摘要:

AbstractMandibular invasion alters the staging and treatment of oral cavity squamous cell carcinoma, and thus its detection is essential to the head and neck oncologist. There is little information assessing the accuracy of the radionuclide bone scan and the roentgenogram in determining mandibular invasion. The present study reports data on 40 patients with squamous cell carcinoma of the oral cavity for whom bone scans, mandibular roentgenograms, and histologic examination of the mandible were available. The bone scan correctly predicted mandibular invasion in 8 of 9 cases; the false positive rate was 53% as a result of mandibular inflammatory changes. The bone scan was more accurate than the roentgenogram in predicting tumor invasion of the mandible, but the bone scan had a higher false positive rate. A normal bone scan and roentgenogram virtually precluded tumor involvement of the mandible. We conclude that the bone scan is an important adjunct in the prediction of carcinomatous invasion of the mandible in squamous cell carcinoma of the oral cavity.

ISSN:0023-852X    

DOI:10.1288/00005537-198201000-00001

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe functional disability and cosmetic deformity after jaw and neck dissection can be very severe due to soft tissue and mandibular loss. Reconstruction of the mandible alone without soft tissue coverage can be complicated with prosthetic exposure, infection and, finally, rejection. We attempted to reconstruct the mandible at the time of tumor resection in a group of patients, using titanium mesh with marrow, rib, scapular spine, and clavicle. We used myocutaneous flaps in order to obtain intraoral coverage of the mandibular grafts. In a second group of patients, delayed reconstruction of the jaw was performed 6 months to 2 years after tumor resection. Titanium mesh prostheses were used for reconstruction of the mandible in conjunction with myocutaneous flaps for soft tissue augmentation. Osteomyocutaneous flaps were also used. The results and complications in 54 patients are presented.

ISSN:0023-852X    

DOI:10.1288/00005537-198201000-00002

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractAdvanced cancer of the laryngopharynx and cervical esophagus is difficult to treat because of the malnutrition produced by pain and obstruction and the problems related to reconstruction. This paper presents the initial results of a regimen used in 14 patients in which there is rapid reversal of nutritional deficiencies, radical resection, and reconstruction using the gastric pull‐up technique and administration of postoperative radiotherapy. Excellent overall palliation and decreased hospitalization have been achieved using this regimen without diminishing chances for cur

ISSN:0023-852X    

DOI:10.1288/00005537-198201000-00003

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe early postoperative hypopharyngeal anatomy of 37 consecutive patients undergoing total laryngectomy at the Boston Veteran's Administration Hospital between July 1977 and April 1980 was studied by barium swallow radiographs and correlated with the technique of closure. The “pseudoepiglottis,” a structure radiographically resembling a normal epiglottis, was seen arising from the anterior hypopharynx near the base of the tongue in 21 of 28 evaluable patients. It occurred in all patients with vertical closuresvs.67% of patients with a “T” shaped closure. The average length in the “T” closure group was 9.6 mm (range 0.35)vs. 18.4 mm (6.40) in the vertical group, a statistically significant difference (p<0.05).Radiologic strictures occurred in 39% of all patients, dysphagia in 29%, fistulae in 18%, and sinus tracts in 14%. All complications occurred more frequently in the vertical closure group. Patients who received preoperative cis‐platinum bleomycin chemotherapy and postoperative irradiation had 50% dysphagia and 67% stricture rates.The average ratio of the width of the retropharyngeal space to that of C4 was 0.48 in stricture patients 08. 0.29 in non‐stricture patients (statistically significant at the p<0.01 level). This ratio taken in the early postoperative period may help predict which patients will dev

ISSN:0023-852X    

DOI:10.1288/00005537-198201000-00004

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractThe most common cause of laryngeal stenosis is trauma. The treatment of this condition is difficult as attested to by the numerous procedures described in the literature. Recently a new modality, the CO2laser, has been added to the list. The advantage of this procedure is that it can be performed endoscopically.The purpose of this paper is to present 16 cases of traumatic laryngeal stenosis treated by the laser. The chance of achieving a successful result was greatest in patients with supraglottic stenosis due to redundant soft tissue or localized scaring.

ISSN:0023-852X    

DOI:10.1288/00005537-198201000-00005

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractA cystic neck mass can be either malignant or benign; 22% of patients (4/18) admitted with the tentative diagnosis of branchial cyst in a recent 2‐year period (1977‐1979) had metastatic carcinoma: epidermoid, thyroid or salivary gland. Preoperative fine needle aspiration was diagnostic in 1 instance and unhelpful in 2. Frozen section analysis of the gross specimen invariably provided the correct diagnosis. All patients with malignancies had subclinical primary disease and in 1 instance random biopsies identified its origin.The prudent surgeon will avoid untoward results if he approaches a neck cyst in an adult as if it were malignant. Guidelines he can follow to prevent the inadvertent removal of a metastasis under the misapprehension that it is a benign neck cyst include:1.Prior to operation, perform a thorough head and neck examination to identify a primary carcinoma;2.Do a fine needle aspiration of the mass for cytology. A negative report must be considered inconclusive;3.Make a gross examination in the operating room of the opened cyst and frozen section processing of suspicious areas;4.Follow with a panendoscopy and random biopsies of appropriate areas and omplete the neck dissection on the involved side, after a metastatic deposit has been recognized. The preoperative procurement of contingency consent for these procedures is underst

ISSN:0023-852X    

DOI:10.1288/00005537-198201000-00006

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractBlunt trauma to the larynx, as a source of vocal paralysis, has become an important consideration for the laryngologist. Direct neurologic injury from strangulation by hand is explored with presentation of 4 patients. Three of these had unilateral paralysis; the fourth had bilateral paralysis on two separate occasions of strangulation. All patients recovered in 4 to 20 days. Correlation is made with other acute nerve compression syndromes, and the pathophysiology discussed in light of experimental evidence. Awareness and recognition of this problem in evaluation and treatment of strangulation assault injuries is stressed.

ISSN:0023-852X    

DOI:10.1288/00005537-198201000-00007

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractPatients with carcinoma of the respiratory tract have been demonstrated to have elevated levels of immunoglobulins in the secretions bathing these areas. The clinical significance of this finding has remained unclear. In the present study, IgA and IgG levels were correlated with 5 year survival statistics in 53 patients with oral squamous cell carcinoma. Our findings indicate that there is no correlation between local IgA or IgG level and length of patient survival.

ISSN:0023-852X    

DOI:10.1288/00005537-198201000-00008

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

ISSN:0023-852X    

DOI:10.1288/00005537-198201000-00009

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY

摘要:

AbstractPrimary middle ear glandular tumors of the adenocarcinoma and adenoma types are rare. The terminology used in describing them is quite varied. Some investigators presume that a distinct recognizable group of these tumors are benign, but because of the rarity of the lesions, such conclusions have been difficult to verify. We review the literature of these lesions and report 11 additional cases. The course was documented in 25 cases in the literature; 20 of these were reported to be benign over periods of follow‐up from 1 month to 10 years, and 5 were fatal. Among our patients, 5 had a benign course, 3 died of causes related to the tumor, and 3 had persistence of their lesion and substantial consequent morbidity. We emphasize the slow growth and elusive nature of these lesions. Histologic evidence of mitoses, roentgenologic evidence of bony destruction, and cranial nerve involvement were factors consistent with a poor prognosis. The origin of these tumors may vary. A similarity to paragangliomas is noted. The ultimate course of these tumors cannot always be predicted from the histologic appearance. Early surgical removal appears to be the most successful therapy.Three of the 4 types of glandular tumors of the external ear canal described by Wetli,et al, can be found in the middle ear: adenoma, adenocarcinoma, and adenoid cystic carcinoma. In addition, several other types of glandular lesions can occur in the middle ear — the “choristomas,” mucoepidermoid carcinomas, and what we believe to be a variant of paragangliomas. The adenoid cystic tumors are well described in the literature2and will not be discussed here. We reviewed cases of the adenoma and adenocarcinoma types, some of which bore a resemblance to the paragan

ISSN:0023-852X    

DOI:10.1288/00005537-198201000-00010

出版商:John Wiley&Sons, Inc.    

年代:1982

数据来源: WILEY