Faculty Bibliography

OBJECTIVE: RADPLAT (concurrent selective supradose intraarterial cisplatin and external-beam irradiation) delivers extraordinarily high cisplatin concentration to head and neck structures. This study was designed to quantify and compare RADPLAT and systemic chemoradiation treatment effects on swallowing and speech. METHODS: Videofluorographic swallowing studies and articulation testing of 14 head and neck cancer patients treated with RADPLAT were compared with 16 treated with systemic chemoradiation 1 month after treatment. RESULTS: RADPLAT and systemic chemoradiation patients did not differ significantly on most swallow outcome measures, and there was significantly less aspiration on 1 and 3 mL liquid for RADPLAT individuals. Speech function was comparable except for RADPLAT's significantly worse /s, z/ productions. CONCLUSIONS: Increased concentration of cisplatin to the head and neck did not result in generally reduced swallowing or articulatory function

Facial nerve repair is a dynamic reanimation technique. Direct nerve repair by suturing or grafting can provide good results within a specific time frame. Immediate nerve repair has been successful in cases of laceration injuries, but nerve grafting techniques are typically delayed when it is clear that direct suturing to the nerve trunk cannot be achieved without tension. Delayed nerve grafting is also employed following ablative procedures and in cases of trauma that cause segmental nerve deficits. Cross-facial nerve grafting is particularly useful when the peripheral branches are intact and the main trunk of the facial nerve is inaccessible. This method is also typically performed in a delayed fashion. Rehabilitation of the facial nerve and subsequent reinnervation of the mimetic motor endplates are achieved through axonal growth. In this article, we describe a consecutive series of five patients who developed facial paralysis following cranial surgery for acoustic neuroma. Each underwent successful cross-facial nerve grafting during the first week following their initial surgery. Each received a sural nerve graft to at least two main divisions of the VIIth cranial nerve. We discuss our operative technique and the degree of restored nerve function

INTRODUCTION: Hodgkin's disease can occur in immunocompromised patients. However, the head and neck manifestations of Hodgkin's disease in human immunodeficiency virus (HIV)-infected patients remain ill defined. The aim of this study was to describe Hodgkin's disease of the head and neck in HIV-infected patients and compare it with noninfected patients. MATERIALS AND RESULTS: Sixteen patients presented with Hodgkin's disease of the head and neck to the King's County Hospital Center, Brooklyn, New York, beginning in January of 1991. Five patients were infected with HIV. Hodgkin's disease involved the head and neck regions in 90.5% of cases, occurring in 100% of HIV-infected and in 81% of noninfected patients. Manifestations of Hodgkin's disease were isolated to the head and neck region in only 20% of HIV-infected and in 27% of noninfected patients. Lymphatic structures were involved in all cases with head and neck involvement. Systemic or group B symptoms (fever, night sweats, fatigue, and weight loss of more than 10% of normal body weight) were present in 40% of HIV-infected patients and in 27% of noninfected patients. Advanced stage disease (Stage III/IV) was diagnosed in 80% of HIV-infected patients compared with 45% of noninfected patients. The mixed cellularity subtype was most common in HIV-infected patients (75%), whereas the nodular sclerosis subtype predominated in noninfected patients (50%). CONCLUSIONS: The data combined with our report of the literature suggest that the course, presentation, and outcome of Hodgkin's disease is markedly altered in HIV-infected patients. An aggressive approach to the diagnosis and management is suggested in this patient population

Organ preservation protocols of high-dose chemoradiotherapy have become fairly common to treat head and neck cancers. However, significant swallowing problems can occur. This study examines swallowing, oral tongue pressures, and tongue base-to-pharyngeal wall pressures in a patient who underwent total laryngectomy for improvement of swallowing after chemoradiotherapy for treatment of a hypopharyngeal tumor. The patient underwent concurrent videofluorographic and manometric examination of swallowing and examination of oral tongue pressures after the laryngectomy. One healthy subject was used as a control. After the laryngectomy, the patient no longer aspirated; however, he could swallow only liquids and pureed foods. He demonstrated difficulty with bolus clearance through the oral cavity and pharyngocervical esophagus. Pharyngeal pressures were reduced compared with those of the control subject. While total laryngectomy will stop unremitting aspiration, swallowing after chemoradiation may be severely compromised. This may not be overcome by total laryngectomy.

Sarcoidosis is a systemic chronic granulomatous disease of unknown etiology. Although it most commonly affects African-Americans, Scandinavians, and the Irish, individuals of all races and ethnicities are susceptible. The otolaryngologist will most frequently encounter sarcoidosis involving the sinonasal region; however, other sites in the head and neck may be involved. Head and neck affliction with sarcoidosis most frequently accompanies pulmonary involvement, although, in rare cases, it may present in the absence of any systemic manifestations. We present a patient of Eastern European origin treated for persistent epiphora and recurrent dacryocystitis without any other medical problems. Because medical therapy and canalicular intubation failed, an endoscopic dacryocystorhinostomy (DCR) was performed. Histologic examination of the lacrimal sac showed noncaseating granulomas. Further workup revealed an elevated angiotensin-converting enzyme (ACE) level and hilar adenopathy. At no time did the patient have any other signs or symptoms of sarcoidosis. This unique case highlights 4 important issues for the otolaryngologist: (1) sarcoidosis may occur almost anywhere in the head and neck and is not strictly limited to the upper respiratory tract; (2) sarcoidosis may occur in the head and neck even in the absence of any pulmonary or other systemic involvement; (3) sarcoidosis may affect persons of all races, both sexes, and all ages; and (4) routine histopathologic examination after excision of the nasolacrimal sac is recommended