Lindsay L. Pratt

Cancer of the Lacrimal Sac Presentation of Five Cases and Review of the Literature

Tumors of the lacrimal sac are rare, and are discussed primarily in the ophthalmological literature. The otolaryngologist, however, often performs the definitive surgery and must, therefore, be familiar with this disease. The lacrimal apparatus secretes and then drains lubricating fluid from the eye. This report focuses on the drainage mechanism which is anatomically and functionally a single structure composed of the canaliculi, the lacrimal sac, and the nasolacrimal duct. By 1963, 184 lacrimal sac tumors had been reported in the world literature. We have collected an additional 21 patients from the literature. This brings the total malignant tumors to 125, of which 74 were of epithelial origin. One sarcoma and four poorly differentiated epidermoid tumors treated in our department are presented in detail. The diagnosis is often evasive though the history of mass and epiphora is typical. Conservative treatment for dacryocystitis only temporizes. Work-up should include external and slitlamp examination, complete rhinological evaluation, sinus x-rays, tomograms of the bony lacrimal sac area, and dacryocystograms. Biopsy gives pathological confirmation. The largest group is epidermoid carcinoma, mostly of the poorly differentiated nonkeratinizing type. The treatment for benign lesions is local excision. Preoperative irradiation is indicated for epidermoid carcinoma, followed by wide local excision. Radical maxillectomy may be reserved for recurrences, and neck dissection for palpable nodes may be helpful. Mesenchymal tumors respond best to radiotherapy. Death in lacrimal sac cancer results from metastases, most often to the neck and lung. Five year survival rates appear to be slightly greater than 50%.

Complications of laryngotracheal disruption

Owing to the increased use of automobiles, minibikes, motorcycles and other devices for recreational activities, we are now seeing a growing number of severe head and neck injuries. In this paper we will discuss a rare and often fatal injury of the neck, namely, traumatic laryngotracheal separation. There are isolated reports in the literature of heroic efforts to save the lives of such patients, but little has been said regarding surgical repair of the injury and possible late complications.

The placement of middle ear ventilation tubes: some indications and complications.

Are they necessary? What are the indications? Does fluid necessitate tubes? A plea for conservatism? Complications? Answers to these questions are presented by an objective evaluation of patients.

A clinical study of delayed reconstruction in ossicular fractures.

Twenty‐eight patients, who underwent ossicular reconstruction one or more years after the incident trauma, were studied.

First branchial cleft syndromes and associated congenital hearing loss

We have recently encountered three cases of first branchial cleft syndromes, two of which had prominent hearing losses. The cases are described, and the literature pertaining to first branchial cleft syndrome is reviewed. Because of the frequent coexistence of various congenital anomalies, we feel that the prevalence of congenital otologic problems associated with a first branchial cleft syndrome may be greater than has previously been suspected.

Complications associated with the surgical treatment of cholesteatoma

The surgical complications associated with a cholesteatoma are predictable preoperatively depending upon the location of a cholesteatoma. If the patient has as attic cholesteatoma the surgeon can anticipate postoperatively a dry ear, minimal chance of persistent or recurrent cholesteatoma, satisfactory hearing restoration, and, although a mastoidectomy is usually necessary, the size of the mastoid cavity in an adult can be extremely small.

Management of the mastoid air cell system in chronic otitis media.

The influence of the Mastoid Air Cell System in Chronic Otitis Media is subject to much speculation. Does a mastoidectomy influence the surgical results following chronic inflammatory ear surgery?

Postoperative complications associated with bilateral stapedectomy.

The need for surgical restoration of hearing is frequently expressed by otologic surgeons. All too frequently the surgeons concern centers around the mechanical reconstruction of the auditory apparatus as demonstrated by the closure of the air bone gap. The functional value of restored hearing to the patient is not considered.

Motivation in hearing aid acceptance.

Patient case histories are presented in an attempt to pinpoint possible motivational factors affecting the acceptance of a hearing aid. Personality profiles were constructed on three representative patients through the use of an in‐depth interview as well as three personality scales: the 16 Multiphasic Personality Scale; the Crowne‐Marlowe Social Desirability Scale; and the Attitude Toward Disabled Persons Scale. The very preliminary results indicate at least some face validity to the assertion that unsuccessful hearing aid wearers are measurably different from successful wearers and that these differences may be used to predict success or failure for future patients.

Surgical classification for chronic otitis media

A surgical classification is proposed for patients with chronic otitis media. Its purpose is to facilitate the preoperative classification of patients to enable an orderly evaluation of subsequent operative procedures. In addition, it provides for a method for classifying surgical reconstruction procedures.