Percutaneous embolization for control of nasal blood circulation.

Percutaneous embolization to control the nasal blood circulation was used in 19 patients with vascular nasal disorders. Embolization was the initial treatment for intractable posterior epistaxis in 11 patients, 9 (82%) of whom were controlled without further treatment. Used as an adjunct to surgery on vascular nasal tumors, embolization reduced intraoperative blood loss in four patients to an average of 800 cc. In four patients with Osler-Weber-Rendu disease, treatment with embolization did not significantly alter the course of their disease. Overall, however, this relatively new technique enhances successful management of difficult epistaxis cases.

Surgical management of bilateral vocal cord paralysis.

Fifty-five patients with bilateral abductor paralysis of the vocal cords were managed surgically from 1957 to 1973. Initially, unilateral arytenoidectomy or arytenoidopexy was employed. If this was not satisfactory, a contralateral arytenoidectomy was performed 6 to 12 months later. If the patient's airway was still inadequate, then open unilateral submucous resection of the vocal cord was accomplished. Initial management was successful in 62 patient (34/55) of patients, and 50 to 55 patients (91 percent) were eventually decannulated. Failure of the arytenoidectomy appeared to be related to traumatic etiology of the bilateral paralysis presence of previous treatment, and technical problems of the procedure itself.

Vocal function following radiation for non-laryngeal versus laryngeal tumors of the head and neck.

OBJECTIVE: The larynx may receive high doses of radiation even in the absence of disease. Preliminary investigation has provided evidence that significant voice alterations exist in patients who received radiotherapy (RT) for non-laryngeal tumors of the head and neck. This study evaluates subjective and objective parameters of vocal function in this patient population compared with a control group of patients irradiated for early glottic tumors. STUDY DESIGN: Retrospective cohort study. METHODS: Vocal function in patients irradiated for non-laryngeal and early glottic tumors was assessed in a comprehensive manner and compared. Microanalytical and macroanalytical acoustic analyses, aerodynamic measurements, and videostroboscopy were performed on vowel production data. The Voice Handicap Index was administered for self-assessment of voice quality. All subjects were male, smokers, and greater than 12 months post-RT. RESULTS: Seventeen patients with non-laryngeal tumors and 13 patients with early glottic tumors were evaluated. Microanalytical acoustic parameters were worse for 75% (6 of 8) of the acoustic measures of vowel production in the non-laryngeal group. These include jitter, relative amplitude perturbation, amplitude perturbation quotient, normalized noise energy, pitch amplitude, and spectral flatness ratio. Macroanalytical acoustic analyses revealed no difference in fundamental frequency but numerically smaller phonational frequency range in the non-laryngeal group. All aerodynamic measures, including mean phonation time, mean airflow, and vocal fold diadochokinetic rate, were decreased in the non-laryngeal group. Videostroboscopy demonstrated increased supraglottic activity in the non-laryngeal group. Voice handicap was significantly greater in the non-laryngeal group. CONCLUSIONS: When compared with patients receiving RT for early glottic tumors, there is objective and subjective evidence of vocal dysfunction in patients treated with wide-field RT for non-laryngeal tumors.

Identification of the facial nerve in parotid surgery.

A short outline of anatomical relations leads to a discussion of the various techniques of facial nerve identification as they present in the literature. Particular attention was given to a relatively unknown technique that has served as a valuable manoeuvre in 14 consecutive cases of superficial parotidectomy.

Flow volume spirometry as a test for postoperative airway evaluation following arytenoidectomy.

The postoperative upper airway of nine patients who had undergone Woodman procedures for bilateral vocal cord paralysis were assessed by means of flow volume spirometry using the FIF-50 measurement expressed in percentage of normal. There appears to be a good correlation between the postoperative FIF-50 and the degree of postoperative subjective laryngeal obstruction.

Lateral rhinotomy for intranasal tumors: a review of 22 cases.

Lateral rhinotomy is a surgical approach not employed often enough for evaluation, diagnosis and removal of intranasal neoplasms. This paper reviews 22 patients with intranasal tumors requiring 28 rhinotomies between 1973 and 1984. Our experience indicates that lateral rhinotomy is a safe, repeatable and cosmetically sound procedure that provides and excellent surgical approach to the nasal cavity and sinuses. Determination of the site of origin and adequate surgical removal of intranasal tumors, concomitant surgery to the sinuses and intranasal skin grafting are possible with the procedure.

Traumatic pseudoaneurysm of floor of mouth treated with selective embolization: a case report.

False aneurysms may be caused by trauma to the floor of the mouth from surgical procedures. The condition is hazardous because of the potential for airway obstruction from hematoma. A case of pseudoaneurysm of the facial artery occurring in the floor of the mouth is described. Treatment with superselective percutaneous angiographic embolization is a novel and efficient alternative for dealing with aneurysms arising in this region, with low morbidity.

Malignant tumors of the salivary glands.

The incidence of malignant salivary gland tumors is influenced by geographic and racial factors. Some etiological aspects and diagnostic pitfalls are discussed. The treatment of salivary gland malignancies is primarily surgical but the extent of the surgery should be dependent on the availability and application of routine postoperative high or supervoltage radiotherapy on a "regional" basis of invasive low-grade and all high-grade malignant tumors.

Epiglottic abscess: its occurrence and management.

Twenty-six cases of epiglottic abscess from the English literature are reviewed. The condition occurs nearly exclusively in adults and it has a high mortality rate (30 per cent). The lingual surface of the epiglottis is most commonly involved and less than half of the patients present with severe airway obstruction. The management of the condition is dictated by the degree of airway obstruction.

Senescent changes in and about the oral cavity and pharynx.

Gradual morphologic and physiological changes in mucosa, bone and salivary glands in and about the oral cavity and pharynx bring about certain pathologic conditions occurring with greater frequency in the elderly than in the general population. The paper's intent is to summarize these changes and where possible provide some guidance in the management of the symptoms.

Chemodectoma of the larynx.

The ninettenth reported case of chemodectoma of the larynx is presented and its management discussed. Some reflections on the laryngeal paraganglia are made and the past literature is reviewed.

Vocal function following vertical hemilaryngectomy: a preliminary investigation.

Seven consecutive male patients who received a vertical hemilaryngectomy were examined for vocal function employing video-stroboscopic, aerodynamic and acoustic measurement techniques. The results of this preliminary investigation suggest that with the group of patients studied, vocal quality was rated as "rough", "breathy" and "constricted". While large variability was noted between individuals, the general tendencies for the group included: (a) incomplete glottic closure; (b) supraglottic structures (ventricular folds, arytenoids) fulfilled or aided vibratory action of the remaining fold; (c) high average transglottal airflow; (d) reduced maximum phonation time; (e) high and more variable vocal frequency positioned near the top of the frequency range; (f) a lower, more variable, and restricted vocal intensity range, and (g) a reduced vocal fold diadochokinetic (vocal fold opening and closing action) rate. We are currently attempting to determine factors related to individual patient strategies for using either glottic or supraglottic valving during phonation.

Therapeutic embolization for severe epistaxis.

Severe intractable epistaxis remains a therapeutic challenge for the otolaryngologist. Embolization would appear to add a valuable treatment modality in dealing with particular cases refractory to conventional management. In selective cases it may prove superior to surgical intervention because of repeated accessibility and circumvention of the problem of collateral internal maxillary artery flow. This paper presents three cases of epistaxis of unusual causes which were initially uncontrolled by conventional management. Each patient received preliminary selective carotid angiography followed by one of two different intra-arterial embolization methods. The results were effective and illustrate the potential adjunctive or primary role embolizing procedures have in dealing with uncontrolled epistaxis.

Radionuclide scans in the assessment of distant metastases from squamous cell carcinoma of the head and neck.

The initial evaluation of patient with squamous cell carcinoma of the head and neck often includes the use of radionuclide scans to detect distant metastases. A retrospective study was conducted of radionuclide liver, bone, and brain scans on 111 patients. An overall 3.8 per cent of liver scans were positive and 2.9 per cent were highly suspicious for metastatic disease. No positive brain scans were encountered but 2.4 per cent of the bone scans were positive. The scan results did not affect the treatment in the majority of cases. One third of the patients with positive/suspect scans were alive at three to six years follow-up. Our results do not support the routine use of radionuclide scans in the initial evaluation of the patient with squamous cell carcinoma of the head and neck.

Pediatric tracheotomy.

The indications and complications of tracheotomy in 93 children between 1970-82 were studied and recorded. There has clearly been a shift in indications for pediatric tracheotomy while the early postoperative complication rate has improved. Longterm tracheotomy is on the increase due to a larger number of children with neurological problems and of infants requiring tracheotomy for chronic obstructive airway disease.

Lethal delayed radiation necrosis of the brain as a complication of radiotherapy for cancer in the head and neck.

Necrosis of the brain following irradiation of tumors adjacent to the cranial cavity is an insidious and often fatal complication. Three patients with this complication are reported. Recognition of the condition is often delayed due to the long time interval between irradiation and manifestation of first symptoms. Accurate shielding and limitation of irradiation to the brain may prevent this problem.

Laryngeal chondrosarcoma: gross pathological, histologic and electron microscopic characteristics.

Chondrosarcoma is an uncommon cartilaginous tumour of the upper respiratory tract, and its morphology and clinical course vary widely. Few reports have evaluated the clinicopathological findings of this tumour in the larynx. This paper reports on a low-grade chondrosarcoma in a 44-year-old woman who required laryngectomy for cure. The gross pathological, histologic and electron microscopic features of the tumour are analysed with respect to its clinical course, using histopathological criteria.

Evaluation of parotid lesions by magnetic resonance imaging.

The effectiveness of magnetic resonance (MR) imaging in the evaluation of parotid lesions was tested by scanning 21 patients with parotid masses. In 20 patients the lesion was visualized, and in 19 benign/malignant differentiation was accurately made, indicating sensitivity and specificity of .95. The deep extent of the lesions was readily assessed by MR but the facial nerve could not be identified.

Osteoradionecrosis of the temporal bone.

Six cases of osteoradionecrosis of the temporal bone are described. Persistent symptoms of otitis externa refractory to local treatment measures should alert the physician to the possibility of underlying osteoradionecrosis. Treatment of superficial parotidectomy and partial temporal bone resection with preservation of the facial nerve is indicated if local aggressive conservative measures fail to control the disease. Benign mixed tumors of the parotid gland should be treated surgically with avoidance of radiotherapy.