Paranasal sinus malignancy: a comprehensive update.

A retrospective analysis of 60 cases of paranasal sinus cancer in patients admitted between 1970 and 1985 was undertaken. Forty-six tumors originated in the maxillary sinus, and 14 originated in the ethmoid sinuses. Computed tomography, magnetic resonance imaging, and endoscopic sinus examination aided in early diagnosis of sinus cancer. Computed tomography aided in staging tumors; Caldwell-Luc alone was inadequate for staging tumors invading deeper sites such as the orbits or pterygoid muscle. There were 15 early (T1 or T2) and 31 advanced (T3 or T4) maxillary sinus cancers. Multimodality therapy incorporated radiation, surgery, and chemotherapy. The 5-year survival rate was 49%. We prefer preoperative radiotherapy for advanced lesions and postoperative radiotherapy for early lesions. The use of preoperative radiation therapy has increased our globe salvage rate. All but one of the patients who developed recurrent disease showed recurrence at the primary site prior to developing regional or distant metastasis. Radiation therapy, combined with aggressive surgical management to remove all tumor, provided the best survival rates in advanced lesions.

The prevention of carotid artery rupture with isobutyl-2-cyanoacrylate.

Carotid artery exposure and rupture is one of the most feared complications of head and neck surgery. The ideal method for preventing rupture of an exposed artery should be easy to perform, safe, effective and should spare local and regional flaps for later use in reconstruction. Isobutyl-2-cyanoacrylate (Bucrylate) is a commercially available compound that appears to meet these criteria. Test animals were divided into two groups. The carotid arteries of 12 dogs (group A) were exteriorized bilaterally and coated with Bucrylate unilaterally. Group B (four dogs) underwent the same procedure except that the vessels were bilaterally coated. Wounds were dressed twice daily with moist-to-dry gauze. No antibiotics were given. Nine of the 12 unprotected arteries in group A ruptured within 2 weeks, and one unprotected artery ruptured on postoperative day (POD) 29. Two dogs healed over both vessels. In group B, three dogs ruptured their arteries within 2 weeks. One dog healed over both vessels. Gross and histologic examination of the arteries showed a striking difference between coated and uncoated vessels. We believe that Bucrylate and cyanoacrylate adhesives hold promise in the clinical protection of exposed carotid arteries.

Extracranial neurogenic tumors of the head and neck.

The vast majority of head and neck nerve tumors are benign. Proper management involves accurate preoperative evaluation and a high degree of suspicion. Ideal treatment involves complete resection but debulking procedures have a definite role. Microneural dissection and reconstruction should be attempted in all cases. Malignant tumors of neural tissue are aggressive and are treated with radical surgical resection followed by radiation. Chemotherapy is reserved for unresectable or metastatic disease.

The mechanical spread of viable tumor during surgery.

The "mechanical" spread of tumor is that which occurs through physical trauma, such as during surgical resection. There has been a waxing and waning of interest in this concept over the past 70 years. We have collected the blood that comes off the surgical field during major head and neck resections and separated and plated all nucleated cells in the tumor stem cell assay of Hamburger and Salmon. In one of six such preparations, we demonstrated the presence of viable, colony-forming tumor cells. Two were contaminated and three did not grow. We demonstrated, therefore, that the blood that bathes the raw open surgical field contains tumor cells that are viable and potentially capable of producing new foci of tumor.

Hypopharyngeal carcinoma.

Early hypopharyngeal carcinoma is a rare but difficult problem to handle. Early metastases, local recurrences, and mediastinal extension are the most common causes of failure. Radical surgery, preserving as much function as possible, and aggressive postoperative radiation are the hallmarks of management.

Nasal and paranasal malignancies. Carcinoma of the paranasal sinuses.

Carcinoma of the paranasal sinuses is an insidious and relentless disease with a notoriously poor prognosis. Our diagnostic approach and treatment philosophy are outlined. The more recent results are also presented.

Potential applications of photoradiation therapy in head and neck surgery.

Current theories of carcinogenesis suggest that premalignant changes should be expected in any area of the mucous membrane exposed to a carcinogen. The place of triple endoscopy in the workup and management of head and neck malignant neoplasms has been well established. Hematoporphyrin derivative has been shown to lend reproducible results in the study of tumor fluorescence. This compound has been used in in vitro and in vivo diagnosis and in the treatment of various tumors. It has not been used extensively in the head and neck, but its properties are ideal for diagnosis and treatment of selected head and neck tumors. Potential applications of photoradiation therapy in otolaryngology-head and neck surgery include detection of small primary tumors, delineation of resection margins, detection of early recurrences, and palliative and curative therapy of lesions.

Hyperparathyroidism: problems in surgical management.

A retrospective study of 210 patients who had 225 operations for hyperparathyroidism over a 20 year period has been reported. These patients were operated on by 20 staff surgeons, 12 of whom performed such an operation less than five times for this disease during the study period. There was a significant operative and postoperative morbidity of about 8 percent. There was one postoperative death, and two patients died later of related problems. The recurrence rate was 1 percent. The total rate of untoward results was about 18 percent. The success rate of primary operations was 95 percent (71 percent for reoperations). These findings were similar to those in many published reports, but were less than satisfactory. It is possible that results could be improved by putting such patients in the care of experienced surgeons. Careful identification of all of the parathyroid glands is essential to obtain satisfactory results. There was an unusually large incidence of this disease in patients with thyroid disease, immobilization, and thiazide intake. There was a correlation between the preoperative serum calcium levels and the size of the parathyroid tumors that were removed. An interesting "rebound" postoperative hypercalcemia has been described.