Protrusion of the jugular bulb is an uncommon but important cause of a bluish-purple mass behind the tympanic membrane. A knowledge of this condition is necessary to prevent massive haemorrhage following tympanotomy or during temporal bone surgery. The diagnosis can be established by jugular venography, which demonstrates the protrusion of the characteristic knuckle of the jugular bulb into the middle ear cavity.

Diagnosis, Differential↗

PubMed1983

Hyponatremia secondary to olfactory neuroblastoma.

A patient with a four-year history of unexplained hyponatremia was seen with recurrent nasal discharge and was found to have a typical olfactory neuroblastoma. The clinical laboratory diagnostic studies suggested that the patient's sodium deficiency was secondary to the syndrome of inappropriate antidiuretic hormone. Subsequent resection of the neoplasm led to resolution of the hyponatremia, suggesting that a (tumor-associated) humoral factor, such as vasopressin or a vasopressinlike substance, was responsible for the electrolyte disturbance. A search of the literature disclosed one previous case of vasopressin-secreting nasal neuroblastoma.

Adult↗

PubMed1982

The use of the pectoralis major myocutaneous island flap for reconstruction after major ablative head and neck surgery.

The anatomy of the pectoralis major myocutaneous island flap and the technique and history of its use in reconstruction after major ablative head and neck surgery are described. Twelve cases illustrating the indications for use of the flap and the surgical applications, complications and results are reported. In the future we may expect great advances in this field due to the versatility and reliability of the flap.

Aged↗

PubMed1981

Laryngeal malignant lymphoma--an entity?

Five patients with laryngeal lymphoma who presented at the Royal National Throat, Nose and Ear Hospital between 1953 and 1979 are described. The literature is reviewed and it is found that 40 cases have been previously reported. A modification of a previous clinical classification is presented. Long-term hoarseness as a presenting symptom, and difficulty in making the diagnosis is emphasized. It is found that most cases are supraglottic, non-ulcerated, pale laryngeal masses. There is no sex or age preference and Hodgkin's lymphoma has not been described in the larynx. A significant number of cases are, and remain localized to the larynx, and consequently have a good prognosis with radiation therapy. However, careful evaluation by experts, and long-term follow-up is emphasized.

Aged↗

PubMed1981

A malignant carcinoid tumour of the supraglottic larynx.

A rare case of carcinoid tumour of the laryngeal surface of the epiglottis in a 49-year-old woman is presented. This is the fourth report of this tumour in the world literature. The clinical features, and the light and electron microscopical appearances are discussed. The literature and the relationship to other carcinoid tumours is reviewed. Based on this and previously reported cases, recommendations are made as to management.

Carcinoid Tumor↗

PubMed1981

Minor salivary gland carcinomas of the mouth and oropharynx.

Sixteen cases of minor salivary gland carcinomas of the mouth and oropharynx have been reviewed. During the 24 year period of the review, 170 cases of all malignancies were seen in these sites. The commonest salivary gland carcinoma was adenoid cystic carcinoma. The palate was the commonest site, and there was no sexual preference in incidence. The usual presentation was with pain, or a lump noticed by the patient in the 5th and 6th decade of life. The age distribution was wide, however, ranging from the 3rd to the 9th decade. Radiotherapy, surgery, or combined therapy gave equally variable results; however, surgical removal and high dose postoperative radiotherapy (over 6,700 rads) would appear to offer the best chance of cure in our cases.

Adult↗

PubMed1980

Examination of the larynx in the histopathology laboratory.

A method is described for examination of the larynx in the histopathology laboratory. Using a slicing machine, transverse slices of the whole larynx are obtained from which representative histological samples may be prepared. This method offers the advantages of a complete gross examination of the normal and pathological structures of the larynx supplemented by histological studies using any of the methods of paraffin embedding, frozen section, plastic embedding, or electron microscopy on any part of the larynx.

Histological Techniques↗

PubMed1976

Vitiligo and malignant melanoma: a significant association?

Three patients with malignant melanoma and coexisting vitiligo are described. All three appear to exhibit at least partial spontaneous control of the melanoma. The hypothesis is made that there may be a significant association between vitiligo and regressing melanoma. The basis for this is the fact that there may be an association between vitiligo and the production of an antimelanoma antibody, promoting rejection of the melanoma.

Antibodies, Neoplasm↗

PubMedDate not supplied

Preservation of function by radiotherapy of small primary carcinomas preceded by neck dissection for extensive nodal metastases of the head and neck.

BACKGROUND: When patients are initially seen with a small primary tumor and regional metastases, the question arises whether the primary can be managed by definitive radiotherapy while treating the neck with surgery and postoperative radiation. The advantage of this is least disturbance of the primary site, while still achieving maximal control of the neck disease. METHOD: A retrospective review was conducted over an 8-year period; of the 619 patients seen during this time, 15 were judged suitable for this approach. Small primaries were defined as T1 or T2 lesions or superficial spreading T3 tumors. Extensive neck disease was defined as at least 3 cm in size. RESULTS: There were no regional recurrences and only 3 local recurrences, 2 of which were successfully salvaged. Four patients died of distant metastases. The arguments for and against this unusual approach are discussed. CONCLUSIONS: It is concluded that, in patients conforming to our criteria, this is a sound oncologic approach.

Adult↗

PubMedDate not supplied

Value of resection of pulmonary metastases in head and neck cancer patients.

BACKGROUND: Literature shows no data about a complete cohort of head and neck cancer patients who developed pulmonary metastases. In this study, we investigate factors related to survival, with emphasis on the role of a pulmonary metastasectomy. METHODS: A retrospective review of 138 patients who developed pulmonary metastases (5.5% of all head and neck cancer patients) in the period 1978 to 1994 is presented. In a stepwise regression analysis (Cox), factors were identified related to survival. Also investigated was whether the prognostic value of potential prognosticators differed between the group that underwent metastasectomy and the group that did not. RESULTS: One hundred thirty-eight patients had metastases originating from head and neck cancer. The 5-year survival rate for all these patients was 13%. Younger patients (P = .011), patients with a longer disease-free interval (DFI) (P = .011), patients with a longer disease-free interval (DFI) (P = .016), and patients with a nonsquamous cell carcinoma (P = .038) did better. No evidence of a relationship between survival and sex or survival and number of metastases was found. Twenty-one patients underwent surgical resection of their pulmonary metastases. In 18 patients the resection was complete. The 5-year survival rate for patients who underwent a metastasectomy was 59%, compared with 4% in the nonmetastasectomy group (P = .0033). CONCLUSION: Isolated pulmonary metastases from head and neck cancer are potentially curable by surgical resection. Preconditions for this approach are locoregional control of the primary lesion and technical resectability of the pulmonary metastases. Patients with a long interval between primary treatment and the diagnosis of pulmonary metastases may benefit more from resection therapy.

Aged↗

PubMedDate not supplied

Systematic approach to the treatment of chylous leakage after neck dissection.

BACKGROUND: Chylous leakage is an uncommon complication after neck dissection for which several treatment modalities have been described in literature. It occurs in 1% to 2.5% of radical neck dissections, with the majority (75% to 92%) being on the left side. In a consecutive series of patients, we investigated the effect of a systematic approach to the complication. METHODS: Over a period of 5 years, the drain production of 221 patients who underwent a neck dissection was analyzed. One hundred thirty-two right-sided and 139 left-sided neck dissections were performed. In 11 patients a chyle fistula occurred, 1 right-sided and 10 lift-sided. In all cases closed vacuum suction drainage was continued and dietary modifications (medium-chain triglycerides [MCT]/Peptison nasogastric tube feeding [PNTF]) were made. RESULTS: In 5 patients dietary modifications were sufficient to stop the leak. In the other 6 patients total parenteral nutrition via the subclavian vein (TPN) was started. In 2 cases with a severe intractable hypoalbuminemia, surgical intervention was necessary. The leak was closed by a pectoralis major muscle flap transfer, after local application of fibrin sealant (Tissucol). CONCLUSIONS: Chylous leakage is a controllable complication after neck dissection for which is most cases a stepwise conservative approach consisting of dietary modifications, maintaining closed vacuum suction drainage, seems to be sufficient. Hematologic and serum values should be monitored very carefully and corrected appropriately. To initiate planned postoperative radiotherapy in a timely fashion, the conservative treatment should be limited to about 30 days.

Adult↗

PubMedDate not supplied

Computed tomography of the larynx: a clinical and pathologic study.

Recent interest in the application of computed tomography (CT) to the evaluation of laryngeal tumors, and the fact that the larynx offers the unique opportunity of whole organ study after total laryngectomy, led to a prospective study of laryngoscopy, conventional tomography, and CT in relation to pathologic findings. The results showed that CT gives an exact assessment of laryngeal anatomy and tumor involvement, particularly in the paracordal and pre-epiglottic spaces. The laryngeal cartilages, which are not well demonstrated by any other means, are accurately delineated by CT. There is also good demonstration of the laryngeal surface of the epiglottis, including the anterior commissure, which is poorly shown by other radiologic methods and is sometimes poorly seen on laryngoscopy. Because CT and conventional tomography present images at 2 different planes, at right angles to each other, we believe that CT is entirely complementary to conventional tomography.

Adult↗

PubMedDate not supplied

The versatility of the pectoralis major myocutaneous flap.

A consecutive group of 50 patients requiring pectoralis major myocutaneous flap reconstruction after head and neck surgery is presented. The tissue defects for reconstruction are divided into five groups to identify any defects in which the flap is more likely to be at risk of complication. Other risk factors such as preoperative radiotherapy, chemotherapy plus radiotherapy, and septic recipient site are analyzed. Its particular use in a "Third World" type population is noted.

Adult↗

PubMedDate not supplied

The preepiglottic space revisited: is it significant?

One hundred fifty-four laryngeal specimens were examined by a serial sectioning method to determine the importance of the preepiglottic space (PES) in the spread of cancer. Controversy surrounds the status of the PES in the two major TNM classifications regarding laryngeal anatomy. However, both the UICC (International Union Against Cancer) and the AJCCS (American Joint Commission on Cancer Staging) imply a T3 grading for tumors invading the PES. Several variables relating to laryngeal cancer spread were entered into a computer program designed to calculate statistical relationships. Of all laryngeal cancers, PES invasion usually occurred in association with primary supraglottic tumors. Preepiglottic space invasion was also found in association with more than half of the cases involving base of tongue and strap muscle invasion. It was also noted in more than half of the cases with transglottic cancer spread. Statistically, these relationships were all highly significant. These findings suggest that PES invasion should be considered equivalent to the spread of cancer outside the larynx, and should therefore be assigned a T4 localized even when advanced, casting doubt on supraglottic partial laryngectomy as a curative procedure in all but the earliest supraglottic tumors.

Black People↗