Cricopharyngeal myotomy: management of cervical dysphagia.

Cricopharyngeal myotomy has gained widespread acceptance as surgical treatment for various forms of cervical dysphagia. The case records of 33 patients who underwent cricopharyngeal myotomy for dysphagia originating from varying underlying diseases are reviewed. The majority of these patients were able to resume oral feeding following myotomy.

Warthin's tumor, a multifocal disease.

Of all salivary gland neoplasms Warthin's tumor is the only lesion which is truly multicentric. The most common presentation of these multiple lesions is bilateral solitary masses. We present the first reported case of bilateral multiple tumors occurring simultaneously.

The early detection of antral malignancy in the postmaxillectomy patient.

A protocol was developed for the radiographic evaluation of the postmaxillectomy patient that called for a six- to eight-week postoperative, baseline computed tomography (CT) scan, followed by CT scans at four- to six-month intervals for at least three years. This protocol allowed for an early, more complete assessment of clinically discovered recurrences and the detection of clinically occult recurrences in three out of 18 patients who followed the protocol. The CT appearance of the normal partial and total maxillectomy is discussed, as well as the focal nodular soft-tissue findings suggestive of recurrent disease.

An analysis of 133 pectoralis major myocutaneous flaps.

Our experience with 133 consecutive pectoralis major island myocutaneous flaps in 126 patients is reviewed. The incidence of complications has been relatively low. Among the 133 flaps used in the head and neck area, 11 flaps (8 percent) failed to accomplish the intended purpose and required secondary repair.

Liaison psychiatry-otolaryngology rounds.

In an attempt to define and resolve patient and staff needs with regard to the psychological, social and economic problems in clinical otolaryngology, psychiatry/otolaryngology rounds were established in the Department of Otolaryngology 18 months ago. These weekly rounds have contributed greatly to improved patient care and better physician-nurse relations. They have also served a significant educational role for residents, medical students and other members of the patient care team.

Experience with immediate and delayed mandibular reconstruction.

The functional disability and cosmetic deformity after jaw and neck dissection can be very severe due to soft tissue and mandibular loss. Reconstruction of the mandible alone without soft tissue coverage can be complicated with prosthetic exposure, infection and, finally, rejection. We attempted to reconstruct the mandible at the time of tumor resection in a group of patients, using titanium mesh with marrow, rib, scapular spine, and clavicle.

Clinical-pathological determinants in prognosis of fibrous histiocytomas of head and neck.

Review of the literature reveals 76 cases of fibrous histiocytoma of the deep structures of the head and neck. To this we have added 11 of our own cases, and analyzed the total group to determine clinical and histological features of a high risk population. Age, sex, presence of pain, location of tumor, size of tumor, and local invasion appear to be important clinical criteria.

A new technique for wide-field exposure of the base of the skull.

Surgical exposure of the extracranial surface of the floor of the middle and posterior cranial fossa is difficult using the available techniques of skull base surgery. Considering this problem, cadaver dissections were performed and a new approach to the skull base developed. The parapharyngeal space is entered through a transcervical incision combined with a median labiomandibulotomy.

Manifestations of parotid gland enlargement: radiographic, pathologic, and clinical correlations. Part I: The autoimmune pseudosialectasias.

Histologic, clinical, and radiographic presentations of the autoimmune salivary gland diseases are reviewed. The punctate and globular sialographic changes observed actually reflect penetration of contrast material through the uniquely diseased glandular ducts and not sialectasis, as was previously thought. "Pseudosialectasis" is suggested as a more accurate term.

Parotid gland sarcoidosis and the CT sialogram.

The clinical and radiographic presentation of salivary gland sarcoid is presented. Computed tomographic sialography is a more sensitive method for detecting the multiple discrete granulomas of sarcoid than is conventional sialography. This appearance is distinctly different from that of the autoimmune salivary diseases with which it can be clinically confused.

Bilateral vertical partial laryngectomy for bilateral vocal cord carcinoma.

This paper presents a technique of partial laryngectomy for tumors involving both vocal cords. The resection includes both vocal cords, adjacent cartilage and one arytenoid. Staged reconstruction consists of rotating the remaining posterior border of the thyroid cartilage 90 degrees in order to obtain adequate anteroposterior length.

Peripheral nerve sheath tumors of the paranasal sinuses.

Only 4% of peripheral nerve sheath tumors of the head and neck occur in the paranasal sinuses. The most commonly involved sinus is the maxillary antrum and the most common histologic type is benign schwannoma. Two new cases of schwannoma occurring in the sphenoid and maxillary sinuses are reported.

Some CT findings in occult thyroid disease.

The hyoid-laryngotracheal complex (HLTC) is a mobile, flexible unit that can be deviated by adjacent neck masses. We present two cases of thyroid disease in which a clinically "silent" lesion rotated the HLTC to an abnormal position. The abnormal location of these normal structures was clinically mistaken for the primary pathology.

Massive necrotizing infections of the neck.

Necrotizing fascitis of the head and neck is a rare condition with only 7 cases recorded in the literature. Two cases are presented in which there was massive necrosis of the soft tissues of the neck with extension into the mediastinum. The offending organisms were a mixed bacterial flora which produced gangrene accompanied by subcutaneous emphysema.

Chyle fistula management.

Chyle fistula is a potentially devastating phenomenon that results from violation of the thoracic duct or right lymphatic duct in the neck, most commonly during radical neck dissection. It may impair nutrition, compromise and delay wound healing, and prolong hospitalization. In view of the morbidity produced by chyle leak discovered postoperatively and the lack of success of its management by aggressive surgical techniques, we have employed a different protocol for the past six years.

The nonspecificity of the antral bowing sign in maxillary sinus pathology.

Although bowing of the posterior antral wall occurs most commonly with juvenile angiofibroma, it can occur with any slow growing noninvasive lesion involving the retromaxillary region. Cases of schwannomas, a lymphoepithelioma, and a fibrous histiocytoma are presented as examples of the nonspecificity of the antral bowing sign.

Panel discussion: the management of advanced laryngotracheal stenosis. Staged tracheal reconstruction.

A staged method of repair of extended tracheal and combined laryngotracheal stenosis is presented. This entails creation of a trough by exteriorization of the involved segments, implantation of an alloplastic material adjacent to it, and the subsequent hinged rotation of the embedded implant over the trough to create a semi-rigid anterior wall to the airway. The development, indications, technique and complications of this method of tracheal reconstruction are discussed.

Pectoralis major myocutaneous island flap in head and neck surgery: Analysis of complications in 42 cases.

The pectoralis myocutaneous island flap was used for head and neck reconstruction in 42 patients. Major necrosis did not occur in any case, and minor necrosis was present in three of the cases (7%). The advantages of this flap over other myocutaneous flaps and cutaneous pedicle flaps are delineated.

Non-traumatic cerebrospinal fluid rhinorrhea.

Non-traumatic cerebrospinal fluid rhinorrhea is uncommon. Review of the literature revealed that 45% of cases are high pressure leaks and 55% of cases are normal pressure leaks. Meningoencephaloceles are very rare occurrences in the latter category and we present the third reported case occurring in the frontal sinus.