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Aim: The aim of this study is to evaluate the role of CD44 and matrix metalloproteinase (MMP)-9 expression in predicting neck metastasis of supraglottic laryngeal carcinoma., Materials and Methods: Two hundred ninety-four supraglottic laryngeal cancers were treated surgically from 1991 to 2005. Ninety-four of the 294 patients had pathologically metastatic lymph node (pN+). Among the 94 patients, 30 pN+ patients were selected via random sampling. Sex-, T value-, and differentiation-matched 30 patients who had pathologically negative neck were also selected. CD44 and MMP-9 antibodies were applied to the tumor representative sections that were derived from paraffin sections by using the streptavidin-biotin method. The association between immunohistochemical results and histopathologic lymph node metastasis was analyzed statistically. The association between immunostaining of CD44 and MMP-9 was also analyzed., Results: Overexpression of CD44 and MMP-9 was found to be significantly higher in pN+ patients. There was fair concordance between immunostaining of CD44 and MMP-9., Conclusion: Although wider multiinstitutional and multidisciplinary studies are needed to draw specific conclusions, CD44 and MMP-9 can be useful in the prediction of neck metastasis in the supraglottic laryngeal carcinoma., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Cancer is a disease the incidence of which rises with age. Given that the risk of developing cancer increases with advancing age, a growing number of elderly patients will need treatment for cancer in the future, and head and neck surgeons are increasingly being faced with therapeutic dilemmas regarding this age group. Related publications show that older patients are less likely than younger patients to receive standard treatment. Therapeutical planning must be based not only on tumor characteristics, but also on the physiological, rather than the chronological, age of the patient. Comorbidity is the most important factor in less intensively treatment of elderly patients. Complete geriatric assessment and a multidisiclinary approach are the crucial points. Surgeons, radiation therapy specialists, medical oncologists and geriatricians must actively cooperate in this setting. Recruitment of elderly cancer patients to more clinical trials is needed to enhance our knowledge and to offer optimum treatment to this unique subgroup.

Objectives: We evaluated patients who were treated for head and neck paragangliomas., Patients and Methods: The study included 40 patients (25 females, 15 males; mean age 48 years; range 26 to 74 years) who were operated on for paragangliomas of the head and neck region between 1993 and 2007. Clinical findings, treatment modalities, and the results of treatment were evaluated., Results: The most common complaint was neck swelling (n=30), followed by tinnitus (n=7), hearing loss (n=6), imbalance (n=3), pain (n=2), hoarseness (n=2), and nasal obstruction (n=1). The mean duration of symptoms was 22 months. The most common paraganglioma was glomus caroticum (n=28) with a mean tumor diameter of 4.5 cm (range 2 to 12 cm). Urinary vanilmandelic acid concentration was measured in 24 patients and found above normal range in two patients. Octreotide scintigraphy was performed in 14 patients and femoral angiography was performed in 27 patients. Multicentric disease was present in one patient and one patient had bilateral involvement. Transcervical excision was the most common approach. Complications were as follows: transient facial nerve paresis (n=3), vagal nerve palsy (n=2), hypoglossal nerve palsy (n=2), permanent facial paralysis (n=1), bleeding (n=1), and total hearing loss (n=1). No recurrences were encountered during a mean follow-up of 71 months., Conclusion: Preoperative evaluation of all patients with respect to catecholamine secretion and multicentric disease is important for choosing the proper treatment and preventing possible complications.

The supraglottic larynx has a rich lymphatic network that places patients with supraglottic laryngeal carcinomas at high risk for early dissemination of the disease into the cervical lymphatics. Therefore, elective neck treatment of clinically N0 neck in patients with supraglottic carcinomas is widely accepted as a standard approach. However, the issue whether elective neck treatment should routinely be directed on both sides of the neck is still controversial. The present study is aimed at determining whether T2-T4 stage supraglottic carcinomas require bilateral neck dissection in the management of N0 necks. We designed a prospective study on 72 patients with N0 supraglottic laryngeal carcinoma. Patients were divided into three groups according to the site and extension of the primary tumors. Group I consisted of 21 patients with lateralized (clear lateral) lesion reaching but not crossing the midline. Group II comprised 25 patients with cancer largely involving one side and crossing to the midline. Group III included 26 patients with carcinoma equally involving both sides of the larynx or growth into the midline larynx. All patients underwent bilateral lateral neck dissection in conjunction with various types of laryngectomies selected to the status of the primary. Of the 72 patients, 16 were found to have occult regional metastases in pathologic examination (9 pN1, 4 pN2b, 3 pN2c). The prevalence of occult metastases proportionally increased with T stage from 8.3 to 22.7 and 31.2%, respectively, for T2, T3 and T4. Bilateral neck metastases were found in 2 of 26 patients (7.7%) with central lesions. There was only one patient (4%) with both ipsilateral and contralateral lymph node metastasis in group II. None of the 21 patients with lateral lesion (group I) had contralateral neck metastasis. Routine bilateral elective neck dissection may not be a part of the surgical procedure in all supraglottic laryngeal carcinoma patients. Bilateral neck dissection should be preferred for cases with central tumors and lateral tumors with positive nodes in the ipsilateral side of the neck.