bluuebunny/crossref_metadata_2025 huggingface dataset:
Carcinoma of the tonsillar fossa: A nonrandomized comparison of irradiation alone or combined with surgery: Long‐term results
Authors: Perez Carlos A. , Carmichael Thomas , Devineni Venkata R. , Simpson Joseph R. , Fredrickson John , Sessions Donald , Spector Gershon , Fineberg Barbara
Published: February 2007

The results of therapy are reported in 296 patients with histologically proven epidermoid carcinoma of the tonsillar fossa; 127 were treated with irradiation alone (5,500 to 7,000 cGy), 133 with preoperative radiotherapy (2,000 to 3,000 cGy) or were initially planned for preoperative irradiation but treated with radiotherapy alone, and 36 with postoperative irradiation (5,000 to 6,000 cGy). The operation in all but 4 patients consisted of an en bloc radical tonsillectomy with ipsilateral lymph node dissection. Actuarial 5‐year no evidence of disease (NED) was as follows: survival rates for patients with T1 tumors, 76%; T2, 54%; T3, 45%; and T4, 20%. Patients with no cervical lymphadenopathy or with a small metastatic lymph node (N1) had better relapse‐free survival (60% to 70% at 5 years) than those with large or fixed lymph nodes (30% to 40%). Primary tumor recurrence rate in the T1‐T2 groups was about 20% in patients treated with irradiation and surgery and 30% for those treated with irradiation alone (difference not statistically significant), 30% in patients with stage T3 lesions in all treatment groups, and 33% in patients with T4 disease treated with surgery and postoperative irradiation compared to 52% with irradiation alone (p = 0.03). The overall recurrence rate in the neck was about 20% for the N0 patients, 25% for N1, and 30% for those with N2 and N3 cervical lymph nodes in the 4 treatment groups. The incidence of contralateral neck recurrences was about 8% with the various treatment modalities. Fatal complications were noted in 7 of 133 patients treated with preoperative irradiation in contrast to only 2 (1.5%) of 127 patients treated with radiotherapy alone. Other severe nonfatal sequelae were noted in 33.8% of the patients treated with preoperative irradiation and surgery, in 22% with postoperative irradiation, and in 18% with radiotherapy alone. We conclude that radiotherapy remains the treatment of choice for patients with stage T1‐T2 carcinoma of the tonsillar fossa. In selected T3‐T4 cases a combination of surgery and postoperative irradiation appears to offer better tumor control, but the possibility of greater morbidity must be considered.
Antibiotic prophylaxis in cranial base surgery
Authors: Carrau Ricardo L. , Snyderman Carl , Janecka Ivo P. , Sekhar Laligam , Sen Chandra , D'Amico Frank
Published: February 2007

The role of perioperative antibiotic prophylaxis was investigated in 95 patients undergoing 100 clean‐contaminated cranial base surgeries. A variety of antibiotic regimens were employed. Potential risk factors for local infection were analyzed. Seven patients (7%) developed infections at the surgical site (meningitis, intracranial abscess, cellulitis/abscess, and osteomyelitis). Antibiotic prophylaxis for 24 hours or less was associated with a significantly increased risk of infection (p < 0.04). Prolonged antibiotic prophylaxis (>48 hours) was not more efficacious than prophylaxis for 48 hours. The surgical approach, type of reconstruction, duration of surgery, and use of drains were not significantly correlated with wound infection. The risk of intracranial infection following cranial base surgery is low despite the presence of bacterial contamination intraoperatively. Broad‐spectrum coverage of gram‐positive and gram‐negative organisms for at least 48 hours is recommended. Attention to surgical technique is important in preventing infectious complications.
Laryngeal flap for hypopharynx reconstruction
Authors: Cook David W. , Canepa Clifford , Winek Thomas , Sasaki Truman M.
Published: February 2007

Hypopharynx repair following resection of a pyriform sinus carcinoma may be accomplished primarily or involve a more extensive procedure, such as a free intestinal graft. Described herein is a laryngeal flap which may be used to repair a hypopharyngeal defect when a strip of mucosa, too narrow for a primary repair, is left. This method has been used successfully in 4 patients and has saved these patients from more extensive repairs.
Swallowing recovery following anterior tongue and floor of mouth surgery
Authors: Hamlet Sandra , Jones Lewis , Patterson Robin , Michou Gina , Cislo Charlotte
Published: February 2007

Videofluoroscopic and clinical data are presented for postsurgical recovery of tongue and hyoid activity during swallowing. Comparison is made to normal controls. Postsurgery, but prior to radiotherapy, both the lingual propulsive gesture and hyoid velocity were slower than normal. These features of the swallow had returned to the normal range following radiotherapy. The general sequencing of swallowing events, and the relationship of the end of the tongue propulsion to anterior hyoid motion were normal in those patients able to swallow. In this patient group, postsurgical radiotherapy did not prevent continued recovery of swalloging function sufficient for oral nutrition.
Median mandibulotomy: A critical assessment
Authors: Dubner Sanford , Spiro Ronald H.
Published: February 2007

Median mandibulotomy (mandibular “swing”) has supplanted mandibular resection for access to oral and oropharyngeal tumors when there is intervening grossly normal tissue between the tumor and bone. It has also proved useful for exposure in selected patients with deep lobe parotid or parapharyngeal space tumors. We have reviewed our experience with 313 mandibulotomies performed between 1959 and 1988 with emphasis on indications, complications, and modifications in technique. Most of our mandibulotomy patients had an uncomplicated recovery, but osteotomy‐related compliations occurred in 20%. These complications were usually minor and no instances of nonunion were recorded. There was no apparent relationship to antecedent or postoperative radiotherapy. Dental splints were used only in selected patients (40%). The technique of osteotomy has been evolving in recent years. Paramedian, rather than median mandibulotomy, minimizes trauma to the genioglossus, geniohyoid, and digastric muscles. Miniplates offer a useful alternative to conventional wire fixation. Preoperative dental assessment has facilitated better occlusion postoperatively in dentulous patients.
Hürthle cell carcinoma of the thyroglossal duct
Authors: Adler Mayer , Freeman Jeremy L.
Published: February 2007

A thyroglossal duct cyst is an embyrologic remnant that often manifests as a swelling in the midline of the neck. The development of a carcinoma in a cyst is rare but well recognized. The majority of those reported are papillary carcinoma; there have been 4 cases of mixed follicular‐papillary (which biologically and clinically behaves as a papillary carcinoma) and only 1 follicular. A computer search of the literature revealed no previous report of a Hürthle cell carcinoma arising in a thyroglossal duct. A case of Hürthle cell carcinoma arising in a thyroglossal duct is presented, and the pathology, clinical manifestations, and management are reviewed.
Aneurysm of the internal jugular vein manifesting after prolonged positive pressure ventilation
Authors: Spiro Scott A. , Coccaro Stephen F. , Bogucki Eugene
Published: February 2007

True internal jugular vein aneurysms are exceedingly rare anomalies. To date very few case reports have appeared regarding this entity. We present a case of a congenital internal jugular venous aneurysm which manifested itself after abdominal surgery and prolonged positive pressure ventilation. A theory regarding its manifestation is presented. We believe this case to be unique in its presentation.
Aneurysmal bone cyst of the cricoid cartilage: An unusual cause of subglottic stenosis
Authors: Sercarz Joel A. , Robert Marie , Alessi David , Fu Yao S. , Calcaterra Thomas C.
Published: February 2007

Aneurysmal bone cysts (ABC) are locally aggressive bony tumors which rarely occur in the head and neck. Only 3 cases have been reported in the larynx previously, 1 involving the cricoid cartilage. A patient is presented who developed subglottic stenosis with airway compromise due to an ABC arising from the cricoid cartilage. The literature on bony tumors of the laryngeal cartilages was reviewed and the clinical and pathologic findings in this case highlighted.
Radiotherapy for chemodectoma of the carotid body and ganglion nodosum
Authors: Guedea Fernando , Mendenhall William M. , Parsons James T. , Million Rodney R.
Published: February 2007

Chemodectomas of the carotid body and of the glomus vagale are uncommon tumors of the head and neck. Between 1981 and 1986, 6 patients with advanced chemodectomas of either the carotid body (5 patients) or the glomus vagale (1 patient) were treated with radiotherapy at the University of Florida. Tumors were bilateral in 2 patients. Five patients have had no evidence of disease progression for 5, 5.5, 7, 7, and 8.5 years following irradiation. One of the 5 patients experienced complete regression, 2 noted partial regression, and 2 remained stable (without progression). One patient, who had received 2 prior operations and a course of irradiation at another institution, died of locally recurrent disease 5 years after re‐irradiation at the University of Florida. No patient experienced a significant complication secondary to irradiation.
Serous otitis media and paranasopharyngeal extension of nasopharyngeal carcinoma
Authors: Sham Jonathan S. T. , Wei William I. , Lau S. K. , Yau C. C. , Choy D.
Published: February 2007

Two hundred thirty‐two patients with nasopharyngeal carcinoma were evaluated for serous otitis media (SOM) at diagnosis. The diagnosis of SOM required the detection of effusion behind the tympanic membrane in association of air‐bone gap of 10 dB or more in pure tone audiogram. These patients were also evaluated by computed tomography for the degree of tumor extension. By stepwise logistic regression analysis, the degree of paranasopharyngeal extension of tumor, erosion of petrous temporal bone, and the obliteration of pharyngeal recess were significantly related to the development of SOM, but sex and age were not. The findings of computed tomography may influence the plan of management for SOM in patients with nasopharyngeal carcinoma at diagnosis.
Recent results of oral cancer research in Kerala, India
Authors: Sankaranarayanan R. , Nair M. Krishnan , Mathew Babu , Balaram Prabha , Sebastian Paul , Dutt Suresh Chandra
Published: February 2007

Findings from a research program in oral cancer at Regional Cancer Centre, Trivandrum, Kerala, India are reviewed. There is evidence of immune impairment in oral cancer patients. Plant lectins are being investigated for specific binding characteristics in various oral precancers and different histological subtypes of oral cancer. Tobacco and alcohol have been identified as the major risk factors for oral cancer. The chemopreventive potential of carotenoids and retinoids have been evaluated in oral leucoplakias. Beta‐carotene and vitamin A in heavier doses induced remission of oral leukoplakias in 25%‐50% of trial participants who continued with their tobacco and alcohol habits during the trial. The remission could be maintained with lower doses. Less than 20% of our patients with oral cancer were initially seen in localized stages. Various community‐oriented programs for prevention of primary and secondary oral cancers are being evaluated. These include antitobacco health education, oral self‐examination, and oral examination by trained volunteers. The results of radical radiotherapy and surgical salvage of radiation failure are also discussed. The 5‐year disease‐free survival rate of 34% is a reflection of the advanced stages of the disease when initially seen. Salvage rates with surgery for radiation failures were encouraging.
Resection of advanced cervical metastasis prior to definitive radiotherapy for primary squamous carcinomas of the upper aerodigestive tract
Authors: Byers Robert M. , Clayman Gary L. , Guillamondequi Oscar M. , Peters Lester J. , Goepfert Helmuth
Published: February 2007

Thirty‐five previously untreated patients with stage IV squamous cell carcinoma of the upper aerodigestive tract with advanced neck disease (mass > 3 cm) but with primary lesions thought to be locally controllable with radiotherapy were selected between 1972 and 1988 for treatment by neck dissection followed by radiotherapy: postoperative to the neck and definitive to the primary. Limited neck dissections spared muscles, nerves, and vasculature structures unless clinically involved with cancer. All patients received at least 50 Gy, postoperatively, to the entire neck with doses of up to 75 Gy being delivered to the primary treatment portals. Regional (neck) failure occured in 11% (4 of 35) patients. Overall, 5‐year survival from cancer was 55%. Multiple levels of neck involvement were associated with poorer survival than a single large node; however, the difference was not statistically significant. Delay in the institution of radiotherapy following surgery adversely affected survival (p = 0.01). This study demonstrates that in selected patients it is possible to resect advanced nodal metastasis prior to treating the primary with radiotherapy without compromising cancer control.
Serratus anterior muscle in composite head and neck flaps
Authors: Loannides Charis , Fossion Eric , Boeckx Willy
Published: February 2007

The serratus muscle (SAM) can be raised as an isolated muscular or osteomuscular flap on its nutrient vessels or in combination with a latissimus dorsi (LD) myocutaneous flap on the thoracodorsal pedicle for various reconstructive purposes. The aim of the present is to report on the results achieved after the use of the SAM alone (n = 7) and in combination with an LD (n = 3) after tumor resection or osteoradionecrosis (ORN) in ten patients with defects of the head and neck. One flap was lost due to venous thrombosis. The donor site morbidity was minimal. Emphasis is given on a new indication, namely ORN of the mandible. Short‐term results show that the use of the SAM prevents a pathologic fracture in cases of a class IIIa osteoradionecrotic mandible. More extensive use of the SAM flap is advocated.
Carcinoma of the nasopharynx: Analysis of treatment results in 167 consecutively admitted patients
Authors: Johansen Lars Vendelbo , Mestre Miguel , Overgaard Jens
Published: February 2007

Radiotherapy with curative intent was administered to 159 of 167 consecutively admitted patients with nasopharyngeal carcinoma. The classification (UICC 1982) gave the staging: stage I 8%, stage II 2%, stage III 28%, and stage IV 61%.

The actuarial local tumor control was 54% and correlated to the T‐classification. Primary control of neck nodes was 67% but was not correlated to the N‐classes. Distant failure occurred in 20% of the patients; this was correlated to the N‐classification. The 10‐year actuarially corrected survival rate was 37% (stage I + II 60%, stage III 49%, stage IV 27%). Late reactions were seen in 69%, and most patients had mild to moderate xerostomia. Men with high hemoglobin had a better prognosis than men with values in the lower part of the normal range. It is concluded that primary control in the T‐ and N‐positions is the parameter most crucial to success.
Cisplatin‐based chemotherapy in advanced adenoid cystic carcinoma of the head and neck
Authors: Dick Haan L. De , De Mulder Pieter H. M. , Vermorken Jan B. , Schornagel Jan H. , Vermey A. , Verweij Jaap
Published: February 2007

Nineteen patients, nine men and 10 women, with advanced adenoid cystic carcinoma (ACC), were treated with cisplatin either alone or in combination with doxorubicin and bleomycin. Median age was 51 years (range: 32‐73 years). Two groups of patients were distinguished: Group 1 (N = 10) received single‐agent cisplatin (50‐120 mg/m2 IV every 4 weeks) for locoregional recurrence (N = 4), pulmonary metastases (N = 5), or as neoadjuvant therapy (N = 1). Five patients failed previous chemotherapy. No objective responses were observed, five patients showed stabilization of their disease for a median duration of 20 months (range: 3‐50 months). Group 2 (N = 9) received a combination of cisplatin (20 mg/m2 IV on days 1‐5), doxorubicin (50 mg/m2 IV on day 1), and bleomycin (30 mg IV on days 1‐5), every 3 weeks. A complete remission (CR) was seen in one patient, lasting for 2 years, a partial remission (PR) in two patients (duration: 6 months and 6 years) (33%), and a stable disease (SD) in five patients (median duration: 15 months; range 3‐24 months). One patient showed progression from the start. The observed toxicity was acceptable: dose reduction was required in five patients for myelosuppression or impairment of renal function; vomiting grade III (WHO) was seen in 10 patients. The median progression‐free survival was 36 months (range: 7‐77 months). Median overall survival was 81 months (range: 14‐216 months). The role of cisplatin in this disease remains questionable. © 1992 John Wiley & Sons, Inc.
Epithelial membrane antigen and S‐100 protein‐labeled cells in primary and metastatic laryngeal carcinomas
Authors: Nakashima Tadashi , Yano Gen , Hayashi Itsuroh , Katsuta Yasaburoh
Published: February 2007

Immunohistochemical studies were done on the expression of S‐100 protein‐labeled cells in human laryngeal carcinoma of epithelial membrane antigen (EMA) and on the population density. EMA was detected in 65 of 76 (86%) squamous cell carcinomas and was usually more extensively positive in well and moderately differentiated carcinomas. Thus, EMA can serve as a marker of malignancy in laryngeal carcinomas. The population density of S‐100 protein‐labeled cells was high in well‐differentiated tissues. In the metastatic tumors, the number of S‐100 protein‐labeled cells decreased as compared to findings in the primary tumors. As a statistically significant difference in survival curve was noted between groups with low and intermediate density of S‐100 protein‐labeled cells, the infiltration of S‐100 protein‐labeled cells seems to be associated with a better prognosis. © 1992 John Wiley & Sons, Inc.
Esthesioneuroblastoma and neck metastasis
Authors: Davis Richard E. , Weissler Mark C.
Published: February 2007

Esthesioneuroblastoma (ENB) is a rare malignant neoplasm arising from the cribriform olfactory epithelium. Its aggressive biologic behavior is characterized by inapparent submucosal spread, local recurrence, atypical distant metastases, and poor long‐term prognosis. Historically, the suspicion of neck metastasis has not been associated with ENB. A retrospective review of all ENB patients treated at the University of North Carolina Hospitals since 1972 has revealed an unusually high incidence of cervical metastases (four of four patients). This prompted a review of the ENB surgical literature. All English‐literature series published since the widespread use of craniofacial surgery with accruals of eight or more patients were examined for reports of neck metastasis. Although the cumulative cervical metastatic rate reached 27% (55 of 207 patients), most authors failed to recognize the potential risk of cervical metastasis in ENB. Furthermore, in patients suffering from Kadish stage C disease, the cervical metastatic rate climbed to 44% (25 of 57 Kadish stage C patients). This further emphasizes the importance of the neck as a high‐risk metastatic site. These findings suggest that cervical metastases may be an important consideration in the evaluation and treatment of patients suffering from ENB. Strategies for evaluation and management of the neck are discussed. © 1992 John Wiley & Sons, Inc.
Temporomandibular arthritis in familial mediterranean fever
Authors: Tovi Ferit , Gatot Albert , Fliss Dan
Published: February 2007

Temporomandibular joint arthritis is a rare manifestation of familial Mediterranean fever and should be considered in patients of Mediterranean origin. Recently we treated four patients suffering from this condition, and intra‐articular corticosteroid injection resulted in rapid resolution of the pain and disability in two. Computed tomography confirmed the usefulness of this therapeutic modality. © 1992 John Wiley & Sons, Inc.
Accuracy of intraoperative frozen section diagnosis in head and neck surgery: Experience at a university medical center
Authors: Gandour‐Edwards Regina F. , Donald Paul J. , Wiese David A.
Published: February 2007

We performed 2,210 intraoperative frozen sections on 258 patients from the Otolaryngology–Head and Neck Surgery Service in 1990 and 1991. Surgery involved a wide variety of benign and malignant lesions. Techniques included biopsies for diagnosis, simple excisions, thyroid and salivary gland surgeries, lymph node biopsies, composite resections with radical neck dissections, laryngectomies, and skull base surgeries. During the 2‐year period, 1,947 (88.1%) sections were requested for evaluation of surgical margins, 258 (11.7%) for diagnosis, and five (0.2%) cases for tissue identification. There was disagreement between the frozen section and permanent section in 46 (2.1%) cases, and the deferral diagnosis rate was 0.8%. Disagreements were the result of sampling errors in 33 and interpretive errors in 13 cases. There were six (0.3%) false‐negative diagnosis of malignancy and four (0.2%) false‐positive diagnoses of malignancy. Three of these had an impact on patient care as discussed. We recommend careful sampling and sectioning of small biopsies and the need for vigilant communication between surgeon and pathologist.
Cervical and mediastinal abscess as a manifestation of histoplasmosis
Authors: Lydiatt William M. , Emanuel Jane M. , Lydiatt Daniel D.
Published: February 2007

Histoplasmosis is the most common endemic respiratory mycosis in the United States. Disseminated histoplasmosis generally is initially seen with systemic or respiratory complaints. Presentation of histoplasmosis as a neck mass is rare. Due to this unusual presentation and the diagnostic implications, we present a case of disseminated histoplasmosis that presented as a neck abscess. Unusual presentations of histoplasmosis may occur even in patients who are not immunocompromised. The diagnosis and management of histoplasmosis is reviewed. Histoplasmosis should be considered in the workup of a cervical abscess even in the immunocompetent host.
Phaeohyphomycosis of the paranasal sinuses masquerading as a neoplasm: A case report
Authors: Mehta Samir A. , Kaul Sameer , Mehta Mona S. , Kelkar R. S. , Mehta Ashok R.
Published: February 2007

A case of fungal infection of the paranasal sinuses simulating a neoplasm is reported. Fonsecaea pedrosoi, a dematiacious fungus, which has not been previously reported, was responsible for this unusual infection. Fungal infection may mimic malignant lesions of the paranasal sinuses; however, coexisting malignancy must be ruled out.
Cavernous sinus involvement in head and neck cancer
Authors: Bumpous Jeffrey M. , Maves Michael D. , Gomez Sandra M. , Levy Beth K. , Johnson Frank
Published: February 2007

Spread of tumor to intracranial structures is an infrequent and late manifestation of head and neck cancers. We recently encountered six patients with a distinct clinical syndrome due to involvement of the cavernous sinus, which forms the basis of this report. This syndrome was a source of significant morbidity and mortality, with a mean survival of only 4 months. The diagnosis is often elusive, but is now made more commonly than previously. Whether this reflects increased incidence (due to alterations in the natural history of disease by therapy) or improved diagnosis (due to modern imaging modalities) is unknown. Cavernous sinus involvement may be the first evidence of distant disease in head and neck cancer. Although survival is poor, palliation is worthwhile. Awareness of this syndrome can lead to earlier diagnosis and alteration of treatment.
Acinic cell carcinoma of the parapharyngeal space: Case report
Authors: Yokoyama Masato , Nomura Yasuya , Semba Tetsuo
Published: February 2007

We describe a case of acinic cell carcinoma (ACC) of the parapharyngeal space in a 58‐year‐old woman. A tumor originating from the deep lobe of the parotid gland was totally excised by an external cervical approach. The occurrence of ACC in the parapharyngeal space is extremely rare. We discuss the management, especially surgical procedure, of ACC in this area.
Clinical significance of laminin deposition and t‐cell infiltration in oral cancer
Authors: Noguchi Makoto , Kohama Gen‐Iku , Hiratsuka Hiroyoshi , Sekiguchi Takashi
Published: February 2007

Biopsied specimens from 55 patients with squamous cell carcinoma (SCC) of the oral cavity were examined immunohistopathologically as to the clinical significance of basement membrane (BM) deposition and T‐cell infiltration at the tumorstromal border using monoclonal anti‐laminin and anti‐CD3 antibodies. According to the immunoreactivity, all specimens could be divided into three groups: group A, a continuous linear pattern of positive staining for BM around tumor nests; group B, an alteration of BM deposition around tumor nests with T cell infiltration into those tumor nests; and group C, an alteration of BM deposition around tumor nests without T cell infiltration into those tumor nests. These groups were correlated with clinical manifestations, such as tumor size, tumor regression rate with induction chemotherapy, and regional lymph node metastatic rate. In these groups, tumors classified as group C showed a trend toward resistance to chemotherapy and high metastatic characteristics. Tumors classified as group B, which showed the same alteration of BM deposition as a result of T cell infiltration into the tumor nests, showed a sufficient tumor regression rate with chemotherapy. The visualization of the staining for BM laminin and T cells in oral SCC appeared not only to increase our understanding of the biologic and clinical behavior of individual tumors, but could be a prognostic indicator.
Radiotherapy for basaloid squamous cell carcinoma of the head and neck
Authors: Larner James M. , Malcolm Ronald H. , Mills Stacey E. , Frierson Henry F. , Banks Evelyn R. , Levine Paul A.
Published: February 2007

Basaloid squamous cell carcinoma (BSCC) of the head and neck is a recently described high‐grade variant of squamous cell carcinoma. It is a biologically virulent neoplasm with a propensity for nodal, as well as systemic, metastases. Because of the limited number of published reports, we reviewed data from patients of the University of Virginia Health Sciences Center and identified 16 cases of BSCC. The intent of this study was to determine the role of radiotherapy in the treatment of BSCC and better define the clinical features of this entity. Radiotherapy alone, or in combination with surgery, resulted in excellent local control rates. Distant metastases, chiefly pulmonary, occurred in more than half of the patients.
Salvage surgery of cervical recurrences after neck dissection or radiotherapy
Authors: Grandi Cesare , Mingardo Massimo , Guzzo Marco , Licitra Lisa , Podrecca Stefano , Molinari Roberto
Published: February 2007

A series of 113 patients operated on in the period 1980–1989 for a neck recurrence from a head and neck cancer was studied. All patients had no other evidence of disease. The male/female ratio was 93/20, and the median age was 58 years (range 28–87). Previous treatment consisted of surgery (SG) ± radiotherapy (RT) in 81 patients (SG group) and only RT in 32 (RT group): 59 cases presented a relapse in the treated neck and 54 in the contralateral side. All but one contralateral recurrences were in the SG group. Ten patients were lost to followup. The observed 5‐year survival rate of the whole series was 29.2% (95% confidence interval, 0%–38%). Considering patients with ipsilateral recurrences, the 5‐year disease‐free survival rate was 38.7% (95% c.i., 28.7%–48.7%) and 27% (95% c.i., 18%–36%) for the SG and the AT group, respectively. The 5‐year disease‐free survival rate after SG for contralateral recurrences was 38.8% (95% c.i., 23.8%–53.8%). Dimension and mobility of the neck nodes were the only demonstrable prognostic factors.
Carcinomas of the lacrimal drainage system
Authors: Callender David L. , Frankenthaler Robert A. , Weber Randal S. , Dodd Leslie , Batsakis John G.
Published: February 2007

Primary carcinomas of the lacrimal drainage system are rare. These malignant neoplasms typically present as noncompressible, nontender masses with low‐grade dacyrocystitis and/or unilateral epiphora. Lymph node metastasis may occur late in the disease course. Complete surgical resection is the best treatment choice; extensive procedures such as orbital exenteration and maxillectomy may be necessary for complete tumor extirpation. Further adjunctive radiotherapy may improve local control. We present two cases of carcinoma of the lacrimal drainage system, including one locally controlled tumor with apparent lymph node metastasis that occurred 21 years after primary treatment. A review of the histopathology and literature concerning carcinomas of the lacrimal drainage system is presented.
Hürthle cell adenoma arising in a thyroglossal duct cyst
Authors: Lyos Andrew T. , Schwartz Mary R. , Malpica Anais , Johnson Paul E.
Published: February 2007

An 18‐year‐old black woman was initially seen with a 1‐year history of a slowly enlarging midline neck mass. On physical examination this was consistent with a thyroglossal duct cyst. Histologic examination following a Sistrunk procedure revealed a Hürthle cell adenoma arising in a thyroglossal duct cyst. This is the second reported case of a Hürthle cell adenoma arising in a thyroglossal duct cyst. Neoplasms of thyroglossal duct cysts are reviewed.
Surgical management of chronic parotitis
Authors: O'Brien Christopher J. , Murrant Nicholas J.
Published: February 2007

A series of 17 consecutive parotidectomies for chronic sialoadenitis is presented. This comprises 10% of all parotidectomies performed by one surgeon over the 5‐year period between 1987 and 1991. In 16 patients, symptoms were relieved by surgery. The extent of surgery was guided by the clinical findings. In this series, near total and superficial parotidectomy were equally efficacious and no patient suffered permanent facial nerve dysfunction. Surgery is a safe and effective treatment for parotitis.
Pilot trial of ribavirin for the treatment of laryngeal papillomatosis
Authors: McGlennen Ronald C. , Adams George L. , Lewis Cynthia M. , Faras Anthony J. , Ostrow Ronald S.
Published: February 2007

The antiviral drug ribavirin was used as an adjunct to laser surgery for the treatment of patients with laryngeal papillomatosis (LP). An uncontrolled clinical trial for four patients with ribavirin treatment at a daily dose of 23 mg/kg was performed. Three adults received drug prior to laser surgery and continuing orally for 6 months. One infant was treated for 3 months. Two adults achieved complete remissions for at least 2 consecutive months, and both patients developed only minimal recurrent disease in 4 months of follow‐up. The other adult and the child sustained a partial response and an increased interval between the required surgeries. Ribavirin caused only a mild, reversible reduction in hemoglobin and reticulocytosis. This preliminary trial shows that ribavirin may be an effective therapy in combination with surgery for LP in a larger controlled clinical trial.
Heterogeneity of salivary gland tumors studied by flow cytometry
Authors: Tytor Maciej , Gemryd Per , Wingren Sten , Grenko Ronald T. , Lundgren Jan , Lundquist Per‐G. , Nordenskjöld Bo
Published: February 2007

Intratumor DNA heterogeneity was investigated by flow cytometric analysis of multiple samples taken from different sites of 8 benign and 16 malignant primarily resected salivary gland tumors. All benign tumors had diploid DNA content. The overall incidence of DNA diploidy in 16 malignant cases examined was 50%. Intratumor differences in DNA ploidy were observed in four malignant tumors (25%); 2 of these 4 heterogenous tumors contained both aneuploid and diploid cell clones. The remaining 12 tumors showed a homogeneous DNA content in the different specimens; 8 were diploid, 3 aneuploid, and 1 was polypoid. The DNA nondiploid tumors were clinically more advanced than the DNA diploid ones (p < 0.01). The tumor proliferation rate (fraction of cells in S‐phase) was higher in DNA nondiploid samples than in diploid ones (p < 0.01). The DNA nondiploid tumors seemed to recur more often than DNA diploid ones did. The data emphasize the usefulness of DNA measurements for the characterization of malignant salivary gland tumors but also the importance of adequate sampling in assessing their DNA ploidy.
Bacteriologic profile of surgical infection after antibiotic prophylaxis
Authors: Clayman Gary L. , Raad Issam I. , Hankins Patti D. , Weber Randal S.
Published: February 2007

Wound infections resulting from contamination during major head and neck surgery continue to be a critical issue. In this study, specimens of pus or draining fluids from the wounds of 43 surgical patients who received perioperative administration of ampicillin/sulbactam or clindamycin were cultured for aerobic and anaerobic isolates to the species level. Polymicrobial infections were identified in 13 of 43 patients (30%); 82% of isolates were aerobic organisms (45 of 55), and 18% were anaerobic or facultative species (10 of 55). Nine of 43 patients (21%) showed no bacterial isolates from cultured material. Independent of the primary site of malignancy or antibiotics used, nine of 25 isolates (36%) obtained from patients who underwent concomitant dental extractions, but only one of 24 (4%) who did not, developed anaerobic infections, (p < 0.001). The minimum inhibitory concentration of anaerobic isolates suggested sensitivity to the antibiotics used, and minimum bactericidal concentration data suggested that further postoperative doses may be required to adequately treat the heavily contaminated wounds. These data suggest that wound colonization following dental extraction procedures in clean contaminated head and neck surgery increases the risk of anaerobic infections. The use of a therapeutic dose and longer duration of perioperative antibiotics may be warranted.
Papillary thyroid cancer in Mexico: Review of 409 cases
Authors: Rodriguez‐Cuevas Sergio , Almendaro Sonia Labastida , Cardoso Juan M. Reyes , Maya Eduardo Rodriguez
Published: February 2007

This is a retrospective review of 409 cases of papillary thyroid cancer treated at the Hospital of Oncologia, National Medical Center, IMSS in Mexico City. The clinical features, histopathologic findings, analysis of recurrences and survivals according to age, sex, tumor size, and modality of treatment are described. The results showed that tumoral diameter > 5 cm, distant metastasis at diagnosis, age > 40 years, and tumoral infiltration beyond the thyroid capsule significantly affect the patient's survival.
Spontaneous infarction of parathyroid adenoma: Case report and literature review
Authors: Mir Rabia , Gerold Thomas , Khan Saad , Weitz Jean
Published: February 2007

A patient with asymptomatic primary hyperparathyroidism who spontaneously became normocalcemia is reported. The only significant finding was that of pain and tenderness in the enlarged parathyroid gland 2 weeks prior to surgery. This was due to a recent infarction of a parathyroid adenoma.
Analysis of frequency of pulmonary atelectasis in patients undergoing pectoralis major musculocutaneous flap reconstruction
Authors: Schuller David E. , Daniels Robert L. , King Mark , Houser Steve
Published: February 2007

The incidence of pulmonary atelectasis following head and neck surgery is not well reported. This study retrospectively evaluated the incidence of pulmonary atelectasis in 161 head and neck cancer patients, with 152 being evaluable. There were 90 patients evaluated following pectoralis musculocutaneous flap reconstruction with their effective flap size and 71 nonflap patients as a control group. Clinical findings were correlated to radiographic scores. Of pectoralis musculocutaneous flap patients screened for preexisting pulmonary disease (PEPD), nine of 45 (20%) demonstrated pulmonary atelectasis in the first 24 hours compared with 10 of 39 or 25.6% nonflap controls. Major pulmonary atelectasis was not found in the pectoralis musculocutaneous flap patients by scoring criteria, and in only one of 39 (2.6%) nonflap patients. In flaps larger than 40 cm2, the incidence was eight of 37 (21.6%), with no major pulmonary atelectasis noted. Only one of nine (11.1%) patients with radiographic pulmonary atelectasis exhibited clinical symptoms (three of 10 or 30% control). In patients with PEPD and pectoralis musculocutaneous flaps, 22 of 45 (48.9%) had evidence of pulmonary atelectasis in contrast to 13 of 32 or 40.6% controls. There were two of 45 (4.4%) who had major pulmonary atelectasis with zero of 32 in the nonflap group. For flaps larger than 40 cm2, the incidence was 19 of 39 (48.7%) with two of 39 (5.1%) scored as major pulmonary atelectasis. The clinical correlation for this group and the major pulmonary atelectasis group was each approximately 50% compared to 15.4% for nonflap patients. These results indicate that, although the incidence of radiographic pulmonary atelectasis in the first 24‐hour postoperative period is high, there is no clinical correlation with the exception of patients with PEPD. © 1994 John Wiley & Sons, Inc.
Axillary metastases from carcinoma of the larynx: A 25‐year survival
Authors: Nelson William R. , Sisk Michael
Published: February 2007

Axillary metastases from squamous cell carcinomas of the head and neck are usually considered signs of incurability. A case is presented in which the patient developed well‐differentiated squamous cell carcinoma in bilateral axillary nodes following total laryngectomy and radical neck dissection for advanced recurrent squamous cell carcinoma of the larynx. Bilateral axillary dissection was performed on this patient followed by a second neck dissection for metastasis. The patient remained well for 25 years free of disease, dying of a massive heart attack. One report of this phenomenon has been found in the literature. The authors conclude that radical axillary dissection should be considered in selective cases of well‐differentiated carcinoma in axillary nodes from a controlled primary in the head and neck mucosa when no other signs of dissemination have been found. A brief review of cervical and axillary lymphatic anatomy is included. © 1994 John Wiley & Sons, Inc.
Soft tissue coverage of mandibular reconstruction plates
Authors: Cordeiro Peter G. , Hidalgo David A.
Published: February 2007

Free tissue transfer was compared to pectoralis major flap coverage of mandibular reconstruction plates in a retrospective review. The study group consisted of 14 patients whose composite defects were reconstructed with metal plates covered with either pectoralis flaps (9) or soft tissue free flaps (5). Four patients in the pectoralis group (44%) had plates that extruded compared to none in the free flap group. The mean operating room time for the free flap group (721 minutes) was longer than the pectoralis group (550 minutes), but the overall hospital stay for the free flap group (20 days) was half that of the pectoralis group (39 days). The pectoralis group required more secondary procedures (88%) than the free flap group (20%). Free flaps have a higher success rate, a shorter hospital stay, and require fewer additional procedures than do pectoralis flaps. This justifies the longer operating time and greater technical complexity of free tissue transfer for reliable coverage of mandibular reconstruction plates. © 1994 John Wiley & Sons, Inc.
Permanent iodine‐125 implants in postoperative radiotherapy for head and neck cancer with positive surgical margins
Authors: Vikram Bhadrasain , Mishra Shantilata
Published: February 2007

Background.Patients with head and neck cancer treated surgically have a high local recurrence rate, unless the surgeon is able to obtain adequate margins of resection. In patients with positive margins, tumor control is suboptimal despite postoperative radiotherapy.

Methods.We treated 25 consecutive patients, who were at high risk for local recurrence by virtue of positive margins, by modest dose postoperative external‐beam irradiation (median 60 Gy) followed by elective iodine 125 (I‐125) implantation.

Results.With a median follow‐up of 1.5 years (range 1‐5 years), there were no instances of necrosis, and only one (4%) instance of a local recurrence. Six patients (24%) developed distant metastases.

Conclusions.These results indicate that elective 1‐125 implantation as a part of postoperative radiotherapy is safe enough for a phase III study in patients with positive margins. © 1994 John Wiley & Sons, Inc.
Thymidylate synthase activity, folates, and glutathione system in head and neck carcinoma and adjacent tissues
Authors: Parise Orlando , Janot François , Luboinski Bernard , Massaad Liliane , Albin Nicolas , Toussaint Caroline , Verjus Marie‐Ange , Bonnay Marc , Gouyette Alain , Chabot Guy G.
Published: February 2007

Background. Head and neck squamous cell carcinomas (HNSCC) present variable aggressiveness and chemosensitivity. Because the glutathione (GSH) system and thymidylate synthase (TS) are involved in the resistance to the main drugs used in HNSCC (cisplatin and 5‐FU), we studied these systems in tumors and normal mucosae.

Methods. Tumor samples and normal adjacent mucosae were collected from 37 untreated HNSCC patients. GSH and glutathione S‐transferase (GST) activity were assayed by spectrophotometry, whereas TS activity and folates were determined by radioassays.

Results. Mean GSH levels were higher in tumors (15.2 ± 8.2 nmol/mg protein) than in mucosae (8.3 ± 4.1 nmol/mg protein) (p = 0.005, paired t test). GST activity was also higher in tumors (394 ± 194 nmol/min/mg protein) than in mucosae (261 ± 132 nmol/min/mg protein) (p = 0.0003). TS activity was markedly higher in tumors (9.2 ± 21.5 pmol/min/mg protein) compared to that of mucosae (0.9 ± 1.2 pmol/min/mg protein) (p = 0.0001). Folate levels in tumors and mucosae were similar (1.2 ± 1.1 and 0.8 ± 0.9 pmol/mg protein, respectively; p = 0.1, NS). In relation to clinical stage and tumor size, a statistical difference was found in GSH and GST values between tumors and mucosae for stage IV and T3/T4. The increase in tumor TS compared to that of mucosae was significant for all clinical stages, tumor sizes, and nodal involvement.

Conclusions. These data enhance our understanding of the enzymatic systems involved in cisplatin and 5‐fluorouracil (5‐FU) resistance in HNSCC and normal mucosae and may help to elucidate tumor behavior and interpatient differences in drug sensitivity. © 1994 John Wiley & Sons, Inc.
Spinal accessory nerve palsy: An unusual complication of rhytidectomy
Authors: Blackwell Keith E. , Landman Michael D. , Calcaterra Thomas C.
Published: February 2007

Rhytidectomy is a safe and effective procedure for rejuvenation of the aging face. Reported complication rates vary between 2.5% and 28%, and with proper management, longterm sequelae are unusual. Injury to the spinal accessory nerve is a rare but potentially debilitating complication of rhytidectomy. Afflicted patients present with dull, constant pain in the shoulder region which can be severe in nature. In addition, there is weakness of shoulder abduction and cosmetic deformity related to trapezius atrophy. Measures for conservative management include analgesics and physical therapy to strengthen the shoulder girdle. Nerve exploration is indicated for cases with documented denervation that do not respond to conservative treatment. A review of the English literature identified two previous case reports of spinal accessory nerve injury sustained during rhytidectomy. In this report, we present two additional cases and review current concepts regarding diagnosis, management, and prevention of this unusual complication of rhytidectomy. © 1994 John Wiley & Sons, Inc.
Intracavernous carotid pseudoaneurysm after blunt trauma: Case report and discussion
Authors: Reiber Mark E. , Burkey Brian B.
Published: February 2007

Epistaxis following blunt facial trauma is usually self‐limited and arises from the nasal mucosa, sphenopalatine, or anterior ethmoid arteries. Pseudoaneurysm of the intracavernous carotid artery (ICCA) occurs rarely with penetrating facial trauma, but is even more rare following blunt trauma. Rupture carries a greater than 50% mortality. Because rupture usually occurs after several episodes of epistaxis, recognition of subtle historic and physical findings is paramount to optimal management. Once suspicion is raised, definitive diagnosis and treatment is best accomplished with cerebral arteriogram and trapping of the pseudoaneurysm. We have noted that rupture may be precipitated by angiography, and, therefore, we advocate availability of emergent and definitive treatment equipment and personnel prior to performing cerebral arteriography. This should include an otolaryngologist, an interventional radiologist, and a neurosurgeon. A case of ICCA pseudoaneurysm is presented, and the key historic factors are discussed. Radiographic diagnosis and management options are discussed. © 1994 John Wiley & Sons, Inc.
Cervical and mediastinal emphysema secondary to third molar extraction
Authors: Goodnight James W. , Sercarz Joel A. , Wang Marilene B.
Published: February 2007

Background. A dramatic case of infected emphysema involving multiple deep cervical and mediastinal fascial planes following surgical extraction of a lower third molar in an otherwise healthy man is presented.

Methods. The differential diagnosis and management of this condition are discussed, specifically contrasting it to necrotizing fasciitis.

Results. The direct cause of this complication was the use of an air turbine handpiece and air syringe for the tooth extraction.

Conclusions. It is advised that air turbine handpieces and air syringes not be used during minor oral surgical procedures. © 1994 John Wiley & Sons, Inc.
Complications of craniofacial resection for tumors involving the anterior skull base
Authors: Kraus Dennis H. , Shah Jatin P. , Arbit Ehud , Galicich Joseph H. , Strong Elliot W.
Published: February 2007

Background.A consecutive series of 85 patients undergoing craniofacial resection for malignant tumors involving the anterior cranial base between 1974 and 1992 was reviewed.

Results.There were two (2%) postoperative deaths. Postoperative complications occurred in 33 (39%) patients. Local major complications occurred in 26 (31%) patients, local minor in 7 (8%), and systemic in 5 (6%). More than one complication occurred in a number of patients. Bacterial contamination led to a significant proportion of local, septic complications. Repair of the skull base defect with a pedicled pericranial flap was unsatisfactory and was associated with an increased incidence of local major complications. A local major complication was associated with a dramatic lengthening of hospitalization.

Conclusion.Future endeavors for prevention of complications should focus on antibiotic prophylaxis and reconstruction of the cranial base defect with better vascularized flaps. © 1994 John Wiley & Sons, Inc.