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Background: Nasopharyngectomy is emerging as an important treatment option for salvaging locally recurrent nasopharyngeal carcinoma (NPC). After nasopharyngectomy, resurfacing the nasopharynx and covering the internal carotid artery is important to minimize the risk of infection, osteoradionecrosis, and carotid rupture. Previous authors have advocated the use of free grafts of skin and mucosa for this purpose but have also described significant rates of partial and total graft failure., Methods: We believe that the best and most reliable way to resurface the nasopharynx is with vascularized tissue, and our preference is for the use of a free radial forearm flap. To illustrate our approach, we present two patients who underwent nasopharyngectomy by means of a maxillary swing approach and who had resurfacing of the surgical defect with a free radial forearm flap., Results: Both patients had complete en bloc resection of tumor followed by the insetting of a free radial forearm flap to reline the surgical defect. Both flaps remained completely viable, and both patients achieved successful resurfacing of the entire nasopharynx. The morbidity of surgery was minimal, and there were no perioperative complications. On assessment 1 year later, the free radial forearm flap continues to reline the entire neonasopharynx, and the long-term functional recovery after surgery is excellent., Conclusion: Resurfacing the nasopharynx after nasopharyngectomy with a free radial forearm flap aids healing and minimizes the risk of complications. The morbidity of surgery is minimal and the functional recovery is excellent., (Copyright 2001 John Wiley & Sons, Inc)

Background: Controversy exists as to the significance of the cervical plexus as efferent to the trapezius muscle. We have sought to further study this question and to add to anatomic and electrophysiologic evidence of a histochemical perspective., Method: The accessory nerve and the cervical plexus branches from 18 neck dissections were studied by histochemical staining for acetylcholinesterase (motor nerve) and carbonic anhydrase (sensory nerve) activity. The motor controls were either accessory nerve, ansa hypoglossi or hypoglossal nerve, and for sensory controls the greater auricular nerve., Results: Eleven of 18 necks (61%) contained evidence of motor axons in the branches of the cervical plexus. Motor axons were noted mainly in C3 and or C4., Conclusion: There is confirmatory histochemical evidence that a significant proportion of cervical spinal nerves to the accessory nerve or trapezius contain motor nerves.

Background: Nonsquamous cell malignant tumors of the nasal cavity and paranasal sinuses are an uncommon and diverse group of neoplasms. Our goal was to define the relative frequency and distribution of these neoplasms, as well as treatment and outcome., Methods: This retrospective study analyzed 106 patients with nonsquamous cell malignant neoplasms of the nasal cavity and paranasal sinuses treated at our institution between 1966 and 1982., Results: Pathology included: salivary type carcinoma (33 patients); sarcoma (25 patients); melanoma (18 patients); esthesioneuroblastoma (11 patients); lymphoma (11 patients); and anaplastic cancer (9 patients). Most tumors arose in the nasal cavity (50%), followed by the antrum (39%), ethmoid sinus (9%), and frontal sinus (2%). Fifty-four percent of all patients were treated with surgery alone. Determinate 5-year and 10-year cure rates were: esthesioneuroblastoma, 70% and 50%; lymphoma, 45% and 30%; anaplastic, 33% and 25%; salivary, 31% and 18%; sarcoma, 25% and 21%; and melanoma, 19% and 0%., Conclusions: Overall survival for patients with nonsquamous cell malignant neoplasms of the nasal cavity and paranasal sinuses is poor, particularly with follow-up extended to 10 years. Local recurrence is the major source of treatment failure. We were unable to demonstrate any survival advantage in the group of patients who received surgery and radiotherapy in combination.

Background: Conventional techniques of laryngoscopy for vocal cord palsy can sometimes be difficult or impossible to perform, and B-mode real-time ultrasonography has been previously reported by the authors to be helpful in these situations. In some cases, however, B-mode ultrasonography can be inconclusive. We investigated whether color Doppler imaging can significantly improve vocal cord examination in these cases., Method: Ten normal volunteers were examined using the Acuson 128XP/5 with a 7-MHz L7384 linear transducer. The thyroid cartilage was used as an acoustic window. Several distinct color flow patterns were observed with the subjects breathing quietly at rest, at the start of vocalization, and in prolonged phonation. Eight patients with hoarseness of voice were then examined by two separate observers in a double-blinded fashion. The first observer performed B-mode ultrasonography and color Doppler imaging, while the second observer performed indirect laryngoscopy and direct fiberoptic laryngoscopy., Results: Laryngoscopy was used as the standard for comparison. B-mode real-time ultrasonography correctly identified vocal cord palsy in three patients and normal vocal cords in one. The remaining four patients were reported as equivocal or normal. Color Doppler imaging correctly identified the problem in all eight patients., Conclusion: Color Doppler imaging for vocal cord examination is more sensitive than B-mode real-time ultrasonography, and seems to be as accurate as laryngoscopy in determining vocal cord palsy or paresis.

Although the surgical anatomy of the spinal accessory nerve and the cervical plexus has been extensively described, the exact motor innervation of the trapezius has been controversial. Attempts to resolve this question have involved anatomic or electrophysiologic studies in human embryos and animals. Extrapolation of the results to adult humans may not be correct. Accurate identification of muscle innervation is obtainable by intra-operative measurement of motor action potentials produced by direct stimulation of the accessory nerve and the cervical plexus. The study involved 14 patients undergoing supraomohyoid or modified neck dissections. Under direct vision, stimulating electrodes were placed on the identified nerves and motor action potentials, and latencies were recorded by surface electrodes placed over the three portions of the trapezius. In 13 patients, when the accessory nerve was stimulated, motor action potentials were obtained in 13 of 13 in the first portion, 11 of 13 in the second portion, and 10 of 13 in the third portion of the trapezius. In the last patient, the accessory nerve ended in the sternocleidomastoid muscle, and innervation of the trapezius was via C3 as demonstrated by motor action potentials. Responses when the roots of the cervical plexus were stimulated varied. Three patterns were seen: In the first group (seven patients), motor action potentials were distinct from those recorded when the accessory nerve was stimulated. Additionally, latencies were different from those of the accessory nerve. The second group (four patients) had motor action potentials that were similar to those obtained from stimulation of the accessory nerve, although their corresponding latencies were different.(ABSTRACT TRUNCATED AT 250 WORDS)

Twenty-four patients with surgical section of the accessory nerve and/or its cervical contribution(s) were examined from 1 to 156 months after surgery, and compared to twenty controls. Thirteen patients had a classical neck dissection; seven had the whole length of the accessory nerve preserved but not the cervical plexus contributions. Four had the upper half of the accessory nerve sectioned, but with preservation of both the lower half and its cervical contributions. Clinical and electrophysiological studies of the three portions of the trapezius suggested the existence of an undescribed motor nerve supply to the trapezius and of a motor input from the cervical plexus contributions via the accessory nerve. The former is also supported by an anatomical study.