bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of human leukocyte antigen ancestral haplotype 8.1 with adverse outcome of non‐Hodgkin's lymphoma
Authors: Nowak Jacek , Kalinka‐Warzocha Ewa , Juszczynski Przemyslaw , Bilinski Przemyslaw , Mika‐Witkowska Renata , Zajko Malgorzata , Bienvenu Jacques , Coiffier Bertrand , Salles Gilles , Warzocha Krzysztof
Published: February 2007

Previous reports have implicated the tumor necrosis factor (TNF−308) locus to non‐Hodgkin's lymphoma (NHL) outcome. The purpose of the study was to examine other chromosome components of the HLA 8.1 ancestral haplotype (AH) and their relation to the clinical course of NHL. HLA class I, II, TNF−308, and lymphotoxin alpha (LTA+252) alleles were analyzed in 154 newly diagnosed NHL patients. Three locus haplotypes were inferred from the unphased genotypes by a Bayesian implementation of the expectation maximization (EM) algorithm using the PHASE 2.1 program. TNF−308A was the only allele associated with fever, poor performance status, elevated β2‐microglobulin, TNF and its p75 receptor plasma levels. Although TNF−308A was in strong linkage disequilibrium with the remaining alleles of 8.1 AH, only HLA‐A*01 and HLA‐B*08 showed association with prognostic variables. A part of 8.1 AH (A*01‐B*08‐TNF−308A) was predictive for shorter freedom from progression and overall survival (RR = 2.47, P = 0.041; RR = 3.15; P = 0.0049), an association that was stronger than TNF−308A alone and independent from International Prognostic Index (RR = 1.55, P < 0.001; RR = 2.36; P < 0.0001). A*01‐B*08‐TNF−308A fragment of 8.1AH remained an independent predictive factor in a multivariate model. We conclude that 8.1 AH is an important contributor to NHL outcome. In contrast to A*01‐B*08‐TNF−308A, the remaining alleles (Cw*07, DRB1*03, LTA+252G) associated with the 8.1 AH seem to be its passive components. © 2007 Wiley‐Liss, Inc.
DNA sequence of the translocation breakpoints in undifferentiated embryonal sarcoma arising in mesenchymal hamartoma of the liver harboring the t(11;19)(q11;q13.4) translocation
Authors: Rajaram Veena , Knezevich Stevan , Bove Kevin E. , Perry Arie , Pfeifer John D.
Published: February 2007

Undifferentiated embryonal sarcoma of the liver is a highly malignant and aggressive tumor that occasionally arises within mesenchymal hamartoma of the liver (MHL), a benign tumor that typically occurs in young children. Undifferentiated embryonal sarcoma arising in MHL, as well as uncomplicated MHL, frequently harbor rearrangements of band 19q13.4, including the translocation t(11;19)(q13;q13.4). In this study we report the cloning and DNA sequence analysis of the translocation breakpoints in an undifferentiated embryonal sarcoma arising in MHL known to harbor t(11;19). In this case, the breakpoint at 11q13 occurred in the MALAT1 gene, also known as ALPHA. MALAT1 is rearranged in renal tumors harboring the t(6;11)(p21;q13) translocation, and noncoding MALAT1 transcripts are overexpressed in a number of human carcinomas. The breakpoint at 19q13.4 occurs at a locus we refer to as MHLB1, for Mesenchymal Hamartoma of the Liver Breakpoint 1. Although the MHLB1 locus does not contain a known gene, several human ESTs map to the region (a subset of which show homology to the nuclear RNA export factor (NXF) gene family), and the region is conserved between many mammalian species. © 2007 Wiley‐Liss, Inc.
Deliberate self‐harm in older adults: a review of the literature from 1995 to 2004
Authors: Chan Jenifer , Draper Brian , Banerjee Sube
Published: February 2007

Background

The prevention of suicide is a national and international policy priority. Old age is an important predictor of completed suicide. Suicide rates in old age differ markedly from country to country but there is a general trend towards increasing rates with increasing age. In 1996 Draper reviewed critically the evidence on attempted suicide in old age in the 10 years between 1985 and 1994. The review highlighted a need for prospective controlled studies in older people with more representative samples as well as studies examining the interaction of risk factors, precipitants, motivations, psychopathology and response to treatment. The aim of this paper is to update this review and to summarise the advances in our understanding of DSH in later life.

Method

We have critically reviewed relevant studies published between 1995 and 2004 to summarise the advances in our understanding of factors associated with deliberate self‐harm in later life.

Results

The main advances in understanding have been to clarify the effect of personality and cultural factors, service utilisation pre and post attempt, and the (lesser) impact of socio‐economic status and physical illness. Methodological weaknesses continue to include inadequate sample sizes performed on highly selected populations, inconsistent age criteria and lack of informant data on studies relating to role of personality.

Conclusions

Future studies should include prospective, cross‐cultural research with adequate sample sizes and which are population‐based. Such approaches might confirm or refute the results generated to date and improve knowledge on factors such as the biological correlates of deliberate self‐harm, service utilisation, costs and barriers to health care, and the interaction of these factors. Intervention studies to elucidate the impact of modifying these factors and of specific treatment packages are also needed. Copyright © 2007 John Wiley & Sons, Ltd.
The surgical treatment of extratemporal facial paralysis: An overview
Authors: Conley John , Baker Daniel C.
Published: February 2007

At present there is no single surgical approach that is ideally suited to rehabilitation of the paralyzed face. Dynamic reconstruction and neural reconstitution are usually preferred to static methods, except under special circumstances. Experience with over 150 autogenous facialnerve grafts using epineural suture technique has resulted in return of movement in 95% of properly selected patients. When grafting is not feasible, as in the obliterated central facial nerve, hypoglossal–facialnerve crossover is a simple and powerful source of reinnervation, usually resulting in minimal intraoral crippling and mild mass movement. A newer procedure, the cross‐face nerve graft, is an alternative to hypoglossal crossover, although it results in less axonal input and longer regenerative time. In cases of long‐standing facial paralysis with muscle atrophy, temporalis and masseter transfers are dependable and may sometimes be combined with a nerve graft.
Squamous cell carcinoma of the pyriform sinus
Authors: Razack Mohamed S. , Sako Kumao , Kalnins Inars
Published: February 2007

At the Roswell Park Memorial Institute, 111 patients were treated for squamous cell carcinoma of the pyriform sinus over a 15‐year period. Treatment modalities included surgery, radiation therapy, or a combination of both. A retrospective study was carried out to determine how these treatments, used singly or in combination, affected the cure rate. TNM clinical staging and recurrence patterns were studied, and a high tendency for distant metastases was documented. The five‐year survival figure in this study was 29% (28/97).
Dysmorphology: An approach to diagnosing children with structural defects of the head and neck
Authors: Jones Kenneth Lyons , Higginbottom Marilyn C.
Published: February 2007

In dealing with a child with a structural defect, an overall diagnosis must be formulated. Such a diagnosis makes it possible to provide genetic counseling for the parents and an accurate prediction relative to such a child's future development. Because there are a great many abnormalities involving the head and neck, it is hoped that the approach set forth in this article will allow for a systematic narrowing of the diagnostic possibilities. Nomenclature is established. Prenatal‐onset defects are described, including both single primary defects (malformations and deformations) and multiple malformation syndromes (chromosomal abnormalities, genetic disorders, defects resulting from teratogenic factors, and disorders of unknown etiology). Genetic and environmental factors of postnatal developmental problems are also discussed.
Chemotherapy of head and neck cancer
Authors: Green Mark R.
Published: February 2007

Chemotherapy has traditionally been relegated to a late palliative role in the management of head and neck cancer. For advanced disease in patients previously treated with surgery or radiation therapy, methotrexate, which has a response rate of approximately 50%, is the best single agent available. Other orally or systemically administered single agents–such as bleomycin, adriamycin, hydroxyurea, and cis‐platinum–produce responses less frequently than methotrexate. Intraarterial chemotherapy with single‐agent methotrexate or with combinations– including methotrexate, vinblastine sulfate (Velban), cyclophosphamide (Cytoxan), and 5‐fluorouracil (5FU)–can match the response rate of systemic methotrexate, but all require inpatient treatment and significant technical expertise. Programs utilizing chemotherapeutic combinations have not produced remission rates or durations of remission greater than those achieved with methotrexate alone. Chemotherapy has also been used in combination with other modalities. In two studies, chemotherapy combined with irradiation produced improvement in median or overall survival in comparison to irradiation alone. Many similar studies have been negative. Recent trials of chemotherapy used preoperatively in the treatment of head and neck cancer have not yielded decreased recurrence rates or increased overall survival rates in comparison to surgery alone, but they do appear to have prolonged the diseasefree interval following definitive surgery.
The significance of “positive” margins in surgically resected epidermoid carcinomas
Authors: Looser Kevin G. , Shah Jatin P. , Strong Elliot W.
Published: February 2007

Sixty‐two patients with epidermoid carcinomas of the head and neck (excluding glottic larynx and skin), in whom surgical‐resection margins were classified as “positive,” were studied to determine the incidence of local recurrence, the subsequent clinical course, and survival. The recurrence rate in this group was compared with that of patients who had “negative” margins. Four histologic findings are classified as positive margins: (1) margin closeness (tumor within 0.5 cm), (2) premalignant change in the margin, (3) in‐situ cancer in the margin, and (4) invasive microscopic cancer at the margin. Patients with these variants showed a significant increase in local recurrence and in mortality when compared to those with negative margins. A review of the literature is presented, and recommendations are made for this clinical setting.
The pathology of head and neck tumors: Salivary glands, part 2
Authors: Batsakis John G. , Chinn Edwin , Regezi Joseph A. , Repola David A.
Published: February 2007

Acinic‐cell carcinomas and mucoepidermoid carcinomas remain somewhat controversial salivarygland lesions. Because of an ambiguity in the literature conceming their malignant potential and a lack of sufficient follow‐up periods, these carcinomas have been underestimated with respect to their morbidity and lethality. The failure of histopathologic evaluation to successfully predict the subsequent biologic course of these neoplasms should not mitigate treatment. Aciniccell carcinomas are usually isomorphic neoplasms having their genesis in the neoplastic reserve cells of the terminal portions of the duct system. Mucoepidermoid carcinomas, on the other hand, may be described as forming a histologic spectrum or continuum from the most highly differentiated to the most poorly differentiated malignancy. They arise from the interlobular and intralobular ducts. The histopathologic features of these two neoplasms are presented, along with a review of their biologic activity in humans.
Repair of the bilateral cleft lip: A personal approach
Authors: Pitanguy Ivo
Published: February 2007

The author presents his personal method of repairing a bilateral cleft lip, focusing on both the embryogenic factors of this condition and its anatomicfunctional abnormalities. The surgical technique used enables correction in a single operation through suture of the lateral portions at the midline and elevation of the bifurcated flap of the prolabium to form the columella and the nasal floor. The deep psychological, social, and economic impact of the pathology is discussed, and the importance of a one‐step surgical correction of the defect for the particular patient population at question is stressed.
Rhabdomyosarcoma of the head and neck: Diagnosis and management
Authors: Healy Gerald B. , Jaffe Norman , Cassady J. Robert
Published: February 2007

Rhabdomyosarcoma represents the most common soft‐tissue neoplasm of the head and neck found in children. The tumor is most commonly seen in Caucasian children under the age of 12, usually presenting as a painless mass. Distant metastases are frequently present, especially in regional lymph nodes, lung, and bone marrow. All patients suspected of having this disorder should have a thorough examination of the head and neck, as well as a complete radiographic evaluation of the primary region. Histologic diagnosis should be made as rapidly as possible. Once this has been accomplished, a thorough search for metastatic disease can be undertaken. Therapy must be individualized, and a team approach is advocated. The roles of surgery, radiation therapy, and chemotherapy are discussed. A staging system and a treatment‐therapy plan are outlined.
Prosthetic management of the maxillectomy patient
Authors: Harrison Richard E.
Published: February 2007

If maximal preservation of appearance and function are to be achieved for the maxillectomy patient, preoperative dental impressions should be obtained, and clear communication should be established between the surgeon and the prosthodontist. The immediate surgical splint, which can be used for edentulous as well as dentulous patients, provides numerous advantages for the patient and the surgeon. Surgical procedures that enhance the fit and comfort of a prosthesis include (1) making the mucosal incision 0.5 cm lateral to the bony cut, (2) extracting the first tooth on the resected side before making the bony cut, (3) preserving the premaxillary segment, (4) creating a skin‐graft mucosal‐scar band, (5) removing the entire velum when the surgical procedure requires resection of more than one‐half of the velum, and (6) evaluating the possible removal of the coronoid process.
Radiation therapy of the oral cavity: Sequelae and management, part 2
Authors: Beumer John , Curtis Thomas , Harrison Richard E.
Published: February 2007

This is the concluding portion of a two‐part series dealing with the effects and manifestations in the oral cavity of radiation therapy of head and neck tumors. Preradiation and postradiation extractions in dentulous patients, as well as dental maintenance of such patients (including fluoride treatments, follow‐up, and restorative care), are discussed. Guidelines for the dental management of edentulous patients are also presented at length (this section covers risk of bone necrosis, soft liners, timing of denture placement, dentures and preexisting bone necrosis, soft‐tissue necrosis and dentures, morbidity, and prosthodontic procedures). The article concludes with a brief discussion of osteoradionecrosis and soft‐tissue necrosis.
Interstitial‐implant radiotherapy in upperaerodigestive‐tract malignancy
Authors: Seagren Stephen L. , Syed A. M. Nisar , Byfield John E.
Published: February 2007

In the treatment of upper‐aerodigestive‐tract malignancy, interstitial‐implant radiotherapy differs in several physical and biologic respects from conventional external‐beam therapy: unlike external‐beam therapy, it can deliver a high central dose with a rapid fall‐off, which overcomes the central hypoxic resistance effect and yet greatly improves normal tissue tolerance. Externalbeam and interstitial‐implant therapy can also be combined to the patient's benefit; in many cases, this combination offers advantages over externalbeam therapy alone, preoperative external‐beam therapy, or aggressive surgery. The recent upsurge of interest in this modality has come about because of three developments: more suitable radioactive sources, afterloading, and computerized dosimetry. The early results in upper‐aerodigestive‐tract malignancy, both as primary and as salvage therapy, are promising; but the precise role of this treatment in our therapeutic armamentarium remains to be established.
Trichoepithelioma: Report of an unusual case and review of the literature
Authors: Osguthorpe J. D. , Calcaterra T. C.
Published: February 2007

Trichoepitheliomas are benign and uncommon skin tumors presenting in the head and neck region. Although they can be solitary, they occur more frequently as multiple lesions with an autosomal dominant inheritance. To the surgeon, they often present the problem of clinical differentiation from basal‐cell carcinoma. An unusual case is described, and experience in the treatment of 19 patients is reviewed.
Complications of radical neck dissection: A survey of 788 patients
Authors: McGuirt W. Frederick , McCabe Brian F. , Krause Charles J.
Published: February 2007

Radical neck dissection remains the keystone to modern head and neck surgery. Like any major operation, it has inherent complications. These complications become greater when the procedure is combined with resection of primary lesions of the upper food and air passages, and when it follows radiation therapy. In this series, 788 patients with head and neck cancer underwent radical neck dissection alone or in combination with resection of a primary lesion, some with and some without irradiation; the overall complication rate was 50.8%. The total rate included 16.2% of the patients having one or more major surgical complications, 33.5% having one or more minor surgical complications, and 28% having one or more medical complications. The complications are reported in detail to allow comparison with other series and to give a true indication of the overall incidence of the risks involved in major head and neck cancer surgery.
The teaching‐case conference
Authors: Gordon Bruce R.
Published: February 2007

A clinicopathologic conference is held on a 51‐year‐old smoker and reformed alcoholic with unilateral nasal mass causing obstruction and epistaxis. The workup, radiologic studies, differential diagnosis, surgical approach, pathology, and therapy are summarized, and the literature is reviewed. Emphasis is placed on the value of preoperative angiography in evaluating unusual masses, and on the importance of electron microscopy in definitive diagnosis.
Orbital diagnosis
Authors: Grove Arthur S.
Published: February 2007

Accurate localization and diagnosis of orbital lesions is necessary to select the appropriate treatment. A systematic method of evaluating a patient with orbital disease is presented. The most common orbital lesions among children and adults are listed, and abnormalities that mimic exophthalmos are described. The tests that are most useful in evaluating orbital disease are described in detail. Several case reports illustrate the value of ultrasonography and three‐dimensional computed tomography in the localization and diagnosis of space‐occupying lesions of the orbit. Special tissue‐processing techniques can be performed on some tumors to aid in establishing a diagnosis and in planning treatment.
Embryonic development of the head and neck: Part 2, the branchial region
Authors: Wilson Doris B.
Published: February 2007

The embryology of the branchial (pharyngeal) region is reviewed in terms of the embryonic pharynx, branchial apparatus and derivatives, tongue, larynx, and trachea. Derivatives of the branchial pouches, grooves (clefts), and arches are analyzed in relation to each other and to the first arch syndrome. Other common head and neck defects attributable to abnormal development of the branchial region are also discussed, particularly those defects involving the incomplete degeneration or the abnormal migration of branchial tissues.
Treatment of carcinoma of the hypopharynx
Authors: Horwitz Steven D. , Caldarelli David D. , Hendrickson Frank R.
Published: February 2007

In a review of 80 patients with hypopharyngeal squamous‐cell carcinoma, 43 patients were found to have had lesions arising in the pyriform sinus, 34 had lesions arising on the postcrolateral wall of the hypopharynx, and 3 had lesions in the postcricoid area. Therapeutic modalities included radical radiation therapy in 56 patients, radiation plus surgery in 13 patients, and planned combined therapy in 11 patients. The five‐year determinate survival rate of all the patients was 20%. Patients with posterolateral wall tumors had a 23% rate of cure, but those with pyriform sinus tumors had only a 13% rate of cure. The five‐year determinant survival rate was 12.5% for patients undergoing radical radiation therapy, 15.4% for those undergoing unplanned radiation and surgery (salvage therapy), and 55.6% for those with planned combined therapy. Over 40% of the patients had a recurrence of their disease; an additional 20% developed distant metastatic spread which usually occurred within the first year. The type of therapy did not alter the rate of recurrence but did affect the rate of distant metastatic spread, with planned combined therapy greatly improving control of the primary lesion. This study suggests that, even with advanced disease, the most effective therapy for hypopharyngeal carcinoma is planned combined radiation therapy and surgery.
Juvenile nasopharyngeal angiofibroma: Management of intracranial extension
Authors: Jafek Bruce W. , Krekorian Edmund A. , Kirsch Wolff M. , Wood Raymond P.
Published: February 2007

Juvenile nasopharyngeal angiofibroma (JNA) is a histologically benign, locally invasive tumor of the nasopharynx that is found primarily in the pubescent male. While most authors recommend surgical excision for smaller, localized extracranial tumors, opinion varies on the management of more aggressive tumors with intracranial extension. The authors present their experience over the past 15 years with 15 cases of JNA with intracranial extension, and formulate a plan of management. A combined otolaryngologic/neurosurgical approach is recommended in order to assess the extent of the tumor and to isolate feeding vessels. Lateral extension into the middle cranial fossae should be resected in continuity with the nasopharyngeal component, which is approached from below in a separate operative field. Medial extensions are transected, verified angiographically three months after surgery, and irradiated. The results of therapy are presented, and a case of dural penetration by JNA is described.
Embryonic development of the head and neck: Part 3, the face
Authors: Wilson Doris B.
Published: February 2007

The embryology of the face is presented with respect to changes affecting the mandible, maxilla, upper and lower lips, palate, nose, and oral cavity. The embryonic development of the teeth and salivary glands is also included. Various facial clefts, including cleft lip and cleft palate, are discussed, in addition to some congenital anomalies affecting the nose and oral cavity.
Transoral mandibulectomy in advanced osteoradionecrosis
Authors: Klein James Cyrus
Published: February 2007

Because vascularity is severely compromised following radiation therapy, aseptic necrosis with secondary infection and extensive bone destruction can result in an advanced state of osteoradionecrosis. Transoral mandibulectomy is an excellent method for dealing with this difficult problem. This article discusses technical aspects of the procedure as well as applied anatomy and a case report. Evidence in the recent literature concerning hyperbaric oxygen therapy is very encouraging.
Angiographic variant in juvenile nasopharyngeal angiofibroma
Authors: Shrewsbury Donald W. , Meyerhoff William L.
Published: February 2007

A 17‐year‐old male with juvenile nasopharyngeal angiofibroma was found, on preoperative evaluation, to have a normal selective angiogram of the internal and external carotid artery system. Possible explanations for this variant include and atypical blood supply from the vertebral artery system, the thyrocervical trunks, or from an ascending pharyngeal artery that branched low from the external carotid artery.
Fluorescein test in the prediction of viability of skin flaps on pigs
Authors: Bardach Janusz , Panje William R.
Published: February 2007

The fluorescein test is widely used in clinical and experimental studies for prediction of the viability of skin flaps. A thorough search of the literature revealed that the accuracy of this test had never been studied. Therefore, this study was designed to evaluate the accuracy of the fluorescein test in predicting the viability of skin flaps. A total of 212 unipedicle porcine skin flaps were used in this study. Statistical analysis demonstrated that the surviving area of the flap was significantly greater than the staining area of the flap. We suggest that caution be exercised when the fluorescein dye test is used to assess skin flap viability and that the test be used for an approximate indication and not for an accurate prediction of the surviving flap area.
Reconstruction of the pharynx and upper esophagus after resection for cancer
Authors: Desanto Lawrence W. , Carpenter Robert J.
Published: February 2007

Construction of a new gullet after circumferential resection of the pharynx and upper portion of the esophagus for cancer is a major challenge to the head and neck surgeon. Techniques for reconstruction use cervical skin, adjacent pedicle flaps, and interposed visceral segments. Each technique has its place; none is ideal or free from complication or failure. Cure rates are poor, and unsolved problems remain. The quest for the perfect technique must continue, but the ultimate solution rests not with reconstruction techniques but with earlier diagnosis and elimination of the need for reconstruction.
The application of hair‐bearing flaps in head and neck surgery
Authors: Wilson J. S. P. , Galvao M. S. L. , Brough M. D.
Published: February 2007

The history of hair‐bearing flaps is presented. A study of the vascular supply of the scalp with a particular emphasis on the posterior branch of the superficial temporal artery revealed that it was possible to transpose the entire scalp or any hairbearing flap on a long, highly mobile, narrow pedicle containing this vessel. Clinical application of this finding to postexcisional defects allowed the reconstruction of hairline, eyebrows, sideburns, and various shapes of beards and moustaches. The technique was used on 80 occasions to produce various cosmetic units and proved to be a safe procedure.
Angiolymphoid hyperplasia with eosinophilia: A disease that may be confused with malignancy
Authors: Barnes Leon , Koss William , Nieland Michael L.
Published: February 2007

Twelve new cases of an unusual, benign vasoproliferative and inflammatory disorder of unknown etiology, angiolymphoid hyperplasia with eosinophilia (ALHE), are described and contrasted clinically and pathologically with those appearing in the literature. Only recently recognized in the United States, the disease is of singular importance because the vascular component may be confused histologically with angiosarcoma, thereby resulting in unwarranted aggressive therapeutic measures. ALHE characteristically affects adults and presents in the head and neck region as either solitary or multiple cutaneous tumors. The lesions are pruritic, frequently bleed after minor trauma, and may be associated with peripheral eosinophilia and regional lymphadenopathy. On rare occasions, the disease may masquerade as a salivary‐gland tumor, cause stenosis of the external auditory canal, or present as an osseous lesion of the skull. Extrafacial tumors are uncommon. Excision is the most frequent form of therapy; however, local irradiation, corticosteroids, electrodessication with curettage, and chemotherapy have also had varying degrees of success.
Surgical treatment of midface deformities
Authors: Champy Maxime
Published: February 2007

Midface deformities may be treated either by osteotomies that advance the maxilla or by osteotomies that retract the mandible. A transfacial technique is presented by which the cheekbones, the infraorbital rim, and the superior dental arch are advanced. The indications for this intervention are more widespread than those for Le Fort I osteotomies or mandibular osteotomies. Postoperative complications and risks of recidivism are reduced for this method because of the use of small screw‐on plates for frontomalar osteosynthesis. Fifty‐two cases of osteotomy are presented with special consideration of problems caused by bone grafting and post‐operative occlusion and with a discussion of the factors responsible for relapse.
Anatomy of the superficial temporal artery
Authors: Stock Alden L. , Collins Hamilton P. , Davidson Terence M.
Published: February 2007

The anatomy of the superficial temporal artery was investigated in radiographic and cadaveric studies. The superficial temporal artery divides into an anterior and posterior branch, and the diameters of these vessels are similar. The anatomy of these two vessels is described, and implications for their use in reconstructive flaps are suggested.
Nasopharyngeal carcinoma: Clinical course and results of therapy
Authors: Baker Shan R.
Published: February 2007

Ninety‐nine patients with carcinoma of the nasopharynx were reviewed. No significant relationship was found between T classification and survival or between tumor cell type and survival. The presence of regional metastases, however, did influence the outcome of therapy. A 5‐year survival of 34.4% was recorded for patients without nodal disease in contrast to 14% for patients with massive lymphadenopathy or bilateral cervical metastases. The significance of regional metastases is supported by the relationship between survival and disease stage. The 5‐year survival for stage I was 67%, while the average survival for stages III and IV was 21%. The average 3‐ and 5‐year survivals for the entire series of patients were 36.2% and 23.9%, respectively. Early lesions confined to the primary site have the greatest chance of cure, but even advanced disease with bone destruction or cranial nerve involvement may be controlled with radiotherapy in some cases. Patients who develop cervical metastases following successful control of nasopharyngeal tumor may be cured by radical neck dissection. Two (28.6%) of seven patients undergoing surgical treatment survived for 10 years following neck dissection.
A review of vascular anastomosis with mechanical aids and nonsuture techniques
Authors: Lee Sun , Wong Louis , Orloff Marshall J. , Nahum Alan M.
Published: February 2007

Devices and techniques for nonsuture vascular anastomosis and for suture anastomosis with minimum blood flow interruption are reviewed from their beginnings in the late 19th century through the development of microvascular surgery in the 20th century. The various devices that have been invented fall into 3 basic categories: butt, flanged, and lapped joints. Although the development of microsurgical instruments and the improvement of suture materials have diminished the use of such mechanical aids in recent years, it is hoped that this historical overview will be of interest to investigators involved in the surgery of vessels of various calibers.
Craniospinal and cervicospinal malformations associated with maxillonasal dysostosis (binder syndrome)
Authors: Resche F. , Tessier P. , Delaire J. , Tulasne J. F.
Published: February 2007

Craniospinal and cervicospinal malformations were found in 15 (53.5%) of 28 cases of maxillonasal dysostosis (Binder syndrome) in which a complete radiographic analysis could be done. These anomalies have not been reported previously. Analysis of the anomalies suggested a common induction factor, or, at least, a simultaneity in the development of the maxillonasal and vertebral dysplasias that characterize Binder syndrome. The following procedures are recommended: (1) examination of the cranial and cervical spine in all subjects with symptoms of Binder syndrome, and (2) regular examination of patients with spinal malformations, so that any neurologic damage may be detected early.
Embolization of hemorrhage caused by carcinoma of the pharynx
Authors: Griska Linda B. , Aghamohamadi Ali M. , Marlowe Frank I. , Gonzales Carlos F.
Published: February 2007

A patient with severe bleeding due to carcinoma of the pharynx, uncontrollable by surgical intervention, was successfully treated by bilateral transcatheter embolization of the external carotid arteries using gel‐foam. Although these lesions may appear hypovascular angiographically, this does not preclude embolization as a valuable therapeutic technique. Our experience with this patient indicates that transcatheter embolization is an especially appropriate approach to controlling bleeding in patients with extensive malignant disease when no other therapy is available.
Internal jugular vein thrombosis
Authors: McNeill Roger
Published: February 2007

This article presents 3 cases of internal jugular vein thrombosis secondary to central venous cannulation. Two patients were symptomatic with tender cervical swelling. In the third patient, the venous thrombosis was discovered as an incidental finding during major head and neck surgery. All patients responded to conservative management, and there were no instances of embolic phenomena.
Reconstruction of massive orbito‐maxillary‐cheek defects
Authors: Sako Kumao , Razack Mohamed S. , Kalnins Inars
Published: February 2007

The problem of soft‐tissue reconstruction in patients who must undergo radical resection of the maxilla, orbit, and cheek is discussed. This problem is greatly complicated by previous radiation therapy or by the need for postoperative radiation therapy. Restoration of oral competence is of primary importance and usually cannot be satisfactorily accomplished with prosthetic appliances when a stable support base is lacking. An orderly reconstructive plan with a high success rate is of the utmost help to the surgeon facing this problem. A multistaged procedure utilizing a deltopectoral flap that has been successful in 7 patients is presented.
Management of thyroid nodules. II: Scanning techniques, thyroid suppressive therapy, and fine needle aspiration
Authors: Ashcraft Michael W. , Van Herle Andre J.
Published: February 2007

For the differentiation of benign from malignant thyroidal disease, ultrasound displays anatomic but not histologic features. Other visualization techniques can be used including isotope scanning (radioiodine, 99mtechnetium, 241americium fluorescence, 131cesium, 67gallium, 75selenomethionine, 201thallium, 32phosphorus, 99mTc‐bleomycin, 197mercury, 133xenon), thermography, x‐ray techniques (plain films, computed tomographic scan, xeroradiography, chest x‐ray, barium swallow, lymphography, angiography), and thyroid hormone suppression. Needle biopsy can be done by core biopsy (Vim‐Silverman and drill biopsy), large needle biopsy for histologic processing and fine needle aspiration for cytologic interpretation. The latter is the safest, most reliable, and most cost‐effective technique currently available to differentiate between benign and malignant thyroidal disease and has great promise for the future.
Mandibular “swing” approach for oral and oropharyngeal tumors
Authors: Spiro Ronald H. , Gerold Frank P. , Strong Elliot W.
Published: February 2007

This study reviews the history, indications, and operative technique for median mandibulotomy with paralingual extension (mandibular “swing”). A 21‐year experience is presented, during which this operative approach was used in 49 patients with tongue cancer and 16 others with oropharyngeal lesions. Mandibular “swing” appears to offer more versatility and fewer problems than either median labiomandibular glossotomy or lateral mandibulotomy. Good local control can be anticipated in properly selected patients because the tumor exposure is comparable to that achieved in operations involving jaw resection.
Management of neoplasms of the head and neck in children. I. Benign tumors
Authors: Handler Steven D. , Raney R. Beverly
Published: February 2007

The otolaryngologist who treats children must have knowledge of the neoplasms that can occur in childhood. Such tumors are usually mesenchymal in origin and may be benign or malignant. Diagnosis and management of the more common benign tumors are undertaken by the otolaryngologist because local excision is generally curative. The proper treatment of malignant lesions requires a more extensive, multidisciplinary team, which includes a pediatric oncologist, diagnostic and therapeutic radiologist, and pathologist, in addition to the otolaryngologist. The purposes of this paper are to outline the types of benign and malignant neoplasms that occur in childhood and to discuss current approaches to therapy.
A ganglion of the temporomandibular joint presenting as a parotid tumor
Authors: Kinkead Lewis R. , Bennett James E. , Tomich Charles E.
Published: February 2007

A case of temporomandibular joint (TMJ) ganglion is described, and 4 previously reported cases are noted. In all cases, initial diagnosis of parotid neoplasm proved incorrect at surgical exploration. Management of all cases consisted of identification of the facial nerve and excision of the ganglion with a cuff of TMJ capsule. The diagnosis of TMJ ganglion should be entertained when a presumed parotid neoplasm changes in size or position with jaw movement.
Diagnosis of salivary gland tumors by fine needle aspiration biopsy
Authors: Sismanis Aristides , Merriam Joseph M. , Kline Tilde S. , Davis R. Kim , Shapshay Stanley M. , Strong M. Stuart
Published: February 2007

The cytologic findings of 51 smears obtained by fine needle aspiration biopsy from salivary gland masses were compared with the histologic findings of permanent sections. The overall concurrence rate between cytologic and histologic findings for benign and malignant lesions was 91%. The diagnostic accuracy (exact histologic diagnosis) for the benign lesions was 87% and for the malignant tumors 60%. One case showed false‐positive results and 1 case false‐negative results. Fine needle aspiration biopsy has been found to be safe, free of complications, and helpful in the planning of treatment.
Thyroid function after radiotherapy and laryngectomy for carcinoma of the larynx
Authors: Palmer B. V. , Gaggar N. , Shaw H. J.
Published: February 2007

Total levels of thyroxine (T4) and thyroid‐stimulating hormone (TSH) were measured in 37 patients who had previously had carcinoma of the larynx treated by radiotherapy and total laryngectomy with thyroid lobectomy. Ten percent of the patients had clinical features of hypothyroidism and 30% had total T4 levels below the lower limit of normal. A further 40% had results in the low normal range. Forty‐four percent of patients had raised TSH levels, 90% of these having low or low normal T4 levels. The histology of the thyroid gland was normal in all 37 patients. Attention should be given to preserving intact the vasculature of the contralateral thyroid lobe whenever it is necessary to remove the ipsilateral thyroid lobe during a laryngectomy. Proper postoperative assessment of thyroid gland function is desirable in all these patients to identity those at risk of hypothyroidism and to avoid unnecessary morbidity.
Peripheral nerve sheath tumors of the paranasal sinuses
Authors: Shugar Joel M. A. , Son Peter M. , Biller Hugh F. , Som Max L. , Krespi Yosef P.
Published: February 2007

Only 4% of peripheral nerve sheath tumors of the head and neck occur in the paranasal sinuses. The most commonly involved sinus is the maxillary antrum and the most common histologic type is benign schwannoma. Two new cases of schwannoma occurring in the sphenoid and maxillary sinuses are reported. The clinical pathologic, and radiographic features of these lesions are reviewed.
Clinical pharmacology of bleomycin and cisplatin
Authors: Evans William E. , Yee Gary C. , Crom William R. , Pratt Charles B. , Green Alexander A.
Published: February 2007

Bleomycin (Blenoxane) and cisplatin (Platinol) are two anticancer drugs with activity for head and neck tumors. Introduced into clinical use in the past ten years, bleomycin is used primarily in the chemotherapy of squamous cell carcinomas, lymphomas, and testicular carcinoma, while cisplatin is effective against testicular and ovarian carcinoma, head and neck cancer, bladder cancer, and neuroblastoma. Bleomycin is rapidly excreted renally (T1/2β = 2‐4 hr) although enzymatic inactivation also occurs in many tissues. Cisplatin is nonenzymatically converted to highly protein‐bound metabolites, which then undergo renal elimination, but total body clearance occurs much more slowly than with bleomycin (T 1/2β = 40‐50 hr). Both agents have acute and chronic toxicities; the acute toxicities are generally reversible but cause a great deal of patient discomfort, while the chronic toxicities are often irreversible and dose‐limiting. For bleomycin, the acute toxicities are mucocutaneous and pyretic, while severe nausea and vomiting represent the major acute toxicities of cisplatin therapy. Cumulative dose‐related pulmonary toxicity is the most serious chronic toxicity of bleomycin. The clinical, radiographic, and pathologic presentations are nonspecific, although identification of high‐risk patients may be possible with serial pulmonary function tests. Cumulative nephrotoxicity occurs with cisplatin use and its incidence and severity can be reduced by maintaining adequate hydration and diuresis during and following administration of the drug.
Exenteration of the orbit using a frontal periosteal flap
Authors: Sevel D.
Published: February 2007

The technique of exenteration of the orbit described is used for orbital malignancies confined to the orbit without lid involvement and without overt evidence of metastases. The exenterated orbit is covered by a periosteal flap derived from the frontal bone. The procedure is simple, shortens the duration of the operation and allows for both pre‐ and postoperative radiotherapy. The procedure is particularly useful in children because of the minimal blood loss compared with exenteration using a temporalis muscle flap.
Postoperative recurrent nerve palsy
Authors: Hockauf Heidemarie , Sailer R.
Published: February 2007

During the past seven years, a total of 1,713 patients underwent strumectomy for a variety of causes at the University of Düsseldorf. Unilateral palsies of the recurrent nerve developed in 147 patients. Both vocal cords were paralyzed in 22 patients. Of the 147 patients with unilateral palsies, 53 patients were available for follow‐up examination after one year. In 28 of these patients, complete paresis of the vocal cord remained. Twenty‐three patients showed complete recovery and normal function of the affected cord. In two patients, reduced but marked mobility of the previously completely paralyzed vocal cord was present. Of the 22 patients with bilateral recurrent nerve palsies, 10 were available for follow‐up examination one year later. In three of these patients vocal cord movement was still absent, in three others one vocal cord showed normal function, and in only one patient did both vocal cords reveal normal physiologic mobility. Three other patients demonstrated a reduced but marked mobility of one vocal cord. The results are discussed in relation to the clinical and histologic data.
The current status of carotid artery surgery
Authors: Bardin Joshua A. , Bernstein Eugene F.
Published: February 2007

The natural history of extracranial cerebrovascular disease and available alternatives in its treatment are reviewed. An evaluation of the evidence suggests that carotid endarterectomy is the treatment of choice in patients with transient ischemic deficits, provided that an anatomically appropriate lesion can be identified. These patients have a 25‐38% chance of stroke if untreated, which can be reduced to 5‐10% by carotid endarterectomy. Patients with asymptomatic carotid stenosis who are good operative risks are also candidates for surgery, although this issue remains controversial. Patients with small asymptomatic ulcerated carotid plaques have a relatively benign prognosis and should not undergo preventive carotid surgery. Carotid surgery is occasionally indicated in patients with vertebral basilar insufficiency and carotid stenoses, fibromuscular dysplasia, or carotid kinks associated with symptoms of ischemia. Carotid endarterectomy may be performed with an overall mortality of 1‐2% and morbidity of 2‐5% if the patients are carefully selected and the surgical team is expert.
Manifestations and management of laryngoceles
Authors: Baker Herbert L. , Baker Shan R. , McClatchey Kenneth D.
Published: February 2007

Six cases of laryngocele are reported including 2 bilateral, external laryngoceles, 1 internal laryngocele associated with amyloidosis, and 3 combined laryngoceles. Laryngoceles occur predominantly in males. Cervical mass and hoarseness were the most common signs and symptoms. Bilateral, external laryngoceles that decompress spontaneously when intralaryngeal air pressure returns to normal were managed conservatively. Combined and internal laryngoceles should be removed surgically through an external, lateral neck approach. This approach is preferable to anterior laryngofissure because it avoids trauma to the anterior commissure and the true vocal cords. In addition, blunting of the anterior commissure and the risk of subglottic stenosis are avoided.
Management of inadvertent injury to the carotid artery during head and neck surgery
Authors: Sobol Steven M. , Freeman Richard , Thawley Stanley , Little John , Beven Edwin
Published: February 2007

Rare, inadvertent injury to the carotid artery during head and neck surgery may result in disastrous neurologic sequelae or even death. Several cases are presented and used as the stimulus for an analytical discussion of the pathogenesis and management of cerebrovascular complications following head and neck surgery. The major pathogenetic mechanisms are identified as (1) microembolism from an ulcerated plaque; (2) intravascular thrombus with occlusion; (3) unintentional ligation, laceration, or transection; (4) ligation of a dominant external carotid; and (5) transient reduction in cerebrovascular perfusion pressure. Methods for identifying and evaluating the patient at risk for developing cerebrovascular complications are discussed and recommendations are made. The central question in the management of inadvertent arterial injury concerns whether to ligate the vessel or to restore blood flow. The controversies surrounding this issue are discussed in perspective through an analysis of current physiological concepts and of the collective clinical experiences of head and neck, vascular, and neurological surgeons handling extracranial cerebrovascular occlusive disease, penetrating injuries to the carotid artery, and tumor‐related carotid catastrophes. Several factors are considered critical in determining appropriate management of any individual case; these include (1) whether recognition of the injury occurs intraoperatively or postoperatively; (2) the presence and severity of neurological deficits; (3) time from the injury to its recognition; (4) a quantitative assessment of collateral circulation; (5) a history of wound contamination or radiation therapy; (6) overall prognosis. These and other considerations are organized into a working framework through which the otolaryngologist and head and neck surgeon can better understand and manage the problem of inadvertent injury to the carotid artery.