Reconstruction after temporal bone resection.

Reconstruction of soft tissue defects after temporal bone resection can vary from simple closure of the external auditory canal to complex flap coverage of extensive defects. Between 1987 and 1996, 34 patients underwent lateral skull base resections and reconstruction for invasive carcinoma of the temporal bone. Seven underwent sleeve resection and/or radical mastoidectomy. Sleeve resection was managed with tympanoplasty, canalplasty, or obliteration of the external auditory canal (10). There were 24 lateral temporal bone resections and four subtotal temporal bone resections. Larger defects created by lateral and subtotal temporal bone resections required closure with a combination of temporalis flaps and local rotational cutaneous flaps (13). Lower island trapezius flaps (five), free flaps (four), and pectoralis major flaps (two) were also used. Indications and efficacy of each method are discussed, and treatment outcomes are presented.

Anterior approach for CT-guided biopsy of skull base and parapharyngeal space lesions.

At our institution we use an anterior approach to biopsy of the parapharyngeal space or skull base lesions because it provides more direct access than the traditional lateral approach through the mandibular notch. The anterior approach follows a course lateral to the alveolar ridge of the maxilla and lateral pterygoid plate, and inferior to the zygomatic process of the maxilla. Biopsy was performed on 15 patients with either a skull base or a parapharyngeal space mass, none of which could be palpated externally or through the oral cavity by the ear, nose, and throat surgeon. In 12 patients the needle biopsy correlated with the surgical pathology. Three needle biopsies were nondiagnostic.

Interleukins 2 and 12 activate natural killer cytolytic responses of peripheral blood mononuclear cells from patients with head and neck squamous cell carcinoma.

OBJECTIVES: To examine the capacity of interleukin-2 (IL-2) and interleukin-12 (IL-12) to modulate the cytolytic activity of peripheral blood mononuclear cells against squamous cell carcinoma, and to determine whether peripheral blood mononuclear cells from healthy donors respond differently to IL-12 than do peripheral blood mononuclear cells from patients with head and neck squamous cell carcinoma. DESIGN: Case-comparison study of a consecutive sample of patients with head and neck squamous cell carcinoma who were scheduled to undergo surgical excision. PARTICIPANTS: The study included 10 patients with stage III or IV carcinoma matched with 10 volunteer blood donors. INTERVENTION: Isolated peripheral blood mononuclear cells from patients and volunteers were treated with IL-2, 10 U/mL and 100 U/mL; IL-12, 1 U/mL or 10 U/mL; or a combination of IL-2 and IL-12. RESULTS: The combination of IL-2 and IL-12 consistently produced the greatest activation cytolysis than either cytokine alone at all concentrations tested. This increased activity against a squamous cell carcinoma cell line was seen in lymphocytes from volunteers and patients. CONCLUSION: Our findings suggest a new treatment regimen for the patient with head and neck cancer that uses immunomodulation with a combination of cytokines.

Simultaneous squamous cell carcinoma of the head and neck and reticuloendothelial malignancies.

BACKGROUND: Multiple primary neoplasms have been reported 4% to 26% of patients with a squamous cell carcinoma (SCC) of the head and neck. The vast majority of these second primaries are SCC and occur in the upper aerodigestive tract; however, head and neck SCC patients are also at higher risk for nonepidermoid neoplasms at any site. Reticuloendothelial malignancies (REM) have been reported in many patients that have SCC of the head and neck as well. METHODS: Retrospective case series of 5 advanced cases of SCC of the head and neck with synchronous REM. RESULTS: There was 40% mortality with 19.4 months mean follow-up. Fifty percent of the case had simultaneous cervical involvement with both processes. CONCLUSION: REM can occur simultaneously with SCC of the head and neck and confound staging of nodal status. Head and neck SCC patients are at increased risk for REM secondary to age and treatment factors.

Plasma levels of a squamous cell carcinoma-associated antigen in athymic nude mice bearing human squamous cell carcinoma xenografts of oral origin. With preliminary clinical data.

A human squamous cell carcinoma (SCC) of oral origin was transplanted into athymic mice that were then divided into six groups. The mice were killed at 1 to 6 weeks after tumor transplantation; the sixth group was killed 1 week after excision of SCC grafts. Plasma samples were obtained from each mouse at the time of death for the determination of SCC-associated antigen (SCCAA), a cytoskeletal protein fraction of about 48,000 daltons originally derived from SCC of the uterine cervix. The plasma SCCAA level rose gradually and proportionately to the growth of SCC xenografts from a baseline of 0.66 ng/ml [standard error (SE) + 0.12] to the preoperative peak of 8.44 ng/ml (SE + 1.86) at 5 weeks, to fall precipitously to the postoperative level of 1.05 ng/ml (SE + 0.27) at 6 weeks. No rise in plasma SCCAA level was observed in mice bearing a human malignant melanoma, and only modest rises were observed in mice bearing human adenocarcinomas and oat cell carcinoma. In this experimental model rising plasma SCCAA levels were found to be dependable indicators of SCC tumor growth. These observations and preliminary data on SCCAA levels in patients with or without SCC of the head and neck lend support to the clinical usefulness of serial plasma SCCAA determinations in monitoring patients with SCC of the oral cavity.

Esophageal perforations: the role of computerized tomography in diagnosis and management decisions.

External drainage is indicated when a neck abscess results from esophageal or hypopharyngeal perforation. Diagnosis, extent of disease, and timing of abscess drainage have traditionally challenged the surgeon in management of the perforated esophagus or hypopharynx. Diagnosis and management decisions are enhanced by use of computerized tomography (CT) as an adjunctive study. Five specific case presentations feature diagnosis and management.

The pectoralis major myocutaneous flap: an angiographic study.

A new era in head and neck reconstruction has been opened with the use of myocutaneous flaps. The pectoralis major myocutaneous flap is considered the most reliable of its kind but flap failures still occur secondary to tension and infection. Our standard procedure has been to follow the acromioxiphoid line as a guide to the location of the blood supply of the pectoralis major muscle. We have noticed in the operating room and during cadaver dissection that the vascular supply is sometimes more laterally located than usually described. A review of the vascular supply of this anatomic area using angiographic studies of the subclavian and its branches is presented, with important findings critical to the surgical technique used to protect the flap's blood supply.

Diagnosis and management decisions in infections of the deep fascial spaces of the head and neck utilizing computerized tomography.

Infections of the deep spaces of the head and neck may still result in major consequences despite the advent of antibiotics. Abscesses in these areas merit special consideration by today's head and neck surgeon because of their relative rarity and the life-threatening complications that may follow inadequate treatment. Diagnosis and management decisions are enhanced by use of computerized tomography (CT) as an adjunctive study. The EMI scan may demonstrate either cellulitis of the neck requiring no surgery or a space abscess displacing the adjacent structures thus requiring surgical drainage. Anatomy of the significant fascial planes and spaces of the neck will reviewed employing CT utilizing 3 mm cuts. Specific case presentations feature early diagnosis and management.

Glomus vagale.

Glomus tumors of chemodectomas are unusual neoplasms of the head and neck. They are more prevalent in the jugular foramen and in the middle ear. Glomus vagale is very rare. To date, there are about 70 cases reported in the literature. Only two of the cases described occurred bilaterally. Two cases are reported here; one was diagnosed as having a bilateral glomus vagale. Radiation therapy was used in the treatment of one side in order to avoid bilateral vagus nerve damage. The incidence, diagnosis and management of glomus vagale tumors are discussed.

Amyloidosis presenting as a mass in the neck.

A 54-year-old white male presented with a large suprahyoid midline mass. On thorough history and physical examination, he had features which characterize amyloidosis, including congestive heart failure and carpal tunnel syndrome. The classification, clinical findings, and associated syndromes are reviewed. A striking feature of the amyloid deposit is its rapid growth. Amyloidosis should now be considered in a differential diagnosis of a neck mass.

Allergy in Ménière's disease related fluctuating hearing loss preliminary findings in a double-blind crossover clinical study.

Several clinical reports suggest allergy as a causative or associated factor in the etiology of Ménière's Disease or endolymphatic hydrops. The A.A.O.O. subcommittee reported in 1972 its criteria for a therapeutic improvement in Ménière's Disease. This important report allows for clinical studies to proceed in a scientific manner using the subcommittee's criteria to evaluate the results. In an ongoing study utilizing a double-blind crossover technique, fourteen Ménière's patients have been evaluated for allergies utilizing the Rinkle and Lee techniques for inhalent and food allergies. Several cases directly relate symptoms to specific food ingestion and were given challenge food tests.

Delayed epistaxis secondary to shotgun wound to maxillary artery. Report of a case.

Severe delayed epistaxis following open or closed trauma has been reported in the literature by many authors. We report a case of delayed epistaxis following a shotgun wound to the face. The evaluation of this type of patient, including the use of angiography to localize the bleeding, is illustrated. We review methods of conservative management of epistaxis and outline the surgical treatment of this patient.