Transactions - Pennsylvania Academy of Ophthalmology and Otolaryngology最新文献

A review of 142 lacrimal gland biopsies performed during a 25 year period revealed that 78% of lacrimal gland lesions were of nonepithelial origin and only 22% were primary epithelial neoplasms. The nonepithelial lesions included inflammation (64%) and lymphoid tumors (14%), while the epithelial lesions included dacryops (6%), pleomorphic adenoma (12%), and malignant epithelial tumors (4%). These results contradict the much quoted teaching that 50% of lacrimal gland lesions are primary epithelial tumors and 50% are nonepithelial lesions.

Thornwaldt's cyst is an uncommon nasopharyngeal lesion which develops from the remnant of the primitive notochord. A case report of a patient with a Thornwaldt's cyst and cervical adenitis is presented. Though computed tomography of the head and neck was unremarkable, magnetic resonance imaging of the nasopharynx revealed the Thornwaldt's cyst, suggesting that this modality may be more sensitive in detecting and evaluating cystic lesions of the nasopharynx. The differential diagnosis of cystic nasopharyngeal masses is discussed.

This study is a retrospective review between 1976 and 1986 of 12 patients with T1(1) and T2(11) NO supraglottic cancers which were managed by a method that utilized planned preoperative radiotherapy (45-51 Gy) to the primary and bilateral necks. If adequate tumor response (greater than 75% reduction in size) was noted by laryngoscopy, therapy was completed at levels of 65-70 Gy to the primary. If a lesser tumor response was noted, the patient underwent supraglottic laryngectomy. Six patients completed primary radiotherapy (RT-RT) and six patients underwent supraglottic laryngectomy (RT-SG). There was evidence of residual tumor in three of six RT-SG patients. No tumor recurred at any site. Laryngeal function was preserved in all patients. Absolute survival was 58% at 67 months. This approach is oncologically sound and permits maximal laryngeal conservation.

A short nose occurs congenitally or as a result of rhinoplasty surgery. The correction is difficult when it involves grafts, flaps and implants. An intranasal technique of lengthening the nose without grafts, flaps or implants is described. It allows the nasal tip to rotate inferiorly, resulting both in an actual and apparent lengthening of the nose.

The management of malignant melanomas of the posterior uvea recently has become a topic of great controversy. The traditional treatment by enucleation of the tumor-containing eye has recently been challenged by a number of authorities, and clinicians more frequently are using alternative methods of management when possible. Current management can range from periodic observation and fundus photography of selected small lesions that appear dormant, to photocoagulation, radiotherapy, or local resection in the case of growing tumors in eyes with useful or salvageable vision. In cases where the tumor is far advanced and there is no hope of useful vision, enucleation is often inevitable. The choice of therapy is a complex issue and each case must be individualized. In selecting a therapeutic approach certain factors must be carefully weighed. These include the size of the melanoma, its extent and location, its apparent activity, the condition of the opposite eye and the age, general health, and psychological status of the patient. Based on personal experience with approximately 3000 cases, the authors discuss their current indications for the various therapeutic techniques for posterior uvea melanomas.

Video-endoscopic sinus surgery is a team approach which has evolved from classic, endoscopic sinus surgery in treating over 500 patients. Unlike classic endoscopic sinus surgery which has the surgeon viewing and operating through the endoscope, this technique permits the surgeon to operate while viewing the T.V. monitor using two hands for instrumentation. This technique greatly facilitates hands-on teaching and learning, while simultaneously providing a reproducible method of documentation.

Histiocytic tumors of the orbit comprise an unusual group of lesions characterized by the infiltration of the orbital tissues by xanthomatous cells. Recently, there have been a number of new observations regarding the various histiocytic tumors that can affect the orbit. The condition previously referred to as histiocytosis X is believed to represent a proliferation of Langerhans cells and the term Langerhans cell histiocytosis is often used instead of histiocytosis X. Juvenile xanthogranuloma has been demonstrated to affect the orbit without involving the skin or the iris. The Erdheim-Chester disease is a condition of adults characterized by infiltration of bone, retroperitoneum, heart, lungs and other tissues by xanthoma cells. This condition has recently been recognized to produce a classic ophthalmological picture of bilateral xanthelasmas and bilateral proptosis. The authors review their personal experience with several patients with histiocytic tumors of the orbit and stress the clinical spectrum of these conditions.