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The amorphous or wide nasal tip is the most commonly encountered nasal tip deformity, but little has been done to measure the effect of standard rhinoplasty techniques on nasal tip width. In the clinical routine, nasal tip width and soft-tissue cover thickness are estimated by inspection and palpation rather than by measurement. In this study, a B-mode sonograph with a 12-MHz transducer was used in a noncontact mode to measure tip width 0.5 cm occipital to the tip defining point, distance between the alar cartilage domes, and thickness of the soft-tissue cover overlying the lower lateral cartilages. These parameters were measured 3 to 8 weeks before and 56 days to 19 months after a transdomal suture tip plasty in 18 patients. The distance between the alar cartilage domes seemed to be an important factor for tip width because interdomal distance, not soft-tissue cover thickness, correlated with tip width before surgery (correlation: 0.53). Conversely, the degree of tip refinement correlated with preoperative soft-tissue cover thickness (correlation: 0.75), but not with interdomal distance. Ultrasonic imaging of nasal soft tissues may help to assess the effect of different tip refining procedures and other soft-tissue changes after rhinoplasty.

In order to identify squamous cell carcinomas of the head and neck (HNSCC) with common biological and clinical features, we investigated the incidence and properties of carcinomas lacking retinoblastoma protein (pR6) cell cycle control. Of 208 HNSCC investigated, 23 (11%) showed a lack of pRb expression. The majority of these tumors (65%) were tonsillar carcinomas. The pRb-negative tonsillar tumors were all stage IV, had metastasized to lymph nodes at the time of diagnosis and were in general poorly differentiated or undifferentiated. Very significantly, the pRb-negative phenotype was strongly associated with the presence of oncogenic human papilloma viruses, implying a viral etiology and functional inactivation of pRb by the viral E7 oncoprotein. Despite the very adverse histopathological factors, patients with pRb-negative tonsillar carcinomas had a better clinical outcome, which was consistent with a uniform favorable responsiveness of these tumors to postoperative radiation therapy.

The diagnosis of cystic echinococcosis (echinococcus granulosus) in an atypical location can be difficult to make and frequently can only be established by histological examination of affected tissues. Surgical excision and fine-needle aspiration biopsy usually lead to the diagnosis. Since puncture of these cysts may cause an anaphylactic reaction due to spillage of hydatid fluid and/or dissemination of infection, the use of fine-needle aspiration biopsy is controversial at present. We report on a patient with a cystic neck mass who developed an allergic reaction after diagnostic fine-needle aspiration biopsy. Cytological examination of the specimen was inconclusive. The allergic reaction led to the diagnosis of echinococcosis, which was confirmed by serological examination. We describe a possible diagnostic procedure for a cystic mass of unknown etiology. If imaging and serological tests are not conclusive, we believe that fine-needle aspiration biopsy is justified. However, this should only be performed in a setting that provides sufficient management for anaphylactic reactions.

In addition to mucositis and myelotoxicity as well known early reactions after radiotherapy or radiochemotherapy in advanced head and neck tumors, late toxicity following treatment is an often underestimated problem. Between 1992 and 1995, 68 patients with advanced oro- and hypopharyngeal tumors were treated primarily with accelerated concomitant boost radiochemotherapy (total dose irradiations of 66 Gy and carboplatin as chemotherapy). Ninety-three per cent of the patients had stage IV disease according to the UICC-TNM classification. Monitoring of follow-up included late toxicity with special attention given to laryngeal edema. In 37 patients (54%) edema of the larynx as a late complication of radiochemotherapy was observed by clinical investigation and CT scan. The median onset of laryngeal edema was found 121 days after completion of therapy, with a median time of observation of 250 days. Observations in these patients demonstrated the chronic character of this edema. An increase in the laryngeal edema in 5 cases resulted in tracheostomy. Laryngeal edema in 10 patients was associated with recurrence of tumor. These results show that after xerostomia laryngeal edema is the main late toxicity in the head and neck after radiochemotherapy and should lead to further investigations to exclude possible recurrent tumor.

Anatomy and perfusion of the nasal septum and inferior turbinate mucosa can be visualized with B-mode and power-Doppler ultrasound. The transducer is placed externally on the nasal ala parallel to the pyriform crest and directed towards the head of the inferior turbinate of the opposite side. An individually prepared dental splint keeps the transducer in position and allows assessment of dynamic changes in mucosal swelling and perfusion. Perfusion changes are evaluated by computerized quantification of power-Doppler color pixels. Coupling of ultrasound across the nasal lumen is achieved by introducing gel into one nasal vestibule and flooding the anterior nasal cavity of the side to be visualized with isotonic aqueous solutions. Perfusion could be visualized in 23 of 30 subjects, while B-mode sonographic anatomy was visualized in 16 subjects. The effect of isotonic saline solution (10 healthy subjects), naphazoline (10 patients with chronic nasal obstruction) and allergen extracts (10 patients with allergic rhinitis) on mucosal perfusion and swelling was studied. Isotonic saline solution induced a maximum drop in power-Doppler color pixel density by 10% and a maximum increase by 27%, but no change was seen in mucosal swelling. Naphazoline induced a 10-57% decrease in power-Doppler pixel density and decongestion of the inferior turbinate and septum mucosa by 17-43% and 4-27%, respectively. Allergen extracts induced an increase in power-Doppler color pixel density by 24-181% and an increase in mucosal thickness by 4-31%. These preliminary results encourage further studies of nasal mucosal perfusion changes using power-Doppler sonography after pharmacologic and allergen provocations.

Two hundred eight primary squamous cell carcinomas of the head and neck have been analyzed with respect to the presence of the retinoblastoma tumor suppressor protein, pRb. Of these, 23 tumors (11%) that preferentially localized to the tonsils revealed complete absence or dramatic reduction in the amount of pRb. Other cell cycle components, cyclin D1 and p16INK4A, which are intimately related to pRb through an autoregulatory loop, were also dramatically decreased or overexpressed, respectively, in these pRb-defective tumors. On the other hand, the majority of the pRb-defective tumors contained the wild-type p53 gene. No evidence was found for genetic defects at the Rb locus in these tumors. Very significantly, in 11 of 12 pRb-defective tonsillar tumors, but in none of 9 pRb-positive tonsillar tumors (P < 10[-7]), DNA of oncogenic human papillomavirus types was identified, providing a strong indication for a human papillomavirus-associated etiology of these tumors and suggesting the functional inactivation of the pRb protein by the viral E7 gene product. In comparison to all head and neck squamous cell carcinomas studied, the pRb-defective tonsillar tumors were in general more poorly differentiated (P = 0.0059), and they were all metastatic at the time of resection. Of particular clinical interest, despite these adverse histopathological factors, the clinical outcome for these patients was relatively favorable, strongly implying that the pRb-defective tumors responded uniformly well toward postoperative radiation therapy.

Alveolar echinococcosis is a life-threatening parasitosis occurring in countries in the Northern hemisphere. The diagnosis of an Echinococcus multilocularis infection is routinely performed by radiological techniques and by the detection of specific antibodies in the sera of infected patients. However, because serodiagnosis fails in 5%-10% and radiological techniques are difficult to interpret in some cases, we developed a polymerase chain reaction for the detection of echinococcal-specific messenger RNA from fine-needle biopsy specimens. This technique was applied to the diagnosis of alveolar echinococcosis in a 20-year-old seronegative woman. Detection of messenger RNA not only allowed the diagnosis of echinococcal disease but also proved to be a reliable measure for determining the efficacy of an antiparasitic therapy.