Little information is available about the effect of childhood atopic dermatitis (AD) on family function. The aim of this study was to identify the areas of family life most affected and their perceived importance. Intensive qualitative interviews with 34 families were conducted and 11 basic problem areas were identified. A detailed questionnaire was prepared, part of which addressed the perceived importance of particular issues using the framework of multi-attribute utility theory. The results from using this questionnaire in 41 families were analysed and a shorter 10-question one-page Dermatitis Family Impact (DFI) questionnaire designed (maximum score = 30). In affected families the mean DFI score was 9.6 +/- 7.0 (range 0-27, n = 56) and in unaffected families the mean score was 0.4 +/- 0.9 (range 0-3, n = 26, P < 0.0001). The DFI could potentially be used as an extra measure in clinical studies, or to help guide appropriate management of AD.

We compared measurements of glottic area obtained by acoustic reflection technique with anatomically equivalent area measured from computerized tomographic (CT) scans of the neck in 11 subjects with glottic pathology. Both measurements were performed in the supine position during tidal breathing at functional residual capacity. We found excellent agreement in glottic areas obtained by both methods: the mean (+/- SD) values were 1.8 +/- 0.8 cm2 for the acoustic method and 1.7 +/- 0.9 cm2 for the CT method. Linear regression analysis revealed the following relationship between the area measured by acoustic technique (AAC) and that measured by CT (ACT): AAC = 0.81.ACT + 0.36. There was a significant correlation between the two measurements of glottic area (r = 0.95, P less than 0.0001). We conclude that the acoustic reflection technique may be used reliably in clinical and physiological studies concerned with glottic geometry.

This report reviews experience with radiation therapy in 77 patients with melanoma of the head and neck, a lesion traditionally but incorrectly considered to be radiation-resistant. Thirteen patients with lentigo malignum and 18 patients with lentigo malignum melanoma have been primarily irradiated. In 11 of the 13 patients, the lentigo malignum has been locally controlled with no recurrence from 6 months to 5 years following treatment. One patient had a local recurrence and was salvaged with further radiation therapy, and one patient had residual tumor after irradiation and was salvaged with simple excision. Seventeen of 18 patients primarily irradiated had lentigo malignum melanomas that have been locally controlled from 6 months to 6 years after irradiation. One patient had a local recurrence and was salvaged by excisional surgery. There have been no deaths from lentigenous melanoma, and the cosmetic results of treatment are excellent. We concluded that radiation therapy is a simple, effective out-patient treatment for lentigo maligna and lentigo maligna melanoma. Nonlentigenous melanoma was irradiated after incisional biopsy in 6 patients; local control was obtained in 4 patients although l died of distant metastases. Fifteen patients were irradiated after excisional biopsy (margins inadequate); 14 of 15 had local control although 6 died of metastases. Only 2 of 16 patients irradiated for recurrent melanoma were controlled. Analysis of local control versus irradiation fraction size revealed that 17/24 (71%) achieved local control with a dose per fraction of greater than 400 rad as compared with 3 of 12 (25%) in those being irradiated with a dose of less than 400 rad per fraction. We concluded that nonlentigenous melanoma is not radiation resistant and that local excision followed by radiation therapy with a large dose per fraction deserves further study, particularly in melanomas of the head and neck where wide local excision is not possible due to age of the patient or location of the tumor. Nine

The pectoralis major myocutaneous flap has become the mainstay of major oral cavity reconstruction. The flap pro¬ vides excellent soft-tissue bulk and cavity or surface lining for major defects. There is a high rate of primary take. However, the flap has some deficiencies. A group of patients were identified that are likely to have less than ideal results with the pec¬ toralis major myocutaneous flap tech¬ nique. In these cases, the flap has been modified and amnion has been added. Initial results indicate enhancement of reconstruction with the modified tech¬ nique. (Arch Otolaryngol 1985;111:230-233) Si nce its advent, the pectoralis major myocutaneous flap has become the mainstay of reconstruc¬ tive techniques in major defects of the oral cavity.1 The flap is an excellent method of obtaining soft-tissue bulk and oral lining for a one-stage reconWing, Toronto Western Hospital, Toronto, Cana¬ da M5T 2S8 (Dr Lawson). structive procedure. Use of the flap in oral cavity reconstruction is generally well accepted by patients because of the low rate of associated morbidity, and the excellent functional and cos¬ metic results. The flap is particularly useful in patients who have received a prior course of radical irradiation. It has the advantage of being harvested outside the therapeutic radiation field.As with any reconstructive tech¬ niques, there are trade-offs. The trade-offs with pectoralis major myo¬ cutaneous flaps, in oral cavity recon¬ struction, range from scarring and loss of bulk of the chest wall, to mal¬ position of the female breast, to weak¬ ness of the shoulder girdle, to hair growth and excessive bulk in the oral cavity. The excessive bulk is due to adipose tissue or breast parenchyma that is interposed between the cutane¬ ous and myogenous aspects of the flap. Usually the deficiencies with the pectoralis major myocutaneous flap reconstructive techniques can be reduced with secondary procedures such as debulking of the oral cavity or augmentation and repositioning of the female breast. The natural history of the cutaneous portion of the flap is such that the epithelium changes from keratinizing to nonkeratinizing epithelium resulting in a pseudomucous membrane consistency with time. This often results in a reduction of hair growth as well.The pectoralis major myocutaneous flap design is such that there is a very low rate of total flap necrosis. Howev¬ er, the rate of partial flap necrosis involving the cutaneous portion of the flap is probably in the order of 10% to 15%. Fortunately, the oral cavity has a propensity for healing by secondary intent. Accordingly, necrosis of the cutaneous component of the pectoralis major myocutaneous flap is usually not a major disaster in terms of wound dehiscence, salivary fistulization, or secondary exposure and rup¬ ture of major vessels. However, if a Fig 1.-Liquefactive necrosis of skin (NS) of pectoralis major myocutaneous flap placed in anterior aspect of mouth floor.

No abstract