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A retrospective study was conducted to assess outcomes of reconstruction of the oral cavity with the platysma myocutaneous flap, in terms of flap survival, complications, and quality of life. Included were 10 patients with squamous cell carcinoma (stage T1 to T4; nodal status N0 to N2) of the oral cavity who were treated between 2002 and 2006. Each patient underwent tumor resection, modified radical neck dissection, and primary reconstruction with a platysma myocutaneous flap. Operating time, length of stay, time to swallow, and complications were assessed, and the University of Washington Quality of Life questionnaire was administered. Mean operating time was <4 hours, mean length of stay was 11 days, and mean time to swallow was 9 days. One patient had distal flap necrosis and one had wound dehiscence. No total flap failures or fistulas occurred. The authors conclude that the platysma myocutaneous flap provides thin, pliable, reliable tissue for use in the oral cavity. The additional operating room time is negligible, the surgical complications minimal, and the overall quality of life very good. This flap should be used more frequently in the reconstruction of oral cavity defects.

Solitary fibrous tumors are benign neoplasms of mesenchymal origin. They usually arise from the visceral or parietal pleura and peritoneum, although they have been found in many areas throughout the body. We report a case of solitary fibrous tumor of the parapharyngeal space. Microscopically, the tumor contained spindle cells with areas of marked hypercellularity without a definitepattern. Consistent with a benign lesion, there were few mitoses and no necrosis. The tumor cells stained strongly positive for CD34 and vimentin. At the 2-year follow-up, the patient was well and free of local and/or distant disease.

Objectives: To determine if nasal septal papilloma is responsive to intralesional cidofovir injections., Methods: Five adult males, ages 37 to 57, presented with nasal septal or columellar papilloma. Three lesions had been previously excised with the laser and recurred. The lesions were injected with cidofovir on a monthly basis until complete resolution or any residual lesion was excised afterwards with the laser., Results: All patients achieved disease remission sustained over 10 to 24 months. Overall doses were much lower than those described for laryngeal papillomatosis and no toxic effects were observed., Conclusions: Office-based intralesional injections of cidofovir may show benefit in the treatment of nasal septal papilloma., Ebm Rating: C-4.

Pathologic examination of an excisional biopsy specimen of a subepidermal nodule from the nasal tip of a 37-year-old black man demonstrated papillae covered by eosinophilic columnar epithelial cells, suggesting cylindric cell papilloma or well-differentiated papillary adenocarcinoma of nasal mucosa. The patient did not submit to further investigation of the sinonasal tract but sought attention 15 months later because of local recurrence of the lesion. A protuberant, 3-cm, cystic nodule of the subcutis over the left nasal ala and tip was excised completely and found to have characteristics of hidradenoma papilliferum, an apocrine gland neoplasm most commonly occurring in the anogenital skin of white women. This case demonstrates how easily an apocrine neoplasm arising near a mucocutaneous junction can be confused with a mucosal tumor, potentially leading to inappropriate treatment.

Objective: Frozen-section analysis of follicular lesions is often inconclusive because capsular or vascular invasions are the hallmarks of malignancy with this technique and may not be seen in the particular field studied. Using preoperative fine-needle aspiration biopsy specimens, we attempted to identify malignant follicular lesions and compare these results against frozen-section analysis., Methods: A retrospective study of 1000 consecutive thyroid fine-needle aspiration biopsy specimens was performed. Surgical pathologic correlation was available in 179 cases., Results: Fine-needle aspiration biopsy yielded a suspicious or positive rate of 23%. Surgical pathology was available in 179 patients, of which 95% had thyroid cancer. The follicular variant of papillary cancer was identified in 26 cases, or 15% of the positive cases. Frozen-section analysis yielded false-negative results in 7 of these 26 cases (27%)., Conclusions: Preoperative recognition of the follicular variant of papillary cancer by fine-needle aspiration biopsy may reduce the overall incidence of false-negative frozen-section findings.

An expanded polytef (polytetrafluoroethylene [ePTFE]) soft-tissue patch was used in nine patients to reconstruct postparotidectomy defects and prevent Frey's syndrome. All nine cases were constructed primarily using either a 1- or 2-mm-thick patch depending on the depth of the defect. All nine patients achieved excellent, nearly normal contour that approximates the uninvolved side. None complained of Frey's syndrome. Average follow-up to date is 12 months.

We report a case involving the localization and surgical removal of a traumatically introduced foreign body deep within the infratemporal fossa. Needle-hookwire placement with computed tomographic guidance allowed the precise localization and marking of the foreign body. Surgical removal under local anesthesia and without extensive exploration was, therefore, possible. The details of the localization and marking techniques are described. Needle-hookwire localization under computed tomographic guidance should be considered for deeply located foreign bodies in the head and neck area.

We have successfully treated two patients with symptomatic pneumatosis cystoides intestinalis using a high FIO2 delivered by face mask, with administration interrupted at meal times. While we advocate oxygen therapy for this disease, caution must be taken to avoid the complications of high PaO2, namely proliferative and fibrotic lung changes. Close attention should be paid to the development of increasing cough, dyspnea and shortness of breath. As the frequency of the diagnosis of pneumatosis cystoides intestinalis increases, the success of high inspired oxygen as therapy should be recognized.

An elderly woman presented with a large, fungating mass over the occipital portion of the scalp. Biopsy revealed this to be a pilar tumor of the scalp. The tumor was excised with a margin of normal tissue and the defect was closed with advancement of scalp and neck skin. Follow-up at 6 months revealed no recurrence of the lesion.

A retrospective review of 64 total thyroidectomies performed at Memorial Sloan-Kettering Cancer Center was conducted. Only one patient had permanent hypocalcemia (1.6%) requiring calcium supplementation. Eight patients had a total of 11 complications, for a complication rate of 12.5%. These results are in sharp contrast to those published in 1972 from this institution, in which the permanent hypocalcemia rate was 29%. The reasons for this difference are discussed.

The shifting of skin and superficial musculo-aponeurotic system (SMAS) fascia in the facelift procedure represents an important development in the improvement of the lax and sagging skin of the face and neck. The pathology of aging skin is reviewed, the anatomy of the SMAS fascia is described, and the use of SMAS fascia in surgery along with attendant potential hazards are discussed.

Cockayne's syndrome is a triad of dwarfism, retinal atrophy, and deafness. Over thirty cases have been presented in the literature. We have examined and audiometrically tested three patients (ages 13 to 17) with confirmed Cockayne's syndrome and have analyzed the temporal bones of another who died at age 24. To our knowledge this is the first reported temporal bone analysis of a patient with Cockayne's syndrome. Audiograms revealed bilateral symmetric sensorineural hearing loss that was greatest in the high frequencies. Temporal bone examinations revealed inner and outer hair cell losses in the basal turn of the cochlea with corresponding neuron losses in the spiral ganglion. We have found that the clinical and histopathologic features resemble those of presbycusis and conclude that this corresponds well with the generalized, rapid, premature aging process characteristic of this disease.

The complications following 100 consecutive laryngectomies performed at our hospital during a recent 18-month period are reviewed. The complication rates for total laryngectomy (63 patients) and extended laryngectomy (37 patients) were 19% and 49%, respectively, while the fistula rates were 8% and 27%, respectively. These rates were influenced primarily by the extent of surgery and the type of reconstruction, which during this interval included primary closure, pectoralis major myocutaneous flap, or gastric transposition. In comparison to our previous study, when the deltopectoral flap was used for patching the pharynx, the fistula rate for extended laryngectomy has decreased as a result of our use of myocutaneous flaps and greater experience with gastric transposition. Currently, we use the pectoralis major myocutaneous flap for pharyngeal repair if the mucosa would otherwise be closed under tension. All circumferential defects are repaired with a gastric transposition.

A rare lesion of the maxillary and ethmoid sinuses, an ossifying capillary hemangioma, is presented. The therapeutic options and our choice of embolization followed one day later by radical surgery under hypotensive, hypothermic anesthesia are discussed. The principles of therapy involved in this lesion apply to the management of any large vascular tumor of the head and neck.

A 30-year retrospective analysis of 50 patients with squamous cell carcinoma of the salivary glands was conducted, including 42 patients with parotid tumors and eight with submandibular lesions. Clinical staging, performed for 48 patients in whom adequate data were available, yielded the following results: Stage I, 17%, Stage II, 12%, Stage III, 71%. Surgery was the primary therapy in 45 patients (86%). The determinate "cure" rate at 5 and 10 years was 24 and 18%, respectively, for patients with parotid lesions and 20% for those with submandibular tumors. As with other malignant salivary gland tumors, advanced stage and pain as a presenting symptom were ominous findings. Locoregional recurrence was the usual site of failure in both parotid (51%) and submandibular (67%) cases. Radical surgical extirpation, preserving the facial nerve when possible, remains our treatment of choice. It is anticipated that planned postoperative radiotherapy will reduce our high locoregional recurrence rates.

Traditionally, gullet closure that is done after a laryngectomy has been accomplished with tedious and time-consuming suturing procedures. As an alternative to this, staple closure of the gullet has been growing in acceptance and implementation as a mucosal eversion technique. In this article, we shall present several aspects and considerations of this method of surgical closure.