bluuebunny/crossref_metadata_2025 huggingface dataset:
Early gold weight lid implant for rehabilitation of faulty eyelid closure with facial paralysis: An alternative to tarsorrhaphy
Authors: Sobol Steven M. , Alward Phillip D.
Published: February 2007

Although tarsorrhaphy has been the mainstay of treatment for lagophthalmus associated with facial paralysis, it has many drawbacks which make it a less than ideal procedure. Gold weight implantation is a functionally and cosmetically superior alternative in many patients. Eighteen patients with both reversible and irreversible facial (eyelid) paralysis underwent early gold weight implantation for rehabilitation of faulty eyelid closure with satisfactory results. The advantages and disadvantages of this technique, when compared with other methods of correcting paralytic lagophthalmus, are discussed.
Atypical granular cell tumor of the larynx: An unusually aggressive tumor clinically and microscopically
Authors: Brandwein M. , Lebenger J. , Strauchen J. , Biller H.
Published: February 2007

A 36‐year‐old man presented with a recurrent, rapidly enlarging laryngeal tumor causing upper airway obstruction. Microscopic study revealed a granular cell tumor (GCT) with marked atypia, pleomorphism, and pagetoid spread to the overlying epithelium. Histologic pleomorphism occurs rarely and is usually mild in laryngeal GCT. Malignant granular cell tumor (MGCT), a very unusual entity, can be diagnosed with confidence when there is clinical evidence of malignancy (i.e., metastasis). We support the concept of “atypical” GCT when marked pleomorphism is present, yet no metastasis has occurred. This will indicate to the otolaryngologist and pathologist the possibility of greater potential for aggressive clinical behavior.
Intraosseous frontal hemangioma
Authors: Hoffmann Dieter F. , Israel Jeffrey
Published: February 2007

Intrasosseous hemangioma is a rare vascular malformation of bone infrequently described in the otolaryngologic literature. We report a case of this unusual tumor involving the frontal bone. Bone scan, computed tomographic (CT) scan, and histologic findings are illustrated. Differential diagnosis includes meningioma, eosinophilic granuloma, metastatic carcinoma, and other bony lesions. Treatment is complete surgical excision.
Carcinoma of the supraglottic larynx: A basis for comparing the results of radiotherapy and surgery
Authors: Mendenhall William M. , Parsons James T. , Stringer Scott P. , Cassisi Nicholas J. , Million Rodney R.
Published: February 2007

An analysis of 129 patients with 131 squamous cell carcinomas of the supraglottic larynx treated between October 1964 and April 1987 with radiotherapy alone or radiotherapy followed by neck dissection is presented. All patients had a minimum 2‐year follow‐up. Patients were excluded from analysis of disease control at the primary site and/or neck if they died within 2 years of treatment with the site(s) continuously disease‐free. Local control rates with radiotherapy and ultimate local control rates, including patients successfully salvaged after a local recurrence, were as follows: T1, 13 of 13 and 13 of 13; T2, 34 of 42 (81%) and 37 of 42 (88%); T3, 25 of 41 (61%) and 34 of 41 (83%); and T4, 3 of 9 and 6 of 9. There was no significant difference in local control rates when comparing patients who were anatomically suitable for a supraglottic laryngectomy with those who would have required a total laryngectomy. Local control rates were slightly diminished in patients with T2‐T3 lesions who had impaired or absent vocal cord mobility. The overall rates of ultimate local control with voice preservation for the entire series of 129 patients were as follows: T1, 100%; T2, 87%; T3, 69%; and T4, 57%. Cause‐specific survival rates at 5 years by stage were 1, 2 of 2; II, 10 of 12 (83%); III, 9 of 13 (69%); IVA, 4 of 6; and IVB, 7 of 22 (32%). The incidence of severe complications was 4 of 115 (3%) for T1‐T3 lesions and 4 of 14 (29%) for T4 lesions.
Tongue mobility in speech after partial glossectomy
Authors: Hamlet Sandra L. , Mathog Robert H. , Patterson Robin L. , Fleming Susan M.
Published: February 2007

Recovery of tongue mobility in speech was investigated in 5 partial glosectomy patients. Jaw range of motion used in speech, and tongue contour changes relative to the jaw, were assessed using sequential videofluoroscopic data recorded presurgery, postsurgery, and postradiotherapy. Data from 2 normal controls were included for comparison. Tongue mobility relative to the jaw was found to be restricted postsurgery. Approximately 4 months later, following radiotherapy, tongue mobility increased. Range of jaw motion used in speech was unchanged. Results are interpreted as preliminary evidence that in this small group of cancer patients, radiotherapy following surgery did not prevent continued recovery of tongue function for speech in the early postradiation period.
Physical rehabilitation after myocutaneous flaps
Authors: Har‐El Gady , Krespi Yosef P. , Har‐El Rivi
Published: February 2007

The neck, shoulder, and upper trunk serve as donor sites for commonly used flaps in head and neck reconstruction. In order to prevent permanent functional disabilities, a physical therapy program was organized. The anatomy, physiology, and kinesiology of the shoulder muscles that are commonly used in myocutaneous flaps are reviewed. Their functional deficit and compensation are described. Exercise protocols for each group of muscles were developed. Prevention of postoperative “frozen shoulder” and the avoidance of tension and torsion of the transposed muscle pedicle are important during the immediate postoperative course. Strengthening the agonistic muscles and learning to use them correctly, in order to regain full range of motion, are the main long‐term goals.
Comparative study of technetium‐99M bone scans and orthopantomography in determining mandible invasion in intraoral squamous cell carcinoma
Authors: Ahuja Rajeev B. , Soutar David S. , Moule B. , Bessent R. G. , Gray H.
Published: February 2007

The accuracy of preoperative assessment in determining invasion of the mandible by intraoral squamous cell carcinoma was analyzed in 48 patients who underwent mandibulectomy, and the results correlated with the histopathological reports of the resected specimens. Only 50% of the patients underwent the “ideal” surgery based primarily on clinical judgement, whereas 10 patients in the series were significantly undertreated.

Clinical judgement and routine preoperative x‐rays are accurate in cases where there is gross involvement of the mandible (17 of 19) but are significantly less successful in determining early bone invasion, invasion of the periosteum, or periosteal new bone formation. In such cases (26 of 48), a technetium‐99m bone scan provides additional information.

A grading system for reporting orthopantomographics (OPTs) and bone scans has been developed and utilized to form a reference grid to determine the optimum extent of man dibular surgery. The results show that using the protocal, unnecessary mandibular surgery may be reduced and inadeqaute surgical excision avoided.
Salivary gland cancer and risk of subsequent skin cancer
Authors: Spitz Margaret R. , Sider Joanne G. , Newell Guy R.
Published: February 2007

There are epidemiologic similarities between salivary and skin neoplasms that could be attributed to exposure to ultraviolet radiation. To explore further the etiologic parallels between these two types of cancer, we studied the multiple primary association between salivary gland cancer with that of other cancers known to be induced by ultraviolet light exposure, using data from the SEER program for 1973‐1984. Because nonmelanoma skin cancers other than cancers of the lip are not routinely reported to the SEER registries, we specifically evaluated the associations with melanoma and lip cancers. Expected numbers of subsequent primaries (melanoma and lip) for the 904 white men and 784 white women with an initial salivary gland cancer were computed from incidence rates using the Connecticut Tumor Registry. There were significantly increased risks for subsequent lip cancer among men (RR = 8.7) and for melanoma among women (RR = 7.1). Among men there was also a significant association between an initial lip cancer and risk of subsequent salivary gland cancer (RR = 12.7). These observations, together with reported increases in incidence of these tumors, suggest a common etiology, which could partly be explained because of exposure to ultraviolet radiation.
Actinomycotic granuloma masquerading as an infraorbital nerve neoplasm
Authors: Har‐Ei Gady , Prager David A. , De Soto La Paix Fidelina , Nash Michael
Published: February 2007

Actinomycotic infections of the head and neck region are rare and frequently present a confusing clinical picture. We document a case of actinomycosis that simulated a neoplasm of the infraorbital nerve, both clinically and surgically. To the best of our knowledge, this is the first report of actinomycosis involving this nerve. Correct diagnosis of actinomycotic infection in the head and neck relies most heavily on clinical suspicion. It is, therefore, imperative for the head and neck surgeon to be familiar with the etiology of this infection and its various modes of presentation as well as its appropriate management.
Clinicostatistical study of lower lip mucoceles
Authors: Yamasoba Tatsuya , Tayama Nirou , Syoji Minoru , Fukuta Masahiro
Published: February 2007

We reviewed 70 patients with lower lip mucoceles for patient characteristics, clinical features, and histopathologic findings. These cases represented approximately 75% of oral mucoceles seen in the Department of Otolaryngology, Takeda General Hospital, between February 1985 and July 1988. Patients were divided almost equally between males and females, with ages ranging from 2 to 63 years, with the highest incidence of lesions occurring in the second decade. Duration of the lesions varied greatly from a few days to 3 years, with no correlation to size. The most commonly affected site was opposite the upper lateral incisor, with the incidence divided almost equally between right and left side. Of 70 biopsies, 68 were mucous extravasation cysts and 2 were mucous retention cysts. Surgical excision was the treatment of choice, with recurrence of the lesion in only 2 cases.
Risk of hypoparathyroidism after surgery for carcinoma of the thyroid
Authors: Rao Raja S. , Jog Vinayak B. , Baluja Chanda A. , Damle Shrikrishna R.
Published: February 2007

The reported incidence of postoperative hypoparathyroidism varies from 3% to 32%, and many surgeons are reluctant to perform a total thyroidectomy because of the risk of permanent damage to the parathyroid glands. We prospectively studied three groups of patients for evidence of acute parathyroid damage: group A consisted of 29 patients with total thyroidectomies; group B, 21 controls with partial thyroidectomies; and group C, 29 patients with total thyroidectomies that had been performed several months to years earlier. Functional status of the glands was measured by serum parathormone, calcium, and phosphorus levels. Although these levels fell postoperatively, they remained within normal limits. None of the long‐term follow‐up patients (group C) was found to have hypoparathyroidism, leading us to conclude that this risk may be overstated in the literature.
Blindness following bilateral radical neck dissection
Authors: Marks Steven C. , Jaques Darrell A. , Hirata Richard M. , Saunders John R.
Published: February 2007

Blindness after bilateral radical neck dissection is a rare complication. A recent patient, who suffered total blindness after simultaneous bilateral radical neck dissection, is the fifth case reported. It is, however, the first with pathological study of the optic tracts. Detailed microscopic examination revealed bilateral intraorbital hemorrhagic optic nerve infarction without evidence of embolization or ophthalmic artery occlusion. The probable etiology of this event is an episode of prolonged hypotension. An additional etiologic factor may be increased resistance to blood flow caused by venous hypertension, resulting from bilateral internal jugular vein ligation.
Extramedullary plasmacytoma of the parotid
Authors: Rothfield Robert E. , Johnson Jonas T. , Stavrides Alexander
Published: February 2007

Primary extramedullary plasmacytoma (PEMP) is a tumor of atypical neoplastic cells that arise outside the bone marrow in patients without clinical evidence of existing multiple myeloma. These rare tumors, which can occur in virtually any part of the body, have shown a clear predilection for the head and neck. Yet despite the fact that nearly 80% of these tumors can be found in the upper respiratory tract or oral cavity, their involvement in the parotid is singularly rare. The clinical behavior of this tumor is not yet well‐defined, and local recurrence, distant metastasis, and transformation to multiple myeloma have all been reported. Since the first case of parotid PEMP was reported in 1965, 8 additional cases have been noted in the literature. This is the 9th case of PEMP of the parotid to be described.
Metastatic involvement of the cavernous sinus from primary pharyngolaryngeal tumors
Authors: Traserra Jose , Comas Jaime , Conde Cesareo , Cuchi Asuncion , Cardesa Antonio
Published: February 2007

The cavernous sinus is an unusual site for metastases from tumors of the larynx and pharynx. In postmortem studies of patients with cancers of the larynx, hypopharynx, and other sites, cavernous sinus metastases have been detected in very few cases. We present 3 cases of metastatic cavernous sinus disease. Despite the lack of pathologic diagnosis by biopsy, we feel that the clinical presentation combined with computed tomography provides an accurate diagnosis.
Modified radical neck dissection in cancer of the mouth, pharynx, and larynx
Authors: Khafif Rene A. , Gelbfish Gary A. , Asase Danilo K. , Tepper Patrick , Attie Joseph N.
Published: February 2007

A retrospective analysis of 390 determinate radical neck dissections (RND) performed for cancers of the mouth, pharynx, and larynx was carried out. There were 75 patients (19%) who had a modified RND. These were separately analyzed and the outcome was compared to those who had a standard total RND. Our goal was to assess the effectiveness of modified RND in controlling disease in the neck, and to identify its impact on survival and quality of life. Overall neck recurrence rate in the entire modified RND group was 28%, 35% in the partial RND, and 25% in the comprehensive modified RND. Neck recurrence rate was no worse in the comprehensive modified RND for NO and N1 cases, but increased significantly (as compared to the group of patients with standard RND) in the N2 and N3 cases (52% vs. 33%) Treatment of neck recurrences following modified RND was primarily by surgery, with a 48% 3‐year disease‐free survival. Overall survival was the same for modified RND (68%) and for standard total RND (63%). This was true for all N stages individually. The morbidity of standard total RND is discussed and the goals of modified RND are analyzed. Definitions and a standardized nomenclature for the various types of modified RND are suggested for uniformity of reporting. From the Department of Surgery, Divison of Head and Neck Surgery, Maimonides Medical Center, Brooklyn, New York.
Innervation of the trapezius muscle: A study in patients undergoing neck dissections
Authors: Soo K. C. , Guiloff R. J. , Oh A. , Rovere G. Querci Della , Westbury G.
Published: February 2007

Twenty‐four patients with surgical section of the accessory nerve and/or its cervical contribution(s) were examined from 1 to 156 months after surgery, and compared to twenty controls. Thirteen patients had a classical neck dissection; seven had the whole length of the accessory nerve preserved but not the cervical plexus contributions. Four had the upper half of the accessory nerve sectioned, but with preservation of both the lower half and its cervical contributions. Clinical and electrophysiological studies of the three portions of the trapezius suggested the existence of an undescribed motor nerve supply to the trapezius and of a motor input from the cervical plexus contributions via the accessory nerve. The former is also supported by an anatomical study.
Metallic clips as a time/cost saving adjunct to head and neck surgery
Authors: Davidson Terence M. , Olson Terry S.
Published: February 2007

Metal surgical clips are commonly used in head and neck surgery today. In this study of 10 patients, 69 vessels in the neck were ligated with tantalum clips and 68 vessels were ligated with silk ties. The times for cutting and ligating each vessel were recorded and the results show a 31‐second timesavings by clipping the vessel as opposed to tying. The use of metal clips on vessels is found to be both safe and effective, while reducing operative time.
Anatomic study of the otic ganglion in humans
Authors: Roitman Roman , Talmi Yoav P. , Finkelstein Yehuda , Sadov Rima , Zohar Yuval
Published: February 2007

The presentation in the literature of the anatomy of the human otic ganglion (OG) has not varied much over the past three quarters of a century, Precise, similar descriptions of its size, color, shape, and relation with neighboring structures are portrayed in numerous textbooks and articles. We have carried out a study of the OG in 30 infratemporal fossae of 15 cadavers. Otic ganglia resembling the classic description were found in less than 60% of the cases. In 13%, some thickening could be seen adjacent to the mandibular nerve and in 27%, no definite structure could be observed. Except for a fleeting mention of this occurrence in a textbook from 1927, substantiated by personal communication with an authority in the field, we could find no record of the possible absence of this structure in the available literature. We describe our findings and stress the apparent anatomic variability of the OG. The pertinent literature is reviewed.
Anterior neopharyngeal diverticulum following laryngectomy
Authors: Sobol Steven M. , Prince Karen , Cronin David
Published: February 2007

While less common than stricture, recurrent neoplasm, and neuromuscular dysfunction, neopharyngeal diveritculum must be considered in the differential diagnosis of postlaryngectomy dysphagia. Symptoms of difficulty clearing the neopharynx during and after a swallow, with regurgitation of undigested material, should alert the clinician to this possibility. Experience with 3 postlaryngectomy patients with anterior neopharyngeal divericulae serve as the springboard for discussion of the clinical spectrum, radiologic features, contributory pathophysiologic factors, and therapeutic options concerning this condition. Surgical indications, approaches, and potential hazards are reviewed.
Development of surgical quality‐control mechanisms in large‐scale prospective trials: Head and neck intergroup report
Authors: Jacobs John R. , Pajak Thomas F. , Weymuller Ernest , Sessions Donald , Schuller David E.
Published: February 2007

One of the current national prospective clinical trials of the Head and Neck Intergroup explores the usage of chemotherapy in advanced operable head and neck cancer patients. The experimental arm consists of the addition of 3 courses of cisplatin‐containing chemotherapy to standard treatment defined as surgery followed by postoperative radiotherapy. In the design of the study it is necessary to define not only the extent of the surgery performed for each eligible lesion, but also to insure uniformity of surgery performed between surgeons and institutions. This will hopefully insure that any variation between the 2 arms of the study represent the effect of the chemotherapy. The procedure to obtain and confirm uniformity of surgery is multifaceted. It is, however, fundamentally based upon the current TNM staging system and therefore has intrinsic limitations.
Modifications of the mandibular swing for preservation of occlusion and function
Authors: Clayman Gary L. , Adams George L.
Published: February 2007

The mandibular swing, or midline mandibular osteotomy with lateral mandibular displacement, provides excellent exposure equivalent to that obtained by composite resections of the mandible while minimizing cosmetic and functional disability and reducing the complexity of reconstruction. This procedure is most commonly described from an oncologic standpoint. Modifications of this procedure, performed on patients with adequate anterior mandibular height, provide access to lesions of the skull base, as well as benign lesions of the parapharyngeal space. Minor modifications of the midline mandibular osteotomy, as well as preservation of anterior mandibular dentition, provide these patients with immediate restitution of interocclusal anatomy and function.
Cranial nerve injuries following carotid endarterectomy: An analysis of 336 procedures
Authors: Maniglia Anthony J. , Han D. Peter
Published: February 2007

Cranial nerve injuries may result from carotid endarterectomy. From January 1984 to December 1987, a total of 336 carotid endarterectomies were performed at University Hospitals of Cleveland and Cleveland Veterans Administration Hospital. Forty‐five cranial nerve injuries were documented (13.5%). Twenty patients (6%) had documented unilateral vocal cord paralysis, 16 (4.8%) had hypoglossal injuries, 8 (2.4%) had facial nerve paresis, and 1 (0.3%) had an injury to the spinal accessory nerve. Although most injuries were due to either retraction or edema of cranial nerves, long‐term follow‐up regarding recovery of function is very important. We feel that proper clinical evaluation of these patients should be routinely done preoperatively in order to document possible preexisting cranial nerve deficits. Postoperatively, if symptoms of possible cranial nerve abnormalities occur, these patients should have a thorough head and neck evaluation in order to identify possible lesions and institute further treatment to improve their quality of life.
Characterization, quantification, and potential clinical value of the epidermal growth factor receptor in head and neck squamous cell carcinomas
Authors: Santini José , Formento Jean‐Louis , Francoual Mireille , Milano Gérard , Schneider Maurice , Dassonville Olivier , Demard François
Published: February 2007

Epidermal growth factor (EGF) stimulates the growth of several types of epithelial tissues and possesses a strong mitogenic activity that is mediated through its cell surface receptor (EGFR). The aim of this study was to characterize EGFR and measure its levels in head and neck tumors biopsies (70 patients); use of a simplified competition technique with a radiolabeled ligand allowed evaluation of functional EGFR. Five samples (4 tumors and 1 control) were used to characterize EGF binding. Graphic representation identified a single family of binding sites. Kd values revealed high affinity for EGF binding: mean Kd, 0.156/pm 0.108 nM (0.095‐0.347 nM). EGF‐binding characteristics (Kd) were similar in nontumoral tissue samples (controls) and in tumor material. In 59 of 60 cases, EGFR levels were higher in the tumor than in the corresponding controls. A significant correlation was found between EGFR levels and tumor size and stage. Controls exhibited a trend toward higher EGFR levels in elevated sizes and stages. According to a cutoff EGFR value of 100 fmol/mg protein, which separated all controls from tumors, EGFR‐positive tumors (>100 fmol/mg protein) had a greater probability of complete response to chemotherapy than EGFR‐negative tumors; other tumor characteristics, such as the degree of tumoral differentiation, tumor size, or stage, were unable to operate such a discrimination in the response to chemotherapy. EGFR may thus be an interesting biological marker for head and neck cancer.
Scintigraphic localization of ectopic parathyroid lesions with thallium‐201
Authors: Moisa Idel I. , Silver Carl E.
Published: February 2007

Six consecutive patients with ectopic parathyroid lesions were studied by preoperative thallium‐technetium scintigraphy. Ectopic lesions were accurately localized in 5 of 6 patients. Four of five lesions deep in the superior mediastinum, and 1 in the superior carotid sheath, were correctly identified. Ectopic lesions in 4 of 5 patients, who had previously undergone unsuccessful exploration, were correctly localized. In 1 previously unoperated patient, a mediastinal lesion was identified by preoperative scintigraphy. In 2 patients, deep mediastinal exploration via manubriotomy was successfully conducted without confirmation by “invasive” intravascular procedures. There were no false‐positive studies. Lesions identified weighed from 185 mg to 9 g and were from 1.1 to 3.0 cm in size. Scintigraphy is particularly effective for demonstration of ectopic parathyroid tissue, because the absence of thyroid tissue in the mediastinum or superior cervical region permits appreciation of areas of abnormal thallium uptake unobscured by uptake in adjacent thyroid tissue. We conclude that ectopic parathyroid tissue may be accurately identified by thallium‐technetium scintigraphy without confirmation by invasive intravascular studies.
New approach to the nasopharynx: The maxillary swing approach
Authors: Wei William L. , Lam Kam H. , Sham Jonathan S. T.
Published: February 2007

A new approach to expose the nasopharynx and the parana sopharyngeal space is described. The maxilla, severed from its bony connections, is swung laterally to provide exposure of the nasopharynx. Tumors in the nasopharynx and the paranasopha ryngeal space can be adequately resected and tubings for after loading brachytherapy can be positioned accurately during surgery. The blood supply of the maxilla is from the attached cheek flap and masseter muscle. Three illustrative cases are presented. The wounds in all of them healed primarily with minimal morbidity. The only disadvantage is the development of mild trismus, which responded to conservative treatment.
Variables predicting oral mucosal lesions in allogenic bone marrow recipients
Authors: Mattsson Torsten , Heimdahl Anders , Dahllof Goran , Nilsson Bo , Lonnqvist Berit , Ringdén Olle
Published: February 2007

One hundred and forty‐eight (72%) of 205 allogenic bone marrow transplant recipients developed mucosal lesions in the oral cavity during the aplastic period after transplantation. Lesions were most frequent 8 to 9 days after transplantation. Factors that correlated with the development of mucosal lesions after univariate and multivariate analysis were a marrow cell dose of < 3 × 108cells/kg body weight, (p< 0.0001), prolonged aplastic period (white blood cell count < 0.2 × 109) cell/l during more than 14 days (p< 0.005), herpes simplex virus‐1 seropositivity of the recipient (p< 0.01), and conditioning with total body irradiation (p< 0.02).
Branchial cleft cyst manifesting as hypoglossal nerve palsy
Authors: Gatot Albert , Tovi Ferit , Fliss Dan M. , Yanai‐Inbar Ilana
Published: February 2007

Hypoglossal nerve palsy occurred in 2 patients with infected second branchial arch cleft cyst. This very unusual complication of the congenital anomaly has been related to the mechanical compression of the mass. Histologic features of the perineural coat were also suggestive for this etio‐pathogenesis.
Fundamentals of expanded tissue
Authors: Baker Shan R.
Published: February 2007

The relatively recent advent of tissue expansion for medical purposes precludes the availability of extensive knowledge concerning the physiologic and histologic changes that occur during controlled expansion of the skin. This paper reviews the basic science and clinical research that has been conducted to investigate the changes and summarizes the findings. It can be concluded that flaps harvested from skin previously expanded have an improved survival rate compared to similar flaps developed in nonexpanded skin. Increased vascularity to either the skin, the capsule that forms around the expander, or both probably in some way accounts for the improved survival. Controlled expansion of the skin results in the creation of additional new skin at the expense of thinning the dermis and subcutis. This thinning is associated with an overall decrease in tensile strength of the expanded skin. The increase in surface area gained from skin expansion probably varies according to the type of skin expanded and the underlying tissues that serve as a foundation for the expander.
Speech patterns following partial glossectomy for small tumors of the tongue
Authors: Heller Keith S. , Levy Joan , Sciubba James J.
Published: February 2007

To determine the type and extent of speech impairment to be expected following partial glossectomy, pre‐ and postoperative speech evaluations were performed on 10 patients undergoing surgery for carcinomas of the mobile tongue less than 3 cm in size. In addition, audiotapes of standardized speech samples were made at each evaluation. Preoperative speech evaluation revealed normal rates of verbal diadochokinesis without distortion in all 10 patients. Phonologic analysis was also normal in 9 of these patients. Postoperative evaluation revealed normal rates of verbal diadochokinesis in 6 patients and mild lingual distortion in 4. At 3 weeks postoperatively 1 patient had sibilant distortion and 1 patient overall slurring of speech. Evaluation of both of these patients at 6 months revealed that speech had returned to normal. Blinded comparison of the pre‐ and postoperative audiotapes revealed no change in 8 patients. In 2 patients the early postoperative tape was thought to “sound different” but the final postoperative tapes in all patients were judged to be normal. This study demonstrates that partial glossectomy for early carcinomas of the tongue can be performed with minimal, if any, permanent speech impairment.
Increased intracranial pressure as a complication of unilateral radical neck dissection in a patient with congenital absence of the transverse sinus
Authors: Lydiatt Daniel D. , Ogren Frederic P. , Lydiatt William M. , Hahn Francis J.
Published: February 2007

We report a patient with increased intracranial pressure occurring after unilateral neck dissection. Subsequent vascular studies reveal a hypoplastic contralateral transverse sinus drainage and occlusion of the ipsilateral jugular bulb. We review the literature on the etiology of this vascular malformation and conclude that vascular anomalies of the venous drainage of the head be considered whenever postoperative signs of increased intracranial pressure occur after unilateral radical neck dissection.
Nodular fasciitis of the oral mucosa: Light and electron microscopy study
Authors: Bodner Lipa , Dayan Dan
Published: February 2007

Nodular fasciitis of the oral mucosa is a rare lesion. The present article describes an additional case and discusses the difficulties in the histologic diagnosis. The final diagnosis is based on immunohistochemistry and electron microscopic morphology. Nodular fasciitis should be considered in the differential diagnosis of swellings in the oral mucosa.
T‐tube modification to decrease the risk of plugging
Authors: Gatot Albert , Tovi Ferit , Fliss Dan M.
Published: February 2007

Laryngotracheal stenosis is a recognized complication of local injuries, such as prolonged intubation. Surgical reconstruction with the use of a tracheal T‐tube is widely recommended. We report a serious complication consisting of the sudden obstruction of the T‐tube by viscous secretions. In order to prevent this undesirable consequence, a simple modification of the T‐tube technique is proposed.
Laryngeal precancer: A review of the literature, commentary, and comparison with oral leukoplakia
Authors: Bouquot Jerry E. , Gnepp Douglas R.
Published: February 2007

Laryngeal keratosis (LK) is a precancerous mucosal change with great similarity to oral leukoplakia. Its malignant transformation rate varies from 1% to 40%, with the highest rates being found in patients microscopically diagnosed as “keratosis with atypia” (KWA). Recent evidence indicates that even cases with only mild or moderate epithelial dysplasias are at increased risk for malignant transformation, with the highest rates occurring in patients with more severe dysplasia or carcinoma in situ. Approximately 81% of LK patients are men and the average age at diagnosis is 50 years, a decade younger than that for laryngeal carcinoma patients. A high proportion of LK patients are tobacco smokers (84%) and alcohol abusers (at least 35%). LK is almost always found on the true vocal cords and is usually bilateral (67%). Clinical signs of high risk include, in decreasing order of importance: erythroplakia, surface granularity, increased keratin thickness, increased size, recurrence after conservative removal, and long duration. The annual incidence of LK in the United States is 10.2 and 2.1 lesions per 100,000 males and females, respectively.
Oral hairy leukoplakia: Clinical aspects, histologic morphology and differential diagnosis
Authors: Ficarra Giuseppe , Gaglioti Domenico , Di Pietro Massimo , Adler‐Storthz Karen
Published: February 2007

Clinical and histologic morphology of oral hairy leukoplakia in 85 HIV‐positive patients were studied. Differential diagnosis of oral hairy leukoplakia in comparison with the normal lingual and buccal epithelium from both HIV‐positive and HIV‐negative patients, and with other tongue conditions was also examined. Oral hairy leukoplakia lesions were located on the lateral borders of the tongue and showed a corrugated/hairy aspect in the majority of cases. Hyperparakeratosis, hyperplasia/acanthosis, and a papillated epithelial surface were common findings. A parakeratin band and ballooning cells were present in 60% and 99% of the cases, respectively. Some of the histologic features of oral hairy leukoplakia were present in the normal lingual epithelium of both HIV‐negative and HIV‐positive patients as well as in other tongue conditions. Thus, many histologic features of oral hairy leukoplakia appear not to be specific.
Benign cystic vs. solid lesions of the parotid gland in HIV patients
Authors: Huang Robert D. , Pearlman Steven , Friedman Willliam H. , Loree Thomas
Published: February 2007

In this study of 13 patients with cystic lesions of the parotid gland, 9 patients were known to be antibody positive for the human immunodeficiency virus (HIV) and 4 were subsequently tested to be positive. All patients had computed tomographic (CT) confirmation of parotid gland cysts. Five patients had fluid aspirates showing high amylase levels. All cystic lesions had lymphoepithelial features and lymphoid histology similar to those seen in HIV infection. This study includes a review of 148 HIV patients reported in the literature, as well as our experience. Of all the reported cases, when gross pathology suggested cystic lesions, the incidence of malignancy was close to 1%. The incidence of malignancy for a solid mass, however, was close to 40%. We propose a nonsurgical management protocol which includes CT scan and needle aspiration with tissue for cytology and fluid for amylase level if possible. Watchful observation is advised for cystic pathology.
Parapharyngeal soft‐tissue infection with Aeromonas hydrophila
Authors: Wells Rebecca G. , Chertow Glenn M. , Marcantonio Edward R.
Published: February 2007

Parapharyngeal soft tissue infections may be rapidly progressive and life‐threatening. Prompt institution of appropriate antimicrobial therapy is of paramount importance. This report highlights the potential virulence of Aeromonas hydrophila in infection of the head and neck and the need to consider this organism in selected patients.
Sphenoid mucocele with intracranial invasion secondary to nasopharyngeal acinic cell carcinoma
Authors: Nicolai Piero , de Zinis Luca O. Redaelli , Tomenzoli Davide , Maroldi Roberto , Antonelli Antonino R.
Published: February 2007

We present a case of sphenoid mucocele with large invasion of the middle cranial fossa, secondary to a nasopharyngeal acinic cell carcinoma, occurring in a 52‐year‐old man. To the best of our knowledge, this association has not been reported so far. We discuss the importance of imaging techniques in delineating the relationship between the two lesions, as long as the clinical and therapeutic problems related both to sphenoid mucocele and acinic cell carcinoma.
Sensitivity of biopsy using local anesthesia in detecting nasopharyngeal carcinoma
Authors: Waldron John , Andrew Hasselt C. Van , Wong Raymond K. Y.
Published: February 2007

Flexible and rigid endoscopes allow good visualization of the nasopharynx using local anesthesia, and permit biopsies to be taken under direct vision. Little information is available on the accuracy of biopsies taken using local anesthesia, and general anesthesia is usually recommended for evaluation and biopsy of the nasopharynx to avoid missing small or submucosal lesions. We report the results from 260 patients biopsied using local anesthesia (188) and general anesthesia (72). All biopsies were taken using large nasal biopsy forceps under direct vision. The sensitivity of this technique in diagnosing nasopharyngeal carcinoma was 95.1% using local anesthesia and 95.6% using general anesthesia. We suggest that general anesthesia is rarely necessary for definitive biopsy of the nasopharynx. In the majority of patients, an accurate diagnosis can be obtained using large biopsy forceps under direct vision using local anesthesia.
Optimal administration schedules of the newly synthesized platinum analog nk121 and bleomycin analog nk313 in nude mice with squamous cell carcinoma
Authors: Kanazawa Harusachi , Yokoe Hideki , Takahashi Kikuo , Sato Kenichi
Published: February 2007

To determine the optimal administration schedules of the newly synthesized, less nephrotoxic platinum analog NK121 and less pneumotoxic bleomycin analog NK313, the antitumor effects of 2 different injection schedules, (1) single injections on days 1, 5, and 9, (2) continuous infusion for 7 days, were compared in nude mice bearing human squamous cell carcinoma. Tumor growth delay was employed as the experimental endpoint of antitumor activity. Body weight and hematologic changes in the mice were also investigated as indications of drug toxicity after the combination treatment of NK121 and NK313. The antitumor effects of the 2 analogs indicated higher responses with the single injections of NK121 and continuous infusion of NK313. In combination chemotherapy with NK121 and NK313, the highest antitumor effect was observed when mice were given NK121 by single injections followed by NK313 by continuous infusion. This sequence was also less toxic than a simultaneous treatment schedule, which was of weak clinical significance because of its low antitumor activity, severe weight loss, slight myelosuppression, and renal toxicity.
Muscle tumors in the parapharyngeal space
Authors: Freije James E. , Gluckman Jack L. , Biddinger Paul W. , Wiot Geoffrey
Published: February 2007

Tumors arising in the parapharyngeal space are rare. Even more rare are those which originate from the pharyngeal and parapharyngeal musculature. Three examples of muscle tumors presenting as paraphyarngeal masses are reported, ie, a rhabdomyoma, rhabdomyosarcoma, and a leiomyosarcoma, and the literature pertaining to these tumors is reviewed. To the best of our knowledge, this represents the first case of a parapharyngeal leiomyosarcoma reported in the literature.
Molecular biology: The polymerase chain reaction
Authors: Lee Norris K.
Published: February 2007

Upper aerodigestive tract (UADT) cancers provide an excellent carcinogenesis model for a number of reasons: they are accessible to observation, are usually associated with a known environmental carcinogen (tobacco by‐products), are sometimes associated with a tumorigenic DNA virus (HPV), and fall along a spectrum of progressive disease from normal mucosa through leukoplakia and verrucous carcinoma to invasive and metastatic carcinoma. Despite the presence of this unique model, the field of head and neck oncology, as a whole, has been slow in establishing an efficient 2‐way conduit between the bedside and the laboratory. Such open communication is important as current evidence suggests that future staging and therapy of head and neck tumors will depend not only on familiar macroscopic and light microscopic criteria, but also on factors that are currently identifiable only in the basic science laboratory. To have a significant impact on the direction and relevance of basic research, clinicians should become knowledgeable and conversant in the vocabulary and general concepts of basic science. The goal of this section is to facilitate communication between the basic researcher and the clinician, thereby promoting clinically relevant basic research. This is to be achieved by fostering understanding of the power, limitations, scope, and horizons of current basic research concepts and techniques. Subsequent articles will review current research topics germane to head and neck cancer, such as oncogenes and tumor suppressor genes, mechanisms of metastasis, tumor immunology and its modulation, and virology.—NKL.
Pediatric functional endonasal sinus surgery: Review of 210 cases
Authors: Lazar Rande H. , Younis Ramzi T. , Gross Charles W.
Published: February 2007

Functional endonasal sinus surgery (FESS) is an effective treatment for chronic or recurrent sinusitis in children, most of whom have failed more conservative medical treatment. The endoscopes used in FESS allow direct visualization of the diseased tissue and restoration of physiologic mucociliary clearance, enabling the sinus mucosa to return to its normal condition after the procedure. For a period of 3 to 36 months, we followed the recovery of 210 children who underwent FESS between 1986 and 1989. The age range of the children at the time of the procedure was 14 months to 16 years. Eighty percent of these patients had improvement of their sinusitis. There were no major complications. Eight percent of the 210 children needed revision surgery. Pediatric FESS is a two‐stage operation requiring follow‐up nasal cleaning under general anesthesia. The most common findings during the second‐stage endoscopy were adhesions and granulation formation.
Histomorphometric analysis of intraoral split‐thickness skin grafts
Authors: Petruzzelli Guy J. , Johnson Jonas T. , Myers Eugene N. , Kline Janet M.
Published: February 2007

Transposition of split‐thickness skin grafts from the anterior thigh to the oral cavity is an ideal method for reconstruction of selected defects following major oncologic ablative surgery. This alternative potentially allows for tongue mobility, deglutition, and articulation superior to that obtained with bulky adynamic myocutaneous flaps. We have examined the adaptive responses of split‐thickness skin grafts to the intraoral environment with biopsies from 10 patients 11 to 90 months following oral cavity reconstruction. Histologic examination of intraoral skin grafts shows preservation of the cytoarchitecture of the epidermis, an absence or atrophy of skin appendages, and a statistically significant thinning of the keratin layer. A “junctional zone” between the normal oral cavity mucosa and the skin graft was identified. This zone is characterized by an abrupt transition from keratinized stratified squamous epithelium with a prominent granular layer, to nonkeratinized stratified squamous epithelium lacking a granular layer. This study clearly demonstrates that split‐thickness skin, when transposed to the oral cavity, maintains the epidermal phenotype and does not assume the histologic characteristics of mucsoa.
Leiomyoblastoma of the larynx: Report of a case
Authors: Mori Hiroshi , Kumoi Takeo , Hashimoto Mitsuhiro , Uematsu Kunio
Published: February 2007

Leiomyomas or benign tumors of smooth muscle origin are extremely rare in the larynx. A review of the literature revealed only 15 confirmed cases of leiomyoma, eight leiomyosarcomas, and no cases of leiomyoblastoma. An unusual case of “bizarre” laryngeal leiomyoma arising from the vocal cord, which is believed to be the first reported case in the literature is presented herein.
Role of modern imaging in decision‐making for elective neck dissection
Authors: Feinmesser Rafael , Freeman Jeremy L. , Feinmesser Meora , Noyek A. , Mullen J. Brendan M.
Published: February 2007

This study examines patterns of early metastatic spread as recorded in 19 clinically negative, histologically positive (occult) neck dissection specimens. Microscopic metastatic deposits were detected in this study in nodes measuring 10 mm and less. No nodes with extension of tumor beyond the capsule and into adjacent structures were noted. Central necrosis was detected in only one node. We suggest that the first stages of metastatic disase as evaluated by the pathologist in clinically occult nodes are minimal and may easily evade the eyes of both pathologists and radiologists. Imaging proved to be efficacious in upstaging clinically occutt necks that were previously irradiated.
Electron beam therapy for skin cancer of the head and neck
Authors: Zablow Andrew I. , Eanelli Thomas R. , Sanfilippo Louis J.
Published: February 2007

We retrospectively analyzed 99 patients with 115 sites of skin cancer, predominantly involving the head and neck, treated with electron beam therapy. Our objective was to determine the local control rate, radiotherapy reactions, cosmesis, and salvage treatment. Forty‐three percent of patients received radiotherapy after biopsy, 41% were treated for recurrence following other modalities of treatment, and 16% had positive margins after surgical excision. With minimum and mean follow‐up of 24 and 47 months, respectively, local control was achieved in 88% of patients. Six of 14 local recurrences were salvaged by surgery (five patients) and radiotherapy (one patient) for a total local control of 93%. Serial photographs and data were available to analyze cosmesis in 56 patients. Excellent or good cosmesis was achieved in 91%. Side effects were mild and self‐limiting. EBT is highly efficacious and offers excellent cosmesis.
Psychosocial adjustment of patients surgically treated for head and neck cancer
Authors: Gamba Alessio , Romano Maria , Grosso Llaria M. , Tamburini Marcello , Cantú Giulio , Molinari Roberto , Ventafridda Vittorio
Published: February 2007

Sixty‐six patients, surgically treated for head and neck cancer and free of disease, were interviewed at the outpatient clinic from 6 months to 8 years after surgery. The patients were divided by the physician into two groups, according to the patients' degree of disfigurement, i.e., minor (24 patients, 36%, minor disfigurement group = MDG) or extensive (42 patients, 64%, extensive disfigurement group = EDG). Subsequently, the patients were interviewed with close‐ended questions. The following subjective aspects were assessed: self‐image; relationship with the partner, family, and friends; and the overall impact of the therapy. The results of the study showed a significantly higher impact in the EDG versus the MDG as regards a changed self‐image (57% vs 25%, P < 0.05), a worsened relationship with the partner (27% vs 0%, P < 0.05), a reduced sexuality (74% vs 39%, P < 0.01), and an increased social isolation (36% vs 12%, P < 0.05). On the whole, 18% of the subjects stated that the disadvantages of therapy outweighed the advantages, and 30% felt that the difficulties encountered were “too harsh.” In such cases, the opportunity of setting up a rehabilitation program offering psychosocial support should be considered.
Inflammatory pseudotumor of the parapharyngeal space: Case report and review of the literature
Authors: Hytiroglou Prodromos , Brandwein Margaret S. , Strauchen James A. , Mirante Joseph P. , Urken Mark L. , Biller Hugh F.
Published: February 2007

Inflammatory pseudotumor of the upper airway is an uncommon lesion of unknown etiology, clinically mimicking a neoplastic process. We document a case of inflammatory pseudotumor of the parapharyngeal space, occurring in a patient with history of cocaine abuse. Corticosteroid treatment was successful in reducing the symptoms. The difficulties in establishing this clinicopathologic diagnosis are discussed and the pertinent literature is reviewed.