\s=b\Merkel cell carcinoma, also known as endocrine carcinoma of the skin, is a recently recognized and particularly aggressive form of skin cancer that exhibits histologic features similar to those of endocrine malignant neoplasms arising from other tissues. Forty-one patients with Merkel cell carcinoma arising from the cutaneous surfaces of the head and neck were seen at the University of Texas M. D. Anderson Hospital, Houston, between 1966 and 1983. Regional lymph node metastasis occur early and frequently, with a 79% overall incidence observed during the course of the disease. Treatment should consist of a wide resection of the primary tumor. A regional lymphadenectomy, when feasible, is successful in controlling nodal metastases. Postoperative radiation is recommended as an important adjuvant. (Arch Otolaryngol 1984;110:707-712) Merkel cell carcinoma, or endo¬ crine carcinoma, originating in skin is a particularly aggressive form of skin cancer believed to arise from the neurotactile, epidermal Merkel

A prospective longitudinal study of shoulder function after 103 neck dissections involving either preservation or sacrifice of the spinal accessory nerve is presented. The postoperative evolution and course of trapezius muscle denervation and resultant shoulder dysfunction were objectively determined for both radical and modified nerve sparing neck dissections. All patients were enrolled in a program of physical therapy aimed at maintaining range of motion at the shoulder joint. Shoulder function was examined preoperatively and for 12 months postoperatively with manual muscle strength testing, range of motion measurements, and electrodiagnostic testing. Results indicate that modified nerve sparing dissections are followed on the average by a significant, but temporary and reversible phase of shoulder dysfunction. By comparison, radical neck dissection is followed by profound and permanent trapezius muscle weakness and denervation. HEAD & NECK SURGERY 8:280-286 1986We gratefully acknowledge the technical collaboration of

Frontal sinus infections can spread to the intracranial space so fast that the clinical situation often becomes far advanced before a complication is recognized. Retrograde septic thrombophlebitis is the most common pathway of extension. A review of recent experiences with fulminating frontal sinusitis and its intracranial complications such as subdural empyema, brain abscess, epidural abscess, and meningitis is presented. Neurologic features of intracranial invasion are interpreted. Good results have been achieved by immediate and aggressive surgical and medical measures.

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Knowledge of osteotomy technique is essential to rhinoplasty. Using cadaver specimens, in addition to clinical observation, a safer method of osteotomy was acquired. Discussion of anatomy with reference to medial and lateral osteotomy follows. Several safety tips for each type of osteotomy are given.