J. Gershon Spector

Delayed Regional Metastases, Distant Metastases, and Second Primary Malignancies in Squamous Cell Carcinomas of the Larynx and Hypopharynx†

Objective To determine the impact of delayed regional metastases, distant metastases, and second primary tumors on the therapeutic outcomes in squamous cell carcinomas of the larynx and hypopharynx.

Allergic aspergillus sinusitis: Concepts in diagnosis and treatment of a new clinical entity

The clinical features in 15 young adult patients with allergic Aspergillus sinusitis includes a history of asthma, recurrent nasal polyps, and radiographic evidence of pansinusitis. Multiple surgical procedures were performed on 12 patients.

Long-term follow-up and recent observations on 305 cases of orbital decompression for dysthyroid orbitopathy

Dysthyroid exophthalmopathy (orbitopathy) results from an enlargement of extraglobal orbital structures, producing ocular proptosis, optic nerve compression, and corneal exposure. Treatment with corticosteroids and radiation may be beneficial; refractory cases require surgical decompression of the orbit. Transantral orbital decompression was described by Walsh and Ogura and has been performed in over 350 patients at this institution. A review of 305 patients with long‐term follow‐up was performed. Visual acuity improved or was maintained ut preoperative levels in over 95% of the patients, with ocular recession ranging from 1 to 12 mm (average: 4 mm). Postoperative ocular balance of relative exophthalmos was to within 1 mm in 76% of the patients and to within 2 mm in approximately 90% of the patients. Normal postoperative extraocular muscle balance was present in 99 patients. Immediate postoperative diplopia was noted in 206 patients. Long‐term follow‐up revealed that in 137 of these patients, diplopia resolved or responded to conservative management. Extraocular muscle surgery was required for correction in 69 patients. Twenty‐seven patients had postoperative complications. These included 16 patients with hypesthesia of the infraorbital nerve, 5 patients with sinusitis, 3 patients who had incomplete decompression, 2 patients with oral antral fistulae, and 1 patient who had CSF rhinorrhea. Five patients, despite surgery, radiation, and steroid therapy progressed to blindness. We conclude that this procedure is effective and carries few complications. Orbital imaging, using computed tomography or magnetic resonance sequence with reconstructive capabilities, permits early diagnosis and treatment of dysthyroid compression optic neuropathy.

Management of stage II (T2N0M0) glottic carcinoma by radiotherapy and conservation surgery.

The best therapeutic approach for the treatment of stage II (T2N0M0) glottic carcinoma is controversial.

Iv. multiple glomus tumors in the head and neck

Eight of 76 glomus tumors in the head and neck region are multiple. The most common association is with carotid body tumors; the most common pattern is an ipsilateral glomus tympanicum and carotid body tumor. The approach to clinical evaluation is based on a complete otolaryngologic, neurologic, and neuroradiologic evaluation of all patients with glomus tumors. The rationale for priorities in management is the resection of the most dangerous lesion first. This study confirms the previous observations that glomus tumors have a definite proclivity for multicentricity (10 percent) and a high incidence for other associated malignancies (8 percent).

Management of temporal bone carcinomas: A therapeutic analysis of two groups of patients and long-term followup

Fifty-one patients with squamous cell carcinomas arising within the temporal bone were subdivided into two groups. The initial group of 17 patients, seen between 1960 and 1980, were reviewed retrospectively and staged into four subgroups on the basis of initial tumor presentation and location (i.e., external auditory canal, superficial invasion, deep invasion, and tumors beyond the temporal bone). After treatment in a variety of surgical and radiotherapeutic combinations, the 5-year cure rates were: 70%, 70%, 50%, and 9%, respectively. Thirty-four patients, seen between 1980 and 1989, were placed in a new prospective protocol for combined surgery and postoperative irradiation. These patients were subdivided into the same subgroups on the basis of tumor location. The surgical procedures were formalized to be more encompassing (i.e., external canal tumors were treated by sleeve resection of the internal auditory canal and tympanic membrane, superficial invasion by superficial temporal bone resection, deep tumors by radical temporal bone resection, and those beyond the temporal bone by an infratemporal fossa approach). Radical neck dissections were performed where needed. The irradiation dosage was increased to 6250+ cGy, with a 4:1 ratio in favor of electrons for deeper penetration, and the fields were widened. At 36.6-month average followup, the cure rates were: 100%, 100%, 70%, and 65%, respectively. Six of ten patients with neck metastases at presentation had tumor recurrence or distant disease (60%).

Rabbit facial nerve regeneration in NGF‐containing silastic tubes

Previous reports suggest that exogenous nerve growth factor (NGF) enhanced nerve regeneration in rabbit facial nerves.1 Rabbit facial nerve regeneration in 10‐mm Silastic® tubes prefilled with NGF was compared to cytochrome C (Cyt. C), bridging an 8‐mm nerve gap. Three weeks following implantation, NGF‐treated regenerates exhibited a more mature fascicular organization and more extensive neovascularization than cytochrome‐C‐treated controls. Morphometric analysis at the midtube of 3‐ and 5‐week regenerates revealed no significant difference in the mean number of myelinated or unmyelinated axons between NGF‐ and cytochrome‐C‐treated implants. However, when the number of myelinated fibers in 5‐week regenerates were compared to their respective preoperative controls, NGF‐treated regenerates had recovered a significantly greater percentage of myelinated axons than cytochrome‐C‐treated implants (46% vs. 18%, respectively). In addition, NGF‐containing chambers reinnervated a higher percentage of myelinated axons in the distal transected neural stumps (49% vs. 34%).

Management of T3N1 Glottic Carcinoma: Therapeutic Outcomes

Objective: The aim of the current study was to determine the best total laryngectomy (TL) approach to the treatment of T3N1 glottic cancer, to study the impact of early nodal disease on stage III glottic cancers, and to describe the preliminary results in a group of patients recently treated for laryngeal preservation (LP).

Parotid masses: Evaluation, analysis, and current management

Two hundred thirty‐one sequential parotid masses seen from January 1982 to July 1986 were reviewed for their clinical presentation, diagnostic evaluation, pathologic findings, and therapeutic approach. The results were compared with the previously reported findings on parotid masses.

Comparison of Rabbit Facial Nerve Regeneration in Nerve Growth Factor-Containing Silicone Tubes to that in Autologous Neural Grafts

Previous reports suggest that nerve growth factor (NGF) enhanced nerve regeneration in rabbit facial nerves. We compared rabbit facial nerve regeneration in 10-mm silicone tubes prefilled with NGF or cytochrome C (Cyt C), bridging an 8-mm nerve gap, to regeneration of 8-mm autologous nerve grafts. Three weeks following implantation, NGF-treated regenerates exhibited a more mature fascicular organization and more extensive neovascularization than Cyt C-treated controls. Morphometric analysis at the middle of the tube of 3- and 5-week regenerates revealed no significant difference in the mean number of myelinated or unmyelinated axons between NGF- and Cyt C-treated implants. However, when the numbers of myelinated fibers in 5-week regenerates were compared to those in their respective preoperative controls, NGF-treated regenerates had recovered a significantly greater percentage of myelinated axons than Cyt C-treated implants (46% versus 18%, respectively). The number of regenerating myelinated axons in the autologous nerve grafts at 5 weeks was significantly greater than the number of myelinated axons in the silicone tubes. However, in the nerve grafts the majority of the axons were found in the extrafascicular connective tissue (66%). The majority of these myelinated fibers did not find their way into the distal nerve stump. Thus, although the number of regenerating myelinated axons within the nerve grafts is greater than that of axons within silicone tube implants, functional recovery of autologous nerve graft repairs may not be superior to that of intubational repairs.