This analysis suggests that pattern of failure in primary head and neck cancer may be dependent upon treatment strategy. Randomized clinical trials of induction chemotherapy are warranted as a means to determine if a decrease in distant metastases can lead to an increase in survival rates in the setting of effective chemoradiotherapy for locoregional control. Additionally, this analysis provides impetus for randomized clinical trials of organ preservation chemoradiotherapy in sites outside the larynx and hypopharynx.

ND improves neck control and is required for patients with clinically residual disease or N3 neck cancer but has no significant impact on the outcome of patients with N2 stage disease who are rendered clinically disease-free with intensive concurrent chemoradiotherapy.

Objectives:To d e te rmine the feasibility of senti· nel node radiolocalization in stage NO in head and neck squamous cell carcinoma and to gain insight as to whether the sentinel node could be prognostic of regional micrometastatic disease. Shidy Design: A prosp ctive report on the application sentinel node radiolocalization in eight patients with NO squamous cell carcinoma of the head and neck region. Methods: For each patient a peritumoral submucosal injection of filtered t echnetium ( 00 mTc) prepared with sulfur colloid wa performed immediately following intubation. After at least 30 minutes, focal ar as of accumulation corr ponding to a sentinel node were marked on the skin surface. Complete n eck dissections were performed, and the sentinel nodes were identified for late r histological evaluation and comparison to the remafoing lymphadenectomy specimen. Results: Sentinel nod radiolocalization accurately identified two or more entinel lymph nodes in all eight cases. In one pati nt, two of the three lymph nodes containing mi· crometastatic diseas were sentinel lymph nodes. There was no instance in which sentinel node was n egative for micrometastatic di ease while being positive in a nonsentinel lymph node. Conclusions: Accurate localization of the sentinel lymph node using radiolabeled sulfur-colloid is feasible in patients with squamous cell carcinoma of the head and neck region. Although s ntinel node radiolocalization in head and neck quamous cell cancer may potentially 1·educe the time, cost, and morbidity of regional lymph node management, more experience with technique is requir d before Its role can be determined.Laryngoscope, 110:198-203, 2000

This study was conducted to determine whether inflammation is present in the uvula mucosa of patients with obstructive sleep apnea (OSA). Uvulas were obtained by uvulopalatopharyngoplasty in 21 patients with moderate OSA (mean apnea/hypopnea index and standard error of the mean: 32 +/- 4) and by autopsy in 5 individuals not known to have OSA. Using point counting in five randomly selected high-power microscopic fields (X100), the authors found that the number of leukocytes in the lamina propria of the uvula mucosa was significantly higher in patients with OSA than in the controls (179 +/- 12 cells vs. 71 +/- 4 cells, respectively; P < .05). This was due to a significant increase in the number of plasma cells in patients with OSA as compared with controls (89 +/- 15 cells vs. 21 +/- 5 cells, respectively; P < .05). The thickness of the lamina propria (an index of interstitial edema) was also significantly increased in patients with OSA compared with controls (0.99 +/- 0.12 mm vs. 0.27 +/- 0.02 mm, respectively; P < 0.05). The authors conclude that inflammation, characterized by plasma cell infiltration and interstitial edema, is present in the uvula mucosa of patients with moderate OSA. They also suggest that soft palate inflammation contributes to upper airway occlusion observed during sleep in these patients.