The Laryngoscope
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The occult primary is a problem well known to head and neck surgeons. Less frequently discussed, but well documented, is cystic degeneration of metastatic nodes. When these conditions combine, they can suggest tumor arising in a pre-existing cervical cyst. This is a controversial condition, rare if it occurs at all, and is not to be invoked lightly.
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Patients with head and neck cancer frequently suffer from chronic obstructive pulmonary disease and arteriosclerotic cardiovascular disease, making them poor risks for anesthesia. Arrhythmogenic inhalation anesthetics along with assisted ventilation used in general anesthesia further complicate the intraoperative, as well as the postoperative, course. Cervical epidural anesthesia has been employed in a number of cases of breast and upper thoracic surgery at Walter Reed Army Medical Center with remarkable success. ⋯ We described the use of cervical epidural anesthesia for a neck dissection. The technique of placing 0.5% Marcaine at the level of C7-T1 is described. Indications, limitations, complications, and the potential uses of cervical epidural anesthesia in head and neck cancer patients are discussed.
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Comparative Study
Comparative study in tympanoplasties with nitrous oxide anesthesia.
A number of intra and postoperative accidents in close cavity surgery when using nitrous oxide have been reported. In order to check the influence of nitrous oxide anesthesia in tympanic surgery, 38 patients were operated on by the usual techniques in middle ear surgery. Half the patients received continuous nitrous oxide inhalation throughout the procedure while, in the remaining cases, the anesthetic gas was suspended 30 minutes before applying the tympanic graft. Audiological differences in both groups, as controlled at 6 and 12 months, were negligible.
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Randomized Controlled Trial Clinical Trial
Antimicrobial prophylaxis for contaminated head and neck surgery.
The use of antibiotic prophylaxis in head and neck surgery is controversial. Most surgeons agree that when surgery requires entry into the aerodigestive tract through the skin the wound is by definition contaminated and antibiotic prophylaxis is indicated as it is in other contaminated wounds. There is no general agreement as to which antibiotic or combination of antibiotics to use or what the schedule of dosage administration should be. ⋯ Multifactorial analysis demonstrated that patients whose surgery included repair with a regional pectoral flap had a statistically significant increased chance of developing postoperative wound infection (P less than .05). Patients undergoing laryngectomy, with or without neck dissection, were at less risk of postoperative infection tham patients undergoing oropharyngeal resection (P less than .05). The preoperative existence of tracheotomy or prior radiation therapy had no demonstrable effect on the incidence of wound infection postoperatively in this study.