Carcinomas of the Head and Neck: Evaluation and Management by Robert Lufkin, William Hanafee (auth.), Charlotte Jacobs

By Robert Lufkin, William Hanafee (auth.), Charlotte Jacobs M.D. (eds.)

It was once no longer too decades in the past that the function of chemotherapy for head and neck melanoma consisted of single-agent methotrexate for chosen sufferers with recurrent affliction. long ago decade, a number of new brokers, high-dose chemotherapy, combos, and intra-arterial methods were used for the sufferer with recurrent illness. Wheeler seriously assesses the present prestige of those ways. whilst oncologists begun checking out chemotherapy within the mixed modality technique, trials consisted of induction chemotherapy and use of unmarried brokers as radiosensitizers. even if very much has been realized from those trials, gain when it comes to survival has been marginal. much more promising could be the concomitant use of mix chemo­ treatment and radiation. Taylor describes the encouraging effects in addition to the aptitude. Induction chemotherapy can have a moment vital target as well as bettering curability-it will be used for organ protection. Dimery et al., current the history for this process within the sufferer with laryngeal melanoma in addition to an outline in their randomized trial for voice upkeep. Head and neck squamous cancers are a heterogeneous crew of ailments, and surgeons have lengthy sought parameters that may support are expecting outcome.

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Contrast infusion is essential in the head and neck CT examination to differentiate vessels from lymph nodes. This is not the case for ultrasound or MRI. Nodes by CT may not enhance after contrast injection or may have only peripheral rim enhancement which may be thick or thin. A thickened enhanced rim suggests nodal capsular or extracapsular extension [12]. Malignant nodes often have a low attenuation center with an enhanced periphery, but this pattern can also occur with infectious processes such as tuberculosis.

Size is used as an indicator of malignancy, but not an absolute one, since inflammatory processes may result in large nodes. Malignant nodes have no absolute pathognomonic pattern by CT, US, or MRI, but large bulky nodes in the neck are suspect, particularly when poorly defined and poorly marginated. These findings suggest infiltration and penetration of adjacent tissues [5]. CT requires intravenous contrast injection to define the vascular structures, determine tumor margination, and differentiate the normal from 32 abnormal soft tissues.

Mirich DR, McArdle CB, Kulkarni MY: Benign pleomorphic adenomas of the salivary glands: surface coil MR imaging verus CT. J Comput Assist Tomogr 11:620-623, 1987. 37. Lufkin R, Hanafee W: MR Atlas of Head and Neck Anatomy, New York, Raven Press, 1989. 30 2. W. Gooding Anatomy of Carotid Artery The carotid artery arises at the bifurcation of the brachiocephalic artery on the right and from the aortic arch on the left and courses superficially in the neck posterior to the sternocleidomastoid muscle, dividing into internal and external branches near the angle of the jaw.

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