No abstract

During the most recently completed academic year (July 1969 to July 1970), 24 laryngectomies were performed for squamous cell carcinoma of the larynx. Twenty‐two of these laryngectomies followed high‐dose preoperative radiotherapy. Of this latter group, 14 represented a planned course of preoperative radiotherapy (5,000 rads in 5 weeks) followed by laryngectomy after a waiting period of 4 to 6 weeks. The remaining eight cases represented the surgical salvage of radiation failures. No mortality or major complications were recorded. Five minor complications were noted; however, of this group, none required a second surgical procedure, and, in all cases, a well‐healed surgical field was obtained. With careful teletherapy and meticulous surgical technique, it is possible and feasible to perform low morbidity major head and neck surgery on heavily irradiated tissues.

High dose pre‐operative radiotherapy has played an increasing role in the treatment of advanced cancer of the larynx at the University of Virginia Hospital since 1966. The results of treatment of 72 cases treated in this fashion are compared with 151 cases treated by surgery alone. Employing the actuarial method for calculating survival, there would appear to be a distinct improvement in the group receiving pre‐operative radiotherapy. Local recurrence was reduced to 15 percent following radiotherapy from a level of 30 percent with surgery alone; however, this is a retrospective study, and the two groups are not strictly comparable by age, sex and race. Comparison by stage demonstrates that the more advanced cases received pre‐operative radiotherapy. Morbidity from the combined approach was not increased with a dose of 5,000 rads delivered in five weeks.

No abstract

The two major indications for common or internal carotid ligation are the resection of neoplasm and the control or prevention of hemorrhage. Sixty percent of those undergoing elective carotid li ation and 12% of those undergoing emergency ligation survive these procedures without eviience of neurological sequelae. This uncompromised survival is based upon the presence or rapid developmnt of collateral circulation to the cerebral vascular bed. Arteriographic studies are utilized to illustrate the development of intra-and extracranial collateralization to the internal carotid artery after interruption of the ipsilateral common carotid. The major collateral circuits demonstrated via a case report are as follows: 1) from the vertebral artery to the external carotid and hence to the internal carotid; 2) from the posterior communicating artery to the internal carotid; and 3) from the ophthalmic artery to the internal carotid.