ISSN:1043-3074    

DOI:10.1002/hed.2880160102

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

年代:1994

数据来源: WILEY

摘要:

AbstractWe reviewed our experience with combined approaches to lesions that transcend the bones of the skull base. Seventy‐seven skull base procedures were performed on 73 patients during a 10‐year period from 1982 to 1992. There were 34 patients (44%) with region I lesions (anterior), seven patients (9%) with region II lesions (anterior‐lateral), 25 patients (32%) with region III lesions (lateral‐posterior), and 11 patients (14%) with lesions that invaded more than one anatomic site. The histopathology in this series was quite variable, with 22 patients (29%) having squamous cell carcinoma and eight patients (10%) having basal cell carcinoma. Forty‐one patients had surgery by an anterior approach and 38 patients had lateral approaches, with 18 undergoing an infratemporal approach and 29 undergoing temporal bone resections. Overall, 44% of the patients had a postoperative complication. Survival of this heterogeneous group of patients is 79% at 2 years and 71% at 4 years, with those patients with region II disease having a statistically significant poorer prognosis with no survivors at 4 years. © 1994 John Wiley

ISSN:1043-3074    

DOI:10.1002/hed.2880160103

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

年代:1994

数据来源: WILEY

摘要:

AbstractTwenty‐nine patients with lesions of the neck, skull base, and cavernous sinus had test balloon occlusions of the internal carotid artery (ICA) to determine the feasibility of sacrifice of the artery. Only one patient (3.4%) showed evidence of cere‐brovascular compromise. Sixteen patients who tolerated test occlusions went on to ICA sacrifice. Ten patients had permanent balloon occlusion (PBO) of the ICA for cavernous aneurysms or to “trap” carotid‐cavernous fistulae (CCF). Complications occurred in three patients (30%) with permanent morbidity in one patient (10%). One patient with CCF had PBO of the proximal ICA only, resulting in an unstable neurologic state and ultimately in death. Two patients had resection of skull base tumors 2 and 6 days after PBO of the ICA. Both suffered strokes and one died. Three patients had surgical sacrifice of the ICA without PBO. Two of these patients suffered cerebral ischemia without permanent sequelae. We conclude that test occlusion of the ICA with clinical monitoring will miss a significant number of patients with inadequate cerebrovascular reserve. Sensitivity is improved by controlled reduction of systemic blood pressure during the test occlusion. Resection of a skull base tumor soon after PBO of the ICA should be done in a delayed fashion or preceded by extracranial‐intracranial arterial bypass. Patients who have had the artery sacrificed should be monitored in an intensive care setting for 48 hours to avoid hypotension, which could cause cerebrovascular ischemia. © 1994 John Wil

ISSN:1043-3074    

DOI:10.1002/hed.2880160104

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

年代:1994

数据来源: WILEY

摘要:

AbstractTracheopulmonary aspiration commonly occurs in patients with dysphagia related to head and neck cancer. Scintigraphic studies were performed in 280 patients with head and neck cancer; 33% of these patients had tracheopulmonary aspiration. A subgroup of 18 tracheostomized patients had a tracheostomy tube with a removable obturator, so they could be studied with the tracheostomy open or occluded. When the tracheostomy was occluded the patients aspirated less frequently, and in significantly smaller quantities, than when it was open. When feasible, occluding the tracheostomy tube or permanent surgical closure may reduce or eliminate tracheopulmonary aspiration in these patients. © 1994 John Wiley&Sons, Inc

ISSN:1043-3074    

DOI:10.1002/hed.2880160105

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

年代:1994

数据来源: WILEY

摘要:

AbstractThe clinical examination of neck masses is clearly imperfect and false‐positive detection of thyroid nodules, termed “pseudonodules.” remains a common problem. Movement on swallowing has been emphasized as a highly specific feature of thyroid masses, but lesions in the vicinity of the thyroid can be displaced by underlying structures during deglutition causing them to mimic thyroid nodules. Two cases are presented to illustrate how additional features of neck mass movement can help determine whether a lesion is located within the thyroid or whether it is extrathyroidal. These include the range of motion of the mass, the presence or absence of a stationary phase prior to descent, and the timing of the movements of the mass. Assessment of these parameters during the physical examination of anterior neck masses may help reduce the incidence of thyroid pseudonocules. © 1994 John Wiley&Son

ISSN:1043-3074    

DOI:10.1002/hed.2880160106

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

年代:1994

数据来源: WILEY

摘要:

AbstractThe incidence of pulmonary atelectasis following head and neck surgery is not well reported. This study retrospectively evaluated the incidence of pulmonary atelectasis in 161 head and neck cancer patients, with 152 being evaluable. There were 90 patients evaluated following pectoralis musculocutaneous flap reconstruction with their effective flap size and 71 nonflap patients as a control group. Clinical findings were correlated to radiographic scores. Of pectoralis musculocutaneous flap patients screened for preexisting pulmonary disease (PEPD), nine of 45 (20%) demonstrated pulmonary atelectasis in the first 24 hours compared with 10 of 39 or 25.6% nonflap controls. Major pulmonary atelectasis was not found in the pectoralis musculocutaneous flap patients by scoring criteria, and in only one of 39 (2.6%) nonflap patients. In flaps larger than 40 cm2, the incidence was eight of 37 (21.6%), with no major pulmonary atelectasis noted. Only one of nine (11.1%) patients with radiographic pulmonary atelectasis exhibited clinical symptoms (three of 10 or 30% control). In patients with PEPD and pectoralis musculocutaneous flaps, 22 of 45 (48.9%) had evidence of pulmonary atelectasis in contrast to 13 of 32 or 40.6% controls. There were two of 45 (4.4%) who had major pulmonary atelectasis with zero of 32 in the nonflap group. For flaps larger than 40 cm2, the incidence was 19 of 39 (48.7%) with two of 39 (5.1%) scored as major pulmonary atelectasis. The clinical correlation for this group and the major pulmonary atelectasis group was each approximately 50% compared to 15.4% for nonflap patients. These results indicate that, although the incidence of radiographic pulmonary atelectasis in the first 24‐hour postoperative period is high, there is no clinical correlation with the exception of patients with PEPD. © 1994 John Wiley&Sons, I

ISSN:1043-3074    

DOI:10.1002/hed.2880160107

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

年代:1994

数据来源: WILEY

摘要:

AbstractSince 1979, we have performed multidisciplinary treatment using intensive immunotherapy with biologic response modifiers (BRM) in combination with surgical treatment of oral cancer. Chemotherapy and radiotherapy were also included as part of the therapy. A historic control study was performed. Adjuvant therapy was administered by standardized methods, and the distribution of patients at various stages was similar between groups. The immunotherapy group showed a shorter treatment period, lower rates of recurrence, metastases, and side effects, greater histologic effects at the end of the first treatment, and a higher survival rate than the nonimmunotherapy group. Immunologically, immunotherapy tended to promote positive immune reactions and inhibit negative immune reactions. © 1994 John Wiley&Sons, Inc

ISSN:1043-3074    

DOI:10.1002/hed.2880160108

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

年代:1994

数据来源: WILEY

摘要:

AbstractStandard treatment of locally advanced laryngeal, hypopharyngeal, and some oropharyngeal cancers includes total laryngectomy. In an attempt to preserve the larynx through induction chemotherapy, we conducted two consecutive phase II studies. From March 1986 to February 1991, 64 patients with advanced untreated but resectable head and neck cancer who would require total laryngectomy were enrolled on one of two cisplatin‐based induction regimens: cisplatin‐bleomycin‐5‐fluorouracil (PBF) in 31 patients and cisplatin‐5‐fluorouracil (PF) in 33; all received definitive radiotherapy. Surgery was reserved for patients who achieved less than a partial response to chemotherapy and patients with residual or recurrent disease after sequential chemotherapy plus radiotherapy. Overall complete plus partial response rates to both cisplatin‐based regimens were comparable. The combined PF and PBF overall response rates were 75% for laryngeal cancer, 78% for hypopharyngeal cancer, and 75% for oropharyngeal cancer. Complete response rates after radiotherapy were 88%, 83%, and 50%, respectively. Neutropenia (<1,000 cells/mm3) was the most common hematologic toxic effect: it occurred in 44% of patients who received PF and 16% of those who received PBF. Grade ≥3 mucositis occurred in 50% of patients who received PF and 4% who received PBF. The data suggest that laryngeal preservation was feasible in all three primary‐site subgroups. With followup of 15+ to 54+ months, 44% of patients with laryngeal cancer, 28% with hypopharyngeal cancer, and 22% with oropharyngeal cancer are alive with laryngeal preservation. The overall 2‐year survival rates for patients with cancer of the larynx, hypopharynx, and oropharynx were 71%, 46%, and 38%, respectively. © 1994

ISSN:1043-3074    

DOI:10.1002/hed.2880160109

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

年代:1994

数据来源: WILEY

摘要:

AbstractOur experience with the free vascularized fascial flap based on the radial artery used for intraoral reconstruction is described. Thirteen patients underwent primary or secondary reconstruction following major resections for malignant disease. The osseofascial flap incorporating radial bone proved to be ideal when reconstruction of composite mandibular or maxillary defects was undertaken. The flaps rapidly underwent surface epithelialization, and submucosal fibrosis provided the ideal attached mucosal lining for prosthetic rehabilitation. © 1994 John Wiley&Sons, Inc

ISSN:1043-3074    

DOI:10.1002/hed.2880160110

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

年代:1994

数据来源: WILEY

摘要:

AbstractThe distribution pattern of the basement membrane (BM) around tumor cells was determined in 72 oral squamous cell carcinomas by immunohistochemical staining with antibodies against human type IV collagen, laminin, and heparan sulfate proteoglycan. An intact continuous BM was found in 29 cases, whereas partial or widespread loss of the BM was detected in the other 43 cases (59.7%). Statistical analysis showed that the degree of BM loss was correlated with the degree of differentiation of tumor cells, but not with tumor size, and, most significantly, with the mode of cancer invasion and the incidence of lymph node metastasis. Carcinoma with a well‐defined tumor‐stromal boundary generally expressed an intact continuous BM. In contrast, the majority of diffusely invasive carcinomas lacked a continuous BM. Carcinomas with a widespread loss of BM structures showed a high frequency of regional lymph node metastasis (16 of 18 cases, 88.9%). © 1994 John Wiley&Sons,

ISSN:1043-3074    

DOI:10.1002/hed.2880160111

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

年代:1994

数据来源: WILEY