Biomedical subjects
E W To
Publications and source records attributed to E W To.
Nasogastric-tube-induced unilateral vocal cord palsy.
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Carcinosarcoma (malignant mixed tumor) of the parotid gland: a case report.
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Cavernous hemangioma of the temporalis muscle: report of a case.
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Nasopharyngectomy for recurrent nasopharyngeal carcinoma: an innovative transnasal approach through a mid-face deglove incision with stereotactic navigation guidance.
Traditional approaches to nasopharyngectomy for the treatment of recurrent nasopharyngeal carcinoma carry considerable complications. This paper presents an innovative transnasal approach with stereotactic navigation guidance through a mid-face deglove incision which has been done for 15 patients with minimal morbidity. All patients had resumed their oral diet within a week, and were discharged within 10 days. The intraoral wound had healed within a week. The only complications were a mild degree of saddling of the nasal dorsum in one patient and temporary facial numbness that resolved within six weeks in three. Tumour had been resected with clear margins in 12/15, in the other three being stuck to the carotid artery.
The use of a radial forearm hybrid free flap in the reconstruction of a pharyngeal defect on the opposite side.
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A prospective study of the effect of botulinum toxin A on masseteric muscle hypertrophy with ultrasonographic and electromyographic measurement.
We evaluated the effect of botulinum toxin A on masseteric muscle hypertrophy by using ultrasound and electromyography. Five patients (four with bilateral and one with unilateral masseteric muscle hypertrophy) were studied prospectively. In each patient, ultrasound-guided percutaneous intramuscular injection of botulinum toxin A was carried out. The change in muscle bulk was evaluated using serial ultrasonography and the electrical activity was assessed with electromyography. All five patients (nine hypertrophic muscles) showed a good response, with the maximal effect of a 31% reduction in muscle bulk seen 3 months after treatment. The effect remained stable one year after injection for six of the hypertrophic muscles, whereas three muscles needed a second injection to maintain the atrophy. This preliminary prospective study suggests that botulinum toxin A is a safe alternative method of treating masseteric muscle hypertrophy. However, the effect may be temporary and further intramuscular injection may be required to maintain atrophy.
Subcranial anterior skull base dural repair with galeal frontalis flap.
The pericranial flap has been widely used to repair surgically created anterior skull base defects during craniofacial resection. This report describes a technique of subcranial dural repair with a galeal frontalis flap after resection of an ethmoidal adenoid cystic carcinoma.
The use of the harmonic scalpel for glossectomy.
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Fibromatosis of the head and neck region.
OBJECTIVE: Five cases of head and neck fibromatosis were analyzed. The imaging and pathologic findings, surgical management, and clinical outcome were discussed. STUDY DESIGN AND SETTING: A retrospective study of 5 adult head and neck fibromatosis cases, evaluating long-term follow-up results of conservative treatment. RESULTS: The 5 patients (2 male and 3 female) ranged in age from 16 to 51 years. The lesion size ranged from 1 to 8 cm. Four cases had limited surgical resection; 1 case was followed only. One of the surgically treated cases had a recurrence that was irradiated. All patients were well for a follow-up period of 2 to 8 years. CONCLUSION: Aggressive excision of head and neck fibromatosis cannot be achieved easily. Vigilant follow-up with or without conservative surgical excision achieves good disease control. Low dose radiotherapy can be used for inoperable cases. SIGNIFICANCE: Judicious conservative treatment should be attempted for head and neck fibromatosis to achieve optimal functional preservation.
Situs inversus--an incident finding.
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Use of an extended glabellar fascial-cutaneous flap for reconstruction of the nasopharynx.
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Pathologic fracture of clavicle after radiotherapy.
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A case of parotid mucoepidermoid carcinoma complicated by fatal gastrointestinal bleeding.
Mucoepidermoid carcinoma is one of the most common of the salivary gland neoplasms. Histologically, it is classified as either a low-, intermediate-, or high-grade tumor, and there are significant differences in prognosis among the different grades. Patients with low-grade disease have an excellent chance of survival. High-grade tumors behave aggressively, and they frequently manifest as local recurrences and distant metastases. We describe a case of a high-grade mucoepidermoid carcinoma of the parotid gland that had metastasized to the skin, stomach, and liver. The disease culminated in a rapidly fatal bleeding from the stomach metastasis. Such a complication is unusual and to our knowledge has not been previously reported. We briefly discuss the clinical features, biologic behavior, and treatment of this tumor.
Cowden's disease with vocal fold involvement.
Cowden's disease is a hereditary disorder characterized by oropharyngeal fibrosis and multiple hamartomas with potential malignant changes. We treated a 47-year-old man who had fibrotic lesions on the left vocal fold and an extensive amount of papillomatous lesions on the mucosa of the lips, tongue, and pharyngeal wall and on the skin of the axillae and buttocks. The pattern of distribution and the histopathologic features of these mucocutaneous lesions were diagnostic of Cowden's disease. To the best of our knowledge, this is the first reported case of Cowden's disease involving a vocal fold.
In vitro inhibition of head and neck cancer-cell growth by human recombinant interferon-alpha and 13-cis retinoic acid.
Three nasopharyngeal carcinoma (NPC) cell lines (CNE-1, CNE-2 and NPC/HK-1), two squamous cell carcinoma (SCC) cell lines (T2/CUHK and PWH-S1) and six head and neck cancer specimens (NPC [n = 4], SCC tongue [n = 1] and a thyroid cancer [n = 1]) were incubated with interferon (IFN)-alpha (5 x 10(4) iu/mL) and/or 13-cis retinoic acid (13RA; 10(-5) mol/L) for two days at 37 degrees C. In vitro chemosensitivity was measured using MTT assay. Mild growth inhibition of the five cell lines by IFN-alpha ranged from 7.1% to 51.8% (mean: 18.5%), whereas with 13RA it was zero to 19.7% (mean: 7%). Greater inhibition (14.8-51.0%, mean: 31.8%) was achieved when the two drugs were used in combination. Growth inhibition of the six surgical specimens ranged from 6.9% to 21% (mean: 13.6%) with IFN-alpha; zero to 10.3% (mean: 6.0%) with 13RA; and 6.6-26.5% (mean: 17.7%) when the two agents were combined. Four of the 11 samples showed synergistic antitumour effect when IFN-alpha and 13RA were combined, and six showed subadditive effect. The results show that IFN-alpha and 13RA have a mild in vitro antitumour effect on head and neck cancer cells, and the drug synergistic effect demonstrated in this study suggests that the two agents should be used in combination in clinical application.
Arteriovenous fistula induced by a peribulbar nerve block.
Arteriovenous fistula (AVF) of the head and neck region is an uncommon clinical condition that can be of congenital or acquired etiology. We report a case of AVF of the left supraorbital vessels that developed after a peribulbar nerve block was given for cataract surgery.
Staging papillary carcinoma of the thyroid: magnetic resonance imaging vs ultrasound of the neck.
AIM: To evaluate the role of magnetic resonance imaging (MRI) for staging local disease and lymph node metastases in papillary carcinoma of the thyroid by comparing MRI with ultrasound (US) of the neck. MATERIALS AND METHODS: Fourteen patients with papillary carcinoma underwent MRI and US. The images were prospectively reviewed for (1) identification of the primary lesion; (2) presence of multifocal thyroid disease; (3) extracapsular extension; (4) invasion into the trachea, oesophagus and major vessels; and (5) presence of lymph node metastases. Correlation was made with the surgical findings. RESULTS: The site of the primary lesion was correctly identified by US in 14 of 14 (100%) and by MRI in 13 of 14 (93%) of patients. Multifocal thyroid tumour was correctly identified by US in two of two patients (100%) and by MRI in zero of two (0%). Extracapsular extension (n = 9), oesophageal invasion (n = 1) and tracheal invasion (n = 2) were identified by MRI in seven, zero, and one, and by US in six, zero and zero patients, respectively. Invasion of the major vessels was not seen. Metastatic cervical nodes were present in 19 nodal groups in 10 patients involving the internal jugular chain (n = 10), posterior triangle (n = 4) supraclavicular fossa (n = 1) and central group (n = 4). Both MRI and US failed to identify metastatic nodes in the central group but correctly identified 14 of the 15 nodal groups outside the central group. CONCLUSION: Ultrasound should be used as the first line of investigation for detecting the primary lesion, multifocal disease and cervical lymphadenopathy. In cases where the primary tumour is not surrounded by normal thyroid tissue MR imaging should be added to assess extracapsular spread, especially into the trachea.