Joseph H. Ogura

Evaluation and treatment of vocal cord paralysis.

One hundred eighty‐one patients with unilateral or bilateral vocal cord paralysis unrelated to laryngeal carcinoma or its therapy were studied. The orderly diagnostic profile used to delineate cause of the paralysis includes CBC, VDRL blood sugar profile, latex fixation and serum sampling for toxic heavy metals. The radiologic and endoscopic evaluation is done to completion unless contraindicated, to assess aspiration as well as to observe laryngopharyngeal structures which may cause the paralysis. This evaluative profile defined the etiology of cord paralysis in 80 percent of patients, despite exclusion of viral disease as a cause subsequent to upper respiratory infection. Blunt trauma and previous neck surgery each were responsible for 23 percent of the cases. Fifty‐four patients had bilateral paralysis of which 22 were post thyroidectomy. Surgical repair for cord paralysis was symptomatic, and included 28 successful teflon injected cords. Recurrent laryngeal nerve decompression was successful in four of five operations and arytenoidectomy was performed in 39 patients.

Frontal sinus disease. II. Development of the frontal sinus model: occlusion of the nasofrontal duct.

The history of the surgical treatment of frontal sinusitis and mucocele is a reflection of the uncertainty surrounding its pathogenesis. Since the pioneer work of Coates, Hilding, Proetz, and Walsh over three decades ago, two principal etiologic factors are usually accepted: obstruction of the nasofrontal duct, and mucosal inflammation; however, no one has been able to obstruct reliably the nasofrontal duct in an experimental model (e.g., canine) to see whether such a blockage would actually incite infection or a mucocele. In addition, all previous work was performed from within the sinus cavity.

Presurgical internal maxillary artery embolization in juvenile angiofibroma

Embolization of the internal maxillary artery with barium impregnated silastic spheres was performed in four patients with juvenile angiofibroma of the nasopharynx. Three of the cases were done prior to the initial surgical resection to reduce operative hemorrhage. The fourth case was a postoperative recurrence, and embolization was performed to evaluate the clinical response of the tumor. The technical aspects of the procedure, the rationale for embolization and pertinent literature are reviewed.

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).

The anterior commissure in glottic carcinoma

The laryngeal anterior commissure is a specific anatomic area of the glottis which is often involved by cancer. Of 586 patients with glottic cancer, five (1 percent) had pure anterior commissure lesions and 175 (25 percent) had vocal cord tumors secondarily involving the anterior commissure. One of three of these anterior commissure tumors also had subglottic extension. Despite the presence of blood vessels and lymphatics in the anterior commissure, metastasis to regional lymph nodes in rare (8 percent). Patients with Stage 1 and 2 lesions were treated by hemilaryngectomy with satisfactory results (45/61 — 74 percent). Only three patients had local recurrence after hemilaryngectomy. Patients with bilateral cord‐anterior commissure lesions had the poorest survival and highest recurrence rate, even after total laryngectomy. Subglottic extension of these anterior commissure tumors did not correlate with survival. Survival and recurrence rates were conversely proportional to the stage of the tumor at presentation. Although the anterior commissure is a theoretical site for cancer breakthrough and lymphatic spread, its apparent significance lies in the fact that its involvement by glottic primaries represents only increasing tumor size and thus an advanced stage of disease.

Clinical experiences in hyoid arch transposition

Autogenous hyoid bone grafts for the repair of subglottic stenosis have been used successfully in canine experiments. This technique was subsequently modified for human use, and the experience in six patients over the past year at Washington University is reported. In five of the six patients, satisfactory results were obtained. Several case reports are included, and the surgical procedure is described in detail.

Angiofibroma: A treatment approach

A systematic treatment approach for nasopharyngeal angiofibromas is presented. Surgery, as the primary treatment modality is advocated. Routine pre‐operative angiography is utilized for diagnosis and delineation of tumor extent. The surgical approach or approaches is dependent upon the tumor extent.

Neurologic implications of glomus tumors in the head and neck

Seventy‐six patients with glomus tumors were evaluated. The incidence of cranial nerve paralysis is 37 percent and the incidence of intracranial extension is 14.6 percent. Jugular foramen syndrome is associated with 50 percent, and hypoglossal nerve involvement with 75 percent incidence of posterior fossa extension. Horners syndrome is associated with 50 percent of middle cranial fossa invasion. The incidence of CNS tumor involvement with cranial nerve paralysis (not including VIIth nerve) is 52 percent.

Total glossectomy for advanced carcinoma of the base of the tongue

The treatment of patients with advanced carcinoma of the base of the tongue is difficult. Selected patients with this lesion can be aided by an aggressive therapeutic approach to this problem. Combined therapy consisting of irradiation therapy followed by composite resection of the entire tongue and larynx and neck dissection may offer the best opportunity for cure or palliation in these patients. Reconstruction of the defect with a non‐delayed full forehead flap has provided a very satisfactory floor of the mouth. The postoperative functional abilities of these patients have clearly been compatible with useful life.

Neurorrhaphy of the recurrent laryngeal nerve.

The authors have experimentally performed neurorrhaphy and its modifications and nerve grafting with end‐to‐end anastomosis of the recurrent laryngeal nerve in dogs.