Fred J. Stucker

Perineural invasion in skin cancer of the head and neck: A review of nine cases☆

PURPOSEnTo review the management and outcome of skin cancer of the head and neck with perineural invasion, a relatively uncommon and complex condition, in nine patients treated between 1965 and 1991.nnnPATIENTSnSeven patients had skin cancers that were larger than 2 cm. All lesions were moderately or poorly differentiated. Curative surgery was performed in all nine cases, with or without radiotherapy.nnnRESULTSnLocal recurrence or regional disease appeared in three individuals; surgical salvage produced satisfactory results. At last follow-up (median, 45 months; range, 18 to 201 months), no one had developed intracranial or skull base metastasis; lung cancer was detected in one patient. The crude survival rate was 33% at 5 years and 22% at 10 years. The median survival was 25 months in patients who presented with neurologic symptoms and was 49 months in asymptomatic persons.nnnCONCLUSIONnAlthough the prognosis in patients with skin cancer of the head and neck complicated by perineural invasion is expectedly poor, long-term disease-free survival is attainable with the use of aggressive therapy.

Laryngotracheoesophageal Cleft: The Anterior Approach:

Laryngotracheoesophageal cleft was reported by Richter in 1792 after he examined an infant at autopsy and found a common lumen of esophagus and laryngotrachea. The next case was not noted until 1949 by Finlay. A recent review shows 40 cases in the world literature to date. Successful surgical approaches to some of these problems have basically employed a lateral pharyngotomy technique. In the case presented herein, the exact pathology was obscured by a severe tetralogy of Fallot and recurrent pneumonitis from a suspected high H-type tracheoesophageal fistula. The length of this cleft prompted an anterior approach with laryngo-fissure, cricoidotomy, and division of four tracheal rings for a complete and successful repair. Thorough endoscopy of all infants suspected of any laryngeal anomaly would yield an earlier diagnosis and opportunity for reconstruction of the cleft.

A pilot study of quantitative aspiration in patients with symptoms of obstructive sleep apnea: Comparison to a historic control group

Objective: It has been shown that many healthy people aspirate secretions at night. Patients with obstructive sleep apnea (OSA) have frequent episodes of gasping at night that may predispose them to aspiration. The purpose of this study was to determine whether patients with symptoms of OSA are predisposed to pharyngeal aspiration.

Rhinophyma: A New Approach to Hemostasis

Rhinophyma is a benign tumor of the nose. It possesses both functional and cosmetic implications. The pathophysiology of the disease is reviewed to illustrate the basis for the treatment options. Many different therapeutic modalities have been reported in the literature, each with reasonable success. A new treatment approach to this condition is developed using a combination of the Weck blade and the argon beam coagulator. This modality is found to be relatively simple and less traumatic than all the other techniques used by the senior author.

The ABCs of rhinophyma management

Background Rhinophyma is a benign inflammatory growth of the nose. It usually involves the caudal one-third of the nose in men. It not only affects the patients appearance, but also can have profound functional implications. Many difficult treatment methods have been advocated, often with acceptable success. Because there appears to be no distinct advantages in the different therapeutic modalities, no one modality is universally endorsed. Methods We performed a retrospective review of patients from 1990–2001 who underwent treatment of their rhinophyma at Louisiana State University, Health Science Center and Overton Brooks Veterans Hospital in Shreveport, LA. The tumescent anesthesia, Weck blade excision and argon beam coagulator technique (TWA) was used on 51 patients. Results Patients undergoing this technique have operating times no greater than ten minutes. The average blood loss was less than 5cc. No surgical complications were noted. Conclusion The TWA technique yields good cosmetic results and is cost-effective.

Management of severe bilateral nasal wall collapse

Objective The aim of this study was to examine and analyze the pathology contributing to severe bilateral nasal wall collapse seen in certain revision rhinoplasty patients and identify those surgical maneuvers in the previous nasal surgery, which may have contributed to this complication; suggest alternatives or modifying steps in nasal surgery to prevent lateral wall collapse; analyze consecutive revision rhinoplasties and identify those patients who have complete bilateral nasal collapse at the internal nasal valve; and analyze the results achieved after surgical reconstruction of complete bilateral nasal collapse. Patients We identified 49 patients, who presented from 1990 to 2000 for revision surgery, who had bilateral collapse of the upper lateral cartilage. All patients had at least one previous rhinoplasty and all but 14 patients had undergone two or more procedures. The patients were reconstructed with a conchal cartilage graft placed through an external rhinoplasty approach. Results All patients complained of nasal obstruction with forced nasal inspiration. The collapse was visualized on inspiration and when prevented with intranasal positioning of a bayonet, all patients experienced an immediate improvement in nasal breathing. Postoperatively, all patients experienced this same improvement in their nasal airway. Collapse was not identified in any of the patients after surgery. Two patients underwent revision because of cosmetic asymmetries. Conclusion We strongly recommend a cartilage overlay to reconstitute the rigid midline continuity of the upper lateral cartilages. Unfortunately, with any significant hump removal, this structural interruption is, to varying degrees, inevitable in most rhinoplasty techniques. The upper lateral cartilages can be sutured to circumvent some of the inferior drift, but this will not reconstitute the rigid lateral cantilever effect of the intact cartilage.

Rhinoplasty from the Goldman/Cottle schools to the present: a survey of 7447 personal cases.

Background To review the personal experience of a single surgeon over a 31 year period. Method A retrospective analysis of 7447 rhinoplasties performed by a single surgeon from 1969 to 2000. Ninety-five surgeries performed at educational courses were excluded from this series. Results During the many years of performing rhinoplasties, cartilage splitting, delivery, and external approach are among the most common techniques. In the first decade, 62% were cartilage splitting, 33% delivery, and 3% external. In the second decade, 13% were cartilage splitting, 58% delivery, and 26% external. In the third decade, 11% were cartilage splitting, 52% delivery, and 36% external. Conclusion Over a three-decade period, the techniques of the author have been influenced by national trends, training, and patient outcomes.

The Strategy of Combining Multiple Procedures in Facial Plastic Surgery

Howard A. Tobin, MD, of Abilene, Tex, reported at the recent meeting of the American Academy of Facial Plastic and Reconstructive Surgery held in Denver his recommendation for combining multiple plastic surgical procedures. He noted that only rarely do patients request all those procedures that will enhance their overall appearance. Dr Tobin believes that the consultant has an obligation to raise the patients level of sophistication to know that multiple ancillary plastic surgical procedures are available. Dr Tobin often combines three or four procedures, which may include all or various combinations of face lift, blepharoplasty, nasal surgery, chin implant, liposuction, coronal lift, or malar implant. He is particularly enthusiastic about recommending the use of malar implants. Dr Tobin cites the economy of time and expense as major reasons for combining multiple procedures.