Prognostic factors of local control after radiotherapy in T1 glottic and supraglottic carcinoma of the larynx.

This study presents a retrospective analysis of a consecutive series of 161 patients treated with curatively intended radiotherapy for T1 supraglottic or glottic carcinoma from 1972 to 1990 at the Department of Oncology, Aalborg County Hospital, Denmark. All patients received radiotherapy given with 4-MV X-rays on lateral opposed fields. Intended dose was 60 Gy in 30 fractions. Multivariate analysis of recorded clinical parameters was applied to identify possible prognostic factors of local control. Tumor size, differentiation grade and sex were identified as significant independent prognostic parameters of local control. Five-year local control was 58% and 78% for supraglottic and glottic tumors, respectively. Applying salvage surgery the ultimate control rates were 82% and 97% for supraglottic and glottic tumors, respectively. Evaluation of treatment response 3-6 weeks following accomplishment of radiotherapy demonstrated that remaining tumor at the time of evaluation was an indicator of failure in local control.

Fine-needle aspiration biopsy of the thyroid gland.

Fine-needle aspiration biopsy is a diagnostic procedure used routinely in the evaluation of patients referred with a thyroid swelling. The technique and the results in our series of 233 patients, which included 39 carcinomas, are presented. A relatively high diagnostic specificity of 81% was found, whereas the diagnostic sensitivity was considerably lower (58%). It is concluded that fine-needle aspiration biopsy is a valuable diagnostic procedure in the preoperative assessment of patients with thyroid swellings. A definitive treatment, however, must never be based entirely on the results of a fine-needle aspiration biopsy. It is concluded that the results can be improved if the procedure is performed by a few highly skilled clinicians and pathologists.

Thyroid surgery.

In a 5-year period we treated 233 patients referred to us with a thyroid swelling. Among them, 39 patients (17%) had a malignant tumor. Seventy-eight percent of the patients were women. The preoperative examination procedure is discussed. Preoperatively, recurrent nerve palsy was found in 2.6% of patients with benign tumors and in 28% of patients with malignant tumors. The histologic features of the benign and the malignant tumors are described. The operative procedure in the benign group consisted of enucleation, resection, or lobectomy. In the patients with malignant tumors a radical operation was performed, consisting of lobectomy (unilateral or bilateral) when possible, eventually combined with radical neck dissection. The operative complications are discussed.

Neurilemmomas of the facial nerve presenting as parotid tumors.

Two cases of rare benign facial neurilemmomas are presented. In both cases the only complaint was a parotid mass and both patients had normal facial function. The true nature of the tumors was not discovered before operation. Repeated fine-needle aspiration biopsy did not contribute to a correct preoperative diagnosis. In both instances the facial nerve had to be sacrificed and free autogenous nerve grafting was done.

Vocal cord sulcus.

Vocal cord sulcus is a congenital condition consisting of a furrow on the medial edge of the vocal cord. It is most often bilateral but may be unilateral. The symptoms are a hoarse and breathy voice due to incomplete closure of the vocal cords. The present series comprises 15 patients found among 1,400 patients with voice and speech disorders. The condition is often overlooked and regarded as part of a primary functional hyperkinetic voice disorder. By close inspection the furrow can often be seen by indirect laryngoscopy. In many cases, however, microlaryngoscopy under general anaesthesia should be performed, but the furrow is only detected if a search is made for it. The condition is often found in younger patients, probably due to the fact that the sulcus is difficult to detect in older patients who have developed severe organic changes in a effort to overcome the incomplete closure of the glottis.

Reversible hearing loss in tumours of the cerebello-pontine angle.

A survey of the literature concerning reversible hearing loss in tumours of the cerebello-pontine angle is presented together with two additional cases. After removal of one meningioma and one epidermoid tumour, respectively, the abolished acoustico-vestibular function returned in both cases. The pre-requisites for the restoration of hearing are discussed.

Peritonsillar abscess. I. Cases treated by incision and drainage: a follow-up investigation.

The purpose of the present follow-up investigation was to evaluate the indications for tonsillectomy à chaud in the presence of a peritonsillar abscess. Of 76 consecutive patients treated for peritonsillar abscess, 45 were treated by incision and drainage, and no tonsillectomy à froid was planned. None of these patients had had previous peritonsillar abscess or recurrent tonsillitis; therefore tonsillectomy was not indicated. A follow-up investigation including 44 of these 45 patients showed that among patients under 30 years of age, 63 per cent had another peritonsillar abscess or recurrent tonsillitis during he follow-up period. Within an average period of 3 years, 41 per cent in this group underwent tonsillectomy. Among patients older than 30 years only 12 per cent had recurrent tonsillar symptoms, and in no case was tonsillectomy performed. The indication for tonsillectomy à chaud is discussed, and the method is recommended as a routine in peritonsillar abscess in patients under 30 years old, whereas conservative treatment with incision and drainage is recommended in patients older than 30 years if the patient has had no previous peritonsillar abscess or recurrent tonsillitis.

Peritonsillar abscess. II. Cases treated with tonsillectomy à chaud.

The treatment of a peritonsillar abscess by tonsillectomy à chaud obviously offers advantages over the more conservative treatment with incision, daily dilatations and possibly a later tonsillectomy. The patient avoids the painful drainage of the abscess with daily dilatations. Technically, the operation is easier to perform than later on when fibrosis has developed. The operative complications are not greater than in elective tonsillectomy, and there is no risk of spread of the infection when the patient is treated with antibiotics.

Inflamed adenolymphoma with cholesterol granuloma.

Twelve cases of adenolymphoma with inflammation are described. Pre-operatively, three of these patients presented clinical signs of inflammation in the parotid gland. In ten cases purulent exudate could be aspirated from the tumour. Rupture of the cyst may cause an aseptic inflammation in the surrounding tissue. It is concluded that adult patients with clinical or cytological signs of inflammation in the parotid gland must be supervised until the gland is normal in order not to miss an underlying tumour.

Ductal carcinoma of the parotid gland.

A case of ductal carcinoma of the parotid gland is described. The medical literature contains only 13 previous reports on this kind of adenocarcinoma of the parotid gland. The tumour is characterized by its histologic resemblance to ductal carcinomas of the breast and prostate. The course of previously described cases suggests that this tumour has a highly aggressive biological behaviour.

[Bilateral paralysis of the vocal cords treated with endolaryngeal arytenoidectomy]. / Dobbeltsidig stemmebåndsparese behandlet med endolaryngeal arytenoidektomi.

Bilateral paralysis of the vocal cords is a serious condition in which even slight oedema of the mucosa may endanger the patient's life. Bilateral paralysis of the vocal cords is most frequently due to thyroid operations but intubation, neuritis etc are among the other causes. Tracheostomy is nearly always necessary. In an attempt to render removal of the tracheal cannula possible with retention of vocal function, the authors have performed endolaryngeal arytenoidectomy. This intervention was carried out in 28 patients. In 23 of these the cannula could be removed while various conditions prevented removal of the cannula in the remaining five patients. The authors consider that arytenoidectomy is a good form of treatment of bilateral paralysis of the vocal cords involving only a slight risk. Thereafter, there are good chances for removal of the cannula with simultaneous retention of vocal function.

[Vermillionectomy]. / Vermillektomi.

Several external factors such as sunlight and tobacco smoking may cause changes in the epithelium of the vermillion border, especially of the lower lip, resulting in a dry and crusty epithelium often accompanied by painful ulcerations. Some of these patients will eventually develop lip cancer in the vermillion border. We would like to present a consecutive series of 25 patients treated with vermillionectomy. It is a very good and efficient treatment which may be the solution to a long standing problem. The functional and cosmetic results are very good.

[Thyroid surgery performed at a head and neck oncologic department]. / Thyreoideakirurgi på en hoved-hals-onkologisk afdeling.

During a period of ten years, 1977-1986, 778 patients were treated for diseases of the thyroid gland. Of these, 678 were benign and 100 malignant. The reasons for referral were most frequently a lump in the thyroid gland, possibly with suspected malignant changes. In the group with benign conditions, there were five times as many women as men whereas the proportion in the malignant group was 1.5 to 1. Technetium-scintigraphy and fine-needle aspiration were undertaken routinely preoperatively. As a rule, none of the preoperative investigations could reveal with certainty whether the condition was benign or malignant but, in certain cases, the investigations may provide indication and guidance for the continued treatment or control of the patients concerned. Treatment with particular attention to the recurrent nerve and the complications, particularly recurrent paresis, is mentioned.

[Thyroid cancer in the county of North Jutland. Diagnosis, treatment and prognosis]. / Cancer thyreoideae i Nordjyllands Amt. Diagnostik, behandling og prognose.

Data concerning 153 patients diagnosed with thyroid cancer during the 15-year period 1976-90 were retrospectively analyzed. Fine needle aspiration was performed in 98 patients. False negative smears occurred in 16.5% of the aspirates, most frequently in the papillary carcinoma group in which 20.5% of the smears contained cystic material. It is conducted, that smears containing cystic material without follicular epithelial cells should not be considered adequate for diagnosis and should always be repeated. The tumors were histologically re-examined. In 14 cases the histological diagnosis was re-classified. The ENT-department of Aalborg Hospital treated 136 of the patients. Unilateral lobectomy was performed in localised, unilateral cases of papillary carcinoma and as a main rule, total thyreoidectomy in all other cases of differentiated carcinoma and in all cases of medullary carcinoma. There were few postoperative complications. Unilateral recurrent nerve paralysis occurred in two percent of the patients. The prognosis of differentiated and medullary carcinoma was good and in accordance with other studies in which total thyreoidectomy has been performed in all cases. The pTNM classification did not correlate well with the actuarial survival.