A-O reconstruction plate and sternal osteomyocutaneous flap in primary mandibular reconstruction.

Mandibular arch reconstruction remains a functional and aesthetic challenge for the head and neck surgeon. The recent popularity of vascularized free composite flaps has made them a first choice for many surgeons. However, the increased operating time, high failure rate, frequent need for operative rescue, specialized postoperative care and facilities, and specialized training required to perform them have prompted many extirpative surgeons to attempt other techniques or to leave the mandible unreconstructed.

Surgical management of malignant tumors of the lacrimal gland.

Malignant lacrimal gland tumors are rare but serious and life-threatening neoplasms. Patients frequently present with symptoms of less than 1 year duration, often demonstrating rapid change during the 6 months preceding diagnosis. Pain and periorbital sensory changes are also reported by patients.

Heterotopic gastric epithelium in the head and neck region.

Heterotopic gastric epithelium in the head and neck area is a little-known entity, unsuspected by clinician and pathologist alike. We have reviewed the literature and discovered 14 cases of this entity. While previous reviews of the subject have, unfortunately, included reports of cases with heterotopic intestinal epithelium, our study addresses itself to separating the two.

Cysts, masses, and tumors of the accessory parotid gland.

An accessory parotid gland occurs in approximately 21 percent of human subjects. It is located anterior to the main parotid gland, usually just above Stensen's duct and connected by its own duct to the latter. Any lesions that can occur in the main parotid gland can also arise in an accessory parotid gland.

Coexisting benign mixed tumor and mucoepidermoid carcinoma of the parotid gland.

Multiple unilateral parotid gland tumors are very rare. A review of the literature shows only seven cases of coexisting unilateral parotid tumors. This patient had a benign mixed tumor and a mucoepidermoid carcinoma of the right parotid gland.

Branchiogenic carcinoma -- fact or fallacy?

The ongoing debate concerning the existence of malignant transformation of branchial cleft cysts has been analyzed, with the aid of previous reports and reviews in the literature. Six new cases are presented and illustrated. These occurred in 4 male and 2 female patients, having an average age of 60 years.

Ankylosis of the temporalis-coronoid complex of the mandible.

Ankylosis of the temporalis-coronoid complex is a clinical entity. The etiology is usually direct trauma to the temporalis muscle or coronoid process of the mandible. It is difficult to differentiate diagnostically from ankylosis of the adjacent temporomandibular joint, and should always be considered in the differential diagnosis of inability to open the mouth.

Actinomycosis: masquerader in the head and neck.

The diagnosis of cervicofacial actinomycosis is usually not simple, but may be essential for adequate treatment. Cases seen in a Head and Neck Service illustrate some of the many guises under which actinomycosis may be concealed, and a review of recent literature confirms its propensity to be a masquerader. A combination of techniques is necessary to diagnose, and both surgical and medical approaches are needed to treat this often distressingly persistent affliction.

Surgical treatment of orbital floor fractures.

Ninety patients with orbital floor fractures were treated by the Otolaryngology Service of the Columbia-Presbyterian Medical Center. Of these 90 patients, 58 were classified as coexisting and 32 as isolated. All fractures with clinical symptoms and demonstrable x-ray evidence should be explored.