Gastro-esophago-pharyngeal reflux.

Reflux of gastric contents into the esophagus, pharynx, and larynx does occur. This phenomenon can produce hoarseness, globus, dysphagia, otalgia and laryngospasm. It may be responsible for the appearance of contact granulomata, esophageal webs, and pachyderma. The key to reflux is the lower esophageal sphincter and the nature of the stomach contents. Multiple factors may be influential including those conditions causing aerophagia. The diagnosis of reflux depends on a high index of suspicion. Physical findings may reveal only subtle changes of arytenoid erythema. Thyrohyoid tenderness is not an infrequent sign. Treatment is usually simple, involving first elimination of those factors which increase intragastric pressure or lower the lower esophageal sphincter pressure. Elevation of the head of the bed and antacids will often prevent further gastric insult to the pharynx and larynx and thus eliminate the patient's discomfort.

Cricopharyngeal myotomy in the treatment of dysphagia.

Deglutition is a complex neuromuscular act. Alterations in anatomy and physiology may lead to dysphagia. The role of the cricopharyngeus appears to be the keystone in the rehabilitation of many patients with dysphagia. This paper examines the physiology of swallowing as well as the patho-physiology of its abberations. Techniques and complications of cricopharyngeal myotomy are presented. Cases of dysphagia due to ablative surgery of the head and neck, dermatomyositis, cerebrovascular accidents, and cricopharyngeal achalasia in which cricopharyngeal myotomy was utilized, are reported. It would appear from this small number of cases, that cricopharyngeal myotomy is indicated in the rehabilitation of dysphagia in patients with varied disease states.

Pharyngeal myotomy for vocal rehabilitation postlaryngectomy.

In those patients requiring total laryngectomy, esophageal speech appears to be the most desirable form of rehabilitation. Satisfactory esophageal speech is only obtained in 40 to 65% of the patients. Tracheoesophageal shunts as per Singer and Panje have provided solutions for a significant number of non-speakers, but still present problems as well as failures. Efforts to correct these failures have led to the concept of constrictor and cricopharyngeal discoordination. Pharyngeal block has demonstrated not only temporary correction of tracheoesophageal shunt failure but improvement and production of esophageal speech in non-shunted patients. Subsequently myotomy has provided permanent esophageal speech. This paper proposes consideration of this procedure in esophageal speech failures, when the Taub test and/or pharyngeal block demonstrates the presence of constrictor-cricopharyngeus discoordination. Representative cases are presented.

Diagnostic use of ultrasound in diseases of the head and neck.

Ultrasound has been utilized for diagnostic purposes for the past ten years. It was originally utilized mainly in ophthalmology and obstetrics and gynecology, although recently it has proven invaluable in diagnosis of cardiac and abdominal diseases. While there have been some reports on its use in thyroid and parotid diseases, there are few reports on its general use in the diagnosis of head and neck diseases. This technique is non-invasive and is cost effective when compared to CAT scanning. Ultrasound is capable of differentiating not only cystic from solid lesions but also can be helpful in the diagnosis of malignant vs. benign masses. Its value in delineating the presence of multiple lymph nodes as well as following the course of resolution of infectious diseases is presented, and its use in the diagnosis of those conditions involving the parotid gland itself as well as the parapharyngeal space is presented. It would appear to be a valuable adjunct in our management of head and neck diseases.

First branchial cleft cysts: clinical update.

First branchial cleft cysts develop as a result of incomplete fusion of the cleft between the first and second branchial arches and give rise to two distinct anomalies, termed type I and type II anomalies. Type I anomalies are purely ectodermal while type II anomalies exhibit ectodermal and mesodermal elements. The type II anomaly incorporates some portion of the first and second arch as well as the cleft. Type I lesions are extremely rare. They appear histologically as cysts lined by squamous epithelium. Clinically, they present as a cystic mass or fistula posterior to the pinna and concha. The cyst is usually superior to the main trunk of the facial nerve and ends in a cul-de-sac on or near a bony plate at the level of the mesotympanum. Type II lesions are more numerous and represent a duplication of both membranous and cartilaginous portions of the external auditory canal. They contain skin as well as adnexal structures and cartilage and may be associated with the parotid gland. Most frequently they are associated with fistulae in the concha or external auditory canal as well as fistulous openings in the neck.

Detection of gastroesophageal reflux in the head and neck: the role of scintigraphy.

Patients with gastroesophageal reflux (GER) present to the head and neck specialist with a myriad of nonspecific complaints that may be manifestations of pharyngoesophageal or upper airway involvement. Numerous diagnostic tests for GER have been used in the past with varying success. In the present study, gastroesophageal scintigraphy using 99mtechnetium-sulfur colloid was used to evaluate 28 patients with head and neck manifestations of GER. The role of gastroesophageal scintigraphy as an accurate and noninvasive method of detecting GER is discussed in the context of other current diagnostic modalities.

Synovial sarcoma of the head and neck.

Primary synovial sarcoma is an unusual tumor of the head and neck. Fewer than 75 cases have been reported in the literature. We have treated 7 additional cases; 3 in the hypopharynx, 2 in the parapharyngeal space, 1 in the oral pharynx and 1 in the posterior triangle of the neck. An enlarging cervical mass, voice change, and dysphagia were among the presenting complaints. CT revealed solitary nonhomogenous tumors from 3 to 7 cm in diameter. Microscopically, all cases showed a biphasic cellular pattern verified by immunohistochemical staining. Multimodality treatment consisted of surgery and postoperative radiation therapy with 3 patients receiving chemotherapy. Although the original pathology report was incorrect in 3 cases, clinical suspicion for synovial sarcoma ensured proper diagnosis.