bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypoparathyroidism following total laryngopharyngectomy and gastric pull‐up
Authors: Krespi Yosef P. , Wurster Carl F. , Wang Tom D. , Stone David M.
Published: October 2006

We have used the gastric pull‐up technique for closure of large pharyngoesophageal defects after radical oncological surgery since 1979. The management of severe hypocalcemia and hypovitaminosis D seemed more difficult in patients undergoing pull‐up reconstruction than in patients undergoing the same extirpative surgery, but reconstructed with more traditional methods.

To determine if hypocalcemia and hypovitaminosis D were more common in gastric pull‐up patients, and if postoperative management of these conditions is more problematic in this group, we retrospectively compared three groups of head and neck surgery patients. Group 1 consisted of 17 patients undergoing total laryngectomy with thyroid complex preservation. Group 2 consisted of 7 patients undergoing mediastinal dissection with total laryngectomy‐thyroidectomy previously or concurrently. Group 3 consisted of 30 patients undergoing total laryngopharyngoesophagectomy‐thyroidectomy and gastric pull‐up reconstruction. The incidences of hypocalcemia requiring therapy were 12%, 50%, and 73%, respectively, with an overall incidence of 51%. The average amounts of supplemental calcium and vitamin D in the three groups were compared. A significant difference between the three groups was noted. Finally, the dietary calcium and vitamin D requirements for one problematic patient were prospectively recorded and summarized graphically.

We conclude that any patient should be carefully monitored for the signs and symptoms of hypocalcemia after major head and neck surgery. In the special instance of the gastric pull‐up patient, calcium requirements and the range of serum calcium fluctuation are greatly increased compared to patients undergoing more traditional methods of reconstruction.
The topical use of 5‐fluorouracil in the ear in the management of cholesteatoma and excessive mucous secretion
Authors: Smith Mansfield F. W.
Published: October 2006

5‐Fluorouracil was introduced in the early 1960s as a topical chemotherapeutic agent and has become increasingly accepted because of its efficacy, economy, and relative absence of side effects in treating many pre‐cancerous conditions, certain benign and malignant tumors, and dermatoses. This paper addresses the use of topical 5‐fluorouracil in the management of cholesteatoma and unwanted mucus‐secreting cells. A retrospective study has suggested a very impressive efficacy of topical 5‐fluorouracil in the management of cholesteatoma and, to a lesser degree, control of hyper‐mucus‐secreting cells at locations in the middle ear and mastoid. The use of topical 5‐fluorouracil in the management of hyperkeratosis, cholesteatoma in the middle ear and mastoid, and in the external canal has been almost 100% effective with very few side effects. In the management of hyper‐mucous‐secreting cells, 5‐fluorouracil has a success rate of approximately 50%.
Restoration of the airway following bilateral recurrent laryngeal nerve paralysis
Authors: Singer Mark I. , Hamaker Ronald C. , Miller Stuart M.
Published: October 2006

Bilateral recurrent laryngcal nerve paralysis has been treated by a number of ingenious techniques that include arytenoidectomies, vocal cord lateralizations, cordectomies, and, recently, reinnervation procedures and laser arytenoidectomies. An arytenoidectomy is recommended by a thyrotomy approach without lateralization of the vocal cord. The resulting airway is adequate for decannulation by expansion of the posterior glottic aperture, with preservation of the anterior glottis for phonation.
Histologic variants in otosclerosis
Authors: Schuknecht Harold F. , Barber Wayne
Published: October 2006

A study of 164 temporal bones with otosclerosis revealed stapes fixation in 123. Large lesions (4 mm or larger) were characterized by involvement of the cochlear endosteum, increased cellular activity, and bone resorption. Anatomical sites of predilection were: 1. anterior to the oval window, 2. margins of the round window, and 3. apical‐medial wall of the cochlea. Two of the five ears with cochlear otosclerosis were from a patient with severe bilateral hearing loss. The size, cellular activity, and location of otosclerotic lesions showed no correlation with the magnitude of sensorineural hearing loss. Subjects over 69 years of age had greater bone‐conduction losses than age‐matched controls. Nine ears showed occlusion of the round window niche.
Intraoperative baer monitoring and hearing preservation in the treatment of acoustic neuromas
Authors: Abramson Maxwell , Stein Bennett M. , Emerson Ronald G. , Pedley Timothy A. , Wazen Jack J.
Published: October 2006

We treated 20 cases of acoustic neuromas in the last 2 1/2 years using the suboccipital approach with intraoperative monitoring of eighth nerve function in an attempt to preserve hearing. Total tumor removal was accomplished in 18 cases. Three tumors were small (less than 2 cm in size); 3 tumors were moderate sized (2 to 3 cm) and 14 tumors were large (greater than 3 cm). In 15 cases, all BAER components were lost during surgery. These patients had no postoperative hearing.

In five patients there was intraoperative preservation of some or all BAER components. These included the three patients with small tumors and two other patients with moderate sized tumors. One patient with a moderate size tumor had preservation of wave 1 only, and had no postoperative speech discrimination. One patient with a small tumor retained all 5 BAER components, but had no postoperative hearing. Three patients in our series retained functional hearing after surgery, including 3 of 5 patients with tumors 2 cm or smaller.

Intraoperative BAER monitoring appears to be useful in predicting postoperative hearing. Tumor size seems to be the primary factor in preservation of hearing following acoustic neuroma surgery.
Laryngeal amyloidosis
Authors: Mitrani Moises , Biller Hugh F.
Published: October 2006

Localized laryngeal amyloidosis is a benign, rare tumor of the larynx. Six cases of laryngeal amyloidosis were evaluated and treated from 1967 through 1984. One case is that of an 8‐year‐old female: the youngest reported case. Therapy is directed towards surgical resection. The cases in this report had significant laryngeal involvement necessitating extensive surgery.
Two modifications of pectoralis major myocutaneous flap (PMMF)
Authors: Lee Keun Y. , Lore John M.
Published: October 2006

Pectoralis major myocutaneous flap is the most commonly used versatile flap in head and neck reconstructive surgery.

The use of entirely tubed pectoralis major myocutaneous flap for reconstruction of the hypopharynx following total laryngectomy and total pharyngectomy has a disadvantage of bulkiness of the flap and poor postoperative deglutition.

One‐stage reconstruction of the entire hypopharynx utilizing a combination of pectoralis major myocutaneous flap and dermal graft minimizes bulkiness, thus achieving satisfactory to excellent functional results. The operation has been performed on four patients with excellent deglutition. The pectoralis major myocutaneous flap is utilized to reconstruct the anterior and lateral walls of the hypopharynx, the dermal graft for the posterior wall as far superior as the vault of the nasopharynx. The operative procedure is described.

Pectoralis major myocutaneous flap usually provides enough length to reach the distant site of the surgical defect. On occasion, however, additional length is desirable to avoid tension along the suture line. This becomes apparent when a random portion of elevated pectoralis major myocutaneous flap presents questionable viability which may require further trimming. Resection of the medial half of the clavicle can provide additional length of this flap by 2 cm to 2.5 cm.
A finite element model of skin deformation. II. An experimental model of skin deformation
Authors: Larrabee Wayne F. , Sutton Dwight
Published: October 2006

Skin flap design has traditionally been based on geometric models which ignore the elastic properties of skin and its subcutaneous attachments. This study reviews the theoretical and experimental mechanics of skin and soft tissues (I) and proposes a mathematical model of skin deformation based on the finite element method (III). Finite element technique facilitates the modeling of complex structures by analyzing them as an aggregate of smaller elements.

This paper gives the results of an animal model developed to study the deformation and mechanical properties of skin, including its viscoelastic properties (hysteresis, creep, and stress relaxation). A new skin extensometer, constructed with digital stepper motors and controlled with a microcomputer, is described to measure these properties for both skin and its subcutaneous attachments. Deformation grids quantitated from photographs with a digitalizing tablet are presented, and computer software is introduced to standardize and analyze them (II). The mathematical model is used to simulate wound closures such as the ellipse and rectangular advancement flap. In addition, a series of mathematical experiments performed to simulate deformation of a strip of skin are described; the relationships between the various elastic constants are investigated; and a comparison of these simulations with actual deformation is presented. Limitations of the model and areas for future investigation are discussed (III).
A finite element model of skin deformation. III. The finite element model
Authors: Larrabee Wayne F. , Galt J. A.
Published: October 2006

Skin flap design has traditionally been based on geometric models which ignore the elastic properties of skin and its subcutaneous attachments. This study reviews the theoretical and experimental mechanics of skin and soft tissues (I) and proposes a mathematical model of skin deformation based on the finite element method (III). Finite element technique facilitates the modeling of complex structures by analyzing them as an aggregate of smaller elements.

This paper gives the results of an animal model developed to study the deformation and mechanical properties of skin, including its viscoelastic properties (hysteresis, creep, and stress relaxation). A new skin extensometer, constructed with digital stepper motors and controlled with a microcomputer, is described to measure these properties for both skin and its subcutaneous attachments. Deformation grids quantitated from photographs with a digitalizing tablet are presented, and computer software is introduced to standardize and analyze them (II). The mathematical model used to simulate wound closures such as the ellipse and rectangular advancement flap. In addition, a series of mathematical experiments performed to simulate deformation of a strip of skin are described; the relationships between the various elastic constants are investigated; and a comparison of these simulations with actual deformation is presented. Limitations of the model and areas for future investigation are discussed (III).
Effect of middle ear infection upon the pneumatization of the mastoid: An experimental study in pigs
Authors: Aoki Kazuhiro , Esaki Shiro , Honda Yoshio
Published: October 2006

The suppression of the temporal bone's pneumatized cavities is commonly observed in chronic middle ear inflammatory disease, but this fact has not been explained in respect to its etiology, i.e., whether the poorly pneumatized cavity induces chronic middle ear infection or middle ear inflammatory condition suppresses the pneumatization of cellulae.

We studied the effect of middle ear infection and eustachian tubal dysfunction in the early stage of life upon the development of pneumatization of the mastoid using 13 pigs, whose mastoid is comparable to that of man. We used two methods, the eustachian tube stenosis test and the tympanic membrane paraffin infusion test. The present study indicated that in six pigs infection of the middle ear in the early stage of life suppressed the normal development of pneumatization of the mastoid bone in pigs.
Gaze nystagmus and blood alcoho
Authors: Goding George S. , Dobie Robert A.
Published: October 2006

Forty‐six patients in an emergency room (ER) setting and 159 people suspected of driving while intoxicated (DWI) had their blood alcohol concentrations estimated by the angle of onset of horizontal gaze nystagmus and confirmed by blood alcohol analysis or breathalcohol analysis (BAA) tests. In the ER group, 25/26 (96%) of legally intoxicated patients (blood alcohol concentration >.10% w/v) had an estimation consistent with intoxication. There were no cases in which the blood alcohol concentration (BAC) was incorrectly estimated to be>.10% w/v in the absence of other drugs. In DWI suspects there was a correlation of .878 between estimated BAC and BAA results. Three subjects were incorrectly classified as intoxicated. No subjects with estimated BAC <.10% w/v were legally intoxicated by BAA testing. Alcohol gaze nystagmus is presented as an effective tool for estimating the BAC in pure alcoholic intoxication.
Tumor responsiveness of squamous cell carcinoma to cisplatin
Authors: Stiernberg Charles M. , Valyi‐Nagy Klara , Hale Price E. , Quinn Francis B. , Bailey Byron J.
Published: October 2006

The addition of chemotherapy to planned multiple modality treatment of patients with advanced head and neck squamous cell carcinomas may improve survival rates, but individual tumor response is unpredictable. An assay for determining tumor responsiveness to specific chemotherapeutic agents would facilitate treatment selection.

This study used the subrenal capsule (SRC) assay to test responsiveness of squamous cell carcinoma to cisplatin. Tumor xenografts obtained from ten patients were implanted beneath the renal capsules of control and treatment mice. Tumor responsiveness was determined by using the paired Student's l‐test to compare base‐line and post‐treatment measurements in the cisplatin‐treated mice. Results indicated six of ten tumors were sensitive to cisplatin.

In conclusion, tumor sensitivity to cisplatin and other drugs may be predictable with the SRC assay, but to be clinically useful, studies will be necessary to correlate assay results with responses observed in patients.
Factors influencing parathyroid allotransplantation in rats
Authors: Friedman Michael
Published: October 2006

For nearly a century, researchers have sought to solve the problem of permanent hypocalcemia by allotransplanting the parathyroid glands. A thorough review of the literature revealed conflicting reports, many of which claim success but lack substantial data and sound criteria on which to base the success. At the present, there is no reproducible method of successfully transplanting parathyroid tissue to a nonimmunosuppressed host. The literature on the transplantation of other organs was reviewed in order to determine which methods might be tested on parathyroid tissue to achieve long‐term graft survival. These methods include the use of fetal tissue and treatment of the host with cyclosporine. Cyclosporine is unique in that it affects graft rejection but does not alter the nonspecific defenses of the host.

Five experimental groups were established to study variables influencing successful allotransplantation. Heterogeneic, aparathyroid adult rats with calcium levels below 5.5 mg/dl were the graft recipients. Our criteria for successful parathyroid transplantation included biochemical, functional, and histologic data. Maintenance of serum calcium levels above 8.0 mg/dl was considered biochemical evidence of graft function. Excision of the graft site with the subsequent return to pregraft hypocalcemia was considered evidence of graft function. Histologic evidence of normal parathyroid tissue at the graft site was the final criterion used to prove a successful transplant. Graft failure was documented through serum calcium determinations and histologic examination of the graft site.

Rats from group 1 received allotransplanted adult parathyroid glands and showed no evidence of graft function. Animals from group 2 received parathyroid allografts from newborn rats and responded with a transient rise in serum calcium levels. Group 3 rats demonstrated a short period of normocalcemia after receiving fetal parathyroid allografts. In addition to undergoing fetal parathyroid allotransplantation, the rats in group 4 were treated with a 7‐day course of cyclosporine. Calcium levels rose quickly and remained elevated for 2 weeks after cessation of cyclosporine. Calcium levels then returned to pregraft levels. Group 5 rats received continuous cyclosporine for 40 to 90 days after receiving fetal parathyroid allografts. These animals showed long‐term graft survival by biochemical, functional, and histologic analysis.
Myofacial pain dysfunction: Analysis of 476 patients
Authors: Cooper Barry C. , Alleva Michael , Cooper David L. , Lucente Frank E.
Published: October 2006

Myofacial Pain Dysfunction (MPD) is a musculoskeletal dysfunction involving malrelationship among the neuromuscular system, temporomandibular joints, and dental occlusion. The illness affects children and adults of all ages and both sexes. Patients complain of pain and/or dysfunction in the mandible, temporomandibular joints, ears, oral cavity, head, and neck. Electronic measurement of mandibular movement and associated muscle function now provide reproducible data with which the parameters of this illness and therapy can be designed and monitored.

In this study, data are presented on 476 MPD patients. Included are statistics on the most commonly occurring symptoms, clinical examination findings, and electronic test data before and following treatment. The mandibular kinesiograph (MKG) is used to track mandibular movement and compare the natural dental occlusal position and a neuromuscularly balanced position of occlusion. Electromyography (EMG) is used to analyze the resting status of mandibular muscles and the functioning in the occlusal position.

The data show a positive correlation between the clinical symptoms of MPD and unhealthy mandibular position at occlusion, accompanied by specific unhealthy muscle activity. There is a strong positive correlation between a therapeutic change in the dental occlusion to a neuromuscularly healthy position using a precision orthotic appliance and the relief of symptoms within 1 month as expressed by 88% of the patients. A similar correlation exists at 3 months and long‐term.
Hypertension, hyperlipoproteinemia, chronic noise exposure: Is there synergism in cochlear pathology?
Authors: Pillsbury Harold C.
Published: October 2006

The purpose of this research is to establish in laboratory animals whether a relationship exists among noise exposure, hypertension, and hyperlipoproteinemia. A discussion of the historical background leading to this work is presented. Previous investigations dealing with each of the three variables, noise, hypertension, and hyperlipoproteinemia, as they relate to hearing, are discussed. Methodology, including new methods developed during this study, will be presented. Results support the concept that a significant relationship does exist among noise, hypertension, hyperlipoproteinemia, and hearing loss.
Prevention of recurrent acute otitis media: Chemoprophylaxis versus tympanostomy tubes
Authors: Gonzalez Carlos , Arnold James E. , Erhardt James B. , Woody Edward A. , Pratt Steven R. , Getts Alan , Kueser Thomas J. , Kolmer John W. , Sachs Marc
Published: October 2006

Otitis media has long been recognized as one of the most common diseases of childhood. Several therapeutic modalities have been advocated for the prevention of recurrent episodes of acute otitis media (AOM). A blinded, prospective, randomized study was designed to determine the efficacy of tympanostomy tubes, antibiotic prophylaxis, and placebo. Children with recurrent AOM were entered in the study and followed for at least 6 months.

A total of 65 children completed the protocol. Sixty‐three of those were under the age of 4 years. Treatment failure was defined as two or more episodes of AOM or otorrhea in less than 3 months. Five of 22 children in the tympanostomy tube group failed, compared to 12 of 20 in the placebo group (p = .02). There were 8 or 21 treatment failures in the sulfisoxazole group. Children with otitis media with effusion (OME) at the time of their initial visit had significantly less middle ear disease when treated with tympanostomy tubes.

Tympanostomy tube insertion for prophylaxis of recurrent acute otitis is supported by these findings. Improvement of recurrent AOM was observed in the sulfisoxazole group, but was not statistically significant.
Choanal atresia: Clinical features, surgical approach, and long‐term follow‐up
Authors: Schwartz Michael L. , Savetsky Lawrence
Published: October 2006

Twenty‐one patients with choanal atresia were treated from 1969 to 1985. Follow‐up of 1 1/2 to 15 years postoperatively has been obtained in 17 patients.

Thirteen patients had bilateral atresia and eight had unilateral atresia. All 13 patients with bilateral atresia were operated on within the first month of life. Eighteen patients were treated transnasally and two transpalatally. Ten of 15 patients treated by transnasal puncture and dilation followed by stenting of the choanae are patent after a single procedure. Five other patients, all of whom had other associated anomalies, required secondary dilations or transpalatal repair.

Our results support the effectiveness of transnasal puncture and dilatation followed by stenting of the choanae as the initial surgical procedure of choice. It may be used safely in the neonate, and is often definitive.
Obstructive sleep apnea in down syndrome children: A surgical approach
Authors: Strome Marshall
Published: October 2006

Obstructive sleep apnea is considered in five Down syndrome children. All had altered anatomy consistent with this syndrome involving the oropharynx, cranium, and midface. Based on earlier work, it was established that, except for specific isolated instances, routine tonsillectomy and adenoidectomy would not reverse obstructive respiratory patterns in this patient population.1 A modified pharyngopalatal surgical approach has been successful in alleviating upper airway sleep obstruction in Down syndrome.
Effect of life in industrialized societies on hearing in natives of easter island
Authors: Goycoolea Marcos V. , Goycoolea Hortensia G. , Rodriguez Leonardo G. , Farfan Corina R. , Martinez Gumaro C. , Vidal Ricardo
Published: October 2006

In an effort to determine whether life in industrialized societies can have an effect on hearing, 90 natives from Easter Island over 45 years old were evaluated. They underwent complete clinical and audiological assessment and were divided into groups according to those having lived only on the island or those having lived in modern civilization. With all factors being equal, except exposure to modern civilization, our results showed that living in civilized societies has a significant negative effect on hearing; the severity is directly proportional to the years of exposure. The median hearing thresholds of natives always living on the island (men and women combined) was found to be similar to those of female citizens of the United States; there was no significant difference in hearing thresholds between men and women among these natives. These results suggest that there are no significant inherent racial differences nor significant inherent differences between males and females in the sensitivity of hearing.

A relationship between aging and hearing was noted and interpreted as true or intrinsic presbycusis. There were no cases of otosclerosis, Meniere's disease, or exostoses of the external ear canal among natives who had always lived on the island. Pure natives were found not to be prone to otitis media in spite of having an extremely high incidence of severe upper respiratory tract allergies.
Nevus sebaceous of jadassohn: The head and neck manifestations
Authors: Hagan Warren E.
Published: October 2006

The Nevus Sebaceous of Jadassohn (SNJ) is a congenitally‐occurring, hamartomatous disorder of the skin and its adnexa of infrequent occurrence. This presentation of five cases emphasizes the smooth, waxy, yellow‐brown lesion's progression into a thickened sebaceous tumor of premalignant predilection. The incidence of neoplastic degeneration of these hamartomatous nevi may be as high as 30% with the capacity of metastasis occasionally reported. Because of malignancy risks as well as cosmetic considerations, early surgical removal is recommended.

Previously unreported problems of dysphagia and malnutrition secondary to pulsion diverticulum at the esophageal inlet and cleft palate, obliterative aural stenosis with associated conductive hearing loss are documented. Regardless of SNJ's occurrence as either an isolated lesion or as the fully developed syndrome, including mental retardation and epilepsy, this congenital malformation of the skin, its hair, and sebaceous glands presents rare and histologically intriguing problems for the practitioner.
The over‐projecting nasal tip: Precise reduction without rotation
Authors: Close Lanny Garth , Schaefer Steven D. , Schultz Barbara A.
Published: October 2006

Excessive projection of the nasal tip is a relatively uncommon deformity, often referred to as the “Pinocchio” nose. When this unaesthetic appearance is secondary to abnormally long medial and lateral crura of the lower lateral cartilages, and when tip rotation is undesirable, surgical correction can represent a challenging problem.

A simple and reproducible method via the open septorhinoplasty approach is described for correction of this deformity. In this technique, preoperative photographs are analyzed to calculate the exact length of cartilage to be excised from the medial and lateral crura. The results of this procedure are critically analyzed in six consecutive patients followed for 7 to 19 months. Based on this experience, the operation is recommended as a reliable method for correction of the over‐projecting nasal tip when minimal or no rotation is desirable.
Penetrating neck injuries during the lebanese war: Aubmc experience
Authors: Ramadan H. H. , Samara M. A. , Hamdan U. S. , Shahinian H. K.
Published: October 2006

During the last decade 419 patients were admitted to the American University of Beirut Medical Center with penetrating neck injuries mainly due to shrapnel. During the first 8 1/2 years of the war, all patients with wounds penetrating the platysma were explored. During the last 2 years, a more selective approach was used.
Vocal cord paralysis in postpoliomyelitis syndrome
Authors: Cannon Stephen , Ritter Frank N.
Published: October 2006

Postpoliomyelitis syndrome is characterized by new neuromuscular symptoms, including weakness, developing years after recovery from acute polio. Bilateral vocal cord paralysis is presented as a new manifestation of this syndrome. Other clinical features of post‐poliomyelitis syndrome in this report are discussed. The etiology of this syndrome is unknown, though attrition or immune‐mediated destruction of collateral muscular innervation appears likely. The pathologic findings include scattered individual muscle fiber atrophy as well as evidence of chronic denervation and reinnervation. This form of motor deterioration is not life‐threatening, but potentially may cause increasing disability in a large number of polio survivors. Proper supportive care of facial, laryngeal, and pharyngeal weakness is crucial in the management of these patients.
Mechanisms of endocochlear potential generation by stria vascularis
Authors: Salt Alec N. , Mleichar Ivo , Thalmann Ruediger
Published: October 2006

It is commonly accepted that the endocochlear potential (EP) of the cochlea is generated by an electrogenic transport of potassium into scala media by the marginal cells of stria vascularis. We have studied the potential and potassium concentration gradients as stria vascularis was penetrated with double‐barreled potassium selective electrodes in the guinea pig cochlea. Our data demonstrate that a region exists in stria which is positively polarized (higher than the EP), but which has a low (perilymph‐like) potassium composition. It is concluded that EP cannot be generated by the marginal cells alone but may involve passive potassium movement across the apical membranes of the basal cells. A model is presented which is consistent with many anatomical and physiological features of stria vascularis.
Cranial bone grafts for post‐traumatic facial defects
Authors: Petroff Mark A. , Burgess Lawrence P. A. , Anonsen Cynthia K. , Lau Pauline , Goode Richard L.
Published: October 2006

Recent Interest in onlay cranial bone grafts has shown it to be a preferred technique in the reconstruction of facial defects. This paper reports seven patients in whom outer table cranial bone grafts were used to reconstruct posttraumatic facial deformities. These included orbital and zygomatic deformities (2 patients), maxillary defects (2 patients), mandibular defects (2 patients), and nasal deformity (1 patient). A brief review of the development of membranous bone grafting for maxillofacial reconstruction is given. Good cosmetic results were obtained in six of seven patients with no evidence of graft resorption. One patient required removal of the graft because of inadequate soft tissue coverage. No patient suffered any significant donor site morbidity. In summary, this technique is extremely useful in treating posttraumatic bony deformities of the facial skeleton. The excellent graft survival and ease in harvesting the graft make this technique preferable to traditional endochondral grafts taken from the iliac crest and rib.
Modified lynch procedure for chronic frontal sinus diseases: Rationale, technique, and long‐term results
Authors: Neel H. Bryan , Mcdonald Thomas J. , Facer George W.
Published: October 2006

The modified Lynch operation (Neel‐Lake) differs in several ways from the operation described by Lynch. The operation begins with an intranasal anterior ethmoidectomy. The agger nasi cells are removed by curetting forward between the frontal process of the maxilla and the septum. The middle turbinate, normal‐appearing mucosa of the frontal‐ethmoid complex, and frontal process of the superior maxilla are preserved. Bone removal is limited in most cases to the anterior floor of the frontal sinus, a portion of the lacrimal bone, and the bone over the anterior ethmoid cells. Another important difference is the use of soft, nonreactive material (thin Silastic® sheeting) to stent the nasal‐frontal passageway. Removal of all the mucosa of the frontal‐ethmoid‐sphenoid complex is unnecessary for a good postoperative result, and the remaining normal mucosa hastens the process of reepithelialization of the nasal‐frontal duct.

The patients in our original study group have been observed for a period of 5 to 20 years (mean, 13.5 years) after the surgical procedure. This is the longest period of follow‐up for any group of patients reported in the literature. The incidence of failures increased from 7% (one duct) to 20% (3 of 15 ducts) after an additional 7 years of follow‐up.
CO2 laser treatment of oral leukoplakia
Authors: Chu Felix W. K. , Silverman Sol , Dedo Herbert H.
Published: October 2006

Treatment of oral leukoplakia has been disappointing with the available treatment modalities, because of inaccurate removal and an approximate 30% to 35% rate of recurrence. The CO2 laser has provided a promising new approach in the management of these lesions with very low morbidity and improved control. Twenty‐nine patients were treated with the CO2 laser for 38 extensive (from 1 × 1 cm to 6 × 8 cm) intraoral leukoplakic lesions, 28 for cure and one for palliation. Microscopically the lesions varied from hyperkeratosis to carcinoma in situ. Follow‐up of these patients ranges from 3 to 10 years, with an average of 5 years. An initial recurrence rate of 10.8% (4/37) was observed, and a 3‐year local control rate of 97% after one to two procedures. A malignant transformation rate of 2.6% was encountered. Excellent wound healing and few complications were observed with this treatment approach. Surgical technique and results are reported supporting the advantages of the CO2 laser over conventional modes of treatment in the management of oral leukoplakia.
Panendoscopy in screening for synchronous primary malignancies
Authors: Parker John T. , Hill James H.
Published: October 2006

The entire upper aerodigestive tract must be evaluated at the time of initial tumor evaluation in patients with squamous cell carcinoma of the head and neck. The necessity of panendoscopy (laryngoscopy, bronchoscopy, esophagoscopy) in this evaluation has not been demonstrated convincingly. Between January 1, 1984 and December 31, 1985, 208 patients with previously untreated squamous cell carcinoma of the head and neck were analyzed prospectively. These patients underwent head and neck examination, chest radiograph, barium esophagram, and panendoscopy. Fifteen (7.2%) had synchronous malignancies of the upper aerodigestive tract. In four patients (1.9%) the synchronous primary tumor was found only by endoscopy. Three patients (1.4%) had cancers of the hypopharynx. One patient (0.5%) had a bronchial cancer detected only on bronchoscopy. No tumors were detected by esophagoscopy that were not also seen on barium esophagram. We conclude that endoscopic examination of the hypopharynx is very helpful in screening for additional tumors in head and neck cancer patients, but routine esophagoscopy cannot be supported. Screening bronchoscopy cannot be strongly supported due to its very low yield.
Airway obstruction due to lymphoma of the larynx and trachea
Authors: Hessan Howard , Houck John , Harvey Harold
Published: October 2006

Involvement of the larynx and trachea by lymphoma is an uncommon problem that can cause life‐threatening airway obstruction. High grade obstruction, involvement of the soft tissues of the neck, and tracheal deviation can make intubation and tracheotomy hazardous, if not impossible. Tracheotomy can be ineffective with obstruction of the distal trachea. The clinical presentation and treatment of eight patients with lymphoma involving the larynx or trachea are presented with emphasis on airway management. Dramatic tumor response with relief of airway symptoms was achieved with a regimen of radiotherapy, chemotherapy, corticosteroids, helium‐oxygen mixtures, humidity, and intensive care unit monitoring. Direct airway intervention, including tracheotomy, was usually successfully and safely avoided.
Juvenile malignant melanoma of the head and neck
Authors: Fisher Samuel R. , Reintgen Douglas S. , Seigler Hilliard F.
Published: October 2006

Malignant melanoma of the head and neck is a potentially lethal disease and considered rare among juveniles. Treatment patterns have historically been dictated by experience with adults, however a paucity of data is available to determine the natural history and treatment guidelines for juveniles and children with malignant melanoma. Therefore a retrospective computer‐aided analysis of patients less than 20 years of age having malignant melanoma were obtained from the records of 4,843 patients with malignant melanoma recorded from 1972 through 1986. Eighty‐seven patients were identified from this group with 17 patients having primary malignant melanomas confined to the head and neck.

Parameters evaluated were age at diagnosis, sex, type of melanoma, Clark Level, Breslow depth of invasion, pathologic classification, site of primary, nodal status at diagnosis, surgical treatment, recurrence rate and site of recurrence, and follow‐up status.

Two of 17 patients had stage II disease and were treated with wide local excision and therapeutic radical neck dissection. Fifteen of 17 patients initially presented with stage I disease were treated with wide local excision. Two of these patients underwent elective radical neck dissection both of which proved to have positive occult nodal disease. Both are alive without evidence of disease 2½ to 7 years later. Of the 13 patients who were initially treated with only wide local excision, nine patients developed local (3), regional (3), or systemic (3) disease within 3 months to 9 years from the date of diagnosis. Seven of the nine died of their disease 5 months to 20 years later.

When juvenile patients with melanomas of the head and neck are compared to a comparable age group of patients with melanomas at other primary body sites, the head and neck group had a significantly higher frequency of death. Compared to the adult head and neck population, juvenile patients had identical actuarial survival time, but shorter disease‐free intervals, even though the adult population had a higher percent of poor prognostic indicies (presence of ulceration and thickness of lesions). Failure to control local and regional disease coupled with the overall poor survival rate, indicates that malignant melanoma occurs in the young as a biologically active tumor and suggests an aggressive approach for better control of local and regional disease and, hopefully, survival.
Intraoperative monitoring of the facial nerve
Authors: Harner Stephen G. , Daube Jasper R. , Beatty Charles W. , Ebersold Michael J.
Published: October 2006

Anatomic preservation of the facial nerve, with maximal facial function, is one of the goals of acoustic neuroma surgery. Application of electrophysiologic monitoring techniques is useful in achieving this goal. Preoperative electromyography and nerve conduction studies provide important prognostic information for preservation of the nerve and postoperative function. Intraoperative electromyography alerts the surgeon to facial nerve proximity and potential injury. Direct nerve stimulation is utilized to confirm the location and integrity of the nerve. Matched‐pair analysis of two groups of patients demonstrated an increased ability to preserve the facial nerve with less postoperative facial deformity.
Cephalometric analysis for diagnosis and treatment of obstructive sleep apnea
Authors: Deberry‐Borowiecki Bernard , Kukwa Andrzej , Blanks Robert H. I.
Published: October 2006

A detailed cephalometric analysis was conducted on lateral x‐rays from 30 adult patients with obstructive sleep apnea (OSA) and 12 age‐ and sex‐matched controls. Statistical findings show that OSA patients are different from controls in at least five ways: 1. Their tongue and soft palate are significantly enlarged. 2. The hyoid bone is displaced inferiorly. 3. The mandible is normal in size and position (no micrognathia or malocclusion), but the face is elongated by an inferior displacement of the mandibular body. 4. The maxilla is retropositioned and the hard palate elongated. 5. The nasopharynx is normal, but the oropharyngeal and hypopharyngeal airway is reduced in area by an average of 25%, a factor that could produce or enhance OSA symptoms. These data suggest that cephalometric evaluation could be useful when used with head and neck examination, polysomnographic and endoscopic studies to evaluate OSA patients, and to assist with the planning/surgical treatment for improvement of upper airway patency.
Metastatic disease to the mandible
Authors: Schwartz Michael L. , Mignogna Frank V. , Baredes Soly
Published: October 2006

Metastatic lesions to the mandible are rare, comprising less than 1% of all malignancies.

Twenty‐two cases of metastatic disease to the mandible were seen from 1938 to 1985. The records of 17 cases were available for detailed review.

The age range was from 27 to 80 years with a female to male ratio of 12 to 5. A mandibular or paramandibular mass or swelling was the most common presenting sign. Three patients presented with mandibular metastasis prior to the discovery of the primary tumor. In the other 14 patients, the mandibular lesion appeared from 2 months to 20 years following discovery of the primary tumor. The mandibular lesion was the initial sign of distant metastatic disease in 11 of the 17 patients. Breast, lung, and colon cancer were the most common primary tumors.

When presented with an isolated mandibular mass, a high index of suspicion is necessary to make the diagnosis of metastatic disease. Since plain x‐rays may initially be normal, technetium or CT scan may be necessary to demonstrate osseous destruction.

Inferior alveolar nerve anesthesia should be considered an indication of tumor until proven otherwise.

Treatment is often of a palliative nature because of the presence of widespread metastatic disease; however, surgical resection may be considered in the rare patient with a well‐documented, solitary mandibular metastasis.
Progression of hearing loss in bilateral meniere's disease
Authors: Palaskas Constantine W. , Dobie Robert A. , Snyder Jack M.
Published: October 2006

Otologists may be reluctant to perform labyrinthectomy in unilateral Meniere's disease, fearing the later development of bilateral disease and severe hearing loss in the previously normal ear. To illuminate this issue, we reviewed audiologic records for 85 patients diagnosed as having bilateral Meniere's disease at the University of Washington Hospital from 1969 to 1986. The progression of hearing loss in each ear was noted, as well as inter/aural relationships. Nine patients experienced a significant reversal, in which the initially better ear surpassed the other ear in hearing deficit, but only one of these patients could at any time have been considered a labyrinthectomy candidate, according to hypothetically liberal audiometric criteria.
Alcohol and tobacco consumption in cancer of the mouth, pharynx, and larynx: A study of 316 female patients
Authors: Luce Danièle , Guenel Pascal , Leclerc Annette , Brugere Jacques , Point Daniel , Rodriguez Joseph
Published: October 2006

Three hundred sixteen female patients with cancer of the larynx, pharynx, and mouth were examined and the following cancer sites were compared with respect to alcohol and tobacco consumption: oropharynx, hypopharynx, larynx, epilarynx, lip, and mouth. The mean daily tobacco consumption of smokers and ex‐smokers was not significantly different between cancer locations; however, significant differences between cancer sites were observed with regard to the proportion of nonsmokers. The percentage of nonsmokers was the highest for cancer of the lips and the lowest for cancer of the epilarynx. Cancer locations differed significantly depending on daily alcohol consumption. Consumption was the lowest for patients with cancer of the lips. The percentage of nondrinkers was high for cancers of the lips and larynx and low for cancer of the epilarynx. Examination of the nonsmoking/nondrinking females (27.2%) did not reveal any features specific to this group, except that the patients were older.
Evaluation of malignant invasion of the carotid artery by CT scan and ultrasound
Authors: Rothstein Stephen G. , Persky Mark S. , Horii Steven
Published: October 2006

Carcinoma adherent to the carotid artery may be present in advanced head and neck cancers. Angiography, ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI) are available for the preoperative evaluation of the carotid artery. This study demonstrates that CT is not accurate in demonstrating malignant invasion of the carotid artery. Ultrasonography appears to be the best modality for assessing carotid artery invasion. Magnetic resonance imaging may prove helpful in this determination.
The histopathological and clinical features of irradiated and nonirradiated temporal paragangliomas
Authors: Hawthorne Maurice R. , Fisch Ugo , Makek Miro S. , Harris Jeffrey P.
Published: October 2006

This study was undertaken to determine the effects of radiation on temporal paragangliomas. The histological features were assessed in a blind fashion from 20 surgical specimens obtained from 20 patients, half of whom received radiotherapy. All patients had progressive temporal paragangliomas and were selected on a random basis for this study. The derived data clearly identify the unpredictable response of these tumors to radiation and supports our contention that surgery is the preferred form of treatment for temporal paragangliomas even after radiation therapy. Analysis of clinical histories reveals that previous radiation therapy is associated with a greater operative blood loss and a longer mean postoperative hospital stay due to delayed healing. Despite this, there was no mortality or serious morbidity from surgery.
Sensorineural hearing loss in sickle cell crisis
Authors: Elwany Samy , Kamel Tarek
Published: October 2006

The present investigation examines the effects of sickle cell crisis on peripheral auditory function and auditory brainstem response (ABR). The study includes 10 homozygous sickle cell anemia patients with documented sickle cell (SS) hemoglobin. Testing was performed during the crisis and 1 month after it subsided. Unilateral high frequency hearing loss was found in three patients but persisted in only one of them. Abnormal ABR tracings occurred in four patients but reversed to normal in one of them. The study suggests a trend toward increased incidence of sensorineural hearing loss (SNHL) and ABR changes as frequency and severity of crisis episodes increases. The relationship between SNHL and ABR is analyzed and discussed.
Anomalies of the middle ear
Authors: Nomura Yasuya , Nagao Yumeko , Fukaya Takashi
Published: October 2006

Malformations of the ossicles in 52 ears of 48 patients were analyzed on the basis of surgical findings. The external meatus of each of these ears was patent. The long process of the incus and the stapes are frequently involved in this series of observations. There are distinct groups of ossicular anomalies, in each of which patients show similar degrees of hearing loss and ossicular findings. These include spindle handle, malleus bar, and dislocated annulus.

Spindle handle gets its name from the shape of the malleus handle. There is disconnection between the long process of the incus and the capitulum of the stapes. Malleus bar is a kind of malleus fixation, in which a small bony bar connects the tip of the malleus handle to the posterior wall of the tympanic cavity. In the dislocated annulus, the annulus is dislocated cranially in relation to the middle‐ear structures. Anomalies of the ossicle are usually present. Surgical repairs for these conditions are discussed.
Electromyographic rehabilitation of facial function and introduction of a facial paralysis grading scale for hypoglossal‐facial nerve anastomosis
Authors: Brudny Joseph , Hammerschlag Paul E. , Cohen Noel L. , Ransohoff Joseph
Published: October 2006

For reinnervation of facial paralysis, the XII‐VII nerve anastomosis provides tone and mass contraction but rarely allows selective muscle control. The efficacy of EMG rehabilitation was evaluated in 30 patients who had no coordinated control of facial muscles. EMG signals from bilateral homologous facial muscle sites were converted into computer‐compatible waveform traces and displayed on a video monitor. This facilitated modification of neuromuscular responses using behavioral shaping techniques. A six‐point Facial Nerve Grading Scale was introduced for hypoglossal‐facial nerve anastomosis to assess the results of EMG rehabilitation. Rehabilitation lasted from 3 to 18 months. Ten patients (33%) achieved the highest possible grading (IT) with symmetry and synchrony of function and spontaneity of expression; 17 (57%) reached grade III, which allowed voluntary control of eye and mouth function; 3 (10%) showed minimal gains. It is suggested that neural plasticity allows therapeutic manipulation of central facilitory and inhibitory mechanisms, and possible unmasking of neural connections between the ipsilateral VII and XII nerve motor nuclei which leads to improved facial function.