Evolution of the extracranial approach for repair of CSF leaks: review of the literature and clinical cases.

The management of cerebrospinal fluid rhinorrhea changed with the advent of endoscopes in the early 1990s. The majority of repairs are now approached endoscopically, i.e.

Frontal sinus fractures: anterior skull base.

The frontal sinus is fractured in 30% of patients sustaining maxillofacial injury. The CT scan has simplified the treatment plan allowing the surgeon to be more selective in the treatment choice, surgical approach, and follow-up. Fractures may involve the anterior, posterior, or both tables of the sinus.

Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer.

Purpose: A multi-institutional, prospective, randomized trial was undertaken in patients with advanced head-and-neck squamous cell carcinoma to address (1) the validity of using pathologic risk features, established from a previous study, to determine the need for, and dose of, postoperative radiotherapy (PORT); (2) the impact of accelerating PORT using a concomitant boost schedule; and (3) the importance of the overall combined treatment duration on the treatment outcome.

Methods And Materials: Of 288 consecutive patients with advanced disease registered preoperatively, 213 fulfilled the trial criteria and went on to receive therapy predicated on a set of pathologic risk features: no PORT for the low-risk group (n = 31); 57.6 Gy during 6.

Radiation effects on osteoblasts in vitro: a potential role in osteoradionecrosis.

Objective: To evaluate the factors involved in bone remodeling and wound healing that may be altered by radiation therapy.

Design: A prospective, controlled study of biochemical activity in vitro.

Subjects: MC3T3-E1 mouse osteoblasts.

Risk factors associated with hypothyroidism after laryngectomy.

Hypothyroidism is a well-documented complication after treatment of head and neck cancer and is particularly significant among patients undergoing laryngectomy. The objective of this study was the identification of factors associated with the development of hypothyroidism in this population. Records of 136 patients treated with laryngectomy were retrospectively reviewed in an attempt to define a risk factor profile for patients in whom hypothyroidism is most likely to develop after laryngectomy.

Transforming growth factor-beta type II receptors and smad proteins in follicular thyroid tumors.

Objective: Resistance to transforming growth factor (TGF)-beta-mediated cell growth inhibition is a well-known pathogenic mechanism in epithelial neoplasia. TGF-beta signaling requires normal function of downstream mediators such as TGF-beta receptors (TbetaRs) and Smad proteins. The goal of this study is to investigate the expression of components of the TGF-beta signaling pathway in follicular tumors of the thyroid.

Factors affecting survival for floor-of-mouth carcinoma.

Objectives: The treatment of extensive floor-of-mouth carcinoma has remained a challenging problem for head and neck surgeons. We have reviewed our experience in the surgical management of floor-of-mouth cancer in an attempt to identify factors influencing survival.

Methods: A total of 144 patients with cancer involving the floor of the mouth were treated between March 1988 and November 1995.

Assessment of plate use for mandibular reconstruction: has changing technology made a difference?

Reconstruction of mandibular defects with a variety of alloplastic materials during a 22-year period was reviewed. Outcomes were examined to determine whether specific plating technology affected the incidence of plate-related complications including plate exposure, plate fracture, and plate removal. Repair with the miniplate, reconstruction plate, titanium hollow screw reconstruction plate, and locking reconstruction plate was evaluated.

Auricular carcinoma with temporal bone invasion: outcome analysis.

Invasion of the temporal bone by cutaneous carcinoma of the auricle and periauricular skin is an ominous prognostic sign. Management includes aggressive resection of cutaneous disease as well as resection of temporal bone to obtain a medial margin. Analysis of data from 21 patients with temporal bone invasion caused by cutaneous malignancy is presented.

Cyclin D1 expression as a prognostic parameter in papillary carcinoma of the thyroid.

Papillary carcinoma of the thyroid is the most common thyroid cancer. At the time of clinical presentation, most papillary carcinomas are still confined to the thyroid gland, and appropriate surgical treatment achieves a 95% 5-year survival rate. Certain carcinomas, however, behave in a much more aggressive fashion.

Transforming growth factor beta receptors and p27kip in thyroid carcinoma.

Objective: To investigate the role of cell cycle regulators in the pathogenesis of papillary carcinoma of the thyroid.

Design: Resistance to transforming growth factor beta-mediated inhibition is a well-known pathogenic mechanism in epithelial neoplasias. In a retrospective study, the expression of transforming growth factor beta receptors types I and II, cyclin D1, and the cyclin-dependent inhibitor p27kip, was analyzed by immunohistochemistry.

Reconstruction after temporal bone resection.

Reconstruction of soft tissue defects after temporal bone resection can vary from simple closure of the external auditory canal to complex flap coverage of extensive defects. Between 1987 and 1996, 34 patients underwent lateral skull base resections and reconstruction for invasive carcinoma of the temporal bone. Seven underwent sleeve resection and/or radical mastoidectomy.

Postoperative accelerated radiotherapy in high-risk squamous cell carcinoma of the head and neck: long-term results of a prospective trial.

Background: For patients treated with combination resection and postoperative radiotherapy, the interval between surgery and completion of radiotherapy represents an opportunity for tumor repopulation and treatment failure. A prospective trial to test the feasibility and efficacy of accelerated postoperative radiotherapy was concluded in August of 1990.

Methods: Thirty-two patients with high-risk pathologic findings were treated with 63 Gy in 35 fractions of 1.

Effects of radiation therapy on reconstruction of mandibular defects with a titanium reconstruction plate.

Titanium fixation plates are commonly used in reconstruction of mandibular defects resulting from tumor resections in head and neck surgery. The effects of radiation therapy on the interface of bone, plate, and soft tissue were examined in this in vivo study. Four conditioned beagles had 1-cm segmental mandibular defects that were reconstructed with titanium plates.

Repair of mandibular fractures using the 2.0 mm system. A review.

The mandible is a commonly injured facial bone with mandibular fractures occurring 3 times more frequently than those in the zygoma. Requirements for repair vary with the type of fracture, the location of the fracture, and the condition of the teeth and bone. Repair of the mandible is complicated by the complex range of function of the mandible.

Assessment of bone formation during osteoneogenesis: a canine model.

Distraction osteoneogenesis, callotasis, has been demonstrated to be an effective means of lengthening long bones. A variation of Ilizarov's technique produces a transport disk from one cut surface of bone within a defect and advances the disk to the opposite surface to close the defect. This process, previously described by Costantino et al.

Comparison of intravenous ketorolac and alfentanil as supplements to propofol anesthesia for diagnostic panendoscopy.

Study Objective: To determine if ketorolac tromethamine is an acceptable alternative to alfentanil as a supplement to propofol for diagnostic panendoscopy.

Design: Randomized, double-blind study.

Setting: University medical center.

Costal osteomyelitis after pectoralis major myocutaneous flap use in head and neck reconstruction.

Costal osteomyelitis and chondritis are rare complications of PMMF usage. They probably represent a secondary complication of a donor-site infection. This diagnosis must be considered in cases of PMMF donor-site infections, which fail to resolve with local wound care and antibiotics.

Evaluation of distraction osteogenesis by scanning electron microscopy.

A model of bifocal distraction osteogenesis in the canine model was used to assess and quantitate the mineral content of the newly forming bone within the canine mandible. A 2-cm defect was created in the body of the mandible, and after a posterior osteotomy, the transport disk was advanced at 0.25 mm per 8 hours for 21 days and then held in rigid fixation for an additional week.

Basement membrane of blood vessels during distraction osteogenesis.

A canine model of distraction osteogenesis has recently been developed that permitted the evaluation of bone formation and its vascularization during bifocal callotasis. In this model, the authors examined the composition of the blood vessels during distraction osteogenesis of the mandible for laminin and for Type IV collagen, both constituents of the vascular basement membrane. At the fibrous distraction site, at the juncture of the free cortical surface and the regenerated bone, and at the abutting cortical surfaces at the distal margin of the defect, laminin and Type IV collagen were present in all vessels.