James K. Masson

Desmoid tumors of the head and neck

Abstract The problem of desmoid tumor of the head and neck is somewhat different from that of desmoid tumor of the abdominal wall or the extremities. Because of the anatomic structure of the neck, this infiltrating, aggressive lesion can involve vital structures, thereby precluding its removal with an adequate border of normal tissue. Of thirty-four patients with desmoid tumor of the head and neck, twenty-two were treated primarily by surgical means alone, with no recurrence noted in five patients and with four lost to follow-up study. Surgical treatment plus irradiation was used primarily in eight cases, with no recurrence noted in three. Irradiation used alone as the primary treatment was successful in one of four cases. Of twentyone patients with thirty-seven recurrences, twelve had a single recurrence treated, four had two each, three had three each, and two had four each. Six patients have survived without further recurrence for periods varying from two to twenty-one years after surgical removal of their last recurrent tumor. One patient who had both surgical treatment and irradiation for his last recurrence has had no further trouble for twenty-six years. Five have survived without further recurrence three to twenty-six years after irradiation for their last recurrence. Of three deaths associated with recurrent tumor, one was proved at autopsy to be due to compression of the trachea. Malignant degeneration and metastasis were not demonstrated in this series.

Embryonal rhabdomyosarcoma of the head and neck. Report on eighty-eight cases.

Abstract Of eighty-eight patients with embryonal rhabdomyosarcoma of the head and neck, forty-eight were female and forty were male patients. Ages ranged from two weeks to seventy-seven years. Sixty-three were children (average age: 6.8 years) and twenty-five were adults (average age: 37.6 years). In nearly 60 per cent of patients the tumor occurred in the orbit, nasopharynx, or nose. The presenting complaint was usually that of a rapidly enlarging, asymptomatic mass. Half the patients had had evidence of the tumor for three months or less and only six had had it for more than a year on admission. Seventy-eight per cent of patients are known to have died as a result of the tumor, 49 per cent within the first year, 20 per cent in the second year, and 9 per cent within three to five years after admission. Eight patients (nine per cent) are known to be alive and free of disease twenty-one months to twenty years after admission, one patient (1 per cent) is alive with tumor metastasis, and ten (11 per cent) have been lost to follow-up study. Of the eight surviving patients assumed to be free of disease, one was treated by surgery alone, five by combined surgery and radiation, and two by radiation only. Histologically, the tumor often presents a varied pattern that in part may be readily confused with many quite dissimilar neoplasms, among which are reticulum cell sarcoma, neuroblastoma, myxoma, and amelanotic melanoma. An error in tissue diagnosis may be minimized by securing adequate and representative tissue for biopsy and by awareness of a chance encounter with such a lesion.

A review of 324 rhytidectomies, emphasizing complications and patient dissatisfaction.

The results and complications after 324 rhytidectomies, done between 1962 and the middle of 1973, were reviewed. The major complications were hematoma, skin slough, and facial nerve damage. In addition, respch as numbness of portions of the face, loss of hair, bothersome scarring, and general dissatisfaction with the operation. In general, these latter were of more concern to them than the major complications.

Treatment of chronic radiation injury over the shoulder with a latissimus dorsi myocutaneous flap.

We report our experiences in treating chronic radiation injury about the shoulder, a complication of radiation after mastectomy. Left untreated, these can result in chronic infection and/or amputation. The coverage of a large shoulder area presents certain unique problems, which severely limit the usefulness of traditional procedures. We have found that the remarkable size and versatility of the latissimus dorsi myocutaneous flap enables one to use it with relative simplicity and safety. A further great advantage is that it brings new permanent blood supply into this ischemic area, thus favoring rapid healing and durable coverage.

Experience with the deltopectoral flap.

The deltopectoral flap is a most versatile source of skin coverage or mucosal lining (or both). There is remarkable safety in the use of this flap in relation to its size, and there is only limited need for delay--because it pedicle is an axial flap. Nonetheless, the terminal part requires the attention to detail which any random flap requires--such as the avoidance of hematoma and infection and the prevention of tension, kinking, and angulation. This not only will ensure the safety of the flap, but also will prevent the rather common and annoying minor complications that delay the patients convalescence.

Xanthelasma: follow-up on results after surgical excision.

Xanthelasma palpebrarum is the most common xanthoma and is associated with other xanthomas or hyperlipemia syndromes in only 5 percent of the patients--even though one third of the affected patients have an elevated serum cholesterol level. Surgical excision is simple, safe, leaves minimal scarring, and will be definitive in more than half of the patients being treated for the first time. Reexcision may still be worthwhile if the xanthelasma recurs. However, recurrence is to be anticipated if all 4 eyelids are involved, if there is an underlying hyperlipemia syndrome, or if there has been more than one previous recurrence.

Silicone implants for contour deformities of the trunk.

A follow-up study of 12 patients who had preformed silicone implants inserted for correction of body contour deformities (8 for pectus excavatum and 4 for soft-tissue deformities of the shoulder and pectoral region) has demonstrated the safety of this technique and its lack of significant early or late complications. No implants have been removed, and 10 of the 12 patients regarded the overall results as good or excellent.

The banner flap.

Wide experience with the banner flap for closure of postsurgical defects of the nasal dorsum shows not only that it is a predictably safe and versatile procedure but also that its use enables a superior cosmetic result to be obtained. The operative technic is described in detail along with our clinical experience.

RESULTS OF RADICAL TREATMENT FOR INTRAORAL CANCER.

Abstract The records of 150 patients treated with combined operations for intraoral cancers were reviewed with emphasis on correlation between prognosis and age, presence or absence of histologically positive nodes, grade of neoplasm, and previous treatment. The three year survival rate was 48 per cent and the five year survival rate was 40 per cent. Of those patients succumbing with uncontrolled local disease, 89 per cent died in less than three years after operation. The close agreement of the three year and five year survival rates, together with the high percentage of deaths from the disease within three years, suggests that three year survival rates are as reliable as five year survival rates in this disease. Survival rates were significantly less than the over-all average for patients in the following categories: patients less than fifty years of age, patients having histologically proved metastatic involvement of lymph nodes, patients having higher grade tumors, and patients who had had previous roentgen therapy to the primary lesion. Mortality and morbidity were not excessive and deformity was surprisingly minimal. If, in the future, the surgeon can proceed with radical surgery at an earlier stage in the disease, even more promising survival rates may be attained.

Use of muscular, musculocutaneous and omental flaps to reconstruct difficult defects.

These recently popularized flaps make reconstruction of some difficult defects possible in a single operation, with surprisingly good results. They have significant advantage over free flaps (except, perhaps, in the hands ofa few experts) because the chance of failure is considerably less. We do not propose that these flaps be used instead of local tissue (when available), or instead of split-skin grafting (when an appropriate bed exists). Additionally, in some instances, the use of muscle flaps would result in a significant loss of function. However, in suitable cases their use is a rewarding addition to the peviously available methods reconstruction.