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Background: Radiation‐associated‐dysphagia is a serious side effect of radiotherapy (RT) for head and neck cancer (HNC). Methods: Seventy‐six patients had a weekly prospective follow‐up from baseline until one week post‐RT. Combined mixed model analysis (n = 43) determined the evolution of self‐perceived swallowing function, isometric tongue strength (MIP), tongue strength (TS) during swallowing (Pswal), and quality of life (QoL) in these patients during RT. Results: Swallowing deteriorated from the third week on, resulting in an increase of tube dependency from 10% at baseline toward 31% post‐RT. Both MIP and Pswal are reduced, with anterior MIP decreasing in 29% of patients and posterior MIP in 17%. Pswal decreases for saliva and a bolus swallow. All QoL subscales except "sleep" were affected during RT. Conclusions: Self‐perceived swallowing function, TS and QoL decrease during RT for HNC. Current findings highlight the need for early monitoring of these parameters. [ABSTRACT FROM AUTHOR]

Objectives: Bisphosphonate-related osteonecrosis of the jaw (BROJ) is a serious oral complication of bisphosphonate (BP) treatment involving the exposure of necrotic maxillary or mandibular bone. Our purpose is to describe the clinical presentation of 34 cases of BROJ and to identify potential risk factors. Study Design: A retrospective study was performed in four Belgian institutions. Methods: Complete medical histories were recorded and analyzed. These data include age, gender, initial disease requiring BP, type and duration of BP treatment, symptomatology and location of BROJ, prior dental procedures, treatment of the BROJ and treatment outcome, and radiographic, histological, and microbiological data. Results: Bisphosphonates (BP) were used in the management of disseminated cancers in 30 patients (88.5% of total studied), while four patients received BP due to osteoporosis (11.5%). The most frequently used BP was zoledronic acid in 29 patients (83%). Microbiological data obtained in 25 patients demonstrated that 72% of these patients were infected or colonized by an actinomyces. Eight of the 14 patients (57%) who received only medical treatment were cured. Of the 20 patients who underwent surgical treatments, only four were completely cured (20%). BROJ lesions smaller than 1 cm are associated with better prognosis in terms of treatment outcomes ( P = .0009). Local treatments combined with long-term antibiotics are also correlated with better prognosis ( P = .02). Conclusions: Lesions smaller than 1 cm and lesions that were subject to medical treatments are associated with a better outcome. Surgical treatments appear to be non-beneficial for BROJ. Laryngoscope, 119:323-329, 2009 [ABSTRACT FROM AUTHOR]

Objective: The purpose of the study was to evaluate the effectiveness of a U-shaped pectoralis major myocutaneous flap (PMMF) to reconstruct a large circumferential defect involving the oro- and hypopharynx. Study design and setting: Retrospective case series. Results: Twelve patients with advanced oro- and hypopharyngeal cancer (stage IV) underwent surgery resulting in a circumferential defect of pharyngoesophageal segment (PES). Those defects were reconstructed using a U-shaped PMMF. Four pharyngocutaneous fistulas were observed postoperatively and healed spontaneously within 3 to 7 weeks. Eight patients were able to resume a regular diet. A voice prosthesis was functional in 5 patients. Conclusion: This preliminary study shows that this technique is a simple and effective method with acceptable morbidity rate and satisfactory functional results. We demonstrate that this procedure allows the reconstruction of large defects involving the oro- and hypopharynx in irradiated patients. This technique could be an interesting alternative for surgical teams suffering from the absence of a microsurgical team. EBM rating: C-4 [Copyright &y& Elsevier]

We propose a new technique of wide vertical hemipharyngolaryngectomy which combines resection of laterally localized extended pharyngolaryngeal tumors with immediate microsurgical reconstruction using a radial forearm free flap, including the tendon of the palmaris longus. It eliminates the limitations of resections, which are usually performed to avoid closure difficulties of the resulting defect. In addition, the new technique avoids the use of tumor-neighboring structures for closure, fulfilling the oncological principles of surgery performed in this region. Our preliminary results show good restored deglutition and phonation. Postoperative irradiation does not seem to affect these results. [ABSTRACT FROM AUTHOR]