It is widely accepted that tumoral invasion of the pre-epiglottic space (PES) has a significant prognostic importance in supraglottic laryngeal carcinomas. The lymphatics of the supraglottic larynx drain to cervical lymph nodes via the PES. Since the supraglottic larynx is an embryological unit that contains the PES, malignant lesions of this region must be resected with en bloc surgery, including the PES. Tumors with PES invasion are already considered to be T3 in TNM staging. The purpose of this study was to review the clinical experience we have had with these tumors at Ankara University. The study comprised 150 patients with squamous cell carcinomas of the supraglottic larynx treated with either partial or total laryngectomies. Findings suggested that PES invasion occurred at early stages of supraglottic tumor progression. Suprahyoid epiglottic lesions behaved less aggressively than tumors originating from other supraglottic subsites and did not invade the PES until advanced stages. PES invasion was not considered to be a significant prognostic factor because the majority of the supraglottic lesions studied demonstrated PES invasion regardless of cervical lymph node metastases. Analysis of oncological and functional results revealed that en bloc resection of the supraglottis with the PES was facilitated by preservation of the hyoid bone.

Adjunctive use of a wound healing inhibitor is considered to increase the success rate of endoscopic endonasal DCR. Its intraoperative use seems to be easy and safe. But the study of this limited series shows no benefit in using it.

Basaloid squamous cell carcinoma (BSCC) is a recently recognized high-grade tumor with a propensity for nodal as well as systemic metastasis and can arise from different anatomic locations. The differential diagnosis includes adenoid cystic carcinoma, small cell neuroendocrine carcinoma and squamous cell carcinoma. Monoclonal antibodies reactive with cytokeratin (34betaE12, AE3, pancytokeratin), as well as other cellular antigens (vimentin [VIM]; synaptophysin [SYNF]; chromogranin A [ChA]; neuron-specific enolase [NSE]; S-100, desmin, smooth-muscle actin [SMA]), were used in an immunoperoxidase method with paraffin-embedded tissue to phenotypically characterize a case with features of BSCC arising in the maxillary sinus. Neoplastic cells reacted with the high-molecular-weight cytokeratin antibody 34betaE12, as well as with other antikeratin antibodies, but failed to react with the antibodies VIM, desmin and SMA and showed variable immunoreactivity for NSE, SYNF and S-100. The staining pattern for NSE was diffuse and intense and reactivity for ChA was inconsistent.

Endoscopic dacryocystorhinostomy (EN-DCR) is a procedure that presents itself as an alternative choice to the conventional external approach. This study describes the results of endoscopic endonasal non-laser lacrimal surgery. We reported the data of 64 procedures of 63 patients with epiphora or chronic dacryocystitis who underwent primary EN-DCR by means of a microdrill or revision EN-DCR. One of these cases had bilateral surgery. There were 42 women and 21 men. Thirty-four cases had primary EN-DCR and 30 cases had revision EN-DCR secondary to previously failed external DCR. Mean follow up time was 11.34 months. The procedure was successful in 79.4% of primary EN-DCR cases and in 80% of revision EN-DCR cases. The overall success rate was 79.6%. Postoperative complications included periorbital edema, eyelid ecchymosis, punctal granuloma, cyst of the punctum, adhesion between the superior and inferior punctum. Tube dislocation occurred in 3 patients. Premature loss of silicone tube was determined in 5 patients and granulation tissue occurred at the internal osteum in 11 cases. EN-DCR, when compared with external dacryocystorhinostomy (EX-DCR), has lower success rate, but provides the potential advantages of better intraoperative hemostasis, and lack of cutaneous scar.

* BACKGROUND AND OBJECTIVES: The antimetabolite mitomycin-C is now being used in endoscopic transnasal dacryocystorhinostomies to prevent the closure of osteotomies. * PATIENTS AND METHODS: A 0.5-mg/ml solution of mitomycin-C was applied to the osteotomy site for 2Vi minutes intraoperatively. Specimens from four patients were collected during surgery and at 1 5 days, 1 month, 3 months, and 6 months after surgery. The specimens were examined under light and electron transmission microscopy and were compared with control specimens. * RESULTS: Light microscopy showed attenuated epithelium with intracytoplasmic vacuoles. Subepithelial connective tissue was looser and hypocellular. Electron microscopy confirmed these findings and demonstrated swelling of mitochondria, dilatation of endoplasmic reticulum, and chromatin-dense granules in nuclei of fibroblasts. * CONCLUSION: By causing a decrease in density and cellularity of mucosa, topical use of mitomycin-C may enhance the success of surgery; however, further studies are necessary to determine the ultimate potential of this agent for this procedure. [Ophthalmic Surg Lasers 1997;28:300-304.]