摘要:

AbstractThis clinicopathologic study was undertaken to determine the meaning of surgical margins “involved” with carcinoma. The fate of hemilaryngectomy patients whose specimens had this finding was compared with that of patients who had “uninvolved” margins.A consecutive series of 111 hemilaryngectomies performed for previously untreated invasive epidermoid carcinoma was analyzed. Serial step sections in a longitudinal plane were available for re‐examination and re‐evaluation of the surgical margins in each case. Clinical follow‐up on every patient was current through 1972.Thirty‐nine patients had cancer involvement of a margin in the hemilaryngectomy specimen. None of these patients received any immediate therapy but were followed only. Seven of these patients (18 percent) subsequently developed a biopsy proven local recurrence. Four of the 72 patients (6 percent) with uninvolved margins developed a local recurrence. The site of the positive margin in the specimen was compared with the clinical site of recurrence.The seven local recurrences in patients with positive margins were treated with full course irradiation or total laryngectomy. All of these patients are alive and free of cancer or have died of other causes without evidence of cancer. Of the four local recurrences in patients with negative margins one died of cancer; two are living and well, and one died of other causes.This study provides evidence to support the conservative management of those hemilaryngectomy patients who have involved margins in the resection specimen. No immediate treatment is required. Careful follow‐up is indicated with 18 percent chance of clinical recurrence. These biopsy proven recurrences can then be successfully treated with total laryngectomy or full course irradiation.Utilizing this approach none of the 39 patients with involved margins died of cancer in the 5 to 12‐ye

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00001

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY

摘要:

AbstractThe charts of 431 patients with squamous cell carcinoma of the supraglottic larynx observed at the M. D. Anderson Hospital between January, 1954, and June, 1971, were analyzed. This study is concerned with those patients who had a technically resectable lesion. Emphasis is directed to the analysis of the effectiveness of primary irradiation instead of partial laryngectomy for those lesions which are technically suitable for a partial resection and to define the groups of patients which are best treated by combining surgery and planned postoperative irradiation.One hundred forty‐seven patients with T1and T2lesions, selected exophytic T3lesions of the suprahyoid epiglottis and aryepiglottic folds and some selected exophytic T4lesions of the suprahyoid epiglottis received irradiation for their laryngeal lesion. A satisfactory control of the laryngeal disease has been obtained with preservation of a normal voice ranging from 88.5 percent for T1lesions to 60 percent for T4lesions.Comparing the groups of patients who had surgery alone or postoperative irradiation an NED rate of 63 percent was found in the latter group which is clearly superior to the 37 percent found in the surgery only group. There is no difference for the five‐year NED rates, because the patients who had surgery and postoperative irradiation had more advanced neck disease which is a cause for distant metastases. The incidence of recurrences above the clavicles is clearly less in the patients having had surgery and postoperative irradiation than in those who had surgery alone. Correlating in the two groups, surgery only and surgery followed by planned irradiation, the surgical staging of the neck metastases with recurrences above the clavicles within 24 months after treatment, it was found that the planned combined treatment has reduced the recurrence rate from 45 percent to 15 percent in the N2and N3patients.Postoperative irradiation should be given routinely after resection for all T4lesions and for any T3lesion which extends to the pharyngeal wall(s), vallecula, base of tongue, and pyriform sinus. Postoperative irradiation should also be given for any patient whose nodal classification is greater than N1. Irradiation should be given within six weeks (preferably three to four weeks) after the surgical procedure. To achieve this goal, the operation need only remove grossly detectable dise

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00002

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY

摘要:

AbstractA series of 815 infectious croup (i.e., laryngotracheobronchitis) cases and 55 epiglottitis cases, encompassing an eight‐year interval, is reviewed to determine the incidence of adverse effects of nasotracheal intubation used to manage upper airway obstruction. The racial, sex, and age distributions, in addition to modalities of treatment, are presented. The intubated cases (86 patients), representing 6.5 percent of all croup cases and 60 percent of all epiglottitis cases, are described in more detail with respect to presenting symptoms and physical findings. The average duration of intubation is 55 hours for epiglottitis and 88 hours for croup. The incidence of immediate, reversible complications for the entire intubated series is 7 percent. The incidence of delayed, irreversible complications, as determined by:1.noting any persistent post‐extubation symptoms;2.measuring peak expiratory flow rates; and3.laryngeal polytomography, is 1.6 percent. The mortality secondary to intubation is 0 percent. Thecomplication rate(1.6 percent) in this series ofnasotracheal intubationsislowerthan themortality(3.6 percent) in a large collective series ofpediatric tracheotomiesperformed for airway obstruction in croup or epiglottitis. Other advantages of intubation vs. tracheotomy are described (i.e., shorter hospital stay, dilatatory effect of endotracheal tube). The authors conclude that nasotracheal intubation is safer than pediatric tracheotomy and should be considered the procedure of choice in the management of upper airway obstruction secondary to croup or epiglotti

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00003

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY

摘要:

AbstractThe utilization of voice spectrography can be an important adjunct to the assessment of vocal cord function by both laryngologists and speech pathologists. It is especially useful in determining the effectiveness of vocal cord Teflon paste injection procedures. Dysphonic characteristics are made visible, and their improvement can be monitored. As such, spectrographic analysis should be considered as a useful tool for the laryngologist.

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00004

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY

摘要:

AbstractThis study of 223 patients with penetrating neck wounds justifies individualizing surgical treatment. Twenty‐four percent was selected for neck surgery. In spite of selective rather than mandatory neck exploration, the mortality rate related to the neck wound in this series was three percent. This compared favorably with the experience of others employing mandatory exploration. There were no deaths in our series attributable to selective observatio

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00005

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY

摘要:

AbstractThe surgical approach to frontal sinus disease has been subject to much variation. Experimental evidence for new treatment modalities is quite limited. Frontal osteoplasty, while probably the best procedure to date, has up to a 25 percent failure rate. Possible complications include recurrent disease, incomplete bony obliteration (Macbeth technique), infection of the adipose implant, frontal bossing or depression, and laceration of the dura.Four experimental groups were designed using the canine frontal sinus model. Results indicated that stripping the mucosa in a normal sinus with intact periosteum and a patent nasofrontal duct willnotconsistently lead to normal mucosal regeneration. Second, the additional factor of removing the periosteum (as in osteoplasty by osteoneogenesis), leads to partial fibrous obliteration complicated by mucocele formation. Third, sinus obliteration by osteoneogenesis was much more consistent with concurrent closure of the nasofrontal duct. Fourth, intentionally leaving a strip of mucosa leads to failure of obliteration by osteoneogenesis 100 percent of the time. Finally, bony‐fibrous obliteration increases with time but is still incomplete after one year.In light of these results, fat obliteration with closure of the nasofrontal duct is probably more reliable than obliteration by osteoneogenesi

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00006

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY

摘要:

AbstractMalignant melanomas arising from the mucosal areas of the head and neck are rare. When such neoplasms are encountered, the problem of their management is often poorly resolved. Cases of primary malignant melanoma of the maxillary sinus, the nasopharynx, oral cavity and laryngo‐pharynx are presented and the results of treatment analyzed.Much of the difficulty in therapy is due to an incomplete understanding of the mechanisms which determine survival. A brief discussion of melanoma immunology is presented. Surgery (including cryosurgery) remains the primary therapy when possible. The role of chemotherapy, immunotherapy and radiation therapy in such lesions cannot be clearly delineated at this tim

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00007

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY

摘要:

AbstractEight ears with complications due to chronic eustachian tube insufficiency had insertion of a silicone rubber tympano‐frontal shunt tube between the mastoid antrum and the ipsilateral frontal sinus. A one‐way valve designed to open at‐10 mm H2O was placed on the tympanic end of the tube to minimize tube obstruction by ear secretions.Follow‐up an average of 20 months post insertion showed six of the eight ears to have an aerated middle ear without fluid or tympanic membrane retraction or perf

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00008

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY

摘要:

AbstractIn an effort to develop a simple and accurate method to identify children in whom adenoidectomy might prevent otitis media, the ventilatory function of the Eustachian tube was assessed by a manometric technique. Nasal pressures during swallowing were also determined in some. The study group consisted of 23 children with otitis media in whom tympanostomy tubes had been inserted. All were judged clinically and roentgenographically to have prominent adenoids. Inflation‐deflation Eustachian tube ventilation studies were obtained in 36 ears that remained intubated, aerated and dry both before and eight weeks after adenoidectomy. Fifteen of the 36 (42 percent) ears had improvement in Eustachian tube ventilatory function postadenoidectomy which was attributed to relief of extrinsic mechanical obstruction of the tube. In the remaining 21 (58 percent) ears in which Eustachian tube function was not improved, mechanical obstruction was not apparent preoperatively. The effect of nasopharyngeal pressures on a pliant Eustachian tube (Toynbee phenomenon) due to obstruction of the posterior nasal choanae by the adenoid mass was suggested as a possible cause of functional Eustachian tube obstruction. In several instances in which preadenoidectomy mechanical obstruction of the Eustachian tube was not demonstrated, the tube appeared to have been made more pliant by the operation. This increase in compliance of the Eustachian tube was attributed to loss of adenoid support of the tube in the fossa of Rosenmuller.From this study, preliminary recommendations for selection of patients for adenoidectomy are the following:1.Eustachian tube ventilation function tests in a dry, intubated middle ear;2.if extrinsic mechanical obstruction of the Eustachian tube is present and chronic inflammation is absent, adenoidectomy will probably improve Eustachian tube function. The surgical technique should include adequate removal of the adenoid tissue in the fossa of Rosenmuller;3.if the Eustachian tube does not appear to be mechanically obstructed, the adenoids should not be removed unless functional obstruction is suspected due to obstruction of the posterior nasal choanae. Adenoid tissue within the fossa of Rosenmuller should not be removed when such circumstances exist; and4.in the absence of obstructive adenoids to the nasal choanae or Eustachian tube, adenoidectomy probably will not improve Eustachian tube function and could make it worse. A more rational and effective approach to adenoidectomy for the prevention of otitis media in children may be possible through this type of preoperative evaluatio

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00009

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY

ISSN:0023-852X    

DOI:10.1288/00005537-197501000-00010

出版商:John Wiley&Sons, Inc.    

年代:1975

数据来源: WILEY