Foregut duplication arising from the pharynx.

An unusual case of duplication of the foregut arising from the posterior pharyngeal wall is presented. Pertinent embryological and etiological considerations are discussed and a literature review included.

Granular cell myoblastoma of the parapharyngeal space.

A granular cell myoblastoma of the parapharyngeal space is presented. Although uncommon, this neoplasm of controversial origin must be considered in the differential diagnosis of all nonenhancing parapharyngeal space masses.

Acrylic frontal cranioplasty.

The correction of contour defects of the frontal bone has been accomplished with a variety of autogenous and alloplastic materials. We report our experience in reconstructing 11 cases of congenital, traumatic, and postsurgical frontal defects with acrylic. The acrylic was cured intraoperatively within the defect in some patients, or prefabricated into a prosthesis and wired into position in others. The operative techniques for both methods of repair are detailed. The reconstruction was successful in all cases and there were no complications. The acrylic implant has been found to be well tolerated after 2-10 yr follow-up. The value of the construction of a facial moulage is stressed, especially when restoration of the orbital rim is required.

Laser lateralization for bilateral vocal cord abductor paralysis.

Unilateral laser excision of the thyroarytenoid muscle combined with suture lateralization of the vocal ligament was successful in 13 of 14 patients (93%) treated for bilateral abduction immobility sufficient to require tracheotomy. Among the four patients requiring revision surgery, three had cricoarytenoid fixation and one had vocal cord paralysis. All patients had a satisfactory voice after surgery. The anesthetic management of laser microsurgery is discussed.

A mucocele of the submandibular gland.

We encountered an unusual case of a mucocele arising from the submandibular gland. Among the limited number of cystic salivary gland neoplasms reported in the literature, there have been no reports, to our knowledge, of a similar cystic lesion. The unique characteristics of this mass permitted definitive diagnosis by computed tomographic scanning.

Reliability of frozen section diagnosis in head and neck neoplasms.

To evaluate the reliability of frozen section diagnosis we reviewed a series of 1146 consecutive frozen sections performed during a 5-year period. The frozen section diagnosis was then compared to that found on paraffin section and the results categorized into 12 regions in the head and neck. We found an overall reliability of 96%. The total percentage of false positive and false negative results were 0.35% and 3% respectively. Frozen section diagnosis was most accurate on the submandibular gland (no errors), nose and paranasal sinuses (no error), followed by the thyroid gland (0.8% error). Areas in which frozen section diagnoses were least accurate included the nasopharynx (12.5% error) and the oropharynx (8.7% error). We conclude that frozen section diagnosis is highly accurate in most regions of the head and neck.

Unusual presentations of penetrating foreign bodies of the upper aerodigestive tract.

Only a small number of ingested foreign bodies perforate the esophagus and even a smaller fraction migrate extraluminally. Four such penetrating and migrating foreign bodies of the upper aerodigestive tract are presented. Review of the literature revealed 321 cases of penetrating ingested foreign bodies, of which 252 remained intraluminal and 43 were found extraluminally, with the status of the remainder indeterminate. Analysis revealed that an intraluminal penetrating foreign body carried a higher overall mortality than one that migrated extraluminally. Although intraluminal and extraluminal penetrating foreign bodies may remain quiescent for years before presenting a complication, no correlation existed between mortality and the duration of the foreign bodies' retention. The greatest mortality was seen with vascular complications followed by diffuse and local suppurative processes. The overall mortality was significantly reduced in the post-antibiotic era.

Acute epiglottitis in adults.

Fourteen cases of adult acute epiglottitis with their clinical manifestations are presented. The history, etiology, pathophysiology, and diagnosis of the disease are reviewed. The controversies of management are discussed and a concise management protocol is outlined.

Rhinitis medicamentosa.

Rhinitis medicamentosa, the syndrome of rebound nasal congestion secondary to prolonged topical intranasal use of vasoconstrictors, is reviewed. In this condition, the nasal airway is very obstructed; atrophic rhinitis is the most serious complication. Management consists of withdrawing the offending nasal spray and alleviating the nasal obstruction by means of any of several treatment modalities.