Roger Boles

Treatment of Large Juvenile Nasopharyngeal Angiofibroma

The management of large juvenile nasopharyngeal angiofibromas with intracranial extension is controversial. We review our experience since 1980 with eighteen patients with juvenile nasopharyngeal angiofibroma. A diagnostic and treatment approach consisting of preoperative magnetic resonance imaging, embolization of feeding branches from the external carotid artery, and attempted complete resection was used in seven patients with intracranial disease since 1987. Serial magnetic resonance images were used for followup. Intracranial disease that was persistent or recurrent and demonstrated subsequent growth was irradiated (35 to 45 cGy). Extracranial tumor recurrences were reexcised. We advocate this approach as a safe and effective alternative to primary irradiation and its sequelae.

Chordomas: Nasopharyngeal Presentation and Atypical Long Survival

Atypical clinical and pathological features of cranio-cervical chordomas have prompted a review of these neoplasms at the University of Michigan Medical Center. Contrary to prior investigations, 92% of the spheno-occipital chordomas reported in this study clinically presented with a nasopharyngeal or intranasal mass. This high incidence indicates the requirement for an otorhinologic examination on all patients presenting with the neuro-ophthalmologic syndrome and roentgenologic findings characteristic of chordomas in this anatomical region. Special attention is called to a histologically distinctive variant of chordoma — the “chondroid chordoma.” Apparently restricted to the cranio-cervical region, this variant has been associated with long survival.

Injury and repair of the recurrent laryngeal nerves in dogs.

Surgical repair of recurrent laryngeal nerve injuries has received renewed experimental attention in recent years.1,2,3 This work has been motivated by the considerable disability which vocal cord paralysis continues to cause, particularly regarding phonation, aspiration on swallowing, and difficulty in breathing. Interest in direct nerve repair has also evolved out of the frequent failure to achieve complete rehabilitation of the laryngeal functions with the usual surgical procedures of tracheostomy, arytenoidectomy and arytenopexy, and vocal fold injection and displacement techniques.

Malignant tumors of salivary glands. A university experience

The management of salivary gland neoplasms continues to be a challenging clinical problem. Despite recent advances in histopathological classification, agreement among head and neck surgeons concerning optimum treatment is lacking. In attempts to eradicate the more malignant varieties of these tumors, surgeons have performed radical and multilating surgery. Radiation therapy has not been considered efficacious in many centers. A review of 93 maligant salivary gland tumors from 1955 to 1973 at the University of California, San Francisco, suggests that these tumors may be more radiosensitive than once thought. Radiation therapy combined with conservative surgical procedures may be as successful and perhaps more rational treatment than radical surgery alone.

Carcinoma in Pleomorphic Adenomas of Salivary Glands

Because of the variability of the histological appearance of a given mixed tumor of the salivary gland and because of “recurrences” following less than total removal, biologically benign (not capable of metastasis) mixed tumors have been considered malignant. The true malignant mixed tumor, or more commonly carcinoma, arising from preexisting mixed tumors are unusual and ill-defined in the literature. These tumors make up no more than 5% of the mixed tumor category and occur primarily in the parotid gland. In this report, we present a clinico-pathological appraisal of the malignant mixed tumor based on five cases from the University of Michigan Medical Center and relate our experience to that in the literature. The importance of recognizing the malignant mixed tumor, or “carcinoma ex-mixed tumor,” lies in the accelerated recurrence rate and surprisingly high metastatic rate manifested by this lesion. Minimal treatment is radical total excision. Wide, early excision of the primary “benign” stage of these mixed tumors should reduce the problem of ultimate “malignification.”

A monoclonal antibody to squamous cell carcinoma

Monoclonal antibody 17.13.CI.10 is a murine IgM kappa monoclonal antibody (Mab) that stains frozen section squamous cell carcinoma (SCC) homogeneously and intensely with a sensitivity greater than 98%, including 106/107 SCC specimens from the head and neck. It was produced using a human laryngeal SCC as immunogen and screened using frozen section human tissue. Monoclonal antibody 17.13.CI.10 faintly stains the basal layer of normal squamous eptihelium, does not stain normal organ tissue other than myoepithelial cells, and reacts with few non‐SCC tumors. It, therefore, may be a useful adjunct to standard histopathologic criteria for the diagnosis of SCC. It may prove helpful in the investigation of tumor‐associated antigens. Despite major technical and immunologic problems, monoclonal antibodies to functional tissue‐specific tumor‐associated antigens have the potential to play a major role in imaging and in treatment in the future.

Surgical Treatment of Essential Blepharospasm

Essential blepharospasm is an unusual disorder characterized by involuntary spasmodic contractions of the eyelids. Both eyes are always involved. As the spasms gradually progress in severity and duration, they lead to increasing visual disability (Fig. 1). In its most severe form, this amounts to functional blindness. Such ordinary activities as driving, cooking, reading, and walking across streets become difficult or impossible to do. Despite the fact that usually they are otherwise in good health, these patients often become entirely dependent upon others for their basic needs. The tragedy of the affliction thereby extends beyond the patient to the remainder of his family. Essential blepharospasm almost always affects older people, rather than younger or middle age groups. This further compounds its emotional and social implications.

Supraglottic carcinoma: a 10-year review at the University Hospital.

The records of all patients with supraglottic laryngeal cancer seen and definitively treated from 1961 to 1970 at the University Hospital were reviewed. The total number of carcinomas felt to arise primarily from the supraglottic area was 118. Of these, 89 had what we considered sufficient follow‐up to be used in tabulating the results of treatment.

Laryngeal lesions in the young.

When a “crowing” inspiratory stridor occurs in an infant or in a child, the chances are that he has a laryngeal lesion. In newborns and infants, almost all lesions—immature supraglottic cartilages, webs, cysts, laryngoceles, vocal cord paralysis, subglottic stenosis and hemangiomas—are congenital. In older children, infections, trauma or juvenile papillomas are more likely to be responsible.

Tumors of the Head and Neck: Clinical and Pathological Considerations

This sequel to the first edition is an expanded and updated version of his first outstanding volume. Four important new chapters have been added that cover the topics of Wegeners and midline granulomas, immunological aspects of head and neck cancer, cysts and sinuses of the head and neck, and odontogenic lesions. Dr Batsakis is a superb general pathologist who has devoted much of his career to the special study of diseases and abnormalities of the head and neck. He has done this in close collaboration with physicians, surgeons, and dentists who have submitted material to him and with whom he has shared research projects. He has become more than a laboratory-bound pathologist and has acquired a broad understanding of the natural history of head and neck diseases and of the special problems with which the head and neck clinicians and surgeons are confronted. This clinicopathological correlative approach makes Dr Batsakiss