Faculty Bibliography

There is no universally acceptable classification or method of treating congenital vascular lesions of the head and neck. An historical perspective, the hemodynamics of arteriovenous fistulas, and the various modalities of treatment are presented. The importance of superselective angiography in studying these lesions is emphasized. Embolization represents a major advance in the treatment of these patients and cooperation between head and neck surgeon and the vascular radiologist is encouraged. The evaluation and treatment of 66 patients with congenital head and neck vascular lesions are presented. The rationale for various types of treatment is reviewed.

Ninety-four squamous cell carcinomas of the oral cavity, treated on the author's service between 1969 and 1981, were evaluated. The series included squamous cell carcinomas of various intraoral sites excluding the lips and hard palate. Survival of 60 mo was 70% for stage I, 65% for stage II, 45% for stage III, and 27% for stage IV carcinoma. Twenty-four of 34 patients with 'early' cancer (stages I and II) were treated by operation alone. Too few patients with 'early' cancer were treated by combined irradiation and surgery to draw conclusions regarding relative efficacy of combination therapy. Sixty patients had 'advanced' cancer (stages III and IV). Five-year survival was 37% for patients treated by operation alone, 18% after salvage surgery after failed irradiation, and 60% for patients treated by operation combined with planned perioperative irradiation. Combination therapy appeared to improve control of locoregional disease as well as survival in patients with 'advanced' cancer

Verrucous carcinoma, a familiar lesion of the oral cavity and larynx, is distinctly rare in the ear. We report five cases of verrucous carcinoma of the temporal bone, each of which fulfills Ackerman's histologic and biologic criteria. Only three cases of verrucous carcinoma of the ear have been previously reported. Most cases of verrucous cancers of the head and neck demonstrate a lack of nodal involvement, relatively slow growth potential, local invasiveness, and responsiveness to surgical treatment. In our five cases of verrucous carcinoma of the temporal bone, three had a biologic behavior similar to other verrucous tumors, while two cases were unusually aggressive. Three patients were treated surgically and had favorable outcomes, while the remaining two were treated with combination therapy. These cases highlight the difficulty in diagnosis and treatment as well as the lack of understanding of the biologic behavior of this rare otologic entity

Nineteen arteriovenous fistulas of the external carotid branches in 17 patients were treated by a variety of percutaneous transvascular techniques. There were nine females and eight males; 11 fistulas were traumatic in origin, five were "spontaneous," and three were thought to be congenital. The most frequent presenting symptoms were a bruit and thrill, followed by pulsatile tinnitus, pulsatile mass, headaches, and ocular problems. The symptoms were related to fistula site and venous drainage. The middle meningeal artery was involved most often, followed by the superficial temporal, occipital, internal maxillary, and ascending pharyngeal arteries. All patients except one were successfully cured, including one recurrence. There were no complications, and the hospital stay averaged 3 days.

Acrofacial dysostosis of Nager is a little known hereditary syndrome in which the findings of mandibulofacial dysostosis are associated with defects of the limbs. The present case showed other abnormalities including the Stilling-Turk-Duane syndrome, conductive deafness and ptosis of the transverse colon

Thyroglossal duct cysts (TDC) classically present as midline neck masses in close relation to the hyoid bone; yet--not uncommonly--their locations may be varied from the midline and from the hyoid. By means of the diagnostic modality of computed tomography (CT), high-resolution images of several cases of alternate presentations and locations of the TDC are examined. Included are examples of TDC in the suprahyoid, transhyoid, infrahyoid, and lateral positions. The potential value of CT in the diagnosis of the unusual cyst will be demonstrated and discussed

The platysma myocutaneous flap has seen limited application in the reconstruction of head and neck defects over the past decade. There are anatomical and physiological reasons for this. There has been an emphasis on the anatomical vascular supply and method of preparation of the platysma myocutaneous flap and its use in the oral cavity. This article emphasizes the use of this flap for reconstruction of defects of the base of tongue, hypopharynx, lateral pharyngeal wall, and supraglottis. The criteria for selection of the platysma myocutaneous flap as a method of reconstruction, and the limitations, are outlined. New variations of harvesting the flap based on randomized muscular support are described. Specific complications as seen in our group of patients add certain precautions in the use of the platysma myocutaneous flap.

An unusual slow-growing tumor was found in the superficial lobe of the right parotid gland. It was multilobulated and encapsulated and consisted of sheets of epithelial oncocytes and minor foci of myoepithelium and ducts. Psammoma bodies were abundant. An antibody directed against keratin protein was localized in all tumor cells and in ductal but not acinar elements of adjacent parotid tissue. Ultrastructurally, the neoplastic cells proved to be ductal epithelial and myoepithelial oncocytes