Search

Nine cases of pleomorphic salivary gland adenomas of the parapharyngeal space are reviewed. In the discussion which follows we show that five of these tumours were situated medial to the superior constrictor muscle and arose within pharyngeal mucosa. We also outline our views on the management of pleomorphic salivary gland adenoma of the parapharyngeal space with particular reference to biopsy, surgical excision and post-operative radiotherapy.

The paper includes brief details of a long term three-dimensional study into the fine structure of the mammalian larynx using whole organ serial sections. Differential staining, including Glees silver technique, is essential if maximum information is to be gained. A specially designed punch card will enable any future investigator to rapidly retrieve relevant information and it is expected that specimens of all available mammalian larynges will be included. Illustrations are included in this paper of the cat, dog, horse and mongoose.

All the classification systems at present adopted for use in carcinoma of the maxillary sinus suffer from both intrinsic inaccuracies and an apparent failure to relate T (extent of primary tumor) categories to clinical experience of the spread of these tumors. Three systems are critically analyzed in relation to personal experience of 86 patients with sinus carcinoma and a fourth system proposed as a compromise solution to this problem.

Involvement of the thyroid cartilage attracts a high T rating in all systems of classification for carcinoma of the larynx. Evaluation of 145 patients with laryngeal cancer treated by total laryngectomy emphasizes the difficulties of preoperatively determining cartilage invasion. The operative specimen was serially sectioned and studied to determine the means by which ossified and nonossified thyroid cartilage is invaded by carcinoma. A minimum 5-year follow-up of these cases indicates the prognostic significance of such invasion.

Direct exposure of the superior mediastinum is essential when resecting subglottic tumours of the larynx, neoplasms of the cervical trachea or cervical oesophagus. This facilitates low resection of the trachea and clearance of the paratracheal nodes. This may best be carried out by removal of most of the manubrium sterni and both sternoclavicular joints and this operation has been performed in 22 patients with minimal morbidity or long term disability.

Between the years 1965 to 1977, 58 patients with advanced hypopharyngeal squamous carcinoma were treated by pharyngolaryngoesophagectomy and total thyroidectomy. Operative mortality for potentially curable cases was 8.6%, with a crude three-year survival rate of 29% for all cases. Mortality was 37% for patients with postcricoid tumors. Long-term management was uncomplicated except for calcium metabolism; two patients died from nephrocalcinosis secondary to return of circulating parathyroid hormone. I discuss the role of this operation in the successful treatment of hypopharyngeal cancer.

At least three clinical variations of idiopathic ulceration of the oropharyngeal cavity are recognized. Major (or giant) aphthous ulceration is uncommon but may affect the hypopharynx producing severe pain, dysphagia, and severe scarring. Healing with systemic prednisolone may require large and prolonged dosage. In 7 out of 14 patients with hypopharyngeal ulceration gastrostomy was performed to assist nutrition and by-pass the cricopharyngeal region in an attempt at reducing subsequent scarring.

A large number of non-human mammalian larynges have been studied in an attempt to relate body mass to maximum glottic and tracheal area in order to confirm symmorphism.

During the period between 1965 and 1983, 101 pharyngolaryngoesophagectomies with primary pharyngogastric anastomosis were carried out for primary hypopharyngeal cancer at The Royal National Throat, Nose and Ear Hospital, London, England. The Hospital mortality rate was 11%; postoperative complications such as pleural effusion and regurgitation of bile occurred in all patients. Successful swallowing occurred in all patients before they left the hospital--usually within 2 wk of surgery. An actuarial survival rate of 58% was obtained for the entire group.

The lessons learned from the personal care of 44 male patients suffering from juvenile angiofibroma are discussed with reference to natural history, pathogenesis, and principles of management. Many of the doctrines often accepted as based on factual evidence are discussed in relation to actual experience. In this manner, a rational view of this interesting but unusual condition is presented in the hope that some of the more bizarre opinions may now be abandoned to the benefit of future patients.

Two studies were conducted examining the stimulus-control effects of conventional traffic signs as prompts for motor vehicle driver safety belt use. Following pilot research which suggested that a traffic sign reading "Fasten Safety Belt" posted at a parking lot exit was effective in producing small increases in safety belt use, Study I demonstrated the superiority of having human prompters display such signs compared to simply posting the signs. Study II replicated the findings of Study I and found that posted signs became more effective in prompting safety belt use if simple posting was preceded by a period involving human prompters who displayed the signs. The results bear upon the development of more effective use of traffic signs in promoting safety belt use and in viewing such use as an instance of rule-governed behavior.

Ossification of the laryngeal cartilages is a random occurrence possibly related to age and sex. A wide variety of primate larynges have been examined radiologically, by macroscopic section or after whole organ serial section with the aim of determining presence of ossification. The results of this investigation will be presented in an attempt to establish possible correlation between structure, function and degree of ossification within each specific larynx. This is a unique enquiry which may assist in the understanding of ossification within the human larynx.

A specialized institute has unique problems relating to its responsibility for teaching, research and clinical care. In the 40 years of its existence it has played a considerable role in the development of the specialty in the United Kingdom, advancing knowledge in all fields--particularly head and neck oncology and audiological medicine. The threat to its associated specialist hospital and to its own future because of severe cuts may result in far-reaching decisions regarding its future role.

Although differentiation of Wegener's granulomatosis from other destructive midline lesions is now clearly recognized by clinicians and pathologists, confusion persists regarding the management of what has erroneously been called "lethal midline granuloma." The experiences of 36 patients with destructive midline granuloma supports the view that probably all are manifestations of malignant lymphoma and should be treated as such. Although radical dosage radiotherapy will control most local lesions, dissemination of lymphoma may still occur despite absence of systemic disease at initial diagnostic work-up. Subsequent control with cytotoxic drugs is frequently unsuccessful, and it is suggested that chemotherapy should be given routinely to every patient with primary nasal lymphoma and possibly to those with polymorphic reticulosis or necrosis with atypical cellular exudate (NACE).

The three-dimensional morphology of the mammalian larynx was studied for 15 years. Using specimens obtained from a wide variety of sources, efforts were made to correlate structure with function and thus explain the variations in size and morphology seen in over 150 families of mammals.

Fifty-three patients had pharyngolaryngoesophagectomy during the years 1965 to 1976 for lower hypopharyngeal or cervical esophageal cancer. The operative mortality--defined as the percent of patients who died within seven days of operation--was 7.5%, which is reduced to 5.6% if one patient with inoperable disease is excluded. Twenty-eight percent of patients survived for longer than one year, and there have been no problems with swallowing. Communication is possible in every patient who possesses good motivation, but the problems of long-term management of calcium metabolism still require attention.

All tumor classifications are compromises based upon clinical or radiological evaluation with little concern for histology and intrinsic errors in application. Laryngeal cancer is no exception, and the present UICC system is critically examined with the intention of highlighting such deficiencies and relating them where possible to prognosis. Possible lymph node and systemic metastases are also considered in the light of personal experience and any intrinsic weaknesses evaluated in relation to variations in published cure rates. No better system is proposed, for at least this system encourages more accurate recording of clinical assessment.

Saccular mucoceles are a definite entity and probably occur more frequently than is supposed. Confusion with internal laryngoceles is possibly due to lack of understanding of basic anatomy and physiology. A 49-year-old man had a saccular mucocele that was possibly associated with laryngeal cancer, although a definitive diagnosis was only made two years later. The laryngectomy specimen was serially sectioned and showed an internal laryngocele on the side that was not operated one. This patient remains alive and well four years after excision of a T4 carcinoma, although a unilateral radical neck dissection was performed two years ago.

Despite possession of a well developed larynx and a gregarious nature, the Giraffe is able to utter only low moans or bleats. Morphological and histological examination, together with measurements of trachea and subglottic area, on three fresh larynges (Giraffa camelopardalis) has made it possible to explain the lack of vocal power. Factors such as thoracic expiratory flow rate, length of trachea and recurrent laryngeal nerves, together with morphological details of vocal folds, and intrinsic laryngeal muscles have all been considered, providing a unique example of the relationship between morphology and function in the mammalial larynx.