A hemangiopericytoma occurred on the posterior tracheal wall in a 46-year-old man. A review of the pathologic findings showed that compressed groups of capillaries were lined by an intact reticulin sheath that was surrounded by spindle-shaped pericytes. The ultramicroscopic findings of small spindle cells with a surrounding basal lamina and intracellular microfilaments in the absence of neurosecretory granules are important diagnostic features. Emphasis is placed on the impossibility of differentiating benign and malignant lesions pathologically, the need for long-term clinical follow-up, and the necessity for adequate complete surgical resection of these lesions. The use of a surgical approach to the posterior side of the tracheal wall can prevent postoperative stenosis.

Diagnosis, Differential↗

PubMed1981

Metastatic malignant disease to the parotid gland.

A survey of over 250 consecutive parotidectomies performed at The Mason Clinic indicates a surprising incidence of metastatic malignant disease to the parotid gland. Four percent of all parotidectomies performed indicated a metastatic focus of malignancy from an ;unsuspected primary outside areas of the head and neck usually implicated in parotid disease. Twenty-five percent of all cancer discovered at parotidectomy was metastatic malignant disease to the parotid gland. The most common site was the lung. A high index of suspicion, evaluation of pathologic specimens by electron microscopy, and detailed metastatic work-up for patients with malignant disease in parotid lymph nodes are recommendations which should be considered by the surgeon performing parotid procedures.

Adenocarcinoma↗

PubMed1981

A rational approach to carcinoma of the tongue.

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Humans↗

PubMed1980

Lingual malignant disease of minor salivary gland origin.

The base of the tongue follows only the palate in frequency of involvement in minor salivary gland malignant disease. We present the clinical history and findings in three patients and review the relevant literature. Surgery is the preferred therapeutic modality, though the judicious use of radiation therapy may enhance local control of the disease.

Adenocarcinoma↗

PubMed1980

Reconstruction of the base of the tongue and lateral pharyngeal wall.

A technique for reconstruction of the lateral pharyngeal wall, with a buccal mucosal rotation flap is presented for use in patients following extensive resections of the lateral pharyngeal wall with partial mandiblectomy. Reconstruction of the base of the tongue, utilizing midline tongue flaps and/or the epiglottis, is also illustrated. These innovative techniques frequently obviate forehead and chest flaps, aid in vocal rehabilitation, and allow single stage resection and reconstruction in nonradiated patients.

Cheek↗

PubMed1980

A protocol for combined treatment of cancer of the oral cavity and tongue.

A protocol for combined treatment of carcinoma of the oral cavity and tongue as practiced at the Mason Clinic for the past five years is presented. This protocol combines surgery with postoperative radiation therapy, and the initial results are presented. Comparison of the results at this institution at the one, three, and five year level for tongue, oral, and pharyngeal cancer compared to other peer group reporting rates, as surveyed by the Commission on Cancer Audit of the American College of Surgeons, indicates that our results compare favorably to those of other institutions. Apparent increase in local control, a probable increased cure rate, together with marked decrease in hospital time and multiple-staged procedures are noted. Disseminated distal metastasis has not been a major problem and is discussed.

Carcinoma↗

PubMed1979

Complete reconstruction of the chin and floor of the mouth.

A method of reconstruction of the entire floor of the mouth and chin is presented, utilizing interdigitated ventral tongue flaps for reconstruction of the floor of the mouth, and a deltopectoral flap for reconstruction of the chin, which, even with loss of bony support of the mandible, provides a watertight, competent oral sphincter with adequate communication and nutrition.

Chin↗

PubMed1979

The ultrastructural diagnosis of tumors of the head and neck.

Electron microscopy has proved to be a valuable diagnostic tool in surgical pathology. As shown in three illustrative cases, the procedure is most useful in accurately classifying light microscopically diagnosed undifferentiated tumors of the head and neck, and is also helpful in predicting the origin of cervical lymph node metastasis in occult cancer. It also serves to quality control diagnoses made by light microscopy. All surgical specimens are fixed in a fixative that gives adequate ultrastuctural preservation and allows retrieval and examination by electron microscopy, if indicated. Recent technical improvements have resulted in a turn-around time of less than two days, thus making diagnostic electron microscopy clinically useful. The ultrastructural examination of undifferentiated tumors has a high diagnostic yield, often obviating additional diagnostic procedures and exploratory surgery. The correct diagnosis results in appropriate therapy and accurate assessment of prognosis.

Aged↗

PubMed1979

The treatment of caustic ingestion.

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Acids↗

PubMed1979

Emergency problems involving sinusitis.

The problems which the primary physician or flight surgeon might expect to encounter with regard to acute sinusitis are presented. The need for exact diagnosis, the goals of treatment, and the management of the progress of the disease processes are reviewed.

Acute Disease↗

PubMed1979

The initial evaluation in maxillofacial trauma.

Evaluation in maxillofacial trauma is primarily an extension of the art of the physical examination, with inspection, palpation, and evaluation of loss of normal function as the primary requisites. X-ray evaluation is critical, and best results are usually obtained by taking films as soon following the injury as possible, before opacification of the sinus with blood, swelling, or hematoma obscures critical bone landmarks. Primary reduction and surgical management of these fractures can usually be delayed for a reasonable period; however, the most accurate findings on both physical examination and x-ray studies are those obtained as soon as possible after the injury.

Child↗

PubMed1979

Trauma involving the air and food passages.

The management of trauma to the air and food passages has been reviewed briefly, with emphasis on the management of the acute problems based upon a thorough evaluation.

Airway Obstruction↗

PubMed1979

Sinusitis as an emergency.

The manifestations of diseases of the paranasal sinuses that may present as acute emergency situations and the more common complications of these diseases are briefly reviewed with suggestions for initial evaluation therapy.

Adult↗

PubMed1978

Management of intraoral injuries.

Primary closure of intraoral wounds can be done up to 24 hours after the injury. A mucosal seal decreases the possibility of infection and allows the wound to heal more rapidly and less painfully than a wound left open to heal by secondary intention. Defects of the lips must be closed with exact alignment of the vermilion-cutaneous margins. Nerve repairs must be done without tension at the repair site. Parotid duct repairs are mandatory to prevent cyst and fistula formation. Anterior permanent teeth may be replanted.

Adult↗