Twenty-six patients diagnosed as having hematologic neoplasms were evaluated clinically and radiographically for the presence of sinus disease before receiving immunosuppressive therapy. Evaluations included basic clinical information, a thorough otolaryngologic history and endoscopic examination of the nasal cavity. Plain sinus films and paranasal sinus computed tomography (CT) scans were obtained on all patients. These patients were then followed for 1 year. Ten patients ultimately developed acute sinusitis, as documented by their symptoms and by CT scan: five of these patients required surgery, and three ultimately died. Potential risk factors for sinusitis were analyzed statistically. We found a significant correlation between preimmunosuppression CT scans indicating either chronic sinusitis or anatomic abnormalities and the development of sinusitis. Also multiple anatomic abnormalities on endoscopic diagnostic nasal examinations tended to identify individuals susceptible to sinusitis. Such patients who subsequently became neutropenic and had acute episodes of sinusitis tended to have a poor outcome. Those who developed fungal sinus infections were prone to have a fatal outcome. This study suggests that patients with hematologic neoplasms who are susceptible to the development of acute sinusitis should be identified before receiving immunosuppressive chemotherapy.

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Tracheoesophageal puncture (TEP) is a highly successful procedure for voice restoration. Occasionally, however, patients fail to achieve satisfactory voice or develop salivary leakage through the fistula into the trachea. Closure of the TEP is then necessary. In most cases, spontaneous closure occurs once the prosthesis has been removed. When the fistula does not close spontaneously, surgical closure is indicated to prevent aspiration and pulmonary complications. We describe a three-layer technique that employs interposition of dermal graft. The technique was used on 14 patients over a 7-year period. Most patients received irradiation to the neck. Complete closure was achieved in 13 of 14 cases; 1 patient developed partial breakdown of the closure. Our technique is relatively easy to perform and has a high success rate (92%). Irradiation did not adversely affect the closure rate.

There is general concern among otolaryngologists that irradiation of a stainless steel prosthesis used in mandibular reconstruction may cause irradiation overdosage to adjacent tissues. A tissue-equivalent plastic/steel model, simulating the characteristics of a stainless steel, reconstructed mandible, was irradiated and measurements were made with a parallel plate ionization chamber. The results of our measurements show that irradiation of an implanted steel plate results in an overdosage (120%) "in front" and an underdosage (80%) "behind" the steel plate. The regions of overdosage and underdosage are 2 to 3 mm thick. The overall dose modification is greatly reduced when two opposing fields are used. We conclude that irradiation of a stainless steel, reconstructed mandible with a 6-mV photon beam through opposing fields does not significantly alter the amount of radiation delivered to surrounding tissues.

\s=b\The transfacial approach to the anterior cranial fossa for tumor removal provides for excellent surgical exposure, improved postoperative appearance, and a minimum of complications. The technique is different from previously reported combined craniofacial ablative procedures in that the head and neck surgeon and the neurosurgeon approach the anterior fossa mass through the same facial incision, thus avoiding the need for a separate craniotomy incision. The formation of a vascularized nasofrontal bone flap allows for better wound healing regardless of preoperative and postoperative radiotherapy and/or chemotherapy. This report presents 42 cases in which the transfacial approach was exclusively used in a combined manner to remove nasal, paranasal sinus, and nasopharyngeal neoplasms. The transfacial technique offers a significant advantage over previously described approaches to the anterior skull base. (Arch Otolaryngol Head Neck Surg 1989;115:301-307) Crani ofaci al surgery for tumor resection was introduced in 1941, when Walter E. Dandy,1 a neurosurgeon, published his text on neuro¬ surgical operative techniques that were used to resect orbital tumors. Dandy1 advocated the concept of extending the resection of orbital tumors into the central nervous sys¬ tem where they most frequently failed. This concept was furthered at first by Ray and McLean2 and later by Tym3 to improve the operative cure rate with retinoblastomas.