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October 1988

The Cutting Edge

Arch Otolaryngol Head Neck Surg. 1988;114(10):1094. doi:10.1001/archotol.1988.01860220028017

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Tumor fixation to the carotid artery is an extremely poor prognostic sign in head and neck cancer. Many otolaryngologist–head and neck surgeons feel that surgery in this setting is unwarranted. A. W. Langman and coworkers, Departments of Otolaryngology–Head and Neck Surgery and Radiology, University of California, San Francisco, recently reported on the use of radiologic assessment of carotid artery involvement by cancer. They compared preoperative studies of magnetic resonance imaging (MRI), ultrasound, and computed tomographic (CT) scanning. In their report at the Second International Head and Neck Oncology Conference in Arlington, Va, they noted that CT is often inadequate in assessing fixation. Magnetic resonance imaging and ultrasound are noninvasive tests, which, compared with CT, provided increased contrast between rapidly flowing blood and surrounding fat and soft tissues. Magnetic resonance imaging and ultrasound prediction of an uninvolved carotid artery was surgically confirmed in all cases. Severe atherosclerotic cerebrovascular disease produced one

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