bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-functional fibre Bragg grating sensors for fatigue crack detection in metallic structures
Authors: Betz D C , Staszewski W J , Thursby G , Culshaw B
Published: October 2006

This paper investigates the use of multi-functional fibre Bragg grating (FBG) sensors for structural health and usage monitoring. It is shown how FBG sensors can be used simultaneously for both a strain-sensing-based load-monitoring system and a Lamb-wave-based damage-detection system. Structural health and usage monitoring has gained considerable interest in engineering technologies. Especially for the aircraft industry where damage can lead to catastrophic and expensive failures and the vehicles involved undergo regular cost intensive inspections, a health and usage monitoring system (HUMS) has one of the highest payoffs. Although different approaches for an HUMS can be found in the literature, a system based on the fusion of load monitoring and damage detection could provide highest potential for implementation in future aircrafts.

For this paper, initial tests have been carried out to demonstrate the dual load and damage monitoring on a simple aluminium plate. A fatigue test was carried out to study the crack propagation of the plate. FBG sensors were used to record the load history of the test. For the fatigue analysis, the crack growth was observed using a conventional method and the Lamb-wave analysis. Piezoceramic transducers and the same FBG sensors that already monitored the load history were applied to record the Lamb-wave signals. A novel damage index that correlates the sensor signals with the crack length is introduced. Subsequently, the results obtained for both transducers are given and their performance is compared. Final remarks on this initial test of a dual load and damage-monitoring system based on FBG sensors conclude the paper.
Prediction of a non-isothermal three-dimensional mixing layer created by a scarfed lobed mixer
Authors: Salman H , McGuirk J J , Page G J
Published: October 2006

The work presented here considers the complex mixing processes associated with a three-dimensional non-isothermal convoluted mixing layer such as produced by scarfed lobed mixers as used in aero-engine gas turbine exhaust ducts. Numerical simulations of the compressible Navier-Stokes equations in Reynolds-averaged form with a k-ε turbulence model are conducted. The discretization of the high-Reynolds-number form of the k-ε model for the unstructured mesh numerical solver used is described. The discretization was verified against two elemental flows that represent subcomponents of lobed mixer problems: a planar shear layer and a developing boundary layer. A grid dependency study is also presented for different grid types: purely quadrilateral, a purely triangular, and a mixed grid, to assess the influence of different mesh types on predictions. Results for a two-dimensional planar shear layer flow indicated that quadrilateral grids yielded best results for a given grid resolution. This result was confirmed in the numerical simulations of three-dimensional convoluted shear layers created by a generic lobed mixer geometry in which hexahedral grids yielded the most accurate results relative to a purely tetrahedral grid and a mixed grid. The model was finally used to simulate the flow field in an engine-representative scarfed mixer configuration under non-isothermal flow conditions representative of current engine practice. Results showed that the scarfed mixer introduced strong flow asymmetries in the azimuthal direction. This caused adjacent vortical structures produced by the alternating short and long gullies of the lobes to interact with one another and this behaviour dominated the flow evolution. Detailed comparisons between predicted and measured temperature fields were also carried out and generally showed encouraging agreement and capture of correct trends. The evolution of the predicted thermal mixing layer slightly lagged the measured data as was also the case for the velocity fields, indicating that improvements in the prediction of the thermal mixing layer may be strongly dependent on correct prediction of the momentum transport process as well as improved modelling of the turbulent heat fluxes.
Silver-induced Enhancement of Magnetic Properties of CoPt3 Nanoparticles
Authors: Du Xueyan , Inokuchi Makoto , Toshima Naoki
Published: October 2006

The influence of Ag on the magnetic properties of CoPt3 nanoparticles has shown that the addition of Ag (5.0 mol %) can not change the size and crystal structure (i.e., fcc structure) of CoPt3 nanoparticles. However, SQUID studies have revealed that the addition of Ag can notably improve the magnetic properties of CoPt3, which could result from the interaction between Ag and CoPt3 nanoparticles.
Oxalic Acid-catalyzed Reaction of Alcohols with NaSCN: The Effects of Additives NaI and I2
Authors: Miyake Hideyoshi , Nakao Yuichi , Sasaki Mitsuru
Published: October 2006

Oxalic acid-mediated conversion of alcohols to thiocyante and/or isothiocyanate is described. Aliphatic tertiary alcohols give isothiocyanate by the reaction with NaSCN in the presence of I2, whereas they give thiocyanate without it.
Iowa results of acoustic neuroma operations
Authors: Harker Lee A. , Mccabe Bryan F.
Published: October 2006

The records of 10 patients, who underwent removal of small vestibular schwannomas by the middle cranial fossa approach at the University of Iowa Department of Otolaryngology and Maxillofacial Surgery between October 1974 and November 1977, are reviewed. The principal deviation from previously described operative techniques is that after identification of appropriate landmarks, the internal auditory canal is first unroofed in its medial portion near the porus rather than following the facial nerve to the fundus of the canal. There were no intraoperative complications, but one patient died after a postoperative brain stem vascular accident. Another patient developed a cerebrospinal fluid leak and, subsequently, meningitis. Auditory function was preserved postoperatively in 8 of 10 patients, but only 6 retained auditory function after discharge from the hospital. Facial nerve function was normal immediately after surgery in 6 of the 10 patients, but return was incomplete in 2 patients more than 1 year after surgery. Postoperative routine and special audiometric studies are discussed.
Posterior tracheal laceration: A rare complication of tracheostomy
Authors: Jacobs John R. , Thawley Stanley E. , Abata Rolando , Sessions Donald G. , Ogura Joseph H.
Published: October 2006

Tracheostomy is an operation with a long history and many potential complications. Two case reports of acute posterior tracheal wall laceration, a rare complication, are presented. Although previously described as being secondary to inadvertent knife contact with the posterior tracheal wall, both of these cases are thought to be due to insertion of the tube with excessive force against tissue made friable by previous radiation. The diagnosis should be suspected if poor ventilation follows insertion of an endotracheal or tracheal tube. The offending tube should be removed and an oral endotracheal tube inserted. After treatment of any accompanying pneumothorax, the site should be evaluated under direct vision as the endotracheal tube is withdrawn proximal to the tracheotomy. If a tear is found, esophagoscopy is performed to insure the integrity of the esophagus. Repair of the tracheal wall is done with a single layer closure through the tracheotomy alternating suturing with ventilation. A generous tracheotomy, soft tubes and care in insertion of tubes into the trachea are suggested preventive measures.
Laryngotracheal separation
Authors: Lejeune Francis E.
Published: October 2006

The popularity of the motorcycle, specifically trail bike riding, in the past several years has produced an increasing incidence of severe “clothesline” injuries to the larynx and trachea. Even at moderately high speed the impact of a horizontal cable with the neck of the rider causes a sudden hyperextension of the neck, and an avulsion of the larynx from the trachea, separating at the relatively rigid fibrous connective tissue between the cricoid cartilage and the first tracheal ring. Interruption of the strap muscles, the recurrent laryngeal nerves, laceration of the esophagus, and compression fracture of the cervical vertebral bodies can occur.

The unseated rider requires immediate assistance, airway obstruction being his greatest problem. In the early minutes after the accident he must be transported to an emergency facility where tracheostomy and resuscitation can be provided.

Mediastinal infection, tracheoesophageal fistula, subglottic stenosis, and intermittent depression many follow the initial repair. Rehabilitative measures include permanent tracheostomy, the use of neuromuscular pedicle graft, hyoid bone graft, intracordal injection of teflon paste, and carbon dioxide laser excision of webs and cicatricial tissue.
Sinus histiocytosis with massive lymphadenopathy (rosai‐dorfman disease): Report of a case with respiratory tract involvement
Authors: Carpenter Robert J. , Banks Peter M. , Mcdonald Thomas J. , Sanderson David R.
Published: October 2006

The term “sinus histiocytosis with massive lymphadenopathy,” introduced in 1969 by Rosai and Dorfman, refers to a newly recognized disease entity characterized by painless cervical lymphadenopathy, fever, leukocytosis, increased erythrocyte sedimentation rate, and hypergammaglobulinemia. The typical course is one of insidious onset, protracted duration of the active disease state, and eventual spontaneous remission, occasionally with subsequent recurrences. Lymph nodes other than those in the cervical area may be involved, and extranodal involvement can occur (such as in the orbit, skin, or respiratory tract). Clinically, this entity may closely simulate malignant lymphoma or nonneoplastic conditions with lymphadenopathy. We present a case in which this disease process extensively involved the respiratory tract and produced obstructive symptoms. The otorhinolaryngologist should be aware of this disease entity and should include it in the differential diagnosis for patients with cervical lymph node enlargement or bronchial obstruction.
Complications of intranasal ethmoidectomy: A review of 1,000 consecutive operations
Authors: Freedman Harvey M. , Kern Eugene B.
Published: October 2006

A series of 1,000 consecutive intranasal ethmoidectomies performed on 565 patients was reviewed. There were 28 complications (2.8%) in 26 patients. No patient died, and none became blind. This experience suggests that, in experienced hands, intranasal ethmoidectomy for polypoid disease and chronic ethmoid sinusitis can be a safe operation.
Early childhood language delay: The otolaryngologist's perspective
Authors: Brookhouser Patrick E. , Hixson Peter K. , Matkin Noel D.
Published: October 2006

Many etiologic factors have been implicated in delayed language development in the preschool child including: low birth weight, perinatal insults to the CNS, and chronic/recurrent middle ear disease with conductive hearing impairment during the first years of life.

The results of an in‐depth evaluation of 24 children, who manifested preschool language delay significant enough to require remedial intervention, are reported. A suggested early identification model employing High Risk Factors and a Developmental Screening Questionnaire for use by otolaryngologists, pediatricians and audiologists is presented.
The influence of embryology of the mid‐face on the spread of epithelial malignancies
Authors: Panje William R. , Ceilley Roger I.
Published: October 2006

A review of 150 cases of mid‐face skin cancers treated by the fresh tissue technique of microscopic controlled excision has revealed local epithelial cancer spread to be markedly influenced by embryological fusion planes. Knowledge of facial embryology which is reviewed in this article should allow the surgeon to better predict and treat mid‐facial skin cancer.
Bronchial adenoma: A malignant misnomer
Authors: Rowe Lee D. , Jafek Bruce W.
Published: October 2006

Bronchial adenomas are a histologically and clinically diverse group of respiratory tract neoplasms arising from mucous glands and ducts of the tracheobronchial tree. They represent 1% of pulmonary malignancies. The traditional concept of a single, histologically benign form is challenged and the malignant potential of these tumors is stressed. Three main cell types with their characteristic histopathologic and clinical features are discussed: carcinoid, adenoid cystic carcinoma, and mucoepidermoid carcinoma.

A case of bronchial carcinoid with hepatic metastases is reported, emphasizing the malignant potential of this controversial group of tumors. The appropriate diagnostic evaluation is outlined and aggressive surgical management is stressed. Chemotherapy and radiation therapy which are reserved mainly for palliation do not add to overall five year survival rates.
Distant metastases in head and neck epidermoid carcinoma
Authors: Dennington Michael L. , Carter Donald R. , Meyers Arlen D.
Published: October 2006

Autopsy findings and case histories of 64 cases of epidermoid carcinoma of the head and neck at the Denver Veterans Administration Hospital between 1967 and 1977 were reviewed. Forty percent of these cases had metastases below the clavicles at autopsy. Incidence of metastasis was related to size of the primary lesion. Correlation with nodal involvement was equivocal. Our data was combined with that of similar studies done by O'Brien in 1970 and Gowen in 1963 and resulted in a combined autopsy series of 247 cases. Overall, 47% had distant metastases at autopsy.
Surgical correction of the convex vocal cord after teflon injection
Authors: Horn Karl L. , Dedo Herbert H.
Published: October 2006

Teflon injection of paralyzed and bowed vocal cords has been performed since 1962. It has been generally accepted that nothing could be done if an excess is injected or a granuloma reaction within the cord occurs causing an early or late convex cord which projects across the midline. A technique is described to correct such convex cord problems and the results are given for 12 patients for whom corrective surgery was done.
Malignant external otitis in infants
Authors: Cóser Pedro Luiz , Stamm Aldo Eden Cassol , Lobo Ruy Carlos , Pinto José Antonio
Published: October 2006

The authors report two cases of malignant external otitis in infant boys, 5 and 6 months old respectively, caused by different etiologic agents (Pseudomonas aeruginosa and Proteus mirabilis). Both of them were in very poor general health, but neither developed complications such as facial paralysis because of the intensive treatment that was employed from the beginning.
Central tinnitus — diagnosis and treatment. observations simultaneous binaural auditory brain responses with monaural stimulation in the tinnitus patient
Authors: Shulman Abraham , Seitz Michael R.
Published: October 2006

Central tinnitus is defined as an abnormal sensation of sound which is perceived by the patient and established by neurotologic diagnosis to be retrocochlear and/or within the central nervous system in location. A method of diagnosis and evaluation using evoked response audiometry (ABR) is reported. A clinical test, Simultaneous Binaural Auditory Brain responses with monaural stimulation (ABR) for central location of tinnitus is presented. The use of a diagnostic approach to the selection of a tinnitus masker will be presented. Electrophysiologic indices for central tinnitus have been observed based on short latency ABR recordings. A classification has been presented. The use of lidocaine I.V. therapy with ABR recordings is presented. The concept, diagnosis, and techniques at this time, relating to central tinnitus, are presented as clinical observations. These observations are a beginning for the establishment of an electrophysiologic series of indices which can be interpreted as an electrophysiologic correlate of tinnitus to be supported by basic clinical research.
Clinical‐Pathological determinants in prognosis of fibrous histiocytomas of head and neck
Authors: Blitzer Andrew , Lawson William , Zak Frederick G. , Biller Hugh F. , Som Max L.
Published: October 2006

Review of the literature reveals 76 cases of fibrous histiocytoma of the deep structures of the head and neck. To this we have added 11 of our own cases, and analyzed the total group to determine clinical and histological features of a high risk population. Age, sex, presence of pain, location of tumor, size of tumor, and local invasion appear to be important clinical criteria. Bizarre giant cells, numerous and atypical mitoses, necrosis, and inflammation appear to be important histologic features. The treatment of choice is wide local excision. Chemotherapy appears to produce tumor regression.
An assessment of grafts in the posterior cricoid lamina
Authors: Strome Marshall , Norris Charles M. , Joseph Michael P. , Brodsky Gilbert , Eavery Ronald D.
Published: October 2006

Subglottic stenosis is a recognized complication of prolonged intubation. To date, there is no uniformly successful operative procedure for severe subglottic stenosis, fulfilling the criteria of decannulation and a serviceable voice. The surgical ideals for such a procedure should include the use of autogenous grafting material, avoidance of internal stenting, and limited manipulation of the mucosa. This study was intended to assess the fate of isolated hyoid and thyroid alar grafts interposed in the posterior cricoid lamina. Additionally, anterior/posterior splits with and without anterior grafting were evaluated. Seventeen dogs were used in the determinate animal model. Vocal cord mobility was evaluated by direct laryngoscopy prior to sacrifice. Graphic gross anatomical specimens depict the effects of anterior/posterior splitting on the cricoid cartilage. Clinical correlations are suggested.
Innominate artery compression of the trachea: Current concepts
Authors: Myer Charles M. , Wiatrak Brian J. , Cotton Robin T. , Bove Kevin E. , Bailey Warren W.
Published: October 2006

One common vascular anomaly that causes airway obstruction in neonates and infants is innominate artery compression of the trachea. A great deal of controversy exists regarding the effect of this anatomic variant on symptom production. Several cases are presented that demonstrate the unique features of innominate artery compression of the trachea: 1. Innominate artery compression can occur in adolescent patients. 2. Flow volume loops are an effective method of documenting airway compromise in this condition. 3. Exercise intolerance should be considered as a relative indication for surgical intervention in these patients. 4. Reimplantation of the innominate artery is a viable surgical alternative in the treatment of affected patients. 5. Telescopic bronchoscopy during surgical correction of this condition will ensure that there has been successful correction of the tracheal compression. 6. Urgent repair is advocated in patients who experience periods of apnea.
The retrolabyrinthine approach and vascular loop
Authors: Wiet Richard J. , Schramm David R. , Kazan Robert P.
Published: October 2006

Several researchers have made progress toward determining the cause of hemifacial spasm, tinnitus, and episodic vertigo. During the past 5 years, we have encountered a vascular loop in six of 36 patients who were undergoing retrolabyrinthine vestibular neurectomy for recurrent disequilibrium and vertigo. In five of these six patients, disequilibrium improved after neurectomy.

This report describes the clinical symptomatology and the results of preoperative cochleovestibular testing for those patients found intraoperatively to have a vascular loop and suspected neurovascular compression syndrome. Audiograms, although varied, characteristically did not demonstrate the low‐frequency sensorineural hearing loss characteristic of Meniere's disease. No preoperative marker, with the single exception of computed tomography pneumocisternography, dependably predicted the presence of a vascular loop.
Facial reanimation by XI‐VII anastomosis without shoulder paralysis
Authors: Poe Dennis S. , Scher Natan , Panje William R.
Published: October 2006

Transposition of the spinal accessory (XI) and facial (VII) nerves has been used successfully in reanimation of facial paralysis, but because of the severity of symptoms associated with denervation of the trapezius muscle, this technique has largely been abandoned. Hypoglossal‐facial (XII‐VII) nerve anastomosis has now become a more favored procedure; however, the resultant hemiglossal atrophy carries some morbidity.

Transposition of the sternocleidomastoid (SCM) branch of the accessory nerve as a way to avoid shoulder paralysis was reported more than 20 years ago with initially excellent results, yet few follow‐up studies have been done.

Twenty‐one fresh cadaver dissections of the accessory nerve‐SCM branch and facial nerve were performed to determine if adequate numbers of fascicle groups and sufficient proximal nerve length are available for an adequate end‐to‐end anastomosis without nerve interposition grafting.

This paper presents our anatomic and histologic findings to support the use of proximal SCM nerve anastomosis to distal facial nerve in facial reanimation. When feasible, the use of this technique to correct facial paralysis is encouraged rather than hypoglossal‐to‐facial nerve anastomotic repair.
The role of tympanocentesis in the management of infants with sepsis
Authors: Arriaga Moises A. , Bluestone Charles D. , Stool Sylvan E.
Published: October 2006

Tympanocentesis is a procedure that can identify pathogenic organisms in otitis media. However, the clinical value of this diagnostic method in the management of infants who have sepsis has not been previously reported. Although otitis media is a significant source of sepsis in infants, tympanocentesis is not routinely employed in the work‐up of infants with sepsis who have abnormal otoscopic findings.

Charts of 40 consecutive infants who had sepsis and were undergoing tympanocentesis as part of their emergency room work‐up were reviewed. Results of middle‐ear aspirations from these infants, the bacteriology of middle‐ear effusions, and the role of this information in their clinical management is presented. In 80% of these patients, clinical management was directly affected by tympanocentesis data.

Tympanocentesis is a safe, effective diagnostic and therapeutic procedure with which otolaryngologists can provide important bacteriologic information to the pediatricians who are managing infants with sepsis.
The incidence and diagnosis of secondary esophageal carcinoma in the head and neck cancer patient
Authors: Grossman Thomas W.
Published: October 2006

The historical development of additional primary neoplasms of the esophagus is traced. To determine the incidence and time of appearance of these esophageal malignancies, a retrospective study of 790 head and neck cancer patients was conducted. In addition, a prospective study of 268 head and neck cancer patients was undertaken to determine the optimum diagnostic approach for esophageal neoplasms. All patients in the prospective study had a pharyngoesophagogram plus esophagoscopy as part of the initial diagnostic evaluation. The false negative rate of the pharyngoesophagogram was 72.2% in patients with esophageal pathology. In patients with esophageal malignancies it was 80%. Esophagoscopy should be a part of the initial evaluation of every patient with an upper aerodigestive tract primary malignancy.
Neuro‐otologic applications of simultaneous multichannel audiotory evoked response recordings
Authors: Hall James W. , Morgan Susan H. , Mackey—Hargadine Judy , Aguilar Eugenio A. , Jahrsdoerfer Robert A.
Published: October 2006

Multichannel auditory brain stem response (ABR) recordings were obtained in 75 acute, severely brain injured patients. The purpose of the study was to assess, in patients with varied neuro‐otologic pathology, the clinical feasibility and value of measuring the ABR simultaneously with more than one electrode array. The use of alternative electrode arrays, in addition to the conventional (vertex to stimulus ipsilateral ear) array, augmented confident identification of wave components I through VI, and was particularly useful in patients with marked middle ear pathology which confounded ABR interpretation. The ABR recorded with an indifferent (noncephalic) reference electrode,e.g., was characterized by increased Wave V amplitude, and improved definition of Wave IVvs. V. Case studies are presented to illustrate neuro‐otologic applications of the multichannel recording technique.
Non‐auditory presentations of cerebellopontine angle lesions
Authors: Meyerhoff William L. , Anderson Robert G.
Published: October 2006

Most patients with cerebellopontine angle (CPA) neoplasms present with asymmetric hearing loss and/or tinnitus. For this reason it is well accepted that patients with these symptoms deserve a detailed neurotologic evaluation. Non‐auditory presentations of CPA neoplasms, on the other hand, are frequently handled in a more complacent manner which may delay diagnosis and, therefore, result in increased morbidity. Six patients seen in the last 18 months serve to exemplify this point, as all 6 presented with non‐auditory symptoms of CPA lesions and, in all cases, the diagnosis was delayed for at least 6 months.

Any cranial neuropathy, unless otherwise explained, should suggest the presence of an intracranial or skull base lesion. The practicing physician must learn to give these non‐auditory symptoms respect equal to that of asymmetric hearing loss and tinnitus and, therefore, equal evaluation.
Homologous dura use in problem pocket repair
Authors: Cross James Parker
Published: October 2006

Recently the author has noted that the use of dura results in a neo‐drum, seemingly more resistent to posterior‐superior quadrant retraction than autologous temporalis fascia.

This presentation, 25 ears representing 22 patients with follow‐up between 26 and 41 months, reflects the particular use now assigned to homologous dura in drum and adjacent area repair; namely, the posterior‐superior quadrant and attic. The present use follows disappointment with previous drum repair attempts which in time seemed to be fruitless because progressive retraction with adhesions redeveloped. In a substantial way the use of dura as discussed in this paper is very similar to the use of autologous cartilage as reported by Glasscock with regard to recurrent retraction tendencies.
Neurilemmoma of the vagus nerve. A case report and brief literature review
Authors: Chang Shi Chueng , Schi Yei Mei
Published: October 2006

A case of neurilemmoma of the vagus nerve is reported. The patient is alive and well 8 years following resection.

The term “neurilemmoma” is the preferred nomenclature.

The disease presentation, differential diagnosis, and the surgical approach is discussed. The proper treatment for this tumor is surgical removal with preservation of the vagus nerve if possible and reanastomosis and/or nerve grafting if that is not possible.
Dysphagia due to simultaneous laryngocele and zenker's diverticulum
Authors: Birt B. D.
Published: October 2006

A case is reported of an elderly woman, a resident, in a nursing home, who developed dysphagia over a short period. Clinical and radiological examination disclosed that she had a large laryngocele and a moderate sized Zenker's diverticulum. The management plan required consideration of her social circumstances, and careful ranking of the medical priorities. Both the laryngocele and the Zenker's diverticulum were excised at a single operation and she was successfully returned to her nursing home environment.
Inverted papilloma of the nose and paranasal sinuses in childhood and adolescence
Authors: Eavey Roland D.
Published: October 2006

Inverted papilloma of the nose and paranasnl sinuses is a tumor not usually associated with childhood. These five cases from the Massachusetts Eye and Ear Infirmary provide the only series in the literature. The patients ranged in age from 6 to 20 years. One case involved the septum exclusively; the patient experienced a recurrence. The other four cases were of sinus origin. One of these patients also experienced recurrences before definitive surgery. Another presented with n simultaneous squamous cell carcinoma. Evaluation of these cases demonstrates that the same successful, comprehensive surgical management advised for adults is justifiable in this younger age group.
Parotid hypertrophy with bulimia: A report of surgical management
Authors: Berke Gerald S. , Calcaterra Thomas C.
Published: October 2006

Benign hypertrophy of the salivary glands can occur in patients with anorexia nervosa. This enlargement has been related to nutritional deficiencies and bulimia, which is a form of episodic binge eating followed by vomiting. The surgical management of a patient with bulimia and benign bilateral parotid enlargement secondary to bulimia will be discussed. Superficial parotidectomy may be a useful adjunct in managing the cosmetic and psychological aspects of patients with anorexia nervosa and bulimia complicated by massive parotid hypertrophy intractable to medical management.
Surgical management of cutaneous carcinomas at the inner canthus
Authors: Spector J. Gershon
Published: October 2006

Surgical management of carcinomas at the inner canthus is based on three criteria which are listed in a descending order of importance: tumor resectability with adequate margins, preservation of vision, and acceptable cosmetic result. The lesions resected are to create trapezoid or rectangular defects which can be closed simply with primary closures or with Z‐ or W‐plasties. In medium sized defects skin is borrowed from the glabella, upper nasal dorsum, or nasolabial sulci and used as rotational flaps. In more extensive lesions, through and through delects, or when lined flaps are required, nondelayed midline forehead pedicled or island flaps are employed. For very large defects, sliding cheek flaps, sickle forehead flaps, horizontal forehead flaps, and (in rare instances) scalping flaps where the distal segment is the temporal, hairless skin is used. Tumors which extend intracranially and are deemed resectable are removed with a combined intracranial approach. The latter may be via a transfrontal sinus resection or a combined lateral rhinotomy and frontal craniotomy resection. Regional lymph node metastasis normally requires a superficial parotidectomy, radical neck dissection (including submaxillary, angular, and mandibular nodes), and occasionally postauricular lymph node dissection. Distant metastases are contraindications for major surgical procedures.
A clinical pathologic study of hearing loss in congenital cytomegalovirus infection
Authors: Strauss Melvin
Published: October 2006

Cytomegulovirus (CMV) infection is currently reported as the most common cause of congenital viral induced deafness. However, few systematic studies of the audiovestibular sequelae of this infection are present in the literature. A clinical pathologic study was conducted from 1976 to 1982 to evaluate this.

Fifty‐two pairs of infant and children's temporal bone studied demonstrated no evidence of CMV endolabyrinthitis even in the single case with evidence of extensive congenital CMV infection. Over 2,000 umbilical cord sera were screened to detect asymptomatic CMV infection with an incidence of 0.38% (and slightly greater than 1% when extrapolated to correct for the sensitivity of the method of detection) in a central Pennsylvania study population. No sensorineural abnormalities were detected in five asymptomatic children and 130 control children. However, three out of six (50%) infants, symptomatic at birth and followed to a mean age of 5.5 years, showed significant and progressive sensorineural loss and vestibular deficits.
Elongated styloid process syndrome: Intraoral versus external approach for styloid surgery
Authors: Strauss M. , Zohar Y. , Laurian N.
Published: October 2006

Elongnted styloid process is a source of craniofacial and cervical pain. This condition is characterized by a dull, nagging, pharyngeal pain and a palpatory finding in the tonsillar fossa. Radiologic demonstration of styloid elongation is readily made in most instances. The incidence and pathogenesis of the styloid syndrome are discussed and the differential diagnosis detailed. The only effective treatment is surgical shortening of the styloid process. Eight patients undergoing surgery for elongated styloids are reported and the intraoral and external surgical approaches are presented. The external cervical approach is preferred since surgical visualization is optimal and the risk of deep cervical infection is minimal.
Auditory brain stem response in experimentally induced hypothyroidism in albino rats
Authors: Ben‐Tovim Reuven , Zohar Yuval, , Laurian N. , Zohiar Shwahni , Laurian L.
Published: October 2006

In order to elucidate the relationship between the auditory function and the thyroid state, experiments were designed to study the effect of hypothyroidism on the onset of auditory brain stem response (ABR) in 26 adult myxedematous albino rats. A state of hypothyroidism was induced by daily oral administration of 6‐N‐propyl‐2‐thiouracil (PTU). In 23 out of 26 rats we found minor changes in the amplitudes of all ABR waves without any correlation with the rats' T4 variation. We noted a conspicuous, dynamic, and reversible change in the amplitude of the third wave (N') of ABR which correlates directly with the thyroxin (T4) levels in the rats' blood. The electrophysiological finding in this report indicates a lesion in the auditory tracts in the brain stem but mainly in the second main relay station of the central auditory pathway, i.e., the superior olivary complex.
Fenestration of the horizontal semicircular canal in congenital conductive deafness
Authors: Farrior Jay B. , Rophie Sharon S.
Published: October 2006

Fenestration of the horizontal semicircular canal enables the otologic surgeon to restore hearing in those patients with congenital conductive deafness who are not candidates for stapedectomy, ossicular reconstruction, or tympanoplasty. Since the development of stapedectomy, much of the finesse technique of fenestration surgery has been lost, and many otologic surgeons today are unfamiliar with the fenestration operation. The surgical technique for creating a permanently patent fenestra in the horizontal semicircular canal is described. The causes of failure in fenestration surgery are reviewed. Thirty‐three patients who have undergone fenestration for congenital conductive deafness over a 30‐year period, and 100 patients who underwent fenestration for otosclerosis in 1950, are reviewed to demonstrate patient selection and the efficacy of this operation in establishing long‐term hearing improvement.
Revision stapes surgery: Problems with some solutions
Authors: Derlacki Eugene L.
Published: October 2006

A review of 217 consecutive revision stapes operations performed during a ten‐year period revealed that the surgeon encounters more pathological variables than he does during primary operations. Hence, the technical solutions are less stereotyped and the net results less predictable.

Prosthesis displacement, with or without incus tip erosion, was the most common primary cause of failure (82%). However, oval window problems such as footplate refixation, perilymph fistula, otosclerotic regrowth, and lateralized oval window membrane in 60% of cases often complicated prosthesis displacement.

First revision operations in 174 cases resulted in postoperative bone‐air deficit of 10 dB or less in 65% of cases, much better than the 45% for second revision results, and the 25% for third revisions. These statistics provide our practice with a realistic prognosis when discussing revision stapes surgery with the individual surgical candidate.
Pediatric nasal resistance
Authors: Principato Jerold J. , Wolf Pamela
Published: October 2006

Rhinometry has provided a quantitative and objective means of assessing nasal airway patency. Previous investigators have established normal nasal resistances for adults and newborn infants. Less material and no such normal references are available for the pediatric ages. In this study, nasal airway resistance is assessed by anterior rhinometric technique in 498 children ranging from four to 16 years of age. Collected nasal resistance data are found to vary inversely with age and fall in an almost linear fashion between already established normals of infancy and adulthood. As far as we can determine, pediatric age specific nasal resistance data with calculated standard deviations and 95% confidence levels have not been previously reported. Such data provides initial age specific reference points enabling the rhinologist to more objectively evaluate concerns regarding nasal obstructive problems in children.
Autologous fibrin tissue adhesive
Authors: Siedentop Karl H. , Harris David M. , Sanchez Ben
Published: October 2006

Various methods of making fibrin tissue adhesive from a patient's own blood were evaluated. The method using ammonium sulfate for fibrinogen preparation produced the greatest bonding strength.

The average bonding strength of the commercially manufactured adhesive and of the autologous fibrin tissue adhesive were compared at 10 minutes and 30 minutes after glucing together lxl cm samples of fresh human dura. Results indicate the commercial glue holding 57 gms/cm2 at 10 minutes and 123 gms/cm2 at 30 minutes, while autologous glue prepared with the “ammonium sulfate method” has a bonding strength of 41 gms/cm2 at 10 minutes and 217 gms/cm2 at 30 minutes.
Extended follow‐up of total inferior turbinate resection for relief of chronic nasal obstruction
Authors: Moore Gary F. , Freeman Todd J. , Ogren Frederic P. , Yonkers Anthony J.
Published: October 2006

Total inferior turbinectomy has been proposed as a treatment for chronic nasal airway obstruction refractory to other, more conservative, methods of treatment. Traditionally, it has been criticized because of its adverse effects on nasophysiology. In this study, patients who had previously undergone total inferior turbinectomy were evaluated with the use of an extensive questionnaire. It confirms that total inferior turbinectomy carries significant morbidity and should be condemned.
The role of fine needle aspiration in the management of the thyroid nodule
Authors: Griffies William Scott , Donegan Elizabeth , Abel Michael E.
Published: October 2006

The role of fine needle aspiration (FNA) in the management of the patient with a thyroid nodule continues to be controversial. We present a retrospective study of 69 patients who underwent FNA for thyroid nodules over a two‐year period. No false positive or false negative fine needle aspirations are reported in 22 patients who underwent surgery. From the results of this study and other studies in the literature, we feel that ultrasonography and thyroid scans are of minimal additional benefit in determining whether a nodule is benign or malignant. It is our opinion that FNA, along with clinical assessment, should be the diagnostic test to determine the management of the thyroid nodule in centers with personnel experienced in FNA.
Rhinocerebral mucormycosis with internal carotid occlusion: Report of two cases and review of the literature
Authors: Anaissie Elias J. , Shikhani Alain H.
Published: October 2006

Two fatal cases of rhinocerebral mucormycosis with fungal invasion and occlusion of the internal carotid artery are described. Review of the literature reveals 35 similar cases of whom only 6 survived.

Emphasis is placed on the need for early diagnosis and prompt therapy which consists of correction of the underlying disease, aggressive surgical debridement, and amphotericin B.
Fourth pharyngeal pouch sinus
Authors: Ostfeld Ervin , Segal Jacob , Auslander Lya , Rabinson Suzanna
Published: October 2006

This is the first description and documentation of an extremely rare developmental anomaly of the pharyngeal apparatus in a 15‐year‐old female. The clinical, radiological, histological, and anatomical findings indicated that the anomaly originated in the pharyngeal fourth pouch. It presented as a recurrent lateral neck abscess which was due to a paratracheal sinus. This sinus penetrated the larynx and after a translaryngeal course ended in the pyriform sinus. It was caudad to the superior laryngeal nerve nnd external to the recurrent laryngeal nerve. Its penetration into the larynx at the cricothyroid joint region could serve as a useful surgical landmark.
High frequency needle dissection rhytidectomy
Authors: Kamer Frank M. , Cohen Alfred
Published: October 2006

Fifty consecutive rhytidectomies were performed utilizing high frequency needle dissection on one side and standard sharp dissection on the other for all incisions and flap elevation. The efficacy of this technique in hemostasis, prevention of hematoma, and wound healing is compared to the conventional technique of rhytidectomy. The advantages and disadvantages of the modality are discussed.
Diagnostic criteria in functional dysphonia
Authors: Morrison Murray D. , Nichol Hamish , Rammage Linda A.
Published: October 2006

One thousand consecutive patients seen in a multidisciplinary voice clinic are reviewed. The incidence and relative severity of diagnostic features in each of five assessment areas are calculated and compared. The five areas include: 1. history, 2. laryngoscopic examination, 3. perceptual‐acoustic assessment, 4. voice related musculoskeletal, and 5. psychological evaluations. Feature prevalence is presented for patients we have classified as having muscular tension dysphonia, which can be primary, or associated with vocal nodules, chronic laryngitis, or polypoidal degeneration; or as having a psychogenic “functional” dysphonia. Following review of the data, we present a suggested list of diagnostic criteria that should be present before using a specific diagnostic label. These criteria have been further broken down into those that will be present to make a diagnosis, and those that may be present.
Pharyngeal plexus neurectomy for alaryngeal speech rehabilitation
Authors: Singer Mark I. , Blom Eric D. , Hamaker Ronald C.
Published: October 2006

Pharyngeal constrictor and cricopharyngeal spasm have been implicated as deterrants to esophageal speech acquisition as well as tracheoesophageal phonation. Recent efforts to reduce the resultant hypertonicity include pharyngeal constrictor myotomies and modifications of pharyngeal reconstruction during laryngectomy. Investigation of the innervation of the muscular wall of the pharynx led to the development of a pharyngeal plexus neurectomy technique to alter the tonicity of the pharynx without myotomy. The resultant alaryngeal speech is fluent, and acoustic parameters compare favorably to esophageal speech.
The intrinsic vasculature of the cat facial nerve
Authors: Balkany Thomas
Published: October 2006

Treatment of facial nerve disorders is based in part on assumptions regarding the intrinsic blood supply of the nerve. This study was designed to comprehensively delineate the intrinsic facial nerve microcirculation and its relation to the extrinsic circulation in an animal model.

Twenty‐eight cat facial nerves were removed intact from brain stem to stylomastoid foramen following intravital fixation. Specimens were studied by gross dissection, silicone injection and tissue clearing, complete vessel counts on serial cross sections of individual nerves, and scanning electron microscopy or transmission electron microscopy.

The labyrinthine segment of the cat facial nerve contains strikingly fewer intrinsic blood vessels than the mastoid and tympanic segments. The geniculate ganglion, however, has a distinct, rich vascular plexus.

The ultrastructure of the intrinsic facial nerve vessels is similar to other small vessels of the body with tight junctions of the endothelium and overlapping spiral smooth muscle fibers of arterioles, as well as surrounding pericytes.
Mandibular involvement by oral squamous cell carcinoma
Authors: Gilbert Scott , Tzadik Abraham , Leonard Gerald
Published: October 2006

Detecting mandibular bone involvement by oral carcinoma prior to definitive therapy poses a difficult problem for the head and neck surgeon. A retrospective study of 104 patients who underwent segmental mandibular resection for oral squamous cell carcinoma was undertaken to detect the incidence of mandibular bone involvement. Specimens from 23 patients (22%) demonstrated tumor invasion on decalcified histologic examination. Histologic evidence of bone involvement was correlated with the site of lesion, stage of the disease, the grade of tumor, the clinical impression of bone involvement, and the presence or absence of neck disease. Bone invasion on histologic examination was also compared with preoperative bone scans and radiographs. The data obtained demonstrates significant mandibular involvement with alveolar tumors and lesions clinically adjacent to the mandible. There was also a high incidence of histologic bone involvement in patients who had radiologic or bone scan evidence of tumor erosion. We support segmental mandibulectomy on the basis of providing adequate tumor margins for patients fulfilling these criteria.
Anterior epistaxis: a new nasal tampon for fast, effective control
Authors: Doyle Donald E.
Published: October 2006

Epistaxis is the second most common cause of spontaneous bleeding. Of the two categories of epistaxis, mundane and severe, the mundane, usually anterior epistaxis, is the more common. It has been reported that 60% of individuals report at least one episode of epistaxis during their lifetime. Eighty percent of epistaxis occurs in Kiesselbach's plexus, a vascular network in the anterior portion of the nasal septum. We have designed a nasal tampon to control this common variety of epistaxis which is a fast, efficient, and cost‐effective method of anterior epistaxis control.

The material used in the manufacture of the device (MerocelTM) has been used for over 5 years by the author, both in treatment of severe epistaxis and as a postoperative nasal packing. The design presented here has been used for anterior epistaxis for 18 months without untoward sequelae and with universal success.
Ineraid® (utah) multichannel cochlear implants
Authors: Youngblood John , Robinson Sylvia
Published: October 2006

For the more than 200,000 individuals in the United States with a bilateral profound sensorineural hearing loss, the cochlear implant offers a means of breaking this barrier of total silence. The pioneers in prosthetic research hoped that direct stimulation of the cochlea might at least give an awareness of sound through the auditory sense.

There will be a review of five patients who were consecutively implanted with the Ineraid®multichannel cochlear implant, with 1 year follow‐up. All individuals were postlingually deafened adults and exhibited a bilateral profound hearing loss.
Head and neck malignancies in children: An age‐incidence study
Authors: Robinson Lee D. , Rightmire Joann , Smith Richard J. H. , Torpy Janet M. , Fernbach Donald J.
Published: October 2006

One hundred forty‐seven (147) children under 18 years have been treated for head and neck malignancies at Texas Children's Hospital from 1970 to 1985 and form the data base for this study. In order of frequency, the most common tumors were lymphoma, Langerhans' histiocytosis (LH), rhabdomyosarcoma, neuroblastoma, and other soft‐tissue sarcoma. Children under 2 were most likely to have LH; those from 3 to 5, LH or lymphoma; and those over 5, lymphoma.
The surgical management of epidural mucoceles
Authors: Schaefer Steven D. , Close Lanny G. , Mickey Bruce E.
Published: October 2006

Mucoceles of the paranasal sinuses extending into the epidural space are both uncommon and difficult to surgically manage. To best overcome the problem of recurrent disease, we have adopted a combined otorhinolaryngologic‐neurosurgical approach which emphasizes removal of as much as possible of the mucocele and marsupialization, or permanent drainage, of the disease site into the nasal cavity. Recently, we have modified this procedure in selected cases to include resection of involved dura and isolation of the epidural space from the nasal cavity. The indications and results of both forms of management are now reported in ten patients.