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Bilateral vocal fold immobility in adduction usually creates severe dyspnoea. Many surgical procedures have been established to improve the airway insufficiency in affected patients.Over the last six years 22 patients with bilateral vocal fold immobility in our department have undergone CO2 laser posterior ventriculocordectomy with partial arytenoidectomy (PVCPA). None had dyspnoea or a disturbance in the immediate post-operative period or during follow up, which ranged from five months to six years. Only one patient required a second procedure.Laser PVCPA appears to be an effective and reliable method for the treatment of bilateral vocal fold immobility in selected patients.

The detection of metastatic lymph nodes in cancer patients is essential for determining the cancer stage, and thus, the therapeutic modalities. However, very small lymph nodes can easily be missed during routine examination. We described a ''Lymph Node Revealing Solution'' (LNRS) that helps to detect tiny lymph nodes in neck dissection specimens. Twenty-one consecutive specimens of neck-dissection were investigated. The entire surgical specimen, fixed at first in formalin, was searched for lymph nodes by the traditional method. These were excised and sent for processing. The remaining tissue was immersed for 24 hours in LNRS. The lymph nodes stood out as white chalky nodules on the background of the yellow fat. They were then excised, and examined. A total of 227 lymph nodes were detected by the traditional method; 38 (17%) were positive for metastasis. Using the LNRS method, an additional 72 nodes were identified, among them 8 (11%) were positive for metastases and 2 cases were upstaged. LNRS is an inexpensive and easy method of detecting tiny lymph nodes; it enhances significantly the yield of normal and metastatic nodes of neck-dissection specimens and helps to establish a more accurate staging. (Otolaryngol Head Neck Surg 2001;124:72-5)

Down-regulation of receptor tyrosine kinase activity plays an essential role in coordinating and controlling cellular growth/differentiation. Ca2+/calmodulin-dependent kinase II (CaM kinase II)-mediated phosphorylation of threonine 1172 in the cytoplasmic tail of HER2/c-erbB2 can modulate tyrosine kinase activity and consensus phosphorylation sites are also found at serines 1046/1047 in the structurally related epidermal growth factor receptor (EGFR). We show that serines 1046/1047 are sites for CaM kinase II phosphorylation, although there is a preference for serine 1047, which resides within the consensus -R-X-X-S-. In addition, we have identified major phosphorylation sites at serine 1142 and serine 1057, which lie within a novel -S-X-D- consensus. Mutation of serines 1046/1047 in full-length EGFR enhanced both fibroblast transformation and tyrosine autokinase activity that was significantly potentiated by additional mutation of serines 1057 and 1142. A single CaM kinase II site was also identified at serine 744 within sub-kinase domain III, and autokinase activity was significantly affected by mutation of this serine to an aspartic acid making this site appear constitutively phosphorylated. We have addressed the mechanism by which CaM kinase II phosphorylation of the EGFR might regulate receptor autokinase activity and show that this modification can hinder association of the cytoplasmic tail with the kinase domain to prevent an enzyme-substrate interaction. We postulate that the location and greater number of CaM kinase II phosphorylation sites in the EGFR compared with HER-2/c-erbB2, leading to differential regulation of autokinase activity, contributes to differences in the strength of downstream signaling events and may explain the higher relative transforming potential of HER-2/cerbB2.

We retrospectively evaluated the management of supraglottic carcinoma at our centre during the last 35 years to determine the preferred mode of treatment. A review of the medical records yielded 114 patients with supraglottic T1and T2carcinoma who were diagnosed and treated in the Departments of Otolaryngology, Head and Neck Surgery, and Oncology between 1959 and 1993. Of these, 47 (41.2%) had T1carcinoma (stage I) and 67 (58.8%) T2(stage II). Treatment varied among radiotherapy, surgery, or combined radiotherapy and surgery. Twelve patients underwent elective neck dissection, one of whom (8.3%) was found to have occult metastases. Local failures were noted in 22 patients (11 T1: 11 T2), three of whom also had neck metastases. All except one T2patient received radiotherapy. Radiotherapy yielded the best survival rates for T1disease as combined therapy did for T2. Five-year recurrence rates for T1patients were 35% for those treated by radiotherapy and 42% for those treated with combined therapy; corresponding figures for T2patients were 39% and 28%. We suggest that patients with T1supraglottic carcinoma be managed with radiotherapy and patients with T2with combined therapy. We believe there is no need for elective neck dissection, especially in T1.

Thyroid cancer is a rare but intriguing malignancy when it occurs in childhood and adolescence. In this retrospective study 58 young patients with thyroid cancer treated at the Rabin Medical Centre are presented. We found that thyroid carcinoma in children presented in a more advanced stage than in adults, and the incidence of regional metastases at the time of presentation is higher. Nevertheless, the biological behaviour of the tumour is more benign. We believe that near-total thyroidectomy is the treatment of choice in this age group for disease limited to the gland, and total thyroidectomy with perithyroidal neck dissection should be performed in patients with nodal disease. For follow-up, we recommend physical examination with measurement of thyroglobulin and TSH levels, ultrasound examination of the neck and chest radiography.

Salivary gland tumors are the most common primary lesions that occur in the parapharyngeal space. The current accepted approach to most deep-lobe tumors is the transparotid. For tumors of non-parotid origin, the preferred approach is transcervical. In cases in which the transparotid approach is insufficient, a transcervical, transmandibular approach is safe and offers excellent visualization.

The autonomic nervous system (ANS) is a mixed nervous system. There are two divisions of the ANS: the parasympathetic autonomous nervous system (PANS), and the sympathetic autonomic nervous system (SANS). The PANS plays a role in the conservation and homeostasis of bodily functions. The cells giving rise to parasympathetic fibers are situated at three different levels of the central nervous system: the midbrain, the medulla oblongata, and the sacral region of the spinal cord. The parasympathetic fibers leave the brain in the facial (VII CN), glossopharyngeal (IX CN), and vagus (X CN) nerves. The postganglionic parasympathetic fibers of the VII CN enter the sublingual and submanidublar glands and the minor salivary glands of the mucous membrane of the mouth, pharynx and nasopharynx, and those of the IX CN converge into the parotid gland. Parasympathetic postganglionic cholinergic nerve fibers supply cells of both the secretory end-piece and ducts and stimulate the rate of salivary secretion, inducing the formation of large amounts of a low-protein, serous saliva. Parasympathetic denervation of the major salivary glands leads to an immediate reduction of salivary secretion.

Drooling is the end result of excessive production of saliva, the inability to retain oral secretions, or the outcome of deglutition problems. Mentally retarded children are frequently affected. Although medically managable, surgical correction is recommended. The classic surgical technique is Wilkie's procedure, consisting of retropositioning of the parotid ducts into the tonsillar fossae region along with bilateral submandibular gland resection. Modifications include transposition (instead of resection) of the submandibular gland ducts, ligation (instead of repositioning the parotid ducts) along with the usual submandibular gland resection and other variants. Surgical results are usually beneficial and are associated with relatively insignificant complications and side effects.

The detection of markers associated with malignancy will help in the early identification of tumors and assessment of the success of treatment in patients suffering from carcinoma. Three characteristics investigated in this study were found to differentiate a premalignant inverted papilloma from a benign simple nasal polyp.

In view of the proven effectiveness of vitamin A for the treatment of hyperkeratosis, it was hypothesized that vitamin A may also be a feasible therapeutic option for cholesteatoma, which has similar histologic features.

Every surgical procedure has its price, and so does resection of parotid tumors. Although damage to the facial nerve when transversing the gland is the main complication, gustatory sweat syndrome, also known as Frey's syndrome, should be mentioned. Although careful surgery and experience may help prevent the damage, 56% of patients undergoing parotid surgery suffer from some degree of postoperative Frey's syndrome, no matter who the surgeon is and what technique is used. The various techniques for treating Frey's syndrome are described. Salivary fistulas and sialoceles are among the complications of parotidectomy that are also described in the present study. The surgical techniques for treating these complications are depicted.

Tumors of the oral cavity requiring maxillary resection may cause functional and aesthetic disabilities involving speech, mastication, and deglutition because food and liquids may be forced into the nasal cavity and out of the nose. To help patients overcome these difficulties, it is essential to provide them with obturator therapy. The different types of obturators and rehabilitation after maxillary resection are described in this article.