bluuebunny/crossref_metadata_2025 huggingface dataset:
Locally invasive papillary thyroid carcinoma: 1940–1990
Authors: McCaffrey Thomas V. , Bergstralh Erik J. , Hay Ian D.
Published: February 2007

Well‐differentiated thyroid carcinoma infrequently invades the upper aerodigestive tract. However, when invasion occurs, it is the source of significant morbidity. The most common structures invaded by thyroid carcinoma are the recurrent laryngeal nerves, larynx, pharynx, and esophagus. Invasion of these structures produces symptoms of airway insufficiency, dysphagia, and hemoptysis.

This study was designed to define more clearly the significance of invasion of papillary thyroid carcinoma on survival. At the Mayo Clinic, 262 patients treated for invasive papillary thyroid carcinoma between 1940 and 1990 were retrospectively evaluated. In this group the sites of invasion were muscle 53%, trachea 37%, laryngeal nerve 47%, esophagus 21%, larynx 12%, and other sites 30%. Complete tumor removal was accomplished in 56% of cases. Kaplan‐Meier survival curves were calculated for the population. The over‐all survival was 79% at 5 years, 63% at 10 years, and 54% at 15 years. When the Cox proportional hazard model was applied to the survival data, the factors that had significant influence on survival were invasion of the trachea and the esophagus. Completeness of resection approached statistical significance. Muscle invasion, laryngeal invasion, and recurrent laryngeal nerve invasion had no significant independent influence on survival. These data suggest that when papillary thyroid carcinoma extends beyond the thyroid capsule and invades adjacent structures, the site invaded will influence survival. Survival may be improved in those cases in which complete surgical excision of the tumor is performed. © 1994 John Wiley & Sons, Inc.
Retropharyngeal node dissection in cancer of the oropharynx and hypopharynx
Authors: Hasegawa Yasuhisa , Matsuura Hidehiro
Published: February 2007

The purpose of this study was to investigate the incidence of metastases to retropharyngeal (RP) nodes and to evaluate the results of RP node dissections in advanced carcinomas of the oropharynx and hypopharynx. Twenty‐four patients with stage III/IV squamous cell carcinomas of the oropharynx and hypopharynx were treated with standard resection, RP node dissection up to the base of the skull, and radiotherapy of 50 Gy postoperatively to the RP space if RP nodes were involved. Fifty percent (12 of 24) of the patients had positive RP nodes, 36% (4/11) with carcinoma of the oropharynx and 62% (8/13) with carcinoma of the hypopharynx. Six patients had recurrences and of them five died of the disease. The cumulative 3‐year survival rate (Kaplan‐Meier) was 53%. Because of the high incidence of metastases to RP nodes in stage III/IV oropharynx and hypopharyngeal cancers, we recommend the adding of RP node dissection in these patients. © 1994 John Wiley & Sons, Inc.
Amyloidoma of the neck: Case report and review of the literature
Authors: Clevens Ross A. , Esclamado Ramon M. , Delgaudio John M. , Myers Michael W.
Published: February 2007

We present a case report of reactive amyloidoma of the neck in a patient with chronic calcaneal osteomyelitis. Localized deposits of amyloid may occur throughout the upper aerodi‐gestive tract, but are rarely observed in the soft tissues of the neck. This is the first report in the literature of localized head and neck amyloidosis secondary to a chronic inflammatory or infectious process. A clinicopathologic review of amyloidosis is presented with particular attention to its head and neck manifestations. © 1994 John Wiley & Sons, Inc.
Osteosarcoma of the jaw
Authors: Delgado Ricardo , Maafs Eduardo , Alfeiran Antonio , Mohar Alejandro , Barrera Jose‐Luis , Zinser Juan , Beltran Arturo
Published: February 2007

Background. Osteogenic sarcoma of the jaw has clinical and prognostic differences from that of long bones.

Methods. We reviewed 23 confirmed cases of osteosarcoma of the jaw seen at the Instituto Nacional de Cancerologia of Mexico between 1972 and 1990.

Results. Fifty‐seven percent of the patients were women. Median age for all patients was 28 years. In 52% of cases, the neoplasm involved the maxilla. Tumor size ranged from 5 to 24 cm (median 10 × 7 cm) and 87% of the neoplasms were grade III or IV (Broder's). Twenty one (91%) patients were treated with surgery (s); radiotherapy (Rt) was administered to 14 (61%) and chemotherapy (Ct) to 11 (48%) patients. Clear (negative) surgical margins were obtained in 43% of surgically treated patients. Median follow‐up for 20 patients eligible for evaluation was 16.5 months. Survival at 5 years was 10%.

Conclusions. We found that tumor size and surgical margins were significant prognostic factors. Early diagnosis of these tumors is mandatory to improve survival; the role of Ct and Rt is still unknown. © 1994 John Wiley & Sons, Inc.
Clear cell variant of calcifying epithelial odontogenic tumor: Case report and review of the literature
Authors: Hicks M. John , Flaitz Catherine M. , Wong Mark E. K. , McDaniel R. Keith , Cagle Philip T.
Published: February 2007

The calcifying epithelial odontogenic tumor (CEOT) is a rare benign odontogenic neoplasm which was first described by Pindborg in 1955 and accounts for less than 1% of all odontogenic lesions. Recently, a clear cell variant of CEOT has been identified with only eight well‐documented cases in the literature. We present an additional case of clear cell CEOT of the mandible and review the salient clinical, radiologic, and histopathologic features of this entity and CEOTs in general. The differential diagnosis of clear cell tumors in the mandible includes: clear cell odontogenic tumor, clear cell ameloblastoma (odontogenic carcinoma), metastatic clear cell adenocarcinoma, primary intraosseous mucoepidermoid carcinoma, acinic cell carcinoma, epithelial‐myoepithelial carcinoma, clear cell salivary gland tumors, and clear cell variant of squamous cell carcinoma. Because of the belief that clear cell odontogenic tumors are locally aggressive neoplasms, definitive resection of the entire mass with tumor‐free surgical margins and long‐term follow‐up are recommended. © 1994 John Wiley & Sons, Inc.
Angiomyolipoma of the nasal cavity: Case report and review of the literature
Authors: Gatalica Zoran , Lowry Louis D. , Petersen Robert O.
Published: February 2007

An unusual localization of intranasal angiomyolipoma is described in an adult male patient with no signs of tuberous sclerosis. The lesion was composed of mature fat cells, vascular spaces with lack of elastic tissue, and presence of bundles of mature smooth muscle cells. Antibodies to intermediate filaments revealed presence of vimentin and absence of desmin in both smooth muscle bundles and in vessel walls. A review of the literature has shown that this is only the third reported case of the angiomyolipoma of the nasal cavity, and some important differences between this entity and renal angiomyolipoma are described. © 1994 John Wiley & Sons, Inc.
Pearson near‐total laryngectomy: A reproducible speaking shunt
Authors: Levine Paul A. , Debo Richard F. , Reibel James F.
Published: February 2007

Background. Since 1980, Pearson and his associates at the Mayo Clinic have accrued an increasing number of patients whom they have treated with what is now designated as a “near‐total” laryngectomy rather than a total laryngectomy. Despite the positive reports of the value of this procedure in providing speech by an internal shunt, the use of this total laryngectomy alternative has not gained wide acceptance. We report our experience with treating 11 patients during a 3‐year period using the near‐total laryngectomy.

Methods. Between September 1989 and September 1992, 11 patients with the following anatomic lesions were offered and accepted the option of the near‐total laryngectomy: (1) T3 or early T4 glottic squamous cell carcinoma that did not involve the interarytenoid space or the vocal process of the opposite arytenoid; (2) T3 supraglottic squamous cell carcinoma with a fixed vocal cord in which a supraglottic laryngectomy could not be performed; (3) T2, T3 pyriform sinus squamous cell carcinomas; (4) radiotherapy failure early glottic lesions in which a vertical hemilaryngectomy for salvage was not able to be performed and met the requirements in (1); and (5) large hypopharyngeal lesions in which the larynx would be sacrificed to prevent aspiration but was not involved with tumor.

Results. Nine of 11 patients (82%) attained successful speech in an average of 5.3 months. Two of the 11 patients required a completion laryngectomy, both due to wound complications. All but two of the patients received postoperative radiotherapy. Of the nine successful speakers, five have had an occasional droplet of fluid through the shunt; three have been on a permanent basis and two transient. Eighty‐nine percent of the speaking patients (8 of 9) are alive without disease, a mean of 25.5 months after therapy completion.

Conclusions. The near‐total laryngectomy can be performed outside the Mayo Clinic with creditable results, with 82% of the patients attaining successful speech, an average of 5.3 months postoperatively. Eighty‐nine percent of the speakers have had a mean disease‐free survival of 25.5 months. Analysis of larger series from multiple institutions in conjunction with voice analyses of these patients compared to those with tracheoesophageal punctures is needed to confirm our initial enthusiasm for this procedure. © 1994 John Wiley & Sons, Inc.
Sternocleidomastoid myofascial flap for head and neck reconstruction
Authors: Alvi Aijaz , Stegnjajic Arsen
Published: February 2007

Background. The use of the sternocleidomastoid (SCM) muscle in the repair of soft tissue defects arising after surgery for neoplasms of the head and neck has been a subject of controversy. We describe a variant of the SCM muscle flap called the “SCM myofascial flap” and report our experience with this flap in head and neck reconstruction.

Methods. Six patients underwent head and neck reconstruction with the SCM myofascial flap. The head and neck defects included partial laryngeal, pharyngeal defects, and concave soft tissue neck defects after resection.

Results. Follow‐up of the patients ranged from 6 to 91 months. In the case of laryngeal and pharyngeal reconstruction, all had a good voice and were able to eat by mouth without aspiration. Two of the four patients were decannulated. The only complication was a laryngocutaneous fistula.

Conclusion. We have used this flap with success, in soft tissue augmentation and in laryngeal and pharyngeal reconstruction following tumor resection. The technique and the results of our experience are discussed. We believe that in selected cases, the SCM myofascial flap is ideal for reconstruction of head and neck defects. © 1994 John Wiley & Sons, Inc.
Carcinoma of the oral tongue: A comparison of results and complications of treatment with radiotherapy and/or surgery
Authors: Fein Douglas A. , Mendenhall William M. , Parsons James T. , McCarty Patricia J. , Stringer Scott P. , Million Rodney R. , Cassisi Nicholas J.
Published: February 2007

Background. Oral tongue cancer may be treated primarily with radiotherapy or with surgery alone or combined with adjuvant radiotherapy: the choice between these two approaches is controversial.

Methods. To evaluate the results of a shift in treatment policy in 1985 in favor of primary surgical treatment for carcinoma of the oral tongue, the results of radiotherapy (with or without neck dissection, 105 patients) were compared with those for surgery (with or without radiotherapy, 65 patients).

Results. Local control rates were improved for T3 (p = .03) and T4 (p = .08) patients treated surgically but were similar for T1‐T2 patients. Local‐regional control and survival rates were not significantly different. The rate of severe complications was significantly higher (p = .01) for T3 patients treated with surgery, particularly in the subset of patients who received postoperative radiotherapy.

Conclusions. We generally recommend surgical treatment for T1‐T2 patients with the addition of postoperative twice‐a‐day radiotherapy in selected cases. For selected T3‐T4 patients we are investigating split‐course twice‐a‐day preoperative radiotherapy in the hope that the extent of the surgical procedure, and hence the rate of severe complications, will be reduced. © 1994 John Wiley & Sons, Inc.
Squamous cell carcinoma arising in recurrent odontogenic keratocyst: Case report and literature review
Authors: Dabbs David J. , Schweitzer Robert J. , Schweitzer Laurie E. , Mantz Fred
Published: February 2007

Background. Keratinizing odontogenic cysts of the mandible commonly have an aggressive clinical course, marked by multiple recurrences. Primary intraosseus carcinoma (PIOC) of the mandible is rare, and when it occurs it is often found to be arising in or closely associated with some type of cystic structure.

Methods. A patient with squamous cell carcinoma arising from an odontogenic keratocyst is studied clinically, radiographically, and pathologically.

Results. The patient who was documented to have an odontogenic keratocyst, 1 year later had a squamous carcinoma removed from the recurrent cyst.

Conclusion. We report the occurrence of squamous cell carcinoma arising from a recurrent odontogenic keratocyst, which has not previously been documented in the literature. The literature on this subject is reviewed. © 1994 John Wiley & Sons, Inc.
Functional endoscopic sinus surgery for isolated sphenoid sinus disease
Authors: Gilain Laurent , Aidan Didier , Coste André , Peynegre Roger
Published: February 2007

Background. This article reviews 12 cases of isolated sphenoid sinus disease: chronic inflammatory sinusitis (7), mucoceles (2), aspergillus lesions (2), and isolated polyp (1).

Methods. Criteria for diagnosis were based on clinical symptoms, nasal endoscopic evaluation, and computed tomography (CT). Magnetic resonance imaging was used only in cases of bone erosion and when patients presented with vision problems. All patients were treated by functional endoscopic sphenoidotomy. Any postoperative complications were noted.

Conclusion. The reported good results, on the basis of regression of functional symptoms and with nasal endoscopic and CT evaluation, suggest that intranasal sphenoidotomy under endoscopic control is a safe and effective method of treatment of nonmalignant isolated sphenoid disease. The mean follow‐up is 26 months. © 1994 John Wiley & Sons, Inc.
Occult distant metastases of well‐differentiated thyroid carcinoma
Authors: Zohar Yuval , Strauss Michael
Published: February 2007

Background. The tendency of well‐differentiated thyroid carcinoma to remain localized and its slow progression have supported the belief that this disease behaves as a low‐grade malignancy. Consequently, a conservative approach in the management of the well‐differentiated thyroid carcinoma has existed during the years. Occult distant metastases of thyroid cancer is an occasional finding considered of ominous significance.

Methods. In a retrospective study, we reviewed the records of 187 adult patients with well‐differentiated thyroid carcinoma treated by total thyroidectomy. These cases were found among 1,240 thyroidectomies performed in our department between 1982 and 1993. Occult distant skeletal and lung metastases disclosed by total body131I scans, after total thyroidectomy, were present at the time of initial treatment in 11 patients (11/187). This group included 9 women and 2 men ranging in age from 36 to 70 years, with a mean age of 47 years. Seven patients had papillary carcinoma, whereas follicular malignancy was found in four. Review of the surgical specimens showed total involvement of the gland in 5 cases, with extracapsular tumoral spread in 3 patients. Multicentric disease was present in 6 specimens. Patient follow‐up revealed a mortality rate of 64% (7/11) during the first 3 postoperative years.

Conclusions. Analysis of this population confirms that well‐differentiated thyroid carcinoma with distant metastases is an aggressive disease with lethal consequence. Early detection and therapy of occult distant metastases present at the time of initial treatment is possible only after total thyroid ablation, because otherwise the radioactive iodine is trapped by the gland's remnants. © 1994 John Wiley & Sons, Inc.
Topical bleomycin treatment of oral leukoplakia: A randomized double‐blind clinical trial
Authors: Epstein Joel B. , Wong Frances L. W. , Millner Amelia , Le Nhu D.
Published: February 2007

Background. Oral leukoplakia and oral erythroplakia may be associated with benign and dysplastic cellular changes, and are at risk of malignant transformation. Additional means of management of these lesions is needed. The results of nonblinded trials using topical bleomycin in oral leukoplakia indicated the need for phase III study.

Methods. A prospective, double‐blind, randomized trial of topical bleomycin versus placebo was conducted. Bleomycin 1% in dimethylsulphoxide (DMSO) or the carrier was applied for 5 minutes for 14 consecutive days. Clinical assessment and pre‐application and post‐treatment biopsies were conducted.

Results. Twenty‐two patients were randomized. Of the patients who received bleomycin, decrease in clinical size of the lesion was achieved (p = 0.001), and histological reduction in dysplasia was seen (p = 0.094).

Conclusions. The topical application of bleomycin in DMSO may represent an additional approach to management of oral leukoplakia. The treatment is well‐tolerated, and may be considered when the location or extent of the lesion may make surgical excision difficult. © 1994 John Wiley & Sons, Inc.
Precancerous lesions of the larynx: Clinical and pathologic correlations and prognostic aspects
Authors: Cuchi Asunción , Bombi José A. , Avellaneda Ramón , Cardesa Antonio , Traserra José
Published: February 2007

Background.Medical literature on the development of malignancy shows wide‐ranging limitations depending on the criteria considered, but all authors agree that the presence of dysplasia in the sample is an important prognostic sign.

Method.This is a retrospective study of 248 patients controlled and treated at the ENT and Pathology Departments of the Hospital Clinic in Barcelona between 1981 and 1991 for larynx lesions. Biopsy studies of the following pathologic entities were carried out: keratosis, chronic inflammation, and papilloma of the adult. The degree of dysplasia present in each sample was assessed.

Results.The overall percentage of malignancy was 15.6% in this series. Malignancy developed in 8.7% of the cases without dysplasia and in 31% (p < 0.0001) with dysplasia. The groups were correlated with gender, age, and smoking habit. The presence of epithelial dysplasia is an important prognostic factor. The risk of malignant transformation increases if the dysplasia occurs in smokers.
Assessment of cryoprecipitate‐thrombin solution for dural repair
Authors: Wiegand David A. , Hartel Maria I. , Quander Troy , Latz Barbara , Dankle Jon A.
Published: February 2007

Background. After resection of cranial and skull base tumors, fibrin‐thrombin solutions can provide a temporary biologic seal of dural closures until final healing occurs. We investigated several variables affecting the strength of these „tissue glues”︁ for repair of dural defects using in vitro methods to model clinical repairs.

Methods. The competence of human cryoprecipitate‐thrombin (CPT) „tissue glues”︁ in providing a watertight seal for patched rat fascia and human cadaveric dural defects was assessed. A saline column was fabricated to allow for controlled pressure (up to 700 mm) to be applied over an open aperature containing the repaired defect. Variables of repair included time after repair, defect size, and mixing temperature.

Results. Wide variations in the strength of different cryoprecipitate glues were found. Time allowed after repair did not significantly affect the repair strength. Cooling the components of the glue solution prior to mixing significantly increased repair strength. Similar results were found for different defect sizes.

Conclusions. Under controlled in vitro conditions, integrity of fibrin glue repairs varied widely. This was not attributable to differences in solution fibrinogen concentration. Cooling the „tissue glue”︁ components prior to mixing significantly increased repair strength of patched tissue defects.
Craniofacial resection at the university of Virginia (1976‐1992): Survival analysis
Authors: Levine Paul A. , Debo Richard F. , Meredith Scott D. , Jane John A. , Constable William C. , Cantrell Robert W.
Published: February 2007

Background.The purpose of this study is to evaluate the survival of patients treated at the University of Virginia Health Sciences Center with an anterior craniofacial resection in conjunction with radiotherapy and/or chemotherapy for malignancies of the superior sinonasal cavity. In addition, the impact of aggressive salvage therapy for patients with recurrent disease is considered.

Methods.Between June 1976 and December 1992, a total of 45 patients underwent a craniofacial resection by the Departments of Otolaryngology‐Head and Neck Surgery and Neurological Surgery at the University of Virginia. One patient was excluded from the analysis because his neoplasm was benign. Another patient died 2 days postoperatively from multiple strokes. The remaining 43 patients were divided into two subgroups: (1) patients with esthesioneuroblastoma (24 patients) and patients with non‐esthesioneuroblastoma malignancies (19). Their survival curves were estimated for the percent survival free of disease by month of follow‐up using the product limit of Kaplan and Meier. In addition, the salvage treatment for recurrences was examined for both groups.

Results.The 5‐year disease‐free survival rate for the entire group was 77%, with a 2.3% postoperative mortality. The 5‐year disease‐free survival for the esthesioneuroblastoma patients was 90%, and that for the non‐esthesioneuroblastoma group was 59.1% (p= 0.028). Four of 8 esthesioneuroblastoma patients who recurred and were treated with aggressive salvage therapy were without evidence of disease 5 years after completion of therapy, and 3 of the 10 nonesthesioneuroblastoma patients salvaged were without evidence of disease 57.3 months after therapy (39% surgical salvage).

Conclusions.There is a statistically significant difference between the 5‐year disease‐free survival for the esthesioneuroblastoma patients and the non‐esthesioneuroblastoma patients (90% vs 59.1%;p= 0.028), and aggressive salvage therapy appears to be a more successful option in the esthesioneuroblastoma group of patients.
Squamous cell carcinoma arising in Hashimoto's thyroiditis
Authors: Chaudhary Rekha K. , Barnes E. Leon , Myers Eugene N.
Published: February 2007

The case of a 76‐year‐old white woman with squamous cell carcinoma of the thyroid gland arising in a background of Hashimoto's thyroiditis is presented. Squamous cell carcinoma of the thyroid gland is a very rare and aggressive tumor, and only a few cases are reported as arising in Hashimoto's thyroiditis. Although Hashimoto's thyroiditis alone does not necessarily predispose patients to malignancy, the finding of a prominent nodule in such a patient should suggest the possibility of malignancy, and an aggressive search and treatment regimen, including surgical intervention, should be pursued.
Anaplastic carcinoma of the thyroid: A 24‐year experience
Authors: Tan Raymond K. , Finley Robert K. , Driscoll Deborah , Bakamjian Vahram , Hicks Wesley L. , Shedd Donald P.
Published: February 2007

Background.Anaplastic carcinoma of the thyroid gland is a lethal entity; few patients live more than 12 months following diagnosis. We retrospectively reviewed the experience with this entity at our cancer institute and identified a subgroup of patients with complete resection who have a 60% 5‐year survival.

Methods.Twenty‐one cases of anaplastic carcinoma of the thyroid gland were analyzed retorspectively with respect to prognostic factors influencing survival. This represents 2.7% of 771 cases of thyroid cancer seen at our institution from 1968 to 1992. The median age at presentation was 65.1 years; male/female ratio was 1:1.1; and the most common symptom was a rapidly enlarging neck mass (76%).

Results.Estimated 5‐year survival was 10% (median: 4.5 months). Tumor size less than 6.0 cm (p= .004) and female gender (p= .02) were significant prognostic factors. Five patients who underwent complete resection had an estimated 5‐year survival of 60% (median: 131 months). Four of these patients had postoperative radiotherapy with or without sequential chemotherapy. Two of these patients survived more than 10 years, and a third remains alive without disease at 26 months.

Conclusions.Complete resection and multimodality therapy result in long‐term survival for a subgroup of patients with anaplastic thyroid carcinoma. © 1995 Jons Wiley & Sons, Inc.
Bilateral chylothorax following neck dissection
Authors: Jabbar Alaa S. Abdul , Al‐Abdulkareem Abdulmajeed
Published: February 2007

Background: Bilateral chylothorax, as a complication of neck dissection, is extremely rare, and was first described in 1907. Ten cases are reported in the literature.

Methods. This presentation illustrates an additional case of bilateral chylothorax occurring after neck dissection. Anatomic and physiologic considerations are presented and possible mechanisms of pathogenesis are discussed.

Results. Chylothorax has two major complications: respiratory and metabolic. The modern concepts of treatment are summarized.

Conclusions. After neck dissection, the clinician should suspect chylothorax if the patient had respiratory embarrassment and an abnormal chest x‐ray postoperatively. © 1995 Jons Wiley & Sons, Inc.
Free jejunal interposition reconstruction after pharyngolaryngectomy: 201 consecutive cases
Authors: Theile David R. , Robinson David W. , Theile David E. , Coman William B.
Published: February 2007

Background. Reconstruction of tubular defects following pharyngolaryngectomy has required complicated surgery with high perioperative morbidity and mortality. Free jejunal interposition provides an excellent reconstruction with potential for lower immediate complications and better long‐term results than other procedures.

Methods. A total of 201 consecutive free jejunal interpositions were performed following pharyngolaryngectomy between 1977 and 1993. Operative details, complications, and outcome were prospectively documented.

Results. Perioperative mortality was low (4.5%) and microvascular success rate high (97%), although a small number of late failures were recorded. Average time until swallowing postoperatively was 11 days, and 92% of patients could maintain full nutrition. Voice rehabilitation was mentioned, and increasingly good results are being obtained.

Complication rates for the neck (17%) and the abdomen (2.5%) were also low. There were no problems with excess mucus production or reflux. Radiation effect on the jejunal conduit was not detrimental to long‐term patency of the vascular anastomoses or to function as a conduit.

Conclusions. Comparison with other published techniques permits the contention that a free jejunal interposition is the reconstruction of choice after pharyngolaryngectomy. © 1995 Jons Wiley & Sons, Inc.
Histocytologic grading of mucoepidermoid carcinoma of major salivary glands in prognosis and survival: A clinicopathologic and flow cytometric investigation
Authors: Hicks M. John , El‐Naggar Adel K. , Flaitz Catherine M. , Luna Mario A. , Batsakis John G.
Published: February 2007

Background. Controversy exists regarding the role of a 3‐tiered grading system for mucoepidermoid carcinoma (MEC) of salivary glands in prognosis and survival. This retrospective investigation evaluated a 3‐tiered grading system modified from Healey by Batsakis and Luna and compared various clinical, pathologic, and flow cytometric parameters and overall survival among MECs of differing grades.

Methods. Forty‐eight patients with 7 low‐grade (LG), 23 Intermediate‐grade (IG), and 18 high‐grade (HG) MECs of parotid (n = 43) and submandibular (n = 5) glands were studied. Data were analyzed using categorical statistics (Wilcoxon, Kruskal‐Wallis and Chi‐squared tests where appropriate).

Results. Mean ages were 42 years for patients with LG tumors; 47 years, IG; and 59 years, HG (p = 0.02). Gender ratio (p < 0.001) changed from female predominance in LG (6 F:1 M) and IG (2.1 F:1 M) to male predominance in HG (3.5 M:1 F). Mean tumor stage was 1.4 LG, 2.4 lG, and 3.6 HG (p < 0.005). Tumor size increased from 2.1 cm for LG to 3.8 cm for HG (p = 0.01). Margins were involved by tumor in 0% LG, 44% IG, and 61% HG (p < 0.001). Lymph node involvement was 0% LG, 22% IG, and 72% HG (p < 0.001). DNA aneuploidy (DNA index < 0.9 or > 1.1) was present in 0% LG, 13% IG, and 28% HG (p = 0.05). Proliferative fraction (S + G2M) was 5% LG, 7% IG, and 13% HG (p = 0.008). Radiotherapy was administered in 14% LG, 35% IG, and 61% HG (p = 0.03). Recurrences (local and/or metastatic) occurred in 0% LG, 39% IG, and 61% HG (p = 0.009). Survival was decreased significantly (p < 0.0001) with increasing tumor grade (100% LG, 70% IG, and 22% HG).

Conclusion. Histologic grading of mucoepidermoid carcinomas of major salivary glands, using the modified Healey 3‐tiered system, correlates well with clinical, pathologic, and flow cytometric factors which influence the prognosis and overall survival in affected individuals. © 1995 Jons Wiley & Sons, Inc.
Radiotherapy for merkel cell carcinoma of the skin of the head and neck
Authors: Suntharalingam Mohan , Rudoltz Marc S. , Mendenhall William M. , Parsons James T. , Stringer Scott P. , Million Rodney R.
Published: February 2007

Background. Merkel cell carcinoma is a relatively rare neuroendocrine carcinoma of the skin. It arises in the head and neck region in approximately 50% of cases. Its aggressive behavior predisposes patients to local‐regional recurrence and distant metastases after surgical excision alone. In this article, we describe our experience with Merkel cell carcinoma of the head and neck.

Methods. Of 18 patients with Merkel cell carcinoma treated in the Department of Radiation Oncology at the University of Florida, 12 patients who had primary tumors in the head and neck region are reported. Eight patients were treated at initial diagnosis (group A), and four were treated at the time of local‐regional recurrence (group B).

Results. Local‐regional control was achieved in seven of eight patients in group A and all four patients in group B. One patient in group A and all patients in group B developed distant metastases and eventually died of their disease. Bone exposure developed in one patient, requiring surgical debridement and hyperbaric oxygen treatment.

Conclusion. Patients with Merkel cell carcinoma of the head and neck should be treated aggressively. Our data suggest that local‐regional recurrence is a harbinger of distant metastases. We recommend that these patients receive treatment to both the primary site and draining lymphatics at initial presentation. The role of chemotherapy remains unclear.
Nonsquamous cell malignant neoplasms of the nasal cavities and paranasal sinuses
Authors: Spiro Jeffrey D. , Soo Kee Chee , Spiro Ronald H.
Published: February 2007

Background. Nonsquamous cell malignant tumors of the nasal cavity and paranasal sinuses are an uncommon and diverse group of neoplasms. Our goal was to define the relative frequency and distribution of these neoplasms, as well as treatment and outcome.

Methods.This retrospective study analyzed 106 patients with nonsquamous cell malignant neoplasms of the nasal cavity and paranasal sinuses treated at our institution between 1966 and 1982.

Results. Pathology included: salivary type carcinoma (33 patients); sarcoma (25 patients); melanoma (18 patients); esthesioneuroblastoma (11 patients); lymphoma (11 patients); and anaplastic cancer (9 patients). Most tumors arose in the nasal cavity (50%), followed by the antrum (39%), ethmoidsinus (9%), and frontal sinus (2%). Fifty‐four percent of all patients were treated with surgery alone. Determinate 5‐year and 10‐year cure rates were: esthesioneuroblastoma, 70% and 50%; lymphoma, 45% and 30%; anaplastic, 33% and 25%; salivary, 31% and 18%; sarcoma, 25% and 21%; and melanoma, 19% and 0%.

Conclusions. Overall survival for patients with nonsquamous cell malignant neoplasms of the nasal cavity and paranasal sinuses is poor, particularly with follow‐up extended to 10 years. Local recurrence is the major source of treatment failure. We were unable to demonstrate any survival advantage in the group of patients who received surgery and radiotherapy in combination. © 1995 Jons Wiley & Sons, Inc.
Mucosal melanoma of the nasal cavity and paranasal sinuses
Authors: Kingdom Todd T. , Kaplan Michael J.
Published: February 2007

Background. Mucosal melanomas of the nasal cavity and paranasal sinuses are rare and do poorly.

Methods. Seventeen patients treated from 1981 to 1993 at a single referral center were retrospectively reviewed.

Results. Thirteen patients underwent surgical resection, with seven receiving postoperative radiotherapy. Eight had microscopically negative margins. The actuarial 2‐year and 5‐year survivals for this group of 13 were 67% (8 of 12) and 20% (2 of 10). The local recurrence rate was 85% (11 of 13) and distant metastases occurred in 31% (4 of 13) patients. In the absence of metastatic disease, resection of recurrent tumor correlated with disease‐free intervals ranging from 3 months to 40 months.

Conclusions. Those who received postoperative radiotherapy appeared to have done better with increased disease‐free intervals and prolonged survival. Negative surgical margins were not predictive of a more favorable outcome. Surgical resection followed by postoperative radiotherapy is appropriate and resection of recurrent tumor should be considered. © 1995 Jons Wiley & Sons, Inc.
Retropharyngeal adenopathy as a predictor of outcome in squamous cell carcinoma of the head and neck
Authors: McLaughlin Mark P. , Mendenhall William M. , Mancuso Anthony A. , Parsons James T. , McCarty Patricia J. , Cassisi Nicholas J. , Stringer Scott P. , Tart Roger P. , Mukherji Suresh K. , Million Rodney R.
Published: February 2007

Background. Little information about the incidence of retropharyngeal adenopathy and its impact on prognosis has been published.

Methods. For 774 patients with squamous cell carcinoma of the nasopharynx, oropharynx, hypopharynx, or supraglottic larynx, pretreatment CT and, in selected cases, MRI scans were reviewed to determine the presence of rotropharyngeal adenopathy. Results were analyzed in 619 patients treated with curative intent to determine the prognostic impact of retropharyngeal adenopathy.

Results. The highest incidence of retropharyngeal adenopathy was seen in patients with nasopharyngeal (74%) and pharyngeal wall (19%) cancers. The number of cervical nodal groups involved was the most significant factor (p < .0001) relating to the incidence of retropharyngeal adenopathy. The rates of neck relapse (40% at 5 years) and distant metastasis were significantly higher in patients with retropharyngeal adenopathy, and the rates of 5‐year relapse‐free survival and absolute survival were significantly lower.

Conclusions. Retropharyngeal adenopathy is a strong predictor of poor prognosis, particularly for patients with advanced neck disease. © 1995 Jons Wiley & Sons, Inc.
Immunolocalization of desmoglein and intermediate filaments in human oral squamous cell carcinomas
Authors: Imai Kazushi , Kumagai Shigehiro , Nakagawa Kiyomasa , Yamamoto Etsuhide , Nakanishi Isao , Okada Yasunori
Published: February 2007

Background. Information is limited as to how to predict the malignant behavior of the oral squamous cell carcinomas. The invasive and metastatic phenotype of the carcinoma cells may be related to changes in the expression of desmosomal and cytoskeletal proteins.

Methods. To investigate the expression of desmoglein, cytokeratins, and vimentin, 22 biopsy specimens of oral squamous cell carcinomas were examined by immunohistochemistry. The data were analyzed by morphometry with reference to the cell differentiation, mode of invasion, and cervical lymph node metastasis.

Results. The expression of desmoglein, a major desmosomal glycoprotein, was remarkably reduced in the poorly differentiated, highly invasive, and metastatic carcinomas. Although the immunohistochemical expression of cytokeratins in the carcinoma cells was a good marker for the differentiation status of the carcinomas, the level of expression demonstrated no correlation with tumor invasiveness or lymph node metastasis. On the other hand, the vimentin expression was inversely correlated to the differentiation and mode of invasion, and carcinomas in the metastatic group had significantly higher levels of vimentin expression than the nonmetastatic group.

Conclusion. The results suggest that immunohistochemical examination of desmoglein and vimentin in oral squamous cell carcinomas is valuable in evaluating the malignant behavior of tumors. © 1995 Jons Wiley & Sons, Inc.
Langerhans' cell histiocytosis: Head and neck manifestations in children
Authors: Quraishi Muhammad S. , Blayney Alexander W. , Walker David , Breatnach Fin B. , Bradley Patrick J.
Published: February 2007

Background. Langerhans' cell histiocytosis (LCH) is an uncommon, poorly understood granulomatous disease, characterized by the idiopathic proliferation of Langerhan's cells or their marrow precursors. In 1985, the Philadelphia Workshop adopted the term “Langerhans' cell histiocytosis” (LCH) to differentiate it from reactive and neoplastic causes of histiocytosis.

Methods. This study includes 73 pediatric patients diagnosed with this condition in Dublin, Ireland, and Nottingham, England, during a 34‐year period (1959 to 1993). These patients are reviewed with respect to clinical presentation, difficulty with making a histological diagnosis, their management, and outcome.

Results. A total of 49 patients (67%) had head and neck involvement. Bony involvement was the most frequent sign, most frequently located in the skull. There were 11 deaths (15%) in this series, all associated with multisystem disease, and nine of these deaths were in children younger than 2 years of age.

Conclusions. The role of otolaryngologists is important in the early and accurate evaluation, staging, and diagnosis of LCH. It may mimic more common diseases, such as otitis externa, acute mastoiditis, skin rash, gingivitis, or cervical lymphadenopathy. Patients with multisystem disease may be so ill at presentation that the head and neck lesions may be overlooked. The current management of LCH has become increasingly conservative, and in the 1990s, fewer cases are given chemotherapy or radiotherapy. The prognosis is very good for single‐system disease and poor for multisystem disseminated disease with early onset. © 1995 Jons Wiley & Sons, Inc.
Radical, modified, and selective neck dissection for cutaneous malignant melanoma
Authors: O'Brien Christopher J. , Petersen‐Schaefer Karin , Ruark Deborah , Coates Alan S. , Menzie Stuart J. , Harrison Richard I.
Published: February 2007

Background. The roles of modified and selective neck dissections in treating patients with clinical metastatic melanoma and the place of adjuvant radiotherapy are unclear. In the elective setting, the efficacy of various selective dissections also requires clarification.

Methods. The prospectively documented experience of the senior author (COB) was analyzed. A total of 175 patients had 183 neck dissections and 92 parotidectomies in 6 years. There were 75 therapeutic and 108 elective operations. Modified or selective neck dissections were performed in 58% of patients with clinical neck metastases. All but two elective operations were modified or selective dissections. Postoperative radiotherapy was given to 27 dissected necks. Minimum follow‐up was 12 months, and 86% of patients were followed up for 2 years or to neck recurrence.

Results. Nodes were histologically positive in 80 dissections. The cumulative rate of control of metastatic melanoma in the neck was 86% at 5 years. Neck recurrence developed in 14% of radical dissections, 0% of modified, and 23% of selective dissections performed for clinical disease. Neck recurrence occurred after 5% of elective dissections. Recurrence was 7% among irradiated necks compared to 23% in nonirradiated (p‐value not significant). The 5‐year survival rate was 50%, and this was significantly worsened by increasing node involvement.

Conclusions. Modified radical neck dissection is highly effective in controlling metastatic melanoma in selected patients. Selective dissections are less effective and need further study. Adjuvant radiotherapy appears to decrease the risk of neck recurrence. In the elective setting, recurrence is uncommon following the selective neck dissections described.
The QT interval following carotid artery resection
Authors: Rassekh Christopher H. , Dellsperger Kevin C. , Bollen Bruce A. , Hoffman Henry T. , Ricks‐Mcgillin Joan
Published: February 2007

Background. Right radical neck dissection has been shown to prolong the QT interval, reportedly caused by surgical trauma to the cervical autonomic system, which may result in malignant ventricular arrhythmias. Carotid artery resection would be expected to be more likely to cause dangerous arrhythmias.

Methods. We prospectively studied eight patients with electrocardiograms before and after carotid resection. Four patients had left‐sided procedures and four patients had right‐sided procedures. In addition, 11 patients were studied retrospectively. QT intervals were normal in all patients preoperatively.

Results. Preoperative corrected QT intervals (QTc) were in the normal range used by our institution for all eight patients in the prospective group. There were no significant QTc changes after either left‐sided or right‐sided carotid resection. However, the retrospective group did show significant changes in QTc following right carotid resection (n = 5), but not left resection (n = 6).

Conclusions. EKG changes associated with carotid resection may not be uniform and may depend on surgical technique or specific anatomic factors. Controlled prospective studies are needed to confirm the prevalence of QT interval changes in radical neck surgery.
Primary ectopic meningioma of the maxillary sinus: Case report and review of the literature
Authors: Lingen Mark W. , Rao Sambasiva M. , Hutten Mark C. , Pelzer Harold J.
Published: February 2007

Methods. A case of a primary ectopic meningioma, arising within the right maxillary sinus, is presented. A review of English literature was also undertaken to determine the prevalence of these lesions in this specific anatomic location.

Results. A total maxillectomy was performed without complications and the surgical defect was covered with an immediate obturator. The patient is well and without evidence of disease 3½ years postoperatively. A review of the English literature revealed four additional reports of primary ectopic meningiomas that were limited to the maxillary sinus.

Conclusions. Primary ectopic meningiomas of the maxillary sinus are uncommon lesions which have a good prognosis when a complete resection of the neoplasm can be performed. © 1995 Jons Wiley & Sons, Inc.
Folded free radial forearm flap for reconstruction of full‐thickness defects of the cheek
Authors: Savant Dhairyasheel N. , Patel Snehal G. , Deshmukh Sanjay P. , Gujarati Rajesh , Bhathena Hosi M. , Kavarana Naozer M.
Published: February 2007

Background. Full thickness defects of the cheek have been conventionally reconstructed using the folded forehead flap, cervical flap, pectoralis major myocutaneous flap, or deltopectoral flap in various combinations. We report a modified technique of folding the radial forearm flap for reconstruction of full‐thickness defects of the cheek.

Methods. The free radial forearm flap is a type C fasciocutaneous flap based on the radial artery along with its vena commitans and superficial forearm vein. The size and shape of the flap are determined according to the dimensions of the surgical defect. The flap is then lifted off with the fascia of the forearm making it a fasciocutaneous flap, in which the radial artery lies deep to the fascia and gives numerous branches. The flap is disconnected from the donor site only after the recipient vessels have been prepared for anastomosis. Vascular anastomosis is then performed using the operating microscope. This technique was used in 13 patients with carcinoma of the buccal mucosa who underwent full‐thickness excision of the cheek.

Results. Flap edema was observed in 4 patients in the immediate post‐operative period. Necrosis of the outer paddle was seen in 1 patient. Donor site morbidity was seen in 4 patients who required dressings on an outpatient basis for up to 3 weeks.

Conclusion. Single‐stage reconstruction of full‐thickness defects of the cheek with the folded free radial forearm flap is reliable and produces excellent cosmesis with minimal donor site morbidity. © 1995 Jons Wiley & Sons, Inc.
Effect of the Passy‐Muir valve on aspiration in patients with tracheostomy
Authors: Dettelbach Mark A. , Gross Roxann D. , Mahlmann Jeanne , Eibling David E.
Published: February 2007

Objective. To assess potential benefit of a Passy‐Muir Speaking Valve (PMV) in decreasing aspiration in patients with a tracheostomy.

Background. Many patients with tracheostomy exhibit clinically significant aspiration. It has been previously noted that aspiration can often be reduced or eliminated by plugging or removing the tracheostomy tube. Some patients, however, do not tolerate removal or plugging of their tracheostomy tube, which then leads to persistent aspiration. We postulated that a one‐way speaking valve may restore more normal subglottic and glottic air flow and reduce aspiration.

Methods. Alert patients with a tracheostomy and clinical evidence of aspiration were eligible for study. Eleven patients with tracheostomy and known aspiration were studied with a modified barium swallow. Radiographic examination was used to evaluate the presence and amount of aspiration while patients swallowed both with and without a PMV in place on their tracheostomy tube.

Results. Aspiration was reduced (or eliminated) during swallowing in all 11 patients when they wore a PMV, when compared to swallowing with an open (unvalved) tube. This improvement was achieved with liquids, semisolids, and pureed consistencies.

Conclusion. This study demonstrates that a Passy‐Muir speaking valve facilitated swallow and reduced aspiration in patients with a tracheostomy and known aspiration. © 1995 Jons Wiley & Sons, Inc.