Staple closure of the gullet after laryngectomy: an experimental study.

Traditionally, gullet closure that is done after a laryngectomy has been accomplished with tedious and time-consuming suturing procedures. As an alternative to this, staple closure of the gullet has been growing in acceptance and implementation as a mucosal eversion technique. In this article, we shall present several aspects and considerations of this method of surgical closure.

A pilot study of cisplatin-vinblastine as the initial treatment of advanced head and neck cancer.

Twenty patients with Stage IV and five patients with Stage III carcinoma of the head and neck were treated with the combination of cisplatin and vinblastine before locoregional therapy. Among 24 patients evaluable for response after chemotherapy, there were four complete responders and 16 partial responders for an overall major response rate of 83%. No complete responses were observed in patients with T4 primary lesions or N3a nodal disease.

Intraoperative radiotherapy in patients with recurrent head and neck cancer.

Patients with head and neck cancer who have a relapse of the disease above the clavicles can sometimes be salvaged by additional surgery. However, if all gross tumor cannot be removed during surgery or if the resection margins are unsatisfactory, the likelihood of salvage is remote, especially when postoperative radiotherapy is not feasible due to previous radiotherapy. Between 1979 and 1983, we employed intraoperative brachytherapy for 21 such patients.

Mandibulotomy approach to oropharyngeal tumors.

We have reviewed our experience with 120 selected patients who had pharyngeal tumors resected through a median mandibulotomy approach with paralingual extension (mandibular swing). Clinical findings, technique, and complications are discussed. Results were gratifying in terms of salvage, patient appearance, and function.

A non-looping afterloading technique for base of tongue implants: results in the first 20 patients.

The results of treatment in the first 20 patients treated by a non-looping afterloading technique for base of tongue implant are described. Ten patients had carcinoma recurrent in the base of tongue after previous treatment and they were treated by implant alone. The other 10 patients had previously untreated carcinoma of the base of tongue and they were treated with a combination of interstitial implant, external radiation therapy and surgery.

Head and neck oncology--1985. Reflections on changing times.

The field of head and neck oncology is keeping pace with the dramatic shift in cancer treatment modalities occurring during this period of medical history. Having achieved a level of surgical elegance, the head and neck oncologist has the future to rely upon for more biological methods of management of this disease. Biochemistry, immunology, and virology occupy much of the research interest pertaining to malignancies of these body systems and it is within this research that the answers will probably be found.

An on-line interactive interviewing program for epidemiological studies.

An on-line interactive verification and entry system (OLIVES) has been developed for conducting telephone interviews in large-scale epidemiological studies. Responses are automatically coded into a computer legible form suitable for analysis. Use of a question stack to control question flow allows on-line response modification, restart from any termination point, and minimal reprogramming in order to change question order.

Technical modifications of the medial maxillectomy.

Several technical modifications to the originally described medial maxillectomy are discussed that enhance orbital retraction, nasolacrimal drainage system reconstruction, and orbital content reapproximation to the surrounding bony cage. The application of these techniques simplifies the procedure and enhances the original goal, ie, better visualization of the posterior part of the specimen intended for removal.

Further observations on the treatment of recurrent respiratory papillomatosis with interferon: a comparison of sources.

Between June 1982 and March 1983, 11 patients with aggressive recurrent respiratory papillomatosis were treated with alpha or human leukocyte interferon (IFN) that was produced by and purchased from the New York Blood Center, Inc. The year before, nine of these patients had been on a similar protocol utilizing alpha-IFN that had been supplied by the Finnish Red Cross Blood Transfusion Service. Comparisons regarding response and toxicity were made and are reported.

[Complications of rhinoplasty].

Following a consequent outline of his communication, the author subsequently describes his experiences, the possibilities of managing and personal techniques available in case of operative problems or postoperative complications such as bleeding, haematoma, dermal necrosis or scar formation or infection. The nasal physiology and its relation to the operative treatment, and the importance of a thoroughly preoperative evaluation of certain tissue characteristics are discussed. Postoperative skeletal alterations, such as insufficient or excessive removal of humps, cartilages and soft tissues as well as their surgical management are pointed out.

Recurrent thoracic outlet syndrome: causes and treatment.

The clinical history and operative findings in a group of 29 patients who underwent reoperation for thoracic outlet syndrome (TOS) are presented. Recurrence of TOS following initial surgical treatment was found to be operation-related (retained first rib segments, regrowth of periosteum), postoperation-related (infection, too early mobilization), or trauma-related. Recurrent TOS may be classified by the location of brachial plexus fixation.

Morphologic and histochemical characteristics of laryngeal muscle.

Laryngeal muscle (LM) is highly specialized for phonation and sphincter activity. We queried whether this specialization is reflected in the structure of LM. We examined, using histochemical techniques, the structure of five LM from three men who died suddenly and who had no evidence of laryngeal disease.

Computed tomography of the major salivary glands.

Forty-eight patients with proven disease of the salivary glands were evaluated by computed tomography (CT). Twenty-seven patients had salivary gland neoplasm and all were identified by CT. Fifteen benign tumors appeared as discrete, sharply marginated, high-density masses embedded in an otherwise normal gland.

Nasal dermal sinuses--new concepts and explanations.

Utilizing a series of 13 consecutive patients with nasal dermal sinus-cyst (NDSC) as a basis for study, this area of embryopathology was re-examined in light of the known and also the speculative knowledge available. Four of these patients had NDSC that involved the intracranial cavity and these served as a basis for correlating preoperative radiologic findings with what was actually found at the time of surgery. In so doing, we have been able to show that the pathogenesis of these lesions is consistent and the predictability of their intracranial involvement is based on this consistency.

Leukocyte interferon in patients with juvenile laryngeal papillomatosis.

Fourteen patients with aggressive juvenile papillomatosis were treated with systemic administration of alpha-type interferon (IFN). This initial dosage of 2 million units alpha-interferon/m2 was modified if a favorable response in the papilloma growth occurred, or if persistent drug-related side effects developed. Half of the patients showed a sustained response while on IFN, and two patients had a complete response.

Intra-arterial cisplatin treatment of adenoid cystic carcinoma.

Adenoid cystic carcinoma (ACC) is unique among salivary gland tumors in both its natural history and in its response to nonsurgical treatment methods (ie, radiation and chemotherapy). The chemotherapeutic agent, cisplatin, seems to be unique in its ability to affect ACC. It might be that ACCs of the minor salivary glands are especially vulnerable to the intra-arterial method of administering this drug, because there are accessible feeding vessels to most locations in which these tumors occur.

Treatment of nasofrontal ethmoidal complex fractures.

Successful reduction of severely telescoped nasofrontal ethmoidal fractures is difficult to achieve. In an effort to improve the results, a technique involving open reduction and external fixation was performed on three patients. These cases, along with ten other nasofrontal ethmoidal fractures treated between 1971 and 1980, are presented, with special emphasis in methods of reduction, stabilization, and results.

Radiographic management of juvenile angiofibromas.

Juvenile angiofibromas are benign, vascular, locally aggressive neoplasms that are preferably treated by surgical resection, or irradiation if surgery is not possible. Adequate surgery in the past has been limited by incomplete knowledge of the anatomy of the tumor and technical difficulties related to the vascularity. To better define the tumor, 12 patients with juvenile angiofibroma have been studied by axial and coronal high resolution computed tomography (CT).

Radiographic staging of juvenile angiofibroma.

A staging system for juvenile angiofibroma based on computerized tomographic findings is suggested. The need for such an endeavor has come about because of a lack of standardization of tumor data in both individual series and interinstitutional reports. The various stages reflect the number of anatomic sites occupied by a lesion rather than the actual tumor size.