Christopher H. Rassekh

Osteosarcoma of the head and neck : Meta-analysis of nonrandomized studies

To assess the role of adjuvant therapy in the treatment of osteogenic sarcoma of the head and neck, treatment and survival information from 173 patients with osteosarcoma of the head and neck was entered into a database. A meta‐analysis of the data was attempted with primary emphasis on the effect of adjuvant therapy on disease outcome. The overall 5‐year survival was 37%. Patients with mandibular and maxillary tumors had similar survival rates; both groups fared significantly better than patients with extragnathic tumors (P<0.001). Treatment with surgery alone was associated with significantly longer survival rates (P<0.03) than surgery with adjuvant therapy. In the majority of patients reported, information about surgical margins was not available. For this reason, the differences may not adequately represent the effect of adjuvant therapy. While there have been encouraging results with adjuvant treatment protocols for long bone osteosarcoma, the ultimate role of radiation and chemotherapy in the management of osteosarcoma of the head and neck remains unproven. Nevertheless, we recommend that adjuvant therapy be considered due to the poor prognosis in osteosarcoma of the head and neck.

Combined Epstein‐Barr Virus and Human Papillomavirus Infection in Nasopharyngeal Carcinoma

Epstein‐Barr virus (EBV) has been shown to be a likely etiologic agent in nasopharyngeal carcinogenesis. Human papillomaviruses (HPVs) have previously been identified in numerous upper aerodigestive tract carcinomas. This pilot study was undertaken to investigate the prevalence of combined EBV and HPV infection in 17 patients with nasopharyngeal carcinoma (NPCA) using polymerase chain reaction (PCR). The primary goal was to determine if the presence of HPV could be correlated with molecular, histologic, or clinical parameters. There were seven patients with undifferentiated NPCA (World Health Organization [WHO] type III) and 10 patients with squamous cell carcinoma (WHO type I). All 17 patients had stage IV disease at presentation. EBV was identified in 15 patients (88.2%), and HPV subtypes were identified in samples from nine patients (52.9%). All HPV‐positive cases were also EBV positive. Western blot analysis of six samples showed a high level of expression of c‐myc and cdc2 kinase and a low level of p53 protein in NPCAs that contained both HPV and EBV (n = 3). Increased expression of c‐myc and cdc2 kinase was seen in the cases that contained EBV only, but to a lesser extent (n = 2). These findings indicate an effect of the virus on cellular proliferation and differentiation. Similarly, an elevated level of Rb protein was found only in the HPV‐containing NPCAs. Moderate differentiation (keratinization) occurred in four of eight HPV‐negative and none of the nine HPV‐positive NPCAs. (All HPV‐positive cases were poorly differentiated or undifferentiated.) This difference is statistically significant for this sample size (P < 0.03). There was a trend for the group that was HPV positive to have WHO III histology and for the HPV‐negative group to have WHO I. The presence of HPV could not be correlated with any clinical parameters in this small group of patients with advanced disease; however, these data suggest that coexistence of EBV and HPV infection may be a factor in the pathogenesis of NPCA and may have an effect on regulation of cellular proliferation and differentiation.

Allergic fungal sinusitis with cranial base erosion

Allergic fungal sinusitis (AFS) usually follows a slow, nonaggressive course. However, massive bone destruction can occur, with extension of the disease process outside of the confines of the sinuses.

Preservation of the superior laryngeal nerve in supraglottic and supracricoid partial laryngectomy.

Conservation laryngeal surgery effectively controls laryngeal carcinoma. The success of conservation laryn- geal surgery is judged by the patient’s ability to achieve physiologic respiration, phonation, and deglutition. Some patients cannot tolerate supraglottic and supracricoid partial laryngectomy and develop sequelae such as aspi- ration pneumonia. The extent of resection in conservation laryngeal pro- cedures varies. After classic vertical partial laryngectomy, rapid resumption of deglutition is usually achieved. After supraglottic laryngectomy, swallowing therapy is initiated and feeding tube removal is usually achieved

Allergic fungal sinusitis. A report of two cases with diagnosis by intraoperative aspiration cytology.

BACKGROUNDnAllergic fungal sinusitis (AFS) is a newly recognized form of sinusitis characterized by opacification of the paranasal sinuses by allergic mucin (AM) admixed with scattered fungal organisms. AM consists of necrotic, or partially necrotic, eosinophils and Charcot-Leyden crystals suspended in lakes of laminated, mucinous material. AFS is characterized by the absence of bone or soft tissue invasion, purulent exudate or granulomatous inflammation. Clinically, it is important to differentiate AFS from both acute invasive fungal sinusitis and noninvasive mycetoma because the three diseases are treated with different modalities and have different prognoses. Although the radiologic features of AFS are often characteristic, occasionally it may be difficult to exclude neoplasia.nnnCASESnTwo cases of AFS, in which intraoperative diagnosis was made on the basis of the presence of both AM and fungal organisms, are reported.nnnCONCLUSIONnCytologic diagnosis of AFS can be made from intraoperative sinus aspirates from the presence of AM and fungal elements. AM and fungi provide presumptive evidence for a noninvasive, allergic fungal disease and can help reassure clinicians intraoperatively and guide clinical management.

Tissue expander insertion through a mini incision

Tissue expanders are usually placed deep to the subcutaneous layer through large incisions.1-3 Expansion is started 2 weeks after insertion in order to allow the wound to develop sufficient integrity to withstand the expansive forces.13 This method, although effective, has some limitations. The large incision delays expansion, may interfere with the final flap design, and may dehisce to expose the expander or cause its extrusion.