Samuel Salinger

XXVII Arrested Development of the Larynx following Irradiation for Recurring Papillomas

A young man, 21 years of age, was first seen at the age of 3 years. He was brought to the clinic wearing a tracheotomy tube which had been inserted a short time previously because of dyspnea supposedly due to diphtheria. Direct laryngoscopy, however, revealed a larynx filled with soft papillomas. During the next two or three years these growths were removed a number of times with only temporary relief. However, the airway was sufficiently established to permit removal of the tracheal cannula and closure of the fistula. A year later, the growths continuing to recur after removal, he was subjected to external irradiation with radium which resulted in a burning of the skin and intralaryngeal swelling necessitating a second tracheotomy. A year later, when 6 years of age, his larynx appeared stenosed in the subglottic region and a tracheostomy was performed followed by the introduction of a Schmiegelow tube. The tube was tolerated for about a month when it was removed and the stenosis treated by retrograde dilatation for a year. By the time the boy had reached puberty the stenosis was well dilated and the papillomas had practically disappeared. It must be noted, however, that all in all he had been subjected to at least forty operations for removal of the papillomas, all done under direct laryngoscopy with blunt forceps.

XLVIII Cartilage Homografts in Rhinoplasty: A Critical Evaluation:

Of all the materials that have been employed for the correction of defects in the contour of the nose, none has stood the test of time as well as human cartilage. This does not necessarily imply that cartilage is ideal in every case nor does it mean that it is 100 per cent effective but, by and large, in the majority of cases it can be relied upon to accomplish a lasting result. Theoretically, the ideal material should be one that approximates as closely as possible the tissue it is supposed to supplant, should be capable of being retained without change in its new environment, should be readily obtainable and easily molded to the desired shape. Furthermore, it should possess sufficient density to withstand the normal minor traumas to which the nose is exposed, and should not be so rigid as to be unyielding under normal stress.

LXVI. Ivory Implants for Saddle Nose: Results in Fifty Cases

Ivory as an implant material in nasal corrective surgery has been used, along with other exogenous substances, off and on for years with varying success here and abroad. It connot be said to have received any marked degree of enthusiastic approval nor to any great extent have displaced autogenous cartilage and bone as a supporting material because of the prevailing prejudice against foreign bodies in general. While this attitude is to a certain extent logical, it must nevertheless be modified by certain mitigating reservations. Ivory cannot be classed with paraffin or celluloid because it is, after all, an animal epithelial appendage similar to dentine or dense bone and therefore more likely to be tolerated by the human host than the strictly chemical bodies just mentioned.

XXVI Cavernous Hemangioma of nose, Nasal Septum and Forehead

Examination revealed a smooth enlargement of the lower half of the nose which was of a bluish purple color and elastic to the touch and which extended almost to the level of the lower border of the nasal bones; The lower portion of the septum was also of the same color and consistency and bulged into the nares, both of which were thereby almost completely obstructed. The mucous membrane covering the septal swelling was very thin and there was a slight pulsation on palpation. The entire mass was easily compressible both externally and within the nose and felt warm to the touch.

Abscess of the Tongue

At operation it was found that the frontal sinus contained thick, pyogenic membranes with foul-smelling pus, and the frontoethmoidal cells showed the same pathologic changes. What was more interesting was that when the stage in the operation of fashioning an opening into the nose was reached it was found that the real nasofrontal duct emptied into the maxillary sinus. Why roentgenographic findings were apparently negative is not easy to explain. The previous successful probing of the frontal sinus had really entered an uninvolved cell over the bregma.

LXIII. Malignancies of the Upper Air Passages: A Statistical Review

This paper is an attempt to summarize the results of treatment of malignancy of the upper air passages as revealed in a series of publications in the German literature and to compare them with similar statistics from other large centers throughout the world. Particular emphasis will be laid on the X-ray and radium treatment of the inoperable cases which comprise such a large percentage of the total. Despite long continued and repeated failure in the use of these measures over a period of years the work has gone on unceasingly, each new detail of technic advanced being carefully studied and each new method obtaining a modicum of success being gratefully received and critically studied. Certainly we have not reached the end of our hopes nor have we by any means exhausted the possibilities of radiation. Definite impetus has been given the work by advances along three lines: first, earlier diagnosis through better morphologic studies; second, increasing appreciation of the degrees of radio sensitivity of various types of malignancy; and third, the new technic of radiation as advanced by Coutard and Berven. We find observers all over the world giving particular attention to the radio sensitivity of the particular growth in question and applying the principles of teleradium and protracted fractional radiation more intelligently and with greater confidence. Broders classification of carcinoma has offered us an excellent guide for determining the degree of malignancy, and more recently a number of authors have taken to a classification based on the radio sensitivity of the growth which, broadly speaking, falls into three groups: (1) Lympho-epithelioma, (2) transitional cell carcinoma,