bluuebunny/crossref_metadata_2025 huggingface dataset:
Acquired airway obstruction from histologically normal, abnormally mobile supraglottic soft Tissues
Authors: Robert Kletzker G. , Bastian Robert W.
Published: October 2006

In patients with nonmalignant upper aerodigestive tract abnormalities such as cysts, neoplasms, and laryngomala‐cia, airway obstruction has been described as a function of not only size and location of abnormal structures, but also of their mobility. This paper describes three patients who developed upper airway restriction with stridor due to abnormally redundant and mobile, but histologically normal, supraglottic mucosa. The specific mechanism of and structures involved in obstruction were clearly defined by videolaryngopharyngoscopy. Endoscopic microdissection and/or laser excision of the redundant supraglottic mucosa restored airway patency and completely relieved the obstructive respiratory symptoms. The pulsion effects of in‐spiratory airflow are postulated as the cause of these acquired lesions. Recommended treatment is reviewed.
Longitudinal effects of single‐channel cochlear implantation on voice quality
Authors: Leder Steven B. , Spitzer Jaclyn B.
Published: October 2006

No studies have reported longitudinal group data on the voice characteristics of adult participants with adventitious profound sensorineural hearing loss before and after single‐channel cochlear implantation. This study investigated voice fundamental frequency, intensity, and speaking duration preimplantation and longitudinally 1‐day, 6‐months, and 1‐year poststimulation. Results revealed only fundamental frequency 1‐day poststimulation to be significantly different from preimplantation. Trends for all three variables, i.e., lowered Fo, reduced intensity, and shortened speaking duration (a faster rate), however, moved toward the measures that typify normal‐hearing speakers.
A comparison of the cartilaginous rib graft and evans‐todd laryngotracheoplasties forsubglottic stenosis
Authors: Muntz Harlan R. , Lusk Rodeny P.
Published: October 2006

Cartilaginous rib graft interposition and Evans‐Todd laryngotracheoplasties were compared in 21 patients with similar degrees of subglottic stenosis. The ultimate success of the repair was similar, but complications were more frequent with the Evans‐Todd laryngotracheoplasty.

Stent removal and decannulation were accomplished earlier with the cartilage graft laryngotracheoplasty—an average of 21 days to decannulation after stent removal versus 66 days for the Evans‐Todd procedure. Granulation tissue was almost universal in the Evans‐Todd procedure, and accounted for the long decannulation time. This retrospective study is used as a basis to discuss the relative merits of the two procedures.
Correlative histological and ultrastructural study of unusual changes in human tracheobronchial epithelium
Authors: Roessler Franz , Grossenbacher Rudolf , Stanisic Marijan , Walt Heinrich
Published: October 2006

In tracheostomy patients with chronic bronchitis, scanning electron microscopy reveals detailed surface changes in the tracheobronchial mucosa. The principle of intermicroscopic correlation, i.e., the sequential examination of a specimen by different microscopic procedures, is illustrated with giant cilia. After re‐embedding the scanning electron microscopic specimens and precisely locating a ciliary convolution by light microscopy in semithin section, the giant cilia were studied in ultrathin sections by transmission electron microscopy. The cilia were shown to be at least 9 (μm long (normal ciliary length = 4 6 μm). Central and peripheral micro‐tubular axonemal structures with a 9 + 2 arrangement were clearly shown in both longitudinal and cross section. Giant cilia, thus, most closely resemble outgrowths of normal cilia. If they are motile at all, they seem unlikely to effect a transport function coordinated in direction and time.
The effect of asymmetric pharyngoesophageal pressures on manofluorographic measurements
Authors: Mcconnel Fred M. S. , Guffin Thomas N. , Cerenko Danko
Published: October 2006

The fact that pressures in the pharynx are asymmetric has raised questions about the validity of measurements made using manofluorography. Using a special manometric catheter that measures the pressures in four different directions, manofluorography was performed on seven normal volunteers and the measurements in the four directions were compared. When the bolus was not present the measurements were found to be asymmetrical. When the bolus filled the cavity, the measurements were symmetrical. Therefore, manometric measurements made in the pharynx during bolus flow are not invalidated by variations in the orientation of the catheter.
The submandibular triangle in squamous cell carcinoma of the larynx and hypopharynx
Authors: Wenig Barry L. , Applebaum Edward L.
Published: October 2006

A 15‐year retrospective analysis was carried out at the University of Illinois College of Medicine, Chicago, reviewing the tumor staging and pathology data of 239 patients treated for carcinoma of the larynx and hypopharynx requiring laryngectomy alone, laryngectomy with neck dissection, or laryn‐gopharyngectomy and neck dissection. Surgery was the primary treatment modality in 205 of the 239 cases, with the remaining 34 having surgery to treat radiation therapy failure. Primary tumors were located within the supraglottic region, the glottic region and, less commonly, the pyriform sinus. Ninety‐five of the 239 patients either presented with or developed nodal metastases following initial treatment. Of these, only two had tumors within the lymph nodes of the submandibular triangle. This data corroborates impressions that tumors of the larynx and hypopharynx rarely metastasize to the submandibular triangle and that sparing this area during neck dissection for lesions of the larynx would seem justified.
The association of laryngoceles with squamous cell carcinoma of the larynx
Authors: Celin Scott E. , Johnson Jonas , Curtin Hugh , Barnes Leon
Published: October 2006

The clinical diagnosis of laryngoceles simultaneously occurring with squamous cell carcinoma of the larynx is infrequent; however, when specimens from patients with laryngeal cancer have been examined closely, the two entities have been associated in 4.9% to 28.8% of cases. Despite this apparent relationship, the literature has failed to address the potential impact of a concurrent laryngocele on surgical decision making. Also, the wide variation in the reported rates of simultaneous occurrence of these two entities is unexplained. We performed whole‐organ histo‐pathologic analysis on a laryngeal specimen with bilateral external laryngoceles associated with squamous cell carcinoma and correlated this to computed tomography findings. Based on this information and other reports concerning the pattern of spread of carcinoma within laryngoceles, it appears that su‐praglottic laryngectomy is oncologically sound in the presence of a laryngocele as long as the usual criteria for this procedure are met.
Development of monoclonal antibodies with specificity to oral squamous cell carcinoma
Authors: Fantozzi Richard D.
Published: October 2006

A panel of five monoclonal antibodies have been produced that show binding when directed against human oral head and neck squamous cell carcinomas. These monoclonal antibodies are derived from antibody‐secreting cells obtained using cell hybridization techniques. The activity of the antibody was tested in vitro against oral head and neck squamous cell carcinoma (n = 10). Control groups included normal oral mucosa (n = 7), hyperkeratosis (n = 5), mild dysplasia (n = 4), and severe dysplasia (n = 3). Results using immunoperoxidase staining confirmed the binding of the five monoclonal antibodies to human head and neck squamous cell carcinoma cells, with predominant reactivity (50% to 90%) in the majority of the specimens, compared with negative (0%) to weak (<5%) or focal (5% to <50%) reactivity in the control specimens.
Inverted papilloma of the nasal cavity: Pathological aspects in a follow‐up study
Authors: Nielsen P. L. , Buchwald C. , Nielsen L. H. , Tos M.
Published: October 2006

The initially removed tumors from 42 patients with inverted papillomas of the nasal cavity and paranasal sinuses were subjected to an extensive histopathological examination in order to define the characteristics associated with multiple recurrences and development of malignancy. Two of the patients subsequently developed squamous cell carcinoma and eight patients had more than one recurrence. No specific histological characteristic was determined to be a predictor of multiple recurrences or development of malignancy. However, three patterns of characteristics emerged from the data which were found to be related to the development of malignancy, multiple recurrences, and benign behaviour. Malignancy was found to be associated with bilateral inverted papilloma, a predominance of mature squamous epithelium, the presence of all three epithelial types (metaplastic squamous, mature squamous, and cylindrical), severe hyperkeratosis, a mitotic index ≥2 per high‐power field (HPF), absence of inflammatory polyps among the papillomas, an abundance of plasma cells, and an absence of neutrophils. Multiple recurrences (without malignancy) were associated with a mitotic index ≥2 per HPF and an absence of inflammatory polyps. Benign behaviour was associated with predominantly mucinous tumors, a mitotic index <1 per HPF, a ratio of neoplastic epithelium/connective tissue stroma ≥6, and the presence of inflammatory polyps among the papillomas.
Early stages of facial nerve regeneration through silicone chambers in the rabbit
Authors: Spector J. Gershon , Lee Patty , Derby Albert , Roufa Dikla G.
Published: October 2006

The early stages of rabbit peripheral facial nerve regeneration [N = 16], over a 10‐mm transectional gap, were analyzed at 1, 3, and 5 weeks of buccal nerve entubation in silicone chambers prefilled with saline. Normal nerve pooled data were obtained in nine nerves. Chronologic morphologic and morphometic light and electron microscopic computer‐captured data reveal that the regeneration process can be subdivided into four stages: 1. The establishment of an acellular intergap matrix; 2. the ingrowth of mesodermally derived cells (macrophages, fibroblasts, endothelial cells, etc.) to form an intergap scaffolding; 3. the ingrowth of ectodermally derived cells (neurons, Schwann's cells, etc.) to reconstitute the transected peripheral nerve; and 4. neural maturation by progressive axonal enlargement, myelination, and compartmentalization. The first two stages occur during the first week, the third stage during the third week, and the fourth stage from the fifth week onwards of neural entubation.

Morphometic analyses indicate that total neuro‐regenerates increase in number from 303 ± 286 to 2693 ± 1334 (± values are standard deviations) and myelination of axons increases from 12% to 48% during the third to fifth week of entubation. The thickness of the myelin (g‐ratio) increases from 0.89 ± .01 to 0.74 ± .06 (SD) during the same period of time. At the end of the fifth week of entubation, the midchambers contain, on the average, 1279 ± 980 myelinated axons (30% of normal counts) and 483 (± 11.2%) axons cross the chambers to innervate the distal transected neural stump (12.5%). Specific target‐organ (quadratus labii superioris muscle) activity can be recaptured with a smaller number (12.5%) of regenerating myelinated axons from the buccal division of the facial nerve during the fifth week of entubation.
Multichannel (Ineraid®) cochlear implant update
Authors: Parkin James L. , Randolph Loren J. , Parkin Brett D.
Published: October 2006

From April 1984 to May 1991, 49 profoundly deaf patients received implantation of the Ineraid® multichannel cochlear implant at the University of Utah. The auditory results of 48 patients indicated improvement in mean pure‐tone performance to 500 Hz (32.9 ± 10.1 dB), 1000 Hz (27.1 ± 10.0 dB), and 2000 Hz (30.1 ± 9.8 dB). This group of patients had mean performances of 61.2% on auditory‐only environmental sounds (Minimum Auditory Capabilities [MAC] battery), 48.8% on auditory‐only CID sentences, and 95.5% on auditory‐plus‐visual CID sentences. The percutaneous pedestal has been well‐tolerated. Changes in the surgical skin incisions have been made. A home use speech therapy program has been developed on VHS tapes.
Acute epiglottitis in the adult: Experience with a seasonal presentation
Authors: Kass Edward G. , McFadden Edith A. , Toohill Robert J. , Jacobson Stephen
Published: October 2006

Acute epiglottitis in adults may follow an unpredictable clinical course, complicated by acute airway obstruction. Our experience with this disease was evaluated by looking at yearly incidence, seasonal occurrence, and clinical variables of both intubated and conservatively managed patients. In our series of 17 cases from 1987 through 1990, 16 occurred in 1988 and 1989. Ten of 17 cases occurred during the summer months. The two patients who developed stridor went on to require intubation and tracheotomy.

Statistical analysis of our data revealed that, in adult acute epiglottitis, stridor is a strong predictor of airway obstruction. A significant summer seasonal predominance was seen, as well as a suggestion of an epidemic in 1988 and 1989.
Contact diode laser microvascular anastomosis
Authors: Lewis William John , Uribe Alexander
Published: October 2006

Contact diode laser microvascular anastomosis appears to be a valuable technique for anastomosing small arteries and veins. Significantly less foreign body reaction and markedly decreased operative time has been shown to be a major advantage of using contact diode laser technology. The authors have found that contact diode laser anastomosis can be performed in vessels as small as 1 mm in size using a 200‐μm flat tip synthetic sapphire probe. Light microscopy has shown a significant decrease in foreign body reaction at the level of the anastomosis using laser techniques as compared to standard vessel anastomosis with 10‐0 nylon sutures.

The role of fibronectin and changes in collagen associated with laser anastomosis were also explored. Light microscopic electron‐microscopic results as well as biotin‐avidin immunoperoxidase fibronectin studies will be discussed.
Development of high endothelial venule‐like characteristics in the spiral modiolar vein induced by viral labyrinthitis
Authors: Stearns Gregory S. , Keithley Elizabeth M. , Harris Jeffrey P.
Published: October 2006

The postcapillary venule is known to be the preferred site of lymphocyte migration into the extravascular compartment. In this study, induction of these high endothelial venule (HEV)‐like vessels has been investigated by inoculation of live cytomegalovirus or inactivated virus into scala tympani of guinea pig cochleas. Endothelial cells of the spiral modiolar vein (SMV) were evaluated histologically 2 to 6 days following inoculation. The experimental group endothelial cells had larger nuclei and increased amounts of cytoplasm. In addition, many lymphocytes were adherent to and present within the vascular wall. Control SMV endothelia showed normal structure and morphology throughout the study. These findings reiterate that nonlymphoid tissues may develop HEV‐like characteristics and suggest that HEV‐like morphology may be acquired during an acute inflammatory condition in the cochlea.
Nasal airway size in cleft and noncleft children
Authors: Drake Amelia F. , Davis Jefferson U. , Warren Donald W.
Published: October 2006

Although the effects of cleft lip and palate on nasal airway size and breathing have been reported for adults, little information is available on children. The present study assessed the effect of age on nasal cross‐sectional size and, in particular, whether type of cleft influenced the outcome. The results indicate that, while the cleft nose continues to grow with age, it remains about 30% smaller than the noncleft nose. The airway is smallest in patients with unilateral cleft lip and palate and is largest in those with bilateral clefts. The prevalence of oral breathing is considerably higher in the cleft population in comparison to noncleft.
Snoring and nasal resistance during sleep
Authors: Miljeteig Harald , Savard Patrick , Mateika Susan , Cole Philip , Haight James S. H. , Hoffstein Victor
Published: October 2006

Although it is widely accepted that nasal obstruction leads to snoring and sleep apnea, the relationship between these variables is not clear, mainly because of the lack of studies in which nasal resistance (Rna) and snoring were measured concurrently. The authors studied eight nonapneic snoring men with healthy noses by nocturnal polysomnography that included quantitative assessment of snoring and concomitant nasal resistance. In six of these eight patients nasal resistance increased during sleep, but there was no significant change for the group as a whole between wakefulness (0.209 ± 0.224 Pa/cm3 per second) and sleep (0.292 ± 0.203 Pa/cm3 per second). Linear regression analysis showed no significant correlation between sleeping nasal resistance and snoring index (partial R2 = .44, P = .071). We used each subject as his own control and compared the snoring profile at a time during sleep when nasal resistance was at its highest (0.550 ± 0.375 Pa/cm3 per second) and lowest (0.146 ± 0.090 Pa/cm3 per second) levels. Despite the significant (P<.01) differences in nasal resistance, they were not reflected in the number of snores or their sound intensity. It is concluded that nasal obstruction during sleep is not correlated significantly to frequency or intensity of snoring during exclusively nasal breathing.
The horizontal vestibulo‐ocular reflex gain during active and passive high‐frequency head movements
Authors: Hoshowsky Borys , Tomlinson David , Nedzelski Julian
Published: October 2006

Patients with bilateral peripheral vestibular loss complain of varying degrees of oscillopsia and balance difficulties. Some are able to engage in sporting activities while others are completely disabled. An assumption that other inputs are available to the vestibulo‐ocular reflex (VOR) enabling it to achieve some degree of visual stability during high‐frequency head movement is reasonable. In this study, the gain of the horizontal vestibulo‐ocular reflex in 10 healthy subjects was examined during active high‐frequency head‐on‐body rotation (head free), and compared to high‐frequency passive whole‐body rotation (head fixed). A statistical difference in the gain (P<.002) was noted for all frequencies between the two groups. In those individuals undergoing passive whole‐body high‐frequency movements, the gain was observed to rise (above unity) with increasing frequency of rotation, while the gain during active head‐on‐body rotation remained close to 1.
Endoscopic laser dacryocystorhinostomy
Authors: Metson Ralph , Woog John J. , Puliafito Carmen A.
Published: October 2006

Endoscopic laser dacryocystorhinostomy (DCR) enables an obstructed lacrimal sac to be opened through an intranasal approach, avoiding the need for a skin incision. The holmiumtyttrium aluminum garnet (holmium:YAG) laser is well‐suited for this procedure because of its properties of fiberoptic delivery, effective bone cutting, and precise soft‐tissue coagulation. Efficient bone ablation is particularly important for primary DCR which requires removal of relatively thick bone along the lateral nasal wall to expose the lacrimal sac. Forty‐six endoscopic laser DCRs were performed on 40 patients. There were no intraoperative or postoperative complications. The surgery successfully relieved lacrimal obstruction in 85% of patients. Endoscopic instrumentation allowed for the rapid identification and correction of intranasal causes of DCR failure, including ethmoid sinus disease and middle turbinate hypertrophy. Endoscopic laser DCR appears to be a safe and effective procedure which should be considered as an alternative to external DCR for the surgical treatment of nasolacrimal duct obstruction.
Long‐term changes in vocal quality following isshiki thyroplasty type I
Authors: Leder Steven B. , Sasaki Clarence T.
Published: October 2006

Long‐term changes in vocal quality, pre‐Isshiki thyroplasty type I and up to 4 years 4 months post‐thyroplasty, were determined in a group of five subjects exhibiting unilateral vocal fold paralysis. Thyroplasty type I medializes the paralyzed fold by using a Silastic® implant for external compression of the paralyzed vocal fold. No periphonosurgical or post‐phonosurgical complications were noted. Longitudinal evaluation resulted in significantly higher vocal fundamental frequency, significant moderation of habitual vocal intensity, and significantly longer maximum phonation time. The thyroplasty group exhibited significantly more breath groups than control subjects both prethyroplasty and post‐thyroplasty; within the thyroplasty group, a reduction in breath groups was exhibited prethyroplasty as compared to post‐thyroplasty. The long‐term positive changes observed in fundamental frequency, intensity, maximum phonation time, and breath groups were attributed to medialization of the paralyzed vocal fold.
Detecting retinoic acid‐induced biochemical alterations in squamous cell carcinoma using intrinsic fluorescence spectroscopys
Authors: Silberberg Michael B. , Savage Howard E. , Sacks Peter G. , Schantz Stimson P. , Tang G. C. , Alfano Robert R.
Published: October 2006

Intrinsic fluorescence spectroscopy offers a new method for diagnosing head and neck cancers. By establishing a unique spectral fingerprint for benign tissue, one can readily identify subtle changes in tissue based on altered spectral patterns. The authors applied this technology to a multicellular tumor spheroid (MTS) model and obtained baseline spectral data. A cohort of MTS was treated with the chemopreventive agent retinoic acid (RA) to determine its effect on tumor cells. Excitation and emission spectroscopy were performed on the samples. Spectroscopic scans demonstrated consistently that RA‐treated MTS exhibit a decrease in the peak associated with reduced nicotinamide‐adenine dinucleotide (NADH) and an increase in the peaks associated with flavins, tryptophan, and cytokeratins when compared to controls. These findings are suggestive of alterations in cellular electron transport, an increase in proteins incorporating tryptophan, and a decrease in adenosine triphosphate (ATP) in the RA‐treated cells. A discussion of the potential clinical applications of intrinsic fluorescence spectroscopy is included.
Applications of image‐directed robotics in otolaryngologic surgery
Authors: Kavanagh Kevin T.
Published: October 2006

This report will evaluate the feasibility of applying image‐directed robotic technology to the field of otolaryngologic surgery. Image‐directed robotic surgery uses a three‐dimensional image to guide a robot in the removal of tissue. To demonstrate the future use of image‐directed robotics in otolaryngologic surgery, five antrostomies will be performed on temporal bones. The accuracy of the surgical defect will be measured. It is the goal of this pilot study to achieve an average surgical error of less than 1.0 mm. Future applications of image‐directed robotic surgery will be presented, along with technical modifications, and future areas of research necessary to adapt this technique to otology and rhinosinus surgery.
Oral and laryngeal muscle coordination during swallowing
Authors: Gay Thomas , Rendell Jill K. , Spiro Jeffrey
Published: October 2006

The objective of this experiment was to determine the relative contributions and patterns of activity of different muscles involved during the oral phase of swallowing. Electromyographic (EMG) signals were recorded from the orbicularis oris inferior, masseter, palatal elevator, anterior and posterior genioglossus, mylohyoid, anterior belly of the digastric, and vocalis muscles of 12 normal adult subjects. Each subject swallowed 15 mL of water, under normal and bite block conditions, 15 to 20 times. The integrated EMG signals for each subject's swallows were ensemble averaged. The results of the analyses showed that swallowing function varies from individual to individual in terms of the specific muscles used and how the various muscle activity patterns are coordinated. These results suggest that swallowing is a highly complex adaptive motor activity which probably relies more on higher‐level control mechanisms than previously believed.
Transpetrosal access to meningiomas juxtaposing the temporal bone
Authors: Pensak Myles L. , van Loveren Harry , Tew John M. , Keith Robert W.
Published: October 2006

Meningiomas arising from the petroclival dura have presented a challenge to both otolaryngologists and neurosurgeons. Access by means of subtemporal, suboccipital, translabyrinthine, or transcochlear routes have inherent limitations both surgically as well as from resultant morbidity.

Since 1988, the authors have used a transpetrosal transtentorial (combined subtemporal suboccipital presigmoid) approach to these lesions in selected cases. The goals of this technique have been to preserve function of the cranial nerves, to avoid excessive retraction of the temporal lobe and cerebellum, and to eliminate damage to the venous sinus and Labbé's vein. Exposure of the base of the tumor for ablation of the blood supply and access for tumor removal is an important advantage of this approach.
Tumor necrosis factor‐alpha production in human head and neck squamous cell carcinoma
Authors: Parks Robert R. , Yan Shi‐Du , Huang Cheng‐Chun
Published: October 2006

Recent studies suggest that tumor necrosis factor‐alpha (TNF‐α), a pleiotropic cytokine, is responsible for some of the systemic and local effects, including tumor‐associated cachexia and neoplastic bone destruction, seen in patients with cancer. This study was undertaken to determine if TNF‐α is produced by human squamous cell carcinoma of the head and neck, and, if so, to determine its source and cellular distribution.

Tumor specimens from nine patients with squamous cell carcinoma of the head and neck region were immunohistochemically examined for the presence of TNF‐α. TNF‐α was localized with antibody to human TNF‐α by the immunoperoxidase method to the tumor and vessel endothelial cells in all nine specimens. By Western blot analysis, two protein bands recognized by anti‐human TNF‐α antibody in the soluble proteins of the tumor specimens were identified. These proteins—25 KD and 17 KD—represent the precursor and mature forms of TNF‐α. To verify squamous cell carcinoma production of TNF‐α, a cell culture of human head and neck squamous carcinoma was examined. The 25 KD immunoreactive protein, the TNF‐α precursor, was found in extracts from this culture by Western blot analysis. These findings suggest that tumor cells are able to produce TNF‐α; this production may explain some of the systemic and local effects seen in patients with squamous cell carcinoma of the head and neck.
The innervation of the human posterior cricoarytenoid muscle: Evidence for at least two neuromuscular compartments
Authors: Sanders Ira , Wu Bei‐Lian , Mu Liancai , Biller Hugh P.
Published: October 2006

Recent work has demonstrated that the dog posterior cricoarytenoid (PCA) muscle is composed of three neuromuscular compartments: a vertical, an oblique, and a horizontal. In this study, the human PCA muscle was examined for evidence of neural compartments. Fifteen human PCA muscles were processed by Sihler's stain, which renders the muscle translucent while counterstaining the nerve supply. The results clearly show that in all specimens the nerve supply of the human PCA muscle is separated into at least two main branches: one supplies the horizontal compartment and a second further subdivides to innervate both the vertical and oblique compartments. In 10 of the specimens, these nerve branches arose as separate branches from the recurrent laryngeal nerve. In all specimens, the nerve branch to the horizontal compartment was either combined or connected with the nerve branch to the interarytenoid muscle. The results suggest that the different compartments of the PCA muscle have distinct functions. In addition, the strong connections with the interarytenoid nerve complicate reinnervation procedures to reanimate a paralyzed or transplanted larynx.
Rapid analysis of mandibular margins
Authors: Arick Forrest L. , Schuller David E. , Sullivan Michael J. , Lucas Joel G.
Published: October 2006

Evaluating surgical margins during composite resection of carcinoma is limited by analysis of the bone margins. The standard pathologic evaluation of bone is by decalcification. A method of analysis was devised based on histologically proven methods of cortical invasion and subsequent spread. Frozen section analysis (FSA) of the cancellous bone was investigated as a rapid method of evaluating adequacy of the mandibular resection. Subjects consisted of 29 patients undergoing full‐thickness mandibular resection, with 16 cases of histologically proven mandibular invasion qualifying for evaluation. Results of FSA were then compared to the permanent section analysis of the cancellous bone and to the decalcified specimen. Complete correlation was found between frozen and permanent section results. Frozen section analysis was able to correctly predict adequacy of resection in 32 (97%) of 33 margins.
The study of vocal fold vibratory patterns in patients with unilateral vocal fold paralysis before and after type I thyroplasty with or without arytenoid adduction
Authors: Thompson Dana M. , Maragos Nicolas E. , Edwards Brian W.
Published: October 2006

Type I thyroplasty and arytenoid adduction have been used for the treatment of symptomatic unilateral vocal fold paralysis since the mid‐1970s. To this date, the vibratory patterns of the vocal folds in patients with unilateral vocal fold paralysis undergoing thyroplasty have not been studied in depth. Abnormal vibration of the vocal fold mucosa often contributes to voice problems in persons diagnosed with vocal diseases or disorders. The preoperative and postoperative videostroboscopic vibratory patterns including mucosal wave, amplitude, glottic closure, and symmetry were studied in 12 patients who underwent unilateral type I thyroplasty separately or in combination with an arytenoid adduction. The observed changes and clinical implications are discussed.
Meningoencephalic herniation into the middle ear: A report of 27 cases
Authors: Arìstegui Miguel , Falcioni Maurizio , Taibah Abdelkader , Russo Alessandra , Landolfi Mauro , Sanna Mario , Saleh Essam
Published: October 2006

Meningoencephalic herniation into the middle ear is a rare and potentially life‐threatening condition that may require prompt surgical intervention. Preoperative diagnosis is based on a high index of suspicion. Sometimes, however, meningoencephalic herniation is discovered during surgery. High‐resolution computed tomography and magnetic resonance imaging should be performed to confirm the diagnosis and to evaluate the extension of the herniated tissue. This article discusses the diagnostic approach, management strategy, and surgical technique used in 27 patients with meningoencephalic herniation. In an attempt to avoid infective complications, the authors used the middle cranial approach in patients with large herniations.
Nonsurgical delay of skin flaps: Effect of a suture delay technique on blood flow and survival
Authors: Odland Rick M. , Kim Pyong , Nadler Dan , Poole David V.
Published: October 2006

Surgical delay is the only clinical means of improving survival of skin flap tissue, but it has inherent risks and costs of a surgical procedure. This study tested the hypothesis that any method of disrupting the circulation at the distal perimeter of a planned skin flap would induce collateral circulation from the base of the flap and thereby improve flap survival. The suture delay technique was performed on rats, and two outcome measures were used: blood flow patterns and skin flap survival. Blood flow patterns were tested before and after the suture technique by means of the base occlusion test. Flap survival in the suture delay group was compared with survival in acute and surgical delay control groups.

Flap survival in the suture delay group (95.6% ± 0.6%, n = 22) was significantly greater than in the acute control group (85.7% ± 1.6%, n = 22) and was not different from that in the surgical delay model (95.2% ± 0.5%, n = 21). Laser Doppler studies demonstrated a change in blood flow patterns. This study supports the theory that the mechanism of the delay phenomenon is the development of collateral blood from the base of the flap and suggests that the benefits of delay can be achieved with minimal surgical trauma.
Local control of oropharyngeal carcinoma by irradiation alone
Authors: Wang C. C. , Montgomery William , Efird Jimmy
Published: October 2006

The authors of this study reviewed the management of 402 patients with squamous cell carcinomas of the faucial tonsil and the base of the tongue. These patients received radiation therapy at Massachusetts General Hospital and the Massachusetts Eye and Ear Infirmary from 1970 through 1993. Radiation therapy remains the treatment of choice for these lesions. Although the data from this review were not randomized, the accelerated hyperfractionated radiation therapy twice‐daily program was shown to achieve significantly higher 5‐year local tumor control rates and disease‐specific survival rates than the conventional once‐daily radiation therapy program (historical control).

In patients with early tumors of the faucial tonsil (cancer stages T1 and T2), the 5‐year actuarial local tumor control and disease‐specific survival rates following the twice‐daily radiation therapy program were 91% and 77%, respectively. In patients with advanced tumors (T3), the corresponding rates following twice‐daily radiation therapy showed marked improvement and were 80% and 68%.

While the treatment results for carcinoma of the base of the tongue generally were inferior to those for carcinoma of the faucial tonsil, they were still much better after the twice‐daily program than after conventional once‐daily irradiation. For patients with carcinoma of the base of the tongue, the local tumor control and disease‐specific survival rates for T1 and T2 lesions were 85% and 76%, respectively. For T3 lesions, the corresponding rates were 54% and 53%.

Extensive T4 tumors are better managed by combined surgery and postoperative irradiation. Residual metastatic nodal disease is managed by neck dissection.
Conservative management of patients with small acoustic tumors
Authors: Wiet Richard J. , Zappia John J. , Hecht Craig S. , O'Connor Cathleen A.
Published: October 2006

Of 432 patients referred for treatment of their cerebellopontine angle tumors, 53 with acoustic neuromas were managed initially without intervention but with adequate follow‐up. Mean presenting tumor size in this subgroup of patients was 0.98 cm (range, 0.2 to 3.0 cm), and average growth rate was 0.16 cm per year. Twenty‐one patients demonstrated tumor growth with a mean follow‐up interval of 1.9 years. Of these 21 patients, 14 underwent microsurgical excision, 4 received radiation, 2 continued to be observed and 1 was lost to follow‐up. The remaining 32 (60%) had no demonstrable growth with a mean follow‐up of 2.13 years. Of these patients, 29 continue to be followed and 3 were lost to follow‐up.

Of the information evaluated, the only statistically significant relationship is with larger tumor size in elderly patients–most likely reflecting the propensity to opt for conservative treatment in elderly patients. Tumor growth rate was unrelated to presenting tumor size or patient age, which suggests that conservative treatment may be appropriate in selected patients.
Transnasal endoscopic medial maxillectomy in inverted papilloma
Authors: Kamel Reda H.
Published: October 2006

This study comprised 17 cases of inverted papilloma, which were divided into two groups. The first group included 8 cases that lacked maxillary sinus involvement. They were subjected to intranasal endoscopic resection with safety margin. The second group included 9 cases involving the maxillary sinus with or without nasal extension. They were subjected to transnasal endoscopic medial maxillectomy. Follow‐up for an average of 43 months in group 1 and 28 months in group 2 (excluding the 5 cases with less than 2 years of follow‐up) showed no recurrence. The author realized that inverted papilloma can be divided into two groups from the anatomic and behavioral points of view and accordingly should be managed differently. For those lesions without involvement of the maxillary sinus, intranasal endoscopic resection is effective; for those lesions with maxillary sinus involvement, transnasal medial maxillectomy, which could be performed safely under endoscopic control, is recommended.
Chemosensory function and diet in HIV‐infected patients
Authors: Mattes Richard D. , Wysocki Charles J. , Graziani Amy , Macgregor Rob Roy
Published: October 2006

Alterations of chemosensory function have been noted in human immunodeficiency virus (HIV)‐infected patients, but their frequency, severity, and relationship to diet have not been adequately assessed. Odor and taste identification tests and a taste‐intensity scaling task were administered to 25 men who were HIV‐infected but otherwise healthy. Responses were compared to those of 49 comparably aged male control subjects. Dietary information was obtained by questionnaire. Although 72% of HIV‐infected patients reported some chemosensory alteration, no significant differences in taste identification ability or intensity ratings were observed between patients and controls. Twelve percent of patients had poor odor identification scores, but the group mean was similar to that of controls. Neither measured nor self‐reported sensory indices were significantly related to any variable of health (e.g., HIV helper cell (CD4) count, body weight, or body composition), treatment, or diet.
Growth of the pediatric skull base: Assessment using magnetic resonance imaging
Authors: Myer Charles M.
Published: October 2006

Minimal information is available concerning the gross anatomic changes that occur with skull base development in children. Because clinical and autopsy material to evaluate skull base growth in this population is rare, the author of this study evaluated normal magnetic resonance imaging (MRI) scans in 76 children ranging in age from newborn to 18 years. Growth of the basicranium was assessed in three dimensions: anterior‐posterior, medial‐lateral, and superior‐inferior. In each dimension, growth was noted to be rapid until age 6 years, with relatively slower growth thereafter. In the superior‐inferior and anterior‐posterior dimensions, both the amount of growth and the asymptotic value were noted to be greater in males than in females (P<.05).

The findings of this study can help surgeons select the appropriate operative approach for skull base masses in children. Certain approaches may involve significant morbidity, including mandibulotomy, loss of teeth, oral contamination, and external auditory canal closure. Representative cases managed through an extrapharyngeal transcervical approach are reviewed.
Advanced techniques in magnetic resonance imaging in the evaluation of the large endolymphatic duct and sac syndrome
Authors: Ric Harnsberger H. , Dahlen Richard T. , Shelton Clough , Gray Steve D. , Parkin James L.
Published: October 2006

The purpose of this report is to compare temporal bone computed tomography (CT) to high‐resolution magnetic resonance (MR) imaging using a novel thin‐section fast spin echo (FSE) pulse sequence in identifying and characterizing patients with large vestibular aqueduct syndrome. Sixteen patients with sensorineural hearing loss and a CT diagnosis of large vestibular aqueduct(s) underwent high‐resolution fast spin echo magnetic resonance imaging with dual, 3‐in phased array receiver coils centered over the external auditory canals. Magnetic resonance imaging parameters included axial and oblique sagittal fast spin echo with an effective slice thickness of 1 mm contiguous. Thirty‐eight patients with 76 normal inner ears who underwent MR imaging using this technique had their endolymphatic duct measured.

MR alone identified the enlarged endolymphatic sac seen along with the large endolymphatic duct in all cases. Three cases (five inner ears) with enlarged bony vestibular aqueducts on CT showed no evidence of endolymphatic duct or sac enlargement on MR. MR alone identified a single case of mild cochlear anomaly in conjunction with an enlarged endolymphatic duct and sac. In the normal population the size of the normal endolymphatic duct at its midpoint measured from 0.1 to 1.4 mm.

Thin‐section, high‐resolution fast spin echo MR imaging of the inner ear may be superior to CT in the evaluation of patients with the large vestibular aqueduct syndrome.
Vascularized auricular perichondrium in airway reconstruction: The effects of stenting with and without a mucosal graft
Authors: Clevens Ross A. , Esclamado Ramon , Naficy Saman
Published: October 2006

This study quantitatively examines the effects of laryngotracheal stenting with and without mucosal grafting on chondrogenesis in a rabbit model. Vascularized auricular perichondrium was transferred to a cricothyroid membrane (CTM) defect in three groups of New Zealand white rabbits: group A, CTM defect alone; group B, CTM defect with endotracheal tube stent; and group C, CTM defect with a buccal mucosa graft (BMG) interposed between the stent and perichondrium.

The rabbits were sacrificed at 7 weeks for histologic examination and determination of cartilage thickness by digitometry. Chondrogenesis was not significantly affected by stenting (n = 11; 0.719 mm ± 0.203 mm) or by BMG (n = 12; 0.775 mm ± 0.203 mm) as compared with controls (n = 14; 0.695 mm ± 0.216 mm) (P value = not significant). Laryngotracheal stenting and BMG do not adversely influence chondrogenesis in airway reconstruction with vascularized perichondrium in the rabbit model. The application of these principles in human airway reconstruction is discussed.
Peroneal motor nerve crush injury and hyperbaric oxygen effect
Authors: Santos Perry M. , Williams Sherri L. , Covey James
Published: October 2006

The potential therapeutic effect of hyperbaric oxygen (HBO) after rat peroneal nerve crush was evaluated. Animals were given 100% oxygen at 2.5 atmosphere absolute for 90 minutes twice daily for 1 week and then once daily for 1 week.

Edema increased in crushed nerves compared with control nerves, but no effect was associated with the administration of HBO. Gait analysis demonstrated injury at 1, 7, and 14 days after nerve crush, but no difference was found at 22 and 28 days after injury (analysis of variance: P<.001, 10 animals per group). Eight weeks after injury, nerve stimulation and muscle force measurements were 114 g for the injured group and 146 g for the control group (P<.001). There were no HBO‐associated changes in gait parameter or nerve/muscle force measurements.

This study demonstrated that rat peroneal nerve crush injury causes acute intraneural edema and temporary decrement of gait parameters. Elicited nerve stimulation demonstrated persistent loss of force 4 weeks after normalization of gait, but no HBO effect.
Reconsidering a Paradigm: The Spread of Supraglottic Carcinoma to the Glottis
Authors: Weinstein Gregory S. , Laccourreye Ollivier , Brasnu Daniel , Tucker John , Montone Kathleen
Published: October 2006

This study was performed to evaluate the spread of supraglottic carcinoma to the glottic level. Whole organ sections of total laryngectomy specimens from 37 patients with previously untreated supraglottic carcinomas were reviewed retrospectively. Of the 37 specimens, 20 (54%) were noted to have extension of cancer to the glottic level.

A significant relationship was noted between glottic extension and abnormal cord motion (P= .0002). A statistically significant trend was noted for the relationship between inferior extension along the supraglottic mucosa and glottic level extension (P< .0001). Contrary to the prevailing model of the spread of supraglottic carcinoma, in which there is a distinct barrier to spread at the ventricle, this analysis of selected supraglottic carcinomas revealed a continuum of spread from the supraglottis to the glottis.
Rate-Controlled Lateral-load Pile Tests Using a Robotic Manipulator in Centrifuge
Authors: Kong LG , Zhang LM
Published: October 2006

Robotic manipulators, as a new facility for centrifuge modeling, can provide a platform to carry out complex in-flight simulation of geotechnical problems. In this study, a four-axis robotic manipulator was employed to conduct a series of laterally-loaded pile tests in sand. Four model piles were installed into a sand bed and laterally loaded at different loading rates consecutively without stopping the centrifuge, which accordingly maximized consistency of the soil sample among the tests. Tests in both loose sand and dense sand were conducted. Detailed information of the test devices and procedures of soil sample preparation and load testing is described in this paper. The test results, including horizontal force-displacement curves, bending moment distributions, relationships between lateral resistance and loading rates, and p-y curves derived from the measured bending moment distributions, are presented. In addition, the effects of loading rate and ground surface are discussed based on the test results. It is found that, under the investigated conditions, loading rate has little effect on the horizontal resistance at specified displacements, but has significant effects on the bending moment and soil reaction distributions. The ground surface also has an effect on the behavior of the laterally-loaded piles. A simple modification method is used to consider the effect of ground surface on p-y curves at shallow depths.
Molecular Analysis, Cytogenetics and Fertility of Introgression Lines From Transgenic Wheat to Aegilops cylindrica Host
Authors: Schoenenberger Nicola , Guadagnuolo Roberto , Savova-Bianchi Dessislava , Küpfer Philippe , Felber François
Published: October 2006

Natural hybridization and backcrossing between Aegilops cylindrica and Triticum aestivum can lead to introgression of wheat DNA into the wild species. Hybrids between Ae. cylindrica and wheat lines bearing herbicide resistance (bar), reporter (gus), fungal disease resistance (kp4), and increased insect tolerance (gna) transgenes were produced by pollination of emasculated Ae. cylindrica plants. F1 hybrids were backcrossed to Ae. cylindrica under open-pollination conditions, and first backcrosses were selfed using pollen bags. Female fertility of F1 ranged from 0.03 to 0.6%. Eighteen percent of the sown BC1s germinated and flowered. Chromosome numbers ranged from 30 to 84 and several of the plants bore wheat-specific sequence-characterized amplified regions (SCARs) and the bar gene. Self fertility in two BC1 plants was 0.16 and 5.21%, and the others were completely self-sterile. Among 19 BC1S1 individuals one plant was transgenic, had 43 chromosomes, contained the bar gene, and survived glufosinate treatments. The other BC1S1 plants had between 28 and 31 chromosomes, and several of them carried SCARs specific to wheat A and D genomes. Fertility of these plants was higher under open-pollination conditions than by selfing and did not necessarily correlate with even or euploid chromosome number. Some individuals having supernumerary wheat chromosomes recovered full fertility.