title: Prolonged facial edema is an indicator of poor prognosis in patients with head and neck squamous cell carcinoma.
abstract: OBJECTIVE
  The purpose of this study was to identify the causes of prolonged facial edema and its associations with other clinical factors. Facial edema sometimes is observed in patients with head and neck squamous cell carcinoma (HNSCC), but its prevalence and association with other factors is unclear.
  
  
  METHODS
  Between July 2003 and July 2007, the medical records from 264 patients with HNSCC were reviewed. Prolonged facial edema is defined as persistence of edematous status (largest thickness >5 mm by CT scan) for more than 100 days. Clinical data including age, gender, tumor stage, and tumor primary sites were recorded. Statistical analyses were performed to determine the prognostic effect of prolonged facial edema, as well as its relationship to other clinical variables. The etiology of prolonged facial edema was also analyzed.
  
  
  RESULTS
  Prolonged facial edema occurred in 32 (12.1%) patients. The etiologies included internal jugular vein thrombosis, local infection, neck lymph nodes dissection, flap reconstruction, and direct vessel compression by tumors or metastatic lymph nodes. There was no significant difference in the incidence of prolonged facial edema in patients receiving different treatment modalities; however, patients receiving neck dissection correlated with the occurrence of late-onset facial edema. In addition to previously demonstrated prognostic factors (T status, nodal involvement and distant metastasis), prolonged facial edema was also identified as independent prognostic indicators for HNSCC patients (P = 0.001).
  
  
  CONCLUSIONS
  Prolonged facial edema may reflect the underlying disease status, and it can be applied as a prognostic marker in patients with HNSCC.
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ming-Huang
authors.initials: MH
authors.lastname: Chen
authors.forename: Peter Mu-Hsin
authors.initials: PM
authors.lastname: Chang
authors.forename: Po-Min
authors.initials: PM
authors.lastname: Chen
authors.forename: Cheng-Hwai
authors.initials: CH
authors.lastname: Tzeng
authors.forename: Pen-Yuan
authors.initials: PY
authors.lastname: Chu
authors.forename: Shyue-Yih
authors.initials: SY
authors.lastname: Chang
authors.forename: Muh-Hwa
authors.initials: MH
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology* / Q000628:therapy; D004487:Edema / Q000453:epidemiology / Q000209:etiology*; D005145:Face; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors