A short outline of anatomical relations leads to a discussion of the various techniques of facial nerve identification as they present in the literature. Particular attention was given to a relatively unknown technique that has served as a valuable manoeuvre in 14 consecutive cases of superficial parotidectomy.
In the 10 years between 1964 and 1974, 276 patients with infiltrating carcinoma of the larynx included 31 cases of varrucous carcinoma (11 per cent of the series). This tumor is characterized by the pushing invasion of well differentiated squamous epithelium growing in a vertically folded invasive pattern. The tumor appears most frequently in the two decades between 50 and 69 years of age. The ratio of male to female patients was 3.4:1. Verrucous carcinoma has a predilection for the supraglottic regions of the larynx. Cut surface of the tumor shows clefting and sharp margins. Lymph node metastasis occurred in five cases. The marked inflammatory host reaction can cause misleading cervical lymphadenopathy. Problems in diagnosis are discussed.
Animal experiments and human temporal bone studies have indicated that hearing losses may occur in ears that have normal populations of sensory cells. The possibility exists that the hair cells have been rendered non-functional because of ultrastructural damage. Preliminary investigation of cilia on hair cells in areas of suspected damage shows no difference from cilia in similar areas of control ears.
The physiological basis, historical evolution, and our own practice of stereotactic surgery for the relief of cancer pain are briefly described. Thirty-nine procedures have been performed on 33 patients, 27 for pain due to cancer. Lesions have been made both in the specific neospinothalamic pathway of midbrain and thalamus and in the non-specific reticulothalamic system with an overall five per cent mortality and five per cent morbidity. Initial pain relief was achieved in 90 per cent of patients with relief till death in 74 per cent. Lesions were more successful in releiving pain when the specific pain system was involved but only if the analgesia produced by the lesion "covered" the patient's pain. On the other hand, dysesthesia occurred only with lesions of the specific system, especially if they involved the thalamus.
Patients who undergo extensive resection of the pharynx along with laryngectomy usually are not able to develop esophageal speech. Since 1971 we have been working on a method for speech rehabilitation for these patients, which utilizes sound from a reed powered by tracheal air outflow. The sound is led into the pharynx via a fistula. Ten patients have been so managed, and six are now using this method of communication with satisfactory results. Preliminary studies on one patient indicated that his speech quality was judged to be superior to that produced by an excellent esophageal speaker. Efforts are continuing to study further the acoustical and perceptual properties of this form of speech and to improve further the method.
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