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Biomedical subjects

R H Spiro

Publications and source records attributed to R H Spiro.

138 records · Page 8Linked to original sources
PubMedDate not supplied

Mandibular "swing" approach for oral and oropharyngeal tumors.

This study reviews the history, indications, and operative technique for median mandibulotomy with paralingual extension (mandibular "swing"). A 21-year experience is presented, during which this operative approach was used in 49 patients with tongue cancer and 16 others with oropharyngeal lesions. Mandibular "swing" appears to offer more versatility and fewer problems than either median labiomandibular glossotomy or lateral mandibulotomy. Good local control can be anticipated in properly selected patients because the tumor exposure is comparable to that achieved in operations involving jaw resection.

Adenocarcinoma↗
PubMedDate not supplied

Salivary neoplasms: overview of a 35-year experience with 2,807 patients.

We have reviewed a 35-year experience with 2,807 patients treated for salivary tumors which arose in the parotid gland (1,695 patients; 70%), submandibular gland (235 patients; 8%), and seromucinous glands of the upper aerodigestive tract (607 patients; 22%). Pleomorphic adenomas comprised 45% of the total, most of which occurred in the parotid gland. The clinical findings and the distribution of patients according to the histology and the site of origin are summarized. Treatment was surgical and the resection was conservative when possible, depending upon the extent of the tumor. The impact of site, histology, grade, and tumor stage on the results is shown.

Adolescent↗
PubMedDate not supplied

Complications following laryngectomy.

The complications following 100 consecutive laryngectomies performed at our hospital during a recent 18-month period are reviewed. The complication rates for total laryngectomy (63 patients) and extended laryngectomy (37 patients) were 19% and 49%, respectively, while the fistula rates were 8% and 27%, respectively. These rates were influenced primarily by the extent of surgery and the type of reconstruction, which during this interval included primary closure, pectoralis major myocutaneous flap, or gastric transposition. In comparison to our previous study, when the deltopectoral flap was used for patching the pharynx, the fistula rate for extended laryngectomy has decreased as a result of our use of myocutaneous flaps and greater experience with gastric transposition. Currently, we use the pectoralis major myocutaneous flap for pharyngeal repair if the mucosa would otherwise be closed under tension. All circumferential defects are repaired with a gastric transposition.

Adult↗
PubMedDate not supplied

Surgical approach to squamous carcinoma confined to the tongue and the floor of the mouth.

This retrospective study concerns 105 patients treated between 1977 and 1981 who had resections of previously untreated squamous carcinomas that were localized to the oral tongue or the floor of the mouth. Almost 80% had simple peroral excisions. Elective lymphadenectomy was performed in about one-third, all but one of whom had either T2 or T3 primaries or a surgical approach that involved entry into the neck. The determinate "cure" rate at 24 mo (median follow-up 50 mo) was 86%. Ninety-three percent and 78%, respectively, of those with T1 and T2 lesions remained alive and well after conservative operations, which yielded good functional results. Uncontrolled neck disease was evident in 10 of the 13 determinate patients who died as a result of their tumor. Although more of our patients with localized oral cancer now undergo elective lymphadenectomy when the primary is resected, T staging has not accurately predicted which patients are at greatest risk of metastasis. Preliminary data suggest that measurement of tumor depth may be a better way to select those patients who need elective neck therapy.

Adult↗
PubMedDate not supplied

Squamous cell carcinoma of salivary gland origin.

A 30-year retrospective analysis of 50 patients with squamous cell carcinoma of the salivary glands was conducted, including 42 patients with parotid tumors and eight with submandibular lesions. Clinical staging, performed for 48 patients in whom adequate data were available, yielded the following results: Stage I, 17%, Stage II, 12%, Stage III, 71%. Surgery was the primary therapy in 45 patients (86%). The determinate "cure" rate at 5 and 10 years was 24 and 18%, respectively, for patients with parotid lesions and 20% for those with submandibular tumors. As with other malignant salivary gland tumors, advanced stage and pain as a presenting symptom were ominous findings. Locoregional recurrence was the usual site of failure in both parotid (51%) and submandibular (67%) cases. Radical surgical extirpation, preserving the facial nerve when possible, remains our treatment of choice. It is anticipated that planned postoperative radiotherapy will reduce our high locoregional recurrence rates.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Diagnosis and pitfalls in the treatment of parotid tumors.

Any swelling near the ear is best considered a parotid neoplasm until proved otherwise. The diagnosis is primarily based on the clinical examination. Imaging studies are best reserved for patients who present with palate or tonsil swellings, which must be distinguished from parapharyngeal or minor salivary gland tumors. Almost all benign, and most malignant parotid tumors can be resected with preservation of the facial nerve. Aspiration biopsy can add useful information, but is not essential for treatment planning as the extent of the surgical procedure is primarily determined by the extent of the tumor. Survival rates in patients with malignant tumors are most significantly influenced by tumor stage. Results seem to have improved in recent years, possibly because we are treating a larger proportion with favorable lesions. Another factor may relate to the enhancement of locoregional control now achieved with postoperative radiotherapy, particularly in patients with Stage III or IV tumors.

Diagnostic Imaging↗
PubMedDate not supplied

Changing trends in the management of salivary tumors.

Fine-needle aspiration biopsy (FNAB) and computed tomography (CT) or magnetic resonance imaging (MRI) are useful in the evaluation of salivary gland tumors, but they are not essential for treatment planning in every patient. The mainstay of therapy is a well-planned and carefully executed surgical procedure which adequately excises the tumor. Disease-free survival is very likely in patients with early stage malignant tumors. When treatment is delayed until the tumor is extensive (Stage 3,4), local recurrence and distant metastases are common and survival rates are low. Adjunctive postoperative radiation therapy can enhance locoregional control in the latter patients, but does not invariably lead to better survival. No consistently effective chemotherapy agents or combinations are presently available. Early diagnosis and consistent, high quality treatment offer the best hope for improved survival.

Biopsy, Needle↗
PubMedDate not supplied

Mucus gland tumors of the larynx and laryngopharynx.

During the 30-year period from 1939 through 1968, 20 patients were seen who had "minor salivary" tumors arising in the mucus glands of the larynx or laryngopharynx. This group comprised about 3% of more than 600 patients with mucus gland tumors of the upper aerodigestive tract treated at Memorial Sloan-Kettering Cancer Center during the same interval. In each instance the tumor was malignant, and all but three of these patients were men. Location and histology of these uncommon tumors is described. Only 2 of 18 treated cases were "cured." Uncontrolled cervical lymph node involvement or distant metastasis was more often the reason for treatment failure, rather than local recurrence at the primary site.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

Hemangioma of the nasal bones: radiographic appearance.

Four additional cases of hemangioma involving the nasal bones are presented, bringing the reported cases to 15. The radiographic findings of nasal bone hemangioma are distinctive, permitting easy diagnosis. Hemangioma involving the nasal bones may result in a reticular or "soap bubble" osteoporosis, spiculation, bone thickening, or a channelled appearance of the nasal bone. Treatment is by local excision.

Adult↗
PubMedDate not supplied

Selecting variants in pharyngeal reconstruction.

A dramatic change in the techniques of immediate pharyngeal reconstruction in the last 10 years is largely due to the availability of myocutaneous flaps, microvascular techniques, and the increasing popularity of the "gastric pull-up" operation. The experience of the Head and Neck Service of Memorial Sloan-Kettering Cancer Center in repair of the pharynx following pharyngeal resection between 1974 and 1983 is reviewed and the changing trends in the philosophy of pharyngeal reconstruction are highlighted. The methods of reconstruction used were deltopectoral flap, gastric pull-up, free microvascular bowel transfer, and pectoralis myocutaneous flap. The indications, morbidity, effectiveness, and complications for each of these procedures are discussed. The optimal reconstructive methods for partial and total pharyngeal reconstruction are as follows: 1) primary closure for defects not exceeding one third of the circumference of the pharynx; 2) pectoralis myocutaneous flap repair for pharyngeal defects with loss of up to 70% of the circumference of the pharynx; 3) gastric pull-up with pharyngogastrostomy for defects exceeding 70% of the circumference of the pharynx; 4) gastric pull-up for all pharyngoesophageal defects where the lower margin of resection is below the tracheostome; and 5) reversed pectoralis myocutaneous flap with split thickness skin graft on the muscle for secondary closure of the pharyngostome.

Colon↗
PubMedDate not supplied

Squamous cancer of the tongue.

Early squamous carcinoma of the tongue (stage I) can be effectively treated by surgery or radiation therapy with good results. In patients with larger, but apparently localized tumors (stage II), we now favor a staging operation (supraomohyoid neck dissection) to select those who require additional treatment directed to the neck. Our preference for patients with advanced tumors (stage III and IV) has shifted to mandible-sparing surgery whenever possible, in combination with postoperative radiation therapy. Using this approach, locoregional tumor control has improved while the morbidity of extraradical surgery and high-dosage radiation therapy has been avoided. This approach may not translate into longer survival times until effective chemotherapy is available to control distant metastases. Meanwhile, there is a need for both public and professional education to increase the proportion of early, curable lesions and promote the necessary changes in lifestyle (i.e., abstinence from alcohol and tobacco) to reduce the incidence of tongue and other cancers of the aerodigestive tract.

Adult↗