ISSN:0148-6403    

DOI:10.1002/hed.2890080402

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

年代:1986

数据来源: WILEY

摘要:

AbstractResection of a segment of mandible, particularly when associated with malignant disease, carries a high morbidity and mortality. Traditional methods of autogenous bone grafting have proved unreliable in immediate reconstruction of such mandibular defects because of the variability of the recipient bed. These unfavorable conditions for bone graft survival can be largely overcome using vascularized bone and vascularized soft tissue reconstruction. The radial forearm free flap has proved a versatile and useful method in intraoral reconstruction and can be used together with a segment of radius as a composite flap. The technique of raising a segment of vascularized radius is described and its use in immediate reconstruction of the mandible at the time of resection illustrated in a series of 14 consecutive cases. There was one microvascular failure in this series and one postoperative death. The remaining 12 cases have had a successful outcome and show clinical union in the follow‐up period varying from 11‐36 months. There is evidence indicating that the bone maintains its viability even in the presence of preoperative or early postoperative radiother

ISSN:0148-6403    

DOI:10.1002/hed.2890080403

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

年代:1986

数据来源: WILEY

摘要:

AbstractThe radiologic and histologic features of mandibular invasion, and its clinical implications, are considered in a retrospective series of 111 patients with squamous carcinomas of the oral cavity and oropharynx treated by composite resection. Eighty percent of the entire group had either recurrent or advanced (T3, T4) local disease, and 33 patients (30%) had histologic evidence of mandibular invasion by tumor. Preoperative radiologic assessment was unreliable in cases in which infiltrating tumor was confined to the periosteum and superficial cortex—44% false negatives. The extent of bone invasion was found to correlate with the size of the tumor, but not with its histologic grade. The mandibular periosteum was not seen as a morphologically discrete “barrier” and infiltration occurred at various points along the mandibular body, mainly related to the course of the inferior dental canal. The gross and microscopic patterns of bone invasion appeared to be similar in irradiated and nonirradiated resections. The incidence and pattern of recurrent disease following composite resection was the same in the groups with and without mandibular invasion: in each group half the patients were dead from disease and one third alive and free of disease at 2 years. Mandibular invasion alone did not appear to influence prognosis in this s

ISSN:0148-6403    

DOI:10.1002/hed.2890080404

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

年代:1986

数据来源: WILEY

摘要:

AbstractThe light microscopic, immunohistochemical, and ultrastructural features of a unique variant of tubular‐trabecular basal cell adenoma are described. The unusual feature of the six examples reported is the richly cellular “stroma” composed of spindle cells coursing between the anastomosing cords of epithelial tumor cells. Immunohistochemistry of all six cases and electron microscopy of two examples illustrated the biphasic differentiation of the epithelial portion of this form of basal cell adenoma, with a central core of duct luminal cells bordered on either side by one or more layers of modified myoepithelial cells. By light microscopy, the features and arrangement of cells in “stromal” regions of this tumor convey a fibroblastic derivation. However, this population of cells stains strongly for S‐100 protein, ultrastructurally displays excessive external lamina production, intercellular junctions, and a growth pattern unlike fibroblasts, and is involved in the formation of extracellular mucinous materials. Such aspects indicate a second population of neoplastic myoepithelial cells in this tumor. Thus, this form of tubulartrabecular basal cell adenoma displays tricellular differentiation and, perhaps, may be considered either a hybrid basal cell adenoma and myoepithelioma or a cellular pleomorp

ISSN:0148-6403    

DOI:10.1002/hed.2890080405

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

年代:1986

数据来源: WILEY

摘要:

AbstractImmunohistochemical distribution of S‐100 protein was evaluated in 129 tumors from major and minor salivary glands. Also, two sensitive immunoperoxidase avidin‐biotin methods using either overnight incubation with primary antibody or pretreatment trypsin digestion and half‐hour incubation were compared. Tumors with S‐100 protein immunoreactivity were demonstrated in numerous benign and malignant histologic categories. Adenoid cystic carcinomas, carcinomas ex pleomorphic adenoma, clear cell carcinomas, and adenocarcinomas NOS showed inconsistent positive staining, whereas all monomorphic and pleomorphic adenomas and polymorphous low grade adenocarcinomas examined stained positively. No staining was observed in mucoepidermoid carcinomas or acinic cell carcinomas. Mesenchymal‐like tumor cells with positive immunostaining were seen only in pleomorphic adenomas and trabeculartubular adenomas. Equivalent results were found with both overnight and same‐day digestion techniques. The consistent S‐100 protein staining in some histologic tumor categories (pleomorphic and monomorphic adenoma and polymorphous low grade adenocarcinoma) compared to mucoepidermoid carcinoma that is devoid of S‐100 protein immunoreactivity has application to some microscopic differential diagnostic situations. Inconsistent staining of adenoid cystic carcinomas and adenocarcinomas did not allow discrimination from other benign and malignant salivary gland tumors with similar

ISSN:0148-6403    

DOI:10.1002/hed.2890080406

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

年代:1986

数据来源: WILEY

摘要:

AbstractBetween 1970 and 1980, we treated 107 previously untreated patients with biopsy‐proven carcinoma of the nasopharynx by megavoltage external radiation therapy to the primary site, the base of the skull, and both sides of the neck. Eighty‐seven percent of the patients had stage IV disease (American Joint Committee, 1980). Eighteen patients developed distant metastases as the first site of relapse. Metastases appeared within 6 months after treatment in 50% of these 18 patients, and in 94% within 2 years. Median survival after the development of distant metastases was 6 months. The most sensitive predictor of which patients would develop distant metastases was the size of cervical lymph node metastases at initial presentation (P= 0.003); patients without palpable cervical nodes or with cervical nodes smaller than 3 cm were the least likely to develop distant metastases (10%), followed by those patients who had cervical nodes measuring 3 to 6 cm (25%), followed by those who had cervical nodes larger than 6 cm, (almost 50%). The incidence of distant metastases was not significantly influenced by age, sex, birthplace, histology, or T‐stage. Studies aimed at decreasing the morbidity and mortality from distant metastases in carcinoma of the nasopharynx should be undertaken in patients who present with bulky cervical metas

ISSN:0148-6403    

DOI:10.1002/hed.2890080407

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

年代:1986

数据来源: WILEY

摘要:

AbstractA prospective longitudinal study of shoulder function after 103 neck dissections involving either preservation or sacrifice of the spinal accessory nerve is presented. The postoperative evolution and course of trapezius muscle denervation and resultant shoulder dysfunction were objectively determined for both radical and modified nerve sparing neck dissections. All patients were enrolled in a program of physical therapy aimed at maintaining range of motion at the shoulder joint. Shoulder function was examined preoperatively and for 12 months postoperatively with manual muscle strength testing, range of motion measurements, and electrodiagnostic testing. Results indicate that modified nerve sparing dissections are followed on the average by a significant, but temporary and reversible phase of shoulder dysfunction. By comparison, radical neck dissection is followed by profound and permanent trapezius muscle weakness and denervation.

ISSN:0148-6403    

DOI:10.1002/hed.2890080408

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

年代:1986

数据来源: WILEY

摘要:

AbstractThe literature describes numerous techniques for reconstruction of the subglottic larynx. The use of rigid bone grafts or flaps has been associated with problems because the rigid bone cannot conform to the defect and form an airtight seal. We have performed subglottic reconstruction using the sternocleidomastoid myoperiosteal flap with very optimistic results on long‐term follow up. The sternocleidomastoid myoperiosteal flap is a relatively simple procedure that can be used for a large variety of defects. The pliable periosteal flap used for closing the defect can be molded over a stent to form an airtight seal. We have demonstrated bone formation in the periosteum which is crucial to the stability of the airway and long‐term success of the procedure. The sternocleidomastoid myoperiosteal flap yields a pliable, durable tissue capable of airtight closure and a tension‐free suture line. This technique will make the closure of subglottic defects a much more practical

ISSN:0148-6403    

DOI:10.1002/hed.2890080409

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

年代:1986

数据来源: WILEY

摘要:

AbstractFive organically impaired and depressed head and neck cancer patients had a marked therapeutic response to methylphenidate (MPD). There was a rapid remission of depressive and cognitive dysfunctions without adverse side effects. The relationship of cognitive, behavioral, and affective symptoms to brain function is discussed. To rule out treatable cognitive and affective disorders, neurobehavioral assessment of the depressed head and neck cancer patient is stressed, and diagnostic and treatment guidelines are given. The results suggest that further evaluation is warranted of the use of MPD in treating seriously ill cancer patients who have either compromised brain function or depression.

ISSN:0148-6403    

DOI:10.1002/hed.2890080410

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

年代:1986

数据来源: WILEY

ISSN:0148-6403    

DOI:10.1002/hed.2890080411

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

年代:1986

数据来源: WILEY