Carcinoma of the prostate metastatic to the maxillary antrum

Metastatic carcinoma of the maxillary antrum is an extreme rarity. Until 1980, less than 100 cases with distant primaries metastatic to the entire sinonasal tract had been reported. In a review of these cases, we found no mention of primary prostate cancer metastatic to the antrum. The purpose of this paper is to document the first case of this entity.     

Physical rehabilitation after myocutaneous flaps

The neck, shoulder, and upper trunk serve as donor sites for commonly used flaps in head and neck reconstruction. In order to prevent permanent functional disabilities, a physical therapy program was organized. The anatomy, physiology, and kinesiology of the shoulder muscles that are commonly used in myocutaneous flaps are reviewed. Their functional deficit and compensation are described. Exercise protocols for each group of muscles were developed. Prevention of postoperative "frozen shoulder" and the avoidance of tension and torsion of the transposed muscle pedicle are important during the immediate post-operative course. Strengthening the agonistic muscles and learning to use them correctly, in order to regain full range of motion, are the main long-term goals.     

Obliteration of the frontal sinus with the pericranial flap

A host of autogenous and synthetic materials ranging from free fat, muscle, and bone to methylmethacrylate, hydroxyapatite cement, and glass beads have been used to obliterate the frontal sinus. These materials carry an increased risk of donor-site morbidity, as well as the risk of resorption, infection, and local inflammatory reactions. The pericranial flap is a local flap that can be used to obliterate small- and medium-sized frontal sinuses. This vascularized flap is easily and quickly harvested, and it avoids the morbidity associated with free-fat and cancellous bone grafts. Its ease of harvest, vascularity, and low complication rate make the pericranial flap an excellent alternative for frontal sinus obliteration.     

Angioblastic meningioma presenting as a pain in the temporomandibular joint

A case of angioblastic meningioma is presented where the presenting symptom was severe TM pain. Theories based on a "referred pain" mechanism, vascular traction, or both, are discussed and suggested as an explanation.     

Surgery of the clivus and anterior cervical spine

Traumatic, degenerative, benign, and malignant lesions of the clivus and cervical spine were treated by three basic surgical procedures. Midline skull base lesions in the nasopharynx, clivus, and C-1 were approached via the transmandibular and transcervical route. Lesions of C-2 and C-3 were operated on through a high transcervical route (above the hypoglossal nerve). A low transcervical route was used for lesions at the level of C-4 to C-7.     

Thyroid cancer in patients 70 years of age or older. Retrospective study of 50 patients

This report presents our experience with 50 thyroid cancer patients 70 years of age or older, out of 606 patients of all ages. Comparing this series to those describing thyroid cancer patients of all ages, we found that thyroid carcinoma in the 70+ age group presents at a more advanced clinical stage, behaves more aggressively, and has a higher death rate. These findings are attributed mainly to the higher incidence of undifferentiated carcinoma and the more aggressive course of the differentiated types of carcinoma in the older age group. If suspected thyroid nodules are managed by initial radical treatment, carcinoma can be diagnosed earlier and patients will survive longer.     

Ossified segments of the stylohyoid ligament. A case of radiological misdiagnosis

An ossified segment of the stylohyoid ligament was misdiagnosed as a foreign body.     

The Wookey flap revisited

BACKGROUND: Complete circumferential pharyngoesophageal reconstruction has undergone remarkable changes and developments during the last three decades. Gastric transposition and microvascular techniques are the standards of care. However, in cases of failure, or where other factors such as severe comorbidities prevent the use of microvascular techniques, reconstruction with local flaps provide a reliable option. We have used the Wookey flap technique in six patients with complete circumferential loss of the pharynx and upper esophagus. To make the procedure more reliable, we added a "delay" stage. METHODS: Retrospective review of charts of six Wookey-type reconstructions of the pharynx and upper esophagus done in our department at SUNY-HSC, Brooklyn, and The Long Island College Hospital. RESULTS: Five of the six patients had successful reconstruction of complete circumferential pharyngoesophageal resection. All five resumed oral alimentation. The flap failed in one patient. CONCLUSIONS: The Wookey flap may still provide surgeons with a "last resort" reconstructive option after complete, circumferential pharyngoesophageal resection.     

Laryngeal Tuberculosis in HIV-Infected Patients: A Difficult Diagnosis

Unrecognized laryngeal tuberculosis (TB) poses a significant hazard to otolaryngologists. However, the changing manifestations of TB in patients with human immunodeficiency virus (HIV) infection can make its diagnosis difficult. In our population of 146 patients with TB involving the head and neck, HIV infection was present in 70 cases (48%). The prevalence of laryngeal TB in this population was 5.5% (8 patients). Concomitant HIV infection was present in 2 (25%) of 8 patients with laryngeal TB. A delay in the diagnosis of laryngeal TB occurred in 100% of patients with HIV infection, compared with 17% of non-HIV-infected patients (P = .055). The cause of the delayed diagnosis was multifactorial, mainly the presence of multiple confounding variables and the carcinoma-like appearance of the laryngeal TB lesions in HIV-infected patients. To reduce risk for transmission of TB to health care providers, a high level of suspicion must be present for all patients with laryngeal lesions, especially those with HIV infection. Laryngoscope, 106:1238-1240, 1996