Parotid duct communicating with a labial pit and ectopic salivary cyst.

Labial pits are usually described as blind epidermal invaginations of lip mucosa with occasional drainage of minor salivary gland secretions. A case of an aberrant parotid duct in communication with both a unilateral, commissural labial pit and an interposed salivary cyst is presented. A 7-year-old boy who had experienced lifelong clear drainage from a congenital pit at his right oral commissure developed fever, pain, and a submucosal mass of the right cheek over a 6-week period. A preoperative sialogram through the pit demonstrated a communication between the oral commissure fistula, an intervening salivary cyst, and a proximal tract from the cyst to the parotid gland. An en bloc resection of the pit, fistula tract, and cyst was performed through a transoral approach. The dissection was medial to the buccinator muscle. There has been no recurrence of the cyst after 1 year follow-up. A description of labial pits and parotid duct anomalies is presented; however, to our knowledge, this combination of anomalies has not been previously described.

Management of the parathyroids in surgery for advanced malignancy of the larynx and hypopharynx.

A thyroidectomy is required in the surgical management of advanced malignancy of the larynx and hypopharynx when there is direct or potential extension to the thyroid of disease from the primary site or adjacent, involved lymph nodes. The parathyroids are at risk of injury either by inadvertent sacrifice with the en bloc resection, or as a result of surgical devascularization. At times the glands must be resected with the specimen. The incidence of postoperative parathyroid insufficiency may be decreased by re-implantation of the glands into the antecubital fossa. A series of parathyroid re-implantations in patients with advanced malignancy of the larynx and hypopharynx is reviewed.

The accuracy of frozen section diagnosis of parotid lesions.

A study to assess the accuracy of frozen section diagnosis for parotid lesions was conducted. All parotid cases from the surgical pathology files at the Toronto General Hospital (TGH) for the period 1978-83 were reviewed. A total of 131 specimens were obtained. Frozen sections were requested for 110 of these specimens, 90 of which were benign and 20 of which were malignant. The pathology reports, patient charts, and histology slides were examined. Errors were analyzed as to type. The frozen section accuracy for providing a specific histopathologic diagnosis was 94%. When considering only the ability to distinguish benign from malignant lesions, the accuracy improved to 97%. The deferral rate was 1.8% (two patients). In five instances, the diagnosis obtained by frozen section directly altered the surgical management. No unnecessary surgery was performed based on a frozen section result. In no case was a frozen section diagnosis of malignancy changed to a benign diagnosis upon paraffin section review. The medical chart review of the 21 patients where frozen section was not requested revealed two patients for whom the knowledge of a specific diagnosis at surgery may have altered the patient management. The TGH experience compares favorably with results obtained in three similar, recently published studies (UCLA, 1979; Stanford, 1983; Seattle, 1984). Frozen section diagnosis of parotid lesions, in our hands, is a safe, accurate and useful diagnostic tool.

An unusual case of airway obstruction.

An unusual case of airway obstruction is presented. A 56 year old woman was admitted with stridor. She gave a history of intermittent upper airway obstruction of four years' duration. Examination revealed gross hypertrophy of the lingual tonsils extending to involve the valleculae and the entire epiglottis. Histological examination confirmed the presence of normal lymphoid tissue. The patient underwent epiglottectomy and cryosurgery to the lingual tonsils with complete resolution of symptoms. A review of the literature is presented and the investigative and treatment modalities are discussed.