David E. Bytell

Swallowing disorders in three types of head and neck surgical patients

This study examined swallowing transit times and motility problems in three groups of patients following ablative surgery for oropharyngeal carcinoma and in a control group of 10 normal subjects. A total of 30 patients was studied: 10 after anterior floor of mouth resection, 12 after tonsil/base of tongue resection, and 8 after supraglottic laryngectomy. Videofluoroscopic studies of liquid, thin paste, thick paste, and thick paste plus liquid swallows were completed 1 week post‐initiation of oral feeding following surgery. From the videotapes, oral and pharyngeal transit times were measured, and motility disturbances were defined during each stage of the swallow. All three types of patients in this study showed severe problems with swallowing. The anterior floor of mouth resection patients had problems with preparation for the swallow and oral transit. Tonsil/base of tongue resection patients had slowing in the preparation for the swallow and in the oral and pharyngeal stages. After supraglottic laryngectomy, patients showed only slight slowing in oral transit and pharyngeal transit as compared to other types of surgical patients.

Total laryngectomy and reconstruction of a pseudoglottis: problems and complications.

A modified procedure for the reconstruction of a pseudoglottis after total laryngectomy is examined. The history of this technique, including our experience, is reviewed with emphasis on problems and complications. Indications and justifications for surgery are discussed. Though we can only speculate on the basis of a few cases, we believe that a good voice can be obtained when a pseudoglottis is either primarily or secondarily constructed after laryngectomy. We acknowledge that perhaps the risk of liability tempers our approach and restricts our case selection which, no doubt, in part accounts for our modification of the procedure that was initially performed in Europe. We believe that continued careful application of this technique and its variations will improve the results of modern laryngeal surgery.

Lymphatics of the Floor of the Mouth and Periosteum: Anatomic Studies with Possible Clinical Correlations

An anatomic study is made to determine the role of the periosteum in the lymphatic drainage of the floor of the mouth in the dog. Microsurgical techniques are used to cannulate and perfuse a lymphatic vessel. Pathways are dissected to the proximity of the mandible, where a full-thickness mucoperiosteal flap is elevated. It is found that the floor-of-the-mouth lymphatics drained through the periosteum prior to entering the cervical lymphatic chain.

Chondrosarcoma of the maxilla.

Three patients with polypoid, glottic pseudosarcomas have been presented; all of them were managed by endoscopic CO, laser excision. Long-term follow-up was not possible for two of the patients because of their death after 1 and 2 years NED, respectively. The third patient is alive and well without recurrence 5 years following treatment. With the literature reporting dismal cure rates with radiation therapy, and a low incidence of metastasis from glottic pseudosarcomas, we have adopted endoscopic surgical excision with the C02 laser as primary treatment of polypoid, glottic pseudosarcoma. If glottic pseudosarcoma treated by conservative surgical procedures recurs, subsequent treatment by laryngectomy is possible (Table 2):;

Steel bar penetrating the skull.

A 42-year-old construction worker was struck in the head by a ten-foot steel bar that fell 240 feet, entering the left parietal area of the skull and exiting above the left zygoma. The bar was surgically removed and the postoperative course was unremarkable. His residual deficits include mild aphasia and the need of a cane for assistance with walking.

Recurrent Benign Mixed Tumor of Lacrimal Gland: Report of a Case with Intracranial Extension

A 66-year-old man with benign mixed tumor of the lacrimal gland underwent an excisional biopsy in 1966. Three recurrences subsequently developed, which resulted in an orbital exenteration. In 1979 he came to us. We discovered radiographic evidence and surgical confirmation of recurrent disease involving the lesser wing of the sphenoid and dura in the floor of the anterior cranial fossa. The natural history and management of this tumor is discussed and the relevent literature is reviewed.

Three Simultaneous Neoplasms of the Larynx

A 39-year-old man had three coexistent neoplasms of the larynx, squamous papilloma, verrucous carcinoma, and squamous carcinoma. In our review of the English literature, we could not find a similar case report. The potential transformation of benign laryngeal papilloma to verrucous carcinoma and infiltrating squamous cell carcinoma is discussed.

Chemodectoma Occurring as a Parotid Mass

A 55-year-old woman had a right-sided neck mass overlying the angle of the mandible, which proved to be a chemodectoma. The occurrence, differential diagnosis, and relatively high frequency of incorrect preoperative diagnosis of carotid body tumors is reviewed. The essential role of angiography to substantiate the diagnosis is discussed.