Canadian journal of otolaryngology最新文献

Delivery of radiation to a deeply located tumor site by external radiation is only accomplished by traversal of normal tissues. Even with the physical advantages of high energy radiation or heavy particles, this is still unwanted radiation. Even a tumor-seeking isotope, such as radio-iodine for carcinoma of the thyroid, must still have an initial total body distribution. While interstitial sources, removable or permanent, present a personnel exposure problem, the delivery and deposition of ionizing radiation in this way has unequalled simplicity, versatility, and availability. Although the method is as old as radiotherapy itself, three dimensional computer dosimetry has given it extended applicability, and extends an invitation to innovations in achieving ideal dose distribution.

Transconioscopy is a reliable method for the diagnosis of even minimal subglottic tumor extension. The technique is briefly described. Transconioscopy has been performed at Karolinska Hospital in more than 400 cases of laryngeal carcinomas without any complications. It is not associated with any risk of spreading of the tumor if performed on proper indications. It is always indicated in glottic carcinomas where a subglottic extension is not visible by direct laryngoscopy but not in the more advanced cases where the subglottic part of the tumor can be visualized by direct laryngoscopy.

At the Institute of Radiology, University of Belgrade, in close collaboration with ENT Hospital, a group of 772 patients were treated at various stages of laryngeal cancer with telecobalt therapy during the 1960-68 period. The supervoltage was consistently the primary approach in the treatment with curative intent, while surgery was resorted to for the failures only. One hundred and thirteen patients with recurrences following their exposure to irradiation, unfit for an operation or refusing surgery, were re-irradiated with telecobalt therapy. The authors studied several overall time, dose and fractionation schemes. The NSD concept of Ellis was employed to compare the biological effects of the different treatment factors. The optimum results were obtained with the doses fractioned over five or six weeks and NSD amounting to 1950. The five year absolute survival rate obtained at glottic cancer was 60.9 per cent. All stages of supraglottic cancer had a survival rate of 39.2 per cent. The five year survival after the second course of irradiation (113 patients) was 22.1 per cent, including 25 patients operated on after two series of irradiation. The authors consider that the risk of a radical re-irradiation has to be accepted in spite of possible complications because it is the only possibility to save a limited number of the patients unfit for an operation or who have a negative attitude to surgical treatment, especially to laryngectomy.

The use of Proplast as an implant material is described in the treatment of atrophic rhinitis. It offers an alterantive implant material to bone graft obtained from the patient. There is no resutling morbidity in relationship to a donor site.

Two unusual cases of chylous fistulae following right radical neck dissection are presented. Treatment in the second case consisted of pressure dressing and replacing the regular blended tube feeding diet with one containing medium chain triglycerides to replace ordinary lipids (long chain triglycerides). Caloric intake was supplemented with parenteral protein and fat infusions. This resulted in prompt cessation of the leak. Other methods of controlling fistulae such as re-operation and oversewing the area or using muscle flaps, or direct packing of the wound often lead to other complications and frequently require considerable time to control the leak.

Following a brief historical review of the sporadic attempts to improve the total laryngectomy, the author presents a technique for reconstructive laryngectomy. This technique should be restricted to one part of the cricoid and, according to certain modifications, to the free part of the epiglottis. Using these modifications, this technique allows the neck to be closed completely, thus avoiding a permanent tracheostomy. Relearning phonation and swallowing is spontaneous. Four cases are presented -- two successful. In the two failures, it was noted that one death was due to a hepatic deficiency and one to failure in relearning to swallow, which was attributable to senility.

Intramuscular hemangioma is a distinct type of hemangioma occurring within skeletal muscle and making up less than one per cent of all hemangiomas. They occur most often in the trunk and extremities, perhaps beacuse of the larger muscle volume in thos areas. 13.5 per cent of intramuscular hemangiomas do occur in the head and neck region and for this reason they should be considered in the differential diagnosis of head and neck masses. The first case of an intramuscular hemangioma of the digastric muscle is presented and confirmed by electron microscopic sections. An interesting finding in this tumor is the proliferation of both endothelial cells and pericytes. Hemangiomas are classified according to vessel size; "large vessel" cavernous, "small vessel" capillary, and "mixed". Various etiologies and modalities of treatment are discussed, and total excision with ligation of the feeding vessels is advocated to prevent the high incidence of later recurrence.