bluuebunny/crossref_metadata_2025 huggingface dataset:
The pathology of head and neck tumors: Fibroadipose tissue and skeletal muscle, part 8
Authors: Batsakis John G. , Regezi Joseph A. , Rice Dale H.
Published: February 2007

Benign and malignant tumors originating from mesenchymal cells destined to become lipoblasts and myoblasts affect the head and neck with contrasting frequencies. Lipomas and especially liposarcomas are unusual lesions above the clavicles but when found there behave in a biologic manner identical to that of their counter‐parts at other anatomic sites. Myogenic tumors, on the other hand, have a predilection for the head and neck, and for rhabdomyosarcomas this predilection is accentuated in childhood. Combination therapy of rhabdomyosarcomas has obviated radical surgery as a method of treatment, and many sites in the head and neck have benefited prognostically by this treatment. Success, however, is dependent on clinical stage of disease, and rhabdomyosarcomas of the nasopharynx, paranasal sinuses, and middle ear remain more resistant to short‐term cures because of the extent of the neoplasm. A review of the clinicopathologic aspects of granular‐cell tumors and alveolar soft‐part sarcomas is also presented because it has been suggested that these tumors have a myogenous origin.
The abnormal temporal bone in the “normal” deaf
Authors: Unger June M. , Shaffer Katherine A.
Published: February 2007

This study is concerned with the incidence and type of temporal bone anomalies that might be present in persons who, apart from their deafness, are normal. It also attempts to correlate demonstrated abnormalities with the etiology of deafness. Review of the results will permit a reassessment of the value of roentgenographic studies in the routine evaluation of deaf children. One hundred and four deaf students, 3 to 21 years of age, were studied by physical examination, audiometry, and temporal bone tomography. A pertinent history was requested, and appropriate medical records were obtained. Roentgenographically demonstrable abnormalities of the temporal bones were present in 19 students (18%) or 28 temporal bones (13%). Meningitis was the only entity to which a specific pathologic change could be ascribed. The number of abnormalities found in this population was significant and should re‐emphasize the importance of temporal bone tomography in the total evaluation of deaf children.
Pitfalls in posterior fossa myelography
Authors: Johnson Dexter W.
Published: February 2007

Positive‐contrast myelography of the structures of the posterior fossa is an established and useful technique of examination. The problems peculiar to this method of examination include premyelographic evaluation, identifying pre‐existing posttraumatic change and extreme anatomic variations, handling the anxieties of the patient, transporting the opaque bolus from the site of introduction to the area of interest, adequate film documentation of the normal or pathologic state, and postmyelogram headache. A discussion of ways to anticipate and eliminate or minimize the problems is presented.
Therapeutic aspects of maxillonasal dysostosis (binder syndrome)
Authors: Tessier P. , Tulasne J. F. , Delaire J. , Resche F.
Published: February 2007

Treatment of maxillonasal dysostosis (Binder syndrome) varies according to the age of the patient. In the newborn, respiratory and alimentary problems resulting from the anomaly may necessitate the insertion of endonasal and gastric tubes. In children, occlusal problems and orofacial dysfunctions caused by maxillonasal dysostosis should be treated as soon as possible with an orthodontic mask. Once a patient reaches adulthood, surgery may be performed. If orthodontic treatment has been successful and there is normal occlusion, the surgery may consist simply of placing the muscles of the nose and upper lip in normal anatomic position. If occlusion is abnormal, osteotomy may be performed.
Management of thyroid nodules. I: History and physical examination, blood tests, x‐ray tests, and ultrasonography
Authors: Ashcraft Michael W. , Van Herle Andre J.
Published: February 2007

The approach to the management of the thyroid nodule remains controversial. Confusion exists because virtually any thyroidal disease can present as a clinically solitary nodule which means there is no uniformity regarding natural history, incidence, prevalence, epidemiology, and patho‐physiology. The variety of definitions of thyroid nodules and thyroid carcinoma and the different modes of study selection and individual bias add to the confusion. Diagnostic approaches have not yielded a completely reliable technique to differentiate benign from malignant thyroidal disease. A history of neck irradiation or cervical lymphadenopathy significantly increases the chance of thyroid malignancy, but other parameters of the history or physical examination as well as blood tests are unreliable. Ultrasound displays anatomic but not histologic features. X‐ray techniques (plain films, computed tomographic scans, xeroradiography, chest x‐ray, barium swallow, lymphography, and angiography) have been used to visualize thyroid nodules, with some techniques proving more useful than others.
The pathology of head and neck tumors: Vasoformative tumors, part 9A
Authors: Batsakis John G. , Rice Dale H.
Published: February 2007

Tumors originating from components of the vascular system vary widely in the degree of morbidity and mortality that they incur. They all have endothelial cells as integral components of their histologic appearance. Vasoformative tumors include hemangiomas, lymphangiomas, and pyogenic granulomas, which are relatively common, and hemangiopericytomas, glomus tumors, and angiosarcomas, which are relatively uncommon. For many vasoformative tumors, including lymphogenous lesions, the head and neck is an area of predilection, and, in some instances, location in the head and neck appears to modify biologic activity.
Benign symmetrical lipomatosis (madelung's disease)
Authors: Argenta Louis C. , McClatchey Kenneth D. , Ferrell William J. , Newman M. Haskell
Published: February 2007

Two patients with benign symmetrical lipomatosis (Madelung's disease) have been followed for 7 and 9 years. Despite extensive surgical procedures, both patients have developed multiple recurrences. Lipomas and normal adipose tissue from the same patients were compared using chromatographic techniques. The lipomas contained significantly increased triglyceride fractions. Conservative surgical debulking is the recommended treatment.
The pathology of head and neck tumors: Vasoformative tumors, part 9B
Authors: Batsakis John G. , Rice Dale H.
Published: February 2007

There are three principal malignant vasoformative tumors that can be found in the head and neck—hemangiopericytoma, angiosarcoma, and Kaposi's sarcoma. All are uncommon and provide challenges for the pathologist and the therapist both. The histogenesis of each tumor is different. Kaposi's sarcoma has many features which suggest that it is an altered immune‐response disease. Angiosarcoma is a malignancy of endothelium. Hemangiopericytoma is a tumor whose cell of origin is considered to be the perithelial pericyte. The general prognosis for patients with Kaposi's sarcoma is good. The biologic course of a hemangiopericytoma is variable and unpredictable, but there appears to be a site dependency. Angiosarcomas, particularly high grade lesions, are resistant to therapy.
Mediastinitis and bilateral pyopneumothorax complicating a parapharyngeal abscess
Authors: Eliachar Isaac , Peleg Haran , Joachims Henry Z.
Published: February 2007

A 38‐year‐old male suffered from mediastinitis, pericarditis, and bilateral sudden pyopneumothorax as a complication of a parapharyngeal abscess that ruptured into the hypopharynx. The full diagnosis remained obscure until the complete clinical picture evolved. Antibiotics and pleural and cervical drainage failed to alleviate the symptoms. Recovery commenced only after tamponade of the retropharyngeal space, which terminated the flow of air and saliva from the neck to the thorax. The anatomic relation of the spaces concerned are discussed, as well as the therapeutic and surgical approaches. The importance of the retropharyngeal space, which may serve as a conduit between the neck and the mediastinum, is pointed out.
The pathology of head and neck tumors: Carcinoma of the nasopharynx, part 11
Authors: Batsakis John G. , Solomon Alvin R. , Rice Dale H.
Published: February 2007

The past decade has witnessed extraordinary advances in the epidemiology, virology, and immunology of carcinomas of the nasopharynx. There has not been a parallel growth in the study of morphologic expressions of the neoplasms. In great part, this has been due to a lack of a universally accepted histologic classification. As a consequence, correlation between histology and other factors relating to the pathogenesis of these neoplasms has been impeded. The World Health Organization (WHO) has proposed a histologic classification of nasopharyngeal carcinomas as squamous‐cell, nonkeratinizing, and undifferentiated. This report presents an argument in favor of using the WHO classification and a hypothesis relating to the histogenesis of the 3 types of nasopharyngeal carcinoma.
Reconstruction of the trachea after resection for neoplasm
Authors: Grillo Hermes C.
Published: February 2007

Sixty‐three patients with primary tracheal tumors were seen in a 15‐year period. The most common lesion was squamous‐cell carcinoma, the next most common lesion was adenoid cystic carcinoma, and the remaining lesions were a variety of malignant and benign lesions. There were 3 carcinoid tumors in the group. Twenty‐four cylindrical resections of the trachea, 2 lateral resections of the trachea, and 10 carinal reconstructions were performed. The balance of the patients seen in this period of time were not amenable to single‐stage reconstruction and were managed by staged procedures, by irradiation, or by no treatment at all. Twenty‐eight of the patients in the group with resections had primary tumors and 8 had secondary tumors. Secondary tumors included carcinoma of the thyroid, carcinoma of the esophagus, and recurrent carcinoid tumor in the left main bronchus. Although the numbers in any group are small and the period of follow‐up not very long, indications are that surgical removal of squamous‐cell carcinoma and adenoid cystic carcinoma of the trachea, usually with adjunctive irradiation, provides good palliation or the possibility of cure. Resection of benign primary tumors and low‐grade malignant tumors resulted in excellent palliation and usually cure. Resection of selected secondary tumors did not offer much prospect for cure but did provide long‐term palliation.
A method for combined dacryocystorhinostomy with external ethmoidectomy
Authors: Wilson William R. , Grove Arthur S.
Published: February 2007

Severe polypoid rhinosinusitis requiring external ethmoid surgery may be seen in conjunction with partial or complete nasolacrimal obstruction. When this obstruction is associated with persistent, unresolved lacrimal symptoms, it is sometimes appropriate to combine surgical procedures, thereby avoiding separate lacrimal surgery. A method combining dacryocystorhinostomy (DCR) with external ethmoidectomy is described. The anatomy involved in this procedure and the indications for it are discussed.
Reconstruction of the laryngotracheal complex in children using the sternocleidomastoid myocutaneous flap
Authors: Eliachar I. , Moscona A. R.
Published: February 2007

Laryngotracheal stenosis in children should be treated effectively with minimal delay, and the tracheostomy should be closed within a reasonable period after surgery so that the child may develop normal speech and language. Successful reconstruction of the laryngotracheal complex was achieved by applying the superiorly based compound myocutaneous sternocleidomastoid muscle flap for wedge enhancement and resurfacing of the endolaryngeal and endotracheal lumen. A short stenting period, incorporating a custom‐carved soft silicone laryngeal stent in direct continuity with an oversized silicone T‐tube, helped in stabilizing the airway and ensuring good take of the flap. Postoperative recovery was relatively short, with good ventilation and vocal results. This single‐stage technique may be readily performed, and it interferes minimally with the child's development.
Intraneural and perineural epithelial structures
Authors: Wysocki George P. , Wright Bruce A.
Published: February 2007

The fact that numerous embryologic epithelial remnants are a normal occurrence in the oral region is well known. That some of these epithelial remnants occur within peripheral nerves is less well known. This study presents examples of intraneural epithelial rests from 3 different anatomic sites: the soft tissues of the jaws (a juxtaoral organ of Chievitz), the posterior maxilla (an odontogenic rest), and the anterior maxilla (a nasopalatine duct remnant). The purpose of this paper is to draw the attention of surgical pathologists to this phenomenon in the head and neck in order to avoid extensive unnecessary surgery.
The management of carcinoma of the nasal vestibule
Authors: Kagan A. Robert , Nussbaum Herman , Rao A. , Chan P. , Gilbert H. , Hintz B. , Ryoo M. , Miles J. , Rice D.
Published: February 2007

Forty‐two patients with squamous cell carcinoma of the nasal vestibule were reviewed. The patients were treated at either the Southern California Permanente Medical Group or the UCLA Medical Center. Thirty‐eight patients (90%) had early lesions and 4 (10%) had late disease (involving the nodes or bone). The following conclusions were formed from this study: (1) Patients without bone destruction or lymph node metastases will do well with either irradiation or surgery. Those with bone destruction or lymph node metastases will do poorly in spite of radical treatment. (2) Early lesions can often be cured with either partial rhinectomy or irradiation. (3) A surgical recurrence following partial rhinectomy can be salvaged with irradiation. (4) A radiation recurrence of an early lesion can be salvaged with surgery. (5) The routine use of total rhinectomy for early carcinoma or radiation failure is unwarranted. (6) Other primary cancers are not uncommon when followup is extended to the 5‐ to 10‐year interval.
Head and neck neoplasia following irradiation for benign conditions
Authors: Scanlon Edward F. , Sener Stephen F.
Published: February 2007

A retrospective review of 143 patients with head or neck tumors who had received radiation therapy in the head and neck area for benign conditions during childhood or adolescence was conducted. This included an analysis of 1,080 patients from the Evanston Hospital Irradiated Thyroid Evaluation Clinic, which was established to define the relationship between irradiation and the subsequent development of thyroid neoplasia. The data support the following concepts of irradiation‐induced neoplasia: (1) The thyroid, parathyroid, and salivary glands can develop benign and malignant changes after irradiation for benign conditions, with latent periods averaging about 30 years; (2) Once a glandular abnormality within the irradiated field appears, the risk of other glands in the field developing neoplastic changes is significantly increased.
Florid dermal cylindroma (turban tumor)
Authors: Fabian Richard L. , Shugar Martin A.
Published: February 2007

A florid case of dermal cylindroma is presented as representative of the natural history and usual clinical findings in a patient afflicted by this tumorous growth. Although histologically and clinically benign, dermal cylindroma can result in considerable disfigurement of the patient. Treatment varies from isolated primary resection to serial resections with subsequent electrocautery or cryosurgery for small recurrences. Total scalping with skin grafting is reserved for only the most severe cases where normal integument has been completely involved by the disease process.
Recent advances in radiation therapy of head and neck cancer
Authors: Seagren Stephen L.
Published: February 2007

The major advances in radiation oncology in this century was the development of megavoltage radiation in the 1950s, which greatly expanded the clinical utility of ionizing radiation in the treatment of many forms of cancer, including cancers of the head and neck. The combination of radiation and surgery for improved control of local and regional cancers followed. The use of interstitial implant therapy is growing rapidly because of new materials and techniques, thus expanding the radio‐therapeutic options available to the oncologist. Investigations into several other therapeutic modalities currently are being carried out. These modalities include the use of particle radiation, oxygen‐mimicking drugs, and hyperthermia, primarily in efforts to overcome the need for the oxygen effect in tumors. New uses of chemotherapy in combination with radiation also are being explored. Details of these activities within the field of radiation oncology are discussed.
Recent advances in facial nerve surgery
Authors: Crumley Roger L.
Published: February 2007

A review of the recent literature on surgery of the facial nerve is presented. Developments in the treatment of hemifacial spasm, nerve grafting, reanimation surgery, and diagnostic testing are described. Reports of facial paralysis following mandibular fractures are included. The roles of brain stem evoked response (BSER) audiometry, electroneuronography, and CT scanning in the evaluation of facial nerve disorders are noted.
Ultrasonography in the preoperative evaluation of neck abscesses
Authors: Kreutzer Erik W. , Jafek Bruce W. , Johnson Michael L. , Zunkel David E.
Published: February 2007

Forty consecutive probable neck abscesses were evaluated prospectively with ultrasonography to determine the necessity and timing of surgical drainage, and the results were correlated with the physical and operative findings. Ultrasonography was found to be superior to physical examination in predicting the presence (or absence) of pus in these cases.
Chondromyxoid fibroma of the jaws
Authors: Thompson Stevan H. , Weathers Dwight R. , Vatral John J.
Published: February 2007

A new case of chondromyxoid fibroma of the jaws is reported, and the current world literature on chondromyxoid fibroma is reviewed. Chondromyxoid fibroma is a rare tumor arising from cartilage‐forming mesenchymal tissue. In the long bones, it has frequently been confused with chondrosarcoma or benign chondroblastoma. When it occurs in the jaws, apparent confusion with myxomas or myxofibromas may result. In the jaws the neoplasm typically occurs in the mandible. Initial symptoms are pain or a slowly growing expansile mass. After evaluation of the natural history of these lesions, a conservative approach to surgical therapy is advocated.
Isolated pericardial metastasis of parotid tumor origin
Authors: Sulkes Aaron , Weshler Zeev , Dolberg Leah , Biran Shoshana
Published: February 2007

Involvement of the heart in cases of parotid tumors has rarely been described and then only in cases where there was widespread metastatic disease. We report here the case of a patient with a pleomorphic‐type adenocarcinoma arising from a parotid gland, in which the patient developed a malignant pericardial effusion as the first and only evidence of distant metastasis. The effusion resolved following radiation therapy (4,000 rad) to the pericardial area, and the patient was alive and disease‐free one year after the diagnosis of pericardial metastasis was established. The literature on the metastatic spread of malignant parotid tumors with particular emphasis on cardiac dissemination is reviewed.
The role of the free jejunal graft in reconstruction of the pharynx and cervical esophagus
Authors: Gluckman Jack L. , McDonough John , Donegan J. Oliver
Published: February 2007

Reconstruction of the pharynx and cervical esophagus presents a formidable problem for the head and neck surgeon. The use of a free jejunal graft offers a reliable and effective means of performing this reconstruction. Experience with 17 cases forms the basis of this report, which emphasizes technique and complications.
Reconstruction of the columella with nasolabial flaps
Authors: Nicolai J. P. A.
Published: February 2007

A one‐stage operation is described for reconstruction of large defects of the columella nasi, the lower part of the nasal septum, and the vestibular floors. Nasolabial flaps are transposed on a cranial, de‐epithelialized pedicle, and passed deep to the nostrils into the vestibular cavity. The method is illustrated with four case reports.
The pathology of head and neck tumors: Mucosal melanomas, part 13
Authors: Batsakis John G. , Regezi Joseph A. , Solomon Alvin R. , Rice Dale H.
Published: February 2007

Pigmented lesions, including melanomas, of the mucous membranes of the head and neck are far outnumbered by their counterparts in the skin. This relative dearth is partially responsible for the fact that scientific inquiry into mucosal melanomas has not kept pace with the advances in knowledge of the pathogenesis of cutaneous melanomas and their diagnosis and treatment. Integral to these latter advances have been the refinements in clinical and histologic classification and clinicopathologic correlations with quantitative evaluation of melanomas of skin—enhancements that up to now have been singularly lacking for mucosal melanomas. This report acknowledges this slowness in progress, presents recommendations for purifying the nomenclature of pigmented lesions of the mucosae, and at the same time, also notes the poorer prognosis for melanomas of the upper aerodigestive tracts, as a group, when compared with cutaneous melanomas. Only prospective studies will answer the question of whether the poor prognosis is intrinsic to these mucosal melanomas or whether delay in detection and removal are responsible.
Radiation therapy for melanomas of the head and neck
Authors: Harwood Andrew R. , Lawson Victor G.
Published: February 2007

This report reviews experience with radiation therapy in 77 patients with melanoma of the head and neck, a lesion traditionally but incorrectly considered to be radiation‐resistant. Thirteen patients with lentigo malignum and 18 patients with lentigo malignum melanoma have been primarily irradiated. In 11 of the 13 patients, the lentigo malignum has been locally controlled with no recurrence from 6 months to 5 years following treatment. One patient had a local recurrence and was salvaged with further radiation therapy, and one patient had residual tumor after irradiation and was salvaged with simple excision. Seventeen of 18 patients primarily irradiated had lentigo malignum melanomas that have been locally controlled from 6 months to 6 years after irradiation. One patient had a local recurrence and was salvaged by excisional surgery. There have been no deaths from lentigenous melanoma, and the cosmetic results of treatment are excellent. We concluded that radiation therapy is a simple, effective out‐patient treatment for lentigo maligna and lentigo maligna melanoma. Nonlentigenous melanoma was irradiated after incisional biopsy in 6 patients; local control was obtained in 4 patients although 1 died of distant metastases. Fifteen patients were irradiated after excisional biopsy (margins inadequate); 14 of 15 had local control although 6 died of metastases. Only 2 of 16 patients irradiated for recurrent melanoma were controlled. Analysis of local control versus irradiation fraction size revealed that 17/24 (71%) achieved local control with a dose per fraction of greater than 400 rad as compared with 3 of 12 (25%) in those being irradiated with a dose of less than 400 rad per fraction. We concluded that nonlentigenous melanoma is not radiation resistant and that local excision followed by radiation therapy with a large dose per fraction deserves further study, particularly in melanomas of the head and neck where wide local excision is not possible due to age of the patient or location of the tumor. Nine mucosal melanomas have been primarily irradiated and four have been locally controlled.
A technique for preservation of spinal accessory nerve function in radical neck dissection
Authors: Weitz Jean W. , Weitz Stephen L. , McElhinney A. J.
Published: February 2007

A new technique is described that preserves trapezius muscle function in radical neck surgery while cutting that part of the spinal accessory nerve which courses through the sternocleidomastoid muscle. The technique takes advantage of the little‐known fact that, in humans, the trapezius muscle has dual innervation. The C2‐3‐4 motor root is joined to the distal portion of the spinal accessory nerve to give motor function to the trapezius muscle. This procedure will save shoulder mobility in the majority of patients who undergo radical neck dissection. The technique is accomplished rapidly with the use of the gastrointestinal stapler in the scalene fat pad.
Carcinomas of the oral cavity: Analysis of various pretherapeutic classifications
Authors: Platz Helmut , Fries Rudolf , Hudec Marcus , Tjoa A. Min , Wagner Roland R.
Published: February 2007

In a retrospective study of 802 patients with carcinomas of the oral cavity, the most frequently used classifications—AJC 1967, UICC 1973, UICC 1978, and AJC 1978—were analyzed. In this study, the unequivocally defined objective of a classification of malignant tumors, namely, the creation of prognostically homogeneous categories which differ mutually in their prognosis, is not attained by any of the 4 classifications. In several experiments, the possibility of improvements in the T and N categories is demonstrated. In order to achieve a more exact assessment of the prognosis of patients with carcinomas of the oral cavity, however, multidimensional analyses of prognostically relevant factors, with a prognosis index as a goal, are necessary.
Immunodeficiency diseases: Head and neck manifestations
Authors: Harris Jeffrey P. , South Mary Ann
Published: February 2007

Infections of the upper respiratory tract are common to both the immunodeficient and the normal child during their development. The most common head and neck manifestations of immunodeficiency disease are recurrent suppurative otitis media, tonsillitis, sinusitis, rhinitis, and nasopharyngitis. Often the head and neck specialist is confronted with a child with one or more of these problems and must institute the appropriate therapy or decide on an avenue for further investigation. This paper outlines the major immunodeficiency states, discusses the immune defects thought to be responsible for the spectrum of clinical findings, and suggests a systematic approach to the evaluation of these difficult diseases. The recognition of immunodeficient individuals is an important step in their treatment so that adjunctive immunological therapy can be provided.
The importance of the pedicle for the survival of a vascularized free flap: An experimental study on rats
Authors: Fried Marvin P. , Horowitz Zeev , Kelly James H,
Published: February 2007

It has been assumed, but never shown experimentally, that the survival of a free vascularized full‐thickness island flap is based on the vascular pedicle. A study using the rat was designed to assess the three parameters of flap survival: the vascular pedicle, the recipient bed, and the perimeter of the recipient area. Isolation of the pedicle by ligation caused flap necrosis in 18 out of the 20 groin flaps. An intact pedicle, with the other two parameters excluded, led to flap survival in 75% (9 of 12 flaps). Our results indicate that the critical factor to island flap survival in the immediate postoperative period is the vasculature supplying the pedicle. The two other factors are of limited importance.
Treatment of a large hemangioma in the head and neck region
Authors: Smith Arlan R. , Van Urk H. , Vaandrager M. , Van Der Meulen J. C.
Published: February 2007

A 15‐year‐old girl with a large hemangioma in the head and neck region was treated with selective embolization and microvascular reconstructive surgery (using a free latissimus dorsi flap) to cover the defect after total ablative surgery.
The pathology of head and neck tumors: Papillomas of the upper aerodigestive tracts, part 18
Authors: Batsakis John G. , Raymond A. Kevin , Rice Dale H.
Published: February 2007

The human papillomavirus class of DNA viruses are more than circumstantially related to oral and airway papillomas. Whether they are fully oncogenic, in the malignant sense, without other agents is questionable. Recent advances in molecular virology and the use of genus‐specific (common) antigen‐antibody reactions have identified papillomavirus in laryngeal and oral papillomas. Laryngeal and oral papillomas could be precancerous lesions, but they show a low‐risk and long‐time interval leading to malignancy unless significant iatrogenic or host variables—such as radiotherapy or immuno‐incompetence—are added. Two different papillomas in the larynx can be recognized; a nonkeratinizing, papillomavirus‐related lesion, and a keratinizing, usually solitary papilloma, which may or may not be related to a virus genesis and may be equated with a keratosis or clinical leukoplakia.
Closure of perforations of the septum including a single‐session method for large defects
Authors: Meyer Rodolphe , Berghaus Alexander
Published: February 2007

It is the impression of the authors that, although the overall frequency of septal perforations has decreased, the proportion of large defects has increased. Therefore, in addition to the methods for surgical treatment of small perforations, a particular description is given of a new procedure in which an extramucosal technique is used, which permits closure of even large perforations in a single session. Very large defects of more than about 2 cm in diameter can be closed most reliably with a three‐step procedure using a pedicled flap from the oral vestibule.
Intratumoral BCG cell‐wall preparation therapy and surgery in bovine ocular carcinoma
Authors: Kleinschuster Stephen J. , Bier Jürgen , Rapp Herbert J. , Smart Ross A. , Van Kampen Kent R. , Walters Jeffrey L.
Published: February 2007

Inbred animal tumor models with artificially induced tumors are inadequately comparable with human neoplasias. Thus, cows with squamous cell carcinomas developing spontaneously in the head and neck region were used for experimental investigations on the immunotherapy of malignant tumors. This experimental model served to investigate the therapeutic effect of a single intratumoral application of bacille Calmette‐Guerin (BCG) cell‐wall preparations (CWP) in comparison to local and radical surgical procedures. One hundred twenty‐nine tumor‐bearing cows were divided into 5 groups. Group 1 received a single intratumoral injection of BCG‐CWP. The procedures in Groups 2 and 3 involved local (primary tumor) and radical (primary tumor and draining lymph nodes) surgery, respectively. A procedure was developed for the radical operation in accordance with the method used for radical neck dissection in patients with head and neck tumors. Group 4 remained untreated and Group 5 received sham (improperly compounded) BCG‐CWP. Twenty‐six percent of the animals treated with BCG‐CWP, and 52% treated with local surgery, were clinically tumor free 2.5 years after treatment, while none of those that had undergone radical surgery showed any evidence of tumor recurrence. In the control groups (Groups 4 and 5), progressive tumor growth was characteristic for all except one animal that had spontaneous remission. The favorable outcome of BCG‐CWP treatment in a bastard animal population with spontaneously developing squamous cell carcinomas in the head and neck region may possibly be attributed to the fact that this experimental system involves a tumor with very marked tumor‐specific transplantation antigens. The successful experimental results obtained with BCG‐CWP therapy have led to a prospective, randomized study in patients with squamous cell carcinomas in the head and neck region.
Pectoralis major myocutaneous island flap revisited: A sentinel vessel simplifying dissection
Authors: Kaplan Ivor B. , Harwick Robert D.
Published: February 2007

Surgical extirpation of advanced cancers of the head and neck almost always requires extensive resections that invariably necessitate some sort of large flap for reconstruction. In recent years immediate one‐stage reconstruction of large defects in the area of the tonsillar fossa and the pharynx have been facilitated by the development of myocutaneous flaps, especially the pectoralis major myocutaneous flap. With this flap, immediate one‐step reconstruction at the time of the initial operation is accomplished. Myocutaneous flaps, however, require more skill and concentration in their elevation than do skin flaps in order to preserve the axial feeder vessel running along the underside of the muscle and supplying the all‐important perforating vessels to the overlying muscles and skin. We have noticed a constant perforating vessel, approximately 2‐cm long, coming off the pectoral branch of the thoracoacromial artery medial to the cephalic vein and 2 cm below the border of the clavicle. This pierces the substance of the overlying pectoralis major muscle and runs anteriorly into the subcutaneous fatty hypodermal layer. This vessel accurately localizes the position of the proximal portion of the pectoral branch of the thoracoacromial artery before elevation of the pectoralis major muscle has been started. The imaginary line joining this vessel and the island skin flap allows simplicity in elevation of the muscle pedicle and obviates fear of transecting the arterial supply to the skin island during the dissection. We have found the vessel to be present in 26 consecutive cases over the last 12 months. We present our findings of a sentinel vessel localizing the pectoral branch of the thoracoacromial artery as a guide in liberating the muscular paddle and axial artery in elevation of pectoralis major myocutaneous island flaps.
Mandibular osteotomy in the surgical approach to the oral cavity
Authors: McGregor Ian A. , MacDonald D. Gordon
Published: February 2007

The improved stability that results from the combination of K‐wire transfixion of a mandibular osteotomy with direct wiring has made it possible to use a straight, as opposed to a stepped, bone cut and to avoid the invariable need for dental extractions. It has also made possible an alternative osteotomy site, immediately anterior to the mental foramen. The use of this site allows mandibular swing to take place after division only of mucous membrane and mylohyoid. It is best combined with a modified lip‐splitting incision which has been found to improve ultimate cosmesis.
A craniofacial approach to advanced recurrent cancer of the central face
Authors: Jackson Ian T. , Laws Edward R. , Martin Raymond D.
Published: February 2007

Recurrent penetrating midface cancer results from basal cell carcinoma, squamous cell carcinoma, adenocystic carcinoma, and chondrogenic and osteogenic sarcoma. In the past, surgical resection frequently resulted in meningitis. A combined neurosurgical and plastic surgical craniofacial approach has been used for total resection of these lesions. The floor of the anterior cranial fossa has been reconstructed with an extended glabellar flap incorporating a forehead Z‐plasty. Over the past 2‐and‐a‐half years, 10 patients have been operated on successfully. Five cases with a follow‐up of over 2 years are presented.
Primary lymph nodal Kaposi's sarcoma of the parotid gland
Authors: Puterman Marco , Goldstein Jed
Published: February 2007

Two cases of Kaposi's sarcoma arising within intraparotid lymph nodes are presented. The tumor masses, clinically thought to be primary epithelial tumors of the parotid gland, were pathologically defined as Kaposi's sarcoma. No other evidence of this disease has been found elsewhere in either of the two patients studied. Immunologic studies performed in both patients demonstrated a depression of T‐lymphocyte function and altered cell‐mediated immunity in one. Search of the medical literature shows that these are the first two reported cases of Kaposi's sarcoma arising within lymph nodes of salivary glands.
Analysis of disability resulting from treatment including radical neck dissection or modified neck dissection
Authors: Schuller David E. , Reiches Nancy A. , Hamaker Ronald C. , Lingeman Raleigh E. , Weisberger Edward C. , Suen James Y. , Conley John J. , Kelly David R. , Miglets Andrew W.
Published: February 2007

A multiinstitutional study to define the impact of total treatment programs involving radical neck dissection (RND) and modified neck dissection (MND) on patient' permanent disability was undertaken. A total of 243 patient responses were included in the study. Comparative analyses between the treatment groups show no advantage of one surgical operation over the other in returning patients to their pretreatment employment status. Radiation therapy was identified as adding significantly to the patient's permanent disability.
Face lift, part 2: Etiology of platysma cording and its relationship to treatment
Authors: Webster Richard C. , Smith Richard C. , Smith Karen F.
Published: February 2007

Based on examination of many necks and observations at surgery and on cadavers, we believe that “platysma cords” or cervical folds are normal when the muscles are being contracted. In the aged, they do not disappear when the muscle is relaxed. We believe that they are caused by a stretching and loss of contractility of skin and fat overlying the anterior platysma muscles from aging and from the many contractions of these muscles which selectively stretch the overlying tissues. In addition, we believe that the superficial musculoaponeurotic system (SMAS), which in youth holds the muscle strongly and closely to the confines of the concavity of the neck, stretches so that the muscle webs more easily out of the concavity when contracted and is returned less completely into it upon relaxation. Treatment and prevention should be directed toward tightening the skin and the SMAS and supporting the muscle in its retrodisplaced, more youthful position.
Extrapharyngeal (anterolateral) approach to the cervical spine
Authors: Komisar Arnold , Tabaddor Kamran
Published: February 2007

The extrapharyngeal approach to the anterior cervical spine is a safe, rapid surgical exposure. Other surgical exposures such as the posterior, lateral, and intraoral (transpharyngeal) have inherent limitations that this approach avoids. By going anterior to the sternocleidomastoid muscle and great vessels, the surgical exposure of the anterior cervical spine is wide and the vital structures of the neck are visualized and not injured. We have used this extrapharyngeal approach to treat various disease states of the anterior cervical spine, such as trauma, osteomyelitis, neoplasia, and degenerative disease. Major complications have been neural injury, and pharyngeal fistula.
Parathyroid gland transplantation after total thyroidectomy with pharyngolaryngoesophagectomy
Authors: Freeman Jeremy L. , Brondbo Kjell , Shaw Henry J. , Rubin Allan M. , Noyek Arnold M. , Goldberg Melvyn
Published: February 2007

Surgical treatment of extensive hypopharyngeal carcinoma often includes total thyroidectomy together with resection of the primary disease. The risk of removing or damaging the parathyroid glands is considerable; this may render the patient permanently hypoparathyroid with all the problems of management. These patients must be on lifelong supplementation and at times, due to failure to take the medication, hypocalcemic crises are precipitated. To avoid this problem, we have been identifying the parathyroid glands intraoperatively and, after pathological confirmation, have transplanted them to the forearm. Three patients who underwent this procedure are presented. All are normocalcemic without supplementation and parathyroid hormone assays on serum from the transplanted forearm show significantly elevated levels.
Failure at the primary site following multimodality treatment in advanced head and neck cancer
Authors: Vikram Bhadrasain , Strong Elliot W. , Shah Jatin P. , Spiro Ronald
Published: February 2007

Recurrence at the primary site is an important cause of morbidity and mortality in head and neck cancer. In patients with stages III and IV disease treated surgically at Memorial Sloan‐Kettering Cancer Center between 1960 and 1970, cancer recurred at the primary site in 39% even when the margins had been deemed satisfactory, and in 73% when the margins were unsatisfactory. Between 1975 and 1980, we treated 114 previously untreated patients with stages III and IV epidermoid carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx with a combination of surgery and postoperative radiation therapy. Twenty‐seven patients also received preoperative chemotherapy. One hundred seven patients were evaluable for disease control at the primary site by the combined treatment. Cancer recurred at the primary site in 6 patients, including 2% of 47 patients whose surgical margins had been satisfactory and 10.5% of 60 patients whose surgical margins had been unsatisfactory. Of the latter, recurrence was seen in 5% of the 25 patients whose margins were less than 5 mm but were microscopically uninvolved, and in 15% of the 35 patients whose margins were microscopically involved by cancer. Comparison of these data with our historical control group suggests a decrease in the failure rate at the primary site with multimodality treatment. However, it still appears important to secure microscopically negative margins for the best results.
Failure in the neck following multimodality treatment for advanced head and neck cancer
Authors: Vikram Bhadrasain , Strong Elliot W. , Shah Jatin P. , Spiro Ronald
Published: February 2007

Failure in the neck is an important cause of morbidity and mortality in head and neck cancer. Patients who underwent therapeutic or elective radical neck dissection at Memorial Sloan‐Kettering Cancer Center between 1960 and 1966 developed recurrence of cancer in the dissected neck in 36.5% of the cases when metastatic carcinoma was present in the cervical lymph nodes at one level, and in 71.3% when metastases were present at multiple levels. Between 1975 and 1980, we treated 114 previously untreated patients with stages III and IV epidermoid carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx with the combination of surgery and elective postoperative radiation therapy. Of these, 106 patients underwent radical neck dissection and 94 were proven to have metastatic carcinoma in the neck. Eleven patients developed recurrences in the neck. Recurrence developed in 16% of 19 patients with metastases at one level, and in 13% of 75 patients with metastases at multiple levels. For 53 patients, radiation therapy was started within 6 weeks after neck dissection and only 2% of them developed recurrence in the neck; for 41 patients, radiation therapy started later than 6 weeks and 29% of them developed recurrence (P < 0.01). Comparison of these data with our historical control group suggests a decrease in the number of failures in the neck when a multimodality treatment is used. It appears, however, that irradiation must be started within 6 weeks after surgery for the best results.
Failure at distant sites following multimodality treatment for advanced head and neck cancer
Authors: Vikram Bhadrasain , Strong Elliot W. , Shah Jatin P. , Spiro Ronald
Published: February 2007

Failure at distant sites has generally not been regarded as a major cause of morbidity and mortality in head and neck cancer. Among patients with advanced cancer of the mouth and throat, treated at Memorial Sloan‐Kettering Cancer Center between 1960 and 1965, over 75% succumbed because of failure to control the disease, but distant metastases were the primary cause of failure in only 4%. More recently, with better local‐regional control of cancer using multimodality treatment, failure at distant sites has become much more of a problem, however. Between 1975 and 1980, we treated 114 previously untreated patients with stages III and IV epidermoid carcinoma of the oral cavity, oropharynx, hypopharynx, and larynx with a combination of surgery and postoperative radiation therapy. Twenty‐seven patients also received preoperative chemotherapy. Twenty patients developed distant metastases (12 in the lungs, 7 in the spine, and 1 on the trunk). The incidence of distant metastases was higher in those patients who presented with palpable cervical lymph nodes than in those who did not (25% vs. 4%, P < 0.05), and especially in those patients who pathologically had metastases at multiple levels in the neck than in those who had metastases at a single level or had negative nodes (35% vs. 5%, P < 0.05). Therapeutic strategies aimed at decreasing the incidence of distant metastases in patients with advanced head and neck cancer should be studied in patients who are pathologically found to have lymph node metastases at multiple levels in the neck.
Craniofacial microsomia in a parasite of a heteropagus conjoined twin: A clinical and histopathologic evaluation
Authors: Silbermann M. , Bar‐Maor J. A. , Auslander L.
Published: February 2007

This report evaluates a rare case of craniofacial microsomia in a partially developed, malformed heteropagus conjoined twin. In this instance, several major components of the craniofacial complex were involved: bones, cartilage, teeth, salivary glands, auditory apparatus, cerebrum, cranial nerves, and ocular neuroepithelium. In addition, cervical vertebrae and appendicular long bones were markedly affected. To date, the underlying disorder (whether genetic, metabolic, or environmental) responsible for the development of this congenital malformation is not fully understood. Our clinical and pathologic examinations tend to suggest that an apparent lack of an adequate arterial blood supply to the growing embryo could have contributed to the elaboration of this complex syndrome. The fact that the parasite's blood supply relied mainly upon a single, medium‐sized artery (1.5 mm in diameter) could have brought about local ischemic milieus during the critical phases of embryogenesis; hence, impeding the preprogrammed migration of neural crest cells to their end targets in the upper branchial arches. In such a case, the normal sequence of cell differentiation is damaged, which in turn imposes a severe impact on the morphogenesis of the various tissues composing the craniofacial complex.
Osteoradionecrosis: Predisposing factors and outcomes of therapy
Authors: Beumer John , Harrison Richard , Sanders Bruce , Kurrasch Madeline
Published: February 2007

Eighty‐three episodes of osteoradionecrosis are reported. Of those episodes affecting the mandible (78), 23 (29.5%) required radical resection. The most common precipitating factors were postradiation extractions (22/83), periodontal disease (19/83), and preradiation extractions (17/83). Those episodes initially located within the zone of attached mucosa fared well with conservative measures while those initially located beyond the zone of attached mucosa fared poorly. In bone necroses where the external radiation dose to the affected bone exceeded 7,000 rad, the mandibular resection rate was high (44%). The most effective way of resolving advanced bone necroses was achieved with a course of hyperbaric oxygen therapy combined with a surgical sequestrectomy.
Reconstruction for cervical irradiation ulcers with myocutaneous flaps
Authors: Strawberry Carl W. , Jacobs Jonathan S. , McCraw John B.
Published: February 2007

Radiation‐induced skin changes are commonly seen in patients who have been treated for head and neck malignancies. Some of these skin changes can progress into chronic postradiation ulcers, which despite aggressive medical wound management will not resolve spontaneously. Skin grafts and local cutaneous flaps located within the radiation field are unreliable and rarely provide adequate stable coverage. In this article, the authors report a combined experience of 52 patients whose postradiation cervical ulcers were successfully and reliably treated with myocutaneous flaps.