Schweizerische medizinische Wochenschrift. Supplementum最新文献

Introduction: Objective evaluation methods for facial nerve function are yet to be standardised. Unresolved issues include what should be measured for different facial movements and how these measurements should be performed.

Methods: 5 facial mimics were analysed in normal subjects and in patients with facial paralysis. For each mimic the best measurement was determined and two global indexes derived.

Results: The best measurements were of surfaces close to the moving facial zone. These measurements and the global indexes correlated well with gradings by the House-Brackmann scale.

Objective: To study the incidence, location and stage of second primary tumours in patients with head and neck cancer and analyse the survival and outcome of patients with early-stage second primary tumours.

Methods: Retrospective chart review of patients treated for head and neck cancer from 1989 to 1993. Survival analyses and statistical comparisons with the Kaplan-Meier method and log-rank test.

Results: 99 of the 311 patients had second primary tumours. 45 patients had synchronous second primary tumours and 54 metachronous second primary tumours, diagnosed at an early stage (stage 0 or I) in 78 and 63% of cases respectively. Patients with second primary tumours had a significantly (p = 0.03) lower survival rate than patients with single tumour. However, for patients with early stage second primary tumours survival was not significantly decreased (p = 0.3).

Discussion: This study confirms the high incidence of second primary tumours and their negative impact on the outcome of patients with head and neck cancer. Early diagnosis and treatment of second primary tumours results in a survival rate very similar to that of patients with a single head and neck cancer. This provides indirect evidence that in patients with curable initial head and neck cancer intensive screening for second primary tumours may result in an improved overall outcome.

Fine needle aspiration is a widely used diagnostic tool. Its use for the evaluation of head and neck masses remains somewhat controversial. This retrospective study analyses all patients presenting with neck masses investigated by fine needle aspiration in our institution from January 1997 to December 1998. 372 fine needle aspirations were performed. Cytological diagnosis was possible in 91%. Sensitivity was found to be 100%, specificity 99% and accuracy 99.7%. When including indeterminants in the false-negatives, overall sensitivity is 73%, overall specificity 100% and overall accuracy 90%. There were no complications, and in particular no suprainfection and no tumoural spread at the puncture site. We conclude that fine needle aspiration is a sensitive and specific modality which is very helpful in the diagnostic work-up of a neck mass.

Madelung's disease, or benign symmetric lipomatosis, is an uncommon disease. It is an unencapsulated fatty infiltration which in rare cases extends into the perilaryngeal space and mediastinum. The authors present a case complicated by an obstructive syndrome and sleep apnoea syndrome, which was successfully treated by continuous positive airway pressure. The literature is reviewed.

Introduction: The aim of this study was to analyse survival and complications in patients undergoing surgery for squamous cell carcinoma of the larynx and hypopharynx as a salvage procedure for recurrent tumours after radiotherapy.

Methods: Between January 1990 and December 1998, 166 patients with previously untreated squamous cell carcinoma of the larynx and hypopharynx were primarily treated by radiotherapy. Local failure occurred in 77 patients (46%). 57 (34%) underwent salvage surgery.

Results: 5-year survival for the 42 patients with carcinoma of the larynx was 60% and for the 15 patients with carcinoma of the hypopharynx 20%. The overall rate of postsurgical complications was 33% in patients with laryngeal and 47% in patients with hypopharyngeal cancer.

Discussion: There are few data in the literature regarding the clinical outcome in patients whose tumours are not controlled by initial radiotherapy. Our results indicate that only in carefully selected cases is salvage surgery successful in treating radiation failure in hypopharyngeal cancer. In patients with carcinoma of the larynx salvage surgery is successful and the rate of postoperative complications acceptable.