Faculty Bibliography

The clinical manifestations of 29 recently encountered sarcomas of the head and neck were analyzed in an attempt to define more accurately the diagnostic characteristics and therapeutic responses of these unusual tumors. The host factors of age, sex distribution, race, habits and associated features differ sufficiently to distinguish the sarcoma from the carcinoma population. In addition, the clinical course of sarcoma patients as monitored by mode of presentation, site of involvement, tumor histology, diagnostic features and certain elements of management and outcome, further indicates that these tumors can be defined and managed as a distinct group of lesions. A review of the recent literature supports the major conclusions of this study

Four patients with spastic dysphonia refractory to speech and phychiatric therapy were treated by crushing the recurrent laryngeal nerve. Vocal cord paralysis was produced in all patients. Vocal spasticity subsided in all patients. Vocal cord motion returned in four to six months. Three of four patients remained free of spasticity for a minimum of 24 months.

Olfactory neuroblastoma is an uncommon malignant tumor arising from olfactory epithelium. Generally considered to be a tumor of slow growth, it varies in aggressiveness and may cause death by distant metastasis or local invasion. The pathologic diagnosis is difficult, and this tumor is often erroneously diagnosed. Nine previously unreported cases are presented, and a review of the various treatment modalities and course of the disease is given. Maximum therapeutic succes is best achieved by radical excision followed by a full course of radiation. Because of the high incidence of local recurrence (46%) and slow growth, patients should be followed up closely for life.

The clinical courses of patients on the Head and Neck Service undergoing radical procedures were reviewed in retrospect. Factors that appeared to influence the courses such as preoperative radiotherapy, reduced serum albumen, and preoperative oropharyngeal obstruction were correlated with fistulization rate, flap necrosis, and other complications. The study included 105 radical procedures performed over a seven-month period. Sixty-six of these operations included laryngectomies, laryngopharyngectomies, and composite resections. The overall complication rate was 37%, with major complications accounting for 9%. A fistula rate of 20% was found in the pharyngeal group and ranged from 12% in the nonirradiated patients to 44% in the irradiated group. Thos patients with preoperative obstruction secondary to tumor bulk had a complication rate of 58%. Patients with reduced serum albumen levels had a higher complication rate of 55% compared with 35% for the group with normal albumen levels. This study suggests that preoperative replenishment of protein, particularly in the obstructed patient or in those with reduced serum albumen levels, would correlate with a more favorable clinical course.

We describe a technique of tracheostoma construction utilizing a deltopectoral flap. This method can be used when entry into the superior mediastinum and low tracheal resection is required.

We have successfully treated two patients with symptomatic pneumatosis cystoides intestinalis using a high FIO2 delivered by face mask, with administration interrupted at meal times. While we advocate oxygen therapy for this disease, caution must be taken to avoid the complications of high PaO2, namely proliferative and fibrotic lung changes. Close attention should be paid to the development of increasing cough, dyspnea and shortness of breath. As the frequency of the diagnosis of pneumatosis cystoides intestinalis increases, the success of high inspired oxygen as therapy should be recognized

An improved fiberoptic laryngoscope is connected to Timcke's stroboscope. The laryngoscope gives a magnified view of 2x and is prefocused from 5 cm to infinity. The combination of the stroboscope and the laryngoscope gives an excellent slow-motion view of the vocal fold movement.

The nasal hemangioma of pregnancy is an uncommon but impressive cause of epistaxis. One patient with this condition recently treated at the Keller Army Hospital, West Point, exemplifies the problems encountered in the diagnosis and treatment of this puzzling disorder