bluuebunny/crossref_metadata_2025 huggingface dataset:
Head and neck cancer in the elderly
Authors: Jun Moo Young , Strong Elliot W. , Saltzman Eric I. , Gerold Frank P.
Published: February 2007

One hundred fifty‐nine patients, 80 years of age or older, with cancer of the head and neck were reviewed. Patients tolerated head and neck resection well and an absolute survival of 36 months for all treated patients and 41 months for all surgically treated patients suggests the efforts are worthwhile. Treatment offered the elimination of uncontrolled cancer in 68% of the patients. Prompt and adequate treatment reduces time, effort, cost, and the actual suffering of the patients. There is little justification for therapeutic nihilism even in the elderly patient.
Computed tomography of orbital medial wall fractures
Authors: Coker Newton J. , Brooks Betty Sue , El Gammal Taher
Published: February 2007

Increasing experience with computed tomographic evaluation of head trauma reveals this radiologic modality to be superior to conventional polytomography in the assessment of certain areas of maxillofacial injury. A comparison of hypocycloidal polytomography and computed tomography in nine patients with fractures of the medial wall of the orbit reveals CT to be superior in localization of the fracture site, delineation of displaced bone fragments, and recognition of herniation of intraorbital contents into the ethmoid labyrinth. Information regarding damage to the nasolacrimal duct and associated intraorbital abnormalities such as the presence and location of hemorrhage and foreign bodies is also available from the CT scan.
Paranasal sinus radiology, part 4B: 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 often affected by intrinsic or neighboring 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.
Carcinoma of the laryngeal margin
Authors: Laccourreye Henri , Brasnu Daniel F. , Beutter Patrice
Published: February 2007

The laryngeal margin constitutes an anatomic and clinical entity that differs from what is commonly referred to as supraglottic. The present retrospective study reviews 189 cases of carcinomas occurring in this specifically defined region. Local, nodal, and distant metastatic spread of these tumors varied depending on whether the initial tumor site was located in the anterior or lateral margin. Treatment regimens were planned according to the tumor's origin. Primary tumor site surgery associated with a modified or radical neck dissection according to N staging, followed by postoperative radiation is advocated for treatment of these tumors. Cervical nodal metastases are frequent and often bilateral (36%) in cases of anterior margin carcinoma suggesting that bilateral neck dissection sparing two jugular veins for N0 staged carcinoma and one jugular vein when there is evidence of a palpable node, be routinely used. Nodal involvement in cases of lateral margin carcinoma is also frequent but is almost exclusively confined to the ipsilateral nodes. It is suggested that homolateral neck dissection therefore be systematically associated with primary tumor site surgery for these tumors. The various anatomical aspects and pathways of extension of laryngeal margin carcinoma are discussed and a modified TNM classification is proposed.
Face lift, part I: Extent of undermining of skin flaps
Authors: Webster Richard C. , Smith Richard C. , Smith Karen F.
Published: February 2007

One theory in cheek‐neck lifting is that it is necessary to undermine skin flaps widely to achieve adequate short and long term results. We have proven that extensive undermining allows no more skin to be excised than is permitted by more conservative undermining when snug skin closures are used. Another part of the theory is that a sheet of scar tissue (“favorable fibrosis”) forms and that the larger sheet of scar from more extensive undermining maintains the improvement from the lift longer than would a smaller sheet from less undermining. Controlled studies presented here cast doubt on this part of the theory. Many years ago we ran a series on patients in whom one side had essentially twice as much undermining as did the other. Equal amounts of skin were removed on both sides. Short and long term results were essentially the same on the two sides.
Pharyngolaryngectomy with extrathoracic esophagectomy
Authors: Davidge‐Pitts Keith J. , Mannel Aylwyn
Published: February 2007

Fourteen patients with squamous cell carcinoma of the hypopharynx underwent total pharyngolaryngectomy and extrathoracic esophagectomy with primary pharyngogastric anastomosis. Histological examination of the resected specimens showed extensive submucosal spread into the cervical esophagus, necessitating a radical excision of the esophagus for adequate distal clearance. The results of this method of management are discussed.
An animal model for the assessment of microvascular patency
Authors: Horowitz Zeev , Strome Marshall , Fried Marvin P.
Published: February 2007

A tubed superficial epigastric flap (TSEF), based on a single vascular pedicle, was designed in a rat. Forty TSEFs were created in three control groups: in 20 TSEFs both the femoral artery and vein were ligated proximal to the take‐off of the superficial epigastric vessels, in 10 TSEFs the femoral artery and in the other 10 the femoral vein were ligated and transected at the same location. All TSEFs in the control groups sloughed, reflecting the dependence on the axial vasculature. A further 232 TSEFs were made with a survival rate of 84.5% (196/232). Delayed arterial or venous ligation was then performed up to 42 days after the initial surgery. The patency of the axial vein was crucial for survival for only the first postoperative week. The axial arterial patency was needed for survival of the TSEF for 6 weeks. The creation of this TSEF fulfills the need for a simple model that is as readily constructed as other models, is reproducible, has a high success rate and most importantly, reflects the patency of its nutrient vessels for a prolonged period of time.
The questionable value of total glossectomy
Authors: Harrison Donald
Published: February 2007

In a personal series of 104 patients with squamous cell carcinoma of the tongue, 14 patients were treated with total glossectomy and laryngectomy, and 2 were treated with total glossectomy alone. The high rate of local recurrence that occurred when partial glossectomy followed curative radiotherapy suggests that in selected patients total glossectomy is of value. Patients with more extensive tumors requiring total laryngectomy are rarely cured and the procedure entails serious rehabilitation problems.
Facial reconstruction following blast injury
Authors: Close Lanny Garth , Lomba Jose A.
Published: February 2007

The facial plastic surgeon, when treating a patient with massive loss of soft tissue and bone of the face secondary to blast injury, must carefully consider available treatment options. The choice of procedure should be dictated by the likelihood of success, donor site morbidity, and the potential for complications. Five illustrative cases of blast injury to the lower face are presented to demonstrate methods of reconstruction currently available. Local soft‐tissue flaps appear to be superior to regional or distant flaps for the restoration of form and function of the lower lip. Autogenous, particulate cancellous bone is a satisfactory grafting material for the great majority of traumatic mandibular defects. Vascularized bone grafts should be considered when extensive defects of the anterior arch exist or when a sterile, supple, well‐vascularized recipient bed is not available.
Incidence of cranial nerve dysfunction following carotid endarterectomy
Authors: Astor Frank C. , Santilli Patricia , Tucker Harvey M.
Published: February 2007

An analysis of postoperative injuries to the recurrent laryngeal, hypoglossal, marginal mandibular, and superior laryngeal nerves was undertaken in 517 patients who underwent 535 carotid endarterectomies between April 1978 and March 1981 at The Cleveland Clinic Foundation. A review of the literature is presented followed by the results of this analysis and a discussion of the findings. Suggestions for decreasing or avoiding such injuries are made. Conclusions are drawn to help the otolaryngologist identify the endarterectomized patient with an impaired upper aerodigestive tract.
The dynamic morris biphase appliance for stabilization of flail facial bones
Authors: Morris Don M. , Gross Bob D. , Sturrock Billy D.
Published: February 2007

This report presents our experience with a modification of the Morris biphase appliance. We have modified the device to let the patient open his or her mouth immediately after surgery to allow for intraoral suture line care. The device prevents deviation of the remaining mandible toward the operated side of the face. We believe this has lessened the esthetic, masticatory, and speech difficulties of the two patients in whom we used the device. We conclude the device deserves further testing.
Laryngeal cystic hygroma
Authors: Myer Charles M. , Bratcher Glenn O.
Published: February 2007

An unusual case of cervical cystic hygroma with laryngeal extension is reported. A patient with acute upper airway obstruction due to a laryngeal lesion was seen 18 years after the original cervical surgery. Maintenance of an adequate airway has required a partial laryngectomy in addition to repeated endoscopic procedures for removal of recurrent disease. The rationale for this therapy is discussed in light of the current literature.
Intraarterial chemotherapy for head and neck cancer, part 2: Clinical experience
Authors: Baker Shan R. , Wheeler Richard
Published: February 2007

Despite almost 3 decades of experience, the use of intraarterial (IA) chemotherapy for the treatment of head and neck cancer is not universally accepted. The overall reported response rates are not substantially different from the therapeutic results obtained with systemic therapy. The additional complications associated with establishing and maintaining arterial access have further dampened enthusiasm for this approach. It is clear that considerable improvement in the techniques and efficacy of IA chemotherapy is necessary. This second and last part of this article considers the past and present clinical experience with IA therapy in the treatment of head and neck cancer and explores future developments.
Closure of large orbital‐maxillary defects with free latissimus dorsi myocutaneous flaps
Authors: Baker Shan R.
Published: February 2007

The treatment of advanced cancer of the maxillary sinus often requires extensive ablation and orbital exenteration that results in large fullthickness defects of the upper cheek and orbital regions. Reconstruction of such defects with local flaps is usually difficult because of the need for a large flap. Several regional flaps such as the deltopectoral flap, the temporal flap, and the shoulder flap may be used, but these techniques frequently require surgery in stages and result in severe deformity of the donor site. The island pedicled, pectoralis major myocutaneous flap may be rotated up to the orbital region; however, the uncertain blood supply to the skin in the distal area of the pectoralis may cause unexpected marginal necrosis of the flap. Reconstruction of large orbital‐maxillary defects can readily be accomplished in one stage using microsurgical free transfer of latissimus dorsi myocutaneous flaps. The thoracodorsal artery and vein that form the nutrient pedicle of the flap approaches 2 mm in external diameter and up to 10 cm in length, allowing greater versatility in head and neck reconstruction. The muscle may be used to fill the orbital and maxillary cavities and will accept a skin graft on its deep surface. The donor defect is closed primarily and the resulting scar is well concealed beneath the arm. If necessary, extremely large flaps may be transferred by harvesting the entire latissimus dorsi muscle and the overlying skin based on the thoracodorsal system.
Current concepts in the management of laryngeal papillomatosis
Authors: Robbins K. Thomas , Woodson Gayle E.
Published: February 2007

A wide variety of methods have been described for the treatment of laryngeal papillomatosis. This attests to the difficulties encountered in controlling this often refractory disease. Recent trends have been directed toward immunotherapy and improved techniques of endoscopic excision. The various treatment modalities are reviewed to provide the reader with updated information and a perspective of the current management of this perplexing disease.
A new external approach to the pterygomaxillary fossa and parapharyngeal space
Authors: Attia E. L. , Bentley K. C. , Head T. , Mulder D.
Published: February 2007

A new direct approach to the area of the pterygomaxillary fossa and the parapharyngeal space is described. This procedure was developed because previously described methods either offered limited access to the area or resulted in significant functional defects. The approach described here results in a wide‐field exposure of both the pterygomaxillary and parapharyngeal spaces with no sacrifice of either mandibular function or the sensory supply of the face or oral cavity. The parapharyngeal space is entered through a transcervical incision. This, combined with double osteotomies of the mandible, allows the ascending ramus with its intact neurovascular bundle to be reflected laterally and superiorly, along with the attached masseter muscle and the overlying skin. The result is an excellent exposure of the pterygomaxillary fossa and the base of skull. Following removal of the tumor, the ramus of the mandible is replaced and fixed with interosseous wiring and the application of arch bars, thus restoring normal dental occlusion. The technique described here was worked out on cadaveric dissection before being applied to a clinical case.
Complete microscopic controlled surgery for head and neck cancer
Authors: Baker Shan R. , Swanson Neil A.
Published: February 2007

Mohs surgery, as it has evolved since its inception by Mohs, is a technique for removing certain cancers using careful, precise microscopic marginal control. The contemporary technique using fresh tissue has enabled the application of Mohs surgery to the treatment of malignancies of the upper aerodigestive tract. Mohs surgery, once limited to large recurrent basal cell carcinomas, has expanded to include several cutaneous and noncutaneous neoplasms. With better understanding of the Mohs technique, its indications, applications, and advantages, an interdisciplinary approach to manage certain head and neck neoplasms is proposed.
Mode of invasion and lymph node metastasis in squamous cell carcinoma of the oral cavity
Authors: Yamamoto Etsuhide , Miyakawa Akira , Kohama Gen‐Iku
Published: February 2007

The relationship between the mode of tumor invasion in the tumor‐host borderline and the frequency of regional lymph node metastasis was investigated in squamous cell carcinoma of the oral cavity. Cases with grades 1‐3 mode of invasion classified by modified Jacobsson criteria showed a low frequency of metastasis (10/72, 13.9%), while those cases with grade 4 mode of invasion, which consisted of grade 4C (cord‐like type) and grade 4D (diffuse type) showed a high frequency of metastasis (4C:11/18,61.1%;4D:9/12,75.0%; total 20/30,66.7%). Moreover, the number of metastatic nodes in each case of mode of invasion ranged from 1 to 3 in grades 1‐3, from 1 to 5 in grade 4C, and from 1 to 7 in grade 4D. The presence of metastasis indicated a poorer prognosis than did the absence of the mode of invasion in each grade, especially in grades 4C and 4D.
Analysis of the methods of pharyngoesophageal reconstruction
Authors: Surkin Marc I. , Lawson William , Biller Hugh F.
Published: February 2007

During the period 1972‐1982, 84 pharyngoesophageal reconstructions were performed on 82 patients (10 benign lesions and 72 malignant lesions) by the Department of Otolaryngology, Mount Sinai Medical Center, New York. The overall mortality for the series was 10%, with postoperative complications developing in the majority of patients and swallowing accomplished in 61%. The most successful method of reconstruction was stomach transposition (92%), followed by cervical flap repair (68%). The least successful methods were the use of the tubed deltopectoral and pectoralis major myocutaneous flaps, colon interposition, and jejunal autografts (40%‐50%). The pertinent literature is reviewed and the reported mortality, morbidity, indications, limitations, and success rates for each method of reconstruction are analyzed and compared with the present series.
Chip fractures of the mandibular condyle
Authors: Avrahami Elieser , Horowitz Isaak
Published: February 2007

Four patients suffered from trauma of the temporomandibular (TM) joints. They were examined by routine x‐ray procedures. The x‐ray films failed to demonstrate a chip fracture of the head of the mandibular condyle. A coronal computed tomographic (CT) view established the fracture shortly after the trauma in three patients. These patients improved clinically after physiotherapy. The fourth patient was retrospectively diagnosed as having a chip fracture of the mandibular head. She underwent CT scan 10 months posttrauma, and ankylosis of the TM joint was established. The mechanism and the clinical symptoms of this injury, which have not been previously described, are reported in this article.
Transverse cervical myelopathy: An unusual complication of retropharyngeal abscess
Authors: Heilbronn Y. D. , Tovi F. , Hirsch M. , Ronen J.
Published: February 2007

Retropharyngeal abscess complicated by suppuration in the central nervous system, intra‐ or extraaxial, is rare. Acute transverse myelopathy complicating a retropharyngeal abscess may be more frequent than epidural spinal abscess and usually affects the thoracic cord. Therefore, the occurrence of acute high cervical transverse myelopathy is rarely encountered and warrants reporting. The need for neuroradiologic diagnostic evaluation is emphasized in order to rule out a surgically treatable lesion.
Carcinoma in situ of the larynx
Authors: Maran A. G. D. , Mackenzie I. J. , Stanley R. E.
Published: February 2007

A series of 28 cases of carcinoma in situ of the larynx treated over the last 16 years is reviewed. The majority of the patients were treated with endolaryngeal stripping of the cords. In the few cases in which the treatment failed, early detection of disease was made and radiotherapy was successful in controlling the carcinoma. The use of radiotherapy is only advocated for selected cases because there is often difficulty in assessing a radiated larynx; radiotherapy may induce field changes, and if treatment fails, laryngectomy may have to be carried out as a salvage procedure.
Cutaneous versus myocutaneous flaps in the repair of major defects in head and neck cancer: A study of 331 flaps
Authors: Faucher Alain , Renaud‐Salis Jean‐Louis , Pinsolle Jacques , Siberchicot Francois , Michelet Francois‐Xavier
Published: February 2007

A retrospective analysis was carried out of 311 reconstructions of major defects following head and neck cancer treatment. Three hundred thirty‐one flaps were used; they included cutaneous flaps from 1972 to 1979 and myocutaneous flaps (MCF) after 1979. The aim of this study was to compare the healing patterns of the two types of flaps used in similar circumstances. Even though the use of myocutaneous flaps reduced necrotic complications, there was no significant improvement in overall healing. In this type of reconstruction, local conditions as well as more general factors have greater prognostic significance. Apart from considerations of reliability, other criteria have led to myocutaneous flaps being the treatment of choice in cervicofacial cancer repair. However, specific indications for the use of cutaneous flaps remain.
Computed tomography of the face and paranasal sinuses: Part I. Normal anatomy
Authors: Sataloff Robert Thayer , Grossman Charles B. , Gonzales Carlos , Naheedy Mohammad H.
Published: February 2007

Computed tomographic (CT) scanning of the face and sinuses has improved markedly with modern equipment and methods. Expertise in facial and sinus anatomy as seen by CT is invaluable to the clinician. A review of normal CT anatomy is presented as a basis for diagnosing, pathologic conditions.
Improved survival in carcinoma of the nasopharynx
Authors: Vikram Bhadrasain , Strong Elliot W. , Manolatos Spero , Mishra Uma B.
Published: February 2007

Between 1970 and 1980, we treated 107 previously untreated patients with biopsy‐proven carcinoma of the nasopharynx by megavoltage external radiation therapy to the primary site, base of the skull, and both sides of the neck. Eighty‐seven percent of the patients had stage IV disease (American Joint Committee 1980), 53% had T4 primaries, and 73% had palpable cervical metastases. The histology was anaplastic or poorly differentiated carcinoma in 81%. The observed 5‐year survival rate was 35% for the patients treated between 1970 and 1976, and increased to 72% for those treated between 1977 and 1980 (P < 0.01). The two patient populations were similar except that the dose of irradiation (median and modal) to the primary site was 6,000 rad during 1970–1976 and 7,000 rad during 1977–1980. The survival rate was not significantly influenced by age, sex, birthplace, histology, or stage. These data suggest that a relatively high cure rate might be possible in carcinoma of the nasopharynx, even though most patients present with locally advanced disease. The patterns of relapse are discussed.
Cosmetic rhinoplasty: Radiological features
Authors: Safian Leroy S.
Published: February 2007

The usual radiologic postoperative appearance of the bony nasal pyramid following a typical cosmetic rhinoplasty is demonstrated, and possible atypical sequelae are discussed. More specifically, the sites of the osteotomies performed as part of this surgical procedure are diagrammatically illustrated. It is believed that because of the increasing popularity of rhinoplastic operations, it is timely to acquaint radiologists with the postsurgical stigmata which, though minor, might be erroneously interpreted as resulting from accidental trauma or other pathologic processes. Beyond academic considerations, potential medicolegal implications also exist. A brief historical overview is included.
High resolution computed tomography, part 2: The salivary glands and oral cavity
Authors: Swartz Joel D. , Saluk Patricia H. , Lansman Amy , Marlowe Frank I. , Popky George L.
Published: February 2007

High resolution computed tomography (CT) has been of extraordinary value in all areas of the head and neck. Previous communications have indicated its effectiveness in the evaluation of the temporal bone and soft tissues of the neck. This current communication illustrates and discusses the anatomy and pathology of the salivary glands and oral cavity as seen on CT.
Chondrosarcoma of the nasal septum: A case report
Authors: Beneck Debra , Seidman Irving , Jacobs Joseph
Published: February 2007

Chondrosarcoma arising in the nasal septum has been previously described only 11 times. In this report, another case occurring in an 89‐year‐old man is discussed. The rarity of such a tumor arising in previously normal cartilage is emphasized. Prognostic factors and surgical treatment are discussed.
Treatment of choice for squamous carcinoma of the tonsillar fossa
Authors: Remmler Daniel , Medina Jesus E. , Byers Robert M. , Meoz Raul , Pfalzgraf Kathleen
Published: February 2007

The records of 160 patients with squamous cell carcinoma of the tonsillar fossa treated from 1968 through 1979 were reviewed. Biologic behavior, local and regional findings, and other prognostic factors were evaluated. Patients were treated by either radiation alone (112 patients), radiation followed by planned neck dissection (31 patients), surgery alone (11 patients), or surgery combined with radiation (6 patients). Analysis of the data supports the recommendation that radiation be used as treatment for T1, T2, and early T3 lesions, whereas surgery alone or combined with radiation is best employed for advanced T3 or T4 tumors. Primary tumor control rates with radiation as the initial modality were 100% for T1 lesions, 89% for T2, 68% for T3, and 24% for T4. In addition, the control of cervical metastases with radiation therapy for patients with neck disease staged NO through N3b was excellent (95%). In instances where a planned neck dissection was done 5 weeks after radiation, the control of cancer in the neck was 100%. The incidence of distant metastases was 10% and was not affected by the selection of therapy. The 2‐ and 5‐year determinate survival figures for 112 patients treated with radiation therapy alone was 67% and 48% respectively, while 31 patients treated with radiation therapy followed by neck dissection achieved survival rates of 70% (2 year) and 58% (5 year). The criteria for selection of treatment are discussed.
High resolution computed tomography: Part 3, the larynx and hypopharynx
Authors: Swartz Joel D. , Lansman Amy , Marlowe Frank I. , Popky George L. , Berger Alan S.
Published: February 2007

High resolution computed tomography (CT) is a highly desirable addition to clinical examination of the larynx and hypopharynx. The anatomy and pathology of the larynx and hypopharynx is discussed and illustrated by CT.
Scalp flaps—reconstruction of the unfavorable result in hair replacement surgery
Authors: Fleming Richard W. , Mayer Toby G.
Published: February 2007

Complications in hair replacement surgery are inevitable. However, many of the most common problems can be avoided. All surgeons should learn by careful analysis of complications. The use of scalp flaps in the reconstruction of unfavorable results is described.
Repair of sequelae from artificial fiber hair implants with hair‐bearing punch grafting
Authors: Monell Charles Marion
Published: February 2007

Several thousand persons had artificial hairs of fiber implanted in their scalps 5 years ago with disastrous results. These persons may still require late repair to remove retained fiber fragments from the skin. The hair‐bearing punch graft is a useful method of repair in some patients.
In vitro immune modulation by thymosin alpha1 in patients with head and neck squamous cell carcinoma
Authors: Wolf Gregory T. , Peterson Karen A. , Lovett Edmund J.
Published: February 2007

To determine if patients with head and neck squamous cell carcinoma represent an appropriate population for immune reconstitution with thymosin alpha1, leukocyte migration inhibition (LMI) in response to phytohemagglutinin was measured in 24 previously untreated patients with head and neck cancer, and the in vitro effects of thymosin alpha1 on migration inhibition were assessed. Compared to normal subjects, LMI was impaired in the head and neck cancer patients. Thymosin alpha1, in vitro, was associated with improvement in LMI in the cancer patients. Improvements in migration response with thymosin alpha1 appeared to be independent of levels of various T‐lymphocyte subpopulations. However, patients with a normal LMI response had lower suppressor/cytotoxic cell levels than normal subjects or patients with impaired LMI. The findings confirm prior reports of the effects of thymic hormones on lymphokine production in vitro and provide rationale for further clinical studies of thymosin alpha1 in patients with head and neck squamous cell carcinoma.
The versatility of the pectoralis major myocutaneous flap
Authors: Joseph Christopher A. , Gregor R. T. , Davidge‐Pitts K. J. , Waner M.
Published: February 2007

A consecutive group of 50 patients requiring pectoralis major myocutaneous flap reconstruction after head and neck surgery is presented. The tissue defects for reconstruction are divided into five groups to identify any defects in which the flap is more likely to be at risk of complication. Other risk factors such as preoperative radiotherapy, chemotherapy plus radiotherapy, and septic recipient site are analyzed. Its particular use in a “Third World” type population is noted.
Computed tomography of the face and paranasal sinuses: Part II. Abnormal anatomy and pathologic conditions
Authors: Sataloff Robert Thayer , Grossman Charles B. , Gonzales Carlos , Naheedy Norman
Published: February 2007

Computerized tomography is extremely useful in delineating abnormal anatomy and pathologic conditions of the face and paranasal sinuses. The familiarity with normal anatomy is essential. Expert interpretation of CT scanning allows superior diagnosis of and treatment planning for lesions of the face and paranasal sinuses.
Myoepithelial cells in salivary gland tumors—revisited
Authors: Dardick Irving , Van Nostrand A. W. Peter
Published: February 2007

It is an interesting parallel that the myoepithelial cell with its hybrid epithelial and mesenchymal structural and functional phenotype has a dual role in such salivary gland tumors as pleomorphic adenoma. This cell is responsible for considerable proportions of the epithelial component of this tumor, including squamous metaplasia, and is also the agent principally involved in the synthesis, organization, and cytologic modifications of the chondromyxoid regions. Neoplastically modified myoepithelial cells are also generally accepted to be a significant component of salivary gland tumors such as epithelial‐myoepithelial carcinoma, certain adenocarcinomas, and, of course, myoepitheliomas. The range of myoepithelial cell alterations can be appreciated via ultrastructural assessment of the above four classes of salivary gland tumors. An electron microscopic survey of monomorphic adenomas, adenoid cystic carcinomas, and mucoepidermoid carcinomas reveals some having a tumor cell component with structural modifications and localization similar to the modified myoepithelial cells in pleomorphic adenomas and the adenocarcinomas noted above. Such ultrastructural findings have important implications for clarifying diagnostic problems, for understanding histogenetic relationships, and for improving the classification of salivary gland tumors.
High resolution computed tomography: Part 4, evaluation of odontogenic lesions
Authors: Swartz Joel D. , Abaza Nabil A, , Hendler Barry H. , Tidwell Otto , Popky George L.
Published: February 2007

High resolution computed tomography (CT) has been a mainstay in the preoperative evaluation of odontogenic lesions. Unsurpassed bony detail is complemented by exquisite delineation of the soft tissue mass itself. Our experience with these lesions is presented. Selected illustrations are supplemented by pathologic review.
Clinical restoration of voice function after loss of the vagus nerve
Authors: Weber Randal S. , Neumayer Leigh , Alford Bobby R. , Weber Samuel C.
Published: February 2007

One hundred eleven patients with unilateral vocal cord paralysis underwent Teflon® injection for the rehabilitation of laryngeal function. The most common etiology was vocal cord paralysis after surgical treatment of thoracic abdominal aortic aneurysms, which accounted for 36.9% of patients. Of the 111 patients, 85% had improved voice function after Teflon® injection. Two patients developed airway obstruction secondary to edema and required temporary tracheostomy. Twenty‐four patients with paralysis after aneurysm surgery were injected acutely with no morbidity and immediate restoration of voice function. We now advocate Teflon® injection in patients with vocal cord paralysis after thoracic aneurysm surgery in the immediate convalescent period to restore voice function and lessen pulmonary complications.
Entire pharyngoesophageal reconstruction with latissimus dorsi myocutaneous Island flap
Authors: Yamamoto Katsura , Yokota Koji , Higaki Kiyotake
Published: February 2007

The entire pharynx and cervical esophagus were reconstructed after total laryngectomy and pharyngoesophagectomy for advanced cancer in 14 patients with the use of a pedicled latissimus dorsi myocutaneous island flap. All flaps were transferred successfully in one stage. The reliability of the flap and postoperative state of food passage were studied. Repair was confirmed by roentgenographic examination 6 months after surgery. A slight narrowness was noted at the portion anastomosed with the esophagus, with dilatation of the reconstructed segment. All patients in our study have been able to resume normal oral feeding. The pedicled latissimus dorsi myocutaneous island flap is reliable and useful for the reconstruction of the pharynx and cervical esophagus.
High‐resolution computed tomography: Part 5, evaluation of the temporomandibular joint
Authors: Swartz Joel D. , Vanderslice Robert , Hendler Barry H. , Abaza Nabil A. , Lansman Amy , Popky George L.
Published: February 2007

High‐resolution computed tomography (CT) is evolving as the most valuable radiographic study when detailed information about the status of the temporomandibular joint is needed.1–5 High‐resolution CT is faster, less invasive, and in most cases much more accurate than other imaging modalities used in the past. Erosive, hypertrophic, and ankylosing arthropathies are illustrated, as are condylar dislocations secondary to acute trauma, chronic trauma, and neoplasm. A detailed discussion of the common problem of the anterior displaced meniscus is undertaken.
New test series for the functional evaluation of oral cavity cancer
Authors: Teichgraeber John , Bowman Julia , Goepfert Helmuth
Published: February 2007

There are few studies that have addressed themselves to measuring speech, swallowing function and the “quality of life” of patients that have been treated for oral cavity cancer. The goal of this study was to develop a test series to assess the oral cavity function and the general health of patients treated for oral cavity cancer. The results of 51 patients treated for oral cavity cancer will be compared by the site and stage of the lesion, as well as by treatment mode. In addition, the functional results achieved by different reconstructive techniques in the oral cavity will be presented. Radiotherapy patients as a group have the best speech and swallowing function while the patients treated with combined therapy have the worst function. In the surgical group, those patients treated with intraoral skin grafts had the best speech results and those with primary closures had the best swallowing performance.
Partial palatomaxillary core ostectomy with multiple flap reconstruction
Authors: Kreutziger Keith L , Murphy Lynn C.
Published: February 2007

Epidermoid carcinoma of the hard palate has most commonly been treated by surgical procedures such as total maxillectomy, hemimaxillectomy, palatectomy, intraoral maxillectomy, and local resection, which leaves the patient with problems of velopharyngeal incompetence, oral‐nasal or oral‐antral fistula, or an inability to wear a denture. This article describes a surgical procedure that uses a partial core palatomaxillary ostectomy for ablation and multiple buccal and palatal flaps for primary closure, thereby avoiding these postoperative problems.
Prognostic significance of lymphatic spread in head and neck carcinomas: Therapeutic implications
Authors: Grandi C. , Alloisio M. , Moglia D. , Podrecca S. , Sala L. , Salvatori P. , Molinari R.
Published: February 2007

A series of 618 patients with neck dissections were performed in 455 consecutively admitted patients with head and neck carcinomas at the Istituto Nazionale Tumori, Milan, from 1976 to 1978. Clinical and pathologic node factors were considered in an effort to correlate lymph node involvement with prognosis. Actuarial survival decreased with the increase in the size of nodes, although no significant difference was found for all categories and the prognosis was poor when nodes were > 5 cm and/or hypomobile (33%, 5‐year survival). The presence of histologically proven neck metastases significantly reduces the 5‐year survival, and the presence of distant metastases correlates directly with the pathologic staging of neck nodes.
Combined polychemotherapy and radiotherapy in advanced inoperable squamous cell carcinoma of the head and neck
Authors: Rosso Riccardo , Merlano Marco , Scarpati Daniele , Grimaldi Andrea , Bonelli Luigina , Barbieri Angelo
Published: February 2007

Between August 1979 and August 1984, 46 untreated, inoperable patients with advanced squamous cell carcinoma of the head and neck were submitted to a combined modality of treatment based on four courses of polychemotherapy (vincristine, bleomycin, and methotrexate), rotated with three courses of radiotherapy, 20 Gy each. Forty‐six patients entered the study: 45 were evaluable for their response to the treatment and 46 for toxicity effects. We observed 26 complete responses (57.7%) and 14 partial responses (31.1%); overall actuarial survival was 28% at 55 months. Mucositis occurred in 11 patients, 3 patients suffered from nausea and vomiting, 2 patients developed fever, and 1 had a platelet count of 50,000/mm3. One toxic death occurred: one patient developed an acute renal failure related to Methotrexate.
Differentiated thyroid cancer in children
Authors: de Keyser Ludo F. M. , van Herle Andre J.
Published: February 2007

Differentiated thyroid cancer in children remains a controversial disease entity. Its incidence has markedly declined over the last decade since the use of radiotherapy in the treatment of benign conditions of the head, neck, and thorax was abandoned. Other etiologic factors have become relatively more important. The clinical presentation of childhood thyroid cancer is similar to that found in adults, except for a higher frequency of local and distant metastases at the time of initial diagnosis. The specificity and sensitivity of diagnostic tests are limited; however, like in adults, fine‐needle aspiration compares favorably with other available diagnostic methods. The therapeutic approach to a child with thyroid cancer represents the most controversial issue associated with the disease. This review provides a discussion of the rationale for the different therapeutic options and emphasizes the excellent prognosis and survival rates, especially when patients are subjected to aggressive treatment with total thyroidectomy followed by the administration of radioactive iodine.
Congenital facial hemihypertrophy: Report of a case with airway compromise
Authors: Sculerati Nancy , Jacobs Joseph B.
Published: February 2007

Facial hemihypertrophy, first described by Beck in 1836, aroused some interest in the early part of this century among European and American clinicians. However, a search of the otolaryngologic literature failed to reveal hemihypertrophy of the head and neck area as a well‐recognized entity. We recently encountered a case of hemifacial hypertrophy in a 2‐year‐old. The chill presented with airway compromise and swallowing difficulty. The treatment of this child and a review of associated head and neck findings are discussed.
A phase II clinical trial of the combination mitomycin C, adriamycin, and cis‐diamminedichloroplatinum in patients with advanced upper aerodigestive cancer
Authors: Creagan Edward T. , Chang Myron , Long Harry J. , Rubin Joseph
Published: February 2007

Twenty‐seven patients with assessable, regionally advanced, or metastatic upper aerodigestive cancer of diverse histology received a combination of mitomycin C, adriamycin, and cis‐diamminedichloroplatinum. All patients had previously received extensive surgery and/or radiation therapy. We observed an overall 46% partial response rate (12/26). This included seven of 15 (47%) responders with squamous cell carcinoma. Six of those seven patients responded within the initial month of treatment. For all study participants, the median time to progression and survival was 3.8 months and 7.3 months, respectively. Moderate‐to‐severe nausea, vomiting, anorexia, and alopecia were the most common toxicities. Myelosuppression (WBC <4,100 cells/mm3) and thrombocytopenia (PLTS <130,000 cells/mm3) occurred in 100% and 71% of the 21 patients with nadir data recorded, respectively. There were no episodes of sepsis nor did we detect any meaningful impairment in renal function. This regimen is active in the previously treated head and neck cancer patient and can be conveniently administered on an outpatient basis with acceptable and manageable side effects.
Primary lymphoma of the mandible
Authors: Robbins K. T. , Fuller L. M. , Manning J. , Goepfert H. , Velasquez W. S. , Sullivan M. P. , Finkelstein J. B.
Published: February 2007

The mandible is an uncommon presentation site for lymphoma and misdiagnosis is common. Eleven patients with lymphoma of the mandible were seen between 1947 and 1983. In 5 of the 11 patients, the diagnosis of lymphoma could not be established from the initial biopsy and additional material for examination was required. In three patients, this resulted in a partial or total removal of the mandible. In a recent histopathologic review, the diagnosis of diffuse large cell was made in seven, diffuse undifferentiated (non‐Burkitt's) in two, diffuse undifferentiated (Burkitt's) in one, and unclassified in one. Using the Ann Arbor method of staging, six patients were determined to have stage IE disease; three had stage IIE, and two had stage IV. In 10 patients definitive treatment consisted of radiotherapy, chemotherapy, or a combination of both. Treatment was limited to surgery in one patient. The 5‐year overall and disease‐free survival rates were 62% and 50%, respectively. These results are comparable to those for lymphoma of other extranodal head and neck sites.
Identification and management of the patient at high risk for wound infection
Authors: Becker Gary D.
Published: February 2007

Despite the use of perioperative antibiotics, wound infection remains a major source of morbidity after contaminated head and neck cancer surgery. Most adjunctive methods designed to control wound infection include techniques to reduce bacterial wound contamination. Additional methods include predicting the high risk patient and the bacteriology of subsequent wound infection, which allows antibiotic prophylaxis to be used on a selective basis. This article reviews relevant experimental and clinical data that evaluated these methods. Based on these results, as well as personal observations, guidelines are suggested for controlling wound infection in patients undergoing contaminated head and neck surgery.
Granulomatous reaction in lymph nodes draining laryngeal carcinoma
Authors: Ophir Dov , Nissim Florence , Marshak Gabriel
Published: February 2007

Presented are two cases of simultaneous occurrence of epithelioid granulomas and metastatic squamous cell carcinoma in cervical lymph nodes draining supraglottic carcinoma. Laboratory tests and radiological and clinical findings ruled out sarcoidosis, as well as mycotic, mycobacterial, or other bacterial infection. Upon finding of epithelioid granulomas in cervical lymph nodes, a malignant tumor of the head and neck region should be considered as a differential diagnostic possibility. Uncritical acceptance of a diagnosis based solely on the histological appearance may lead to erroneous treatment.
Cartilage grafts—present status
Authors: Zalzal George H. , Cotton Robin T. , McAdams A. James
Published: February 2007

Cartilage grafts have been in use for almost a century and have proved their usefulness. Many questions about immunology, survival, growth, and role of perichondrium are still debated. We are presenting a review of the literature and of our experimental work on cartilage grafts. Ear cartilage was transplanted from 28 young New Zealand rabbits subcutaneously in the chest walls. The grafts were divided into 1) bare cartilage, 2) perichondrium, 3) cartilage covered with perichondrium on one side, and 4) cartilage covered with perichondrium on both sides. The grafts were measured in length and weight before transplantation, and at 2 and 4 months after transplantation; they were compared to a control piece of cartilage tagged in situ. Histologic examination was performed on all retrieved grafts. Transplanted cartilage survival was good in over 75% of cases; however, cartilage production from perichondrium was minimal and no growth was noticed in any of the grafts.
Craniofacial resection for tumors of the nasal cavity and paranasal sinuses
Authors: Cheesman Anthony D. , Lund Valerie J. , Howard David J.
Published: February 2007

The craniofacial approach for resection of tumors of the nose and paranasal sinuses is well established, as are its advantages over previous methods of treatment. The technique has been considerably modified, resulting in an operation that combines excellent access, a sound oncologic resection with excellent cosmesis, and low postoperative morbidity for conditions associated hitherto with an extremely poor prognosis. The 7‐yr experience of 60 patients is presented. Results suggest improved survival in a group of patients who are potentially curable by this procedure, while in those with extensive disease good palliation is achieved. In addition, large benign tumors that would previously have been considered inaccessible can be resected. Its many advantages recommend it as the treatment of choice for tumors of the nose and paranasal sinuses.
Accuracy of frozen‐section diagnosis in salivary gland neoplasms
Authors: Rigual Néstor R. , Milley Paul , Loré John M. , Kaufman Sol
Published: February 2007

A retrospective review of 100 patients with major or minor salivary gland neoplasms was conducted to ascertain the accuracy and effect on therapy of frozen‐section diagnosis. Of these patients, 23% had malignant and 77% benign neoplasms. Twelve patients benefited by further surgery during the initial operation, and no treatment delay occurred as a result of frozen‐section diagnosis. There were four incorrect diagnoses of clinical significance, two false positives (benign tumor called malignant on frozen section) and two false negatives (malignant tumor called benign on frozen section). The accuracy of frozen section for specific pathologic diagnosis was 92%. No unnecessary radical surgery was performed. Frozen‐section diagnosis of salivary gland neoplasms in our institution was found to be accurate and useful.
Heterotopic cervical salivary gland tissue in a family with probable branchio‐otorenal syndrome
Authors: Joseph Michael P. , Goodman Max L. , Pilch Ben Z. , Bieber Frederick R. , Holmes Lewis B. , Reardon Edward
Published: February 2007

Heterotopic cervical salivary gland tissue was found in a 4‐yr‐old girl with branchial and otologic abnormalities. Her mother and sister also had heterotopic cervical salivary tissue in association with anomalies that suggest the branchio‐otorenal (BOR) syndrome. Heterotopic cerivcal salivary gland tissue may result from abnormal branchial development.
Giant acquired tracheoesophageal fistulas: Strategy for successful management
Authors: Freeman M. Sean , Livingstone Alan S. , Goodwin E. Jarrard
Published: February 2007

Giant tracheoesophageal fistulas (TEF) present a significant management problem for the head and neck surgeon. Chronic aspiration and sepsis are associated complications that occur in these patients, who are frequently already debilitated from preexisting medical calamities. The combination results in prolonged morbidity and frequent mortality. Recently, we have managed two patients with this difficult problem. The first patient was managed using conventional methods well described in the literature with an unsuccessful outcome. The second was managed differently using a two‐stage approach. The esophageal stream was first excluded from the respiratory system via a surgical approach, which to the best of our knowledge has not been previously described in the literature. After a period of convalescence, the patient's alimentary tract is reconstituted with a gastric pull‐up, reversed gastric tube, or colon interposition. We propose this as an alternative method of management for TEF.