Archives of Otolaryngology - Head & Neck Surgery

KVETON, JOHN F.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110017002

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Michael H. Fritsch, MD, of the Otology Group, Nashville, Tenn, presented the results of a cooperative study by Michael E. Glasscock, MD, and C. Gary Jackson, MD, of the Otology Group and John R. D. Dickins, MD, Little Rock, Ark, on the effectiveness of the Denver inner ear shunt on controlling Meniere's disease at the American Neurotology Society Meeting, Denver. In their study, 100 patients underwent insertion of the shunt. Questionnaires were sent to these patients with 56 patients responding, adequate data thereby becoming available on 41 patients. Seventy percent of those in the study continued to receive therapy consisting of diuretics and salt restriction. Patients were evaluated according to the 1985 guidelines of the American Academy of Otolaryngology–Head and Neck Surgery for vertigo control and hearing. Vertigo control was evaluated by obtaining a ratio of the number of attacks over a 24-month period postoperatively to the number of vertigo

Cook, Ted A.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110017001

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Michael D. Maves, MD, Janusz Bardach, MD, D. Bradley Welling, MD, and David E. Schuller, MD, of the University of Iowa (Iowa City) reported the fate of irradiated homologous cartilage when used in various surgical procedures to reconstruct the face. This is a follow-up of a group of patients described by Schuller et al in 1977, and it was presented at the spring scientific meeting of the American Academy of Facial Plastic and Reconstructive Surgery in Denver. These workers reported a ten-to 15-year assessment of approximately 40% of patients from the original series who had undergone graft implantation. The authors report that checkup at up to ten years after the implant showed 28% of the grafts underwent total reabsorption of the grafted implant. In the 11-to 16-year period, however, the astonishing total of 75% of the grafts became totally reabsorbed. The numbers involved in the study are certainly adequate to

Cook, Ted A.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110017003

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract A thorough review of basic concepts of surgery of the cleft nose was presented by Robert Bumsted, MD, at the spring scientific meeting of the American Academy of Facial Plastic and Reconstructive Surgery in Denver. The author reviewed a series of 200 cases that occurred over a ten-year period. He performed maneuvers to enhance columellar length and to reposition the alar base at the time of the primary cleft lip repair at approximately 10 weeks of age. Alar base implants of irradiated autogenous cartilage are inserted intraorally with extreme overcorrection of the alar base support. Septoplasty and turbinate resection surgery are performed at the age they become necessary for maintenance of adequate nasal airway. The ultimate rhinoplasty repair work during the teenage years is performed through an external rhinoplasty approach with total freeing of the lateral crura from vestibular skin and an asymmetrical V-to-Y columellar lengthening procedure. The overall surgical

LORÉ, JOHN M.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110031004

Abstract The American College Encyclopedic Dictionary1 defines the word dabble, "to do anything in a slight or superficial manner." One of the problems that faces medicine today is the so-called dabbler. The dabbler in head and neck oncology is one who manages a few patients, eg, five or six patients a year, usually with stage 1 or II disease, and possibly one or two patients with stage III or IV disease, does not have the necessary support personnel, lacks appropriate rehabilitation facilities, and fails to keep abreast of continuing education in head and neck oncology. In turn, this infers that the involved hospital is also part and parcel of dabbling in their credentialing system. We might call the hospital "the dabblice." When one attempts to analyze the cause of this problem, a number of possibilities appear, one of which might be our free enterprise system. This, however, is not the cause; References 1. Barnhart CL: The American College Encyclopedic Dictionary . Chicago, Spencer Press Inc, 1960. 2. Baker RR, Hyland J: Papillary carcinoma of the thyroid gland . Surg Gynecol Obstet 1985; 161:546-550. 3. Beierwaltes WH, Rabbani R, Dmuchowski C, et al: An analysis of 'ablation of thyroid remnants' with 1131 in 511 patients from 1947-1984: Experience at University of Michigan . J Nucl Med 1984;25:1287-1293. 4. Loré JM Jr: Issues in community hospital or cancer center care of head and neck cancer patients , in Myers EN, Barofsky I, Yates JW (eds): Rehabilitation and Treatment of Head and Neck Cancer , US Dept of Health and Human Services publication (NIH) 86-2762,1968, pp 155-165. 5. Loré JM Jr: Head and neck oncologic surgery: Where we have been and where we are going . Am J Surg 1981;142:104.

Zimmerman, Marilyn C.;Mickel, Robert A.;Kessler, David J.;Mehringer, C. Mark;Hieshima, Grant B.;Calcaterra, Thomas C.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110035005pmid: 3663343

Abstract • Acute carotid artery rupture is frequently heralded by prodromal arterial bleeding. This warning signal provides the physician with a brief interval in which to hemodynamically stabilize a patient, electively occlude the carotid, and consequently improve the patient's chance of survival. For three years, we have employed an initial nonoperative approach to patients with impending carotid rupture. A trial of endovascular balloon occlusion followed by detachable balloon embolization of the carotid artery has been utilized. Patients unable to tolerate temporary occlusion underwent a vascular bypass procedure followed by embolization. Six patients have undergone this approach, and all had permanent cessation of bleeding. None died as a result of the procedures. One patient developed permanent neurologic deficits. Balloon embolization offers improved results over elective ligation and should be considered as an alternative treatment for patients in this dire predicament. (Arch Otolaryngol Head Neck Surg 1987;113:1169-1175) References 1. McCoy G, Barsocchini LM: Experiences in carotid artery occlusion . Laryngoscope 1968; 78:1195-1210.Crossref 2. Shumrick DA: Carotid artery rupture . Laryngoscope 1973;83:1051-1061.Crossref 3. Huvos AG, Leaming RH, Moore OS: Clinicopathologic study of the resected carotid artery: Analysis of 64 cases . Am J Surg 1973;126:570-574.Crossref 4. Swain RE, Biller HF, Ogura JH, et al: An experimental analysis of causative factors and protective methods in carotid artery rupture . Arch Otolaryngol Head Neck Surg 1974;99:235-241.Crossref 5. McCready RA, Hyde GL, Bivins BA, et al: Radiation-induced arterial injuries . Surgery 1983;93:306-312. 6. Heller KS, Strong EW: Carotid arterial hemorrhage after radical head and neck surgery . Am J Surg 1979;138:607-610.Crossref 7. Lynn M: The first ligation of the carotid artery ever performed in this country . Lancet 1832;1:63-64. 8. Moore OS, Karlan M, Sigler L: Factors influencing the safety of carotid ligation . Am J Surg 1969;118:666-668.Crossref 9. Stell PM: Catastrophic haemorrhage after major neck surgery . Br J Surg 1969;56:525-527.Crossref 10. Martinez SA, Oller DW, Gee W, et al: Elective carotid artery resection . Arch Otolaryngol Head Neck Surg 1975;101:744-747.Crossref 11. Marandas P, Bobin S, Leridart AM, et al: Contribution à étude des ligatures de l'axe carotidien principal . J Otolaryngol 1984;13:27-31. 12. Coleman JJ: Treatment of the ruptured or exposed carotid artery: A rational approach . South Med J 1985;78:262-267.Crossref 13. James NJ, Stuteville OH, Tasche C: Elective carotid artery ligation in the treatment of advanced cancer of the head and neck . Plast Reconstr Surg 1971;47:243-245.Crossref 14. Friess CC, Fontaine DJ, Kornblut AD: Complications of therapy for oral malignant disease . Otolaryngol Clin North Am 1979;12:175-181. 15. Osguthorpe JD, Hungerford GD: Transarterial carotid occlusion: Case report and review of the literature . Arch Otolaryngol Head Neck Surg 1984;110:694-696.Crossref 16. Watson WL, Silverstone SM: Ligature of the common carotid artery in cancer of the head and neck . Ann Surg 1939;109:1-27.Crossref 17. Nishioka H: Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage: VII. Part I: Results of the treatment of intracranial aneurysms by occlusion of the carotid artery in the neck . J Neurosurg 1966;25:660-682.Crossref 18. Landolt AM, Millikan CH: Pathogenesis of cerebral infarction secondary to mechanical carotid artery occlusion . Stroke 1970;1:52-62.Crossref 19. Heros RC: Thromboembolic complications after combined internal carotid ligation and extra-to-intracranial bypass . Surg Neurol 1984; 21:75-79.Crossref 20. Razak MS, Sako K: Carotid artery hemorrhage and ligation in head and neck cancer . J Surg Oncol 1982;19:189-192.Crossref 21. Matas R: Testing the efficiency of the collateral circulation as a preliminary to the occlusion of the great surgical arteries . Ann Surg 1911;53:1-43.Crossref 22. Toole JF, Bevilacqua JE: The carotid compression test . Neurology 1963;13:601-606.Crossref 23. Jawad K, Miller JD, Wyper DJ, et al: Measurement of CBF and carotid artery pressure compared with cerebral angiography in assessing collateral blood supply after carotid ligation . J Neurosurg 1977;46:185-196.Crossref 24. Fee WE, Steadman MG: Planned carotid artery resection in head and neck surgery . Trans Am Acad Ophthalmol Otolaryngol 1977;84:814-815. 25. Woodhall B, Odom GL, Bloor BM, et al: Studies on cerebral intravascular pressure . J Neurosurg 1953;10:28-34.Crossref 26. Wilkinson HA, Wright RL, Sweet WH: Correlation of reduction in pressure and angiographic cross-filling with tolerance of carotid occlusion . J Neurosurg 1965;22:241-245.Crossref 27. Tindall GT, Odom GL: Treatment of intracranial aneurysms by proximal carotid ligation , in Krayenbuhl H, Maspes PE, Sweet WH (eds): Progress in Neurological Surgery . New York, S Karger AG, 1969, vol 3, pp 66-114. 28. Olcott C, Fee WE, Enzmann DR, et al: Planned approach to the management of malignant invasion of the carotid artery . Am J Surg 1981;142:123-127.Crossref 29. Wyper DJ, Lennox GA, Rowan JO: A 133xenon inhalation technique for CBF measurement: Theory and normal responses , in Harper AM, Miller JD, Jennett B, et al (eds): Blood Flow and Metabolism of the Brain . New York, Churchill-Livingstone Inc, 1975, vol 8, pp 7-11. 30. Mount LA, Taveras JM: Arteriographic demonstration of the collateral circulation of the cerebral hemispheres . Arch Neurol Psychiatry 1957;78:235-253.Crossref 31. Beatty RA, Richardson AE: Predicting intolerance to common carotid artery ligation by carotid angiography . J Neurosurg 1968;28:9-13.Crossref 32. Enzmann DR, Miller DC, Olcott C, et al: Carotid back pressures in conjunction with cerebral angiography . Radiology 1980;134:415-419.Crossref 33. Serbinenko FA: Balloon catheterization and occlusion of major cerebral vessels . J Neurosurg 1974;41:125-145.Crossref 34. Debrun G, Lacour P, Caron JP, et al: Inflatable and released balloon technique experimentation in dog: Application in man . Neuroradiology 1975;9:267-271.Crossref 35. Debrun G, Lacour P, Vinuela F, et al: Treatment of 54 traumatic carotid-cavernous fistulas . J Neurosurg 1981;55:678-692.Crossref 36. Tomsick TA, Tew JM, Lukin RR, et al: Balloon catheters for aneurysms and fistulae . Clin Neurosurg 1983;31:135-164. 37. Graeb DA, Robertson WD, Lapointe JS, et al: Avoiding intra-arterial balloon detachment in the treatment of posttraumatic carotid-cavernous fistulae with detachable balloons . AJNR 1985;6:602-605. 38. Debrun G, Fox A, Drake C, et al: Giant unclippable aneurysms: Treatment with detachable balloons . AJNR 1981;2:167-173. 39. Scialfa G, Valsecchi F, Scotti G: Treatment of vascular lesions with balloon catheters . AJNR 1983;4:395-398. 40. Khoo CTK, Molyneux AJ, Rayment R, et al: The control of carotid arterial haemorrhage in head and neck surgery by balloon catheter tamponade and detachable balloon embolisation . Br J Plast Surg 1986;39:72-75.Crossref 41. Hieshima GB, Grinnell VS, Mehringer CM: A detachable balloon for therapeutic transcatheter occlusions . Radiology 1981;138:227-228.Crossref 42. Reilly JJ, Caparosa RJ, Latchaw RE, et al: Aberrant carotid artery injured at myringotomy: Control of hemorrhage by a balloon catheter . Arch Otolaryngol Head Neck Surg 1983;249:1473-1475. 43. Konno A, Togawa K, Iizuka K: Analysis of factors affecting complications of carotid ligation . Ann Otol Rhinol Laryngol 1981;90:222-226. 44. Leikensohn J, Milko D, Cotton R: Carotid artery rupture: Management and prevention of delayed neurologic sequelae with low-dose heparin . Arch Otolaryngol Head Neck Surg 1978; 104:307-310.Crossref 45. Gandhi K, Oppenheimer P: Emergency carotid ligation . Arch Otolaryngol Head Neck Surg 1962;75:451-456.Crossref 46. The EC/IC Bypass Study Group: Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke . N Engl J Med 1985;313:1191-1200.Crossref 47. Chuang VP, Wallace S, Gianturco C, et al: Complications of coil embolization: Prevention and management . AJR 1981;137:809-813.Crossref 48. Braun IF, Hoffman JC, Casarella WJ, et al: Use of coils for transcatheter carotid occlusion . AJNR 1985;6:953-956.

Castro, Dan J.;Saxton, Romaine E.;Fetterman, Harold R.;Castro, Donna J.;Ward, Paul H.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110042006pmid: 3663344

Abstract • Rhodamine 123 (Rh 123), a mitochondrial-specific dye with an absorption maxima at 511 nm, was tested as a new chemosensitizing agent for argon laser treatment of P3 human squamous carcinoma cells. After exposure of P3 cells in vitro to Rh 123 at doses of 1, 3, 6, and 10 μg/mL for one hour, we observed significant inhibition of DNA synthesis, except at the lowest dose. Rhodamine 123 at 1 μg/mL was selected to sensitize P3 tumor cells for treatment with the monochromatic argon laser at 514.5 nm. Exposure of P3 cells to laser energy levels of 700 to 950 J/cm2 (36°C to 40°C after sensitization with Rh 123 completely inhibited tumor development of the P3 cells transplanted subcutaneously into nude mice. Control P3 cells treated with the laser alone at 36°C to 40°C or only with Rh 123 formed visible tumors by one week and continued to grow for the entire-week observation period. These results show that Rh 123 is a highly sensitive new fluorochrome for argon laser phototherapy of human squamous carcinoma cells. (Arch Otolaryngol Head Neck Surg 1987;113:1176-1182) References 1. Johnson LV, Walsh L, Chen LB: Localization of mitochondria in living cells with rhodamine 123 . Proc Natl Acad Sci USA 1980;77:990-995.Crossref 2. James TW, Bowman R: Proliferation of mitochondria during the cell cycle of human cell line (HL-60) . J Cell Biol 1981;89:256-262.Crossref 3. Bernal SD, Shapiro HM, Chen LB: Monitoring the effect of anti-cancer drugs on L1210 cells by a mitochondrial probe, rhodamine 123 . Int J Cancer 1982;30:219-226.Crossref 4. Evenson DP, Darzinkiewicz Z, Melamed MR: Simultaneous measurement by flow cytometry of sperm cell viability and mitochondrial membrane potential related to cell motility . J Histochem Cytochem 1982;30:279-286.Crossref 5. Clark MA, Shay JW: Long-lived cytoplasmic factors that suppress adrenal steroidogenesis . Proc Natl Acad Sci USA 1982;79:1144-1150.Crossref 6. Wells MJ, Chen LB: Rhodamine 123: A lipophilic, cationic, mitochondrial-specific, vital dye . Kodak Lab Bull 1984;55:1-8. 7. Summerhayes IC, Lampidis TJ, Bernal SD: Unusual retention of rhodamine 123 by mitochondria in muscle and carcinoma cells . Proc Natl Acad Sci USA 1982;79:5292-5298.Crossref 8. Lampidis TJ, Bernal SD, Summerhayes IC, et al: Selective toxicity of rhodamine 123 in carcinoma cells in vitro . Cancer Res 1983;43:716-720. 9. Bernal SD, Lampidis TJ, Chen LB: Anticarcinoma activity in vivo of rhodamine 123, a mitochondrial-specific dye . Science 1984;222:169-273.Crossref 10. Davis S, Weiss MJ, Wong JR, et al: Mitochondrial and plasma membrane potentials cause unusual accumulation and retention of rhodamine 123 by human breast adenocarcinoma-derived MCF-7 cells . J Biol Chem 1985; 260:13844-13850. 11. Flanagan SP: 'Nude,' a new hairless gene with pleiotrophic effects in the mouse . Genet Res 1966;8:295-309.Crossref 12. Pantelouris EM: Absence of thymus in a mouse mutant . Nature 1968;217:370-371.Crossref 13. Rygaard J, Povlsen CO: Heterotransplantation of human malignant tumor to 'nude' mice . Acta Pathol Microbiol Scand 1969;77:761-762.Crossref 14. Le Bodic MF, Le Bodic L, Patrice T, et al: Importance of using hematoporphyrine derivative in the destruction of adenocarcinomas with the Nd:YAG or argon lasers . Ann Pathol 1984;4:37-42. 15. Hill JH, Plant RL, Harris DM, et al: The nude mouse xenograft system: A model for photodetection and photodynamic therapy in head and neck squamous cell carcinoma . Am J Otolaryngol 1986;7:17-27.Crossref 16. Kasai M, Saxton RE, Holmes ED, et al: Hybridoma monoclonal antibody: Use in defining surface antigens on human lung carcinoma cells . J Transplant Proc 1981;13:1942-1945. 17. Kasai M, Saxton RE, Holmes ED, et al: Membrane antigens detected on human lung carcinoma cells by hybridoma monoclonal antibody . J Surg Res 1981;30:403-408.Crossref 18. Iwaki Y, Kasai M, Terasaki PL, et al: Monoclonal antibody against A1 Lewis antigen produced by the hybridoma immunized with a pulmonary carcinoma . Cancer Res 1982;42:409-411. 19. Forrest JB, Forrest HJ: Case report: Malignant melanoma arising during therapy for vitiligo . J Surg Oncol 1980;13:337-340.Crossref 20. Tappeiner HV, Jodbauer A: Die sensibilisierende Wirkung der fluoreszierender Substanzen . Leipzig, East Germany, Vogel, 1907. 21. Maiman TH: Stimulated optical radiation in ruby . Nature 1960;187:493-494.Crossref 22. Policard A: Études sur les aspects offerts par des tumeur experimentales examinée à la lumière de woods . C R Soc Biol 1924;91:1423. 23. Gregory RO, Goldman L: Application of photodynamic therapy in plastic surgery . Lasers Surg Med 1986;6:62-66.Crossref 24. Castro DJ, Johnston KJ, Adomian GE, et al: Wound healing: Biological effects of Nd:YAG laser on collagen metabolism in pig skin in comparison to thermal burn . Ann Plast Surg 1983;11:131-140.Crossref 25. Castro DJ, Meeker C, Dwyer RM, et al: Effects of the Nd:YAG laser on DNA synthesis and collagen production in human skin fibroblast cultures . Ann Plast Surg 1983;11:214-222.Crossref 26. Castro DJ, Stuart A, Benvenutti D, et al: A new method of dosimetry: A study of comparative laser-induced tissue damage . Ann Plast Surg 1982;9:221-226.Crossref 27. Castro DJ, Saxton RE, Fetterman HR, et al: Rhodamine 123 as a new photosensitizing agent with the argon laser: 'Non-thermal' and thermal effects on human squamous carcinoma cells in vitro . Laryngoscope 1987;97:554-561. 28. Marchesini R, Melloni E, Dasdia T, et al: Photosensitizing properties of rhodamine 123 on different human tumor cell lines . Lasers Surg Med 1986;6:163.Crossref 29. Darzynkiewicz Z, Traganos F, Staiano-Coico, et al: Interactions of rhodamine 123 with living cells studied by flow cytometry . Cancer Res 1982;42:799-806. 30. Svaasand LO, Boerslid T, Oeveraasen M: Thermal and optical properties of living tissue: Application to laser-induced hyperthermia . Lasers Surg Med 1985;5:589-602.Crossref

Baker, Shan R.;Forastiere, Arlene A.;Wheeler, Richard;Medvec, Barbara R.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110049007pmid: 3663345

Abstract • Intra-arterial chemotherapy for the treatment of localized malignant neoplasms in the head and neck is an appealing approach for several reasons. Perhaps the most important is the possibility of obtaining a regional advantage such that an increased drug concentration is delivered to the tumor site compared with that delivered systemically. The patient may, therefore, be spared systemic toxicity. We report our accumulated experience using a totally implantable infusion pump in 37 patients. A total of 42 pumps were implanted: 28 single-catheter pumps and 14 dual-catheter pumps. Radionuclide imaging demonstrated total perfusion of the tumor in all patients. A combination of cisplatin (50 to 100 mg/m2) and floxuridine (0.01 to 0.045 mg/kg/d) was used to treat 26 patients. For these heavily pretreated patients, we observed a 43% complete and partial response rate in the subgroup of patients with squamous cell carcinoma. These results are comparable with those reported for these drugs administered systemically and for other drug combinations tested in the treatment of recurrence disease. (Arch Otolaryngol Head Neck Surg 1987;113:1183-1190) References 1. Barberio JR, Klopp CT, Ayres WW, et al: Effects of intra-arterial administration of nitrogen mustard . Cancer 1951;4:1341-1363.Crossref 2. Klopp CT, Alford TC, Bateman J, et al: Fractionated intra-arterial cancer chemotherapy with methylbisaminohydrochloride: Preliminary report . Am Surg 1950;132:811-832. 3. Helsper JT, DeMoss EV: Regional intra-arterial infusion of 5-fluorouracil for cancer . Surgery 1964;56:340-348. 4. Johnson RO, Kisken WA, Curreri AR: A report upon arterial infusion with 5-fluorouracil in 100 patients . Surg Gynecol Obstet 1965;120:530-536. 5. Humphrey LJ, Rush BF: Chemotherapy for tumors of chest wall and base of neck by arterial infusion . Arch Surg 1968;96:810-813.Crossref 6. Oberfield RA, Sullivan RD: Prolonged and continuous regional arterial infusion chemotherapy in patients with melanoma . JAMA 1969; 209:75-79.Crossref 7. Freckman HA: Results in 169 patients with cancer of the head and neck treated by intra-arterial infusion therapy . Am J Surg 1972; 124:501-509.Crossref 8. Eckman WW, Patlak CS, Fenstermacher JD: A critical evaluation of the principles governing the advantages of intra-arterial infusions . J Pharmacokinet Biopharm 1974;2:257-285.Crossref 9. Collins JM: Pharmacologic rationale for regional drug delivery . J Clin Oncol 1984;2:498-504. 10. Ensminger W, Niederhuber J, Dakhil S, et al: A total implanted drug delivery system for hepatic arterial chemotherapy . Cancer Treat Rep 1981;65:393-400. 11. Greenberg HS, Phillips TW, Chandler WF, et al: A new implantable intra-carotid drug delivery system for continuous and intermittent treatment of malignant astrocytomas . Ann Neurol 1982;12:100. 12. Baker SR, Wheeler RH, Ensminger WD, et al: Intra-arterial infusion chemotherapy for head and neck cancer using a totally implantable infusion pump . Head Neck Surg 1981;4:118-124.Crossref 13. Chen HG, Gross JF: Intra-arterial infusion of anticancer drugs: Theoretic aspect of drug delivery and review of responses . Cancer Treat Rep 1980;64:31-40. 14. Wheeler RH, Baker SR, Medvec BR: Single-agent and combination-drug regional chemotherapy for head and neck cancer using an implantable infusion pump . Cancer 1984;54:1504-1512.Crossref 15. Baker SR, Wheeler RH, Medvec BR: Surgical aspects of intra-arterial chemotherapy of outpatients with head and neck cancer . Otolaryngol Head Neck Surg 1985;93:192-200. 16. Baker SR, Wheeler RH, Ziessman HA, et al: Radionuclide localization of intra-arterial infusions in head and neck cancer . Cancer Drug Deliv 1984;1:145-156.Crossref 17. Kish JA, Weaver A, Jacobs J, et al: Cisplatin and 5-fluorouracil infusion in patients with recurrent and disseminated epidermoid cancer of the head and neck . Cancer 1984;53:1819-1824.Crossref 18. Rowland KM, Taylor SG, O'Donnel MR, et al: Cisplatin and 5-FU infusion chemotherapy in advanced recurrent cancer of the head and neck: An Eastman Cooperative Oncology Group pilot study . Cancer Treat Rep 1986;70:461-464. 19. Creagan E, Ingle J, Schutt A, et al: A phase II study of cisdiamminedichloroplatinum and 5-fluorouracil in advanced upper aerodigestive neoplasms . Head Neck Surg 1984;6:1020-1023.Crossref 20. Choksi A, Dimery I, James P, et al: Twenty-four-hour infusion cisplatin and five-day infusion 5-fluorouracil in recurrent head and neck squamous cancer . Proc Am Soc Clin Oncol 1986; 5:138. 21. Vogl SE, Schoenfeld DA, Kaplan BH, et al: A randomized prospective comparison of methotrexate, bleomycin, and cisplatin in head and neck cancer . Cancer 1985;56:432-442.Crossref 22. Drelichman A, Cummings G, Al-Sarraf M: A randomized trial of the combinations of cisplatinum, oncovin, and bleomycin (COB) vs methotrexate in patients with advanced squamous cell carcinoma of the head and neck . Cancer 1983;52:399-403.Crossref

Close, Lanny Garth;Burns, Dennis K.;Reisch, Joan;Schaefer, Steven D.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110057008pmid: 3663346

Abstract • The presence of squamous cell carcinoma within capillaries and/or venules in the immediate vicinity of primary lesions of the oral cavity and oropharynx may be related to regional lymph node metastasis. To evaluate this possibility, we have reviewed the clinical and histopathologic features of 43 consecutive cases of previously untreated T2 or greater squamous cell carcinoma of these sites managed with simultaneous surgical treatment of the primary neoplasm and the neck. The incidence of histologically proved cervical metastasis for all lesions with vascular invasion compared with those without vascular involvement was highly significant. No statistical correlation was found for the clinical stage of neck disease or for the other pathologic features of the primary tumor, ie, size, appearance, differentiation, depth of invasion, periphery of lesion, inflammatory infiltrate, and perineural invasion, when compared with the histopathologic status of regional lymph nodes. (Arch Otolaryngol Head Neck Surg 1987;113:1191-1195) References 1. Spiro RH, Alfonso AW, Farr HW, et al: Cervical node metastasis from epidermoid carcinoma of the oral cavity and oropharynx . Am J Surg 1974;128:562-567.Crossref 2. Sako K, Pradier RN, Marchetta FC, et al: Fallibility of palpation in the diagnosis of metastases to cervical nodes . Surg Gynecol Obstet 1964;118:989-990. 3. Byers RM: Modified neck dissection . Am J Surg 1985;150:414-421.Crossref 4. Spiro RN, Strong EW: Epidermoid carcinoma of the oral cavity and oropharynx . Arch Surg 1973;107:382-384.Crossref 5. Southwick HW, Slaughter DP, Trevino ET: Elective neck dissection for intraoral cancer . Arch Surg 1960;80:905-909.Crossref 6. Cunningham MJ, Johnson JT, Myers EN, et al: Cervical lymph node metastasis after local excision of early squamous cell carcinoma of the oral cavity . Am J Surg 1986;152:361-366.Crossref 7. Spiro RH, Strong EW: Epidermoid carcinoma of the mobile tongue . Am J Surg 1971;122:707-710.Crossref 8. Johnson JT, Leipzig B, Cummings CW: Management of T1 carcinoma of the anterior aspect of the tongue . Arch Otolaryngol Head Neck Surg 1980;106:249-251.Crossref 9. Jesse RH, Barkley HT, Lindberg RD, et al: Cancer of the oral cavity . Am J Surg 1970; 120:505-508.Crossref 10. Spiro HR, Huvos AG, Wong GY, et al: Predictive value of tumor thickness in squamous carcinoma confined to the tongue and floor of the mouth . Am J Surg 1986;152:345-350.Crossref 11. Van Nagell JR Jr, Donaldson ES, Wood EG, et al: The significance of vascular invasion and lymphocytic infiltration in invasive cervical cancer . Cancer 1978;41:228-234.Crossref 12. American Joint Committee on Cancer: Staging of Cancer of Head and Neck Sites and of Melanoma . Chicago, American Joint Committee on Cancer, 1980. 13. Fleiss JL: Statistical Methods for Rates and Proportions , ed 2. New York, John Wiley & Sons Inc, 1981. 14. Afifi AA, Clark V: Computer-Aided Multivariate Analysis . Belmont, Calif, Lifetime Learning Publications, 1984. 15. Batsakis JG: Invasion of the microcirculation in head and neck cancer . Ann Otol Rhinol Laryngol 1984;93:646-647. 16. Sugarbaker EV: Cancer metastasis: A product of tumor-host interactions . Curr Probl Cancer 1979;3:3-59.Crossref 17. Poleksic S, Kalwaic HJ: Prognostic value of vascular invasion in squamous cell carcinoma of the head and neck . Plast Reconstr Surg 1978; 61:234-240.Crossref 18. Crissman JD, Liu WY, Gluckman JL, et al: Prognostic value of histopathologic parameters in squamous cell carcinoma of the oropharynx . Cancer 1984;54:2995-3001.Crossref 19. Lindberg R: Distribution of cervical lymph node metastases from squamous cell carcinoma of the upper respiratory and digestive tracts . Cancer 1972;29:1446-1449.Crossref 20. Jakobsson PA, Eneroth CM, Killander D, et al: Histologic classification and grading of malignancy in carcinoma of the larynx . Acta Radiol Ther 1973;12:1-8.Crossref 21. Lund C, Søgaard H, Elbrønd 0, et al: Epidermoid carcinoma of the tongue . Acta Radiol Ther 1975;14:513-521.Crossref 22. Yamamoto E, Miyakawa A, Kohama GI: Mode of invasion and lymph node metastasis in squamous cell carcinoma of the oral cavity . Head Neck Surg 1984;6:938-947.Crossref 23. Anneroth G, Batsakis JG, Luna M: Malignancy grading of squamous cell carcinoma in the floor of the mouth related to clinical evaluation . Scand J Dent Res 1986;94:347-358. 24. Mendelson BC, Woods JE, Beahrs OH: Neck dissection in the treatment of carcinoma of the anterior two-thirds of the tongue . Surg Gynecol Obstet 1976;143:75-80. 25. Mohit-Tabatabai MA, Sobel HJ, Rush BF, et al: Relation of thickness of floor of mouth stage I and II cancers to regional metastasis . Am J Surg 1986;152:351-353.Crossref

Kessler, David J.;Trapp, Terrence K.;Calcaterra, Thomas C.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110062009pmid: 3663347

Abstract • Total laryngectomy has traditionally been considered the optimal treatment for patients with advanced glottic carcinoma who present with a fixed true vocal cord. However, using whole-organ sectioning techniques, it has been demonstrated that vertical partial laryngectomy is a sound oncologic procedure for selected fixed vocal cord lesions. During the period 1969 to 1984, 27 patients who presented at UCLA with T3 glottic carcinoma were treated using vertical partial laryngectomy. Follow-up for these patients averaged 4.0 years. The absolute two-year disease-free survival rate for this group was 85% (23 of 27 patients), and the local cancer recurrence rate during a two-year postoperative interval was 11% (three of 27 patients). These encouraging results support the continued use of partial laryngeal surgery for a subgroup of patients with T3 glottic cancer. Successful patient selection requires a careful analysis of disease extent based on data obtained from physical examination, magnetic resonance imaging or computed tomographic scanning, and direct laryngoscopy. (Arch Otolaryngol Head Neck Surg 1987;113:1196-1199) References 1. DeSanto LW: T3 glottic cancer: Options and consequences of the options . Laryngoscope 1984;94:1311-1315.Crossref 2. Kaplan MJ, Johns ME, Clark DA, et al: Glottic carcinoma: The roles of surgery and irradiation . Cancer 1984;53:2641-2648.Crossref 3. Kirchner JA: Two hundred laryngeal cancers: Patterns of growth and spread as seen in serial section . Laryngoscope 1977;87:474-482.Crossref 4. Kirchner JA, Som ML: Clinical significance of fixed vocal cord . Laryngoscope 1971;81:1029-1044.Crossref 5. Pillsbury HRC, Kirchner JA: Clinical vs histopathologic staging in laryngeal cancer . Arch Otolaryngol Head Neck Surg 1979;105:157.Crossref 6. American Joint Committee on Cancer: Manual for Staging of Head and Neck Sites . Philadelphia, JB Lippincott, 1980. 7. Kirchner JA: Invasion of the framework by laryngeal cancer: Surgical and radiological implications . Acta Otolaryngol 1984;97:392-397.Crossref 8. Pressman JJ, Simon MB, Monell C: Anatomical studies related to the dissemination of cancer of the larynx . Trans Am Acad Ophthalmol Otolaryngol 1960;64:628-638. 9. Tucker G Jr: A histological method for the study of the spread within the larynx of carcinoma . Trans Am Laryngol Assoc 1961;82:40-53. 10. Lenz M, Okrainetz C, Berne AS: Radiotherapy of cancer of the larynx , in Pack GT, Ariel IM (eds): Treatment of Cancer and Allied Diseases . New York, Hoeber, 1959; vol 3, p 542. 11. Som ML, Arnold LM: Hemilaryngectomy surgery for cordal carcinoma with extension posteriorly . Otolaryngology 1969;5:31-38. 12. Bryce DP, Ireland PI, Rider WD: Experience in the surgical and radiological treatment of 500 cases of carcinoma of the larynx . Ann Otol Rhinol Laryngol 1963;72:416-436. 13. Yuen A, Medina JE, Goepfert H, et al: Management of stage T3 and T4 glottic carcinoma . Arch Otolaryngol Head Neck Surg 1984; 148:467-472. 14. Harwood AR, Bryce DP, Rider WD: Management of T3 glottic cancer . Arch Otolaryngol Head Neck Surg 1980;106:697-699.Crossref 15. Shamboul K, Doyle-Kelly W, Bailey D: Results of salvage surgery following radical radiotherapy for laryngeal carcinoma . J Laryngol Otol 1984;98:905-907.Crossref 16. Ogura JH, Sessions DG, Spector GJ: Analysis of surgical therapy for epidermoid carcinoma of the laryngeal glottis . Laryngoscope 1975;85:1521-1530. 17. Biller HF, Lawson W: Partial laryngectomy for vocal cord cancer with marked limitation or fixation of the vocal cord . Laryngoscope 1986;96:61-64.

Wolf, Gregory T.;Schmaltz, Stephen;Hudson, Jerry;Robson, Harriet;Stackhouse, Thomas;Peterson, Karen A.;Poore, Judy A.;McClatchey, Kenneth D.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110066010pmid: 3499156

Abstract • Impaired cell-mediated immunity has been consistently demonstrated in patients with advanced head and neck squamous cancer (HNSC); however, the results of prior studies of correlations of cellular immune parameters with treatment outcome have been inconsistent, and routine assessment of immune parameters has been of limited clinical use. To determine the prognostic importance of alterations in the proportions of various T-lymphocyte subpopulations in the peripheral blood of patients with HNSC, levels of T3, T4, T6, T8, T9, T10, T11, and Leu 7 cells were quantitated by flow cytometry in 80 previously untreated patients and prospectively correlated with tumor characteristics and clinical course (median length of follow-up, 27 months). The mean helper/suppressor cell ratio (T4/T8) increased progressively with increasing tumor stage and was significantly elevated among patients with cancer as a group and in patients with advanced (stage III or IV) disease compared with 40 normal subjects. Decreased disease-free survival was significantly associated with elevated T4/T8 ratios and low percent T8 and T11 cell levels. The prognostic significance of percent T8 (cytotoxic/suppressor) cell levels persisted even after adjusting for known prognostic factors of tumor stage, T class, N class, and tumor site. These correlations provide new insight into immune alterations in HNSC that may prove useful in identifying patients with early clinical disease who have a poor prognosis. (Arch Otolaryngol Head Neck Surg 1987;113:1200-1206) References 1. Maisel RH, Ogura JH: Dinitrochlorobenzene skin sensitization and peripheral lymphocyte count: Predictors of survival in head and neck cancer . Ann Otol Rhinol Laryngol 1976;85:517-522. 2. Wanebo HJ, Jun MX, Strong FU, et al: T-cell deficiency in patients with squamous cell carcinoma of the head and neck . Am J Surg 1975; 130:445-451.Crossref 3. Ryan RE, Neel HB: Correlation of preoperative immunologic test results with recurrence in patients with head and neck cancer . Otolaryngol Head Neck Surg 1980;88:58-63. 4. Wolf GT, Lovett EJ, Peterson KA, et al: Lymphokine production and lymphocyte subpopulations in patients with head and neck squamous carcinoma . Arch Otolaryngol Head Neck Surg 1984;110:731-735.Crossref 5. Hilal Ey, Wanebo HJ, Pinsky CM, et al: Immunological evaluation and prognosis in patients with head and neck cancer . Am J Surg 1977;134:469-473.Crossref 6. Catalona WJ, Sample WF, Chretien PB: Lymphocyte reactivity in cancer patients: Correlation with tumor histology and clinical stage . Cancer 1973;31:65-71.Crossref 7. Chretien PB: Unique immunobiological aspects of head and neck squamous carcinoma . Can J Otolaryngol 1975;4:225-235. 8. Browder JP, Chretien PB: Immune reactivity in head and neck squamous carcinoma and relevance to the design of immunotherapy trials . Semin Oncol 1977;4:431-439. 9. Mandel MA: Skin testing for prognosis or therapy formulation in cancer patients: Caveat emptor . Plast Reconstr Surg 1976;57:64-66. 10. Bostworth JL, Thaler S, Ghossein NA: Delayed hypersensitivity and local control of patients treated by radiotherapy for head and neck cancer . Am J Surg 1976;132:46-48.Crossref 11. Bier J, Nicklisch A, Platz H: The doubtful relevance of non-specific immune reactivity in patients with squamous cell carcinoma of the head and neck region . Cancer 1983;52:1165-1172.Crossref 12. Gilbert HA, Kagan AR, Miles J, et al: The usefulness of pretreatment DNCB in 85 patients with squamous cell carcinoma of the upper aerodigestive tract . J Surg Oncol 1978;10:73-77.Crossref 13. Eskinazi DP, Helman J, Ershow AG, et al: Nonspecific immunity and head and neck cancer: Blastogenesis reviewed and revisited . Oral Surg Oral Med Oral Pathol 1985;60:642-647.Crossref 14. Mason JM, Kitchens GG, Eastham RJ, et al: T lymphocytes and survival of head and neck squamous cell carcinoma . Arch Otolaryngol Head Neck Surg 1977;103:223-227.Crossref 15. Schuller DE, Rock RP, Rinehart JJ, et al: T lymphocytes as a prognostic indicator in head and neck cancer . Arch Otolaryngol Head Neck Surg 1986;112:938-941.Crossref 16. Johnson JT, Rabin BS, Hirsch B, et al: T-cell subpopulations in head and neck carcinoma . Otolaryngol Head Neck Surg 1984;92:381-385. 17. Gray WC, Chretien PB, Suter CM, et al: Effects of radiation therapy on T-lymphocyte subpopulations in patients with head and neck cancer . Otolaryngol Head Neck Surg 1985;93:650-660. 18. Hayashi Y, Yoshida H, Furumoto N, et al: Monoclonal antibody analysis of peripheral blood lymphocyte subpopulations in squamous cell head and neck cancer . Cancer 1986;1:25-30. 19. Wolf GT, Amendola BE, Diaz R, et al: Definitive vs adjuvant radiotherapy: Comparative effects on lymphocyte subpopulations in patients with head and neck squamous carcinoma . Arch Otolaryngol Head Neck Surg 1985; 111:716-726.Crossref 20. Dawson DE, Everts EC, Vetto RM, et al: Assessment of immunocompetent cells in patients with head and neck squamous cell carcinoma . Ann Otol Rhinol Laryngol 1985;94:342-345. 21. Gebel HM, Anderson JE, Gottschalk LR, et al: Determination of helper:suppressor T-cell ratios . N Engl J Med 1987;316:113. 22. Bertouch JV, Roberts-Thomson PJ, Bradley J: Diurnal variation of lymphocyte subsets identified by monoclonal antibodies . Br Med J 1983;286:1171-1173.Crossref 23. Hersh EM, Mansell PWA, Reuben JM, et al: Immunological characterizations of patients with acquired immune deficiency syndrome, acquired immune deficiency syndrome–related symptom complex, and a related life-cycle . Cancer Res 1984;44:5894-5901. 24. Cosimi AB, Colvin RB, Burton RC, et al: Use of monoclonal antibodies to T-cell subsets for immunologic monitoring and treatment in recipients of renal allografts . N Engl J Med 1981; 305:308-314.Crossref 25. Reinherz E, Weiner HL, Hauser SL, et al: Loss of suppressor T cells in active multiple sclerosis . N Engl J Med 1980;303:125-129.Crossref 26. Bellamy N, Cairns E, Bell DA: Immunoregulation in rheumatoid arthritis: Evaluation of T-lymphocyte function in the control of polyclonal immunoglobulin synthesis in vitro . J Rheumatol 1983;10:19-23. 27. Sakane T, Kotani H, Takada S, et al: A defect in the suppressor circuits among OKT4+ cell populations in patients with SLE occurs independently of a defect in the OKT8+ suppressor cell function . J Immunol 1983;131:753-755. 28. Bakhashi A, Miyasaka N, Kavathas P, et al: Lymphocyte subsets in Sjögren's syndrome: A quantitative analysis using monoclonal antibodies and the fluorescence-activated cell sorter . J Clin Lab Immunol 1983;10:63-65. 29. Hubbard GW, Wanebo H, Fukuda M, et al: Defective suppressor cell activity in cancer patients: A defect in immune regulation . Cancer 1981;47:2177-2184.Crossref 30. Pierri I, Cordone G, Rogna S, et al: Decreased sensitivity of T lymphocytes to normal adherent suppressor cells in patients with head and neck cancer . Cancer Detect Prev 1984;7:73-78. 31. Pierri I, Cordone G, Rogna S, et al: T-lymphocytes phenotype and functions in patients with head and neck cancer . Laryngoscope 1985; 95:577-581.Crossref 32. Prehn RT, Prehn LM: The autoimmune nature of cancer . Cancer Res 1987;47:927-932. 33. Miller LG, Goldstein G, Murphy M, et al: Reversible alterations in immunoregulatory T cells in smoking . Chest 1982;5:526-529. 34. Ginns LC, Goldenheim PD, Miller LG, et al: T-lymphocyte subsets in smoking and lung cancer . Am Rev Respir Dis 1982;126:265-269. 35. Klatzmann D, Barre-Sinoussi F, Nugeyre MT, et al: Selective tropism of lymphadenopathy-associated virus (LAV) for helper-inducer T lymphocytes . Science 1984;225:4657.Crossref 36. Weigle KA, Sumaya CV, Montiel MM: Changes in T-lymphocyte subsets during childhood Epstein-Barr virus infectious mononucleosis . J Clin Immunol 1983;13:151-155.Crossref 37. Arneborn P, Biberfeld G: T-lymphocyte subpopulations in relation to immunosuppression in measles and varicella . Infect Immun 1983;39:29-37. 38. Wolf GT, Hudson JL, Peterson KA, et al: Lymphocyte subpopulations infiltrating squamous carcinomas of the head and neck: Correlations with extent of tumor and prognosis . Otolaryngol Head Neck Surg 1986;95:142-152. 39. Morimoto C, Hafler DA, Weiner HL, et al: Selective loss of the suppressor-inducer T-cell subset in progressive multiple sclerosis: Analysis with anti-2H4 monoclonal antibody . N Engl J Med 1987;316:67-72.Crossref 40. Ting CC, Yang SS, Hargrove ME: Lymphokine-induced cytotoxicity: Characterization of effectors, precursors, and regulatory ancillary cells . Cancer Res 1986;46:513-518. 41. Itoh K, Tilden AB, Balch CM: Interleukin 2 activation of cytotoxic T-lymphocytes infiltrating into human metastatic melanomas . Cancer Res 1986;46:3011-3017. 42. Kurnick JT, Kradin R, Blumberg R, et al: Functional characterization of T lymphocytes propagated from human lung carcinomas . Clin Immunol Immunopathol 1986;38:367-380.Crossref 43. Gray WC, Hasslinger BJ, Suter CM, et al: Suppression of cellular immunity by head and neck irradiation: Precipitating factors and reparative mechanisms in an experimental model . Arch Otolaryngol Head Neck Surg 1986;112:1185-1190.Crossref

Schantz, Stimson P.;Goepfert, Helmuth

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110073011pmid: 3663348

Abstract • One hundred eighty-two previously untreated head and neck cancer patients were stratified by pretreatment-quantitated natural killer (NK) cell activity (<60 lytic units [LU] vs ≥60 LU) and followed up longitudinally for the development of distant metastases (DMs). Patients with NK activity of less than 60 LU (n = 99) developed DMs at a higher rate than the remaining group. Further stratification of patients on the bases of both regional nodal disease and treatment demonstrated that the risk of DMs predominantly involved one group, ie, patients with histopathologically documented nodal metastases, NK activity of less than 60 LU, and prior treatment with combined surgery and radiation therapy (12 [46%] of 26 patients). If one of these three factors was absent, the risk of DMs was not greater than 12%, regardless of the factor. Head and neck cancer patients should be stratified by pretreatment natural immune status to determine the impact of therapy on disease progression. (Arch Otolaryngol Head Neck Surg 1987;113:1207-1213) References 1. Strong EW: Preoperative radiation and radical neck dissection . Surg Clin North Am 1969; 49:271-276. 2. Merino OR, Lindberg RD, Fletcher GH: An analysis of distant metastases from squamous cell carcinoma of the upper respiratory and digestive tracts . Cancer 1977;40:145-151.Crossref 3. Vikram B, Strong EW, Shah JP, et al: Failure at distant sites following multimodality treatment for advanced head and neck cancer . Head Neck Surg 1984;6:730-733.Crossref 4. O'Brien CJ, Smith JW, Soong SJ, et al: Neck dissection with and without radiotherapy: Prognostic factors, patterns of recurrence, and survival . Am J Surg 1986;152:456-463.Crossref 5. DeSanto LW, Beahrs OH, Holt JJ, et al: Neck dissection and combined therapy . Arch Otolaryngol Head Neck Surg 1985;111:366-370.Crossref 6. Tarpley JL, Potvin C, Chretien PB: Prolonged depression of cellular immunity in cured laryngopharyngeal cancer patients treated with radiation therapy . Cancer 1975;35:638-644.Crossref 7. Wara WM, Wara DW, Ammann AJ, et al: Immunosuppression and reconstitution with thymosin after radiation therapy . Int J Rad Oncol Biol Phys 1979;5:997-1001.Crossref 8. Scully C: The immunology of cancer of the head and neck with particular reference to oral cancer . Oral Pathol 1979;5:997-1001. 9. Chretien PB: Immunology and immunotherapy , in Chretien PB, Johns ME, Shedd DP, et al (eds): Head and Neck Cancer . St Louis, CV Mosby Co, 1985, vol 1, pp 557-580. 10. Gorelik E, Fogel M, Segal S, et al: Differences in resistance of metastatic tumor cells from local tumor growth to cytotoxicity of natural killer cells . JNCI 1979;63:1397-1406. 11. Hanna N: Role of natural killer cell in control of cancer metastasis . Cancer Metastasis Rev 1982;1:45-64.Crossref 12. Pollack SB, Hollenbeck LA: In vivo reduction of NK activity with anti-NK1 serum: Direct evaluation of NK cells in tumor clearance . Int J Cancer 1982;29:203-210.Crossref 13. Schantz SP, Shillitoe EJ, Brown B, et al: Natural killer cell activity and head and neck cancer: A clinical assessment . JNCI 1985;77:869-875. 14. Schantz SP, Poisson L: Natural killer cell response to regional lymph node metastases . Arch Otolaryngol Head Neck Surg 1986;112:545-551.Crossref 15. Schantz SP, Campbell BH, Guillamondegui OM: Pharyngeal carcinoma and natural killer cell activity . Am J Surg 1986;152:467-474.Crossref 16. American Joint Committee on Cancer: Manual for Staging of Cancer . Philadelphia, JB Lippincott, 1983, pp 25-42. 17. Schantz SP, Romsdahl MM, Babcock GF, et al: The effect of surgery on natural killer cell activity in head and neck cancer patients: In vitro reversal of a postoperatively suppressed immunosurveillance system . Laryngoscope 1985;95: 588-594.Crossref 18. Pross HF, Baines MG, Rubin P, et al: Spontaneous human lymphocyte-mediated cytotoxicity against tumor target cells: IX. The quantitation of natural killer cell activity . J Clin Immunol 1981;1:51-57.Crossref 19. Kaplan EL, Meier P: Non-parametric estimation from incomplete observations . J Am Statistics Assoc 1958;53:457-481.Crossref 20. Cox DR: Analysis of Binary Data . London, Chapman and Hall, 1970. 21. Cox DR: Regression models and life tables (with discussion) . J R Statistics Soc 1972;34:187-220. 22. Jesse RH, Fletcher GH, Lindberg RD, et al: Cancer of the head and neck , in Clark RL, Howe CD (eds): Cancer Patient Care . Chicago, Year Book Medical Publishers Inc, 1976, pp 89-124. 23. Byers RM: Modified neck dissection: A study of 967 cases from 1970 to 1980 . Am J Surg 1985;150:414-426.Crossref 24. Strong MS, Vaughan CW, Kayne HL, et al: A randomized trial of preoperative radiotherapy in cancer of the oropharynx and hypopharynx . Am J Surg 1978;136:494-500.Crossref 25. Terz JJ, King ER, Lawrence WJ: Preoperative irradiation for head and neck cancer: Results of a prospective study . Surgery 1981;89:449-453. 26. Hong WK, Bromer R: Chemotherapy in head and neck cancer . N Engl J Med 1983; 308:175-179.Crossref 27. Ervin TJ, Clark JR, Weichselbaum RR, et al: An analysis of induction and adjuvant chemotherapy in the multidisciplinary treatment of squamous-cell carcinoma of the head and neck . J Clin Oncol 1987;5:10-20. 28. Wasson JH, Sox HC, Neff RK, et al: Clinical prediction rules: Applications and methodological standards . N Engl J Med 1985;313:793-799.Crossref

Robbins, K. Thomas;Bowman, Julia B.;Jacob, Rhonda F.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110080012pmid: 3663349

Abstract • For patients who may have significantly impaired deglutitory and articulatory functions after glossectomy, an important aspect of the rehabilitative management in our institution is the use of palatal augmentation prostheses. The aim is to reduce the free space between the roof and floor of the oral cavity to permit stronger lingual propulsion during oral deglutition and better linguopalatal contact during articulation. We evaluated ten patients who received this device after glossectomy during the past two years. Modified barium swallows and voice recordings were performed when possible with and without the use of the palatal augmentation prosthesis. Articulatory and deglutitory functions were evaluated on a scaled score ranging from 0 to 10 points. The scores of the patients' average immediate improvements were 4.5 points (range, 2 to 7) for articulation and 3.5 points (range, 2 to 7) for deglutition; the scores of average long-term improvements were 3.4 points (range, 2 to 7) and 2.2 points (range, 6 to 8), respectively. Patients using the palatal augmentation prosthesis experienced significant improvement in both functions. We believe that this device contributes greatly to rehabilitative therapy for patients who have undergone extirpative surgery for tumors of the oral cavity. (Arch Otolaryngol Head Neck Surg 1987;113:1214-1218) References 1. Knowles JC, Chalian VA, Shanks JC: A functional speech impression used to fabricate a maxillary speech prosthesis for a partial glossectomy patient . J Prosthet Dent 1984;51:232-237.Crossref 2. Kalfuss AH: Analysis of Speech of the Glossectomy Patient, doctoral dissertation. Wayne State University, Detroit, 1968. 3. Skelly M, Donaldson RC, Fust RS: Glossectomee Speech Rehabilitation . Springfield, Ill, Charles C Thomas Publisher, 1973. 4. Cantor R, Curtis TA, Shipp T, et al: Maxillary speech prostheses for mandibular surgical defects . J Prosthet Dent 1969;22:253.Crossref 5. Logemann JA: Can data on normal swallowing improve treatment selection? in Rehabilitation and Treatment of Head and Neck Cancer , US Dept of Health and Human Services, National Institutes of Health Publication 86-2762,1986, pp 23-32. 6. Aramany MA, Downs JA, Beery QL, et al: Prosthodontic rehabilitation for glossectomy patients . J Prosthet Dent 1982;48:78-81.Crossref

Muldowney, J. Bart;Cohen, James I.;Porto, Dennis P.;Maisel, Robert H.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110085013pmid: 3663350

Abstract • While a number of flaps are available that can "plug the hole" created by the resection of an oral cavity malignancy, the final functional and cosmetic result is often far from satisfactory. The ideal flap for this area should provide a one-stage, reliable reconstruction (regardless of previous surgery or irradiation) with the options of thin pliable skin and/or vascularized bone. Donor-site morbidity must be acceptable. In our experience, the free radial forearm flap best approaches these ideals. Unfortunately, it has received relatively little attention in the otolaryngology literature. The results of using 15 of these flaps to reconstruct 14 oral cavity defects are reported here. Despite the fact that most of the reconstructions were performed in older patients who had undergone irradiation (nine of 14) and previous surgical treatment (ten of 14), there were no flap failures. Hospital stays were short (less than two weeks), cosmetic results were good, and all but one patient had resumed oral intake by the time of hospital discharge. The specific applications and limitations of this flap are emphasized so that the reader can better understand its role in head and neck reconstructive surgery. (Arch Otolaryngol Head Neck Surg 1987;113:1219-1224) References 1. Timmons MJ: The vascular basis of the radial forearm flap . Plast Reconstr Surg 1986; 77:80-91.Crossref 2. Cormack GC, Lamberty GH: A classification of fascio-cutaneous flaps according to their patterns of vascularization . Br J Plast Surg 1984; 37:80-87.Crossref 3. Soutar DS, Widdowson WP: Immediate reconstruction of the mandible using a vascularized segment of radius . Head Neck Surg 1986; 8:232-246.Crossref 4. Song R, Gao Y, Song Y, et al: The forearm flap . Clin Plast Surg 1982;9:21-26. 5. Soutar DS, McGregor IA: The radial forearm flap in intraoral reconstruction: The experience of 60 consecutive cases . Plast Reconstr Surg 1986;78:1-8.Crossref 6. Corrigan AM, O'Neill TJ: The use of the compound radial forearm flap in oro-mandibular reconstruction . Br J Oral Maxillofac Surg 1986; 25:86-95.Crossref 7. Soutar DS, Scheker L, Tanner HSB, et al: The radial forearm flap: A versatile method for intraoral reconstruction . Br J Plast Surg 1983; 36:1-8.Crossref 8. Brookes M: The Blood Supply of Bone . Stoneham, Mass, Butterworth Publishers Inc, 1971, p 119.

Wharam, Moody D.;Beltangady, Mohan S.;Heyn, Ruth M.;Lawrence, Walter;Raney, R. Beverly;Ruymann, Frederick B.;Soule, Edward H.;Tefft, Melvin;Maurer, Harold M.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110091014pmid: 3663351

Abstract • Eighty-nine children with localized rhabdomyosarcoma of orofacial and laryngopharyngeal sites were treated in accordance with the first and second Intergroup Rhabdomyosarcoma Study (IRS) protocols (IRS-I and IRS-II) between 1972 and 1984. Treatment included surgery (or biopsy) and chemotherapy for all patients and radiotherapy in the majority. The actuarial estimate of the three-year survival rate for all patients was 83% and did not differ significantly by primary site, histologic findings, or presence of adenopathy. A trend for a worse survival rate was seen in clinical group III patients and in those less than 5 years of age at diagnosis. Factors associated with an increased risk of local/regional relapse included omission of radiotherapy and a radiation dose of less than 40 Gy (4000 rad). We conclude that treatment of these patients as recommended in the IRS-I and IRS-II protocols results in very good local and regional tumor control and survival rates. Salvage therapy for local/regional recurrence may yield long-term remission and possibly cure. (Arch Otolaryngol Head Neck Surg 1987;113:1225-1227) References 1. Wharam MD, Beltangady M, Hays DM, et al: Localized orbital rhabdomyosarcoma: An interim report of the Intergroup Rhabdomyosarcoma Study Committee . Ophthalmology 1987; 94:251-253.Crossref 2. Raney RB, Tefft M, Newton WA, et al: Improved prognosis with intensive treatment of children with cranial soft-tissue sarcomas arising in nonorbital parameningeal sites: A report from the Intergroup Rhabdomyosarcoma Study . Cancer 1987;59:147-155.Crossref 3. Wharam MD, Foulkes MA, Lawrence W, et al: Soft-tissue sarcoma of the head and neck in childhood: Nonorbital and nonparameningeal sites: A report of the Intergroup Rhabdomyosarcoma Study (IRS)-I . Cancer 1984;53:1016-1019.Crossref 4. Maurer HM: The Intergroup Rhabdomyosarcoma Study: Update, November 1978 . NCI Monogr 1981;56:61-68. 5. Maurer HM: The Intergroup Rhabdomyosarcoma Study II: Objectives and study design . J Pediatr Surg 1980;15:371-372.Crossref 6. Maurer HM, Beltangady M, Gehan EA, et al: The Intergroup Rhabdomyosarcoma Study I: A final report . Cancer , in press. 7. Gaiger AM, Soule EH, Newton WA: Pathology of rhabdomyosarcoma: Experience of the Intergroup Rhabdomyosarcoma Study, 1972-1978 . NCI Monogr 1981;56:19-27. 8. Kaplan EL, Meier P: Nonparametric estimation from incomplete observations . J Am Stat Assoc 1958;53:457-481.Crossref 9. Mantel N: Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chemother Rep 1966; 50:163-170. 10. Heyn RM: Late effects of therapy in rhabdomyosarcoma . Clin Oncol 1985;4:287-297. 11. Hazra TA, Shipman B: Dental problems in pediatric patients with head and neck tumors undergoing multiple modality therapy . Med Pediatr Oncol 1982;10:91-95.Crossref 12. Fromm M, Littman P, Raney RB, et al: Late effects after treatment of 20 children with soft-tissue sarcomas of the head and neck: Experience at a single institution with a review of the literature . Cancer 1986;57:2070-2076.Crossref

Warde, Padraig;Harwood, Andrew;Keane, Thomas

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110094015pmid: 3117073

Abstract • During the 12-year period 1971 to 1982, 23 patients with primary squamous cell carcinoma of the subglottis were treated with initial radical radiation therapy. There were 19 men and four women, with a mean age of 64 years. Five patients had T1 tumors, four had T2, three had T3, and 11 had T4. The actuarial overall and cause-specific survival rates were 26% and 61%, respectively. Local control was achieved with initial radiation therapy in 16 patients (70%). Subsequent local control was achieved in one other patient following surgery for recurrence, giving an ultimate local control figure of 74% (17 of 23 patients). All patients with T1, T2, and T3 disease achieved local control with initial treatment; however, seven of the 11 patients with T4 disease either had residual disease following radiation therapy or developed local recurrence on follow-up. (Arch Otolaryngol Head Neck Surg 1987;113:1228-1229) References 1. Sessions DG, Ogura JH, Frifo MP: Carcinoma of the subglottic area . Laryngoscope 1975; 85:1417-1423.Crossref 2. Shaha AR, Shah JP: Carcinoma of the subglottic larynx . Am J Surg 1982;144:456-458.Crossref 3. TNM Classification of Malignant Tumours . Geneva, International Union Against Cancer, 1979. 4. Coldman AJ, Elwood JM: Examining survival data . Can Med Assoc J 1979;121:1065-1071. 5. Vermund H: Role of radiotherapy in cancer of the larynx as related to the TNM system of staging: A review . Cancer 1970;25:485-504.Crossref

Loury, Mark C.;Johns, Michael E.;Danes, Betty S.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110096016pmid: 3663352

Abstract • The role of heredity in the cause of head and neck cancer has not been clarified. Contrary to the autosomal-dominant heritable cancer syndromes, there is no clear genetic pattern seen in oropharyngeal or laryngeal squamous cell carcinoma. Pedigree data demonstrating clusters of affected relatives suggest that some head and neck squamous cell cancers result from an interaction between environmental factors and germinal predisposition. Though no genetic marker has been described for head and neck epidermoid carcinomas, some heritable single tumor syndromes demonstrate increased amounts of hyperdiploidy (defined as a metaphase with more than 46 chromosomes exclusive of 92) in in vitro cultures of dermal fibroblasts. In the present study, dermal fibroblasts were cultured from 30 patients with biopsy-proved oropharyngeal and laryngeal squamous cell cancer. Compared with the percentage of cells with in vitro hyperdiploidy (IVH) of 0% to 1% in 155 clinically normal individuals without a family cancer history, 13 (43%) of these 30 patients had significantly elevated (7% to 12%) IVH. Six of the seven clinically affected women had IVH, a proportion significantly greater than that for the men. In vitro hyperdiploidy remained stable for each assayed cell line from the third through sixth passage. Each patient's IVH percentage of dermal and oropharyngeal fibroblasts remained nearly constant varying 0% to 1%. The stability of the hyperdiploid fraction independent of the biopsy site eliminates local factors as the sources of the elevated IVH. Since IVH is considered to be an in vitro expression of a heritable pre-disposition to develop carcinoma, the observation of IVH in patients with oropharyngeal and laryngeal epidermoid carcinomas suggests that some individuals have a propensity for epithelial neoplasia when exposed to appropriate carcinogens. (Arch Otolaryngol Head Neck Surg 1987;113:1230-1233) References 1. McKusick VA: Mendelian Inheritance in Man: Catalogues of Autosomal Dominant, Autosomal Recessive, and X-Linked Phenotypes , ed 4. Baltimore, The Johns Hopkins Press, 1974, pp 3-664. 2. Lutzner MA: Nosology among the neoplastic genodermatoses , in Mulvihill JJ, Miller RW, Fraumeni JF (eds): Genetics of Human Cancer . New York, Raven Press, 1977, pp 145-168. 3. Swift M: Malignant neoplasms in heterozygous carriers of genes for certain autosomal recessive syndromes , in Mulvihill JJ, Miller RW, Fraumeni JF (eds): Genetics of Human Cancer . New York, Raven Press, 1977, pp 209-216. 4. Swift M: Fanconi's anemia in the genetics of neoplasia . Nature 1971;230:370-373.Crossref 5. Lynch HT, Frichot BC, Lynch P, et al: Family studies of malignant melanoma and associated cancer . Surg Gynecol Obstet 1975;141:517-522. 6. Lynch HT, Lynch J, Lynch P: Management and control of familial cancer , in Mulvihill JJ, Miller RW, Fraumeni JF (eds): Genetics of Human Cancer . New York, Raven Press, 1977, pp 235-256. 7. Lynch HT: Miscellaneous problems: Cancer and genetics , in Lynch HT (ed): Cancer Genetics . Springfield, Ill, Charles C Thomas Publisher, 1976, pp 491-554. 8. Terasaki PI, Perdue ST, Mickey MR: HLA frequencies in cancer , in Mulvihill JJ, Miller RW, Fraumeni JF (eds): Genetics of Human Cancer . New York, Raven Press, 1977, pp 321-328. 9. Danes BS: In vitro expressions of cancer genes for heritable human tumours: Numerical alterations in chromosome complement . Dis Markers 1984;2:371-380. 10. Delhanty JDA, Davis MB, Wood J: Chromosome instability in lymphocytes, fibroblasts, and colon epithelial-like cells from patients with familial polyposis coli . Cancer Genet Cytogenet 1983;8:27-50.Crossref 11. Danes BS: In vitro hyperdiploidy in a family with nasopharyngeal cancer . Cancer Genet Cytogenet 1986;21:107-115.Crossref

FECHNER, ROBERT E.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110100017

Abstract PATHOLOGIC QUIZ CASE 1 Richard Scharf, DO; Jamie R. Stern, MD; Barry L. Wenig, MD, New Hyde Park, NY.A 53-year-old man presented with a 5 × 5-cm firm, nontender, midline neck mass inferior to the hyoid bone that moved during deglutition. The patient denied drainage from the mass hoarseness, hemoptysis, otalgia, or dysphagia. There was no change in the patient's weight, skin, hair, or bowel habits. He denied cigarette smoking or alcohol abuse.Results of a thyroid scan using technetium 99m (Fig 1) demonstrated normal thyroid tissue with a small increase in activity in the region of the mass. Results of laboratory studies disclosed the following values: 24-hour uptake of radioiodine, 0.24 (24%) (normal, 0.15 to 0.40 [15% to 40%]); triiodothyronine, 2.6 nmol/L (167 ng/dL) (normal, 1.5 to 2.9 nmol/L [100 to 190 ng/dL); thyroxine, 132 nmol/L (10.28 μg/dL) (normal, 71 to 148 nmol/L [5.5 to 11.5 μg/dL]); and thyroid-stimulating hormone, 5 mU/L (5 μU/mL) (normal, 0 to 10 mU/L [0 to 10 μU/mL]). References 1. Trail ML, Zerique GP, Chicola J: Carcinoma in thyroglossal duct remnants . Laryngoscope 1977;87:1685-1691.Crossref 2. Widstrom A, Magnusson P, Hellquist H, et al: Adenocarcinoma originating in the thyroglossal duct . Ann Otol Rhinol Laryngol 1976;85:286-290. 3. Joseph TJ, Komorowski RA: Thyroglossal duct carcinoma . Hum Pathol 1975;6:717-729.Crossref 4. Roses DF, Snively SL, Phelps RG, et al: Carcinoma of the thyroglossal duct . Am J Surg 1983;145:266-269.Crossref 5. Judd ES: Thyroglossal duct cysts and sinuses . Surg Clin North Am 1963;43:1023-1032. 6. LiVolsi VA, Perzin KH, Saretsky L: Carcinoma arising in median ectopic thyroid (including thyroglossal duct tissue) . Cancer 1974; 34:1303-1315.Crossref 7. Ward PH, Strahan RW, Acquarelli M, et al: The many faces of cysts of the thyroglossal duct . Trans Am Acad Ophthalmol Otolaryngol 1970;74:310-318. 8. Nuttal FQ: Cystic metastases from papillary adenocarcinoma of the thyroid with comments concerning carcinoma associated with thyroglossal remnants . Am J Surg 1965;109:500-505.Crossref 9. Barker GR: Unifocal lymphomas of the oral cavity . Br J Oral Maxillofac Surg 1984;22:426-430.Crossref 10. McGurk M, Goepel JR, Hancock BW: Extranodal lymphoma of the head and neck: A review of 49 consecutive cases . Clin Radiol 1985;36:455-458.Crossref 11. Eisenbud L, Sciubba J, Mir R, et al: Oral presentations in non-Hodgkin's lymphoma: A review of 31 cases . Oral Surg Oral Med Oral Pathol 1983;56:151-156.Crossref 12. Bacci G, Picci P, Bertoni F, et al: Primary non-Hodgkin's lymphoma of bone: Results in 15 patients treated by radiotherapy combined with systemic chemotherapy . Cancer Treat Rep 1982;66:1859-1862 13. McNelis F, Pai V: Malignant lymphoma of the head and neck . Laryngoscope 1969;79:1076-1086.Crossref 14. Spagnoli I, Gattoni F, Viganotti G, et al: Roentgenographic aspects of non-Hodgkin's lymphoma presenting with osseous lesions . Skeletal Radiol 1982;8:39-41.Crossref 15. Rodman D, Raymond A, Phillips W, et al: Case report 201 . Skeletal Radiol 1982;8:235-237.Crossref 16. Bacci G, Jaffe N, Emiliani E, et al: Therapy for primary non-Hodgkin's lymphoma of bone and a comparison of results with Ewing's sarcoma . Cancer 1986;57:1468-1472.Crossref

MCGUIRT, W. FREDERICK

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110104020

Abstract In Reply.—In response to the letter by Greene, determination of the vocal quality in the patients reported in our study was graded in a single-blind fashion by three independent, trained, speech and voice therapists. Recordings were made three months or more postoperatively. The grading system was that employed by Koufman1 in a previous article and noted on page 534 of Otolaryngology—Head & Neck Surgery. With future stroboscopic evaluations, we hope to better delineate the vocal function following endoscopic laser surgery of the vocal cords, and we hope that others will also review their cases in a more critical fashion using more sophisticated measurements of vocal quality. Assuming that the cure rate following endoscopic laser surgery for small carcinomas of the vocal cords is certainly equivalent to that of previously recommended forms of therapy, and that the cost and time of treatment are much less, we believe that improved References 1. Koufman JA: The endoscopic management of early vocal cord carcinoma with the carbon dioxide laser: Clinical experience and a proposed subclassification . Otolaryngol Head Neck Surg 1986;95:531-537.

GREENE, DENNIS A.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110104019pmid: 3663356

Abstract To the Editor.—In their article "Endoscopic Laser Surgery,"1 McGuirt and Koufman assert that small carcinomas of the vocal cord can be managed by marginal resection or cordectomy, using the carbon dioxide laser, with excellent vocal results as long as the anterior commissure is not involved. They state that vocal quality is comparable with that following radiation therapy, and imply that even when a bulky mass is removed, laryngoplasty or Teflon vocal cord augmentation can be done to correct the breathy voice. This is a critical issue, which requires some amplification. Is the determination of vocal quality in their patients made by an unbiased observer, or by the surgeons themselves? What criteria do they use? Only with objective data, scientifically designed parameters of observation, and a sufficient sample of patients, can this contention be proved. If so, I would agree that laser vaporization of these small lesions will eventually References 1. McGuirt WF, Koufman JA: Endoscopic laser surgery: An alternative in laryngeal cancer treatment . Arch Otolaryngol Head Neck Surg 1987;113:501-505.Crossref

LORÉ, JOHN M.;BANYAS, JEFFREY B.;NIEMIEC, EDWARD R.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110104018pmid: 3663355

Abstract To the Editor.—Arguments against total thyroidectomy for well-differentiated carcinoma of the thyroid have usually centered on an unacceptably high risk factor for the operation. Permanent vocal cord paralysis and permanent hypoparathyroidism are always mentioned. Using the senior author's technique for total thyroid lobectomy,1 408 consecutive recurrent laryngeal nerves were placed at risk, with an incidence of less than 0.5% permanent vocal cord paralysis. There were no patients with permanent and complete paralysis of the external branch of the superior laryngeal nerve. With the same technique for total thyroidectomy, together with search of the surgical specimen,2 liberal autotransplantation of parathyroid glands thought to be at risk, one patient in 66 consecutive total thyroidectomies (1.5%) has documented persistent hypoparathyroidism that has been readily controlled. One other patient has some transient symptoms of hypocalcemia that is responding to treatment with calcium despite documented normal parathormone levels. If both of these References 1. Lore JM Jr: The thyroid and parathyroids , in An Atlas of Head and Neck Surgery . Philadelphia, WB Saunders Co, 1962, chap 14, pp 354-379. 2. Lore JM Jr, Pruet CW: Retrieval of the parathyroid glands during thyroidectomy . Head Neck 1983;5:268-269.Crossref

RAYMOND, JAMES R.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110104021pmid: 3663357

Abstract To the Editor.—The article by Wells and Gernon1 in the June issue of the Archives concerning use of 2-cyano-butyl-acrylate (Histoacryl) was most interesting. The results would appear to indicate that the medication can be used successfully, at least on animal models. The authors also mention that the medication has not been approved by the Food and Drug Administration, although it is widely used in Europe. I am writing to further caution that use of this drug may cause much legal difficulty. I am personally aware of a case in which cyano-acrylate was used in a dental oral procedure and suit was brought against the dentist. The suit was settled out of court because of the fact that a nonapproved drug had been used. Therefore, I think that even though the drug appears to work well on test models, it should not be used by otologic surgeons in References 1. Wells JR, Gernon WH: Bony ossicular fixation using 2-cyano-butyl-acrylate adhesive . Arch Otolaryngol Head Neck Surg 1987;113:644-646.Crossref

JACKSON, RICHARD T.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110105024

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract In Reply.—We appreciate Dr Wexler's careful reading of our article, and we share his mistrust of data purporting to show a beneficial effect of a drug on chronic dizziness. Can we attribute our results to a drug effect? There did not seem to be a best way to present the data from a relatively small pool of patients that had been treated with three doses of drug in three different sequences. We carefully chose our illustrations so as to best demonstrate the many facets of the responses. Figure 5 showed a typical variation in nystagmic beats over the course of the study in a nonresponder. In our discussion, we stated that the average nystagmus after one week of placebo was 135% of the control value. It never dropped lower than 86.9% of the control value. Also, we stated that 26 of the 28 responders evidenced a return of nystagmus

GATES, GEORGE A.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110105022pmid: 3663358

Abstract To the Editor.—I write to applaud the work by Salzman and coworkers,1 and to emphasize three important aspects of their report. First, the authors correctly delineate the power of this, a negative study, and exercise appropriate caution to the reader in interpretation of the results. Would that more investigators were cognizant of this problem. Second, the report illustrates the difficulty with retrospective research. If all 169 parents had been interviewed about cigarette smoking at the time of admission to the hospital, the study size would have tripled and the research question might have been answered definitively. Although this project was completed as part of a medical student clerkship requirement, the nature of the study and the time constraints that operate are not unlike those of our residents who are seeking "do-able" projects for their limited research time. It behooves us to establish the wherewithal for our residents to References 1. Salzman MB, Biller HF, Schechter CB: Passive smoking and croup . Arch Otolaryngol Head Neck Surg 1987;113:866-868.Crossref

WEXLER, DAVID B.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110105023pmid: 3117074

Abstract To the Editor.—The recent report by Jackson and Turner1 provides encouraging illustrations of how the nonsedating antihistamine, astemizole, may be used to treat chronically dizzy patients. Twenty-eight of 38 study patients were said to show a "significant reduction in symptoms and a 50% reduction of spontaneous and/or positional nystagmus." While these are impressive results, the article did not include sufficient information to attribute this to drug effect. Two responders are graphically presented in Figs 6 and 7, but no group summary statistics are recorded to document overall trends, or the variability in the data. Although the patients were screened to exclude patients with probable Meniere's disease, an estimate of the baseline natural fluctuation in signs and symptoms is highly desirable in the remaining heterogeneous group of dizzy patients. Perhaps predrug symptom diaries or serial predrug evaluations would have been helpful in making quantitative analysis of variation possible. Appropriately, References 1. Jackson RT, Turner JS: Astemizole, its use in the treatment of patients with chronic vertigo . Arch Otolaryngol Head Neck Surg 1987;113:536-542.Crossref 2. American Medical Association: Drug Evaluations , ed 6. Chicago, American Medical Association, 1986, pp 1043-1047.

GACEK, RICHARD R.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110106025pmid: 3663359

Abstract To the Editor.—The preliminary report by Miller and coworkers,1 and two other presentations at our national meetings, have demonstrated the temporary effectiveness of botulinum toxin (BT) for the relief of spasmodic dysphonia. The use of a myoneural blocking agent such as BT is logical, and has the advantage that different adductor muscles can be paralyzed selectively or in combination. The injection of this toxic substance, however, should be carefully controlled and appropriately placed so as to produce a maximal effect on the motor end-plate junctions. A knowledge of the distribution of the motor end plates in the adductor muscles of the human larynx is, therefore, an important prerequisite for the accurate injection of BT. For example, in a muscle such as the thyroarytenoid muscle, where the motor end plates are diffusely distributed throughout the muscle, multiple small injections of BT should effectively block most of the motor end References 1. Miller RH, Woodson GE, Jankovic J: Botulinum toxin injection of the vocal fold for spasmodic dysphonia . Arch Otolaryngol Head Neck Surg 1987;113:603-605.Crossref 2. Rosen M, Malmgren LT, Gacek RR: Three-dimensional computer reconstruction of the distribution of neuromuscular junctions in the thyroarytenoid muscle . Ann Otol Rhinol Laryngol 1983;92:424-429. 3. DeVito M, Malmgren LT, Gacek RR: Three-dimensional distribution of neuromuscular junctions in human cricothyroid . Arch Otolaryngol Head Neck Surg 1985;111:110-113.Crossref 4. Freije J, Malmgren LT, Gacek RR: Motor end-plate distribution in the human lateral cricoarytenoid muscle . Arch Otolaryngol Head Neck Surg 1986;112:176-179.Crossref 5. Freije J, Malmgren LT, Gacek RR: Motor end-plate distribution in the human interarytenoid muscle . Arch Otolaryngol Head Neck Surg 1987;113:63-68.Crossref

MILLER, ROBERT H.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110106026

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract In Reply.—I can assure Dr Gacek that we are very aware of his research on the localization of motor end plates in laryngeal muscles, and that we are not ignoring this important work. Our preliminary experiment was performed to determine if botulinum toxin (BT) would be useful in patients with spasmodic dysphonia. The electromyographic technique was chosen because it was the simplest, least invasive means of administering the BT, and it has been used to inject BT into the extraocular muscles. However, it does not permit localization of the BT to discrete anatomic areas within a muscle with any certainty. It may be that the diffusion of BT within a muscle is such that precise localization is neither desirable nor necessary. Furthermore, I suspect that the only way to obtain such fine control of the injection would be by visual inspection, which would require direct laryngoscopy or, perhaps, a

BERGSTROM, LAVONNE

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110107028

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract This book has seven sections. The first deals with general areas of examination; anesthesiology (that chapter alone worth the price of the book); birth defects and genetic counseling; allergic diseases; and ear, nose, and throat manifestations of systemic disease. That chapter ends with useful brief lists of diseases that produce coagulopathies, head and neck infections, hearing loss, and mucosal ulcers. Developmental and anatomic chapters addressing specific disorders and their importance lead most sections. At the end of most chapters there are decision trees or algorithms that are quite useful. Chapters 19 through 22 are valuable for pediatric and general otolaryngologists. The authors discuss referral guidelines, speech disorders, auditory rehabilitation of the hearing-impaired child, and management of voice disorders, including stuttering. Section four deals with oropharyngeal and dentofacial development and disorders. The section in Chapter 23, on swallowing and sucking, is almost poetic, but informative. Pashley's chapter on cleft lip and

NOYEK, ARNOLD M.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110107029

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract I smiled when I received this book for review—only last week had I just read and, happily, placed my own copy on my bookshelf for ready reference. This was going to be easy—and pleasant! Joel Schwartz, a radiologist from the Department of Radiologic Sciences of the Medical College of Pennsylvania and Hospital (Philadelphia), has produced, with the support of Thieme Medical Publishers, an outstanding text/atlas devoted to imaging of the temporal bone. Additional contributions are provided by Lansman, Lufkin, and Roos to this richly illustrated volume. This text/atlas is a 223-page exposition, on excellent quality paper, devoted almost entirely to state-of-the-art, high-resolution, thin-section computed tomography (CT) of the temporal bone. The book is divided into nine chapters, eight devoted to CT. In order, they deal with technical considerations, the external auditory canal, the middle ear and mastoid, neurovascular compartments, the inner ear, the otodystrophies, trauma, and the facial nerve. A

MEYERHOFF, WILLIAM L.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110107027

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract The ABR Handbook by Glasscock et al is an original work on a very significant subject. The figures and illustrations add significantly to the work and the writing is such that its intent is not only clear, but that the reading is quite easy. The organization is good, which makes this an enjoyable reading experience. The authors begin with an interesting historical perspective that serves as an excellent introduction and tantalizes the reader. This is followed by a glossary of terms to set the groundwork for the text itself. A concise description of anatomy and physiology as it applies to auditory brain-stem response is then supplied. In this description, the authors include the pathways, where problems may arise, and what causes problems within the auditory system and how auditory brain-stem testing can help identify these problems. The authors follow with a good basic review of instrumentation and techniques for measuring

GATES, GEORGE A.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110108032

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Parkton, Md, York Press, 1986. This work is the result of a closed research conference sponsored by the National Institute of Child Health and Child Development held in 1985 in Bethesda, Md. The 18 contributed chapters were edited by James Kavanagh, PhD, a staff member of the National Institute of Child Health and Child Development. It is a compendium of the then current status of the research of the participants, and, as such, contains much useful information to workers in this important clinical area. All the issues surrounding the controversy, does otitis media impair cognitive development, are discussed here, clearly exposited, and carefully edited. The book reads well and is thoroughly referenced. The first three chapters discuss the importance of hearing in early childhood in regard to development in the three separate areas of language, speech, and cognition. Particularly intriguing to me as a clinician was the discussion of the

SCHOENROCK, LARRY D.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110108030

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract The text Suction Lipectomy and Body Sculpturing, written by Bahman Teimourian, was reviewed as it relates to the head and neck facial plastic surgeon. This book deals with the entire gamut of lipectomy surgery, including the evolution of suction lipectomy, the physiologic and biologic considerations, patient selection, as well as the specifics of face and neck lipectomy. The author purports to be one of the originators of liposuction surgery, having used a uterine curet to remove fat on a secondary thigh lift operation in October 1976. The physiologic, metabolic, and growth considerations that Teimourian describes are published with a very adequate bibliography. However, the basic factual information provided is scanty, at best. His description of "standard lipectomy" procedures in the face and neck are embellished with drawings of incision sites and dissection approaches. He further describes the use of surgical currettes and recommends the use of a 4.5-mm plastic curet

MATTOX, DOUGLAS E.

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110108031

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract This book is a part of a large series of atlases covering all of surgery. The volume devoted to the ear has chapters from leading otologic surgeons from the United Kingdom, Europe, and the United States. The book is strictly a surgical atlas, and, as such, is a good catalog of techniques used in various centers around the world. Beyond this, the book is disappointing. The chapters are short and concern themselves only with technique. There is little or nothing about the evaluation of the patient, the pathophysiology of disease, why one technique is chosen over another (other than it is better in the author's hands), or problem solving in the difficult or unusual case. Indications for the procedures are brief and inconsistently described; results are almost nonexistent. The editing of the book is also disappointing. There are sentences that do not make sense and statements that clearly need to

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110109033

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables. Abstract Meeting.—The 11th annual midwinter meeting of the Association for Research in Otolaryngology will be held from Jan 31, 1988, to Feb 4, 1988, at the Holiday Inn, Clearwater Beach, Fla. For further information, contact The Association for Research in Otolaryngology, Parmly Hearing Institute, Loyola University of Chicago, 6525 N Sheridan Rd, Chicago, IL 60626. Congress Meeting.—The 19th Congress of the Pan-Pacific Surgical Association and the Section on Otolaryngology—Head and Neck Surgery meeting will be held Jan 24 through 29, 1988, at the Sheraton-Waikiki Hotel, Honolulu. Information can be obtained by writing to Charlotte Winget, Executive Director, Pan-Pacific Surgical Association, 733 Bishop St, Suite 1910, PO Box 553, Honolulu, HI 96809. Seminar.—The Department of Otolaryngology and Maxillofacial Surgery at the University of Cincinnati Medical Center is sponsoring a seminar on fundamentals of otolaryngology to be held Aug 7 through 12, 1988, at Kings Island, Ohio. This course is approved for

1987 Archives of Otolaryngology - Head & Neck Surgery

doi: 10.1001/archotol.1987.01860110122034

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.