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Laser lithotripsy: A preliminary study on its application for sialolithiasis
224 of 11 mm to 20 mm after surgery in the dentate patient. Improvement in IDD and reduction of clinical symptoms were found to be statistically significant using a paired ttest. Eminectomy was reported to be a safe, simple method of relieving a closed lock of the TMJ, although not recommended for pain relief only. A course of conservative treatment including joint physiotherapy was recommended preoperatively and postoperatively.--GusTAvo PENA-VELASCO, M.J. RISSER Reprint requests to Dr Stassen:Departmentof Oral and Maxillofacial Surgery, SunderlandDistrict General Hospital, Kayll Road, Sunderland SR47TD, England.
Fine Needle Aspiration Cytology of Salivary Gland Lesions. Jayaram G, Verma AK, Sood N, et al. J Oral Pathol Med 23:256, 1994 A total of 247 palpable salivary gland lesions were subjected to fine needle aspiration (FNA) cytology. Sixty-eight were designated as non-neoplastic. One hundred seventynine were designated as neoplastic. These neoplastic and non-neoplastic lesions were given final diagnosis based on cytomorphologic characteristics. A brief review of key features of each type of lesion is presented. Of the 179 neoplastic cases, histologic material was available on 143. The overall diagnostic accuracy of FNA cytology was 91% for salivary neoplasms. For malignant tumors, there was a sensitivity rate of 87.8% and a specificity of 98.0%. For benign tumors, there was 100% sensitivity. In experienced hands, the high sensitivity and specificity of FNA cytology makes it a valuable instrument in the diagnosis of salivary gland lesions.--C.E. PEOPLES Reprint requests to Dr Jayaram: Department of Pathology, Faculty of Medicine, University of Malaya, 59100 Kuala Lumpur, Malaysia.
Laser Lithotripsy: A Preliminary Study on Its Application for Sialolithiasis. McGurk M, Prince MJ, Jiang ZX, et al. Br J Oral Maxillofac Surg 32:218, 1994 Technologic advances have reduced the need for surgical intervention in many surgical specialties. In Urology for example, lithotripsy has reduced surgical intervention for removal of calculi to 1% of cases. This preliminary study evaluates in vitro the use of a coumarin dye laser to fragment salivary calculi. Thirteen calculi of various sizes were placed in water and subjected to the pulsed-dye laser at an energy level of 93 mJ/pulse and pulse length of 4 uS. The number of pulses until fragmentation and number of fragments were recorded. Also, two fresh submandibular glands with calculi were studied. Results showed all calculi fragmented between 5-463 pulses. The number of pulses and number of fragments did not correlate. Histologic examination of the ducts adjacent to the calculi showed inflammation without evidence of ductal damage from the laser. In conclusion, it appears likely that laser lithotripsy will play a future roll in management of salivary calculi.--G.T. LYNAM Reprint requests to Dr McGurk: Department of Maxillofacial Surgery, Floor 24 Guy's Tower, Guy's Hospital, London SE1 9RT.
Warthin's Tumor: A 40-Year Experience at The Johns Hopkins Hospital. Yoo GH, Eisele DW, Askin FB, et al. Laryngoscope 104:799, 1994
CURRENT LITERATURE This retrospective study reviewed 132 patients with Warthin's tumor from July 1952 to June 1992. The authors reviewed the surgical pathology specimens and hospital records. There were a total of 90 men (68%) and 42 women (32%). The percentage of women in each decade was shown to increase from 21%, 29%, 31%, and 39% over the 40-year span. Thus, the men-to-women ratio decreased from 3.8, 2.5, 2.3, and 1.6 over the studied time span. Overall, there were 120 Caucasian patients (91%), 11 African American patients (8.3%), and 1 Asian American patient (0.8%). The percentage of African Americans with Warthin's tumor increased from 0%, 4.8%, 5.5%, and 16% over the four decades. The average age of the 132 patients was 60.3 years (range, 35 to 84 years). Eighty-eight percent of the men smoked tobacco, whereas 89% of the women smoked tobacco. Of the 132 Warthin's tumors that were reviewed, 119 were found in the parotid gland. Three were located within the submandibular gland. The remaining 10 tumors were found in cervical lymph nodes. A superficial parotidectomy was performed on 106 patients (88%) and a total parotidectomy was performed on eight patients (6.7%). Local excisions was performed on six patients (5%). Five patients (4.2%) had recurrence following a superficial parotidectomy and one patient (0.8%) had recurrence after an inadequate local excision. The authors' data suggest a changing pattern of the incidence of Warthin's tumor in women and in African Americans. The data shows a steady decrease in the men-to-women ratio (3.8, 2.5, 2.3, 1.6) over the 40-year span. The study also demonstrated an association of Warthin' s tumors with smoking (men, 88% and women, 89%). The authors suggest the increased incidence of the tumor in women may be related to increasing incidence of smoking in women over the past four decades. The data also indicate an increasing proportion of African American patients over the 40-year span. The authors agree that the tumor occurs predominately in whites, however, they also may occur in nonwhites. They suggest genetic factors may play a role. Finally, the authors recommend a superficial parotidectomy as the treatment of choice for Warthin's tumor.--K.N. CHow Reprint requests to Dr Yoo: The Johns Hopkins Hospital, Department of Otolaryngology-Headand Neck Surgery, PO Box 41402, Baltimore, MD 21203-6402.
Cervical Necrotizing Fasciitis. Maisel RH, Karlen R. Laryngoscope 104:795, 1994 This report summarizes the diagnosis and treatment of nine cervical necrotizing fasciitis patients between June I, 1992, and January 1, 1993. Presentation included rapidly progressive and painful neck or facial swelling with a dusky or red appearance. Other common symptoms and signs were fever, dysphagia, trismus, and an elevated white blood count with a significant left shift. Five cases were odontogenic, three were pharyngeal in origin, and one developed from a soft-tissue spider bite. The bacteria cultured at surgery were all consistent with the site of origin. All surgical treatment patients were taken to the operating room within 12 hours of admission. The fascial planes of the deep cervical fascia were exposed through wide neck incisions, as a low transverse incision reaching 1 cm below the cricoid. Superior and inferior skin flaps were developed. The fascia surrounding the sternocleidomastoid were identified, and the anterior strap muscles and all other involved planes of the anterior and posterior neck were explored. Grossly abnormal tissue planes were followed until normal tissue was found and serous or cloudy fluid was no longer seen. Findings at sur-
Fine Needle Aspiration Cytology of Salivary Gland Lesions. Jayaram G, Verma AK, Sood N, et al. J Oral Pathol Med 23:256, 1994 A total of 247 palpable salivary gland lesions were subjected to fine needle aspiration (FNA) cytology. Sixty-eight were designated as non-neoplastic. One hundred seventynine were designated as neoplastic. These neoplastic and non-neoplastic lesions were given final diagnosis based on cytomorphologic characteristics. A brief review of key features of each type of lesion is presented. Of the 179 neoplastic cases, histologic material was available on 143. The overall diagnostic accuracy of FNA cytology was 91% for salivary neoplasms. For malignant tumors, there was a sensitivity rate of 87.8% and a specificity of 98.0%. For benign tumors, there was 100% sensitivity. In experienced hands, the high sensitivity and specificity of FNA cytology makes it a valuable instrument in the diagnosis of salivary gland lesions.--C.E. PEOPLES Reprint requests to Dr Jayaram: Department of Pathology, Faculty of Medicine, University of Malaya, 59100 Kuala Lumpur, Malaysia.
Laser Lithotripsy: A Preliminary Study on Its Application for Sialolithiasis. McGurk M, Prince MJ, Jiang ZX, et al. Br J Oral Maxillofac Surg 32:218, 1994 Technologic advances have reduced the need for surgical intervention in many surgical specialties. In Urology for example, lithotripsy has reduced surgical intervention for removal of calculi to 1% of cases. This preliminary study evaluates in vitro the use of a coumarin dye laser to fragment salivary calculi. Thirteen calculi of various sizes were placed in water and subjected to the pulsed-dye laser at an energy level of 93 mJ/pulse and pulse length of 4 uS. The number of pulses until fragmentation and number of fragments were recorded. Also, two fresh submandibular glands with calculi were studied. Results showed all calculi fragmented between 5-463 pulses. The number of pulses and number of fragments did not correlate. Histologic examination of the ducts adjacent to the calculi showed inflammation without evidence of ductal damage from the laser. In conclusion, it appears likely that laser lithotripsy will play a future roll in management of salivary calculi.--G.T. LYNAM Reprint requests to Dr McGurk: Department of Maxillofacial Surgery, Floor 24 Guy's Tower, Guy's Hospital, London SE1 9RT.
Warthin's Tumor: A 40-Year Experience at The Johns Hopkins Hospital. Yoo GH, Eisele DW, Askin FB, et al. Laryngoscope 104:799, 1994
CURRENT LITERATURE This retrospective study reviewed 132 patients with Warthin's tumor from July 1952 to June 1992. The authors reviewed the surgical pathology specimens and hospital records. There were a total of 90 men (68%) and 42 women (32%). The percentage of women in each decade was shown to increase from 21%, 29%, 31%, and 39% over the 40-year span. Thus, the men-to-women ratio decreased from 3.8, 2.5, 2.3, and 1.6 over the studied time span. Overall, there were 120 Caucasian patients (91%), 11 African American patients (8.3%), and 1 Asian American patient (0.8%). The percentage of African Americans with Warthin's tumor increased from 0%, 4.8%, 5.5%, and 16% over the four decades. The average age of the 132 patients was 60.3 years (range, 35 to 84 years). Eighty-eight percent of the men smoked tobacco, whereas 89% of the women smoked tobacco. Of the 132 Warthin's tumors that were reviewed, 119 were found in the parotid gland. Three were located within the submandibular gland. The remaining 10 tumors were found in cervical lymph nodes. A superficial parotidectomy was performed on 106 patients (88%) and a total parotidectomy was performed on eight patients (6.7%). Local excisions was performed on six patients (5%). Five patients (4.2%) had recurrence following a superficial parotidectomy and one patient (0.8%) had recurrence after an inadequate local excision. The authors' data suggest a changing pattern of the incidence of Warthin's tumor in women and in African Americans. The data shows a steady decrease in the men-to-women ratio (3.8, 2.5, 2.3, 1.6) over the 40-year span. The study also demonstrated an association of Warthin' s tumors with smoking (men, 88% and women, 89%). The authors suggest the increased incidence of the tumor in women may be related to increasing incidence of smoking in women over the past four decades. The data also indicate an increasing proportion of African American patients over the 40-year span. The authors agree that the tumor occurs predominately in whites, however, they also may occur in nonwhites. They suggest genetic factors may play a role. Finally, the authors recommend a superficial parotidectomy as the treatment of choice for Warthin's tumor.--K.N. CHow Reprint requests to Dr Yoo: The Johns Hopkins Hospital, Department of Otolaryngology-Headand Neck Surgery, PO Box 41402, Baltimore, MD 21203-6402.
Cervical Necrotizing Fasciitis. Maisel RH, Karlen R. Laryngoscope 104:795, 1994 This report summarizes the diagnosis and treatment of nine cervical necrotizing fasciitis patients between June I, 1992, and January 1, 1993. Presentation included rapidly progressive and painful neck or facial swelling with a dusky or red appearance. Other common symptoms and signs were fever, dysphagia, trismus, and an elevated white blood count with a significant left shift. Five cases were odontogenic, three were pharyngeal in origin, and one developed from a soft-tissue spider bite. The bacteria cultured at surgery were all consistent with the site of origin. All surgical treatment patients were taken to the operating room within 12 hours of admission. The fascial planes of the deep cervical fascia were exposed through wide neck incisions, as a low transverse incision reaching 1 cm below the cricoid. Superior and inferior skin flaps were developed. The fascia surrounding the sternocleidomastoid were identified, and the anterior strap muscles and all other involved planes of the anterior and posterior neck were explored. Grossly abnormal tissue planes were followed until normal tissue was found and serous or cloudy fluid was no longer seen. Findings at sur-