Carl F. Wurster

Mediastinitis occurring as a complication of odontogenic infections

Mediastinitis occurring from a descending odontogenic infection occurs rarely. The diagnosis is sometimes difficult to make and is often delayed until the patient is in extremis. The physical examination is often nondiagnostic, but may include brawny edema of the neck and chest. CT scanning provides the most accurate diagnostic information. The treatment is always surgical, in combination with appropriate antibiotics. Five patients with mediastinitis secondary to odontogenic infections are presented, and the technique of transcervical drainage of the anterior and posterior mediastinum is reviewed.

Immediate reconstruction after total laryngopharyngoesophagectomy and mediastinal dissection

Advanced or recurrent carcinoma surrounding the tracheostoma in a previously laryngectomized patient is most effectively treated with transsternal radical dissection of the upper mediastinum and relocation of the trachea to the upper chest. The use of the pectoralis major myocutaneous flap, now enables the head and neck surgeon to perform immediate reconstruction and provide protection for the great vessels after mcdiastinal dissection for stomal recurrence. Formerly, patients with stomal recurrence also involving the cervical or upper thoracic esophagus were poor surgical candidates. Frequently, patients succumbed to their disease before the continuity of the digestive tract could be re‐established.

Laser lingual tonsillectomy.

Diseases of the lingual tonsils are generally overlooked in both clinical practice and medical literature. Infections of the lingual tonsils are usually treated medically, although in patients with symptomatic chronic inflammation or hyperplasia of the lingual tonsils, surgical intervention may be indicated.

Mucocele of the sphenoid sinus causing sudden onset of blindness.

Mucoceles are uncommon lesions of the paranasal sinuses and usually occur in the frontal and ethmoid sinuses. They may cause symptomatic unilateral exophthalmos and extraocular muscle paresis. Mucoceles of the sphenoid sinus, however, are rare, with fewer than 160 cases cited in the worlds literature to date. I Preoperative diagnosis had only been made consistently within the past 20 years. In 1872, Rouge? was first to identify a sphenoid mucocele, when, during a routine cadaver dissection, he noted pus in the sphenoid sinus. Seventeen years later a Swedish surgeon, John Berg, published the first clinical account of an isolated sphenoid mucocele.

Osteoradionecrosis of the temporal bone.

Osteoradionecrosis of the temporal bone is a rare but potentially lethal complication of therapeutic irradiation to the cranial vault and surrounding tissues. The possibility that radionecrosis of the endomeatal skin and secondary infection are simultaneously prerequistite and responsible for the development of this condition is reviewed. The long-term follow-up of such patients is urged as well as the continued reporting of this complication.

Four separate and simultaneous pharyngolaryngeal squamous cell carcinomas.

Repeat bronchoscopy via a nasal approach was performed to confirm the absence of an endobronchial lesion. A tracheal mass, just inferior to the true vocal cords, extended 4 cm down the trachea. The tracheal lumen was approximately 30% occluded. No other endobronchial lesions were noted. Biopsy and brushings of the tracheal lesion revealed moderately differentiated squamous cell carcinoma. Random bronchial washings were again positive for squamous cell carcinoma.

Chin reconstruction with pectoralis myocutaneous flap.

Chin reconstruction after radical surgery for carcinoma of the oral cavity is a complex and controversial problem. We have developed a simple, single-stage, primary procedure for chin reconstruction. It is easily mastered and is based on a simple modification of the pectoralis major myocutaneous flap. Our experience includes seven cases, including two with total chin reconstructions. The number and type of complication is low and consistent with the magnitude of the surgical procedure. This operation provides acceptable aesthetic and functional results to patients undergoing partial or total resection of the chin.