Faculty Bibliography

Of the large variety of tumors that may occur in the parapharyngeal space, malignant fibrous histiocytoma is one of the most rare. We present such a case and discuss the diagnosis, classification, and treatment.

There is a variety of tumors which may occur in the parapharyngeal space; malignant Schwannoma is one of the rarer type. The authors present such a case and discuss the clinical and microscopic diagnosis. Treatment is wide surgical excision, as recurrence rates are high and the prognosis poor.

Angiography is useful in following selected patients with chemodectoma of the head and neck treated by radiotherapy. Comparison of preradiotherapy and post radiotherapy angiograms in three patients revealed a decrease in the following: size of feeding arteries, size of tumor, intensity of tumor opacification, and degree of venous shunting. When chemodectomas are not amenable to physical examination and when the question of radiotherapy complication vs further growth of tumor arises, postradiotheraphy angiography may be of particular value.

An extended area of stenosis of the upper mediastinal trachea, which normally would require extensive thoracic mobilization for primary anastomosis, was corrected by resection of the manubrium with the creation of a trough. This was closed in several stages utilizing embedded Marlex mesh and regional skin flaps. The development and modifications of this technique are discussed.

A technique is described whereby limited soft tissue defects may be cosmetically improved using autogenous fascial strips. These strips of fascia lata are threaded onto a cadaveric needle that is tunneled subdermally, in a "basket weaving," criss-crossed fashion, augmenting the soft tissue defect and separating the scar from the underlying tissue. There are minimal incisions in the skin for this augmentation and there is very little local tissue reaction.

This paper reviews 13 cases of chordoma in the cervical spine and base of the skull which have been seen at the Pack Medical Foundation over the past 25 years. Chordomas are dysonto genetic, malignant, slow-growing neoplasms that arise in remnants of the embryonic notochord. Concealed along the axial skeleton, these slow-growing tumors are usually well entrenched before they are accurately diagnosed. The majority of the chordomas of the spine occur in the sacroccygeal region. Of the 13 cases in the area of the cervical spine, 39% occurred in the region of the base of the skull and 61% in the area of the cervical spine. The treatment of the cervical tumors consisted of laminectomy to relieve the pressure on the cord and to remove as much of the neoplasm as possible. Some of the tumors at the base of the skull were nonresectable and were treated with radiotherapy. Radiotherapy was ultimately used in every case, either in combination with surgery or as a primary or subsequent method of management. The overall prognosis for palliation was fair but ineffective for cure.