Stanley W. Coulthard

Retropharyngeal abscess – a ten-year experience†

The authors present an extensive review of current literature as well as their ten‐year experience in management of patients with retropharyngeal abscesses. Emphasis is placed upon age, sex, type and duration of symptoms, bacteriology, methods of diagnosis, therapy, and complications. The authors series reveals that retropharyngeal abscesses are found in adults, there is a wide spectrum of bacteriological organisms represented, and with appropriate antibiotic and surgical management the majority of patients survive without major residual sequelae.

Radiation therapy for paragangliomas of the temporal bone.

Treatment of paragangliomas of the temporal bone (glo‐mus jugulare and glomus tympanicum tumors) is controversial, with both surgery and radiation therapy having their advocates. This paper discusses the experience at the University of Arizona Health Sciences Center in treating 10 cases of this uncommon tumor between 1971 and 1988. Seven of 10 cases were initially treated using irradiation and achieved complete tumor control for a mean of 67 months (range = 23‐107 months). Two patients, one treated surgically and the other by embolization, had recurrences and were salvaged by radiation, and neither has recurred. The final patient is disease‐free 9 months after embolization and surgery. There have been no serious sequelae of treatment. We conclude that moderate‐dose irradiation can safely control most temporal bone paragangliomas.

Adriamycin/cis-platinum/cyclophosphamide combination chemotherapy for advanced carcinoma of the parotid gland.

Five patients were treated with a combination of Adriamycin/cis‐platinum/cyclophosphamide for faradvanced and/or recurrent cancers of the salivary gland. Adriamycin, 40 mg/m2, and cis‐platinum, 50 mg/m2, were given on day 1; cyclophosphamide, 200 mg/m2 daily for four days, was given by mouth on the third to sixth day of each monthly therapy course. Two patients achieved a complete remission, each lasting five months, and the three others had partial remissions from one to seven months (median six months) in duration. Therapy was well tolerated. Severe nausea and vomiting occurred on the first day of therapy but was self‐limited. There was only mild to moderate leukopenia, no significant thrombo‐cytopenia or elevations of serum creatinine, and no evidence of dose‐limiting peripheral neuropathy. Adriamycin/cis‐platinum/cyclophosphamide chemotherapy appears to be effective in the treatment of advanced parotid gland cancers.

Radiation therapy for squamous cell carcinoma of the supraglottic larynx.

Sixty-five patients with invasive squamous cell carcinoma of the supraglottic larynx received irradiation with curative intent between 1975 and 1984, with a 5-year actuarial survival of 48% and a local control rate of 70%. Five-year survivals for clinical Stages I, II, and III + IV were 60, 53, and 52%, respectively; local control rates were 88, 76, and 63%, respectively. These patients included one treated with preoperative irradiation, 35 treated with surgery followed by postoperative irradiation, and 29 treated with radiation therapy alone. In the surgery plus irradiation group, 5-year local control was 93% for clinical Stages I + II (14 patients), and 61% for clinical Stages III + IV (21 patients). Three patients had pathologic Stage II disease, with the remainder demonstrating a higher pathologic than clinical stage. Multiple positive nodes predisposed to local/regional recurrence, while no relationship could be established between recurrence and extracapsular nodal spread, positive margins, emergency tracheostomy, total versus less-than-total laryngectomy, radiation field size, radiation dose, or delay until radiation therapy, probably because of patient numbers. Six patients, five with positive nodes, developed distant metastases, and three developed second primary tumors outside the head and neck region. In the radiation therapy alone group, 5-year local control rates were 86, 59, and 53% for clinical Stages I (7 patients), II (11 patients), and III + IV (11 patients), respectively. However, three of four Stage II local/regional failures were surgically salvaged for periods>30 months, for an ultimate Stage II local control of 89%. No relationship could be established between local control and radiation dose or field size, again probably because of small patient numbers. Three patients developed distant metastases, and eight developed second malignancies, one within the irradiated volume. Fifteen patients developed acute toxicity during irradiation, and there were eight chronic complications, five requiring surgery; toxicity was more common in the group treated with radiation alone. Radiation therapy alone with surgical salvage is an effective, function-preserving treatment for clinical Stages I and II carcinoma of the supraglottic larynx, and appears to yield local control and survival comparable with that of combined irradiation and surgery in more advanced disease.

Sleep apnea syndrome associated with a neck mass.

Sleep apnea is an entity that is becoming more commonly diagnosed as the signs and symptoms are becoming better understood. In this report, the first known case of sleep apnea secondary to a lipoma of the submandibular area of the neck is presented. A brief discussion of the types of sleep apnea, along with the most common signs and symptoms of the entity, are reported. The diagnostic workup, operative findings, and postoperative results in this patient are discussed.

Low-dose radiation therapy for benign salivary disorders

Two patients, one with a persistent salivary fistula after surgery for a skin tumor overlying the parotid region, and the other with a ranula recurrent after surgery, were treated with low-dose irradiation. Both problems resolved after a total dose of less than 30 Gy, and neither patient experienced xerostomia. In selected patients, low-dose radiation therapy offers a solution to persistent salivary flow refractory to surgical management.

Sialadenitis in children

Sialadenitis in children has been discussed. A literature review highlighting salient points in sialadenitis is presented. Classification of sialadenitis is discussed using the categories of several authors. An unusual case involving acute suppurative parotitis in a child is presented. The development of contralateral disease while treatment was in progress was unusual. In this case, association with mumps parotitis was strongly suspected despite previous immunization. Progression of disease with abscess formation is also unusual. Mumps virus parotitis has been rarely reported in association with acute suppurative parotitis. Immunization affords protection, but a definite failure rate exists. Based upon histologic examination, mumps parotitis would seem to be a predisposing factor for bacterial infection.

Otolaryngologic Effects of “The Pill”

The symptom of fullness in the ears is secondary to congestion of the eustachian tube or, in some cases, results from an unusual patulous condition.s The congested mucous membrane of the eustachian tube is a manifestation of a vascular response to hormone levels. The patulous condition is known to occur after weight loss and during pregnancy. The mechanism for its action in patients taking the pill is probably the same as in pregnancy.