Mucormycosis

Three cases of mucormycosis are presented; two with unusual aspects: one with previously unreported involvement of the mandible, and one presenting as a cavernous sinus thrombosis. Review of the literature reveals a limited number of survivors. Survival in two of the cases presented here suggests that early diagnosis, aggressive therapy with surgery, and amphotericin B should improve the prognosis.

Nasopharyngeal angiofibroma

Nasopharyngeal angiofibromas have traditionally been difficult tumors to manage. Their extreme vascularity has led to excessive bleeding during surgical removal, which often obscured the surgical field and contributed to high recurrence rates because of incomplete removal. High recurrence rates have also been due to failure to recognize the full size and extent of these tumors preoperatively by routine physical examination and X-ray techniques. A combined experience of the authors with over 45 cases from the University of Michigan and the University of California, San Francisco, is presented to review the problems in management of these tumors and to present techniques of diagnosis and management which have been used to overcome some of these problems. The most important advances in diagnosis have been the radiographic techniques of laminagraphy and carotid angiography. Previously unrecognized tumor extensions into the areas surrounding the nasopharynx have been quite clearly demonstrated by these techniques. Improved surgical treatment of these tumors by wider surgical exposure and removal, utilizing multiple approaches when necessary, and by better control of bleeding by ligation and embolization of the main arterial supply, has led to fewer recurrences.

The role of otolaryngology in primary care practice. Report of a survey

A survey was conducted to assess how family practitioners rated certain knowledge skills and procedures in the field of otolaryngology. A questionnaire was designed as the instrument of the survey, and family practitioners were asked to complete the questionnaire based entirely on their experience in practice. The results of the survey showed that the practitioners considered that the majority (64%) of the items ranged from necessary to imperative. A highly consistent response was obtained. We discuss implications for curriculum design based on such surveys.

Conservative management of Méniére's disease: Furstenberg regimen revisited

This study reviews twenty years' experience at the University of Michigan with 500 consectutive patients suffering from symptoms of Méniére's disease. An especially strong tradition of medical therapy of Méniére's disease has prevailed at the University of Michigan because of the influence of Albert C. Furstenberg, who developed and promoted the Furstenberg regimen of a low-sodium diet and diuretics. It has been our distinct clinical impression over the years that the Furstenberg regimen has been quite satisfactory in relieving the most disturbing symptoms of Méniére's disease in the vast majority of cases and often in patients who have failed other treatment programs. This study quantifies, as much as possible, our extensive experience with this disease and confirms for us the efficacy of this treatment. Relatively few operative procedures have had to be performed for conservative treatment failures in our hands. The success of this conservative management program has been largely dependent upon the strict adherence by the patient to a professionally prescribed, low-sodium diet. Occasional patients with chronic symptoms which are refractory to medical management continue to be a problem, particularly since it is in this group of patients that bilateral involvement tends to ultimately occur.

Chordomas: nasopharyngeal presentation and atypical long survival

Atypical clinical and pathological features of a cranio-cervical chordomas have prompted a review of these neoplasms at the University of Michigan Medical Center. Contrary to prior investigations, 92% of the spheno-occipital chordomas reported in this study clinically presented with a nasopharyngeal or intranasal mass. This high incidence indicates the requirement for an otorhinologic examination on all patients presenting with the neuro-ophthalmologic syndrome and roentgenologic findings characteristic of chordomas in this anatomical region. Special attenion is called to a histologically distinctive variant of chordoma - the "chondroid chordoma.' Apparently restricted to the cranio-cervical region, this variant has been associated with long survival.

Carcinoma in pleomorphic adenomas of salivary glands

Because of the variability of the histological appearance of a given mixed tumor of the salivary gland and because of “recurrences” following less than total removal, biologically benign (not capable of metastasis) mixed tumors have been considered malignant. The true malignant mixed tumor, or more commonly carcinoma, arising from preexisting mixed tumors are unusual and ill-defined in the literature. These tumors make up no more than 5% of the mixed tumor category and occur primarily in the parotid gland. In this report, we present a clinico-pathological appraisal of the malignant mixed tumor based on five cases from the University of Michigan Medical Center and relate our experience to that in the literature. The importance of recognizing the malignant mixed tumor, or “carcinoma ex-mixed tumor,” lies in the accelerated recurrence rate and surprisingly high metastatic rate manifested by this lesion. Minimal treatment is radical total excision. Wide, early excision of the primary “benign” stage of these mixed tumors should reduce the problem of ultimate “malignification.”