bluuebunny/crossref_metadata_2025 huggingface dataset:
Head and neck pain: T‐M joint syndrome
Authors: Norris C. W. , Eakins K.
Published: September 2006

The otolaryngologist is frequently consulted by patients with a confusing array of complaints of pain in the head and neck region. It is the purpose of this paper to re‐introduce the problem of the temporomandibular joint pain dysfunction syndrome and stress its frequent occurrence.

Costen in 1934 and 1944 brought to the attention of otolaryngologists the problem of temporomandibular joint dysfunction. In his 1944 report he stated that the diagnosis of tic doloreaux had been frequently made in patients with temporomandibular joint pain dysfunction syndrome. The number of cases included in this report are those collected over the past six months. Between June and December of 1973, 25 patients with the diagnosis of temporomandibular joint pain dysfunction syndrome were asked to fill out a questionnaire covering the history and symptomatology of their problem. Just over 50 percent were under the age of 50, with the largest number between the ages of 30 and 49. No patients had symptoms less than three months and most of the patients had symptoms from three months to one year. Unilateral symptoms were present in all but four cases, and the right side was most frequently involved. Many physicians were consulted and averaged 2.3 for each patient. All but two patients described pain in multiple areas, the most frequent combinations being the joint, ear and lower jaw; however, most patients were unaware of joint pain primarily. One patient complained only of throat pain and one complained only of pain in the lower jaw. Eight patients described “popping” in the joint, and eight had a history of teeth clenching or bruxing. Thirteen complained of fullness or pressure along with tinnitus and vertigo on an intermittent basis. Four case histories are presented to exemplify certain problems.

The history is one of many nerve roots involved with pain in and around the ear, pain down the side of the neck, a gnawing aching tight feeling under the jaw to a burning sensation down the skin of the neck. In most all patients treatment has often been given by many doctors. They frequently present to the examiner as an individual with a large psychosomatic overlay.

Physical examination reveals subjective pain and tenderness in the joint, clicking or crepitation upon auscultation of the joint, spasm of the external pterygoid, tenderness of the masseter muscle, deviation of the mandible on opening, impaired motion of one or both condyles and a generalized sensitiveness of the skin in the involved region.

Representative X‐rays are presented. Intra‐articular injection of 1 cc. of 2 percent lidocaine will relieve some or all of the symptoms the patient is experiencing. Complications of the injection have been minimal. A small number of patients obtained complete relief of their head and neck pain after three to five injections. A possible mechanism to explain the genesis of the syndrome is presented. Treatment is varied and not agreed upon. Three patients have been treated by the insertion of a temporomandibular joint prosthesis.
Labyrinthine pathology of chronic renal failure patients treated with hemodialysis and kidney transplantation
Authors: Oda Makoto , Preciado Manuel C. , Quick Cedric A. , Paparella Michael M.
Published: September 2006

An audiologic study of 290 hemodialysis and renal transplant patients revealed that in 43 of these patients significant hearing loss developed which could be directly attributed to the therapy of the kidney problem.

The clinicopathologic findings in 16 temporal bones of eight chronic hemodialysis and renal transplant patients were presented. The five patients treated with 59 or less hemodialyses had no subjective hearing loss; on the other hand, the three patients receiving 264 or more hemodialyses and multiple transplants, complained of hearing and vestibular difficulties. The pathologic findings common to all 14 temporal bones of the seven patients who underwent transplantation were blue stained concretions in the stria vascularis and/or vestibular receptors. The cochlear changes noted ranged from mild loss of outer hair cells and spiral ganglion cells in patients with few hemodialyses and transplants to complete absence of the organ of Corti in patients receiving more than 264 hemodialyses and multiple transplants; thus, the severity of the clinical and histopathological temporal bone findings was directly proportional to the number of hemodialyses and transplants to which the patient had been subjected. This seems to suggest that numerous hemodialyses or recurrent kidney transplants can induce electrolytic, osmotic, biochemical, vascular and/or immunological changes in the inner ear which can lead to severe audioves‐tibular symptoms and pathology.
Red chorda tympani nerve and bell's palsy
Authors: May Mark
Published: September 2006

This is the first report of a red chorda tympani nerve observed in association with Bell's palsy. A prospective study was designed to determine the frequency and significance of this sign in association with Bell's palsy. Twenty‐eight patients were evaluated within two days of onset of paralysis. The red chorda tympani sign was correlated with alterations in chorda tympani function in terms of taste and submandibular salivary flow as well as response of the extracranial facial nerve to the maximal stimulation test. The chorda tympani was red in 10 of 20 patients (50 percent) where the nerve could be seen through the tympanic membrane. This finding is discussed in terms of a viral‐inflammatory involvement of the chorda tympani as part of the pathogenesis of Bell's palsy. In addition, the red chorda tympani sign was clinically significant. It indicated a more severe involvement of the chorda tympani than in those patients where the nerve was normal. The patients with the finding had a greater incidence of loss of taste by history and testing. In addition, 4 of the 10 patients with a red chorda tympani on the side of the facial paralysis had a salivary flow of less than 25 percent as compared to only 1 of 10 patients with a normal chorda tympani on the ipsilateral side. The study suggested a worse prognosis for patients with a red chorda tympani, although the difference was not statistically significant. The most important clinical significance of the red chorda tympani was its exclusive association with Bell's palsy and, therefore, may be an important diagnostic sign.
An anomalous facial nerve: The otologist's albatross
Authors: Leek Joseph H.
Published: September 2006

A facial nerve coursing inferior to the oval window niche was injured during a stapedectomy. In this location, the nerve did not have normal gross characteristics and was not recognized as a vital structure.

The relationship between the facial nerve and the stapes is determined by the fourth week of fetal life. Even when the nerve lies inferior to the stapes, it is postulated that a normal bony facial canal and stapedial muscle can develop.
Granular cell myoblastoma of the larynx
Authors: Thawley Stanley E. , May Mark , Ogura Joseph H.
Published: September 2006

Granular cell myoblastoma is a relatively uncommon lesion but one important to remember because of the diagnostic difficulty it may present. Six cases over a 15‐year period were reviewed. The lesions occurred more in females (five to one) in the fourth and fifth decades. Most were symptomatic with hoarseness. Half (three) of the lesions were located on the posterior true vocal cord, two on the mid cord and one on the anterior cord, and all were removed endoscopically. Follow‐up of six months to six years has revealed no recurrences. Microscopically the lesions consist of pink cells with the characteristic granules. The cell of origin is probably the Schwann cell. A problem in diagnosis is the frequently present overlying epithelial layer of pseudoepitheliomatous hyperplasia which must not be mistaken for carcinoma. The lesions are benign. Although a few malignant cases have been reported, there have been none in the larynx. Endoscopic local excision is usually adequate, although very large lesions may require laryngofissure or hemilaryngectomy. Even total laryngectomies have been reported.
Computer processing of audiological and vestibular data: A preliminary report
Authors: Abel S. M. , Barber H. O.
Published: September 2006

This paper describes the development of a computerized record system for storage, retrieval and analysis of data generated by audiological, vestibular and otoneurological data. The computer system found most suitable was the APL PLUS 360 with disk storage for programs and data bank. The reasons for choice of computer language and storage mode are outlined. In its present stage of development, the computer record system consists of three files for each patient: identification data, a listing of all tests together with the dates on which they were given and the matrix of data generated by each test. Patient security is assured by entering files through special codes rather than names. Examples of the retrieval of both personal information and the complete and partial data for particular tests are given. The ease of statistical analysis of a particular datum for a series of patients is demonstrated.
The conacher memorial lecture: “100 years of effort”
Authors: Bryce Douglas P.
Published: September 2006

The academic goals of the Centennial Conference on Laryngeal Cancer are, the provision of a forum for a full and frank discussion among experts in the field of laryngeal cancer covering all aspects of the management of this disease; the review of clinical investigation in this field; to identify areas in which research appears to be fruitful, and, finally, the dissemination of the transactions, discussions and conclusions of this Conference by means of the medical literature, audiovisual tapes and television tapes of special interviews and discussions.

The Conference is dedicated to the human larynx and to Charlie Conacher whose Memorial Fund has strongly supported investigation in this field in the Toronto area. With the help of the Conacher Research Fund, extensive investigation, including serial whole organ sectioning of the larynx, has been carried on in Toronto for six years.

Increase in knowledge of the laryngeal anatomy in the spread of tumors as a result of serial sectioning has led to improvements in conservation surgery and in the planning of fields for radiotherapeutic treatment.

The efforts of surgeons, clinicians and radiotherapists in the past 100 years, has transformed laryngeal cancer from one of the least favorable to one of the most favorable of human malignant diseases. We have improved the preservation of life for people suffering from this disease, and, indeed, we have also increased the number of cases in which the voice may be preserved by radiotherapy or by conservation surgery.

The Laryngeal Conference is convened to stimulate our clinic and basic research in the field of laryngeal cancer. Our survival figures for patients with this disease have changed little in the past 20 years, and new ideas and the development of new therapeutic approaches are essential.

The Conference is designed to stimulate interest, research and new methods of therapy and earlier diagnosis and to distribute this knowledge as widely as possible to doctors working in the field so that the patients with laryngeal cancer will ultimately benefit.
The incidence and mortality rates for laryngeal cancer from total cancer registries
Authors: Barclay T. H. C. , Rao N. Nanda
Published: September 2006

Reliable data concerning the incidence of and mortality from cancer of the larynx have been gathered from widely separated geographic areas throughout the world.

These data have been used in the construction of a comparative study and have formed the basis for an assessment of the magnitude of the problem.
Epithelial neoplasia—a homeostatic disorder
Authors: Smithers David
Published: September 2006

Malignant disease presents in a vast variety of forms. Cancerous reactions can occur in any tissue capable of cell division, at any age from in utero to senility. They can develop at any speed and produce sudden devastation or cause little disturbance during a lifetime. They can advance from a conditional or dependent state toward autonomy. They can arise in many parts of the same tissue concurrently or successively; they can progress, regress, maturate and undergo metaplasia. Their cell composition is characterized by its heterogeneity. They arise as disorders in normally well controlled dynamic systems and express a degree of disorganization which not only varies from one cancerous reaction to another but also from time to time in any one reaction.

Despite the great number of possible cancerous reactions these changes are quite rare in most parts of the body, the majority are concentrated in comparatively few tissues.

The tissues most liable to neoplastic reactions have certain significant things in common: they are either those surfaces at which demands are often made for repair of damage done by the environment or those organs subjected to cyclical and often to thwarted demands for function.

With many forms of demand, a great variation in susceptibility and differing reasons for failure of control, the causes of epithelial neoplasia are numerous and complex. The end result, however, is much the same.

When the stresses are applied over a wide area, multiple tumors may appear; on the other hand, in some cases it is the susceptibility which is widespread, giving rise to multiple tumors on little provocation.
Trigeminal neurinomas
Authors: Fee Willard E. , Epsy Clarke D. , Konrad Horst R.
Published: September 2006

Trigeminal neurinomas may produce atypical facial pain, loss of facial sensation, facial palsy, hearing loss, nystagmus, or vertigo, and thus may be confused with nasopharyngeal carcinomas or acoustic neurinomas. The diagnosis can be made by the clinical presentation together with radiographic features showing widening of the foramen ovale and/or smooth destruction of the anteromedial portion of the petrous apex. Tomography, pneumoencephalography, angiography, and other diagnostic procedures are sometimes helpful. Treatment is removal by transtemporal craniotomy and offers an excellent prognosis.
Density of goblet cells in chronic secretory otitis media: Findings in a biopsy material
Authors: Tos M. , Bak‐Pedersen K.
Published: September 2006

In 30 ears from 24 children with chronic secretory otitis the density of goblet cells and of glands was determined on biopsies from the anterior part of the promontory. The goblet‐cell and gland density proved to be highly increased in all cases, with marked individual variations. The median density of goblet cells was 142 cells/field, corresponding to 8,000 cells/mm2. This substantiates the fact that in chronic secretory otitis the mucous secretion is a product of goblet cells and mucous glands and confirms the secretory pathogenesis of the disease.
An absorbent, non‐adherent nasal pack
Authors: Kamer Frank M. , Parkes Morey L.
Published: September 2006

A modification of an absorbent, non‐adherent material (Telfa) is described for use as an anterior nasal packing. The ideal nasal packing should fulfill certain criteria. It should be easy to introduce and remove, contour to the nasal cavity to exert a tamponade effect, and should not prolapse or react unfavorably with the mucous membranes of the nose. The advantages of Telfa as a nasal packing is discussed and compared to previously described materials in this regard. During the past three years this pack has been used in over 800 patients for anterior epistaxis, septal and rhinoplastic surgery. The results have been extremely satisfactory, and the authors suggest their use in these cases.
Malignancy and the benign lymphoepithelial lesion
Authors: Batsakis John G. , Bernacki Edward G. , Rice Dale H. , Stebler Michael E.
Published: September 2006

The benign lymphoepithelial lesion of salivary glands is now considered the histological hallmark of a variety of clinical and pathological disorders affecting salivary tissues. Malignancy arising in the lesion is uncommon, but may take origin in either the epithelial or lymphoreticular components. Lymphomas and pseudolymphomas associated with salivary gland lymphoepithelial lesions have been predominately extra‐salivary and strongly correlated with Sjogren's syndrome. Epithelial malignancy has not been associated with autoimmunity and with few exceptions has been of the anaplastic type.

This report presents two patients with intra‐salivary lymphomas arising in a benign lymphoepithelial lesion of salivary glands and a patient with anaplastic carcinoma arising in the epithelial islands of the lesion. The fourth patient manifested pseudolymphomatous lymphoreticular hyperplasia in lung and submandibular gland and illustrates the possible multiple organ involvement that may occur in patients with benign lymphoepithelial lesion, even without clinical evidence of concommitant autoimmune disorders.
Alveolar rhabdomyosarcoma of the ethmoid sinus
Authors: Makishima Kazumi , Iwasaki Hiroshi , Horie Akio
Published: September 2006

A case of the alveolar rhabdomyosarcoma originating in the left ethmoid sinus was reported. Despite treatment by radical excision of the tumor, irradiation and chemotherapy, the patient died of generalized metastases of the tumor six months after surgery; however, no local recurrence of the tumor was found at an autopsy.

The tumor was further studied by light and electron, microscopic procedures.
Replacement of the arytenoid following vertical hemilaryngectomy
Authors: Blaugrund Stanley M. , Kurland Stephen R.
Published: September 2006

A considerable body of literature advocates and defines treatment of vocal cord cancer with posterior extension by hemilaryngectomy. The present study was carried out to determine the feasibility of using a newly devised pedicle flap, composed of thyroid cartilage and inferior constrictor muscle, to replace the ablated arytenoid cartilage. Animal investigation revealed satisfactory viability of the pedicle flap in canines, and in humans, five patients with T2 glottic carcinoma demonstrated excellent postoperative deglutition and return of voice. The results of the study indicate that this surgical technique merits consideration for its use in minimizing protracted glottic incompetence following hemilaryngectomy. The thyroid cartilage‐inferior constrictor muscle pedicle flap may also prove useful as partial cricoid replacement in selected cases of subglottic extension and in cricoid reconstruction following trauma.
Reasons for irradiation failure in squamous cell carcinoma of the larynx
Authors: Fletcher Gilbert H. , Lindberg Robert D. , Hamberger Arthur , Horiot Jean‐Claude
Published: September 2006

The reasons for irradiation failure in squamous cell carcinoma of the larynx can be

1. Geographical miss because of undiagnosed extensions is the exception. Almost all of the recurrences were well within the treatment portals.

2. Specific extensions with an unfavorable tumor bed. Extension of disease into poorly vascularized structures and/or deep infiltration with fixation are causes of failure.

3. Low dose for the volume cancer. Higher doses delivered in longer treatment time are necessary for 90 percent control of bulky exophytic supraglottic lesions.

4. Techniques which do not assure daily coverage of the tumor. With carefully drawn and checked anatomical portals, geographical misses should be nonexistent.

5. Sigmoid response curve. There is an 85 percent control of the T1 glottic tumors. The control rate is 90 percent of the T1 and T2 supraglottic tumors, and the 10 percent failures have no obvious explanation except that the plateau of the sigmoid response curve has been reached. A negligible yield would be obtained by increasing doses which would not be justified because of concomitant increase in frequency and severity of complications and lessening of the quality of voice.

6. New cancer. Probably 25 percent of the so‐called recurrences on the vocal cords are actually new primary lesions.

The ultimate failure rates respectively are 2 percent for T1 lesions and 10 percent for T2 lesions after a rescue surgical procedure. All patients with T1 vocal cord lesions who did not experience a failure or a complication, have a normal voice. In the patients with T2 lesions in whom the cancer had completely replaced the cord(s), some hoarseness is present; but most of these lesions would have been suitable only for a total laryngectomy.

In the 15 failures in T1 and T2 supraglottic lesions, surgery was not attempted in only three patients, one of whom was salvaged by re‐irradiation. Following 12 laryngectomies there is only one definite failure and two patients died within two years NED locally. Except in the patients who had severe edema and/or necrosis, the voice has been normal or near normal. In patients with lesions of the suprahyoid epiglottis which had amputated the suprahyoid epiglottis swallowing difficulty has not developed.
Kinetics of tumor growth and of cell proliferation in U.R.D.T. cancers: Therapeutic implications
Authors: Tubiana M. , Richard J. M. , Malaise E.
Published: September 2006

After a brief survey of the factors of clinical tumor radioresistance the available data on the growth rate and on the kinetics of cell proliferation of U.R.D.T. tumors are reviewed.

The growth fraction and the cell turnover rate appear to be similar in U.R.D.T. tumors and in other squamous cell carcinomas. These two parameters are correlated with clinical tumor radiosensitivity and chemosensitivity. The possible value of tailoring fractionation and drug administration to the biological characteristics of the tumor is discussed.
Acalculous parotid sialadenopathy
Authors: Fried Marvin P. , Spector Gershon J. , Webber Bruce L. , Ogura Joseph H.
Published: September 2006

Acalculous inflammation of the parotid gland has been regarded by some as a specific disorder that can be staged as to the severity of the disease process. A review of the literature, however, indicates a divergence of opinion. It is the purpose of this study to test this hypothesis by a retrospective double‐blind analysis of clinical, sialographic and histopathologic findings.

Forty‐two patients who were seen by the Department of Otolaryngology, Washington University School of Medicine from 1961 to 1970 were evaluated by two separate teams. There were 20 sialograms and 30 pathologic specimens, and all were re‐examined. Eleven patients had both sialographic studies and histopathologic examination. The clinical presentations and sialographic findings were reviewed. These findings were then compared to each other. Our results indicate that we could not evaluate the severity of the clinical disease by sialography or histopathology. There was no consistent method of staging the sialographic and pathologic findings. In addition, there was no correlation between these two parameters. They reflect neither the patient's clinical syndrome pattern nor the extent of disease. It appears that the parotid gland responds variably to inflammation. These observations are exemplified by case histories.
Iv. multiple glomus tumors in the head and neck
Authors: Spector Gershon J. , Ciralsky Robert , Maisel Robert H. , Ogura Joseph H.
Published: September 2006

Eight of 76 glomus tumors in the head and neck region are multiple. The most common association is with carotid body tumors; the most common pattern is an ipsilateral glomus tympanicum and carotid body tumor. The approach to clinical evaluation is based on a complete otolaryngologic, neurologic, and neuroradiologic evaluation of all patients with glomus tumors. The rationale for priorities in management is the resection of the most dangerous lesion first. This study confirms the previous observations that glomus tumors have a definite proclivity for multicentricity (10 percent) and a high incidence for other associated malignancies (8 percent).
Pseudomonas aeruginosa meningitis following stapedectomy
Authors: Lairmont Albert A. , Nicholson William L. , Turner John S.
Published: September 2006

Meningitis is a rare complication following stapedectomy. Most cases are preceded by a fistula in the oval window. Although fatalities have been reported, most cases respond to parenteral and intrathecal antibiotics if diagnosed and treated early. Gram‐positive organisms are the usual pathogens, but Gram‐negative organisms may be found, especially as a superinfection following antibiotics administered prophylacticly or for the treatment of otitis media or mastoiditis. A case of Pseudomonas aeruginosa meningitis five weeks after stapedectomy, successfully treated with gentamicin, is reported. The discussion includes the diagnosis of post‐stapedectomy fistula and meningitis and current trends in treatment.
Carcinoma of the subglottic area
Authors: Sessions Donald G. , Ogura Joseph H. , Fried Marvin P.
Published: September 2006

The subglottic area is defined as an anatomic region which is cylindrical in shape whose inferior margin is the inferior border of the cricoid cartilage and which is limited superiorly by an imaginary circle 5 mm below the free margin of the true vocal cords. Of 591 patients with glottic and subglottic cancers, only five (1 percent) had primary subglottic tumors and 132 (22 percent) had glottic tumors with subglottic extension. Sixty‐five percent of the patients with glottic primary with subglottic extension were Stage 2 and 35 percent were Stage 3. Most patients were treated surgically. Hemilaryngectomy is a very satisfactory primary modality in the treatment of Stage 2 and some Stage 3 glottic lesions with subglottic extension. Stage 2 and 3 glottic cancers which involve greater than 10 mm of the subglottis carry a significantly decreased prognosis. Patients with T3 lesions with cord fixation with subglottic extension show a decreased survival.
Panel discussion on glottic tumors. I. The evaluation of treatment of patients with extensive squamous cancer of the vocal cords
Authors: Jesse Richard H.
Published: September 2006

Fifty‐one patients with previously untreated squamous carcinoma originating on the true vocal cord, staged T4, were analyzed. Forty‐eight of the 51 patients were selected for treatment. Total laryngectomy was the minimal surgical procedure, and the pathologist confirmed the presence of cancer outside the confines of the larynx in 47 of 48 patients. Seventy‐three percent of the patients were thought clinically to have negative nodes, but examination by the pathologist showed a 20 percent false negative rate in this evaluation. Twenty‐one percent of the patients had received an emergency tracheostomy prior to being referred to our institution. An additional 8 percent required an emergency tracheostomy or laryngectomy. Radiation therapy was employed postoperatively for 16 patients.

Twenty‐six (54 percent) of the 48 patients had no further evidence of cancer after treatment. In evaluating the failures, previous tracheostomy, extension of the disease to the pharyngeal wall, and positive cervical lymph nodes were found to effect adversely the survival of the patient; however, extension of the disease into the trachea, when it occurred alone, was not an adverse factor.

In this patient group with a median age of 66 years, 27 percent died of causes other than the cancer within four years. Based on the data in this series, postoperative radiation therapy is now being routinely given to patients with disease extending to the pharyngeal wall, those with nodes in the neck, and those who have had an emergency tracheostomy previously.
Panel discussion on glottic tumors. V. Carcinoma of the laryngeal glottis therapy and end results
Authors: Skolnik Emanuel M. , Yee King F. , Wheatley Michael A. , Martin Lawrence O.
Published: September 2006

The end results of 264 patients with vocal cord carcinoma treated by either surgery or radiation therapy at the University of Illinois from 1955 to 1972 are analyzed. Stage I glottic carcinoma can be cured by either surgery or radiation alone (86 percent and 80 percent). Stage II glottic cancer treated by surgery has achieved survival rates of 70 percent. The five‐year end results of Stage III glottic cancer are 49 percent for surgery and 30 percent for radiation. The management of glottic carcinoma, according to anatomic site and indications for various modalities are discussed.
Panel discussion on glottic tumors. VIII. The treatment of glottic carcinoma: An analysis of 800 cases
Authors: Hawkins N. V.
Published: September 2006

All patients with cancer of the glottis seen at the Ontario Cancer Institute from 1955 to 1971 are reviewed. Changes in referral patterns and treatment policy are noted. Particular attention is given to those patients who received radiation for cure, and the place of laryngectomy in their subsequent management is examined. Of the estimated incidence of the disease in the geographic region served, 95 percent are now being seen and of these 97 percent receive treatment with curative intent. Two‐thirds or 67 percent are cured at five years with their larynges intact, while a further 18 percent are cured by subsequent laryngectomy.
Panel discussion on glottic tumors. IX. Radiotherapeutic management of cancer of the glottis, university of virginia, 1956–1971
Authors: Constable William C. , White Robert L. , El‐Mahdi Anas M. , Fitz‐Hugh G. Slaughter
Published: September 2006

All patients with cancer of the glottis treated by radiotherapy with curative intent at the University of Virginia from 1956 through 1971 have been reviewed. Follow‐up is complete through December, 1973. Results are presented by both stage and treatment policy and indicate that with our present methods of management a high degree of local control is achieved. The complications of treatment are examined, particularly those arising as a result of combined radiotherapy and surgery. A small number of cases have been salvaged following local recurrence and these are described in detail. Particularly striking has been the effectiveness of radiotherapy in the treatment of advanced (Stage III and IV) lesions. In this group 58 percent of the patients survive with their larynges intact. Considering the poor general condition and advanced nature of the lesions in these cases this result is important and may indicate the nature of future trends in treatment, namely radiotherapy, with surgery held in abeyance until there is overt recurrence.
Conservative neck dissection
Authors: Bocca E.
Published: September 2006

The areolar tissue which fills the laterovisceral spaces of the neck is thought to be in close contact with the limiting muscle and the large vessels and nerves of the neck. The site of lymph nodes and lymphatic vessels in such tissue is not clearly defined. A more profound anatomical study shows that the areolar tissue contains the whole lymphatic system of the neck, limited by a series of aponeuroses. These are derived from the embryonal mesenchyme, surrounding muscles and vessels, giving origin to a series of compartments which are in continuity with each other. These compartments, which contain the lymphatic structures, may be entirely removed en bloc including their limiting aponeurotical membranes, as long as the latter are carefully stripped from the muscular and vascular structures. This technique of neck dissection originating with O. Suarez in Argentina, is as radical as any traditional neck dissection, providing that some technical details are respected and that the nodes are still mobile. By preserving many useful or necessary structures of the neck, which themselves are unrelated to the lymphatic spread of cancer, conservative neck dissection presents important functional and cosmetic advantages as compared with traditional neck dissection.
Analysis of surgical therapy for epidermoid carcinoma of the laryngeal glottis
Authors: Ogura Joseph H. , Sessions Donald G. , Spector Gershon J.
Published: September 2006

Four hundred sixty‐three patients with glottic carcinoma were treated by surgical techniques with or without preoperative irradiation. Two hundred eighty‐one had hemilaryngectomy and 182 total laryngectomy procedures. The overall cure rate for the hemilaryngectomy group was 91 percent and 80 percent for the total laryngectomy group, with an overall cure rate of 87 percent.

Our observations support the fact that Stage I glottic carcinoma has slightly better prognosis when treated by hemilaryngectomy. Stage II and III lesions have a significant improvement in cure rate and survival when treated with combined preoperative irradiation and partial vertical laryngectomy or total laryngectomy than by irradiation alone.
Life‐threatening complications of infectious mononucleosis
Authors: Mccurdy John A.
Published: September 2006

Infectious mononucleosis is a common febrile disorder of children and young adults which is generally benign and self‐limited. Patients with this disorder, however, may develop life‐threatening complications which require prompt recognition and treatment. The clinical features of three such cases are presented and pertinent features of other life‐threatening complications are reviewed.
The role of the middle ear in acoustic trauma from impulses
Authors: Eames B. L. , Hamernik R. P. , Henderson D. , Feldman A.
Published: September 2006

Exposure to high intensity impulse noise may produce a wide range of audiometric and histological effects in experimental animals. The objective of this study was to assess the changes in the middle ear mechanism after impulse noise exposure and to relate these changes to the audiometric and histological effects.

Nine monaural chinchilla were exposed to either 161 or 166 db peak SPL impulses of 1 msec “A” duration, presented at a rate of 1 per minute for 50 minutes. The conductive mechanism of the chinchilla was assessed using standard clinical measures of static and dynamic impedance before and after the noise exposure. Auditory thresholds were measured before and after noise exposure using the average evoked response (AER) technique. At 30 days post‐exposure, the animals were sacrificed for histology.

Pre‐exposure tympanometry showed that: 1. the total mean impedance of the chinchilla ear is considerably lower than that of man; 2. a method related hysterisis effect is present in both the susceptance and conductance tympanograms; and 3. sedation has a significant effect on the total impedance of the ear and on the shape of the tympanograms. After exposure to high level impulse noise: 1. tympanograms become irregular and double peaked, indicating tympanic membrane stress; 2. for the given exposure, 166 db is the impulse intensity needed to rupture consistently the tympanic membrane; and 3. audiometric and histological data correlate with the tympanometry findings and demonstrate a protective effect of a tympanic membrane rupture on the cochlea.
Specialties and the specialty boards
Authors: Holden William D.
Published: September 2006

As specialism has developed in the United States, multiple specialty societies and specialty boards have been created. Although they, in a very realistic fashion, have established the general standards for the delivery of specialty care and for graduate medical education, they, with other national medical organizations such as the American Medical Association, the Association of American Medical Colleges, and the American Hospital Association, function with a considerable degree of independence. There is lacking a cohesive and integrated effort to develop unified attitudes, postures, and policies that represent the medical profession and the health care industry in general. Recently the Coordinating Council on Medical Education and the Liaison Committee on Graduate Medical Education have been established. These two agencies represent a significant attempt to integrate policies for medical education and to identify a single accrediting agency that will apply uniform standards to the process of accrediting programs of graduate medical education.

The federal government for the past several years has had an increasing interest in the health care industry and medical education. Many legislative bills have been passed which have imposed more and more regulations on medicine and have established more bureaucratic control over the professional activities of physicians. Insidiously the medical profession is being socialized.

If accountability for the public welfare cannot be exercised by medicine, at least in the perspective of the federal government, more and more legislation and regulation are inevitable.

The pluralistic structure of organized medicine will ultimately be self defeating. Cohesive policies on behalf of the medical profession must be developed if leadership in medicine is to remain in the private sector. The Coordinating Council on Medical Education is unquestionably a significant attempt to demonstrate public accountability. It is, however, only the first step in the long and difficult process of developing cohesive national policies on behalf of organized medicine.
Human laryngeal reinnervation
Authors: Tucker Harvey M.
Published: September 2006

Bilateral vocal cord paralysis is fortunately an uncommon occurrence although the incidence of this injury secondary to external neck trauma is increasing. In general, a patient with this lesion is faced with the choice between adequate airway at the expense of a breathy, weak voice or a fairly good voice with the need for a permanent tracheotomy. In an effort to provide a better solution to this dilemma, an attempt has been made to develop a means of reinnervation of at least one vocal cord without the problems inherent in the usual nerve anastomosis techniques. After extensive preliminary work in dogs the nerve‐muscle pedicle technique for reinnervation has been developed. In this procedure the branch of the ansa hypoglossi to the anterior belly of the omohyoid is mobilized and a small block of muscle containing the terminal branches is freed from the muscle proper.

Using an approach similar to the Woodman arytenoidectomy, the posterior cricoarytenoid muscle is exposed, and its fibers are partially incised. The previously prepared nerve‐muscle pedicle is sutured to it.

In the first five patients subjected to this procedure, return of spontaneous abduction of the reinnervated vocal cord was noted between six and eight weeks post surgery. In no case was the voice weakened nor was there any problem with aspiration. All five patients have achieved sufficient air‐way so that exercise tolerance for daily activities is adequate without a tracheotomy. The physiologic and histologic background of this technique is discussed in detail.
A radiologic advance in the diagnosis of disorders of the larynx
Authors: Travis Lawrence W. , Work Walter P. , Whitehouse Walter M.
Published: September 2006

The cervical spine greatly reduces the usefulness of anteroposterior soft tissue radiologic examination of the larynx. Fractures of the laryngeal and cricoid cartilages are difficult to diagnose by soft tissue technique, and time‐consuming laminagraphy is often required.

A new technique for single exposure anteroposterior soft tissue radiography of the cartilages and airway is described. An esophageal cassette containing ultraspeed dental film placed in a retrolaryngeal position is shown to yield detailed radiographs of high contrast. The feasibility of this technique is illustrated by the presentation of radiographs from patients with laryngeal disorders. The new technique is compared with existing examinations available to the clinician and its application in other disorders of laryngeal cartilages and soft tissue is discussed.
Transposition of the lingual thyroid
Authors: Skolnik Emanuel M. , Yee King F. , Golden Theodore A.
Published: September 2006

Lingual thyroid represents the only functioning thyroid tissue in the body in 70–80 percent of the cases, surgical ablation of which will produce hypothyroidism. Transposition of the lingual ectopic thyroid with its vascular supply intact as a pedicle graft is presented. This seems to be the most logical approach in preserving the viability and function of these ectopic tissues.
Prognostic significance of lymph node histology in patients with squamous cell carcinoma of the larynx, pharynx, or oral cavity
Authors: Berlinger Norman T. , Tsakraklides Vasilis , Pollak Kurt , Adams George L. , Yang Monica , Good Robert A.
Published: September 2006

In a double‐blind retrospective analysis, sections of lymph nodes regional to head and neck squamous cell carcinomas were microscopically examined to assess morphologically the immunologic pattern of response. Patients whose nodes showed evidence of immunologic stimulation had five‐year survival rates significantly higher than those whose nodes showed no evidence of immunologic stimulation.

None of the patients whose nodes showed the lymphocyte depletion pattern survived five years. The stage or histologic grade of the tumors did not influence these correlations. Metastases occurred much more frequently in patients whose nodes showed immunologic activity than in those whose did not. The data support the concept that immunologic capacities are important host defense mechanisms against malignancy. Histologic assessment of immunologic activity in regional nodes seems to be an important parameter for predicting survival.
Postoperative chylous fistula prevention and management
Authors: Crumley Roger L. , Smith James D.
Published: September 2006

Postoperative chylous fistulas occur as a complication in 1–2 percent of all radical neck dissections. Twelve cases are reviewed herein. Chylous fistulas are more common with left neck dissections, but 25 percent occurred on the right side in this series. An intraoperative chylous fistula was recognized and treated in 75 percent of the cases which later developed a postoperative fistula.

Postoperative fistulas may be divided into two groups: minor fistulas may be treated with pressure dressings and repeated aspirations; fistulas which do not respond to conservative management should be re‐explored early and the fistula ligated.
Surgical pathology of cancer of the larynx and hypopharynx
Authors: Sessions Donald G.
Published: September 2006

A study was designed to determine the influence of certain surgical pathologic findings on tumor spread and survival in patients with cancer of the larynx and hypopharynx. All patients with primary epidermoid carcinoma of the larynx and hypopharynx, treated by either surgery or preoperative irradiation and surgery, between 1955 and 1971 were included in the study. The patient population consisted of 791 patients all of whom were eligible for three‐year follow‐up.

Information from a retrospective study of the surgical pathology reports regarding resection margins, size and differentiation of the primary tumor, histopathologic characteristics of the primary tumor and neck dissection, number, position and size of positive lymph nodes and post treatment staging, was correlated with tumor spread and survival.
Arytenoidectomy revisited
Authors: Newman M. Haskell , Work Walter P.
Published: September 2006

The spectrum of disabilities attendant to laryngeal paralysis range from mild hoarseness to complete upper airway obstruction depending upon the static position of the paralyzed cord or cords. The most distressing disabilities are those of bilateral vocal cord paralysis in which both vocal folds are fixed in the midline resulting in severe upper airway obstruction.

Clearly the most acceptable solution to the problem of persistent laryngeal paralysis is through the establishment of normal neuromuscular integrity by vagal repair or neural transfer techniques. While electromyographic evidence of reinnervation and some restoration of cord motion has been described, synchronous neuromuscular activity is, at best, unpredictable and generally unsuccessful.

Successful reinnervation procedures depend in part on early repair and herein lies a disparity between experimental work and its clinical applicability. Given the realities of delays in diagnosis and the unpredictability of operative reinnervation of the paralyzed larynx, we rely on alternative methods of improving the compromised glottic airway consequent to bilateral recurrent nerve paralysis of the larynx.

During the period 1962 through 1974, 23 patients with complete bilateral paralysis of the larynx have been treated by the posterior extralaryngeal approach originally described by Woodman. The following is a description of the operative technique utilized with technical modifications which we consider important in enhancing operative results.
Amyloid deposits in the trachea and esophagus — ultrastructural confirmation
Authors: Busuttil A. , More I. A. R. , Jones D. Glyn
Published: September 2006

The clinical details of two patients suffering from amyloid infiltration of the trachea and esophagus respectively are presented. The “amyloid tumor” in the trachea presented with dysphonia and a swelling in the lower subglottic region. Attempts at complete surgical excision of it were unsuccessful. The patient with esophageal amyloid presented acutely with dysphagia and features of dehydration and malnutrition. Systematized amyloidosis was discovered at autopsy, but no primary initiating cause for it was found. In both cases it was possible to confirm the diagnosis by electron microscopy. The current views on the composition, structure, causation and treatment of amyloid disease are reviewed.
Arterial blood gas determination in patients with anterior packing
Authors: Slocum Carl W. , Maisel Robert H. , Cantrell Robert W.
Published: September 2006

Twenty‐two healthy males ranging in age between 18 and 43 years were studied by arterial blood sample obtained before nasal surgery and again after complete bilateral nasal obstruction produced by nasal packing. Five of these patients had a third sample drawn after pack removal.

The pO2 dropped from a preoperative mean of 85 mm Hg to 74 mm Hg. This difference is statistically significant; pCO2 did not change between the two measurements.

This result is attributed to hypoxia caused by acute total nasal obstruction. It suggests that anterior packing alone may cause a clinically important hypoxia in patients with inadequate pulmonary reserve and that these patients merit close observation when bilateral anterior packing is placed. The early removal of anterior packing in patients where possible seems indicated. Supplemental O2 (40 percent) for patients over 40 years of age requiring nasal packing is practiced at this Center.
Palamed G compared with Palacos R with gentamicin in Charnley total hip replacement
Authors: Hallan G. , Aamodt A. , Furnes O. , Skredderstuen A. , Haugan K. , Havelin L. I.
Published: August 2006

We performed a randomised, radiostereometric study comparing two different bone cements, one of which has been sparsely clinically documented. Randomisation of 60 total hip replacements (57 patients) into two groups of 30 was undertaken. All the patients were operated on using a cemented Charnley total hip replacement, the only difference between groups being the bone cement used to secure the femoral component. The two cements used were Palamed G and Palacos R with gentamicin. The patients were followed up with repeated clinical and radiostereometric examinations for two years to assess the micromovement of the femoral component and the clinical outcome.

The mean subsidence was 0.18 mm and 0.21 mm, and the mean internal rotation was 1.7° and 2.0° at two years for the Palamed G and Palacos R with gentamicin bone cements, respectively. We found no statistically significant differences between the groups. Micromovement occurred between the femoral component and the cement, while the cement mantle was stable inside the bone. The Harris hip score improved from a mean of 38 points (14 to 54) and 36 (10 to 57) pre-operatively to a mean of 92 (77 to 100) and 91 (63 to 100) at two years in the Palamed G and Palacos R groups, respectively. No differences were found between the groups.

Both bone cements provided good initial fixation of the femoral component and good clinical results at two years.