Edward C. Weisberger

Comparison of ultrasound-fine needle aspiration and computed tomography in patients undergoing elective neck dissection

Ultrasound of the neck with fine needle aspiration (US‐FNA) of suspicious lymph nodes has potential advantages over other radiologic techniques as a screening method for the N0 neck in head and neck cancer.

Endoscopic stapled diverticulotomy: treatment of choice for Zenker's diverticulum.

Objective To evaluate the efficacy and safety of endoscopic stapled diverticulotomy in the treatment of patients with Zenkers diverticulum.

Carotid body tumors, inheritance, and a high incidence of associated cervical paragangliomas

BACKGROUND Current experience with carotid body tumors suggesting a high prevalence of associated cervical paragangliomas prompted this review. PATIENTS AND METHODS An 8-year retrospective study of patients with carotid body tumors was undertaken, detailing presentation, diagnosis, and treatment. RESULTS Eleven patients harboring 17 carotid body tumors were discovered. All patients had a neck mass. Seven patients (64%) had bilateral carotid body tumors. Six (55%) reported a positive family history-4 were first-generation relatives, 5 had bilateral tumors, and 3 had other head and neck paragangliomas. Angiography documented 4 associated vagal and 2 glomus jugulare paragangliomas in addition to the carotid body tumors. Precise surgical care limited blood loss to an average of 590 cc. The carotid artery was repaired during 5 resections (29%). Cranial nerve injury occurred in 3 cases, all following vagal body or glomus jugulare resection. Every patient is currently alive, stroke free, and functioning without major disability. CONCLUSIONS Patients with carotid body tumors have a propensity for multiple head and neck paragangliomas. Angiography is diagnostic. The need for associated paraganglioma resection dramatically increases the risk of cranial nerve injury.

Zenker's diverticulum: Analysis of surgical complications from diverticulectomy and cricopharyngeal myotomy

Objective: To identify risk factors for postoperative complications in patients undergoing diverticulectomy and cricopharyngeal (CP) myotomy for Zenkers diverticulum. Study Design: Retrospective. Materials and Methods: A chart review was conducted of all patients with a Zenkers diverticulum who were treated with diverticulectomy and cricopharyngeal myotomy at three tertiary care centers in central Indiana between 1988 and 1998. Results: Of the 24 patients identified, 9 developed postoperative complications (2 medical and 7 surgical). Statistical analysis of multiple potential risk factors revealed that only diverticulum size greater than 10 cm2 at surgery placed the patient at increased risk for postoperative surgical complications. To our knowledge, this is the first report that has specifically addressed diverticulum size as an independent risk factor for postoperative surgical complications following diverticulectomy and CP myotomy. Conclusions: Given our findings, we recommend considering diverticulopexy rather than diverticulectomy in a patient with a Zenkers diverticulum greater than 10 cm2 in size if a cervical approach is the selected treatment. Key Words: Zenkers diverticulum, cricopharyngeal myotomy, surgical complications, diverticulectomy.

Unusual presentations of lymphoma of the head and neck in childhood

Lymphoma of the head and neck in children can pose a significant diagnostic problem, especially when histologic analysis indicates non‐Hodgkins lymphoma and the initial site of involvement is extranodal.

Resorbable Fixation Plates in Head and Neck Surgery

A skeletal fixation system employing plates made of polylactic and polyglycolic acid has been employed at Indiana University Medical Center since July 1993 in 105 craniofacial reconstructions, 45 cases of maxillofacial trauma, 10 craniotomy flap repairs, and five cases involving reconstruction of the laryngotrachea. Because these plates eventually resorb, they offer significant theoretical advantages. No inhibition of structural growth should occur when using this system in children. Tissue tolerance of these plates has been excellent. The technical details of using heat to allow reshaping of the plates as well as the methods of fixation of the plates are discussed.

Radiologic percutaneous gastrostomy: Results in 56 patients with head and neck cancer†

Objective: The establishment of a direct enteral feeding route is critical in the overall treatment of many patients with head and neck cancer. Use of radiologic percutaneous gastrostomy (RPG), the newest technique for gaining enteral access, has not been studied in such patients extensively. This study evaluated the indications, technique, success rate, and complications associated with RPG in patients with head and neck cancer. Study Design: Retrospective. Methods: A comprehensive chart review was undertaken of 56 patients with head and neck cancer treated at a tertiary care institution who had undergone successful or attempted RPG at some point during their treatment course. Results: Most study patients had advanced oropharyngeal squamous cell carcinoma. The most frequent indications for RPG were dysphagia/aspiration following tumor resection (n = 26) and dysphagia following completion of single‐ or combined‐modality therapy (n = 22). The success rate of attempted RPGs was 98.2%. The overall complication rate for RPG was 12.7% (10.9% minor and 1.8% major). Conclusions: RPG is a valuable tool for establishing enteral nutrition in patients with head and neck cancer. Advantages of RPG include high success rate despite obstructing lesions, low complication rate, time efficiency and scheduling ease compared with intraoperative percutaneous gastrostomy (PEG) by a second team, no reported tumor seeding of the tube site, and the fact that postoperative RPG allows for more accurate selection of patients who require a gastrostomy tube.

The efferent supply of the trapezius muscle: A neuroanatomic basis for the preservation of shoulder function during neck dissection†‡

The hypothesis that there is an alternative motor input to the trapezius muscle through cervical spinal nerves is evaluated through a review of the literature and through experimental studies performed by the author.

Predictive Factors for Functional Recovery after Free Tissue Transfer Oromandibular Reconstruction

BACKGROUND Recovery of upper aerodigestive tract function after reconstruction of segmental oromandiblectomy defects is frequently incomplete. The purpose of this study was to quantitate postreconstruction function and define variables that predict functional outcome in this population. METHODS A prospective study of 21 patients who underwent microvascular free tissue transfer reconstruction of segmental oromandibular defects was performed. Measures of swallowing, speech, bite, and oral intake were performed preoperatively and at 1, 3, 6, and 12 months postoperatively or until plateau. Preoperative versus maximal postoperative measures were compared and correlated with nine potentially predictive variables. Univariate and multivariate analyses were performed to determine the most significant predictive factors. RESULTS Baseline function in the study population was abnormal. Postoperative bite force improved, but swallowing, speech, and oral intake were worse than preoperative. Significant (univariate) predictors of outcome included diagnosis of cancer, tongue resection, pharynx resection, and flap skin paddle area. Only tongue resection remained significant in multivariate analysis. CONCLUSIONS Increasing need for oropharyngeal lining replacement, especially after tongue resection, is the most important predictor of functional outcome in reconstruction of segmental mandible defects.

Apneic anesthesia for improved endoscopic removal of laryngeal papillomata

During a 2‐year period at Indiana University Medical Center, nine patients underwent 51 endoscopic procedures employing the technique of apneic anesthesia for removal of papillomata involving the larynx.