R. Kim Davis

The anatomy and complications of “t” versus vertical closure of the hypopharynx after laryngectomy

The early postoperative hypopharyngeal anatomy of 37 consecutive patients undergoing total laryngectomy at the Boston Veterans Administration Hospital between July 1977 and April 1980 was studied by barium swallow radiographs and correlated with the technique of closure. The “pseudoepiglottis,” a structure radiographically resembling a normal epiglottis, was seen arising from the anterior hypopharynx near the base of the tongue in 21 of 28 evaluable patients. It occurred in all patients with vertical closures vs. 67% of patients with a “T” shaped closure. The average length in the “T” closure group was 9.6 mm (range 0.35) vs. 18.4 mm (6.40) in the vertical group, a statistically significant difference (p<0.05).

Palliation of Airway Obstruction from Tracheobronchial Malignancy: Use of the CO2 Laser Bronchoscope

A CO2 laser rigid bronchoscope system has been used to palliate symptoms of a malignancy obstructing the tracheobronchial airway. Fifty-nine endoscopic laser operations (34 patients) were done between 1975 and 1981. Severe dyspnea and obstructive atelectasis were the most common indications for treatment. Contraindications for treatment included extrinsic tracheobronchial compression, widespread distant metastases, rapidly progressing tumors, and highly vascular neoplasms. There were nine primary tracheal malignancies, five metastases from distant sites, and 20 primary lung cancers with tracheobronchial obstructions. Most patients were previously treated with one or more standard modalities (radiation therapy, surgery, and chemotherapy). Removal of airway obstruction was occasionally indicated prior to radiation therapy to facilitate treatment. There were seven instances of complications in this group of patients and one mortality. Most patients (23 of 34) have died from their malignancy. The best palliation was achieved in proximal (tracheal and main stem bronchial), slower growing tumors.

Otosurgical Model in the Guinea Pig (Cavia porcellus)

The guinea pig is a useful model for otologic research. Common problems encountered In working with Individual animals include preexisting chronic middle ear disease, anesthetic deaths, and a lack of knowledge of the surgical anatomy and landmarks of the middle and inner ear. The methods detailed in this article will benefit those interested In a reliable, inexpensive, otosurgical animal model.

The pectoralis myocutaneous flap for salvage of necrotic wounds

The authors have utilized six pectoralis major myocutnneous flaps in attempts to salvage extensive necrotic wounds of the pharynx and neck. The flap was employed in the following situations: massive necrosis of the entire neck skin with both carotid artery systems exposed, radiation necrosis of the neck skin with exposure of carotid artery, dehiscence of gastric pull‐up from pharynx with resultant carotid exposure, failed trapezius flap in a radionecrotic oral cavity, and two cases of pharyngocutaneous fistula with extensive soft tissue necrosis.

The tailored CT evaluation of persistent facial nerve paralysis

The clinical, radiographic, and pathologic records of 39 patients with peripheral facial nerve dysfunction seen from October 1981 through July 1984 are reviewed. The extent of preradiologic clinical localization of suspected lesions and their subsequent pathologic confirmation is correlated to the number, sequence, and type of radiographic evaluations performed.

Multimodality therapy for unresectable squamous cell carcinoma of the head and neck.

EIGHTEEN PATIENTS WITH VNRESECTABLE Stage III or IV squamous cell carcinoma of the head and neck were treated with induction therapy consisting of sequential methotrexate and 5-fluorouracil. This was followed by full course radiation therapy and radical neck dissection for those with residual neck disease. Those with local control were then treated with vin-blastine, bleomycin, and cisplatin (VBP). Although 79% of patients achieved a partial or complete response to chemotherapy, only 50% of patients achieved local control. Marked mucositis limited the dose and schedule of radiation therapy. The methotrexate and 5-fluorouracil combination appears to be too toxic for multimodality therapy of advanced head and neck cancer.

Intraoperative Phototherapy: A Comparative Study of Intravenous and Topical Photofrin II and Aminolevulinic Acid

This study compares the systemic and topical application of photofrin II and aminolevulinic acid as an intraoperative adjuvant therapy in the C3H mouse radiation-induced fibrosarcoma model. Dose-development and time-dependent studies were first conducted followed by intraoperative phototherapy studies with photofrin II and aminolevulinic acid. Study results clearly show that intraoperative phototherapy after aminolevulinic acid topical application is significantly more effective than treatment with photofrin II given intravenously or topically (p < 0.05) in this animal tumor model. The concept of topical application of photosensitizers and the rationale for intraoperative adjuvant phototherapy are discussed.

Role of endocrine function tests in the evaluation of transsphenoidal hypophysectomy for advanced breast cancer.

Forty-three women underwent transsphenoidal hypophysectomy for metastatic breast cancer. Endocrine tests (luteinizing hormone, follicle-stimulating hormone, thyrotropin, prolactin and growth hormone) were done in 28 patients to evaluate the completeness of the procedure. Response of the metastatic breast cancer and duration of survival after hypophysectomy were determined and statistically compared with the posthypophysectomy hormone levels. Only one patient had an endocrinologically complete hypophysectomy, but the objective remission rate (32 percent) is comparable to the 30 to 40 percent objective remission rate reported in other studies that claim to have achieved complete hypophysectomy. No statistically significant associations were found between the levels of the hormones measured and the type of response (objective, subjective or none) to hypophysectomy. However, objective responders survived longer than nonresponders (p = 0.01). When analyzing the associations of the various hormone levels with the duration of survival after hypophysectomy, a positive correlation (p less than 0.05) of peak thyrotropin levels with duration of survival was found. Our data indicate that the clinical benefit advanced breast cancer patients received from an endocrinologically incomplete hypophysectomy is probably as great as that received from an endocrinologically complete hypophysectomy. It appears that a nonspecific disturbance of the hormonal milieu may adversely affect the growth of breast cancer. More studies are needed to elucidate the nature of the endocrine disturbance produced by hypophysectomy and its effects on hormone-sensitive tumors.

The effect of variable concentrations of mitomycin C on ECM proteins in wounds

durally. After that, the radial artery graft was passed through the hole inside the dura. Then, after opening the carotid and sylvian cisternas, exposing the MCA and its trunks, the graft is brought to reach the M2 segment of MCA. Results: We have found that the calibers of MA, radial artery, and M2 segment of proximal MCA match well, and as the mean caliber of these arteries was over 2 mm, such a bypass will provide sufficient blood flow. Conclusion: When a higher blood flow is needed or the caliber of STA is inadequate, MA–to–proximal MCA bypass using a short arterial graft will be a good alternative to STA-MCA bypass or ECCA–to–proximal MCA bypasses using long venous grafts. Significance: To investigate whether the application of MA–to–proximal MCA bypass with a radial artery graft can be an alternative to STA-MCA bypass when a higher blood flow is needed or the diameter of STA is inadequate. Support: None reported.

Assessment of Success of Treatment of Head and Neck Neoplasia

The assessment of success of therapy in head and neck cancer has historically been a difficult problem. Cancers arising in the head and neck represent about 5% of cancers in men and 2% of all cancers in women occurring in the United States. The estimated number of cases of head and neck carcinoma in 1981 in the United States was approximately 37,000 while the number of deaths was approximately 10,000. These numbers represent a small proportion of the total number of cancer cases and mortality; because of this, few institutions have an opportunity to treat a large number of cases of head and neck cancer. This problem is further compounded because there are numerous sites of origin of head and neck neoplasia in the upper aerodigestive tract. When treatment of head and neck cancer is classified by specific sites of origin, even cancer centers with large numbers of patients find difficulty in accumulating very many patients. For this reason, there are very few prospective randomized studies of head and neck cancer.