Manning M. Goldsmith

A prospective randomized study of four commonly used tympanostomy tubes

Tympanostomy tube placement has clearly been shown to be an efficacious treatment for recurrent bouts of acute otitis media or chronic otitis media with effusion. However, there are few objective, prospective, randomized studies present in the literature to aid the clinical otolaryngologist with the proper tube choice for middle ear aeration.

Part I. DNA Flow Cytometry as a Prognostic Indicator in Head and Neck Cancer

The prognostic significance of deoxyribonucleic acid (DNA) flow cytometry has been investigated for many solid tumors, but few data have been accumulated for squamous cell carcinomas of the head and neck. To our knowledge, we report the largest number of patients (69) with head and neck primary carcinomas to be studied by DNA flow cytometry. In the first part of this study, we reviewed 109 consecutive patients with laryngeal or hypopharyngeal primary carcinomas which were treated at North Carolina Memorial Hospital during the period of 1981 to 1984. The final analysis comprised 139 DNA histograms (mean coefficient of variation: 8.02) on paraffin-embedded specimens from 48 patients. Of the 48 patients with primary carcinomas, 24 had glottic, 18 had supraglottic, and 6 had carcinomas from the piriform sinus. Patients had follow-up for a minimum of 12 months, with a mean follow-up period of 23 months. Twenty-three of the 48 primary carcinomas (48%) were clearly aneuploid, and the remaining 52% were tetraploid (22%) or diploid (30%). We have concluded that patients with clearly aneuploid primary carcinomas had significantly better prognoses than those with diploid tumors (p = 0.008). High DNA amounts (greater than 40% of cells beyond the diploid peak, DNA G1GO) also correlated with a favorable prognosis when compared with low DNA amounts (p <0.01), and this remained significant when the clinical outcome was adjusted for staging of the primary site (T), nodal status, and stage of disease. Ploidy was the most significant prognostic variable for the laryngeal group of patients. In the second part of the study, twenty-one patients with oral cavity squamous cell carcinomas were studied in a similar fashion as the group with laryngeal carcinomas. In this group, a low DNA amount, with 40% as the cutoff point, was associated with a favorable prognosis (p = 0.024), and this remained significant while controlling for I, nodal status, and stage of disease. Numbers were too small to permit evaluation of the impact of ploidy in this group, but there was a slight trend toward aneuploidy and tetraploidy, correlating with a poor treatment outcome (p = 0.228). DNA amount was the most significant prognostic variable for the group of patients with oral cavity carcinomas. We conclude that DNA flow cytometry may be a powerful prognostic indicator in malignant conditions of the head and neck. The implications of these data for the management of head and neck cancer are discussed.

The importance of the eosinophil in head and neck cancer.

In a previous study, we found tumor-associated tissue eosinophilia (TATE) to be a favorable prognostic indicator for squamous cell carcinoma of the head and neck (p < 0.05). The present expanded study was undertaken to confirm this finding. The pathology of 120 head and neck tumors was examined for histologic features suggestive of poor prognosis. Ten descriptive histopathologic variables, including two malignancy grading scales, were correlated with DNA flow cytometric data and clinical outcome. No correlation was found between the malignancy grading scales and DNA flow cytometric data or clinical outcome. The present expanded study confirmed with greater statistical significance (p < 0.001) that high-grade TATE is a favorable prognostic indicator for head and neck cancer. Furthermore, high-grade TATE was associated with the absence of distant metastasis (p < 0.05). Using a stepwise logistic regression analysis of the clinicopathologic variables in the study, high-grade TATE was the most influential variable affecting clinical outcome, followed by border, stage, and perineural invasion. We conclude that the grade of TATE is a significant prognostic indicator for head and neck cancer. The significance and possible role of the eosinophil in the tumor–host interaction are discussed.

Significance of ploidy in laryngeal cancer

We studied 48 patients with laryngeal or hypopharyngeal primary tumors with DNA flow cytometry. Twenty-four of the tumors were glottic, 18 were supraglottic, and 6 were from the pyriform sinus. Patients were followed for a minimum of 12 months, with a mean follow-up of 23 months. Twenty-three of the 48 primary tumors (48 percent) were clearly aneuploid, 22 percent were tetraploid, and 30 percent were diploid. We concluded that patients with aneuploid primary tumors, high DNA levels, or both have a significantly better prognosis than those with diploid tumors, and this remained statistically significant when clinical outcome was adjusted for tumor status, stage, and nodal status.

Iodine-125 seed implantation as an adjunct to surgery in advanced recurrent squamous cell cancer of the head and neck.

Survival for extensive recurrent squamous cell carcinomas of the head and neck remains poor, with the major cause of death being local recurrence. Surgical implantation of iodine-125 interstitial seeds allows tumoricidal doses of radiation to be delivered to residual tumor while minimizing radiation doses to the surrounding tissues. From 1978 to 1988, 39 implantations were performed on 35 patients for extensive recurrent squamous cell carcinoma of the head and neck. The decision for implantation was based on positive margins or close to resection margins from frozen sections after salvage resection. The determinate 5-year disease-free survival was 41%, with both the overall and no evidence of disease 5-year survivals being 29%. Significant complications occurred in 36% of all cases. This figure increased to 56% when flap reconstruction was required. Possible reasons for this seemingly high complication rate are discussed. Considering the advanced nature of these recurrent carcinomas, surgical resection with iodine-125 seed implantation appears to be an effective method of managing disease that might otherwise be judged unresectable and treated for palliation only.

Part II. The Prognostic Significance of Stromal Eosinophilia in Head and Neck Cancer

The pathologies of 82 head and neck tumors were examined for histologic features suggestive of poor prognoses. Twelve descriptive histopathologic variables, including two grading scales for malignant tumors, were correlated with DNA flow cytometric data and clinical outcome. We found no correlation between the grading scales and DNA flow cytometric data or clinical outcome. Only one of the histopathologic variables—stromal eosinophilia—was found to significantly correlate with favorable outcome (p = .018). Stromal eosinophilia may be an important new prognostic indicator for head and neck cancer.

Metastasizing Pleomorphic Adenoma with Myoepithelial Cell Predominance

The biological behavior of pleomorphic adenomas (mixed tumors) of salivary gland origin is complex. Tumors with benign histologic features may exhibit recurrence and locally aggressive behavior especially after incomplete excision. A small percentage of pleomorphic adenomas have obvious malignant components in epithelial or in both epithelial and mesenchymal components and can metastasize. There are also rare case reports which appear to document typical pleomorphic adenomas of salivary gland with histologically identical visceral and lymph node metastases. Recently myoepithelial cell proliferation has been identified as a possible predictor of aggressive clinical behavior in otherwise histologically benign pleomorphic adenomas. We report such a parotid gland lesion with local recurrence and retroperitoneal spread. DNA-flow cytometry of cells from the paraffin-embedded primary and metastasis showed similar aneuploid populations. Aneuploidy appeared to reflect the malignant potential of this particular pleomorphic adenoma and suggests that DNA-flow cytometry of salivary gland tumors may yield important prognostic information.

Presentation and management of postcricoid hemangiomata in infancy

Phillips and Ruh (1912)1 were the first to describe a congenital hemangioma of the larynx. Sweetser2 subsequently classified laryngeal hemangiomata into infantile and adult types and noted differences in incidence, location, and symptoms. According to Sweetser, the infantile form is less common, is almost always subglottic, and presents with stridor which may be intermittent. The adult form is somewhat more common, is generally supraglottic, and often presents with hoarseness or dysphagia.

The adjustable two-piece nasal septal button.

Small, posterior nasal septal perforations with wellhealed edges often do not require any treatment. The symptomatic perforation is generally greater than 1 ern in diameter, located more anteriorly, and has thickened granulations at its edges. Temporary relief from intranasal crusting can be provided by frequent saline irrigations and petroleum-based ointments. If these conservative measures fail to relieve the patients symptoms, closure of the perforation is indicated. A trial with a septal button is appropriate when the nature of the perforation (size and location) and septal anatomy are appropriate, and when surgical closure is contraindicated or not desired by the patient. Generally, anterior septal perforations that are 2 cm or less in

A Method of Closure after Resection of Anterior Floor of Mouth Cancers

A variety of methods may be used to reconstruct head and neck defects after ablative surgery for cancer. Increasingly, choices of reconstructive techniques must be made on the basis of functional results attained. Described is a method of reconstruction for anterior floor of mouth defects with marginal mandibulectomy, which has yielded good functional results. All patients undergoing this form of reconstruction are on a soft oral diet, without drooling and with good speech intelligibility.