摘要:

AbstractSchwannomas are relatively rare tumors that arise from Schwann cells of the sheaths of peripheral nerves. They may be found in any portion of the body. In reported series of schwannomas, the percentage of tumors in the head and neck varies from 16% to 45%. Usually demonstrating slow growth, they often have a history of long duration, and are most often diagnosed in adults. Approximately 10% of schwannomas are diagnosed in patients under 21 years of age.In this paper two children with large schwannomas of the head and neck are reported. In both, the symptoms were of relatively short duration, but physical findings suggested that the tumors had been present much longer. One patient was a 10‐year‐old female with a schwannoma filling the anterior and posterior triangles of the left side of her neck and extending superiorly to the base of the skull. The tumor intimately involved the vagus, spinal accessory, and hypoglossal nerves. The other patient was a 12‐year‐old female with a nasal tumor filling the right naris and nasopharynx. Our management of these patients is di

ISSN:0023-852X    

DOI:10.1288/00005537-198012000-00001

出版商:John Wiley&Sons, Inc.    

年代:1980

数据来源: WILEY

摘要:

AbstractAspiration becomes an intractable problem for some patients who have lost normal neurological function of the glottis. Over the long term, a cuffed tracheotomy tube is inadequate. Several methods have been developed to relieve this problem surgically. These include the use of muscle flaps, tracheoesophageal anastomosis, and use of an epiglottic flap. In this paper, we discuss these previous surgical attempts to alleviate aspiration and present our own technique, which involves creation of a tracheostome and closure of the larynx at the level of the first tracheal ring. This has been used with success in three patients. We feel this technique is less complex and results in less surgical trauma to the larynx, important factors when dealing with critically ill patients. This_ technique is theoretically reversible by re‐anastomosing the trachea to the cricoid cartilage after excising the first tracheal rin

ISSN:0023-852X    

DOI:10.1288/00005537-198012000-00002

出版商:John Wiley&Sons, Inc.    

年代:1980

数据来源: WILEY

摘要:

AbstractA prospective study of patients undergoing major head and neck cancer surgery was undertaken to define the value of preoperative and intraoperative cultures in identifying the patient at “high risk” of wound infection and in predicting the bacteriology of wound infection.One or two days before surgery, the skin of the operative site on the neck, the oropharynx and anterior nares were swabbed. An intraoperative wound culture was obtained after the pharyngeal defect was closed and the wound irrigated with water. All cultures were processed for aerobes in the Anaerobic Bacteriology Research Laboratory at Wadsworth Hospital Center.Wound infections developed in 10 of 31 patients who received cefazolin prophylactically and 21 of 25 patients who received no perioperative antibiotics. Fifty‐five percent of infected patients and 68% of noninfected patients demonstrated potential pathogens preoperatively. A potential pathogen isolated preoperatively or intraoperatively was subsequently recovered from 35% of infected wounds. The majority of infected wound cultures grew one or more additional pathogens. A poor correlation was also noted between preoperative nasal Staphylococcus aureus isolation and subsequent recovery from wound infections.We conclude that preoperative and intraoperative aerobic wound cultures are not predictive of the “high risk” patient or of the bacteriology of subsequent wound infection in major head and neck cance

ISSN:0023-852X    

DOI:10.1288/00005537-198012000-00003

出版商:John Wiley&Sons, Inc.    

年代:1980

数据来源: WILEY

摘要:

AbstractThe orbital manifestations of Graves' disease usually comprise the most distressing component of this inadequately understood disease entity. Patients with optic neuropathy, exposure keratopathy, or disfiguring proptosis can be helped considerably by decompression of the swollen orbital tissues into the maxillary and sinus cavities. Experience with 104 patients personally operated by the senior author and analyzed by chart review and patient questionnaire indicates that antral‐ethmoidal decompression is a successful form of therapy, generally free of serious complications. It is now employed earlier in the course of Graves' ophtholmopathy than in the pas

ISSN:0023-852X    

DOI:10.1288/00005537-198012000-00004

出版商:John Wiley&Sons, Inc.    

年代:1980

数据来源: WILEY

摘要:

AbstractTotal laryngectomy is often applied in the treatment of invasive squamous cell carcinomas that fix one side of the larynx. The major drawback, of course, is loss of the voice. In many instances, however, preservation of the uninvolved portion of the larynx is compatible with adequate tumor margins, and the preserved laryngeal remnant, although it cannot be reconstituted to allow breathing, can readily be used for voice.The principle involved is the creation of a valved tracheopharyngeal shunt, which functions as a neoglottis during expiration but constricts to close during swallowing. To accomplish this the recurrent laryngeal nerve and the myomucosal segment of intrinsic glottic musculature to which it is attached is preserved on the uninvolved side. The myomucosal segment is formed into a mucosal lined tube by releasing the soft tissues from the cartilage. The diameter and flaccidity of the tube is augmented by incorporating a flap of hypopharyngeal mucosa. Safe performance of this operation depends on careful preoperative evaluation and laryngoscopic verification and a close‐working relationship with an interested surgical pathologist.The first 7 consecutive cases in which this management program has been applied are presented in review. The patients, ranging in age from 58 to 69 years old, had T3grade 2 or 3 invasive squamous cell carcinoma. The average hospitalization was 13 days. The longest follow‐up is 5 years.Clear surgical margins, local control of the disease, and satisfactory voice without significant aspiration have been achieved thus far in each case. The average subglottic pressures measured at the tracheotomy were 25 ± 6 cm. of water (threshold opening) and 43 ± 20 cm. of water (for phonation).Whether these encouraging initial results can be widely duplicated will probably depend on the care with which cases are selected. The dangers of applying this surgery to patients with extensive submucosal spread will be obvious to experienced laryngolo

ISSN:0023-852X    

DOI:10.1288/00005537-198012000-00005

出版商:John Wiley&Sons, Inc.    

年代:1980

数据来源: WILEY

摘要:

AbstractThe benign, monomorphic adenoma, derived from the respiratory epithelium of the middle ear, is a well circumscribed, greyish, avascular tumor. Its histology — documented by light and electron micrographs contained in this report — supports a distinct entity and pathogenesis apart from the malignant adenocarcinoma. Utilizing two case reports, this compendium emphasizes the clinical presentations, as well as radiographic and audiometrical characteristics, of the tumor. The first case represents the typical tumor with conductive hearing loss. The second case is the first reported facial paralysis associated with hemorrhagic infarction of an adenoma which was reversible by surgical resection of the tumor. Based on the histology and four year postoperative follow‐up, the authors conclude the adenoma may be effectively managed by surgical rese

ISSN:0023-852X    

DOI:10.1288/00005537-198012000-00006

出版商:John Wiley&Sons, Inc.    

年代:1980

数据来源: WILEY

ISSN:0023-852X    

DOI:10.1288/00005537-198012000-00007

出版商:John Wiley&Sons, Inc.    

年代:1980

数据来源: WILEY

摘要:

AbstractContinuing medical education is rapidly growing. During the four‐year period between 1974‐75 and 1978‐79, the number of continuing medical education courses in otolaryngology increased 136%. It has become a mandatory requirement for membership in 19 state medical societies and is also a mandatory requirement for relicensure in 12 states. Although voluntary continuing medical education has proved to be satisfactory in maintaining a physician's competency in the past, the present trend is toward mandatory continuing medical education in order to ensure better health care for the public. Methods of obtaining continuing medical education are discussed and suggestions made as to how these could be imp

ISSN:0023-852X    

DOI:10.1288/00005537-198012000-00008

出版商:John Wiley&Sons, Inc.    

年代:1980

数据来源: WILEY

摘要:

AbstractSixty‐three serum specimens from American patients with nasopharyngeal carcinoma were examined for antibodies to antigens associated with Epstein‐Barr virus (EBV) and compared with 98 specimens from patients with other head and neck cancers, 133 from patients with benign head and neck diseases, and 96 from healthy donors. The level of antibody titers to EBV‐associated antigens was correlated with nasopharyngeal carcinoma. The anti‐EBV profile of elevated antibody titers directed against viral capsid antigen and early antigen was seen in undifferentiated and nonkeratinizing tumors but usually not in squamous cell tumors. Titers tended to rise with large increases in total tumor burden caused by distant metastases, often before clinical evidence of metastases. At the time of diagnosis, antibody‐dependent cellular cytotoxicity testing was performed on serum samples from 46 of the patients with nasopharyngeal carcinoma. Pretreatment titers were usually low in patients in whom recurrence developed and were high in most of the patients who had a good response to treatment and have remained free of r

ISSN:0023-852X    

DOI:10.1288/00005537-198012000-00009

出版商:John Wiley&Sons, Inc.    

年代:1980

数据来源: WILEY

摘要:

AbstractDifferentiated thyroid carcinoma was studied with regard to mode of presentation, initial findings, treatment and survival. The classic signs, symptoms, physical and scan findings were found to be present in approximately 70% of the patients. Thirty percent of the patients had either unusual presentations or findings.Prognosis was found to be dependent on age of presentation more than any other factor. The effects of neck metastasis, extracapsular invasion and recurrent laryngeal nerve involvement on long‐term survival are studied in detail.Patients with prior exposure to radiation were found to have more extensive disease and require more extensive surgery but ultimately had the same prognosis for 15‐year cure.Treatment for distant metastatic disease by surgery, radioactice iodine and external radiation all resulted in long‐term survival in certain

ISSN:0023-852X    

DOI:10.1288/00005537-198012000-00010

出版商:John Wiley&Sons, Inc.    

年代:1980

数据来源: WILEY