Analysis of disability resulting from treatment including radical neck dissection or modified neck dissection.

A multiinstitutional study to define the impact of total treatment programs involving radical neck dissection (RND) and modified neck dissection (MND) on patients' permanent disability was undertaken. A total of 243 patient responses were included in the study. Comparative analyses between the treatment groups show no advantage of one surgical operation over the other in returning patients to their pretreatment employment status. Radiation therapy was identified as adding significantly to the patient's permanent disability.

Longitudinal consistency of adult personality: self-reported psychological characteristics across 45 years.

The longitudinal consistency of personality characteristics over a period of 45 years is examined. The data are drawn from the Kelly Longitudinal Study, a panel involving an original group of 300 men and 300 women. Measures of emotional disturbance (from the Bell and Bernreuter inventories) during the 1930s and the 1950s had significant correlations in the .25-.40 range with measures of psychiatric symptoms (from the Cornell Medical Index) taken in 1979-1981. Revised inventory scales with content related to neuroticism and social introversion-extraversion had moderate longitudinal consistency across several decades of adult life and demonstrated convergent and discriminant validity. This study demonstrates the utility of personality measurements in predicting significant psychological outcomes over the full interval of the normal adult lifespan.

Longitudinal stability of personality traits: a multitrait-multimethod-multioccasion analysis.

The longitudinal stability of personality was investigated in a group of several hundred adults who were rated by themselves, their marriage partners, and their acquaintances in 1935-1938 and by themselves and their marriage partners in 1954-1955. For both men and women, there were very similar factorial structures in all five sources of ratings. Individual differences in neuroticism, social extraversion, and impulse control had reasonably high levels of longitudinal stability over a 19-year period. Both the synchronic and diachronic correlations converged across methods and discriminated among traits. Self-report personality inventory data available in 1935-1938 and 1954-1955 provided corroborating evidence of the longitudinal and methodological robustness of personality traits. In data gathered on the same panel in 1980-1981, the questionnaire and the life history correlates of neuroticism and social extraversion displayed patterns indicative of temporal stability, methodological convergence, and discrimination among constructs. The data of this longitudinal study carried out over five decades strongly indicate that there is a set of personality traits that are generalizable across methods of assessment and are stable throughout adulthood.

Personality and compatibility: a prospective analysis of marital stability and marital satisfaction.

The antecedents of marital stability (divorce or remaining married) and marital satisfaction (within the group that remains married) were investigated with a panel of 300 couples who were followed from their engagements in the 1930s until 1980. Twenty-two of the couples broke their engagements; of the 278 couples who married, 50 got divorced at some time between 1935 and 1980. Personality characteristics (measured by acquaintance ratings made in the 1930s) were important predictors of both marital stability and marital satisfaction. The three aspects of personality most strongly related to marital outcome were the neuroticism of the husband, the neuroticism of the wife, and the impulse control of the husband. In combination, the 17 major antecedent variables were moderately predictive of a criterion variable composed of both marital stability and marital satisfaction (R = .49). The three major aspects of personality accounted for more than half of the predictable variance. The remaining variance was accounted for by attitudinal, social-environment, and sexual history variables.

Melanomas of the mucous membrane of the head and neck.

This is a report comprised of 78 cases of melanoma of the mucous membrane of the head and neck and is part of a larger study of 995 cases of head and neck melanoma. These cases represent a review of patients over a 55-year period from the Pack Medical Foundation. Melanoma of the mucous membrane is a rare condition and the most serious of all head and neck melanomas. Its highest incidence is in the oral cavity, followed by the nasal and pharyngeal cavities. It usually occurs during the fifth decade of life. In its early stages it is asymptomatic and often located in areas difficult to see upon visual examination and technically inaccessible. These facts lead to a delay in diagnosis, which reduces curability to 8%. In spite of these negative factors, there has been a significant improvement in the extension and quality of life for patients with melanoma of the mucous membrane. The biological characteristics of this disease are analyzed and a philosophy of management is offered.

Sublabial surgical approach to the nasal cavity and paranasal sinuses.

A sublabial approach to the nasal cavity, paranasal sinuses and the nasopharynx degloving the middle third of the face has been described. Its major advantages over the other approaches have been compared and the usefulness of this approach has been stressed. The incidence of complications from this approach has been described and found to be acceptable.

Capsular significance in parotid tumor surgery: reality and myths of lateral lobectomy.

Historically, parotid gland surgery has evolved from an operation of surgical enucleation to that of lateral lobectomy or total parotidectomy with facial nerve dissection. While the enucleation operation originally resulted in recurrence rates as high as 45% in some series, the technique of lateral lobectomy has resulted in recurrence rates of 2% in benign tumors. However, the currently recommended procedure of lateral lobectomy or total parotidectomy with facial nerve preservation for benign or low grade malignant tumors is not a pure en bloc resection in most cases, and in fact enucleation in part or total is often the reality of the operation. Tumor characterization, technical features, and operative findings of parotid gland surgery are examined in 100 consecutive cases. In over 60% of the cases, superficial or total parotidectomy with facial nerve preservation incorporated the principle of limited enucleation or capsular dissection at some point in the technique. The illusion that en bloc removal of parotid tumors with wide surgical margins is discredited. The reality of the procedure and the reasons for its success are examined.

"Practical suggestions in facial plastic surgery--how i do it." "Threading" augmentation for facial wrinkles.

For hundreds of years various types of sutures and threads have been placed in the human body by surgeons. The technique of thread augmentation involves the use of colorless absorbable (Vicryl) and non-absorbable (Neurolon) suture material on a long, straight Keith needle tunneled subdermally beneath prominent facial wrinkles in an effort to make the deep grooves less severe and to augment atrophic areas about the lips and oral commissures. This may be done as an isolated procedure or as an ancillary procedure at the time of a blepharoplasty or cervicofacial rhytidectomy.

Glomus intravagale.

Glomus intravagale (paraganglioma of the nodose ganglion and/or vagus nerve) is an unusual tumor. There are approximately 45 cases reported in the literature; the authors report four more cases. This tumor may ba associated with other paragangliomas of the head and neck, such as carotid body tumors, and may metastasize to regional lymph nodes, although the histology always appears benign.

Platysma myocutaneous flap revisited.

The platysma myocutaneous flap has seen limited application in the reconstruction of head and neck defects over the past decade. There are anatomical and physiological reasons for this. There has been an emphasis on the anatomical vascular supply and method of preparation of the platysma myocutaneous flap and its use in the oral cavity. This article emphasizes the use of this flap for reconstruction of defects of the base of tongue, hypopharynx, lateral pharyngeal wall, and supraglottis. The criteria for selection of the platysma myocutaneous flap as a method of reconstruction, and the limitations, are outlined. New variations of harvesting the flap based on randomized muscular support are described. Specific complications as seen in our group of patients add certain precautions in the use of the platysma myocutaneous flap.

Personality typology of men and women alcoholics in relation to etiology and prognosis.

In a study of the MMPI personality types of hospitalized men and women alcoholics, the Neurotic and Classic types had the characteristics of reactive alcoholism, and the Psychopathic, Schizoform A and Schizoform B types had the characteristics of essential alcoholism. Demographic variables and treatment prognosis also varied according to MMPI personality types.

Problems with reoperation of the parotid gland and facial nerve.

The decision as to how to handle recurrent benign disease in the parotid gland can be a perplexing problem. It may cover the gamut of clinical observation, through conservative surgery to radical ablation. The situation is a balance between the nature of the biological process, the possibility of cure or control, and the status of the facial nerve. These problems can be exceptionally difficult in analysis and philosophical management, and are frequently pinioned between technical craftsmanship, curability, and deformity. An understanding, however, of the variety of possibilities--and particularly their relationship to the facial nerve--will help to position these cases within the realm of surgical reality. A new technique of interfascicular dissection is proposed in certain instances.

Surgical management of adenoid cystic carcinoma in the parotid gland.

Although adenoid cystic carcinoma may be found in multiple sites in the head and neck as well as other glandular sites throughout the body, nowhere is management of the disease more controversial than in the parotid gland. Here the facial nerve is at risk from both the disease and the treatment. Seventy-five cases of adenoid cystic carcinoma of the parotid were analyzed. Patients were placed in four groups, depending on the type of parotid surgery received as definitive therapy: (1) lateral lobectomy, (2) total parotidectomy, (3) radical parotidectomy without preoperative facial weakness, and (4) radical parotidectomy with preoperative facial weakness. Patients were assessed with regard to staging of the initial lesion, the status of surgical margins, and the use of postoperative radiotherapy. The incidence of local recurrence and distant metastases were also recorded. Survival statistics are presented for each group. Though associated with facial nerve sacrifice, radical parotidectomy appears to offer clear advantages in terms of long-term disease-free survival in patients with T2 and T3 lesions. The residual facial paralysis may be rehabilitated primarily or secondarily to reduce patient morbidity. Four of 16 patients (25%) with preoperative weakness achieved 10-year survival when radical parotidectomy was used. Obtaining clear margins at the initial setting appears to offer improved survival.

The midline vertical forehead flap.

The midline vertical forehead flap is an unheralded flap that has valuable and specific application. It is ideal for certain reconstructions around the nose, orbit, and upper melonasal regions. The color match is excellent. The donor area is repaired per primum and because there is a double blood supply it rarely fails when nondelayed and rotated 180 degrees.

Pectoralis myocutaneous flap for chin augmentation.

Radical resection of the anterior portion of the oral cavity, including a portion of the tongue, floor of the mouth, mandible, and neck, has always been, and remains, a perplexing problem in immediate rehabilitation of the area of the oral cavity and mentum. In the past, these deformities were classified as "Andy Gump." Attempts at correction of this deformity are protracted and complex. The use of the pectoralis myocutaneous flap offers an improvement in the concept of mamagement in that it supplies a skin lining for the oral cavity and augments the chin and neck in a single-stage procedure that may be combined with the primary operation.

A new technique for total reconstruction of the lower lip in a patient with malignant melanoma.

A very rare case of malignant melanoma of the lower lip was presented. While there are many concepts and techniques for reconstruction of the lower lip including advancement flaps, switching flaps, rotation flaps, and regional flaps from the cheek, upper lip, tongue, forehead, neck, and chest, no single flap is ideal in every instance. Lower lip reconstruction utilizing a modification of bilateral nasolabial flaps has been described. The distinct advantages of utilizing myocutaneous flaps in a Z augmentation manner, including the maintenance of good functional competence of the lower lip, maintenance of adequate oral commissure diameter, and a good cosmetic result, have been demonstrated. While no single technique for reconstruction of the lower lip is ideal for every case, we feel that the method presented here offers a very good option when faced with the challenge of complete reconstruction of the lower lip.

Primary adenocarcinoma of the middle ear.

Adenocarcinoma arising from the mucosa of the middle ear is a rare tumor. This report adds four new cases to the 13 cases that have been previously reported in the literature. These neoplasms tend to have a rather slow growth pattern and have an infrequent incidence of distant metastases. The observations that local recurrence is the major problem with adenocarcinoma of the middle ear suggest that aggressive locoregional treatment should be strongly considered.

Malignant fibrous histiocytoma of the parapharyngeal space. Case report.

Of the large variety of tumors that may occur in the parapharyngeal space, malignant fibrous histiocytoma is one of the most rare. We present such a case and discuss the diagnosis, classification, and treatment.

Intramuscular hemangioma of the masseter muscle.

We present a case of intramuscular hemangioma of the masseter muscle. We stress that, although there can be apparent vascular infiltration of the muscle, this lesion is benign; it should not be mistakenly diagnosed as an angiosarcoma.

Adenoid cystic carcinoma of the parotid gland: a review of surgical management with reference to the facial nerve.

The purpose of this study was to review a large series of patients with adenoid cystic carcinoma of the parotid gland in order to develop clinical criteria for sacrifice versus selective sparing of the seventh nerve. We studied 43 patients followed over 36 years. Study patients were grouped according to the preoperative status and intraoperative management of the facial nerve. Criteria for choosing various management strategies are discussed.