bluuebunny/crossref_metadata_2025 huggingface dataset:
Paranasal sinus radiology, part 2A: Ethmoidal sinuses
Authors: Dolan Kenneth D.
Published: February 2007

The clinician must have a high level of suspicion in order to detect ethmoidal sinus disease. Survey plain film radiographic examination may provide information about gross changes in ethmoidal sinus transparency and the sinus walls. Conventional tomographic study will often aid evaluation of the ethmoidal sinus walls which may be obscured by overlying structures on plain films. Computerized tomography adds a new dimension to ethmoidal sinus study. By revealing not only bone changes but soft‐tissue abnormality as well, more complete understanding of the disease process is gained. Computerized tomography is particularly useful in evaluating orbital structural change due to ethmoidal sinus abnormality.
The pathology of head and neck tumors: Spindle cell lesions (sarcomatoid carcinomas, nodular fasciitis, and fibrosarcoma) of the aerodigestive tracts, part 14
Authors: Batsakis John G. , Rice Dale H. , Howard Donald R.
Published: February 2007

The term spindle cell lesion, or tumor, is a purely descriptive one and if applied without further qualification is meaningless as a guide to therapy and prognosis. The three lesions presented in this report—sarcomatoid carcinomas, nodular fasciitis, and fibrosarcoma—serve to illustrate this point. One, the sarcomatoid carcinoma, is an epithelial malignancy in which the majority of the sarcoma‐like spindle cells are believed to be variants of the epithelial cells. Nodular fasciitis, a self‐limited and benign soft tissue lesion, is composed principally of myofibroblasts. Primarily an extramucosal lesion, it presents a pseudosarcomatous microscopic appearance. Fibrosarcomas represent the other end of the spindle cell lesion spectrum in that they are soft tissue malignancies of fibroblastic origin. Clinical, pathologic, and biologic implications of these lesions when they arise in the mucosae of the upper aerodigestive tracts of the head and neck are presented.
Diagnosis of carotid body tumors by dynamic computerized tomography
Authors: Shugar Martin A. , Mafee Mahmood F.
Published: February 2007

The carotid body tumor although uncommon, is frequently considered in the differential diagnosis of cervical masses. When this lesion becomes a serious diagnostic possibility, angiography must be considered. Currently angiography is the only nonsurgical modality that can reliably confirm the clinical diagnosis. We describe the case of a patient in whom a carotid body tumor was diagnosed preoperatively by dynamic computerized tomography. Dynamic computerized tomography, a relatively noninvasive technique, should now be deemed the technique of choice for diagnosis of carotid body tumors, thus avoiding the potential morbidity of angiography. In patients for whom tumor removal is indicated, however, preoperative angiography is still mandatory in order to plan the best operative procedure.
Treatment of cervical lymph nodes in carcinoma of the tongue
Authors: Leipzig Bruce , Hokanson James A.
Published: February 2007

Treatment of the regional lymph nodes forms an integral part of the management of any patient with carcinoma of the tongue. It is the most important determinant of survival. Although survival correlates with the size of the primary tumor, it may also be explained by the higher incidence of metastatic nodes in larger lesions. The incidence of contralateral neck nodes is high, and treatment of the contralateral neck, even in smaller carcinomas of the tongue, must be considered. Anterior tongue carcinomas are equally as aggressive as posterior carcinomas of the tongue. An analysis of the cause of failure following treatment of tongue carcinomas emphasizes the fact that too many clinical stages I and II cancers—those with clinically negative neck examination—are in fact pathologic stage III cancers.
Orbital and periorbital cellulitis in children
Authors: Rubinstein Jeffrey B. , Handler Steven D.
Published: February 2007

The proper management of patients with orbital and periorbital cellulitis represents a distinct challenge to the clinician. A retrospective study is presented of 165 patients with the diagnosis of orbital or periorbital cellulitis admitted to the Children's Hospital of Philadelphia (CHOP) from January 1975 through December 1980. Sinusitis, trauma, local skin inflammations, and otitis were the most common etiologies. Twenty‐three of the patients had orbital cellulitis, all of which were secondary to sinusitis. There was one death in this series. No patients had permanent ocular sequelae related to orbital or periorbital cellulitis. A discussion of etiology and management is presented, with emphasis on the usefulness of computerized tomography (CT).
Aneurysmal bone cyst of the ethmoid
Authors: Baker Herbert L. , Papsidero Michael J. , Batsakis John G. , Krause Charles J.
Published: February 2007

Although nearly 500 cases of aneurysmal bone cyst have been recorded in the English literature, involvement of the facial bone is uncommon. To our knowledge, this is the first case of extragnathic, facial aneurysmal bone cyst to be reported in the English literature. A left ethmoid aneurysmal bone cyst was found in a 20‐year‐old pregnant woman who had a 5‐month history of progressive left periorbital swelling, left cystic nasal mass, progressive nasal obstruction, blurred vision, and occasional diplopia. The diagnostic evaluation included a sinus series, facial lamiograms, and an EMI scan. Needle aspirates taken frequently from the intranasal cyst consisted of a dark bloody fluid. The surgical procedure, using external rhinotomy approaches, pathologic findings, and a literature review are presented.
The pathology of head and neck tumors: The myoepithelial cell and its participation in salivary gland neoplasia, part 17
Authors: Batsakis John G. , Kraemer Beverly , Sciubba James J.
Published: February 2007

Sharing a common ectodermal origin with salivary duct epithelium, the myoepithelial cell is two‐sided in several respects. It lies between the epithelial cells and the basal lamina, with one side facing the duct or acinar cells and the other facing the stroma. It has a fine structure not unlike that of smooth muscle, and one of its functions is to contract. Despite its electron‐optic similarity to smooth muscle, the myoepithelial cell's principal filamentous protein is cytokeratin, which is found only in epithelial cells. Myoepithelial cells do not have a demonstrable secretory capability, but they can store glycogen in abundance. In some tumors of the salivary glands, myoepithelial cells do not participate in histogenesis. These tumors arise from portions of the salivary duct system in which myoepithelial cells are not normally found. In tumors originating from intercalated ducts, myoepithelial cells may assume one of two roles; a passive presence or an active and integral formation of the tumors. Mixed tumors, clear cell tumors, plasmacytoid (hyaline cell) and fibroblastic myoepitheliomas, and terminal duct adenocarcinomas are examples of tumors in which the myoepithelial cell is prominent or dominant.
Paranasal sinus radiology, part 3B: Sphenoidal sinus
Authors: Dolan Kenneth D.
Published: February 2007

Mucoceles involving the sphenoidal sinus are not as common as those affecting the frontal and ethmoidal sinuses. The subtle expansile change produced by a sphenoidal sinus mucocele often requires conventional tomography or computed tomography examination to be detected. Similarly, involvement of surrounding structures by a sphenoidal mucocele may require special study, which this section illustrates. The sphenoidal enlargement and density change produced by fibrous dysplasia may mimic sinus disease. Focal or widespread bone destruction resulting from neoplastic involvement of the sphenoidal sinus requires special examination similar to that used with mucoceles.
Retrieval of the parathyroid glands during thyroidectomy
Authors: Loré John M. , Pruet Charles W.
Published: February 2007

A recommended technique of intraoperative search of the removed thyroid lobe or entire gland for attached parathyroid glands is presented. Diligent examination of the thyroid capsule and folds of the thyroid gland is made in the sterile operative field. Any recovered parathyroid gland or glands are then finely sectioned and reimplanted in a location which is not likely to be violated in any future surgical procedure. This technique has significantly reduced the incidence of permanent hypoparathyroidism after total thyroidectomy.
Head and neck cancer in a young age group: High incidence in black patients
Authors: Slotman Gus J. , Swaminathan A. P. , Rush Benjamin F.
Published: February 2007

From the Tumor Registries of the East Orange, New Jersey, Veterans Administration Medical Center, and the College of Medicine and Dentistry of New Jersey/New Jersey Medical School, 1,066 cases of head and neck cancer were reviewed. Blacks comprised 32% of the population reviewed. Charts of 70 patients, 45 years old or younger, were examined. Seventy percent of this group was black. At diagnosis, the proportion of patients 45 years old or younger was 14% for blacks and 2.9% for whites, a significant difference (P < 0.001). Seventy‐six percent of lesions in black patients and 86% in white patients were situated above the hypopharynx. Sixty‐one percent of all patients 45 years old or younger had Stage III or IV lesions when first diagnosed, regardless of race. Black‐to‐white survival rates were 23 to 40% after 2 years, and 5 to 13% for those at risk after 5 years. Prognosis is poor for younger patients, in general, and worse for young black patients than for whites.
Traumatic granuloma of the tongue
Authors: Wright John M. , Rankin K. Vendrell , Wilson James W.
Published: February 2007

The traumatic granuloma is a rare, reactive lesion that occurs primarily in the tongue of males. It can mimic other diseases, including malignancy, both clinically and histologically. It is, therefore, a lesion with which clinicians and pathologists should be familiar.
Extralaryngeal spread of cancer of the larynx: A study with whole‐organ sections
Authors: Lam K. H.
Published: February 2007

Thirty total laryngectomy and five pharyngolaryngoesophagectomy specimens were studied with the whole‐organ sectioning technique. The horizontal plane of sectioning was chosen to study the pattern and degree of extralaryngeal spread in carcinoma of the larynx. There were 22 transglottic, 6 supraglottic, and 7 infraglottic tumors. Among them there were 1 T1, 2 T2, 5 T3, and 27 T4 lesions. Spreading anteriorly, the tumor was found to penetrate the thyrohyoid membrane in 7 (32%) out of 22 transglottic tumors. Among the entire group of 35 specimens the thyroid cartilage was penetrated in 18 cases (51%), and the infrahyoid strap muscles were invaded by tumor in 17 cases (49%). The cricothyroid membrane was penetrated in 19 cases (54%). Spreading posteriorly, the tumor reached or eroded the mucosa of the pyriform fossa in 15 cases (43%), including 10 total laryngectomy specimens. The postcricoid submucosa was involved by tumor in 13 cases (37%) among which 9 were total laryngectomy specimens. It is thus recommended that the wide‐field technique should be used for laryngectomy. Awareness of the possibility of tumor reaching the mucosa of the pyriform fossa and the postcricoid area allows the surgeon to keep clear of tumor in performing total laryngectomy.
Sternocleidomastoid myoperiosteal flap for the repair of laryngeal and tracheal wall defects
Authors: Tovi F. , Gittot A.
Published: February 2007

A myoperiosteal flap consisting of the sternocleidomastoid muscle and clavicular periost was successfully used in the repair of deficient laryngeal and cervical tracheal wall in three cases. Complete epithelialization took place with no granuloma formation in any of the three. This flap proved to be rigid enough to form a noncollapsed wall at times of alternative pressure changes. The method described consists of a one‐stage procedure where the donor site is in the same surgical field as the defect. There is no interference with any vital function and no apparent cosmetic defect. Therefore, it can be considered a viable alternative to procedures already in use.
High resolution ct air cisternography in the diagnosis of small acoustic neuromas
Authors: Khangure Makhan S. , Dolan Kenneth D.
Published: February 2007

High resolution CT air cisternography was used to examine 38 patients with clinical findings and audiovestibular function studies consistent with a retrocochlear lesion. Four strictly intracanalicular lesions and 10 acoustic neuromas extending medially into the cerebellopontine angle (CPA) cistern by no more than 1 cm were detected and verified at surgery. There was one false‐positive diagnosis produced by a tortuous inferior cerebellar artery branch. The contrast‐enhanced axial scan was positive in only two patients. Both had extension of the tumor into the CPA by 1 cm. In these two cases the axial intravenous (IV) contrast‐enhanced scan provided more information than the air CT. A patient with suspected acoustic neuroma is best examined initially with an IV contrast‐enhanced axial scan followed by CT air cisternography where the contrast study is negative.
Central island myomucosal tongue flap
Authors: Harris Jeffrey P. , Fabian Richard L.
Published: February 2007

Resection of intermediate‐sized (T2 and T3) lesions of the anterior floor of the mouth is often associated with defects in speech, glutition, and cosmesis despite reconstructive efforts. This paper describes the use of the central island myomucosal tongue flap to reconstruct defects of this size. Since this flap possesses the same vascular characteristics as the myocutaneous flap it offers similar advantages. Experience with seven patients in whom this flap was used suggested that this is a dependable method of anterior floor of mouth reconstruction since there was no evidence of nonviability, delayed healing, or wound breakdown. The advantages of this flap are: (a) it is rapidly developed from easily accessible local tissue, (b) it offers the same reliability as myocutaneous flaps, (c) it causes less disability of articulation and deglutition than other tongue flaps, and (d) it results in no cosmetic deformity.
Squamous cell carcinoma of the maxillary sinus: Analysis of 66 cases
Authors: St.‐Pierre Sylvain , Baker Shan R.
Published: February 2007

A retrospective review was performed of 66 patients with squamous cell carcinoma of the maxillary sinus. The majority of patients presented with tumors classified as T3 (31.8%) and T4 (54.5%). Seven (10.6%) patients presented initially with neck metastases and 13 (19.7%) patients subsequently developed regional disease. For the 66 patients studied, the observed 5 and 10 year actuarial survival rate was 27.3% and 20.7% respectively. The presence of cervical metastases, particularly when they developed subsequent to initial therapy, was associated with a poorer survival rate. Five year survival rate for patients without cervical metastases was 32.6% in contrast to 28.6% for patients initially presenting with nodal disease and 7.7% for patients who subsequently developed regional metastases. Overall, 5‐year survival rate for all patients with cervical metastases was 15.0%. A combined treatment regimen (surgery and radiation therapy) appeared to be superior to single modality therapy. A 58.0% observed 5‐year actuarial survival rate was achieved with combined therapy. Surgery or radiation therapy when used alone as a single modality resulted in a 5‐year survival rate of 20.0% and 15.7% respectively.
Postradiation dental extractions: A review of the literature and a report of 72 episodes
Authors: Beumer John , Harrison Richard , Sanders Bruce , Kurrasch Madeline
Published: February 2007

This report outlines our experiences involving 72 episodes of postradiation dental extraction over an 11‐year period. Bone exposures of 3 months or longer developed following 16 of the 72 postradiation extraction episodes (22%). The necrosis rate in the mandible was 29% (13 of 45) and in the maxilla was 11% (3 of 27). The risk of bone necrosis increased when the dose to bone exceeded 6,500 rad, and when 75% or more of the body of the mandible was within the radiation treatment volume. Five of the 13 mandibular bone necroses precipitated by postradiation extractions eventually required radical resection of the affected portion of the mandible. The remaining eight mandibular episodes healed with conservative measures. When possible, given the two above conditions, root canal therapy rather than dental extraction should be employed to resolve mandibular dental infection within the radiation field after radiotherapy.
Correction of cervical esophageal stricture using an axial island cheek flap
Authors: Sasaki Truman M. , Taylor Lloyd , Martin Lynn , Baker Harvey W. , McConnell Donald B. , Vetto R. Mark
Published: February 2007

Chronic strictures of the cervical esophagus after laryngectomy and radiation therapy pose a difficult problem in reconstructive surgery. Most conventional operations for cervical esophageal reconstruction are not well suited to the treatment of stricture because of lack of mucosal surface, or because of bulky tissues that awkwardly fit around the tracheal stoma. This report describes our experience with a new operation designed to correct this defect. We transposed an island full‐thickness cheek flap, which included an inner lining of mucosa and outer covering of skin. The flap was based on the facial artery and vein, and used as a patch to the stricture area. Normal swallowing and excellent cosmetic appearance were achieved. There has been minor numbness of the corner of the upper lip. This flap has excellent reach, and may have multiple applications to reconstruction problems in the head and neck.
Benign osteoblastoma of the maxillary sinus
Authors: Osguthorpe J. D. , Hungerford G. D.
Published: February 2007

Benign osteoblastoma is an uncommon fibroosseous neoplasm with a predilection for the vertebrae and long bones, and a 2‐to‐1 male‐to‐female ratio of occurrence. Peak incidence occurs in the second decade, with 80% of all patients being under 30 years of age. The clinical, radiographic, and histologic presentation of a large maxillary sinus osteoblastoma is reviewed. Preoperative embolization of this vascular neoplasm is advocated.
The lower trapezius myocutaneous flap for head and neck reconstruction
Authors: Dinner Melvyn I. , Guyuron Bahman , Labandter Harold P.
Published: February 2007

The lower trapezius myocutaneous flap has proved to be another useful adjunct in the reconstructive armamentarium of the head and neck surgeon. The flap is based on the descending branch of the transverse cervical artery and vein. Providing these structures are protected during neck dissection, this flap may well become the first consideration of flaps for reconstruction of extensive defects of the head and neck. The flap is safe, reliable, and easy to raise, with constant vascular anatomy. The donor site functional deficit is minimal and the donor site may be closed by direct closure without the necessity of skin graft. Its cutaneous reach and arc of rotation make it a suitable source for skin and muscle replacement for the entire neck, face, and occipital region of the scalp and oral cavity.
Intraarterial chemotherapy for head and neck cancer, part 1: Theoretical considerations and drug delivery systems
Authors: Baker Shan R. , Wheeler Richard
Published: February 2007

The principal objective of regional chemotherapy is tumor cell kill. The rationale for regional delivery is based on the steep dose/response curve exhibited by most antineoplastic agents. Intraarterial (IA) chemotherapy has the potential advantage of increased drug concentration at the tumor site, decreased systemic drug levels, and continuous tumor cell exposure to an antineoplastic agent. Despite these advantages, the use of IA chemotherapy has not been universally accepted. This is in part due to the difficulties associated with establishing and maintaining arterial access. Considerable improvement in the techniques and efficacy of regional therapy for head and neck cancer will be necessary before there is widespread clinical acceptance. These improvements must be based on anatomic and pharmacologic factors that ensure success of regional therapy. In addition, the development of safe, reliable delivery systems will be necessary. Part 1 of this two‐part article will review these factors and discuss delivery systems.
Face lift, part 3: Plication of the superficial musculoaponeurotic system
Authors: Webster Richard C. , Smith Richard C. , Smith Karen F.
Published: February 2007

It is thought that plicating or folding the superficial musculoaponeurotic system (SMAS) upon itself near the ear with permanent sutures will improve and help maintain the results of cheek‐neck lifting of the skin layer alone. Getting proof of this conjecture with controlled studies is difficult in the existing medicolegal climate. However, many years ago, we did carry out a limited study in a few patients in whom plication was performed on one side only. We found that plication does have some relatively long‐lasting effects, particularly in improvement of platysma cording and in elevation and deepening of the cervical angle. Plication is not a substitute for adequate skin and/or fat resection. Because the early improvement in cases with platysma cording was so marked in contrast to the unplicated side, we had to limit the series stringently. As time went by, the differences on the two sides lessened.
Face lift, part 4: Use of superficial musculoaponeurotic system suspending sutures
Authors: Webster Richard C. , Smith Richard C. , Smith Karen F.
Published: February 2007

We describe nonabsorbable sutures running from one or more sites in the superficial musculoaponeurotic system (SMAS), to other sites at a distance, or to fixed sites beyond or deep to SMAS for the purpose of pulling on or suspending the distal selected SMAS sites or changing contours between the suture ends. Our reasons for abandoning some sutures and continuing with others are stated. In face lifting, we still often employ sutures running from the anterior part of the platysma and SMAS back to the sternocleidomastoid fascia. These sutures help prevent platysma “cording” and are useful in the restoration and preservation of a more youthful profile in the neck. Examples and controls are demonstrated. These sutures and the long‐term results of their use have never been shown before. Problems encountered in using suspending sutures are described.
The management of dural tear resulting from mid‐facial fracture
Authors: O'Brien Michael D. , Reade Peter C.
Published: February 2007

This study examines the relative risks and benefits of conservative and surgical management of dural tear secondary to middle third facial fracture and ascertains the type of skull and facial injury most often associated with the development of posttraumatic meningitis. Two projects were undertaken. First, the histories of 247 cases of major middle third facial fracture were reviewed with a recent follow‐up of those patients who also sustained a dural tear. Second, 280 cases of bacterial meningitis were reviewed and particular attention was given to cases of posttraumatic meningitis. Of the 247 cases of middle third facial fractures studied, 43% (107/247) had evidence of a dural tear; of this group, 76 patients were managed conservatively and 31 patients were managed surgically. In the former group, there were three instances of recurrent cerebrospinal fluid rhinorrhea (CFR). In the surgically managed group, 77% (24/31) sustained surgical complications including two cases of posttraumatic meningitis and 21 cases of neurological deficit. Of the 280 cases of bacterial meningitis, 48 patients had sustained dural tear following trauma. The prognosis for posttraumatic meningitis is considerably better than for other forms of meningitis. The preceding trauma involved the vault of the skull in 90% (43/48) of cases, and discrete middle third facial fracture in one case (2.1%). Posttraumatic meningitis followed a previous operative repair in 15% (7/48) of the patients. The results of this study indicate that dural tear subsequent to middle third facial fractures is a different proposition than dural tear subsequent to direct skull trauma. In the former, spontaneous repair most often occurs following reduction and immobilization of the fracture, and surgical repair with its attendant complications is thereby usually not warranted. Spontaneous repair is unlikely to occur where there is gross damage to the anterior cranial fossa, aerocele, significant frontal fracture separate from the facial injury, and in cases of definite persistent or recurrent CFR and late meningitis. In these cases surgical repair is indicated.
Face lift, part 5: Suspending sutures for platysma cording
Authors: Webster Richard C. , Smith Richard C. , Smith Karen F.
Published: February 2007

We describe the technical details used in applying nonabsorbable sutures running from the anterior platysma muscles and/or adjacent fascia back to the fascia just in front of or covering the sternocleidomastoid muscles. These sutures usually pass 1.5–2 cm below the angle of the mandible. Anteriorly, they cover or are attached to the platysma muscles at the level of the cervical concavity or angle. The sutures suspend or draw back the superficial musculoaponeurotic system (SMAS) at this level, preventing some of the anterior displacement of the platysma when it is contracted in normal use. We believe that the sutures have relatively long‐lasting effects and that they delay the early return of “platysma cording” after cheek‐neck lifting. Their application using Reverdin and Keith needles is demonstrated. Differences in technique when submental lipectomy is and is not performed with the lift are shown.
Treatment of tumors involving the anterior cranial fossa
Authors: Jackson Ian T. , Marsh W. Richard , Hide T. A. H.
Published: February 2007

The potential for a tumor of the upper face, either malignant or nonmalignant, to involve the anterior cranial base is often not appreciated. This leads to inadequate preoperative investigation and to surgery performed by the head and neck surgeon without the help of the neurosurgeon. In this way, complete tumor resection may be compromised or delayed. Neither of these situations is desirable. If the potential for anterior cranial fossa invasion is recognized, there should be prior consultation with the neurosurgeon and a combined operative procedure. Exposure of these lesions has considerably improved with experience in congenital craniofacial deformities: this will allow en bloc resection of most pathologies. Immediate reconstruction after resection of non‐malignant tumors is advocated, but in aggressive—particularly in recurrent—malignancies, delayed reconstruction is advised. Careful combined follow‐up with frequent blind biopsies should be carried out as indicated.
An unusual complication of the pectoralis major myocutaneous flap
Authors: Donegan J. Oliver , Gluckman Jack L.
Published: February 2007

The development of myocutaneous flaps has been a major advance in reconstructive surgery of the head and neck. The pectoralis major myocutaneous flap has proven to be the most reliable and versatile for use in this area. There have been several reports of its advantages with few complications noted. This article reports two patients who developed osteomyelitis of the rib in the donor area of the pectoralis major myocutaneous flap. The etiology of this potentially serious complication is discussed and the management is outlined.
Analysis of persistent disease on the ear following mohs surgery
Authors: Robins Perry , Nix Michael
Published: February 2007

A retrospective study of 338 patients with malignant lesions of the auricle is presented. The results of treatment using Mohs microscopically controlled surgery and conventional surgical excision are compared and the high incidence of recurrence is stressed. The incidence, etiology, pathology, and subclinical extension of auricular tumors are discussed. The treatment of choice is Mohs microscopically controlled surgery and a plea is made for a more radical therapeutic approach to these often casually treated neoplasms.
A phase II study of cis‐diamminedichloroplatinum and 5‐fluorouracil in advanced upper aerodigestive neoplasms
Authors: Creagan Edward T. , Ingle James N. , Schutt Allan J. , O'Fallon Judith R.
Published: February 2007

Thirty patients with advanced head and neck cancer of diverse histologies received the combination of cis‐diamminedichloroplatinum (CDDP) (100 mg/m2) and 5‐fluorouracil (5‐FU) (1,000 mg/m2/24 hours × 4 days) at 3–4‐week intervals. Among all study participants, the median time to progression was 3.9 months and the median survival was 7.2 months. Among 20 patients with squamous cell carcinoma, we observed five objective regressions (25%). None of the responders had prior chemotherapy; four had extensive prior radiation therapy. Among 10 patients with non‐squamous cell carcinoma neoplasms, we detected three objective responses (30%). Histopathology of the responding patients included poorly differentiated sarcoma, anaplastic carcinoma, and malignant mixed parotid tumor. Significant gastrointestinal toxicities included moderate‐to‐severe nausea (60%), vomiting (43%), and stomatitis (57%). Leukopenia (< 4,000 cells/mm3) and thrombocytopenia (< 130,000 cells/mm3) affected 78% and 41% of patients, respectively, without sepsis or hemorrhage.
Tracheotomy and inhalation injury
Authors: Sataloff Dahlia M. , Sataloff Robert T.
Published: February 2007

Indications for tracheotomy in patients with respiratory burns have been unclear. Much of the literature is inconclusive or misleading. A thorough understanding of the pathogenesis, diagnosis, and therapy of inhalation injury is necessary to understand the role of tracheotomy. A critical review reveals relatively clearcut indications for the use of tracheotomy in inhalation injury, but many unanswered questions. Increased participation by otolaryngologists in burn management is recommended.
Assessment and treatment of neurogenic and non‐neurogenic tumors of the parapharyngeal space
Authors: Ferlito Alfio , Pesavento Gastone , Recher Gianfranco , Nicolai Piero , Narne Surendra , Polidoro Franco
Published: February 2007

The clinical and pathologic findings in eleven cases of parapharyngeal space tumors are described. The anatomy of this area and diagnostic procedures are discussed. Investigations should include a few basic examinations such as sialogram‐computed tomographic (CT) scan, carotid angiogram, and echography. Several surgical approaches are considered in relation to the site and the size of the neoplasm. Prognosis depends on the histologic type of the tumor.
Clinical evaluation and surgical treatment of hemangiomata
Authors: Pitanguy Ivo , Caldeira Alberto M. L. , Calixto Carlos Alberto , Alexandrino Adelson
Published: February 2007

We report on the histologic and anatomopathologic aspects of cutaneous hemangiomas, stressing the involutive and noninvolutive aspects of these malformations. We analyze its clinical evolution, approaching the propedeutic and therapeutic methods, and present a detailed commentary on the conservative methodology of a series of 473 consecutive patients, encompassing a follow‐up of 1 to 18 years.
Late sequelae of superficial irradiation
Authors: Hood Ian C. , Young J. Edward M.
Published: February 2007

Superficial irradiation results in well recognized late sequelae including not only sclerosis and atrophy of skin and subcutaneous tissue, but also the development of benign and malignant tumors of skin and adjacent structures. The long latency between irradiation and its late effects allowed the early uncontrolled use of radiation treatment for benign conditions. The subsequent recognition of the causal relationship between tumors and previous irradiation has restricted its use to more appropriate purposes, although it is possible that it is still overused in some areas of dermatologic practice. Clinicians need to be aware of the time interval between irradiation and the development of its late sequelae, and the incidence of these sequelae. Appropriate irradiation exposure history should be a part of the evaluation of every patient.
High resolution computed tomography, Part 1: Soft tissues of the neck
Authors: Swartz Joel D. , Korsvik Holly , Saluk Patricia H. , Popky George L.
Published: February 2007

Normal and pathologic anatomy of the soft tissues of the neck is clearly delineated with high resolution computed tomography (CT). The CT densities of soft tissues, fat, and enhanced blood vessels are strikingly different from each other and, therefore, mass lesions are clearly discernable. Often, a histologic diagnosis may be suggested with a high level of confidence based on the location and tissue characteristics.
Pilomatrixoma of the head and neck
Authors: Toback Jeffrey M. , Hoover Larry A. , Dudley James P.
Published: February 2007

Pilomatrixoma is an uncommon neoplasm which occurs most frequently in the head and neck region. It usually presents as a slowly growing dermal or subcutaneous mass. Unfamiliarity with this lesion may lead the physician to mistake it for more common infectious or neoplastic processes. Most pilomatrixomas are benign and are adequately treated by local excision. Since a spectrum of clinical and histologic aggressiveness (pilomatrixoma carcinoma) has been noted in some lesions, a more aggressive surgical approach for such tumors is recommended. Two patients with pilomatrixoma are presented to emphasize the diagnostic confusion that can occur.
The incidence of hypercalcemia in squamous cell carcinoma of the head and neck
Authors: Dorman E. B. , Yang H. , Vaughan C. W. , Hong W. K. , Strong M. S.
Published: February 2007

Hypercalcemia is a well‐recognized phenomenon in squamous cell carcinoma of the head and neck, but the incidence of hypercalcemia in this group of patients is not clear. We have reviewed the records of 166 patients with squamous cell carcinoma of the head and neck presented at the Boston VA Medical Center over a 2‐year period (October 1981 to September 1983). Hypercalcemia (> 11 mg/dl), for which a benign etiology could not be identified, occurred in the clinical course of seven patients (4.2%). Of the hypercalcemic patients, 5/7 (71.4%) had advanced stage IV disease and serum calcium levels ranging from 11.2 to 15 mg/dl at presentation. The incidence of hypercalcemia in this stage IV group was 5/78 (6.4%). On the basis of concomitant serum alkaline phosphatase, x‐ray films, and radionuclide bone scans in these patients, bone metastases or a humoral factor were felt to be the etiologic agent. Six of the seven patients died within 77 days of the onset of the hypercalcemia despite vigorous antihypercalcemic and chemotherapeutic measures, and the remaining patient is under chemotherapy at present. We conclude that hypercalcemia is a late manifestation of advanced squamous cell carcinoma of the head and neck and is an ominous prognostic sign. Hypercalcemia without bone metastases is presumably due to the production of ectopic parathormone (PTH)‐like substances from the tumor. To control this hypercalcemia, the underlying tumor must be treated vigorously in conjunction with symptomatic treatment. It should be noted that of 166 patients not all have been followed to the end stage of their disease and, thus, the true incidence of hypercalcemia may be slightly higher than 4.2%.
Plexiform ameloblastoma of the maxilla with extension to the skull base
Authors: Komisar Arnold
Published: February 2007

Ameloblastomas are locally invasive benign tumors believed to originate from the developing dental lamina. Maxillary ameloblastomas are rare, comprising only 20% of all ameloblastomas. Of these, 90% arise posterior to the canine tooth. As tumors of the posterior maxilla grow slowly, symptoms are few until the tumor has reached considerable size. At the time of presentation there may be evidence of extension into anatomic areas adjacent to the posterior maxilla. Hemimaxillectomy through wide surgical exposure has the best chance of achieving tumor control. However, once the tumor has extended beyond the confines of the maxilla the prognosis for control of the disease is poor.
Complications associated with free jejunal graft reconstruction of the pharyngoesophagus—a multiinstitutional experience with 52 cases
Authors: Gluckman Jack L. , McDonough John J. , McCafferty Gerard J. , Black Robert J. , Coman William B. , Cooney Timothy C. , Bird Russell J. , Robinson David W.
Published: February 2007

Fifty‐two patients who underwent reconstruction of the pharynx and esophagus using the free jejunal graft were retrospectively reviewed. The complications were categorized into those associated with the resection, those associated with the harvesting of the graft, and those related to the reconstruction per se. In this series, the graft failure rate was 7.6% with an overall success rate of 90.3%. Graft necrosis was found to be the most serious complication occurring in four patients. Methods of detection of graft necrosis and management of these complications are discussed.
A model for staged compression of the vascular pedicle in a porcine myocutaneous flap
Authors: Cummings Charles W. , Trachy Ronald E.
Published: February 2007

There is a need for a laboratory model that would allow assessment of the effects of vascular pedicle compression in the myocutaneous flap. We describe a technique as used in the pig that responds to the needs of technical reproducibility and sequential compromise of vascular flow as measured by laser velocimetry and dermofluorometry.
Unusual anatomic presentations of inverting papilloma
Authors: Astor Frank C. , Donegan J. Oliver , Gluckman Jack L.
Published: February 2007

Due to their tendency to recur, and a potential for malignancy, inverting papillomas of the nasal cavity and paranasal sinuses pose a challenge to the head and neck surgeon. Although the majority of these benign neoplasms arise from the lateral nasal wall, middle meatus, and ethmoid complex, they occasionally originate from atypical areas in which Schneiderian membrane is present. Four unusual anatomical presentations of inverting papilloma are presented and discussed.
Midline alopecia reduction combined with hair transplantation
Authors: Unger Martin G. , Unger Walter P.
Published: February 2007

The advantages gained by incorporating alopecia reduction (AR) in patients undergoing hair transplantation, or with patients who have previously had hair transplantation, are delineated. The specific advantages of the midline elliptical pattern are discussed. Clinical considerations that determine whether ARs are necessary are the degree of baldness, laxity of the scalp, age of the patient, and ultimate goal of the individual. The advantages and disadvantages of performing ARs or hair transplantation first are discussed and the new concept of minireductions also outlined.
Medical treatment of male pattern alopecia (androgenic alopecia)
Authors: Tromovitch Theodore A. , Glogau Richard G. , Stegman Samuel J.
Published: February 2007

The causes and potential causes of androgenic alopecia in men and women are discussed. The scientific attempts at reversing this process are detailed including use of estrogen, thyroid, progesterone, and minoxidil. At present, the practical approach for the clinician is to ascertain in females that an androgen overproduction syndrome is not present. A therapeutic trial of topical progesterone at a 2%–5% concentration appears to be reasonable when the physician and patient appreciate the limitations of this approach.
Thyroid carcinoma presenting as a parapharyngeal mass
Authors: Robbins K. Thomas , Woodson Gayle E.
Published: February 2007

Nodal metastases from occult head and neck primaries presenting as a pharyngeal space mass are unusual. In this report, a patient with dysphagia and a large parapharyngeal mass was found to have metastatic papillary thyroid carcinoma. Although it is common for such tumors to metastasize to regional lymph nodes, to our knowledge, this is the only reported case of a thyroid neoplasm masquerading as a primary parapharyngeal space tumor. It indicates upward lymphatic spread of tumor to involve the lateral retropharyngeal nodes. This pattern of spread is in keeping with Rouviere's description of a direct lymphatic pathway from the posterior surface of the superior thyroid lobe to the lateral retropharyngeal nodes. The case presentation is intended to alert the reader of this possibility and to emphasize the inclusion of regional metastatic nodal disease as a possible cause of parapharyngeal space masses.
Metastases to the larynx
Authors: Batsakis John G. , Luna Mario A. , Byers Robert M.
Published: February 2007

Eleven cases of metastases to the intrinsic larynx are reported. This number constitutes the largest collection from a single institution in the literature and brings the total recorded cases to 83. Cutaneous melanomas are the preponderant primaries, followed by renal cell carcinomas, and carcinomas of the breast and lung, respectively. The supraglottis is the favored site for the metastatic deposit; the glottis, the least frequently involved area.
Metastatic carcinoma of oral soft tissue
Authors: Zohar Yuval , Ben‐Tovim Reuven , Gal Rivka , Laurian Nelu
Published: February 2007

Metastatic carcinomas to the oral region are rare. Most of the lesions are located in the bones of the jaw. The medical literature contains quite a few examples of metastatic lesions located strictly in the oral soft tissue. We present two cases of oral soft tissue metastatic carcinoma of urogenital origin.
The need for elective irradiation of occult lymphatic metastases from cancers of the larynx and pyriform sinus
Authors: Marks James E. , Breaux Sherry , Smith Peter G. , Thawley Stanley E. , Spector Gershon G. , Sessions Donald G.
Published: February 2007

The incidence of palpable and occult cancer and the absence of cancer in lymph nodes were determined for individual sites in the larynx and pharynx of 540 patients who underwent neck dissection. The incidence of palpable cancer in lymph nodes was lowest for cancers of the central supraglottis and transglottis (32–41%), intermediate for cancers of the marginal supraglottis and glossoepiglottis (48–57%), and highest for cancers of the pyriform sinus (69%). The incidence of occult cancer in lymph nodes for individual sites in the larynx and pharynx was determined by pathologic study of neck dissection specimens from 253 patients without palpable lymph nodes (NO neck). The incidence of occult lymphatic metastases in the NO neck and the need for elective neck irradiation were least for cancers of the transglottis and central supraglottis (14–16%), intermediate for cancers of the glossoepiglottis and the marginal supraglottis (20–38%), and greatest for cancers of the pyriform sinus (47%). The risk of nodal recurrence increased from 8% for those without cancer in lymph nodes to 38% for those with occult or palpable cancer in lymph nodes. A policy of observing the NO neck in patients with a low incidence of occult lymphatic metastases and a low risk of neck recurrence to avoid the unnecessary irradiation of many to benefit a few is discussed.
Staffieri's procedure revisited
Authors: Vuyk Hadé , Tiwari Rammohan , Snow Gordon B.
Published: February 2007

Our long‐term experience with Staffieri's procedure in 42 patients is presented. Our results were evaulated regarding voice production, aspiration problems, and pharyngocutaneous fistula formation. Approximately 50% of the patients were successfully rehabilitated. Twenty‐five percent of the patients did not use the neoglottis for speech production, mostly because of stenosis of the neoglottis. The remaining 25% had serious aspiration problems that needed treatment. It was striking that half of these patients initially benefitted from the Staffieri procedure and had no aspiration problems. These 42 patients were compared with a group of 43 patients who underwent conventional total laryngectomy in the same period. After total laryngectomy and Staffieri's procedure, >35% of the patients had a pharyngocutaneous fistula, while after conventional total laryngectomy the fistula rate was <20%. The average postoperative stay in the hospital was longer in the Staffieri group. In the long run, the results of this surgical technique do not justify its further use, especially after previous radiotherapy.
False‐positive and false‐negative neck nodes
Authors: Ali Shaukat , Tiwari Ram M. , Snow Gordon B.
Published: February 2007

We report our experience of the incidence of false‐positive (i.e., clinically positive and histologically negative) and false‐negative (i.e., clinically negative and histologically positive) neck nodes and define their relationship to the primary site, T‐stage, and the histologic grade of the primary lesion. Clinical and pathologic records of 255 patients with squamous cell carcinoma (SCC) of the head and neck who underwent 266 radical neck dissections were reviewed. We did not find any relationship between the T‐stage of the primary tumor and the incidence of the false‐positive and false‐negative neck nodes. Regarding the primary site, the benefit of an elective neck dissection is likely to be maximum in oropharyngeal SCC and minimum in supraglottic SCC. The incidence of false‐negative neck nodes was lower in well differentiated primary lesions.
Survival results from a phase III study of simultaneous versus 1‐hour sequential methotrexate—5‐fluorouracil chemotherapy in head and neck cancer
Authors: Browman George P. , Levine Mark N. , Russell Rosemary , Young J. E. M. , Archibald Stuart D.
Published: February 2007

There were 79 patients with squamous cell head and neck cancer randomized to receive simultaneous or 1 hour sequential methotrexate‐5 fluorouracil (MTX—5‐FU) chemotherapy: 47 patients were previously untreated and 32 patients had recurrent disease. The treatment groups were comparable for important prognostic features. The median survival for the 47 newly prsenting patients was 22 months and for recurrent disease patients was 14 months. No difference could be detected in the survival of patients who received simultaneous versus sequential chemotherapy. When only chemotherapy responders were compared, no difference in survival was detected for those who received sequential versus simultaneous therapy. Subsequently, 19 chemotherapy responders received radical radiation therapy, and 15 were rendered disease‐free whereas only 4 of 17 chemotherapy nonresponders were rendered disease‐free by subsequent radiation (P =.002). The survival of the 19 chemotherapy responders was 34 months compared with 16 months for the 17 chemotherapy nonresponders treated with radiation. We conclude that there is no therapeutic advantage for 1 hour sequential MTX‐5 FU chemotherapy compared with simultaneous use of these drugs in squamous cell head and neck cancer. Chemotherapy responders are more likely to respond to radiation therapy.
Pedicled myocutaneous flap of latissimus dorsi muscle for reconstruction of anterior and middle skull defects: An alternative
Authors: Seckel Brooke R. , Upton Joseph , Freidberg Stephen R. , Gilbert Kenneth P. , Murray Joseph E.
Published: February 2007

Three cases are presented demonstrating the use of a pedicled myocutaneous flap of latissimus dorsi muscle to reconstruct large defects of the anterior and middle skull after ablative surgery for carcinoma. This method is proposed as an alternative to reconstruction with a free myocutaneous flap in selected patients.
One‐stage total mandibular reconstruction with rib, pectoralis major osteomyocutaneous flap
Authors: Bhathena Hosi , Kavarana N. M.
Published: February 2007

One stage reconstruction of the mandible and lower third of the face with pectoralis major osteomyocutaneous flap incorporating the rib on a muscular pedicle in oral cancer case is described. The composite tissue provides the exact replacement of lost tissues. The technique described replaces adequate mucosa, soft tissue, and bone with minimum functional loss at the donor site. Two ends of the refashioned rib were anchored to masseteric muscle mass and zygoma. This has established functional rehabilitation of chewing, swallowing, and speech in a short period.