Gary L. Schechter

Changing face of treatment of peritonsillar abscess.

Changing trends in the treatment of peritonsillar abscess are demonstrated by this retrospective study of 74 patients treated from 1975 through 1980 by a standardized regimen. This included needle aspiration at three points, intravenous antibiotics, hydration, and pharyngeal douches. The patients ages ranged from 11 to 73 years. There were 45 males and 29 females. Needle aspiration was positive in 52 patients (70%) and repeat aspiration was necessary in 10% of patients. Tonsillectomy was performed in 42 patients. No recurrent peritonsillar abscesses occurred during the 1 to 5 year follow-up of the 32 patients who did not have tonsillectomy. Recurrent tonsillitis did occur in 4 of these patients and 3 of them had a past history of recurrent tonsillitis. The authors conclude that treatment of peritonsillar abscess should consist of needle aspiration, intravenous antibiotics and supportive measures. Interval tonsillectomy should be performed only when there is a history of recurrent tonsillitis or previous peritonsillar abscess.

Management of panesophageal cancer by blunt resection without thoracotomy and reconstruction with stomach.

Encouraged by their experience since 1978 with blunt esophagectomy and gastric reconstruction in the management of pharyngolaryngeal malignancy, the authors have extended their use of this technique to the management of thoracic esophageal cancer. A study of 43 blunt esophageal resections is presented; 23 were performed in the management of pharyngolaryngeal cancer, and 20 were performed (22 attempted) for the resection of intrathoracic esophageal cancer. In the first group, two deaths occurred secondary to liver failure in cirrhotic patients with moist ascites. One death occurred due to anastomotic leak in the neck of a patient with laryngeal cancer treated with extended mediastinal dissection and tracheal resection for surgical and radiation failure. Two tracheal injuries occurred; one could be managed through the neck, and one required thoractomy for repair. In the 20 resections performed for intrathoracic cancer, there were no deaths, no tracheal injuries, and one chest was explored for bleeding in the splenic bed, which decompressed itself into the right chest. The overall mortality was 7.5%. The evaluation emphasizes: The applicability of this technique for the management of esophageal problems at all levels. The safety of the technique, particularly in the typical population with advanced aged and severe underlying medical illness. Good functional results with palliation and/or cure. The benefit of intact mediastinal pleura in avoiding certain thoracic complications. The authors conclude that blunt esophagectomy is a safe resection procedure with limited morbidity and mortality, and that gastric reconstruction is reliable and affords excellent functional results. They are encouraged to continue management of panesophageal cancer with this technique.

Epiglottic reconstruction and subtotal laryngectomy

Vertical hemilaryngectomy has been expanded aggressively in recent years so that, in some cases, the term subtotal laryngectomy would be more appropriate. Reconstruction after these extended resections is a problem. Intraluminal stenting has not been successful in cases where resection has been aggressive. The resulting lumen is inadequate. As a means of overcoming this problem, the epiglottic reconstruction procedure has been promoted. This paper presents experiences with 12 patients who underwent epiglottic reconstruction after subtotal laryngectomy. Indications, anatomic details, and overall results using this reconstructive technique are outlined. It is the conclusion of the author that epiglottic reconstruction is an effective procedure for preservation of function after subtotal laryngectomy.Vertical hemilaryngectomy has been expanded aggressively in recent years so that, in some cases, the term subtotal laryngectomy would be more appropriate. Reconstruction after these extended resections is a problem. Intraluminal stenting has not been successful in cases where resection has been aggressive. The resulting lumen is inadequate. As a means of overcoming this problem, the epiglottic reconstruction procedure has been promoted.

Combined treatment of advanced cancer of the laryngopharynx and cervical esophagus

Advanced cancer of the laryngopharynx and cervical esophagus is difficult to treat because of the malnutrition produced by pain and obstruction and the problems related to reconstruction. This paper presents the initial results of a regimen used in 14 patients in which there is rapid reversal of nutritional deficiencies, radical resection, and reconstruction using the gastric pull‐up technique and administration of postoperative radiotherapy. Excellent overall palliation and decreased hospitalization have been achieved using this regimen without diminishing chances for cure.

Free jejunal transfer for the reconstruction of pharyngeal and cervical esophageal defects.

Free jejunal transfer is a useful alternative for the reconstruction of defects of the pharynx and cervical esophagus. We describe 17 patients who received free jejunal grafts between 1980 and 1984 at the Eastern Virginia Medical School. The rationale and indications for the procedure are discussed. We emphasize certain technical considerations and improvements.

Maintaining quality in a discount store arena.

The following was presented as the Presidential Address at the 37th Annual Meeting of the American Society for Head and Neck Surgery. Your leaders have spent the majority of this past year planning more of the product that has distinguished this organization from its inception, namely, education. This has been accomplished with an increasing awareness of the changes, both real and perceived, that are on us. Relative to these changes, I wish to set the tone of this meeting by conveying my view of the course we have traveled, the course we are on, and a warning about the currents and shoals that will affect our journey in the future. Each day, all of us are asked to don a cloak of change unlike any we have worn. In accepting this garment, we are asked to bring about the greatest change in patient care that has been seen in the