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Article
October 1964

Antimetabolite Therapy in Midline Lethal Granuloma

Author Affiliations

LOS ANGELES; COPENHAGEN, DENMARK
From the Department of Surgery, University of California School of Medicine, Los Angeles (Dr. von Leden); and the Connective Tissue Research Laboratory, Rigshospitalet, University of Copenhagen (Dr. Schiff).

Arch Otolaryngol. 1964;80(4):460-468. doi:10.1001/archotol.1964.00750040472016
Abstract

During the past decade several authors1,6 have reviewed the scientific literature pertaining to midline lethal granuloma, and their efforts have culminated in a detailed description of the characteristic clinical picture and in an extensive evaluation of the available therapeutic modalities.

While the etiology of midline lethal granuloma continues to remain a mystery, there is an increased tendency to regard this dread malady as a collagen disease related to periarteritis nodosa.16,21 The location of the major clinical manifestation strongly supports such a hypothesis, for the structures near the median line of the face are supplied by a rich network of smaller blood vessels. A breakdown in the normal defense mechanism of these tissues results in the formation of a granuloma whereas involvement of larger blood vessels leads to extensive destruction and necrosis.

Recent experiments by Hans Selye17 focus additional light on the development of allergic phenomena. Without

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