Management of neck metastasis with carotid artery involvement.

Objectives: To demonstrate aggressive management of neck metastasis adherent to the internal or common carotid artery using sound oncologic principles while minimizing the significant risk of complications.

Study Design: Our 13 year experience of treating patients with recurrent or residual neck metastasis adherent to the internal or common carotid artery was retrospectively reviewed.

Methods: Angiography was used in patients who demonstrated fixation of the carotid artery on examination or imaging, followed by balloon test occlusion and single photon emission computer tomography (SPECT) scanning.

Botulinum neurotoxin for pharyngeal constrictor muscle spasm in tracheoesophageal voice restoration.

Objectives/hypothesis: The purpose of the study was to evaluate the effectiveness of Botulinum neurotoxin (Botox) for elimination of pharyngeal constrictor muscle spasm in tracheoesophageal voice restoration.

Study Design: A retrospective review was made of 62 patients between 1991 and 2002 who had Botox as the initial treatment for pharyngeal constrictor muscle spasm.

Methods: One hundred units of Botox properly diluted in 3 mL saline was instilled unilaterally under electromyographic guidance after fluoroscopic identification and marking of the contracted pharyngeal constrictor muscles.

Zenker's diverticulum: analysis of surgical complications from diverticulectomy and cricopharyngeal myotomy.

Objective: To identify risk factors for postoperative complications in patients undergoing diverticulectomy and cricopharyngeal (CP) myotomy for Zenker's diverticulum.

Study Design: Retrospective.

Materials And Methods: A chart review was conducted of all patients with a Zenker's diverticulum who were treated with diverticulectomy and cricopharyngeal myotomy at three tertiary care centers in central Indiana between 1988 and 1998.

Phenylephrine and the prevention of postoperative tympanostomy tube obstruction.

Objective: To determine the efficacy of phenylephrine hydrochloride, a topical vasoconstrictor, in preventing tympanostomy tube obstruction.

Design: Prospective, randomized, double-blind, controlled trial of patients undergoing myringotomy with tympanostomy tube insertion.

Setting: Academic, tertiary referral medical center.

An efficiency comparison of four heat and moisture exchangers used in the laryngectomized patient.

Bypassing the upper airway places the burden of humidification on the lower airway. For this reason passive heat and moisture exchangers (HMEs) are used in the laryngectomized patient in an attempt to minimize the effect of lost upper airway function. We measured efficiency and airflow resistance and calculated the costs of four HMEs used in the laryngectomized patient.

Utility of preoperative radionuclide scanning for primary hyperparathyroidism.

This study retrospectively reviews 60 cases of primary hyperparathyroidism, 21 of whom underwent technetium 99 sestamibi scanning and 10 of whom underwent thallium 201/technetium 99 pertechnetate scanning preoperatively. The sestamibi and thallium scans demonstrated an 89.5% and a 62.

Fine-needle biopsy techniques of aspiration versus capillary in head and neck masses.

Fine-needle aspiration and fine-needle capillary biopsy techniques were compared, and the number of samples necessary to assure a diagnostic specimen was determined. In this study, each mass served as its own control, since both aspiration and capillary fine-needle biopsy were performed randomly on each mass. The study found the number of "superior" slides to be evenly distributed between the two biopsy techniques, but a different preference, based on tumor type, was noted for one or the other technique.

Functional outcome after surgery for prevention of pharyngospasms in tracheoesophageal speakers. Part II: Swallow characteristics.

The swallowing function of 29 patients with primary tracheoesophageal puncture who received either a pharyngeal constrictor myotomy, a unilateral pharyngeal plexus neurectomy, or a unilateral pharyngeal plexus neurectomy with a small drainage myotomy limited to the cricopharyngeus was studied. Swallowing function data were collected on each patient at 3 weeks, 6 months, and 12 months after surgery using videofluoroscopy. Differences in swallowing function among the treatment groups were primarily the amounts and loci of oral and pharyngeal residues.

Functional outcome after surgery for prevention of pharyngospasms in tracheoesophageal speakers. Part I: Speech characteristics.

The speech characteristics of 29 patients with primary tracheoesophageal puncture who received either a pharyngeal constrictor myotomy, a unilateral pharyngeal plexus neurectomy, or a unilateral pharyngeal plexus neurectomy with drainage myotomy limited to the cricopharyngeus were studied. All patients used a Blom-Singer low-pressure voice prosthesis. Audio recordings of each patient speaking with both the Blom-Singer tracheostoma valve and manual occlusion of the tracheostoma were recorded at 3 weeks, 6 months, and 12 months after surgery.

Management of advanced cervical metastasis using intraoperative radiotherapy.

Seventy-five patients who had advanced cervical metastasis with possible invasion of the deep muscles or carotid artery were approached with aggressive resection and intraoperative radiotherapy (IORT). All metastatic nodes were greater than 3 cm, 65% were fixed on clinical examination, and 35% involved the carotid artery. Forty-six (61%) of the patients had previously received irradiation.

Intraoperative radiation therapy for recurrent head and neck cancer.

Forty-seven patients with recurrent head and neck cancer in a previously irradiated field were treated with surgical resection and intraoperative radiation therapy (IORT). Recurrent disease occurred at a median of 18 months from primary treatment, and was at the primary tumor site in 31 and metastatic to regional lymph nodes in 16. Recurrences were squamous cell carcinomas in 42 and adenoid cystic in five.

Intraoperative radiotherapy of skull base cancer.

As the head and neck surgeon expands the boundaries of resectability into the skull base, the margin of tumor clearance diminishes. Intraoperative radiotherapy (IORT) can be used as an adjunct to skull base surgery and external beam radiation to enhance local control in areas with close margins or remaining microscopic disease. During the period from May 1982 to May 1988, 25 patients underwent IORT of the skull base following resection and prior to closure to treat microscopic disease in 9 patients, sterilize close margins in 14 patients, and attempt to eliminate remaining gross disease in 2 patients.

Evaluation of swallowing disorders: the modified barium swallow.

Swallowing is a complex process. The diagnosis and treatment of swallowing dysfunction are more objective due mostly to recent research. The performance of a barium swallow, modified to study the dynamics of swallowing and its value in the management of patients with swallowing dysfunction, is described.

Reconstructive and rehabilitative aspects of head and neck cancer in the elderly.

Age should not be considered a contraindication to adequate head and neck oncologic surgery. Reconstructive efforts should be by the most direct means to attain restoration of form and function in one stage. The next significant breakthroughs in the battle against cancer may well come on the cellular or molecular level.

Intraoperative radiotherapy of head and neck cancer.

Intraoperative radiotherapy (IORT) was developed as an adjuvant to surgery and external beam radiation for aggressive, extensive, or recurrent cancers of the head and neck. This report reviews the indications, technique, response, and complications of IORT. From May 1982 to May 1988, 104 patients received 15 to 20 Gy of radiation delivered through a Lucite cone to areas of high risk of recurrence following resection and prior to closure.

Applications of the voice prosthesis during laryngectomy.

With the recent introduction of the voice prosthesis for alaryngeal speech rehabilitation, its application in the early postlaryngectomy period is gaining acceptance. One hundred twenty-eight patients received a tracheoesophageal puncture and adjunctive pharyngeal constrictor relaxation during laryngectomy. The voice prosthesis was applied as early as 10 days after surgery, and the results of a 9-year experience are presented.

What is the role of carotid arterial resection in the management of advanced cervical cancer?

From 1977 through 1988, 16 patients underwent carotid artery resection and reconstruction or simple ligation in the treatment of advanced cervical carcinomas. Three patients underwent carotid artery ligation, with postoperative transient ischemic attacks, which resolved, in one patient. In the remaining 13 patients, interposition saphenous vein grafts were used to reconstruct the resected carotid arteries.

Surgical salvage for stomal recurrence: a multi-institutional experience.

Recurrence of squamous cell cancer following total laryngectomy constitutes an extremely difficult therapeutic problem. Satisfactory management is elusive and frustrating to the head and neck oncologist. Various recommended therapeutic regimens include symptomatic treatment, palliation with chemotherapy and radiation, and aggressive surgical salvage.

Sternocleidomastoid myocutaneous flap.

The sternocleidomastoid myocutaneous flap has several applications for reconstruction of defects about the head and neck. It is used for augmentation of facial defects, carotid artery protection, and repair of oral cavity defects. Additional reconstructive efforts suggest the sternocleidomastoid myocutaneous flap can be used for facial reanimation and as an osteomyocutaneous flap incorporating the clavicle for mandibular reconstruction.

Intraoperative radiation therapy for advanced or recurrent head and neck cancer.

Between 1982 and 1984, we treated 28 patients with advanced head and neck cancer with surgery, combined with intraoperative radiation. All patients had squamous cell carcinoma. One patient had two separate sites treated and a second patient was treated on two occasions, allowing 30 sites for analysis.