The treatment of a congenital laryngeal web.

Past descriptions of the surgical treatment of congenital laryngeal webs have involved a laryngofissure to achieve division of the web and the insertion of a tantalum keel to prevent its reformation. The technique described below obviates the need for an open operation on the larynx. The web is divided under magnified vision through a laryngoscope using a Zeiss operating microscope. A silastic keel is secured between the vocal cords at the anterior commissure by means of a loop of nylon passing externally through the crico-thyroid and crico-hyoid membranes.

Marginal mandibulectomy for malignant disease: indications, rationale, and results.

The theoretical basis for performing marginal mandibular resection, as opposed to segmental resection, is discussed; and criteria are suggested. Results are presented that suggest that, in the treatment of malignant disease around the jaw, although the mortality from other tobacco- and alcohol-related diseases remains high, good functional and cosmetic results can be achieved with no loss of local control.

Aspects of mandibular reconstruction.

We present in this paper the indications for bony reconstruction following mandibular resection, together with evaluation of the reconstructive techniques available. Case reports illustrate methods we have found satisfactory and are followed by our recommendations for their specific use.

Giant cell reparative granuloma of the cricoid cartilage.

Giant cell reparative granuloma (GCRG) is an uncommon benign lesion which has been reported at several sites in the head and neck. We present a case of a GCRG of the cricoid cartilage not previously described in the literature. It must be differentiated from the brown tumour of hyperparathyroidism and true giant cell tumours of bone. These were excluded on clinical, biochemical, radiological and histological grounds. The lesion responded well to surgical debulking and curettage and the patient remained disease-free 15 months after treatment.

Experience with the radial forearm flap in 14 cases.

In 14 cases aged 9-79 years the radial forearm flap has been used for reconstruction. Of 4 island flaps, 2 were distally based (1 with nerve anastomosis) and 2 proximally based (1 innervated). Of the free flaps, 7 were for intra-oral lining following major resection and 3 of these included hemi-radius for mandibular reconstruction. Most flaps were put into a hostile environment resulting from chronic infection and/or radiotherapy or fast neutron therapy. Two flaps failed including one osseocutaneous free flap. Important anatomical, pre-operative and operative aspects are considered, including a description of the timed Allen test, and potential pitfalls and refinements are described.

Radial forearm flap for floor of mouth reconstruction.

Approaches to reconstructing floor of mouth defects are reviewed including methods of bony reconstruction following mandibular resection. The place of the free radial forearm flap, incorporating vascularized hemiradius if necessary, is described together with the anatomy, operative technique and a review of seven cases. It is concluded that this flap is an important addition to current methods of reconstructing substantial intraoral soft tissue defects alone or associated mandibular defects as well, owing to the high quality of results and to its low morbidity.