bluuebunny/crossref_metadata_2025 huggingface dataset:
Functioning lipoadenoma of a supernumerary parathyroid gland in the mediastinum
Authors: Wolff Marianne , Goodman Edmund N.
Published: February 2007

A patient underwent reexploration for a parathyroid adenoma; following identification of four normal glands in the cervical region, the mediastinum was entered, and an intrathymic lipoadenoma was excised. These very rare tumors have been associated with hypercalcemia in approximately half of the previously reported cases; however, none has previously been described as occurring entirely in the mediastinum.
The sternocleidomastoid muscle flap
Authors: Conley John , Gullane Patrick J.
Published: February 2007

The sternocleidomastoid muscle has significant application in the head and neck following radical ablative surgery about the mandible, face, and oral cavity. It can be used in the following ways to rehabilitate the paralyzed face, to correct a soft‐tissue defect about the upper neck and oral cavity, and to protect the major arteries in the head and neck. (a) It may be transposed with a segment of the clavicle and/or sternum as a composite pedicle flap for reconstruction of the mandible. (b) It may be transposed into the lower cheek and jaw to reconstruct a mandibular defect. (c) It may be transposed into the anterior floor of the mouth as a myocutaneous flap following major ablative surgery to assist in correcting the defect and rehabilitating the oral cavity. (d) It may assist in facial paralysis to reanimate the lower third of the face. (e) It may be used to reinforce a suture line and protect the carotid and innominate arteries. (f) It may assist in shoulder elevation following poliomyelitis when transposed to the acromial process of the clavicle.
Guidelines for prophylactic radical lymph node dissection in cases of carcinoma of the external ear
Authors: Afzelius Lars‐Erik , Gunnarsson Mats , Nordgren Hans
Published: February 2007

All cases of squamous‐cell carcinoma of the external ear that were treated at the ENT Clinic, University Hospital, Lund, Sweden, between 1970 and 1977 were analyzed retrospectively to determine parameters for predicting the development of metastases. These cases included 62 males and 3 females, with a mean age of 77 years. The frequency of metastases for these patients was 16.4%. The carcinomas were graded according to four parameters: depth of growth, mode of invasion, cellular differentiation, and cellular plasmolymphocytic response. We concluded that depth of growth and mode of invasion were the most useful of these parameters and that prophylactic lymph node dissection should be performed in cases of tumors larger than 4 cm in diameter, of tumors infiltrating the cartilage, and of smaller tumors with maximum scores for depth of growth and mode of invasion.
Postirradiation carcinoma in a thyroglossal duct remnant: Follicular variant of papillary thyroid carcinoma
Authors: McGuirt W. Frederick , Marshall Richard B.
Published: February 2007

A case of carcinoma in a thyroglossal duct remnant is presented. The tumor was a rare follicular variant of the papillary type of thyroid carcinoma. The patient had received external beam radiation to the head and neck both as a child and as an adolescent. The recently reported increased incidence of thyroid carcinoma is believed to be related to the former practice of irradiating cervical thymic and lymphoid tissue in children. Since it is normal thyroid tissue that remains in the thyroglossal duct tract, this ectopic tissue presumably has the same malignant potential as that in the thyroid gland. Therefore, more cases of carcinoma in a thyroglossal duct remnant may be seen as those patients who underwent head and neck irradiation in childhood mature.
Problems of terminal head and neck cancer patients
Authors: Shedd Donald P. , Carl Allen , Shedd Charlotte
Published: February 2007

In recent years, there has been increased interest in defining what constitutes good quality of care for the terminal cancer patient. Progress in this area depends upon adequate knowledge of the problems in the terminal period for patients with cancer in specific sites. The present study is a survey of the final period of life in 60 head and neck cancer patients. The average survival time from diagnosis to death was 17.2 months. The mean time of hospitalization was 4 months. Pain was a problem in 85% of the patients, with feeding problems in 62% and respiratory difficulties in 43%. Eighty‐six percent of the patients died in a hospital setting, with the average duration of the final hospitalization being 68 days. Our analysis documents the complex problems in the terminal phase of a head and neck cancer patient's life. These problems challenge medical facilities caring for such patients to develop programs that will provide the best possible levels of care for head and neck cancer patients and to develop approaches that will reduce the suffering experienced by the patient's family.
Radiologic evaluation of irradiated cartilage grafts on the facial skeleton of sheep
Authors: Donald Paul J. , Wildes Thomas O. , Miller Donald C. , Hahn Jeanine
Published: February 2007

Augmentation mentoplasty is a commonly performed procedure for correction of retrognathia and microgenia. Implantable Silastic prostheses have become the mainstay of therapy, but have some disadvantages. One of the most important complications is erosion of the underlying mandible. An attempt was made to produce an experimental animal model to test the efficacy of irradiated costochondral cartilage in this regard. In order to prevent a biological material from eroding the underlying bone, the irradiated sheep cartilage grafts were placed subperiosteally, deep to a pair of large muscles of facial expression in five Suffolk sheep. Irradiated cartilage was used as the test material and merthiolate‐treated cartilage as the control. Only 1 of the 20 grafts showed any absorption after 1 year, and this was only 1 mm in depth. Because of the meager amount of absorption of irradiated cartilage grafts, the ease with which they can be carved, and their ready availability, they would appear to be ideal implants for chin augmentation.
Surgical treatment of parathyroid disease: A review
Authors: Colacchio Thomas A. , Gerfo Paul Lo , Feind Carl
Published: February 2007

Since the first parathyroidectomy was performed by Mandl in 1925, there have been many advances in our understanding of the parathyroid gland and its related disorders of calcium homeostasis. Our ability to establish the diagnosis of parathyroid neoplasia and locate the source of autonomous parathormone production has also dramatically improved. Nevertheless, it was the advent of the routine calcium and phosphate screening done on the sequential multiple analyzer (SMA‐12) that has caused a tremendous increase in the number of patients who are diagnosed to have hyperparathyroidism and who therefore present for surgical treatment. Essential for successful and uncomplicated treatment of this disorder is a thorough understanding of the anatomy, physiology, and pathology of the parathyroid glands. This review will consider the parathyroid glands in their normal state, as well as the diagnosis and management of the various disorders associated with them.
Repair of nasal fistula secondary to radiation therapy for Eales's disease
Authors: Fried Marvin P.
Published: February 2007

Eales's disease is characterized by neovascularization and idiopathic retinal and vitreous hemorrhages. Therapy in the past included the use of radiation. A case is reported of a patient who received a dose of 15,000 roentgens (approximately 14,250 rad) to the right eye via temporal and nasal portals. He subsequently lost vision in that eye. Thirty years after the radiation was administered, a nasocutaneous fistula developed, and it was closed with a forehead island flap.
Dental management and prosthetic rehabilitation of patients with head and neck cancer
Authors: Carl William
Published: February 2007

Dentistry has a significant supportive role in the management of head and neck cancer. Early preparations for prosthetic rehabilitation of patients who are in need of maxillary resections, and the use of prostheses in patients who have undergone partial mandibulectomies are explained. Patients being treated by radiation for tumors in the head and neck area require particular preventive care and instructions in oral hygiene. Systemic chemotherapy for tumors distant from the head and neck may precipitate severe oral complications. Occurrence and management of these problems are discussed.
The pathology of head and neck tumors: Neoplasms of cartilage, bone, and the notochord, part 7
Authors: Batsakis John G. , Solomon Alvin R. , Rice Dale H.
Published: February 2007

Neoplasms of the supporting tissues in the head and neck are outnumbered by their histologic counterparts in the trunk and extremities. This is especially true for tumors of bone, cartilage, and the remnants of the notochord. Malignancies occurring in all three tissues, however, are just as lethal as those sited elsewhere. Chondrosarcomas and osteogenic sarcomas of the facial bones are resistant to all conventional modes of therapy, manifest many recurrences, and have an often protracted morbidity. The craniocervical chordoma manifests a similar biologic course. For the tumors of cartilaginous origin and the osteogenic sarcomas, the initial surgical attempt at removal is of key importance. Neoplasms present at the margins of resection have a poor prognosis. Chordomas are not likely to be cured by any modality.
Multicentric squamous‐cell carcinoma of the upper aerodigestive tract
Authors: Gluckman Jack L. , Crissman John D. , Donegan J. Oliver
Published: February 2007

In an attempt to define the true frequency of multiple primary squamouscell carcinomas of the upper aerodigestive tract, 3 separate population groups were studied. The results of this investigation confirmed the high incidence of multicentric carcinomas in the upper aerodigestive tract, lung, and esophagus. The clinical significance of this phenomenon is discussed, particularly its effect on patient survival and its possible relationship to local tumor recurrence. The value of routine panendoscopy in the initial assessment is stressed as well as the need for a lifelong follow‐up of these patients.
Clinical and radiologic aspects of maxillonasal dysostosis (binder syndrome)
Authors: Delaire J. , Tessier P. , Tulasne J. F. , Resche F.
Published: February 2007

Maxillonasal dysostosis, described by Binder in 1962, is probably more common than one would think from the small number of cases that have been published (fewer than 40). We have seen 37 cases of this syndrome over a period of 8 years. Diagnosis of the syndrome is easy because of its characteristic anomalies of the upper lip and nose: smallness of the nose, a groove under the columella, a “half‐moon” appearance of the nasal apertures, absence of the nasal spine, and projection of the chin. In addition, we have observed several associated abnormalities: convergent strabismus (2 cases), mongolism (1 case), labiomaxillopalatine cleft (1 case), and, of particular note, numerous abnormalities of the cervical spine, frequently associated with mandibular prognathism. In view of the frequency of the latter abnormalities, Binder syndrome might well be called a “nasomaxillovertebral syndrome”.
Parotid cancer: A rational basis for treatment
Authors: Johns Michael E.
Published: February 2007

Parotid gland cancers are uncommon neoplasms whose management is complicated by their variable histopathology, their equally variable clinical course, and the intricate relationship of the facial nerve to the parotid gland and potential threat to the muscles of facial expression. In order to expand the limited familiarity with this unusual cancer that any single surgeon may acquire, a review is presented of factors influencing survival, including histopathology, lymph node metastasis, facial nerve palsy, skin involvement, size (stage), recurrence, pain, deep lobe and distant metastasis. The personal experiences of the author, experiences at the University of Virginia, and those in the literature were reviewed to derive the principles of treatment based on the TNM staging system and histopathologic diagnosis.
Radiologic evaluation of the cerebellopontine cistern and the internal auditory canal
Authors: O'Connor Sheilah M. , Sackett Joseph F.
Published: February 2007

Radiologic evaluation of patients with unilateral sensorineural hearing loss depends on the quality of the computed tomographic (CT) scanner. Two scanners were evaluated in the present study: one utilizing thick collimation (10‐ and 13‐mm sections) and the second utilizing thin collimation (1.5‐mm sections). In both evaluations, intravenous contrast medium was used to exclude a cerebellopontine angle mass. If the cerebellopontine cistern is normal and there is clinical evidence of an intracanalicular lesion, air or metrizamide CT is used. When 10‐ and 13‐mm sections are used, air provides the best contrast with overlapping sections. When 1.5‐mm sections are used, coronal CT shows metrizamide in the internal auditory canal.
Radiologic evaluation of the normal adult nasopharynx
Authors: Keller Jeanne D.
Published: February 2007

Adenoid hypertrophy complicates the radiographic evaluation of the adult nasopharynx. To define the limits of normal soft‐tissue thickness of the nasopharynx on the lateral film, I measured the profiles of 2 different groups of adult patients: 60 patients examined by x‐ray for trauma who had no sinus disease or nasopharyngeal complaints and 30 patients examined by x‐ray who had nasopharyngeal complaints necessitating biopsies. Histologic examinations of the biopsy specimens indicated benign disease, usually caused by an inflammatory process. The asymptomatic group showed a more uniform appearance of the nasopharynx than the symptomatic patients, who had a wide variation in the thickness of the nasopharynx. The symptomatic group manifested nasal and eustachian tube obstruction, frequently associated with serious otitis media. When the soft‐tissue thickness of the nasopharynx was correlated with age, nasopharyngeal thickening was unusual in asymptomatic persons older than 30 years. Conversely, persons over 30 with nasopharyngeal thickening were often symptomatic and had biopsies indicating some inflammatory change in the nasopharynx.
Computed tomography of the larynx: A clinical and pathologic study
Authors: Gregor R. T. , Lloyd G. A. S. , Michaels L.
Published: February 2007

Recent interest in the application of computed tomography (CT) to the evaluation of laryngeal tumors, and the fact that the larynx offers the unique opportunity of whole organ study after total laryngectomy, led to a prospective study of laryngoscopy, conventional tomography, and CT in relation to pathologic findings. The results showed that CT gives an exact assessment of laryngeal anatomy and tumor involvement, particularly in the paracordal and pre‐epiglottic spaces. The laryngeal cartilages, which are not well demonstrated by any other means, are accurately delineated by CT. There is also good demonstration of the laryngeal surface of the epiglottis, including the anterior commissure, which is poorly shown by other radiologic methods and is sometimes poorly seen on laryngoscopy. Because CT and conventional tomography present images at 2 different planes, at right angles to each other, we believe that CT is entirely complementary to conventional tomography.
The pathology of head and neck tumors: The occult primary and metastases to the head and neck, part 10
Authors: Batsakis John G.
Published: February 2007

Metastases from carcinomas to the head and neck, either to lymph nodes or to extranodal sites, arise most often from known primary neoplasms. However, some are from a clinically inapparent neoplasm—the so‐called occult primary. If the metastasis is an epidermoid carcinoma in a lymph node, the odds clearly favor the primary being in the upper aerodigestive tract. The success rate of discovery is variable, however, and a significant number of primaries remain undetected. Metastatic adenocarcinomas, to either nodal or extranodal sites, are most often from infraclavicular neoplasms. In general, the incidence of metastases to the head and neck from visceral primaries below the clavicle follows the general incidence of the primary cancer itself. Renal‐cell carcinoma is the exception since its frequency of metastases to the head and neck exceeds the expected incidence in the general population. Branchiogenic carcinoma is more a conceptual than a literal clinicopathologic entity. The diagnosis should be made with reluctance and only after fulfillment of several rather stringent criteria.
Management of burns of the head and neck
Authors: Wachtel Thomas L. , Frank David H. , Frank Hugh A.
Published: February 2007

Burns of the head and neck with or without respiratory tract injury remain a serious and complex problem. Care of patients with this injury requires astute frequent clinical examinations, repeated laryngoscopy or flexible bronchoscopy, and serial laboratory investigations. Superb monitoring and care by the entire burn team with frequent dialogue among the individuals with specialized knowledge, mature clinical judgment in regard to therapy, and long‐term follow‐up help burn victims survive the injury and achieve the best possible functional ability and cosmetic appearance. There are no simple answers or rote decisions in the management of these injuries. The challenge requires the most innovative and creative care coupled with large amounts of hard work. Many of the recent advances in the management of burns of the head and neck have permitted these patients to survive and have helped them to return as functioning members of society.
Non‐Hodgkin's lymphoma of the nose and paranasal sinuses: A study of 17 cases
Authors: Kapadia Silloo B. , Barnes Leon , Deutsch Melvin
Published: February 2007

Non‐Hodgkin's lymphoma of the nose and paranasal sinuses occurred in 14 men and 3 women with a mean age of 61 years. Nasal obstruction, unilateral facial swelling, and nasal discharge were frequent initial manifestations. The maxillary sinus and nose were the commonest primary sites. Using Rappaport's classification, there were 9 histiocytic, 5 poorly differentiated lymphocytic, and 3 mixed histiocytic‐lymphocytic lymphomas. Sixteen patients had radiation therapy to the primary site, and 9 patients later received chemotherapy. Eleven patients (69%) are dead, with a median survival time of 11 months after diagnosis. Dissemination of lymphoma was the most common cause of death. Five patients (29%) are alive up to 40 months after diagnosis. Patients with poorly differentiated lymphocytic lymphoma survived longer than those with histiocytic or mixed histiocytic‐lymphocytic lymphomas (median survival times 35, 9, and 12 months, respectively). Poor response to radiation therapy and dissemination of lymphoma were poor prognostic indicators.
Management of neoplasms of the head and neck in children. II. Malignant tumors
Authors: Raney R. Beverly , Handler Steven D.
Published: February 2007

The otolaryngologist who treats children must have knowledge of the neoplasms that can occur in childhood. Such tumors are usually mesenchymal in origin and may be benign or malignant. Diagnosis and management of the more common benign tumors are undertaken by the otolaryngologist because local excision is generally curative. The proper treatment of malignant lesions requires a more extensive, multidis‐ciplinary team, which includes a pediatric oncologist, diagnostic and therapeutic radiologist, and pathologist, in addition to the otolaryngologist. This article outlines the types of malignant neoplasms that occur in childhood and discusses current approaches to therapy.
The pathology of head and neck tumors: Cysts of the jaws, part 12
Authors: Regezi Joseph A. , Courtney Richard M. , Batsakis John G.
Published: February 2007

The jaws are unique bones of the skeleton because of their intimate involvement with tooth and facial development. Abnormal sequelae of these developmental processes may give rise to cystic lesions later in life. This paper reviews the pathogenesis, clinical features, and behavior of these odontogenic and nonodontogenic cysts. Justification is found for the exclusion of the globulomaxillary, midmandibular, and midpalatine cysts from a current classification. Emphasis is placed on the importance and controversy surrounding the odontogenic keratocyst.
Recent advances in ultrasound: High‐resolution imaging of superficial structures
Authors: Scheible William
Published: February 2007

In the past few years, sophisticated ultrasound systems specifically designed for the evaluation of superficial organs and structures have been developed. These “high‐resolution” scanners are particularly well suited to diagnostic imaging in the neck. This review summarizes current clinical applications of this evolving technology and highlights initial experience with a prototype scanner that is now commercially available. Particular attention is directed to high‐resolution ultrasonography of the thyroid and parathyroid glands, the extracranial carotid arteries, and neoplastic and inflammatory masses of the neck.
Transtracheal microsurgical closure of tracheoesophageal fistulas
Authors: Gerhardt H.‐J.
Published: February 2007

A patient with a 1.5‐ to 2.5‐cm tracheoesophageal fistula secondary to prolonged assisted ventilation and feeding by a nasogastric tube was operated upon by a transtracheal microsurgical approach. The advantages of this approach are as follows: (1) the surgery is not extensive and therefore does not cause much stress to the patient: (2) this technique avoids the necessity for a wide mediastinotomy or sternotomy and thoracotomy and therefore averts the danger of a widespread infection with the highly antibioticresistant bacteria that are always present in these cases; and (3) there is no risk of damage to the recurrent nerve. The ENT surgeon who is welltrained and experienced in microsurgery should try this approach in selected cases first. If this method fails, other methods are still available.
Chemotherapy for advanced carcinoma of head and neck: An effective outpatient schedule of cytoxan, oncovin, methotrexate and bleomycin
Authors: Didolkar M. S. , Coleman J. J. , Elias E. G. , Gray W. C. , Cosentino E.
Published: February 2007

To evaluate an effective, cell‐cycle‐specific combination chemotherapy which could be administered on an outpatient basis, COMB of Maryland (Cytoxan, Oncovin, methotrexate and bleomycin) was used in 20 patients with stage IV squamous cell carcinoma of head and neck origin. All patients had unresectable but measurable disease. Nine patients had distant metastases. Prior to this chemotherapy, 15 (75%) patients underwent radiation therapy, 12 (60%) had radical surgery, and 3 (15%) were administered other chemotherapeutic drugs. The distribution of the primary site of tumor was identical to the overall distribution of squamous cell carcinoma of head and neck found in this country. Drug dosages were: Cytoxan 100 mg/m2 p.o. days 1‐14, Oncovin 1 mg/m2 IV days 1 and 8, methotrexate 25 mg/m2 IV days 1 and 8, and bleomycin 15 units/m2 IM days 1 and 8. This cycle was repeated every four weeks. Two (10%) patients had complete response and 7 (35%) had partial response, thus giving the total response rate of 9 (45%). Seven (35%) patients had static disease and 4 (20%) had progression of disease. Duration of response was from 8 to 26+ weeks with a median duration of 17+ weeks. Response rate was statistically related to performance status and previous chemotherapy. However, it was not related to age, sex, site of origin, previous radiation therapy, or differentiation of the tumor. Increased survival (P < 0.01) was seen in responders (median 16+ weeks) as compared to nonresponders (9 weeks). Hematologic toxicity was seen in 9 (45%) patients, resulting in one chemotherapy‐related death. Overall, this chemotherapy has been well tolerated on an outpatient basis. Although 15 (75%) patients received prior radiation therapy, the results were comparable to those obtained by other, more toxic combination chemotherapeutic regimens.
Nuclear medicine in diagnosis and treatment of diseases of the head and neck. I. Salivary and parathyroid gland disease and one identification and staging of head and neck tumors
Authors: Blahd William H. , Rose Judith G.
Published: February 2007

The advent of both improved imaging systems and new radioactive agents has increased the effectiveness of nuclear medicine in diagnosing and treating diseases of the head and neck. In this first in a series of two articles, the role of nuclear medicine is discussed in the evaluation of diseases of the salivary and parathyroid glands, and in the identification and staging of head and neck tumors. Radionuclide studies of the salivary glands are useful in the identification of tumors and the evaluation of gland function. Such studies are a valuable adjunct in the diagnosis of Sjögren's syndrome and of acute and chronic inflammatory disease. Radionuclide imaging also has been helpful in the detection of adenomata and hyperplasia of the parathyroid glands and often complements ultrasonography localization procedures. The advent of gallium‐67 imaging has improved the staging of head and neck tumors.
Recent advances in paranasal sinus surgery
Authors: Donald Paul J.
Published: February 2007

Recent advances in paranasal sinus surgery have occurred in the treatment of trauma and neoplasia, rather than in the more traditional management of inflammatory disease. Cranialization of the frontal sinus in severe penetrating trauma was first described in 1978. By removal of the sinus posterior wall, excision of the mucosa, and preservation of the anterior wall fragments, the forehead contour can be preserved and the cavity ablated by the forward expansion of the frontal lobes. Craniofacial surgery for malignancies of the paranasal sinuses has vastly improved the survival rate for these patients. Simultaneous en bloc resection, done transcranially to establish the margins of resection of the superior‐most extent and transfacially to ablate the site of origin of the neoplasm, has produced five‐year survival rates of 50%. Involvement of even the cavernous sinus can be handled, providing initial control of the internal carotid artery is achieved and an adequate cerebral circulation is ensured. Decompression of the optic nerve following facial trauma that results in fractures of the orbital apex remains controversial. Documented cases of progressively failing vision in such patients provides the clearest indication. Surgical decompression through the transethmoidal sphenoidal route provides excellent access to remove the maximum amount of bone from the optic canal.
Reconstruction of the hypopharynx and cervical esophagus with bilateral pectoralis major myocutaneous flaps
Authors: Strawberry Carl W. , De Fries Hugh O. , Deeb Ziad E.
Published: February 2007

A patient is presented in whom bilateral pectoralis major myocutaneous flaps, one of which was lined by a split‐thickness graft, were used in the total reconstruction of the hypopharynx.
Computed tomography of the nose
Authors: Osborn Anne G. , McIff E. Bruce
Published: February 2007

The nose is presented as a roentgenographic entity. The gross anatomy of the nasal fossa is reviewed, and its normal appearance on computed to‐mographic scan is described. The roentgenographic appearance of congenital, metabolic, traumatic, and inflammatory nonneoplastic mass lesions and malignant neoplasms is discussed, and an algorithmic approach to the roentgenographic evaluation of nasal masses is suggested.
The role of suprahyoid neck dissection in the management of cancer of the tongue and floor of the mouth
Authors: Donegan J. Oliver , Gluckman Jack L. , Crissman John D.
Published: February 2007

Suprahyoid lymph node dissection often is used as part of the surgical treatment of cancers of the anterior two thirds of the tongue and the floor of the mouth. In recent years the use of this procedure has become less widespread, but it is still advocated by some surgeons as a sound operation in the treatment of cancer. Anatomic, roentgenographic, and pathologic evidence is presented to show that this may not be the case. The evidence points out that such neoplasms do not metastasize in an orderly or predictable pattern. These patients may have isolated metastases in any region of the neck. If the decision is made to treat the neck in these situations, the whole neck should be treated. We feel that suprahyoid neck dissection has a very limited role to play in the management of cancers of the anterior two thirds of the tongue and the floor of the mouth and should be employed only when it will be of help in developing an adequate margin around the primary lesion.
Traction diverteculum: A complication of cervical esophagostomy
Authors: Kaplan Harold J. , Bray David A. , Eichel Berkley S.
Published: February 2007

Cervical esophagostomy has become a preferred technique for a long‐term enteral alimentation in chronically ill patients. It has relatively few complications and many benefits. We present a case of traction diverticulum as a complication of the procedure. This complication will probably become more prevalent as more esophagostomas are reversed. Management of the complication by a “tack‐up” operation is discussed.
Osteonecrosis of the jaws: A complication of cancer chemotherapy
Authors: Schwartz Harry C.
Published: February 2007

Two unusual cases of osteonecrosis of the jaws in edentulous patients are described. One case involved the maxilla and the other the mandible. Both patients were compromised hosts who were undergoing cancer chemotherapy. Both developed local mucosal infections beneath their dentures before the bone became involved. The role of dentures in producing local irritation and in masking the problem is discussed.
Malignant lymphoma of the thyroid gland: A clinicopathologic study
Authors: Kapadia Silloo B. , Dekker Andrew , Cheng Vincent S. , Desai Uma , Watson Charles G.
Published: February 2007

This study reviews 21 cases of thyroid lymphoma diagnosed between 1969 and 1980. The thyroid gland was the primary site in all but two cases. The 20 patients with non‐Hodgkin lymphoma had a mean age of 66 years, 75% were women, and all were Caucasian. A rapidly growing thyroid mass with hoarseness, dysphagia, and difficulty in breathing was the initial finding. Most patients had diffuse histiocytic lymphomas. Associated Hashimoto thyroiditis was found histologically in 57% of the cases. Using the immunoperoxidase stain method on tissue sections, intracytoplasmic monoclonal immunoglobulin was demonstrated in 5 of 15 cases. All but two patients received radiation therapy, and 13 received chemotherapy. The median survival was 8 months; 20% died of unrelated causes and 32% are alive (average duration: 27 months). Dissemination, after local control by radiation therapy, was the leading cause of death. The prognosis was better in men, in patients under the age of 65 years, and in those patients who, on biopsy, did not have involvement of the extrathyroid soft tissue or regional lymph nodes.
Free flaps to the head and neck
Authors: Achauer Bruce M. , Salibian Arthur H. , Furnas David W.
Published: February 2007

Early attempts at microvascular reconstruction in the head and neck area with free tissue flaps failed, leading some authors to feel that these techniques would have a limited role, especially when such flaps had to be used in recipient sites in which they were in contact with saliva or when the microvascular anastomoses had to be done with recipient vessels that had been irradiated. Today, however, many aspects of neck and facial reconstruction routinely use composite free tissue transfer. These methods are the first choice for reconstruction in traumatic amputations and repair of large mandibular defects, and for some facial contour and skin loss situations. Free composite tissue transfer is an excellent alternative for esophageal reconstruction (small bowel) and has great potential for facial animation (free muscle) and total nose reconstruction (dorsalis pedis).
Augmentation rib grafting to the inferior border of the mandible
Authors: Sanders Bruce
Published: February 2007

Several techniques have been advocated for osseous augmentation of atrophic edentulous mandibles. This article presents a description of grafting rib to the inferior border of the mandible for augmentation in 31 cases. The indications, advantages, and disadvantages of the technique are outlined.
Familial osteodysplasia
Authors: Schendel Stephen A. , Delaire Jean
Published: February 2007

A family with characteristics that have striking similarities to the syndrome of familial osteodysplasia is reported. The inheritance pattern appears to be autosomal dominant. The typical facies has a lack of vertical facial development and a functional prognathism caused by overclosure of the mandible and opening of the gonial angle. Midfacial hypoplasia and a pointed chin are characteristic. Alveolar and sutural bone growth in the face is diminished and associated with partial dental agenesis. Variable cranial digital markings and possible synostosis are also seen. These typical facial changes are associated with other bony and systemic abnormalities. The long bones have a flask shape and occasionally have increased cortical thickness. The superior pubic ramus is often thin and scoliosis is common. The dermatoglyphic pattern demonstrates a distal triradius and small whorl abnormalities. The most significant laboratory values are an increased erythrocyte sedimentation rate and C3 complement found on the erythrocytes. The plasma fibrinogen level was low in all family members.
cis‐Platinum and 5‐fluorouracil as initial therapy in advanced epidermoid cancers of the head and neck
Authors: Weaver Arthur , Fleming Susan , Vandenberg Henry , Drelichman Anibal , Jacobs John , Kinzie Jeannie , Loh John J.‐K. , Al‐Sarraf Muhyi
Published: February 2007

A total of 44 patients with previously untreated Stage IV squamous cell carcinomas of the head and neck were treated with a combination of cis‐platinum (100 mg/sq m) and 96‐hour infusion of 5‐fluorouracil (5‐FU) (1,000 mg/sq m/day) in two courses or with cis‐platinum (100 mg/sq m) and 120‐hour infusion of 5‐FU (1,000 mg/sq m/day) in three courses. In the 26 patients receiving the two course regimen, the tumor response rate was 88.5%. In five of the 26 patients complete disappearance of the tumor was achieved; partial remission was obtained in 18 of 26 patients. The main side effects were nausea and vomiting (70%), leukopenia (27%), and mild‐to‐moderate renal toxicity (27%). In the 18 patients who received the three course regimen of 5‐FU and cis‐platinum, there were 11 (61%) complete responses, 6 (33%) partial responses, and 1 (6%) minimal response. The incidence of complete response was increased with each course given. No added toxicity was observed with surgery or radiotherapy.
Paranasal sinus radiology, part 1 B: The frontal sinuses
Authors: Dolan Kenneth D.
Published: February 2007

Alteration in the appearance of the mucosa, fluid accumulations, and changes in the shape and texture of the sinus wall form the basis of the radiologic information that aids in the diagnosis of frontal sinus disease. Inflammatory disease of the frontal sinuses was discussed in Part 1A of this article; other disease processes of the frontal sinuses as they appear in the various roentgenographic modalities are described and illustrated here.
The role of nuclear scanning in head and neck surgery
Authors: Pretorius Dolores , Taylor Andrew
Published: February 2007

A number of procedures in nuclear medicine are available to assist the surgeon in evaluating pathologic conditions of the head and neck. Gallium‐67 citrate scanning is occasionally useful in determining the extent of head and neck tumors but rarely can it detect an occult tumor and it cannot distinguish between an infection and a tumor. Technetium‐99m pertechnetate can be used to evaluate diseases of the salivary glands including parotitis, duct obstructions, and tumors. Iodine 123 and technetium‐99m pertechnetate are commonly used to obtain images of the thyroid, but some malignant thyroid nodules will accumulate technetium‐99m pertechnetate and the suspicious character of the nodule may be only appreciated by iodine scanning. The use of iodine 131 is generally limited to the detection of a substernal thyroid, therapeutic thyroid ablation, and the treatment of hyperthyroidism and thyroid cancer. Bone scanning has been used experimentally to evaluate the healing of mandibular bone grafts and to detect local extension of primary head and neck tumors to skull and facial bones.
The newer microsurgical techniques in neurosurgery
Authors: Camp Perry E.
Published: February 2007

The application of microsurgical techniques to neurological surgery has changed the treatment of several important neurological and neurosurgical diseases. Microsurgical decompression of the 5th and 7th nerves for trigeminal neuralgia and hemifacial spasm has become established as an accepted and effective technique. Application of the newer microvascular techniques in neurological surgery has increased the number of patients for whom surgical correction is possible and has, additionally, revolutionized the treatment of giant intracerebral aneurysms.
Preoperative chemo‐radiotherapy in advanced head and neck cancer
Authors: Pearlman Nathan W. , Meyers Arlen D. , Johnson F. Bing , Dibella Nicholas J.
Published: February 2007

In a prospective evaluation, two preoperative courses of methotrexate, bleomycin, and cisplatin combined with 2,000 rad/10 fractions (“chemo‐radiotherapy”) yielded 78% response rates in previously untreated advanced head and neck cancer. Similarly staged patients receiving preoperative irradiation of 5,000 rad alone had a 67% response rate. Treatment‐related mortality in the chemo‐radiotherapy patients was equal to that seen with standard combinations of surgery and preoperative or postoperative irradiation. At 24 months, disease‐free survival is 47% with chemo‐radiotherapy vs 33% with standard therapy; however, patients benefiting most from the former approach were those with T4 primary lesions or N3a neck nodes.
Verrucous carcinoma of the oral cavity
Authors: McDonald John S. , Crissman John D. , Gluckman Jack L.
Published: February 2007

Since verrucous carcinoma was first identified as a distinct clinicopathologic entity, a great deal of confusion has developed in interpreting the proper criteria for diagnosis. Various authors, therefore, have developed considerably different concepts of the features that make this lesion a unique variant of squamous cell carcinoma. Consequently, there is great confusion in the literature as to the appropriate therapeutic approach, the incidence of recurrence, and the frequency of anaplastic transformation of verrucous carcinoma. The literature was reviewed to identify all cases of verrucous carcinoma of the oral cavity that appear to meet the clinical and histopathologic criteria for this lesion as originally set forth by Ackerman.1 The problems encountered in arriving at the diagnosis of verrucous carcinoma are discussed. Cases with at least a 1‐year reported follow‐up were grouped according to the primary modality of therapy employed and were evaluated as to the effectiveness of the initial therapy. The frequency of anaplastic transformation following radiation therapy is also addressed.
The pathology of head and neck tumors: verrucous carcinoma, part 15
Authors: Batsakis John G. , Hybels Roger , Crissman John D. , Rice Dale H.
Published: February 2007

Verrucous squamous cell carcinoma is a distinctive clinicopathologic entity. The lesion's biologic activity places it between conventional (nonverrucous) carcinomas and nonautochthonous hyperplasias of squamous epithelium. The diagnosis of the lesion requires full communication and cooperation between surgeon and pathologist. Once the diagnosis is confirmed, the selection of surgery over radiotherapy should be based on the recorded effectiveness of each modality and not on the phenomenon of anaplastic transformation reported to follow radiotherapy.
Ulceration and stenosis of the hypopharynx and its surgical management
Authors: Kobayashi Takeo , Kikawada Toru , Shima Kazuharu , Fukuda Osamu
Published: February 2007

Two patients presented with ulcerative lesions of the hypopharynx. One patient developed dysphagia due to a stenotic hypopharynx which followed an ulcerating mucosal lesion. The stenotic site was reconstructed using a subcutaneous pedicle flap. The advantages of this method are the possibility of a one‐stage operation and a good cosmetic result. In our review of the medical literature, we were unable to find other cases with a similar manifestation treated by surgery. The most likely diagnostic possibilities are Behicet's disease and Crohn's disease. Differential diagnoses are discussed.
The pathology of head and neck tumors: The lymphoepithelial lesion and sjögren's syndrome, part 16
Authors: Batsakis John G.
Published: February 2007

The clinical disorder Sjögren's syndrome and its putative histologic marker in salivary tissues, the lymphoepithelial lesion, have been and continue to be sources of confusion as well as the subjects of extensive immunologic and pathologic research. At the present time, Sjögren's syndrome is defined as a lymphocyte‐mediated exocrinopathy but definition does little justice to the profound immunogenetic basis of the syndrome. This report presents a contemporary review of the lymphoepithelial lesion and the syndrome and presents a hypothesis of pathogenesis based on a graft vs host disease‐like disorder. The hypothesis incorporates the immunogenetic, immunoregulatory, and neoplastic aspects of Sjögren's syndrome.
Local control of T1 vocal cord cancer with radiation therapy: The importance of tumor character VS. Treatment parameters
Authors: Hintz Brace L. , Kagan A. Robert , Wollin Myron , Miles John , Flores Luis , Nussbaum Herman , Rao Aroor R. , Chan Paul Y. M. , Ryoo Monica C.
Published: February 2007

Ninety‐one patients with T1 vocal cord carcinoma received primary irradiation treatment. The 5‐ and 10‐year determinate disease‐free survival was 80%; the 5‐ and 10‐year determinate survival including surgical salvage was 92%. Tumors involving more than one‐half of a vocal cord or involving the anterior commissure or exhibiting an exophytic growth pattern had numerically, but not statistically, higher local failure rates than tumors without these characteristics. Precise radiation treatment technique appears more important for local control (LC) than tumor character. The crucial treatment factors for high LC with few radiation complications are reproducible daily patient positioning, use of contour‐compensating devices (wedges), field size of 5 × 5 cm, and a radiation prescription with a time‐dose fractionation value of 101 to 106.
Sternoclavicular joint hypertrophy following radical neck dissection
Authors: Cantlon Gary E. , Gluckman Jack L.
Published: February 2007

The classic radical neck dissection continues to dominate therapy for cervical metastasis. While the morbidity, complications, and sequelae of this procedure are well documented, sternoclavicular joint hypertrophy appears to have escaped attention. In order to establish the true incidence of this frequently noted but poorly documented condition, 50 randomly selected patients who had undergone radical neck dissection were evaluated retrospectively. Significant sternoclavicular hypertrophy was noted in 54% of the patients, but in only 4 (8%) was the condition severe enough to cause patient or physician concern. Surgical exploration was performed in 2 cases. The etiology of this condition is discussed, as are the radiologic findings, which may be suggestive of metastasis. The major clinical significance is an awareness of the condition and avoidance of overinvestigation and surgical exploration except in the most suspicious circumstances.
Benign lipoblastoma in the mandible
Authors: Obwegeser Hugo L. , Makek Miro S.
Published: February 2007

Large benign tumors and cysts of the mandible cause such massive bulging in the soft tissue of the cheek that one is tempted to try to find an external approach to the tumor. In our experience an oral approach has proven to be sufficient and advantageous in most cases of benign mandibular tumors even when they were very large. This is demonstrated in an unusual case of lipoblastoma of the ascending mandibular ramus. It is the first endosteal case of this rare tumor in the literature.
Acral lentiginous melanoma of the oral cavity
Authors: McDonald J. S. , Miller R. L. , Wagner W. , Giammara B.
Published: February 2007

Lentiginous melanomas may be classified clinicopathologically as either lentigo maligna melanomas or acral lentiginous melanomas. Lentigo maligna melanoma is generally characterized by its slow rate of growth, lateness of metastasis, and relatively good prognosis. Acral lentiginous melanoma, while demonstrating a radial growth phase which is histologically similar to that of lentigo maligna, appears biologically more similar to superficially spreading malignant melanoma once the vertical growth phase supervenes. Mucous membrane melanomas with lentiginous characteristics are likely to be aggressive lesions with a marked propensity for metastasis and a uniformly poor prognosis, much like the acral lentiginous type of melanoma. It would seem, therefore, that superficial melanomas of the oral mucous membranes with a lentiginous pattern should best be termed acral lentiginous melanomas instead of lentigo maligna melanomas so as to more accurately predict their true biologic potential. An amelanotic case is presented which we believe illustrates this point.
Surgical management of advanced scalp cancer
Authors: Lang Nicholas P. , Kendrick John H. , Flanigin Herman , Wetmore Steve J. , Suen James Y. , Westbrook Kent C.
Published: February 2007

A series of 53 advanced scalp cancer patients treated with surgery is presented. A review of these patients concludes: 1) local tumor growth—not distant metastasis—is the primary problem; 2) management is based on the tendency of a tumor to spread laterally early in its development with a deep invasion occurring later on; 3) when deep invasion occurs, radical excision and reconstruction is indicated to control the disease; 4) recurrence following adequate local therapy requires a change in treatment modality.
Expression plasty: A new approach to esthetic surgery
Authors: Fanous Nabil
Published: February 2007

Training in esthetic surgery focuses on correcting crooked noses, wrinkled skin, bald scalps, and other unsightly facial structures. However, little importance is placed upon facial expressions—eg, “weak,” “serious,” “feminine,” etc. Surgeons have discovered, through experience, that a recessed chin gives one a “dumb” expression, that a drooping nose denotes an “aging” expression, and that baggy eyelids confer a “tired” expression; yet few efforts have been made to study this area in more depth. This article explores the field of facial expression and its place in facial esthetic surgery.
Meningiomas presenting in the paranasal sinuses and temporal bone
Authors: Granich Mark S. , Pilch Ben Z. , Goodman Max L.
Published: February 2007

Head and neck meningiomas are primarily intracranial neoplasms; they rarely present in extracranial locations. Two cases of meningiomas in the paranasal sinuses and seven cases in the temporal bone are described. The pathology, pathogenesis, clinical evaluation, and therapy are discussed. It is stressed that intracranial components of such meningiomas be sought and, as appropriate, treated.
Paranasal sinus radiology, part 4A: Maxillary sinuses
Authors: Dolan Kenneth D. , Smoker Wendy R. K.
Published: February 2007

The maxillary sinus is frequently involved by inflammatory change. It is also the sinus that is most affected by intrinsic or nearby neoplasms. Since neoplasia and inflammatory disease may mimic each other, radiologic examination often becomes the principal means of differentiating them. Principles of radiologic diagnosis, with attention to changes in the various bony margins in maxillary disease processes, form the basis of this article.