Surgical treatment of squamous cell carcinoma of the oral tongue: factors influencing survival.

One hundred fifty patients with squamous cell carcinoma of the oral tongue (anterior two thirds) treated initially by surgery alone were analyzed and factors influencing survival were evaluated. Thirteen patients who died without evidence of disease in less than five years were excluded, leaving 137 determinate cases for review. The overall survival was 67.9%. The presence or absence of cervical node metastases appeared to be the most important determining factor in this series. The size of the primary lesion in itself did not play a substantial role in local control. However, overall survival was affected because the larger the primary lesion the higher the incidence of cervical metastases, and therefore, the lower the survival. It is concluded that partial glossectomy is effective treatment for control of localized disease (92.7%). Since cervical node metastases lowered the survival figures to 31%, it appears that more aggressive prophylactic treatment in the form of neck dissection or radiotherapy is indicated for lesions larger than 2 cm.

The recurrent laryngeal nerve.

Nonrecurrence and variations in the ascending course of the recurrent laryngeal nerves make it essential to identify the nerve to avoid injury to it during thyroidectomy. We believe that visual identification of the nerve without undue handling is all that is necessary. The recurrent nerve is no more delicate than other similar nerves. Unilateral injury to the recurrent nerve may result in temporary hoarseness which will improve with time. Some restriction of the airway during exertion may be present. Bilateral injury to the recurrent nerves may produce initially a loss of voice without airway constriction. Later the voice may return, accompanied by serious respiratory embarrassment on exertion.

The superior laryngeal nerve.

Injury to the internal (sensory) branch of the superior laryngeal nerve during thyroidectomy is unlikely. Signs of injury are loss of sensation in the upper larynx, resulting in choking and aspiration of swallowed fluids. Injury to the external (motor) branch of the superior laryngeal nerve produces no problem of respiration, but may result in changes in the quality of the voice or even voicelessness. Injury to the external branch can be avoided if the anatomical variations are kept in mind during ligation of upper pole vessels.

Inflammatory carcinoma of the breast: A correlation of clinical, radiologic and pathogic findings.

In a study of 75 patients with inflammatory carcinoma of the breast seen at Emory University Clinic over a 38 year period, the average longevity from the time of diagnosis was 22 months and the 5-year survival 5.6%. The results of treatment were poor with all methods used, although supervoltage therapy improved local control, and when followed by mastectomy, gave the longest average local control and survival. The designation of inflammatory carcinoma as primary and secondary is often not applicable and should be dropped. Instead, the terms inflammatory carcinoma and recurrent inflammatory carcinoma seem more appropriate. It is suggested that in a number of patients fulfilling certain criteria, surgery should be contemplated and all others treated by non-surgical means. The diagnosis of inflammatory cancer is still primarily clinical. However, radiologic and pathology examination are invaluable to confirming the clinical impression and occasionally suggest the diagnosis before inflammatory signs appear.