Reconstruction of full-thickness cheek defects with combined cervicopectoral and pectoralis major myocutaneous flaps.
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Adult↗
Biomedical subjects
T C Calcaterra
Publications and source records attributed to T C Calcaterra.
Mohs micrographic surgery for skin cancers of the neck.
The neck is not a common area for a skin cancer to occur. However, when it does occur and extends deeply, careful extirpation is necessary so that vital structures will be identified and, if possible, preserved. The Mohs surgeon can most accurately determine the true extent of malignancies in this area; the head and neck surgeon can best identify and protect important anatomic structures. Together both physicians can achieve the best chance of cure and lessen the complication rate for patients with selected invasive cutaneous tumors of the neck. Future collaborative efforts will undoubtedly be directed toward complete extirpation of deeper tumors of the neck, especially those of the pharynx, hypopharynx, and trachea.
Head and Neck Neoplasms↗
Nonsalivary sinonasal adenocarcinoma.
Thirteen cases of primary non-salivary gland adenocarcinoma of the nasal cavity and paranasal sinuses were studied at UCLA over 20 years. All pathologic specimens were reviewed and those tumors that were histologically distinct from the more common salivary gland-derived tumors were included in the study. Three classifications were identified: well, moderately, and poorly differentiated adenocarcinoma. A distinct variant of sinonasal adenocarcinoma was the intestinal type. The clinical behavior of the latter resembled the well or moderately differentiated types, with behavior mainly predicted by the extent of the disease. These groups have prognostic significance, with the poorly differentiated group having the most virulent course. Nine of 13 tumors occurred in the ethmoid sinuses and all were aggressive locally. Only one case had distant metastases (nodal neck disease in a terminal case). Of five long-term survivors (median five-year follow-up), all had extensive surgical resections and three had full-course radiotherapy. The single most important factor in the treatment of these lesions is adequacy of surgical margins. Four of six patients with confirmed negative margins were cured despite extensive tumors. Three survivors had the cribriform plate taken and one required a combined intracranial/extracranial approach for tumor resection. There were no survivors in four patients treated with primary irradiation.
Adenocarcinoma↗
Osteomyelitis of the clavicle.
Osteomyelitis of the clavicle is a rare entity and can occur as a complication of head and neck surgery. Ten consecutive cases of the clavicular osteomyelitis were reviewed at the University of California Medical Center, Los Angeles, over the past seven years. Six cases were associated with prior surgical procedures, and five cases presented as chronic wound drainage. One case was related to a pharyngocutaneous fistula following a supraglottic laryngectomy. Four patients presented with acute symptoms resulting from hematogenous spread, and two of the four patients had Staphylococcus aureus on blood cultures. Long-term intravenous antibiotic therapy (six to eight weeks) was used to successfully treat cases of hematogenously spread osteomyelitis. Wide surgical débridement was the mainstay of treatment in the chronic conditions, with antibiotic therapy having a secondary role. Myocutaneous flaps were required in two patients who had had surgery and antecedent radiotherapy. To conclude, the surgeon should be aware that osteomyelitis of the clavicle can occur as a complication of head and neck procedures. In addition, the treatment of the chronic form of clavicular osteomyelitis is surgical débridement and possible flap reconstruction.
Adult↗
Unilateral proptosis.
Unilateral proptosis is not uncommonly encountered by the otolaryngologist. A thorough understanding of the potential causes and the appropriate diagnostic evaluation will ensure a successful outcome.
Angiography↗
The pectoralis major myocutaneous flap. Use in surgery of the lower neck and superior mediastinum.
Surgery of the lower neck and superior mediastinum is most frequently performed for parastomal recurrence of laryngeal carcinoma. It has been associated with a high incidence of complications, often leading to fatal innominate artery rupture. The use of the pectoralis major myocutaneous flap has permitted wide en bloc resections of the superior mediastinum in ten patients without a major complication. Several technical innovations add versatility to the pectoralis major myocutaneous flap, including tailor fitting each skin paddle and incorporating the pectoralis minor into the muscular pedicle. Superior mediastinal resection should be performed in conjunction with laryngectomy and cervical lymph node dissection in patients who are at high risk for parastomal recurrence. We also recommend that patients with parastomal recurrence undergo this procedure for salvage.
Aged↗
Melanoma of the nasal and paranasal sinus mucosa.
Melanoma involving the nasal and paranasal sinus mucosa is a rare disease that is difficult to treat and generally has a poor prognosis. Data on 17 patients treated at the UCLA Medical Center during the period 1970 to 1985 were reviewed in a retrospective manner. The five-year disease-free survival was 25% (3/12). Surgery, with or without radiation therapy, is the mode of treatment to control disease in most patients. Treatment failures, which include both local recurrence and distant metastases, may occur many years after initial therapy. We found a correlation between the thickness of tumor and the clinical outcome.
Adult↗
Treatment of impending carotid rupture with detachable balloon embolization.
Acute carotid artery rupture is frequently heralded by prodromal arterial bleeding. This warning signal provides the physician with a brief interval in which to hemodynamically stabilize a patient, electively occlude the carotid, and consequently improve the patient's chance of survival. For three years, we have employed an initial nonoperative approach to patients with impending carotid rupture. A trial of endovascular balloon occlusion followed by detachable balloon embolization of the carotid artery has been utilized. Patients unable to tolerate temporary occlusion underwent a vascular bypass procedure followed by embolization. Six patients have undergone this approach, and all had permanent cessation of bleeding. None died as a result of the procedures. One patient developed permanent neurologic deficits. Balloon embolization offers improved results over elective ligation and should be considered as an alternative treatment for patients in this dire predicament.
Adult↗
The treatment of T3 glottic carcinoma with vertical partial laryngectomy.
Total laryngectomy has traditionally been considered the optimal treatment for patients with advanced glottic carcinoma who present with a fixed true vocal cord. However, using whole-organ sectioning techniques, it has been demonstrated that vertical partial laryngectomy is a sound oncologic procedure for selected fixed vocal cord lesions. During the period 1969 to 1984, 27 patients who presented at UCLA with T3 glottic carcinoma were treated using vertical partial laryngectomy. Follow-up for these patients averaged 4.0 years. The absolute two-year disease-free survival rate for this group was 85% (23 of 27 patients), and the local cancer recurrence rate during a two-year postoperative interval was 11% (three of 27 patients). These encouraging results support the continued use of partial laryngeal surgery for a subgroup of patients with T3 glottic cancer. Successful patient selection requires a careful analysis of disease extent based on data obtained from physical examination, magnetic resonance imaging or computed tomographic scanning, and direct laryngoscopy.
Adolescent↗
Salivary gland tumors of the palate: the UCLA experience.
A retrospective review of 38 patients with salivary gland tumors of the palate treated between 1961 and 1984 is presented. The majority of tumors were identified at an early stage. Most (23 of 38 cases) originated over the hard palate. The most common histological type was adenoid cystic carcinoma (22 cases). Twenty-five patients were treated with surgery alone, of whom, three had wide local excision. Thirteen patients received postoperative radiation therapy in addition to surgery. The local control was comparable for surgery alone and combined therapy (88% and 85%, respectively) although the combined therapy group was biased by more advanced disease, inadequate margins, and/or poorly differentiated histologies. Mucoepidermoid lesions had an excellent prognosis with local control of 100%. In contrast, there was a 23% recurrence rate for adenoid cystic carcinoma. Regional neck node metastasis was noted in 2% of the patients. This experience indicates that radical resection of palate salivary gland malignancy with adequate margins results in excellent local control. Adjuvant radiation therapy is recommended in cases where there is a question of adequate margins and in advanced lesions of high grade tumors.
Adenocarcinoma↗
Inserting and securing the nasogastric tube.
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Humans↗
Bilateral omohyoid muscle flap reconstruction for anterior commissure cancer.
Partial laryngectomy for anterior commissure cancer often results in a shortened glottis which produces a high pitched strained voice and an inadequate airway lumen which requires permanent tracheostomy. Vocal fold vibration is impaired both by the shortened length and anterior scarring which profoundly affects the myoelastic properties of the larynx. Many different methods of reconstructing the anterior commissure have been attempted with limited success and many require multiple procedures. A method of anterior commissure reconstruction employing bilateral omohyoid muscle flaps has been performed successfully in four patients. The omohyoid muscles and investing fascia are readily available during partial laryngectomy and can be tailored to reconstitute the anterior commissure. The myofascial flaps epithelialize rapidly and there is little tendency for anterior glottic stenosis. The sphincteric function of the larynx remains intact and the vocal quality surpasses other methods of reconstruction employed by the author.
Glottis↗
Tetracycline sclerotherapy for chylous fistula following neck dissection.
In chylous fistulas following radical neck dissections, we have found reexploration to be unrewarding, with infrequent identification of a specific leakage site intraoperatively and persistent fluid accumulation postoperatively. As an alternative, we injected tetracycline hydrochloride into the supraclavicular wound bed. This procedure resulted in a rapid, sustained decline in fistula output in two of three cases, avoiding surgical intervention. Tetracycline sclerotherapy has been described for treatment of intrathoracic and other intracavitary fluid collections. We believe that tetracycline sclerotherapy is an effective adjunct in the management of chylous fistulas following radical neck dissections and that this therapy should be attempted before surgical reexploration.
Adenocarcinoma↗
Tongue flap repair of postlaryngectomy hypopharyngeal stenosis.
Hypopharyngeal stenosis after total laryngectomy has been reported as high as 40%. The most consistent and important causal factor is the extent of the pharyngeal resection since cancers of the pyriform sinus and postcricoid region have the highest incidence of stenosis. Dilation is frequently unsuccessful in the management of postlaryngectomy hypopharyngeal stenosis probably because of its excessive length. The laterally-based tongue flap is effective for repair of these stenoses because of its proximity, epithelial compatibility, and ample length. The technique, details, and successful use in three patients are presented.
Airway Obstruction↗
Major salivary gland tumors: treatment results and prognostic factors.
A retrospective review of 133 patients with major salivary gland carcinomas treated between 1955 and 1981 is presented. The majority of cases (104) originated in the parotid gland. The most common histological type was mucoepidermoid carcinoma (39 cases). Tumor-free interval was longest for patients with acinic cell and mucoepidermoid carcinomas. In contrast, adenoid cystic carcinoma was poorly controlled, regardless of the form of treatment. Initial control of primary major salivary gland tumors was inversely related to the presence of disease at the surgical margins. In cases with microscopic or gross disease at the surgical margins, postoperative radiation therapy controlled the tumor locally in 18 of 26 patients (69%). Postoperative radiation therapy was generally used only in cases with high-grade histologies, advanced stages, or positive surgical margins. Of the patients treated with surgery alone, 53% achieved local control, as compared to 75% of the group which received postoperative radiation therapy. Although the difference was not statistically significant, we would have expected the combined therapy group to have a lower control rate due to more advanced disease. There was a low salvage rate (22%) and a high incidence of distant metastasis (60%) in recurrent cases. The data indicates that complete surgical resection results in the best local control, with or without adjuvant radiation. When the surgical margin is inadequate and re-excision not possible, adjuvant radiation therapy appears to have a role to optimize local control and survival.
Adolescent↗
Chondrocalcinosis of the temporomandibular joint. A parotid pseudotumor.
Chondrocalcinosis, ie, calcium pyrophosphate dehydrate (CPPD) crystal deposition disease, has a spectrum of clinical manifestations ranging from an absence of symptoms to a severely destructive arthropathy. We recently treated a patient with CPPD deposition adjacent to the temporomandibular joint, which simulated a parotid tumor. The CPPD crystals are weakly positively birefringent under a polarizing microscope. Most frequently they are found roentgenographically as asymptomatic deposits in fibrocartilaginous structures, especially the knee meniscus. A less frequent manifestation is "pseudogout" acute arthritis. Rarely, joint destruction is found.
Calcium Pyrophosphate↗
Malignant salivary gland tumors of the base of the tongue.
Malignant salivary gland tumors of the base of the tongue are unusual lesions and optimal treatment has not been established. As a group, these tumors tend to be diagnosed at an advanced stage, and consequently carry a grave prognosis. Fourteen patients were treated at UCLA between 1954 and 1984. Twenty-three percent of the patients have survived longer than ten years, although only one patient is free of disease. Eight of 14 patients developed distant metastases. Salivary tumors in this location are difficult to completely excise and surgical margins are frequently positive. Treatment using a planned combined approach is advocated.
Adult↗
Parotid hypertrophy with bulimia: a report of surgical management.
Benign hypertrophy of the salivary glands can occur in patients with anorexia nervosa. This enlargement has been related to nutritional deficiencies and bulimia, which is a form of episodic binge eating followed by vomiting. The surgical management of a patient with bulimia and benign bilateral parotid enlargement secondary to bulimia will be discussed. Superficial parotidectomy may be a useful adjunct in managing the cosmetic and psychological aspects of patients with anorexia nervosa and bulimia complicated by massive parotid hypertrophy intractable to medical management.
Feeding and Eating Disorders↗