Browse Health
Otolaryngologist (ear, nose, throat)
13 years of experience
Accepting new patients

Education ?

Medical School Score Rankings
University of North Carolina (1997)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Associations
American Academy of Otolaryngology: Head and Neck Surgery
American Board of Otolaryngology

Affiliations ?

Dr. Moyer is affiliated with 3 hospitals.

Hospital Affilations

Score

Rankings

  • University of Michigan Hospitals & Health Centers
    Otolaryngology
    1500 E Medical Center Dr, Ann Arbor, MI 48109
    • Currently 4 of 4 crosses
    Top 25%
  • Ann Arbor Veterans Affairs Medical Center
    2215 Fuller Rd, Ann Arbor, MI 48105
  • University of Michigan Health System
  • Publications & Research

    Dr. Moyer has contributed to 25 publications.
    Title Maxillomandibular-labial Reconstruction: an Autogenous Transplant As an Alternative to Allogenic Face Transplantation.
    Date January 2011
    Journal Plastic and Reconstructive Surgery
    Title Chemotherapy Alone for Organ Preservation in Advanced Laryngeal Cancer.
    Date December 2010
    Journal Head & Neck
    Excerpt

    For patients with advanced laryngeal cancer, a trial was designed to determine if chemotherapy alone, in patients achieving a complete histologic complete response after a single neoadjuvant cycle, was an effective treatment with less morbidity than concurrent chemoradiotherapy.

    Title Thoracodorsal Artery Scapular Tip Autogenous Transplant: Vascularized Bone with a Long Pedicle and Flexible Soft Tissue.
    Date November 2010
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    To demonstrate that the 3 reconstructive advantages of the thoracodorsal artery scapular tip transplant (Tdast), a long pedicle, independently mobile tissue components, and the 3-dimensional nature of the scapular tip, will improve the quality and success of complex reconstructions by avoiding vein grafting, preventing the need for 2 separate transplants, and facilitating bony inset.

    Title Predictors of Satisfaction with Facial Plastic Surgery: Results of a Prospective Study.
    Date September 2010
    Journal Archives of Facial Plastic Surgery : Official Publication for the American Academy of Facial Plastic and Reconstructive Surgery, Inc. and the International Federation of Facial Plastic Surgery Societies
    Excerpt

    To identify demographic and psychological factors that predict satisfaction or dissatisfaction with outcomes among patients undergoing facial plastic surgery.

    Title Intensity-modulated Chemoradiotherapy Aiming to Reduce Dysphagia in Patients with Oropharyngeal Cancer: Clinical and Functional Results.
    Date July 2010
    Journal Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
    Excerpt

    To assess clinical and functional results of chemoradiotherapy for oropharyngeal cancer (OPC), utilizing intensity-modulated radiotherapy (IMRT) to spare the important swallowing structures to reduce post-therapy dysphagia.

    Title Hpv-positive/p16-positive/ebv-negative Nasopharyngeal Carcinoma in White North Americans.
    Date July 2010
    Journal Head & Neck
    Excerpt

    Human papillomavirus (HPV) has been detected in keratinizing nasopharyngeal carcinomas (NPCs); however, the relationship between HPV and Epstein-Barr virus (EBV) among whites with nonkeratinizing NPCs remains unclear. The HPV, p16, and EBV status was examined in current University of Michigan patients with NPC.

    Title Tobacco Use in Human Papillomavirus-positive Advanced Oropharynx Cancer Patients Related to Increased Risk of Distant Metastases and Tumor Recurrence.
    Date April 2010
    Journal Clinical Cancer Research : an Official Journal of the American Association for Cancer Research
    Excerpt

    The goal of this study was to examine the effect of tobacco use on disease recurrence (local/regional recurrence, distant metastasis, or second primary) among patients with human papillomavirus (HPV)-positive squamous cell carcinoma of the oropharynx (SCCOP) following a complete response to chemoradiation therapy.

    Title Auricular Tophi As the Initial Presentation of Gout.
    Date September 2009
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title The Pattern of Failure After Reirradiation of Recurrent Squamous Cell Head and Neck Cancer: Implications for Defining the Targets.
    Date August 2009
    Journal International Journal of Radiation Oncology, Biology, Physics
    Excerpt

    Reirradiation (re-RT) of recurrent head and neck cancer (HNC) may achieve long-term disease control in some patients, at the expense of high rates of late sequelae. Limiting the re-RT targets to the recurrent gross tumor volume (rGTV) would reduce the volumes of reirradiated tissues; however, its effect on tumor recurrence pattern is unknown.

    Title Early Prediction of Outcome in Advanced Head-and-neck Cancer Based on Tumor Blood Volume Alterations During Therapy: a Prospective Study.
    Date December 2008
    Journal International Journal of Radiation Oncology, Biology, Physics
    Excerpt

    PURPOSE: To assess whether alterations in tumor blood volume (BV) and blood flow (BF) during the early course of chemo-radiotherapy (chemo-RT) for head-and-neck cancer (HNC) predict treatment outcome. METHODS AND MATERIALS: Fourteen patients receiving concomitant chemo-RT for nonresectable, locally advanced HNC underwent dynamic contrast-enhanced (DCE) MRI scans before therapy and 2 weeks after initiation of chemo-RT. The BV and BF were quantified from DCE MRI. Preradiotherapy BV and BF, as well as their changes during RT, were evaluated separately in the primary gross tumor volume (GTV) and nodal GTV for association with outcomes. RESULTS: At a median follow-up of 10 months (range, 5-27 months), 9 patients had local-regional controlled disease. One patient had regional failure, 3 had local failures, and 1 had local-regional failure. Reduction in tumor volume after 2 weeks of chemo-RT did not predict for local control. In contrast, the BV in the primary GTV after 2 weeks of chemo-RT was increased significantly in the local control patients compared with the local failure patients (p < 0.03). CONCLUSIONS: Our data suggest that an increase in available primary tumor blood for oxygen extraction during the early course of RT is associated with local control, thus yielding a predictor with potential to modify treatment. These findings require validation in larger studies.

    Title Lateral Oromandibular Defect: when is It Appropriate to Use a Bridging Reconstruction Plate Combined with a Soft Tissue Revascularized Flap?
    Date October 2008
    Journal Head & Neck
    Excerpt

    BACKGROUND: A quasi-experimental retrospective study was undertaken to evaluate a new concept of free tissue volume restoration combined with bridging reconstruction plate (compartment approach) to reduce plate-related complication rates. METHODS: We evaluated 40 patients with large lateral mandible defects and associated complex soft tissue defects reconstructed with a revascularized soft tissue flap and titanium hollow screw reconstruction plates. A case-control comparison was performed based on reconstruction type: restoration of soft tissue defect (conventional approach-group 1) versus over-reconstruction of soft tissue defect (compartment approach-group 2). RESULTS: Plate exposure rate was 6 of 16 (38%) in group 1 versus 2 of 24 (8%) in group 2, and the difference was statistically significant (p = .04). The mean time to exposure was 10 months. Plate fracture rate was 6 of 23 (26.1%) in dentulous patients versus 1 of 17 (5.9%) in edentulous patients. Gastrostomy tube dependence was 6 of 16 (38%) in group 1 versus 6 of 24 (25%) in group 2. CONCLUSION: The "compartment approach" reduces plate exposure rate and gastrostomy tube dependence. Revascularized osseocutaneous reconstruction is still required in dentulous patients.

    Title Unilateral Submandibular Gland Aplasia Associated with Ipsilateral Sublingual Gland Hypertrophy.
    Date March 2007
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    Congenital absence of the major salivary glands is an infrequent disorder. Clinically, patients may be asymptomatic or may present with dryness of the mouth, difficulty in chewing and swallowing, and dental caries. The absence of the submandibular gland may be associated with hypertrophy of the contralateral submandibular gland. We report a case of ipsilateral sublingual hypertrophy associated with unilateral submandibular aplasia.

    Title Early Vaccination with Tumor-lysate-pulsed Dendritic Cells After Allogeneic Bone Marrow Transplantation Has Antitumor Effects.
    Date March 2007
    Journal Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation
    Excerpt

    Allogeneic bone marrow transplantation (BMT) remains the primary treatment for many hematologic malignancies but has had limited success against solid tumors. The antitumor activity of this treatment approach involves the tumoricidal activity of chemoradiation and the additive graft-versus-tumor activity of donor T cells. However, even with current protocols, some tumors develop resistance and become unresponsive to current therapeutic regimens. To address the problem of resistance and lack of solid tumor activity in allogeneic BMT, we undertook experiments to determine whether the graft-versus-tumor activity of donor T cells could be enhanced in the period immediately after allogeneic BMT with tumor lysate-pulsed dendritic cell (DC) vaccines. Using the B16 melanoma model, we found that the treatment of 6-day tumors with allogeneic BMT and 3 weekly vaccinations of tumor lysate-pulsed DCs starting 3 days after BMT had a significant effect on the growth of murine flank melanomas. This effect was tumor specific and occurred in the absence of full immune reconstitution as measured by donor T cell engraftment and cytotoxic T lymphocyte activity. In addition, DC vaccinations did not appear to exacerbate graft-versus-host disease. These experiments support the feasibility of DC vaccine strategies in the setting of allogeneic BMT.

    Title Sclerosing Mucoepidermoid Carcinoma of the Parotid Gland.
    Date March 2007
    Journal European Archives of Oto-rhino-laryngology : Official Journal of the European Federation of Oto-rhino-laryngological Societies (eufos) : Affiliated with the German Society for Oto-rhino-laryngology - Head and Neck Surgery
    Excerpt

    Mucoepidermoid carcinoma is the most common malignant tumor of the parotid gland. Its clinical behavior is determined by the relative ratio of mucous and epidermoid cells with pathologic high-grade tumors containing a greater proportion of epidermoid cells. Sclerosing mucoepidermoid carcinoma is a rarely reported variant with unclear long-term clinical behavior. A 23-year-old female was found to have a deep lobe parotid mass on imaging studies. Preoperative evaluation was non-diagnostic. Intraoperatively, the tumor was found to be adherent to the lower division of the facial nerve and portions of the posterior digastric muscle. Frozen section specimens showed only squamous metaplasia with background inflammatory fibrosis. Final pathological analysis demonstrated multiple solid and cystic nests and glands within a background of dense, sclerotic, collagenized stroma and inflammatory infiltrate consistent with low-grade sclerosing mucoepidermoid carcinoma. Sclerosing mucoepidermoid carcinoma is a very rare salivary gland tumor with uncertain behavior. Complete surgical excision with tumor-free margins with preservation of the facial nerve (in the absence of clinical invasion) is recommended. Postoperative radiation therapy is suggested for positive or close margins given the adherent nature of the tumor and the risk of recurrence and distant disease found in some case reports. Patients should be followed closely with serial MRI imaging studies of the tumor bed with complete clinical evaluation of the regional lymphatics and chest to evaluate for evidence of recurrence or metastasis.

    Title Complications of Rhytidectomy.
    Date October 2005
    Journal Facial Plastic Surgery Clinics of North America
    Excerpt

    Complications after rhytidectomy can be distressing for the patient and surgeon. Although meticulous surgical technique and a complete understanding of the causes of adverse outcomes can minimize the risk for severe complications, an open and honest rapport with the patient when complications do occur is essential for effective management. This article discusses the likely etiologies of face-lift complications, techniques to prevent them, and helpful treatments when complications occur.

    Title Osseocutaneous Radial Forearm Free Tissue Transfer for Repair of Complex Midfacial Defects.
    Date July 2005
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVE: To evaluate the resulting aesthetics, function, and donor site morbidity of the osseocutaneous radial forearm free flap (OCRFFF) used for midface reconstruction. DESIGN: Prospective case series and a retrospective review of results. PATIENTS: Ten patients from an academic practice who underwent reconstruction at the University of Michigan Hospitals between 1995 and 2001. INTERVENTIONS: All patients had maxillectomy defects in which the entire infraorbital rim was reconstructed with an OCRFFF. Of the 10 patients included in the study, 3 underwent a total maxillectomy with orbital exenteration, 4 had a total maxillectomy without orbital exenteration, and 3 had a limited maxillectomy that did not involve the palate. Patients with palatal defects underwent reconstruction with a prosthetic palatal obturator. MAIN OUTCOME MEASURES: Facial contour and aesthetic results, speech understandability, ability to eat solid foods, oronasal separation, socializing outside the home, and return-to-work status. Flap success, donor site morbidity, and orbital complications were also studied. RESULTS: Mean +/- SEM follow-up was 23.2 +/- 5.0 months. A modified Funk facial deformity scale was used, and 7 of the 10 patients had either no deformity or minimal deformity. The mean aesthetic score for these reconstructions was 2.1 +/- 0.3 on a scale of 1 to 4, with 1 representing no deformity and 4 representing a severe deformity. All patients returned to a solid diet and had understandable speech, although patients who had an orbital exenteration trended to poorer scores. All patients socialized either frequently or occasionally outside the home, and all patients not retired or disabled prior to surgery returned to work. CONCLUSION: The OCRFFF reconstruction of the infraorbital rim in patients with total maxillectomy defects and obturator of the palatal defect controls orbital complications and optimizes aesthetic outcome while achieving nearly normal palatal function.

    Title Contemporary Skull Base Reconstruction.
    Date November 2004
    Journal Current Opinion in Otolaryngology & Head and Neck Surgery
    Excerpt

    PURPOSE OF REVIEW: Tumors of the skull base that would have been considered inoperable thirty or forty years ago are now routinely resected with reliable results due to the advancement of modern reconstructive techniques. High mortality rates were common prior to the use of vascularized tissue for skull base repair. However, the advent of local flap reconstruction for skull base defects in the 1960s revolutionized skull base surgery. The use of regional flaps in the 1970s and 1980s allowed skull base surgeons to perform more extensive surgeries, but complication rates were still quite high. RECENT FINDINGS: Experience with free tissue reconstruction increased through the 1980s and 1990s and has become a reliable method to separate the intracranial from extracranial environments. Free tissue transfer has allowed surgeons to address the large volume defects created by extensive skull base resections and has provided dependable, vascularized tissue that is relatively resistant to adjuvant radiation. Local flaps have also become a powerful reconstructive tool in conjunction with free tissue transfer, and in some select cases, may be sufficient alone for reconstruction. SUMMARY: The prevention of serious complications after skull surgery has improved with the use of vascularized tissue. Depending on the anatomic site, the extent of the defect, and the quality of local tissues, either free tissue transfer and/or local flap reconstruction is preferred. Regional flap reconstruction should be reserved for cases where alternative reconstructive techniques are not available.

    Title Current Thoughts on the Role of Chemotherapy and Radiation in Advanced Head and Neck Cancer.
    Date June 2004
    Journal Current Opinion in Otolaryngology & Head and Neck Surgery
    Excerpt

    PURPOSE OF REVIEW: The management of advanced malignancies of the head and neck continues to be a challenging clinical problem. During the last three decades, the traditional treatments of surgery and/or radiation have not yielded significant improvements in survival in this patient population. In addition, surgery for advanced disease can create significant functional and cosmetic defects that adversely impact a patient's quality of life. Newer "organ preservation" approaches using chemotherapy and radiation are currently being studied in an attempt to improve survival while maintaining the functional integrity of the disease site. RECENT FINDINGS: Recent studies have demonstrated that for advanced head and neck squamous cell cancers, concurrent chemoradiation is superior to radiation alone for local tumor control and perhaps overall survival. With the exception of laryngeal cancer, phase III data comparing chemoradiation with surgery is lacking for most head and neck subsites. However, comparisons with historical controls suggest that chemoradiation strategies may offer improved outcomes when compared with more traditional treatment regimens. SUMMARY: This review emphasizes recent phase III trials that support the use of chemoradiation strategies in the treatment of advanced head and neck squamous cell cancers.

    Title Sympathetic Paraganglioma As an Unusual Cause of Horner's Syndrome.
    Date August 2001
    Journal Head & Neck
    Excerpt

    BACKGROUND: Paragangliomas are rare tumors arising from paraganglionic tissue of neural crest origin. They are present in any location where autonomic ganglia are found. The most common location in the head and neck is the carotid body, followed by the jugular bulb and vagus nerve. METHODS: A 30-year-old woman with a slowly growing left neck mass, aniscoria, and left eyelid ptosis was found to have a vascular tumor consistent with a paraganglioma arising near the left carotid bifurcation. After preoperative embolization, the patient underwent resection of the tumor. RESULTS: The tumor was found to be arising from the left sympathetic trunk and did not involve any other surrounding structures. Histopathologic analysis revealed the typical findings of a paraganglioma. CONCLUSIONS: Sympathetic paragangliomas are exceedingly rare tumors in the head and neck and should be considered in the differential diagnosis when clinical and radiographic evidence suggest a paraganglioma. The presentation is typically a slow-growing neck mass with the presence of an ipsilateral Horner's syndrome.

    Title Angiotensin-converting Enzyme and Male Fertility.
    Date April 1998
    Journal Proceedings of the National Academy of Sciences of the United States of America
    Excerpt

    The angiotensin-converting enzyme (ACE; EC 3.4.15.1) gene (Ace) encodes both a somatic isozyme found in blood and several other tissues, including the epididymis, and a testis-specific isozyme (testis ACE) found only in developing spermatids and mature sperm. We recently used gene targeting to disrupt the gene coding for both ACE isozymes in mice and reported that male homozygous mutants mate normally but have reduced fertility; the mutant females are fertile. Here we explore the male fertility defect. We demonstrate that ACE is important for achieving in vivo fertilization and that sperm from mice lacking both ACE isozymes show defects in transport within the oviducts and in binding to zonae pellucidae. Males generated by gene targeting that lack somatic ACE but retain testis ACE are normally fertile, establishing that somatic ACE in males is not essential for their fertility. Furthermore, male and female mice lacking angiotensinogen have normal fertility, indicating that angiotensin I is not a necessary substrate for testis ACE. Males heterozygous for the mutation inactivating both ACE isozymes sire wild-type and heterozygous offspring at an indistinguishable frequency, indicating no selection against sperm carrying the mutation.

    Title Angiotensin-converting Enzyme Gene and Atherosclerosis.
    Date September 1997
    Journal Arteriosclerosis, Thrombosis, and Vascular Biology
    Excerpt

    Common variants of the angiotensin-converting enzyme (ACE) gene (ACE ie humans, Ace in mice) associated with changes in circulating ACE activities have been suggested to confer differential risks for atherosclerosis. Using a mouse model of atherosclerosis induced by heterozygosity for apolipoprotein E gene disruption and an atherogenic diet, we have studied the impact on atherogenesis of a mutation that changes the level of function of Ace. We find that this genetically determined change does not influence the size or complexity of atherosclerotic lesions. Ace genotype was not a significant determinant of lesion size in female (+/+ = 12.9 +/- 1.5 and +/- = 11.7 +/- 1.6 microns2 x 10(4)) or male (+/+ = 0.95 +/- 0.25 and +/- = 1.83 +/- 0.59 microns2 x 10(4)) mice; however, lesions were significantly larger (P < .001) in female than male mice. Ace genotype also did not affect lesion complexity; however, lesions in females showed significantly increased frequency of cholesterol clefts, acellular cores, fibrous caps, and calcifications compared with those in males. The hypothesis that genetic variation in the level of ACE gene expression affects the development of atherosclerosis is not supported by these findings.

    Title Angiotensin-converting Enzyme Gene Mutations, Blood Pressures, and Cardiovascular Homeostasis.
    Date March 1997
    Journal Hypertension
    Excerpt

    A common polymorphism of the angiotensin-converting enzyme (ACE) gene (ACE in humans, Ace in mice) is associated with differences in circulating ACE levels that may confer a differential risk for cardiovascular diseases. To study the effects of genetically determined changes in Ace gene function within a defined genetic and environmental background, we have studied mice having one, two, or three functional copies of the Ace gene at its normal chromosomal location. ACE activities in the serum increased progressively from 62% of normal in the one-copy animals to 144% of normal in the three-copy animals (P < 10(-15), n = 132). The blood pressures of the mice having from one to three copies of the Ace gene did not differ significantly, but the heart rates, heart weights, and renal tubulointerstitial volumes decreased significantly with increasing Ace gene copy number. The level of kidney renin mRNA in the one-copy mice was increased to 129 +/- 9% relative to that of the normal two-copy mice (100 +/- 4%, P = .01, n = 16). We conclude that significant homeostatic adaptations successfully normalize the blood pressures of mice that have quantitative changes in Ace gene function. Our results suggest only that quantitative changes in expression of the Ace gene will observably affect blood pressures when accompanied by additional environmental or genetic factors that together with Ace exceed the capacity of the homeostatic mechanisms.

    Title Alteration of Reproductive Function but Not Prenatal Sexual Development After Insertional Disruption of the Mouse Estrogen Receptor Gene.
    Date January 1994
    Journal Proceedings of the National Academy of Sciences of the United States of America
    Excerpt

    Estrogen receptor and its ligand, estradiol, have long been thought to be essential for survival, fertility, and female sexual differentiation and development. Consistent with this proposed crucial role, no human estrogen receptor gene mutations are known, unlike the androgen receptor, where many loss of function mutations have been found. We have generated mutant mice lacking responsiveness to estradiol by disrupting the estrogen receptor gene by gene targeting. Both male and female animals survive to adulthood with normal gross external phenotypes. Females are infertile; males have a decreased fertility. Females have hypoplastic uteri and hyperemic ovaries with no detectable corpora lutea. In adult wild-type and heterozygous females, 3-day estradiol treatment at 40 micrograms/kg stimulates a 3- to 4-fold increase in uterine wet weight and alters vaginal cornification, but the uteri and vagina do not respond in the animals with the estrogen receptor gene disruption. Prenatal male and female reproductive tract development can therefore occur in the absence of estradiol receptor-mediated responsiveness.

    Title Intratumoral Dendritic Cells and Chemoradiation for the Treatment of Murine Squamous Cell Carcinoma.
    Date
    Journal Journal of Immunotherapy (hagerstown, Md. : 1997)
    Excerpt

    Dendritic cells are potent antigen-presenting cells that have been shown to have significant antitumor effects in vitro and in vivo. However, the therapeutic efficacy of dendritic cells as an immunotherapeutic treatment has been limited by both immunologic tolerance and active immunosuppression in the tumor microenvironment. To address this problem, we examined the ability of concurrent systemic chemotherapy and local, fractionated radiation to augment intratumoral dendritic cell injections in a mouse model of squamous cell carcinoma. Intratumoral injections of dendritic cells alone did not have a significant antitumor effect in mice with squamous cell carcinoma flank tumors, but the addition of chemoradiation resulted in significant tumor regression. Concurrent chemoradiation alone resulted in slower tumor growth, but no complete tumor regressions. The combination of chemoradiation and intratumoral dendritic cell injections resulted in improved survival and complete tumor regression in 30% mice. Mice with complete tumor regression were partially resistant to the repeat challenge with relevant tumor 60 days after treatment. These findings were partially dependent on the presence of CD4 T cells, CD8 T cells, and natural killer cells. Chemoradiation may augment intratumoral dendritic cell injections through increased intratumoral apoptosis and decreased intratumoral regulatory T cells. This work suggests a possible role for the use of intratumoral dendritic cell therapy with more traditional chemoradiation strategies.

    Title Skin Cancer of the Head and Neck with Perineural Invasion: Defining the Clinical Target Volumes Based on the Pattern of Failure.
    Date
    Journal International Journal of Radiation Oncology, Biology, Physics
    Excerpt

    PURPOSE: To analyze patterns of failure in patients with head-and-neck cutaneous squamous cell carcinoma (HNCSCC) and clinical/radiologic evidence of perineural invasion (CPNI), in order to define neural clinical target volume (CTV) for treatment planning. METHODS AND MATERIALS: Patients treated with three-dimensional (3D) conformal or intensity-modulated radiotherapy (IMRT) for HNCSCC with CPNI were included in the study. A retrospective review of the clinical charts, radiotherapy (RT) plans and radiologic studies has been conducted. RESULTS: Eleven consecutive patients with HNCSCCs with CPNI were treated from 2000 through 2007. Most patients underwent multiple surgical procedures and RT courses. The most prevalent failure pattern was along cranial nerves (CNs), and multiple CNs were ultimately involved in the majority of cases. In all cases the involved CNs at recurrence were the main nerves innervating the primary tumor sites, as well as their major communicating nerves. We have found several distinct patterns of disease spread along specific CNs depending on the skin regions harboring the primary tumors, including multiple branches of CN V and VII. These patterns and the pertinent anatomy are detailed in the this article. CONCLUSIONS: Predictable disease spread patterns along cranial nerves supplying the primary tumor sites were found in this study. Awareness of these patterns, as well as knowledge of the relevant cranial nerve anatomy, should be the basis for CTV definition and delineation for RT treatment planning.

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