bluuebunny/crossref_metadata_2025 huggingface dataset:
Intubation granuloma of the larynx: Successful eradication with low‐dose radiotherapy
Authors: Harari Paul M. , Blatchford Steven J. , Coulthard Stanley W. , Cassady J. Robert
Published: February 2007

Postintubation granuloma of the larynx is a well recognized entity, which has accompanied the increased use of endotracheal intubation for general anesthesia. Voice rest, corticosteroids, antibiotics, antacids, and surgical removal are generally accepted conventional therapies, although select cases are fraught with a high rate of recurrence. We recently evaluated a patient who had undergone 6 surgical excisions of a postintubation laryngeal granuloma during a 5‐month interval. The larynx was treated with 1,200 cGy photon irradiation during a 4‐day period, and there has been no granuloma recurrence in 36 months of follow‐up. The rationale and selection criteria for patients who might benefit from low‐dose radiotherapy for recurrent laryngeal granulomas are discussed.
Malignant neuroendocrine tumor presenting in the mandible
Authors: Peters Edmund , Richards Allen , Hille Johannes , Phillips Jim
Published: February 2007

The carotid body, jugulotympanic, vagal, and laryngeal paragangliomas are the most common paragangliomas respectively within the head and neck, although unusual examples in other sites have been described. Among these are several references in the literature to a mandibular or “alveolar body” paraganglioma, even though such an entity does not appear to have been adequately documented. This report describes a case which presented as an extensive osteoblastic tumor involving the mandible and which radiographically appeared as a typical osteosarcoma. However, the immunohistochemical and electron microscopic features were of a neuroendocrine tumor and the histologic pattern suggested a paraganglioma. The tumor was nonfunctional and an extensive search failed to reveal any further lesions. Eight months after resection of the lesion, metastatic deposits appeared within the left iliac crest and lumbar vertebra. The origin of this tumor is discussed.
Labeling index in squamous cell carcinoma of the larynx
Authors: Balzi Manuela , Ninu Benedetta M. , Becciolini Aldo , Scubla Elena , Boanini Patrizia , Gallina Ezio , Gallo Oreste , Fini‐Storchi Omero , Bondi Roberto
Published: February 2007

Two cell kinetic parameters, the 3H‐thymidine labeling index (TLI) and the mitotic index (MI), were studied in vitro on fragments of squamous cell carcinoma tissue of the larynx. They were evaluated to identify those elements able to characterize the growth of these solid tumors. The values of these parameters were analyzed as a function of the clinical stage and the involvement of the regional lymph nodes. Results showed a statistically significant increase in the TLI from stage T1 to T3. No statistically significant differences in the TLI values were observed between the patients with positive and negative lymph nodes.
Temporal bone involvement by prostatic adenocarcinoma: Report of two cases and review of the literature
Authors: Sahin Aysegul A. , Ro Jae Y. , Ordonez Nelson G. , Luna Mario A. , Weber Randal S. , Ayala Alberto G.
Published: February 2007

Although axial bone and cranial metastases are common in patients with prostatic carcinoma, temporal bone involvement is rare. We report 2 cases of prostatic adenocarcinoma with temporal bone metastasis and review the relevant literature. One case had a 3‐year history of a prostatic carcinoma, whereas in the second case the temporal bone metastasis was the initial presentation. Awareness of the possibility of temporal bone involvement by prostate carcinoma and application of immunohis‐tochemical studies will help to arrive at the correct diagnosis.
Lymphoma of the maxillary sinus in a patient infected with human immunodeficiency virus type 1
Authors: Goldstein Jeffrey , Rubin John , Becker Norwin , Moser Franklin , Silverstein Martin , Davis Lawrence
Published: February 2007

A 27‐year‐old woman with a history of intravenous drug abuse presented with a stage IE, diffuse, large cell lymphoma of the right maxillary sinus. A test for antibodies to the human immunodeficiency virus was positive. The patient was treated with systemic chemotherapy and local maxillary sinus irradiation which resulted in complete regression of the disease. Therapy was complicated by mucositis, neutropenia, and opportunistic infections. This is the first case report to discuss the presentation and treatment of acquired immunodeficiency syndrome (AIDS)‐related lymphoma of the maxillary sinus.
Glottic cancer involving anterior commissure: Surgery vs radiotherapy
Authors: Rucci Lucio , Gallo Oreste , Fini‐Storchi Omero
Published: February 2007

A retrospective review of 182 patients with glottic cancer involving the anterior commissure (AC) is presented. Of these, 123 patients were first treated with conservative surgery and 59 underwent radiotherapy. Patients were staged according to the AJCC system and by the modality of neoplastic involvement of AC (pure AC cancer, glottic cancer involving AC up to the midline, and beyond the midline). Our results indicate a higher rate of local control and of specific‐disease survival in the group of patients first treated with surgery than those treated with radiotherapy (86% vs 74% and 97.5% vs 84%, respectively) (p < 0.05). For pure AC cancers, our results show better local control with primary radiotherapy than with conservation surgery (82% vs 76.5%), but surgical failures have been more successfully salvaged than have radiotherapy recurrences (ultimate local control, 97.5% vs 82%, respectively). These data suggest that the treatment of choice for AC cancers is conservation surgery, particularly frontolateral laryngectomy.
Chemotherapy rapidly alternating with accelerated radiotherapy for advanced carcinomas of the hypopharynx and upper esophagus: A feasibility study
Authors: Vikram Bhadrasain , Malamud Stephen , Gold Jay , Nussbaum Moses , Kimmelman Charles , Lucente Frank , Pavlou William , Pisch Julianna , Chadha Manjeet , Beattie Edward
Published: February 2007

Patients with advanced carcinomas of the hypopharynx or upper esophagus have among the worst prognoses in head and neck oncology. We developed a treatment regimen of rapidly alternating multi‐agent chemotherapy and accelerated interrupted radiotherapy as follows: Three cycles of chemotherapy were delivered [day 1, cisplatin 100 mg/m2; days 1‐4, 5‐fluorouracil (5‐Fu) 900 mg/m2] and repeated every 3 weeks. On day 8 of each chemotherapy cycle radiotherapy was started, consisting of 10 fractions of 200 cGy delivered twice daily, for 5 days. The total dose of radiotherapy was 6,000 cGy over 7 weeks, and the total duration of chemotherapy and radiotherapy was 8 weeks. Nineteen patients with locally advanced, epidermoid carcinoma of the hypopharynx (9 patients) or upper esophagus (10 patients) were treated on this protocol. Minimum follow‐up was 1 year. Twelve patients had tumors judged technically unresectable, whereas 7 had tumors considered resectable only with total laryngectomy, which was unacceptable to the patients. One patient died of nadir sepsis during treatment, but otherwise the acute toxicity was relatively mild (grade I/II in 16 patients, grade III/IV in 3 patients). The complete response rate was 83% (15 of 18 patients), and the partial response rate was 17% (3 of 18). No patient failed to respond. The survival rate was 80% at 1 year and 73% at 18 months. At 1 year, 89% of the patients remained in remission and at 18 months, 74%. Late complications occurred in 4 patients. These included laryngeal necrosis, pneumonitis, esophageal stricture, and tracheoesophageal fistula. Our experience suggests that this regimen is quite useful in cancers of the hypopharynx and upper esophagus and deserves further investigation.
Thyroid‐stimulating hormone levels after radiotherapy and combined therapy for head and neck cancer
Authors: Weissler Mark C. , Berry Billy W.
Published: February 2007

Sixty‐eight patients were studied prospectively with serial thyroid‐stimulating hormone (TSH) levels after radiotherapy for head and neck neoplasms. Overall, 57% of the patients developed elevated TSH levels. Excluding patients with less than 2 years follow‐up, 85% developed an elevated TSH. Ninety‐two percent of patients treated with partial thyroidectomy and radiotherapy developed an elevated TSH. Most TSH elevations occurred within 1 year of treatment. The dose of radiotherapy used and the performance of hemithyroidectomy were related to the development of elevated TSH levels (p < 0.05). The performance of radical neck dissection, gender, hyperfractionated radiotherapy, and the use of chemotherapy were not related to the development of an elevated TSH (p > 0.05).
Conservation surgery for inverted papillomas
Authors: Benninger Michael S. , Lavertu Pierre , Levine Howard , Tucker Harvey M.
Published: February 2007

To evaluate the role of conservation surgical treatment of inverted papillomas of the nose and paranasal sinuses, the clinical course of 46 patients treated during a 10‐year period was evaluated. Twelve patients were noted to have either invasive squamous cell carcinoma or carcinoma in situ and were excluded from analysis. Of the remaining 34 patients, 19 had previous treatment for inverted papilloma. Subsequently, 20 patients were treated with lateral rhinotomy and medial or partial maxillectomy. Fourteen patients were treated with conservation surgical therapy. There were 5 recurrences (15%), which all occurred in the conservation‐treated group. Four of six (66%) patients treated with an intranasal procedure recurred but only 1 of the 8 (12%) patients treated with a Caldwell‐Luc approach combined with an intranasal procedure. Successful treatment was achieved in all patients undergoing salvage surgery for recurrence. The role of conservation treatment in the management of inverted papillomas of the nose and paranasal sinuses is discussed.
Mediastinal and thoracic complications of necrotizing fasciitis of the head and neck
Authors: Lalwani Anil K. , Kaplan Michael J.
Published: February 2007

Mediastinal and thoracic extension of head and neck infections are rare but occur even in the modern antibiotic era. Early intervention is paramount to successful clinical outcome. 111Indium‐labeled white blood cell (WBC) scan, a new imaging modality, appears to play a role in complementing computed tomographic (CT) findings, demonstrating early extension of disease, and following therapeutic efficacy. Together, the CT scan and WBC scan aid in directing early intervention and extent of surgery in this disease of high‐potential mortality. We report 3 cases of deep head and neck infection complicated by mediastinal extension, including mediastinitis, pericardial effusion, and tampon‐ade, empyema, and respiratory failure. Early surgical intervention included neck drainage, tracheostomy, thoracotomy, and pericardiotomy. While usually associated with greater than 50% mortality, all of the patients in this series survived. Based on our experience, we recommend prompt aggressive surgical debride‐ment in treating mediastinal complications resulting from head and neck infections.
Head and Neck Sarcoma: Report of the Head and Neck Sarcoma Registry
Authors: Wanebo Harold J. , Koness R. James , Macfarlane John K. , Eilber Frederick R. , Byers Robert M. , Elias E. George , Spiro Ronald H.
Published: February 2007

A Head and Neck Sarcoma Registry was established by the Society of Head and Neck Surgeons to review treatment results of a rare tumor by surgeons with special interest in this anatomic site. Two hundred fourteen patients were analyzed. There were 194 adult tumors and 20 pediatric tumors. The major sites included parotid and neck, 20%; face and forehead, 18%; maxilla and palate, 13%; scalp, 12%; mandible, 11%; paranasal sinuses, 7%; larynx, 2%; and oral cavity, 5%. Eighty‐four percent were resectable. The disease‐free survival was 56%; overall survival was 70% at 5 years. Major determinants of survival were adequacy of resection (margins free of tumor) and tumor type. Survival differed according to tumor cell type (tumor grade was not available). Patients with chondrosarcoma and dermat‐ofibrosarcoma had survival approaching 100%. Patients with malignant fibrous histiocytoma (MFH) and fibrosarcoma (FSA) had intermediate survival of 60% to 70%. The worst survival, < 50% at 5 years, occurred in patients with osteosarcoma, an‐giosarcoma, and rhabdomyosarcoma in decreasing order. This suggests a rationale for identifying high‐risk patients for prospective adjuvant protocols. This sutdy emphasizes the value of recording uncommon tumors to provide relevant information for future study and possibly therapy.
Effect of advanced age and medical disease on the outcome of microvascular reconstruction for head and neck defects
Authors: Shestak Kenneth C. , Jones Neil Ford , Wu Wayne , Johnson Jonas T. , Myers Eugene N.
Published: February 2007

During the 5‐year period from July 1984 to 1988, 72 patients over the age of 50 underwent microvascular free tissue transfers for head and neck reconstruction. There were 22 patients aged 50‐59 years, 31 patients aged 60‐69 years, and 19 patients aged 70‐79 years. Seventy of these procedures (97%) were done at the time of ablative surgery utilizing a two‐team approach. There was 1 total flap loss for a flap viability rate of 99% (73/74). There were 46 complications in 40 patients: 21 surgical and 25 medical. Twelve of the surgical complications required reoperation for a major surgical complication rate of 16%. Major medical complications developed in 12 patients (16%). Medical complications more commonly were observed in patients aged 60‐69 years who had significant preoperative comorbidity and were classified as ASA class 3 or greater. There were 5 postoperative deaths for a mortality rate of 7%. Advanced chronologic age does not compromise the technical success of microsurgical free tissue transfer in the elderly patient with head and neck cancer. The risk of medical complications is significant and is directly related to concurrent illness of the individual patient rather than to age alone.
Synovial sarcoma of the head and neck
Authors: Bukachevsky Roman P. , Pincus Robert L. , Shechtman Frank G. , Sarti Edward , Chodosh Paul
Published: February 2007

Primary synovial sarcoma is an unusual tumor of the head and neck. Fewer than 75 cases have been reported in the literature. We have treated 7 additional cases; 3 in the hypopharynx, 2 in the parapharyngeal space, 1 in the oral pharynx and 1 in the posterior triangle of the neck. An enlarging cervical mass, voice change, and dysphagia were among the presenting complaints. CT revealed solitary nonhomogenous tumors from 3 to 7 cm in diameter. Microscopically, all cases showed a biphasic cellular pattern verified by immunohistochemical staining. Multimodality treatment consisted of surgery and postoperative radiation therapy with 3 patients receiving chemotherapy. Although the original pathology report was incorrect in 3 cases, clinical suspicion for synovial sarcoma ensured proper diagnosis.
Carcinoma of the uvula and midline soft palate: Indication for neck treatment
Authors: Har‐El Gady , Shaha Ashok , Chaudry Rashid , Hadar Tuvia , Krespi Yosef P. , Lucente Frank E.
Published: February 2007

According to common classification and staging systems, tumors of the uvula and soft palate are included in the group of oropharyngeal cancers. As such, the same staging systems apply and therapeutic decisions are made accordingly. Our experience with small tumors of the uvula and midline soft palate has shown that these common rules may not apply in these anatomical sites. A multicenter retrospective study was performed to examine the aspects of presentation and clinical course of tumors of the uvula. Only patients with small tumors, less than 2.0 cm in diameter, were included. Twenty‐three cases were reviewed. Eleven (47.8%) patients had clinical or radiologic evidence of neck disease on presentation. Five of 12 (41.7%) patients who presented with negative neck were found eventually to have neck disease. Eight patients had cervical recurrence. Only one patient had local recurrence. We suggest that attention may need to be directed to the treatment of the neck of all tumors of the uvula and midline soft palate, regardless of size.
Primary reconstruction of head and neck cancer with anterior rib, osteomyocutaneous composite flap
Authors: Bhathena Hosi M. , Kavarana Naozer M.
Published: February 2007

The anterior rib, osteomyocutaneous composite flap (AROCF) incorporating both vessels, supracostal and intercostal, has been harvested for primary reconstruction in advanced head and neck cancer patients. The adequacy of the periosteal circulation alone for the successful free osseous transfer has been well proved.1,2 The available length of the internal mammary vessels is sufficient for the successful microvascular anastomosis in the neck. This same AROCF can be used as a pedicled flap based on the pectoralis major musculo‐vascular pedicle for successful primary reconstruction in cases in which it is deemed unsuitable for use as a free flap. This is possible because of the unique functional blood supply of the rib.
Sublethal damage repair in squamous cell carcinoma cell lines
Authors: Pekkola‐Heino Kirsi , Kulmala Jarmo , Grenman Reidar
Published: February 2007

Squamous cell carcinoma (SCC) cell lines recently established from head and neck tumors were studied for their capability of repairing sublethal radiation induced damage (SLDR). Total doses of 1.25, 2.50, 5.00, and 7.50 Gy were used either as a single dose or split in two equal fractions with a 24 h interval. Cell survival was determined using a 96‐well plate clonogenic assay based on limiting dilution. Survival data was fitted by linear quadratic model, and the area under the survival curve (AUC) was obtained with numerical integration. The amount of SLDR was expressed as AUC‐ratio comparing survivals from split dose vs single dose experiments.

SLDR capacity was observed to vary markedly between individual cell lines (AUC‐ratios 1.0‐1.5). The relatively radiationsensitive cell lines had a tendency toward higher SLDR proficiency (correlation coefficient 0.85). The differences in repair capacity could not be explained by the differences in doubling times of the cell lines. The inverse relationship between SLDR capacity and inherent radiosensitivity could explain the poor radiocurability of the sensitive donor tumors. Two of the most resistant cell lines were found SLDR deficient. This is a novel finding, since SLDR has been previously reported in all studied cells.
Value of clinical follow‐up for local nasopharyngeal carcinoma relapse
Authors: Sham Jonathan S. T. , Choy D. , Wei W. I. , Yau C. C.
Published: February 2007

Three hundred seventy‐nine new patients with nasopharyngeal carcinoma (NPC) were followed clinically and the physical examination, including that of the nasopharynx by indirect mirror for symptoms after treatment. At the time of analysis, with a median follow‐up of 34.8 months, 47 patients had developed recurrent disease in the nasopharynx and in the immediately adjacent regions. In 31 patients the first clinical features to suggest local recurrence were progressive symptoms (group A). In another 13 patients recurrence of tumor in the nasopharynx was detected by indirect mirror examination (group B). In the remaining three patients, the diagnosis was made during investigation for neck node recurrence. The more common symptoms at diagnosis of local recurrence were headache; cranial nerve palsy involving the third, fourth, fifth, and sixth nerves; and ear and nasal symptoms. Group B patients tended to have less of these symptoms. The presence of tumor was confirmed by fiberscopic examination and biopsy in all group B patients and 14 of 31 group A patients, the tumor was submucosal in the remaining 17 group A patients. The recurrence in group B patients was diagnosed significantly earlier than the group A patients (p = 0.0294), and group A patients suffered from more invasive and extensive disease in comparison with group B patients (p = 0.0044). There were significantly less patients in group A who were amenable to curative brachytherapy (p = 0.0280). Clinical follow‐up for local NPC recurrence was found to be useful. More frequent use of fiberscopic examination in the follow‐up, especially for those not adequately examined by indirect mirror examination, will improve the detection rate. Cross‐sectional imaging techniques and the monitoring of tumor markers may supplement clinical and fiberscopic examinations. An algorithm for diagnosing recurrent NPC and possible treatment are suggested.
Embolization of the ophthalmic artery for control of epistaxis: Report of two cases
Authors: Moser Franklin G. , Rosenblatt Marjorie , De La Cruz Francisco , Silver Carl , Burde Ronald M.
Published: February 2007

Embolization of the internal maxillary artery, an accepted method for control of severe or recurrent posterior epistaxis, usually involves the ipsilateral artery, but occasionally the contralateral vessel and the facial arteries as well. Such endovascular treatment may fail if the vascular supply to the bleeding vessels originates in derivative branches of the ophthalmic artery. We report two unusual cases in which embolization of the ophthalmic artery was performed to control epistaxis. The first patient had a prosthetic eye. In the second, sight in one eye was sacrificed after careful consideration in order to prolong life. © 1992 John Wiley & Sons, Inc.
Association between malignancies of the upper aerodigestive tract and uterine cervix
Authors: Spitz Margaret R. , Sider Joanne G. , Schantz Stimson P. , Newell Guy R.
Published: February 2007

Cancers of the cervix and buccal cavity share histologic, epidemiologic, and exposure characteristics. In particular, cigarette smoking and human papillomavirus (HPV) have been cited as etiologic cofactors of both malignancies. Using incidence data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute for the years 1973 through 1984, we evaluated the incidence of second cancers of the buccal cavity following an initial cervical cancer. Standardized incidence ratios (SIR) were uniformly elevated for both white (SIR = 2.0), and black (SIR = 3.5) women. There were also elevated risks for the development of cervical cancer following an initial buccal cavity cancer (SIRs = 3.3 and 2.5, respectively). A similar pattern was evident for laryngeal cancer among white women. HPV transmission could account in part for the paired occurrence of these two anatomically distinct cancer sites. Cigarette smoking could act as a synergistic cofactor in the malignant transformation of viral genome‐harboring tissue. © 1992 John Wiley & Sons, Inc.
Sarcoidosis masquerading as a parathyroid adenoma
Authors: Nabriski Dan , Bendahan Jose , Shapiro Menachem S. , Freund Uri , Lidor Cobi
Published: February 2007

Two patients presented with a presumptive diagnosis of hyper‐parathyroidism. Surgically excised “parathyroid glands” were found to be, in fact, large lymph nodes with sarcoid granulomata. In one patient, the preoperative localization of the “parathyroid adenoma” was based on scintigraphy (thallium‐technetium subtraction imaging) and sonography procedures. The differential diagnosis of hypercalcemia, and positive scintigraphy‐sonography studies, must include sarcoidosis in an isolated cervical lymph nodes. © 1992 John Wiley & Sons, Inc.
Multifocal adult rhabdomyomas of the head and neck
Authors: Shemen Larry , Spiro Ronald , Tuazon Ricardo
Published: February 2007

Rhabdomyomas are usually found in the myocardium. Of the extracardiac sites, the head and neck is the most frequent region where this rare tumor arises. Multifocal head and neck lesions have only been described in 11 cases. We herein present two additional multifocal lesions. © 1992 John Wiley & Sons.
Dual free flap transfer using forearm flap for mandibular reconstruction
Authors: Nakatsuka Takashi , Harii Kiyonori , Yamada Atsushi , Ueda Kazuki , Ebihara Satoshi
Published: February 2007

To reconstruct a composite mandibular defect, we have simultaneously transferred a vascularized bone graft or osteocutaneous flap together with a forearm flap. The radial forearm flap, being thin, pliable, and having a long vascular stalk, served as mucosal lining and/or an interpositional flap acting as a vascular bridge. Between 1982 and 1989, we used this procedure in 17 patients with a mandibular defect or deformity which developed following treatment of oral cancer. Our clinical experience has demonstrated that this dual free tissue transfer has many advantages. It is useful for obtaining a good alveolar ridge in patients with a composite mandibular defect. It is applicable in cases where only a single pair of recipient vessels are present and may be useful when the recipient vessels are positioned some distance from the defect. © 1992 John Wiley & Sons, Inc.
Sister chromatid exchange frequencies in carcinoma of the human oral cavity: Effect of treatment
Authors: Ankathil Ravindran , Vijayakumar T. , Bhattathiri V. N. , Nair M. Krishnan
Published: February 2007

Spontaneous and mitomycin‐C‐induced sister chromatid exchange frequencies were studied in the lymphocytes of 25 oral cancer patients. For these patients, the mean spontaneous SCE value was 8.31 (±SD), which was significantly higher than the value of 6.60 (±SD) obtained for the controls (p < 0.001). But there was no significant difference between the Mitomycin C induced mean SCE values of oral cancer patients and controls. Seven of these 25 oral cancer patients were selected for second sampling after surgical removal of the tumor. Six of these seven patients showed a decrease in mean SCE/cell value following surgery, which was almost equal to the SCE values obtained for the controls. This indicates that the increased spontaneous SCE rates in oral cancer patients might be due to the metabolic stress imposed by the tumor on the host body or by some clastogenic product of the malignant cells. Surgical removal of the tumour might have resulted in normalization of the lymphocytic SCE rates in postoperatively studied patients. © John Wiley & Sons, Inc.
Management of squamous cell carcinoma of the floor of mouth
Authors: Rodgers Lawrence W. , Stringer Scott P. , Mendenhall William M. , Parsons James T. , Cassisi Nicholas J. , Million Rodney R.
Published: February 2007

Between 1964 and 1987, 194 patients with previously untreated squamous cell carcinoma of the floor of mouth were managed at the University of Florida. A retrospective analysis was undertaken in order to evaluate the treatment results and associated complication rates. Surgery or irradiation alone was found to result in similar local control rates for stage I and II lesions, whereas more advanced tumors had better local control rates with a combination of surgery and irradiation. Radiotherapy had a higher incidence of minor and moderate complications, whereas a greater number of severe complications occurred after surgery. We recommend surgery for early lesions due to the lower overall incidence of associated complications. Despite a higher risk of severe complications, combination therapy is recommended for more advanced lesions due to improved local control as compared to single modality therapy.
Surgery for parathyroid adenoma and hyperplasia: Relationship of histology to outcome
Authors: Hosking Shorland W. , Jones Hugh , Du Boulay Claire E. H. , McGinn Frances P.
Published: February 2007

Recent histopathologic evidence challenges the teaching that enlargement of a solitary parathyroid gland is invariably caused by an adenoma, whereas multiple gland enlargement results from hyperplasia. We have re‐examined the parathyroid tissue obtained from 152 consecutive patients undergoing surgery for primary hyperparathyroidism and compared it with their clinical outcome. Our approach was to excise enlarged glands and biopsy the remainder. In 124 patients (82%) at least three glands were biopsied or removed. The ratio of adenoma to hyperplasia was reversed by our histologic re‐examination; adenomas were found in only 27 patients (25 single, two double), whereas hyperplasia was found in 117 patients (one gland, 87 patients; two glands, 16 patients; three glands, five patients; four glands, nine patients). Normal tissue only was reported in eight patients. During a 2‐year follow‐up, five patients (3%) developed hypocalcemia and none developed recurrent hypercalcemia. Our results indicate that a full neck exploration with removal of all enlarged glands is more important than the histologic diagnosis in planning a successful surgical strategy for primary hyperparathyroidism.
Phase II trial of recombinant interferon gamma in refractory undifferentiated carcinoma of the nasopharynx
Authors: Mahjoubi Raoudha , Bachouchi Mounir , Munck Jean‐Nicolas , Busson Pierre , Gasmi Jamel , Azli Nacer , Brandely Mande , Tursz Thomas , Cvitkovic Esteban , Armand Jean‐Pierre
Published: February 2007

The presence of Epstein–Barr virus (EBV) genomes in the DNA of tumor cells of undifferentiated carcinoma of nasopharyngeal type (UCNT), associated with significant lymphocytic infiltration of tumor led to therapeutic trials with interferon (IFN) because of its antiviral, antiproliferative, and immunomodulatory properties. Fourteen patients with histologically proven UCNT (2 had locoregional disease alone and 12 metastatic disease) who were refractory to conventional chemotherapy, were treated with IFN gamma 20 × 106 U twice a week. Treatment was well tolerated. No objective response were achieved in the 13 evaluated patients, and all patients progressed after a median treatment duration of 10 weeks (6–32). IFN gamma seems unable to induce antitumor activity alone in such heavily pretreated patients. Its possible place in the management of UCNT is probably earlier in the natural history of this disease.
Cancer of the larynx in Mexico: Review of 357 cases
Authors: Rodriguez‐Cuevas Sergio A. , Labastida Sonia
Published: February 2007

Descriptions of the patients population suffering from carcinoma of the larynx are not common in Mexico. This article deals with the clinical features, treatment, and results of 357 cases of cancer of the larynx treated at the Hospital de Oncologia, Centro Medico Nacional, IMSS, during a 10‐year period. In this series, 68% of the patients were in advanced stage (T3–T4) at the time of diagnosis; nevertheless, a combination of surgery and radiotherapy achieved an actuarial 5‐year survival for the entire group of 77.5%. Metastatic cervical nodes and tracheotomy previous to the treatment were factors that influenced a poor prognosis (p = 0.01). The survival of cases in the early stages (T1–T2) of 95.2% is comparable to that reported by most authors. In 87.5% of the cases that develop recurrence, it appears during the first 24 months of control.
Immediate free flap mandibular reconstruction: Significance of adequate surgical margins
Authors: Schusterman Mark A. , Harris Scott W. , Raymond A. Kevin , Goepfert Helmuth
Published: February 2007

The pathologic records of 182 consecutive patients who had mandible resections were reviewed to determine the incidence of positive margins in the bone specimens and the risk factors associated with positive margins. Of the 182 cases reviewed, 82 (45%) were found to have involvement of the mandible at the time of resection and four (2%) were found to have positive margins. The predominant tumor histology was squamous cell carcinoma, 148 of 182 (81%), followed in frequency by osteosarcoma 12 of 182 (7%), salivary gland tumors 13 of 182 (7%), and miscellaneous other tumors nine of 182 (5%). Of the four tumors with positive margins, two (50%) were squamous cell carcinomas, one (25%) was an osteosarcoma, and one (25%) was a salivary gland tumor. All four tumors were large tumors that had failed to respond to previous therapy. All obviously involved the mandible at the time of presentation. This study demonstrates that the incidence of bone margin involvement after mandibulectomy is rare and predictable and that clinical selection of candidates for immediate reconstruction is reliable in preventing inappropriate use of free bone flaps in patients at risk for positive bone margins.
Radiotherapy for adenoid cystic carcinoma of the palate
Authors: Regine William F. , Mendenhall William M. , Parsons James T. , Stringer Scott P. , Cassisi Nicholas J. , Million Rodney R.
Published: February 2007

This is an analysis of 16 patients with adenoid cystic carcinoma of the palate who were treated with curative intent by radiotherapy alone (9) or surgery and radiotherapy (7). No patient received adjuvant chemotherapy. Follow‐up ranged from 3 years to 19 years with 69% of the patients having follow‐up of more than 5 years. Two patients in the radiotherapy alone group developed local recurrences, and both have had long‐term surgical salvage. No local failures were seen in the combined therapy group. Twelve patients (75%) are alive and disease‐free. Two patients died with distant disease, one within each treatment group. One patient in the combined therapy group is alive at 8 years with distant metastases, while one in the radiotherapy alone group died of intercurrent disease at 12 years. No significant complications were seen in either treatment group. The role of radiotherapy in the treatment of adenoid cystic carcinoma of the palate is reviewed.
Inversion of Zenker's diverticulum: The preferred option
Authors: Morton Randall P. , Bartley James R. F.
Published: February 2007

A review of patients who had surgery for Zenker's diverticulum in our institution in recent years was conducted. A comparison of inversion versus excision of the sac shows that inversion carries lower morbidity and more rapid rehabilitation of swallowing than does excision. Inversion (plus cricopharyngeal myotomy) is to be preferred for diverticula that are neither too large to invert nor too longstanding to risk leaving subclinical carcinoma behind in the wall of the diverticulum.
Cartilage‐shaving procedure for the control of tracheal cartilage invasion by thyroid carcinoma
Authors: Park Cheong Soo , Suh Kwang Wook , Min Jin Sik
Published: February 2007

This study was carried out to ascertain whether the cartilageshaving procedure is appropriate to control thyroid carcinoma with tracheal cartilage invasion. Of 432 thyroid carcinoma patients treated between 1979 and 1988, 16 had tracheal cartilage invasion only. This patient population was made up of 3 men and 13 women, with a mean age of 55.8 years. Fourteen were diagnosed histologically as having papillary carcinoma and the remaining two as having follicular carcinoma. Cartilage shaving was the primary treatment in all the patients, and subsequent radioactive iodine (131) or external‐beam radiotherapy was administered to control any possible residual disease. Lifelong thyroid hormone replacement was instituted in all patients, and the follow‐up period averaged 70.7 months. Only four of the 16 patients remained disease free; the disease was not controlled in the other 12, and seven of this latter group eventually died of their disease. We feel that a more extensive resection procedure than cartilage shaving should be considered, even in patients with superficial tracheal invasion, to increase the diseasefree survival rate.
Recovery of postoperative swallowing in patients undergoing partial laryngectomy
Authors: Rademaker Alfred W. , Logemann Jerl A. , Pauloski Barbara Roa , Bowman Julia B. , Lazarus Cathy L. , Sisson George A. , Milianti Franklin J. , Graner Darlene , Cook Barbara S. , Collins Sharon L. , Stein David W. , Beery Quinter C. , Johnson Jonas T. , Baker Theresa M.
Published: February 2007

This study assessed the achievement of postoperative swallowing in patients undergoing partial laryngectomy surgery. Oropharyngeal swallow efficiency was used to predict time to achievement of outcome. Fifty‐five patients were followed for up to 1 year in two hemilaryngectomy and four supraglottic laryngectomy groups. Within 10 days of healing, a videofluoroscopic evaluation enabled the measurement of swallowing efficiency. Times to achievement of oral intake, removal of feeding tube, preoperative diet, and normal swallow were analyzed using actuarial curves. Patients with hemilaryngectomies achieved swallowing rehabilitation sooner than patients with nonextended supraglottic laryngectomies (p < .05) who, in turn, achieved swallowing function sooner than did patients undergoing supraglottic laryngectomies with tongue base resection (p < .05). Median time to attainment of preoperative diet in these three groups was 28 days, 91 days, and > 335 days, respectively. Higher early postoperative oropharyngeal swallow efficiency was related to earlier achievement of oral food intake and of preoperative diet (p < .05). Results show that the time course for swallowing rehabilitation covers an extended postoperative period. In some surgical groups, functional swallowing and eating may be achieved within 3 months of surgery while for other types, significant impairment remains up to 9 months postoperatively. Early radiographic assessments of swallowing function are useful in predicting the time to swallow recovery. Recovery of swallowing ability may be delayed in patients who have not achieved oral intake before radiotherapy is started.
Secondary microvascular tongue reconstruction: Functional results
Authors: Salibian Arthur H. , Allison Glenn R. , Strelzow Victor V. , Krugman Mark E. , Rappaport Irving , McMicken Betty L. , Etchepare Terry L. , Sultan Mark R.
Published: February 2007

Between 1978 and 1991, 56 microvascular composite flaps were used for oromandibular reconstructions: 15 for primary total and subtotal tongue reconstruction and five for secondary major tongue reconstruction. The delayed reconstructions were performed to improve the oral and pharyngeal phases of swallowing. Using a floor of the mouth composite bone grafting technique to reposition the tongue and obliterate the oral dead space intraoral food transport was improved (three of five patients), but aspiration persisted (three of four patients). When compared with 10 patients evaluated for primary total and subtotal tongue reconstruction the primary reconstruction group showed superior swallowing (eight dynamic oral transport, no aspiration) and speech results. The poor results of secondary reconstruction are attributed to scarring and irreversible damage to remaining functional muscles involved in protecting the laryngeal aditus.
Intracranial complications resulting from frontal pyocele: Case presentation and review of experience in japan
Authors: Yamasoba Tatsuya , Kikuchi Shigeru
Published: February 2007

A case of subdural empyema resulting from an acute infection of frontal cysts is reported. Urgent surgery was performed to create a right frontal burr hole, followed by an osteoplastic frontal sinusotomy and postoperative chemotherapy. Thus, this intracranial complication was successfully treated with no further sequelae. MRI was useful for clearly revealing a transtentorial herniation and the affected site of the dura mater from which bacterial infection spread intracranially. Review of rhinogenic intracranial complications in Japan shows a dramatic decrease in the mortality rate from the preantibiotics era to the pre‐CT‐scan era, and also from the pre–CT‐scan era to the present CT‐scan era. This suggests that CT scan and, more recently, MRI, have indirectly helped to reduce the mortality rate by enabling an earlier and accurate diagnosis.
Vocal cord paralysis from prostatic carcinoma metastasizing to the larynx
Authors: Park Youn W. , Park Myoung H.
Published: February 2007

According to 1992 Cancer Statistics, prostate carcinoma is once again predicted to be the most common cancer in men, exceeding the incidence of lung cancer. In American men, this cancer is estimated to be the second most frequent cause of cancer deaths by site. Although metastases have been reported in practically every organ in the body, prostatic cancer most often metastasizes to bones, regional lymph nodes, and viscera. Although secondary involvement of the larynx by malignant neoplasms arising in contiguous structures is well known, metastatic cancer to the larynx from a prostate carcinoma is rare. This report discusses a unique case that presented with hoarseness resulting from vocal cord paralysis. The diagnosis of the tumor was confirmed by immunoperoxidase stains for prostate‐specific antigen.
Validity of test occlusion studies prior to internal carotid artery sacrifice
Authors: McIvor Nicholas P. , Willinsky Robert A. , Terbrugge Karel G. , Rutka John A. , Freeman Jeremy L.
Published: February 2007

Twenty‐nine patients with lesions of the neck, skull base, and cavernous sinus had test balloon occlusions of the internal carotid artery (ICA) to determine the feasibility of sacrifice of the artery. Only one patient (3.4%) showed evidence of cere‐brovascular compromise. Sixteen patients who tolerated test occlusions went on to ICA sacrifice. Ten patients had permanent balloon occlusion (PBO) of the ICA for cavernous aneurysms or to “trap” carotid‐cavernous fistulae (CCF). Complications occurred in three patients (30%) with permanent morbidity in one patient (10%). One patient with CCF had PBO of the proximal ICA only, resulting in an unstable neurologic state and ultimately in death. Two patients had resection of skull base tumors 2 and 6 days after PBO of the ICA. Both suffered strokes and one died. Three patients had surgical sacrifice of the ICA without PBO. Two of these patients suffered cerebral ischemia without permanent sequelae. We conclude that test occlusion of the ICA with clinical monitoring will miss a significant number of patients with inadequate cerebrovascular reserve. Sensitivity is improved by controlled reduction of systemic blood pressure during the test occlusion. Resection of a skull base tumor soon after PBO of the ICA should be done in a delayed fashion or preceded by extracranial‐intracranial arterial bypass. Patients who have had the artery sacrificed should be monitored in an intensive care setting for 48 hours to avoid hypotension, which could cause cerebrovascular ischemia. © 1994 John Wiley & Sons, Inc.
Differential movement during swallowing as an aid in the detection of thyroid pseudonodules
Authors: Siminoski Kerry
Published: February 2007

The clinical examination of neck masses is clearly imperfect and false‐positive detection of thyroid nodules, termed “pseudonodules.” remains a common problem. Movement on swallowing has been emphasized as a highly specific feature of thyroid masses, but lesions in the vicinity of the thyroid can be displaced by underlying structures during deglutition causing them to mimic thyroid nodules. Two cases are presented to illustrate how additional features of neck mass movement can help determine whether a lesion is located within the thyroid or whether it is extrathyroidal. These include the range of motion of the mass, the presence or absence of a stationary phase prior to descent, and the timing of the movements of the mass. Assessment of these parameters during the physical examination of anterior neck masses may help reduce the incidence of thyroid pseudonocules. © 1994 John Wiley & Sons, Inc.
Multidisciplinary treatment of head and neck cancer using BCG, OK‐432, and GE‐132 as biologic response modifiers
Authors: Fukazawa Hajime , Ohashi Yasushi , Sekiyama Saburo , Hoshi Hideki , Abe Michio , Takahashi Mamoru , Sato Toshihisa
Published: February 2007

Since 1979, we have performed multidisciplinary treatment using intensive immunotherapy with biologic response modifiers (BRM) in combination with surgical treatment of oral cancer. Chemotherapy and radiotherapy were also included as part of the therapy. A historic control study was performed. Adjuvant therapy was administered by standardized methods, and the distribution of patients at various stages was similar between groups. The immunotherapy group showed a shorter treatment period, lower rates of recurrence, metastases, and side effects, greater histologic effects at the end of the first treatment, and a higher survival rate than the nonimmunotherapy group. Immunologically, immunotherapy tended to promote positive immune reactions and inhibit negative immune reactions. © 1994 John Wiley & Sons, Inc.
Chondrosarcoma of the larynx: Challenges in diagnosis and management
Authors: Bogdan Charles J. , Maniglia Anthony J. , Eliachar Isaac , Katz Robert L.
Published: February 2007

Chondrosarcoma is a rare neoplasm of the larynx with approximately 200 cases reported in the literature. The infrequent occurrence of this neoplasm, and its indolent pattern of growth, can result in a delayed or missed diagnosis, thereby jeopardizing the preservation of laryngeal function. Four cases of chondrosarcoma of the larynx are presented demonstrating the challenges in the diagnosis and management of this neoplasm. Conservation surgery remains the mainstay of therapy aiming towards preservation of the framework and function of the larynx. Two innovative reconstructive techniques are presented which made conservation laryngeal surgery possible in two of the four patients. Indeed, surgical resection with sound oncologic principles must be applied and total laryngectomy may be necessary. On rare occasion radiotherapy may be used, although its value remains controversial. © 1994 John Wiley & Sons, Inc.
Vascular basis of lateral osteotomy of the mandible
Authors: McGregor Alan D. , MacDonald D. G.
Published: February 2007

The sources of periosteal blood supply to the mandible have been investigated by dissection, histology, and injection studies. The facial artery has been identified as a major extraosseous source of blood supply to the body. The study confirms the importance of preserving the soft tissue attachments on the buccal aspect and lower border of the mandible during lateral mandibular osteotomy. © 1994 John Wiley & Sons, Inc.
Giant cell lesions of the maxilla and paranasal sinuses
Authors: Stolovitzky J. Pablo , Waldron Charles A. , McConnel Fred M. S.
Published: February 2007

Giant cell lesions of the maxilla and paranasal sinuses represent a rare, locally aggressive disorder which present as a soft tissue mass with distinct histologic and clinical features. There is considerable controversy on the therapeutic modalities, the prediction of clinical behavior based on histologic features, and whether these growths are reactive or neoplastic in nature. We present our clinical experience with four of these lesions. Follow‐up ranged from 3 to 11 years. Our results and the rationale for aggressive surgical treatment will be discussed.

We hypothesize that giant cell “granuloma” of the maxilla and paranasal sinuses and giant cell tumor of other bones represent a continuum of a single disease process, which may have an aggressive clinical behavior. This paper, with a literature review, will address the treatment controversy and advocate surgical resection for all giant cell lesions. © 1994 John Wiley & Sons, Inc.