Evaluation of outcome and QOL in patients with craniofacial resection for malignant tumors involving the anterior skull base.

The purpose of this study was to retrospectively evaluate the effectiveness of anterior craniofacial resection in the treatment of nasal and paranasal malignant tumors involving anterior skull base. Between 1992 and 1998, 13 patients with nasal or paranasal malignant tumors underwent this surgical procedure. The site and time of metastasis or recurrence, and survival outcome were retrospectively surveyed. Current status of long-surviving patients and their subjective assessment of the surgical treatment were also evaluated through questionnaires. Median follow-up period was 52 months. Nine patients (69%) were alive with no evidence of disease. Of these patients, eight had survived for more than three years. Recurrence or metastasis occurred in four patients (31%). The mean time interval between surgery and recurrence or metastasis was 11 months. According to the results of questionnaires to long-surviving patients, 89% patients had some complaints. In particular, complaints of unsightly appearance were manifested by all these patients. When the patients themselves evaluated their current conditions resulting from this surgical treatment, 63% were dissatisfied. These results suggest that this surgical treatment is valid for selected patients in regard to survival outcome. When the effectiveness of this treatment is evaluated, however, psychological and functional issues should not be taken lightly.

Laryngeal afferent inputs during vocalization in the cat.

To reveal the kind of information about the larynx which is transmitted to the central nervous system during vocalization, we studied discharge patterns of single fibers of the laryngeal afferent nerve during electrically induced vocalization in ketamine-anesthetized cats. Recorded fibers were classified into four types based on their discharge patterns. Type A fibers responded to vocal fold vibration during vocalization. Type B fibers increased their activity during vocalization without synchronization with vocal fold vibration. Type C fibers decreased their activity during vocalization. Type D fibers discharged only at the onset of vocal fold adduction and abduction. We discuss the functional properties of these afferents and the possibility that these afferent inputs participate in the feedback control of vocalization.

Contralateral external carotid-middle cerebral artery bypass for carotid artery resection.

Resection of the common carotid or internal carotid artery is occasionally unavoidable in cases of advanced head and neck carcinoma with carotid artery involvement. To prevent the consequent decrease in cerebral perfusion, we have developed a contralateral external carotid-middle cerebral artery bypass grafting technique. From 1990 through 1995, six patients with advanced head and neck cancer involving the carotid artery underwent total tumor resection combined with vascular reconstruction using the contralateral external carotid- middle cerebral artery bypass grafting. No bypass-related complications occurred in any patient postoperatively. Cerebral hemodynamics after surgery indicated that this bypass graft worked steadily over a long term and supplied sufficient volume of blood to the cerebral cortex on the opposite side in every case.

[Laryngeal control mechanisms during respiration and phonation analyzed by excitability changes of laryngeal motoneurons in decerebrate cats].

Laryngeal motoneurons (LMNs) innervating the intrinsic laryngeal muscles also control glottal movements such as swallowing, respiration and phonation. The present study was performed on decerebrate cats to clarify the laryngeal control mechanisms during respiration and phonation using extracellular single unit recordings from the nucleus ambiguus. First, functional differences among LMNs during the respiratory phases were investigated by analysis of the activity of LMNs innervating laryngeal adductor (TA-LCA: thyroarytenoid-lateral cricoarytenoid) or abductor (PCA: posterior cricoarytenoid) muscles; Second, laryngeal control mechanisms during phonation were investigated by the analysis of neural activity of TA-LCA motoneurons during vocal fold vibration elicited by a constant air flow through the glottis. In both cases, motoneuronal excitability changes were expressed by measuring fluctuation of peak latencies of action potentials antidromically elicited by selective stimulation of the recurrent nerve or its peripheral branch. In 14 out of 24 TA-LCA motoneurons, neuronal excitability was increased during the expiratory phase, whereas in the remaining 10, it was increased during the later half of the inspiratory and the early half of the expiratory phase. On the other hand, 9 out of 13 PCA motoneurons showed increased neuronal excitability during the end of the expiratory and the beginning of the inspiratory phase, while the remaining 4 showed increased excitability during the inspiratory phase. These results suggest that there are functional differences among the homogeneous laryngeal motoneurons. In seven TA-LCA motoneurons, neuronal excitability was decreased by vocal fold vibration elicited by phonation throughout the whole respiratory cycle. On the other hand, when the bilateral superior laryngeal nerves were cut, neuronal excitability was increased during phonation throughout the whole respiratory cycle. These results indicate that TA-LCA motoneurons receive inhibitory inputs from the superior laryngeal nerve and excitatory inputs from the recurrent laryngeal nerve during the vocal fold vibration elicited by phonation.