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Badawy MK, Norris SA, Gutowski A, Carrion D, Braniff C, Masterson M. Evaluating brain and lens radiation exposure in interventional neuroradiology. Phys Med 2025; 134:104996. [PMID: 40319796 DOI: 10.1016/j.ejmp.2025.104996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Revised: 02/10/2025] [Accepted: 04/29/2025] [Indexed: 05/07/2025] Open
Abstract
OBJECTIVES This study evaluated brain and lens radiation doses during interventional neuroradiology (INR) procedures, focusing on cumulative mean organ absorbed doses and risks of exceeding dose thresholds for tissue reactions. METHODS A retrospective audit of adult INR procedures from January 2018 to June 2024 at a tertiary centre. Dose calculations were performed using the Dose Area Product (DAP), and organ doses were simulated per procedure. Regression analyses were used to determine the predictive value of DAP and Cumulative Air Kerma (CAK) for brain and lens doses. RESULTS A total of 2668 INR procedures were included. Dural arteriovenous fistula (dAVF) embolisation demonstrated the highest median brain doses, while diagnostic had the lowest. A considerable number of cases (13 %) exceeded the 0.5 Gy threshold for brain tissue, but much fewer (<1%) exceeded the lens threshold of 0.5 Gy. During the observation period, 18 % of patients exceeded the brain tissue dose threshold, while fewer than 1 % exceeded the lens threshold. Among those undergoing more than two procedures, 78 % surpassed the brain dose threshold, highlighting the cumulative impact of repeated exposures. DAP strongly predicted brain and lens doses, with an R2 of 0.89 and 0.70, respectively. CONCLUSIONS INR procedures frequently approach or exceed dose thresholds for the brain, while the risk of exceeding the threshold for the lens remains low. DAP is a reliable metric for predicting organ doses and guiding risk assessments. Clinicians should consider cumulative exposure in justification and procedure planning. Further research is warranted to explore long-term outcomes and guide optimisation.
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Affiliation(s)
- Mohamed Khaldoun Badawy
- Monash Imaging, Monash Health, Clayton, Australia; Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Australia.
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Mohammadzadeh M, Erfanian R, Khoozani AS, Abdullah H, Anari MR, Ardehali MM, Zarch VV. The Effects of Cold Application on Internal and External Carotid Artery Flows: an Evaluation of Conventional Epistaxis Management. Indian J Otolaryngol Head Neck Surg 2025; 77:1813-1817. [PMID: 40226261 PMCID: PMC11985727 DOI: 10.1007/s12070-025-05410-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 02/15/2025] [Indexed: 04/15/2025] Open
Abstract
Applying cold is a common method for epistaxis management. In this study, the effect of cold on the blood flow of the internal and external carotid system was examined, with the help of ultrasonography, to get a more accurate picture of the effect of cold on blood flow to the head and neck. This study consisted of three separate phases conducted on healthy adult volunteers. Phase 1: Cervical skin and tympanic temperatures, systolic and diastolic blood pressure (SBP and DBP), and heart rate (HR) were measured at baseline and every 5 min for 25 min, with an ice collar in place and after removal. Phase 2: Blood flow of the Internal carotid artery (ICA), External carotid artery (ECA), Facial Artery (FA), and Temporalis Artery (TA) were assessed before applying a regular cervical collar, and promptly after removing it, using Doppler ultrasound. FA and TA blood flows were also measured 5 and 15 min after collar application. Phase 3: The second phase was repeated, this time using an ice collar. Blood flows were additionally assessed 10 min after collar removal. Cold application was associated with tympanic and cervical skin temperatures (P-values: 0.002, < 0.0001), while it had no association with HR, SBP, or DBP (P-values: 0.16, 0.51, 0.36). Applying a regular collar did not affect ICA, ECA, FA, and TA blood flow (P-values:0.9,0.1,0.5,0.06). Pearson's correlation coefficients for flow assessment of ICA, ECA, FA, and TA by Doppler ultrasound before collar use and after its removal were 0.73, 0.96, 0.76, and 0.90, respectively (P-values: 0.01, < 0.001, 0.02, < 0.0001). The cold application did not alter ICA blood flow (P-value: 0.1) but decreased ECA, FA, and TA blood flows (P-values: 0.0002, < 0.0001, < 0.0001). Cold application on the neck can significantly decrease ECA, FA, and TA blood flows, while ICA blood flow remains unchanged. These findings indicate a differing effect of cold on the neck in epistaxis management within the internal carotid system, compared to the external carotid system.
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Affiliation(s)
- Maryam Mohammadzadeh
- Department of Radiology, Amir Alam Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Reza Erfanian
- Otolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Science, Tehran, Iran
| | | | - Hakima Abdullah
- Otolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mahtab Rabbani Anari
- Otolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Science, Tehran, Iran
| | | | - Varasteh Vakili Zarch
- Otolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Science, Tehran, Iran
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Yoon CY, Engler AM, Konisky H, Hogeg A, Detton AJ, Erlich MA, Mishall PL, Pinkas A. Unilateral double facial artery: an anatomic variant and clinical implications. Case Reports Plast Surg Hand Surg 2024; 11:2376136. [PMID: 39011067 PMCID: PMC11249143 DOI: 10.1080/23320885.2024.2376136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Accepted: 07/01/2024] [Indexed: 07/17/2024]
Abstract
Background This paper reports a rare anatomical variant of the facial artery (FA) - namely, a double FA pattern - which has significant implications in a wide range of surgical and aesthetic medicine disciplines. Case The study involves a case report and literature review of the FA and its variants. The case is that of a 61-year-old female cadaver with a unilateral FA variant branching pattern discovered during a cadaveric dissection for an anatomy course. Discussion The dissection revealed an unusual supply of the typical FA distribution by two separate branches from either side of the maxillary artery. The first branch, termed FA1, followed a typical FA course arising from the external carotid to supply the lower portion of the face via lingual, inferior labial, and mental arterial branches. The second branch, termed FA2, arose superior to the maxillary artery near the origin of a typical transverse facial artery, to supply the upper portion of the face via superior labial, lateral nasal, and angular arterial branches. No direct communication between the two branches was observed grossly via dissection. The observed branching pattern has not previously been reported in literature and has critical implications for surgical planning and intervention. Conclusion This study emphasizes the importance of understanding variant FA anatomy in procedures requiring precise anatomical knowledge of arterial supply to the face. Duplicate and/or secondary facial arteries necessitate careful consideration for their potential consequences on the success of surgery of the head and neck, dermal fillers, and embolization for epistaxis procedures.
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Affiliation(s)
- Christine Y Yoon
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alan M Engler
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Hailey Konisky
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Avia Hogeg
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alan J Detton
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mark A Erlich
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Priti L Mishall
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adi Pinkas
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY, USA
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Heitzer M, Kilic K, Merfort R, Winnand P, Emonts C, Bock A, Ooms M, Steiner T, Hölzle F, Modabber A. Tensile strength of adhesives in peripheral nerve anastomoses: an in vitro biomechanical evaluation of four different neurorrhaphies. Eur J Med Res 2024; 29:264. [PMID: 38698476 PMCID: PMC11067280 DOI: 10.1186/s40001-024-01858-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND The fundamental prerequisite for prognostically favorable postoperative results of peripheral nerve repair is stable neurorrhaphy without interruption and gap formation. METHODS This study evaluates 60 neurorrhaphies on femoral chicken nerves in terms of the procedure and the biomechanical properties. Sutured neurorrhaphies (n = 15) served as control and three sutureless adhesive-based nerve repair techniques: Fibrin glue (n = 15), Histoacryl glue (n = 15), and the novel polyurethane adhesive VIVO (n = 15). Tensile and elongation tests of neurorrhaphies were performed on a tensile testing machine at a displacement rate of 20 mm/min until failure. The maximum tensile force and elongation were recorded. RESULTS All adhesive-based neurorrhaphies were significant faster in preparation compared to sutured anastomoses (p < 0.001). Neurorrhaphies by sutured (102.8 [cN]; p < 0.001), Histoacryl (91.5 [cN]; p < 0.001) and VIVO (45.47 [cN]; p < 0.05) withstood significant higher longitudinal tensile forces compared to fibrin glue (10.55 [cN]). VIVO, with △L/L0 of 6.96 [%], showed significantly higher elongation (p < 0.001) compared to neurorrhaphy using fibrin glue. CONCLUSION Within the limitations of an in vitro study the adhesive-based neurorrhaphy technique with VIVO and Histoacryl have the biomechanical potential to offer alternatives to sutured neuroanastomosis because of their stability, and faster handling. Further in vivo studies are required to evaluate functional outcomes and confirm safety.
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Affiliation(s)
- Marius Heitzer
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany.
| | - Konrad Kilic
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany
| | - Ricarda Merfort
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital of RWTH Aachen, Aachen, Germany
| | - Philipp Winnand
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany
| | - Caroline Emonts
- Institute of Textile Technology, RWTH Aachen University, Otto-Blumenthal-Straße 1, 52074, Aachen, Germany
| | - Anna Bock
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany
| | - Mark Ooms
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany
| | - Timm Steiner
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of RWTH Aachen, Pauwelsstraße 13, 52074, Aachen, Germany
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Nguyen Van D, Le Van Q, Nguyen Thi Thu N, Bui Van G, Ta Van T. The impact of trans-arterial embolization on the result of chemoradiotherapy in oral cavity cancer. EAR, NOSE & THROAT JOURNAL 2024; 103:NP272-NP277. [PMID: 34821166 DOI: 10.1177/01455613211054181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Evaluation of the hemostatic effect of trans-arterial embolization on patients with advanced oral cavity cancer who had bleeding complications while undergoing definitive concurrent chemoradiotherapy (CCRT). Additionally, assess the effect of trans-arterial embolization on treatment response following concurrent chemoradiotherapy, as well as overall survival (OS) and progression-free survival (PFS) in the group of patients following the intervention. Method: From September 2018-June 2021, a retrospective descriptive study was conducted on 16 patients with inoperable, locally advanced oral cavity cancer who received definitive concurrent chemoradiotherapy, experienced acute bleeding complications, and received selective intravascular intervention with various embolization materials at Vietnam National Cancer Hospital. Results: After selective embolization, 16/16 patients ceased bleeding; 1 patient re-bled for the second time after 3 weeks. The average duration of chemoradiotherapy interruption due to intervention was 6.7 days. After CCRT, 15/16 (93.75%) patients achieved a response, with 9/16 (56.25%) patients achieving a complete response. The median OS was 14 months (range, 3-26 months), and the median PFS was 10 months (range, 3-20 months). There were no significant complications, particularly neurological side effects. ConclusionsTumor bleeding is a common and serious complication of CCRT treatment in patients with locally advanced oral cavity cancer. Embolization is a safe and effective method of controlling acute bleeding that has no adverse effect on the outcome of definitive concurrent chemoradiotherapy.
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Affiliation(s)
- Dang Nguyen Van
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
- Department of Head and neck Radiation Oncology, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Quang Le Van
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Nhung Nguyen Thi Thu
- Department of Head and neck Radiation Oncology, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Giang Bui Van
- Radiology Center, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - To Ta Van
- Center of Pathology and Molecular biology, Vietnam National Cancer Hospital, Hanoi, Vietnam
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Yunaiyama D, Takara Y, Kobayashi T, Muraki M, Tanaka T, Okubo M, Saguchi T, Nakai M, Saito K, Tsukahara K, Ishii Y, Homma H. Transcatheter arterial embolization for traumatic injury to the pharyngeal branch of the ascending pharyngeal artery: Two case reports. World J Clin Cases 2022; 10:12015-12021. [PMID: 36405265 PMCID: PMC9669858 DOI: 10.12998/wjcc.v10.i32.12015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/13/2022] [Accepted: 10/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The ascending pharyngeal artery (APhA) comprises the pharyngeal trunk (PT) and neuromeningeal trunk. The PT feeds the nasopharynx and adjacent tissue, which potentially connects with the sphenopalatine artery (SPA), branched from the internal maxillary artery (IMA). Due to its location deep inside the body, the PT is rarely injured by trauma. Here, we present two cases that underwent transcatheter arterial embolization (TAE) of the PT of the APhA due to trauma and iatrogenic procedure.
CASE SUMMARY Case 1 is a 49-year-old Japanese woman who underwent transoral endoscopy under sedation for a medical check-up. The nasal airway was inserted as glossoptosis occurred during sedation. Bleeding from the nasopharynx was observed during the endoscopic procedure. As the bleeding continued, the patient was referred to our hospital for further treatment. Contrast-enhanced computed tomography (CT) demonstrated extravasation in the nasopharynx originating from the right Rosenmuller fossa. TAE was performed and the extravasation disappeared after embolization. Case 2 is a 28-year-old Japanese woman who fell from the sixth floor of a building and was transported to our hospital. Contrast-enhanced CT demonstrated a complex facial fracture accompanying extravasation in the left pterygopalatine fossa to the nasopharynx. Angiography demonstrated an irregular third portion of the IMA. As angiography after TAE of the IMA demonstrated extravasation from the PT of the APhA, additional TAE to the artery was performed. The bleeding stopped after the procedure.
CONCLUSION Radiologists should be aware that the PT of the APhA can be a bleeding source, which has a potential connection with the SPA.
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Affiliation(s)
- Daisuke Yunaiyama
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
| | - Yuki Takara
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
| | - Takehiro Kobayashi
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
| | - Mika Muraki
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
| | - Taro Tanaka
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
| | - Mitsuru Okubo
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
| | - Toru Saguchi
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
| | - Motoki Nakai
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
| | - Kazuhiro Saito
- Department of Radiology, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
| | - Yuri Ishii
- Department of Emergency and Critical Care Medicine, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
| | - Hiroshi Homma
- Department of Emergency and Critical Care Medicine, Tokyo Medical University Hospital, Shinjuku-ku 160-0023, Japan
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Pinheiro GL, Lima BC, Pinto LMC, Da Silva LMF, Cavalcante MADA. Computed tomography angiography-assisted embolization of arteriovenous malformation prior to dental extractions in a patient with Sturge-Weber syndrome. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 134:e39-e43. [PMID: 35431180 DOI: 10.1016/j.oooo.2021.12.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
Sturge-Weber syndrome is a developmental condition characterized by hamartomatous vascular proliferation involving the tissues of the brain and face. Hemangiomatous proliferations and arterial venous malformations are common intraoral alterations that may be fatal due to incontrollable bleeding when performing surgical procedures in the face. The goal of this case report is to present the management of a 21-year-old woman with Sturge-Weber syndrome in whom it was necessary to perform embolization guided by computed tomography angiography before multiple tooth extractions.
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Affiliation(s)
- Giulianna Lima Pinheiro
- Trainee of Oral and Maxillofacial Surgery, Oral and Maxillofacial Surgery Service, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bernardo Correia Lima
- Trainee of Oral and Maxillofacial Surgery, Oral and Maxillofacial Surgery Service, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Luiza Máximo Cunha Pinto
- Trainee of Vascular Surgery, Vascular Surgery Service, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luciana Moura Farjoun Da Silva
- Director of Vascular Surgery Residency Program, Clementino Fraga Filho, University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Aparecida De Albuquerque Cavalcante
- Professor and Director of Oral and Maxillofacial Surgery Residency Program, Chair of Oral and Maxillofacial Surgery Service, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Cognetti DM, Johnson JM, Curry JM, Kochuparambil ST, McDonald D, Mott F, Fidler MJ, Stenson K, Vasan NR, Razaq MA, Campana J, Ha P, Mann G, Ishida K, Garcia-Guzman M, Biel M, Gillenwater AM. Phase 1/2a, open-label, multicenter study of RM-1929 photoimmunotherapy in patients with locoregional, recurrent head and neck squamous cell carcinoma. Head Neck 2021; 43:3875-3887. [PMID: 34626024 PMCID: PMC9293150 DOI: 10.1002/hed.26885] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 08/24/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022] Open
Abstract
Background Recurrent head and neck squamous cell carcinoma (rHNSCC) represents a significant global health burden with an unmet medical need. In this study we determined the safety and efficacy of RM‐1929 photoimmunotherapy in patients with heavily pretreated rHNSCC. Methods RM‐1929 (anti‐EGFR–IR700 dye conjugate) was infused, followed by tumor illumination. We evaluated safety, tumor response, and pharmacokinetics. Results Nine patients were enrolled in Part 1 (dose‐finding) and 30 patients in Part 2 (safety and efficacy). No dose‐limiting toxicities were experienced in Part 1; 640 mg/m2 with fixed light dose (50 J/cm2 or 100 J/cm) was recommended for Part 2. Adverse events (AEs) in Part 2 were mostly mild to moderate but 19 (63.3%) patients had AE ≥Grade 3, including 3 (10.0%) with serious AEs leading to death (not treatment related). Efficacy in Part 2: unconfirmed objective response rate (ORR) 43.3% (95% CI 25.46%–62.57%); confirmed ORR 26.7% (95% CI 12.28%–45.89%); median overall survival 9.30 months (95% CI 5.16–16.92 months). Conclusions Treatment was well tolerated. Responses and survival following RM‐1929 photoimmunotherapy in heavily pretreated patients with rHNSCC were clinically meaningful and warrant further investigation. Clinical Trial Information NCT02422979.
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Affiliation(s)
- David M Cognetti
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jennifer M Johnson
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Samith T Kochuparambil
- Department of Medical Oncology, Virginia Piper Cancer Institute, Minneapolis, Minnesota, USA
| | - Darren McDonald
- Department of Otolaryngology-Head and Neck Surgery, Virginia Piper Cancer Institute, Minneapolis, Minnesota, USA
| | - Frank Mott
- Department of Thoracic/Head and Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mary J Fidler
- Department of Hematology, Oncology, and Cell Therapy, Rush University Medical Center, Chicago, Illinois, USA
| | - Kerstin Stenson
- Department of Otorhinolaryngology, Rush University Medical Center, Chicago, Illinois, USA
| | - Nilesh R Vasan
- Department of Otolaryngology-Head and Neck Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Mohammad A Razaq
- Division of Hematology and Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - John Campana
- Department of Otolaryngology, University of Colorado Head and Neck Specialists, Denver, Colorado, USA
| | - Patrick Ha
- Division of Head and Neck Surgical Oncology, University of California San Francisco, San Francisco, California, USA
| | - Grace Mann
- Department of Clinical Development, Rakuten Medical, Inc, San Mateo, California, USA
| | - Kosuke Ishida
- Department of Biostatistics, Rakuten Medical Japan, Tokyo, Japan
| | - Miguel Garcia-Guzman
- Department of Translational Sciences, Rakuten Medical, Inc, San Diego, California, USA
| | - Merrill Biel
- Department of Clinical Development, Rakuten Medical, Inc, San Mateo, California, USA
| | - Ann M Gillenwater
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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9
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Dalle Carbonare M, Yeung E, Siddiqui J, Kandasamy N, Fan K. A life-threatening dental implant: A case report. Clin Implant Dent Relat Res 2021; 23:477-481. [PMID: 33977650 DOI: 10.1111/cid.13010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intraoral bleeding complications in implant surgery are infrequent; nevertheless, serious and life-threatening complications have been described, generally related to mandibular implants. PURPOSE This article presents the exceptional case of a 24-year-old woman who underwent repeated delayed life-threatening episodes of intraoral bleeding following uncovering of a maxillary dental implant. Local measures afforded only temporary control. RESULTS The episodes were successfully managed by embolising the greater descending palatine artery, and the patient remains now under close follow-up. CONCLUSIONS Early recognition of shock secondary to hemorrhage following intraoral surgery is of paramount importance.
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Affiliation(s)
- Marco Dalle Carbonare
- Oral and Maxillofacial Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Elizabeth Yeung
- Oral and Maxillofacial Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Juveria Siddiqui
- Interventional Neuroradiology, King's College London NHS Foundation Trust, London, UK
| | - Naga Kandasamy
- Interventional Neuroradiology, King's College London NHS Foundation Trust, London, UK
| | - Kathleen Fan
- Oral and Maxillofacial Surgery, King's College Hospital NHS Foundation Trust, London, UK
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10
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Cohen EEW, Bell RB, Bifulco CB, Burtness B, Gillison ML, Harrington KJ, Le QT, Lee NY, Leidner R, Lewis RL, Licitra L, Mehanna H, Mell LK, Raben A, Sikora AG, Uppaluri R, Whitworth F, Zandberg DP, Ferris RL. The Society for Immunotherapy of Cancer consensus statement on immunotherapy for the treatment of squamous cell carcinoma of the head and neck (HNSCC). J Immunother Cancer 2019; 7:184. [PMID: 31307547 PMCID: PMC6632213 DOI: 10.1186/s40425-019-0662-5] [Citation(s) in RCA: 470] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/02/2019] [Indexed: 02/06/2023] Open
Abstract
Head and neck cancers, including those of the lip and oral cavity, nasal cavity, paranasal sinuses, oropharynx, larynx and nasopharynx represent nearly 700,000 new cases and 380,000 deaths worldwide per annum, and account for over 10,000 annual deaths in the United States alone. Improvement in outcomes are needed for patients with recurrent and or metastatic squamous cell carcinoma of the head and neck (HNSCC). In 2016, the US Food and Drug Administration (FDA) granted the first immunotherapeutic approvals - the anti-PD-1 immune checkpoint inhibitors nivolumab and pembrolizumab - for the treatment of patients with recurrent squamous cell carcinoma of the head and neck (HNSCC) that is refractory to platinum-based regimens. The European Commission followed in 2017 with approval of nivolumab for treatment of the same patient population, and shortly thereafter with approval of pembrolizumab monotherapy for the treatment of recurrent or metastatic HNSCC in adults whose tumors express PD-L1 with a ≥ 50% tumor proportion score and have progressed on or after platinum-containing chemotherapy. Then in 2019, the FDA granted approval for PD-1 inhibition as first-line treatment for patients with metastatic or unresectable, recurrent HNSCC, approving pembrolizumab in combination with platinum and fluorouracil for all patients with HNSCC and pembrolizumab as a single agent for patients with HNSCC whose tumors express a PD-L1 combined positive score ≥ 1. These approvals marked the first new therapies for these patients since 2006, as well as the first immunotherapeutic approvals in this disease. In light of the introduction of these novel therapies for the treatment of patients with head and neck cancer, The Society for Immunotherapy of Cancer (SITC) formed an expert committee tasked with generating consensus recommendations for emerging immunotherapies, including appropriate patient selection, therapy sequence, response monitoring, adverse event management, and biomarker testing. These consensus guidelines serve as a foundation to assist clinicians' understanding of the role of immunotherapies in this disease setting, and to standardize utilization across the field for patient benefit. Due to country-specific variances in approvals, availability and regulations regarding the discussed agents, this panel focused solely on FDA-approved drugs for the treatment of patients in the U.S.
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Affiliation(s)
- Ezra E W Cohen
- Moores Cancer Center, University of California San Diego, San Diego, CA, USA
| | - R Bryan Bell
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, USA
| | - Carlo B Bifulco
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, USA
| | - Barbara Burtness
- Yale School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - Maura L Gillison
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Nancy Y Lee
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rom Leidner
- Earle A. Chiles Research Institute at the Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, USA
| | | | - Lisa Licitra
- Fondazione IRCCS Istituto Nazionale dei Tumori Milan and University of Milan, Milan, Italy
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Loren K Mell
- Moores Cancer Center, University of California San Diego, San Diego, CA, USA
| | - Adam Raben
- Helen F. Graham Cancer Center, Newark, DE, USA
| | | | - Ravindra Uppaluri
- Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA
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11
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Kreiser K, Gröber I, Zimmer C, Storck K. Stent grafts in patients with carotid blowout syndrome: Outcome and antiplatelet therapy in preventive versus emergency cases. Head Neck 2018; 40:2521-2527. [PMID: 30102823 DOI: 10.1002/hed.25388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/20/2018] [Accepted: 05/29/2018] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Carotid blowout syndrome due to tumor infiltration, fistulas, and therapy-related necrosis can occur as late as years after the treatment. Reporting our experiences with preventive and acute treatment with stent grafts and discussing different ways of antiplatelet therapy. METHODS We reviewed all patients between 2010 and 2016 who underwent stent graft placement and analyzed outcome, complications, and antiplatelet regime. RESULTS Seventeen patients were treated in 24 sessions (n = 7 threatened, n = 5 imminent, and n = 12 acute bleeding). The antiplatelet regime covered the entire range from aspirin only to loading doses of aspirin/clopidogrel, perioperative heparin, and aspirin/clopidogrel for 12 months followed by lifelong aspirin. Rare complications were not associated with the preprocedural or periprocedural but were associated with the postprocedural antiplatelet regime. CONCLUSION Most complications of stent graft implantations due to a carotid blowout syndrome occur postprocedurally: rare thrombotic events are linked to not taking a medication and frequent rebleedings may be reduced by an earlier reduction of dual-antiplatelet to mono-antiplatelet therapy.
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Affiliation(s)
- Kornelia Kreiser
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Muenchen, Germany
| | - Isabell Gröber
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Muenchen, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Muenchen, Germany
| | - Katharina Storck
- Department of Otorhinolaryngology, Klinikum rechts der Isar, Technische Universität München, München, Germany
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12
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Walsh M, Supriya M, Railton N. Major haemorrhage requiring transarterial embolisation following open biopsy of an unusual neck mass. Ann R Coll Surg Engl 2017; 99:e162-e164. [PMID: 28660821 DOI: 10.1308/rcsann.2017.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A 65-year-old man presented with a right supraclavicular neck mass and right arm pain. Magnetic resonance imaging revealed a 96mm lesion in the upper thoracic paraspinal region extending into the deep supraclavicular fossa. The presentation was consistent with a sarcoma or lymphoma but fine needle aspiration was inconclusive. During open biopsy of the lesion, the patient had a rapid intraoperative haemorrhage of 1l from the tumour. Haemostasis could only be achieved by transarterial embolisation of the feeding vessel and the biopsy result confirmed Ewing's sarcoma. Open biopsy is considered the gold standard in the diagnosis of certain tumour types; however, the morbidity from haemorrhage must be considered. This case highlights the key role that transarterial embolisation can play in achieving haemostasis in the neck.
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Affiliation(s)
- M Walsh
- Mid Essex Hospital Services NHS Trust , UK
| | - M Supriya
- Mid Essex Hospital Services NHS Trust , UK
| | - N Railton
- Mid Essex Hospital Services NHS Trust , UK
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