Recent advances in laryngo, pharyngo, esophageal reconstruction.

Laryngopharyngeal reconstruction has remained a challenging field since the performance of the first laryngectomy near the turn of the century. Cutaneous, myocutaneous and colonic reconstruction is still occasionally used but is fraught with a high stenosis and fistula rate. Gastric pull-up has remained the procedure of choice for single staged pedicled reconstruction.

Screening for distant metastases in head and neck cancer patients.

The search for distant metastases in head and neck cancer patients, at the time of initial presentation and evaluation, is justified in order not to subject a patient to radical local therapy if cure cannot be attained. This study reviews 897 consecutive cases of squamous carcinoma of the larynx, oropharynx, hypopharynx and oral cavity, presenting to the Department of Otolaryngology--Head and Neck Surgery. One hundred and twenty-one patients presented with advanced disease or other factors that suggested distant metastases were highly likely to be present.

Vertico-frontolateral laryngectomy (hemilaryngectomy). Indications, technique, and results.

The hemilaryngectomy procedure includes the entire hemithyroid cartilage with the extent of the cartilage cut beyond the midline determined by endoscopy and cord cut determined after anterolateral pharyngotomy to minimize or maximize the procedure according to tumor size. Hypopharyngeal or piriform sinus mucosa was used to reconstruct the resected hemilarynx. There were 56 male subjects and one female subject.

The free jejunal graft in head and neck reconstruction.

Reconstruction of the pharynx and cervical esophagus presents a tremendous surgical challenge to the Head and Neck Surgeon. Over the past 2 years the free jejunal graft with microvascular anastomosis has been used in 12 consecutive cases. Careful follow-up included not only clinical assessment, but regular radiographic evaluation, as well as fiberoptic esophagoscopy and biopsy of the jejunum.

Tonsil carcinoma--treatment results.

Epidermoid carcinoma of the tonsil region is one of the most common malignancies of the upper aerodigestive tract, equal in frequency to laryngeal carcinoma at the University of Cincinnati Medical Center. This paper reviews the author's experience in treating these lesions with a combination of 5000 rads preoperatively followed by composite resection. The overall two-year crude survival is 58%.