Base of tongue carcinoma.

Vigilance must remain high in order to detect the rare occurrence of base of tongue carcinoma. The combination of ubiquitous and nonspecific complaints coupled with difficult physical examination of this area contribute to delays in diagnosis, with patients often presenting at an advanced stage. This advanced presentation creates challenging treatment decisions in which adequate tumor control must be balanced with subsequent patient quality of life. The result is controversy over the primary treatment modality--external beam radiation, with or without brachytherapy, alone or in combination with surgical extirpation. Though the role of neck dissection in patients with neck disease is widely accepted, timing and implementation in patients whose neck disease completely responds to radiation are also contentious issues. Although evolving surgical reconstruction techniques and accelerated radiation protocols are improving treatment regimens, the prognosis for this disease remains poor.

Surgical management of the aging upper face.

Creating a more youthful appearance of the aging upper face requires a treatment plan which is tailored to address the patient's individual needs. The process begins with a comprehensive knowledge of anatomy and the physical effects of aging, involves discussion and understanding of aesthetic ideals, and culminates in the selection and performance of the appropriate procedure.

Epidural abscess masquerading as lateral sinus thrombosis.

Controversy regarding the use of anticoagulants, the evacuation of the sinus, or the use of medical treatment alone surrounds the treatment of lateral sinus thrombosis. Treatment of an epidural abscess associated with coalescent mastoiditis is much less controversial-drainage is usually recommended. The differing treatments of these complications mandate accurate diagnosis. The advent of more sophisticated radiological studies has facilitated diagnosis of these complications; however, tests are not infallible. We present three cases in which preoperative imaging demonstrates an epidural abscess mimicking lateral sinus thrombosis by compression of the vessel. A false-positive computed tomography (CT) or magnetic resonance imaging (MRI) study may lead to the wrong diagnosis and, consequently, improper treatment. In light of this possibility, we recommend surgical exploration in all such cases.

Subglottic stenosis: evaluation and management.

Surgical correction of subglottic stenosis aims to provide an adequately enlarged lumen while preserving vocal quality and airway protection. Treatment success is predicted upon a thorough preoperative evaluation and tailoring the repair to address the severity and location of the individual lesion. Understanding the complex pathophysiology of subglottic stenosis along with the wide variety of available surgical options will aid the surgeon in achieving a successful outcome.

Evaluation of solitary thyroid nodules.

The yield of malignancy when evaluating solitary thyroid nodules can be significantly increased by following a stepwise approach. The gold standard is fine needle aspiration. A thorough history and physical, thyroid scintigraphy, as well as exogenous suppression therapy, aid clinicians to efficiently evaluate the abundance of solitary thyroid nodules and isolate those which are likely to be neoplastic.