The significance of the carotid bifurcation angle in carotid body tumours.

This is a retrospective report on 22 patients with carotid body tumours (intercarotid paragangliomas or carotid chemodectomas) treated by excision using either the dissection technique or en bloc resection. The type of operation to be carried out can be predicted pre-operatively by measuring the carotid bifurcation angle or degree of splaying of the carotid arteries. An angle of less than 90 degrees implies that the tumour can be dissected off the internal carotid artery. An angle of more than 90 degrees implies that it will probably require en bloc resection, including the carotid bifurcation, followed by carotid reconstruction.

Are carotid body tumours malignant?

Carotid body tumours (CBTs) are slow-growing, malignant neoplasms by virtue of their local spread by continuity and contiguity and metastatic spread by lymph and blood. This article reports the findings of a pathological study of the growth characteristics of CBTs.

Carotid body tumours. A review of 52 cases.

During a 22-year period (1962-1984) 52 carotid body tumours were encountered in 50 patients. In addition, 2 of the patients had tumours of the glomus intravagale. One patient had a recurrent tumour, the first one having been removed 23 years previously. The ages ranged from 23 to 80 years, the female/male ratio was 2:1, and the right side was affected twice as often as the left. Four patients were treated non-surgically; 3 were too elderly and frail to undergo the operation and in the 4th case the tumour was considered inoperable. In 2 cases excision was attempted but abandoned for technical reasons. In the remaining 44 patients 46 tumours were excised, with grafting of the internal carotid artery in 6 cases. There were 2 deaths (4.5%), 1 after hemiplegia and 1 a pulmonary embolus. Eight patients were left with cranial nerve palsy, which had been present preoperatively in 5 cases. Of the tumours 7 (13.5%) were found to be malignant. The results of endocrine studies when undertaken were normal. Although ultrasonography and computed tomography were used in some cases, arteriography was the definitive mode of investigation.

Laryngeal paraganglioma. A case report.

The treatment of a 27-year-old woman with a superior paraganglioma is described. The tumour was excised with a partial supraglottic laryngectomy after repeated biopsies showed chronic inflammatory tissue. The patient has shown no evidence of malignancy during a 4-year follow-up.

The versatility of the pectoralis major myocutaneous flap.

A consecutive group of 50 patients requiring pectoralis major myocutaneous flap reconstruction after head and neck surgery is presented. The tissue defects for reconstruction are divided into five groups to identify any defects in which the flap is more likely to be at risk of complication. Other risk factors such as preoperative radiotherapy, chemotherapy plus radiotherapy, and septic recipient site are analyzed. Its particular use in a "Third World" type population is noted.

Trapezius osteomyocutaneous flap for mandibular reconstruction.

The recent introduction of myocutaneous flaps has kindled the interest in including bone in the flap to reconstruct the anterior mandibular arch and floor of mouth--still one of the most challenging reconstructions in head and neck surgery. The trapezius osteomyocutaneous compound flap has certain advantages over other osteomyocutaneous flaps; the scapula, being a flat bone, receives relatively more blood supply from the periosteum. The absence of bone resorption at more than two years postoperatively has been encouraging, and it has been possible to reconstruct mandible from angle to angle.

Chondrosarcoma of the head and neck--the value of computed tomography.

Chondrosarcomas of the head and neck represent a small percentage and differ in their treatment and prognosis compared with chondrosarcomas elsewhere. Four different cases of chondrosarcoma are presented. One arose intracranially, two in the jaws, one of which followed irradiation for a retinoblastoma, and the last represents chondrosarcomatous transformation in cervical spine Paget disease which is exceptionally rare. Computer tomography (CT) plays an important role in delineating the extent of the tumor with visualization of bony destruction, associated soft-tissue mass, and calcification, information which is extremely important for surgical and therapeutic planning. CT can be vital in suggesting the best possible site for biopsy which is particularly important in this group of neoplasms where the histological diagnosis may be difficult.

Carotid body tumors.

A review of carotid body tumors is presented together with a personal series of 16 patients managed in 4 years. Angiography was diagnostic in all instances. Five patients showed evidence of local invasion, while no patient had distant spread. Early recognition and surgical management were effective in the treatment of all operable tumors. Local removal of group 1 tumors without shunting is safe, with no morbidity or mortality in this series. The use of an indwelling shunt in group 2 tumors is recommended because of the risk of vessel wall damage during dissection and because reduction in blood supply to these large tumors facilitates their removal. We also recommend the use of an indwelling shunt in group 3 tumors when an en bloc resection of the vessels and tumor is performed in order to maintain cerebral perfusion.

Recurrent meningitis due to round-window fistula in Klippel-Feil syndrome. A case report.

Hearing is impaired in 30% of patients with Klippel-Feil syndrome, owing to a variety of anatomical deformities of the inner and middle ear cavities. Recurrent meningitis due to a stapedial footplate fistula associated with this syndrome is rare. A case of Klippel-Feil syndrome, deafness and recurrent meningitis due to a round-window fistula is described. Surgical sealing of the defect prevented further meningeal infections.

Pharyngolaryngectomy with extrathoracic esophagectomy.

Fourteen patients with squamous cell carcinoma of the hypopharynx underwent total pharyngolaryngectomy and extrathoracic esophagectomy with primary pharyngogastric anastomosis. Histological examination of the resected specimens showed extensive submucosal spread into the cervical esophagus, necessitating a radical excision of the esophagus for adequate distal clearance. The results of this method of management are discussed.

Pharyngeal reconstruction after pharyngolaryngoesophagectomy in African patients.

Six African patients with squamous cancer of the laryngopharynx underwent pharyngolaryngoesophagectomy. Transposition of the stomach to the neck was the method selected for reconstruction of the pharynx. The operative technique and results of this method of pharyngeal reconstruction are discussed. Pharyngogastric anastomosis is compared to other methods of pharyngeal reconstruction.