Posterior packs and the nasopulmonary reflex.

Increased mortality and arterial hypoxemia have long been associated with posterior nasal packs placed for control of severe epistaxis. Several authors have postulated a nasopulmonary reflex to partially explain this clinically observed phenomenon. In ten young, healthy subjects, using a multiparameter pulmonary evaluation, posterior nasal packs were placed and no significant changes were observed in lung volumes, flow and alveolar gas exchange, especially oxygenation. These findings suggest that aspiration, sedation, and degeneration of pulmonary function with age, not a nasopulmonary reflex, have not been adequately emphasized in previously performed studies.

Palliative orbital decompression for metastatic melanoma to the orbit.

Although relatively rare, metastatic carcinomas to the orbit are the second most common orbital neoplasm in the adult. There are only ten cases reported in the literature of cutaneous melanoma metastatic to the orbit and, of these, only two had disease involving both orbits. This paper presents the third case of bilateral orbital melanoma; however, in this case, the primary site was the uveal tract in the first eye, with contralateral involvement being a metastasis of the orbital primary. The patient developed severe unilateral proptosis in his only seeing eye with progressive loss of vision. A palliative orbital decompression was performed which successfully restored visual acuity for an extended period of time. A brief discussion of the rationale for this procedure in this type of case is presented.

Metastatic sweat gland carcinoma.

In summary the diagnosis of malignant non-metastasizing sweat gland carcinoma is difficult. In cases of metastasizing malignant sweat gland carcinomas, one must distinguish this lesion from metastastic breast carcinomas. The regional lymph nodes are the most likely site of metastasis in sweat gland carcinomas. Wide excision of the primary tumor with resection of the involved regional lymph nodes is considered to be the best initial treatment. Cure rates are in general poor, based on the small number of cases and inadequate follow-up.

Repair of anterior floor of mouth defects: the island pedicle tongue flap.

The island pedicle tongue flap has been utilized for situations where split-thickness skin or dermis had been used previously. It has been found to provide rapid, reliable healing, without excess scarring or problems of desquamation. No functional deficit of the tongue is produced, so swallowing and speech remain unaffected. This method is recommended for those anterior floor of mouth lesions amenable to wide local excision, but too large for primary closure.

Supraglottic laryngectomy.

This paper describes the experience with subtotal supraglottic laryngectomy for laryngeal carcinoma at the Department of Otolaryngology of the Tulane University School of Medicine. Of 36 patients, 32 (89%) had local control of diseases at one year. Of 27 patients followed up for at least three years, 22 (81%) are free of disease. Postoperative aspiration was the most frequent complication, but was a serious problem in only one patient. Because of the significant functional advantage of partial laryngectomy, the high rate of disease control, and an acceptable complication rate, we believe supraglottic laryngectomy is the procedure of choice for laryngeal carcinoma in selected patients.

Malignant Glomus vagale: report of a case and review of the literature.

Tumors of the chemoreceptor system are quite rare, and are usually considered to be benign, but locally invasive. We report a case of a glomus juxtavagale tumor with metastasis to cervical lymph nodes, lung, and bone. Review of the literature shows that 19% of similar cases reported also showed distant metastases, a rate significantly higher than for other chemodectomas. Clinically and histologically, benign and malignant tumors are identical, so only the demonstration of distant metastasis indicates malignant neoplasm. Primary treatment is surgical, but radiotherapy is useful for palliation.

Clinical experiences in hyoid arch transposition.

Autogenous hyoid bone grafts for the repair of subglottic stenosis have been used successfully in canine experiments. This technique was subsequently modified for human use, and the experience in six patients over the past year at Washington University is reported. In five of the six patients, satisfactory results were obtained. Several case reports are included, and the surgical procedure is described in detail.

Neurologic manifestations of glomus tumors in the head and neck.

In 75 patients with glomus tumors in the head and neck region, 57 tumors arose from the jugular bulb region, 11 from the middle ear, and seven from the vagus nerve. Thirty-seven percent (28 patients) had cranial nerve paralysis, and 14.6% (11) had intracranial tumor extension. The jugular foramen syndrome was associated with a 50% (two of four patients) incidence, and hypoglossal nerve paralysis with a 75% (three of four) incidence of posterior fossa tumor invasion. Horner syndrome and labyrinthine destruction had a 50% (two of four) incidence of a middle cranial fossa tumor invasion. The incidence of central nervous system (CNS) invasion with cranial nerve paralysis (excluding the seventh nerve) was 52% (11 of 21). Otologic findings and seventh nerve paralysis did not correlate with CNS tumor extension.

Cricoid arch replacement in dogs. Further studies.

Published reports by Delahunty et al and Alonso et al described the feasibility of correcting subglottic defects with cricoid arch transplantation. Using normal dogs, satisfactory results, including airway patency and vocal cord function, were reported. This report describes a second series of dogs in which subglottic stenosis was first induced by an open procedure and was subsequently repaired with an allotransplanted cricoid arch. The resulting subglottic defect in the donor dogs was repaired by autogenous hyoid arch transposition. No immunosuppressive measures or stents were used in either group. The animals were followed for periods up to one year prior to histologic study. Satisfactory results were obtained in both groups.