William R. Hudson

Spontaneous csf otorrhea from tegmen and posterior fossa defects

Spontaneous cerebrospinal otorrhea (SCSFO) from tegmen or posterior fossa defects is uncommon. Twenty‐nine cases have been detailed in the literature to date. We report an additional four cases from three patients. This group of 33 cases of SCSFO from tegmen or posterior fossa defects is characterized by certain clinical features. These patients are usually older adults (mean age 48 years, range 8 months to 80 years). Aural fullness with a serous appearing middle ear effusion, or clear otorrhea, often subsequent to tube myringotomy, are the usual initial symptoms. Meningitis was the initial manifestation in eight patients (24%), and ultimately occurred in an additional four patients (12%).

Rhinocerebral Phycomycosis and Internal Carotid Artery Thrombosis

This is a report of a case of internal carotid artery occlusion associated with rhinocerebral phycomycosis. In 18 autopsied similar cases that have been reported previously, hyphae were described in the walls of the internal carotid artery. Four survivors have been reported even though arteriograms demonstrated internal carotid artery occlusion, and a high index of suspicion for this complication should be maintained in all patients with rhinocerebral phycomycosis.

Penile Metastasis Secondary to Supraglottic Squamous Cell Carcinoma: Review of the Literature

We report an unusual supraglottic carcinoma metastasis to the penis. Review of the literature revealed more than 300 cases of metastatic lesions to the penis, excluding primary neoplasms from skin, urethra and blood. Of these metastatic neoplasms 16 originated above the diaphragm, only 4 of which were from the head and neck region. The most common neoplastic metastases to the penis in order of frequency were from the bladder, prostate, rectum and rectosigmoid areas, and kidney in 32, 30, 13 and 8% of the cases, respectively. The incidence of other primary tumor sites that metastasize to the penis is extremely rare.

Elevated serum secretory immunoglobulin A levels in patients with head and neck carcinoma.

Secretory immunoglobulin A (SlgA) is a major component of the secretory immune system and has been demonstrated in the sera of patients with various pathologic conditions. Current studies were undertaken to quantitate secretory components (SC) in sera of patients with squamous cell carcinoma in the head and neck region by means of a sensitive double-antibody radioimmunoassay. Patients with head and neck carcinoma were found to have threefold higher levels of SC (1.54 ± 0.74 mg/ml) compared to normal controls (0.51 ± 0.22mg/ml, P < .0001). Of interest was that the sera of patients who had successfully been treated 2 to 6 months prior to the study demonstrated statistically lower levels than those of patients with untreated carcinoma or recurrent disease. SC in sera appears to be in the form of SlgA. The origin and diagnostic significance of SC are briefly discussed.

Tomographic diagnosis of palatal defects.

We present the results of a pilot study conducted to evaluate the effectiveness of palatal tomography in patients suspected of having palatal defects not detectable by other methods. Twelve patients were involved in the projects, ranging in age from 3 to 11 years. There were 8 boys and 4 girls. Each patient was evaluated with voice recordings, lateral cineradiographic x-rays, and palatal tomograms. Nine of the 12 patients were found by tomography to have palatal defects that had not been detected either by cineradiography or by clinical investigation, including physical examination of the palate. The results of this study are presented with clinical findings.

Major Ambulatory Surgery of the Otolaryngologic Patient

Many otolaryngologic procedures can be performed safely on an ambulatory basis. Complications can be minimized by careful patient and procedure selection. This article describes common procedures adaptable to outpatient surgery and addresses the surgeons added responsibility in this setting.