bluuebunny/crossref_metadata_2025 huggingface dataset:
Trigeminal Neuralgia: Retrolabyrinthine Selective Posterior Root Section
Authors: Pulec Jack L. , Hitselberger WiLliam E.
Published: February 2017

Selective section of the posterior root of the trigeminal nerve was performed 42 times on 41 patients over the past 5 years. Twenty‐eight retrolabyrinthine procedures for the selective section of the posterior root of the trigeminal nerve were performed for typical tic douloureux with complete lasting relief in 25; 1 was relieved with the addition of aspirin; and 2 were relieved by Tegratol, even though it was ineffective before surgery. Of 8 patients with atypical trigeminal neuralgia, 5 required subsequent surgery for treatment of geniculate neuralgia before relief was obtained. Two patients with atypical pain continued their discomfort despite surgery. Selective Vth nerve section was accomplished during translabyrinthine approach in 5 cases with acoustic neuroma and 1 during VIIIth nerve section and facial nerve decompression.

There were no deaths and no serious complications. None had facial paralysis or anesthesia dolorosa resulting from the nerve section. The retrolabyrinthine approach to the posterior root of the trigeminal nerve is ideally suited for those patients with refractory tic douloureux or patients with facial pain secondary to other causes such as tumor. Because of its effectiveness and low morbidity this procedure offers advantages over other surgical techniques.
Limitations of Pathologic Diagnosis in Salivary Gland Tumors
Authors: Harker Lee A.
Published: February 2017

The pathologist's diagnosis of mucoepidermoid tumor, acinic cell tumor, or oncocytoma may lull the surgeon into a false sense of security about the biologic potential of these tumors. A small percentage of low‐grade mucoepidermoid carcinomas pursue an aggressive biologic course leading to metastases and death of the host. There are also acinic cell tumors and oncocytomas which biologically behave malignantly, metastasizing and causing death. Histologically and cytologically, these malignant varieties cannot be separated from those which pursue a benign course and would theoretically require only conservative excision.

It is suggested that when the surgeon receives one of these three diagnoses, the extent of surgical resection be determined by the patient's clinical presentation, as well as knowledge of the tumor's potential, rather than the histopathologic appearance. Evidence from the literature is presented to support this concept.
Evaluation of the Polytetrafluoroethylene‐Membrane Ventilation Tube
Authors: Cantekin Erdem I. , Bluestone Charles D. , Rood Stewart R.
Published: February 2017

In an effort to evaluate the safety and efficacy of the currently available polytetrafluoroethylene (PTFE)‐membrane ventilation tube, in a group of 41 children, the experimental tube was inserted into one ear and a conventional tympanostomy tube was placed in the other ear. The membrane tubes, except in a few instances, were inserted into ears without effusion. After the procedure the children were forbidden to swim and their ears were protected during bathing. In addition to pneumatic otoscopy, a specially designed tympanometric test—which determined if the membrane tube was functioning—was used to assess the operation of the new device postoperatively. In many of the children, Eustachian tube function studies were also performed on the ears with the conventional tympanostomy tubes.

The study was aborted early in the clinical trial period due to the early findings: only 10 of 41 (24%) of the membrane tubes continued to function, the remainder having become occluded; whereas 35 of 41 (85%) of the conventional tympanostomy tubes were found to be still functioning during the same period of observation. Twelve of the 41 membrane tubes had to be removed prematurely and replaced with conventional tympanostomy tubes due to recurrence of middle ear effusion. Scanning electron microscopic studies of the removed tubes revealed blockage of the membrane pores.

From the extraordinarily high failure rate of the PTFE‐membrane ventilation tube in this study, it is evident that the experimental tube should not replace the conventional tympanostomy tube at this time. The selection of the PTFE covering‐membrane on this tube was ill advised, but the rationale of a semipermeable‐membrane ventilation tube has merit. However, should another membrane ventilation tube be designed, its routine use must await controlled clinical trials to determine safety and efficacy in humans.
Metabolic Aspects Of MéNièRe's Disease
Authors: Powers W. Hugh
Published: February 2017

Metabolic dysfunction is one of many factors mentioned as a primary or contributing cause of Ménière's disease. This evaluation consists of three parts: (1) thyroid studies, (2) five‐hour glucose tolerance test, and (3) adrenal and pituitary tests.

Ninety‐eight patients with Ménière's disease are evaluated with an FTA absorption test. neuro‐otologic, allergic, and metabolic studies. The results of the metabolic evaluation are reviewed.

Thyroid function is evaluated with the thyroxine (T4) free index test and the serum‐bound thyroxine (T4) test of Murphy‐Pattee. Although 27% had low normal or hypothyroid findings, it was of clinical significance in only 17% of the patients.

The five‐hour glucose tolerance test was used to diagnose hyperglycemia and hypoglycemia.

Thirty percent of the 70 patients evaluated had an abnormal five‐hour glucose tolerance test. The 19 patients (28%) with a hypoglycemic curve are almost equally divided between a flat glucose tolerance curve, a reactive hypoglycemic curve, and chemical or latent diabetic curve. A manifest diabetic curve was present in two patients. Hypoglycemia was not a primary factor in Ménière's disease but was an important contributing cause in 12 patients that responded to a combination of dietary, allergic or endocrine therapy.

The symptoms of Ménière's disease often become manifest during periods of stress. The adrenal pituitary axis plays a vital role in man's reaction to stress. For this reason, hypoadrenal function was suggested as an etiology in some patients with Ménière's disease.

In this study two recently devised tests were used to measure adrenocortical reserve: (1) ACTH plasma cortisol stimulation test, and (2) insulin stimulation test.

Sixty of the 98 patients were evaluated with the ACTH plasma cortisol stimulation test, and one‐third had a lowered adrenocortical reserve. Further endocrine studies are being performed to determine the presence of a specific endocrine problem.

After evaluation of 98 patients with Ménière's disease, we concluded the following:

The five‐hour glucose tolerance test is helpful in identifying hypoglycemia, which may be a contributing factor in Ménière's disease.

Non‐myxedematous hypothyroidism may play an important role in some patients with Ménière's disease.

Further endocrine studies will be necessary to determine the significance of the lowered adrenocortical reserve as shown by the ACTH plasma cortisol stimulation test.
Bell's Palsy: Progressive Ascending Paralysis, Therapeutic Implications
Authors: May Mark
Published: February 2017

This prospective study of 61 patients with Bell's Palsy supports the concept of a progressive ascending paralysis via the chorda tympani nerve. The severity of degeneration is directly related to the linear extent of facial nerve involvement within the fallopian canal.

Reliably poor prognostic indicators are progression of paresis to complete paralysis, loss of tearing, reduced submandibular salivary flow to 25% or less, or a decreased or loss of response to maximal percutaneous electrical stimulation.

Of the 61 patients selected for this study, 29 patients did not exhibit any of the above indicators and each had, without treatment, a complete or satisfactory return of facial function.

However, 32 patients who exhibited one or more of the poor prognostic indicators, did not do as well. Of 12 patients operated on, four patients had complete recovery, while 3 patients had a fair return of facial function. None of the nonoperated‐on or steroid‐treated patients recovered completely. The number of patients having a poor recovery was highest among the steroid treated, lower among those who did not receive steroids, and lowest among those operated on. Decompression of the vertical and horizontal segments of the facial nerve was an effective form of treatment provided it was performed when submandibular salivary flow was 25% or less, while tearing and response to electrical stimulation were still normal. Seven of eight patients operated on with these criteria had a complete or satisfactory return of facial function.

A loss of tearing was the most important prognostic sign. There were 14 patients with a loss of tearing on the involved side. Each one had a poor return of facial motor function with severe complications of faulty regeneration in spite of surgical decompression of the vertical‐horizontal segment of the facial nerve in 4 patients, steroid therapy in 7 patients, or no treatment in 3 patients. Based upon these results, a prospective study of the effectiveness of a total facial nerve decompression is justified for the few select cases with a dry eye, who would otherwise be destined to spend their lives as a facial cripple.
Lymphocyte‐Tumor Cell Interaction in Patients with Head and Neck Cancer
Authors: Adelstein Edward H. , Davis William E. , Oxenhandler Ronald W. , Templer Jerry W. , Barrett Barbro A.-L.
Published: February 2017

Peripheral lymphocytes from 12 patients with squamous cell carcinoma of the head and neck were incubated with autologous tumor explants. Four of the 12 patients demonstrated lymphocyte induced tumor cytotoxicity. These lymphocytes adhered to the tumor cells and deposited a radioactive label from their surface onto tumor cells. The deposition of this label was associated with tumor death.

Tissue sections from those patients who demonstrated lymphocyte cytotoxicity showed a marked plasmacytic infiltration. This was in contrast to non‐responders where only a desmoplastic tissue response was observed with few inflammatory cells.
Electromyographic Correlation of Tensor Tympani and Tensor Veli Palatini Muscles in Man
Authors: Kamerer Donald B.
Published: February 2017

It is the purpose of this study to attempt a correlation of function, by electromyographic means, of the tensor tympani and tensor veli palatini muscles in humans. Despite the small number of patients tested, it is believed that the similarities and characteristics of the two are unmistakably equivalent. A separate theory for the combined tensor function is discussed in distinction to the stapedius mediated acoustic reflex. The concept of a single tensor muscle, with two anatomic divisions, a common nerve supply, and parallel function, is therefore submitted.
Benign Nasal Polyps Causing Bone Destruction in the Nasal Cavity and Paranasal Sinuses
Authors: Winestock David P. , Bartlett Philip C. , Sondheimer Fred K.
Published: February 2017

Benign nasal polyposis, when extensive, can cause bone displacement and destruction within the nasal cavity and paranasal sinuses. Consequently it may be difficult to distinguish this entity from a malignant neoplasm.
The Large Vestibular Aqueduct Syndrome
Authors: Valvassori Galdino E. , Clemis Jack D.
Published: February 2017

The radiographic observation of 50 patients, each having an enlarged (greater than 1.5 mm. diameter) vestibular aqueduct, are analyzed. In addition to the aqueduct other associated inner ear anomalies have been identified in 60% of this population including: enlarged vestibule (14); enlarged vestibule and lateral semicircular canal (7); enlarged vestibule and hypoplastic cochlea (4); and hypoplastic cochlea (4). The large aqueduct then presumably represents an arrested phase of inner ear development common to all 50 cases. Only 8 of these cases may fall into the Mondini or Mondini‐Alexander classification wherein cochlear abnormalities have been identified.

The size of the aqueduct ranged from 1.5 to 8 mm. in the anteroposterior diameter; the clinical incidence is 50 in 3700 consecutive cases referred for inner ear tomography. Bilateral involvement is twice as common as unilateral with a female to male predominance of 3:2. Most cases are associated with congenital hearing losses.
The True Nature of Bell's Palsy: Analysis af 1,000 Consecutive Patients
Authors: Adour Kedar K. , Byl Frederick M. , Hilsinger, Raymond L. , Kahn Z. M. , Sheldon M. I.
Published: February 2017

In a series of 1502 patients seen in our Facial Paralysis Research Clinic 1048 were diagnosed as having Bell's palsy. Review of clinical, epidemiologic, and laboratory data, plus review of the literature, has led to the conclusion that Bell's palsy is an acute benign cranial polyneuritis probably caused by reactivation of the herpes‐simplex virus, and the dysfunction of the motor cranial nerves (V, VII, X) may represent inflammation and demyelinization rather than ischemic compression. Spinal fluid analysis suggests that the disease is a phenomenon of the central nervous system with secondary peripheral neural manifestations. With our presently available information, treatment of a viral disease with an anti‐inflammatory agent is rational. Prednisone treatment started within the first week of the disease can restore better function to the paralyzed face than is achieved without such therapy, and facial nerve decompression has been unnecessary.
Infiltrating Lipomata of The Head and Neck
Authors: Bennhoff David F. , Wood James W.
Published: February 2017

Recent discovery and subsequent excision of two histologically benign but unusual infiltrating intramuscular lipomas prompted a review of available literature and a collection of lipomatous disorders of interest to the head and neck surgeon. Such lesions may, by their position, cause significant symptoms. Other instances occur wherein their unusual location causes initial confusion in diagnosis. Finally, accurate histologic identification may be obscured by the inclusion of other tissues within the benign fatty tissue.
Bell'S Palsy: A Theory as to Etiology. Observations in Six Patients
Authors: Jannetta Peter J. , Bissonette David J.
Published: February 2017

The etiology of Bell's palsy, like a number of other cranial nerve afflictions which consist of rapid or sudden loss of function, has never been satisfactorily explained despite extensive analysis by a number of investigators over the years. These entities may have a simple mechanical explanation in some patients. This consists of the sudden shift of an arterial loop in the cerebellopontine angle stretching the appropriate nerve. In Bell's palsy, the facial‐acoustic nerve bundle appears to be stretched and compressed from the anterior aspect. Operative findings showing these abnormalities have been demonstrated in six patients and treated in five. A clinical‐pathological analysis of the events of the history and findings in this modest series of patients with Bell's palsy appears to correlate clearly with such a cause.
Homografts in Chronic Ear Surgery
Authors: Viscomi George J.
Published: February 2017

There has been a considerable expansion in the use of tympano‐ossicular homografts in the past decade. The use of homograft tympanic membranes and homograft ossicles as well as combined tympano‐ossicular homografts has been shown to be effective in reconstructive surgery for chronic otitis media. While homograft tympanic membranes are effective in the repair of perforations, temporalis fascia is at least as effective and more readily available. Therefore, the unique benefit of the tympano‐malleal homograft (TMH) is that it is an effective way of replacing the malleus, the “building block” for reconstruction of the ossicular chain. The indications and techniques for the use of the TMH are presented and illustrated through representative cases. The inclusion of the TMH in the otologist's armamentarium offers another avenue for reconstruction of the chronically diseased ear.
The Evaluation of Middle Ear Meningiomas Using Computerized Axial Tomography
Authors: Parisier Simon C. , Som Peter M. , Shugar Joel M. A. , Marovitz William F.
Published: February 2017

Meningiomas localized within the middle ear and mastoid which have no intracranial component are rare tumors. Three patients with meningiomas which were thought to involve only the middle ear were treated surgically, were followed for two to six years and were thought to have been cured. However, when computerized axial tomography became clinically available, these patients were examined using this radiographic technique. Unexpectedly, all three patients were found to have a large intracranial meningiomatous extentiion, A review of the literature reveals only 13 primary meningiomas; these case reports are summarized. It was noted that definitive tests for an intracranial extension of the meningioma were performed in only 2 of the 13 cases. Therefore, in view of our recent clinical experience, it is recommended that a patient presenting with a middle ear meningioma should have a computerized axial tomographic examination of the head to detect the possible presence of a clinical silent intracranial involvement.
Laryngotracheoplasty for Acquired Subglottic Stenosis in Infants and Children: Experience With Six Cases
Authors: Gates George A. , Fernandez Alberto T.
Published: February 2017

Six children aged 6–50 months with acquired subglottic stenosis persisting after medical and endoscopic treatment underwent 7 open resections of the stenotic tissue followed by internal stenting. Five were successfully decannulated after an average treatment time of 6.8 months; the sixth died after accidental extubation. All 5 have satisfactory vocal and respiratory function 11 to 36 months postoperatively (6–18 months postextubation).

Transcartilaginous open resection of subglottic stenosis is a feasible treatment option which can be used, even in the infant, when expectant observation is not advisable.
Ménière's Disease in Children
Authors: Meyerhoff William L. , Paparella Michael M. , Shea Donald
Published: February 2017

Approximately 3% of all patients with Meniere's disease are in the pediatric age group. These children require extensive evaluation. A history of physical or acoustic trauma should be sought and an allergic work‐up should be obtained. A search for metabolic disturbances and identification of inflammatory disorders is also necessary. If a treatable etiology is identified, specific therapy should be directed toward its control. If, after careful evaluation, the etiology remains obscure, non‐specific therapy should be instituted in an effort to alleviate the symptomatology of Meniere's disease. Surgical decompression of the endolymphatic sac and drainage into the mastoid cavity results in relieving the symptoms, particularly vertigo, and appears to be efficacious in patients who have failed diligent attempts at medical therapy.
Horizontal Glottectomy
Authors: Calearo Carlo V. , Teatini Gianpietro
Published: February 2017

Horizontal glottectomy is a procedure which allows removal of the whole glottis, together with its cartilaginous framework. It is performed by means of two horizontal incisions, the lower through the cricothyroid membrane, and the upper one across the wings of the thyroid. The gap is then closed by approximating the cricoid to the thyroid remnants (cricothyropexy).

The indications for horizontal glottectomy are: 1) “double” cancers (i.e. two independent tumors, one on each vocal cord). 2) Hyperkeratosis of the glottis associated with carcinoma in situ. 3) Verrucous cancers of the glottis. 4) Cancers of one vocal cord invading the opposite one via the anterior commissure. In a period of 4 years, 16 patients have been operated on with good early results.
Intra and Extracranial Meningiomas Involving the Temporal Bone
Authors: Maniglia Anthony J.
Published: February 2017

Meningiomas involving the temporal bone are very rare. Until 1964, only 39 cases had been reported in the world literature. Most series reported are very small and a physician is unable, based on his own experience, to acquire a sufficient knowledge about this entity and may raise serious doubts regarding the diagnosis and management of these tumors.

In the past nine years the author has encountered five cases of meningiomas involving the temporal bone. This became a stimulus for a thorough research of the world literature of meningiomas in general, with emphasis on temporal bone involvement. Nine more cases were collected from cooperative physicians with whom the author has been associated. These 14 cases are the clinical material analysed in this study.

This thesis is divided into three sections: 1. Exhaustive review of the world literature on meningiomas with emphasis on involvement of the temporal bone. 2. A detailed presentation and discussion of the clinical material stressing the importance of the newer diagnostic methods available and the most modern microsurgical techniques used in otological and neurological surgery procedures, applied to the treatment of those lesions. A light microscopic histopathological study of all cases reported is presented. Electronmicroscopy demonstrates the true intracellular nature of an atypical, recurrent meningioma occurring in a child. 3. A critical evaluation of the cases presented and the value of the diagnostic and therapeutic methods applied in this series of patients are here analysed. Conclusions are then drawn based on the experience and knowledge accumulated in this study.

The histopathological diagnosis of meningiomas sometimes is difficult. Probably those tumors involve the temporal bone more commonly than has been reported in the literature. Some of these lesions probably are being misdiagnosed as chemodectomas or other neoplasias. Computerized axial tomography, particularly applied to the diagnosis of brain lesions, is the major break‐through of recent modern medicine. A noninvasive technique, when used with contrast enhancement, offers great diagnostic possibilities. Early diagnosis of meningiomas and their complete surgical excision are the key factors necessary for a successful result with a good prognosis and a low recurrence rate.

Although these tumors are classically considered radioresistant, radiotherapy may play a role in the treatment of incompletely excised lesions or in patients of a poor surgical risk. Further experiences and time will probably lead to more definite conclusions regarding the role of radiation therapy or the combined surgical and postoperative radiation treatment.

Of all brain tumors, meningiomas offer the best prognosis.
Malignant Melanoma of the Scalp
Authors: Close Lanny Garth , Goepfert Helmuth , Ballantyne Alando J. , Jesse Richard H.
Published: February 2017

Malignant melanoma of the scalp has a significantly worse prognosis than cutaneous melanoma arising in other head and neck sites. In this series, 125 patients were treated for Stage I invasive melanoma of the scalp and followed 3 to 19 years. Survival rates for these patients were calculated on the basis of several factors. Survival after treatment was not affected by the age and sex of the patient, size and site of the primary, or treatment of the primary lesion, although local failure was higher among those treated by primary excision and closure. Patients undergoing elective neck dissection with histologically negative nodes had significantly better survival rates than those with histologically positive nodes or patients in whom a neck dissection was not performed.
Amyloidosis Presenting as a Mass in the Neck
Authors: Endicott James N. , Cohen Jacobo S.
Published: February 2017

A 54‐year‐old white male presented with a large suprahyoid midline mass. On thorough history and physical examination, he had features which characterize amyloidosis, including congestive heart failure and carpal tunnel syndrome. The classification, clinical findings, and associated syndromes are reviewed. A striking feature of the amyloid deposit is its rapid growth. Amyloidosis should now be considered in a differential diagnosis of a neck mass.
Late Syphilitic Hearing Loss: A Diagnostic and Therapeutic Dilemma
Authors: Becker Gary D.
Published: February 2017

Cochleovestibular dysfunction may occur as the only manifestation of late syphilis. It may occur singly, in combination, and be unilateral or bilateral. A presumptive diagnosis may be made on the basis of excluding other known etiologies of inner ear dysfunction and on a positive serological test for syphilis. The combined experience of the author and a literature review suggests that a combination of penicillin and prednisone is the treatment of choice. Since no controlled clinical trials have been reported, antibiotic and corticosteroid dosage, timing and route of administration are conjectural. All patients with a presumptive diagnosis of late otitic syphilis should be treated regardless of previous syphilitic treatment. Duration of symptoms and magnitude of functional loss are not contraindications. Penicillin is the antibiotic of choice and the minimal treatment should be the United States Public Health Service schedule for late syphilis, i.e., benzathine penicillin G, 2.4 million units by intramuscular injection weekly for three successive weeks. Since penicillin acts on dividing cells only and since treponemes probably divide very slowly in late syphilis, prolonged penicillinemia is desirable. This may be maintained with injectable depo‐penicillin (benzathine penicillin G) or penicillin by mouth, depending upon patient compliance. Duration of treatment of one year is suggested. Prednisone, 40 to 60 mgm/day by mouth is started and continued for at least two weeks. If symptomatic improvement occurs the dose is tapered to a level which will maintain this improvement.
Alveolar Soft Part Sarcoma of the Head and Neck
Authors: Spector Richard A. , Travis Lawrence W. , Smith Jason
Published: February 2017

The twelfth case (in 25 years of literature) of alveolar soft part sarcoma of the head and neck is presented. It represents the seventh case to occur in the base of tongue and the second to be associated with pregnancy. The average age of onset is in the second decade with a 2:1 female preponderance and a marked tendency to right‐sided occurrence. Treatment with surgery and/or radiotherapy is not curative. Local recurrence is common as are distant metastases, usually to lung, brain or bone. Theoretically, chemotherapy may offer better control of disease but few agents have shown dramatic response. The characteristics of the tumors are discussed and various chemotherapeutic agents are reviewed.
Unusual Uses of the Deltopectoral Flap
Authors: Sofferman Robert A.
Published: February 2017

For the past decade the deltopectoral flap has become the premier reconstructive tool in oncologic head and neck surgery. It has achieved a level of reliability that has not been approached by any other single flap. Its most common application has been replacement of lost skin either from planned surgical resection or necrosis following ablative surgery. This paper illustrates a few unusual clinical settings in which the deltopectoral flap was used instead of other conventional methods: 1. Use of the same deltopectoral flap in two different locations. 2. Employment of the base of the deltopectoral tube for skin coverage. 3. Successful application of bilateral simultaneous deltopectoral flaps. 4. Three‐stage reconstruction of the cervical esophagus in a tenuous metabolic setting. 5. Two‐stage technique for soft palate replacement. 6. An alteration of the design of the conventional deltopectoral flap because of an upper pectoral abscess.
Ganglioneuroblastomas of the Cervical Sympathetic Nerve
Authors: Hagan Warren E. , Lejeune Francis E. , Mitchell William T.
Published: February 2017

Although ganglioneuroblastomas occur infrequently in the head and neck area, if they are recognized and completely excised initially, the chances of cure are greatly increased. Two patients are reported who demonstrate some of the more important aspects of diagnosis and treatment. The first patient, whose retropharyngeal tumor was diagnosed when he was 12 years of age, was treated with transoral excisional biopsy. He is alive and tumor‐free 3½ years later. The second patient, a 2‐year‐old boy, was treated by incisional biopsy without a major resection. He died one year later. The diagnostic evaluation of a patient with suspected neurogenic tumor includes a complete physical examination for distant adenopathy, abdominal masses, hypertension, and neurological impairment. Intraoperatively, neurosurgical and pathological consultation should be available.
Relationships between Cervical Node Histological Patterns and Rosette Test Scores: Possible Prognostic Value in Laryngeal Cancer
Authors: Menzio P. , Cortesina G. , Sartoris A. , Morra B. , Bussi M. , Tabaro G.
Published: February 2017

In previous research the authors have remarked that some hystological patterns — macrophagic hyperplasia and thymus‐dependent areas hyperplasia — when prevailing in cervical nodes of laryngeal cancer patients, possess a positive prognostic value.

In this study the possible relationship between the results of E and EAC‐rosettes and prevailing hystologic patterns in cervical nodes is investigated. A positive correlation was not found.

Conclusively, the inconsistency of aspecific tests for prognostic purposes and the need for a specific immunological monitoring system are outlined.
Management of Malignant Salivary Gland Tumors
Authors: Byun Young S. , Fayos Juan V. , Kim Young H.
Published: February 2017

A total of 54 patients with major salivary gland tumor were treated with radiation therapy at the University of Michigan from 1955 to 1975, inclusive. Fifteen had total resection and radiation, 16 had subtotal resection and radiation, and 23 were inoperable and received radiation only. Local control rate was different between these groups, 86.7%, 75%, 21.7% respectively, as was survival rate at 5 years, 78.4%, 59.8%, 29.9% In patients with facial nerve palsy, with combined surgery and radiation, 65.3% local control and 49.7% 5year survival was obtained. Regional neck node metastasis was noted in 25.5% and distant metastasis in 24.1%. Local tumor control was found to be a very important factor in survival: 70.2% survival in patients with local control and 28.7% without. The authors conclude that a combined radical surgery and postoperative radiation would improve the prognosis of these patients with major salivary gland tumors.
Primary Carcinoma Involving the Temporal Bone: Analysis of Twenty‐Five Cases
Authors: Wagenfeld Derrick J. H. , Keane Tom , van Nostrand A. W. Peter , Bryce Douglas P.
Published: February 2017

Twenty‐five patients with primary carcinoma involving the temporal bone were reviewed. Pain and discharge were the most common complaints. A history of previous otitis media was found in 64% of the patients. On clinical and radiological assessment, 18 cases were deemed surgically resectable and 7 unresectable. Analysis of treatment revealed 3 groups of patients: an unresectable group of 7 patients treated by primary radical radiation therapy in which there were no long‐term survivors; another group received primary radiotherapy with surgery reserved for residual or recurrent disease — 4 of this group of 12 survived 4 years or longer; and the remaining group had primary surgery with radical postoperative radiation therapy — 4 of this group of 6 patients survived 4 years or longer despite incomplete surgical removal of tumor in all except 1 patient. The results and possible reasons for failure are discussed.
Panel Discussion: Otolaryngologic Allergy. Management of Allergy‐Like Symptoms in Otolaryngology
Authors: McNelis Francis L. , McNelis Francis L.
Published: February 2017

Allergic disorders have been found to be among the most common and costly health problems afflicting our nation. Many of the symptoms presenting daily in an ENT office practice can be triggered by an atopic or IgE mediated mechanism, or by a non‐atopic or non‐immune mechanism. The ability to differentiate between these two mechanisms has been enhanced by an in vitro serologic test for total IgE known as Prist test. A 10‐month study demonstrated the value of this test in determining a treatment plan that was both acceptable to the patient and resulted in a high success rate. The need for including allergic disorders in the future training of the otolaryngologist is presented.
Management of the Scoliotic Nose
Authors: Stucker Fred J.
Published: February 2017

The twisted nose represents an enigma to many rhinoplasty surgeons because of its frequent recurrence following correction. Reasons for failure include improper preoperative evaluation, failure to understand and compensate for the dynamics of cartilage and faulty surgical execution.

One cannot expect a perfectly straight nose on all occasions but an analytic evaluation and appropriate surgical execution can routinely yield an apparently straight nose.

The dynamics of the twisted nose are explored with special emphasis on the septal contribution to the scoliosis. The contribution of the bony and cartilaginous structures to the deformity is emphasized. An appreciation of the nasal cartilage‐osseous unit is essential to understand the production of the twisted nose and its subsequent correction.
Accuracy of Hearing Prediction by the Acoustic Reflex
Authors: Hall James W. , Koval Charles B.
Published: February 2017

Seven methods of hearing loss prediction from acoustic reflex data were compared in 225 adult subjects. The prediction methods were two versions of Sensitivity Prediction by the Acoustic Reflex (SPAR), four regression equations and a bivariate plot technique. Accuracy of hearing prediction varied significantly among methods. Hearing loss was identified most accurately with the bivariate plot technique. One SPAR version best categorized degree of hearing loss. With two of the regression equations, predicted hearing threshold level (HTL) was within ± 15 dB of actual HTL in two‐thirds of the subjects. When hearing level was categorized, all methods produced a sizeable proportion of predictive errors (29 to 48%). Serious errors, however, were uncommon.

Accuracy of hearing loss prediction among methods was assessed as a function of subject age and minor impedance aberration. In general, neither factor was associated with a statistically significant change in predictive accuracy.
Middle Ear Effusions and the Nitrous Oxide Myth
Authors: Kennedy Thomas L. , Gore Larry Brooks
Published: February 2017

Myringotomies were performed on 75 ears suspected of having chronic or recurrent otitis media with effusion. Preanesthesia and intraoperative tympanograms with halothane, nitrous oxide, and oxygen anesthesia were compared for possible changes in middle ear pressure due to anesthesia. In addition, preanesthesia tympanograms were compared with tympanograms taken 2 weeks before hospital outpatient surgery. Tympanograms of 11 ears were found to shift from a flat type recorded at the office visit to normal range at pre and postinduction anesthesia. Middle ear fluid was not present in any of these 11 ears. The remaining 64 ears were broken down into three abnormal tympanogram configurations; flat, roll‐over, and peaked negative pressure types. Comparing the tympanograms done in the office, preanesthesia and intraoperatively, only one of the 64 ears showed a change after induction of anesthesia. Three of the 64 ears revealed an unpredictable result with negative myringotomies. These results tend to support tympanometry as a means in predicting myringotomy findings, and also refute the contention that short‐term nitrous oxide anesthesia changes the middle ear effusion during myringotomy.
Chemodectomas Arising in Temporal Bone Structures
Authors: Dickens W. Jackson , Million Rodney R. , Cassisi Nicholas J. , Singleton George T.
Published: February 2017

Eighteen patients with chemodectomas arising in temporal bone structures were evaluated and treated at the University of Florida. Seventeen patients have each been followed a minimum of 3 years. Patients were retrospectively staged as having “local” or “advanced” disease, depending on the presence or absence of bone destruction and/or cranial nerve involvement. Fourteen of the patients received radiation therapy as all or part of their therapy; 6 patients were treated with radiation therapy alone, 3 patients were irradiated immediately postoperatively for residual disease, and 5 patients had radiation therapy for recurrence after operation. They were treated with cobalt‐60 radiation with doses ranging from 3760 to 5640 rad. All irradiated patients demonstrated evidence of tumor regression, and none have had tumor recurrence with followup of 3–12 years. Of the 8 patients with cranial nerve paralysis prior to therapy, 5 had return of function of 1 or more cranial nerves. One of 6 patients treated initially with radiation therapy had a complication, while 6 of 8 patients Irradiated postoperatively had complications. None of the complications were fatal. Three patients treated by operation for early disease limited to the hypotympanum had the disease controlled for 11–12 years. Guidelines for the selection of initial therapy are discussed.
Effects of a Soluble Fraction of Porcine Tissue on the Aggregation of Human Blood Platelets
Authors: Davis Richard B. , Yonkers Anthony J. , Heywood Barbara B. , Fritz Jene
Published: February 2017

Epistaxis has been controlled by the use of porcine strip packing in patients with thrombocytopenia prior to and with platelet transfusion. The present study has extended previous observations about the probable mode of action of porcine tissue, to show that the addition of an aqueous fraction (AF) of homogenized porcine tissue to platelets causes prompt aggregation in vitro. Human platelet rich plasma was aggregated by the AF using standard turbidimetric techniques. AF acted synergistically with nonaggregating amounts of either adenosine diphosphate or collagen to cause aggregation. Platelet aggregation was enhanced by AF both with 300,000 platelets/cu mm (standard) or with reduced platelet numbers (50,000/cu mm). The results further define possible mechanisms of action of porcine strip packing in patients who have epistaxis and are thrombocytopenic.
Validation of a Vocal Cord Lateralization Procedure
Authors: Lewy Robert B. , Borkenhagen Robert , Hinojosa Jorge
Published: February 2017

Various corrective procedures have been described to move the midline paralyzed vocal cord laterally in order to create a more desirable air exchange position. They have been complicated and often unsatisfactory, even for the skilled operator.

A newer, direct approach by direct laryngoscopy, including incision and debulking of the paralyzed vocal process, as first reported by Fernando Kirchner, M.D., is described. The direct laryngoscopic method permits easier accessability for this problem

In three involved surgical cases discussed, the air exchange in each was improved. The patients have continued to have good functional voices and no longer require tracheostomy.
Treatment of Recurrent Carcinoma at the Base of the Skull With Carbon Dioxide Laser
Authors: Rontal Michael , Rontal Eugene
Published: February 2017

The extension of carcinoma to the cribriform plate is a poor prognostic finding. Two extremes of treatment approach have been advocated. On the one hand, patients may be abandoned to palliative chemotherapy. On the other hand, heroic and aggressive resections may be advocated including combined neurosurgical transdural and otolaryngologic facial‐orbital resection. Armed with the surgical microscope and the CO2 laser there may be a place for a middle ground of therapy.

We present our experience with recurrent tumor after full course radiation therapy and maxilloethmoidectomy. The biopsy proven recurrences were found at the cribriform plate but could not be shown to have crossed into the anterior cranial fossa by polytomography or high resolution CT scanning. The CO2 surgical laser delivered through the surgical microscope was used with repeated applications. Recurrent epidermoid carcinoma found to be confined to the nasal side of the cribriform plate can be controlled by careful microscopic stripping of soft tissue from the cribriform plate with a surgical laser.
Carotid Sinus Itypersensitivity: A Cause of Syncope in Patients with Tumors of the Head and Neck
Authors: Muntz Harlan R. , Smith Peter G.
Published: February 2017

Carotid sinus hypersensitivity secondary to the presence of an underlying head and neck cancer has only recently been discussed in the literature. We present seven cases of carotid sinus hypersensitivity, each with paroxysmal bradycardia and hypotension associated both with and without palpation of the carotid bifucation. A discussion of the anatomy and the etiology of the hypersensitivity is given. Currently available therapeutic modalities are discussed in regard to their efficacy in this study.

Carotid sinus hypersensitivity secondary to tumor in the neck is most often vasodilatory in nature and hence does not respond well to transvenous pacemaker. The best treatment for severe hypersensitivity appears to be periarteriectomy or intracranial nerve root section. Radiation therapy is occasionally beneficial.
Tumor Involvement of the Facial Nerve
Authors: Wiet Richard J. , Lotan ABraham N. , Monsell Edwin M. , Shambaugh George E.
Published: February 2017

Tumors involving the facial nerve are rare and challenging in both diagnosis and treatment. In this paper we report 18 cases of benign and malignant neoplasms involving the temporal portion of the facial nerve. The selection of those patients with facial paralysis who require detailed evaluation is discussed. Often, despite thorough evaluation of these patients, a preoperative diagnosis is unavailable or erroneous. An occasional patient may require surgical exposure of the nerve from the middle cranial fossa to the parotid gland.
Experimental Use of Fibrin Tissue Adhesive in Middle Ear Surgery
Authors: Siedentop Karl H. , Harris David M. , Loewy Arthur
Published: February 2017

The biocompatibility of a new tissue adhesive was tested. Its major advantages are adhesions, hemostasis, and the promotion of wound healing. In experimental surgery on 43 middle ears of chinchillas, documented by histological evidence obtained 45 days after operation, the validity of the following two hypotheses was established.

1. That fibrin tissue adhesive placed upon the footplate of the stapes is biologically compatible, biodegradable and does not cause toxic, inflammatory or foreign body reactions, or other tissue damage to middle ear structures.

2. That a small piece of bone glued on the long process of the incus with fibrin tissue adhesive shows permanent tissue union.

In addition, in cases where the inner ear was accidentally opened by surgically subluxating the stapes and adhesive was free to enter the vestibule, evidence was obtained that there was no damage to inner ear structures. This finding deserves further investigation.
Diagnosis and Management of the Opacified Sphenoid Sinus
Authors: Kron Thomas K. , Johnson Charles M.
Published: February 2017

The growing number of surgical procedures at the base of the skull makes a clear understanding of sphenoid disease and its anatomic relationships important for the modern otolaryngologist. We present five cases demonstrating the spectrum of sphenoid sinus disease, its systemic as well as local complications, and its surgical management.

Pertinent anatomic and embryologic relations are reviewed and their diagnostic evaluation is discussed. Pitfalls in the diagnosis and management of these diseases are reviewed noting possible complications and significant danger points. The necessity for cooperation among the otolaryngologist, neurosurgeon, and ophthalmologist in the management of these entities is also demonstrated.
Endo‐Extralaryngeal Needle Carrier Instrument
Authors: Lichtenberger György
Published: February 2017

The author reports on an instrument which is suitable for stitching from inside to outside under laryngomicroscopic control without opening the larynx.

The instrument, as well as the operation techniques based on the instrument, permit the simple treatment of vocal cord synechiae and of laryngostenosis consequent to bilateral paralysis of the recurrent laryngeal nerve.
Sternohyoid Myofascial Flap Reconstruction Of The Larynx For Vertical Partial Laryngectomy
Authors: Calcaterra Thomas C.
Published: February 2017

Reconstruction of the larynx for vertical partial laryngectomy is of paramount importance in eventual voice and deglutition rehabilitation. Many different methods of laryngeal reconstruction have been tried attesting to the challenge of minimizing hoarseness and aspiration after this type of surgery.

During the past decade the scope of partial laryngeal surgery has broadened, mandating more extensive reconstructive procedures in order to acceptably rehabilitate upper aerodigestive function. During the past 6 years the author has employed a superiorly‐based sternohyoid myofascial flap to reconstruct the larynx after vertical partial laryngectomy in 31 patients.

Swallowing was resumed in all patients without significant aspiration. Although decannulation was delayed in 8 patients, all patients were eventually extubated. Voice quality was considered far superior to other reconstructive methods formerly used by the author.
Microscopic Sinus Surgery, Transnasal Ethmoidectomy and Sphenoidectomy
Authors: Dixon Hamilton S.
Published: February 2017

Intranasal ethmoid surgery has traditionally been a “blind procedure” using monocular vision, the delicate control of instruments being less than optimal. The addition of the operating microscope with a special self‐retraining retractor speculum is presented in a series of 87 patients over 7 years, 49 of these having had transethmo‐sphenoidectomy. Evaluation, anatomy, technique and results are discussed. Whereas the rate of serious complications is reported at 3% in large series, there were no complications in this series. The results of 181 microscopic antrostomies is also discussed. This technique offers considerable added safety to the patient, more self‐confidence to the surgeon with binocular vision and much better control of instruments, and allows a more adequate procedure because of less fear of dreaded complications.