Nasal septal squamous cell carcinoma: a chart review and meta-analysis.

Squamous cell carcinoma of the nasal septum occurs infrequently and is often misdiagnosed because its symptoms are similar to everyday rhinologic complaints. The published series have been too small to determine the best form of treatment for this cancer. The authors of this study retrospectively reviewed nasal septal squamous cell carcinomas treated at three university-affiliated hospitals over a 30-year period. Sixteen primary tumors were identified and reviewed for presentation, staging, treatment, recurrence patterns, and risk factors. The authors then combined their findings with those of suitable literature series and performed a meta-analysis to evaluate predictors of survival. There were too few patients in each stage and treatment group to significantly determine the optimal treatment for nasal septal squamous cell carcinoma. However, based on the present study and the literature series, the authors suggest that small lesions may be confidently treated with either radiation or surgery and that combined therapy may be reserved for more advanced tumors.

Hemoptysis and pseudohemoptysis: the patient expectorating blood.

Patients expectorating blood seek evaluation and treatment from a variety of clinicians. Although the bleeding may arise either from the lungs (hemoptysis) or from the upper aerodigestive tract (pseudohemoptysis), the evaluation commonly focuses on exclusion of a pulmonary neoplastic source. Likewise, most literary reviews only focus on hemoptysis as it relates to pulmonary malignancies. The present retrospective review identifies 471 patients with the diagnosis of hemoptysis over a six-year period, and 10% were ultimately found to have UAT etiologies for their bleeding. UAT cancers were identified as the source in 2.1% of all patients, either due to primary lesions or via metastases. The majority of UAT cancers had been previously diagnosed prior to this episode of hemoptysis. This review indicates that a thorough UAT history and exam is warranted in the hemoptysis patient because of the significant occurrence of UAT causes. However, the likelihood of finding an occult UAT cancer in this patient population is very low with the only risk factor being a previous history of a UAT neoplasm.

Eagle's syndrome: the Ochsner experience.

Eagle fully described the syndrome that bears his name in 1948. He noted that the typical patient had undergone tonsillectomy in the past. Although reported in the literature, the carotid artery syndrome is frequently overlooked in patients manifesting craniofacial or pharyngeal pain but who have not undergone tonsillectomy. Cases representative of the variety of patients with Eagle's syndrome treated at the Ochsner Clinic Department of Otolaryngology are presented. The diversity of symptoms and its rather uncommon occurrence often make the diagnosis of Eagle's syndrome elusive. The anatomy and embryology of the stylohyoid complex is discussed, as well as the symptoms, differential diagnosis, workup, and treatment of Eagle's syndrome. We hope to refamiliarize the clinician with this condition in order that it be considered in the assessment of patients with craniofacial pain.

Composite tumor of the larynx.

Composite tumor of the larynx has been described as a mixed squamous cell and oat cell carcinoma originating in the larynx. Only eight cases of composite tumor of the larynx have been described in the world medical literature. We present the ninth case ever reported. Therapy for this very aggressive malignancy is with a combined approach--surgery, radiation, and chemotherapy. A common etiology for both squamous cell and oat cell carcinoma has been proposed. Recommendations for diagnostic evaluation as well as therapeutic intervention will be discussed.

A palmar dermatosis linked to occult carcinoma of the upper thorax, head and neck: Bazex's syndrome and tripe palm.

An unusual, persistent, corregated-to-honeycombed thickening of the palms accompanied by tenderness around the fingernails was found to be a cutaneous marker for internal malignancy. This combination of signs and symptoms has been reported under two clinical entities: Bazex's syndrome and tripe palm. This paraneoplastic syndrome is of interest to head and neck surgeons due to the location of the primary tumor, the site of metastatic disease, and the ability to cure the cutaneous disease by surgical removal of the primary tumor. In our patient, a squamous cell carcinoma of the lung not detectable on chest x-ray presented as a cervical mass accompanied by cutaneous changes on the palms and fingernails. Recognition of the relationship of the dermatologic changes to malignancy of a specific body region eventually led to the detection of the primary tumor. The characteristics of these paraneoplastic syndromes were reviewed in this report.

The perioperative management of neonates with congenital oropharyngeal teratomas.

Oropharyngeal teratomas are rare congenital neoplasms that distort orofacial anatomy and often cause respiratory embarrassment at birth. Immediate management of such lesions should include establishment of a secure upper airway, radiographic exclusion of midline central nervous system anomalies, and early surgical excision to prevent asphyxia or permanent disfigurement. Perioperative assessment and surgical management are reported for three oropharyngeal teratomas.

Severe upper airway obstruction in children secondary to lingual tonsil hypertrophy.

Lingual tonsil hypertrophy in children is a rarely reported disorder. Two cases of severe upper airway obstruction in pediatric patients secondary to marked lingual tonsil enlargement are reported. Both children were effectively treated with lingual tonsillectomy. The surgical technique, using an insulated Bovie tip, is described.

Basal cell carcinoma of the head and neck.

Basal cell carcinoma is the most commonly occurring skin cancer in the United States with 85% of the lesions occurring in the head and neck region. Several risk factors have been identified but the most critical is cumulative light exposure in the ultraviolet B spectrum. Treatment of these lesions is variable and must be individualized as to the type and location of the tumor, the status of the individual patient, and the skill and experience of the operator.

Composite nasal septal cartilage graft for reconstruction after extended frontolateral hemilaryngectomy.

With the advent of extended partial laryngectomy for T2 and selected T3 true vocal cord carcinomas, the head and neck surgeon has had to deal not only with the rehabilitation of voice, but with the problem of laryngeal stenosis with obstruction of laryngeal airflow. To manage this difficult problem, it is necessary to restore the cartilagenous superstructure to prevent collapse of the laryngeal soft tissues. This is best done at the time of initial cancer resection. At the time of extended frontal lateral hemilaryngectomy, an exact template of the resected cartilage is made. From this, a composite nasal septal cartilage graft is utilized to restore the laryngeal superstructure. The anterior commissure is reconstructed by scoring the septal cartilage. It has been our experience with this procedure that the neoglottis remains both competent and functional.

Treatment of chronic aspiration as a complication of cerebrovascular accident.

Chronic aspiration remains one of the most difficult complications to treat in the patient recovering from brain stem infarction. Aspiration in these patients is often due to an incompetent glottis in association with dysfunction of the pharyngeal phase of swallowing. A systematic approach to the evaluation and treatment of these patients is presented with illustrative case presentations. Such individual treatment protocols allow for optimum rehabilitation of the post-stroke victim.

Malignant potential of keratoacanthoma.

Keratoacanthoma is generally considered to be a benign cutaneous lesion with initial rapid growth and spontaneous involution over several months. It is not generally appreciated that the keratoacanthoma may have a malignant potential or be associated with carcinoma. When a lesion diagnosed as keratoacanthoma recurs after excision, underlying malignancy must be considered. Four examples of keratoacanthoma associated with underlying malignancy are presented from the Ochsner Medical Institutions to emphasize the above points.

Surgical treatment of hypopharyngeal (Aenker's) diverticulum.

Twenty-six patients underwent surgical repair of a pharyngoesophageal diverticulum at Ochsner Clinic, New Orleans, from 1957 through 1977. The majority of the patients (22) had a one-stage excision with intraluminal packing of the diverticulum and esophageal closure after excision. Of the 22 patients whose diverticula were treated by this method, 16 reported they were asymptomatic postoperatively, and six stated their symptoms improved. There were three complications: two wound infections and a temporary recurrent laryngeal nerve paresis. During long-term follow-up, recurrent diverticula developed in two patients. The addition of packing to the diverticulum and the resection and closure over Maloney's dilator have proven to be important aids in this surgical approach.

Surgical correction of complete tracheoesophageal cleft.

Laryngotracheal esophageal cleft is a rare congenital anomaly that should be considered in the differential diagnosis of any neonatal respiratory distress aggravated by feeding. Diagnosis is difficult and repeat endoscopic examinations may be necessary. In complete clefts, immediate surgical repair is indicated with combined approach through the chest and neck and incorporation of part of the esophageal wall into the repair. Because the cleft may be associated with esophageal atresia and/or tracheal esophageal fistula, it should be suspected in patients who have persistent symptoms after successful repair.

Otitic hydrocephalus.

This case of otitic hydrocephalus emphasizes a complication of ear disease which is rarely seen in modern otologic practice. The diagnosis and treatment of this entity have been reviewed in detail. Although the mechanism of this hydrocephalus is unknown, several theories have been presented.