Daniel D. Rabuzzi

Degloving approach for total excision of inverted papilloma

Inverted papilloma, because of its insidious and aggressive clinical course, must be completely excised. Previously, the customary procedure advocated for this goal was a lateral rhinotomy. The degloving approach, which consists of lifting the soft tissues from the mid portion of the face, thereby furnishing unlimited exposure to the pyriform fossae and the lateral nasal walls, offers an excellent alternative to the lateral rhinotomy technique.

Frontal Sinus Septectomy for Chronic Unilateral Sinusitis

Fibrous dysplasia of bones comprising the paranasal sinuses is well recognized. Depending on the anatomic areas of the skull involved by this neoplasm, a combined approach for surgical removal may be necessitated. A case of a patient with fibrous dysplasia of the ethmoid sinus, possibly the first reported case of such change in the ethmoid bone itself, is presented. A two-stage, combined otolaryngologicneurosurgical craniofacial resection was the method of treatment.

Apnea and airway obstruction during feeding and sleep

Recent awareness of the magnitude of sudden unexplained deaths in apparently healthy infants has lead to an increased interest in those circumstances that are associated with or can elicit prolonged and serious apneic episodes. In the present studies, attention was directed toward the study of physiologic activity during sleep and feeding.

Treatment results of combined high-dose preoperative radiotherapy and surgery for oropharyngeal cancer.

Fifty‐eight patients receiving planned high‐dose preoperative radiotherapy followed by en bloc oro‐mandibular‐cervical resection for oropharyngeal cancer were reviewed. These patients received continued close observation and care from both the Otolaryngology and Radiotherapy services. In light of the ongoing controversy of preoperative vs. postoperative radiotherapy, we present our data demonstrating the value of preoperative radiation.

Use of computerized axial tomography of the head and neck region

The use of the computerized axial tomography has been well received in the field of otolaryngology. Five cases are presented illustrating the capability of the total body scanner (Delta scanner) to contribute to radiologie diagnosis below the level of the base of the skull. The advantages of non‐invasibility and three dimensionality are compared to the disadvantages of added cost, added radiation exposure, comparatively long exposure time and relatively poor detail.

Recurrent Massive Cystic Lymphangioma

THAT the first encounter with disease is the optimal time for its eradication is a maxim of surgical management. No disease exemplifies this more than cystic lymphangioma, a histologically benign tumor of infancy and childhood. These tumors are often poorly understood and unsuccessfully managed because of their infrequency. They can obtain new and rapid growth to massive size and infiltrate into and around muscles, vital nerves, and vessels even after long periods of quiescence.

Postoperative problems of tracheal resection

With the advent of the intermittent positive pressure breathing apparatus and cuffed endotracheal tubes, the problem of tracheal stenosis has increased in both incidence and severity. The lesion may be at the tracheotomy stoma or at the site of the tracheal tube cuff, or both. Treatment of severe cases revolves around primary tracheal resection and anastomosis, often with laryngeal release procedures. This report reviews all cases of tracheal stenosis and resection at the Upstate Medical Center, and presents postoperative problems of significance.

Composite resection in the elderly: A well‐tolerated procedure

The advisability of surgery in the elderly must be weighed against continued nonoperative care. The gloomy prospects of the patient with uncontrolled carcinoma of the head and neck led to the development and wide application of the composite resection for control of carcinoma of the oral cavity. The risks involved in this major undertaking in the elderly have not been previously reported.

Prevention of complications of composite resection after high dose preoperative radiotherapy

Recent reports have suggested that carcinoma of the tonsil and adjacent structures (tonsillar pillars, adjacent soft palate and lateral pharyngeal wall) can be treated with improved survival rates by combining definitive surgery with planned preoperative radiotherapy. Experience to date does not clearly demonstrate the ideal dose of preoperative radiotherapy; however, in general it appears that survival rates improve in proportion to increasing dosage of preoperative radiation. The use of preoperative radiation in doses approaching or exceeding tumoricidal levels (6,000‐6,500 rads at approximately 1,000 rads/week) has been limited by the unacceptable complication rate to be expected. The rate of major complications reported has ranged from 18 percent to almost 47 percent.Recent reports have suggested that carcinoma of the tonsil and adjacent structures (tonsillar pillars, adjacent soft palate and lateral pharyngeal wall) can be treated with improved survival rates by combining definitive surgery with planned preoperative radiotherapy. Experience to date does not clearly demonstrate the ideal dose of preoperative radiotherapy; however, in general it appears that survival rates improve in proportion to increasing dosage of preoperative radiation. The use of preoperative radiation in doses approaching or exceeding tumoricidal levels (6,000-6,500 rads at approximately 1,000 rads/week) has been limited by the unacceptable complication rate to be expected. The rate of major complications reported has ranged from 18 percent to almost 47 percent. For the past three years, all patients seen by the Department of Otolaryngology of the Upstate Medical Center with malignancies involving the tonsil and its adjacent structures have been managed by a combined modality of 5,500 rads preoperative radiotherapy followed by definitive surgical resection, using distant, unirradiated flaps for repair where necessary. There were 33 patients in the group, including three T2, 20 T3 and 10 T4 lesions. Joint evaluation and planning of treatment between radio-therapy and otolaryngology coupled with meticulous attention to various aspects of surgical management has yielded the results reported in the table. The major complication rate has been limited to 3.03 percent. These results indicate that it is possible to undertake extensive resections for carcinoma of the tonsil and adjacent structures after high-dose preoperative radiotherapy without incurring any significant increase in morbidity over surgery alone.

Intralaryngeal Release for Tracheal Anastomosis

An operation for obtaining additional length in order to achieve end-to-end anastomosis of the trachea without significant suture-line tension is described. The intralaryngeal procedure lengthens the larynx approximately 1 to 2 cm without restricting its function. It is an expedient, effective technique when used primarily, or adjunctively, with a suprahyoid or mediastinal release.