Albert A. Clairmont

Submandibular gland tumors.

Tumors involving the submandibular gland are rare. However, the incidence of malignancy is much higher than in the parotid (approaching 50 percent). In addition, the 5-year survival rate in patients with malignant tumors of the submandibular gland is much poorer in our series--28 percent versus 71.8 percent for the parotid gland. Because of the poor prognosis in patients with malignant tumors involving the submandibular gland we feel that composite resections should be carried out for all tumors except low-grade mucoepidermoid tumors. In addition, postoperative radiation should be given for specific indications (detailed in the article).

Intramuscular hemangioma of the masseter muscle.

We present a case of intramuscular hemangioma of the masseter muscle. We stress that, although there can be apparent vascular infiltration of the muscle, this lesion is benign; it should not be mistakenly diagnosed as an angiosarcoma.

Dermal-Fat-Fascia Grafts

Free dermal-fat-fascia grafts are used for subdermal augmentation in soft tissue or bony deficiencies resulting from surgical extirpation of cancer, congenially arrested development, and trauma. The most important determinant for graft survival is the health of the recipient area and the volume of the graft. At least 70% resorption of these large grafts must be anticipated. Initial overcorrection has some justification but may be self-defeating. Calcification of dermal-fat-fascia grafts, common in other areas of the body, does not appear to be a problem in the head and neck region. When possible, other types of augmentation procedures should be considered.

The Effect of Carbon Dioxide Inhalation on Cerebral Blood Flow: A Two-Hour Duration Study in Dogs With Microspheres

Dogs breathed one of four gas mixtures (5% CO2-95% O2, 5% CO2-95% air, 10% CO2-90% O2, and 10% CO2-90% air) for as long as two hours. Regional cerebral blood flow as well as flow in nasal, otic, pituitary and skin tissue were measured by means of 15 ± 5 μ radioactively labeled microspheres. The normal values for cerebral blood flow and arterial blood gases were very similar to those of other investigators. Inhalation of CO2 induced an increase in cerebral blood flow that was significantly higher than is usually reported. Increases varied from 100% (with 5% CO2-95% air) to 250% (with 10% CO2-90% O2). Blood flow in the temporal bone behaved much like that of brain in response to CO2. In most instances, the pituitary gland blood flow did not increase with inhalation of CO2.

Blood Flow in Otorhinologic Tissue after Histamine and Papaverine

A method has evolved that allows one to quantitatively measure nutritional blood flow in the labyrinth. Several otic symptoms (e.g., sudden hearing loss) are thought to be due to decreased labyrinthine blood flow. Our aim was to test two common vasodilators, histamine and papaverine, to determine if they were effective in increasing blood flow to otic tissue. The method employs the intracardiac injection of radioactive microspheres (15 μ in diameter). These spheres become embolized in the microcirculation and provide a measure of blood flow in ml/gm/min. Histamine or papaverine were infused intravenously for five min at several doses. Blood flow was measured before and after infusion. Both drugs cause a significant increase in blood flow to temporal bone tissue if used in the appropriate dose range, i.e., about 1 ug/kg/min for histamine and 0.5 mg/kg/min for papaverine. If the dose of either drug is increased to the point that causes a drop of more than 15 mm Hg in systemic blood pressure, there is either no increase or a drop in otic blood flow. This reversal of the drug response is felt to be due to autoregulatory mechanisms in intracranial blood vessels.

Polypoid spindle-cell carcinoma (pleomorphic carcinoma)

Abstract A case of spindle-cell carcinoma (pleomorphic carcinoma), a rare polypoid tumor of the tongue, is reported. The characteristic clinical, gross, and microscopic features of this peculiar lesion and its common sites of location are presented. Origin and pathogenesis of the sarcoma-like elements of the lesion are discussed and the literature on the subject is reviewed. Sites of apparent transition between the spindle-cell elements of the tumor and the overlying epithelium were observed in light microscopic sections, and the electron micrographs of the spindle-cell portion of the lesion demonstrated the presence of tonofilaments and desmosomes in many tumor cells. These findings support the concept that this group of lesions are pleomorphic variants of squamous-cell carcinoma with predominantly spindle-cell pattern. Current evidence in the literature also suggests that metaplastic transformation of the tumor cells into mesenchymal elements may take place in some of these lesions, and that “metaplastic carcinoma” may probably be a more proper designation for them.

Carcinoma of Stensen's duct.

The authors present 2 cases of carcinoma primary in Stensens duct, one a mucoepidermoid carcinoma and the other an adenoid cystic carcinoma. This is an unusual site for a primary carcinoma and these are apparently the thirteenth and fourteenth cases to be reported in the English literature. The authors review the diagnosis and treatment for primary carcinoma of Stensens duct.

Primary carcinoma of the mastoid bone.

The diagnosis of carcinoma primary in the mastoid bone is usually made while performing a mastoidectomy in an effort to control presumed chronic mastoiditis. The association of chronic infection, serosanguineous otorrhea, and severe otalgia, common warning signs of carcinoma of the middle ear or external auditory canal, may or may not be present with a carcinoma primary in the mastoid bone. If the amount of bony mastoid destruction seen by roentgenography is out of proportion to the degree of clinical infection, malignancy should be strongly suspected. The authors present a case of primary carcinoma of the mastoid bone, and review the diagnosis and treatment.

Actinomycosis masquerading as depression headache: Case report — management review of sinus actinomycosis†‡

Differentiating an organic from a functional headache can be difficult; recognizing the unusual organic cause even more so. A unique case of actinomycosis centering on the clivus and sphenoid sinus is presented. This report reviews the history, diagnosis, and treatment of actinomycosis especially as they pertain to otolaryngology.

MALIGNANT FIBROUS HISTIOCYTOMA OF THE PARAPHARYNGEAL SPACE Case Report

Of the large variety of tumors that may occur in the parapharyngeal space, malignant fibrous histiocytoma is one of the most rare. We present such a case and discuss the diagnosis, classification, and treatment.