Surgical treatment of carcinoma of the larynx, pharynx, base of tongue and cervical esophagus.
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Esophageal Neoplasms↗
Biomedical subjects
T C Calcaterra
Publications and source records attributed to T C Calcaterra.
An evaluation of the treatment of subglottic hemangioma.
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Bronchitis↗
Reconstruction of massive defects of the scalp, cranium, and dura after resection of scalp neoplasms.
Massive defects of the scalp, cranium, and dura can be covered with local rotation, transposition scalp flaps. Five cases of massive defects of up to 300 square centimeters resulting from resection of scalp neoplasms were reconstructed by this technique. Excellent cosmetic and functional results were obtained in all cases. Although the emphasis in the recent literature has been on free flap coverage of these massive defects, our series demonstrates that these extensive scalp defects can be reconstructed using large local scalp flap transposition.
Adult↗
Aneurysmal bone cyst of the cricoid cartilage: an unusual cause of subglottic stenosis.
Aneurysmal bone cysts (ABC) are locally aggressive bony tumors which rarely occur in the head and neck. Only 3 cases have been reported in the larynx previously, 1 involving the cricoid cartilage. A patient is presented who developed subglottic stenosis with airway compromise due to an ABC arising from the cricoid cartilage. The literature on bony tumors of the laryngeal cartilages was reviewed and the clinical and pathologic findings in this case highlighted.
Adult↗
Spinal accessory nerve palsy: an unusual complication of rhytidectomy.
Rhytidectomy is a safe and effective procedure for rejuvenation of the aging face. Reported complication rates vary between 2.5% and 28%, and with proper management, longterm sequelae are unusual. Injury to the spinal accessory nerve is a rare but potentially debilitating complication of rhytidectomy. Afflicted patients present with dull, constant pain in the shoulder region which can be serve in nature. In addition, there is weakness of shoulder abduction and cosmetic deformity related to trapezius atrophy. Measures for conservative management include analgesics and physical therapy to strengthen the shoulder girdle. Nerve exploration is indicated for cases with documented denervation that do not respond to conservative treatment. A review of the English literature identified two previous case reports of spinal accessory nerve injury sustained during rhytidectomy. In this report, we present two additional cases and review current concepts regarding diagnosis, management, and prevention of this unusual complication of rhytidectomy.
Accessory Nerve↗
Malignant clear cell hidradenoma of the upper lip.
Malignant clear cell hidradenoma is an uncommon tumor of eccrine sweat gland origin that has a predilection for the head and neck. It is characterized by an indolent growth pattern yet frequently recurs following surgical excision and has a high incidence of regional and distant metastases. A case of recurrent malignant clear cell hidradenoma of the upper lip is presented. The lesion was treated with surgical excision followed by radiotherapy. The literature on this rare lesion is reviewed and treatment strategies discussed.
Acrospiroma↗
Trichoepithelioma: report of an unusual case and review of the literature.
Trichoepitheliomas are benign and uncommon skin tumors presenting in the head and neck region. Although they can be solitary, they occur more frequently as multiple lesions with an autosomal dominant inheritance. To the surgeon, they often present the problem of clinical differentiation from basal-cell carcinoma. An unusual case is described, and experience in the treatment of 19 patients is reviewed.
Aged↗
Cancer of the oropharynx.
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Carcinoma, Squamous Cell↗
Laryngeal edema induced by neck dissection and catheter thrombosis.
PURPOSE: There are many possible causes of airway edema in a patient being treated for squamous cell carcinoma of the head and neck. The differential diagnosis includes radiation changes, anaphylaxis, and venous or lymphatic obstruction secondary to mechanical compromise resulting from infection, recurrent tumor, or anatomic distortion. METHODS: A 60-year-old man underwent partial glossectomy and right radical neck dissection for squamous cell carcinoma of the tongue. He subsequently required insertion of a Hickman catheter for administration of chemotherapy to treat recurrent disease. Edema of the left neck, shoulder, and arm was noted to accompany the onset of laryngeal obstruction secondary to supraglottic edema. RESULTS: Catheter-induced thrombosis of the left brachycephalic vein obstructed the only residual jugular vein and was responsible for the sudden airway obstruction. CONCLUSION: Acute laryngeal edema may be caused by obstruction of venous outflow. Invasive catheters should be placed with caution in patients who have undergone surgical sacrifice of the contralateral internal jugular vein.
Brachiocephalic Veins↗
Propofol for maintenance of general anesthesia: a technique to limit blood loss during endoscopic sinus surgery.
PURPOSE: Most cases of endoscopic sinus surgery are amenable to techniques using local anesthesia with monitored sedation. However, it is frequently the preference of the patient to have surgery under general anesthesia. One major drawback of general anesthesia is the increased bleeding encountered which can interfere with optimal visualization of the intranasal anatomy. In this study, an analysis was made to see if technique of general anesthesia has an impact on estimated blood loss in patients undergoing endoscopic sinus surgery. METHODS: Twenty-five patients undergoing outpatient endoscopic sinus surgery under general anesthesia over a 1-year period were reviewed retrospectively to determine if anesthetic technique had an impact on estimated blood loss. Twelve patients were identified who received a continuous intravenous infusion of the nonbarbituate hypnotic agent propofol as the primary anesthetic agent, and 13 patients were identified who received anesthesia based on inhalational isoflurane. RESULTS: There was no difference between the duration of surgery or the intraoperative mean arterial blood pressure when comparing the two groups. The average estimated blood loss in the propofol group was 101 mL compared with an average estimated blood loss of 251 mL in the isoflurane group (P < .01). CONCLUSIONS: General anesthesia based on propofol infusion may have the advantage of decreased bleeding compared with conventional inhalation agents, making endoscopic sinus surgery technically easier and safer by improving endoscopic visualization of the surgical field. This anesthetic technique may have other applications in otolaryngology, where bleeding within a confined space frequently can interfere with visibility.
Adult↗
Squamous papillomas of the nasopharynx treated by a uvulopalatopharyngoplasty approach.
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Adult↗
Testicular carcinoma metastatic to the neck.
PURPOSE: To show that a supraclavicular neck mass may be indicative of metastatic testicular carcinoma and to offer further insight into the treatment of residual neck disease. METHOD: We report six cases of testicular carcinoma metastatic to the neck. All were initially treated with radiation, chemotherapy, or a combination of both depending on histological type. RESULTS: Neck masses persisted despite primary therapy. Three patients underwent subsequent modified neck dissection and remained free of disease; three others received nonsurgical forms of adjuvant therapy and ultimately died of their cancer. CONCLUSION: Metastatic testicular carcinoma may manifest as a supraclavicular neck mass and must therefore be considered in the differential diagnosis of a mass in this region. Surgical resection is indicated in the management of neck masses that persist after cytoreductive chemotherapy to remove residual foci of disease and potential source of spread.
Adolescent↗
Gamma-probe localization of a parathyroid adenoma in the reoperative neck.
Preoperative localization of parathyroid adenomas in patients with hyperparathyroidism currently relies on a combination of computed tomography, magnetic resonance imaging, ultrasound, (99m)Tc-sestamibi scintigraphy, and venous sampling of parathyroid hormone. No procedure is universally reliable, however, and in reoperation for missed parathyroid adenomas, development of an optimal preoperative localization strategy becomes especially problematic. We report the case of a patient with hyperparathyroidism who required reoperation for a missed parathyroid adenoma despite preoperative localization with (99m)Tc-sestamibi scintigraphy. (99m)Tc-sestamibi scintigraphy was done 2.5 hours before reoperation. On reoperation, a gamma-detecting probe (C-Track; Care Wise Medical Corporation, Morgan Hill, CA) introduced through a right neck incision was used to localize a 4-cm adenoma within 45 minutes. No significant radiation hazard existed, and no special handling of the specimen was required. The patient's hyperparathyroidism resolved within 24 hours postoperatively. Therefore, this intraoperative technique may prove to be a useful adjunct to preoperative localization studies of parathyroid adenomas, particularly in patients requiring reoperation for persistent postsurgical hyperparathyroidism.
Adenoma↗
Hemangiopericytoma of the head and neck.
PURPOSE: To report a series of patients with hemangiopericytoma (HP) of the head and neck, to review pathological features of these tumors, and to discuss management options. MATERIALS AND METHODS: A retrospective review of the medical records at the University of California, Los Angeles (UCLA) Medical Center in Los Angeles, CA, was done in order to identify those patients with primary HP of the head and neck, including soft tissue and mucosal sites. RESULTS: Ten patients with HP of the head and neck were identified. There was an equal sex distribution and an average age of 36 (range 10-65). Seven of the tumors arose from soft tissue sites in the head and neck, and the remaining 3 arose from the mucosa. All patients underwent wide excision of the primary lesion with a local recurrence rate of 40%. Thirty percent of patients developed metastatic lung disease 0 to 8 years after initial diagnosis. Each patient who developed metastatic disease had abundant mitoses on pathological review compared with rare or absent mitoses in the lesions that took a more benign course. CONCLUSIONS: Pathological appearance of resected HP is predictive of later metastatic potential. Long-term follow-up is necessary in patients even after radical resection because recurrence or metastasis may be delayed by many years.
Adolescent↗
Cutaneous vascular anatomy of pectoral skin flaps.
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Adult↗
Operative treatment of surgical lesions with objective tinnitus.
This article discusses the importance of the elevation and diagnosis of objective tinnitus (tinnitus heard by the patient and the physician). Intracranial arteriovenous communications and vascular anomalies are most frequently responsible for the tinnitus and auscultable bruits and are highly amenable to current surgical treatment. While the otolaryngologists may initially see these patients and be responsible for the diagnosis of their problem, the surgical correction of the intracranial lesions is usually the province of the neurosurgeon. Illustrative cases of extracranial causes are presented. Particular emphasis is placed on the diagnosis and treatment of venous hum. Formerly called cephalic bruit and essential objective tinnitus, venous hum is now a recognized nosological entity that is amenable to treatment by ligation of the internal jugular vein.
Adolescent↗
Local anesthesia for suspension microlaryngoscopy.
Despite the strong trend toward use of general anesthesia for laryngoscopy, local anesthesia retains inherent advantages from the standpoint of patient safety and maintenance of physiologic function of the larynx during endoscopy. Topical anesthesia produces incomplete sensory blockade and is unsatisfactory for suspension laryngoscopy. A method of infiltration anesthesia is described whereby profound anesthesia of the base of the tongue, valleculae, and larynx can be achieved to allow suspension laryngoscopy.
Anesthesia, Local↗
New insights into the causes of postoperative aspiration following conservation surgery of the larynx.
This study was conducted specifically to determine and document the various possible causes of postoperative aspiration. Such information may assist in better selection of candidates as well as provide insights that facilitate improvement of operative techniques for conservation surgery for cancer of the larynx. The major significant information derived from this study is the recognition and delineation of the part played by paralysis of the superior and recurrent laryngeal nerves as causes for aspiration following conservation laryngeal surgery.
Aged↗