No abstract

Necrotizing fasciitis is a rare but well recognized clinical entity which most often occurs on the trunk, perineum or legs following surgery or trauma. The condition is much less common in the head and neck and it is particularly uncommon in the midface/periorbital region. In almost all the cases occurring in the neck the condition follows obvious dental or oropharyngeal sepsis and in all the cases of the scalp there is a history of previous surgery or trauma. However, necrotizing fasciitis of the midface/periorbital region may lack any obvious traumatic aetiology or may follow relatively minor trauma. The diagnosis in these cases may not be suspected and treatment may be delayed with fatal consequences. Treatment by wide excision of all affected skin can lead to disastrous cosmetic consequences in facial disease and it is suggested that disease control can be achieved by raising wide based skin flaps with excision of the underlying necrotic tissue. The flaps are then returned onto normal muscle with much improved cosmetic results. This paper discusses the diagnosis and treatment of patients with necrotizing fasciitis of the face which has arisen without significant trauma.

Investigation into the underlying disease causing an aural polyp is often hampered when the polyp itself obscures the tympanic membrane. This retrospective analysis of 65 patients undergoing aural polypectomy was carried out to identify any predictive factors for underlying cholesteatoma and to determine a correct management strategy for aural polyps. The duration of symptoms, size of polyp, size of conductive component of hearing loss and bacteriology of otorrhoea were unhelpful as predictors of the underlying disease. Radiological evidence of bony erosion of the mastoid is a useful sign of cholesteatoma when present. Aural polypectomy resulted in 58.3 per cent of ears becoming inactive. It is proposed that aural polypectomy and histological assessment should be employed as initial treatment with mastoid exploration reserved for those ears thus identified as high risk for cholesteatoma.

Background. The risk of multiple primary tumors in the head and neck area is higher than that in other areas of the body.Methods. A total of 573 patients with squarnous cell carcinoma of the head or neck were studied prospectively during a 4.5-year period to determine the incidence of associated synchronous and metachronous second primary carcinoma.Results. Multiple primary carcinoma was found in 2.4% of these patients (69% with synchronous primary tumors). Sixty-three percent of all second primary tumors occurred in the esophagus.Conclusions. This report emphasizes the importance of esophagoscopy in the initial assessment of patients with squamous cell carcinoma of the head or neck. Cancer 1992: 70:815-820.