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Objective To evaluate the feasibility and outcomes of porcine submucosal allograft (Biodesign Sinonasal Repair Graft [Cook Medical, Bloomington, IN]) in oral cavity and oropharynx reconstruction after ablative surgery. Methods We conducted a prospective and retrospective review of patients who underwent Biodesign Sinonasal Repair Graft reconstruction for oral and oropharyngeal surgical defects at a single institution between 2018 and 2020. A total of 11 patients were included in the study. Data points included their perioperative medical and demographic data, immediate postoperative course, and follow‐up visits at 10 days and at 2 months. The clinicopathologic characteristics of their disease, postoperative esthetic, and functional outcomes were recorded and analyzed. Results Eleven procedures have been performed, and all patients received Biodesign reconstruction either immediately after ablation or after they failed a previous reconstruction. None of the patients had bone exposure. The subsites included oral tongue (n = 6), floor of the mouth (n = 3), buccal mucosa (n = 1), and soft palate (n = 1). In all cases, the operations and the postoperative course were uneventful. The mean defect size was 22 cm2. The median start of oral intake was at 2 days postoperatively. The Biodesign graft healed well in all patients with no total graft loss. There was one complication that required revision surgery due to obstruction of Wharton's duct by the Biodesign material. Conclusions Biodesign can be a viable option for small and medium‐sized oral and oropharyngeal defects in patients who are medically unfit or do not want to undergo a free flap surgery. Level of Evidence 4., This is a case series of 11 subjects describing a single‐institution experience with the use of Biodesign synthetic porcine material for reconstruction of oral cavity and soft palate (oropharyngeal) defects. This graft material has been used in the head and neck previously including the ear and the nose as well as other non‐head and neck locations around the body. This is the first article discussing its clinical use in the oral cavity.

Osteosarcoma of the jaw (OSJ) is a rare malignancy, accounting for less than 1% of head and neck malignancies. OSJ can arise as a primary malignancy or secondary to locoregional radiation treatment. Radiologically, these tumors show large, destructive growth with periosteal reaction, which can suggest the diagnosis of osteosarcoma (OS). However, histology with demonstration of neoplastic, "lacelike" osteoid is the key to determining the diagnosis. Small tissue samples can complicate the diagnosis, especially in cases of high-grade OS with sheetlike growth and scant areas of immature osteoid formation. We report 3 cases of OSJ, including 1 rare case of epithelioid OS of the mandible, diagnosed at our hospital over a 6-month period: case 1: a 48-year-old male with history of Hodgkin lymphoma, who was treated with radiation and developed osteoblastic OS of the mandible 14 years later; case 2: a 79-year-old female with a history of fibrous dysplasia, who presented with a large destructive maxillary mass, which was diagnosed as histologically fibroblastic OSJ of the maxilla; and case 3: a 70-year-old male with radiation-induced high-grade epithelioid OS, which had been incorrectly diagnosed as poorly differentiated squamous cell carcinoma on a small biopsy specimen; this patient experienced recurrence with multiple neck nodules after treatment, underwent repeat resection, and was finally diagnosed with high-grade OS (epithelioid type).

Optical fluorescent technology has the potential to deliver real time imaging of cancer into the operating room and the clinic. To determine the efficacy of fluorescently labeled anti-vascular endothelial growth factor (VEGF) antibody to be used as a cancer specific optical contrast agent to guide surgical resections, we evaluated the sensitivity and specificity of this agent to detect microscopic residual disease in a preclinical model of head and neck squamous cell carcinoma (HNSCC). Using a flank murine model, mice were xenografted with SCC-1 tumor cells and injected with anti-VEGF antibody (bevacizumab) conjugated to an optically active fluorophore (Cy5.5). Tumors underwent sub-total resections and were assessed for the presence of residual disease by fluorescent stereomicroscopy. Expected positive and negative biopsies were taken according to the presence or absence of fluorescence, respectively. Histology was used to confirm the presence or absence of disease. Biopsies taken from areas of fluorescence within the wound bed (n=18) were found to be histologically malignant in all but one biopsy. Samples taken from a non-fluorescing tumor bed (n=15) were found to be histologically benign in 11 of 15. These findings correlated with a sensitivity and specificity of 80.9% and 91.7%, respectively. This data supports previous data presented by this group and supports further investigation of fluorescently labeled anti-tumor antibodies to detect disease in the surgical setting.

Objective The aim of this study is to determine the efficacy of indocyanine green (ICG) conjugated to antiepidermal growth factor receptor antibody (cetuximab) to image head and neck cancer. Study Design Mice (n = 3) were injected with unconjugated ICG and imaged at 100-second intervals for a total of 1000 seconds to assess imaging characteristics. Mice (n = 10) xenografted with SCC-1 cells were then systemically injected with cetuximab conjugated to indocyanine green and imaged over a 72-hour period. To assess the sensitivity and specificity, xenografted tumors underwent subtotal resections and then were assessed for residual disease by fluorescence stereomicroscopy and confirmed by histology. Results Tumors demonstrated excellent fluorescence 24 hours after injection of cetuximab-ICG. There was a direct relationship between fluorescence and the given dose of cetuximab-ICG. Following subtotal resection, we found fluorescence correlated with a sensitivity of 78.4% and specificity of 96%. Conclusions This study provides evidence that supports further preclinical investigation of cetuximab in the evaluation of surgical margins, but linkage to ICG lacks the sensitivity for use in a clinical setting.

Objective: Combining the therapeutic and diagnostic properties of targeted antibodies may improve clinical assessment of disease with limited added toxicity during treatment. Methods: Mice (n=10) were xenografted with SCC-1 tumor cells and then treated with radiation, cisplatin, and cetuximab. Brightfield and fluorescent imaging was performed after systemically injecting fluorescently labeled cetuximab prior to treatment and at 6 or 10 weeks after initiation of treatment. The relative fluorescence intensity was determined for each image. Results: The tumor luminosity measured before (week 0), during (week 6) and after treatment (week 10) did not significantly change. Actual tumor measurement corresponded to fluorescent measurements of tumors both before treatment and after treatment. Complete response to therapy occurred in one animal, where resolution of the tumor correlated with loss of fluorescent activity. Conclusions: This preclinical data suggests combining the diagnostic and therapeutic properties ...

Purpose: Assessment of donor site morbidity and recipient site complications following free radial forearm osteocutaneous flap (FRFOCF) harvest and evaluation of patient perceived upper limb disability for free radial forearm osteocutaneous versus fasciocutaneous flaps (FRFF). Methods: First a case series was undertaken of 218 patients who underwent an FRFOCF at two tertiary referral centers between February 1998 and November 2010. Outcomes included forearm donor site morbidity and recipient site complications. Second, the disability of the arm, shoulder, and hand (DASH) questionnaire assessing patient perceived arm disability was administered by phone to 60 consecutive patients who underwent an FRFOCF or FRFF. Results: Mean patient age was 63 years with male predominance (62.8%). Median bone length harvested was 8 cm (range, 3–12 cm) with prophylactic plating of the radius following harvest. Donor site morbidity included fracture (1 patient, 0.5%) and sensory neuropathy (5 patients, 2.3%). Mean DASH scores were comparative between groups and to established normative values. Mandibular malunion rate was 3.2% and hardware extrusion at the recipient site occurred in 15.6%. Conclusion: Reluctance to perform FRFOCF by surgeons usually centers on concerns regarding potential donor site morbidity and adequacy of available bone stock; however, we identified minimal objective or patient perceived donor site morbidity or recipient site complications following harvest of FRFOCFs. Mild wrist weakness and stiffness are common but do not impede ability to perform activities of daily living. Data from this and other reports suggest this flap is particularly useful for midfacial and short segment mandibular reconstruction. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.

Objective: 1) Assess donor site morbidity following harvest of osteocutaneous radial forearm free flaps (OCRFF). 2), Evaluate patient perceived upper limb disability for osteocutaneous vs fasciocutaneous radial forearm free flapsMethod: Retrospective cross-institutional review of OCRFF performed between 2001 and 2010. There were 218 included patients. The primary outcome measure was forearm donor site morbidity. The Disability of the Arm, Shoulder and Hand (DASH) questionnaire was used to compare patient perceived arm disability for osteocutaneous vs fasciocutaneous radial forearm flaps.Results: Mean patient age was 63 years with a male predominance (63%). The left arm was the donor site in 86%. Median bone length harvested was 8 cm (range, 3-12 cm). Following harvest, the radius was plated in 99% of patients. Recipient sites primarily included the mandible (62%) and maxilla (34%). Donor site morbidity included fracture (2 patients, 0.9%) and sensory neuropathy (5 patients, 2%). Fractures were treated wit...

Detection of regional and distant metastatic disease has significant implications for patient management. The vast majority of distant metastasis in head and neck squamous cell carcinoma (HNSCC) occurs in the chest and, when present, is a contraindication to surgical therapy. Development of regional metastasis from HNSCC is associated with a 50% reduction in patient survival.1 Complete removal of cervical lymph nodes is performed in patients with head and neck cancer for prognostic and therapeutic reasons; however, cervical lymphadectomy is associated with significant morbidity and operative time. Noninvasive imaging modalities used for detecting metastatic disease are CT, MR, and 18F-fluoro-deoxy-glucose positron emission tomography (FDG PET). The most sensitive and specific modality of imaging pulmonary metastasis is currently performed by PET-CT imaging, followed by lung or mediastinal lymph node biopsy.2 Unfortunately, these modalities cannot be used in real time to guide surgical resection or biopsy. Furthermore, unlike many radiological techniques, optical imaging allows simultaneous viewing of the anatomical surface and the fluorescent image in real time. Accurate detection and pathologic confirmation of metastatic disease during surgical procedure may improve patient outcomes by promoting minimally invasive procedures. The coupling of fluorescent dyes to tumor-specific probes for the purposes of optical imaging is a rapidly emerging imaging modality because of its high sensitivity and spatial resolution.3,4 The selective property of therapeutic antibodies for tumor cells makes this an optimal method for imaging. Epidermal growth factor receptor (EGFR) is overexpressed in 80% to 90% of head and neck cancers and is upregulated during the early stages of tumor development.5,6 Cetuximab (Erbitux, ImClone Systems, Branchburg, New Jersey) is a therapeutic antibody directed against EGFR and approved for treatment of head and neck cancer.7 We hypothesize that fluorescently labeled cetuximab would localize in small islands of pulmonary or cervical metastasis due to the abundance of EGFR in HNSCC compared with the surrounding normal cells. We hypothesize that this technique can detect and guide the removal of regional and distant metastatic disease. We have previously demonstrated that the fluorescently labeled antibody is specific to head and neck cancer xenografts in a preclinical murine model.8–10 The purpose of this study is to determine if the fluorescently labeled cetuximab could be used in head and neck cancer to detect metastatic disease. To address feasibility of this hypothesis, we assessed fluorescence imaging of metastatic head and neck cancer in the lung and neck in a preclinical murine model.