aesthet Surg 2017; 70(4):529–538 [55] Neovius EB, Lind MG, Lind FG Hyperbaric oxygen therapy for wound complications after surgery in the irradiated head and neck: a review of the literature and a report of 15 consecutive patients Head Neck 1997; 19(4):315– 322 [56] Nolen D, Cannady SB, Wax MK, et al Comparison of complications in free flap reconstruction for osteoradionecrosis in patients with or without hyperbaric oxygen therapy Head Neck 2014; 36(12):1701–1704 [57] Forastiere AA, Goepfert H, Maor M, et al Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer N Engl J Med 2003; 349(22):2091–2098 [58] Thom SR Hyperbaric oxygen: its mechanisms and efficacy Plast Reconstr Surg 2011; 127 Suppl 1:131S–141S [59] Freiberger JJ, Yoo DS, de Lisle Dear G, et al Multimodality surgical and hyperbaric management of mandibular osteoradionecrosis Int J Radiat Oncol Biol Phys 2009; 75(3):717–724 [60] Maeda T, Yamamoto Y, Tanaka S, Hayashi T Application of vacuum-assisted closure therapy and hyperbaric oxygen therapy for an exposed titanium plate after mandible reconstruction J Craniofac Surg 2016; 27(7):e601–e604 [61] Friedman HIF, Fitzmaurice M, Lefaivre JF, Vecchiolla T, Clarke D An evidencebased appraisal of the use of hyperbaric oxygen on flaps and grafts Plast Reconstr Surg 2006; 117(7) Suppl:175S–190S, discussion 191S–192S [62] Withers EH, Franklin JD, Madden JJ, Jr, Lynch JB Pectoralis major musculocutaneous flap: a new flap in head and neck reconstruction Am J Surg 1979; 138(4):537–543 [63] Bakamjian VY Milestones in modern plastic surgery A two-stage method for pharyngoesophageal reconstruction with a primary pectoral skin flap By V K Bakamjian 1965 Ann Plast Surg 1984; 13(3):243–252 [64] Ariyan S The pectoralis major myocutaneous flap A versatile flap for reconstruction in the head and neck Plast Reconstr Surg 1979; 63(1):73–81 [65] Gordin EA, Ducic Y Microvascular free tissue reconstruction in the patient with multiple courses of radiation Laryngoscope 2014; 124(10):2252–2256 [66] Chan JKK, Harry L, Williams G, Nanchahal J Soft-tissue reconstruction of open fractures of the lower limb: muscle versus fasciocutaneous flaps Plast Reconstr Surg 2012; 130(2):284–295 [67] Freeman JL, Brondbo K, Osborne M, et al Greater omentum used for carotid cover after pharyngolaryngoesophagectomy and gastric ‘pull-up’ or colonic ‘swing’ Arch Otolaryngol 1982; 108(11):685–687 [68] Bayles SW, Hayden RE Gastro-omental free flap reconstruction of the head and neck Arch Facial Plast Surg 2008; 10(4):255–259 [69] Genden EM, Kaufman MR, Katz B, Vine A, Urken ML Tubed gastro-omental free flap for pharyngoesophageal reconstruction Arch Otolaryngol Head Neck Surg 2001; 127(7):847–853 [70] Ellis H The aetiology of post-operative abdominal adhesions An experimental study Br J Surg 1962; 50(219):10–16 441 Head and Neck Cancer | 19.07.19 - 12:09 Index Note: Page numbers set bold or italic indicate headings or figures, respectively 3D modeling 138, 138, 139 A abdominal fat graft – parotid gland 276 – skull base 311 acellular grafts – scalp 380 – skull base 309, 309, 310, 310 actinic keratosis (AKs) 349, 362 adenocarcinoma – differential diagnosis 280, 281 – epidemiology 252, 280 adenoid cystic carcinomas – defect 274 – facial nerve paralysis 259, 259 – natural history 258, 280 – sinonasal, differential diagnosis 280, 283 – survival 280 ADEPT trial 164 afatinib 194 Agrawal, A 208 Aksu, G 13 alar defects 393 alcohol as risk factor 2, 33, 52, 84, 252 Alloderm 309, 309 ALT flap – buccal mucosa 46 – cheek/face 391 – laryngeal/hypopharyngeal 224, 226, 227 – oral commissure 391, 391 – oral tongue/FOM 27, 28, 29 – palatomaxillary 76, 76, 77 – parotid gland 272 – pharyngeal 102, 103, 115–116 – skull base 318, 319, 319 Amdur, R J 190 anaplastic thyroid carcinoma – adjunctive therapy 240 – epidemiology 239 – etiology 239 – follow-up 240 – presentation 239, 240 – prognosis 240 – staging 240, 240 – treatment 240 anatomy – body of mandible 132 – buccal mucosa 31, 31, 32, 43, 43 – carotid artery 157–158, 158 – cheek/face 383, 384 – facial nerve 383 – glossopharyngeal nerve 157 – hypoglossal nerve 157 – hypopharynx 181, 181, 182, 183, 217 – larynx 203, 203, 217 – lingual artery 156, 156 – mandible/composite defect 130 – mandibular alveolus 117, 117, 118 – nasopharynx 324, 324, 325 – oral tongue/FOM 19 – oral tongue/FOM, muscular 1, 442 – oral tongue/FOM, neurovascular 1, – oropharynx 141, 141, 142, 155, 156, 158–159, 170 – palatomaxillary 52, 53, 66, 66 – parotid gland 253, 254, 270 – pharynx (lateral) 85, 85, 87, 102 – ramus 131 – retromolar trigone 117, 117, 118 – salivary gland tumors 253, 254–255 – scalp 377 – skull base 304 – soft palate 94, 95, 102, 142 – soft palate, muscular/ neurovascular 103 – sublingual gland 254, 256 – submandibular gland 254, 255 – thyroid 230, 231 angiosarcoma, cutaneous 352 anterior pharyngotomy 148 antibiotics in salvage surgery 437 anxiety 151–152 atypical fibroxanthoma 352 Ayad, T 122 B Barbosa, J F 122, 123 basal cell carcinoma – adjunctive testing 354 – aggressive 350, 350 – biopsy 354 – diagnosis 353 – epidemiology 347 – genetics/molecular biology 348 – histopathology 350 – radiation-induced 349 – systemic agents 369 – topical agents 362 basal cell nevus syndrome 348 base of tongue cancer 158, 159, 161– 162, 172 basket trials 417, 418 Bataini, P 190–191 Bernier, J 60 betel quid 32, 34 Bethesda system, thyroid cytopathology 234 bicellular theory 256 bilayer button grafts 312 biopsy – carcinoma of unknown primary 400 – hypopharynx carcinoma 184 – nasopharynx 328 – oral tongue/FOM – palatomaxillary tumors 56 – pharyngeal cancer 88 – salivary gland tumors 260, 262 – sentinel lymph node 365, 366–367 – skin cancer 354 – thyroid carcinoma 233, 233, 234 Blackwell, K E 135 Blot, W J 142 body of mandible, anatomy 132 Bonawitz, S C 108 bone – mandibular bone invasion 119, 119 – preoperative assessment 121 bone grafts – composite 136 – mandible/composite defect 131, 131–132, 135 – nonautologous 136 – physiology 135 bone morphogenetic protein (BMP2) 136 bone scintigraphy 121 Bowen's disease 362 brachytherapy 335, 336 BRAF mutations 348, 369, 417 breast cancer 290 Brown, J S 67 buccal fat flap – buccal mucosa 49 – pharynx (lateral) 109, 110 buccal mucosa – anatomy 31, 31, 32, 43, 43 – carcinoma –– cheek flap 35, 36 –– chemotherapy 37, 38 –– clinical cases 39, 39, 40–41, 41 –– CT imaging 35, 35 –– diagnosis 35 –– etiology 33 –– follow-up 38 –– history 34 –– induction chemotherapy 38 –– mandibulectomy, marginal vs segmental 36, 36 –– metastatic lymphadenopathy 33 –– neck management 37 –– pathology 32, 33 –– physical examination 34 –– presentation 34 –– prevalence 31 –– primary surgical resection 35 –– radiation therapy 37, 38 –– staging 34, 34 –– transfacial resections 36 –– transoral resections 35 –– treatment complications 38, 38 –– tumor spread patterns 31, 32–33 –– workup 35, 35 – cheek/face 388, 390 – defect reconstruction –– ALT free flap 46 –– buccal fat pad flap 49 –– buccinator myomucosal flap 50 –– commissuroplasty 50 –– Estlander flap 50 –– evaluation of 43 –– facial artery musculomucosal flap 50 –– fibula osteocutaneous free flap 46, 47 –– flap design 44 –– goals of 44 –– lateral arm free flap 44, 46 –– mucosal grafts 51 –– primary closure 51 –– radial forearm flaps 44, 45 –– scapular osteocutaneous flap 46, 48–50 –– skin grafts 51 –– submental island flap 50 – lymphatic drainage 31 buccinator muscle 43, 43 buccinator myomucosal flap 50 butterfly shaped flap 116 Byers, R M 122, 122 C C225 414, 415 Calcaterra, T C 122, 124 Califano, J 143 carcinoma of unknown primary – background 397 – chemotherapy 402 – clinical case 402 – clinical presentation 398 – diagnosis 398 – epidemiology 397 – etiology 397 – FNA biopsy 400 – HPV-related disease 397, 400 – imaging 400 – neck management 402 – neck metastases 368 – nodal drainage patterns 398, 398– 400 – primary site prediction 398 – prognosis 397 – radiation therapy 402 – staging 397 – TORS 401, 401 – workup 398 carotid arteries – anatomy 157–158, 158 – microvascular reconstruction 431, 432 CDK4 mutations 348 CDKN2A mutations 348 central neck dissection 244, 244, 245 cephalic vein 430, 431 cephalic vessels 429 cervicofacial flap – cheek/face 386, 386, 387 – parotid gland 276 cetuximab – clinical trials, ongoing 417 – cutaneous SCC 369 – development of 413, 415, 415 – EPIC trial 416 – hypopharynx, recurrence 194 – mechanism of action 37, 415 – radiation therapy and 165, 416 checkpoint inhibitors 194, 297, 419, 420–421 cheek/face reconstruction – ALT flap 391 – anatomy 383, 384 – background 383 – buccal mucosa defects 388, 390 – cervicofacial flap 386, 386, 387 – defect evaluation 384 – eyelid 393 – gold/platinum weight 395 – lip 391, 392 – local flaps 385, 385 – microvascular free flaps 386, 389 – nasal 393, 394 – options 384 – primary closure 385, 385 – radiation therapy 388, 391 Head and Neck Cancer | 19.07.19 - 12:09 Index – revisions, refinements 395 – skin grafts 386, 386, 388 chemotherapy – buccal mucosa 37, 38 – carcinoma of unknown primary 402 – hypopharynx 189, 191, 192, 194 – induction, buccal mucosa 38 – induction, hypopharynx 192 – larynx cancer 212, 217 – metastatic NMSC 369 – nasopharynx 334 – oropharynx 150 – palatomaxillary tumors 60 – salivary gland tumors 265 – salvage surgery and 435 – sinonasal malignancies 297 – soft palate cancer 95 – TORS 164 Chepeha, D B 20, 82, 318 Chevalier, D 186 chondrosarcoma 288, 288, 289–290 chordoma 288, 288, 289 Christensen implant 130 Chung, E J 189 cisplatin 37, 334 clinical cases – bilateral neck dissection 98, 98 – buccal mucosa 39, 39, 40–41, 41 – carcinoma of unknown primary 402 – HPV-related disease 165–166 – hypopharynx 194, 195–196 – malignant melanoma 298–299 – medullary thyroid carcinoma 249, 249–250 – melanoma 371, 372 – nasopharynx 339, 340–341, 341, 342, 342 – oral tongue/FOM 14, 15, 15, 16 – palatomaxillary tumors 60, 61, 61, 62, 62 – papillary thyroid carcinoma 247, 247, 248, 248, 249 – parotid gland 267 – pharynx (lateral) 96–97 – salivary gland tumors 267 – sinonasal malignancies 298 – skin cancer 370 – squamous cell carcinoma 370, 371, 371 – surveillance 406, 407–409, 409, 410–411 – thyroid carcinoma 247 – tongue cancer 406, 407, 409, 409, 410 – tonsil cancer/retropharyngeal node 87, 96, 97 – tonsillar carcinoma 409, 411 – TORS 165 collagen matrix 309, 310, 310 colonic interposition 225 commissuroplasty 50 computer-aided planning 138, 138, 139 CONDOR trial 421 condyle 130, 131–132 Connell straight closure 221, 221 Cooper, J S 60 CORD classification 172 Cordeiro, P G 67, 75 cryotherapy 359, 363 CTL antigen (CTLA4) 420–421 CTLA-4 protein inhibitors 369 D da Vinci robot 154 dacryocystorhinostomy 74 Dahm, J D 211 De-ESCALaTE trial 165 deltopectoral fasciocutaneous flap 223 dental implants 139 dental trauma (chronic) as risk factor 2, 4, Deo, S V 122, 123 depression 151–152 dermatofibrosarcoma protuberans 352 diet limitations 20 diffuse large B-cell lymphoma 287 digastric flaps – lateral pharynx 218 – pharyngeal/soft palate 111, 113 dimethylnitrosamine 325 drug development – background 413 – basket trials 417, 418 – clinical trial phase 414 – clinical trials, ongoing 417 – phase I study 414 – phase II study 415 – phase III study 416 – phase IV study 416 – post-approval monitoring 414 – preclinical phase 413, 414 – process of 413, 414 – umbrella trials 417, 418 Dubois, J B 190 Duragen 309, 309 durvalumab 421 Duvvuri, U 108 E EAGLE trial 421 ECOG 1308 trial 165 ECOG E3311 trial 164 Edson, M A 191 EGFR inhibitors 369, 414 electrodissection/curettage 359 enteric transposition flaps 225 enzymatic topical treatments 438 EPIC trial 416 Epstein-Barr virus 325, 329, 400 erlotinib 194, 369 esthesioneuroblastoma 286, 286, 287, 299 Estlander flap 50 extended commando operation 123 extracapsular extension (ECE) 60 extranodal natural killer/T-cell lymphoma 287 EXTREME trial 194 eyelid reconstruction 393 F facial nerve – anatomy 383 – paralysis 259, 259 – reconstruction 394 FAMM flap – buccal mucosa 50 – oropharynx 173, 174 – pharyngeal 108–109 Fanconi's anemia fasciocutaneous free flaps 224 Fein, D A 190–191 femur flap 135, 138 fibroxanthoma, atypical 352 fibula free flap – buccal mucosa 46, 47 – mandible/composite defect 134, 135, 136 – palatomaxillary 72, 72, 72, 73, 73, 74, 74, 75 fish, salted 325 flap closure 221 FNA biopsy 233, 234, 260, 262 follicular thyroid carcinoma – epidemiology 236 – etiology 236 – presentation 236 – treatment 236 Ford, S 147 foveocranial defects reconstruction 308 free mucosal grafts 311 Futran, N A 72, 75 G gabapentin 334 Garvey, P B 136 gasket seal 312 gastric pull-up 225 gastro-omental free flap 439, 439–440 gefitinib 194, 369 Genden, E M 104 genetic model of cancerization 143 Gilbert, R W 75 Gillison, M 145 glossopharyngeal nerve anatomy 157 glottic carcinoma 203, 204, 208, 213, 213, 213–214 gold/platinum weight – cheek/face 395 – parotid gland 276 Goldstein, G P 13 Gomez, D 122 Gorlin's syndrome 348 GORTEC trial 146 Gupta, T 191 H Hao, S P 122 HAWK trial 421 hemangiopericytoma 288, 290, 290– 291 hematoma, postoperative 246 Hitchcock, K E 122, 122 Hoffman, H T 185 Hong, W K 212 horizontal partial laryngectomy 209, 210 HPV-related disease – adjuvant chemoradiation 164 – as risk factor 84–85, 180 – carcinoma of unknown primary 397, 400 – clinical cases 165–166 – clinical presentation 145 – de-escalation 90, 97, 164 – distant metastasis 160 – epidemiology 154 – etiology 145, 155 – extracapsular spread 159 – hematogenous dissemination 161 – immunology 145 – matted lymph nodes in 159 – outcomes 155 – spread patterns 160 – staging 146, 146 – surgical treatment 147 – survival 159 – tonsillar tumors 155 – tumor status determination 86, 86 – VEGF in etiology of 160 HPV16 155, 397 Huang, C J 122, 122 Hull, M C 190–191 Hürthle cell carcinoma – adjunctive therapies 237 – epidemiology 236 – etiology 236 – presentation 237 – treatment 237 – variants 237 hyperbaric oxygen 438 hyperparathyroidism 239 hypoglossal nerve anatomy 157 hypoparathyroidism 247 hypopharynx, see pharynx (lateral) – anatomy 181, 181, 182, 183, 217 – carcinoma –– adjuvant chemoradiation 191, 193 –– adjuvant radiotherapy 191, 191 –– advanced-stage disease treatment 186–187, 191, 191 –– background 180 –– biopsy 184 –– chemoradiotherapy 192 –– chemotherapy 189, 191, 192, 194 –– clinical cases 194, 195–196 –– diagnosis 184 –– early-stage disease treatment 186, 186, 187, 187, 190, 190 –– epidemiology 180, 217 –– etiology 180 –– follow-up 193 –– hemithyroidectomy/total thyroidectomy 188 –– history 183 –– imaging 184, 185, 193 –– immunotherapy 194 –– induction chemotherapy 192 –– laryngeal preservation surgery 188, 188 –– lateral pharyngotomy 187 –– metastatic survey 184 –– neck management 189 –– nodal metastases 189 –– open surgical approaches 187, 187 –– organ-preservation trials 186 –– panendoscopy 184 –– physical examination 183 –– presentation 183 –– prognosis 185, 186 –– radiation therapy 189, 189, 190, 190, 191, 191 –– recurrence treatment 193–194 –– spread patterns 181, 181, 182, 182, 183 –– staging 182, 183 –– surgical approaches 187 –– targeted agents 194 –– transhyoid approach 187, 187 –– transoral approaches 188 –– treatment 185–186 –– workup 184 443 Head and Neck Cancer | 19.07.19 - 12:09 Index – lymphatic drainage 182, 183, 398, 400 – reconstruction –– complications prevention 222 –– defect classification 218, 219 –– microvascular enteric flaps 225 –– microvascular fasciocutaneous flaps 226 –– partial pharyngectomy defects 218, 220, 220 –– patch 223 –– physiologic considerations 217 –– posterior pharyngeal wall 218 –– primary closure 220, 220, 221 –– primary closure/bolster flap 222, 222 –– regional tissue transfer 223 –– salivary bypass tubes 227 –– total laryngectomy 220, 224 – swallowing rehabilitation 227 – voice rehabilitation 227 I iliac crest flap – internal oblique muscle, palatomaxillary 80, 80, 81, 81, 82 – mandible/composite defect 135, 137 – palatomaxillary 75 iliac crest myo-osseous flap 77 imaging – buccal mucosa 35, 35 – hypopharynx 184, 185, 193 – microvascular 432, 433 – nasopharynx 327, 327, 329, 330, 331, 331 – oral tongue/FOM SCC 7, 8, – oropharynx 143, 144 – palatomaxillary tumors 56, 57 – salivary gland tumors 261, 261, 262, 262, 266–267 – sinonasal malignancies 293 – skin cancer 354, 355 – thyroid carcinoma 233 imiquimod 362–363 immunotherapy – development of 419, 419 – head/neck cancer 420 – hypopharynx carcinoma 194 – melanoma 419 – sinonasal malignancies 297 INK4a/ARF mutations 348 interferon-Ỵ±-2b (IFN-Ỵ±-2b) 419 interleukin (IL-2) 419 internal mammary vessels 428, 428, 429 inverting papilloma 278, 292 ipilimumab 297, 369, 420 irinotecan 416 Irish, J C 305, 306 J jejunal free flap 225 Johnson, J T 150 Jones, A S 212 K Kaposi's sarcoma 56 Karapandzic technique 391 Karatzanis, A D 186, 188 444 KEYNOTE-012 421 KEYNOTE-48 421 Khuri, F R 143 Kokemueller, H 13 Kowalski, L P 122, 123 Kurokawa, H 13 L Laccourreye, O 186, 188 Lam, L 20 Lapierre, E 138 laryngectomy – defect classification 218, 219 – horizontal partial 210 – salvage 222 – vertical partial 209, 209 larynx – anatomy 203, 203, 217 – cancer –– case studies 213, 213 –– chemotherapy 212, 217 –– diagnosis 207 –– distant metastasis 206, 212 –– epidemiology 203, 217 –– etiology 203 –– function preservation therapies 208 –– innervation 204 –– neck management 212 –– paraglottic space 204, 204 –– presentation 205 –– radiation therapy 210, 212, 217 –– regional disease 206, 207 –– spread patterns 203, 204 –– staging 205, 205, 206 –– subglottic region 204 –– surgical treatment 208 –– total laryngectomy 209, 211, 218 –– transcervical approaches 208, 208, 209 –– transoral approaches 208, 208, 209 –– treatment 208, 218 –– workup 207 – lymphatic drainage 207 – reconstruction –– complications prevention 222 –– defect classification 218, 219 –– goals of 217 –– microvascular enteric flaps 225 –– microvascular fasciocutaneous flaps 226 –– partial pharyngectomy defects 218, 220, 220 –– patch 223 –– physiologic considerations 217 –– primary closure 220, 220, 221 –– primary closure/bolster flap 222, 222 –– regional tissue transfer 223 –– salivary bypass tubes 227 –– total laryngectomy 220, 224 – speech rehabilitation 218 – swallowing rehabilitation 227 – voice rehabilitation 227 laser ablation 362, 363 lateral arm free flap – buccal mucosa 44, 46 – parotid gland 271, 271, 272–273 lateral neck dissection 245, 246 lateral pharyngeal cancer, see under pharynx (lateral) lateral pharyngotomy 149 latissimus dorsi flap – laryngeal/hypopharyngeal 224 – palatomaxillary 76, 76, 77 – scalp 379 lentigo maligna 352, 353, 362–363 lentigo maligna melanoma 353, 363 lingual artery anatomy 156, 156 lip reconstruction 391, 392 – See also oral commissure Lo Galbo, A M 188 lower lip wedge excision 277 Lydiatt, W M 151 lymphatic drainage – buccal mucosa 31 – carcinoma of unknown primary 398, 398–400 – CNS 161 – hypopharynx 182, 183, 398, 400 – larynx 207 – mandibular alveolus 117 – minor salivary glands 256 – nasopharynx/nose 324, 398, 399 – oral tongue/FOM 1, 3–4, 398, 398– 399 – oropharynx 141, 142, 158, 159 – palatomaxillary 60, 87 – retromolar trigone 117 – skin cancer 363, 364, 366 – soft palate 94, 95, 142, 399 – sublingual glands 256 – submandibular gland 255–256 – thyroid 230 – tongue base 159, 399 – tongue, lateral 398, 399 – tonsil/hard palate 400 lymphoma 241 M MAC-NPC study 334 Machtay, M 150, 417 mandible/composite defect reconstruction – 3D modeling 138, 138, 139 – anatomy 130 – background 130 – BMP-2 136 – body of mandible 132 – bone grafts 131, 131–132, 135 – bone grafts, physiology 135 – bridging titanium plates 135 – classification systems 133 – condyle 130, 131–132 – dental implants 139 – evaluation of 133, 134 – femur flap 135, 138 – fibula free flap 134, 135, 136 – free flap options 134, 135 – goals of 132 – iliac crest flap 135, 137 – nonosseus options 135 – prostheses 130, 131 – radial forearm flap 135, 137 – ramus 131 – reconstruction bar 135 – scapula free flap 135, 137 – serratus flap 135, 137 – symphysis 132, 133 – virtual planning 138, 138, 139 mandibular alveolus – anatomy 117, 117, 118 – background 117 – bone, preoperative assessment 120, 121 – clinical features 118 – etiology 118 – lymphatic drainage 117 – mandibular bone invasion 119, 119 – marginal mandibulectomy 123–126, 126 – nodal metastases 120 – patterns of spread 119, 119, 124 – presentation 118 – prognosis 123, 126, 127 – radiation therapy 122 – recurrence 127 – segmental mandibulectomy 126, 127 – staging 120, 120 – surgical treatment 123, 124–125 – survival 120, 124–126 – treatment complications 123 – treatment modality 121, 122 mandibular osteoradionecrosis 38, 38 mandibular swing 92, 93 marginal mandibulectomy 123–126, 126 Marshall, D M 68 Martin, A 186 Martin, D 22 masseteric nerve 395 maxillary carcinoma, see palatomaxillary tumors maxillectomy – defect rehabilitation 295 – inferior 72 – total 58, 58, 59 – total/orbital exenteration 82 – total/orbital preservation 74, 74, 75 MC1 R mutations 348 MEDI4736 trial 421 medullary thyroid carcinoma – adjunctive therapies 239 – clinical cases 249, 249–250 – epidemiology 238 – etiology 238 – follow-up 239 – hereditary 238 – presentation 238 – prognosis 239 – staging 239, 239 – treatment 238 Mehanna, H 212 melanoma, see skin cancer – ABCDE evaluation 353 – acral lentiginous 353 – advanced unresectable, systemic therapy 369 – clinical cases 371, 372 – cutaneous –– epidemiology 347 –– genetics/molecular biology 348 –– precursor lesions 349 –– prevention 370 –– previous malignancy 349 –– risk factors 349 –– staging 355, 356–357, 357, 358, 364 –– treatment, primary lesion 359 – desmoplastic 353 – distant metastasis 359, 369 – etiology 348 – immunotherapy in 419 – lentigo maligna 352, 353, 362–363 – lentigo maligna melanoma 353, 363 – localized Head and Neck Cancer | 19.07.19 - 12:09 Index –– classification/staging 357 –– excision 362 –– treatment 362 – malignant clinical cases 298–299 – metastases, multimodality therapy 368 – Mohs' micrographic surgery 362 – mucosal 56, 280, 282 – nodal metastases 364, 366 – nodular 353 – pathology report components 351 – prognosis 364 – radiation therapy 363 – regional metastasis –– classification/staging 357 –– detection of 367 –– diagnosis/treatment 363 –– radiation therapy 368 – staging 356, 357 – superficial spreading 353 – treatment 362–363 – unknown primary/neck metastases 368 – workup 354 Memorial Sloan Kettering Cancer Center 55 Mendenhall, W M 122, 122 Meoz-Mendez, R T 190 Mercante, G 163 Merkel cell carcinoma 347, 351 microcystic adnexal carcinoma 352 microvascular reconstruction, see neck management – background 423 – carotid arteries 431, 432 – cephalic vein 430, 431 – cephalic vessels 429 – cheek/face 386, 389 – flap failure 423 – imaging 432, 433 – internal mammary vessels 428, 428, 429 – radial forearm flap 431 – recipient vessels selection 423, 424 – retrograde-flow venous drainage 427 – superficial temporal vessels 426, 427, 427 – thoracoacromial artery 429 – thoracoacromial vessels 429 – transverse cervical vessels 424, 425– 426 Miles, B A 75 Mohs' micrographic surgery 360, 362 Mok, G 191 Moore, E J 163 Mosleh-Shirazi, M S 13 Mount Sinai classification system 67 Mount Sinai surveillance protocol 406 mucositis 334 Muir-Torre syndrome 352 multicellular theory 256 N Nameki, H 305 nasal reconstruction 393, 394 nasopharyngectomy 336, 337–339 nasopharynx – anatomy 324, 324, 325 – biopsy 328 – brachytherapy 335, 336 – cervical metastasis 326, 326, 335 – chemotherapy 334 – clinical cases 339, 340–341, 341, 342, 342 – diagnosis 327, 328 – distant metastasis 327, 334 – EBV serology 329 – endoscopic examination 328, 328, 329 – epidemiology 324 – etiology 324 – external beam radiotherapy 336 – histopathology 324 – imaging 327, 327, 329, 330, 331, 331 – lymphatic drainage 324, 398, 399 – metastatic, chemotherapy for 334 – nodal metastasis 328 – persistent 335–336 – plasma EBV DNA titer 329 – presentation 326, 326 – radiation therapy 329, 332, 333 – radiation therapy side effects 333– 334 – recurrence 331, 334–336 – salvage surgery 336 – staging 331, 332 – surgical treatment 336 – treatment 332 – workup 327 nasoseptal flap 309, 313, 314 National Lung Matrix Trial 417 neck management, see microvascular reconstruction – buccal mucosa carcinoma 37 – carcinoma of unknown primary 402 – central neck dissection 244, 244, 245 – hypopharynx carcinoma 189 – laryngeal cancer 212 – lateral neck dissection 245, 246 – nasopharynx cancer 335 – oropharyngeal cancers 150 – palatomaxillary tumors 59 – papillary thyroid carcinoma 235 – pharyngeal cancer (lateral) 90 – salivary gland tumors 264 – skin cancer 365, 368 – skin cancer metastases, multimodality therapy 368 – TORS 163 – watchful waiting 365 necrotizing sialometaplasia 56 negative pressure wound therapy 438 neuroendocrine carcinoma 285, 285, 285, 286 neurofibromatosis type 158 nicotine 52 Nielson, K A 151 nivolumab 297, 369 nodal drainage patterns, see lymphatic drainage non-Hodgkin lymphoma 287 non-recurrent laryngeal nerve 231, 232 NRAS mutations 348 O O'Brien, C J 356, 365 O'Sullivan, B 89 obturator/palatal lift prosthesis 95, 96 Okuyemi, O T 13 olfactory neuroblastoma 286, 286, 287, 299 oral cavity, see mandibular alveolus, retromolar trigone oral commissure – commissuroplasty 50 – lip reconstruction 391, 392 – reconstruction 391, 392 – suspension 276 oral lichen planus as risk factor 3, oral tongue/FOM – anatomy 19 – lymphatic drainage 1, 4, 398, 398– 399 – reconstruction –– allografts, synthetic 22 –– ALT free flap 27, 28, 29 –– background 19 –– bulk restoration 20 –– defect classification 20 –– defect evaluation 19 –– FAMM flaps 24, 25 –– free flaps 25 –– goals of 19, 20 –– local flaps 22 –– options for 20 –– outcome assessment 19 –– postoperative changes 20 –– primary closure 21, 21–22 –– radial forearm free flaps 25, 26, 26, 27, 27 –– secondary intention 20 –– sensory innervation 20 –– skin grafts 22 –– submental flaps 22, 23, 23, 24, 24 –– surgery adjuncts 29 – SCC –– adjuvant therapy 12 –– biopsy –– clinical cases 14, 15, 15, 16 –– clinical presentation –– clinicopathologic models, prognosis 14 –– CT imaging 8, –– depth of invasion 8–9, 9, 14 –– diagnostic evaluation –– etiology –– failure patterns 13 –– genetic testing –– histologic risk assessment 9, 9, 14, 14 –– history –– imaging –– immunosuppression 14 –– incidence –– lymphatic drainage 1, 3–4 –– mandibulectomy 10–11, 11 –– margin status 11, 14 –– microscopic tumor cut-through 11 –– MRI –– muscular anatomy 1, –– negative margins 11 –– neurovascular anatomy 1, –– outcomes 13 –– pathology 2, 4, 8, –– perineural invasion 14 –– PET/CT –– physical examination 6, –– primary nonsurgical management 13 –– primary tumor surgery 10, 10 –– prognosis 9, 11, 13 –– regional metastasis 11 –– risk factors –– staging 5, 5, 6, –– submandibular gland preservation 12 –– survival 13, 13, 14 –– treatment 10 –– tumor thickness 8, 9, 14 –– ultrasound orbital prosthesis 320 oropharynx – anatomy 141, 141, 142, 155, 156, 158–159, 170 – cancers, see HPV-related disease, under pharynx (lateral) –– anterior pharyngotomy 148 –– brain metastases 161 –– chemotherapy 150 –– clinical presentation 143, 158, 159 –– distant metastasis 160 –– epidemiology 142 –– etiology 142 –– extracapsular spread 150, 159 –– gastrostomy tubes, prophylactic 151 –– hematogenous dissemination 161 –– HPV negative 142, 143, 158 –– HPV positive 143, 145–146, 158, 160 –– imaging 143, 144 –– lateral pharyngotomy 149 –– lung metastases 161 –– multiple subsite disease 149 –– neck management 150 –– nodal disease 144 –– nonoperative treatment 146 –– pathology 143 –– prognosis 150, 159, 161 –– psychosocial issues 151 –– pull-through procedure 149, 149 –– radiation therapy 146, 150–151, 151 –– recurrence 163 –– second primary malignancy 143 –– segmental mandibulectomy 149 –– spread patterns 160 –– surgical treatment 147 –– transcervical approach 148 –– transoral approaches 147, 148 –– treatment complications 150, 150 –– treatment of 146 –– work-up 143 – lymphatic drainage 141, 142, 158, 159 – reconstruction –– background 169 –– defect classification 105–106, 172 –– defect evaluation 170, 171 –– FAMM flap 173, 174 –– goals of 169, 170 –– options, selection of 171 –– pectoralis major flap 169, 169, 172, 174, 174, 175–176, 176 –– radial forearm flap 176, 177, 177 –– skin grafts 172 –– soft palatal defect 170, 171 –– TORS 177, 177 – swallowing rehabilitation 151 osteocutaneous flap 274, 274 osteoinduction 136 Overholt, S M 122 P Paget's disease 362 palatal island flap 445 Head and Neck Cancer | 19.07.19 - 12:09 Index – palatomaxillary 68, 69–70 – pharynx (lateral) 106, 107, 107–108 palatomaxillary reconstruction – ALT flap 76, 76, 77 – anatomy 66, 66 – bony 66, 66 – defect classification 67 – defect evaluation 67 – fibula free flap 72, 72, 72, 73, 73, 74, 74, 75 – flap selection 67, 67 – flaps 65–66, 66 – goals of 65, 65 – iliac crest free flap 75 – iliac crest free flap/internal oblique muscle 80, 80, 81, 81, 82 – iliac crest myo-osseous flap 77 – latissimus dorsi flap 76, 76, 77 – lymphatic drainage 60, 87, 400 – maxillectomy, inferior 72 – maxillectomy, total/orbital exenteration 82 – maxillectomy, total/orbital preservation 74, 74, 75 – palatal island flap 68, 69–70 – palate defects 68 – pedicled temporalis flap/skin grafting 72 – prosthetic 65, 71 – radial forearm flap 68, 69, 70, 70– 71, 72, 72 – rectus abdominis flap 76, 76, 77 – scapula free flap 77, 78–79, 79, 80 – scapular angle free flap 80 – subscapular system in 75 palatomaxillary tumors – ablative approaches 58 – anatomy 52, 53 – biopsy 56 – chemotherapy 60 – clinical cases 60, 61, 61, 62, 62 – clinical presentation 55 – diagnosis 56 – differential diagnosis 56 – etiology 52, 52 – followup 60 – imaging 56, 57 – malar aspect surgical approaches 59, 59 – metastases 55 – neck treatment 59 – of salivary origin 52 – prevalence 52 – primary tumor resection 57, 58–59 – prognostic factors 54 – radiation therapy 60 – recurrence 55, 59–60 – spread patterns 54, 54 – staging 54, 55 – transoral inferior maxillectomy 58 – treatment 57 – workup 56 Pandey, M 126 panendoscopy 184 panitumumab 369 papillary thyroid carcinoma – adjunctive therapies 235 – clinical cases 247, 247, 248, 248, 249 – epidemiology 234 – etiology 234 – neck management 235 – presentation 235 – treatment 235 446 – variants 236 paraglottic space 204, 204 parasagittal orbitocranial defects reconstruction 317, 318 parascapular fasciocutaneous flap 274, 274 parathyroid glands 231, 232 parotid duct 43, 43 parotid gland – abdominal fat graft 276 – ALT flap 272 – anatomy 253, 254, 270 – cervicofacial advancement flap 276 – clinical cases 267 – defect evaluation 270 – facial nerve management 276 – facial nerve preservation 263 – gold/platinum weight 276 – lateral arm free flap 271, 271, 272– 273 – lower lip wedge excision 277 – monitors, intraoperative 264 – oral commissure suspension 276 – osteocutaneous flap 274, 274 – parascapular fasciocutaneous flap 274, 274 – presentation 260 – radial forearm flap 274, 275 – reconstruction 266, 270 – reconstruction goals 270 – rectus abdominis flap 275 – submental island flap 275 – treatment 263, 263 partial patch flap closure 221 partial pharyngectomy defects 218, 220, 220 Pascoal, M B 125 Patel, M R 305 Paterson-Brown-Kelly syndrome 180 pathology report components 351 PATHOS trial 165 patient surveillance, see surveillance PD-1/PD-L1 inhibitors 194, 297, 369, 419, 420 Peck, B W 143 pectoralis major flap – laryngeal/hypopharyngeal 223 – oropharynx 169, 169, 172, 174, 174, 175–176, 176 pembrolizumab 297, 369, 420 pericranial flap 309, 313–314, 315, 315 Petruzzelli, G J 125 pharyngotomy – anterior 148 – lateral 149 pharynx (lateral), see hypopharynx – anatomy 85, 85, 87, 102 – cancer –– biopsy 88 –– clinical cases 96–97 –– clinical presentation 86 –– diagnosis 88, 98 –– elective neck dissection 90 –– epidemiology 84 –– etiology 84 –– followup 93, 93 –– HPV tumor status determination 86, 86 –– HPV-related disease, deescalation 90, 97 –– immunohistochemistry 86 –– mandibular swing 92, 93 –– metastases 86 –– –– –– –– –– –– –– –– –– –– –– –– –– –– –– multimodal therapy 90 nodal metastasis 87, 87, 88 pathology 85, 86 physical examination 87 prognosis 88 risk factors 84 spread patterns 87 staging 89, 89, 90–91, 93 surgical technique 90, 91 TORS 91 tracheostomy indications 92 transcervical approach 91, 92 transoral approaches 91 transoral laser microsurgery 91 transoral lateral oropharyngectomy 91 –– treatment 89, 98 –– treatment complications 92 –– tumor margins 90 –– unimodal therapy 89 –– workup 88, 88 – reconstruction –– algorithm 106 –– ALT free flap 102, 103, 115–116 –– buccal fat flap 109, 110 –– defect evaluation 103 –– FAMM flap 108–109 –– mandibulotomy 102, 102 –– options 218, 220 –– palatal island flap 106, 107, 107– 108 –– radial forearm free flap 113–115 –– regional muscle flaps 111 –– secondary intention 105–106 –– submental island flap 111, 112–114 –– temporoparietal fascia (TPF) flap 110 –– TORS defect classification 104, 104 –– transoral approaches 102 –– type I/II defects 104, 105, 105 –– type III/IV defects 105, 105, 106, 115 –– ulnar flap 113–115 pheochromocytoma 239 photodynamic therapy 361 Pignon, J P 146, 192 Plummer-Vinson syndrome 180 postcricoid tumors 182, 182, 197, 197, 198–199 postoperative radiation therapy (PORT) 60 Prader-Willi syndrome 158 primary closure – bolster flap, larynx 222, 222 – buccal defects 51 – cheek/face 385, 385 – larynx 220, 220, 221 – oral tongue/FOM 21, 21–22 – suture techniques 221, 221 proliferative verrucous leukoplakia 3, prostheses – obturator/palatal lift 95, 96 – orbital 320 – palatomaxillary 65, 71 – TMJ 130, 131 PTCH mutations 348 pull-through procedure 149, 149 pyriform sinus malignancies 181, 181, 189, 192, 194, 195, 195, 196, 196 Q Quarterback trial 165 R radial forearm flap – buccal mucosa 44, 45 – laryngeal/hypopharyngeal 224, 226 – mandible/composite defect 135, 137 – microvascular 431 – oral tongue/FOM 25, 26, 26, 27, 27 – oropharynx 176, 177, 177 – palatomaxillary 68, 69, 70, 70–71, 72, 72 – parotid gland 274, 275 – pharyngeal 113–115 – scalp 379 – skull base 317, 317 radiation therapy – adjuvant, hypopharynx carcinoma 191, 191 – buccal mucosa carcinoma 37, 38 – carcinoma of unknown primary 402 – cetuximab and 165, 416 – cheek/face 388, 391 – Hürthle cell carcinoma 237 – hypopharynx carcinoma 189, 189, 190, 190, 191, 191 – larynx cancer 210, 212, 217 – mandibular alveolus cancer 122 – melanoma 363 – melanoma regional metastasis 368 – nasopharynx 329, 332, 333, 336 – nasopharynx, side effects 333–334 – oropharynx 146, 150–151, 151 – palatomaxillary tumors 60 – papillary thyroid carcinoma 235 – retromolar trigone cancer 122–123 – salivary gland tumors 264 – salvage surgery and 435 – sinonasal malignancies 297, 298 – skin cancer 361 – soft palate cancer 95 – TORS 164–165 ramus 131 rectus abdominis flap – palatomaxillary 76, 76, 77 – parotid gland 275 – scalp 379 – skull base 320 recurrent laryngeal nerve 231 recurrent laryngeal nerve injury 246 remote access thyroid surgery 244 renal cell carcinoma 290 retrograde-flow venous drainage 427 retromolar operation 123, 125 retromolar trigone – anatomy 117, 117, 118 – background 117 – bone, preoperative assessment 120, 121 – bony resection margins 123 – clinical features 118 – etiology 118 – lymphatic drainage 117 – mandibular bone invasion 119, 119 – marginal mandibulectomy 123–126, 126 – nodal metastases 120 – patterns of spread 119, 119 – presentation 118 – prognosis 123, 126, 127 – radiation therapy 122–123 – recurrence 127 – staging 120, 120 – surgical treatment 123, 124–125 Head and Neck Cancer | 19.07.19 - 12:09 Index – survival 120, 124–126 – treatment complications 123 – treatment modality 121, 122 rhabdomyosarcoma 286 RMT, see retromolar trigone Robb, G L 20 RT-PCR 367 RTOG 91-11 study 210–212, 222 RTOG 0920 417 RTOG-1016 trial 165 S Saethre-Chotzen syndrome 158 salivary bypass tubes 227 salivary gland tumors, see specific glands – anatomy 253, 254–255 – background 252 – cervical metastasis 259, 262, 264 – chemoradiation 265 – chemotherapy 265 – classification 256, 257 – clinical cases 267 – clinical presentation 56, 259 – development of 256 – diagnosis 260 – differential diagnosis 56, 262 – distant metastasis 262 – embryology 253 – epidemiology 252 – etiology 252, 253 – facial nerve paralysis 259, 259 – FNA biopsy 260, 262 – followup 266 – grading 258, 258–259 – histology 259 – history 259 – imaging 261, 261, 262, 262, 266–267 – lateral commissure management 266 – minor glands 256, 260, 264 – neck management 264 – perineural invasion 266 – physical examination 260 – prognosis 258 – radiation therapy 264 – reconstruction 266 – soft tissue 266 – staging 257, 257, 258, 259 – surgery 258 – surgical margins 259 – systemic therapy 265 – targeted therapy 265 – treatment 252, 263–264 salvage surgery – antibiotics 437 – background 435 – chemoradiation effects 435 – hyperbaric oxygen 438 – indications 435, 436 – laryngectomy 222 – nasopharynx 336 – preoperative management 437 – reconstruction 438, 439–440 – TORS as 163 – wound biology, pathophysiology 435, 435 – wound complications in 436, 436 – wound healing, local 438 Samman, N 20 Santamaria, E 67 Santoro, R 211 scalp reconstruction – anatomy 377 – artificial dermal grafts 380 – background 377 – calvarial defects 380, 381–382 – defect classification 377 – flaps, local 378, 379 – flaps, regional 379, 380–381 – free tissue transfer 379 – hair transplantation 380 – options for 378 – skin grafts 378 – tissue expanders 378 scapula free flap – mandible/composite defect 135, 137 – palatomaxillary 77, 78–79, 79, 80, 80 – scalp 379 scapular donor site 48, 50 scapular osteocutaneous flap 46, 48– 50 scapular tip osteocutaneous free flap 320, 321 SCC, see squamous cell carcinoma sebaceous carcinoma 352 segmental mandibulectomy – buccal defect 46, 48–50 – oropharynx 149 sentinel lymph node biopsy 365, 366– 367 serous otitis media 326 serratus flap – mandible/composite defect 135, 137 – pharynx (lateral) 222, 222 Sessions, D G 13 Shestak, K C 74 sinonasal malignancies – cavernous sinus management 296 – chemotherapy 297 – chondrosarcoma 288, 288, 289–290 – chordoma 288, 288, 289 – clinical cases 298 – clinical presentation 278, 292 – clival lesions 283, 288–289, 296 – diagnosis 292 – differential diagnosis 278 – endoscopic surgery 294 – epidemiology 278 – esthesioneuroblastoma 286, 286, 287, 299 – etiology 278, 278 – extranodal natural killer/T-cell lymphoma 287 – hemangiopericytoma 288, 290, 290– 291 – histopathologic markers 286 – imaging 293 – immune therapies 297 – infratemporal fossa involvement 296 – management 293 – maxillectomy defect rehabilitation 295 – metastasis 290, 291 – NCCN guidelines 293 – neuroendocrine carcinoma 285, 285, 285, 286 – non-Hodgkin lymphoma 287 – orbital management 281, 283–284, 296 – physical examination 280, 292 – pterygopalatine fossa involvement 296 – – – – – – – – radiation therapy 297, 298 rhabdomyosarcoma 286 staging 290, 292 surgery, open technique 294, 295 surgery, open vs endoscopic 294 surgical complications 297 survival 290 undifferentiated carcinoma 280, 284, 286 – workup 292 SIRS trial 164 skin cancer – adjunctive testing 354 – angiosarcoma, cutaneous 352 – atypical fibroxanthoma 352 – BCC, see basal cell carcinoma – biopsy 354 – clinical cases 370 – cryotherapy 359, 363 – dermatofibrosarcoma protuberans 352 – diagnosis 353 – elective neck dissection 365 – electrodissection/curettage 359 – epidemiology 347 – etiology 348 – histopathology 350 – history 353 – imaging 354, 355 – immune compromise 350 – laser ablation 362, 363 – lymphatic drainage 363, 364, 366 – melanoma, see melanoma – Merkel cell carcinoma 347, 351 – metastatic 354 – microcystic adnexal carcinoma 352 – Mohs' micrographic surgery 360 – neck management 365, 368 – nonmelanoma –– advanced/systemic disease 369 –– aggressive 351, 351 –– epidemiology 347 –– genetics/molecular biology 348 –– metastases, multimodality therapy 368 –– pathology report components 351 –– regional metastases 356, 356, 357 –– regional metastases risk factors 363, 366 –– staging 351, 355, 356 –– treatment 359 – photodynamic therapy 361 – physical examination 353 – precursor lesions 349 – prevention 370 – previous malignancy 349 – radiation exposure 349 – radiation therapy 361 – reconstruction 363 – recurrent 351 – risk factors 349 – SCC, see squamous cell carcinoma – sebaceous carcinoma 352 – sentinel lymph node biopsy 365, 366–367 – staging 355, 355, 356 – surgical margins 359 – temporal bone/skull base involvement 360, 360 – topical agents 362 – treatment, primary lesion 359 – UV light exposure 348 – watchful waiting 365 – wide excision 359 skin grafts – buccal mucosa 51 – cheek/face 386, 386, 388 – oral tongue/FOM 22 – oropharynx 172 – scalp 378 skull base reconstruction – abdominal fat graft 311 – acellular grafts 309, 309, 310, 310 – ALT flap 318, 319, 319 – anatomy 304 – arachnoid disruption 305 – background 304 – CSF leak 307 – defect classification 305, 306 – defect evaluation 304, 305 – factors adversely affecting 304 – fat grafts 309, 311 – foveocranial defects 308 – free mucosal grafts 311 – graft healing 307 – intracranial pressures 304, 305 – location evaluation 304 – nasoseptal flap 309, 313, 314 – options 307, 309 – orbital prosthesis 320 – parasagittal orbitocranial defects 317, 318 – pericranial flap 309, 313–314, 315, 315 – principles of 305 – radial forearm flap 317, 317 – rectus abdominis flap 320 – repair bolstering 307, 308 – scapular tip osteocutaneous free flap 320, 321 – sinonasal malignancies 296 – site preparation 305 – size evaluation 305 – temporoparietal fascia flap 309, 315, 316, 316 – tensor fascia lata grafts 309, 312, 312 – ventricular involvement 305 slow Mohs 362 smoking as risk factor 2, 32, 33, 52, 84, 252 soft palate – anatomy 94, 95, 102, 142 – bilateral neck dissection, clinical case 98 – cancer –– background 93 –– bilateral neck dissection, clinical case 98, 98 –– clinical presentation 94, 94, 158 –– complications 95, 96–97 –– etiology 94 –– multimodal therapy 90 –– nodal disease 94, 95 –– prognosis 94 –– risk factors 94 –– spread patterns 94 –– staging 89–91, 93, 95 –– surgical technique 95 –– treatment 95, 98, 161, 162 –– unimodal therapy 89 – lymphatic drainage 94, 95, 142, 399 – muscular/neurovascular anatomy 103 – reconstruction –– algorithm 106 447 Head and Neck Cancer | 19.07.19 - 12:09 Index –– –– –– –– –– –– –– –– defect evaluation 103 defined 102 regional flaps 110 regional muscle flaps 111 secondary intention 105–106 TORS defect classification 104, 104 type I/II defects 104, 105, 105 type III/IV defects 105, 105, 106, 115 –– velopharyngoplasty, locoregional flaps in 106 squamous cell carcinoma – adjunctive testing 354 – basosquamous 351 – biopsy 354 – characterization 279, 279, 280 – clinical cases 370, 371, 371 – desmoplastic 351 – diagnosis 353 – differential diagnosis 278 – disease-specific survival 351, 351 – epidemiology 347 – histopathology 350 – metastatic, rates of 363 – nasopharynx, see nasopharynx – oral tongue/FOM –– adjuvant therapy 12 –– biopsy –– clinical cases 14, 15, 15, 16 –– clinical presentation –– clinicopathologic models, prognosis 14 –– CT imaging 8, –– depth of invasion 8–9, 9, 14 –– diagnostic evaluation –– etiology –– failure patterns 13 –– genetic testing –– histologic risk assessment 9, 9, 14, 14 –– history –– imaging –– immunosuppression 14 –– incidence –– lymphatic drainage 1, 3–4 –– mandibulectomy 10–11, 11 –– margin status 11, 14 –– microscopic tumor cut-through 11 –– MRI –– muscular anatomy 1, –– negative margins 11 –– neurovascular anatomy 1, –– outcomes 13 –– pathology 2, 4, 8, –– perineural invasion 14 –– PET/CT –– physical examination 6, –– primary nonsurgical management 13 –– primary tumor surgery 10, 10 –– prognosis 9, 11, 13 –– regional metastasis 11 –– risk factors –– staging 5, 5, 6, –– submandibular gland preservation 12 –– survival 13, 13, 14 –– treatment 10 –– tumor thickness 8, 9, 14 –– ultrasound – radiation-induced 349 448 – regional metastases 357 – spindle cell 351 – staging 355–356 – thyroid 241 – variants 279 Steiner, W 186, 208 sternocleidomastoid flaps – lateral pharynx 218 – pharyngeal/soft palate 111, 113 strap muscle flaps – lateral pharynx 218, 220 – pharyngeal/soft palate 111, 113 stroboscopy 207 stylomandibular ligament 253, 254– 255 subglottic carcinoma 204, 204, 211 subglottic region 204 sublingual gland – anatomy 254, 256 – presentation 260 submandibular gland – anatomy 254, 255 – presentation 260 – treatment 264 submental island flap – buccal mucosa 50 – lateral pharynx 218, 220 – parotid gland 275 – pharynx (lateral) 111, 112–114 Sunbelt Melanoma Trial 364 superficial temporal vessels 426, 427, 427 superior laryngeal nerve 231, 242 superior laryngeal nerve injury 246 surveillance – anaplastic thyroid carcinoma 240 – background 404 – buccal mucosa 38 – clinical cases 406, 407–409, 409, 410–411 – considerations 404 – hypopharynx 193 – imaging 404 – medullary thyroid carcinoma 239 – morphologic imaging 405 – Mount Sinai protocol 406 – palatomaxillary tumors 60 – PET imaging 405 – pharynx (lateral) 93, 93 – salivary gland tumors 266 suspicious for papillary carcinoma 234 suture techniques 221, 221 swallowing rehabilitation – larynx/hypopharynx 227 – oral tongue/FOM 20 – oropharynx 151 symphysis 132, 133 T T-cell lymphoma 362 T-shaped simple interrupted closure 221, 221 TAX 324 trial 192 temporalis flaps 111, 113 temporoparietal fascia flap 110, 222, 309, 315, 316, 316 tensor fascia lata grafts 309, 312, 312 thoracoacromial artery 429 thoracoacromial vessels 429 THORP implant 130 thyroid carcinoma – anaplastic 239, 240 – anatomy 230, 231 – biopsy 233, 233, 234 – central neck dissection 244, 244, 245 – clinical cases 247 – diagnosis 233 – differentiated 234 – differentiated, staging/ prognosis 237, 237, 238 – embryology 230, 231 – epidemiology 230 – evaluation 233 – follicular 236 – follicular neoplasia 234 – history 233 – Hürthle cell carcinoma 236 – imaging 233 – laboratory assessment 233 – lateral neck dissection 245, 246 – lymphatic drainage 230 – lymphoma 241 – medullary 238, 249 – metastatic 241 – papillary 234, 247, 247, 248–249 – parathyroid glands 231, 232 – physical examination 233 – recurrent laryngeal nerve 231 – remote access thyroid surgery 244 – squamous cell carcinoma 241 – superior laryngeal nerve 231 – surgical complications 246 – surgical landmarks 231 – surgical techniques 241 – tubercle of Zuckerkandl 230, 231– 232, 232 thyroidectomy 241–242, 243–244 tissue expanders 378 TMJ reconstruction, see mandible/ composite defect reconstruction tobacco as risk factor 2, 32, 33, 52, 84, 252 Tombolini, V 191 tongue cancer 406, 407, 409, 409, 410 tonsillar tumors 87, 96, 97, 155, 158, 161–162, 409, 411 topical agents 362, 438 TORS, see transoral robotic surgery (TORS) total laryngectomy 209, 211, 218, 220, 224 Totsuka, Y 124 tracheoesophageal puncture (TEP) 227 tracheostomy indications 92 transoral inferior maxillectomy 58 transoral laser microsurgery (TLM) 91, 208, 208, 209 transoral laser surgery (TOLS) 188 transoral lateral oropharyngectomy 91 transoral robotic surgery (TORS) – adjuvant therapy 164 – as salvage procedure 163 – benefits of 169 – carcinoma of unknown primary 401, 401 – chemotherapy 164 – clinical cases 165 – clinical presentation 158, 159–160 – disease epidemiology 154 – historical background 154 – – – – – hypopharynx carcinoma 188 indications 161, 162, 177 laryngeal cancer 208, 208, 209 neck management 163 operative margins 156, 162, 162, 163 – oropharyngeal cancers 147, 154 – oropharynx 177, 177 – oropharynx anatomy 155, 156, 158 – outcomes 161 – pharynx 91, 106, 107 – radiation therapy 164–165 – recurrence 163 – surgical morbidity 162 transverse cervical vessels 424, 425– 426 TREMPLIN trial 192 Triana, R J., Jr 67, 75 Tripier flap 393 trismus 56 TROG trial 165 Trotter procedure 147, 148 tubed flap closure 221 tubercle of Zuckerkandl 230, 231–232, 232 Turner's syndrome 158 tyrosine kinase inhibitors 369 U ulnar flap 113–115 umbrella trials 417, 418 UV light exposure 348 V VA Laryngeal Cancer Study 208 velocardiofacial syndrome 158 velopharyngeal insufficiency 158 velopharyngoplasty 95, 97, 106 verrucous carcinoma 2, 4, 33 vertical partial laryngectomy 209, 209 Villaret, D B 72 virtual planning 138, 138, 139 vismodegib 369 vocal cord carcinoma 209, 209 voice rehabilitation 227 von Ebner's glands 256, 260, 264 W Wald, R M., Jr 122, 124 Wang, C 190 Weber's glands 256, 260, 264 Weber-Fergusson incision 59, 59 Weinstein, G S 163 Wickham's striae 3, wide excision 359 workup 260 X xerostomia 38 Y Yang, X 55 Yano, T 305, 306 Yu, P 20 MedOne Access the additional media content with this e-book via Thieme MedOne Access additional media now! Quick Access With three easy steps, unlock access to the additional media for this title via MedOne, Thieme’s online platform After you successfully register and activate your code, you can find your book and additional online media at medone.thieme.com/9781626232310 Note your access code below: or with this QR code EBRBSUBMuanjB Scan the QR code or enter your access code at MedOne.thieme.com/code Important Notes Set up a username on MedOne and sign in to activate your access to the e-book and its additional online media • Use of this product is restricted to the buyer or, for library copies, authorized users • Sharing passwords is not permitted The publisher has the right to take legal steps for violations • Access to online material is solely provided to the buyer for private use Commercial use is not permitted Connect with us on social media ... disciplines Head and Neck Cancer: Management and Reconstruction is a combination and thorough update of two prior texts, Reconstruction of the Head and Neck: A Defect-Oriented Approach, and Head and Neck. .. management and reconstruction / [edited by] Eric M Genden Other titles: Head and neck cancer (Genden) Description: Second edition | New York : Thieme, [2019] | "Head and neck cancer: management and reconstruction. .. Otolaryngology? ?Head and Neck Surgery Houston, Texas Matthew O Old, MD, FACS Associate Professor Head and Neck Division Director Medical Director, Head and Neck Service Line The James Cancer Hospital and