Head and neck cancer : management and reconstruction

Head and Neck Cancer Management and Reconstruction Second Edition
Title Page
Copyright
Dedication
Contents
Video Contents
Preface
Acknowledgments
Contributors
1 Carcinoma of the Oral Tongue and Floor of Mouth
	1.1 Introduction
	1.2 Epidemiology
		1.2.1 Incidence
	1.3 Anatomy of the Oral Tongue and Floor of Mouth
		1.3.1 Neurovascular and Muscular Anatomy
		1.3.2 Lymphatic Drainage
	1.4 Pathology
	1.5 Risk Factors/Etiology
		1.5.1 Tobacco and Alcohol
		1.5.2 Chronic Dental Trauma
		1.5.3 Oral Lichen Planus
		1.5.4 Proliferative Verrucous Leukoplakia
		1.5.5 Fanconi抯 Anemia
	1.6 Staging
	1.7 Clinical Presentation
		1.7.1 History
		1.7.2 Physical Examination
	1.8 Diagnostic Evaluation
		1.8.1 Biopsy
		1.8.2 Imaging
		1.8.3 Ultrasound
		1.8.4 Computed Tomography
		1.8.5 Magnetic Resonance Imaging
		1.8.6 Positron Emission Tomography/ Computed Tomography
		1.8.7 Pathology
		1.8.8 Genetic Testing
	1.9 Treatment
		1.9.1 Surgery
		1.9.2 Primary Nonsurgical Management
	1.10 Oncologic Outcomes
		1.10.1 Patterns of Failure
		1.10.2 Survival
	1.11 Prognostic Factors
		1.11.1 American Joint Committee on Cancer Tumor, Node, Metastasis Stage
		1.11.2 Clinicopathologic Models
		1.11.3 Histologic Risk Assessment
		1.11.4 Margin Status
		1.11.5 Tumor Thickness and Depth of Invasion
		1.11.6 Perineural Invasion
		1.11.7 Immunosuppression
	1.12 Conclusion
	1.13 Clinical Cases
		1.13.1 Case 1: cT1N0 Squamous Cell Carcinoma of the Right Lateral Oral Tongue
		1.13.2 Case 2: T4aN2c SCC of the Floor of Mouth
	References
2 Reconstruction of the Oral Tongue and Floor of Mouth
	2.1 Introduction
	2.2 Relevant Anatomy
	2.3 Evaluation of the Oral Tongue Defect
	2.4 Reconstructive Goals and Assessment of Outcomes
	2.5 Options for Reconstruction
		2.5.1 Secondary Intention
		2.5.2 Primary Closure
		2.5.3 Skin Grafts or Synthetic Allografts
		2.5.4 Local Flaps
		2.5.5 Submental Flap
		2.5.6 Facial Artery Musculomucosal Flap
		2.5.7 Free Flaps
		2.5.8 Radial Forearm Free Flap
		2.5.9 Anterolateral Thigh Free Flap
	2.6 Adjuncts to Surgery
	References
3 Carcinoma of the Buccal Mucosa
	3.1 Introduction
	3.2 Anatomy
	3.3 Patterns of Tumor Spread
	3.4 Pathology
	3.5 Etiology
		3.5.1 Tobacco and Alcohol
		3.5.2 Betel Quid
	3.6 Staging
	3.7 Presentation
		3.7.1 History
		3.7.2 Physical Examination
	3.8 Diagnosis andWorkup
	3.9 Treatment
		3.9.1 Surgical Treatment
		3.9.2 Radiation Therapy
		3.9.3 Chemotherapy
	3.10 Complications of Treatment
	3.11 Post-treatment Surveillance
	3.12 Clinical Cases
		3.12.1 Case 1
		3.12.2 Case 2
		3.12.3 Case 3
	References
4 Reconstruction of Buccal Defects
	4.1 Introduction
	4.2 Relevant Anatomy
	4.3 Evaluation of the Buccal Defect
	4.4 Goals of Reconstruction
	4.5 Options for Microvascular Reconstruction
		4.5.1 Radial Forearm
		4.5.2 Lateral Arm
		4.5.3 Anterolateral Thigh
		4.5.4 Fibula Osteocutaneous
		4.5.5 Scapular Osteocutaneous
	4.6 Options for Local and Regional Flaps
		4.6.1 Buccal Fat Pad Flap
		4.6.2 Submental Flap
		4.6.3 Facial Artery Musculomucosal and Buccinator Myomucosal Flap
		4.6.4 The Estlander Flap and Commissuroplasty
	4.7 Other Options
		4.7.1 Primary Closure
		4.7.2 Skin Graft/Mucosal Graft
	4.8 Conclusion
	References
5 Carcinoma of the Palate and Maxilla
	5.1 Introduction
	5.2 Epidemiology
	5.3 Etiology
	5.4 Anatomy
		5.4.1 Patterns of Spread
		5.4.2 Staging
		5.4.3 Prognostic Factors
		5.4.4 Clinical Presentation
		5.4.5 Differential Diagnosis
		5.4.6 Diagnosis andWorkup
		5.4.7 Imaging
		5.4.8 Biopsy
		5.4.9 Treatment
	5.5 Surgical Treatment
		5.5.1 Primary Tumor Resection Approaches and Considerations
		5.5.2 Treatment of the Neck
		5.5.3 Radiation
		5.5.4 Chemotherapy
		5.5.5 Posttreatment Surveillance
	5.6 Clinical Cases
		5.6.1 Case 1
		5.6.2 Treatment Approach
		5.6.3 Case 2
		5.6.4 Treatment Approach
		5.6.5 Case 3
		5.6.6 Treatment Approach
	5.7 Conclusion
	References
6 Reconstruction of the Palate and Maxilla
	6.1 Introduction
	6.2 Relevant Anatomy
	6.3 Evaluation of the Maxillary Defect and Determining the Options for Reconstruction
	6.4 Classification of the Maxillectomy Defect
	6.5 Palate Defects
	6.6 Options for Reconstruction
		6.6.1 The Palatal Island Flap
		6.6.2 The Radial Forearm Free Flap
		6.6.3 The Inferior Maxillectomy
	6.7 More Options for Reconstruction
		6.7.1 Radial Forearm Flap
		6.7.2 Fibula Free Flap
	6.8 Total Maxillectomy with Orbital Preservation
		6.8.1 Anterolateral Thigh, Rectus Abdominis, or Latissimus Dorsi Free Flap
		6.8.2 Fibula Free Flap
		6.8.3 Iliac Crest Myo-osseous Free Flap
		6.8.4 Scapula Free Flap
		6.8.5 Scapular Angle Free Flap
		6.8.6 Iliac Crest Free Flap with Internal Oblique Muscle
		6.8.7 Total Maxillectomy with Orbital Exenteration
	6.9 Conclusion
	References
7 Management of Carcinoma of the Lateral Pharynx and Soft Palate
	7.1 The Lateral Pharynx
		7.1.1 Introduction
		7.1.2 Etiology and Risk Factors
		7.1.3 Epidemiology
	7.2 Anatomy of the Lateral Pharynx
		7.2.1 Pathology
		7.2.2 Clinical Presentation of Lateral Pharyngeal Cancer
		7.2.3 Diagnosis andWorkup for Lateral Pharyngeal Cancer
		7.2.4 Prognostic Factors for Lateral Pharyngeal Cancer
		7.2.5 Treatment
		7.2.6 Surgical Technique
		7.2.7 Complications of Treatment
		7.2.8 Posttreatment Surveillance
	7.3 The Soft Palate
		7.3.1 Introduction
		7.3.2 Etiology and Risk Factors
		7.3.3 Anatomy
		7.3.4 Clinical Presentation of Carcinoma of the Soft Palate
		7.3.5 Prognostic Factors
		7.3.6 Treatment of Carcinoma of the Soft Palate
		7.3.7 Surgical Technique
		7.3.8 Complications
	7.4 Clinical Cases
		7.4.1 Case 1: Tonsil Cancer with Retropharyngeal Node
		7.4.2 Case 2: HPV and De-Escalation
		7.4.3 Case 3: Bilateral Neck Dissection for Soft Palate Lesion
	7.5 Conclusion
	References
8 Reconstruction of the Lateral Pharynx and Soft Palate
	8.1 Introduction
	8.2 Relevant Anatomy
		8.2.1 General Anatomical Considerations
		8.2.2 Muscular and Neurovascular Anatomy
	8.3 Evaluation of Pharynx and Palate Defects and Options for Reconstruction
	8.4 Classification of Pharynx and Soft Palate Defects
		8.4.1 Types I and II Defects
		8.4.2 Types III and IV Defects
	8.5 Options for Reconstruction
		8.5.1 Secondary Intention
	8.6 Locoregional Flaps in Velopharyngoplasty
		8.6.1 Posterior Pharyngeal Flap or Palatal Island Flap
		8.6.2 Facial Artery Myomucosal Flap
		8.6.3 Buccal Fat Flap
	8.7 Regional Flaps
		8.7.1 Temporoparietal Fascia Flap
		8.7.2 Submental Island Flap
		8.7.3 Regional Muscle Flaps (Temporalis, Sternocleidomastoid, Digastric, Strap Muscles)
		8.7.4 Radial Forearm Free Flap and Ulnar Free Flap
		8.7.5 Anterolateral Thigh Flap
	8.8 Conclusion
	References
9 Carcinoma Involving the Mandibular Alveolus and Retromolar Trigone
	9.1 Introduction
	9.2 Anatomy
	9.3 Clinical Features
		9.3.1 Etiology
		9.3.2 Presentation
		9.3.3 Staging
	9.4 Preoperative Assessment of Bone
	9.5 Treatment
		9.5.1 Modality
		9.5.2 Surgical Treatment
	9.6 Prognosis
	9.7 Conclusion
	References
10 Reconstruction of the Mandible and Composite Defect
	10.1 Introduction
	10.2 Anatomy of the Mandible
		10.2.1 Condyle
		10.2.2 Ramus
		10.2.3 Body
		10.2.4 Symphysis
	10.3 Goals for Reconstruction
	10.4 Evaluation of the Defect
	10.5 Options for Reconstruction
		10.5.1 Nonosseus Options
		10.5.2 Free Bone Graft
		10.5.3 Physiology of Bone Grafting
		10.5.4 Nonautologous
	10.6 Composite
		10.6.1 Local Regional
		10.6.2 Fibula
		10.6.3 Iliac Crest
		10.6.4 Scapula
		10.6.5 Osteocutaneous Radial Forearm
		10.6.6 Serratus
		10.6.7 Femur
	10.7 Three-Dimensional Modeling and Virtual Planning
	10.8 Dental Implants
	10.9 Conclusion
	References
11 Open Management of Carcinoma of the Oropharynx
	11.1 Introduction
	11.2 Anatomy of the Oropharynx
	11.3 Human Papillomavirus Negative and Oropharyngeal Carcinoma
		11.3.1 Epidemiology
		11.3.2 Etiology
		11.3.3 Clinical Presentation
		11.3.4 Work-up
		11.3.5 Pathology
	11.4 Human Papilloma Virus and Oropharyngeal Carcinoma
		11.4.1 Introduction
		11.4.2 HPV Immunology
		11.4.3 Etiology
		11.4.4 Clinical Presentation
		11.4.5 Staging
	11.5 Treatment of Oropharyngeal Carcinoma
		11.5.1 Historical Perspective and Nonoperative Treatment
	11.6 Surgical Management of Oropharyngeal Carcinoma
		11.6.1 Transoral Approaches
		11.6.2 Trans-cervical Approaches
		11.6.3 Anterior Pharyngotomy
		11.6.4 Lateral Pharyngotomy
		11.6.5 Combined Approach (Pull Through)
		11.6.6 Approaches for Multiple Subsite Disease
	11.7 Treatment of the Neck
	11.8 Complications of Treatment
	11.9 Psychosocial Concerns
	11.10 Conclusion
	References
12 Transoral Robotic Management of the Oropharynx
	12.1 Introduction
	12.2 Epidemiology of the Disease
	12.3 TORS Anatomy of the Oropharynx
	12.4 Clinical Presentation
		12.4.1 Local Disease
		12.4.2 Regional Disease
		12.4.3 Distant Disease
	12.5 Surgical Treatment
		12.5.1 Indications and Oncologic Outcomes
	12.6 Operative Margins
	12.7 Surgical Morbidity
	12.8 Neck Disease
	12.9 Adjuvant Therapy
	12.10 Conclusion
	12.11 Clinical Cases
		12.11.1 Case 1
		12.11.2 Case 2
	References
13 Reconstruction of the Oropharynx
	13.1 Introduction
	13.2 Relevant Anatomy
	13.3 Evaluation of the Oropharynx Defect and Determining Options for Reconstruction
		13.3.1 Evaluation of the Defects
		13.3.2 Determining Reconstructive Options
	13.4 Classification of Oropharynx Defects
	13.5 Split-Thickness Skin Graft
		13.5.1 Patient Selection
		13.5.2 Surgical Technique and Considerations
		13.5.3 Perioperative Management
		13.5.4 Pearls
	13.6 Facial Artery Musculomucosal Flap
		13.6.1 Patient Selection
		13.6.2 Surgical Technique and Consideration
		13.6.3 Perioperative Management
	13.7 Pectoralis Major Flap
		13.7.1 Patient Selection
		13.7.2 Surgical Technique and Consideration
		13.7.3 Perioperative Management
		13.7.4 Pearls
	13.8 Radial Forearm Free Flap
		13.8.1 Patient Selection
		13.8.2 Surgical Technique and Considerations
		13.8.3 Perioperative Management
		13.8.4 Pearls
	13.9 TORS Reconstruction
		13.9.1 Patient Selection
		13.9.2 Surgical Technique
		13.9.3 Perioperative Management
		13.9.4 Pearls
	13.10 Conclusion
	References
14 Carcinoma of the Hypopharynx
	14.1 Introduction
	14.2 Epidemiology
	14.3 Etiology
	14.4 Hypopharyngeal Anatomy and Patterns of Disease Spread
		14.4.1 Anatomical Associations
		14.4.2 Local Patterns of Spread
		14.4.3 Regional Patterns of Spread
	14.5 Staging
	14.6 Presentation
		14.6.1 History
		14.6.2 Physical Examination
	14.7 Diagnosis andWorkup
		14.7.1 Panendoscopy and Biopsy
		14.7.2 Diagnostic Imaging and Metastatic Survey
	14.8 Prognostic Factors
	14.9 Treatment
		14.9.1 Overall Treatment Philosophy
		14.9.2 Surgical Approaches
	14.10 Management of the Neck
		14.10.1 Nodal Metastases
	14.11 Radiation Therapy
		14.11.1 Early-Stage Lesions (T1/T2 with N0/N1)
		14.11.2 Advanced Lesions (T3/T4, or Any T Stage with N2/N3)
		14.11.3 Adjuvant Radiotherapy
	14.12 Chemotherapy
		14.12.1 Concurrent Chemotherapy with Radiation
		14.12.2 Induction Chemotherapy and Sequential Chemoradiotherapy
		14.12.3 Adjuvant Chemoradiation
	14.13 Posttreatment Surveillance
	14.14 Treatment of Recurrence
		14.14.1 Regional Recurrence
		14.14.2 Local and Distant Recurrence
	14.15 Conclusion
	14.16 Clinical Cases
		14.16.1 Case 1: T2N2bM0 SCC Right Piriform Sinus
		14.16.2 Case 2: T4aN2aM0 SCC of the Piriform Sinus
		14.16.3 Case 3: Recurrent T4N0M0 Postcricoid Carcinoma after Concurrent Chemoradiation
	References
15 Carcinoma of the Larynx
	15.1 Epidemiology
	15.2 Etiology
	15.3 Anatomy of the Larynx
	15.4 Staging
	15.5 Presentation
	15.6 Diagnosis andWorkup
	15.7 Regional Disease
		15.7.1 Treatment
		15.7.2 Nonsurgical Treatment
	15.8 Management of the Neck
	15.9 Clinical Cases
		15.9.1 Case 1: T3N0M0 Glottic Cancer
		15.9.2 Case 2: T1N0M0 Glottic Cancer
	References
16 Reconstruction of Laryngeal and Hypopharyngeal Defects
	16.1 Introduction
		16.1.1 Anatomy
		16.1.2 Physiologic Considerations
		16.1.3 Defect Classification
	16.2 Reconstructive Options
		16.2.1 Partial Pharyngectomy Defect
		16.2.2 Posterior PharyngealWall
		16.2.3 Lateral Pharyngeal Defects
	16.3 Total Laryngectomy, Partial Pharyngectomy Defect Management Options
		16.3.1 Primary Closure
		16.3.2 Primary Closure with Bolster Flap
		16.3.3 Patch Reconstruction: Regional Tissue Transfer
	16.4 Total Laryngopharyngectomy Defect Management Options
		16.4.1 Enteric Flap Transposition
		16.4.2 Gastric Pull-Up
		16.4.3 Colonic Interposition
		16.4.4 Microvascular Enteric Flaps
		16.4.5 Microvascular Fasciocutaneous Flaps
	16.5 Salivary Bypass Tubes
	16.6 Swallowing Rehabilitation
	16.7 Voice Rehabilitation
	16.8 Conclusion
	References
17 Carcinoma of the Thyroid
	17.1 Introduction
	17.2 Thyroid Anatomy and Embryology
		17.2.1 Thyroid Anatomy
		17.2.2 Embryology
		17.2.3 Surgical Landmarks
	17.3 Diagnosis and Evaluation of Thyroid Cancer
		17.3.1 History
		17.3.2 Physical Examination
		17.3.3 Laboratory Assessment
		17.3.4 Imaging
		17.3.5 Fine-Needle Aspiration
	17.4 Differentiated Thyroid Carcinomas
		17.4.1 Papillary Thyroid Carcinoma
		17.4.2 Follicular Thyroid Carcinoma
		17.4.3 H黵thle Cell Carcinoma
		17.4.4 Staging and Prognosis of Differentiated Thyroid Carcinoma
	17.5 Medullary and Poorly Differentiated Thyroid Carcinomas
		17.5.1 Medullary Thyroid Carcinoma
		17.5.2 Anaplastic Thyroid Carcinoma
	17.6 Other Carcinomas
		17.6.1 Lymphoma
		17.6.2 Squamous Cell Carcinoma
		17.6.3 Metastatic Cancer
	17.7 Surgical Techniques
		17.7.1 Conventional Open Thyroidectomy
		17.7.2 Minimally Invasive Thyroidectomy and Minimally Invasive Video-Assisted Thyroidectomy
		17.7.3 Remote Access Thyroid Surgery
		17.7.4 Central Neck Dissection
		17.7.5 Lateral Neck Dissection
	17.8 Complications of Thyroid Surgery
		17.8.1 Postoperative Hematoma
		17.8.2 Recurrent Laryngeal Nerve Injury
		17.8.3 Superior Laryngeal Nerve Injury
		17.8.4 Hypoparathyroidism
	17.9 Clinical Cases
		17.9.1 Case 1: T4aN1bM0 Papillary Thyroid Carcinoma with Tracheal Invasion
		17.9.2 Case 2: T2N1bM0 Medullary Thyroid Carcinoma
	References
18 Carcinoma of the Salivary Glands
	18.1 Introduction to Salivary Gland Carcinoma
	18.2 Epidemiology
	18.3 Etiology
	18.4 Anatomy of the Salivary Glands
		18.4.1 Embryology
		18.4.2 Parotid Gland
		18.4.3 Submandibular Gland
		18.4.4 Sublingual Gland
		18.4.5 Minor Salivary Glands
	18.5 Development
	18.6 Classification and Staging of Salivary Gland Cancer
		18.6.1 Evolving Classification System
		18.6.2 Stage
		18.6.3 Grade
	18.7 Prognostic Factors for Salivary Gland Cancer
		18.7.1 Surgery
		18.7.2 Stage
		18.7.3 Surgical Margins
		18.7.4 Grade/Histology
		18.7.5 Facial Nerve Paralysis
		18.7.6 Cervical Metastasis
	18.8 Clinical Presentation
		18.8.1 History
		18.8.2 Physical Examination
		18.8.3 Parotid Gland
		18.8.4 Submandibular Gland
		18.8.5 Sublingual Gland
		18.8.6 Minor Salivary Glands
	18.9 Diagnosis andWorkup
		18.9.1 Fine-Needle Aspiration Biopsy
		18.9.2 Imaging
	18.10 Treatment
		18.10.1 Parotid Gland
		18.10.2 Submandibular Gland
		18.10.3 Minor Salivary Glands
	18.11 Nonsurgical Treatment
		18.11.1 Radiation Therapy
		18.11.2 Systemic Therapy
	18.12 Reconstruction
	18.13 Posttreatment Surveillance
	18.14 Clinical Cases
		18.14.1 Case 1
		18.14.2 Case 2
		18.14.3 Case 3
		18.14.4 Case 4
	References
19 Reconstruction of the Parotid Defect
	19.1 Introduction
	19.2 Relevant Anatomy
	19.3 Evaluation of the Parotid Defect
	19.4 Goals of Parotid Reconstruction
	19.5 Options for Microvascular Reconstruction
		19.5.1 Lateral Arm
		19.5.2 Anterolateral Thigh
		19.5.3 Parascapular Fasciocutaneous and Osteocutaneous Flaps
		19.5.4 Radial Forearm
		19.5.5 Rectus Abdominis
	19.6 Regional Flaps, Local Flaps, and Fat Grafts
		19.6.1 Submental Island Flap
		19.6.2 Cervicofacial Advancement Flap
		19.6.3 Abdominal Fat Graft
	19.7 Management of the Facial Nerve during Parotid Reconstruction
	19.8 Adjunctive Facial Nerve Procedures
		19.8.1 Gold or Platinum Weight
		19.8.2 Static Suspension of Oral Commissure
		19.8.3 Wedge Excision of Lower Lip
	19.9 Conclusion
	References
20 Carcinoma of the Nasal Cavity and Anterior Skull Base
	20.1 Introduction
	20.2 Epidemiology and Etiology
	20.3 Differential Diagnosis of Nasal Cavity and Ventral Skull Base Malignancies
		20.3.1 Squamous Cell Carcinoma
		20.3.2 Squamous Cell Carcinoma Variants
		20.3.3 Adenocarcinoma
		20.3.4 Mucosal Melanoma
		20.3.5 Adenoid Cystic Carcinoma
		20.3.6 Undifferentiated Carcinoma
		20.3.7 Neuroendocrine Carcinoma
		20.3.8 Esthesioneuroblastoma (Olfactory Neuroblastoma)
		20.3.9 Rhabdomyosarcoma
		20.3.10 Non-Hodgkin Lymphoma
		20.3.11 Extranodal Natural Killer/T-Cell Lymphoma
		20.3.12 Chordoma
		20.3.13 Chondrosarcoma
		20.3.14 Hemangiopericytoma
		20.3.15 Metastasis
	20.4 Staging
	20.5 Clinical Presentation
	20.6 Diagnosis andWorkup
		20.6.1 Physical Examination
		20.6.2 Imaging
	20.7 Management
		20.7.1 NCCN Guidelines
		20.7.2 Surgical Treatment
		20.7.3 Nonsurgical Treatment
	20.8 Complications of Treatment
		20.8.1 Surgical Complications
		20.8.2 Complications of Nonsurgical Therapy
	20.9 Conclusion
	20.10 Clinical Cases
		20.10.1 Case 1
		20.10.2 Case 2
	References
21 Reconstruction of the Anterior Skull Base
	21.1 Introduction
	21.2 Relevant Anatomy
	21.3 Evaluation of Anterior Skull Base Defect and Determining Options for Reconstruction
		21.3.1 Location
		21.3.2 Size
		21.3.3 Arachnoid Disruption and Ventricle Involvement
		21.3.4 Raised Intracranial Pressures
	21.4 Classification of Skull Base Defects
	21.5 Reconstruction: General Principles
		21.5.1 Site Preparation
		21.5.2 Graft Healing
		21.5.3 Bolstering Repairs
	21.6 Reconstructive Options
		21.6.1 Reconstruction of Foveocranial Defects
		21.6.2 Reconstruction of Parasagittal Orbitocranial Defects
	21.7 Conclusion
	References
22 Carcinoma of the Nasopharynx
	22.1 Anatomy of the Nasopharynx
	22.2 Histopathology
	22.3 Epidemiology and Etiology
	22.4 Presentation
	22.5 Diagnosis andWorkup
		22.5.1 Endoscopic Examination
		22.5.2 EBV Serology and Plasma EBV DNA Titer
		22.5.3 Imaging Studies
	22.6 Staging
	22.7 Treatment
		22.7.1 Radiotherapy
		22.7.2 Adjuvant Chemotherapy to Radical Radiotherapy
		22.7.3 Chemotherapy for Metastatic and Advanced Recurrent Nasopharyngeal Carcinoma
		22.7.4 Treatment of Recurrence
		22.7.5 External Beam Radiotherapy
		22.7.6 Brachytherapy
		22.7.7 Surgical Treatment
	22.8 Clinical Cases
		22.8.1 Case 1
		22.8.2 Case 2
		22.8.3 Case 3
		22.8.4 Case 4
	References
23 Carcinoma of the Skin of the Head, Face, and Neck
	23.1 Epidemiology
		23.1.1 Nonmelanoma Skin Cancer
		23.1.2 Cutaneous Melanoma
	23.2 Etiology
		23.2.1 Ultraviolet Light Exposure
		23.2.2 Molecular Biology and Genetics of Nonmelanoma Skin Cancer
		23.2.3 Molecular Biology and Genetics of Melanoma
		23.2.4 Precursor Lesions
		23.2.5 Previous Skin Malignancy
		23.2.6 Other Risk Factors
	23.3 Histopathology
		23.3.1 Basal Cell Carcinoma
		23.3.2 Squamous Cell Carcinoma
		23.3.3 Aggressive Nonmelanoma Skin Cancer
		23.3.4 Merkel Cell Carcinoma
		23.3.5 Cutaneous Angiosarcoma
		23.3.6 Sebaceous Carcinoma
		23.3.7 Microcystic Adnexal Carcinoma
		23.3.8 Dermatofibrosarcoma Protuberans
		23.3.9 Atypical Fibroxanthoma
		23.3.10 Melanoma
	23.4 Diagnosis andWorkup
		23.4.1 History and Physical Examination
		23.4.2 ABCDs of Melanoma
		23.4.3 Biopsy
		23.4.4 Adjuncts
	23.5 Staging
		23.5.1 Staging of Nonmelanoma Skin Cancer
		23.5.2 Staging of Melanoma
	23.6 Treatment of the Primary Lesion
		23.6.1 Treatment of Nonmelanoma Skin Cancer
		23.6.2 Treatment of Localized Melanoma
		23.6.3 Reconstruction of Cutaneous Defects of the Head and Neck
	23.7 Diagnosis and Treatment of Regional Disease
		23.7.1 Lymphatic Drainage Pathways
		23.7.2 Risk Factors for Regional Metastases
		23.7.3 Treatment of the Clinically N0 Neck
		23.7.4 Horizons in the Detection of Regional Metastases
		23.7.5 Management of the Positive Neck
		23.7.6 Management of the Unknown Primary with Neck Metastases
	23.8 Treatment of Advanced and Systemic Disease
		23.8.1 Nonmelanoma Skin Cancer
		23.8.2 Melanoma
	23.9 Prevention
	23.10 Clinical Cases
		23.10.1 Case 1
		23.10.2 Case 2
	References
24 Scalp Reconstruction
	24.1 Introduction
	24.2 Relevant Anatomy
	24.3 Classification of Defects
	24.4 Options for Reconstruction
	24.5 Conclusion
	References
25 Reconstruction of the Cheek and Face
	25.1 Introduction
	25.2 Relevant Anatomy
	25.3 Evaluation of the Cheek and Face Defect and Determining the Options for Reconstruction
	25.4 Options for Management of Small Cheek Defects
		25.4.1 Primary Closure
		25.4.2 Local Flaps
		25.4.3 Moderate Defects
	25.5 Options for Management of Large Cheek Defects
		25.5.1 Skin Grafts
		25.5.2 Microvascular Free Flaps
	25.6 Lip Reconstruction
		25.6.1 Surgical Technique and Considerations for ALT Flap Reconstruction of through-and-through Cheek and Oral Commissure Defect
	25.7 Nasal Reconstruction
	25.8 Eyelid Reconstruction
	25.9 Facial Nerve Reconstruction
	25.10 Revisions and Refinements
	25.11 Conclusion
	References
26 Carcinoma of Unknown Primary
	26.1 Introduction
	26.2 Epidemiology/Etiology of the Disease
	26.3 Staging
	26.4 Prognostic Factors
	26.5 Clinical Presentation
	26.6 Diagnosis andWorkup
	26.7 Transoral Robotic Surgery Technique
	26.8 Complications of TORS
	26.9 Postoperative Care
	26.10 Role of Neck Dissection in CUP
	26.11 Radiation in CUP
	26.12 Chemotherapy in CUP
	26.13 Posttreatment Surveillance
	26.14 Clinical Case
		26.14.1 Presentation
		26.14.2 Diagnosis andWorkup
		26.14.3 Treatment Options
	References
27 Surveillance of the Patient
	27.1 Introduction
	27.2 Considerations for a Surveillance Program
		27.2.1 Morphologic Imaging
		27.2.2 Positron Emission Tomography
	27.3 The Mount Sinai Surveillance Protocol
		27.3.1 Pretreatment and Surveillance Protocol
		27.3.2 Posttreatment Assessment
	27.4 Clinical Cases
		27.4.1 Case 1
		27.4.2 Case 2
		27.4.3 Case 3
		27.4.4 Case 4
		27.4.5 Case 5
	References
28 Drug Development in the 21st Century: Monoclonal Antibodies and Immunotherapy
	28.1 Introduction
	28.2 Drug Development: The Cetuximab Story
		28.2.1 Preclinical Phase
		28.2.2 Phase I Clinical Trial
		28.2.3 Phase II Clinical Trial
		28.2.4 Phase III Clinical Trial
		28.2.5 Phase IV Clinical Trial
		28.2.6 Ongoing Clinical Trials Involving Cetuximab in Head and Neck Cancer
	28.3 Newer Innovative Trial Designs
		28.3.1 Basket Trials
		28.3.2 Umbrella Trials
	28.4 Immunotherapy: The Next Round of Innovation in Head and Neck Cancer
		28.4.1 Immunotherapy in Melanoma
		28.4.2 Immunotherapy in Head and Neck Cancer
	28.5 Conclusion
	References
29 The Vessel-Depleted Neck: Microvascular Reconstruction
	29.1 Introduction
	29.2 Vascular Considerations
	29.3 Transverse Cervical Vessels
	29.4 Superficial Temporal Vessels
		29.4.1 Superficial Temporal Vein: A Retrograde Venous Outflow Option
	29.5 Internal Mammary Vessels
	29.6 The Thoracoacromial and Cephalic System
		29.6.1 Thoracoacromial Artery
		29.6.2 The Cephalic Vein
	29.7 The Common and Internal Carotid Artery
	29.8 Imaging in the VesselDepleted Neck
	29.9 Conclusion
	References
30 Salvage Surgery: MinimizingWound Complications
	30.1 Introduction
		30.1.1 Wound Biology and Pathophysiology
		30.1.2 Wound Complications in Salvage Surgery
		30.1.3 Strategies for Management of Salvage Surgery Patients
	30.2 Conclusion
	References
Index
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