A new technique is described that preserves trapezius muscle function in radical neck surgery while cutting that part of the spinal accessory nerve which courses through the sternocleidomastoid muscle. The technique takes advantage of the little-know fact that, in humans, the trapezius muscle has dual innervation. The C2-3-4 motor root is joined to the distal portion of the spinal accessory nerve to give motor function to the trapezius muscle. This procedure will save shoulder mobility in the majority of patients who undergo radical neck dissection. The technique is accomplished rapidly with the use of the gastrointestinal stapler in the scalene fat pad.

A patient with asymptomatic primary hyperparathyroidism who spontaneously became normocalcemia is reported. The only significant finding was that of pain and tenderness in the enlarged parathyroid gland 2 weeks prior to surgery. This was due to a recent infarction of a parathyroid adenoma.

Solitary choristomas containing gastrointestinal mucosa occur rarely in the tongue and the oral mucosa and usually present as an asymptomatic mass. This report documents the occurrence of two congenital intraoral cystic choristomas in a 5-month-old male infant. The cysts were located on the dorsum of the base of the tongue and left floor of mouth anterior to the lingual cyst. Both cysts were lined by nonkeratinizing squamous epithelium and gastric, intestinal, and respiratory epithelium. The cysts were excised by an oral approach.

No abstract

The Cavitron Ultrasonic Surgical Aspirator (CUSA System) has been used at our institution in the resection of carcinoma of the tongue in 10 patients. This device is an ultrasonically powered aspirator that selectively fragments and aspirates tissue within a 1- to 2-mm radius of its tip. The technique used in our unit in tongue surgery was to incise the touch mucosal capsule of the tongue with electrocautery, and then to divide muscle and skeletonize blood vessels using the CUSA System. Smaller vessels, up to 2 mm in size, were cauterized directly by the friction created at the tip of the instrument. In this way, excellent control was available at all times and blood loss was consequently minimal. As our experience in the use of the CUSA System increased, blood loss was virtually eliminated, anatomic landmarks were more easily defined, and at no stage did any tongue necrosis occur in any of the patients of the series.