bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolated sphenoid sinus disease
Authors: Rothfield Robert E. , de Vries Rgbert J. , Rueger Raimund G.
Published: February 2007

Isolated sphenoid sinus disease is an unusual entity that is encountered infrequently. With advances in antibiotic therapy and imaging techniques, the nature of isolated sphenoid sinus disease has significantly changed. More tumors and less inflamrnatory disorders are being encountered. We have retrospectively reviewed the medical records of patients who had undergone sublabial transseptal sphenoidotomy for isolated sphenoid sinus disease at Allegheny General Hospital for Pittsburgh between January 1985 and July 1989. Thirteen patients were identified with isolated sphenoid sinus disease who were successfully managed with sublabial transseptal sphenoidotomy. This approach allows maximal visualization and safety with minimal morbidity.
Phase I study of concurrent carboplatin and radiotherapy in previously untreated patients with stage III and IV head and neck cancer
Authors: Osoba David , Flores Albino D. , Hay John H. , Wong Frances , Maher Maureen
Published: February 2007

This study evaluated the toxicity resulting from combined therapy using carboplatin and radiotherapy in 22 patients with locally advanced (stage III and IV) head and neck cancer. Carboplatin was given after radiotherapy during the first 5 consecutive days of a 16‐fraction course of radiotherapy delivered in a total of 22 days. To find the acceptable toxic dose of carboplatin, the patients were treated in groups of 3 patients each. The first group received 50 mg/m2carboplatin and the dose was increased by 10 mg/m2in each subsequent group. Unacceptable toxicity (severe mucositis, nausea and vomiting, and/or myelo‐suppression) was encountered at a carboplatin dose of 80 mg/m2. A further 10 patients were then treated at a dose of 70 mg/m2. At this dose toxicity was acceptable. Although the group of 22 patients is too small for response and survival data to be meaningful, 10 complete responses were seen and median survival is in excess of 67 weeks.
Schwannoma of the submandibular gland
Authors: Diaz Dennis D. , Kennedy Kevin S. , Parker Gregg S. , White Valerie J.
Published: February 2007

Neurilemmomas (schwannomas) are solitary neurogenic tumors that arise from cells of the neural sheath. They are slow growing and represent a proliferation of Schwann cells. Extracranial neurogenic tumors of the head and neck are uncommon, with benign tumors occurring with greater frequency than malignant tumors. These tumors often mimic primary or metastatic disease in the head and neck. Schwannoma of the salivary gland is a particularly rare form of an extracranial neurogenic tumor, with most presenting in the parotid gland originating from a peripheral branch of the facial nerve. An unusual case of neurilemmoma of the submandibular gland is presented, and the literature concerning this subject is reviewed. We believe this tumor originated in an autonomic nerve of the submandibular gland. The mass was discrete and well demonstrated on CT scan. Total excision of the gland resulted in complete resolution of symptoms with no cranial nerve deficits.
Time to recurrence of squamous cell carcinoma of the head and neck
Authors: Stell Philip M.
Published: February 2007

A personal series of 3,215 patients with proven squamous cell carcinoma of the mucosal surfaces of the upper aerodigestive tract is presented. Of these patients, 515 suffered a recurrence of their primary tumor after a course of radiotherapy. The time from the end of radiotherapy to diagnosis of a primary recurrence was not related to any known host factors, nor to tumor factors except site. However, it was the most significant predictor of survival, both from initial presentation and from the date of recurrence. The time to recurrence did not relate to the size of the tumor at recurrence, suggesting that large recurrences are multicentric. The time to recurrence also predicted response and survival of 67 patients with end‐stage disease treated by chemotherapy. The response and survival were better in tumors with a time to recurrencelongerthan the median; the increased survival was not significant, but the increased response was.
Induction intra‐arterial cisplatin and bleomycin in head and neck cancer
Authors: Frustaci Sergio , Barzan Luigi , Caruso Giuseppe , Ghirardo Riccardo , Foladore Silva , Carbone Antonino , Comoretto Yroberto , Serafini Italo , Monfardini Silvio
Published: February 2007

Fifty‐two consecutive patients, affected by large T2 (>3 cm), T3, T4, N0, or N1 previously untreated squamous cell carcinoma of the head and neck, entered this phase I ‐ II study. Treatment consisted of a continuous 8‐day infusion on the following daily schedule: cisplatin 25 mg and bleomycin 15 mg administered for 4 and 20 hours, respectively. Technical‐related toxicities were 1 case each of coagulation and displacement of the catheter and 1 case of reversible monoparesis of the contralateral arm. Drug‐related relevant toxicities accounted for 4 cases of grade 3 or 4 leukopenia and 2 cases of peripheral palsy of the 7th and 12th cranial nerve, respectively. Forty‐five of 50 evaluable patients obtained an objective response. In particular, 13 patients obtained a complete response, 22 a partial response ⩾75%, and 10 a partial response ⩾50%. Furthermore, 5 of 31 patients showed a complete pathologic disappearance of the tumor, whereas in 12 of 31 only a microscopic residue was found.
Prognostic value of paranasopharyngeal extension of nasopharyngeal carcinoma on local control and short‐term survival
Authors: Sham Jonathan S. T. , Choy D.
Published: February 2007

The local tumor control of 262 patients with nasopharyngeal carcinoma (NPC) at median follow‐up of 27 months was studied with reference to the paranasopharyngeal and other aspects of extranasopharyngeal extension of tumor, as well as to other possible prognostic factors. Only cranial nerve palsy, oropharyngeal involvement, and paranasopharyngeal extension of tumor were found to be significant in a multivariate analysis using Cox model for factors influencing local tumor control. Other factors and other parameters of extranasopharyngeal extension of tumor, namely, erosion of the base of skull, intracranial extension, and involvement of nasal fossa, were found not to be significant. The degree of paranasopharyngeal extension in each side was correlated with scales measuring extranasopharyngeal extension of tumor in other directions (p= 0.001). Although the T stage and the paranasopharyngeal extension were individually found to be well correlated with local tumor control, the prognostic value of paranasopharyngeal extension remained significant among subgroups of patients with T3 and T4 disease (p= 0.1044 and 0.0010, respectively).
Preoperative evaluation of the mandible in patients with carcinoma of the floor of mouth
Authors: Shaha Ashok R.
Published: February 2007

Preoperative evaluation of the mandible for invasion by tumor has always been a difficult problem. Various methods have been used, including clinical evaluation, panoramic x‐rays, dental films, routine mandible films, bone scans, computed tomographic (CT) scans, and magnetic resonance imaging (MRI) scans. The diagnostic accuracy of these methods has not been totally satisfactory from the clinical standpoint. We compared the diagnostic effectiveness of clinical evaluation, panorex films, and CT scans in 60 patients with carcinoma of the floor of mouth. The relative value of these tests was studied in relation to marginal or segmental mandibulectomy. Our data showed that CT scanning was not very helpful, mainly because of the presence of irregular dental sockets and artifacts. Clinical evaluation was the most accurate, both to determine bone invasion and to decide the type of mandibular resection necessary in association with the primary tumor.

Panoramic films were helpful in evaluating the gross extent of mandibular invasion. However, they were not of any help in determining minimal bony invasion or cortical invasion. Even though CT scanning has made a tremendous impact in other areas of head and neck surgery, it is not of much help in making the critical decisions in the type of mandible resection, marginal or segmental, in patients with carcinoma of the floor of mouth. Our experience demonstrates that clinical evaluation is superior in preoperative evaluation of the mandible, and especially in deciding the type of mandible resection.
Value of needle biopsy in directing management of parotid lesions in HIV‐positive patients
Authors: Casiano Roy R. , Cooper Jonathan D. , Gould Edwin , Ruiz Phillip , Uttamchandani Raj
Published: February 2007

Fourteen human immunodeficiency virus (HIV)‐positive patients with parotid enlargement were reviewed retrospectively in order to elucidate the natural history of this clinical entity. The efficacy of fine‐needle aspiration (FNA) in predicting benign nonsurgical disease was evaluated. The most common findings on FNA were proteinaceous fluid and/or epithelial cells consistent with cyst contents in 71% of the patients, followed by reactive lymphadenitis (50%), and chronic or granulomatous inflammation (21%). No evidence of malignancy was seen in any patient. These results correlated well with the histopathologic diagnosis in all operated patients. Surgery did not affect the ultimate clinical outcome. This study suggests that HIV‐positive patients with isolated asymptomatic parotid swelling in the absence of other clinical features suggestive of malignancy can be followed conservatively with FNA, avoiding the risks of surgery.
Miniplate fixation of zygomatic fractures
Authors: Berman Peter D. , Jacobs Joseph B.
Published: February 2007

The availability and application of miniplate systems for the repair of displaced zygomatic fractures may effect commonly accepted guidelines for fixation of these injuries. A retrospective review of 20 patients at New York University‐Bellevue Medical Center was conducted to further delineate issues concerning surgical repair and fixation. Our experience with one‐ and two‐point fixation is evaluated and guidelines are presented.
Carcinoma of the skin metastatic to parotid area lymph nodes
Authors: Taylor Bernard W. , Brant Timothy A. , Mendenhall Nancy Price , Mendenhall William M. , Cassisi Nicholas J. , Stringer Scott P. , Million Rodney R.
Published: February 2007

This is a retrospective analysis of 60 patients with previously untreated metatypical basal cell (3 patients) or squamous cell (57 patients) carcinoma of the skin, metastatic to the parotid area. All patients had a minimum 2‐year follow‐up, and 43% had a minimum 5‐year follow‐up. Treatment was surgery alone (8 patients), irradiation alone (16 patients), or planned combined surgery and irradiation (36 patients). The ultimate rates of control of disease in the parotid area were surgery alone, 5 of 8 (63%); irradiation alone, 6 of 13 (46%); planned combined surgery and irradiation, 32 of 36 (89%). In the combined‐treated group, all 4 recurrences were in patients who had positive surgical margins and gross involvement of the facial nerve. In patients with negative surgical margins, without involvement of the facial nerve, who had combined treatment, the control rate was 100%. Of the surgery‐alone group, only 1 patient ultimately had the disease controlled and retained a functioning facial nerve.
Neurilemmomas of the cervical vagus nerve
Authors: Park Cheong Soo , Suh Kwang Wook , Kim Choon Kyu
Published: February 2007

Four patients were seen with neurilemmoma which arose in the cervical vagus nerve. Three tumors arose in the upper third of the lateral neck, and the remaining one in the lower third. Lateral neck mass was a prominent symptom in 3 patients, and parapharyngeal mass in the remaining one. The parapharyngeal mass bulged into the oropharynx in the tonsillar and retrotonsillar region and caused mild swallowig difficulty. Complete surgical extirpation by means of intracapsular enucleation was possible in all 4 patients. All patients remained free of disease for periods ranging from 15 to 75 months following surgery. It would appear that an intracapsular enucleation may be advisable for clearance of this kind of tumor.
Giant teflon granuloma of the larynx
Authors: Benjamin Bruce , Robb Peter , Clifford Anthony , Eckstein Robert
Published: February 2007

Endolaryngeal injection of Teflon paste to augment and medialize the paralyzed hemilarynx aims to improve dysphonia and relieve aspiration. After an initial short‐lived inflammatory reaction in the laryngeal tissues, a foreign body granuloma forms around the Teflon. In most cases the results are good but it may occasionally be necessary to consider removal of the granuloma if too large a volume has been injected, if it is inappropriately placed, or if the paralyzed vocal cord subsequently recovers. Surgical removal is difficult and the results are unpredictable. This case illustrates, for the first time, that evaluation using both a high‐resolution computed tomographic (CT) scan and endos‐copy with telescopes permits satisfactory assessment before removal of Teflon.
Prognostic factors in head and neck cancer: Histologic grading, dna ploidy, and nodal status
Authors: Zätterström Ulf K. , Wennerberg Johan , Ewers Sven‐Börje , Willen Roger , Attewell Robyn
Published: February 2007

Histopathologic malignancy score and DNA ploidy were investigated as prognostic factors for 72 cases of squamous cell carcinoma of the head and neck (HNSCC). The malignancy grading was based upon four different morphologic characteristics for the tumor cell population and four characteristics for the tumorhost relationship. DNA ploidy was determined through flow cytometry on fresh‐frozen tumor samples. The median malignancy score was 20, with 71% of the tumors scoring < 20 being diploid and 68% of the tumors scoring ⩾ 20 being nondiploid (p = 0.003). Univariate analysis revealed that tumors scoring < 20 and diploid tumors had a significantly higher proportion of complete response and better survival as compared to tumors scoring ⩾ 20 and nondiploid tumors, respectively. There was a tendency toward better survival among patients without regional metastasis (NO) as compared with patients with regional spread (N+), whereas the other single factors, patient age, clinical stage, histologic grade, and tumor size did not correlate with prognosis. In N+ patients both malignancy score and DNA ploidy were predictive for survival, whereas in NO patients only malignancy score was related to prognosis. A multivariate analysis showed that the combination of malignancy score and nodal status were the strongest predictors for survival. DNA ploidy did not contribute further information in this test, due to its close relation with the histopathologic malignancy score.
Neuroendocrine tumors of the larynx
Authors: Moisa Idel I.
Published: February 2007

A review of the international literature has revealed 68 paragangliomas, 42 large cell, and 74 small cell tumors of the larynx. Paragangliomas are usually benign, although malignant cases have been reported. Large cell tumors are malignancies associated with a high incidence of early cervical metastasis. Small cell tumors are aggressive cancers characterized by early, diffuse metastatic disease. All three neoplasms demonstrate a propensity for the supraglottic larynx. While surgery remains the treatment of choice for paragangliomas and large cell cancers, small cell cancers are best treated by radiotherapy and chemotherapy. The determinate 5‐year survival for patients with paragangliomas, large cell, and small cell cancers is 60%, 34%, and 14%, respectively. While representing distinct clinical entities, these neoplasms demonstrate similar ultrastructural and histochemical features and should be classified as neuroendocrine tumors of the larynx (NETL). A comprehensive analysis of these laryngeal tumors is presented herein. Their clinical behavior and management options are reviewed and a scheme for their nomenclature and classification is proposed.
Anaplastic large cell lymphoma
Authors: Foss Robert D. , Laskin William B. , Lombardi Donald P. , Morton Anthony L. , Snyder James
Published: February 2007

Anaplastic large cell lymphoma (ALCL) or Ki‐1 lymphoma is a recently described and distinctive non‐Hodgkin's lymphoma. Cervicofacial adenopathy caused by ALCL may mimic involvement by metastatic carcinoma or other malignancies common to the head and neck. A case in which ALCL was originally interpreted as metastatic nasopharyngeal carcinoma is presented. The clinicopathologic features of this uncommon entity are discussed.
Gene amplification and overexpression of epidermal growth factor receptor in squamous cell carcinoma of the head and neck
Authors: Rikimaru Koichi , Tadokoro Keiko , Yamamoto Tadashi , Enomoto Shoji , Tsuchida Nobuo
Published: February 2007

The degree of gene amplification for epidermal growth factor receptor (EGFR) and its expression levels were examined in 4 cases of tumor lesions and their cell lines of human squamous cell carcinoma (SCC) of the oral cavity. The amplification was detected in 1 case (ZA), but not significantly in 3 other cases (HOC605, HOC815, and HOC927) in which the amplification did not occur during the cell line establishment. In those 3 cases, levels of EGFR synthesis and human EGF (hEGF) binding capacity were varied: HOC605 and HOC815 had slightly increased levels of hEGF binding capacity and EGFR synthesis, respectively. While HOC927 had the lowest levels of both, the hEGF binding capacity was elevated in the tumor lesion when compared with the normal counterpart of the same patient. These results suggest that the increased capacity for EGF binding plays a more important role than does gene amplification on the tumorigenesis of SCC of the head and neck.
Medical liaisons for continuity of head and neck cancer care
Authors: Benninger Michael S.
Published: February 2007

The role of assistance in coordinating treatment and follow‐up on the effectiveness and reliability of long‐term care of head and neck cancer patients was evaluated. A comparison between the Department of Radiation Oncology, where a liaison team assists cancer patients, and the Department of Otolaryngology, where there were no such personnel, was made. Of 124 consecutive patients with head and neck squamous cell carcinoma, 31 were treated with surgery alone and 93 had radiation therapy alone or in combination with surgery. Patients were nearly equally divided among stages, although a higher percentage receiving surgery were stage I and those receiving radiation were stage IV. Nineteen radiation patients and 1 surgery patients have died; this is consistent with the differences in stage distribution. Thirteen of 31 surgery patients had unreliable follow‐up, with 7 lost to follow‐up. Only 8 of 93 radiation patients were unreliable, with 4 lost. The difference is statistically significant. The importance of nursing/social work liaisons in coordinating treatment and follow‐up of head and neck cancer patients is discussed.
Botulinum a toxin for spasmodic torticollis: Multiple vs single injection points per muscle
Authors: Borodic Gary E. , Pearce L. Bruce , Smith Karen , Joseph Michael
Published: February 2007

Eighty‐six injections in 49 patients with adult onset spasmodic torticollis were evaluated for efficacy with respect to single point per muscle versus multiple point per muscle injection techniques. Parameters of the syndrome assessed were pain, posture deformity, range of cervical motion, disfigurement, cervical muscle hypertrophy, activity limitation, and degree of involuntary movement. The multiple point per muscle injection strategy appeared superior to the single injection per muscle technique with respect to pain (p < 0.002, chi‐square), posture deformity (p < 0.001), range of motion (p < 0.001), and improvement in activity endurance (p < 0.001). No significant differences were noted with respect to cervical muscle hypertrophy or degree of involuntary movements, although the injections were considered beneficial in both groups to these syndrome components.
Bilateral tonsillar metastasis of gastric adenocarcinoma
Authors: Gallo Andrea , Pescarmona Edoardo , Crupi Jacqueline , Corsetti Gian Luca , De Vincentiis Marco
Published: February 2007

The occurrence of metastatic tumors in the tonsils, although rare, must be considered in the differential diagnosis of tonsillar lesions. In particular, the review of the literature reports only 7 cases of tonsillar metastasis of gastric carcinoma. The authors describe a case of adenocarcinoma involving bilaterally the palatine tonsils and the lingual tonsil, in a patient previously operated due to gastric adenocarcinoma. The clinical appearance of the lesion could be also consistent with lymphoproliferative or infectious diseases. The clinical and pathologic differential diagnosis of this peculiar case is discussed, together with a brief review of the literature.
Pleomorphic adenoma of the palate in a child
Authors: Austin John R. , Crockett Dennis M.
Published: February 2007

Pleomorphic adenoma of the palate is a rare entity in childhood. Only 4 cases of this lesion are documented in detail in the literature. We present a patient with this lesion and discuss the usefulness of magnetic resonance imaging (MRI) in the preoperative evaluation. A review of the previously reported cases is provided along with a discussion of the treatment of this lesion.
Induction chemotherapy in head and neck cancer: Results of a phase III trial
Authors: Mazeron Jean‐Jacques , Martin Michel , Brun Bernard , Grimard Laval , Lelièvre Gilles , Vergnes Laurence , Haddad Elias , Feuilhade Frank , Piedbois Pascal , Strunski W. , Peynègre Roger , Pierquin Bernard , Bourgeois Jean‐Paul Le
Published: February 2007

Between December 1982 and October 1986, 131 patients with stage II‐III‐IV squamous cell carcinoma of the oropharynx or oral cavity were randomized to induction chemotherapy, consisting of bleomycin (10 mg/m2/day in continuous infusion from day 1 to day 5), methotrexate (120 mg/m2on day 2) followed by folinic acid, 5‐fluorouracil (5 FU) (600 mg/m2on day 2), and cisplatin (120 mg/m2on day 4) every 4 weeks for a total of three cycles followed by definitive locoregional treatment versus locoregional treatment alone. The modalities of definitive treatment (radiotherapy ± surgery) were chosen prior to randomization. A total of 116 patients were evaluable. Of 55 patients in the chemotherapy arm, four (7%) had a complete response (CR) and 23 (42%) a partial response (PR) following the induction regimen. At the completion of locoregional treatment, 76% (42 of 55) of patients in the experimental group were in CR compared to 89% (54 of 61) in the control group. There was no difference in survival, cause‐specific survival, and pattern of relapse between both groups. The median survival was 22 months in the chemotherapy group and 29 months in the control group. Responders to chemotherapy did not fare better than nonresponders. Chemotherapy‐related toxicities were few and most of them related to cisplatin which was reduced to 100 mg/m2for 35 patients. There were no treatment‐related deaths and, in the experimental arm of the trial, no increased morbidity from locoregional treatment. This induction regimen does not offer any advantages over standard treatment.
Pectoralis major myocutaneous flap: Analysis of complications in a VA population
Authors: Huang Robert D. , Silver Steven M. , Hussain Akhtar , Parnes Steven M. , Wing Paul D.
Published: February 2007

Forty‐five cases of head and neck reconstruction with pectoralis major myocutaneous flaps (PMMF) between 1985 and 1990 were analyzed retrospectively for complications. Thirty‐two cases were done at the VA Medical Center and 13 at Albany Medical Center, a private university hospital. Total complication rate was 58%. In the VA population, complication rate was 59% as compared to 54% at the Albany Medical Center, which appears statistically not significant. It has been suggested that VA populations tend to have poorer health and socioeconomic status and are more likely to have higher complication rates. This conjecture is not borne out by this study. Complications are described and compared.
Metastatic papillary cancer of the neck: A diagnostic dilemma
Authors: Homan Mal R. , Gharib Hossein , Goellner John R.
Published: February 2007

The finding of papillary carcinoma in a neck mass usually leads to the presumptive diagnosis of metastatic thyroid carcinoma, with total thyroidectomy revealing the primary tumor. We report five cases of metastatic papillary carcinoma of the neck. The primary tumor in three of the cases was found to be nonthyroidal; two being discovered only after total thyroidectomy failed to reveal a primary cancer. In the two thyroidal neoplasms, pathologic examination of the thyroid demonstrated only minimal tumor in one case and no detectable tumor in the other. These cases illustrate the pitfalls of diagnosis and treatment of these tumors and the utility of antithyroglobulin immunostaining in such cases.
Computed tomography of primary subglottic cancer: Clinical importance of typical spread pattern
Authors: Saleh Ezzat M. , Mancuso Anthony A. , Alhussaini Ahmed A.
Published: February 2007

The spread pattern of 14 cases of primary subglottic cancer, as seen on computed tomography (CT), is analyzed. Cricoid cartilage invasion was present in nine cases. Tracheal invasion was definite in four cases and questionable in three. Extralaryngeal soft tissue spread was present in nine cases; all but one had cartilage destruction. The patterns of spread seen accurately reflect reports in previous whole‐organ section studies, and suggest that the elastic cone has a primary role in directing the spread of tumor.

Anticipating spread to areas described above with CT and/or magnetic resonance imaging (MRI) can be used to try to improve treatment planning and perhaps outcome by: (1) avoiding placement of urgent tracheostomies close to the tumor; (2) helping to modify standard surgical approaches by suggesting lower‐than‐usual tracheostomies, or more extensive‐than‐usual thyroid gland resection; and (3) avoiding delay in diagnosis by strongly suggesting rebiopsy when imaging indicates a tumor is present, and initial endoscopy and biopsy cannot confirm the imaging findings.
Streptococcal gangrene of the head and neck: A case report and review of the literature
Authors: Miles L. Tracey , Jacobs Joseph B. , Gittelman Paul D. , Lebowitz Arthur S.
Published: February 2007

Necrotizing bacterial infections that occur in the head and neck are exceedingly rare and are often associated with a group A beta‐hemolytic streptococcus (Streptococcus pyogenes). The disease is associated with soft tissue necrosis and vascular thrombosis. There appears to be an increasing incidence of hyperaggressive beta hemolytic streptococcal infections associated with high mortality rates. We report the survival of an otherwise healthy patient who developed a flu‐like illness followed by a rapidly progressive toxic systemic illness associated with subtotal facial soft tissue necrosis down to bone. The recent literature related to this necrotizing bacterial infection is reviewed. Otolaryngologists must be aware of this entity since survival depends upon aggressive early wound management and highdose intravenous antibiotics.
Value of grading squamous cell carcinoma of the head and neck
Authors: Roland Nicholas J. , Caslin Anthony W. , Nash John , Stell Philip M.
Published: February 2007

We report a series of 3,294 patients with squamous cell carcinoma of the head and neck seen by one of us between 1963 and 1990. Two thousand and seven patients had a histologically proven and graded, but previously untreated, squamous cell carcinoma of the mucosal surfaces of the head and neck. These tumors had been graded previously by many different pathologists in many different hospitals, both in the United Kingdom and the United States, as well as continental Europe, over this period. Of the host factors both sex and age were associated with differentiation: 34% of patients less than age 50 had a well‐differentiated tumor compared with 44% greater than age 50; 32% of women had a poorly differentiated tumor compared with 26% of men. General condition had no correlation with degree of differentiation. Site was closely associated with grading: well‐differentiated tumors were more common in the mouth and larynx and poorly differentiated tumors in the pharynx. Furthermore, of poorly differentiated tumors, 19% arose from areas normally lined by keratinized squamous epithelium, 22% from a nonkeratinized area, 36% from respiratory epithelium, and 45% from areas normally covered by lymphoid epithelium. T stage had no significant correlation with differentiation. However, 46% of patients with poorly differentiated tumors had a nodal metastasis at presentation compared with only 28% of well‐differentiated tumors. Distant metastases at presentation were found in 3.4% of poorly differentiated tumors compared with 1.8% of well‐differentiated tumors. The survival fell significantly from 33% for well‐differentiated tumors to 27% for poorly differentiated tumors. The recurrence rate at the primary site rose from 25% for well‐differentiated tumors to 27% for poorly differentiated tumors, and recurrence in the lymph nodes rose from 26% to 30%. Both differences were just significant.
Lymph node metastasis in squamous cell carcinoma of the oral cavity: Correlation between histologic features and the prevalence of metastasis
Authors: Umeda Masahiro , Yokoo Satoshi , Take Yoshiaki , Omori Akiteru , Nakanishi Koichi , Shimada Keikichi
Published: February 2007

A retrospective study was made of the correlation between pre‐operative clinical or histologic findings and the prevalence of lymph node metastasis in 60 patients with squamous cell carcinoma of the oral cavity who had histologically confirmed neck metastasis. Of these 60 patients, 39 with clinically N+ necks underwent immediate therapeutic neck dissection, and 21 whose necks were initially NO but progressed to N+ during observation underwent subsequent therapeutic neck dissection. The primary site, TNM staging, histologic grade of malignancy of biopsy specimen, and location and number of histologically positive lymph nodes were reviewed in each case. The results were as follows:(1) The prevalence of neck metastasis was not significantly correlated with primary site and T stage; however, there was an apparent correlation between histologic grade of malignancy and the prevalence of neck metastasis. Patients with grade I‐II histologic malignancy showed limited metastases that involved lymph nodes in levels I‐II. On the other hand, patients showing grade III‐IV histologic malignancy often had metastases that extended beyond level III, regardless of T stage. These results suggest that histologic grade of malignancy, as well as clinical features, must be taken into consideration when deciding whether supraomohyoid neck dissection is indicated. (2) The group that underwent subsequent neck dissection exhibited less advanced neck metastasis and a better prognosis than the group which underwent immediat neck dissection. These findings show that if they are closely followed up, it is possible to delay neck dissection in NO patients until a neck metastasis is detected. © 1992 John Wiley & Sons, Inc.
Thyroid and parathyroid surgery without drains
Authors: Ruark Deborah S. , Abdel‐Misih Raafat Z.
Published: February 2007

The question of routine wound drainage after thyroid and parathyroid surgery remains controversial among experienced surgeons. Review of the literature failed to reveal any study that established the benefit of drainage after thyroidectomy and para‐thyroidectomy. A retrospective review of 139 thyroid or parathyroid procedures performed without drainage was conducted. One hundred ten thyroid operations were performed, including unilateral lobectomy with isthmusectomy [82 (74.5%)], total or bilateral subtotal thyroidectomy [26 (23.6%)], and isthmusectomy [2 (1.8%)]. Histologic examination yielded a benign diagnosis in 94 specimens (85.4%); 16 specimens (14.5%) contained thyroid carcinoma. Parathyroid explorations were performed in 29 patients (20.8%) all of whom had adenomas. Postoperatively, there were no instances of wound hematomas, infections, or rebleeding necessitating reoperation. Minor complications included asymptomatic wound seromas (4‐30 mL) in five (3.6%) patients, which were aspirated 2 weeks after discharge without further recurrence. This minimal complication rate of 3.6% with undrained neck incisions suggests that routine prophylactic drainage of thyroid and parathyroid wounds is unnecessary. © John Wiley & Sons.
Postoperative radioactive iodine evaluation of total thyroidectomy for thyroid carcinoma: Reappraisal and therapeutic implications
Authors: Attie Joseph N. , Bock George , Moskowitz Gerard W. , Margouleff Donald , Dubner Sanford
Published: February 2007

The records of 430 patients who underwent total thyroidectomy with radioactive iodine (RAI) uptake studies performed postop‐eratively were reviewed. Indications for the administration of an ablative dose of iodine 131 are given. The majority (85.4%) had no or low (less than 2%) evidence of focal uptake and therefore were not treated with ablative doses of iodine 131. RAI scanning is necessary postoperatively to determine the completeness of the surgical procedure and to detect residual or metastatic disease. Small foci of residual disease or occult distant metastases can be adequately treated with therapeutic doses of RAI. Nodal or distant metastases that become clinically evident following thyroidectomy are usually not successfully treated with RAI. © John Wiley & Sons, Inc.
Primary mucinous adenocarcinoma of the eyelid
Authors: Andrews Thomas M. , Gluckman Jack L. , Weiss Mark A.
Published: February 2007

Primary mucinous adenocarcinoma of the skin is a rare entity arising from eccrine sweat glands with a propensity for local recurrence and metastasis. This tumor has been widely reported in the ophthalmology literature, but not to our knowledge in the otolaryngology literature. A case of a 48‐year‐old man with a mucinous adenocarcinoma extensively involving the right eyelid and orbit necessitating craniofacial resection is presented together with a discussion of the pathology, clinical features, and management. © John Wiley & Sons, Inc.
Glandular odontogenic cyst
Authors: Van Heerden Willem F. P. , Raubenheimer Erich J. , Turner Martin L.
Published: February 2007

Two cases of glandular odontogenic cysts are reported. The unique histological features, eg, the intraepithelial glandular structure, papillary processes, and eosinophilic cuboidal and larger granular superficial cells are sufficient to warrant glandular odontogenic cyst as a distinct entity. Electron microscopic examination of the superficial eosinophilic cuboidal cells are suggestive of a process similar to apoptosis. Eroded cortical plates suggest an aggressive behavior.
Videofluoroscopy of the pharyngoesophageal segment during tracheoesophageal and esophageal speech
Authors: Isman Karin A. , O'Brien Christopher J.
Published: February 2007

The purpose of this preliminary investigation was to identify the location and length of the pharyngoesophageal (PE) segment during esophageal and tracheoesophageal (TE) speech among laryngectomees who were proficient in both methods of vocalization. Four patients who had undergone total laryngectomy and tracheoesophageal puncture served as subjects. Voice recordings were obtained and played to listeners of varying experience with laryngectomees. Videofluoroscopy was performed while the patients sustained “ah” in both modes of speech. Results of these analyses revealed that TE speech was rated as more effective than esophageal speech in all 4 subjects. However, only minimal differences were found in the length and the location of the PE segment during TE and esophageal speech when within subject comparisons were made. This study is the first to compare the physical characteristics of the PE segment during esophageal speech and TE speech as produced by the same speaker. © 1992 John Wiley & Sons, Inc.
Basaloid squamous carcinoma of the buccal cavity
Authors: Cadier Michael A. , Kelly Sarah A. , Parkhouse Nicholas , Brough Michael D.
Published: February 2007

Basaloid‐squamous carcinoma was first recognized as a separate pathologic entity in 1986. It has been described in the hy‐popharynx, larynx, base of tongue, and nasal cavity. We report the first case of this rare tumor occurring in the buccal cavity and review the atypical squamous cell carcinomas that occurred in these sites. © 1992 John Wiley & Sons, Inc.
Curative irradiation of the entire orbit in rhabdomyosarcoma: A case report
Authors: Van Den Bogaert Walter , Van Limbergen Erik , Dralands Godelieve , Drochmans Alfons
Published: February 2007

Rhabdomyosarcoma (RMS) is a relatively frequent tumor in children. Judicious combinations have markedly improved treatment results in recent years. Orbital localizations are treated with chemotherapy and radiotherapy. It has been advocated that radiotherapy be limited to the original tumor bed. This case report illustrates the danger of shielding part of the orbit: in a clinically tumor‐free region before chemotherapy, which was shielded during radiotherapy, a local recurrence was seen while the original tumor bed remained controlled. Therefore, the whole content of the orbit should be irradiated in orbital RMS. © 1992 John Wiley & Sons, Inc.
Epithelial‐myoepithelial carcinoma of salivary gland with metastasis to lung: Report of a case and review of the literature
Authors: Noel Scott , Brozna John P.
Published: February 2007

A 63‐year‐old man was initially seen with multiple pulmonary nodules 14 years after a left parotidectomy for an epithelial‐myoepithelial carcinoma of salivary gland. Eight and 18 months after parotidectomy, the patient had local recurrence of his salivary gland tumor. He remained disease‐free before being seen with pulmonary nodules, which were evaluated by open lung biopsy. The pathologic features of the pulmonary nodules were identical to the salivary gland tumor resected 14 years earlier. This is the fourth reported case of epithelial‐myoepithelial carcinoma of salivary gland metastasizing to a distant site. © 1992 John Wiley & Sons, Inc.
Basic science reviews: Tumor suppressor genes
Authors: Lee Norris K.
Published: February 2007

Tumor suppressor genes are negative regulators of cell growth. When their normal function is compromised, absence of their inhibitory effects can lead to unrestrained cell cycling and growth. Strong evidence now confirms that loss of proper function of these genes is a common occurrence leading to cancer. Their failure can be caused by alterations in the gene DNA or malfunction of their protein products. The recent extraordinary accumulation of knowledge about these genes reveals that normal carcinogenesis represents breakdown of normal regulatory processes. © 1992 John Wiley & Sons, Inc.
Metastatic thyroid cancer as an incidental finding during neck dissection: Significance and management
Authors: Vassilopoulou‐Sellin Rena , Weber Randal S.
Published: February 2007

Occult thyroid cancer is an occasional incidental finding during surgery for other indications and is usually considered of minor clinical significance; however, the appropriate approach for incidentally found metastatic thyroid cancer is less clear especially when it occurs in the context of another malignancy that has more aggressive potential. Among 2,855 patients treated for squamous cancer of the tongue at The University of Texas M. D. Anderson Cancer Center, eight patients had coexisting differentiated thyroid cancer metastatic to cervical lymph nodes which was found incidentally during regional lymph node dissection. The eight patients included three women and five men with a median age of 47 years (range, 32‐62 years); tumors were of the papillary variety in four patients and follicular in the other four. In one patient, no gross or microscopic primary tumor could be identified after thyroidectomy; in another patient, no gross tumor was evident, but whole organ section revealed an area of fibrosis consistent with a primary lesion. Two patients had primary lesions less than 1 cm in maximal diameter. In four patients who had no surgery, physical exam and radiologic evaluation failed to show any intrathyroidal lesions. Clinically relevant thyroid cancer did not develop in any of those patients during the duration of documented follow‐up (1‐15 years). Three patients died of progressive tongue cancer, one patient of unrelated pulmonary disease, and four patients remain alive without evidence of disease for 1 to 15 years of available follow‐up. We suggest that differentied thyroid cancer discovered incidentally during surgery for another, potentially more aggressive mallignancy may be approached conservatively when the thyroid gland does not demonstrate clinical or radiologic lesions. © 1992 John Wiley & Sons Inc.
Double skin island pectoralis major myocutaneous flap with nipple‐areola complex preservation: A case report
Authors: Espinosa Manuel H. , Phillip John A. , Khatri Vijay P. , Amin Atul K.
Published: February 2007

A horizontal double skin island pectoralis major myocutaneous flap with preservation of nipple‐areola complex is described, a different modification used to reconstruct a complex defect following radical resection of a locally advanced gingival carcinoma. The skin islands are horizontally separated by a distance of 2.5 cm but rely on one vascular pedicle for their blood supply. The muscle between the skin islands provides the soft tissue bulk between the internal mucosal and external skin lining. The need for a separate segmental flap or a split‐thickness skin graft for mucosal lining was eliminated. © 1992 John Wiley & Sons, Inc.
Spontaneous rupture of the common carotid artery: A case report
Authors: Kim Kwang Hyun , Sung Myung Whun , Oh Seung Ha
Published: February 2007

Spontaneous rupture of the common carotid artery is an extremely rare vascular disorder in the head and neck region. Pseudoaneurysm can be formed by arterial rupture, presenting clinically as an expanding mass lesion. A 37‐year‐old fisherman suffered from the spontaneous rupture of the left common carotid artery and resultant pseudoaneurysm was radiologically recognized. Surgical exploration revealed a 0.5‐cm rent in the common carotid artery, 2 cm proximal to the bifurcation. The lesion was successfully managed with polypropylene sutures during temporary clamping of the carotid artery. The literature is reviewed and the principles of management are discussed. © 1992 John Wiley & Sons, Inc.
Dentascan imaging of the mandible and maxilla
Authors: Yanagisawa Ken , Friedman Craig D. , Vining Eugenia M. , Abrahams James J.
Published: February 2007

DentaScan is a unique new computer software program which provides computed tomographic (CT) imaging of the mandible and maxilla in three planes of reference: axial, panoramic, and oblique sagittal (or cross‐sectional). The clarity and identical scale between the various views permits uniformity of measurements and cross‐referencing of anatomic structures through all three planes. Unlike previous imaging techniques, the oblique sagittal view permits the evaluation of distinct buccal and lingual cortical bone margins, as well as clear visualization of internal structures, such as the incisive and inferior alveolar canals. Several case reports are presented to demonstrate the clinical usefulness of DentaScan.
Simultaneous chemoradiotherapy as salvage treatment in locoregional recurrences of squamous head and neck cancer
Authors: Gandia Daniel , Wibault Pierre , Guillot Thierry , Bensmaine Amine , Armand Jean P. , Marandas Patrick , Luboinski Bernard , Cvitkovic Esteban
Published: February 2007

This study was designed to determine if long‐term palliation could be obtained in pre‐irradiated locoregional recurrent squamous head and neck cancer patients, with the administration of simultaneous chemoradiotherapy. Mandatory eligibility criteria were histologically documented squamous head and neck cancer in previously irradiated territory, surgical or brachytherapy salvage unfeasibility, or patient refusal. The protocol consisted of radiotherapy, at a rate of 5 daily fractions of 2 Gy on altermate weeks, with simultaneous continuous intravenous infusion of 5‐fluorouracil (5FU) at 800 mg/m2 and oral hydroxyurea (HU) at 1.000–1,500 mg/day for 5 days. Tolerance was good. Acute toxicity was low with no grade ‐⩾ III WHO hematologic toxicity observed. Nine patients had grade III mucositis, one had grade IV, three had grade III skin toxicity, and only four patients required a 20% to 30% 5FU dose reduction because of it. Two patients had hand and foot syndrome, and two had asymptomatic 5FU‐related cardiac signs (1 ECG, 1 echographic + ECG). Chronic radiotherapy‐related effects consisted of Her mitte's sign observed in two patients. Of 34 registered patients, 33 were evaluable for response. An overall rate of 55% (18 patients) of objective responses [complete response (CR) + partial response (PR)] was obtained, with 12 patients (36%) achieving local control of disease. The median survival was 11 months. These data show that palliation could be obtained for the majority of responding patients, and also suggest an improvement in the immediate prognosis with this type of salvage procedure for a selected group of recurrent squamous head and neck cancer patients.
Association of hyperparathyroidism with nonmedullary thyroid carcinoma: Review of 31 cases
Authors: Attie Joseph N. , Vardhan Reddy
Published: February 2007

In a series of 948 patients operated on for primary hyperparathyroidism (HPT) by one surgeon (JNA) from 1952 to 1992, there were 242 (26%) instances of coincidental thyroid and parathyroid disease. Of these, 211 had benign thyroid lesions. In the remaining 31 cases HPT was associated with nonmedullary thyroid carcinoma; all were treated by resection of parathyroid adenomas and thyroidectomy. One patient died of unrelated cause (carcinoma of breast) 11 years following surgery. The remaining 30 patients are living and well 2 to 20 (mean 8.2 years) years after surgery; there was no recurrence or thyroid cancerrelated mortality in the series. In contrast to prior reports, only six (20%) of our patients had a history of prior radiotherapy. We suggest that during neck exploration for HPT, the entire thyroid gland be evaluated and all palpable nodules resected and submitted to pathologic study.
Local control of squamous cell carcinoma following marginal and segmental mandibulectomy
Authors: Dubner Sanford , Heller Keith S.
Published: February 2007

The records of 130 consecutive patients undergoing marginal or segmental mandibulectomy for squamous cell carcinoma of the oral cavity or oropharynx were reviewed. An attempt was made to correlate incidence of recurrence with characteristics of the primary tumor and extent of mandibulectomy. The local recurrence rate was 19% following marginal mandibulectomy and 6% following segmental mandibulectomy. The incidence of local recurrence was independent of the size of the primary tumor or the extent of lymph node metastases. Neither mandibular invasion by tumor nor the addition of radiotherapy influenced local recurrence. Ten of 15 patients recurring locally after marginal mandibulectomy were salvaged by further surgery. This study suggests that local control following marginal mandibulectomy is comparable to that following segmental mandibulectomy regardless of the size of the tumor. Segmental mandibulectomy should be reserved for those tumors invading deeply into the mandible or wrapping around it.