The controversial treatment of anterior commissure carcinoma of the larynx.

There are two basic approaches to the appropriate therapy for carcinoma of the anterior commissure. The dilemma of whether to treat by primary irradiation or by conservative surgery is not yet solved. In this study, 67 patients were treated between 1967 and 1987 for anterior commissure carcinoma of the larynx. Radiation was used with 47 patients and conservation surgery with 20 patients. Initial lesion control was achieved with 72% of the patients treated by primary irradiation. Conservation surgery, when used as a primary treatment modality, achieved local control in 90% of the patients. The new techniques of reconstruction of the larynx enhance the surgeon's ability, strengthen his conviction to proceed to enlarged partial laryngectomies, and thus improve the oncologic control of the anterior commissure carcinoma as well.

Basaloid-squamous carcinoma of larynx metastatic to the skin of the nasal tip.

Basaloid-squamous carcinoma is a rare, highly malignant epithelial tumour with problematic histological characteristics and a poor prognosis. This unusual tumour has been described in the tongue, hypopharynx, and larynx. A unique case of basaloid-squamous carcinoma of the larynx metastatic to the skin of the nasal tip is presented. The literature regarding the histopathological and clinical aspects of basaloid-squamous carcinoma is reviewed.

Brainstem auditory evoked responses in rats with experimental chronic renal failure.

1. Chronic renal failure was induced in rats by five-sixths nephrectomy. Brainstem auditory evoked response (BAER) was recorded after 3 months. 2. In the uraemic rats latency of the first wave was delayed, while the interpeak I-V latency was similar to that of the controls. 3. These results suggest a delayed neural conduction along the acoustic nerve or cochlear changes in uraemic rats.

Brainstem auditory evoked responses in chronic renal failure and the effect of hemodialysis.

Brainstem auditory evoked responses (BAER) were recorded in patients with chronic renal failure before commencement of chronic dialysis treatment, and in patients with end-stage renal failure on chronic hemodialysis for several years. Both groups of patients had delayed latencies of the third and fifth waves. The patients on hemodialysis revealed delayed latency of interpeak I-V as well. There was no correlation between wave latency, serum urea, creatinine, PTH or duration of chronic hemodialysis treatment. A hemodialysis session led to a slight shortening of the third wave. This study suggests that neural conduction along the brainstem in patients with chronic renal failure is delayed even before hemodialysis is started. Although 1 dialysis session may have some beneficial effect, long-term hemodialysis treatment does not seem to shorten the delay in neural conduction observed in patients with chronic renal failure.

Delayed brainstem auditory evoked responses in diabetic patients.

The incidence of subclinical central diabetic neuropathy is unclear due to difficulty in detecting latent alterations of central neural transmission process. The aim of this study was to evaluate a central neuroconductive mechanism in diabetics by brainstem auditory evoked responses (BAER). We found increased latencies of peaks I, III, V in diabetics as compared to control subjects. These BAER abnormalities were demonstrated in 62 per cent of insulin-controlled diabetics and in 33 per cent o patients treated by diet, or peroral drugs. No alterations in brainstem responses were observed in patients with latent diabetes. We did not find any correlation between the BAER abnormalities and the duration of the disease, the blood glucose level or the level of control of the diabetes.

Use of human amniotic membrane in otolaryngologic practice.

Human amnion is a readily available allograft with low antigenicity, high antimicrobial potential, and the ability to foster epithelialization. We have used human amniotic membrane in our department for replacing nasal mucosa in Rendu-Osler-Weber disease, as tympanic membrane grafts, and for covering head and neck sites after flap necrosis. Our experience shows moderate success for management of severe epistaxis and excellent results in covering surfaces after flap necrosis. Use of amnion in eardrum perforations was unsuccessful and was discontinued. Properties of human amniotic membrane are listed and its application in the otolaryngologic practice is reviewed.

Surgical management of epistaxis in hereditary hemorrhagic telangiectasia.

The most common manifestation of hereditary hemorrhagic telangiectasia (HH) is recurrent epistaxis. Numerous treatments have been used over the years, none proving entirely satisfactory. We have applied a new surgical treatment in seven selected cases of HHT with severe, life-threatening epistaxis. It consists of a near-total excision of the diseased nasal mucosa and its replacement by different skin flaps or a myocutaneous flap. This procedure has been performed since 1981. We stress the reliability and versatility of using the forehead myocutaneous island flap. Our original technique is described, follow-up of the patients is reported, and the criteria for selection of treatment are discussed.

Otolaryngologic cases of Munchausen's syndrome.

Münchausen syndrome (MS) is now a well recognized and demonstrated entity. This syndrome is characterized by patients who seek hospitalization and present factitious but usually well-rehearsed histories and symptoms. Five cases of MS, genuine by their ear-nose-throat-maxillofacial factitious signs, are presented. Two of the cases are related to the uncommon MS by proxy. In this subentity the parents fabricate pathological signs for their children. The psychodynamics and the clinical symptoms of our cases are described and the differential diagnoses of malingering, conversion disorders, and hypochondriasis are brought to attention.

Epiglotto-aryepiglottopexy: a surgical procedure for severe aspiration.

The loss of the protective function of the larynx is a severe complication of major ablative procedures in the upper aerodigestive tract and of certain severe neurological disorders. This may result in chronic life-threatening aspiration. Anterior pharyngotomy was used to perform epiglotto-aryepiglottopexy in four patients. The aim of this procedure is to close the laryngeal inlet and thus prevent aspiration without permanent loss of speech. In two of the patients, it was necessary to reoperate because of partial detachment of the epiglottis. This was performed successfully using the endoscopic approach. As a result, three patients have no aspiration and one has mild aspiration following epiglotto-aryepiglottopexy.

Conservative surgical management of invasive differentiated thyroid cancer.

The majority of well differentiated thyroid carcinoma are tumours of low grade malignancy. Laryngotracheal invasion by well differentiated thyroid carcinoma is an uncommon occurrence. The surgical management of patients with thyroid cancer invading the upper airway has primarily been by total laryngectomy. Other surgeons recommend in selected cases partial laryngeal and/or tracheal resection. A total of 122 patients with thyroid carcinoma were treated in our department between 1967 and 1982. Only seven patients with well differentiated tumours had airway invasion. In these seven patients we used a partial laryngeal and/or tracheal resection. In three of the patients with tracheal invasion a myoperichondrial flap was used for closing the tracheal defect. A partial resection of the larynx and trachea, and end to end anastomosis between the trachea and the remaining part of the larynx was performed in another four patients. The techniques used and a long-term follow-up are presented (Table I).