George F. Reed

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.

Voice change after radiotherapy. Some preliminary results.

A one-third octave spectral analysis was performed on two sentences spoken by 5 patients with laryngeal cancer, 5 with head/neck cancer not involving the vocal cords, and 12 normal subjects. Recordings were made prior to and at weekly intervals during radiotherapy as well as at periodic intervals post-treatment. Patients with laryngeal cancer exhibited lower spectral levels than normal throughout radiotherapy as well as several months post-treatment. By one year after treatment, the spectral levels of these patients were largely in the normal range. Patients with head/neck cancer not involving the vocal cords exhibited greater than normal sound pressure levels throughout most of the spectrum. These levels remained high even at one month post-treatment. Irradiation of normal vocal cord tissue also seems to result in higher spectral levels.

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.

Recurrence as a mode of determining efficacy in treatment of carcinoma of the larynx

A study population of 374 patients with cancer of the larynx was evaluated, treated, and followed at yearly intervals up to a maximum of 18 years post‐diagnosis. Of these, 348 received definitive therapy to attempt to eradicate their disease and were followed for recurrence and presence of cancer at death. In Stages I, II, and III recurrence of disease appears to be a very good indicator of therapeutic efficacy. Stage I carcinomas of the larynx should be treated with radiation as the proportions of patients with recurrences were the same for both primary surgical or radiation therapy. In Stages II and III, primary surgical therapy significantly lowered the proportion recurring when compared with primary radiation therapy. In Stage IV carcinomas of the larynx, both survival and recurrence accurately reflect therapeutic efficacy since most patients suffer recurrence of their carcinoma and die of the disease.

Massive surgery for palliation in malignancy of the head and neck

Since World War II, major advances in surgical management and life support have made possible operative procedures that could not have been undertaken previously. As a result of these encouraging developments, it has become apparent that the possibilities for palliative surgery now demand our attention and should be considered along with radiotherapy, chemotherapy, cryosurgery, and immunotherapy as suitable management of the patient with advanced malignancy.

Eighth Daniel C. Baker, Jr, Memorial lecture. Subcertification: a dilemma for otolaryngology--head and neck surgery.

The issue of subspecialization and subcertification has been one of great concern for many years and has recently received increased attention, especially in our specialty of Otolaryngology-Head and Neck Surgery. The problem being faced by the various specialties and their boards is not so much that of subspecialization, since this has definitely occurred in most of the specialties and today is an accepted fact. More specifically, the problem is that of subcertification, or some form of recognition of the subspecialists advanced training, knowledge and expertise. This matter is indeed creating a serious dilemma, not only for Otolaryngology-Head and Neck Surgery but for most of the specialties. On the one hand, the specialists are concerned about fragmentation of the parent specialty while, on the other hand, there is a growing demand for recognition by those individuals who feel that they have acquired special competence in their areas of subspecialization.

Book Review: Human Larynx-Coronal Section AtlasHuman Larynx-Coronal Section Atlas By TuckerGabriel F.Jr., M.D., Soft cover, illustrated, bibliography. Published by the Armed Forces Institute of Pathology. Can be purchased from the American Registry of Pathology.

This Atlas, authored by Dr. Tucker and published by the Armed Forces Institute of Pathology, is a superb contribution to the field of laryngology. For the first time, serial sections of a human larynx in the coronal plane is available in book Form for unhurried and detailed study. The normal larynx is presented at 37 different levels spanning the distance from the thyroid notch through the posterior plate of the cricoid. Each level is represented not only in the usual hematoxylin eosin stain but also in V & E (elastic stain). In many areas of special interest, views at higher magnification are provided.