Citations

Septic necrosis of the internal carotid artery is a major complication of peritonsillar abscess. Although once a common complication, its occurrence is rare since the introduction of antibiotics. A 12‐year‐old girl was referred to our institution after a false aneurysm of the internal carotid artery had been entered during routine tonsillectomy for a peritonsillar abscess. Review of the literature and features of the present case demonstrate the following findings suggestive of erosion of the internal carotid artery as a result of peritonsillar abscess: (1) spontaneous hemorrhage from a peritonsillar abscess, (2) persistent peritonsillar swelling after resolution of symptoms of peritonsillar abscess, (3) ipsilateral Horner's syndrome, and (4) otherwise unexplained cranial nerve palsies (nerves IX, X, XI, and XII).

The response of laryngeal airway resistance to chemoreceptor stimulation was measured before and after vagotomy in ten anesthetized dogs. With the vagus nerves intact, stimulation of chemoreceptors produced a decrease in both inspiratory and expiratory laryngeal resistance. After bilateral vagotomy below the origin of the recurrent laryngeal nerves, stimulation of chemoreceptors produced a smaller decrease in inspiratory laryngeal resistance and an increase in expiratory laryngeal resistance. We concluded that pulmonary afferent input to the respiratory neurons maintains a low airway resistance during chemoreceptor stimulation.

Extraskeletal Ewing's sarcoma is a rare malignant neoplasm. Arising from a primitive mesenchymal stem cell and primarily affecting young adults, this lesion demands aggressive therapy, including surgical treatment, radiation therapy, and chemotherapy.

One hundred seventy‐one patients had closure of symptomatic nasal septal perforations by insertion of a Silastic nasal septal prosthesis between June 1972 and August 1981. Follow‐up revealed that successful closure of the defect was accomplished in 73% of cases, with reduction in crusting and epistaxis and improvement in nasal respiration in many cases. Prefabricated prostheses have been effective in treating smaller perforations. The treatment of four patients with unusually large septal perforations by custom‐carved prostheses sized using computerized axial tomographic scanning is described.

From 1910 to 1979, 33 patients were seen for treatment of cartilaginous tumors of the larynx. Most of the patients had hoarseness and dyspnea, several had impaired vocal cord mobility, and one third had a lump low in the neck. A diagnosis of grade 1 chondrosarcoma was made in 21 patients, grade 2 chondrosarcoma in 10 patients, and benign chondroma in 2 patients. Most of the tumors were removed by way of laryngofissure (thyrotomy) and some by total laryngectomy. This paper describes the outcome, including retreatment for recurrence.

This review of 30 cases of Behçet's disease seen at the Mayo Clinic between 1965 and 1975 describes the multisystem nature of the disease and emphasizes its upper aerodigestive tract manifestations. The major clinical features include aphthous ulceration of the upper aerodigestive tract and genitalia, ocular inflammation, cutaneous vasculitis, and synovitis; less frequent features are meningoencephalitis and thrombophlebitis. There are no specific laboratory abnormalities, and corticosteroids remain the mainstay of therapy.

Giant cell granuloma is a benign lesion that generally involves the mandible and maxilla. It may be locally aggressive and result in extensive tissue destruction in advanced cases. A retrospective analysis of giant cell granuloma during the Interval 1970 to 1990 revealed 18 cases of advanced disease, as defined by bone destruction and a greatest dimension of 2.0 cm or more. Epidemiologic factors, physical findings, Imaging studies, pathologic specimens, treatment modalities, and outcome were reviewed for each case. Eight lesions were treated by local excision and curettage, and 10 were treated by partial mandibulectomy. Five mandibular defects were reconstructed with lilac bone grafts and one with a free flap. Only one patient with maxillary giant cell granuloma who underwent curettage had regrowth of what is suspected to have been residual disease. Individualized treatment, tailoring the extent of resection to the extent of disease, provided excellent results.

Adenomas and adenocarcinomas originating from the middle ear are few in number and have met with significant controversy in the literature. Our experience with 11 previously described patients is updated and five new cases are added. These tumors were seen in persons whose ages ranged from 7 to 77 years. The most common initial symptom was decreased hearing (11 cases), followed by otorrhea (4 cases), and otalgia (4 cases). At the time of diagnosis, facial nerve weakness was present in several patients (seven), and this was a poor prognostic sign. These glandular tumors engender controversy regarding histologic origin and the pathologic demarcation between adenoma and adenocarcinoma. In this review, we show that otorrhea, bone erosion, facial nerve involvement, and aggressive clinical behavior can be the result of lesions that appear microscopically benign. Furthermore, we present evidence of the similarity of these glandular lesions to paragangliomas and carcinoid tumors. Finally, pathologic data are presented to develop the previously unreported theory that the origin for this group of tumors is paraganglionic tissue.

Seventy‐five cases of laryngotracheal stenosis treated between 1981 and 1991 were reviewed to determine the effectiveness of surgical treatment on the basis of site and severity of stenosis. Decannulation and absence of exertional dyspnea were the criteria of successful management. The treatment methods used were endoscopic laser incision and dilatation, expansion laryngotracheoplasty, and segmental resection. Endoscopic procedures were effective in treating thin (< 1 cm) stenoses in the subglottis and trachea. Laryngotracheoplasty was most effective in treating thick stenoses of the glottis and subglottis. Tracheal stenoses were most effectively treated by segmental resections. The probability for decannulation decreased with longer narrower stenoses and with increasing clinical stage. (OTOLARYNGOL HEAD NECK SURG 1993;109:468‐73.)