bluuebunny/crossref_metadata_2025 huggingface dataset:
DNA methylation dependent silencing of the human glutamate transporter EAAT2 gene in glial cells
Authors: Zschocke Jürgen , Allritz Claudia , Engele Jürgen , Rein Theo
Published: February 2007

Glutamate is the major excitatory neurotransmitter in the CNS that is cleared from the extracellular space by a family of high‐affinity glutamate transporters. The astroglial glutamate transporter EAAT2 is thought to carry out the uptake of the vast quantity of glutamate, and dysregulation of EAAT2 expression is involved in the pathogenesis of neurological disorders with marked excitotoxic components. Here, we present a novel epigenetic mechanism by which the human EAAT2 gene is kept in a silent state. Sequence inspection identified a classical CpG island at the EAAT2 promoter. Bisulfite analysis of the DNA methylation profile revealed that lack of EAAT2 expression in human glioma cell lines was associated with a densely methylated EAAT2 promoter. In contrast, EAAT2 positive normal human brain tissue used as reference displayed hypomethylation of the same promoter regions. In vitro methylation of EAAT2 promoter sequences indeed altered the binding properties of nuclear factors to the respective DNA sites as illustrated by electrophoretic mobility shift assay. Moreover, we observed a reduced activity of a methylated EAAT2 promoter construct as compared to the unmethylated control, both in a human glioma cell line and rodent primary astrocytes. Further supporting a role of DNA methylation for EAAT2 silencing, inhibition of DNA methyltransferases robustly enhanced EAAT2 mRNA transcription in several cell lines tested. In conclusion, the idea is put forward of an epigenetic mode of EAAT2 regulation based on the differential methylation of the gene promoter. © 2007 Wiley‐Liss, Inc.
Browplasty as an adjunct to rhinoplasty
Authors: Webster Richard C. , Davidson Terence M. , Smith Richard C.
Published: February 2007

Brbrow may be indicated. If the nasofrontal angle should not be retrodisplaced to deepen a shallow angle, brow augmentation may prove helpful in separating the nose from the forehead or in making the nose appear shorter in the vertical dimension. Augmentation and reduction browplastic techniques are discussed, and selected methods are illustrated. Some involve additional resection of frontal bone or procerus muscle at the time of nasal‐hump removal. Others employ grafts of bone and/or cartilage removed from the nose at the time of septorhinoplasty. The versatile aesthetic surgeon should be capable of changing all structures adjacent to the nose. Certain difficult cosmetic problems are best treated by directing appropriate attention to these structures and to the nose rather than by concentrating on the nose alone. That the brow is one of these important abutting landmarks is demonstrated.
Evaluation of the eye following periorbital trauma
Authors: Binder Perry S.
Published: February 2007

Periorbital trauma is usually associated with ocular complications. When confronted with a traumatized patient, one should therefore evaluate the eyes to determine the extent of injury. First, a noncontact examination should be conducted to assess the degree of ocular integrity. Once it is established that the eye is not damaged, further diagnostic work‐up and evaluation can be performed. Although most ocular complications are treated by ophthalmologists, eyelid lacerations, orbital hemorrhage, blowout fractures, and brain injuries may be treated by other subspecialists. Before orbital and ocular adnexal reconstructive surgery is performed, however, one must establish the patient's ocular status so that ocular damage will not be increased during surgery.
Wegener's granulomatosis and midline (nonhealing) “granuloma”
Authors: Batsakis John G.
Published: February 2007

There has been considerable controversy over the years regarding the distinctions between various disorders characterized by a necrotizing and granulomatous inflammation of the tissues of the upper respiratory tract and oral cavity. It now seems clear that if infections and other known agents can be excluded, three clinicopathologic entities remain: Wegener's granulomatosis (a systemic disease), idiopathic midline (nonhealing) granuloma, and premalignant or malignant lymphoreticular lesions. The antigenic stimulus for all three may be related but remains unidentified.
Angiosarcoma of the maxillary sinus: Literature review and case report
Authors: Bankaci Murat , Myers Eugene N. , Barnes Leon , Dubois Philip
Published: February 2007

A rare case of angiosarcoma of the maxillary sinus is reported. Review of the literature concerning angiosarcoma of the head and neck revealed 14 previously published cases involving the nose, nasal sinuses, and nasopharynx. Angiosarcoma of the skin and soft tissues of the head and neck differs in behavior from that affecting the nose, nasal sinuses, and nasopharynx. The case reported presents the protracted clinical course of this malignant tumor.
The pectoralis major myocutaneous island flap for reconstruction of the head and neck
Authors: Baek Se‐Min , Biller Hugh F. , Krespi Yosef P. , Lawson William
Published: February 2007

The anatomy, design, and blood supply of the pectoralis major myocutaneous island flap are described. This versatile, nondelayed flap has, for the most part, replaced the usual cutaneous flaps. Clinical examples of its use in head and neck reconstructive surgery are presented.
Radiation therapy of the oral cavity: Sequelae and management, part 1
Authors: Beumer John , Curtis Thomas , Harrison Richard E.
Published: February 2007

This is the first article in a two‐part series dealing with the effects and manifestations in the oral cavity of radiation therapy of head and neck tumors. In this section, oral mucous membranes, taste buds, edema and trismus, diet, salivary glands, bone, periodontium, teeth, and composition of oral flora are discussed. Dental management of the dentulous patient is then approached; criteria for preradiation extraction are delineated. In the next issue of Head & Neck Surgery, the final article in this series will discuss preradiation and postradiation extractions and will elaborate on the dental management (fluoride treatments, follow‐up, and restorative care) of the dentulous patient. Dental management of the edentulous patient will also be presented.
The pathology of head and neck tumors: Salivary glands, part 4
Authors: Batsakis John G. , Regezi Joseph A.
Published: February 2007

Adenoid cystic carcinomas and adenocarcinomas of salivary tissues are more plentiful in minor than in major salivary glands. In the latter, they comprise no more than 10% of tumors. In both sites, however, their clinical course is characterized by local aggressiveness, recurrences, and a relatively torpid and protracted course, eventually leading to death. The clinicopathologic aspects of these two lesions form the major part of this report. Their behavior is contrasted with that of the two other lesions presented: heterotopic salivary tissue, which is seldom the site of neoplasia; and necrotizing sialometaplasia, a self‐limited disorder that simulates malignancy both clinically and histopathologically.
Laryngeal keratosis and subsequent carcinoma
Authors: Crissman John D.
Published: February 2007

The frequency with which carcinoma develops in laryngeal keratoses is a controversial subject. A study of 92 cases of laryngeal keratosis with a minimum of five years' follow‐up resulted in identification of three patients (3.26%) who developed laryngeal carcinoma. A review of the literature reveals that, in series of keratoses defined by stringent pathologic criteria, subsequent laryngeal carcinoma develops in 3.33%–4.31%. These findings support a low but predictable frequency of conversion to malignancy in laryngeal keratosis. A grading system for keratosis is presented and discussed with reference to clinicopathologic correlation.
Thyroid and associated polyglandular neoplasms in patients who received head and neck irradiation during childhood
Authors: Katz Alfred D.
Published: February 2007

One hundred fifty‐one patients with a history of childhood irradiation to the head, neck, and thorax had neck explorations (142 for “cold” thyroid nodules and 9 for hypercalcemia). Fifty‐nine of the patients had thyroid carcinoma, and associated glandular tumors were found in 20 others. In addition, 6 female patients developed breast carcinoma; 4 of these women also had thyroid carcinoma. In this series, 48.6% of the patients irradiated for acne and 36.4% with tonsil and adenoid irradiation developed thyroid carcinoma, but only 10.5% with thymic irradiation did so. It is suggested that the workup on these patients include not only complete thyroid and parathyroid testing, but also a careful examination of all salivary glands, both major and minor. Women should have thorough breast examinations and should perhaps be followed as if they were in the potentially high‐risk breast group. When thyroid surgery is performed, a total thyroidectomy is recommended.
Importance of the columellar‐labial junction in rhinoplasty
Authors: Webster Richard C. , Davidson Terence M. , Smith Richard C.
Published: February 2007

Concentration on tip positioning may draw a surgeon's attention away from modifying positions of the nasofrontal angle and of the columellar‐labial junction. All three landmarks are, however, vital to the establishment of desirable profiles. This article emphasizes that changes in the positioning of the columellar‐labial junction may (1) eliminate certain hazards involved in changing tip position, (2) make it possible to produce aesthetic effects that cannot be achieved with tip positioning alone, and (3) make rhinoplasty safer and more predictable in certain difficult cases. Also presented are techniques that have been found to work most satisfactorily in changing angle and position. A few patients selected from among several thousand rhinoplastic cases are analyzed to underscore the significance of this area in rhinoplastic planning. Follow‐up varied from several months to several years.
Surgical approaches to the pituitary gland, with emphasis on the transseptal route
Authors: McDonald Thomas J. , Kern Eugene B. , Laws Edward R. , Pearson Bruce W.
Published: February 2007

There are many different surgical approaches to the pituitary gland. The earliest approach was intracranial. Extracranial methods (transsphenoidal) then became briefly popular but were subsequently dropped in favor of a return to intracranial methods. Now extracranial approaches have definitely returned to favor, and the reasons for this interesting evolution are discussed. The various techniques are also described. The authors prefer the transseptal‐transsphenoidal variation of the extracranial approach and explain the advantages.
Diagnosis of infratemporal fossa tumors using percutaneous core needle biopsy
Authors: Shapshay Stanley M. , McCann Charles F. , Ucmakli Alptekin , Vaughan Charles W. , Strong M. Stuart
Published: February 2007

Three patients with infratemporal fossa carcinomas presented with severe, unrelenting facial pain, weight loss, and 5th cranial nerve deficit. Erosion of the base of the skull at the foramen ovale was present in two of these patients. Histologic diagnosis of infratemporal fossa malignancy was obtained by needle biopsy of the foramen ovale region; the technique is described. This approach to the infratemporal fossa is preferred to the more complicated external surgical approach with its greater risk of morbidity. Surgical approaches to the infratemporal fossa are also reviewed. Two of the patients were treated with radiotherapy; the third refused further therapy. Supravoltage radiotherapy with curative intent is the recommended treatment because of the difficulty of an en bloc tumor resection in the infratemporal fossa. Radioactive gold seeds may be implanted through an external surgical approach to boost the local dose.
Immunobiology of head and neck cancer: Basic concepts
Authors: Wanebo Harold J.
Published: February 2007

Patients with squamous cancer of the head and neck have unique perturbations of the immune system. These patients have marked depression of cellular immunity even in the early stages of disease. The known facts about the immunobiology and the immunodeficiencies that commonly occur are discussed. Also reviewed are the relationships of the immunologic deficits to stage of disease, to prognosis, and to the suspected etiologic factors of smoking, alcoholism, and malnutrition. Highlights are given of current immunotherapeutic trials. To date, most of the successful efforts in both immunobiologic research and immunotherapy of head and neck cancer have dealt with general, rather than specific, immune reactions. Future development in the area of specific immune responses may permit more meaningful measurements of tumor‐specific reactions, thus yielding useful tools for immunodiagnosis as well as providing more effective and precise methods of immunotherapy.
Twenty‐five‐year experience with primary hyperparathyroidism at Columbia Presbyterian medical center
Authors: Dolgin Carey , Gerfo Paul Lo , Livolsi Virginia , Feind Carl
Published: February 2007

A retrospective review of 500 patients with primary hyperparathyroidism seen from 1951 to 1975 was conducted; the effect of routine screening of calcium and phosphate levels (initiated in 1968) on the incidence and spectrum of the disease was analyzed. The majority of the patients (77%) were diagnosed in the eight‐year period after routine biochemical screening was instituted. Comparing the group of patients diagnosed before the advent of biochemical screening and those diagnosed since screening was instituted, we found: (1) a small but significant increase in the number of asymptomatic patients diagnosed (from 2% to 12%); (2) no change in the incidence of related medical disorders, i.e., nephrocalcinosis and hypertension; (3) no change in the incidence of primary hyperplasia and adenoma; and (4) no change in the mean serum calcium level, the mean age at diagnosis, or the number or location of the involved parathyroid glands. Although routine calcium screening has identified significantly more cases of primary hyperparathyroidism, screening apparently does not enable diagnosis at an earlier stage.
Cryosurgery: Theory and application to head and neck neoplasia
Authors: Carpenter Robert J. , Snyder G. Gordon
Published: February 2007

While surgery and radiation therapy remain the time‐tested modalities for the treatment of cancer in the head and neck, recent experimental and clinical experience has documented the effectiveness of cryosurgery as an adjunct in the treatment of selected neoplasms in individual patients. A review is provided of the theory of freezing as a method of cell destruction, and experimental and clinical experience illustrate the principles and application of cryosurgery to head and neck tumors.
Cervical metastases following radical neck dissection that preserved the spinal accessory nerve
Authors: Carenfelt C. , Eliasson K.
Published: February 2007

In contrast to the original neck dissection technique, the spinal accessory nerve is routinely sacrificed in the so‐called classical neck dissection. The benefit of this routine has never been documented; on the contrary, facts have accumulated that indicate that the nerve should be preserved. The results in this article serve to emphasize this opinion. Of 80 patients who underwent radical neck dissection that preserved the spinal accessory nerve, the potential for cure was not jeopardized in a single case.
Myocutaneous trapezius flap
Authors: Panje William R.
Published: February 2007

A random pattern flap, such as the nape‐of‐the‐neck flap, is a delayed cutaneous flap that relies on collateral circulation based on the skin pedicle. The myocutaneous trapezius flap, however, is a cervical flap that does not need to be delayed since it receives its blood supply from a musculocutaneous artery. The author has radiographic and clinical evidence that demonstrates that the upper one‐half of the trapezius muscle is primarily, and abundantly, supplied by the transverse cervical artery. If this artery is kept intact during resection and reconstruction, a flap as large as 12 × 42 cm may be maintained. This flap has been used in various types of reconstruction on 23 patients, and it has been successful in terms of viability, versatility, safety, and cosmesis.
Management of the congenital midline nasal mass: A review
Authors: Hughes Gordon B. , Sharpino George , Hunt William , Tucker Harvey M.
Published: February 2007

The nasal encephalocele, the glioma, and the dermoid are the most common of the congenital midline nasal masses. Due to similar embryologic development, each of these lesions may be associated with bony cranial defects and intracranial abnormalities, as well as CSF leakage and the potential for fatal meningitis if not handled properly. Preoperative manipulation should be avoided. Radiologic studies are instructive only if they are positive. If intracranial attachments are identified radiologically or suspected clinically, neurosurgical consultation should be obtained, and intracranial exploration and resection should be carried out as the initial procedure. Extracranial resection of the remaining mass may be performed immediately after intracranial resection, may be postponed, or may become unnecessary.
Folded forehead flap for reconstruction of full‐thickness defects of the cheek
Authors: Shah Jatin P.
Published: February 2007

A simplified technique is described for reconstruction of through‐and‐through full‐thickness defects of the cheek following resection of cancer. The standard forehead flap is employed with an extended application, whereby it is folded over itself twice to provide both an inner and an outer lining. This alternative technique appears to be a reliable and quick way of obtaining both cover and lining for reconstruction of through‐and‐through defects of the cheek.
Nonsimultaneous bilateral radical neck dissection
Authors: Baffi Raul , Razack Mohamed S. , Sako Kumao
Published: February 2007

From January 1963 to December 1977, 63 patients underwent a therapeutic second (staged) neck dissection at our institute. The mean interval between the first neck dissection and the second neck dissection was 13.2 months; 58.7% of the second neck dissections were performed between 6 and 12 months after the first. Forty‐six patients had histologically positive and 17 patients had histologically negative nodes in the first neck clearance; 57 patients had histologically positive and 6 patients had histologically negative nodes in the second neck clearance. Forty‐two of the 63 patients had bilateral nodal disease, while 2 patients had no disease in either side of the neck. Fifty‐four percent of the patients had postoperative complications; 30% developed immediate postoperative edema, and 14% had wound infection. The overall three‐year and five‐year survival rates were 60% and 38%, respectively. Patients who had bilateral histologically positive nodes had a 16% five‐year survival rate, while those who had histologically positive nodes in one side of the neck only had a 26% five‐year survival rate.
The assessment and enhancement of skin flap viability
Authors: Donegan J. Oliver
Published: February 2007

One of the most difficult tasks facing the reconstructive surgeon is the successful transfer of skin flaps. Despite recent dramatic advances in the application of skin flaps and despite the skill and experience of the surgeon, flaps still fail. This review discusses the methods regarded as most accurate in assessing skin flap viability, and the techniques used to augment flap survival.
The pathology of head and neck tumors: Squamous and mucous‐gland carcinomas of the nasal cavity, paranasal sinuses, and larynx, part 6
Authors: Batsakis John G. , Rice Dale H. , Solomon Alvin R.
Published: February 2007

Carcinomas of the nasal cavity and paranasal sinuses are statistically dominated by squamous‐cell lesions, which account for between 85% and 90% of the epithelial malignancies in these sites. Neoplasms of glandular derivation are far less frequent, accounting for between 4% and 8% of carcinomas in this region. Both classes of malignancy, however, indicate an ominous prognosis for their hosts, and for both, it is the extent of the cancer, and hence the clinical stage, that is the major determinant. The clinicopathologic characteristics of squamous‐cell and glandular carcinomas of the nasal cavity and paranasal sinuses are presented, and for the latter, a review of their presentation in the larynx is also offered.
Squamous‐cell carcinoma of Stensen's duct
Authors: Vigorita Vincent J. , Huvos Andrew G. , Gerold Frank
Published: February 2007

A case of epidermoid carcinoma of Stensen's duct, the major duct of the parotid gland, is reported. The literature on this rare tumor is reviewed including four previously reported cases. In the current case, both the gross appearance of the tumor confined to the duct and the lack of histologic involvement of adjacent parotid tissue establish that the carcinoma arose from the duct itself, presumably following development of squamous metaplasia. The patient was alive without evidence of disease 12 months following surgery.
Squamous‐cell carcinoma of the floor of the mouth
Authors: Crissman John D. , Gluckman Jack , Whiteley Joseph , Quenelle David
Published: February 2007

Among the histologic parameters described by Jakobsson, only the stage (depth) of invasion appears to be of value in predicting lymph node metastases. Early carcinomas of the FOM examined in our institution (T1 and some T2) grew in a superficial or horizontal manner and none developed metastases or local recurrence. Larger neoplasms (some T2 and all T3 and T4) had extensive submucosal and deep soft tissue infiltration and a corresponding high frequency of regional lymph node metastases. T1 and T2 neoplasms with only superficial or microinvasion of the submucosa have little or no propensity for lymph node metastases, while T2 cancers with nodular or vertical infiltration into the submucosa have a substantial frequency of metastatic disease (44%). If the biopsy sites are carefully selected, these growth patterns can be identified by the pathologist. In addition, our experience is that clinical assessment of cervical lymph nodes for the presence of metastatic disease is often erroneous. Rates of 56% false positives and 24% false negatives were observed, which were similar to rates reported in other series. Biopsy evaluation of the extent and growth pattern of the primary neoplasm is as important as physical examination in determining the type of surgery to be done and whether lymph node dissection should be performed.
Elective neck irradiation in squamous‐cell carcinoma of the head and neck
Authors: Mendenhall William M. , Million Rodney R. , Cassisi Nicholas J.
Published: February 2007

One hundred fifty‐nine patients with squamous‐cell carcinoma of the oral cavity, oropharynx, nasopharynx, hypopharynx, and supraglottic larynx, and with clinically negative neck (Stage NO) were reviewed to determine the value of elective neck irradiation (ENI). The primary cancer was controlled in 125 patients; in these patients the neck failure rate was 1.9% with ENI and 18% without ENI. Recurrence in the neck in cases where the primary cancer was controlled was associated with an increased risk of death due to cancer. The primary cancer was not controlled in 34 patients; in these patients the neck failure rate was 25% with ENI and 67% without ENI. Ten of 11 patients in whom treatment failed both at the primary site and in the neck died of cancer despite attempts at surgical salvage. ENI may be associated with an increased risk of local failure in oral tongue lesions as a result of a decreased proportion of treatment given with interstitial therapy.
A bloodless technique for tongue surgery
Authors: Weitz J. , Hodgson W. J. B. , Loscalzo L. J. , McElhinney A. J.
Published: February 2007

The Cavitron Ultrasonic Surgical Aspirator (CUSA System) has been used at our institution in the resection of carcinoma of the tongue in 10 patients. This device is an ultrasonically powered aspirator that selectively fragments and aspirates tissue within a 1‐ to 2‐mm radius of its tip. The technique used in our unit in tongue surgery was to incise the tough mucosal capsule of the tongue with electrocautery, and then to divide muscle and skeletonize blood vessels using the CUSA System. Smaller vessels, up to 2 mm in size, were cauterized directly by the friction created at the tip of the instrument. In this way, excellent control was available at all times and blood loss was consequently minimal. As our experience in the use of the CUSA System increased, blood loss was virtually eliminated, anatomic landmarks were more easily defined, and at no stage did any tongue necrosis occur in any of the patients of the series.
Radiographic staging of juvenile angiofibroma
Authors: Sessions Roy B. , Bryan R. Nick , Naclerio Robert M. , Alford Bobby R.
Published: February 2007

A staging system for juvenile angiofibroma based on computerized tomographic findings is suggested. The need for such an endeavor has come about because of a lack of standardization of tumor data in both individual series and interinstitutional reports. The various stages reflect the number of anatomic sites occupied by a lesion rather than the actual tumor size. The “simpler” tumors are confined to the medial part of the skull base and are entirely extracranial. As a tumor extends laterally and/or intracranially, the staging designation, and therefore the treatment plan, changes accordingly. Presumably, with the application of consistent diagnostic tools and standardized stage designations, the analysis of both morbidity and treatment data will become more meaningful.
The management of parotid neoplasms
Authors: Krause Charles J.
Published: February 2007

In recent years, the management of parotid gland neoplasms has changed considerably, to include a more aggressive surgical approach and multimodality therapy. An organized approach to surgical management and the rationale for postoperative irradiation for selected tumors are presented. A review of several studies supporting the efficacy of postoperative irradiation is included. The principles of palliative management of adenoidcystic carcinoma are unlike those for most other malignancies, and include repeated use of limited procedures to control local and regional disease over extended periods of time, and delayed treatment of distant disease until the patient becomes symptomatic.
Pi meson radiotherapy for advanced head and neck neoplasms: Preliminary results
Authors: Khan Kutub M. , Bush Steven , Herzon Fred , Kligerman Morton M.
Published: February 2007

Under the auspices of the University of New Mexico Cancer Research and Treatment Center, trials are under way at the Los Alamos Meson Physics Facility to evaluate the effects of pi meson irradiation on locally advanced human tumors. This paper summarizes the preliminary results in patients with locally advanced head and neck tumors treated under Phase I and Phase II studies. A total of 26 patients were treated between June 1977 and May 1979 with a minimum follow‐up of 9 months and a maximum follow‐up of 33 months. Sites of disease included the oropharynx in 10 cases (base of tongue in 7, tonsil in 2, and pharyngoepiglottic fold in 1), the supraglottic larynx in 4, the nasopharynx in 5, the oral cavity in 4, the hypopharynx in 2, and the sublingual salivary gland in 1. Twelve of the 26 patients are alive, and 10 survive with no evidence of disease. Doses employed ranged from a minimum of 1,000 peak pion rad in 7 fractions over 9 days to a maximum of 5,400 peak pion rad in 51 fractions over 89 days. The minimum dose employed for any patients treated with peak pions alone was 3,000 rad. These data are analyzed according to dose, site, histology, tumor response, local control, and survival. Results from these cases form the basis of the Phase III randomized trials for advanced squamous‐cell carcinomas of the head and neck, which are currently in progress.
Massive necrotizing infections of the neck
Authors: Krespi Yosef P. , Lawson William , Blaugrund Stanley M. , Biller Hugh F.
Published: February 2007

Necrotizing fasciitis of the head and neck is a rare condition with only 7 cases recorded in the literature. Two cases are presented in which there was massive necrosis of the soft tissues of the neck with extension into the mediastinum. The offending organisms were a mixed bacterial flora which produced gangrene accompanied by subcutaneous emphysema. Both patients were successfully treated with a regimen of intravenous antibiotics, fasciotomy, radical debridement, and hyperbaric oxygenation (1 case). The clinical features, bacteriology, and treatment of necrotizing fasciitis are reviewed.
Recent advances in neuro‐otology
Authors: Brackmann Derald E.
Published: February 2007

Four advances in the field of neuro‐otology are described: (1) auditory brain‐stem response audiometry, (2) electroneuronography, (3) the cochlear implant, and (4) the infratemporal fossa approach to the skull base. Auditory brain‐stem response audiometry is an accurate method for the early detection of hearing impairment and early diagnosis of acoustic neurinomas. Electroneuronography accurately assesses the degree of injury to the facial nerve, thereby improving management of facial nerve lesions. The cochlear implant restores the sensation of sound to totally deaf patients. The infratemporal fossa approach is used to treat extensive lesions of the skull base.
Intraarterial infusion chemotherapy for head and neck cancer using a totally implantable infusion pump
Authors: Baker Shan R. , Wheeler Richard H. , Ensminger William D. , Niederhuber John E.
Published: February 2007

Intraarterial infusion chemotherapy has not been widely accepted for the treatment of head and neck cancer due to the high rate of complications it involves. To avoid these complications, a totally implantable infusion pump has been developed to achieve continuous low‐level drug delivery for long periods of time. The pump is implanted in a subcutaneous pocket and connected to a permanent, indwelling, arterial catheter. It can be repeatedly refilled with chemotherapeutic agents by hypodermic needle injection through the skin and through a self‐sealing septum located at the entry to the pump. Refilling the pump recharges an inexhaustible power source for the next delivery cycle. Preliminary results suggest that long term intraarterial infusion chemotherapy for the treatment of head and neck cancer is practical for outpatients.
Framework invasion by laryngeal carcinomas
Authors: Pittam M. R. , Carter R. L.
Published: February 2007

The accuracy of standard clinical and radiologic methods in detecting invasion of the laryngeal framework or the presence of a transglottic tumor was examined by comparing clinical and pathologic findings in a series of 50 randomly selected laryngectomies for squamous carcinoma. Forty‐two of the patients had received radiation therapy as primary treatment. The presence of pain referred to the ear immediately before laryngectomy indicated invasion of the laryngeal framework or spread into the extralaryngeal soft tissues in 11 of 12 patients. Transglottic tumors were correctly identified in 10 of 14 patients from laryngeal tomograms, but seven additional tumors were incorrectly designated as transglottic. Both transglottic tumors and infraglottic extension were seriously underdiagnosed by direct laryngoscopy. Framework invasion was seen to be a feature of transglottic tumors 2 cm or more in diameter. The morphology of this process is described. Limited follow‐up has already shown a pattern of early recurrence, frequently as cervical node metastases, that is significantly more common in patients with framework invasion.
New concepts in lower lip reconstruction
Authors: Meyer Rodolphe , Failat Abdul S. Abul
Published: February 2007

Three new methods for reconstructing the lower lip after partial or total resection are described. An advancement flap is used to reconstruct partial defects. It can be combined with a reverse Abbé‐Estlander flap for repair of total loss of the lower lip. A new technique also is presented that allows single‐stage reconstruction after total resection of the lower lip.
Approaches to the diagnosis and treatment of tumors of the parapharyngeal space
Authors: Bass Richard M.
Published: February 2007

Tumors of the parapharyngeal space appear as painless masses bulging into the tonsillar, nasopharyngeal, or retromandibular area. Most are benign and represent a wide range of tumor growth, from parotid extension to intrinsic growth of nerves, blood vessels, and salivary gland tissues within or around the parapharyngeal area. The anatomy of this area and diagnostic procedures are discussed. Sinus films, tomograms of the skull base and lateral pharyngeal area, CT scans with simultaneous parotid sialograms, and angiograms are part of the evaluation of these rarely seen tumors. The approach to therapy is discussed.
Temporal bone anatomy: Comparison of computed tomography and complex motion tomography
Authors: Shaffer Katherine A. , Littleton Jesse T. , Durizch Mary Lou , Callahan William P.
Published: February 2007

Specially reconstructed 1.5‐mm thick CT scans and complex motion tomograms of the temporal bones were compared with anatomic sections of the same bones. Computed tomography demonstrated sloping bone surfaces and soft tissues better than tomography, whereas standard complex motion tomography produced a slightly thinner section with better spatial resolution. The advantages of computed tomography will probably make it the preferred radiologic study for many abnormalities of the temporal bone.
Voice change surgery in the transsexual
Authors: Donald Paul J.
Published: February 2007

Sexual reassignment surgery for individuals with gender identity confusion has been highly successful, especially in the male‐to‐female transformation. A troublesome problem for some of these individuals is the retention of their male voice. Although castration and estrogen therapy may produce minor elevations of pitch and the assumption of a falsetto voice produces a more typical but contrived female tone, the basic male anatomic structure of the larynx must be altered to effect a physiological transformation. In three transsexuals, an attempt was made to effect a more female tonal quality by shortening the vibrating length of the vocal folds. Through a laryngofissure, the anterior one third of each cord was denuded and the raw edges approximated. This produced an anterior web that successfully resulted in pitch elevation in all three cases.
Intratumoral BCG therapy of transplanted head and neck tumors in strain 2 guinea pigs
Authors: Bier Jurgen , Bier Henning , Kleinschuster Steve , Rapp Herb
Published: February 2007

The generally unfavorable prognosis associated with advanced squamous cell carcinoma in the head and neck region in humans led us to immunotherapeutic experiments with bacillus Calmette‐Guerin (BCG) in inbred guinea pigs with solid growing and lymphogenous metastasizing tumors. The injection of live BCG or BCG cell wall preparation (CWP) into the planum buccale in the guinea pig led to a pronounced local inflammatory reaction. If live BCG or BCG CWP were injected into the planum buccale together with line 10 tumor cells, no growth of the tumor could be observed. Animals treated in this manner developed a tumor‐specific immunity. Guinea pigs treated intratumorally with live BCG or BCG CWP in established, 6‐day‐old tumors of the planum buccale showed regression of the primary tumor and prevention of the development of lymph node metastases. These cured animals also developed a tumor‐specific immunity. Guinea pigs with 6‐day‐old tumors of the planum buccale remained tumor free after surgical removal of the primary tumor and the draining submandibular and cervical lymph nodes (radical operation) whereas locally operated animals (primary tumor excision) developed lymph node metastases. Animals that were tumor free after radical surgery did not develop tumor‐specific immunity. Despite insufficiently clarified mechanisms for the induction and effect of BCG immunotherapy, we can state that, with intratumoral BCG therapy, a tumor experimentally placed in the head and neck region is eliminated, regionally manifest metastases are eliminated, and specific tumor immunity can be demonstrated in successfully treated animals.
Recent advances in surgery of the larynx and trachea
Authors: Sessions Donald G.
Published: February 2007

Recent advances in surgery of the larynx and trachea have occurred in the general areas of diagnosis, pretreatment nutritional therapy, surgical technique, and reconstruction. In diagnosis the routine use of the flexible fiberoptic laryngoscope in the office and the use of computerized tomography have been valuable. The addition of enteral and parenteral nutrition therapy in selected patients with laryngeal cancer has been an advance. In the area of surgical technique, section of the recurrent nerve for the treatment of abductor laryngeal spastic dysphonia has proved successful. In the area of reconstruction the use of the epiglottic flap for repair of the larynx after near‐total laryngectomy for glottic cancer and the use of the pectoralis major myocutaneous flap for one‐stage pharyngoesophageal reconstruction have been significant advances. An increase in the number of patients with chronic lung disease has created a new interest in tracheal fenestration.
Ectopic parathyroid tissue in the hypopharyngeal mucosa (pyriform sinus)
Authors: Joseph Michael P. , Nadol Joseph B. , Pilch Ben Z. , Goodman Max L.
Published: February 2007

Ectopic thyroid tissue was discovered in the mucosa of the pyriform sinus as an incidental finding in two patients who underwent laryngectomy for squamous cell carcinoma. Reports of ectopic parathyroid tissue in the neck are summarized, and the relevance for the endocrine surgeon is discussed.
Mechanisms of hypercalcemia in patients with head and neck cancer
Authors: Angel Michael F. , Stewart Andrew , Pensak Myles L. , Pillsbury Harold R. C. , Sasaki Clarence T.
Published: February 2007

Hypercalcemia associated with head and neck malignancy is not an uncommon occurrence; its causes are multiple. Eight hypercalcemic patients with head and neck malignancy were studied. Serum calcium, serum phosphorus, tubular phosphorus threshold, fasting calcium excretion, plasma 1,25‐dihydroxyvitamin D, nephrogenous cyclic adenosine monophosphate (AMP), and immunoreactive parathyroid hormone were measured. Excessive dietary calcium administration in the form of an oral hyperalimentation preparation appeared to be the cause of hypercalcemia in 2 patients. Six patients demonstrated humorally mediated hypercalcemia. These patients resembled patients with primary hyperparathyroidism in having elevated nephrogenous cyclic AMP excretion and reduced proximal tubular phosphorus reabsorption, but they differed from patients with primary hyperparathyroidism by having normal levels of immunoreactive parathyroid hormone, MA rkedly increased fasting calcium excretion, and strikingly reduced mean plasma levels of 1,25‐dihydroxyvitamin D. These data strongly suggest that the humoral factor responsible for hypercalcemia in patients with head and neck cancer is not parathyroid hormone, and that patients with hyperparathyroidism can now be distinguished with confidence from those with malignancy‐associated hypercalcemia.
The thyroglossal cyst
Authors: Allard Remy H. B.
Published: February 2007

The thyroglossal cyst is the most common nonodontogenic cyst in the neck. This cyst may also occur in the lingual or submental areas, though more rarely. Malignant changes have been described. Clinically, no differentiation between a benign cyst and a malignancy can be made. The literature is reviewed regarding the embryology, epidemiology, etiology, symptomatology, radiology, histology, and treatment of this cyst and its malignant counterpart.
Traumatic aneurysm of the proximal superficial temporal artery
Authors: Myer Charles M. , Donegan J. Oliver
Published: February 2007

Traumatic aneurysms of the external carotid artery and its branches are uncommon. A case of a traumatic pseudoaneurysm of the proximal portion of the superficial temporal artery is presented. In addition, a general review of this problem is provided, including the etiology, clinical presentation, differential diagnosis, and management.
Melanoma of the head and neck in queensland
Authors: Harris Trevor J. , Hinckley Del M.
Published: February 2007

The incidence of melanoma in Queensland, 40 cases per 100,000 population, is the highest in the world. In this series of 740 melanomas over a 7‐year period at the Royal Brisbane Hospital, 21.75% occurred on the head and neck. Of these, 46.5% arose in Hutchinson's melanotic freckle and 54.8% were histologically superficial, that is, Clark Levels I and II or less than 0.76 mm in thickness, or both. As local recurrence and distant metastasis is infrequent in superficial melanoma, less radical surgical excision of these lesions is advocated than for thicker lesions or those exhibiting a greater depth of invasion, where aggressive excision and even regional node dissection may be required. Anatomical variations in areas such as the nose, eyelid, ear, and scalp influence patterns of spread and necessitate differences in treatment at each site.
An approach to face‐lift surgery
Authors: McCurdy John A.
Published: February 2007

An approach to the aging face based upon an analysis of surgical principles and dynamics is presented. This approach emphasizes that the face‐lift operation should be directed toward areas in which its potential for improvement is greatest, that is, the jowl and neck. Correction of associated manifestations of aging is best accomplished using ancillary procedures specifically designed for rejuvenating these areas rather than by extension of the face‐lift operation per se.
Digital subtraction angiography: Applications in otolaryngology—head and neck surgery
Authors: Miller Roger W. , Carmody Raymond F. , Seeger Joachim S. , Coulthard Stanley W. , Smith Jan R. L. , Koopmann Charles F.
Published: February 2007

Digital electronic technology has made its most notable contribution to radiology in the form of the CT scanners which have so greatly benefited medical practice. Experience with intravenous angiography using a digital fluoroscopy unit developed at the University of Arizona gives promise of a further major benefit in the area of angiography. The majority of examinations are conducted on an outpatient basis with a risk level comparable to that of an intravenous pyelogram. The authors review their experience with this unit, including it's diagnostic and therapeutic applications to congenital and acquired vascular diseases, neoplasms, and vascular trauma of the head and neck.
The complex nasal dermoid
Authors: Bradley Patrick J.
Published: February 2007

In a series of 74 nasal dermoids, 45 (61%) were of the simple variety involving skin only. Twenty nine (39%) were of the complex variety with deeper tissue involvement requiring more extensive surgery. Of the 29 complex dermoids, 9 (31%) extended to the cribriform plate region but only 3 (10%) of these had an extradural extension. All of the complex nasal dermoids were adequately managed by a transnasal approach. On these findings a preliminary craniotomy should only be considered in exceptional circumstances.
Preradiation dental extractions and the incidence of bone necrosis
Authors: Beumer John , Harrison Richard , Sanders Bruce , Kurrasch Madeline
Published: February 2007

Studies were done with 120 patients submitting to preradiation dental extraction within the radiation treatment volume. Bone necroses developed at the extraction sites in 17 patients (14.1%). The risk of bone necrosis in these patients is primarily dependent upon the size of the radiation treatment volume, radiation dose to mandibular bone, and healing time for the extraction wounds. Of the 13 mandibular bone necroses occurring at preradiation extraction sites, only two have not responded favorably to conservative management. Our data indicates that a policy of selected tooth removal, before radiation treatment, will minimize the risk of osteoradionecrosis. Mandibular molars with advanced chronic periodontal bone loss, residing within the proposed radiation field should be considered for removal before commencement of radiation treatment.
Scaling of disfigurement and dysfunction in postoperative head and neck patients
Authors: Dropkin Mary Jo , Malgady Robert G. , Scott Diane W. , Oberst Marilyn T. , Strong Elliot W.
Published: February 2007

The primary purpose of this investigation was to construct a quantitative scale to measure the perception of severity of visible disfigurement and dysfunction following ablative head and neck cancer surgery. Facial disfigurement and disruption of physical function induced by head and neck surgery pose formidable obstacles to the medical and psychosocial adaptation of cancer patients. Although this problem is widely acknowledged, virtually no research has attempted reliable and valid measurement of such concepts. Consequently, the present study investigated the psychological perceptions of 100 registered nurses regarding 11 disfiguring surgical procedures and loss of associated functions. Results indicated that the nurses' judgments of disfigurement and dysfunction were highly consistent and not a function of patient gender. Judgments of the severity of disfigurement, moreover, were independent of the perceived severity of associated dysfunction. It was concluded that this is a reliable method for measuring the relative degree of disfigurement and dysfunction and represents a critical precursor to prediction of a patient's psychological rehabilitation and compliance with medical care after surgery.
The restoration of resected mandibles in children without the use of bone grafts
Authors: Boyne Philip J.
Published: February 2007

Following resection of the mandible for various types of neoplastic disease, six patients between the ages of 5 and 14 were followed for a period of 8 to 12 years after osseous surgical reconstructive surgery. It was found in children of this age group that a surgical technique may be employed which will effect complete bone regeneration without the use of bone graft materials. All six of the patients spontaneously regenerated large segments of the mandible from full‐body ostectomy to hemimandibulectomy defects. The surgical procedure involves the use of a titanium mesh implant between the ostectomized bone fragments to maintain the surrounding soft tissues in a distracted position. It is found that if the soft tissues of the growing child are surgically prepared using the described technique, a new periosteum and bone will be formed along the titanium mesh implant. The titanium mesh may be removed at a later date or, depending on its method of placement, may be allowed to remain as the child grows, regenerating additional bone structure. It was found that in only one case was additional grafting necessary to obtain osseous union between the spontaneously regenerated mandibular bone and the host‐bone ostectomized fragments. The technique is advocated for bone restoration in cases of large osseous discontinuity defects of the mandible in children.