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1/23. Management of chyle fistulization in association with neck dissection.

    Chylous fistula after neck dissection is a relatively rare but potentially lethal complication. Sequelae range from severe fluid, electrolyte, and protein loss to fistula formation, skin-flap necrosis, and carotid blowout. A thorough knowledge of the anatomy is essential to avoid injury to the thoracic duct or right lymph duct. After surgery, drainage of large amounts of fluid, particularly if milky, may alert the surgeon to the danger of chylous leakage. Certain diagnosis, however, is not so easy. Once the diagnosis is made, the management has to address the immediate and late effects of the loss of chyle into an operative site. This article seeks to examine these factors through review of the literature and personal experience with the problem. Total parenteral nutrition allows for control of the fluid and protein loss while avoiding flow of chyle, and in most cases it results in resolution. In those cases that do not resolve, fibrin glue with some type of mesh and muscle flaps usually succeed in closure. ( info)

2/23. Hyperosmolar nonketotic coma: prevention, diagnosis, and treatment.

    With the multi-faceted approach to head and neck cancer today, maintaining caloric intake by long-term enteral hyperalimentation is commonplace. Along with the tremendous advantages of this form of nutrition, the disadvantage of hyperosmolar nonketotic diabetic acidotic coma is present. mortality rates are quoted from 40% to 70% according to the literature reviewed. Therefore, prevention is the best form of treatment. The cause, diagnosis, and treatment will be discussed. ( info)

3/23. Fluorodeoxyglucose positron emission tomography, a new technique for increasing the detection rate of coincident thyroid cancer in head and neck oncology.

    Clinically occult thyroid cancer is not uncommon and may occur in 1% to 10% of the population Since the first studies on the use of fluorodeoxyglucose positron emission tomography (FDG PET) in clinical oncology some reports have appeared on the detection of occult tumors using this imaging modality. According to these results, the number of patients with head and neck cancer and clinically occult coincident primary tumors at initial presentation may be expected to increase. In two of the four patients presented, the coincident tumor was detected with FDG PET. The possible role of this new imaging technique is discussed in correlation with treatment and clinical outcome. ( info)

4/23. Endoscopic sinus surgery in previously irradiated patients.

    PURPOSE: Our purpose was to evaluate the safety and efficacy of endoscopic sinus surgery in irradiated patients with absolute indications for sinus surgery. patients AND methods: During 5 years at a tertiary referral center, more than 200 patients received irradiation to a field that included the paranasal sinuses. Complaints related to the sinuses are common in such patients and often include crusting and increased mucus drainage. Six patients presented with significant sinus infections in the absence of tumor recurrence and failed medical management. Additional problems included epiphora and nasal obstruction caused by cicatricial choanal stricture. Surgical interventions included ethmoidectomy, multiple osteotomies, debridement of scarred or devitalized tissue, and dacryocystorhinostomy. Outcome measures included intraoperative findings and complications, length of hospital stays, endoscopic assessments of the healing over 6 months post-operatively, and improvement or persistence of symptoms over 2 to 3 years of follow-up. RESULTS: Surgery can be technically difficult because of derangements of normal anatomy and dehiscence of important structures. Although bleeding problems, prolonged admission, and delayed healing were noted in certain cases, they did not result in long-term morbidity. CONCLUSIONS: Endoscopic sinus surgery has become an invaluable tool in the treatment of refractory sinusitis. Our literature review has revealed no information, however, regarding endoscopic sinus surgery in previously irradiated patients. Theoretically, such patients are at risk for healing problems and anatomic derangements, which could lead to complications. There is, nevertheless, a theoretical benefit to avoiding external approaches in patients who might heal poorly. ( info)

5/23. Implantation metastasis of head and neck cancer after fine needle aspiration biopsy.

    One possible complication of the aspiration biopsy of malignant tumors is dissemination of tumor cells along the needle track. However, a search of the literature revealed few definite reports of implantation metastases of head and neck tumors after fine needle aspiration biopsy (FNAB). Here we report two cases of skin metastasis of head and neck cancer after FNAB, including a patient with papillary adenocarcinoma of the thyroid and one with adenoid cystic carcinoma of the submandibular gland. Surgical treatment prevented the spread of the tumor in both cases and there have been no evidence of recurrence to date. This report should alert head and neck surgeons to the possibility of implantation metastasis after FNAB. ( info)

6/23. Basaloid squamous carcinoma of the buccal cavity.

    Basaloid-squamous carcinoma was first recognized as a separate pathologic entity in 1986. It has been described in the hypopharynx, larynx, base of tongue, and nasal cavity. We report the first case of this rare tumor occurring in the buccal cavity and review the atypical squamous cell carcinomas that occurred in these sites. ( info)

7/23. otolaryngology problems in the immune compromised patient--an evolving natural history.

    As the human immunodeficiency virus is being detected in increasing numbers of asymptomatic individuals at risk, newer earlier patterns of disease have become apparent--including cranial and cervical herpes zoster, oral hairy leukoplakia, and oral candidiasis--thus linking viral and other disease to the development of acquired immunodeficiency disease (AIDS). Many similarities between patients with AIDS and other immunosuppressed patients have emerged. As immunosuppressed patients survive longer, they begin to manifest cancers such as lymphomas and squamous cell cancers in addition to Kaposi's sarcoma. Otolaryngologists can learn to identify and treat otitis and sinusitis in the immunosuppressed patient, to identify predictive early signs such as oral hairy leukoplakia, herpes simplex virus, and oral candidiasis, and to diagnose and treat Kaposi's sarcomas of the head and neck, lymphomas, squamous cell cancers, and opportunistic infections as the immunodeficiency disease progresses. ( info)

8/23. Extra-nasopharyngeal extension of juvenile angiofibroma.

    Nasopharyngeal angiofibroma (NPA) is a highly vascular, infiltrative tumour that occurs exclusively in the nasopharynx of young males. It is of special interest on account of its serious complications, and the difficulties that are encountered at the time of treatment. Various surgical approaches have been mentioned for both naso- and extra-nasopharyngeal angiofibromas. But a massive extra-NPA involving the naso-spheno-oro-palato-maxillary-infratemporal region, orbit and cheek is difficult to treat adequately with any of the approaches so far described in the literature. In these cases, a more radical approach (constituting embolization and subsequent clamping or ligation of the external carotid artery followed by total maxillectomy) may be needed. These procedures will not only give a dry operative field but also adequate exposure to the different parts of the extension of the tumour, thereby facilitating complete removal without any risk of recurrence. ( info)

9/23. Lymphoplasmacytic lymphoma of the larynx, soft palate and nasal cavity.

    Non-Hodgkin's lymphoma of the larynx is uncommon and when it occurs usually presents as a non-ulcerating supraglottic mass with a predilection for the ventricle. No case of the lymphoplasmacytic variety occurring in the larynx has been reported in the literature to date. We present such a case with distant lesions in the soft palate and nasal cavity, mimicking nasal polyps. ( info)

10/23. Childhood rhabdomyosarcoma in otorhinolaryngology.

    Two cases of childhood rhabdomyosarcoma with otorhinolaryngological localization are reported and the literature of this rare malignancy is reviewed. The prognostic importance of localization, early diagnosis and combined surgical, irradiation and cytostatic treatment are emphasized. ( info)
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