0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:12
662 Head and Neck Cancer Head Trauma➣osteoradionecrosis of mandible (2–5%) minimized by pre-
treatment dental evaluation, extractions as needed, and subsee-
quent rigorous long-term attention to periodontal care including
extra fluoride treatments
➣prior radiation severely restricts the ability to subsequently irra-
diate the same anatomic area
➣radiation-induced malignancy: incidence estimated to be
between 0.01% and as high as 1%; 7–30 years later
➣1% incidence of tracheotomy dependence following successful
glottic irradiation for T1–2 tumors
■Chemotherapy
➣cisplatin: peripheral neuropathy, ototoxicity, renal toxicity
Prognosis
■Strongly dependent on TNM staging of primary site as well as numer-
ous other factors; N (+) neck generally halves survival statistics; of
all H&N SCC, about 65% is cured
■Examples:
➣T1 N0 glottic SCC is cured by EBRT in >95%, and the rare failure
frequently salvaged with surgery
➣T1 N0 lateral tongue SCC cured by surgery 80–90%
➣T3 N0 BOT 60% by EBRT
➣T3 N2 hypopharynx <20–35% with combined therapy
■Rate of 2nd tumors 4–5%/year (20–25% at 5 yrs)
■IORT, data suggests, improves prognosis for resectable recurrent
neck disease from <15–20% 2-year survival to 70% 2-year survival
and 50% 2-yr NED survival.
■Overall patient survival affected by nondisease comorbidities asso-
ciated with alcohol and tobaccoHead Trauma.......................................
MICHAEL J. AMINOFF, MD, DSc
history & physical
■Head injury w/ or w/o LOC
■May be headache, confusion, personality change, drowsiness
■Seizures may occur in 1st week
■Findings may be normal
■Coma or obtundation may be present
■Focal deficits sometimes present; depend on location & severity of
injury
■Signs of increased ICP or meningeal irritation may be present