Bilateral dissection of the RPLN during initial surgery is highly recommended in every surgical case of carcinoma of the hypopharynx and cervical esophagus.
Myringitis granulosa is not a rare pathologic condition of the tympanic membrane. However, the condition can be misdiagnosed as chronic suppurative otitis media, since intermittent purulent discharge is the commonest symptom in both disorders. Although the clinical features of myringitis granulosa have been well described by several authors, its pathogenesis is still obscure. In this study, 40 cases of myringitis granulosa were examined in detail to clarify the clinical features and the pathogenesis present. No drum perforations, no hearing impairments and normal X-ray findings indicated that myringitis granulosa had no relation to chronic suppurative otitis media. The other areas of the affected tympanic membrane, except for the site of granulation, showed such pathologic conditions as atrophy, clouding and calcifications. In these pathologic tympanic membranes, epithelial migration was disturbed to a high degree. We suggest that the granulation process on the tympanic membrane should be divided into two stages: (1) injury reaching the lamina propria of the tympanic membrane; and (2) disturbed epithelization of the tympanic membrane. The disturbance of epithelial migration of the tympanic membrane occurs with both stages.
The healing process in 10 human tympanic membrane perforations after trauma and 20 myringotomies was observed under the microscope and was photographed. The movement of the healing process was from the central portion of the perforation to the periphery and followed the same direction as the drum's epithelial migration. At the central portion of the perforation's margin, the keratin layer proceeded to the periphery and was followed by the epidermal cell layer. Only slight movement was observed at the peripheral portion of the perforation. Histopathological examination confirmed these observations. These findings demonstrate that epithelial migration on the tympanic membrane plays a great role in the healing of a perforation.
This paper describes a primary voice restoration technique designed to eliminate the problem of aspiration commonly encountered in rehabilitation procedures following laryngectomy. This technique, utilized in 16 patients, consists of a unique combination of tracheal flap for voice production and bilateral esophageal constrictor muscle flaps to prevent aspiration. Fourteen patients developed satisfactory tracheoesophageal speech; of them 12 had normal deglutition without problems of aspiration. On radiographic examination, the bilateral esophageal muscle flaps, in combination with the dilatation and elevation of the cervical esophagus, provide a sphincter mechanism that prevents tracheal reflux during deglutition.
An innovation in the preparation of the vascular pedicle of the free radial forearm flap is presented. While the radial artery is commonly used as the arterial pedicle of the flap, either the cutaneous venous system or the radial comitant vein (deep venous system) is used as the venous pedicle. The perforating vein communicates between these two venous systems at the cubital fossa, and we confirmed its presence in all but one of more than 180 cases. When the vascular pedicle is dissected proximally to the perforating vein contained in the flap, the venous drainage of both the deep and cutaneous systems can be restored by anastomosis of only one vein: the cutaneous or the radial comitant vein. On the other hand, the flap can be raised with the radial vessels (without the cutaneous vein) at the start of surgery, and a large caliber cutaneous vein, such as the median cubital, the cephalic, or the basilic, can be used for anastomosis in cases where the cutaneous veins in the distal forearm are too thin, or where the radial comitant vein is composed of two thin separated veins. We believe that preserving the perforating vein would make the forearm flap more reliable and more convenient in reconstructive surgery.
Ten speakers with tracheoesophageal shunts were subjected to aerodynamic investigation. Measurements were made of tracheal pressure, airflow rate, and intensity and fundamental frequency of voice. Airway resistance, pulmonary power, acoustic power, and efficiency of voice were calculated from the data. It was found that intensity and airflow rate showed a tendency to augment with increased tracheal pressure, while fundamental frequency remained almost unchanged as tracheal pressure increased. Airway resistance of the tracheoesophageal speakers ranged from about 100 to 1,200 dyne s/cm5 and tracheal pressure ranged from 12 to 80 cm of water, while efficiency of voice ranged from 0.3 X 10(-4) to 6.5 X 10(-4). These results revealed that compared to the normal larynx, efficiency of voice was approximately the same, although airway resistance and tracheal pressure were substantially greater.
Malignant fibrous histiocytoma has been the most common soft-tissue sarcoma of late adult life. However, it is relatively uncommon in the head and neck. Furthermore, there has been no report of malignant fibrous histiocytoma of the hypopharynx in the literature. The first case of malignant fibrous histiocytoma of the hypopharynx is presented. The patient, a 70-year-old male, underwent extended laryngectomy and elective neck dissection with primary tracheoesophageal shunt operation and pharyngeal myotomy for voice restoration following total laryngectomy. For more than 2 years, there has been no evidence of the disease or metastasis. He has the satisfactory phonatory and swallowing function.
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