Citations

The need to preserve hearing during acoustic neuroma removal has rekindled interest in labyrinth‐sparing procedures. This review of 11 years' experience with the retrosigmoid approach to acoustic neuroma removal includes 335 procedures in 332 patients. There were no intraoperative deaths; two patients died in the postoperative period. The facial nerve was preserved in 86.3% of procedures, and auditory function was preserved in 45 procedures (34% of those tumors were 2 cm or smaller). Postoperative complications occurred in 101 procedures, the most common being cerebrospinal fluid otorhinorrhea in 40 cases; 25 of these required secondary surgery. Meningitis occurred 16 times and aspiration 8 times; all other complications were less frequent. Tumor removal was incomplete in eight procedures; In only one of these cases has tumor recurred. The six recurrences usually were identified 5 or more years postoperatively. This has prompted us to follow patients for 7 years postoperatively. Major changes in our management include the use of the supine position and of electrophysiologic monitoring. Advantages of the approach are: (1) wide access to the tumor, (2) applicability to all tumor sizes, (3) potential to preserve facial and auditory function in all cases, and (4) ability to change procedure without sacrificing labyrinth. This review confirms our confidence in this approach to acoustic neuroma removal.

Allergic fungal sinusitis is a newly recognized entity consisting of a pansinusitis with allergic mucinous infiltrates in all involved sinuses. The disease process itself is very different from all other types of rhinosinusitis. Pathophysiologically the disease is a combination of both IgE‐mediated and antibody‐antigen reactions to the specific fungal antigens. Here we present two cases of allergic fungal sinusitis—one caused by Curvularia lunata species (an ubiquitous soil fungi), another caused by Alternaria. Only one other case of allergic fungal sinusitis caused by curvularia in which extensive immunologic testing was done has appeared in the literature. No reports of alternaria causing allergic fungal sinusitis have appeared in the literature. Diagnostic criteria for allergic fungal sinusitis include radiologic evidence of pansinusitis in an atopic individual; findings at surgery of allergic mucin; positive fungal cultures; and specific immunologic testing, including both humoral and cellular arms of the immune system. Treatment options for allergic fungal sinusitis are discussed and include surgery alone, surgery and steroids, or steroids alone. The role of allergy immunotherapy injections remains to be defined. In general, fungal infections—and especially phaeohyphomycosis—are very rare, but appear to be increasing in frequency, especially in the paranasal sinus region.

The tetrad of bronchial asthma, nasal disease, eosinophilia, and systemic vasculitis is the main feature of allergic granulomatosis and angiitis. Twenty‐two of 32 patients (69%) with this disorder had nasal manifestations, including nasal polyps, thick crusts, rhinitis, sinusitis, and occasionally septal perforations. Histopathologic study of involved tissue from the nose or subcutaneous nodules in conjunction with clinical evaluation will aid in establishing the correct diagnosis. Treatment with corticosteroids favorably influences symptoms and prognosis.

At the Mayo Clinic from 1962 to 1974, 182 patients with early squamous cell cancer of the true vocal cord were treated by laryngofissure and cordectomy. Seven patients (4%) had recurrences: four in the larynx and three in the neck (although the larynx was free of disease). The case histories of these patients are reported. Only three (2%) of the patients died as a consequence of their laryngeal cancer. The data substantiate our belief that the laryngofissure and cordectomy operation, and its minor variations, is an expeditious and highly successful means of eradicating glottic cancers.

Excellent speech can be produced by diverting expired pulmonary air to the pharynx through a tracheopharyngeal fistula. This study contributes basic information regarding the selection and fate of autogenous skin‐lined tubes created for this purpose in a standardized fashion in pigs. Our specific objectives were to determine (1) the best cutaneous autograft for constructing a 6‐ to 7‐cm skin‐lined tube, (2) the airflow resistance of surviving skin‐lined tubes, and (3) the effect of salivary contamination on the survival of tube grafts.

Numbers and percentages of T and B cells in peripheral blood; blastogenic responses to PHA, Con A, and PWM; and serum levels of albumin, total protein, and IgA were assessed in patients with stages I to III operable squamous cell carcinoma of the upper aerodigestive passageways in the head and neck.The patients were categorized into two groups: those who remained tumor free and those in whom cancer recurred. It was found that pretreatment PHA‐ and Con A‐induced blastogenesis was often depressed in patients in whom clinically apparent recurrences developed regardless of stage or nodal involvement. This point is consistent with the idea that cellular immune function (blastogenesis) can identify, within the clinical staging system (TN), subpopulations of patients who are less likely to survive after conventional therapy.

IgA immunoglobulin fractions containing antibodies to Epstein‐Barr virus (EBV)‐induced membrane antigens were isolated from the sera of two patients with nasopharyngeal carcinoma (NPC), from one non‐NPC patient, and from three persons with sera negative for IgA antibodies. IgA antibodies were not cytotoxic against cells expressing EBV‐induced membrane antigens in the antibody‐dependent cellular cytotoxicity (ADCC) assay. However, IgA antibodies blocked IgG‐mediated ADCC, which indicated that these antibodies could serve as a blocking “factor” in patients with disease and, therefore, were potentially detrimental to the host.

Photoplethysmography was used to evaluate 14 skin flaps in the pig. Eight skin flaps were 4×12 cm and were based dorsally. Six skin flaps were 4×18 cm and were based ventrally. All flaps were designed to undergo necrosis of the distal end. After elevation of the flap, blood flow to the skin flaps was estimated immediately by means of intravenously administered fluorescein. Photoplethysmography was used to determine blood flow to the skin flaps at 3, 24, 72, and 144 hours after elevation. Surviving length of the skin flaps was measured at nine days. Fluorescein accurately predicted the surviving length of the skin flaps. Photoplethysmography did not show a decrease in blood flow at the level of fluorescein penetration 3 or 48 hours after elevation. However, 72 and 144 hours after elevation, an abrupt decrease in blood flow was noted by photoplethysmography at the level of eventual skin necrosis.

Photoplethysmography was used to evaluate 14 skin flaps in the pig. Eight skin flaps were 4×12 cm and were based dorsally. Six skin flaps were 4×18 cm and were based ventrally. All flaps were designed to undergo necrosis of the distal end. After elevation of the flap, blood flow to the skin flaps was estimated immediately by means of intravenously administered fluorescein. Photoplethysmography was used to determine blood flow to the skin flaps at 3, 24, 72, and 144 hours after elevation. Surviving length of the skin flaps was measured at nine days. Fluorescein accurately predicted the surviving length of the skin flaps. Photoplethysmography did not show a decrease in blood flow at the level of fluorescein penetration 3 or 48 hours after elevation. However, 72 and 144 hours after elevation, an abrupt decrease in blood flow was noted by photoplethysmography at the level of eventual skin necrosis.

Primary “colonic type” tumors of the nasal cavity and paranasal sinuses are adenocarcinomas with histologic features similar to those of colonic cancers. Their behavior is one of local invasion and recurrence. Unlike tumors of the colon, they rarely metastasize. Surgical resection by means of lateral rhinotomy with or without radiation is the treatment of choice. Prognosis is poor. This type of tumor should be recognized by pathologists and its implications should be known to head and neck surgeons.