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Cartilage can be shaped by scoring. In an exploratory study in living adult animals, this phenomenon was demonstrated in cartilage of the nasal septum. Bending was observed immediately after superficial scoring of the cartilage surface, and the cartilage always warped in the direction away from the scored side. The scored piece of cartilage still showed its initially distorted shape 10 weeks after primary surgery. In ex vivo experiments, a clear relation between incision depth and bending of septal cartilage was observed. Under these controlled conditions, the variation between different septa was small. Deformation of the septal specimens was increased by introducing single superficial incisions deepening to half the thickness of the cartilage. A positive correlation between incision depth and bending was demonstrated. A model was used to accurately predict the degree of bending of the cartilage after making an incision of a particular depth. Hence, the effect of cartilage scoring can be predicted. Because the results of this controlled study showed excellent reproducibility for different septa, it is expected that this model can be extrapolated to human nasal septum cartilage. This would enable the surgeon to better predict the result of cartilage scoring, either preoperatively or perioperatively. Plast. Reconstr. Surg.111 1948, 2003.

Cartilage structures from the head and neck possess a certain but limited capacity to heal after injury. This capacity is accredited to the perichondrium. In this study, the role of the inner cambium and the outer fibrous layers of the perichondrium in cartilage wound healing in vitro is investigated. For the first time, the possibility of selectively removing the outer perichondrium layer is presented. Using rabbit ears, three different conditions were created cartilage explants with both perichondrium layers intact, cartilage explants with only the outer perichondrium layer dissected, and cartilage explants with both perichondrium layers removed. The explants were studied after 0, 3, 7, 14, and 21 days of in vitro culturing using histochemistry and immunohistochemistry for Ki67, collagen type II,transforming growth factor beta 1 TGF1, and fibroblast growth factor 2 FGF2. When both perichondrium layers were not disturbed, fibrous cells grew over the cut edges of the explants from day 3 of culture on. New cartilage formation was never observed in this condition. When only the outer perichondrium layer was dissected from the cartilage explants, new cartilage formation was observed around the whole explant at day 21. When both perichondrium layers were removed, no alterations were observed at the wound surfaces. The growth factors TGF1 and FGF2 were expressed in the entire perichondrium immediately after explantation. The expression gradually decreased with time in culture. However, the expression of TGF1 remained high in the outer perichondrium layer and the layer of cells growing over the explant. This indicates a role for TGF1 in the enhancement of fibrous overgrowth during the cartilage woundhealing process. The results of this experimental in vitro study demonstrate the dual role of perichondrium in cartilage wound healing. On the one hand, the inner layer of the perichondrium, adjacent to the cartilage, provides in time cells for new cartilage formation. On the other hand, the outer layer rapidly produces fibrous overgrowth, preventing the good cartilagetocartilage connection necessary to restore the mechanical function of the structure. Plast. Reconstr. Surg.110 1073, 2002.

Injury-induced abnormal development of the cricoid ring has been demonstrated in previous growth studies. In this study we focused on the immediate effects of various types of lesions to the cricoid, eliminating the influence of inserting muscles. In isolated, vital cricoids (cricoid explants) the anterior arch was split, creating a small gap between the cut ends. Previous injury to the internal surface of the cricoid ring resulted in a three to four fold increase of the diameter of the gap, actually widening the interrupted cricoid. On the contrary, injuring the external surface of the cricoid cartilage prior to anterior cricoid split, leads to an overlap of the cut edges, and a narrowing of the ring. These injury-specific changes in shape of the cricoid ring are ascribed to the release of interlocked stresses, present in the cartilage. It is suggested that the demonstrated methods to change the shape of the cricoid ring in a predictable way, are relevant for the treatment of patients with cricoid malformation.

A pedicled auricular perichondrial flap wrapped around trabecular demineralized bovine bone matrix can generate an autologous cartilage graft. In earlier experimental studies, it was demonstrated that this graft could be used for nasal and cricoid reconstruction. It was assumed that the vascularization of the perichondrial flap was obligatory, but it was never proven that the flap should be pedicled. Moreover, for clinical use, the dimensions of the auricle would set restrictions to the size of the graft generated. Therefore, the possibility to generate cartilage with a composite graft of a free perichondrial flap wrapped around demineralized bovine bone matrix, by using young New Zealand White rabbits, was studied. This composite graft was implanted at poorly subcutaneously in the abdominal wall n12, fairly subcutaneously in the pinna n12, and wellvascularized sites quadriceps muscle n12. As a control, trabecular demineralized bovine bone matrix was implanted without perichondrial cover. Half of these grafts n 6 were harvested after 3 weeks, and the remaining grafts n6 after 6 weeks of implantation. In histologic sections of these grafts, the incidence of cartilage formation was scored. Furthermore, the amount of newly formed cartilage was calculated by computerized histomorphometry. Trabecular demineralized bovine bone matrix without perichondrial cover demonstrated early resorption no cartilage or bone was formed. In demineralized bovine bone matrix wrapped in perichondrium, early cartilage formed after 3 weeks at well and fairly vascularized sites. No cartilage could be detected in grafts placed at a poorly vascularized site after 3 weeks minimal cartilage formed after 6 weeks. In summary, the highest incidence of cartilage formed when trabecular demineralized bovine bone matrix was wrapped either in a pedicled auricular perichondrial flap or in a free perichondrial flap, which was placed at a wellvascularized site. Second, a significantly higher percentage of the total area of the graft was cartilaginized at wellvascularized sites after 3 weeks. The newly generated cartilage contained collagen type II and proteoglycans with hyaluronic acid binding regions, whereas collagen type I was absent, indicating the presence of hyaline cartilage. This study demonstrates that new cartilage suitable for a graft can be generated by free perichondrial flaps, provided that the site of implantation is well vascularized. Consequently, the size of such a graft is no longer limited to the dimensions of the auricle. Plast. Reconstr. Surg.102 2012, 1998.

Studies that have examined correlations between psychosocial factors and survival in cancer patients do not permit any definitive conclusions. To the authors' knowledge, to date no study has examined the relation between medical as well as quality of life variables and survival in head and neck carcinoma patients. The current study focused on the complex interactions among psychosocial, medical, behavioral, and demographic variables as they relate to prognosis in these patients. A total of 133 consecutive head and neck carcinoma patients were included in a prospective study at pretreatment. In addition to clinical variables, psychosocial and physical functioning was assessed by means of a self-report questionnaire. During the observation period 57 patients died whereas 76 were still alive at 6 years after treatment. Results of the multivariate survival analysis indicated that patients without head and neck metastasis had a better prognosis than patients with positive cervical lymph nodes. Pretreatment smoking showed a negative correlation with overall survival. Patients who were more physically self-efficacious (i.e., higher perceived physical abilities) were more likely to survive and less likely to develop a recurrence. In addition, patients who expressed intense psychosocial complaints prior to treatment had a better prognosis than had those who did not express such negative feelings. The current findings linking physical self-efficacy and prognosis are promising, but clinical trials are necessary to examine the direct and indirect mediational pathways of the variables that underlie physical efficacy and influence survival and recurrence. Also, the negative correlation between pretreatment smoking and survival suggests a need for increased efforts to address smoking in newly diagnosed patients. Cancer 1998;83:2567-2579. © 1998 American Cancer Society.

• The assessment of nodal involvement in patients with squamous cell carcinoma of the head and neck is still a major diagnostic problem. Although the sensitivity of imaging techniques for detection of neck nodes is gradually improving, the specificity for metastases remains low. Cytologic examination could, theoretically, supply additive information. Computed tomographic—and magnetic resonance—guided aspiration techniques have been described, but these were not efficacious and laborious. In 1984, we developed a technique for ultrasound-guided (UG) fine-needle aspiration biopsy (FNAB). This technique is described herein, and the value of UGFNAB is compared with conventional FNAB. All statistical characteristics of UGFNAB appeared to be superior to conventional FNAB (sensitivity, 98% vs 88%; specificity, 95% vs 82%; positive predictive value, 98% vs 93%; negative predictive value, 95% vs 74%; and accuracy, 97% vs 87%). Furthermore, UGFNAB was characterized by less nondiagnostic aspirations. It is concluded that UGFNAB is a reliable technique for differentiation between benign nodes and cervical lymph node metastases and it may, therefore, contribute to a more accurate assessment of the neck in squamous cell carcinoma of the head and neck.(Arch Otolaryngol Head Neck Surg. 1991;117:402-404)

• Nodal disease is a diagnostic problem in head and neck oncology. Current methods for investigation of the neck are not satisfactory as far as differentiation between necks with positive nodes and those with negative nodes is concerned. In the present study, the results of palpation and ultrasound examination were compared with histopathologic examination results of 120 neck dissection specimens. Furthermore, the value of ultrasound examination, combined with cytologic examination, of neck nodes was evaluated. Ultrasound examination was characterized by high sensitivity, ie, 96.8%; specificity was 32.0%. When the results of ultrasound-guided fine-needle aspiration biopsy were added to the ultrasound findings, specificity was as high as 92.9%. From these results, it was concluded that ultrasound examination with fine-needle aspiration biopsy is an accurate method for assessment of the neck in head and neck oncology.(Arch Otolaryngol Head Neck Surg 1989;115:689-690)