Paul H. Ward

Positron emission tomography: A new, precise imaging modality for detection of primary head and neck tumors and assessment of cervical adenopathy

Positron emission tomography (PET) has been shown to be effective in detecting intracranial malignancies based on cerebral glucose metabolism. To evaluate the ability of PET to detect extracranial head and neck neoplasms and cervical metastases, 16 patients with primary squamous cell carcinomas were examined. All patients received preoperative computerized tomography (CT) and magnetic resonance imaging (MRI) scans and underwent PET evaluation using intravenous 18F‐2‐fluoro‐2‐deoxy‐D‐glucose (FDG). Histopathologic analysis compared tumor invasion and positive lymph nodes with findings on MRI, CT, and PET images. All primary tumors were delineated by PET, while MRI and CT failed to detect one superficial tumor involving the anterior tongue. Ten nodes were detected by CT and MRI versus 12 nodes demonstrated by PET. PET is highly effective in detecting head and neck carcinomas as well as metastatic cervical lymph nodes. In addition, PET may be useful in evaluating postsurgery and postradiotherapy patients for recurrent and new primary tumors.

Reflux as an etiological factor of carcinoma of the laryngopharynx.

This study examined charts and 16‐mm pictures or videotapes of 138 patients with carcinoma of the larynx treated during the last 10 years. Among these patients, 19 were nonsmokers and nondrinkers or only light social drinkers with moderate to severe gastroesophageal reflux (GER). Serial cinephotographs are presented with follow‐up of up to 10 years. The common presence of GER in these nonsmoking, nondrinking patients and the probable role of this chronic irritative disorder as a causative agent in carcinoma of the laryngopharynx are discussed.

Major complications following tracheoesophageal puncture for voice rehabilitation

The successful use of the tracheoesophageal voice prosthesis for speech rehabilitation of the total laryngectomy patient has lead to common application of this device. Although the creation of a tracheoesophageal fistula is a simple procedure, it is not without complications. A review of 104 patients who underwent this procedure indicated a complication rate of 25%. Complications were related primarily to the fistula and included migration and progressive enlargement of the puncture, persistent or recurring infection of the fistula site, aspiration pneumonia, and death. Other problems included aspiration of the prosthesis, vertebral osteomyelitis, and tracheal stomal and esophageal stenosis. Many of these patients required hospitalization, intravenous antibiotics, and major surgical procedures to treat these complications. Guidelines for early identification and management of these problems as well as methods to prevent complications are discussed.

Cinegraphic observations of laryngeal function in parkinson's disease†‡

Thirty‐two unselected male patients with Parkinsons disease were examined by telescopic cinelaryngoscopy. Correlation of vocal abnormality and general neurologic symptoms with the laryngoscopic examination leads to the conclusion that the phonatory abnormalities noted in Parkinsons disease are related to rigidity in the phonatory posture of the larynx. The described dysfunctions correlated with the symmetry of trunk and limb rigidity in 100% of the patients.

Contact Ulcers and Granulomas of the Larynx: New Insights into Their Etiology as a Basis for More Rational Treatment

Repeated analysis of cinephotographic and cinefluorographic studies, correlated with clinical observations, has helped elucidate the causes of contact ulcers. Habitual throat clearing, excessive glottic attack in initiation of speech, and, most important, acid regurgitation secondary to hiatal hernia are the causal factors of contact ulcers. Contact granulomas produced by intubation trauma and other granulomas are compared and discussed. The successful treatment of contact ulcers and granulomas is dependent on elimination of vocal abuse, cessation of throat clearing, and control of the factors that cause the irritation and throat clearing.

Nasopharyngeal carcinoma: Treatment results with primary radiation therapy

One hundred three patients with nasopharyngeal carcinoma were treated with radiotherapy at UCLA Medical Center from January 1955 to December 1990. Overall survival, disease‐free survival, and local control rates were analyzed. In addition, survival from 1955 to 1978 and from 1979 to 1990 were evaluated. Overall 5‐ and 10‐year actuarial survival rates for all patients were 58% and 47%, respectively. Disease‐free survival rates at 3 and 5 years were 45% and 30%, respectively. Local, persistent, or recurrent disease in the nasopharynx was the primary cause of failure, occurring in 32% of patients and correlating with the initial tumor size (T stage). Twenty‐four percent of patients developed distant metastases, which correlated with nodal status but not with T stage. Seventy‐nine percent of patients failed either locally or distally by 4 years. Sex, race, age, and T and N stage categories were evaluated as prognostic variables in terms of survival. Control of primary disease is important in determining long‐term outcome. Modern imaging techniques have greatly assisted in the evaluation of disease extent and treatment options.

Early experience with percutaneous tracheotomy

Early reports of a percutaneous dilatational technique for tracheotomy tube placement have been encouraging. This method uses a needle for placement into the trachea, a J‐tipped guidewire, and progressively larger dilators to widen the stoma for insertion of a tracheotomy tube.

Juvenile nasopharyngeal angiofibroma: An update of the ucla experience, 1960–1985†

The UCLA experience with juvenile angiofibroma (JNA) over a 25‐year period is reviewed. There were 83 patients, the majority being adolescent males. Surgery was the primary method of treatment for disease not extending intracranially; 63 of 68 patients (92.5%) became asymptomatic with this modality. In patients treated with a single course of primary radiation, 10 of 14 (78.5%) became asymptomatic. Trends in diagnosis and treatment were evaluated. Contrast computerized tomography reliably assesses tumor extent. Preoperative arteriography is essential for the evaluation and embolization of feeding vessels; this in turn significantly reduces operative blood loss and the need for transfusions. Radiotherapy should be reserved for disease extending intracranially and should be in doses of 3,600 cGy or larger.

Transcutaneous teflon injection of the paralyzed vocal cord: A new technique†‡§

Because of anatomical deformity, trismus, or for other reasons, it may on occasion be impossible to visualize a larynx by the usual laryngoscopy methods. Such difficulties in patients who have paralytic dysphonia may also make it impossible to effect improved vocal cord closure by the usual techniques of Teflon® injection. We have applied a new technique, detailed in this report, to these problem cases.

The enigma of post-radiation edema and recurrent or residual carcinoma of the larynx.

Persistence of significant edema of the larynx beyond six months after completion of radiotherapy presents the lavyngologist with a diagnostic dilemma. Review of the results of 43 cases demonstrated a high incidence of residual or recurrent carcinoma. Based upon this experience earlier and frequent laryngeal biopsies are recommended for these cases.