Endoscopic techniques in facial rejuvenation surgery.

The endoscopic approach to rejuvenation surgery of the forehead is standing the test of time. We feel that aesthetic results obtained from this procedure are equal to or better than results associated with the conventions coronal lift, while remarkably reducing recovery time and incision-related morbidity (Figs. 9,10).

Two-stage temporalis flap reconstruction for facial paralysis.

Treatment of the paralyzed face remains a challenging surgical problem. When facial nerve damage is irreparable or facial nerve grafting has failed, static and dynamic techniques must be considered. A two-staged modification of the dynamic muscle transfer using ipsilateral temporalis muscle is described. Initially, a free temporalis fascia graft, harvested from the contralateral scalp, is placed around the oral commissure of the paralyzed side of the face through an incision in the nasolabial crease. Several weeks later, an ipsilateral temporalis muscle and fascia transfer is made to the anterior face and attached to the previously placed fascia graft. Oral commissure grafting, as a first step, provides for a secure anchoring point for the temporalis flap, and achieves a more satisfactory correction of the oral commissure.

Production of lymphokine-activated lymphocytes. Lysis of human head and neck squamous cell carcinoma cell lines.

Lymphokine-activated killer cells are thought to be important mediators of host tumor defense. In the present study, the cytotoxic potential of lymphokine-activated lymphocytes against different head and neck squamous cell carcinoma cell lines was investigated. Lymphokine-activated killer cells were derived from peripheral blood lymphocytes. Effector peripheral blood lymphocyte cell suspensions were incubated in the presence or absence of recombinant interleukin-2. Cytotoxicity of incubated cells or fresh peripheral blood lymphocytes was determined in a 3-hour chromium 51 release assay. Target cell lines included K562 (a natural killer-sensitive target) and the following head and neck squamous cell carcinoma cell lines: Cal 27, UMSCC-1, UMSCC-8, UMSCC-16, UMSCC-19, and UMSCC-22a. Fresh peripheral blood lymphocytes and peripheral blood lymphocytes cultured in the absence of added interleukin-2 demonstrated minimal cytotoxic effects against the squamous cell carcinoma targets. In contrast, these fresh and incubated lymphocytes showed significant cytotoxic effects against K562. Cells preincubated in the presence of interleukin-2 demonstrated a statistically significant increase in cytotoxic effects against K562 and all squamous cell carcinoma targets. These investigations support the possible role of lymphokine-activated killer cells in host defense against squamous cell carcinoma. In vitro natural killer cell activity against head and neck squamous cell carcinoma cell lines is low; however, significant lymphokine-activated killer cell cytotoxicity is present.

Suicide by burning.

Of 164 patients admitted to a university hospital burn unit, 15 (9%) had attempted suicide, and 5 of the 15 died. The use of a flammable liquid was the most common method of attempted suicide; the most common psychiatric diagnosis was schizophrenia.

Cranial complications of frontal sinusitis.

Complications of frontal sinusitis are potentially serious. The best prevention is adequate antibiotic treatment of acute sinusitis or of the acute exacerbation of chronic sinusitis. Intracranial complications include extradural, subdural and brain abscesses, meningitis and cavernous sinus thrombophlebitis. Bony complications include localized or spreading osteomyelitis. Surgical intervention is often required to prevent unacceptable mortality.

Accidents masking suicide attempts.

Two case reports presented describe situations in which a patient presented in trauma due to an accident which masked a suicide attempt. Factors which obscure the suicide intent of an 'accident' include a dangerous vocation, lifestyle, or hobby, and absence of overt depression. These factors may aid in the identification of and appropriate intervention methods for patients presenting with masked suicide attempts.

Neurogenic sarcoma of the head and neck.

We discuss our experience in the diagnosis and management of seven cases of neurogenic sarcomas of the head and neck. These uncommon tumors, which affect all ages, arise most frequently from the brachial plexus, sympathetic chain, and the cranial nerves or their branches. An enlarging mass is the most common initially appearing symptom. Diagnosis may be difficult and rests heavily on gross evidence of a relationship between the tumor and its nerve of origin. Histologically, the lesions are composed of spindle cells with varying degrees of pleomorphism in a pattern that is frequently undistinguishable from fibrosarcomas. Ultrastructural studies may be helpful in establishing the neurogenic origin of these tumors. Neurogenic sarcoma of the head and neck has an extremely poor prognosis. Surgery remains the cornerstone of treatment, although radiotherapy is important for palliation.

Evaluation of the speech perception in noise (SPIN) test.

Several investigations were perfomed with normal hearing subjects to determine the effects of presentation level and signal-to-babble ratio on the speech perception in noise (SPIN) test. The SPIN test contains sentences that simulate a range of contextual situations encountered in everyday speech communication. Findings from several representative patients with sensorineural hearing loss demonstrate the possible clinical utility of the test to measure the effects of context on speech discrimination.

Suicide attempts by rock-climbing falls.

The true intent of a suicidal act is sometimes masked by it appearing as an "accident". Two cases are reported that present a unique opportunity to study suicide attempts that took the form of rock-climbing "falls" and to study the two people who chose this way to die. Rock-climbing falls, occasionally speculated about as possible suicidal equivalents yet having no recognition as such in the literature, are illustrated as methods used by these impulsive, action-oriented and risk-taking people.

Long-term follow-up of patients with congenital diaphragmatic hernia.

A long-term follow-up was carried out on 30 patients who had congenital diaphragmatic hernias operated on over a 21-yr period. The review took the form of clinical examination, chest x-rays, pulmonary function tests, and lung scans. Lungs that were hypoplastic at birth remained underdeveloped as judged by pulmonary function tests and hypoperfusion on lung scan; however, children who survived birth6 and operative repair went on to live normal lives through the period studied. There was some suggestion from pulmonary function tests and lung scans that in the older group a preemphysematous state may exist but this was asymptomatic. There was no evidence of increased susceptibility to respiratory infection in the group. Ten per cent of the children were mentally retarded, evidently from hypoxia after birth.

Liver scanning in patients with suspected metastatic malignant disease.

Liver scans of 72 patients with suspected malignant disease were evaluated to determine the accuracy of the investigation in detecting disease, including metastases and also its use to the referring surgeon. A comparison between the liver scan result and clinical and biochemical findings was also made. The liver scan had an overall accuracy of 83% in diagnosing metastases, compared with 64% for the serum alkaline phosphatase (SAP) level and was more useful clinically than the SAP level. Careful classification of the liver scan patterns allowed more consistent interpretation and improved the specificity of the diagnostic information obtained. Clinical assessment of liver and spleen size by abdominal palpation was unreliable and occasionally misleading.