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J R Soc Med. 1982 August; 75(8): 598–606.
PMCID: PMC1438049

Pain and dysphagia in patients with squamous carcinomas of the head and neck: the role of perineural spread1

Abstract

Clinical and pathological features of perineural spread have been investigated in patients with squamous carcinomas at several sites in the head and neck. In 100 surgical cases, the clinical and pathological findings were congruent in 76%. Combined clinical and histological evidence of perineural invasion was recorded in 33% and the overall incidence of nerve involvement detected morphologically was 44%. Perineural infiltration was demonstrated histologically in 51% of major excisions from the buccal cavity and in 34% of resections from the oropharynx, hypopharynx and cervical oesophagus. The neurological findings were dominated by hypoaesthesia, dysaesthesia and referred pain – mainly in the territories of cranial nerves V and IX. Multiple and/or sequential nerve involvement was occasionally seen. No correlation was established between nerve invasion and metastasis to regional lymph nodes. Long-distance infiltration of nerve trunks, and multiple involvement, are grave prognostic features.

In 17 terminal patients submitted to autopsy, 65% had combined clinical and pathological evidence of perineural spread and the overall incidence of nerve involvement detected morphologically was 88%. Sensory changes again predominated. Multiple nerve involvement was observed in 35%. An apparently new `dysphagia syndrome' is described in 4 patients with oropharyngeal carcinomas in whom gross mechanical obstruction was simulated by a combination of perineural spread of tumour into the ipsilateral vagal trunk, sometimes accompanied by segmental infarction, variable invasion of the sympathetic chain, and `splinting' of the pharynx by local fibrosis and tumour in the soft tissues of the neck. Short-term palliation was achieved in these patients with high-dose steroids.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • BALLANTYNE AJ, MCCARTEN AB, IBANEZ ML. THE EXTENSION OF CANCER OF THE HEAD AND NECK THROUGH PERIPHERAL NERVES. Am J Surg. 1963 Oct;106:651–667. [PubMed]
  • Carter RL, Pittam MR. Squamous carcinomas of the head and neck: some patterns of spread. J R Soc Med. 1980 Jun;73(6):420–427. [PMC free article] [PubMed]
  • Carter RL, Tanner NS, Clifford P, Shaw HJ. Perineural spread in squamous cell carcinomas of the head and neck: a clinicopathological study. Clin Otolaryngol Allied Sci. 1979 Aug;4(4):271–281. [PubMed]
  • Dodd GD, Dolan PA, Ballantyne AJ, Ibanez ML, Chau P. The dissemination of tumors of the head and neck via the cranial nerves. Radiol Clin North Am. 1970 Dec;8(3):445–461. [PubMed]
  • Pittam MR, Carter RL. Framework invasion by laryngeal carcinomas. Head Neck Surg. 1982 Jan-Feb;4(3):200–208. [PubMed]
  • Tschen JA, Fechner RE. The juxtaoral organ of Chievitz. Am J Surg Pathol. 1979 Apr;3(2):147–150. [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press