Timothy M. McCulloch

Arytenoid adduction combined with Gore-Tex medialization thyroplasty.

Objective To describe the technique of combined Gore‐Tex medialization thyroplasty with arytenoid adduction and to determine the long‐term vocal outcome of patients treated for unilateral vocal cord paralysis with this procedure.

Long‐Term Follow‐up of Fat Injection Laryngoplasty for Unilateral Vocal Cord Paralysis

Objective The objective of the study was to evaluate the results of autologous fat injection laryngoplasty in the long‐term management of unilateral vocal cord paralysis.

Risk factors for pulmonary complications in the postoperative head and neck surgery patient

Pulmonary complications are a primary source of increased cost and morbidity in surgically treated head and neck cancer patients. This study investigates potential risk factors related to postoperative pulmonary complications (pneumonia, adult respiratory distress syndrome (ARDS), and prolonged mechanical ventilation) in head and neck cancer patients.

Esthesioneuroblastoma: The University of Iowa experience 1978-1998

Objective Esthesioneuroblastoma is rare and the best treatment has yet to be defined. The purpose of this study is to analyze the natural history, treatment, and patterns of failure of esthesioneuroblastoma treated at one institution.

Patterns of metastases to the upper jugular lymph nodes (the “submuscular recess”)†

Cervical lymphadenectomy to remove metastatic disease in level II encompasses lymph nodes associated with the upper third of the internal jugular vein and the adjacent spinal accessory nerve (SAN). Conservative neck dissection (ND) preserves these structures but requires manipulation of the SAN to remove tissue located in the posterosuperior aspect of level II. Limiting the dissection to the nodal group anterior to the SAN may reduce operating time and limit injury to it without compromising the removal of lymph nodes at risk for involvement with cancer.

Pectoralis major myofascial flap: A valuable tool in contemporary head and neck reconstruction

The pectoralis major myofascial (PMMF) unit is rapidly mobilized, reliable, and extremely useful in a number of clinical situations calling for vascularized soft‐tissue coverage in the head and neck. Although free‐tissue transfer has emerged as the preferred method of reconstruction for a large variety of defects in the head and neck, the pectoralis major muscle should be considered when vascularized soft‐tissue coverage is required in this area.

Risk factors for malignancy in adult tonsils

Tonsillectomy in adults (age 18 years and older) is performed for a variety of conditions. The palatine tonsils may harbor carcinoma or lymphoma, and this potentially unanticipated finding may follow routine tonsillectomy in the adult. The ability to preoperatively identify adult tonsillectomy patients at increased risk for tonsillar malignancy could sensitize the clinician to this possibility and the potential need for expedited rather than routine tonsillectomy scheduling.

Locoregional treatment for adult soft tissue sarcomas of the head and neck: An institutional review

PURPOSEThe purpose of this study was to review treatment results for primary soft tissue sarcomas of the head and neck in order to determine prognostic factors. PATIENTS AND METHODSFrom 1970 to 2000, 44 adult patients were diagnosed with a biopsy-proven, nonmetastatic primary soft tissue sarcoma in a head and neck subsite; were treated with curative intent; and had adequate follow-up and records for our review. Patients with extraosseous Ewings sarcoma, Kaposis sarcoma, rhabdomyo-sarcoma, dermatofibrosarcoma protuberans, and desmoid tumor were excluded. The most common tumor histologies included malignant fibrous histiocytoma (15 patients), angiosarcoma (nine patients), fibrosarcoma (six patients), and leiomyo-sarcoma (six patients). RESULTSThe median overall survival for all patients was 79 months. The actuarial 5-year local control for all patients was 55% and was highly correlated with the extent of surgical excision: 25% for subtotal resection/debulking, 65% for wide local excision, and 100% for radical excision. Local control at 5 years was 60% for patients treated with both surgery and radiotherapy, 54% for those treated with surgery alone, and 43% for those treated with radiotherapy alone. Adjuvant radiotherapy significantly improved the local control rates (from 25% to 54%) for patients with close (<2 mm) or positive surgical margins. Of 14 patients with locoregional failure in whom salvage was attempted, nine (64%) were rendered disease free. CONCLUSIONSMultimodality therapy with both surgery and radiotherapy improves local control, particularly in patients with close or positive surgical margins. Aggressive attempts at salvage therapy for locoregional failures are warranted and frequently produce long-term disease control.

Botulinum neurotoxin injection after total laryngectomy.

One of several causes of tracheoesophageal puncture (TEP) speech failure after total laryngectomy is disturbance in relaxation of the pharyngoesophageal (PE) segment. We introduce the use of chemical denervation of the PE segment through botulinum neurotoxin (Botox®) injection to improve TEP speech.

Malignant triton tumor of the head and neck: A case report and review of the literature

Malignant triton tumor (MTT) is a relatively rare, aggressive tumor comprised of both malignant schwannoma cells and malignant rhabdomyoblasts. Because MTT frequently arises in the head and neck, the otolaryngologist must be aware of the nature of the tumor and its response to various treatment modalities.