Since 1949, only 52 cases of hemangiopericytoma (HPC) of the nose and paranasal sinuses have been reported in the literature. Of the latter, only 2 originated from the maxillary sinus. This article reports 2 new cases. One arose in the maxillary sinus and involved the pterygopalatine fossa, skull base, and infratemporal fossa. The second tumor was located in the sphenoethmoidal recess. A new combination of techniques for resection of hemangiopericytoma of the skull base is described. Prognostic criteria for such tumors are reviewed, in conjunction with histological diagnosis.

Adult↗

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Modifications of the mandibular swing for preservation of occlusion and function.

The mandibular swing, or midline mandibular osteotomy with lateral mandibular displacement, provides excellent exposure equivalent to that obtained by composite resections of the mandible while minimizing cosmetic and functional disability and reducing the complexity of reconstruction. This procedure is most commonly described from an oncologic standpoint. Modifications of this procedure, performed on patients with adequate anterior mandibular height, provide access to lesions of the skull base, as well as benign lesions of the parapharyngeal space. Minor modifications of the midline mandibular osteotomy, as well as preservation of anterior mandibular dentition, provide these patients with immediate restitution of interocclusal anatomy and function.

Dental Occlusion↗

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Neoplastic seeding of squamous cell carcinoma of the oropharynx.

Neoplastic seeding is a concept of mechanical disruption and spread of tumor into normal tissues. It is well-documented and accepted as an explanation for unusual patterns of tumor recurrence at multiple sites in the body. Neoplastic seeding is often invoked as an explanation for stromal recurrences following treatment of laryngeal carcinoma. However, it is impossible to discern whether these recurrences represent peritracheal lymph nodes, persistent or recurrent local disease, or neoplastic seeding of tumor. The purpose of this article is to report two cases of tracheostomy site recurrences after treatment of oropharyngeal squamous carcinoma, in which neoplastic seeding is the most plausible explanation of recurrence. The rarity of this phenomenon appears strikingly small despite significant experimental evidence supporting the possibility of its occurrence. Although specific recommendations for prevention cannot be made, it appears prudent to avoid re-use of instruments that come into direct contact with squamous cell carcinoma tumor surface.

Aged↗

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Pilot trial of ribavirin for the treatment of laryngeal papillomatosis.

The antiviral drug ribavirin was used as an adjunct to laser surgery for the treatment of patients with laryngeal papillomatosis (LP). An uncontrolled clinical trial for four patients with ribavirin treatment at a daily dose of 23 mg/kg was performed. Three adults received drug prior to laser surgery and continuing orally for 6 months. One infant was treated for 3 months. Two adults achieved complete remissions for at least 2 consecutive months, and both patients developed only minimal recurrent disease in 4 months of follow-up. The other adult and the child sustained a partial response and an increased interval between the required surgeries. Ribavirin caused only a mild, reversible reduction in hemoglobin and reticulocytosis. This preliminary trial shows that ribavirin may be an effective therapy in combination with surgery for LP in a larger controlled clinical trial.

Adult↗

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Rhabdomyosarcoma of the infratemporal fossa: diagnostic dilemmas and surgical management.

We present a rare case of embryonal rhabdomyosarcoma in the infratemporal fossa presenting as an atypical facial pain syndrome. Radiographic imaging of the patient is discussed, and magnetic resonance imaging is recommended as the diagnostic modality of choice when mass lesions of the infratemporal fossa are suspected. Finally, a temporal approach to the infratemporal fossa is described, along with its advantages as an application for tumor resection in this anatomic region.

Child↗

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Emergency management of carotid artery rupture.

Rupture of the carotid artery has been one of the most feared postoperative complications in head and neck cancer patients. Traditional management of carotid artery rupture has been disappointing, and morbidity and mortality have been high. Experience with carotid artery rupture at the authors' institution over the past 20 years has been reviewed. The current method of management seems to result in a decreased number of neurologic sequelae and episodes of rebleeding. Of the last 23 carotid ruptures encountered, four occurred while the patient was at home. Two patients had neurologic complications, and there were two deaths. Only one episode of rebleeding occurred. All patients except one were discharged from the hospital. These patients were managed according to an established protocol, and the results of the authors' experience are reported and analyzed. Preoperative preparation prior to ligation is explained, and prognostic indicators and risk factors are reviewed.

Adult↗

PubMedDate not supplied

Neuroendocrine carcinoma of the larynx.

Neoplasms of the larynx showing neuroendocrine differentiation are uncommon, with less than 100 previously reported cases. These tumors encompass subcategories that have been designated heretofore as "malignant carcinoid" and "oat cell carcinoma" and have been associated with ectopic production of neuropeptides and biogenic amines. We report a case of neuroendocrine carcinoma that arose in the epiglottis in an elderly man, metastasized widely, and was responsible for death. Immunohistochemical studies showed the presence of serotonin, calcitonin, ACTH, met-enkephalin, chromogranin, and neuron-specific enolase within tumor cells, although clinical endocrinopathy was absent. This case is used as a focus for discussion of the spectrum of neuroendocrine tumors of the head and neck, including recommended treatment approaches for such neoplasms.

Carcinoid Tumor↗

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Dysphagia in laryngectomized patients.

Records of 226 laryngectomies performed at the University of Minnesota Hospitals and Minneapolis Veterans Administration Hospital from 1967 to 1976 were surveyed, yielding 36 patients with significant dysphagia. The majority of these patients were treated with combined therapy of preoperative radiation followed by surgical intervention. They were evaluated by esophagographic and endoscopic examinations. Among this group of patients, 16 had a benign pharyngeal stricture, 14 had recurrent tumor, two had lower esophageal stricture, and four had malignant esophageal carcinoma. Early detection of recurrent tumor is often difficult in a firm, woody radiated neck. Dysphagia may be the first sign of recurrence preceding obvious detectable recurrent tumors by several months. A barium swallow may show signs of early recurrence that may not be detectable by endoscopic examination. The radiographic evidence of recurrent tumor is described.

Adult↗

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Carcinoma of the tonsillar region: a comparison of radiation therapy with combined preoperative radiation and surgery.

Ninety-six patients with cancer of the tonsillar region in all stages were studied to compare full-course radiation therapy with surgical salvage to planned radiation and surgery. Full-course radiation therapy was effective in controlling T1 and T2 tumors without neck node involvement. Combined therapy was much more effective in treating T3 tumors with neck node disease. Patients with T4 tumors did poorly regardless of therapy.

Humans↗

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Mandibular reconstruction: external fixation.

Explore the source record for details and available documents.

Fracture Fixation↗

PubMedDate not supplied

Mental health in primary care training and practice: an innovative approach.

The need to augment the number of primary care physicians throughout the nation has been well documented. Moreover, there is increasing recognition of the importance of mental health in primary care practice. The authors present a working definition of primary care practice, discuss the role of mental health in primary care, and describe an innovative program developed in Houston which integrates primary care mental health training into the education of primary care physicians and mental health professionals.

Adaptation, Psychological↗