Surgical management of combined cervical tracheo-esophageal defects.
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Biomedical subjects
Publications and source records attributed to B W Pearson.
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Teratomas of the neck are rare in adults. Nine adult patients have been previously reported on in the world literature; six had malignant and three had benign lesions. Most of the lesions were seen as a mass in the neck, but teratoma is rarely considered in the differential diagnosis of neck lesions. A tenth patient, whose case we are presenting, had a supraclavicular sinus mass that was diagnosed at surgical exploration. The tumor was successfully resected and proved to be benign.
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Excellent speech can be produced by diverting expired pulmonary air to the pharynx through a tracheopharyngeal fistula. This study contributes basic information regarding the selection and fate of autogenous skin-lined tubes created for this purpose in a standardized fashion in pigs. Our specific objectives were to determine (1) the best cutaneous autograft for constructing a 6- to 7-cm skin-lined tube, (2) the airflow resistance of surviving skin-lined tubes, and (3) the effect of salivary contamination of the survival of tube grafts.
A review of 85 Mayo Clinic patients with carcinoma of the nasal septum revealed squamous cell carcinoma (58 patients) to be the predominant cell type, with adenocarcinoma (12 patients) and malignant melanoma (7 patients) being next in frequency. Twenty-five (29%) of the 85 patients had metastatic disease. Twenty percent (17) of the patients had another malignancy at some time during their lives. The study suggests that tobacco smoking may have a role in the etiology of squamous cell carcinomas of the nasal septum. In most patients, wide excision was the initial choice of treatment.
An ectopic carotid artery is rare. Its first symptoms may be neurological and could bring the patient to the neurologist during the initial evaluation. However, more often, the neurologist examines a patient in whom serious neurological deficit has occurred after transtympanic exploration of an undiagnosed vascular mass. Because diagnosis can be definitively established by angiography and the consequences of injury to an aberrant carotid artery are serious, operative exploration of vascular middle ear masses probably should be deferred until an ectopic carotid artery has been excluded by angiography.
Thirteen patients, six men and seven women, were seen at the Mayo Clinic with chondrosarcomas of the nasal cavity, paranasal sinuses, or nasopharynx in a 25-year period. Nasal obstruction, discharge, and bleeding were the major symptoms and a nasal mass was the most common sign. The typical chondrosarcoma is low in grade but malignant and it arises in the nasal cavity as a large, pale, glistening mass. Local excision was employed initially in seven patients and five had local recurrence. Definitive block excision cured four of six patients and the two others had a protracted clinical course and ultimately died of the disease. Long-term follow-up shows that chondrosarcomas are insidious, locally progressive tumors. Radiotherapy, used for palliation after recurrence, failed to produce any cures. Lateral rhinotomy and block excision are advocated as the primary treatment.