John Wanamaker - Academia.edu (original) (raw)

Papers by John Wanamaker

Head & neck, Jan 1, 1995

Background. The craniofacial approach is a reliable method for excising tumors involving the ante... more Background. The craniofacial approach is a reliable method for excising tumors involving the anterior skull base. Advances in technique have minimized complications. Although cerebrospinal fluid leaks and meningitis are well known complications, tension pneumocephalus is not well described. We review two cases and discuss the pathophysiology, clinical manifestations, radiographic features, and treatment of tension pneumocephalus.Methods. Case study. We reviewed the records of all patients who underwent anterior craniofacial resection at our institution, a tertiary care center, from 1976 to 1993. Among 45 patients identified, 2 had tension pneumocephalus.Results. Neurologic deterioration after anterior craniofacial resection occurred in both patients in the immediate postoperative period. Both patients had extradural intracranial air under pressure and were diagnosed with tension pneumocephalus. In one patient, this was treated by needle aspiration followed by catheter drainage, and the second patient was treated with needle aspiration followed by airway diversion. The first patient recovered fully and was discharged on postoperative day 14; the second patient's mental status did not return to the preoperative level, and he was discharged on postoperative day 23 to a rehabilitative facility. Approximately 3 months later, his level of mentation returned to baseline.Conclusions. Tension pneumocephalus is a potentially devastating complication that may occur after craniofacial resection. It requires prompt recognition and treatment to minimize morbidity. © 1995 Jons Wiley & Sons, Inc.

The incidence of papillary thyroid carcinoma arising in a thyroglossal duct cyst is rare and occu... more The incidence of papillary thyroid carcinoma arising in a thyroglossal duct cyst is rare and occurs in about 1 % of thyroglossal duct cysts. Only 17 such cases diagnosed with fine-needle aspiration biopsy have been previously reported in the English-language literature, with a diagnostic rate of 53%. In this article, the cytologic features of the current case are emphasized and those of the previous reported cases are briefly reviewed. Diagnostic pitfalls of papillary carcinoma arising in thyroglossal duct cysts diagnosed by fine-needle aspiration biopsy are also discussed.

Ontology Neurotology, Feb 28, 1995

Adenomatous lesions of the temporal bone represent a diverse group of neoplasms. At least three h... more Adenomatous lesions of the temporal bone represent a diverse group of neoplasms. At least three histopathologic patterns have been described: glandular; ribbon-like, or "festooning;" and aggressive papillary. Combinations of glandular and ribbon-like histologies in the same lesion are not uncommon. The glandular and ribbon-like histologies have been associated with carcinoid tumors, and the aggressive papillary tumor has been considered a separate entity. Recently, the endolymphatic sac has been proposed as the site of origin of the aggressive papillary lesions. Previous reports have described neuroendocrine properties with characteristics embracing the three histologic types. The authors postulate that the neural crest is the site of origin of this unusual group of neoplasms. Immunohistochemical analysis on the pathologic specimens of patients with adenomatous lesions of the temporal bone was performed to test this hypothesis. From 1975 to 1992 seven patients were treated at the Cleveland Clinic Foundation with a diagnosis of middle ear adenoma. A panel of special stains for neuroectodermal markers, including synaptophysin, chromogranin, neuron specific enolase, calcitonin, and serotonin was used on the paraffin-embedded formalin-fixed specimens. Three lesions were also evaluated by electron microscopy, all demonstrating dense core, intracytoplasmic granules. Three ribbon-like tumors were positive for synaptophysin and chromogranin, and two of these were positive for serotonin. One glandular tumor was positive for synaptophysin, and an aggressive papillary tumor was positive for synaptophysin and neuron specific enolase. An additional papillary tumor was referred following a third recurrence without accompanying immunohistochemical data. Cholesteatoma-like material was identified with a few glandular cells interspersed, all negative by immunohistochemical evaluation. The seventh specimen, initially diagnosed as papillary adenoma on light microscopy, was not studied by the aforementioned stains, and was later identified as a papilloma of sinonasal origin. The neural crest gives rise to pluripotential stem cells with widespread anatomic distribution, including the temporal bone. Because immunomarkers used in this study are specific for neuroectodermal differentiation, results suggest that temporal bone adenomas have neuroendocrine characteristics and could be derived from the specialized neuroectoderm of the neural crest.

Archives of Otolaryngology Head and Neck Surgery, Feb 1, 1994

A variety of systemic diseases may manifest with laryngeal symptoms. Cricoarytenoid arthritis wit... more A variety of systemic diseases may manifest with laryngeal symptoms. Cricoarytenoid arthritis with or without limitation of vocal fold motion is an example. It has been described in up to 25% of rheumatoid patients. Ankylosing spondylitis is classified among the seronegative spondylarthritides. Besides its systemic features, rare reports of cricoarytenoid involvement have been published. Six previous cases reported have been characterized by a long history of ankylosing spondylitis before the cricoarytenoid joint involvement occurred. We describe only the seventh case of cricoarytenoid arthritis secondary to ankylosing spondylitis and the first patient (to our knowledge) to present with bilateral vocal fold fixation as the initial presenting symptom.

Archives of Otolaryngology - Head and Neck Surgery

Current Opinion in Otolaryngology & Head and Neck Surgery, 1996

Facial Plastic Surgery, 1996

The functional and aesthetic consequences of ablative head and neck oncologic surgery pose a sign... more The functional and aesthetic consequences of ablative head and neck oncologic surgery pose a significant challenge to the reconstructive surgeon. With the advent of microvascular free tissue transfer the reconstructive capabilities of the surgeon have been greatly expanded. The rectus abdominis musculocutaneous free flap has assumed an important role in contemporary head and neck reconstruction because of its ease of dissection, length and size of the vascular pedicle, convenience of harvest in the supine position, reliability and versatility, and low donor site morbidity.

The Laryngoscope, 1993

The rising popularity of surgery involving the laryngeal framework (surgical medialization of imm... more The rising popularity of surgery involving the laryngeal framework (surgical medialization of immobile vocal folds, vocal fold tightening, pitch variation, etc.) has resulted in increasing case experience. Little has appeared in the literature regarding complications or long-term results of this type of surgery. Several years' experience in a major referral center with various types of laryngeal framework surgery has led to a small number of complications. These have included late extrusion of the prosthesis and delayed hemorrhage. A review of these complications and recommendations for modification of technique to minimize them in the future are discussed.

The Laryngoscope, 1992

Twenty-six patients underwent computed tomography (CT) and magnetic resonance imaging (MRI) of sk... more Twenty-six patients underwent computed tomography (CT) and magnetic resonance imaging (MRI) of skull base lesions at the Cleveland Clinic Foundation. CT provided improved bone detail, documenting invasion of the lamina papyracea, orbital floor, fovea ethmoidalis, cribriform plate, pterygoid plates, hard palate, and skull base. MRI defined invasion of the orbit, dura, brain, and cavernous sinus. Improved soft-tissue-tumor interface was evident on MRI. MRI was superior to CT in determining carotid artery involvement. MRI distinguished between tumor and retained secretions in the paranasal sinuses. Combining radiographic tumor staging reliably predicted surgical findings; however, MRI consistently yielded sufficient diagnostic information and the additional expense of performing two imaging procedures may not be justified.

The American Journal of Surgery, 1994

We reviewed the records of 27 patients who underwent primary mandibular reconst~'uction outcome a... more We reviewed the records of 27 patients who underwent primary mandibular reconst~'uction outcome and with AO plates to investigate the n complications of this procedure. Immediate soft-tissue flap coverage was required in 26 patients. Early complications were seen in 44% of the patients, with the highest incidence after irradiation (P ffi 0.02). Late complications were mostly t~elated to Dlmor recurrence (12). Late complications not associated with recurrence were persistent pain (2), minor infections (3), plate exposure (3), and plate fracture (l). Good to excellent cosmetic results were obtained in all but 1 patient. Full mastication was not possible for any of our patients, and therefore function was not fully restored. Speech and deglutition were mostly influenced by the amount of soft-tissue resection. Mean follow-up was 20 months (rnnge 3 to 52). At last evaluation, 12 patients were alive and free of disease, and 15 were dead of disease or other causes. Our results show that primary mandibular reconstruction with rigid plates is a safe, effective, and reliable technique to restore mandibular continuity and cosmesis. For lateral defects, this method is a viable alternative to free vascularized osseocutaneons flaps.

Otolaryngology - Head and Neck Surgery, 1997

view of the literature during the past century documents only two case reports confirming the cli... more view of the literature during the past century documents only two case reports confirming the clinical disappearance of squamous carcinoma without treatment. We report a case of the spontaneous disappearance of a recurrent laryngeal carcinoma after biopsy-proven recurrence. The radiologic studies, pathology slides, and serial clinical photographs of the lesion are presented.

Otolaryngology - Head and Neck Surgery, 1995

Educational objectives: To better understand the preoperative and intraoperative risk to the inte... more Educational objectives: To better understand the preoperative and intraoperative risk to the internal carotid artery in neck and skull base surgery and to work more closely and knowledgeably with their neurovascular surgical colleagues in combined cases.

Otolaryngology - Head and Neck Surgery, 1995

... Disorders, Cleveland Clinic Foundation; ... Next Section. CASE REPORT. A 55-year-old man admi... more ... Disorders, Cleveland Clinic Foundation; ... Next Section. CASE REPORT. A 55-year-old man admitted to the intensive care unit at the Cleveland Clinic Foundation after full cardiac arrest, cardiopulmonary resuscitation, and intubation was started on heparin (1000 U/hour). ...

Head & Neck, 1995

Background. The craniofacial approach is a reliable method for excising tumors involving the ante... more Background. The craniofacial approach is a reliable method for excising tumors involving the anterior skull base. Advances in technique have minimized complications. Although cerebrospinal fluid leaks and meningitis are wellknown complications, tension pneumocephalus is not well described. We review two cases and discuss the pathophysiology, clinical manifestations, radiographic features, and treatment of tension pneumocephalus.

Head & Neck, 1996

To identify factors predicting prosthesis use and final speech quality in patients undergoing sec... more To identify factors predicting prosthesis use and final speech quality in patients undergoing secondary tracheoesophageal puncture (TEP) for voice restoration alter laryngectomy. We undertook a retrospective study of 168 patients who underwent secondary TEP at the Cleveland Clinic between June 1980 and October 1993. Factors examined were: patient demographics, extent of initial surgery, method of pharyngeal preparation, history of irradiation, insufflation test results, pharyngeal stricture, and concurrent medical conditions. Univariate and multivariate statistical analyses were performed to identify predictive factors. At last evaluation, 73.8% (124) of the patients were still using the prosthesis. Quality of speech was the only predictor of prosthesis use (p < .001). Phonation on the first day was achieved in 90% (151) of patients. Speech result improved significantly over the first 6 months (p < .001). Univariate analysis found that the need for reconstruction at laryngectomy (p = .04), the presence of pharyngeal stricture (p = .001), and continued prosthetic use (p < .001) were associated with the speech result. There was no significant advantage to the lack of approximation of the pharyngeal constrictors (p = .31). Stepwise logistic regression showed that only the absence of pharyngeal stricture was associated with a better-quality voice (p = .001). Tracheoesophageal puncture is a reliable method for restoring voice after laryngectomy. Prosthesis use decreases with time, and good voice quality is the only predictor of continued prosthesis use. In this series the absence of pharyngeal stricture was the only significant predictor of good to excellent speech.

Head & Neck, 1994

Background. Nasopharyngeal carcinoma has a variety of presentations. However, in more than 50% of... more Background. Nasopharyngeal carcinoma has a variety of presentations. However, in more than 50% of cases it may present with serous otitis or cervical metastases. Although the metastases usually occur in the neck, the lymphatic network of the parotid may also serve as a site for the metastatic deposits. We present a case in which the initial manifestation of nasopharyngeal carcinoma of the lymphoepithelioma type was a parotid mass.

Head & Neck, 1996

The purpose of this study was to evaluate our experience with the diagnosis and management of tum... more The purpose of this study was to evaluate our experience with the diagnosis and management of tumors of the parapharyngeal space (PPS), with particular emphasis on the evolving role of magnetic resonance imaging (MRI). A case series review of 51 patients with parapharyngeal tumors who underwent surgical excision between 1980 and 1992 were analyzed with regard to presenting signs and symptoms, histologic diagnosis, imaging technique (computed tomography [CT] versus MRI), surgical approach, and outcome. Fifty-one patients underwent surgical excision of a parapharyngeal tumor of which the vast majority (78%) were benign neoplasms. Compared with benign neoplasms, the malignant tumors were much more likely to be associated with pain, trismus, and a cranial nerve deficit. MRI was able to locate the tumor in 20 of 21 patients (95%), while CT was able to localize the tumor in 32 of 38 patients (84%). MRI, because of its superior soft-tissue resolution and ability to provide imaging in multiple planes, is the imaging modality of choice to diagnose neoplasms of the parapharyngeal space. Because most of these tumors are benign, MRI allows the surgeon to select the surgical approach with the least morbidity.

Head & Neck, 1993

Although metastatic neoplasms in the head and neck are rare compared to primary head and neck neo... more Although metastatic neoplasms in the head and neck are rare compared to primary head and neck neoplasms, metastatic breast carcinoma has been described at numerous sites in the head and neck region. Two cases of breast carcinoma metastatic to sites in the head and neck are reported. In one case a laryngeal metastasis represented the first manifestation of recurrent breast cancer. The second case, a nasal metastasis, was unsuspected and was treated as cellulitis. The presentation of metastatic breast carcinoma to the head and neck may in fact be atypical, posing a diagnostic dilemma. These cases illustrate the importance of past medical history and the high index of suspicion in patients with a history of prior malignancy. Q 1993 John Wiley & Sons, Inc. HEAD & NECK 1993;15:257-262

Head & neck, Jan 1, 1995

Background. The craniofacial approach is a reliable method for excising tumors involving the ante... more Background. The craniofacial approach is a reliable method for excising tumors involving the anterior skull base. Advances in technique have minimized complications. Although cerebrospinal fluid leaks and meningitis are well known complications, tension pneumocephalus is not well described. We review two cases and discuss the pathophysiology, clinical manifestations, radiographic features, and treatment of tension pneumocephalus.Methods. Case study. We reviewed the records of all patients who underwent anterior craniofacial resection at our institution, a tertiary care center, from 1976 to 1993. Among 45 patients identified, 2 had tension pneumocephalus.Results. Neurologic deterioration after anterior craniofacial resection occurred in both patients in the immediate postoperative period. Both patients had extradural intracranial air under pressure and were diagnosed with tension pneumocephalus. In one patient, this was treated by needle aspiration followed by catheter drainage, and the second patient was treated with needle aspiration followed by airway diversion. The first patient recovered fully and was discharged on postoperative day 14; the second patient's mental status did not return to the preoperative level, and he was discharged on postoperative day 23 to a rehabilitative facility. Approximately 3 months later, his level of mentation returned to baseline.Conclusions. Tension pneumocephalus is a potentially devastating complication that may occur after craniofacial resection. It requires prompt recognition and treatment to minimize morbidity. © 1995 Jons Wiley & Sons, Inc.

The incidence of papillary thyroid carcinoma arising in a thyroglossal duct cyst is rare and occu... more The incidence of papillary thyroid carcinoma arising in a thyroglossal duct cyst is rare and occurs in about 1 % of thyroglossal duct cysts. Only 17 such cases diagnosed with fine-needle aspiration biopsy have been previously reported in the English-language literature, with a diagnostic rate of 53%. In this article, the cytologic features of the current case are emphasized and those of the previous reported cases are briefly reviewed. Diagnostic pitfalls of papillary carcinoma arising in thyroglossal duct cysts diagnosed by fine-needle aspiration biopsy are also discussed.

Ontology Neurotology, Feb 28, 1995

Adenomatous lesions of the temporal bone represent a diverse group of neoplasms. At least three h... more Adenomatous lesions of the temporal bone represent a diverse group of neoplasms. At least three histopathologic patterns have been described: glandular; ribbon-like, or "festooning;" and aggressive papillary. Combinations of glandular and ribbon-like histologies in the same lesion are not uncommon. The glandular and ribbon-like histologies have been associated with carcinoid tumors, and the aggressive papillary tumor has been considered a separate entity. Recently, the endolymphatic sac has been proposed as the site of origin of the aggressive papillary lesions. Previous reports have described neuroendocrine properties with characteristics embracing the three histologic types. The authors postulate that the neural crest is the site of origin of this unusual group of neoplasms. Immunohistochemical analysis on the pathologic specimens of patients with adenomatous lesions of the temporal bone was performed to test this hypothesis. From 1975 to 1992 seven patients were treated at the Cleveland Clinic Foundation with a diagnosis of middle ear adenoma. A panel of special stains for neuroectodermal markers, including synaptophysin, chromogranin, neuron specific enolase, calcitonin, and serotonin was used on the paraffin-embedded formalin-fixed specimens. Three lesions were also evaluated by electron microscopy, all demonstrating dense core, intracytoplasmic granules. Three ribbon-like tumors were positive for synaptophysin and chromogranin, and two of these were positive for serotonin. One glandular tumor was positive for synaptophysin, and an aggressive papillary tumor was positive for synaptophysin and neuron specific enolase. An additional papillary tumor was referred following a third recurrence without accompanying immunohistochemical data. Cholesteatoma-like material was identified with a few glandular cells interspersed, all negative by immunohistochemical evaluation. The seventh specimen, initially diagnosed as papillary adenoma on light microscopy, was not studied by the aforementioned stains, and was later identified as a papilloma of sinonasal origin. The neural crest gives rise to pluripotential stem cells with widespread anatomic distribution, including the temporal bone. Because immunomarkers used in this study are specific for neuroectodermal differentiation, results suggest that temporal bone adenomas have neuroendocrine characteristics and could be derived from the specialized neuroectoderm of the neural crest.

Archives of Otolaryngology Head and Neck Surgery, Feb 1, 1994

A variety of systemic diseases may manifest with laryngeal symptoms. Cricoarytenoid arthritis wit... more A variety of systemic diseases may manifest with laryngeal symptoms. Cricoarytenoid arthritis with or without limitation of vocal fold motion is an example. It has been described in up to 25% of rheumatoid patients. Ankylosing spondylitis is classified among the seronegative spondylarthritides. Besides its systemic features, rare reports of cricoarytenoid involvement have been published. Six previous cases reported have been characterized by a long history of ankylosing spondylitis before the cricoarytenoid joint involvement occurred. We describe only the seventh case of cricoarytenoid arthritis secondary to ankylosing spondylitis and the first patient (to our knowledge) to present with bilateral vocal fold fixation as the initial presenting symptom.

Archives of Otolaryngology - Head and Neck Surgery

Current Opinion in Otolaryngology & Head and Neck Surgery, 1996

Facial Plastic Surgery, 1996

The functional and aesthetic consequences of ablative head and neck oncologic surgery pose a sign... more The functional and aesthetic consequences of ablative head and neck oncologic surgery pose a significant challenge to the reconstructive surgeon. With the advent of microvascular free tissue transfer the reconstructive capabilities of the surgeon have been greatly expanded. The rectus abdominis musculocutaneous free flap has assumed an important role in contemporary head and neck reconstruction because of its ease of dissection, length and size of the vascular pedicle, convenience of harvest in the supine position, reliability and versatility, and low donor site morbidity.

The Laryngoscope, 1993

The rising popularity of surgery involving the laryngeal framework (surgical medialization of imm... more The rising popularity of surgery involving the laryngeal framework (surgical medialization of immobile vocal folds, vocal fold tightening, pitch variation, etc.) has resulted in increasing case experience. Little has appeared in the literature regarding complications or long-term results of this type of surgery. Several years' experience in a major referral center with various types of laryngeal framework surgery has led to a small number of complications. These have included late extrusion of the prosthesis and delayed hemorrhage. A review of these complications and recommendations for modification of technique to minimize them in the future are discussed.

The Laryngoscope, 1992

Twenty-six patients underwent computed tomography (CT) and magnetic resonance imaging (MRI) of sk... more Twenty-six patients underwent computed tomography (CT) and magnetic resonance imaging (MRI) of skull base lesions at the Cleveland Clinic Foundation. CT provided improved bone detail, documenting invasion of the lamina papyracea, orbital floor, fovea ethmoidalis, cribriform plate, pterygoid plates, hard palate, and skull base. MRI defined invasion of the orbit, dura, brain, and cavernous sinus. Improved soft-tissue-tumor interface was evident on MRI. MRI was superior to CT in determining carotid artery involvement. MRI distinguished between tumor and retained secretions in the paranasal sinuses. Combining radiographic tumor staging reliably predicted surgical findings; however, MRI consistently yielded sufficient diagnostic information and the additional expense of performing two imaging procedures may not be justified.

The American Journal of Surgery, 1994

We reviewed the records of 27 patients who underwent primary mandibular reconst~'uction outcome a... more We reviewed the records of 27 patients who underwent primary mandibular reconst~'uction outcome and with AO plates to investigate the n complications of this procedure. Immediate soft-tissue flap coverage was required in 26 patients. Early complications were seen in 44% of the patients, with the highest incidence after irradiation (P ffi 0.02). Late complications were mostly t~elated to Dlmor recurrence (12). Late complications not associated with recurrence were persistent pain (2), minor infections (3), plate exposure (3), and plate fracture (l). Good to excellent cosmetic results were obtained in all but 1 patient. Full mastication was not possible for any of our patients, and therefore function was not fully restored. Speech and deglutition were mostly influenced by the amount of soft-tissue resection. Mean follow-up was 20 months (rnnge 3 to 52). At last evaluation, 12 patients were alive and free of disease, and 15 were dead of disease or other causes. Our results show that primary mandibular reconstruction with rigid plates is a safe, effective, and reliable technique to restore mandibular continuity and cosmesis. For lateral defects, this method is a viable alternative to free vascularized osseocutaneons flaps.

Otolaryngology - Head and Neck Surgery, 1997

view of the literature during the past century documents only two case reports confirming the cli... more view of the literature during the past century documents only two case reports confirming the clinical disappearance of squamous carcinoma without treatment. We report a case of the spontaneous disappearance of a recurrent laryngeal carcinoma after biopsy-proven recurrence. The radiologic studies, pathology slides, and serial clinical photographs of the lesion are presented.

Otolaryngology - Head and Neck Surgery, 1995

Educational objectives: To better understand the preoperative and intraoperative risk to the inte... more Educational objectives: To better understand the preoperative and intraoperative risk to the internal carotid artery in neck and skull base surgery and to work more closely and knowledgeably with their neurovascular surgical colleagues in combined cases.

Otolaryngology - Head and Neck Surgery, 1995

... Disorders, Cleveland Clinic Foundation; ... Next Section. CASE REPORT. A 55-year-old man admi... more ... Disorders, Cleveland Clinic Foundation; ... Next Section. CASE REPORT. A 55-year-old man admitted to the intensive care unit at the Cleveland Clinic Foundation after full cardiac arrest, cardiopulmonary resuscitation, and intubation was started on heparin (1000 U/hour). ...

Head & Neck, 1995

Background. The craniofacial approach is a reliable method for excising tumors involving the ante... more Background. The craniofacial approach is a reliable method for excising tumors involving the anterior skull base. Advances in technique have minimized complications. Although cerebrospinal fluid leaks and meningitis are wellknown complications, tension pneumocephalus is not well described. We review two cases and discuss the pathophysiology, clinical manifestations, radiographic features, and treatment of tension pneumocephalus.

Head & Neck, 1996

To identify factors predicting prosthesis use and final speech quality in patients undergoing sec... more To identify factors predicting prosthesis use and final speech quality in patients undergoing secondary tracheoesophageal puncture (TEP) for voice restoration alter laryngectomy. We undertook a retrospective study of 168 patients who underwent secondary TEP at the Cleveland Clinic between June 1980 and October 1993. Factors examined were: patient demographics, extent of initial surgery, method of pharyngeal preparation, history of irradiation, insufflation test results, pharyngeal stricture, and concurrent medical conditions. Univariate and multivariate statistical analyses were performed to identify predictive factors. At last evaluation, 73.8% (124) of the patients were still using the prosthesis. Quality of speech was the only predictor of prosthesis use (p < .001). Phonation on the first day was achieved in 90% (151) of patients. Speech result improved significantly over the first 6 months (p < .001). Univariate analysis found that the need for reconstruction at laryngectomy (p = .04), the presence of pharyngeal stricture (p = .001), and continued prosthetic use (p < .001) were associated with the speech result. There was no significant advantage to the lack of approximation of the pharyngeal constrictors (p = .31). Stepwise logistic regression showed that only the absence of pharyngeal stricture was associated with a better-quality voice (p = .001). Tracheoesophageal puncture is a reliable method for restoring voice after laryngectomy. Prosthesis use decreases with time, and good voice quality is the only predictor of continued prosthesis use. In this series the absence of pharyngeal stricture was the only significant predictor of good to excellent speech.

Head & Neck, 1994

Background. Nasopharyngeal carcinoma has a variety of presentations. However, in more than 50% of... more Background. Nasopharyngeal carcinoma has a variety of presentations. However, in more than 50% of cases it may present with serous otitis or cervical metastases. Although the metastases usually occur in the neck, the lymphatic network of the parotid may also serve as a site for the metastatic deposits. We present a case in which the initial manifestation of nasopharyngeal carcinoma of the lymphoepithelioma type was a parotid mass.

Head & Neck, 1996

The purpose of this study was to evaluate our experience with the diagnosis and management of tum... more The purpose of this study was to evaluate our experience with the diagnosis and management of tumors of the parapharyngeal space (PPS), with particular emphasis on the evolving role of magnetic resonance imaging (MRI). A case series review of 51 patients with parapharyngeal tumors who underwent surgical excision between 1980 and 1992 were analyzed with regard to presenting signs and symptoms, histologic diagnosis, imaging technique (computed tomography [CT] versus MRI), surgical approach, and outcome. Fifty-one patients underwent surgical excision of a parapharyngeal tumor of which the vast majority (78%) were benign neoplasms. Compared with benign neoplasms, the malignant tumors were much more likely to be associated with pain, trismus, and a cranial nerve deficit. MRI was able to locate the tumor in 20 of 21 patients (95%), while CT was able to localize the tumor in 32 of 38 patients (84%). MRI, because of its superior soft-tissue resolution and ability to provide imaging in multiple planes, is the imaging modality of choice to diagnose neoplasms of the parapharyngeal space. Because most of these tumors are benign, MRI allows the surgeon to select the surgical approach with the least morbidity.

Head & Neck, 1993

Although metastatic neoplasms in the head and neck are rare compared to primary head and neck neo... more Although metastatic neoplasms in the head and neck are rare compared to primary head and neck neoplasms, metastatic breast carcinoma has been described at numerous sites in the head and neck region. Two cases of breast carcinoma metastatic to sites in the head and neck are reported. In one case a laryngeal metastasis represented the first manifestation of recurrent breast cancer. The second case, a nasal metastasis, was unsuspected and was treated as cellulitis. The presentation of metastatic breast carcinoma to the head and neck may in fact be atypical, posing a diagnostic dilemma. These cases illustrate the importance of past medical history and the high index of suspicion in patients with a history of prior malignancy. Q 1993 John Wiley & Sons, Inc. HEAD & NECK 1993;15:257-262