Antibiotics and topical surgical preparation solution in septal surgery.

One thousand forty patients undergoing septal surgery of the nose were included in this 5-year study of no prophylactic antibiotics and no topical surgical preparation solution before surgery. Minor nasal infections developed in only five patients (0.48%) postoperatively. All five of these patients responded to oral antibiotic therapy and did not require hospitalization or intravenous antibiotic treatment. The incidence of infectious complications resulting from nasal surgery without the use of topical surgical preparation solution and without prophylactic antibiotics is minimal. No topical surgical preparation solution and no prophylactic antibiotic technique is a safe and acceptable approach for septoplasty and rhinoplasty surgery.

Electrodissection tonsillectomy.

A prospective, double-blind study was undertaken to compare the technique of removing tonsils using cold dissection with selective cauterization vs electrocautery dissection. The length of the procedure, blood loss, degree of pharyngeal pain, otalgia, and incidence of postoperative hemorrhage was recorded for 106 consecutive patients. In addition, our experience in performing the electrodissection tonsillectomy in 2431 patients is reviewed. Electrodissection tonsillectomy is a safe and effective procedure that offers several advantages over that of cold dissection using selective cautery.

Early diagnosis of acute laryngeal injuries.

Most acute laryngeal injuries are caused by motor vehicle accidents. Patients with multiple injuries who present with head or chest wounds should be carefully examined for signs or symptoms of laryngeal trauma. Primary patients with laryngeal injury presenting with life-threatening airway obstruction present a special problem to the accident surgeon. Tracheostomy rather than intubation is then the procedure of choice. A high index of suspicion must be maintained if laryngeal trauma is to be recognized and treated early. Prompt diagnosis and appropriate management is essential in maintaining an airway, preventing subsequent laryngeal stenosis and preserving the quality of the voice.

Antibiotics and nasal surgery.

Despite the widespread use of prophylactic antibiotics in nasal surgery, the subject has been paid little attention in the literature. In a retrospective analysis of 210 patients who underwent septal surgery or a rhinoplasty, only 5 developed minor infections. Patients undergoing septal surgery or rhinoplasty (174) were evaluated in a randomized sequence, prospectively, to study the efficacy of systemic antibiotic prophylaxis. Only 4 patients developed minor infections; and 173 patients demonstrated no clinical nor radiographic evidence of subsequent sinusitis. The incidence of infectious complications resulting from intranasal surgery is not sufficient to warrant the use of prophylactic antibiotics. Furthermore, proof of their effectiveness in preventing such infections is lacking.

Evaluation of frontal sinus fractures.

Forty-six instances of frontal sinus fracture were reviewed to determine the factors that are important in the initial clinical and radiologic evaluation. Associated injuries, the appearance of the forehead, and roentgenographic studies were all considered. Polytomography is the most accurate diagnostic technique and is justified in all patients. The otolaryngologist must examine all roentgenograms personally, with particular attention paid to the nasofrontal duct region and to the magnitude of depression of fracture fragments.

Calcifying odontogenic cyst of the maxilla.

Large cystic lesions of the maxillary sinus may initially manifest with malocclusion, cosmetic deformity, or both. Their origin may be odontogenic or nonodontogenic. Proper diagnosis of these cysts immeasurably aids in adequate (nonmutilating) treatment. A recent case of a calcifying and keratinizing odontogenic cyst that initially manifested as a facial mass exemplifies the need for adequate clinical and histological diagnosis to ensure appropriate treatment. Fewer than 35 cases have been reported since the original description in 1962.

Acinic cell carcinoma: a clinicopathologic study of thirty-five cases.

A clinicopathologic study of 35 cases of acinic cell carcinomas is presented. Complete follow-up information was available on 31 patients (average period, 7-5 years). The malignant potential of these neoplasms is affirmed by observations that metastases (local and distant) occurred in nine patients and that eight patients died as a consequence of their carcinoma. Retrospective classification of the carcinomas into high and low grade lesions correlated well with ultimate biologic behavior but is unlikely to be successful in an intra-operative (frozen section) mode. This limitation is due to: (a) sampling limitations at the time of primary surgery and (b) the malignant behavior of the occasional low grade carcinoma. Histologic features characterizing high grade carcinomas are local aggressive infiltration and areas of the tumor that appear analogous to the embryonic and post-embryonic terminal tubules and intercalated ducts. The best opportunity for cure of these neoplasms lies in their complete surgical removal at the time of initial treatment. For this, a total parotidectomy is the procedure of choice. Enucleation and local excision is to be condemned.

Altered bacterial flora and clinical course with intraoral cancer.

Nineteen consecutive patients with intraoral cancer were cultured and tested for cell-mediated immunity. They were then treated and followed for three years. The recurrence rate for those patients with normal flora was similar to that reported for dinitrochlorobenzene (DNCB) reactors; and the recurrence rate for those patients with abnormal microorganisms was similar to that reported for DNCB non-reactors.

Haemophilus influenzae cellulitis.

Cellitis that is caused by Haemophilus influenzae demonstrates a unique predilection for the faces of young children. Although previously considered a rare entity, it is currently being recognized more frequently. Despite the importance of early recognition and treatment in preventing potentially fatal complications, it has been noticeably neglected in the otolaryngologic literature. We report a case and discuss the diagnosis and management of H influenzae cellulitis.

Carcinomas of the nasal septum.

Fourteen new cases of primary squamous cell carcinoma of the nasal septum are presented. Their inclusion brings the total reported in the literature to 97. Early, confined neoplasms are amenable to cure by surgical excision, external irradiation or radium implants. Prognosis does not correlate with histological grade of the neoplasm but is inversely related to the size of the carcinoma at the time of diagnosis and the presence of metastases.

Bilateral asynchronous mixed tumors of the parotid gland.

Bilateral occurrence of benign mixed tumors of the salivary glands is rare. Simultaneous involvement of the submandibular and parotid glands has been described. Multicentric foci in the parotid gland has also been reported. Only four cases of bilateral mixed tumors, occurring simultaneously and confined to the parotid glands, have been reported. We report the first known cases of bilateral asynchronous benign mixed tumors of the parotid and review the pertinent literature.