摘要:

AbstractA retrospective study was made of the correlation between pre‐operative clinical or histologic findings and the prevalence of lymph node metastasis in 60 patients with squamous cell carcinoma of the oral cavity who had histologically confirmed neck metastasis. Of these 60 patients, 39 with clinically N+ necks underwent immediate therapeutic neck dissection, and 21 whose necks were initially NO but progressed to N+ during observation underwent subsequent therapeutic neck dissection. The primary site, TNM staging, histologic grade of malignancy of biopsy specimen, and location and number of histologically positive lymph nodes were reviewed in each case. The results were as follows:(1) The prevalence of neck metastasis was not significantly correlated with primary site and T stage; however, there was an apparent correlation between histologic grade of malignancy and the prevalence of neck metastasis. Patients with grade I‐II histologic malignancy showed limited metastases that involved lymph nodes in levels I‐II. On the other hand, patients showing grade III‐IV histologic malignancy often had metastases that extended beyond level III, regardless of T stage. These results suggest that histologic grade of malignancy, as well as clinical features, must be taken into consideration when deciding whether supraomohyoid neck dissection is indicated. (2) The group that underwent subsequent neck dissection exhibited less advanced neck metastasis and a better prognosis than the group which underwent immediat neck dissection. These findings show that if they are closely followed up, it is possible to delay neck dissection in NO patients until a neck metastasis is detected. © 1992 John Wiley&S

ISSN:1043-3074    

DOI:10.1002/hed.2880140402

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractNineteen patients, nine men and 10 women, with advanced adenoid cystic carcinoma (ACC), were treated with cisplatin either alone or in combination with doxorubicin and bleomycin. Median age was 51 years (range: 32‐73 years). Two groups of patients were distinguished: Group 1 (N= 10) received single‐agent cisplatin (50‐120 mg/m2IV every 4 weeks) for locoregional recurrence (N= 4), pulmonary metastases (N= 5), or as neoadjuvant therapy (N= 1). Five patients failed previous chemotherapy. No objective responses were observed, five patients showed stabilization of their disease for a median duration of 20 months (range: 3‐50 months). Group 2 (N= 9) received a combination of cisplatin (20 mg/m2IV on days 1‐5), doxorubicin (50 mg/m2IV on day 1), and bleomycin (30 mg IV on days 1‐5), every 3 weeks. A complete remission (CR) was seen in one patient, lasting for 2 years, a partial remission (PR) in two patients (duration: 6 months and 6 years) (33%), and a stable disease (SD) in five patients (median duration: 15 months; range 3‐24 months). One patient showed progression from the start. The observed toxicity was acceptable: dose reduction was required in five patients for myelosuppression or impairment of renal function; vomiting grade III (WHO) was seen in 10 patients. The median progression‐free survival was 36 months (range: 7‐77 months). Median overall survival was 81 months (range: 14‐216 months). The role of cisplatin in this disease remains questionable. © 1992

ISSN:1043-3074    

DOI:10.1002/hed.2880140403

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractMagnetic resonance (MR) imaging provides superior soft tissue delineation of head and neck tumors compared to previous radiologic studies. Further refinements using fat suppression and gadolinium (Gd‐DTPA) enhancement have added to these improved images. We performed MR studies of 16 patients with head and neck tumors with detailed clinical, surgical, and pathologic information. MR studies included standard spin‐echo T1‐weighted images (T1WI) with and without fat suppression and T2‐weighted images (T2WI) with fat suppression. Gadolinium was also administered with fat suppression. Conventional and paired fat suppression MR images were compared by a grading system. Post‐Gd‐DTPA fat suppression T1WI, and T2WI with fat suppression, showed superior sensitivity for tumor delineation when compared to conventional T1WI. Fat suppression T2WI was the best technique to delineate squamous cell carcinoma both in the primary site and regional lymph nodes. Clinical, surgical, and pathologic results correlated perfectly with imaging findings. These refinements in MR imaging represent a significant advance in the radiologic evaluation of head and neck tumors. © 1992 John Wil

ISSN:1043-3074    

DOI:10.1002/hed.2880140404

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

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

ISSN:1043-3074    

DOI:10.1002/hed.2880140405

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractThe role of radiographic and nuclear imaging in evaluation of postradiotherapy osteonecrosis of the jaw was studied. Patients who had received imaging at diagnosis and following hyperbaric oxygen therapy were studied. Radiographic changes did not correlate with the clinical status of patients. All bone scans were abnormal at the time of diagnosis of osteonecrosis, but remained abnormal following changes in the clinical status of patients. Thus, the bone scan may aid in the detection of osteonecrosis. Gallium uptake did not aid i diagnosis, but did correlate with clinical findings following treatment. Persisting positive gallium scans may indicate the need for surgery following hyperbaric oxygen therapy. © 1992 John Wiley&Sons, Inc

ISSN:1043-3074    

DOI:10.1002/hed.2880140406

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractEctodermally derived tissue in ectopic sites is seen in the head and neck. Extracranial dermoid and epidermoid tumors are relatively rare. While most otolaryngologists are familiar with the cholesteatoma of the otic area, not very many are exposed to this lesion in other sites. Those of the cranial bones are even rarer still. These tumors may expand (1) laterally in the cranial bones, (2) externally to present as masses in the scalp or facial region, or (3) internally to involve the intracranial contents. A patient with a frontal bone epidermoid, whose tumor had expanded in all three directions to erode both inner and outer cortex of cranium and laterally to rupture into the frontal sinus, is discussed. The literature is reviewed and the management of these rare masses is discussed. © John Wiley&Sons, Inc

ISSN:1043-3074    

DOI:10.1002/hed.2880140407

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

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

ISSN:1043-3074    

DOI:10.1002/hed.2880140408

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractPrimary mucinous adenocarcinoma of the skin is a rare entity arising from eccrine sweat glands with a propensity for local recurrence and metastasis. This tumor has been widely reported in the ophthalmology literature, but not to our knowledge in the otolaryngology literature. A case of a 48‐year‐old man with a mucinous adenocarcinoma extensively involving the right eyelid and orbit necessitating craniofacial resection is presented together with a discussion of the pathology, clinical features, and management. © John Wiley&Sons,

ISSN:1043-3074    

DOI:10.1002/hed.2880140409

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractEmbolization of the internal maxillary artery, an accepted method for control of severe or recurrent posterior epistaxis, usually involves the ipsilateral artery, but occasionally the contralateral vessel and the facial arteries as well. Such endovascular treatment may fail if the vascular supply to the bleeding vessels originates in derivative branches of the ophthalmic artery. We report two unusual cases in which embolization of the ophthalmic artery was performed to control epistaxis. The first patient had a prosthetic eye. In the second, sight in one eye was sacrificed after careful consideration in order to prolong life. © 1992 John Wiley&Sons, Inc

ISSN:1043-3074    

DOI:10.1002/hed.2880140410

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY

摘要:

AbstractVariation in the gross anatomy of the thyroid gland is relatively common. Although thyroid hemiagenesis is felt to be a rare anomaly, its incidence is probably underestimated as the diagnosis is usually incidental. The case of a 41‐year‐old woman with right thyroid hemiagenesis associated with papillary adenocarcinoma is presented. The diagnosis of hemiagenesis was established by isotope imaging and surgical exploration for a benign nodule. Seven years later she was seen with a recurrent neck mass, and an isotope scan revealed it to be a cold thyroid nodule. As she was diagnosed to have papillary adenocarci‐noma, total thyroid lobectomy was performed and at present she remains disease‐free. © 1992 John Wiley&S

ISSN:1043-3074    

DOI:10.1002/hed.2880140411

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1992

数据来源: WILEY