Otolaryngology and head and neck surgery最新文献

Conservation of physiologic values of circulating parathormone is a surgical objective in those instances in which a hyperfunctional parathyroid state exists as well as in those instances in which cervical evisceration employed as an ablative measure for the management of neoplastic disease threatens to impose postoperative tetany. Because the parathyroid glands may vary in number and in anatomic sites, a predictable and reproducible surgical approach that permits the operator an avenue of access to these structures is used. The viscerovertebral angle provides a surgical modality which facilitates the operative effort. The method has been applied in more than 70 patients.

This case report of a 20-year-old white woman is the youngest patient with a documented squamous cell carcinoma in a solitary nonirradiated laryngeal papilloma. It is rare for malignant degeneration of solitary squamous cell papilloma to occur in a patient under the age of 40. This case is also unique in that most solitary laryngeal papilloma with or without neoplasm occur in males. Most reported malignant neoplasms in squamous papilloma have been previously treated with irradiation. Because approximately 2% to 3% of solitary laryngeal papilloma have malignant neoplasms, adequate biopsy of the lesion and thorough histologic examination must always be done.

A major controversy surrounding juvenile papilloma is whether or not these lesions ever spontaneously undergo malignant change. One view contends that malignant change never takes place unless the lesion is irradiated. Presented is a 22-year-old man who suddenly develops features of extensive malignant invasion of his neck and mediastinum but has no history of irradiation.

An analysis of specimens of 43 head and neck tumors revealed that collagenase and protease activities paralleled each other and varied according to the anatomic site; highest activities were in tongues and tonsils, which are known to have low five-year survival rates. The greatest differences in both enzyme activities were observed in the studies of histologic patterns and tumor differentiation. The ulcerated tumors with inflammatory infiltrates having high enzyme activities suggest that collagenase and protease may be derived from inflammatory cells.

Over a three-day period, pharyngitis, neck swelling, deep voice, dysphagia, fever, and cellulitis of the anterior neck and upper chest developed in a 63-year-old woman. Sixteen hours following the institution of intravenous ampicillin, septic shock developed and the patient became comatose. Ampicillin-resistant Hemophilus influenzae type B was found in a culture taken from her blood and pharynx. In patients who have an upper respiratory tract infection and severe cellulitis of the neck, initial therapy should include chloramphenicol because of the possibility of ampicillin-resistant Hemophilus influenzae infection.

A retrospective analysis of 103 selected patients with floor-of-mouth epidermoid carcinoma compared the effectiveness of surgical therapy alone vs planned preoperative radiation combined therapy vs irradiation therapy. All three treatment methods appeared equally effective in irradicating stage I and II disease. Stage III floor-of-mouth epidermoid carcinoma was similarly controlled by either surgical therapy or combined therapy. Irradiation therapy alone was markedly inferior in treatment of stage III disease. Stage IV disease was poorly handled by any of the treatment methods. Histologic factors, tumor characteristics, tumor spread, nodal status, and staging did not appear in the majority of cases to significantly influence treatment selection or survival or both.

An anatomic study is made to determine the role of the periosteum in the lymphatic drainage of the floor of the mouth in the dog. Microsurgical techniques are used to cannulate and perfuse a lymphatic vessel. Pathways are dissected to the proximity of the mandible, where a full-thickness mucoperiosteal flap is elevated. It is found that the floor-of-the-mouth lymphatics drained through the periosteum prior to entering the cervical lymphatic chain.

Postoperative infection after placement of myringotomy tubes is common. Surgeons and manufacturers of surgical devices have frequently substituted one material for another in middle ear prostheses without analyzing the interaction of material and infection. Implant material attributes are reviewed. Scanning electron micrographs are presented that demonstrate characteristic surface differences between materials and between the same material of different manufacturers. A preliminary clinical controlled study of the covariance of purulence with silicone vs fluorocarbon tubes demonstrates statistically significant differences. The implications of this information are discussed.

An objective examination of olfactory function is needed for evaluation and clinical progression of patients with olfactory deficits. Two hundred sixty-eight healthy subjects were studied in order to establish olfactory thresholds for three test odorants. Subjects were required to simply detect the presence of an odor when comparing various log dilutions of test odorant against two "blank flasks. These data have provided a means of quantitating existing olfactory deficits in affected patients. Olfactory function was found to be diminished in elderly subjects and should be considered a factor when evaluating older patients.