Tonsillar carcinoma: analysis of treatment results.

OBJECTIVE: Early stage squamous cell carcinoma of the tonsil is amenable to treatment by either surgery or radiation therapy as a single modality, with comparable rates of local control. Unfortunately, manifestation of the disease at an early stage is infrequent, and surgery or radiation alone is less successful in controlling advanced disease. This study was conducted to elucidate the optimal treatment plan for advanced stages of tonsillar carcinoma and to identify significant risk factors for development of recurrence or failure of local control. METHOD: We reviewed the UCLA experience with treatment of all stages of tonsillar carcinoma between 1970 and 1990. RESULTS: Actuarial local control rates were 70% for T1, 72% for T2, 50% for T3, and 0% for T4 at 5-year follow-up. Local control and overall survival rates were compared according to the type of treatment rendered for each stage. CONCLUSIONS: From our analysis we conclude that aggressive combination therapy with surgery and radiation yields significantly higher local control rates for stages 3 and 4 tonsillar carcinomas. The advantages and disadvantages of preoperative versus postoperative radiation therapy are discussed.

Molecular temporal bone pathology: III. Genotyping of the deltaF508 deletion in the DNA of patients with cystic fibrosis.

Genomic DNA from a single celloidin-embedded archival temporal bone section was used to identify a specific genetic mutation. The polymerase chain reaction was used to amplify and detect the deltaF508 deletion, a common molecular genetic defect in cystic fibrosis. This mutation, present in more than 70% of white patients and carriers with cystic fibrosis, results in the deletion of codon 508, which specifies the amino acid phenylalanine of the cystic fibrosis transmembrane conductance regulator (CFTR) gene. When this technique was applied to archival specimens from four patients with cystic fibrosis, all expressed the carrier state of this defective gene. These data demonstrate the feasibility of identifying genetic mutations in archival temporal bone specimens.

Molecular temporal bone pathology: IV. Analysis of DNA template length using mitochondrial PCR primers.

The focus of this study was to identify, via molecular biology techniques, the length of the DNA templates present in individual archival celloidin-embedded human temporal bone sections. Earlier studies have suggested that the maximum template length present in these tissues is on the order of 471 base pair (bp). Polymerase chain reaction (PCR) amplification of 92 bp, 121 bp, 471 bp, and 609 bp regions of mitochondrial DNA (mtDNA), extracted from single archival celloidin-embedded human temporal bone sections, was used to assess the length of the template DNA extracted. These data are crucial to determine the limits of applying PCR technology to amplify specific genomic DNA targets located within the human inner ear. The results described should be of value to those investigators extracting DNA from archival individual human temporal bone sections for polymerase chain reaction assays of specific genetic alterations or infectious agents associated with temporal bone pathologies.

Palatal mucoperiosteal free graft: another reconstruction option for oral defects.

Traditional methods of repair for medium-size (3-5 cm) oral defects include allowing granulation, primary closure, skin grafts, and buccal mucosal grafts. Each of these methods has several disadvantages, and all tend to result in significant scar contracture and often lack sufficient bulk. In 10 patients, the defect left by resection of cancer lesions was reconstructed with a free palatal mucoperiosteal graft. In all patients, the grafts survived with little contracture, allowing for adequate tongue mobility. Because of the thickness of the palatal mucoperiosteum, local depressions typically associated with floor of the mouth defects could be avoided. The palatal donor site was left to granulate and recovered in 2-3 weeks with little residual deformity. In 4 patients a through-and-through resection of a floor of the mouth cancer was performed in continuity with a neck dissection. A palatal mucoperiosteal free graft was utilized exclusively in the reconstruction, without the development of salivary fistula.

Amyloidosis of the head and neck. A clinicopathologic study of the UCLA experience, 1955-1991.

OBJECTIVE: To characterize the otolaryngologic manifestations of amyloidosis; classify patients with amyloidosis by specific location and type of underlying disease; and compare disease presentation and long-term outcome in these patients. DESIGN: Retrospective review of biopsy specimens recorded as amyloidosis. SETTING: Tertiary care referral center serving a diverse patient base. PATIENTS: Of 141 patients with biopsy-verified amyloidosis who met the inclusion criterion for the study, 27 (19%) had head and neck manifestations. OUTCOME MEASURES: Good functional outcome and survival of patients with amyloidosis. RESULTS: The tongue was the most commonly affected site of the head and neck. Distinct differences exist in functional outcome and long-term survival in patients with the localized form of amyloidosis when compared with patients with systemic amyloidosis. CONCLUSION: Because amyloidosis often affects the head and neck, otolaryngologists need to be familiar with this disease.

Characterization of DNA extracted from archival celloidin-embedded human temporal bone sections.

The focus of the present investigation was to study, via molecular biology techniques, the character of the DNA present in individual archival celloidin-embedded human temporal bone sections. Polymerase chain reaction (PCR) amplification of 92 base pair (bp), 121 bp, and 471 bp regions of mitochondrial DNA (mtDNA) extracted from a single archival celloidin-embedded human temporal bone section was used to assess the length of the template DNA extracted. The effects of digestion time and sample motion during the extraction method on DNA concentration was also studied. These data are crucial to determine the limits of applying PCR technology to amplify specific genomic DNA targets located within the human inner ear. Further development of these methods will allow additional molecular temporal bone pathologic studies to be completed and, more specifically, hypotheses regarding the molecular etiopathogenesis of many auditory, vestibular, and facial nerve disorders, such as autoimmune hearing loss, congenital hearing losses, Meniere's disease, otosclerosis, or Bell's palsy could be tested. The results described should be of great value to those investigators extracting DNA from archival individual human temporal bone sections for PCR assays of specific genetic alterations or infectious agents associated with temporal bone pathologies.

Papillary squamous neoplasms of the head and neck.

Papillary squamous neoplasms of the upper respiratory tract are rare variants of squamous cell carcinoma and are related temporally to proliferative verrucous leukoplakia. Fifty-two cases of papillary squamous neoplasms were selected from 2366 cases of squamous cell carcinoma. This is the first study to characterize the biological behavior of papillary squamous neoplasms. Papillary squamous neoplasms exhibit two distinct, yet sometimes overlapping, histologic patterns including an exophytic papillary and an inverting verrucous morphologic appearance. A high rate of synchronous or metachronous lesions were found, especially with the inverting-type of papillary squamous neoplasm. Stage T3 and T4 lesions had a high rate of neck metastasis. Early surgical intervention and close long-term follow-up is mandatory.

Cloning and sequencing of genomic DNA extracted from archival human temporal bone sections.

Cloning techniques allow the engineering and production of highly purified DNA. Further advances in molecular biology have provided the means to identify DNA sequences in a rapid fashion. Sequencing methods can identify mutations, deletions, polymorphisms, or confirm a known genetic sequence. The use of these techniques in clinical medicine has made it possible to accurately diagnose infectious diseases and determine the molecular etiology of many genetic disorders and malignancies. In this study, DNA extracted from archival, celloidin-embedded temporal bone sections has been cloned and sequenced using these techniques. We amplified, cloned, and sequenced varicella-zoster viral DNA extracted from archival temporal bone sections from patients who had herpes zoster oticus. The application of cloning and sequencing techniques to DNA extracted from archival temporal bones provides the methodology to study temporal bone pathology at the molecular level.