[Mucosal malignant melanomas of the head and neck]. / Slimhinnederiverte maligne melanomer i hodet og halsområdet.

Mucosal malignant melanomas in the head and neck are most frequently located in the nose and sinuses. The tumours are rare, the clinical course unpredictable and the prognosis poor. 13 patients were presented with malignant melanoma in nose and sinuses in the ENT department, Ullevål Hospital, in the course of 30 years. Average age at presentation was 72 years; there were eight women and five men. Ten patients were primarily operated, and two of these received postoperative irradiation. Three patients received only palliative treatment. Four patients are alive, observation time respectively ten, seven and approximately two years (two patients). Several of the dead patients had long observation periods before death and several had operations for recurrences. The longest observed survival was 19 years. All tumours had histological characteristics indicating aggressive growth. The material is too small and sampled over too long a period for conclusions to be drawn with regard to the effect of different treatment modalities.

Bulbar myoclonus without palatal myoclonus. A hypothesis on pathophysiology.

A 40-year-old woman with myoclonic contractions bilaterally in the infrahyoid neck muscles, especially in the left cricothyroid muscle, was presented and successfully treated with botulinum toxin injections. The patient had a wide, aberrant vessel curving into the left dorsolateral reticular formation of the medulla oblongata. Based on our observations, we propose that symptomatic bulbar and palatal myoclonus is caused by pathology in the dorsolateral reticular formation, and not by inferior olivary dysfunction as is currently thought.

[Prognostic factors in squamous cell carcinomas of the head and neck]. / Prognostiske faktorer ved plateepitelkarsinomer i hode- og halsområdet.

A review of prognostic factors in oral, pharyngeal and laryngeal carcinomas is presented. Distinctions are made between different kinds of prognostic predictors: external, host, and tumour predictors. The latter includes localization, stage, histological grading, DNA ploidy and biochemical characteristics. Finally, ideas on how best to utilize this knowledge and the implementation of any prophylactic measures are detailed.

[Computer tomography of pathological neck lesions]. / Computertomografi av patologiske tilstander på halsen.

The introduction of high resolution computed tomography (CT) has significantly improved the quality of imaging of neck masses. Incremental dynamic scanning immediately after a quick bolus injection of contrast medium is essential in a majority of patients in order to obtain an optimum of information. This is especially true in the identification, mapping and staging of malignant lesions, which is the main indication for the examination. CT is also very sensitive, and yields detailed information about the location and extent of cystic and other benign lesions. Owing to the low attenuation of fat, the examination is very specific with respect to lipomas. CT has low specificity in the differentiation between benign and malignant lesions, and between cysts and solid tumours of the thyroid gland. In thyroid and parathyroid imaging other modalities such as ultrasound and scintigraphy are often more specific.

Prognostic factors of survival in a cohort of head and neck cancer patients in Oslo.

A cohort of 433 Oslo patients with head and neck (H/N) carcinomas was analysed for prognostic factors of survival. Mean observation time was 635 days, the distribution of men and women was 2:1 and the mean age was 64.5 years. Tumour localisations were: oral cavity 32.1%, oro/hypopharynx 19.3%, larynx 22.6% and others 25.2%. Stage distribution was: stage I: 21.0%, stage II: 22.6%, stage III: 18.7% and stage IV: 37.4%. Pragmatic strategy showed independent prognostic factors of survival to be gender, age, tumour localisation and stage. A model of predicting 3 year survival was generated. An explanatory approach showed that female patients had a 38% lower risk of mortality compared to male patients after controlling for age, stage and tumour localisation. Comparing observed to expected mortality of the age and gender matched Norwegian population, showed excess risk of death among male compared to female patients when also adjusted for demographic confounders.

[Survival of patients with advanced head and neck cancer. Are we treating too many patients?]. / Overlevelse ved avansert hode- og halskreft. Behandler vi for mange pasienter?

Survival of patients with carcinoma in head or neck is positively associated with the stage of the disease at diagnosis. A dynamic cohort of 433 patients from Oslo with head and neck carcinoma included 162 (37.4%) patients staged 4. For these patients, the prognosis was extremely serious, 5-year survival was 22.3%. In 120 of these, the primary tumour was staged 4. It was found that the presence of an advanced primary tumour (T4) in the oral cavity, oro- or hypopharynx gave the worst prognosis. Compared with NO patients, Neck metastasis, irrespective of T-stage, increased the odds ratio for mortality to the double in N1 patients, by a factor of three in N2 patients and by a factor of nearly eight in N3 patients. Owing to the serious prognosis and reduced quality of life after surgery, this is not the treatment of choice for stage 4 disease, especially when the primary tumour is advanced and localized in the oral cavity or oro/hypopharynx, or if neck metastases are present. Irrespective of treatment (surgery or irradiation) the patient's outcome (quality of life) must be evaluated against the chance of survival. 34 (8%) patients of the cohort did not receive any active treatment.

Head and neck cancer in Norway. A study of the quality of the Cancer Registry of Norway's data on head and neck cancer for the period 1953-1991.

Data from population-based cancer registries provide information on the causes and outcome of cancer and form a basis for important decision making in connection with the prevention of cancer and the planning of health services. This makes it of the utmost importance to assess the data at all stages of collection to ensure the highest possible quality. The present study focuses on the quality of the Cancer Registry of Norway's data on head and neck cancer for the period 1953-1991. When the study was started, 16,104 cases of head and neck malignancies had been registered. All histological codes were reviewed. The pathologists' reports were reevaluated for 369 cases selected according to set criteria: 133 cases received a new histological code without being excluded from the data material: 112 cases were excluded. The distribution of histological diagnoses for each location is presented. A reevaluation of 300 cases selected at random from the corrected series indicates discrepancies between the pathologist's classification and the Registry's coding in less than 2% (1.4%) of all cases. The percentage that lacked histological verification fell from 5.7% in the first decade to 2.1% during the last 9-year period. Completeness of the Cancer Registry's data base was checked against hospital-based registries and this investigation showed that virtually all new cases are reported. We conclude that the data on head and neck cancer for the studied time period meet standards that justify their use as a basis for epidemiological as well as clinical studies.

Influence of CT on tumor classification of laryngeal carcinomas.

The routine use of CT in 51 consecutive patients with squamous cell carcinoma of the larynx revealed cartilage involvement or extralaryngeal tumor growth consistent with a T4 tumor which made 14 patients candidates for laryngectomy. Only 5 of these had a T4 classification by clinical examination while 8 cases were upstaged from T3. Except for one supraglottic tumor upstaged from T2 to T4, CT did not change the classification for T1 and T2 tumors, whose localization was mainly glottic, and there were 2 false-negative examinations. It is concluded that CT is mandatory only in advanced tumors of the glottic region or when the anterior commissure is involved. However, in suspected malignancies of the sub- or supraglottic regions CT should always be carried out because these patients are at an increased risk of unexpected deep tumor growth.

Glossopexia--evaluation of a new surgical method for treating obstructive sleep apnea syndrome.

Uvulopalatopharyngoglossoplasty, UPPGP, is a modification of the uvulopalatopharyngoplasty, UPPP, technique, originally used for surgical treatment of the obstructive sleep apnea syndrome. The first method seems to be the more successful. However, polysomnography performed after UPPGP showed that about 35% of the patients still had obstructive apnea periods during sleep. Eight of these patients were reoperated with a new technique which is a combination of partial tongue resection and anterior suspension of the tongue (glossopexia). After glossopexia all the patients were subjectively relieved of their symptoms. However, polysomnography carried out postoperatively demonstrated that only 2 patients were objectively cured. The authors want to stress the necessity of meticulous polysomnographical registration pre- and postoperatively. Subjective and objective parameters recorded before and after surgery are discussed.

Acute and latent mastoiditis.

The diagnosis 'acute' mastoiditis is not an unambiguous entity. It contains both 'classical' and 'latent' mastoiditis. 'Classical' mastoiditis was often seen before the antibiotic era, had serious complications and was cured by mastoidectomy. After the introduction of antibiotics, the number of cases of 'classical' mastoiditis decreased and was replaced by a more prolonged condition called 'latent' mastoiditis. Lately in Oslo, we have seen an increase in numbers of 'classical' mastoiditis and at the same time a decrease in the incidence of 'latent' mastoiditis. A four year study of patients with 'classical' mastoiditis is described.

Projection from the inferior colliculus to the superior olivary complex in the albino rat.

The origin and termination of the fibers projecting from the inferior colliculus to the superior olivary complex have been studied in rat by means of the Fink and Heimer and horseradish peroxidase techniques (anterograde and retrograde transport of free horseradish peroxidase and peroxidase conjugated to wheat germ agglutinin). The colliculoolivary fibers originate in layer 3 of the external cortex and the adjacent part of the central nucleus, particularly in the former. Via the lateral lemniscus the fibers reach the ipsilateral periolivary region where they terminate in the rostral and medioventral zones. The terminal field contains at least two types of cells which could constitute the next link in the descending projection to the cochlea and/or the cochlear nuclei. One of these is the large olivocochlear neuron, and the other a smaller neuron projecting to the cochlear nuclei. Judged by their topographic relationship in the inferior colliculus and in the superior olive, the colliculoolivary neurons may form a link in a oligosynaptic projection from the auditory cortex to the cochlea and/or the cochlear nuclei. The observations are based on light microscopy, however, and do not allow conclusions concerning synaptic contacts.

The neocortical projection to the inferior colliculus in the albino rat.

The purpose of the present study was to define the field of termination of the neocortical projection to the inferior colliculus in rat. The study was based on fiber degeneration following large lesions of the cerebral cortex, and anterograde transport of wheat germ agglutinin horseradish peroxidase ejected iontophoretically into more restricted neocortical loci. Neocortical fibers were found to supply the dorsal and external cortices of the inferior colliculus. The central nucleus, in contrast, did not receive such fibers. The results speak in favor of three separate projections, one partly bilateral to the deeper part of the dorsal collicular cortex, a second ipsilateral to the superficial part of this subdivision, and a third ipsilateral to the external collicular cortex.

Anatomy of the inferior colliculus in rat.

This paper defines the pattern of subdivision of the inferior colliculus in rat. It is based on serial sections of brains of albino and hooded rats cut in the frontal, sagittal and horizontal planes using Golgi, Nissl and a combined cell-myelin method. In rat, like in other mammals, the inferior colliculus consists of a central nucleus, an external cortex, and a dorsal cortex. The central nucleus is flattened in the frontal plane and confined to the caudomedial part of the inferior colliculus. It is characterized by a lamellar organization of disc-shaped neurons interspersed with multipolar cells. The cells are small to medium-sized. Although there is a dorsoventral gradient in size and packing density of cells within the nucleus, the overall size is smaller and the packing density larger than in adjacent subdivisions. The two cortices each consists of three layers. The outer-most layer is common to the two cortices, forming a fibrocellular capsule continuous along most of the circumference of the inferior colliculus. The external cortex is located lateral, rostral, ventral and ventrocaudal to the central nucleus. Its second layer, deep to the superficial capsule, is characterized by clusters of many small and a few medium-sized neurons in a myelin-dense neuropil. Layer 3, which constitutes the major portion of the subdivision, consists of relatively scattered, small, medium and large cells, the most characteristic element being large multipolar neurons with coarse Nissl granules. The dorsal cortex is located dorsocaudal and dorsomedial to the central nucleus. Its second layer is composed of small neurons, while the third, deep layer in addition contains medium-sized neurons. The cell density is intermediate to that of the central nucleus and the deep part of the external cortex. We have tried to facilitate the parcellation by reference to easily recognizable, nearby structures and to standard stereotaxic coordinates.

Long-term results of bilateral stapedectomy.

Bilateral stapedectomy was performed in 122 cases of bilateral otosclerosis at Ulleval Hospital between 1960 and 1978. Ninety-six patients (192 ears), or 79 per cent, were re-examined in 1980. The long-term results showed that the air/bone gap was closed to within 10 db. in 142 ears (74 per cent). Twenty-four patients (25 per cent) used a hearing aid at the time of the examination, mainly because of presbyacusis. Deafness or serious sensori-neural loss ascribed to the operation was found in 21 ears (11 per cent). Immediate deafness occurred in three ears (1.5 per cent), and in seven ears (3.7 per cent) the patient became deaf later. Eleven ears (5.8 per cent) had marked sensori-neural losses, but with some speech comprehension. None of the patients had bilateral deafness, but one patient was deaf in one ear, with a sensori-neural loss of 80 db. in the other. Eleven patients (13 ears) who had undergone previous stapediolysis or crurotomy, were treated as a separate group, and their results were compared with those obtained in the other patients. We have also tried to find out if there is any difference between the long-term results of surgery in the first and in the second ear.