The incidence of occult metastases for cancer of the oral tongue and floor of the mouth: treatment rationale.

One hundred thirty-six surgical cases of squamous cell carcinoma of the oral tongue and floor of the mouth at the Emory University Hospitals were reviewed for the incidence of occult metastases. Thirty-five percent of the T1 T2 lesions of the anterior tongue had occult metastases. The figure was 31.5% for similarly staged lesions of the floor of the mouth. The presence of regional metastases resulted in a 2-year determinate survival rate of 37% and 32% for patients with oral tongue and floor of the mouth lesions, respectively. The poor prognosis in the study for delayed cervical metastases and the high incidence of occult cervical metastases have led the authors to propose a more aggressive therapy for the clinically negative necks in these two sites of squamous cell carcinoma of the oral cavity.

The pseudocapsule of pleomorphic adenomas (benign mixed tumors): the argument against enucleation.

The "well encapsulated" pleomorphic adenoma has at best a pseudocapsule which allows for bits of satellite tumor to be left behind at ""enucleation" surgery as well as for easy "spillage" of tumor by the overconfident surgeon. Recurrent pleomorphic adenomas then become difficult tumors to eradicate and place vital structures, such as the facial nerve, in jeopardy.

"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.

Pseudomonas aeruginosa meningitis following stapedectomy.

Meningitis is a rare complication following stapedectomy. Most cases are preceeded by a fistula in the oval window. Although fatalities have been reported, most cases respond to parenteral and intrathecal antibiotics if diagnosed and treated early. Gram-positive organisms are the usual pathogens, but Gram-negative organisms may be found, especially as a superinfection following antibiotics administered prophylacticly or for the treatment of otitis media or mastoiditis. A case of Pseudomonas aeruginosa meningitis five weeks after stapedectomy, successfully treated with gentamicin, is reported. The discussion included the diagnosis of post-stapedectomy fistula and meningitis and current trends in treatment.

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.

Submandibular gland tumors.

Tumors involving the submandibular gland are rare. However, the incidence of malignancy is much higher than in the parotid (approaching 50 percent). In addition, the 5-year survival rate in patients with malignant tumors of the submandibular gland is much poorer in our series--28 percent versus 71.8 percent for the parotid gland. Because of the poor prognosis in patients with malignant tumors involving the submandibular gland we feel that composite resections should be carried out for all tumors except low-grade mucoepidermoid tumors. In addition, postoperative radiation should be given for specific indications (detailed in the article).

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.

Advanced applications of revascularized free jejunal flaps for difficult wounds of the head and neck.

The rationale, technique, and an example of full utilization of the jejunomesenteric free flap have been described as a means of reconstructing complex wounds of the head and neck. Not only jejunum, but also well-vascularized mesentery will protect vascular structures and intestinal anastomoses and, in addition, accept a skin graft. No additional muscular or other flaps are necessary to achieve these ends. Finally, no additional donor-site morbidity is incurred by harvesting the supplementary mesentery.

Cystic lesions of the parotid gland.

In a series of 708 parotidectomies (partial or total), we found 23 cystic lesions. Of these, 16 met the criteria for so-called "branchial cysts"; five were retention cysts of duct origin, and the remaining two were epidermal inclusion cysts. The principles of diagnosis and treatment of parotid cysts are presented.

Primary carcinoma of the mastoid bone.

The diagnosis of carcinoma primary in the mastoid bone is usually made while performing a mastoidectomy in an effort to control presumed chronic mastoiditis. The association of chronic infection, serosanguineous otorrhea, and severe otalgia, common warning signs of carcinoma of the middle ear or external auditory canal, may or may not be present with a carcinoma primary in the mastoid bone. If the amount of bony mastoid destruction seen by roentgenography is out of proportion to the degree of clinical infection, malignancy should be strongly suspected. The authors present a case of primary carcinoma of the mastoid bone, and review the diagnosis and treatment.