Verruca vulgaris of the larynx. Demonstration of human papillomavirus types 6/11 by in situ hybridization.

Verruca vulgaris of the larynx (VVL) is a distinctly uncommon lesion related to the human papillomavirus (HPV). The clinical and pathologic features of a case involving the true vocal cords of a 37-year-old woman are presented and compared with the seven cases previously reported in the English language literature. Papillomavirus capsid antigen was detected in the excised tissue on immunostaining, and viral particles were seen by electron microscopy. In situ hybridization with biotinylated DNA probes clearly demonstrated HPV types 6/11. To our knowledge, this is the first case of VVL in which the virus associated with VVL has been genotyped. The results were unexpected because verruca vulgaris of the skin, lips, and oral cavity is associated with HPV types 2 and 4. This implies that verruca vulgaris can be caused by HPV types other than 2 and 4. In addition, since HPV types 6 and 11 are also the same genotypes associated with multiple papillomatosis of the larynx, it further indicates that VVL is virologically more related to multiple papillomatosis of the larynx than to its counterpart on the skin, lips, and oral cavity. The clinical and pathologic features that distinguish VVL from other similar lesions of the larynx are also discussed.

Compulsory employee benefits: pro and con.

Government-mandated employee health benefits spurred heated debate in the last congress and are expected to raise temperatures again this year. Here, two association executives present their views from opposite sides of the fence.

Parathyroid adenomas; computed tomographic imaging and the importance of preoperative localization.

Contrary to what is frequently stated in the literature, preoperative localization of parathyroid adenomas is important. Surgery limited to removal of the adenoma is associated with significantly less morbidity than when bilateral exploration is undertaken. In fact, a 2 to 12 fold decrease in post-operative hypocalcemia has been reported when the surgical exploration is unilateral. Pre-operative CT scans localized 10 of 13 surgically proven adenomas for an overall detection rate of 77%. Only one adenoma in our series had an average axial diameter of greater than 1 cm, the smallest measuring 5 mm X 3 mm. This paper outlines our CT technique and results and summarizes the pertinent recent surgical literature in reference to the importance of preoperative localization.

Dynamic compression plating in treatment of the fractured, edentulous mandible.

The repair of a mandibular fracture in the edentulous patient can be a difficult surgical problem. A recent report of a large series of such cases by the University of Michigan disclosed a 20% rate of nonunion. Dynamic compression plating is particularly suited to the repair of fractures of the edentulous mandible as intermaxillary fixation is unnecessary, normal speech and diet are resumed immediately, and bone grafts can be used when necessary. This series of 36 plates used in the management of mandibular fractures in 24 edentulous patients is the largest series of its type reported thus far. No nonunion or other major complication occurred in this series. Because nonunion, delayed union, and the problems associated with intermaxillary fixation were avoided in this series, it is suggested that compression plating is a highly effective method for repair of fractured edentulous mandibles.

Preoperative computerized tomographic imaging in hyperparathyroidism.

The surgery of hyperparathyroidism can be technically very difficult, even for an experienced surgeon. Until the present decade, preoperative localization procedures were of little help because of poor resolution of imaging modalities, significant morbidity, and the cost of invasive procedures. The efficacy of preoperative high-resolution CT scanning was evaluated in ten patients with primary hyperparathyroidism who had not previously been operated on. Contrast and noncontrast scans were performed on each patient, under the supervision of an experienced radiologist. Surgical findings were the standard against which all CT scans were judged. Each patient was diagnosed as having a single adenoma. Preoperative scans localized eight of ten adenomas for an overall sensitivity of 80 percent. In one patient, the adenoma was incorrectly localized for a specificity of 89 percent. The smallest adenoma correctly localized measured 4 x 4 mm in its axial dimensions. In addition to shortening operative time, accurate preoperative localization permitted use of unilateral dissection technique. Recent literature has repeatedly proved unilateral dissection superior to bilateral dissection by production of identical cure rates and a 2- to 12-fold decrease in postoperative hypocalcemia. We suggest that CT scanning be considered in the routine preoperative workup of patients who have primary hyperparathyroid disease.

Nasopharyngeal complications following uvulopalatopharyngoplasty.

This report presents our experience with nasopharyngeal complications of UPPP in 85 patients undergoing the procedure from May, 1982 to January, 1985. Three patients developed nasopharyngeal stenosis and one patient developed permanent velopharyngeal insufficiency. Surgical management in two patients with nasopharyngeal stenosis resulted in adequate nasopharyngeal airway, while one patient still has a moderate stenosis following two surgical procedures. The patient with velopharyngeal insufficiency underwent Teflon paste injection in the posterior pharyngeal wall. This resulted in complete alleviation of his nasal regurgitation.

The Goldman tip in secondary rhinoplasty.

The ingenious division and suture of the mesial crura of the lower lateral cartilages devised by Goldman has found little utilization in recent years, even by surgeons familiar and experienced with this procedure. However, in secondary rhinoplasty, many of the disadvantages inherent in the Goldman tip can be turned to the surgeon's advantage and used to correct nasal tip defects which might otherwise prove refractory to treatment. Cartilage deficit, tip asymmetry, unacceptable bifidity, excessive tip elevation, hanging columella, and insufficient bulk are readily corrected with the Goldman tip and variations on its basic theme. This report covers the authors' 20-year experience with the Goldman tip, including a recent increase in the utilization of this procedure for secondary rhinoplasty.