bluuebunny/crossref_metadata_2025 huggingface dataset:
Complications in surgery for stomal recurrences
Authors: Myers Ernest M.
Published: October 2006

Stomal recurrences are diffuse epidermoid carcinomas of the tracheostoma. There is a 8.3% incidence associated with patients having a total laryngectomy. Most can be prevented by several prophylactic measures; however, surgery may be required. The procedure advocated is mediastinal dissection and its surgical technique is outlined. Recently the use of the pectoralis myocutaneous flap has greatly diminished morbidity and mortality associated with this procedure. The complications that may be encountered with mediastinal dissection have been categorized and analyzed. The dynamic interplay of these complications is stressed.

Separately, each complication is formidible, but collectively, they may be overwhelming. This entire web of complications is synergistic and at times fatal. In essence, the motto of the surgeon when operating on a patient with a stomal recurrence should be eternal vigilance.
Facial nerve decompression complications
Authors: May Mark , Klein Susan R.
Published: October 2006

Every structure contained within the temporal bone in close proximity to the facial nerve is at risk during intratemporal bone surgery on the facial nerve. We present a review of the causes of injuries to these structures and of ways to prevent such injuries. This review includes information drawn from pertinent literature, from the author's experience managing 139 patients undergoing temporal bone surgery for a variety of facial nerve disorders between 1974 and 1981, from an analysis of 43 of our patients whose hearing was evaluated before transmastoid facial nerve surgery and again 6 months after surgery, and from the experiences of colleagues.

We found that the most frequent complication of intratemporal facial nerve surgery is auditory involvement. An air‐bone gap of 15 dB or greater was noted in 14% of the 43 patients studied and a sensorineural loss, primarily at the 4000 and 8000 cycles, occurred in 51% of these patients. A decrease in discrimination of 15% or greater was noted in 7% of patients, and a shift in speech reception threshold of 15 dB or greater was noted in 16% of the patients. Twelve percent of the patients had tinnitus following surgery and 5% required a hearing aid as a result of a combined sensorineural and conductive hearing loss which occurred in their better hearing ear as a result of surgery. Structures less commonly injured during transmastoid decompression of the facial nerve included the facial nerve itself, the chorda tympani nerve, the balance function of the labyrinth, the cochlea, the ossicles, the sigmoid sinus and superior petrosal vein, the middle meningeal artery and the stylomastoid artery, the dura, and the brain. We review all of these complications, as well as discuss the incidence of cerebrospinal fluid leak and infection which also may result from this type of surgery.
Complications of flaps and grafts in the oral cavity and pharynx
Authors: Schechter Gary L.
Published: October 2006

Numerous complications are associated with the use of flaps and grafts in oral cavity and pharyngeal reconstruction. A study is presented that highlights the factors that are associated with these complications and ways to prevent them.
Complications of conservation surgery of the laryngopharynx
Authors: Yonkers Anthony J.
Published: October 2006

Conservation surgery of the larynx describes various surgical techniques which are generally used in the management of neoplastic conditions involving the larynx or the laryngopharynx. By utilizing these partial resections of the larynx, the phonotary and protective functions of the organ are preserved, as well as an adequate laryngeal lumen for breathing without compromising the patient's overall survival rate.

In the majority of instances, conservation surgery of the larynx is carried out with only a low incidence of complications. When proper surgical technique is followed, the metabolic condition of the patient is acceptable, and the blood supply to the tissues subjected to surgery remains good, the incidence of complications is low. Alternatively, if surgery is undertaken when conditions are not totally correct or are marginal, the complication rate rises accordingly.

This paper will summarize the complications which occur more commonly when undertaking this type of surgery and will describe some of the circumstances in which a higher incidence of complications can be expected to occur.
Identification and functional recording of the recurrent nerve by electrical stimulation during neck surgery
Authors: Hvidegaard Torkil , Vase Poul , JØSrgensen Karsten , Blichert‐Toft Mogens
Published: October 2006

A method for identification and functional recording of the recurrent nerve during neck operations is described. The basic principle implicates electrical stimulation of the recurrent nerve causing adduction of the vocal cord registered by means of a balloon placed between the vocal cords. Three different recording methods have been tested in animal experiments and during 26 neck operations on patients. The most simple method employed is recommended as a routine procedure, likely to reduce surgical damage to the recurrent nerve.
Lingual tonsillectomy: A treatment for inflammatory lesions of the lingual tonsil
Authors: Joseph Michael , Reardon Edward , Goodman Max
Published: October 2006

Lingual tonsillectomy is a surgical treatment that is seldom performed because lingual tonsillitis is infrequently diagnosed. We have reviewed a group of patients with lingual tonsillitis or lingual tonsil hyperplasia who were treated with lingual tonsillectomy. Lingual tonsil lesions, the anatomy and histology of the lingual tonsil, and surgical approaches to lingual tonsillectomy are discussed.
Caldwell‐Luc operation in the treatment of childhood bronchial asthma
Authors: Juntunen Kaisu , Tarkkanen Jorma , Mäkinen Judith
Published: October 2006

A follow‐up study was carried out in 15 children with severe bronchial asthma. Chronic infection of the paranasal sinuses was connected with the unfavorable course of their bronchial asthma. As adenoidectomy and intranasal antrostomy had failed to cure the sinusitis, the Caldwell‐Luc operation was performed at the age of 6–16 years. The follow‐up examination was done 3–12 years after the radical operation of the maxillary sinuses. The majority of the patients had normal working capacity, and the need of medical treatment was reasonable. It is concluded that the Caldwell‐Luc operation is indicated in children with severe bronchial asthma, when repeated respiratory infections are associated with asthmatic attacks and adenoidectomy and intranasal antrostomy have proved ineffective.
Preoperative ct scan evaluation for laryngeal carcinoma: Correlation with pathological findings
Authors: Hoover Larry A. , Calcaterra Thomas C. , Walter Gary A. , Larrson Sven G.
Published: October 2006

The advent of newer generation high resolution computed tomography (CT) scanners has revolutionized diagnostic evaluation in head and neck cancer. Since the development of conservation surgical techniques for the larynx, a precise preoperative evaluation of the extent of laryngeal involvement by carcinoma has been of prime importance. No single diagnostic study now yields more information regarding the anatomic extent of tumor than high resolution CT scanning.

This study was designed to evaluate the reliability of CT scanning in determining extent of disease at several laryngeal levels by comparing preoperative CT scans with corresponding postoperative pathology obtained by serially sectioning laryngeal specimens. We found very good correlation in the inferior larynx and good correlation in the superior larynx. Determination of cartilage invasion proved very difficult, and scanning was unreliable at all levels when severe postradiation reactions were present.
Honored guest's address. The inverse relationship between cost and prognosis
Authors: Cohn Roy B.
Published: October 2006

While doctors get the blame for increasing medical costs, studies show that societal, political factors, and medicine's limitations are the culprit.

Clinicians (I use the term to distinguish between those M.D.s who work at the bedside and others who are in nonpatient direct care) are well aware of the huge costs associated with serious illness, but it is only recently that many papers are appearing in the medical literature discussing this problem in relation to medical care. In a study published in JAMA (April 10,1981), Steven A. Schroeder, el at., found that high cost illness is really terminal illness in a random sample of 776 adult high‐cost patients. Two years after discharge at least 34% of high‐cost patients had died and these patients accounted for 39% of the hospital charges incurred by the total group studied. Francis Moore and colleagues pointed out in the New England Journal of Medicine (March 12,1981) that this very group of patients also had the highest incidence of complications in the surgical field. In one year they identified 36 such cases at the Peter Bent Brigham Hospital in Boston; the total cost of their care was nearly $2,000,000. While there were unnecessary complications, in this group of patients it is very likely inevitable that the complication rate will be high.

Since many authors seem to imply that it is the clinicians who are at fault to a large extent in generating these costs, I would like to point out that the physician‐clinician actually has control over a relatively small percent of the total cost.
Life‐threatening soft‐tissue infections of the neck
Authors: Beck Howard J. , Salassa John R. , Mccaffrey Thomas V. , Hermans Paul E.
Published: October 2006

Four adult patients had life‐threatening soft‐tissue infections of the neck. One had Hemophilus influenzae infection, one had Streptococcus pyogenes infection, and two had polymicrobial mixed aerobic and anaerobic infections. Three of the four patients died despite appropriate antimicrobial therapy and surgical intervention. These cases demonstrate the spectrum of serious soft‐tissue infections of the neck in both the compromised and the uncompromised host. Soft‐tissue infections of the neck may be necrotizing or nonnecrotizing. Cellulitis secondary to H. influenzae and β‐hemolytic streptococci is usually non‐necrotizing, whereas necrotizing infections are caused most commonly by synergistic organisms. Potential complications include septic shock, disseminated intravascular coagulation, acute renal failure, adult respiratory distress syndrome, mediastinitis, and pericarditis. Early recognition with aggressive medical and surgical therapy is essential to reduce the mortality.
High septal hemitransfixion for the correction of caudal septal deformities
Authors: Kamer Frank M. , Churukian Michael M.
Published: October 2006

High septal hemitransfixion has demonstrated superior versatility and reliability in a series of 68 patients for correction of caudal septal deformity. The literature has contained many references to high septal transfixion for use in rhinoplasty to preserve tip support. An alternative application of this approach for repair of caudal septal deformity is herein discussed.
Carbon dioxide laser enucleation of polypoid vocal cords
Authors: Yates Alan , Dedo Herbert H.
Published: October 2006

Polypoid vocal cords have routinely been treated by endoscopic vocal cord stripping, often‐times resulting in prolonged hoarseness postoperatively. Submucosal CO2 laser enucleation of the polypoid tissue, with preservation of a mucosal flap on the medial edge of the cord, has proved to be a valuable improvement. The surgical procedure is described and results are presented which suggest that voice quality is better earlier than is the case after vocal cord stripping.
Hyperparathyroidism, hypercalcemia and the otolaryngology head and neck surgeon
Authors: White Irving L.
Published: October 2006

Ability to successfully accomplish parathyroid surgery, as well as to understand the pathophysiology of parathyroid disease and hypercalcemia, is essential to the Otolaryngology Head and Neck surgeon (who must treat parathyroid disease), because of the more frequent identification of parathyroid adenomata and parathyroid hyperplasia (with their inherent hypercalcemia). Today many more cases are recognized because of hypercalcemia identified by now routine multiphasic biochemical screening tests.

The etiology of hypercalcemia is discussed in considering the differential diagnosis of pseudohypoparathyroidism, and true hyperparathyroidism of parathyroid hyperplasia and parathyroid adenomata.

Pseudohypoparathyroidism, secondary to ectopic elaboration of parathormone‐like substance is treated medically. Parathyroid hyperplasia can sometimes be controlled medically, but the only definitive trentment for hyperplasia and parathyroid adenomata is surgery, to the extent indicated, in these often critically ill patients with this multisystem disease. Medical, as well as surgical treatment, is described.

A patient is described who demonstrated in a slowly moving montage all the classic history and findings of severe hyperparathyroidism in successive phases to her ultimate demise, manifesting neurological, renometabolic, skeletal, cardiovascular and gastrointestinal multisystem symptoms which arc described.

The complete relief of the acute symptoms following excision of a massive parathyroid adenomata is described and the spectacular pathologic specimen is demonstrated.

This patient's course is compared with that of a typical case of pseudohypoparathyroidism.
Otologic involvement in late syphilis
Authors: Steckelberg James M. , Mcdonald Thomas J.
Published: October 2006

In 38 patients with cochleovestibular dysfunction and no cause other than syphilis (congenital in 15, acquired in 23), there was no characteristic pattern to the dysfunction. Sensorineural hearing loss was present in all (bilateral in 82%, unilateral in 18%), and 42% had episodic rotatory vertigo. Only 24% had the classic triad of symptoms of endolymphatic hydrops. The impairment was less in the first 5 years of hearing loss than in subsequent intervals; the average impairments were comparable in the second through fifth decades.
ANTERIOR HYPOTYMPANIC APPROACH FOR GLOMUS TUMOR OF THE INFRATEMPORAL FOSSA.
Authors: Farrior Jay B.
Published: October 2006

The anterior hypotympanic approach to the infratemporal fossa permits direct exposure of glomus jugularc and glomus tympanicum tomors of the middle ear, hypotympanum and petrous apex with the preservation of normal structures and hearing. Smaller glomus tumors arising in the middle car extend anteriorly along the paths of least resistance into the hypotympanum and petrous apex to involve the carotid canal and, only later in the course of disease, extensively involve the jugular bulb, neck, or mastoid air cell system. Clinical experience demonstrates that this approach can effectively cure or control small glomus tumors in selected patients. In patients with more extensive disease, the surgical field may be expanded by removing the mastoid tip with facial nerve mobilization to remove the jugular bulb and posterior tumor extensions while preserving middle ear function and hearing.
Mastoidectomy for acquired cholesteatoma: Follow‐Up to 20 years.
Authors: Cody Thane D. R. , Mcdonald Thomas J.
Published: October 2006

The results of 423 mastoidectomies for acquired cholesteatoma were reanalyzed 6 years after the first analysis. The mastoidectomies were placed into three groups: open‐cavity, 135 modified radical and 37 radical; obliteialvd‐cavity, 60 modified radical and 20 radical in which the mastoid cavities were obliterated with pedicle muscle grafts; and inlacl‐canal‐wall, 69 complete and 102 complete with opening of the facial recess. The following observations were made.

1. The cholesteatoma failure rate increased: for the open‐cavity group, from 6% to 7%; obliterated‐cavity group, 16% to 18%; intactcanal‐wall group, 35% to 45%.

2. The precholesteatoma (retraction pocket) failure rate in the open‐cavity and obliterated‐cavity groups did not change. In the intact‐canal‐wall group, recurrent cholesteatomas developed in 8 cases initially classified as precholesteatomu failures. In 9 initially classified as successful, retraction pockets developed and 7 of these went on to recurrent cholesteatomas. Consequently, despite the progressive increase in formation of retraction pockets, the overall incidence dropped from 20% to 16%.

3. Failure due to chronic or frequent recurrent infection did not change in the open‐cavity and intact‐canal‐wall groups. However, in the obliterated‐cavity group, it increased from 4% to 5%.

4. The overall failure rate increased: open‐cavity group, 18% to 19%; obliterated‐cavity group, 29% to 30%; intact‐canal‐wall group, 60% to 66%.
Office diagnosis of sinus disorders: The role ofultrasound scanning.
Authors: Mabry Richard L.
Published: October 2006

The accurate diagnosis of sinus disorders has traditionally depended on history‐taking, physical examination, and sinus radiographs. Other helpful tools include transillumination, sinus irrigation, and direct sinoscopy. Ultrasound scanning to define and follow the course of sinus disorders, although used for years in Europe, has only recently been introduced in this country. It is characterized as an inexpensive, non‐invasive diagnostic aid which does not carry the risk of ionizing radiation. This paper discusses the use of ultrasound scanning in the management of sinus disorders commonly seen in office otolaryngologic practice, comparing it to other diagnostic modalities, and pointing out its advantages and shortcomings.
Extracranial presentation of craniocervical chordoma.
Authors: Berryhill Bruce H. , Armstrong Beverly W.
Published: October 2006

Chordomas are rare tumors of notochordal origin which arise in the sacral, vertebral, and craniocervical areas. Most patients with craniocervical chordomas have either neurological or ophthalmological symptoms. A patient presented with a parotid mass which was initially diagnosed as benign mixed tumor. One and one‐half years later, this patient was found to have an extensive intracranial tumor which was diagnosed as chordoma. Treatment consisted of subtotal surgical excision and radiotherapy. This case demonstrates an unusual presentation of an unusual tumor and the difficulty that may arise in diagnosing these tumors.
Transsphenoidal approach to the sella: The johns hopkins experience.
Authors: Kennedy David W. , Cohn Edward S. , Papel Ira D. , Holliday Michael J.
Published: October 2006

The transsphenoidal hypophysectomy has become a relatively frequent procedure in recent years, with the otolaryngologist playing a major role in its renewed popularity. This paper reviews the evoluation of pituitary surgery, duscusses the surgical technique currently used, and reviews the results and complications of 114 cases over a 13‐year period.

Of the 129 procedures performed at Johns Hopkins Hospital between 1970 and 1983,114 charts were available for review. Twelve of these were palliative hypophysectomies and 102 were for sella tumors. Sixty‐eight patients were treated with surgery alone, and 34 received surgery and postoperative irradiation. Significant complications such as CSF rhinorrhea, diabetes insipidus, meningitis, septal perforation, anosmia, and visual field defects are discussed. The mortality rate for the series was 1.7%.

These results are compared with those of previously published series and the differences are discussed in detail. In analyzing these data we feel that the transseptal, transsphenoidal hypophysectomy has become a safe and effective therapy for sella lesions.
Supraorbital rim approach to the anterior skull base
Authors: Johns Michael E. , Kaplan Michael J. , Park Tae Sung , Jane John A. , Cantrell Robert W.
Published: October 2006

Advances in the surgical approach to the anterior skull base have resulted in increased opportunity for the cure of tumors involving these structures. This paper describes a modification of the frontal craniotomy technique which allows excellent access to the anterior cranial fossa and orbit. This technique results in the en bloc removal of a bone flap which incorporates the orbital roof, superior orbital rim, and frontal bone. We have utilized this approach in 5 anterior skull base tumors (2 esthesioneuroblastomas, an angiofibroma, a case of orbital invasion by an aggressive inverted papilloma, and a squamous cell carcinoma of the ethmoid complex).

This approach has the advantage of excellent exposure, clear visibility in the placement of chisel cuts, and less brain retraction than conventional techniques. It is the approach of choice for orbital tumors.
Lateral mandibulotomy: A technique of exposure for penetrating injuries of the internal carotid artery at the base of the skull
Authors: Dichtel William J. , Miller Robert H. , Woodson Gayle E. , Feliciano David V. , Hurt Julian
Published: October 2006

Injuries to the internal carotid artery are rare but are frequently fatal or associated with significant neurologic sequelae. Exposure for surgical repair of penetrating injuries to the internal carotid artery at the base of the skull is difficult because of the overlying ramus of the mandible and the facial nerve. In the past, these injuries have been treated by techniques such as occlusion of the artery with a Fogarty balloon catheter, or subluxation of the temporomandibular joint to gain access to the arterial injury.

Based on techniques previously reported for extirpation of parapharyngeal space tumors, we describe lateral mandibulotomy for exposure of penetrating carotid artery injuries at the base of the skull. The technique affords relatively rapid and adequate exposure of these injuries allowing ligation, or in selected cases, arterial repair.
Reconstruction of the stenotic hypopharynx and cervical esophagus without total laryngectomy
Authors: Goodwin W. Jarrard , Lundy Donna S. , Livingstone Alan S.
Published: October 2006

Reconstruction for severe stenosis of the hypopharynx, laryngeal inlet, and/or cervical esophagus is a challenging problem for the surgeon and his patient who want to avoid total laryngectomy. We reviewed the case records of eight patients and the relevant published literature in an effort to define the requirements for success and the causes of failure.

A variety of surgical techniques were used. Seven of 8 patients eat a normal or near normal diet. Two of 4 patients, who sustained laryngeal damage at the time of initial injury, required total laryngectomy because of persistent aspiration. The 2 remaining patients and the 4 patients, who did not sustain laryngeal damage at the time of injury, speak with a good voice. Total laryngectomy should be reserved for those patient who cannot be rehabilitated following optimal reconstruction.
Normal speech for patients with laryngeal webs: An achievable goal
Authors: Mcguirt W. Frederick , Salmon James , Blalock David
Published: October 2006

Normal speech as well as an improved airway is now an achievable goal in the treatment of laryngeal webs. Seven acquired webs and 3 congenital webs were seen at the North Carolina Baptist Hospital/Bowman Gray School of Medicine. The speech of 6 patients was tested preoperatively and again postoperatively: speech was considered normal postoperatively in 5 patients without the need for speech therapy; normal in the sixth patient after 6 sessions of speech therapy. The authors' preferred method of treatment is development of an endolaryngeal mucosal flap with a variable beam CO2 laser under operating microscopic control.
Biology of tumors and head and neck cancer chemotherapy
Authors: Gussack Gerald S. , Brantley B. Alton , Farmer Joseph C.
Published: October 2006

The management of advanced squamous cell carcinomas of the head and neck has shown disappointing results with surgery and radiation alone. Chemotherapy offers a third method of managing these patients. A background of basic tumor biology and cell cycle kinetics is essential in designing an effective head and neck chemotherapeutic protocol. The principles of the cell cycle, stem cell regulation, and doubling times are discussed. The kinetic classification of chemotherapeutic agents and experimental hypotheses of clinical relevance arc reviewed.
Snoring: Surgical vs. nonsurgical management
Authors: Fairbanks David N. F.
Published: October 2006

Eighteen children were treated for snoring. Surgical removal of enlnrcd tonsils and/or adenoids resulted in prompt and total elimination of snoring in 17 of these patients. One child required nasal and sinus surgery to gain relief from snoring.

Eighty‐three adults were interviewed, examined, and treated for snoring. Correction of anatomical abnormalities in the nose, soft palate, uvula, and pharynx achieved elimination of snoring in 72% of surgically treated cases. By contrast, nonsurgical remedies achieved snoring elimination in only 5% of patients (controls). Tracheostomy was required in 10% of snoring adults — those who proved to have severe obstructive sleep apnea syndrome.

Snoring is due to the combined effect of several anatomic and physiologic abnormalities in the nasal and pharyngeal segments of the airway. It may be amenable to surgical therapy when the severity of the problem warrants it.
Surgical treatment for malignant exophthalmos of endocrine origin
Authors: Hanabury Mark R. , Cole T. Boyce , Clark Charles E. , Chandler Arthur C.
Published: October 2006

Endocrine exophthalmos is a poorly understood disease process thought to be related to a dysfunction of the thyroid‐pituitary axis. Initial therapy for symptomatic endocrine exophthalmos is medical. Failure to respond to medical management is heralded by progressive exophthalmos, exposure keratitis, and decreasing visual acuity. The pathophysiologic processes involved and an historical review of the various surgical procedures used are discussed. The results of 28 patients surgically decompressed by a transantral transethmoid approach are presented. Preservation or improvement in visual acuities were observed in all but one patient. Diplopia was generally not improved and may be worsened in some patients.
Reconstruction of post‐traumatic sinus osteomyelitis
Authors: Lekas Mary D. , Welch Paul T.
Published: October 2006

Osteomyelitis with a fistulous tract of the left fronto‐nasnl area. The patient received an Anzio Beachhead WW II right fronto‐nasal injury repaired with a lucite cranioplasty. A staphylococcal infection involved the remnant of the left frontal sinus with a fistula at the nasion near the orbital ridge. Bone scan revealed increased activity consistent with osteomyelitis. Patient was treated with intravenous oxacillin. The lucite skull prosthesis was removed 2 weeks after admission via the bilateral osteoplastic coronal flap approach with fat obliteration of the residual frontal sinus. The intravenous oxacillin was maintained for 48 days and the patient was discharged. The patient was later readmitted for a cranioplasty using a preformed tantalum plate. The nasal flnnge of the tantalum caused a deformity that did not allow the patient to wear his glasses. His third admission was for reconstruction of the tantalum and nasal deformity via a W‐shaped incision.
Fine‐needle aspiration biopsy: Efficacy in the diagnosis of head and neck sarcoidosis
Authors: Frable Mary Ann Smith , Frable William J.
Published: October 2006

The authors report. The usefulness of fine‐needle aspiration biopsy to establish the diagnosis of sarcoidosis in patients with palpable disease in the head and neck areas. Aspiration biopsy proved to be a simple and quick method for establishing this diagnosis in the eight cases reported in this series. Interpretation of cytologic smears with identification of typical sarcoid‐like granulomas proved to be quite easy. No complications occurred secondary to use of this technique.
Planned preoperative radiation therapy vs. definitive radiotherapy for advanced laryngeal carcinoma
Authors: Kazem Ismail , Broek Paul Van Den
Published: October 2006

In the period 1970‐1980 inclusive, 191 patients with T3T4 laryngeal carcinoma (glottic.: 63 and supraglottic.: 128) received either definitive radiation therapy (RT) (60‐65 Gy in 6‐7 weeks) or planned preoperative radiation therapy (25 Gy in 5 equal daily fractions of 5 Gy) followed by laryngectomy with or without neck dissection (RT+S).

Selection for RT vs. RT+S was based on medical operability and/or patient's refusal to undergo surgery. All patients are evaluable with minimum of 2 years observation. Crude 5 and 10‐year survival probability for 32 patients with glottic localization who received RT is 55% and 38% vs. 65% and 65% respectively for 31 treated with RT+S. For 52 patients with supraglottic site who received RT, the 5 and 10‐year survival is 44% and 44% vs. 82% and 60% for 76 patients treated with RT+S.
Reconstruction of the skull base
Authors: Schuller David E. , Goodman Joseph H. , Miller Carole A.
Published: October 2006

Tumor surgery of the skull base has been increasingly undertaken in recent years. This report involves a series of 18 consecutive patients who have undergone 22 operations at Ohio State University from July 1980 to January 1983 for removal of tumors either adjacent to or through the skull base. A variety of reconstructive techniques such as pericranial flaps, muscle flaps, temporalis fascial grafts, split‐rib grafts, fat grafts, and bone grafts have been found to be reliable. This series also included the successful use of a temporalis myocutaneous flap. The conclusion of this study is that these techniques provide a safe approach to the resection of tumors involving the base of skull.
Meningioma of the parapharyngeal space: A unique extension of intracranial tumor
Authors: Haratake Joji , Ishii Nobuyoshi , Yoshida Akio , Horie Akio , Lin Meiin
Published: October 2006

A 45‐year‐old woman with a meningioma growing in the parapharyngeal space is reported. Her initial symptom was a stuffy feeling in the right ear and swelling of the right parapharynx. The parapharyngcal mass was biopsied, and a frozen section diagnosis suggested a paraganglioma. On electron microscopy, however, the tumor cells failed to show secretory granules, and represented a prominent interdigitation of the cytoplasm with occasional desmosomal attachments. Based on these features the tumor was diagnosed as a meningioma. Thereafter a mass lesion in the temporal lobe of the brain was detected by computerized tomography of the brain. The extracranial extension of the meningioma may occur in some occasions, but such cases in which the infiltrative portion in the parapharyngeal space was initially discovered have been rarely reported.
Schwannomas of the jugular foramen.
Authors: Horn Karl L. , House William F. , Hitselberger William E.
Published: October 2006

Schwannomas of the jugular foramen are relatively uncommon tumors. The growth and initial presentation of these tumors are variable and may not be associated with neuropathies of cranial nerves IX, X and XI. Seven patients with jugular fossa schwannomas are presented. Auditory brain stem response, electronystagmogram, computed cranial tomography, and carotid angiography arc helpful in diagnosis and preoperative evaluation. The surgical approach should be individualized to the lesion and may include transmastoid with extended facial recess, translabyrinthine, retrolabyrinthine, and infratemporal/cervical approaches.
Conservative management of acoustic neuroma in the elderly patient
Authors: Silverstein Herbert , Mcdaniel Alan , Norrell Horace , Wazen Jack
Published: October 2006

A subtotal resection through the translabyrinthine approach should be used in the treatment of large symptomatic acoustic neuromas in patients over the age of 65. This approach will consistently relieve the patient's symptoms of brain stem compression, reduce postoperative morbidity and complications, and preserve facial nerve function.

In the elderly, after subtotal resection, the remaining tumor in 80% of cases appears to remain dormant during the average six year follow‐up (1‐16 year range). Eighty percent of acoustic neuromas not operated upon, appear to grow at a slow rate (0.2 cm/yr) while 20% grow at a fast rate (1 cm/yr). Patients over the age of 65 with small acoustic neuromas do not need surgical intervention. Yearly CT scanning is recommended to determine the growth rate of the acoustic neuroma. A conservative approach should be used in the treatment of all acoustic neuromas in the elderly.
Palliative laser surgery for melanoma metastatic to the larynx: Report of two cases.
Authors: Morgan Alice Hardin , Norris Joel William , Hicks Julius Norton
Published: October 2006

Melanoma metastatic to the larynx is an extremely rare entity. This paper describes two patients previously treated for cutaneous melanoma who developed recurrent melanoma involving their larynges. Surgical excision of these lesions was accomplished with the carbon dioxide laser. Apparently, these two patients are the first reported cases of successful management of melanoma metaslatic to the larynx using laser surgery. The paper also discusses the evolving history and diagnosis of laryngeal melanoma, the use of the carbon dioxide laser in the treatment of other laryngeal and tracheobronchial lesions, the incidence of cutaneous and mucosal melanoma of the head and neck, and the diagnostic evaluation and management of melanoma.
Some acoustic evidence for vocal abuse in adult speakers with repaired cleft palate.
Authors: Leder Steven B. , Lerman Jay W.
Published: October 2006

Acoustic evidence for vocal abuse in adult speakers with cleft palate and hypernasality has not been reported. This study was undertaken to determine if there was acoustic evidence of inappropriate vocal fold adduction during stop consonant production in this population. The results indicated that spectrograms of speakers with cleft palate and severe hypernasality exhibited acoustic characteristics different from spectrograms of speakers without cleft palate and speakers with cleft palate and mild hypernasality. Specifically, voiceless stop productions of severe hypernasal speakers resembled voiced stop productions. Their vocal folds were inappropriately adducted to provide a constriction inferior to the inadequately functioning velopharyngeal port to minimize the nasal air leak. The acoustic evidence supports the hypothesis that a cause of vocal abuse in the cleft palate population is due to compensatory laryngeal valving activities secondary to severe hypernasality.
Etiological diagnosis in sinusitis: Ultrasonography as clinical complement.
Authors: Berg Olle , Carenfelt Christer
Published: October 2006

Accumulation of purulent sinus secretion reflects an inflammation caused by pyogenic bacteria, whereas the accumulation of nonpurulent effusion may have origins other than a bacterial infection. Ultrasonography differentiates the disordered sinus from the healthy one, but not purulent from nonpurulent secretion. In 90 patients, supposed to suffer from sinusitis, a correct diagnosis, sinus empyema us. not sinus empyema, was established in a majority of cases by means of clinical evaluation alone. By introducing ultrasonography as a complement to the clinical evaluation, the diagnostic reliability became lower. It is concluded that ultrasonography seems to have little or no implication in the therapeutic decision unless diagnostic puncture is also performed.
Correlation between nasal ciliary beat frequency and mucus transport rate in volunteers
Authors: Duchateau Guus S.M. J. E. , Merkus Frans W. H. M. , Zuidema Jan , Graamans Kees
Published: October 2006

The correlation between mucus transport time (MTT) and nasal ciliary beat frequency (CBF) in human volunteers was investigated. Mucus transport was measured with the indigo carmine/saccharin sodium test. The test can be performed easily, with no need for sophisticated equipment. CBF was measured photometrically in biopsies from the ciliated epithelium of the nose.

After statistical analysis with the Shapiro‐Wilk test, it appeared that the logarithms of the MTTs were distributed normally. The correlation between the CBF and the log‐MTT was tested with the least‐square method. Correlation coefficients are r= −0.55 and r= −0.51 (n = 31) for the log‐MTTs as measured with saccharin sodium and indigo carmine respectively. The results arc significant at a level α = 0.005.

The highly significant correlation between CBF and log‐MTT suggests that CBF is the main factor in the nasal mucociliary clearance in healthy volunteers. The indigo carmine/saccharin sodium test appears to be useful in testing the in vivo effects of nasal drugs on mucociliary clearance.
Comparative skin and rast test results — An update
Authors: Sogg Alan J.
Published: October 2006

Ninety allergy patients who had RAST testing prior to skin testing are evaluated by the comparison of the results of these two contrasting methods of testing. The skin tests were done on the basis of the RAST results and the size of the wheal obtained was greater than expected in the less sensitive patients with both pollens and non‐pollens. The opposite was found with the more sensitive patients — Rast classes 4 and 5.

The distribution of the results was statistically analyzed and the p‐value was less than .001 for both pollens and non‐pollens. The resultant conclusions are that desensitization based on RAST testing alone is contraindicated and that the patient is best handled by integration of the findings of these two different testing modes.
Aerodynamic assessment of the henley‐cohn tracheoesophageal prosthesis
Authors: Hillman Robert E. , Holmberg Eva , Walsh Michael , Vaughan Charles
Published: October 2006

In vitro airway resistance measurements were performed for eight Henley‐Cohn voice prostheses. The results of these measures demonstrated that the Henley‐Cohn device offers substantially less resistance to the flow of air than either the Blom‐SingerN or Panje devices.g The lower overall resistance of the Henley‐Cohn device was shown to be due to both its larger inner cross sectional area and to an improved valve tip design.

The lower airway resistance of the Henley‐Cohn prosthesis should theoretically result in more ‘efficient’ production of esophageal voice than would be the case when using the Blom‐Singer or Panje devices. However, the results of this investigation also point to the need for the development of methods which will enable investigators to evaluate the in vivo performance of tracheoesophageal prostheses.
Facial plastic surgery in an otolaryngology training program
Authors: Osguthorpe J. David , Lomax William R.
Published: October 2006

The medical complications and unsatisfactory results of facial plastic surgery performed by residents under close supervision are compared with those of the staff who train them and the literature. In 502 rhinoplasty, rhytidectomy, browlift, blepharoplasty, otoplasty, dermabrasion, and chemical peel procedures, there were no significant differences between the resident and staff operations except that residents required more time to perform the procedure. Operations which might be combined at one sitting should be staged during a resident's early experience with cosmetic surgery.
Laryngeal epidermoid carcinoma associated with juvenile laryngeal papillomatosis
Authors: Matsuba Howard M. , Thawley Stanley E. , Spector Gershon J. , Mauney Marc , Pikul Frank J.
Published: October 2006

The speculation whether juvenile laryngeal papillomatosis may transform into or be associated with epidermoiel carcinoma is explored. We document a case of invasive laryngeal carcinoma arising in preexisting juvenile laryngenl papillomatosis. After multipe childhood laryngoscopies and a tracheotomy, a 54‐year‐old, 30‐pack per year smoker, who had never received radiation therapy, developed a florid exophytic transglottic squamous cell carcinoma. Histologically, the invasive epidermoid carcinoma was surrounded by a field of papillomata with varying degrees of atypical changes. After total laryngectomy, isolated papillomata were found in the lower trachea. There were no cervical lymph node metastases. No postoperative radiation therapy was given. Persistent squamous papillomata in the trachcostomy site, the lower trachea, and the posterior pharynx were treated with the CO2 laser.

We emphasize the need to maintain a high index of suspicion for malignancy. In addition, we review the problem of benign papillomata in the aerodigestive tract following laryngeetomy.
CT‐directed fine needle aspiration biopsies of masses in the head and neck
Authors: Abemayor Elliot , Ljung Britt‐Marie , Larsson Sven , Ward Paul H. , Hanafee William
Published: October 2006

Fine needle aspiration (FNA) biopsy is a safe, reliable, and cost‐effective technique available for the evaluation of head and neck masses. Its utility is enhanced by the use of CT‐directed aspiration. Candidates for CT‐directed FNA include patients with: 1. deep‐seated lesions; 2. distorted anatomy as a result of surgery or irradiation; 3. medical problems which contraindicate general anesthesia. The initial UCLA experience with this modality is reviewed. In certain clinical settings, CT‐directed FNA can be a highly productive source of clinical information.
Perilymphatic fistulas: Are they exclusive to the round and oval windows?
Authors: Yaniv E. , Hacking D. , Ziv‐El L.
Published: October 2006

Eleven patients suspected of having perilymphatic fistulas were evaluated. A perilymphatic fistula was demonstrable in ten of these patients. In six patients, fistulas of one of the windows, or both were found. In two patients, combined fistulas of both the round window and lateral semicircular canal were found. In two other patients, fistulas were found only in the lateral semicircular canal. The patients in whom fistulas were found and repaired improved dramatically. The patient without a demonstrable fistula remained symptomatic.

We have shown that perilymphatic fistulas can occur in the lateral semicircular canal, and suggest exploring this area when indicated.
Head and neck manifestations of neurofibromatosis
Authors: White Ann K. , Smith Richard J. H. , Robert Bigler C. , Brooke William F. , Schauer Philip R.
Published: October 2006

Neurofibromatosis is a neurocutaneous systemic disease that occurs in 1:2500 to 3300 live births. Prevalence figures have shown it to be as common as cystic fibrosis or Down's syndrome and more than twice as common as muscular dystrophy. In this study, our experience with 257 cases of neurofibromatosis seen since 1972 is reviewed. Intracranial, bony, and extracranial anomalies are described in the 223 patients (87%) who presented with, or ultimately developed, head and neck manifestations of the disease. The most common intracranial tumor was optic glioma, found in 35 patients (14%), 19 younger than 10 years of age. Acoustic neuromas were diagnosed in eight individuals (3%) and were bilateral in three. The most common skull anomaly was macrocephaly, noted 78 times (30%). Absence of the sphenoid wing occurred in 11 patients (4%) and 19 others (7%) had facial asymmetry due to other skull abnormalities. Extracranial manifestations included neurofibromas of the plexiform and nonplexiform type, Lisch nodules, and cafe‐au‐lait spots.
Esthesioneuroblastoma: the university of virginia experience 1960–1985
Authors: Levine Paul A. , Copley McLean W. , Cantrell Robert W.
Published: October 2006

Twenty‐six cases of esthesioneuroblastoma were treated by the Department of Otolaryngology‐Head and Neck Surgery from 1960 to 1985. This period was divided into the precraniofacial period (1960 to 1975) and the craniofacial period (1976 to 1985) to denote the transition to a more aggressive combined therapeutic approach.

Of the eight patients in the precraniofacial group (group I), only 37.5% are alive without disease. In group II (the craniofacial group), 82% of the patients are alive without disease with an average follow‐up of 4 years. This latter survival rate compares favorably with the survival rate of group I and the cure rate of 10% to 67% as stated in other studies.
Primary mandibular reconstruction using the ao reconstruction plate
Authors: Chow James M. , Hill James H.
Published: October 2006

Primary reconstruction of segmental defects of the mandible following cancer resection remains a major problem. In 1976, a stainless steel plate was developed by AO/ASIF (Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation) for mandibular reconstruction. This plate completely stabilizes both mandibular stumps without the need for intermaxillary or external fixation. In addition, when bone grafting is performed, the design of this plate promotes revascularization by allowing maximal contact between grafted cancellous bone and surrounding soft tissue.

Since April 1985, we have used this reconstruction plate in six patients undergoing composite resection. The technique did not compromise cancer resection, excessively prolong operating time, or alter postoperative management. All six patients have retained the AO reconstruction plate and have been reconstructed successfully with achievement of satisfactory function and cosmesis.
Individual data from the 3M/vienna extracochlear implant
Authors: Facer George W. , Rose Darrell E. , Mcdonald Thomas J. , King Anna Mary , Fabry David A.
Published: October 2006

Five patients who received the 3M/Vienna extracochlear implant were given a standard battery of tests before and after implantation. Pure‐tone audiograms, hearing aid evaluation, and promontory threshold and dynamic range stimulation were conducted to evaluate implant candidacy and to determine whether a particular patient met the criteria for inclusion in the study. Speech reading tests were also given before implantation. Postimplantation testing consisted of thresholds and tolerance levels for pure tones and speech reading with and without acoustic stimulation. Tests on environmental sounds, speech discrimination, and word discrimination were scored. Minimal Auditory Capabilities (MAC) Battery scores were determined on MAC, I, II, IV, V, VII, VIII, and XII subtests over several time intervals (sessions). The hearing results varied greatly among patients. All five patients expressed satisfaction and are presently wearing their units.
The effect of tracheostomy on posterior cricoarytenoid muscle
Authors: Lieberman Marc E. , Malmgren Leslie T. , Woo Peak , Colton Raymond H.
Published: October 2006

It has been reported previously that the amount of electromyographic (EMG) potential of the posterior cricoarytenoid (PCA) decreases after prolonged tracheostomy. It is, therefore, reasonable to assume that a significant alteration of the biochemical characteristics of this muscle would also occur. In addition to histochemical analysis, endoscopic and EMG data were recorded to give a direct comparison in each subject. Seven male beagles were used for this study. Four were tracheostomized and three served as controls. They were examined immediately before and after surgery and again after 4 weeks by EMG and endoscopic techniques. Histochemical staining was performed on each subject. All three modalities failed to demonstrate a substantial difference between the controls and the experimental dogs.