Faculty Bibliography

This is a retrospective study of the results of various types of surgical treatment of early breast cancer staged histologically using the following characteristics: (1) poor cytologic differentiation, (2) lymphatic permeation, (3) blood vessel invasion, or (4) invasion of the tumor into the surrounding soft tissue. Four hundred and three patients who had early tumors of the breast--228 T1N0M0 (tumor 2 cm or less in diameter, no nodal involvement, and no metastasis) and 175 T2N0M0 (tumor 2 to 5 cm in diameter, no nodal involvement, and no metastasis)--were treated at St. Vincent's Hospital and Medical Center between January 1, 1965, and December 31 1976. Eighty-three were classified as being at low risk 190 at intermediate risk, and 130 at high risk. At 10 years, 100% of the low-risk group were alive; 99% were free of disease, and any type of mastectomy performed--radical, modified radical, or total--was adequate. At 10 years, 44% of those at high risk were alive, and 30% were free of disease. Radiotherapy improved life expectancy when added to radical mastectomy in the high-risk group. We recommend a prior excisional biopsy for proper histologic evaluation to allow a more appropriate choice of surgical procedure.

Necrotizing fascitis of the head and neck is a rare condition with only 7 cases recorded in the literature. Two cases are presented in which there was massive necrosis of the soft tissues of the neck with extension into the mediastinum. The offending organisms were a mixed bacterial flora which produced gangrene accompanied by subcutaneous emphysema. Both patients were successfully treated with a regimen of intravenous antibiotics, fasciotomy, radical debridement, and hyperbaric oxygenation (1 case). The clinical features, bacteriology, and treatment of necrotizing faciities are reviewed

The pectoralis myocutaneous island flap was used for head and neck reconstruction in 42 patients. Major necrosis did not occur in any case, and minor necrosis was present in three of the cases (7%). The advantages of this flap over other myocutaneous flaps and cutaneous pedicle flaps are delineated

The roentgen findings of a rare benign chondroma of the petrous apex are presented. This patient's clinical history made it imperative that we rule out a metastatic breast lesion. A transcochlear approach verified the benign nature of this lesion

A rare lesion of the maxillary and ethmoid sinuses, an ossifying capillary hemangioma, is presented. The therapeutic options and our choice of embolization followed one day later by radical surgery under hypotensive, hypothermic anesthesia are discussed. The principles of therapy involved in this lesion apply to the management of any large vascular tumor of the head and neck

The shifting of skin and superficial musculo-aponeurotic system (SMAS) fascia in the facelift procedure represents an important development in the improvement of the lax and sagging skin of the face and neck. The pathology of aging skin is reviewed, the anatomy of the SMAS fascia is described, and the use of SMAS fascia in surgery along with attendant potential hazards are discussed

Three children with post-meningitic hearing loss were seen for evaluation and aural rehabilitation over a 4-yr period. Fluctations in hearing levels during that time period were noted. The hearing of one child improved, while that of the other two children decreased. Changes in sensitivity were documented and discussed with reference to the habilitation process. The need for frequent monitoring and for otologic intervention in the post-meningitic child is emphasized

Labyrinthectomy may be the therapy of choice for intractable and disabling vertigo that is caused by unilateral disease of the vestibular labyrinth. The transcanal method through the oval window offers the most direct surgical approach for complete ablation of the vestibular sense organs. The technique includes visual identification and removal of the utricle; this is followed by blind probing of the ampullae. This method was used in 124 patients, including 90 patients with unilateral Meniere's disease. Three of four cases of moderately severe continuing postoperative vertigo were successfully managed by revision transcanal labyrinthectomy. Twenty-seven (22%) of the 124 patients had continuing mild transient unsteadiness associated with quick head movements; this condition is considered to be the physiologic consequence of unilateral loss of vestibular function rather than unremitted disease

We report two cases of bilateral vocal cord paralysis in patients with Parkinson's disease and review the possible causes of this condition. We suggest that the vocal cord muscle paralysis is a manifestation of advanced disease. Bilateral vocal cord paralysis in Parkinson's disease may be seen more commonly in the future as therapy enables more patients to live longer