A retrospective review was conducted of 64 patients with deep neck abscesses. Based on clinical and operative findings, these abscesses were categorized as retropharyngeal abscess (29 patients), parapharyngeal abscess (10 patients), Ludwig's angina (19 patients), or necrotizing cervical fasciitis (six patients). Regional trauma from an ingested foreign body was the cause for 59 per cent of the patients with a retropharyngeal abscess. In 90 per cent of subjects with Ludwig's angina, an odontogenic cause was established; however, in the majority of cases of parapharyngeal abscess (80 per cent) and necrotizing fasciitis of the neck (85 per cent), aetiology was unknown.Fifty-five patients (86 per cent) required open neck drainage. In the remaining nine (14 per cent) endoscopic drainage of the abscess was possible. Eight patients (12 per cent) needed a tracheotomy for airway control. The overall mortality was eight per cent despite aggressive anti-microbial therapy and early surgical intervention. Thirty-four cultures grew aerobic organisms. Seventy-six per cent of these were gram-negative microorganisms. The bacteriological pattern of deep neck abscesses is changing and may be responsible for the considerable mortality rate with which the abscesses are still associated despite anti-microbial therapy.

An endoscopic study of the sphenoid sinus was carried out, on 30 cadavers, to understand the important anatomical relationships of the sphenoid sinus, and the sella turcica. The aim was to study the endoscopic anatomy and the variants, and to determine if endoscopic instrumentation and techniques, could play a beneficial role in endoscopic management of sellar lesions.The results of this study are discussed, with particular reference to the important surgical anatomical features of the sphenoid sinus. A surgical technique for the endoscopic transsphenoid approach to the sella turcica was developed.Anatomical variants can be identified endoscopically, and endoscopic techniques have the advantages of improved visualization, magnification, angled vision, and a panoramic perspective of the intrasphenoid anatomy, compared to currently employed methods of pituitary/sellar surgery, using the operating microscope/.

\s=b\In this retrospective study of 19 cases of recurrent pleomorphic adenoma of the parotid gland, all 19 patients underwent primary surgery elsewhere, namely, lumpectomy in five cases and superficial parotidectomy in 14 cases. The age at which those patients with recurrence had originally been seen was significantly earlier than those seen in our series of cases of primary surgery for pleomorphic adenoma. If the primary operation had been a parotidectomy, the average time interval between the first and second operation was 7.7 years; however, if it had been a lumpectomy, it was ten months. Implantability of the tumor and inadequate surgery were reasons for tumor recurrence.The suggested treatment of recurrence is total parotidectomy with preservation of the facial nerve. Revision surgery has been successful in all cases with no further recurrences, except in two cases in which multiple operations had already been performed. nomas of the parotid gland is a difficult problem, both in prevention and management. The incidence of recurrence after receiving primary treatment varies from 0% to 43.8% as reported by Patey and Thackray1 and Krolls and Boyers.2 There is a trend toward a lower recurrence rate with general acceptance of a supraneural parotidectomy as the minimum proce¬ dure for the removal of a pleomorphic adenoma of the parotid gland.3 Local recurrence is not an immedi¬ ate threat to life, since most are benign and slow growing, but there are two reasons for concern in their management:1. Morbidity is higher in a second operation with respect to postopera¬ tive facial nerve paralysis due to scar¬ ring and location of the recurrent tumor.2. There is a possibility of malig¬ nant transformation in a pleomorphic adenoma. Patey et al4 have shown that at least 50% of the parotid gland carcinomas arise from a benign pleo¬ morphic adenoma and its proper treatment from the outset can reduce the incidence of this tumor.We report a series of 19 cases of recurrent pleomorphic adenomas of the parotid gland that were referred to one of us (A.G.D.M.) during a 16-year period. In this article, the profile of patients, causes of recurrence, their treatment, and the results are studied. The important surgical prin¬ ciples in the removal of recurrent tumors are also highlighted. PATIENTS AND METHODSThis is a retrospective study of 19 patients with recurrent pleomorphic ade¬ nomas of the parotid gland seen between 1967 and 1982. It is part of a larger series of 334 cases of salivary gland diseases in which 156 parotidectomies were per¬ formed, 64 of which were for pleomorphic adenoma. All 19 patients received their primary treatment elsewhere. The revision parotidectomy was performed by one of us (A.G.D.M.) and the patients' conditions were followed up regularly on a yearly basis.The results of surgery were assessed clinically with respect to facial nerve func¬ tion and further recurrences. The status of the facial nerve postoperatively was classi¬ fied as a total paralysis (ie, involving all branches of the facial nerve) or a...

Fifty-five patients with deep neck infections treated consecutively over a period of six and a half years between January 1983 and July 1989 were reviewed. Nine of these patients had abscesses localized to the pharapharyngeal space and form the basis of this study. The aetiology of the parapharyngeal abscess was odontogenic in two patients and remained unknown in the other seven. Five patients had associated systemic disease; four were diabetics and one patient had non-Hodgkin's Lymphoma. High dosage intravenous antibiotics directed towards the causative micro-organisms, airway control and early surgical intervention was the mainstay of treatment. All patients underwent open surgical drainage of the parapharyngeal abscess within 24 h of admission. Bacteriology results showed Klebsiella sp. to be the dominant micro-organism cultured in four patients. Morbidity was low; seven patients had no post-operative complications and were discharged from the hospital between 7-24 d (mean 12.9 d). There were two deaths. Early open surgical drainage remains the most appropriate method of treating parapharyngeal space infections; it avoids life threatening complications with rapid recovery.

On the following day, the patient still complained of pain at the thyroid cartilage level. Repeat lateral neck radiography showed the same linear opacity. The possibility of a foreign body embedded in the hypopharyngeal mucosa could not be excluded. A computed tomography (CT) scan ofthe hypopharynx demonstrated a densely calcified ridge on the posterior lamina ofthe cricoid cartilage (Fig 2). No foreign body was shown on the cr scan.The patient was observed in the ward. He was able to eat normally. There was no symptom or sign suggestive of infection due to perforation of the digestive tract by any ingested foreign body. The CASE REPORTA 50-year-old man complained of severe throat pain at the level ofhis thyroid cartilage after swallowing a fish bone during his lunch on the same day. Clinical examination did not reveal any foreign body in his oropharynx or hypopharynx. Palpation of his larynx did not cause any tenderness. Radiography of his neck in the lateral view revealed a linear opacity posterior to the calcified cricoid cartilage. This linear opacity was not continuous with the cricoid cartilage calcification (Fig 1). It was determined that the patient had an impacted foreign body at the level of his cricopharyngeal sphincter. He was admitted for rigid esophagoscopy under general anesthesia to remove the ingested foreign body. At esophagoscopy, no Fig 1. Plain lateral neck radiograph showing calcified fi · bod fi d d all · ridge on cricoid posterior lamina appearing as linear oreigny was OUD an no mucos esion was opacity (wide arrow) separated from rest of cricoid calcifiseen. The procedure was terminated and the patient cation (narrow arrow). This linear opacity mimics inwas returned to the ward for observation. gested foreign body impacted at cricopharyngeus.