Natan Scher

Radiotherapy of the resected mandible following stainless steel plate fixation

There is general concern among otolaryngologists that irradiation of a stainless steel prosthesis used in mandibular reconstruction may cause irradiation overdosage to adjacent tissues.

Immediate Free Gastro-Omental Flap Reconstruction of the Mouth and Throat

a portion of the greater curve of the stomach with its attached omentum was transplanted to reconstruct the pharynx and oral cavity after ablation of upper aerodigestive tract cancer. The tissue characteristics of the transplanted material were similar to those of the removed oropharyngeal tissue. The gastro-omental free flap produced a moist mucosal surface that was self-cleaning and distensible. The free gastro-omental flap was successful in five of seven patients. Because of excessive flap secretions during the early postoperative period, all patients had tracheotomies to protect the lower airway from aspiration.

Surgical Closure of Persisting Failed Tracheoesophageal Voice Fistula

Tracheoesophageal puncture (TEP) is a highly successful procedure for voice restoration. Occasionally, however, patients fail to achieve satisfactory voice or develop salivary leakage through the fistula into the trachea. Closure of the TEP is then necessary. In most cases, spontaneous closure occurs once the prosthesis has been removed. When the fistula does not close spontaneously, surgical closure is indicated to prevent aspiration and pulmonary complications. We describe a three-layer closure technique that employs interposition of dermal graft. The technique was used on 14 patients over a 7-year period. Most patients received irradiation to the neck. Complete closure was achieved in 13 of 14 cases; 1 patient developed partial breakdown of the closure. Our technique is relatively easy to perform and has a high success rate (92%). Irradiation did not adversely affect the closure rate.

Proliferative myositis of the masseter muscle

The authors present a case of a 33‐year‐old white man with a 4‐month history of a rapidly enlarging, tender, painful, circumscribed facial mass located in the masseter muscle. CT scan and fine needle aspiration cytology, coupled with clinical assessment, suggested the diagnosis of proliferative myositis. Curative intraoral excisional biopsy was done, thereby avoiding a parotidectomy incision and approach to the lesion. The pathology showed proliferative myositis. A review of the literature revealed 36 cases which indicated that proliferative myositis is a relatively rare etiology of a head and neck mass. Careful clinical, radiologic, and pathologic evaluations were required to make this unusual diagnosis and avoid any unnecessary facial mutilation in its treatment.

Osteochondroma presenting as a neck mass: a case report.

Osteochondromas are benign bone tumors which rarely present as neck masses. This report reviews the literature and presents the case of a 10‐year‐old girl with a neck mass and hoarseness due to an osteochondroma of the cervical spine. An extensive diagnostic evaluation and partial surgical excision were necessary. Although rare, osteochondromas should be considered in the differential diagnosis of a firm neck mass. Surgical excision of these lesions is recommended.

Facial reanimation by XI-VII anastomosis without shoulder paralysis

Transposition of the spinal accessory (XI) and facial (VII) nerves has been used successfully in reanimation of facial paralysis, but because of the severity of symptoms associated with denervation of the trapezius muscle, this technique has largely been abandoned. Hypoglossal‐facial (XII‐VII) nerve anastomosis has now become a more favored procedure; however, the resultant hemiglossal atrophy carries some morbidity.

Risk Factors in the Development of Acute Sinusitis in Immunocompromised Patients

Twenty-six patients diagnosed as having hematologic neoplasms were evaluated clinically and radiographically for the presence of sinus disease before receiving immunosuppressive therapy. Evaluations included basic clinical information, a thorough otolaryngologic history and endoscopic examination of the nasal cavity. Plain sinus films and paranasal sinus computed tomography (CT) scans were obtained on all patients. These patients were then followed for 1 year. Ten patients ultimately developed acute sinusitis, as documented by their symptoms and by CT scan: five of these patients required surgery, and three ultimately died. Potential risk factors for sinusitis were analyzed statistically. We found a significant correlation between preimmunosuppression CT scans indicating either chronic sinusitis or anatomic abnormalities and the development of sinusitis. Also multiple anatomic abnormalities on endoscopic diagnostic nasal examinations tended to identify individuals susceptible to sinusitis. Such patients who subsequently became neutropenic and had acute episodes of sinusitis tended to have a poor outcome. Those who developed fungal sinus infections were prone to have a fatal outcome. This study suggests that patients with hematologic neoplasms who are susceptible to the development of acute sinusitis should be identified before receiving immunosuppressive chemotherapy.

Post-traumatic prandial rhinorrhea

A patient with a LeFort III fracture developed clear prandial rhinorrhea as a late complication. A parotid-antral communication was discovered and surgically corrected. Only one previous case of parotid-antral rhinorrhea has been reported in the literature. Although it is a rare complication, salivary origin for post-traumatic rhinorrhea must be considered in the differential diagnosis.