H. Bryan Neel

Laryngofissure and Cordectomy for Early Cordal Carcinoma: Outcome in 182 Patients

At the Mayo Clinic from 1962 to 1974, 182 patients with early squamous cell cancer of the true vocal cord were treated by laryngofissure and cordectomy. Seven patients (4%) had recurrences: four in the larynx and three in the neck (although the larynx was free of disease). The case histories of these patients are reported. Only three (2%) of the patients died as a consequence of their laryngeal cancer. The data substantiate our belief that the laryngofissure and cordectomy operation, and its minor variations, is an expeditious and highly successful means of eradicating glottic cancers.

Wegener's Granulomatosis of the Subglottis and the Upper Portion of the Trachea:

A relatively little-known complication of Wegeners granulomatosis is involvement of the subglottis and upper part of the trachea, which is illustrated in this report on 17 patients. Each of the patients had biopsy-proved Wegeners granulomatosis of the nose and paranasal sinuses. Some had concomitant involvement of the eye, kidney, lung and skin. Nine of the 17 patients required tracheotomy; 5 still require a tracheotomy tube, and 4 have had decannulation (1 had successful reconstructive surgery of the trachea). Medical treatment consisted of cyclophosphamide, with or without corticosteroids. All 17 are currently alive, the average follow-up having been 81 months. The otolaryngologist plays a key role in the detection and management of patients with Wegeners granulomatosis, particularly when the onset is a sudden progressive upper tracheal obstruction with airway symptoms that may overshadow the sometimes more subtle nasal manifestations.

Nasal Manifestations of Allergic Granulomatosis and Angiitis (Churg-Strauss Syndrome)

A postauricular mastoid cutaneous fistula may be a complication of chronic ear disease or ear surgery or both. Simple closure is often unsuccessful because of the necrotic skin edges, and it may result in a larger fistula. This paper illustrates a method of closing a large postauricular mastoid cutaneous fistula. The steps include excising the fistula, everting the mastoid epithelium toward the external auditory meatus, covering the undersurface of the everted skin edges with an anteriorly based periosteal flap, covering the flap with bone paté, placing a free graft of abdominal fat, and closing the defect with a rotational skin flap. This technique closes the fistula and obliterates the mastoid cavity.

Laryngeal Sarcoidosis Report of 13 Patients

Of 220 patients with sarcoidosis of the head and neck region, representing 9% of 2,319 patients with sarcoidosis seen at the Mayo Clinic from 1950 through 1981, we identified 13 who had laryngeal sarcoidosis. Edematous, pale, diffuse enlargement of the supraglottic structures was the most common laryngeal manifestation. The diagnosis is made by a group of clinical, radiologic, and laboratory findings, confirmed by the finding of noncaseating granuloma on biopsy. Sarcoidosis is a disease with frequent remissions and exacerbations and generally burns itself out; glucocorticoids may be indicated in particularly severe disease. When laryngeal sarcoidosis is suspected, the laryngologist should collaborate with other clinicians in a thorough evaluation of the patient.

Antibodies to Epstein-Barr Virus in Patients with Nasopharyngeal Carcinoma and in Comparison Groups

One hundred fifty-one patients with nasopharyngeal carcinoma (NPC) were enrolled in a prospective collaborative study of North American patients (most were white). Serum samples were collected concurrently from 903 Mayo patients for comparisons of serologic analyses. Both IgA antiviral capsid antigen [VCA (IgA)] and the anti-early antigen [EA (D)] antibody responses were associated with diagnosis, but not always in the same way. Both responses were positive in 85% of patients with World Health Organization types 2 and 3 NPC. Only 16 % with WHO type 1 NPC had positive IgA responses and only 35% had positive EA (D) responses, prevalences close to those in the comparison groups. Increased titers were found in the squamous carcinoma comparison group with tumors of the tongue and in the group with benign nasal polyps (p<0.01). We believe that the tests are specific, sensitive, and useful in diagnosis and treatment planning in patients with NPC, particularly those with occult primary NPC.

Neural and Neuroendocrine Tumors of the Larynx

Benign and malignant neural and neuroendocrine tumors of the larynx are uncommon enough that knowledge about them is sparse, coming from single case reports and literature reviews. We have reviewed the clinical behavior, pathologic findings, treatment, and outcome in 42 patients seen at one institution from 1907 to 1986. In some cases, electron microscopy or immunocytochemistry, or both, may be needed to reach the correct diagnosis. Treatment is largely determined by the histopathologic features, size, and location of the tumor. The most common sites are the supraglottic region and posterior larynx. Most tumors are treated by conservation surgery, including transoral excision; however, some are aggressive and require larger surgical procedures, including wide-field laryngectomy and complete neck dissection.

Cryosurgery of respiratory structures. I. Cryonecrosis of trachea and bronchus

Although extirpative surgery is the mainstay of treatment of tumors of the trachea and bronchial tree, other methods for cure or palliation of neoplasms in these structures should be explored. The present study was designed to assess, in dogs, 1. the pathophysiologic effects of complete circumferential cryonecrosis of a segment of trachea, and 2. the feasibility of performing cryosurgery within the distal tracheobronchial tree through a bronchoscope.

Malignant melanoma of the oral cavity: Review of 10 cases†‡

Oral malignant melanoma is uncommon, comprising less than 1% of all malignant melanomas. Consequently, few cases have been reported from any one institution. We report 10 cases of malignant melanoma of the oral cavity seen at the Mayo Clinic between 1905 and 1979.

Choanal Atresia: Treatment Trends in 47 Patients over 33 Years

From 1977 through 1985, 11 patients underwent surgical correction of choanal atresia. This group brings the total number of patients corrected at our institution since 1951 to 47. This review compares treatment and outcome in the most recent group with the previous series of 36 patients. Eight patients were female and three were male; their ages at the time of surgical treatment ranged from 1 day to 19 years. The atresia was bilateral in five patients and unilateral in six. Six patients had other physical or mental developmental problems. Mean follow-up was 5.6 years (range, 2 to 10 years). All five patients who had transnasal puncture as primary treatment required reoperation; this is a higher incidence of failure than in the previous group. None of the three patients who had transpalatal procedures needed further operation. In two of the eight patients who had transseptal repair, restenosis developed.

Cryosurgical Control of Cancer: Effects of Freeze Rates, Tumor Temperatures, and Ischemia:

These studies in mice show that, in order to control malignant tumors consistently by cryosurgery, it is important to utilize low probe-tip temperatures, large probe lip-to-tumor contact surfaces or liquid nitrogen sprays, repetitive probe applications, spontaneous thaw between freezes, freezing to tumor temperatures below −30° C, and rapid rates of freezing. In the experimental tumor-host system, ischemia induced either by local administration of pharmacologic doses of epinephrine or by temporary clamping significantly potentiated heat extraction as reflected in tumor control and the time course of recurrences. The effects of ischemia are seen primarily in the thaw portion of the freeze-thaw cycle, during which time spontaneous thawing is consistently prolonged.