Leon F. Davis

Computed tomography and magnetic resonance imaging of cervical metastasis.

Thirteen patients with head and neck cancer underwent staging by clinical examination, computed tomography (CT), and magnetic resonance imaging (MRI) in a standardized blinded fashion. All patients subsequently underwent radical neck dissection with subsequent pathologic staging. CT and MRI each predicted 93% of staging results correctly, with clinical examination correct 67% of the time. Staging of primary tumors had an accuracy of 90% by clinical examination, 40% by CT, and 50% by MRI when compared to staging of the pathologic specimen. Understaging was seen in 50% of CT scans and 30% of MRI scans. We believe either CT or MRI should be considered for routine staging of the neck in all head and neck malignancies.

Problems in evaluation of penetrating foreign bodies with computed tomography scans: Report of cases

Computed tomography is the best radiologic modality available in the evaluation of penetrating injuries to the soft tissues. The technique is the best available when the foreign body has a density similar to the surrounding tissues. Limitations of CT scanning include difficulty in identifying small foreign bodies, objects with densities similar to surrounding structures, and detecting vascular injury. Interpretation of postoperative changes is also difficult. Two cases have been presented to illustrate the advantages, and limitations of CT scanning in penetrating soft tissue trauma.

Trephine technique to obtain cancellous bone

The ilium is a common donor site for autogenous cortical, cancellous, and corticocancellous bone used for reconstructive, orthognathic, and augmentation procedures in oral and maxillofacial surgery. This site is useful because of the ease of operation and the fact that all three types of bone are available in sufficient quantities. The major limitation is the significant morbidity associated with the practice of stripping the gluteus medius and gluteus maximus muscles from the ilium, leading to considerable discomfort and hampered ambulation following surgery. While an approach through the inner table has less morbidity, pain remains significant and there is risk of ileus, viscus perforation, or internal hernia. In selected cases in which limited amounts of cancellous bone and marrow are needed, such as for alveolar cleft grafts, we have been using a 7mm-diameter Michelle trephine (Fig. 1) for harvesting cancellous bone from the iliac crest. A standard incision lateral and inferior to the iliac crest is used. However, the incision need only be 2-3 cm in length, rather than the usual 6-8 cm. After incising skin and subcutaneous tissue, the incision site is positioned superoanteriorly so that it lies directly over the iliac crest. The dissection is

Effects of chlordiazepoxide and diazepam on respiration and oxidative phosphorylation in rat brain mitochondria

Abstract The effects of chlordiazepoxide and diazepam on respiration and oxidative phosphorylation of succinate, pyruvate and alpha-ketoglutarate by rat brain mitochondria were investigated polarographically. Chlordiazepoxide and diazepam were each found to decrease respiration as evidenced from decreased state 3 and 2,4-dinitrophenol-stimulated state 4 oxygen uptake in the presence of the above three substrates. The decreases in state 3 and 2,4-dinitrophenol-stimulated state 4 rates were related to the added concentration of each drug. With respiratory control indices and ADP:O ratios as an index of oxidative phosphorylation, it was found that chlordiazepoxide and diazepam decreased oxidative phosphorylation. The decrease in oxidative phosphorylation may be due in part to an increase in adenosine triphosphatase activity as evidenced from the increased rates of oxygen uptake during state 4. To achieve a given effect on the above mitochondrial functions, it was found that the concentration in vitro of chlordiazepoxide had to be five to seven times greater than that of diazepam.

Mesenchymal chondrosarcoma: A case report

Mesenchymal chondrosarcoma is a rare tumor distinctly different from the more common chondrosarcoma. It shows a predilection for the head and neck in both osseous and extraosseous forms. The prognosis for cure is poor, with a high incidence of local recurrence as well as regional and distant metastasis. Treatment is based on radical surgical excision, although combination chemo-therapy has recently shown promise. Additional experience with this tumor is required to define the most efficacious form of treatment.

Recurrent chin swelling

A 32-year-old black woman came to the Oral and Maxillofacial surgery clinic with a 3-week history of an increasingly tender mass underneath her chin. She reported a history of chin trauma at age 4. The patient denied fever, chills, weight loss, and constitutional symptoms. The patient’s medical history was significant for hypertension, hypothyroidism, and asthma. She had been hospitalized for childbirth and pneumonia. Her medications included beclomethasone dipropionate (Beconase, Allen & Hanburys, Research Triangle Park, NC) and cromolyn sodium (Nasalcrom, Fisons Pharmaceuticals, Rochester, NY) by inhaler as needed. She was allergic to sulfa drugs and cephalosporins. She quit smoking tobacco 3 years ago and denied alcohol abuse. Her family history was noncontributory. Physical examination showed a well-developed, wellnourished, black woman appearing her stated age. Vital signs showed a blood pressure of 130/82 mmHg, a regular pulse of 62 beats/min, a regular respiratory rate of 18 breaths/min, and a temperature of 37.2”C. Facial examination showed a 2-cm, mildly tender, firm, linear nodule in the submental region. A well-healed scar was present over the mass. Oral examination was within normal limits. The neck was without lymphadenopathy, and the thyroid was mildly enlarged. The remainder of her physical examination was unremarkable. The lesion was excised under local anesthesia. Microscopic examination showed florid granulomatous inflammation with focal necrosis and very focal, polarizable foreign material. Special stains for acid-fast bacilli and fungi were performed and were negative (Fig IA, B). The patient returned to the Oral and Maxillofacial clinic 6 days later. The sutures were removed, and a well-healing incision was noted. The patient returned 1 week later for another postoperative visit and after that was instructed to return if necessary. Four months later, the patient presented to the clinic with increasing swelling and tenderness in the previous surgical

Management of acute alcohol withdrawal

The relationship between maxillofacial trauma and alcohol abuse has been well documented. The onset of acute alcohol withdrawal following the injury can seriously complicate and compromise the treatment of the maxillofacial injuries as well as be potentially lethal for the patient. A clear understanding of the biochemistry, development, signs and symptoms, and management of acute alcohol withdrawal is necessary for the oral and maxillofacial surgeon.

Case 37, Part II: Cervicofacial actinomycosis

Abstract A case is presented that was unusual in its clinical manifestation. The firm, nontender, submental mass showed no evidence of erythema or fluctuation. It did not respond to intravenous antibiotic therapy until after it had been drained surgically. The apparent source of infection was a chronic periodontal lesion involving tooth No. 18. The patient gave no history of discomfort involving tooth No. 18 or his left mandible. In many respects, the case is a classic one of actinomycosis. The lesion was slow growing, hard, and nontender. Like the majority of the cases in the literature it involved the cervicofacial region. The infection began to resolve rapidly following surgical drainage and debridement. The lesion was identified surgically as an abscess with a central necrotic area surrounded by granulation tissue and firm fibrous tissue, all of which are hallmarks of actinmycosis. After two months of oral penicillin G therapy, the patient was free of any evidence of disease.