bluuebunny/crossref_metadata_2025 huggingface dataset:
Deep neck abscesses secondary to methylphenidate (Ritalin) abuse
Authors: Zemplenyi Jan , Colman Marc F.
Published: February 2007

Methylphenidate (Ritalin) abuse has been and continues to be a major medical and social problem. In the past 6 months, we have seen five deep neck abscesses secondary to intravenous Ritalin abuse. This constitutes more than 50% of the deep neck abscesses seen by us in the same time period. The pathogenesis is related to an inflammatory foreign‐body reaction to the fillers in the methylphenidate tablets, followed by superinfection by oral or cutaneous flora. Mixed flora infections with weakly pathogenic organisms may also occur.
Reconstruction of the larynx and cervical trachea with the pectoralis major myocutaneous island flap
Authors: Eliachar I. , Goldsher M. , Moscona A. R. , Hurwitz D. J.
Published: February 2007

Trauma to the anterior cervical region, whether blunt or penetrating, is life threatening and often causes a major loss of tissue to both the larynx and the trachea. We report our experience in reconstructing the larynx and trachea with the pectoralis major myocutaneous island flap in an unusual case of extensive traumatic cervical injury.
High resolution computed tomography in evaluation of the temporal bone
Authors: Swartz Joel D. , Russell Kamal B. , Wolfson Robert J. , Marlowe Frank I.
Published: February 2007

High resolution computed tomography has completely replaced conventional multidirectional tomography in the evaluation of the temporal bone. Unprecedented detail is now available for evaluation of both middle ear and inner ear structures. A sampling of our experience in the evaluation of tubotympanic disease, otosclerosis, trauma, neoplastic disease, and congenital abnormalities is included in this publication. The state of the art in evaluation of sensorineural hearing loss is also illustrated.
Facial fractures: Hippocratic management
Authors: Gahhos Fivos , Ariyan Stephan
Published: February 2007

Hippocrates, the famous Greek physician of the fifth century B.C., is considered to be the “Father of Medicine.” Little, however, is known about his principles for the management of facial trauma. In this article, the Manuscripts in Ancient Greek, which deal with the management of mandibular fractures and dislocations, and with nasal and midfacial fractures have been translated and discussed. Hippocrates' methods for reducing mandibular dislocations and treating fractures of the mandible by wiring the teeth and immobilizing the jaw are described. His technique of closed reduction and immobilization of deviated nasal fractures with internal packing and rigid dorsal splints remains timeless. Hippocrates has taught us how to achieve medical wisdom through accurate clinical observation and practical creative ideas. The discovery of x‐rays and antisepsis only furthered his established sound principles for the management of facial trauma.
Internal carotid artery aneurysm: A singular anomaly
Authors: Evans Colin Everson
Published: February 2007

A 9‐year‐old Indian boy was found to have an aneurysm of the left internal carotid artery. The vessel was heavily atherosclerosed, and the distal segment of the artery was tortuous and dilated. Serum lipid estimations showed the presence of type IIB hyperlipoproteinemia, with evidence of the disease in the patient's identical twin sibling and 37‐yearold father. There was also a marginal increase in serum triglycerides in a 4‐year‐old younger brother. The patient's 29‐year‐old mother was unaffected. The patient had suffered hemolytic disease as a newborn, which resulted in kernicterus and subsequent mental retardation. This incident is considered to have been the result of a proven glucose‐6‐phosphate dehydrogenase deficiency. The aneurysm was resected and arterial continuity was ensured by using an end‐to‐end anastomosis. Postoperative blood flow studies showed normal flow patterns in the reconstituted artery. Postoperatively, the patient's mental performance increased dramatically; it is hypothesized that such progress is the consequence of an improvement in the blood supply to the limbic system, following the operative procedure.
Traumatic arteriovenous malformation of the external carotid arterial system
Authors: Marks Malcolm W. , Argenta Louis C. , Dingman Reed O.
Published: February 2007

Traumatic arteriovenous (AV) malformations of the face and scalp are rare lesions characterized by multiple endothelial‐lined channels between the arterial and venous systems. If improperly managed they have a high propensity to recur, and may result in severe cosmetic deformity. Lesions should be delineated by arteriography unless small and localized. They are managed by complete excision and ligation of arterial feeding vessels. Five cases of traumatic AV malformation of the face and scalp and their management are reported.
Arterial blood supply to the infrahyoid muscles: An anatomical study
Authors: Eliachar I. , Marcovich A. , Shai Y. Har , Lindenbaum E.
Published: February 2007

The arterial supply to the infrahyoid strap muscles originating from the superior thyroid artery (STA), the inferior thyroid artery (ITA), and the internal mammary artery (IMA), also called the internal thoracic artery, were investigated. Intraarterial silicone dye was injected into eight fresh cadavers followed by dissections. The blood supply to the infrahyoid muscles was found to be segmented in nature with the dividing line at the level of the cricoid ring. No axial pattern of vascularization could be demonstrated within the strap muscles. The skin overlying these muscles is supplied by tributaries arising from the above‐described arteries. Application of the information gathered is discussed in consideration of local myocutaneous and myoosseous flaps for reconstructive surgery, particularly of the larynx and trachea.
The incidence of occult metastases for cancer of the oral tongue and floor of the mouth: Treatment rationale
Authors: Teichgraeber John F. , Clairmont Albert A.
Published: February 2007

One hundred thirty‐six surgical cases of squamous cell carcinoma of the oral tongue and floor of the mouth at the Emory University Hospitals were reviewed for the incidence of occult metastases. Thirty‐five percent of the T1 T2 lesions of the anterior tongue had occult metastases. The figure was 31.5% for similarly staged lesions of the floor of the mouth. The presence of regional metastases resulted in a 2‐year determinate survival rate of 37% and 32% for patients with oral tongue and floor of the mouth lesions, respectively. The poor prognosis in the study for delayed cervical metastases and the high incidence of occult cervical metastases have led the authors to propose a more aggressive therapy for the clinically negative necks in these two sites of squamous cell carcinoma of the oral cavity.
Surgical stents for the head and neck cancer patient
Authors: Martin Jack W. , Jacob Rhonda F. , Larson David L. , King Gordon E.
Published: February 2007

Split‐thickness skin graft reconstruction following intraoral cancer surgery maintains functional mobility within the oral cavity and gives excellent support for the final intraoral rehabilitative prosthesis. We describe the use of a dental material, called tissue conditioner, for skin graft immobilization as an alternative to the usual gauze bolus and thermoplastic materials following surgery in various intraoral anatomic sites.
Surgical pathology of olfactory neuroblastoma
Authors: Harrison Donald
Published: February 2007

The natural history of a personal group of eight patients with olfactory neuroblastoma is reviewed with particular reference to surgical pathology as revealed by a study of the operative specimens in seven of these patients. This reveals that spread to the cranial surface of the overlying dura must be considered to be present in all patients irrespective of the radiologic findings. Craniofacial resection is therefore considered to be an essential part of any treatment regimen.
The trapezius musculocutaneous FLAP in head and neck reconstruction: Potential pitfalls
Authors: Nichter Larry S. , Morgan Raymond F. , Harman David M. , Horowitz  , Edlich Richard F.
Published: February 2007

Defects resulting from bulky tumor resection of the head and neck region represent a reconstructive challenge. The trapezius musculocutaneous paddle flap based on the transverse cervical vessels is a useful tool for the reconstructive surgeon. Failure to recognize the variable anatomy is discussed in relation to other musculocutaneous flaps used for the purpose of head and neck reconstruction. The trapezius muscle has a variably located vasculature and diverse nomenclature. The knowledge of the variance of its anatomical vasculature is essential in the successful use of the trapezius musculocutaneous flap.
Heterotopic gastric cyst of the oral cavity
Authors: Daley Tom D. , Wysocki George P. , Lovas Guyla L. , Smout Marvin S.
Published: February 2007

The heterotopic gastric cyst of the oral cavity is a rare lesion. A recurrent gastric cyst in the floor of the mouth of a young female patient is presented. Current theories dealing with the histogenesis of these lesions are presented and discussed. Based on the available embryologic and clinical information, a new histogenetic concept for the development of the heterotopic gastric cyst is proposed.
Radiation and thyroid carcinoma: Radiotherapy, head and neck regions, thyroid carcinoma
Authors: Auguste Louis Joseph , Sako Kumao
Published: February 2007

Radiotherapy for benign conditions of the head and neck area was first linked to thyroid carcinoma in 1950. All the salivary glands, the parathyroids, and the facial skin can also develop neoplastic lesions in this setting. Thyroid carcinoma is most commonly papillary or mixed papillary and follicular. It is very often multifocal and can be detected by hand palpation, nuclear scanning, high resolution sonography, and needle aspiration. Each test has its limitations and appropriate protocols for screening and detection should be adapted to different medical centers. The surgical management is controversial and ranges from simple lobectomy to total thyroidectomy with adjuvant 131I treatment and thyroid suppression. We prefer total thyroidectomy if it can be performed safely. With adequate treatment the survival should be good. Prevention by administration of iodine at the time of exposure to radiation seems feasible and deserves further clinical trial.
Bilateral chylothorax complicating radical neck dissection: Report of a case with no concurrent external chylous leakage
Authors: Har‐El Gady , Segal Karl , Sidi Jack
Published: February 2007

Bilateral chylothorax as a complication of radical neck dissection is extremely rare. Six cases are reported in the English literature. All of these patients' cases were associated with a concurrent external chylous fistula, as evidenced by the appearance of a milky fluid confirmed to be chyle by chemical determination. Chyle had also been noted to leak during the operation. This presentation illustrates an additional case of bilateral chylothorax occurring after radical neck dissection, and the first case, to our knowledge, with no concurrent external lymph leakage. Anatomic and physiologic considerations are presented and possible mechanims of pathogenesis are discussed. Chylothorax has two major complications—respiratory and metabolic. A short summary of the modern concepts of treatment is presented.
Hair transplantation for male pattern baldness: Aesthetic considerations and current status
Authors: Ayres Samuel
Published: February 2007

The multiple punch technique of hair transplantation, utilizing the principle of donor dominance, has proven to be a cosmetically acceptable procedure in properly selected patients in the presenter's 24‐year experience. Careful planning with attention to aesthetic principles, especially in frontal hairline placement, in donor site selection and with regard to the ratio between the donor supply and the existing or potential future extent of baldness, together with meticulous surgical technique, are essential for satisfactory results. Scalp reduction, in which bald areas of crown and midscalp are serially excised, with extensive subgaleal undermining is a highly useful adjunct to grafting in many patients with moderately extensive male pattern baldness who have adequate scalp mobility by enabling the available donor supply to be concentrated and thus provide more effective coverage in the frontal scalp.
Hairline aesthetics and styling in hair replacement surgery
Authors: Mayer Toby G. , Fleming Richard W.
Published: February 2007

Punch grafting and flap surgery are proven methods of correcting baldness. Using either method, the location and shape of a new hairline on the frontal and temporal scalp is one of the most important aspects of hair replacement surgery. If the hairline is not aesthetic, the results can be unacceptable or even devastating for the patient and surgeon alike. The principles of planning the frontal and temporal hairline are presented using punch grafts as well as flaps. Postoperative styling of the “new” hair will vary depending upon the method used to transfer the hair (flaps or grafts), the local factors involved (texture, direction, density, tufting, etc.), as well as the patient's preference. The various advantages and disadvantages of styling possibilities with each method are presented. These factors should be discussed with the patient preoperatively.
Computed tomography evaluation of the nasal septal reconstructed larynx
Authors: Zohar Y. , Hadar H. , Laurian N.
Published: February 2007

Computed tomography (CT) of the larynx was performed in 15 patients who had their larynx reconstructed by compsite nasal septal autograft after frontal, or frontolateral laryngectomy. Five representative cases each with CT scan and additional laryngoscopic documentation are presented. The CT permitted a detailed appraisal of the nasal septal grafted larynx. Our attention was directed to the image of the graft in what concerned its patterns of distortion, fibrosis or chondrification, and width of the laryngeal airway. The scan from 10 patients brought radiographic evidence that the implanted cartilage retained vitality and structural integrity.
Prominent ears—Pitanguy'S island technique: Long‐term results
Authors: Pitanguy Ivo , Fiazza Giuseppe , Calixto Carlos Alberto , Muller Paulo Malta , Caldeira Alberto M. L. , Alexandrino Adelson
Published: February 2007

Through the analysis of 300 cases of prominent ears operated by Pitanguy's technique with a follow‐up of 1‐15 years we observed the preservation of the aesthetic aspect as well as the cephaloauricular angle. We call attention to its easy performance and almost no incidence of early or late complications.
Accuracy of frozen‐section diagnosis in salivary gland lesions
Authors: Granick Mark S. , Erickson E. Ralph , Hanna Dwight C.
Published: February 2007

A retrospective study is presented comparing the results of 462 frozen‐section analyses of surgically extirpated salivary gland tumors with the permanent‐section results. The overall agreement between frozen‐ and permanent‐section analyses was 95.7%. A separate review of the last 47 months of this 32‐year study revealed an accuracy rate of 98.8%. Frozen‐section diagnosis of salivary gland tumors has been reliable and clinically valuable in our practice.
The soft tissue myxoma of the head and neck region—Report of a case and literature review
Authors: Tse Jack J. , Vander Seymour
Published: February 2007

A case of soft tissue myxoma in scalp is reported in a patient with a history of congenital cleft lip and palate. Review of the literature shows head and neck soft tissue myxoma occurs almost in every decade of life with peak occurrence in the fourth decade. Men are affected more than women. The most common location in the head and neck region is the palate, followed by the parotid area. The prognosis of this soft tissue tumor is good. Conservative surgical excision with adequte margins is the treatment of choice. Several theories concerning the pathogenesis of this tumor are discussed, with the theory that a basic error in tissue metabolism during initial growth is the most compatible to the elements of this case. Differential diagnosis regarding this type of lesion is also discussed.
A dramatic complication of peroral fiberoptic endoscopy
Authors: Burstein Fernando D. , Colman Marc F.
Published: February 2007

The advent of the flexible fiberoptic gastroscope has revolutionized clinical gastroenterology. The morbidity and mortality rates with flexible fiberoptic endoscopes are comparable to those associated with rigid and semirigid scopes. Insufflation devices are routinely used with flexible fiberoptic scopes. This may lead to complications, differing from those associated with rigid endoscopy. A case involving an insufflation injury to the piriform sinus is presented. The pathophysiology of insufflation injuries and their management are discussed.
Aspergillosis of the nose and paranasal sinuses in neutropenic patients at an oncology center
Authors: Landoy Zvi , Rotstein Coleman , Shedd Donald
Published: February 2007

Invasive aspergillosis of the nose and paranasal sinuses is one of the presentations of aspergillosis in granulocytopenic patients with neoplastic disorders. It is most prevalent among patients with leukemia and granulocytopenia and is associated with a high mortality rate. We report five cases of invasive aspergillosis of the nose and paranasal sinuses in profoundly neutropenic patients treated with broad spectrum antibiotics. Both Aspergillus fumigatus and Aspergillus flavus were cultured and identified in this entity. Awareness of this disease and early diagnosis made by culture and histologic examinations of biopsy material are essential. Treatment consisting of amphotericin B therapy and surgical debridement can be effective in eradicating this form of aspergillosis.
A compendium of intraoral flaps
Authors: Komisar Arnold , Lawson William
Published: February 2007

Intraoral flaps are an excellent source of tissue for reconstruction after resection of small malignant tumors of the oral cavity, pharynx, and hypopharynx. The principal donor sites used are the tongue, buccal mucosa, and palate. Intraoral flaps enable rapid rehabilitation of deglutition and speech with minimal morbidity. They provide easily transferred, well‐vascularized tissue from sites adjacent to the operative defects. These flaps permit closure without tension and obviate the need for more distant tissue transfers. Their use does not compromise the oncologic resection.
Clear cell odontogenic tumor— a new histologic variant with aggressive potential
Authors: Hansen Louis S. , Eversole L. Roy , Green T. L. , Powell Nelson B.
Published: February 2007

This report delineates the clinical and laboratory findings for a previously unreported neoplasm of putative odontogenic origin. We describe the clinical, radiographic, operative, histologic, histochemical, and ultrastructural findings of the tumor in three women. All lesions were centrally located in the jaw bones, were expansile, and, except for mobile teeth and/or jaw enlargement, exhibited few symptoms. Radiographically, there was bone and tooth destruction resulting in poorly delineated margins. Microscopically, the tumors were nearly identical in that they consisted primarily of large sheets and islands of uniform vacuolated and clear cells without evidence of amyloid deposition, calcification, or glandular differentiation. One of the lesions recurred 1 1/2 years after removal without evidence of metastasis. The results, based only on these cases, suggest that this is a locally aggressive neoplasm of odontogenic origin. Casual microscopic examination of this rare neoplasm could result in misdiagnosis as a metastatic clear cell neoplasm, especially renal cell carcinoma.
Congenital benign mesenchymoma of the head and neck
Authors: Doraiswamy Nanjappachetty Velaswamychetty , Naqeeb Nai'L Al , Ali Syed Mukarram
Published: February 2007

Congenital benign mesenchymoma of the head and neck is rare. One such case, presenting as a mass in the neck, is reported and the literature reviewed. Pathologic nature of the lesion is discussed. Prognosis after adequate local excision is good.
Preoperative simultaneously administered cis‐platinum plus radiation therapy for advanced squamous cell carcinoma of the head and neck
Authors: Slotman Gus J. , Cummings Frank J. , Glicksman Arvin R. , Doolittle Charles L. , Leone Louis A.
Published: February 2007

Synchronously administered cis‐platinum (cis‐DDP) and radiation therapy have been used to treat unresectable squamous cell carcinomas of the head and neck. The purpose of this study was to evaluate the efficacy and tolerance of preoperative adjuvant cis‐DDP plus radiation therapy in operable stage III and IV head and neck cancers. Radiation therapy (4,500 rad) was delivered in 180‐rad daily fractions. Cis‐DDP (20 mg/M2) was given before radiotherapy on days 1–4 and 21–24. Eighteen patients began therapy; 16 completed the combined regimen. Toxicity included stomatitis (3) and WBC below 2,500/mm3 (2). One patient died from therapy of a cerebrovascular accident. Sixteen patients (89%) achieved a complete or partial response to therapy. Complete responses were observed in 13 of 18 primary tumors (72%), and in all three patients with cervical lymphadenopathy. Complete responses were noted for lesions of the nasopharynx, oral cavity, pharynx, hyopharynx, and larynx, for all histologic grades of squamous cell carcinoma. Twelve patients underwent curative surgery. Site‐related morbidity occurred in two patients (15%) and a third patient developed postoperative pneumonia. Five of 10 resected primary tumors with preoperative complete responses were pathologically negative for tumor. Concurrent bolus cis‐DDP and radiation therapy are welltolerated and result in impressive tumor reduction. Morbidity after subsequent curative surgery is low, and histologic complete responses are frequent. Trials of this promising combined modality approach to advance operable cancers of the head and neck, when compared to other treatment sequences, appear warranted.
Salivary neoplasms: Overview of a 35‐year experience with 2,807 patients
Authors: Spiro Ronald H.
Published: February 2007

We have reviewed a 35‐year experience with 2,807 patients treated for salivary tumors which arose in the parotid gland (1,695 patients; 70%), submandibular gland (235 patients; 8%), and seromucinous glands of the upper aerodigestive tract (607 patients; 22%). Pleomorphic adenomas comprised 45% of the total, most of which occurred in the parotid gland. The clinical findings and the distribution of patients according to the histology and the site of origin are summarized. Treatment was surgical and the resection was conservative when possible, depending upon the extent of the tumor. The impact of site, histology, grade, and tumor stage on the results is shown.
Modified pectoralis major myocutaneous flap with partial preservation of the muscle: A study of 55 cases
Authors: de Azevedo Jorge Ferreira
Published: February 2007

The results of a technical modification of the pectoralis major myocutaneous flap are presented in which the clavicular bundles, the first two or three sternocostal bundles, and the lateral border of the muscle were preserved. The flap was delivered into the neck through a subclavicular tunnel. The procedure was performed in 55 patients, with a bilateral simultaneous flap used in one. Four instances of flap necrosis occurred, although it was felt that they were not related to the modified technique, and no damage to the subclavian vessel occurred. In the first 25 flaps, we did not identify the neurovascular bundle supplying the preserved musculature. Eighteen of these flaps were evaluated, and atrophy was encountered in 10. Of the latter 31 patients, only one suffered atrophy of the sternocostal bundle. The technical modification of preserving part of the muscle and its neurovascular supply is especially important in manual workers. Twentyeight of 38 patients with preserved muscle function at the donor site were manual workers, and 10 of them returned to normal activity. None of the patients who developed atrophy of the pectoralis major muscular remnant was able to return to work within 1 year or longer after treatment. In the successful cases, there were no functional sequelae of the arm, visible depressions in the infraclavicular area, or loss of the anatomic configuration of the anterior axillary line.
Salvage surgery for recurrent neck carcinoma after multimodality therapy
Authors: Urken Mark , Biller Hugh F. , Lawson William , Haimov Moshe
Published: February 2007

Recurrent carcinoma of the neck after treatment by radical neck dissection and radiotherapy leads to a progressive downhill course if no further therapy is instituted. Nine such patients having fixed, recurrent neck tumors with carotid artery involvement underwent 10 salvage procedures with carotid artery resection and replacement. One patient developed a transient hemiparesis that resolved in 3 days, and in another, a permanent hemiparesis occurred. Three patients have survived longer than 12 months. One patient is free of disease at 42 months following two salvage operations. We attribute the low operative morbidity to the frequent use of the subclavian artery for proximal anastomosis and myocutaneous flaps to resurface cutaneous and mucosal defects. We conclude that salvage surgery with carotid artery replacement can be performed on selected patients who have failed combined therapy as a palliative and possibly curative measure.
Small cell carcinoma of the head and neck
Authors: Baugh Reginald F. , Wolf Gregory T. , McClatchey Kenneth D.
Published: February 2007

Treatment methods for patients with small cell carcinoma of the head and neck are changing. Increasing clinical experience with these tumors and a better appreciation of patterns of recurrence, the need for thorough tumor staging, and the importance of chemotherapy as a form of primary therapy have contributed to these changes. Current concepts regarding small cell carcinoma arising in the head and neck are reviewed. Reported results of treatment for a variety of head and neck sites and site‐specific relapse rates are summarized. New cases of small cell carcinoma arising in the hypopharynx, paranasal sinus, and from an unknown primary are added to the reported experience in the literature.
Hemimandibulectomy without bone grafting: Report of a case
Authors: Lambert Paul M. , Patel Mahendra
Published: February 2007

Some patients require hemimandibulectomy who are poor candidates for reconstructive surgery or who do not want to subject themselves to multiple surgical episodes. With the use of an articulated external skeletal fixation appliance, near‐normal esthetics and function can be achieved in these patients without bone grafting. A report of one such case is presented.
Mucoepidermoid carcinoma of salivary glands: A clinicopathologic study of 46 cases
Authors: Nascimento Antonio G. , Amaral Ana Lucia P. , Prado Lygia Anne F. , Kligerman Jacob , Silveira Telma Ruth P.
Published: February 2007

Forty‐six cases of mucoepidermoid carcinoma (MEC) of the salivary glands were reviewed with an emphasis on the clinicopathologic aspects and prognosis of the tumors. MEC occurred in a wide age range, with few cases being diagnosed in childhood. Its peak of incidence was in the fifth decade and it involved major and minor salivary glands with equal frequency; the parotid gland was the gland most commonly affected. Presence of a mass was the most common complaint of all 46 patients. About 64% of the patients presented with stages 3 and 4 disease. Three distinct histologic grades were found after analyzing cellular pleomorphism, mitotic activity, and presence of necrosis. This study showed that clinical staging and histologic grading are the most important factors influencing survival and they seem to be independent of each other. Other variables found to be important in prognosis were age, sex, and the development of recurrent disease after surgery. Surgery with total resection of the tumor was the most effective treatment in our cases and adjuvant radiotherapy proved to be of little value in improving survival of MEC in our series of cases, considering that the patients in whom this type of treatment was used had unfavorable clinicopathologic factors.
Pharyngolaryngoesophagectomy with pharyngogastric anastomosis for cancer of the hypopharynx: Review of 101 operations
Authors: Harrison D. F. N. , Thompson A. E.
Published: February 2007

During the period between 1965 and 1983, 101 pharyngolaryngoesophagectomies with primary pharyngogastric anastomosis were carried out for primary hypopharyngeal cancer at The Royal National Throat, Nose and Ear Hospital, London, England. The Hospital mortality rate was 11%; postoperative complications such as pleural effusion and regurgitation of bile occurred in all patients. Successful swallowing occurred in all patients before they left the hospital‐usually within 2 wk of surgery. An actuarial survival rate of 58% was obtained for the entire group.
Cold nodules of the thyroid: Current treatment
Authors: Rothenberg Robert E. , Laraja Raymond D. , Lobbato Vincent J. , Radulescu Valentin O.
Published: February 2007

Within recent years differing approaches to the treatment of cold nodules of the thyroid gland have evolved. To assess these differences and to discover whether a general consensus exists, questionnaires were sent to professors of surgery and endocrinology and to chiefs of head and neck sections at various medical colleges and university hospitals throughout the country. Fifty‐three surgeons and 13 endocrinologists answered the questionnaires and their responses are analyzed and recorded here.
Impact of smoking and smokeless tobacco on the risk of cancer of the head and neck
Authors: Stockwell Heather G. , Lyman Gary H.
Published: February 2007

A case‐control epidemiologic study was conducted to determine the relationship between quantities and types of tobacco and the risk of cancers of individual sites within the head and neck. Substantial variations were found to exist in the tobacco‐associated risk for each site. The use of cigarettes was associated with an increased risk of cancers of all sites, except the salivary glands. Cancers of the floor of the mouth and larynx exhibited the highest cigarette‐related risks. Cigar smokers experienced excess risks of cancers of the tongue, pharynx, and larynx. Pipe smokers experienced elevated risks of cancer of the tongue, mouth, pharynx, and larynx. Among users of smokeless tobacco, increased risks of cancer of the mouth and gum, pharynx, and salivary glands were observed.
Lymphocyte phenotypes at tumor margins in patients with head and neck cancer
Authors: Guo Min , Rabin Bruce S. , Johnson Jonas T. , Paradis Irvin L.
Published: February 2007

Lymphocyte phenotypes were identified by monoclonal antibodies and avidin‐biotin peroxidase reagents and enumerated in tumor tissue removed from 26 patients with head and neck cancer. T lymphocytes (T11) were the predominate phenotype at the tumor margin, with twice as many helper/inducer (T4) as suppressor/cytotoxic (T8) lymphocytes. Patients with Stage II and III carcinoma of the glottis, tongue, and hypopharynx had significantly increased numbers of all T lymphocyte phenotypes when compared to patients with Stage IV disease, thus achieving statistical significance for the T11 and T8 phenotypes. All patients were followed for 2.5 years; those patients who remained free of malignant disease had an increased number of all T lymphocyte phenotypes compared to patients with recurrent malignancy, but this did not achieve statistical significance. Thus, increased numbers of 111 positive lymphocytes of both the T4 and T8 subsets in the tissue at the margins of head and neck tumors were associated with a more favorable prognosis. These results support the concept of an immunologic reaction at the tumor margin, which may be limiting the growth and spread of tumor.
Ultrasound B‐scans in the follow‐up of head and neck tumors
Authors: Westhofen Martin
Published: February 2007

In recent years, diagnostic ultrasound has become established in head and neck surgery. Modern equipment allows high resolution imaging of neck tissue masses, cervical vessels, and lymph nodes. The major advantage of B‐mode sonography is its ability to detect neoplasms in solid scarred neck tissue, commonly seen in patients with radical neck surgery. Postoperative or radiogenic edema, tumor recurrence, and lymph node involvement can be differentiated. Inflammatory and neoplastic lymph node diseases detected by echography must be differentiated by biopsy. Tumor recurrence was seen in 21 of 152 patients by echography. Twelve patients were diagnosed by clinical examination and 17 were diagnosed by computed tomography. Two false positive and one false negative sonographic diagnoses were made. B‐mode sonography is an important instrument in the follow‐up examination of head and neck tumors for early detection of tumor recurrence or tumor persistence.
Pharyngoesophageal diverticulum complicated by squamous cell carcinoma
Authors: Zitsch Robert P. , O'brien Christopher J. , Maddox William A.
Published: February 2007

Pharyngoesophageal (Zenker's) diverticulum is a relatively common acquired codition that may cause dysphagia and regurgitiation of food. Squamous carcinoma mayi develop in such a dverticulum, but this complication is exceedingly rare and may not be suspected preoperatively. This report describes a case in which the diagnosis of squamous carcinoma was made after regurgitation of malignant tissue from a radiographically proven pharyngoesophageal diverticulum. The patient was treated by simple diverticulectomy and postoperative radiation therapy.
Hibernomas of the head and neck
Authors: Abemayor Elliot , McClean Patrick H. , Cobb Camilla J. , Hashimoto Claire H.
Published: February 2007

Hibernomas are rare tumors derived from brown adipose tissue, a specialized form of fat tissue found in hibernating and nonhi‐bernating animals. Only a minority of reported hibernomas have occurred in the head and neck region. This report describes two cases of cervical hibernomas, one of which was preoperatively diagnosed by the use of fine‐needle aspiration biopsy. The clinical and pathologic characteristics of this neoplasm are reviewed. In general, hibernomas are slow‐growing tumors with inconclusive evidence for the existence of a malignant variant. A review of the literature supports the conclusion that excision, sparing vital structures, appears to be curative.
Squamous cell carcinoma of the pyriform sinus: Retrospective study of 351 cases treated at the institut Gustave‐Roussy
Authors: Vandenbrouck C. , Eschwege F. , De Rochefordiere A. La , Sicot H. , Mamelle G. , Le Ridant A. M. , Bosq J. , Domenge C.
Published: February 2007

The first part of the study was devoted to 199 tumors treated by surgery, either conservative for the smallest tumors (18 cases) or radical (181 cases), with systematic postoperative radiotherapy. The 3‐year survival rate was 48% and the 5‐year, 33%, with a 12% local recurrence rate, a 7.5% neck recurrence rate, and 27.6% rate distant metastases. Histologic correlations were developed. The second part of the study reported 152 cases treated by external radiotherapy alone either as a variant of our treatment protocol for the small‐sized tumors (31 cases) or, for the major part (121 cases), as a result of surgical inoperability or patient refusal. The former subgroup had a variable survival rate (65% at 3 years and 40% at 5 years) equivalent to similarly staged patients treated with conservation laryngeal surgery, whereas the prognosis of the latter subgroup was poor. The two main causes of failure were the inability to apply the curative treatment protocol in 35% of patients ineligible for a surgery and the high risk of distant metastases in the 65% of patients able to undergo the usual management.
Combined radiation therapy and surgery in the management of advanced head and neck cancer: Final report of study 73–03 of the radiation therapy oncology group
Authors: Kramer Simon , Gelber Richard D. , Snow James B. , Marcial Victor A. , Lowry Louis D. , Davis Lawrence W. , Chandler Richard
Published: February 2007

Between March 1973 and June 1979, patients with advanced operable squamous cell carcinoma of the supraglottic larynx or hypopharynx were randomly allocated to receive either preoperative radiation therapy (5,000 rad) or postoperative radiation therapy (6.000 rad). Patients with oral cavity or oropharynx lesions were randomly assigned either preoperative radiation, postoperative radiation, or definitive radiatio therapy (6,500–7,000 rad), with surgery reserved for slavage if residual disease was present 6 weeks after completion of irradiation. Three hundred twenty patients were evaluable with a median follow‐up of 60 months. Based on results in 277 patients across all four region combined, locoregional control was significantly better for patients assigned to receive psotoperative radiation therapy (65%) compared with those assigned to receive preoperative radiation therapy (48%,P=0.04). This was due to higher rate of both persistent and recurrent local and regional disease in the preoperative group. Survival also showed a trend to be better in the postoperative group (38%) compared with the preoperative group (38%) compared with the preoperative group (33%,P= 0.10). Rates of severe surgical and radiation therapy complications were similar overall. Forty‐three patients were evalauble for each of the three treatment regimens assigned to patients with oral cavity or oropharynx lesions. Due to the small number of patients available for this portion of the trial, the observed differences for overall survival (4‐year percentage 33% overall; 30% preoperative, 36% postoperative, 33% definitive radiation therapy) and for locoregional control (45% overall; 43% preoperative, 52% postoperative, 38% definitive radiation therapy) were not statistically significant. The use of definitive radiation therapy with surgical rescue as an ethically justified alternative treatment for these tumors remains a question for further research.
Osteonecrosis: Study of the relationship of dental extractions in patients receiving radiotherapy
Authors: Epstein Joel B. , Rea Giuseppe , Wong Frances L. W. , Spinelli John , Stevenson‐ Moore Peter
Published: February 2007

Osteonecrosis is a severe complication of radiotherapy for cancer. Prevention of osteonecrosis is most important, as the condition may be chronic, progressive, and lead to pathologic fracture. The clinical experience, of 627 dental extractions at the Cancer Control Agency of British Columbia either before or after radiotherapy is presented.
Carcinoma of the prostate metastatic to the maxillary antrum
Authors: Har‐El Gady , Avidor Irena , Weisbord Arie , Sidi Jack
Published: February 2007

Metastatic carcinoma of the maxillary antrum is an extreme rarity. Until 1980, less than 100 cases with distant primaries metastatic to the entire sinonasal tract had been reported. In a review of these cases, we found no mention of primary prostate cancer metastatic to the antrum. The purpose of this paper is to document the first case of this entity.
Long‐term effects of orbital irradiation
Authors: Guyuron Bahman , Dagys Arlene P. , Munro Ian R.
Published: February 2007

This retrospective study is a review of 18 patients who received radiotherapy to the orbit between the ages of 1 month and 10 years. Patients were followed for 7–21 years in an attempt to define the effects of orbital irradiation on a growing child. None of the patients in the study was spared injurious effects on soft tissue or bone, but soft tissue appeared to be more vulnerable to radiation than bone. Orbital irradiation caused soft tissue deficits of the upper face in 100% of the patients. Sixty‐seven percent of patients had soft tissue deformities of the midface, and 13% had soft tissue deformities of the lower face. Bony deficits were found in the upper face in 67% of the patients, the midface in 50%, and the lower face in 6%. This study found no correlation between age and time of radiotherapy on the effects of facial growth.
Photo‐chemotherapy in advanced head and neck cancer
Authors: Jacobs John R. , Weaver Arthur , Ahmed Khurshid , Crissman John , Ensley John F. , Kish Julie A. , Cummings Glen , Al‐Sarraf Muhyi
Published: February 2007

Induction (proto) chemotherapy consisting of 3 courses of ci‐splatin and 120‐hour 5‐fluorouracil infusion was administered to 88 patients who had locally advanced, previously untreated head and neck cancer. The majority (81%) of these patients were classified as stage IV, and 17% had second primary carcinomas of the upper aerodigestive tract. An overall response rate of 94% was observed, with a 54% incidence of complete clinical response. The toxicity of the chemotherapy was judged acceptable, and no life‐threatening or fatal drug‐related side effects occurred. Twenty‐four percent of the patients failed to comply with recommended standard treatment. In patients achieving a complete clinical response, 47% refused recommended surgery. Any response less than a complete clinical response to induction chemotherapy was not associated with any survival advantage. We conclude that future research efforts should be directed toward the identification of chemotherapeutic regimins that maximize the incidence of complete clinical response. In addition, any large‐scale chemotherapy trial in patients with re‐sectable disease should avoid the use of an induction sequence to minimize compliance problems with standard treatment.
Value of postoperative radiotherapy for thyroid cancer
Authors: Wu Xue Lin , Hu Yu Hua , Li Qing Hong , Guo Jin Rong , Sun Duo , Van Jie Hua , Xu Guo Zhen , Qin De Xing , Ha Xian Wen , Gu Xian Zhi
Published: February 2007

A series of 405 patients with thyroid cancer treated by surgery with or without postoperative radiotherapy from February 1958 through 1979 is reported. The immediate evaluation of the operation was that it was either incomplete or complete. Incomplete surgery implied that there was (1) possible residual tumor in the operative field, the result of difficult dissection of the tumor off the neighboring organs or tissues, as assessed by the surgeon; (2) multiple (more than five) lymph nodes involved; (3) positive border of the removed lesions; or (4) microscopic evidence of tumor in the operative field. Complete surgery implied thorough extirepation of cancer grossly and microscopically. In 297 patients who had complete surgery, 238 patients treated by surgery alone had a 5‐year survival rate of 92% (218/238), while 59 patients who received postoperative radiotherapy had a 5‐year survival rate of 78% (46/59). The optimum dose of postoperative radiotherapy was 50–70 Gy in 5 to 8 weeks, with the spinal dose kept under 40 Gy. Our experience shows that postoperative radiotherapy did not improve the survival of patients who had had complete surgery. Yet, in 108 patients who had incomplete surgery, surgery alone yielded a 5‐year survival rate of 33% (19/57), while surgery plus radiotherapy yielded a 5‐year survival of 71% (36/51). Our observation shows a remarkable benefit with postoperative radiotherapy in patients who have had incomplete surgery (P < 0.05). According to pathologic criteria, postoperative radiotherapy was more effective in well‐differentiated cancers than in poorly differentiated ones. It was equally effective in untreated as well as recurrent lesions. The prognosis for younger patients was better, but the sex of the patients did not affect prognosis.
Chondrosarcoma of the temporomandibular joint: Case report
Authors: Morris Michael R. , Clark Stephen K. , Porter Bruce A. , Delbecq Ronald J.
Published: February 2007

Chondrosarcoma of the head and neck region is a rarely encountered tumor. Aggressive surgical excision offers the best chance for cure. In our case, combined diagnostic techniques consisting of fine needle aspiration (FNA), computed tomography (CT), and magnetic resonance imaging (MRI) made an accurate preoperative assessment possible and greatly influenced the treatment provided.
Rationale for elective modified neck dissection
Authors: Byers Robert M. , Wolf Patricia F. , Ballantyne Alando J.
Published: February 2007

A retrospective study was conducted to give surgeons direction in deciding which type of modified neck dissection is proper elective treatment for the patient with a clinically negative neck. The medical records of 428 previously untreated patients (seen between January 1, 1970, and December 31, 1979) whose necks (i.e., NO) were electively dissected and who had had a primary squamous carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx were included. The three major types of modified neck dissections studied were the supraomohyoid, the anterior, and the functional. Sixteen percent (70 of 428) of the patients had multiple positive nodes and 6% (28 of 428) had evidence of extracapsular invasion. A unilateral supraomohyoid dissection was most often used for primaries of the oral cavity. Bilateral anterior dissection was common for cancers of the larynx and hypopharynx, and functional neck dissection was equally distributed among the primary sites. None of the patients with primaries of the larynx or hypopharynx had pathologically positive nodes in the submental or submaxillary triangles. Advanced T‐stage was generally associated with a greater incidence of subclinically positive nodes. Thirty percent of the patients received postoperative radiotherapy. The total number of nodes removed, the number of positive nodes with or without extracapsular invasion, and the anatomic location of the positive nodes were correlated with the type of dissection, the stage and site of the primary cancer, the degree of histologic differentiation of the primary cancer, the use of postoperative radiotherapy, the regional (neck) failure, and survival. An elective modified neck dissection appeared to be an appropriate part of the initial surgical treatment for patients with primaries of the oral tongue, floor of the mouth, retromolar trigone, pharyngeal wall, base of the tongue, pyriform sinus, and glottic and supraglottic larynx. Adjunctive postoperative radiotherapy appeared to have a statistically significant effect for only those patients who had pathologically multiple positive nodes and extracapsular invasion.
Characterization of epimyoepithelial islands in benign lymphoepithelial lesions of major salivary gland: An immunohistochemical and ultrastructural study
Authors: Dardick Irving , Van Nostrand A. W. Peter , Rippstein Peter , Skimming Linda , Hoppe Dianne , Dairkee Shahnaz H.
Published: February 2007

Knowledge of the processes leading to the development of epimyoepithelial islands bears on histogenetic and morphogenetic processes in salivary gland tumors. Immunohistochemical and ultrastructural investigations of the cellular composition of epimyoepithelial islands were carried out on three examples of benign lymphoepithelial lesions with varying histologic features. The monoclonal anti‐keratin antibody 312C8‐1, which specifically decorates myoepithelial cells of the normal salivary gland, also stains the myoepithelial cells surrounding residual acini and intercalated ducts in benign lymphoepithelial lesions and the cell population of epimyoepithelial islands, with the exception of persisting luminal epithelial cells. Ultrastructurally, the myoepithelial cells of involuting acini and ducts and the modified myoepithelial cells of epimyoepithelial islands, identified in both locations by the monoclonal antibody 312C8‐1, show an increasing complement of tonofilament bundles. In addition, persisting lumens (often distended with lymphocytes) and definite luminal eipithelial cells can be seen in electron micrographs of some epimyoepithelial islands. The designation for this characteristic epithelial feature of benign lymphoepithelial lesions is therefore appropriate.