{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T22:58:35Z","timestamp":1768258715916,"version":"3.49.0"},"reference-count":34,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2011,10,12]],"date-time":"2011-10-12T00:00:00Z","timestamp":1318377600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2011,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives:<\/jats:title><jats:p>To determine if patients who have undergone an open neck biopsy (a \u201cviolated\u201d neck) have improved disease control and survival with completion neck dissection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods:<\/jats:title><jats:p>Retrospective review of patients who underwent open cervical biopsy for diagnosis prior to definitive treatment between February 1997 and February 2010 at two academic tertiary referral centers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>Ninety\u2010four patients met study criteria, with completion neck dissection performed in 53 patients (56%). The majority of patients (84%) had oropharyngeal tumors. Human papilloma virus (HPV) status was positive in 55 of 63 patients (87%). Chemotherapy was used more often in patients treated nonoperatively (88%) compared to patients who underwent neck dissection (49%; <jats:italic>P<\/jats:italic> &lt; .001). Five\u2010year disease\u2010specific survival (DSS) was 84% for patients treated with neck dissection and 82% for nonoperative treatment (<jats:italic>P<\/jats:italic> = .5806), and disease\u2010free survival (DFS) was 82% for patients treated with neck dissection and 70% for nonoperative treatment (<jats:italic>P<\/jats:italic> = .6047). Five\u2010year DSS was 84% for patients with HPV\u2010positive disease and 63% for HPV\u2010negative disease (<jats:italic>P<\/jats:italic> = .0086), and DFS was 79% for HPV\u2010positive disease and 50% for HPV\u2010negative disease (<jats:italic>P<\/jats:italic> = .0004). Only advanced primary tumor (T3\/T4) stage (hazard ratio [HR] = 8.8, <jats:italic>P<\/jats:italic> = .004) was associated with DSS, whereas advanced primary tumor stage (HR = 5.3, <jats:italic>P<\/jats:italic> = .008), N3 disease (HR = 5.6, <jats:italic>P<\/jats:italic> = .036), and HPV\u2010positive disease (HR = 0.2, <jats:italic>P<\/jats:italic> = .032) were significant predictors of DFS, after controlling for all other variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>In the era of chemoradiation, completion neck dissection following an open cervical biopsy does not appear to provide a survival advantage. A high proportion of HPV\u2010positive oropharyngeal tumors may explain the favorable outcomes observed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.22186","type":"journal-article","created":{"date-parts":[[2011,10,12]],"date-time":"2011-10-12T16:17:02Z","timestamp":1318436222000},"page":"2349-2358","source":"Crossref","is-referenced-by-count":10,"title":["Management of the \u201cViolated Neck\u201d in the era of chemoradiation"],"prefix":"10.1002","volume":"121","author":[{"given":"Myriam","family":"Loyo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas T.","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William H.","family":"Westra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simion 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