Biomedical subjects
Publications and source records attributed to J D Langdon.
The history of surgical reconstruction of the lips is outlined and a series of procedures described, which together enable lip reconstruction to be successfully undertaken in a variety of different circumstances.
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The advantages and limitations of sialography, CT scanning and ultrasound are described with particular reference to neoplastic disease.
Stress fracture is a rarely reported late complication of radical neck dissection. The condition should be recognised as its clinical and radiological differentiation from avascular necrosis or bony metastasis may be difficult.
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Sixty-eight cases of tumors of the salivary glands treated at one institution over a six-year period were classified according to the World Health Organization criteria (Thackray AC, Sobin LH: Histological Typing of Salivary Gland Tumours. WHO, Geneva, 1972). Parotid, submandibular, and minor tumors were classified as epithelial, nonepithelial, or unclassified tumors or as allied conditions. Symptoms, demographic features, and management of the tumors are discussed.
Previous ultrastructural studies of pleomorphic adenoma have presented conflicting results with regard to the role of myoepithelial cells in the histogenesis of this tumour. In the present study specimens of ten major salivary gland pleomorphic adenomas were examined ultrastructurally and a number of cell types identified. The material was subjected to quantification using the stereological method of point counting. The results showed a wide spectrum of differentiation within these tumours in which typical myoepithelial cells were rarely encountered even in situations where they are reported to occur in routine histological preparations. Cells with some myoepithelial features were more numerous but duct cells accounted for the majority of tumour cells. The ultrastructural findings correlated well with previously reported immunocytochemical data and further support certain ideas about salivary gland tumour histogenesis.
In a consecutive series of 61 parotid operations only one case of unexpected permanent facial nerve injury was seen although transient disturbances of facial nerve function were more common. Frey's syndrome subsequently developed in 13% of patients although its onset was delayed on average for 22.2 months.
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Regression analysis using actuarial life tables has been applied to the STNMP system for the grading and staging of oral cancer. Based on 170 patients, the five-year survival figures were 78% for Stage 1, 67% for Stage 2, 36% for Stage 3, and 20% for Stage 4. This represents a considerable improvement in prognostic differentiation over existing TNM system applied to the same cohort of patients. A further variable, velocity of tumor growth, was also assessed and shown to be of value in predicting the ultimate survival of the patients.
The tumor within the carotid sheath described in this article is unusual in that its clinical presentation mimicked a deep-lobe parotid tumor. Despite extensive investigation with conventional sialography, technetium pertechnetate scintigraphy, and computerized axial tomography, the correct preoperative diagnosis was not established. The value of CAT scanning in the diagnosis of parapharyngeal tumors is demonstrated.
The so-called median cysts of the jaws (median mandibular and median palatine) are currently classified as fissural cysts. Their existence as distinct clinical and histological entities has been the cause of debate. It is the purpose of this paper to point out that from present evidence in published case reports and reviews of the literature, the presence of these cysts in the midline of the jaws is a random finding. It is suggested that the title median mandibular and median palatine cysts should be discontinued and that cysts at these sites should be labelled according to their particular histopathology.
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The development of computerised axial tomography is briefly described and the application of this investigative procedure to the diagnosis of tumours in the maxillo-facial region is illustrated by two cases.
The management of cancer of the head and neck is so complex that it demands the participation of two teams, one major or curative and the other minor or supportive, and also of the patient. The make-up of these teams and the functions of their members are discussed. The principles of treatment planning along these lines are outlined and the importance of close interdisciplinary collaboration is emphasised.
The current concepts of histiocytosis X are discussed, and the literature concering this rare disease of obscure aetiology reviewed. Two case reports of histiocytosis X presenting in similar sites in young children of similar ages, but with markedly different courses, are presented. The importance of early recognition of the disease, particularly by the dental surgeon who may see the first oral signs, is stressed. Attention is drawn to the danger of misdiagnosing the oral signs of histiocytosis X, particularly as periodontal disease. The possible aetiologies are examined and current treatment regimes discussed.