Otolaryngology–Head and Neck SurgeryVolume 110, Issue 1 p. 131-135 Case Report Avascular carotid body tumor Dr. Scott J. Trimas MD, Dr. Scott J. Trimas MD Departments of Otolaryngology, University of Florida, College of Medicine, Gainesville, FloridaSearch for more papers by this authorDr. Anthony Mancuso MD, Corresponding Author Dr. Anthony Mancuso MD n/a@dne.dne Departments of Radiology, University of Florida, College of Medicine, Gainesville, FloridaReprint requests: Anthony Mancuso, MD, Department of Otolaryngology, J. Hillis Miller Health Center, 1600 Southwest Archer Rd., Gainesville, FL 32610.Search for more papers by this authorDr. Egbert J. De Vries MD, Dr. Egbert J. De Vries MD Department of Otolaryngology, Albert Einstein College of Medicine, Bronx, Bronx, New YorkSearch for more papers by this authorDr. Nicholas J. Cassisi MD, DDS, Dr. Nicholas J. Cassisi MD, DDS Departments of Otolaryngology, University of Florida, College of Medicine, Gainesville, FloridaSearch for more papers by this author Dr. Scott J. Trimas MD, Dr. Scott J. Trimas MD Departments of Otolaryngology, University of Florida, College of Medicine, Gainesville, FloridaSearch for more papers by this authorDr. Anthony Mancuso MD, Corresponding Author Dr. Anthony Mancuso MD n/a@dne.dne Departments of Radiology, University of Florida, College of Medicine, Gainesville, FloridaReprint requests: Anthony Mancuso, MD, Department of Otolaryngology, J. Hillis Miller Health Center, 1600 Southwest Archer Rd., Gainesville, FL 32610.Search for more papers by this authorDr. Egbert J. De Vries MD, Dr. Egbert J. De Vries MD Department of Otolaryngology, Albert Einstein College of Medicine, Bronx, Bronx, New YorkSearch for more papers by this authorDr. Nicholas J. Cassisi MD, DDS, Dr. Nicholas J. Cassisi MD, DDS Departments of Otolaryngology, University of Florida, College of Medicine, Gainesville, FloridaSearch for more papers by this author First published: 01 January 1994 https://doi.org/10.1177/019459989411000117Citations: 2 Presented at the Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery, Kansas City, Mo., Sept. 22-26, 1991. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume110, Issue1January 1994Pages 131-135 RelatedInformation

A case of a bacterial abscess developing in the sphenoid sinus 2 weeks after transsphenoidal surgery is presented. Although abscesses within the sella turcica have been reported as rare complications of transsphenoidal surgery, this is the first reported case of the postoperative formation of an abscess of the sphenoid sinus. The patient sought treatment for severe headaches, nausea and vomiting, and marked temperature elevation. A computed tomographic scan demonstrated soft tissue and air within the sphenoid sinus. A regimen of stress doses of hydrocortisone and antibiotics was prescribed, and the patient underwent transsphenoidal drainage of the sphenoid sinus. The sella turcica was not involved. Anaerobic cultures were positive for Fusobacterium necrophorum.

Free tissue transfer of a jejunal segment was undertaken for laryngopharyngoesophageal reconstruction in 20 patients who received postoperative irradiation therapy. Treatment consisted of 1.8- to 2-Gy-fractions, the average total dose was 55.57 Gy (range, 40 to 66 Gy). Anastomotic strictures (six) were encountered early in the series and associated with stapled anastomoses. Hand-sewing the jejunoesophagostomy eliminated the problem. Enteric cutaneous fistula, bowel necrosis, and hemorrhagic enteritis were not observed. We conclude that the application of postoperative irradiation therapy to patients requiring jejunal interposition grafts is feasible.

Otolaryngology–Head and Neck SurgeryVolume 103, Issue 3 p. 484-486 Case Report Extrinsic Tracheal Compression from an Anterior Mediastinal Mass in an Adult: The Multidisciplinary Management of the Airway Emergency Dr. Guy J. Petruzzelli MD, PhD, Corresponding Author Dr. Guy J. Petruzzelli MD, PhD n/[email protected] Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Eye and Ear Hospital of Pittsburgh, Pittsburgh, PennsylvaniaReprint requests: Guy J. Petruzzelli, MD, PhD, Department of Otolaryngology, Eye and Ear Hospital of Pittsburgh, 230 Lothrop St., Pittsburgh, PA 15213Search for more papers by this authorDr. Egbert J. de Vries MD, Dr. Egbert J. de Vries MD Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Eye and Ear Hospital of Pittsburgh, Pittsburgh, PennsylvaniaSearch for more papers by this authorDr. Jonas Johnson MD, Dr. Jonas Johnson MD Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Eye and Ear Hospital of Pittsburgh, Pittsburgh, PennsylvaniaSearch for more papers by this authorDr. Michael Klein MD, Dr. Michael Klein MD Department of Anesthesia, Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Presbyterian University Hospital, Pittsburgh, PennsylvaniaSearch for more papers by this authorDr. Robert Kormos MD, Dr. Robert Kormos MD Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Presbyterian University Hospital, Pittsburgh, PennsylvaniaSearch for more papers by this authorDr. Andrew Herlich MD, Dr. Andrew Herlich MD Department of Anesthesia, Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PennsylvaniaSearch for more papers by this authorDr. Hugh Curtin MD, Dr. Hugh Curtin MD Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Eye and Ear Hospital of Pittsburgh, Pittsburgh, PennsylvaniaSearch for more papers by this author Dr. Guy J. Petruzzelli MD, PhD, Corresponding Author Dr. Guy J. Petruzzelli MD, PhD n/[email protected] Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Eye and Ear Hospital of Pittsburgh, Pittsburgh, PennsylvaniaReprint requests: Guy J. Petruzzelli, MD, PhD, Department of Otolaryngology, Eye and Ear Hospital of Pittsburgh, 230 Lothrop St., Pittsburgh, PA 15213Search for more papers by this authorDr. Egbert J. de Vries MD, Dr. Egbert J. de Vries MD Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Eye and Ear Hospital of Pittsburgh, Pittsburgh, PennsylvaniaSearch for more papers by this authorDr. Jonas Johnson MD, Dr. Jonas Johnson MD Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Eye and Ear Hospital of Pittsburgh, Pittsburgh, PennsylvaniaSearch for more papers by this authorDr. Michael Klein MD, Dr. Michael Klein MD Department of Anesthesia, Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Presbyterian University Hospital, Pittsburgh, PennsylvaniaSearch for more papers by this authorDr. Robert Kormos MD, Dr. Robert Kormos MD Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Presbyterian University Hospital, Pittsburgh, PennsylvaniaSearch for more papers by this authorDr. Andrew Herlich MD, Dr. Andrew Herlich MD Department of Anesthesia, Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PennsylvaniaSearch for more papers by this authorDr. Hugh Curtin MD, Dr. Hugh Curtin MD Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Eye and Ear Hospital of Pittsburgh, Pittsburgh, PennsylvaniaSearch for more papers by this author First published: September 1990 https://doi.org/10.1177/019459989010300325AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1Davis RD, Oldham HN, Sabiston DC. The mediastinum. In: DC Sabiston, FC Spencer, eds. Surgery of the chest. 5th ed. Philadelphia: WB Saunders Co., 1990: 498– 535. 2Bryant LR, Morgan CV. Chest wall, pleura, lung, and mediastinum. In: I Seymour, SI Schwartz, eds. Principles of surgery. 4th ed. New York: McGraw-Hill Book Co., 1984: 603– 732. 3Ginsberg RJ. Evaluation of the mediastinum by invasive techniques. Surg Clin North Am 1987; 67: 1025– 36. 4Helman S, Mauch P. Role of radiation therapy in the treatment of Hodgkin's disease. Cancer Treat Rep 1982; 66: 915– 21. 5Piro AJ, Weiss DR, Hellman S. Mediastinal Hodgkin's disease: A possible danger for intubation anesthesia. Int J Radial Oncol Biol Phys 1976; 1: 415– 9. 6MacKie AM. Anesthetic management of mediastinal masses—again. Anesth Analg 1987; 66: 696. 7MacKie AM, Watson CB. Anaesthesia and mediastinal masses. naesthesia 1984; 39: 899– 903. 8Neuman GC, Weingarten AE, Abramowitz RM, Kushins LG, Abramson AL, Ladner W. The anesthetic management of the patient with an anterior mediastinal mass. Anesthesiology 1984; 60: 144– 7. 9Bittar D. Respiratory obstruction associated with induction of general anesthesia in a patient with mediastinal Hodgkin's disease. Anesth Analg 1975; 54: 399– 403. 10Northrop DR, Bowman KB, Tsueda K. Total airway occlusion and superior vena caval syndrome in a child with an anterior mediastinal tumor. Anesth Analg 1986; 65: 1079– 82. 11Azizhan RG, Dudgeon DL, Buck JR, et al Life-threatening airway obstruction as a complication to the management of mediastinal masses in children. J Pediatr Surg 1985; 20: 816– 22. 12Price SL, Hecker BR. Pulmonary oedema following airway obstruction in a patient with Hodgkin's disease. Br J Anaesth 1987; 59: 518– 21. 13Woods FM, Neptune WB, Palatchi A. Resection of the carina and main-stem bronchi with the use of extra-corporeal circulation. N Engl J Med 1961; 2664: 492– 4. 14Weymuller EA, Paugh D, Pavlin EG, Cummings C. Management of difficult airway problems with percutaneous transtracheal ventilation. Ann Otol Rhinol Laryngol 1987; 96: 34– 7. 15Mandell-Brown MK, Bedger R, Chang JL, Johnson JT. Jet stylet catheter for airway management. Laryngoscope 1987; 97: 1104– 5. 16Mizrahi S, Yaari Y, Lugassy G, Cotev S. Major airway obstruction relieved by helium/oxygen breathing. Crit Care Med 1986; 14: 986– 7. Volume103, Issue3September 1990Pages 484-486 ReferencesRelatedInformation

Neutropenic enterocolitis is a recognized complication of immunosuppression or chemotherapy for leukemia. It presents as severe abdominal pain and tenderness, fever, and diarrhea associated with granulocytopenia. Gastrointestinal symptoms associated with chemotherapy for head and neck neoplasms include nausea and emesis, but not acute abdominal distress. We present, to our knowledge, the first case of neutropenic enterocolitis in a patient receiving cisplatin and fluorouracil chemotherapy for metastatic head and neck cancer.

Complications following total laryngectomy may include pharyngocutaneous fistula or pharyngeal stricture. Traditional techniques of repair of fistula and stricture with local or regional flaps lead to a high rate of failure. In this study, we report 18 patients treated by secondary jejunal interposition (JI) to rehabilitate swallowing following recalcitrant postlaryngectomy stricture or fistula. All patients had undergone total laryngectomy with or without partial pharyngectomy for treatment of squamous cell carcinoma of the larynx (8) or hypopharynx (10). Four were stage II; 5, stage III; and 9, stage IV. Thirteen patients (72%) regained swallowing function. Complications of secondary JI included perioperative death (2), flap loss (1), and persistent fistulas (3). Jejunal interposition may be the best modality in the rehabilitation of swallowing in patients with persistent fistula or stricture that fails to respond to traditional management.

A patent internal carotid artery (ICA) is essential in most patients. Management of skull base lesions often requires translocation, balloon embolization, or resection of this vessel. Preoperative tests to assess the availability of collateral flow have not been uniformly accurate. A new test that significantly increases the safety of surgical removal of the ICA is described. One hundred thirty-six patients were studied with temporary balloon occlusion (TBO) of the ICA and determination of stable xenon-enhanced computed tomography cerebral blood flow (Xe/CT CBF) measurements. Eleven patients failed TBO and were determined to be at very high risk of stroke with loss of the ICA. Ninety-six of the patients were predicted to be at minimal risk with permanent loss of the ICA by Xe/CT CBF studies. Twenty-one patients in this group had either permanent balloon occlusion (PBO) or surgical resection of the ICA with no permanent neurologic sequelae. Our studies show that the combination of preoperative TBO and Xe/CT CBF studies significantly increases the safety of ICA resection.

Use of enteric grafts is a popular method for reconstruction of the cervical esophagus and hypopharynx. Free jejunal transfer (FJT) and gastric pull-up (GP) are the most popular methods used. This discussion is a retrospective review of our experience with 50 cases of free jejunal transfer and 15 cases of gastric pull-up. The graft survival rate was 94 percent (47 of 50) for free jejunal transfer and 87 percent (13 of 15) for gastric pull-up. Successful swallowing was achieved in 88 percent (44 of 50) of free jejunal transfers and 87 percent (13 of 15) of gastric pull-ups. Patients with free jejunal transfers were able to swallow and leave the hospital sooner: 10.6 versus 16.0 days and 22.3 versus 29.0 days, respectively. Fistulas occurred in 16 percent (8 of 50) of free jejunal transfers, most of which (6 of 8) healed spontaneously. Fistulas occurred in 20 percent (3 of 15) of gastric pull-ups, only one of which healed spontaneously. Stricture was the most common late complication for free jejunal transfers, 22 percent (11 of 50), whereas reflux was most common in gastric pull-ups, 20 percent (3 of 15). In patients with advanced cancer, extensive esophageal resection into the chest is often required, and gastric pull-up seems to be an easier and more direct form of reconstruction. In limited resection of the hypopharynx and esophagus, especially with proximal lesions, free jejunal transfer is simpler and avoids mediastinal dissection. This concept as well as other advantages and disadvantages of both techniques will be discussed.

In an attempt to determine if both pleomorphic adenomas and adenoid cystic carcinomas are derived from myoepithelial cells, 23 pleomorphic adenomas, 22 adenoid cystic carcinomas, and 17 normal salivary glands were examined immunohistochemically by using monoclonal antibodies directed against actin (HUC1-1, 1A4), keratin (AE-1, 34 beta E 12), and vimentin (V9). In normal salivary glands, the myoepithelial cells demonstrated a positive reaction to the monoclonal antibodies against actin and only rarely reacted with those against vimentin. No reaction to those against keratin was noted. In pleomorphic adenomas, cells that histologically resembled myoepithelial cells displayed a positive reaction to HUC1-1 in 60.9% and to 1A4 in 65.2%. In adenoid cystic carcinoma, 59.1% of cases demonstrated a positive reaction to both HUC1-1 and 1A4. These results supported the hypothesis that the majority of pleomorphic adenomas and adenoid cystic carcinomas arise from cells of myoepithelial origin.

Gastric pull‐up or free jejunal interposition was used for reconstruction after total laryngopharyngectomy in 31 patients. Complications and functional outcomes of the two methods are compared. Primary swallowing was achieved in 86% of patients after gastric pull‐up and in 82% of patients after jejunal interposition. Patients who underwent jejunal interposition were able to swallow sooner and had a shorter hospital stay than patients who underwent gastric pull‐up. Esophageal tumor recurrence after jejunal interposition was not observed. Hepatic failure occurred in two gastric pull‐up patients, leading to perioperative death in one. Flap necrosis occurred in two jejunal interposition patients and one gastric pull‐up patient. Two additional fistulas occurred in jejunal interposition patients as a result of microvascular complications. Stricture developed in four jejunal interposition patients, requiring revision surgery in two. Minor complications were more common in the gastric pull‐up group. Long‐term speech and swallowing function are compared. Our current choice of jejunal interposition or gastric pull‐up for reconstruction after total laryngopharyngectomy primarily depends on the location of the tumor.

Otolaryngology–Head and Neck SurgeryVolume 100, Issue 6 p. 613-616 Case Report Aneurysmal Bone Cyst Masquerading as Acute Mastoiditis Dr. Egbert J. Devries MD, Corresponding Author Dr. Egbert J. Devries MD n/a@dne.dne Department of Otolaryngology, Eye and Ear Hospital, University of Pittsburgh School of Medicine, PittsburghReprint requests: Egbert J. deVries, MD, Department of Otolaryngology, Eye and Ear Hospital, 230 Lothrop St., Pittsburgh, PA 15213Search for more papers by this authorDr. Donald B. Kamerer MD, Dr. Donald B. Kamerer MD Department of Otolaryngology, Eye and Ear Hospital, University of Pittsburgh School of Medicine, PittsburghSearch for more papers by this authorDr. David Rafalko MD, Dr. David Rafalko MD Department of Surgery, The Medical Center, Beaver, PennsylvaniaSearch for more papers by this author Dr. Egbert J. Devries MD, Corresponding Author Dr. Egbert J. Devries MD n/a@dne.dne Department of Otolaryngology, Eye and Ear Hospital, University of Pittsburgh School of Medicine, PittsburghReprint requests: Egbert J. deVries, MD, Department of Otolaryngology, Eye and Ear Hospital, 230 Lothrop St., Pittsburgh, PA 15213Search for more papers by this authorDr. Donald B. Kamerer MD, Dr. Donald B. Kamerer MD Department of Otolaryngology, Eye and Ear Hospital, University of Pittsburgh School of Medicine, PittsburghSearch for more papers by this authorDr. David Rafalko MD, Dr. David Rafalko MD Department of Surgery, The Medical Center, Beaver, PennsylvaniaSearch for more papers by this author First published: June 1989 https://doi.org/10.1177/019459988910000617Citations: 2 Presented at the Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery. Washington, D.C., Sept. 25-29, 1988. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume100, Issue6June 1989Pages 613-616 RelatedInformation

Curability of skull base tumors is related to the ability to achieve a complete resection. Resection of the internal carotid artery with the tumor puts the patient at risk for catastrophic cerebral injury. Autogenous vein grafting is not always technically or physiologically possible. We present eight patients with tumors eroding the cranial base who underwent safe resection or occlusion of the internal carotid artery as predicted by three tests: 1. carotid arteriography, 2. temporary balloon occlusion of the internal carotid artery, and 3. xenon computerized tomography cerebral blood flow mapping. No patient suffered permanent central nervous system injury.

Teratoma is the most common nasopharyngeal tumor in neonates. The tumor is usually limited to the oropharynx and is manifest by stridor and respiratory distress. Complete excision affects a cure. An unusual case of nasopharyngeal teratoma extending into the temporal bone, causing facial paralysis and conductive hearing loss, in addition to stridor, is presented. Stridor was relieved by transoral partial excision shortly after birth. Complete removal of the tumor by way of a subtemporal and infratemporal fossa approach was performed at 14 months of age. The defect was filled with a rectus abdominis muscle graft with microvascular anastomoses. The facial nerve was reconstructed secondarily with a sural nerve graft. The patient has no recurrence tumor and has good facial function at 30 months. This case demonstrates the first known case of facial paralysis due to nasopharyngeal teratoma. The surgical approach for tumor removal: lateral infratemporal fossa dissection, and the method of reconstruction: free rectus abdominis muscle flap with microvascular anastomoses, had so far not been described in a patient this young.

Persistent generalized lymphadenopathy is a nonspecific symptom of acquired immune deficiency syndrome (AIDS). The histopathology of the lymphadenopathy in homosexual men is complex and varied.‘ It includes a spectrum of morphologic changes, from lymphoid hyperplasia to lymphoid depletion. The development of lymphomas in populations at risk for AIDS often follows persistent lymphadenopathy.’ We describe two patients with lymphoproliferative disease of the salivary gland associated with acquired immune disease. The first case is a malignant lymphoma that manifested as a salivary gland tumor in a patient with AIDS, and the second case is a benign lymphoepithelial lesion and florid reactive follicular hyperplasia of the parotid gland in a patient with hemophilia with AIDS-related complex (ARC).

Salivary tumors of the base of the tongue are encountered infrequently. A retrospective review of medical records from 1955 to 1985 was undertaken to determine the incidence of occurrence and to assess the outcome of the therapy provided. One hundred seventy-eight minor salivary gland tumors of the oral cavity and oropharynx were identified, of which 22 (13%) were located in the tongue base. All were malignant. The most common histologic type was mucoepidermoid carcinoma (10 patients), followed by adenocarcinoma (6 patients), and adenoid cystic carcinoma (6 patients). Thirteen patients were available for a mean follow-up of 5 years. Treatment was most often a combination of wide resection combined with postoperative radiation therapy. Ten patients (77%) are alive, one with persistent disease 8 years after diagnosis. Three patients died within 2 years of diagnosis, one with intercurrent disease. Improved control of disease in this series, when compared to previously reported series, is attributed to adequate surgical therapy and adjuvant radiotherapy. The deaths in our series occurred in patients who were unable to proceed with the recommended therapy. These unusual lesions require aggressive multimodality treatment for improved survival.