摘要：

Patterns of tumour spread are examined in 160 patients with squamous carcinomas of the head and neck with reference to perineural infiltration, direct invasion of bone and ossified cartilage, and lymph node metastases in the previously irradiated neck. Perineural spread is comparatively common in large (T3, T4) tumours; it may be apparent early in the disease; it is often detectable clinically; and it is an adverse prognostic feature which may modify clinical management. Direct bone invasion is described with particular reference to tumours of the oral cavity. Most bone destruction is mediated by osteoclasts which appear to be stimulated by materials such as prostaglandins released in the vicinity of the tumour. The numbers of involved lymph nodes in surgical dissections from the irradiated neck are usually few and restricted to the submandibular and jugular groups; nodes in the posterior triangle are infrequently involved by metastatic carcinoma. Transcapsular spread and keratin granulomas are common. The scope of modified neck dissections in this group of patients is discussed.ReferencesSection: Ballantyne, A.J., McCarten, A.B., & Ibanez, M.L. (1963) American Journal of Surgery 106, 651 Google Scholar, Crossref, Medline Bennett, A., Carter, R.L., Stamford, I.F., & Tanner, N.S.B. (1980) British Journal of Cancer 41, 204 Google Scholar, Crossref, Medline Byars, L.T. (1955) Archives of Surgery 70, 914 Google Scholar, Crossref Carter, R.L. (1978) Investigative and Cell Pathology 1, 275 Google Scholar, Medline Carter, R.L., Tanner, N.S.B., Clifford, P., & Shaw, H.J. (1979) Clinical Otolaryngology 4, 271 Google Scholar, Crossref, Medline Carter, R.L., Tanner, N.S.B., Clifford, P., & Shaw, H.J. (1980) Clinical Otolaryngology 5, 107–116 Google Scholar, Crossref, Medline Dodd, G.D., Dolan, P.A., Ballantyne, A.J., Ibanez, M.L., & Chau, P. (1970) Radiologic Clinics of North America 8, 445 Google Scholar, Medline Galasko, C.S.B. (1975) Journal of Bone and Joint Surgery 57B, 353 Google Scholar, Crossref Galasko, C.S.B. (1976) Nature (London) 263, 507 Google Scholar, Crossref, Medline Goldman, J.L., Gieren, R.V., Zak, F.G., & Gunsberg, M.J. (1966) Annals of Otology 75, 313 Google Scholar, Link, ISI Goldman, J.L., Bloom, B.S., Zak, F.G., Friedman, W.H., Gunsberg, M.J., & Silverstone, S.M. (1969) Archives of Otolaryngology 89, 620 Google Scholar, Crossref, Medline Kalnins, I.K., Leonard, A.G., Sako, K., Razack, M.S., & Shedd, D.P. (1977) American Journal of Surgery 134, 450 Google Scholar, Crossref, Medline Lee, E.S., & Wilson, J.S.P. (1973) British Journal of Surgery 60, 85 Google Scholar, Crossref, Medline Lindberg, R. (1972) Cancer 29, 1446 Google Scholar, Crossref, Medline Marchetta, F.C., Sako, K., & Badillo, J. (1964) American Journal of Surgery 108, 505 Google Scholar, Crossref, Medline Marchetta, F.C., Sako, K., & Murphy, J.B. (1971) American Journal of Surgery 122, 711 Google Scholar, Crossref, Medline Tanner, N.S.B., Carter, R.L., Dailey, V.M., Clifford, P., & Shaw, H.J. (1980) Clinical Otolaryngology S (in press) Google Scholar Willis, R.A. (1973) The Spread of Tumours in the Human Body. 3rd edn. Butterworths, London Google Scholar Zoller, M., Goodman, M.L., & Cummings, C.W. (1978) Laryngoscope 88, 135 Google Scholar, Crossref, Medline

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