Showing papers in "Head & Neck Surgery in 1981"
TL;DR: For the differentiation of benign from malignant thyroidal disease, ultrasound displays anatomic but not histologic features as discussed by the authors, which is the safest, most reliable, and most cost-effective technique currently available.
Abstract: 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, 99m technetium, 241 americium fluorescence, 131 cesium, 67 gallium, 75 selenomethionine, 201 thallium, 32 phosphorus, 99m Tc-bleomycin, 197 mercury, 133 xenon), 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.
331 citations
TL;DR: Mandibular "swing" appears to offer more versatility and fewer problems than either median labiomandibular glossotomy or lateral mandibulotomy.
Abstract: 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.
152 citations
TL;DR: There are three principal malignant vasoformative tumors that can be found in the head and neck--hemangiopericytoma, angiosarcoma, and Kaposi's sarcoma; all are uncommon and provide challenges for the pathologist and the therapist both.
Abstract: There are three principal malignant vasoformative tumors that can be found in the head and neck--hemangiopericytoma, angiosarcoma, and Kaposi's sarcoma All are uncommon and provide challenges for the pathologist and the therapist both The histogenesis of each tumor is different Kaposi's sarcoma has many features which suggest that it is an altered immune-response disease Angiosarcoma is a malignancy of endothelium Hemangiopericytoma is a tumor whose cell of origin is considered to be the perithelial pericyte The general prognosis for patients with Kaposi's sarcoma is good The biologic course of a hemangiopericytoma is variable and unpredictable, but there appears to be a site dependency Angiosarcomas, particularly high grade lesions, are resistant to therapy
148 citations
TL;DR: The approach to the management of the thyroid nodule remains controversial because virtually any thyroidal disease can present as a clinically solitary nodule and there is no uniformity regarding natural history, incidence, prevalence, epidemiology, and pathophysiology.
Abstract: The approach to the management of the thyroid nodule remains controversial Confusion exists because virtually any thyroidal disease can present as a clinically solitary nodule which means there is no uniformity regarding natural history, incidence, prevalence, epidemiology, and pathophysiology The variety of definitions of thyroid nodules and thyroid carcinoma and the different modes of study selection and individual bias add to the confusion Diagnostic approaches have not yielded a completely reliable technique to differentiate benign from malignant thyroidal disease A history of neck irradiation of cervical lymphadenopathy significantly increases the chance of thyroid malignancy, but other parameters of the history or physical examination as well as blood tests are unreliable Ultrasound displays anatomic but not histologic features X-ray techniques (plain films, computed tomographic scans, xeroradiography, chest x-ray, barium swallow, lymphography, and angiography) have been used to visualize thyroid nodules, with some techniques proving more useful than others
134 citations
TL;DR: A staging system for juvenile angiofibroma based on computerized tomographic findings is suggested, and with the application of consistent diagnostic tools and standardized stage designations, the analysis of both morbidity and treatment data will become more meaningful.
Abstract: A staging system for juvenile angiofibroma based on computerized tomographic findings is suggested. The need for such an endeavor has come about because of a lack of standardization of tumor data in both individual series and interinstitutional reports. The various stages reflect the number of anatomic sites occupied by a lesion rather than the actual tumor size. The “simpler” tumors are confined to the medial part of the skull base and are entirely extracranial. As a tumor extends laterally and/or intracranially, the staging designation, and therefore the treatment plan, changes accordingly. Presumably, with the application of consistent diagnostic tools and standardized stage designations, the analysis of both morbidity and treatment data will become more meaningful.
108 citations
TL;DR: The cytologic findings of 51 smears obtained by fine needle aspiration biopsy from salivary gland masses were compared with the histology findings of permanent sections and diagnostic accuracy for the benign lesions was 87% and for the malignant tumors 60%.
Abstract: 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.
62 citations
TL;DR: The diagnosis of Branchiogenic carcinoma is more a conceptual than a literal clinicopathologic entity, and the diagnosis should be made with reluctance and only after fulfillment of several rather stringent criteria.
Abstract: Metastases from carcinomas to the head and neck, either to lymph nodes or to extranodal sites, arise most often from known primary neoplasms. However, some are from a clinically inapparent neoplasm--the so-called occult primary. If the metastasis is an epidermoid carcinoma in a lymph node, the odds clearly favor the primary being in the upper aerodigestive tract. The success rate of discovery is variable, however, and a significant number of primaries remain undetected. Metastatic adenocarcinomas, to either nodal or extranodal sites, are most often from infraclavicular neoplasms. In general, the incidence of metastases to the head and neck from visceral primaries below the clavicle follows the general incidence of the primary cancer itself. Renal-cell carcinoma is the exception since its frequency of metastases to the head and neck exceeds the expected incidence in the general population. Branchiogenic carcinoma is more a conceptual than a literal clinicopathologic entity. The diagnosis should be made with reluctance and only after fulfillment of several rather stringent criteria.
55 citations
TL;DR: Two cases are presented in which there was massive necrosis of the soft tissues of the neck with extension into the mediastinum and the offending organisms were a mixed bacterial flora which produced gangrene accompanied by subcutaneous emphysema.
Abstract: Necrotizing fascitis of the head and neck is a rare condition with only 7 cases recorded in the literature. Two cases are presented in which there was massive necrosis of the soft tissues of the neck with extension into the mediastinum. The offending organisms were a mixed bacterial flora which produced gangrene accompanied by subcutaneous emphysema. Both patients were successfully treated with a regimen of intravenous antibiotics, fasciotomy, radical debridement, and hyperbaric oxygenation (1 case). The clinical features, bacteriology, and treatment of necrotizing faciities are reviewed.
52 citations
TL;DR: A classification of lower lip involvement is presented, the various modes of treatment are reviewed, and surgical techniques for providing a pouting lower lip vermilion are described.
Abstract: Carcinoma of the lip arises in the strip of exposed mucosa between the mucocutaneous junction and the point of contact of the lips. Removal of the entire area at risk usually prevents recurrence or the development of a second primary tumor. A classification of lower lip involvement is presented, the various modes of treatment are reviewed, and surgical techniques for providing a pouting lower lip vermilion are described.
51 citations
TL;DR: Only 4% of peripheral nerve sheath tumors of the head and neck occur in the paranasal sinuses and the most commonly involved sinus is the maxillary antrum.
Abstract: 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.
44 citations
TL;DR: Proper postoperative assessment of thyroid gland function is desirable in patients with previously had carcinoma of the larynx treated by radiotherapy and total laryngectomy with thyroid lobectomy to identify those at risk of hypothyroidism and to avoid unnecessary morbidity.
Abstract: 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 identify those at risk of hypothyroidism and to avoid unnecessary morbidity.
TL;DR: Non-Hodgkin's lymphoma of the nose and paranasal sinuses occurred in 14 men and 3 women with a mean age of 61 years, and poor response to radiation therapy and dissemination of lymphoma were poor prognostic indicators.
Abstract: Non-Hodgkin's lymphoma of the nose and paranasal sinuses occurred in 14 men and 3 women with a mean age of 61 years. Nasal obstruction, unilateral facial swelling, and nasal discharge were frequent initial manifestations. The maxillary sinus and nose were the commonest primary sites. Using Rappaport's classification, there were 9 histiocytic, 5 poorly differentiated lymphocytic, and 3 mixed histiocytic-lymphocytic lymphomas. Sixteen patients had radiation therapy to the primary site, and 9 patients later received chemotherapy. Eleven patients (69%) are dead, with a median survival time of 11 months after diagnosis. Dissemination of lymphoma was the most common cause of death. Five patients (29%) are alive up to 40 months after diagnosis. Patients with poorly differentiated lymphocytic lymphoma survived longer than those with histiocytic or mixed histiocytic-lymphocytic lymphomas (median survival times 35, 9, and 12 months, respectively). Poor response to radiation therapy and dissemination of lymphoma were poor prognostic indicators.
TL;DR: This report presents and argument in favor of using the WHO classification and a hypothesis relating to the histogenesis of the 3 types of nasopharyngeal carcinomas as squamous-cell, nonkeratinizing, and undifferentiated.
Abstract: The past decade has witnessed extraordinary advances in the epidemiology, virology, and immunology of carcinomas of the nasopharynx. There has not been a parallel growth in the study of morphologic expressions of the neoplasms. In great part, this has been due to a lack of a universally accepted histologic classification. As a consequence, correlation between histology and other factors relating to the pathogenesis of these neoplasms has been impeded. The World Health Organization (WHO) has proposed a histologic classification of nasopharyngeal carcinomas as squamous-cell, nonkeratinizing, and undifferentiated. This report presents and argument in favor of using the WHO classification and a hypothesis relating to the histogenesis of the 3 types of nasopharyngeal carcinoma.
TL;DR: Bleomycin (Blenoxane) and cisplatin (Platinol) are two anticancer drugs, with activity for head and neck tumors, that were introduced into clinical use in the past ten years.
Abstract: 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 (T 1/2 beta = 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 1/2 beta = 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.
TL;DR: The routine use of total rhinectomy for early carcinoma or radiation failure is unwarranted and other primary cancers are not uncommon when followup is extended to the 5- to 10-year interval.
Abstract: Forty-two patients with squamous cell carcinoma of the nasal vestibule were reviewed. The patients were treated at either the Southern California Permanente Medical Group or the UCLA Medical Center. Thirty-eight patients (90%) had early lesions and 4 (10%) had late disease (involving the nodes or bone). The following conclusions were formed from this study: (1) Patients without bone destruction or lymph node metastases will do well with either irradiation or surgery. Those with bone destruction or lymph node metastases will do poorly in spite of radical treatment. (2) Early lesions can often be cured with either partial rhinectomy or irradiation. (3) A surgical recurrence following partial rhinectomy can be salvaged with irradiation. (4) A radiation recurrence of an early lesion can be salvaged with surgery. (5) The routine use of total rhinectomy for early carcinoma or radiation failure is unwarranted. (6) Other primary cancers are not uncommon when followup is extended to the 5- to 10-year interval.
TL;DR: Two patients with benign symmetrical lipomatosis (madelung's disease) have been followed for 7 and 9 years and despite extensive surgical procedures, both patients have developed multiple recurrences.
Abstract: Two patients with benign symmetrical lipomatosis (Madelung's disease) have been followed for 7 and 9 years. Despite extensive surgical procedures, both patients have developed multiple recurrences. Lipomas and normal adipose tissue from the same patients were compared using chromatographic techniques. The lipomas contained significantly increased triglyceride fractions. Conservative surgical debulking is the recommended treatment.
TL;DR: A 38-year-old male suffered from mediastinitis, pericarditis, and bilateral sudden pyopneumothorax as a complication of the parapharyngeal abscess that ruptured into the hypopharynx as well as the therapeutic and surgical approaches.
Abstract: A 38-year-old male suffered from mediastinitis, pericarditis, and bilateral sudden pyopneumothorax as a complication of the parapharyngeal abscess that ruptured into the hypopharynx. The full diagnosis remained obscure until the complete clinical picture evolved. Antibiotics and pleural and cervical drainage failed to alleviate the symptoms. Recovery commenced only after tamponade of the retropharyngeal space, which terminated the flow of air and saliva from the neck to the thorax. The anatomic relation of the spaces concerned are discussed, as well as the therapeutic and surgical approaches. the importance of the retropharyngeal space, which may serve as a conduit between the neck and the mediastinum, is pointed out.
June1
TL;DR: In this article, a prospective study of laryngoscopy, conventional tomography, and computed tomography (CT) in relation to pathologic findings of laryngeal tumors was conducted.
Abstract: Recent interest in the application of computed tomography (CT) to the evaluation of laryngeal tumors, and the fact that the larynx offers the unique opportunity of whole organ study after total laryngectomy, led to a prospective study of laryngoscopy, conventional tomography, and CT in relation to pathologic findings. The results showed that CT gives an exact assessment of laryngeal anatomy and tumor involvement, particularly in the paracordal and pre-epiglottic spaces. The laryngeal cartilages, which are not well demonstrated by any other means, are accurately delineated by CT. There is also good demonstration of the laryngeal surface of the epiglottis, including the anterior commissure, which is poorly shown by other radiologic methods and is sometimes poorly seen on laryngoscopy. Because CT and conventional tomography present images at 2 different planes, at right angles to each other, we believe that CT is entirely complementary to conventional tomography.
TL;DR: The diagnosis of TMJ ganglion should be entertained when a presumed parotid neoplasm changes in size or position with jaw movement.
Abstract: 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.
TL;DR: Preliminary results suggest that long term intraarterial infusion chemotherapy for the treatment of head and neck cancer is practical for outpatients.
Abstract: Intraarterial infusion chemotherapy has not been widely accepted for the treatment of head and neck cancer due to the high rate of complications it involves. To avoid these complications, a totally implantable infusion pump has been developed to achieve continuous low-level drug delivery for long periods of time. The pump is implanted in a subcutaneous pocket and connected to a permanent, indwelling, arterial catheter. It can be repeatedly refilled with chemotherapeutic agents by hypodermic needle injection through the skin and through a self-sealing septum located at the entry to the pump. Refilling the pump recharges an inexhaustible power source for the next delivery cycle. Preliminary results suggest that long term intraarterial infusion chemotherapy for the treatment of head and neck cancer is practical for outpatients.
TL;DR: The methods of surgical exposure utilized in conservation pharyngeal surgery are reviewed and the important principles involved in the preservation of laryngeals and pharynGEal functions are emphasized.
Abstract: Carcinoma of the posterior pharyngeal wall is an aggressive disease that demands vigorous therapy, often in the form of combined surgery and radiotherapy. Surgical excision of wide areas of the posterior pharyngeal wall may allow acceptable swallowing function in many patients. This article reviews the methods of surgical exposure utilized in conservation pharyngeal surgery and emphasizes the important principles involved in the preservation of laryngeal and pharyngeal functions.
TL;DR: Current clinical applications of "high-resolution" ultrasound technology in clinical applications are summarized and initial experience with a prototype scanner that is now commercially available is highlighted.
Abstract: In the past few years, sophisticated ultrasound systems specifically designed for the evaluation of superficial organs and structures have been developed. These "high-resolution" scanners are particularly well suited to diagnostic imaging in the neck. This review summarizes current clinical applications of this evolving technology and highlights initial experience with a prototype scanner that is now commercially available. Particular attention is directed to high-resolution ultrasonography of the thyroid and parathyroid glands, the extracranial carotid arteries, and neoplastic and inflammatory masses of the neck.U
TL;DR: The data support the following concepts of irradiation-induced neoplasia: (1) the thyroid, parathyroid, and salivary glands can develop benign and malignant changes after irradiation for benign conditions, with latent periods averaging about 30 years.
Abstract: A retrospective review of 143 patients with head or neck tumors who had received radiation therapy in the head and neck area for benign conditions during childhood or adolescence was conducted. This included an analysis of 1,080 patients from the Evanston Hospital Irradiated Thyroid Evaluation Clinic, which was established to define the relationship between irradiation and the subsequent development of thyroid neoplasia. The data support the following concepts of irradiation-induced neoplasia: (1) The thyroid, parathyroid, and salivary glands can develop benign and malignant changes after irradiation for benign conditions, with latent periods averaging about 30 years; (2) Once a glandular abnormality within the irradiated field appears, the risk of other glands in the field developing neoplastic changes is significantly increased.
TL;DR: Treatment of maxillonasal dysostosis (Binder syndrome) varies according to the age of the patient, and orthodontic treatment has been successful and there is normal occlusion.
Abstract: Treatment of maxillonasal dysostosis (Binder syndrome) varies according to the age of the patient. In the newborn, respiratory and alimentary problems resulting from the anomaly may necessitate the insertion of endonasal and gastric tubes. In children, occlusal problems and orofacial dysfunctions caused by maxillonasal dysostosis should be treated as soon as possible with an orthodontic mask. Once a patient reaches adulthood, surgery may be performed. If orthodontic treatment has been successful and there is normal occlusion, the surgery may consist simply of placing the muscles of the nose and upper lip in normal; anatomic position. If occlusion is abnormal, osteotomy may be performed.
TL;DR: 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.
Abstract: 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.
TL;DR: Three patients with internal jugular vein thrombosis secondary to central venous cannulation were treated during major head and neck surgery, and all patients responded to conservative management, and there were no instances of embolic phenomena.
Abstract: 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.
TL;DR: As the experience in the use of the CUSA System increased, blood loss was virtually eliminated, anatomic landmarks were more easily defined, and at no stage did any tongue necrosis occur in any of the patients of the series.
Abstract: The Cavitron Ultrasonic Surgical Aspirator (CUSA System) has been used at our institution in the resection of carcinoma of the tongue in 10 patients. This device is an ultrasonically powered aspirator that selectively fragments and aspirates tissue within a 1- to 2-mm radius of its tip. The technique used in our unit in tongue surgery was to incise the touch mucosal capsule of the tongue with electrocautery, and then to divide muscle and skeletonize blood vessels using the CUSA System. Smaller vessels, up to 2 mm in size, were cauterized directly by the friction created at the tip of the instrument. In this way, excellent control was available at all times and blood loss was consequently minimal. As our experience in the use of the CUSA System increased, blood loss was virtually eliminated, anatomic landmarks were more easily defined, and at no stage did any tongue necrosis occur in any of the patients of the series.
TL;DR: Reconstruction of the laryngotracheal complex was achieved by applying the superiorly based compound myocutaneous sternocleidomastoid muscle flap for wedge enhancement and resurfacing of the endolaryngeal and endotrachesal lumen.
Abstract: Laryngotracheal stenosis in children should be treated effectively with minimal delay, and the tracheostomy should be closed within a reasonable period after surgery so that the child may develop normal speech and language. Successful reconstruction of the laryngotracheal complex was achieved by applying the superiorly based compound myocutaneous sternocleidomastoid muscle flap for wedge enhancement and resurfacing of the endolaryngeal and endotracheal lumen. A short stenting period, incorporating a custon-carved soft silicone laryngeal stent in direct continuity with an oversized silicone T-tube, helped in stabilizing the airway and ensuring good take of the flap. Postoperative recovery was relatively short, with good ventilation and vocal results. This single-step technique may be readily performed, and it interferes minimally with the child's development.
TL;DR: The failure rate of the deltopectoral flap was higher when the flap was used in the reconstruction of defects in the anterior part of the oral cavity, particularly the floor of the mouth, than at other sites in the head and neck.
Abstract: Despite the development of many alternative methods of reconstruction in head and neck surgery, the deltopectoral skin flap still remains a useful method in our armamentarium. Its use as a nondelayed procedure in 44 patients with various defects in the head and neck following tumor surgery is discussed. The reliability of the deltopectoral flap is evaluated. Major necrosis of the flap occurred in 6 (13.6%) of our patients. As to the cause of failure, more than one factor could be identified in the individual patient. However, the failure rate was higher when the flap was used in the reconstruction of defects in the anterior part of the oral cavity, particularly the floor of the mouth, than at other sites in the head and neck.
TL;DR: Justification is found for the exclusion of the globulomaxillary, midmandibular, and midpalatine cysts from a current classification and emphasis is placed on the importance and controversy surrounding the odontogenic keratocyst.
Abstract: The jaws are unique bones of the skeleton because of their intimate involvement with tooth and facial development. Abnormal sequelae of these developmental processes may give rise to cystic lesions later in life. This paper reviews the pathogenesis, clinical features, and behavior of these odontogenic and nonodontogenic cysts. Justification is found for the exclusion of the globulomaxillary, midmandibular, and midpalatine cysts from a current classification. Emphasis is placed on the importance and controversy surrounding the odontogenic keratocyst.