Periorbital, subgaleal, and epidural empyema secondary to Eikenella sinusitis.
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Biomedical subjects
Publications and source records attributed to J R Chandler.
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The recent trend has been away from elective neck dissection in the management of patients with cancer of the head and neck. In addition, improved techniques of radiation therapy have demonstrated their capacity to eliminate and sterilize occult and even frank neck metastases. An unselected series of 409 radical neck dissections performed in 357 patients in a period of eight years has been critically reviewed to determine the incidence of microscopically negative nodes in patients who were previously radiated for cure and in whom a neck dissection had been performed as a part of the surgical procedure. Findings and results support our current position that a neck dissection in the presence of clinically negative nodes, particularly when they were never previously present, need not be included in the surgical procedure designed to salvage patients following radiation failure. Because of the documented increase of postoperative complications following such surgery, the decrease in morbidity and mortality seems to justify this policy.
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Anatomical variations of the styloid process and its ligaments may be responsible in some patients for vague symptoms referrable to the throat and neck. On occasions, they result in some diagnostic and therapeutic quandaries. The anatomy is reviewed and five case reports used to illustrate typical and unusual problems.
Hypercalcemia occurs rarely at the time of diagnosis in patients found to have epidermoid carcinoma of the head and neck. It is particularly unlike in those patients who present with potentially curable lesions. Only 2 of our 307 patients who presented with potentially curable lesions were hypercalcemic at the time of diagnosis. Two hundred thirty-eight of these patients were followed up for two years or until death. Of the 139 who did not remain free of disease, hypercalcemia of clinical significance developed in ten (7.2 per cent). Pseudohyperparathyroidism was the suspected cause in seven of twelve patients. Debilitating symptoms were present in all patients with serum calcium levels greater thn 12.0 mg/100 ml. Treatment, when given, was effective in alleviating gastrointestinal and central nervous system problems. Although usually temporary, symptomatic improvement was appreciated by most patients and family members.
A revised clinical staging system for cancers arising in head and neck sites has been prepared. It utilizes a uniform N classification for cervical node metastases. The T classifications describing the extent of the primary tumor are generally similar but differ in specific details for each site. Although the present system makes use of past field trials and more recent clinical studies, it cannot be considered final. Clinicians managing cancer in head and neck sites are encouraged to test the system with their own patient data to elicit further areas for improvement.
The bulge of the osseous anterior canal wall frequently prevents visualization not only of the margins of the perforation but also of the pathologic changes in the middle ear. In such instances, removal of this bone is absolutely necessary. In other instances, removal of the bulge facilitates both the surgical procedure and postoperative care. While the skin over the bulge may be sacrificed, it is preferable to preserve the skin by creating either a laterally or medially based flap. This provides access to the bone which is removed with motor driven burrs. The techniques are essentially the same whether the approach is through the canal or from behind the ear.
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