Removal of the internal jugular vein (IJV) in unilateral radical neck dissection (rND) necessitates redirection of cerebrovenous blood to collateral pathways. If adaptation is insufficient, neurologic sequelae develop that are due to impaired venous drainage and increased intracranial pressure. The authors studied venous hemodynamic effects of unilateral rND using Doppler and duplex ultrasound in 17 patients. Blood flow velocities (BFVs) were recorded from the distal IJV (dIJV) and the vertebral vein (VV) before and 9 to 88 days after surgery. A preoperative compression test of the dIJV was performed to identify the side of dominant drainage. The BFV increased in the contralateral dIJV after right-sided rND (n = 10) by 111% (range, 50% to 320%), and after left-sided rND (n = 7) by 34% (range, 5% to 105%). In the contralateral VV, a rise of BFV by 75% was found. Our results confirm the role of the contralateral dIJV as the predominant collateral pathway. The VVs serve as an important additional major outflow. Doppler ultrasound may help to identify patients at risk of insufficient cerebrovenous drainage after rND.
Patients who undergo laryngectomy typically lose their sense of smell. One device that has been used to rehabilitate olfactory function in these patients is the larynx bypass. We conducted a long-term study of the larynx bypass in 16 laryngectomized patients. After undergoing objective and subjective baseline evaluations, patients were asked to use the device at home for at least 30 minutes each day for 3 months. They were also asked to record in a diary subjective ratings of their sense of smell and the practicability of using the device every day. At study's end, patients experienced a statistically significant improvement (p < 0.001) in olfactory function on objective measurement (Sniffin’ Sticks testing). Subjective improvement was seen after 1 week (p < 0.001) and maintained throughout the study. Practicability scores improved statistically (p = 0.003), but the device remained difficult to use. The long-term use of the larynx bypass has not been studied previously, and we hope that our findings will serve as a basis for further investigation.
Malignant fibrous histiocytoma is a rare sarcoma. This is the report of a radiation-induced histiocytoma of the right tonsillar region. Because of squamous cell carcinoma of the left tonsil, a 64-year-old woman was treated with primary surgery and postoperative radiotherapy. Six years later, a histiocytoma was diagnosed histologically within the former field of radiation. This second primary tumor was resected radically. Clinical, radiological, and histological findings are presented, and the importance of this very rare malignant tumor, especially when it is radiation-induced, is discussed.
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