A major complication of head and neck cancer surgery following radiation and extensive resection is pharyngocutaneous fistula. A retrospective analysis of 36 fistula patients out of 376 major head and neck procedures between January 1971 and July 1973 revealed certain guidelines for improved clinical management. Since a large discrepancy existed in the incidence of fistulas between the different surgical procedures, each operative group was examined separately. The incidence, predisposing factors, and methods of treatment for this complication following composite jaw-neck resections and various laryngeal procedures are analyzed and discussed.

Pediatric vocal cord paralysis accounts for approximately 10% of all congenital laryngeal lesions. Early detection of these neurogenic disorders is based upon a high index of suspicion and is important to prevent catastrophes during periods of acute respiratory embarrassment. This paper reviews the symptoms, etiology and management of unilateral and bilateral vocal cord paralysis as it pertains to this age group. A case is presented of a neonate with vocal cord paralysis and associated hydrocephalous and meningomyelocele to illustrate many of the problems associated with pediatric laryngeal paralysis.

Introduction: In an effort to study the changes of subcutaneous fat after exposure to a low-level diode laser and tumescent infiltration, the magnetic resonance imaging (MRI) findings are presented. The subcutaneous abdominal fat is exposed for 4 and 6 minutes irradiation time. This has previously been studied using a scanning electron microscope. The anatomical characteristics of the superficial and deep fat previously described by other authors are correlated with the scanning electron microscope and MRI. The changes in the characteristics of the fat before and after tumescence and before and after application of the low-level diode laser are shown. Materials and Methods: By using MRI techniques, 3 patients were evaluated prior to infiltrating the subcutaneous tissue with tumescent fluid with T1 and T2 sequences. The same patients were evaluated again after applying or infiltrating the tumescence and again after exposure using the low-level laser beam for 4 and 6 minutes. Conclusion: The MRI showed no laser exposure in the T1 sequence; the adipose tissue, both superficially and deep, appears to have a bright signal and is homogenously distributed. After 4 minutes of laser exposure, the T1 sequence demonstrated that the adipose tissue is partially coalescent and has changed its signal. After 6 minutes of laser exposure, the MRI demonstrated that the adipose tissue is much more coalescent and is blurred. The fatty density and organization seems to have changed completely after exposure to the laser beam for this period of time. (The scanning electron microscope revealed that at this particular time 100% of the fat was in the interstitial space and the transitory pore was now open.) The MRI evaluation of the subcutaneous fat seems to correlate well with the findings of the scanning electron microscope, showing that there is a definite change in the consistency of the subcutaneous fat following exposure to the low-level electronic diode laser.

Introduction: The purpose of this IRB approved, multicenter, partially double-blind study was to determine the effectiveness of low-level laser-assisted liposuction in decreasing the patients' degree of postoperative discomfort, reducing swelling, enhancing wound healing at surgical entry points, decreasing the use of recovery medications for pain management, facilitating fat extraction for the surgeon, enhancing the emulsification of extracted fat, and decreasing surgical time spent to obtain optimal results. Materials and Methods: The Erchonia EML, 635-nm, 14-mW dual-diode low-level laser was used to irradiate the target tissue for 12 minutes after infiltration of tumescent fluid. Results: Of the 36 test-group patients who received laser treatment, 75% met their major success criteria compared with 32% of the 34 placebo-group patients who received “fake” treatment. Success criteria were defined as at least a 30% difference between groups. Forty-three percent more of the test subjects than placebo subjects met success criteria, exceeding the target by 13%. Discussion: The Erchonia EML Laser is an effective device for assisting liposuction procedures with low-level laser therapy. It significantly enhances the ease of performing liposuction procedures; reduces the time in surgery; enhances the ease of facilitating fat extraction; enhances the emulsification of extracted fat; facilitates the recovery process; decreases the patients' degree of postoperative discomfort, decreases swelling; and decreases the use of recovery medications for pain management for patients undergoing body contouring in the areas of the thighs, hips, and stomach.

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