Objectives/Hypothesis: To prospectively assess the effects of irradiation on the carotid artery in patients with head and neck cancer, as a possibly relevant factor in cancer treatment planning. Study Design: Prospective study from a tertiary care academic setting on university (22 patients) and Veterans Affairs (14 patients) hospital patients; 1-year follow-up, including comparison of study data with age-matched and sex-matched control subjects from epidemiological studies. Methods: Thirty-six patients with head and neck cancer who underwent therapeutic neck irradiation were examined by highresolution ultrasound before and 1 year after treatment. Twelve patients were also studied at 2 years. Measurements included the intima-media thickness (IMT) of the carotid artery wall, the degree of stenosis as estimated from velocity measurements, and the presence and size of plaque. Results: The pretreatment carotid IMT at baseline was 0.68 mm and was comparable to age-matched and sex-matched control subjects. Significant increase in the IMT was observed on both the left (0.67 vs. 0.84 mm) and the right (0.7 vs. 0.87 mm) sides (P < .001) 1 year after irradiation. In 12 patients who completed 24 months of follow-up the carotid IMT continued to significantly increase statistically compared with that at the first year after treatment (left side, 0.79 vs. 0.85 mm, P ‫؍‬ .037; right side, 0.79 vs. 0.95 mm, P ‫؍‬ .014). Statistically significant thickening of the carotid wall developed in all 36 patients by 1 year. Two patients experienced post-treatment neurological events and an area of stenosis greater than 75%. Conclusions: Neck irradiation significantly increases the thickness of the carotid wall during the first year after treatment-on average, 21 times more than in epidemiologically matched control volunteers. This phenomenon should be taken into consideration when planning treatment for the node-negative (N0) neck.

Selective neck dissection, when used in combination with postoperative radiation therapy, is an efficacious way to manage metastatic squamous cell carcinoma to the neck.

: The treatment of pediatric cholesteatomas should be individualized with CWD mastoidectomy chosen for patients with recurrent or more extensive disease. We conclude that the CWU procedure is an adequate surgical option for treating most acquired and congenital cholesteatomas, preventing disease recurrence, and maintaining good hearing outcomes.

This report is the first to our knowledge that evaluates thickness as a risk factor for contralateral cervical metastasis in oral tongue SCCa. We recommend consideration be given to treating the contralateral neck in cases where the primary tumor is > 3.75 mm thick.