bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgery versus combined therapies for cancer of the anterior floor of the mouth
Authors: Grandi Cesare , Chiesa Fausto , Cervia Marco , Sala Luigi , Barbano Pier R. , Molinari Roberto
Published: February 2007

We report the results of treatment in a consecutive series of 75 patients operated on at the Istituto Nazionale Tumori of Milan, from January 1965 to December 1979, for cancer of the anterior floor of the mouth. Most of the tumors were advanced: 39 were treated with simple resection, and 36 underwent combined treatment, consisting of surgery associated with either chemotherapy or surgery. Three‐ and five‐year observed survival rates of the whole series were good (41% and 25%, respectively), considering the tumor stage of these patients, but the determined survival rates were particularly high (56% and 46%, respectively). No real advantage was found in the use of multiple planned sequential therapies over surgery alone, and deaths from intercurrent diseases seemed to be more frequent in the patients who underwent combined therapies. We conclude that for patients in poor general condition, such as those with carcinomas of the anterior floor of the mouth, aggressive and complex treatments should be considered with caution in controlled clinical trials.
Mohs surgery: Techniques, indications, and applications in head and neck surgery
Authors: Swanson Neil A. , Grekin Roy C. , Baker Shan R.
Published: February 2007

Mohs surgery, as it has evolved since its inception by Dr. Mohs, is a technique for removal of certain cancers using careful, precise microscopic marginal control. The contemporary technique using fresh tissue is detailed, illustrating advantages that include maximal conservation of normal surrounding tissue and structures, an extremely high cure rate, and a tumor‐free defect which can be reconstructed immediately. The indications and applications for Mohs surgery, once limited to large recurrent basal cell carcinomas, have expanded to include several cutaneous and paracutaneous neoplasms. These, with an emphasis on certain basal cell carcinomas, are discussed in detail. With better understanding of the Mohs technique, its indications, applications, and advantages, an interdisciplinary approach to certain cutaneous and paracutaneous neoplasms is proposed.
Second malignant neoplasms in patients successfully treated with multimodality treatment for advanced head and neck cancer
Authors: Vikram Bhadrasain , Strong Elliot W. , Shah Jatin P. , Spiro Ronald
Published: February 2007

One hundred fourteen patients with advanced (stage III or IV) epidermoid carcinoma of the oral cavity, pharynx, larynx, and hypopharynx were treated by surgery and postoperative radiation therapy between 1975 and 1980. Twenty‐seven patients also received preoperative platinum‐containing chemotherapy. Sixteen patients developed second malignant neoplasms. The site of the second malignant neoplasm was in the esophagus in seven patients (44%), in the lung in six patients (37.5%), and at other sites in three patients (18.5%). Relapse of the head and neck cancer (at the primary site in 6 patients, in the neck in 11 patients, and at distant sites in 20 patients) appeared within the first 2 years in virtually all cases. In contrast, second malignant neoplasms have appeared at a steady rate of approximately 6% per year, for at least the first 4 years. Future efforts at improving the survival of patients with advanced head and neck cancer, therefore, must include strategies aimed at decreasing the incidence and the morbidity and mortality from second malignant neoplasms.
Cyclophosphamide, adriamycin, and 24‐hour infusion of cis‐diamminedichloroplatinum (II) in the management of patients with advanced head and neck neoplasms
Authors: Creagan Edward T. , O'Fallon Judith R. , Schutt Allan J. , Rubin Joseph , Woods John E.
Published: February 2007

Twenty‐eight patients with measurable or evaluable, regionally advanced or metastatic head and neck cancer received the combination of cyclophosphamide (C), adriamycin (ADR), and a 24‐hour infusion of cis‐diamminedichloroplatinum (II) (P). Most patients had received extensive prior surgery and radiation therapy, but only two had prior chemotherapy. We observed a 46% response rate (13/28) which included five complete responders and eight partial responders. Nine of the 13 patients responded within the initial month of treatment. The median response duration for the 13 responding patients was 7.5 months. Moderate to severe nausea and vomiting, and alopecia were the most significant toxicities. Myelosuppression (WBC < 4,100 cells/mm3) occurred in 90% of patients but there were no episodes of sepsis, nor did we detect any meaningful impairment in renal function.
Approach to and reconstruction for lesions of the posterior third of the tongue via midline labiomandibular glossotomy
Authors: Alperin Kenneth M. , Levine Howard L. , Wood Benjamin G. , Tucker Harvey M.
Published: February 2007

Most benign and malignant lesions of the posterior third of the tongue may be approached through a median labiomandibular glossotomy. This is accomplished by splitting the lower lip, mandible, floor of the mouth, and tongue in the midline to expose such areas as the posterior tongue, pharynx, and nasopharynx. This technique is useful for lesions of the posterior third of the tongue for several reasons: 1) it provides excellent exposure, 2) it is cosmetically superior to most other approaches, 3) it allows for several alternatives to reconstruction, such as retrusion or rotation tongue flaps, 4) the procedure sustains minimum blood loss since the tongue is bisected in the midline in an avascular plane, (5) when preoperative radiation therapy has been included, this approach minimizes the amount of surgery performed through the radiated field, and 6) postoperative tongue mobility is usually sufficient to permit articulation and deglutition to approach normal. The Cleveland Clinic Foundation's experience with this approach is reviewed, the technique is described, and a variety of cases are presented to illustrate its applicability.
Malignant tumors of the paranasal sinuses: Radiologic, clinical, and histopathologic evaluation of 200 cases
Authors: Weber Alfred L. , Stanton Andrea C.
Published: February 2007

Malignant tumors of the paranasal sinuses are often found to be greatly advanced by the time a clinical or radiologic diagnosis is established. Therefore, the overall cure rate is low, even when surgery and radiation therapy are combined. The clinical manifestations and pathologic findings are analyzed in 200 cases to illustrate the wide spectrum of these tumors as to their type, specific location, and the extent to which they can spread within the sinuses and to adjacent anatomic areas. The various radiologic modalities, including conventional x‐ray films, angiography, and conventional and computed tomography are presented. Their relative merit in the diagnosis and staging of these tumors is evaluated.
Neurofibromatosis of the head and neck
Authors: Maceri Dennis R. , Saxon Keith G.
Published: February 2007

Neurofibromatosis (von Recklinghausen's disease) is an autosomal dominant disease that affects one in 2,500–3,000 births. Because the head and neck is unique in its anatomical compartmentalization of the central and peripheral nervous systems, the potential for involvement of these areas with neurofibromas is substantial and accounts for a myriad of clinicopathologic presentations. In the present study, the incidence of involvement in the head and neck is 37%. We found 81% of the patients had café au lait spots, 63% had positive family histories, and 66% had multiple cutaneous nodules. An incidence of malignant transformation was documented in 3.5% of the cases. Management of benign neurofibromatosis must be individualized for each patient and ranges from incisional biopsy to wide local excision. In every case, the risk of severe neurologic deficit must be weighed against the benefits of surgical resection, which is usually incomplete. Genetic counseling is advised for all patients with this disease, since no cure is available.
The value of the prognostic nutritional index in the management of patients with advanced carcinoma of the head and neck
Authors: Goodwin W. Jarrard , Torres Julio
Published: February 2007

Nutritional status was evaluated in 50 consecutive patients with advanced squamous cell carcinoma of the head and neck. Using a linear equation developed by Busby, the prognostic nutritional index (PNI) was calculated from the serum albumin, triceps skin‐fold thickness, serum transferrin, and delayed hypersensitivity reaction. The treatment plan was determined by the patient's attending physician and complications were retrospectively evaluated. The patients were divided into three groups by the value of the PNI. The complication rate was not significantly higher in patients with moderate malnutrition (PNI between 20% and 39%). However, with severe malnutrition (PNI greater than 39%), the incidence of iatrogenic complications was prohibitive and 12 of 14 patients were dead within 6 months. We conclude that the PNI is a simple, objective measure of nutritional status that will identify patients at high risk for therapy‐related complications and early death.
Thyroid function following radiation and surgical therapy in head and neck malignancy
Authors: Zohar Yuval , Tovim Reuben Ben , Laurian Nello , Laurian Lydia
Published: February 2007

A retrospective 10‐year review of thyroid function in 144 patients treated for cancer of the head and neck by radiation therapy, surgery, and combined surgery and radiation therapy was done. In five patients, hypothyroidism had been found in the posttreatment period. Two of them had developed a pharyngeal fistula resistant to intensive local care and surgical procedures, and a third patient had edema and necrosis of the skin flap. The five hypothyroid patients reported here have all been treated for laryngeal malignancy. In any other group of patients treated for head and neck malignancies studied within this article, we did not find clinical or chemical signs of thyroid hypofunction. Our report stresses the importance of periodic evaluation of thyroid function in patients who underwent irradiation of the neck or combined therapy for malignancy in the neck, even if they were clinically euthyroid. Hypofunction may be more frequent than generally recognized after multimodality treatment, and hormonal replacement therapy may be the keystone in curing rebellious pharyngeal fistula and shortening the disabled state of the patient.
Uncommon clinical manifestations in a case of thyroid carcinoma
Authors: Tovi Ferit , Leiberman Alberto , Hirsch Menachem
Published: February 2007

A case of multiple, functional bone metastases from a previously operated follicular thyroid carcinoma is reported in an apparently euthyroid patient. Additional uncommon clinical manifestations encountered in this case were: 1) mandibular metastasis mimicking an intraoral arteriovenous malformation, 2) extensive, destructive, and expansive intraspinal metastases in the thoracic vertebral column protruding into the posterior mediastinum and causing severe spinal lesions, and 3) the precipitation of a fatal thyroid crisis following radioactive iodine treatment.
The current status of mandibular reconstruction using autogenous frozen mandibular grafts
Authors: Leipzig Bruce , Cummings Charles W.
Published: February 2007

A review of recent developments in experimental canine surgery using autogenous frozen grafts for mandibular reconstruction has elicited enthusiasm for their human application in cancer surgery. They do reossify, even under adverse conditions of perioperative irradiation, to regenerate a mandibular graft in the dog. Our experience with six patients who underwent immediate autogenous mandibular graft reconstruction is dismal. All failed because of intraoral complications; none evidenced recurrence of tumor in bone. A delayed procedure, in which revascularization of the midportion of the bone graft may be improved, may prevent many of these problems.
A safe technique for thyroidectomy with complete nerve dissection and parathyroid preservation
Authors: Karlan Mitchell S. , Catz Boris , Dunkelman Daniel , Uyeda Robert Y. , Gleischman Stewart
Published: February 2007

A series of 1,000 consecutive thyroid operations is presented, without a case of permanent recurrent laryngeal nerve injury. Emphasis is placed on the identification of variations and complete dissection of the recurrent laryngeal nerve, including peripheral branches and technical aspects of the dissection. Sixty‐five percent of the cases had multiple terminal branches of the recurrent laryngeal nerve and five cases on the right side had a nonrecurrent course. A low incidence of hypoparathyroidism is presented, due in part to the avoidance of ligating the inferior thyroid artery in continuity and the technique of extracapsular dissection of the thyroid gland. The external branch of the superior laryngeal nerve was protected by the early mobilization of the superior thyroid vessels and ligatures placed flush on the capsule of the superior pole.
Pure squamous cell carcinoma and mixed adenosquamous cell carcinoma of the thyroid gland
Authors: Segal Karl , Sidi Jack , Abraham Aristide , Konichezky Miriam , Ben‐Bassat Mina
Published: February 2007

Four cases of pure squamous cell carcinoma and two cases of mixed squamous cell and glandular carcinoma are reported. Obviously, there is a possibility that squamous cell carcinoma of the thyroid gland develops from the existing squamous cells or as a result of metaplasia of follicular cells. Metastases and direct extension of squamous cell carcinoma in the thyroid gland are much more frequent and must be excluded before the diagnosis can be established. Although the gross and microscopic pathology of these lesions presents no unusual features, follicles lined by metaplastic squamous cells offer strong presumptive evidence of a primary thyroid neoplasm. These tumors are comparatively radioresistant and biologically highly malignant. The treatment of choice is radical surgical resection, and these neoplasms must be treated more aggressively in the initial stage.
Advanced supraglottic carcinoma: A comparative study of sequential treatment policies
Authors: Seiden Allen M. , Mantravadi Rao P. , Haas Richard B. , Applebaum Edward L.
Published: February 2007

Data from 131 consecutive patients with operable stage III or IV (American Joint Committee) supraglottic carcinoma were analyzed. Based on existing treatment policies at the time of presentation, patients received either preoperative radiation therapy (RT) (48 patients), surgery alone (42 patients), or postoperative RT (41 patients). Preoperative RT dose levels were either 2,000 rad in five fractions (33 patients) or 5,000 rad in 25 fractions (15 patients). Postoperative RT dosages were 5,000 to 6,000 rad in 6 to 6 1/2 weeks. Surgical procedures included either subtotal or total laryngectomy and radical neck dissection. Tumor control was achieved in 21 of 42 patients (50%) treated with surgery alone, 23 of 48 patients (48%) treated with preoperative RT, and 29 of 41 patients (71%) treated with postoperative RT (P = 0.005). The actuarial, recurrence‐free survival at 5 years was 36% and 35%, respectively, in the surgery alone or preoperative RT groups as compared to 55% in postoperatively irradiated patients. The authors conclude that advanced but resectable supraglottic carcinomas may be best treated with surgery followed by RT, rather than with surgery alone or with combined preoperative RT and surgery.
The “Crossbow” incision and nasal FLAP—Its blood supply and clinical application
Authors: Hassard Alexander Daniel , Holness Renn Osmond
Published: February 2007

An anatomical study of the blood supply of the nose and upper lip was done on 10 specimens. This demonstrated the blood supply of an inferiorly based nasal flap, which was successfully used to gain access for an en bloc resection of adenoid cystic carcinoma of the ethmoid sinuses, frontal sinuses, and nose. The “crossbow” incision and inferiorly based nasal flap facilitate the tridimensional excision of lesions in the anterior base of the skull, the midline portion of middle base of the skull, and the paranasal sinuses.
Temporal approach to the TMJ, the orbit, and the retromaxillary–infracranial region
Authors: Obwegeser Hugo L.
Published: February 2007

Anatomical and surgical details of the author's temporal approach to the temporomandibular joint (TMJ), the orbit, and the retromaxillary–infratemporal space are described using drawings and photographs taken during surgery. The approach is advocated because it gives any desirable access to the operating fields without leaving a visible scar in the face and because it preserves the condyle and, thereby, the integrity of the TMJ.
Occipital arteriovenous fistulae
Authors: Mikalov Abraham , Nussbaum Moses , Raifman Leonard , Lozman Harvey
Published: February 2007

Occipital arteriovenous fistulae may be congenital or traumatic. The distinguishing characteristics of each and diagnosis by dynamic computed tomographic (CT) scanning, obviating the need for angiography, is outlined and illustrated by a case report. The indications for surgery and operative approach are discussed.
Multiple facial hemangiomas and iron‐deficiency anemia: Blue rubber‐bleb nevus syndrome
Authors: Ohishi Masamichi , Tanaka Yoichi , Higuchi Yoshinori , Otsuka Teruhisa , Kagimoto Masaaki , Niho Yoshiyuki
Published: February 2007

A 21‐year‐old female complained of bluish soft tumors on her face. Her past history of anemia led us to investigate a possibility of “Blue Rubber‐Bleb Nevus syndrome.” Subsequent examinations revealed a severe iron‐deficiency anemia and gastrointestinal tract hemangiomas. The facial hemangiomas were removed after controlling anemia. It is important to examine the gastrointestinal tract when multiple cutaneous hemangiomas are associated with anemia.
Surgical refinements of the hairline in hair transplant surgery
Authors: Resnik Sorrel S.
Published: February 2007

A hairline placed too low on the forehead is the most common error in hair transplant surgery, and misdirection of grafts is the second most common. Correction of these and other errors in this subtle surgery is difficult and challenges the surgeon's artistic talents. In most cases, a natural appearance can be achieved.
Vertical partial laryngectomy for recurrent glottic carcinoma after irradiation
Authors: Croll Gerard A. , Van Den dBroek Paul , Tiwari Ramu M. , Manni Johannes J. , Snow Gordon B.
Published: February 2007

Vertical partial laryngectomy after a full course of irradiation was performed in 26 patients as salvage surgery for recurrent or residual glottic carcinoma. An excellent cure rate and conservation of function was obtained, while complications were few. A prerequisite for this type of surgery is a limited extent and infiltration of the recurrent local tumor growth. As the great majority of local recurrence appears within the first 2 years after radiotherapy, frequent follow‐up during this period is stressed for early detection of a recurrence.
Congenital granular cell epulis causing polyhydramnios
Authors: Ophir Dov , Marshak Gabriel
Published: February 2007

We report a case of an extremely large granular cell epulis situated on the maxillary alveolar ridge of a newborn. It obstructed the infant's mouth and caused polyhydramnios. The lesion was detected in utero by ultrasonography and removed after birth in the delivery room, with satisfactory results. It is evident that the epulis increased in size during the last phase of pregnancy. The literature concerning this peculiar lesion is reviewed and theories of histogenesis are discussed.
Psychosocial ramifications of childhood malignancy for the child and family
Authors: Copeland Donna R.
Published: February 2007

The changes that occur in a child's life following the diagnosis of cancer extend to other members of the family and, through time, far beyond the biologic cure of the disease. The responses of the family to this stress and the ways in which they cope with it will depend partially on their own resources and partially on the severity of the disease and its treatment. This paper describes the factors that influence the family's adaptation to illness and presents a case example that illustrates criteria useful in assessing the need for psychologic consultation in childhood cancer patients and their families. Also presented are guidelines for the physician in his/her continuing observation and follow‐up of these patients and families.
Complications following laryngectomy
Authors: Shemen Larry J. , Spiro Ronald H.
Published: February 2007

The complications following 100 consecutive laryngectomies performed at our hospital during a recent 18‐month period are reviewed. The complication rates for total laryngectomy (63 patients) and extended laryngectomy (37 patients) were 19% and 49%, respectively, while the fistula rates were 8% and 27%, respectively. These rates were influenced primarily by the extent of surgery and the type of reconstruction, which during this interval included primary closure, pectoralis major myocutaneous flap, or gastric transposition. In comparison to our previous study, when the deltopectoral flap was used for patching the pharynx, the fistula rate for extended laryngectomy has decreased as a result of our use of myocutaneous flaps and greater expeience with gastric transposition. Currently, we use the pectoralis major myocutaneous flap for pharyngeal repair if the mucosa would otherwise be closed under tension. All circumferential defects are repaired with a gastric transposition.
Adenoid cystic salivary gland carcinoma: A clinicopathologic correlation
Authors: Matsuba Howard M. , Simpson Joseph R. , Mauney Marc , Thawley Stanley E.
Published: February 2007

Between 1960 and 1980, 71 cases of adenoid cystic carcinoma (ACC) were reviewed according to treatment modality and clinical course. Histologic review of pathologic slides was performed to classify the tumors into their predominant histologic pattern (tubular, cribriform, solid). The predominant histologic patterns of the tumors were equally divided between tubular and cribriform. Very few were classified as a solid pattern. In the patients receiving the same type of therapy (surgery and irradiation), the cribiform and tubular variants of ACC demonstrated no difference in the rate of distant metastases and overall survival. The cribriform variant demonstrated a significantly worse prognosis in terms of local recurrence rate. The patients who had a solid histologic pattern of ACC appeared to have an overall worse prognosis in terms of distant metastases and long‐term survival. The long‐term survival of patients with ACC may be related to the development of distant metastases despite local control.
Thyroglossal duct carcinomas: Light and electron microscopic studies
Authors: Ronan Salve G. , Deutsch Elise , Ghosh Luna
Published: February 2007

Two cases of papillary carcinoma arising in thyroglossal duct cysts are reported. Electron microscopic studies were done on both cases and similar ultrastructural features were noted. When compared with a case of papillary adenocarcinoma arising in the thyroid gland proper, no difference was seen both at the light microscopic and ultrastructural levels.
Cranioplasty with a silicone prosthesis and split rib grafts
Authors: Chicarilli Zeno N. , Ariyan Stephan
Published: February 2007

A method to reconstruct visible cranioplasty defects involving the anterior cranium with the durability of bone and the exacting contours of the custom silicone implant is described. This technique is simple, quick, and does not require intraoperative assessment of subtle contours. The patient has a rigid underlying bony support with a perfectly contoured external surface. In patients with cranioplasty involving the cranium anterior to the hairline, we take advantage of both split rib grafts and a silicone prosthesis in one stage to obtain optimal results.
Sphenoid sinus brown tumor, hypercalcemia, and blindness: An unusual presentation of primary hyperparathyroidism
Authors: Schweitzer Vanessa G. , Thompson Norman W. , McClatchey Kenneth D.
Published: February 2007

This is a first report of primary hyperparathyroidism (HPT) masquerading as a destructive fibrous sphenoid sinus “Brown tumor” associated with progressive blindness and hypercalcemia. Diagnosis of a Brown tumor was delayed despite serial computerized tomography of the head and repeated transnasal and transethmoid sphenoid biopsies demonstrating diffuse fibrosis. Only detection and medical evaluation of hypercalcemia, demonstrating elevation of both serum calcium and C‐terminal parathyroid hormone with an elevated chloride/phosphate ratio, prompted neck exploration, thus confirming a solitary left superior parathyroid adenoma. Postoperative normocalcemia occurred synchronously with the return of light perception and the arrest of sphenoid sinus and parasellar erosion. Although maxillary Brown tumors of secondary HPT have been reported, this is the first report of osteitis fibrosa of the sphenoid sinus. Differential diagnosis of an erosive sphenoid lesion with cranial nerve dysfunction, exclusive of inflammatory or vascular disease, should include sarcoidosis, primary and metastatic sphenoid carcinoma, fibrous dysplasia, giant cell reparative granuloma, midline lethal granuloma, chordoma, and chondrosarcoma. Furthermore, the bony destructive lesions with concomitant hypercalcemia of sarcoidosis and HPT are distinguishable by radiographic and laboratory analyses and by the Dent corticosteroid suppression test. Hypercalcemia of primary HPT is associated with elevated serum C‐terminal parathormone, osteitis fibrosa, a negative Dent test, and a chloride/phosphate ratio greater than 33 in 94% of primary HPT patients. Hypercalcemia of sarcoidosis is associated with a normal or decreased C‐terminal parathormone assay and a positive Dent test, as well as elevated serum immunoglobulins and erythrocyte sedimentation rate, and a positive angiotensin‐converting enzyme assay. Although in primary HPT the incidence of hypercalcemia approaches 100% with the incidence of osteitis fibrosa less than 7%, the mortality of undiagnosed hypercalcemia approaches 60%. A delay in diagnosis and in curative parathyroidectomy can result in unnecessary complications as demonstrated by this report of progressive blindness associated with a destructive sphenoid Brown tumor.
Surgical treatment of early‐stage carcinoma of the oral tongue—would adjuvant treatment be beneficial?
Authors: O'brien Christopher J. , Lahr Christopher J. , Soong Seng‐Jaw , Gandour Michael J. , Jones J. Michael , Urist Marshall M. , Maddox William A.
Published: February 2007

A group of 97 patients with clinical stage I and stage II squamous carcinoma of the oral tongue, treated by partial glossectomy alone, has been reviewed to define prognostic indicators. Sixty‐seven patients were staged T1NO and 30 were T2NO. Disease recurred in 28 patients (27%) and the most common site of failure was the ipsilateral neck (21%). The incidence of initial recurrence did not vary significantly with patient age, sex, T‐stage, or when tumor size was examined in other subdivisions. The presence of perineural invasion significantly increased recurrence rate (P = 0.003) and decreased survival (P = 0.002). Disease‐free survival at 5 yr was 73% for patients with T1 tumors, and 62% for T2 tumors. This difference was not significant. In this low‐risk patient population with early stage carcinoma of the oral tongue, partial glossectomy is adequate treatment in most cases. However, we recommend postoperative radiation therapy to the primary site and ipsilateral neck for patients with perineural invasion. No evidence could be found to support adjuvant local therapy or elective neck treatment in the remaining patients.
Scapular free flap for repair of massive lower facial composite defects
Authors: Granick Mark S. , Newton E. Douglas , Hanna Dwight C.
Published: February 2007

The scapular osteocutaneous free flap provides excellent tissue for reconstruction of massive lower facial defects. Five cases of full‐thickness cheek and lip defects associated with mandibular loss were successfully repaired with sandwiched osteocutaneous scapular flaps plus a parascapular or latissimus dorsi flap. In two instances the osteocutaneous scapular flap was harvested along with a parascapular skin paddle. The other three patients had latissimus dorsi myocutaneous units taken with the scapular osteocutaneous flap from the same subscapular pedicle.
Examination of swallowing after total laryngectomy using manofluorography
Authors: McConnel Fred M. S. , Mendelsohn Martyn S. , Logemann Jerilyn A.
Published: February 2007

Investigation of postlaryngectomy dysphagia is usually limited to the standard barium swallow. Manofluorography (mano, manometry; fluoro, videofluoroscopy; graphy, picture) is a new technique that permits analysis of simultaneous manometry and videofluoroscopy of deglutition. Manofluorography provides more detailed analysis of the swallowing dynamics during the pharyngeal stage of deglutition than either barium studies or manometry used alone. This study uses manofluorography to examine swallowing in two patient groups, total laryngectomees and total laryngectomees with tongue impairment, to analyze the role of various anatomic components in the swallowing process. Pharyngeal transit times were prolonged in both patient groups studied, with the tongue impairment group exhibiting the longest times. The postlaryngectomy pharynx offered greater resistance to bolus flow. The laryngectomy patients compensated by using increased lingual propulsion, whereas the patients with tongue impairment and total laryngectomy could not. This emphasizes the importance of the tongue in bolus propulsion in the pharynx. Other postoperative changes in swallowing are discussed.
Rhabdomyosarcoma of the soft palate in three patients with follow‐up of longer than ten years
Authors: Maso Maurizio Dal , Kushner Joseph H. , Dedo Herbert H.
Published: February 2007

Rhabdomyosarcoma of the head and neck is a rare childhood neoplasm. Most occur in the orbit, which accounts for the scarcity of papers on modern techniques of treatment of soft palate rhab‐domyosarcomas. Only 30 cases of soft palate rhabdomyosar‐coma have been reported in recent years and none had long‐term follow‐up periods (>10 yr). This study reports three cases of pediatric soft palate rhabdomyosarcomas treated with surgery, radiotherapy (two of three), and chemotherapy. The complications that occurred in one patient are discussed.
Desmoplastic squamous cell carcinoma of the tongue simulating myositis or fasciitis
Authors: Norris Charles M. , Mustoe Thomas A. , Ross Jeffrey S. , Goodman Max L.
Published: February 2007

An unusual form of squamous cell carcinoma of the tongue is reported, the “de novo” submucosal evolution of which is unique. Histologic definition of this malignancy and its distinction from clinically similar benign and malignant conditions are detailed through a brief review of the relevant differential diagnoses. The importance of circumspect diagnostic reassessment when the clinical behavior of a lesion contradicts apparent histologic benignancy is emphasized and treatment inferences are drawn.
Malignant salivary tumors—analysis of prognostic factors and survival
Authors: O'brien Christopher J. , Soong Seng‐Jaw , Herrera Guillermo A. , Urist Marshall M. , Maddox William A.
Published: February 2007

A group of 113 patients with malignant salivary gland tumors was retrospectively reviewed to analyze the association of clinical and histologic factors with survival. These factors were patient sex and age, tumor site, clinical stage, histologic diagnosis, tumor grade, and whether or not final surgical margins were clear. There were 57 parotid, 40 minor salivary, and 16 submandibular gland cancers. The histologic groups were mucoepidermoid carcinoma (49 patients), adenoid cystic carcinoma (31), adenocarcinoma not otherwise specified (18), acinic cell carcinoma (7), malignant mixed tumor (5), squamous cell carcinoma (2), and undifferentiated carcinoma (1). Univariate analysis of clinical factors showed that age and clinical stage significantly influenced survival. At 10 yr the predicted cumulative survival rates for Stage I, II, III, and IV tumors were 74%, 56%, 32%, and 10%, respectively. Tumor grade was the only significant histologic factor. This was most obviously reflected among patients with mucoepidermoid carcinomas. Cumulative survival at 5 yr was 94% for those with low‐grade tumors and 26% for high‐grade tumors. By multivariate analysis, clinical stage, age, and tumor grade remained highly significant. Analysis of patients with only Stage I and II disease demonstrated that the significant factors were patient age, tumor site, tumor grade, and whether or not surgical clearance was achieved. These results suggest that clinical stage should not be the exclusive determinant of the extent of surgery and that the selection of patients, for adjuvant therpay may be improved by an awareness of these prognostic factors.
Preauricular approach to infratemporal fossa
Authors: Wetmore Stephen J. , Suen James Y. , Snyderman Nancy L.
Published: February 2007

We present an approach to the skull base that allows access to both the infratemporal fossa and the middle cranial fossa with minimal morbidity. This approach is different from most of the previously described approaches in that it uses a preauricular incision, preserves the facial nerve, and avoids the mastoid bone. It involves dividing the zygomatic arch and displacing it inferiorly, dividing the malar eminence (zygoma) and displacing it anteriorly, and cutting the coronoid process and retracting it superiorly with the attached temporalis muscle. Reconstruction is accomplished by using the temporalis muscle or a pericranial flap to cover the dura, a free fat graft to fill the space left by tumor excision, and by wiring the zygomatic arch and malar eminence into their original positions. Case reports of both benign and malignant lesions are presented.
Role of transoral irrigation in mediastinitis due to hypopharyngeal perforation
Authors: Santos Gil Hauer , Shapiro Barry M. , Komisar Arnold
Published: February 2007

Mediastinitis resulting from perforations of the hypopharynx is a life‐threatening complication associated with a high morbidity and mortality. In cases of perforation, which are not amenable to primary closure, transoral irrigation has been found to be an effective means of therapy. This technique rapidly controls sepsis, favoring the closure of perforations of the hypopharynx and cervical esophagus. Using this technique we have had no mortality attributed to mediastinitis in patients with mediastinitis due to perforation of the hypopharynx, cervical and thoracic esophagus.
Manofluorography of deglutition after supraglottic laryngectomy
Authors: McConnel F. M. S. , Mendelsohn M. S. , Logemann J. A.
Published: February 2007

Manofluorography (mano: manometry, fluoro: videofluoroscopy, graphy: picture) provides a simultaneous display of manometry and fluoroscopy on one video screen. This study uses mano‐fluorography to analyze the swallowing patterns of nine patients who had undergone supraglottic laryngectomy. The results show that during swallowing the pharyngeal mechanism for preventing aspiration depends upon three processes: (1) tight lingual‐laryn‐geal contact, (2) coordination of the swallowing reflex, and (3) tongue base and pharyngeal constrictor clearing of the hypopharynx and laryngeal inlet. Anterior suspension of the larynx under the tongue base serves to improve lingual‐laryngeal contact. This close contact during deglutition protects the airway from the bolus and also opens the postcricoid region, aiding bolus passage into the esophagus. Impairment of the swallowing reflex, which can cause severe aspiration before the swallowing reflex is triggered, can be rehabilitated by swallowing therapy. Minor aspiration is commonly caused by impaired clearing of the superior hypopharynx after supraglottic laryngectomy.
Spread of squamous cell carcinoma to the nonirradiated edentulous mandible—A preliminary report
Authors: McGregor Ian A. , Gordon Macdonald D.
Published: February 2007

The changes in the mandible and in its relationship to surrounding soft tissue structures after loss of the teeth are described; the regular presence of deficiencies in the cortical bone along the line of the occlusal ridge is emphasized. Resection specimens of squamous carcinoma of the oral cavity not treated by radiotherapy were examined where there was mandibular involvement by tumor, and showed that the main route of tumor entry into the bone was through the occlusal ridge. Subsequent perineural spread along the inferior alveolar nerve has been found to be a regular occurrence.
High resolution CT scan of temporal bone fractures: Association of facial nerve paralysis with temporal bone fractures
Authors: Aguilar Eugenio A. , Yeakley Joel W. , Ghorayeb Bechara Y. , Hauser Michelle , Cabrera Juan , Jahrsdoerfer Robert A.
Published: February 2007

This radiologic study analyzed high resolution computed tomographic (CT) scans of 22 patients with temproral bone fractures. There were 19 males and three females. Fifteen of 22 had clinical evidence of facial nerve injury ranging from mild paresis to complete paralysis. The high resolution CT scan analysis identified a characterstic fracture of the temproral bone in every patient with facial nerve injry. A high percentage of these fractures (68%) could be classified as mixed and did not fall into a longitudinal or transverse fracture category. The characteristic fracture extends from the petroytympanic fissure at the glenoid fossa to the anterior inferior aspect of the medial bony external auditory canal. It resumes at the superior aspect to the external auditory canal (scutum) extending laterally along the external canal wall. If the vector force of the fracture is projected medially, it will cross the facial nerve in its horizontal protion. Often, the evaluation of trauma patients with routine CT scans for central nervous system (CNS) (brain) evaluation is inadequate for evaluation of temporal bone fractures. A high resolution CT scan should be performed when clinical criteria warrant its use. It is recognized that the incidence of facial nerve injury may be higher in this select population.
MacFee incisions: Dispelling the myth of cervical flap vascular inadequacy
Authors: Daniell Christopher H. , Fee Willard E.
Published: February 2007

MacFee (double horizontal) incisions have often been criticized for transecting the dominant blood supply of the central bipedicled cervical flap. To assess the viability of this flap we reviewed our recent surgical data. Ninety‐three patients who underwent 100 radical neck dissections were evaluated retrospectively for cervical skin viability after surgery. MacFee incisions were used in 50 of these; in the remaining 50 a variety of other incisions were used. With MacFee incisions no ischemic tissue loss resulted. By contrast, six patients (12%) in the comparison group experienced partial flap necrosis due to ischemia. Chi‐square analysis shows this difference to be statistically significant (P < 0.01). This study shows the bipedicled cervical flap to be durable, dependable, and sufficiently vascularized to prevent ischemic tissue loss, even when incisions were previously placed in the ipsilateral neck or antecedent radiation therapy was delivered.
Pectoralis minor flaps: An experimental study and clinical applications of osteomuscular, osteomyocutaneous, and myocutaneous models
Authors: De Azevědo Jorge Ferreira
Published: February 2007

The pectoralis minor myocutaneous, osteomyocutaneous, and osteomuscular flaps were used in 14 patients. Thirteen cases had mandibular replacement, with bilateral flap application in three. The first eight flaps incorporated the fifth rib and the last eight flaps included the sixth rib. In the last four cases, the flap was transferred through a subclavicular tunnel. A mentum defect was present in 11 patients. There was one total flap necrosis due to venous thrombosis caused by surgical trauma. The flap provides rich vascularization and versatility, requires a small volume, and does not present serious sequelae to the donor site. It may be performed by a two‐team approach and is a valid option for head and neck reconstruction.
Periorbital cellulitis
Authors: Jackson Keith , Baker Shan R.
Published: February 2007

Periorbital cellulitis is a commonly occurring infectious process limited to the eyelids in the preseptal region. It occurs with greater frequency in the pediatric age group. It is important to distinguish this disease from orbital cellulitis, a potentially lethal infectious process involving the contents of the orbit. A retrospective study of clinical and laboratory data from 137 cases with orbital and periorbital cellulitis was performed. Periorbital cellulitis was documented in 98 cases (71%) in contrast to orbital cellulitis, which was noted in 39 (28%) patients. Sinusitis was the most frequently encountered predisposing factor for the development of periorbital cellulitis occurring in 29 patients. All patients with a diagnosis of periorbital cellulitis were hospitalized and received antibiotics, the majority (95%) receiving intravenous therapy. Hemophilus influenzae was the most frequently isolated pathogenic organism. It was necessary to operate on eight patients. Six patients underwent incision and drainage of an eyelid or periorbital abscess. A distinction between perioribital and orbital cellulitis is clarified. The separation of these entities on the basis of physical examination and radiographic studies is stressed.
Incidence of wharton's duct stenosis in floor of the mouth cancers excised with scalpel or cautery VS CO2 laser
Authors: Mihail Radu , Zajtchuk Joan T. , Davis R. Kim
Published: February 2007

Surgery of the floor of the mouth (FOM) using a scalpel or cautery has produced stenosis of Wharton's duct, necessitating further surgery because of painful enlargement to the gland or suspected metastasis. The laser has been proposed as an alternative method that might avoid this complication. A retrospective study comparing these excisional techniques was done at Walter Reed Army Medical Center between 1973 and 1983. Of a total of 58 lesions, 35 were T1NOMO and 23 were T2NOMO (two synchronous lesions being present). Of 35 lesions excised with a scalpel, 11 had an associated submandibular gland resection. Of the remaining 25, two developed secondary duct stenosis. Of 10 lesions excised with cautery, three had an associated excision of the submandibular gland. Of the remaining seven, two developed stenosis and one required subsequent excision of the gland. Of 12 lesions excised with laser, four developed stenosis and two required subsequent excision of the gland. Laser excision appears to be of no advantage in avoiding further surgery of the submandibular gland. A submandibular gland resection at the time of the original resection of T1NO or T2NO cancers of the FOM does not appear warranted.
Histoplasmosis presenting as a neck mass
Authors: Belani Anusha , Shands Joseph W.
Published: February 2007

A unilateral neck mass is an unusual clinical presentation for histoplasmosis. A patient with a large, unilateral neck mass caused by Histoplasma capsulatum is presented to alert readers to such a possibility and to illustrate some of the difficulties in diagnosing and managing the disease.
Radioimmunoscintigraphy of squamous carcinomas of the head and neck
Authors: Soo K. C. , Ward M. , Roberts K. R. , Keeling F. , Carter R. L. , McCready V. R. , Ott R. J. , Powell E. , Ozanne B. , Westwood J. H. , Gusterson B. A.
Published: February 2007

A pilot study was carried out to assess the value of a radiolabeled antibody against epidermal growth factor receptor (EGFR1) in localizing tumors in patients with squamous carcinomas of the head and neck. Positive images of large tumours (> 3 cm diameter) were obtained in 8 of 11 patients after intravenous administration of 111indium‐labeled EGFR1. Two patients gave equivocal results, while negative scans were obtained from the patient with the smallest tumor (1 cm diameter). There were no false‐positive images. The success of this study in localizing relatively large squamous carcinomas indicates that the antibody should be evaluated in patients with smaller tumors to establish the limits of detection of the technique.
Lymph node invasion in hypopharynx and lateral epilarynx carcinoma: A prognostic factor
Authors: Lefebvre J. L. , Castelain B. , De Torre J. C. La , Delobelle‐Deroide A. , Vankemmel B.
Published: February 2007

Hypopharynx (HC: pyriform fossa, postcricoïd area, and posterior wall) and lateral epilarynx carcinomas (LEC: aryepiglottic fold, pharyngoepiglottic fold, and arytenoid) have a high tendency to cervical lymph node invasion. Such nodal extension is a well‐known prognostic factor. This study is based on a retrospective review of 884 clinical records of previously untreated HC or LEC. Seventy percent of patients revealed palpable nodes at their first examination, with a higher percentage for HC (73%) than LEC (62%). The 5‐year survival rate was divided by three in the presence of contralateral, bilateral, or fixed nodes, or in cases of nodes exceeding 3 cm. Multiple positive nodes, extracapsular spread, or lower‐neck positive nodes significantly decreased survival, doubled the number of neck recurrences, and tripled the number of distant metastases while control at the primary site remained unvaried.
Injury to the orbital plate of the frontal bone
Authors: Potter James A. , Siddoway John R. , Mathog Robert H.
Published: February 2007

Twelve cases of fracture of the orbital plate of the frontal bone are reviewed to clarify this important clinical problem and to suggest satisfactory methods of management. Common signs and symptoms include forehead laceration and deformity, and fracture of the frontal sinus. Loss of vision can occur, and in the seeing eye, diplopia can develop in several fields of gaze. Downward or upward projection of the orbital plate of the frontal bone can cause exophthalmos or enophthalmos. Cerebrospinal fluid leak, with or without meningitis, and seizures can also be part of the syndrome. Effective treatment consists of repairing or obliterating the frontal sinus, reducing the orbital root fracture, and repositioning the globe. Rib or iliac crest grafts, acrylic implants, and temporalis muscle‐galea flaps are useful in correcting the deformity and restoring appropriate function. Long‐term follow‐up examinations are an important part of patient care.
Pharyngeal repair after laryngopharyngectomy: 4‐year experience
Authors: Rifai Mohamed , Amer Faisal , Abdel‐Meguid Hassan , Mebed Hassan
Published: February 2007

The most common forms of surgical intervention carried out at the National Cancer Institute of Cairo for patients initially seen with hypopharyngeal carcinoma are (1) laryngopharyngectomy and pharyngeal repair using the pectoralis major myocutaneous flap (PMMF) and (2) extrapleural total pharyngolaryngoesopha‐gectomy with gastric transposition (GT) and pharyngogastrostomy. The advantages and disadvantages with both techniques will be discussed on the basis of results of 69 patients with different tumor distributions over a 4‐year period.
Esthesioneuroblastoma metastatic to the trachea
Authors: Franklin Daniel , Miller Robert H. , Kim Bloom M. G. , Easley James , Stiernberg Charles M.
Published: February 2007

Esthesioneuroblastoma is an uncommon nasal neoplasm of neural crest origin, which is recognized for its propensity for local recurrence and distant dissemination by both lymphatic and hematogenous routes. Hematogenous spread occurs most frequently to the lungs and bones, but metastases to the liver, spleen, scalp, face, breast, adrenal, aorta, and ovary have been reported. We present a patient who developed metastatic esthe‐sioneuroblastoma of the trachea 1 year after successful craniofacial resection of his primary tumor. The patient was treated by YAG laser resection of the metastatic tumor followed by radiotherapy. He was free of tracheal disease 1 year after treatment of the metastases.