bluuebunny/crossref_metadata_2025 huggingface dataset:
The intranasal ethmoidectomy procedure: Historical, technical and clinical considerations.
Authors: Eichel Berkley S.
Published: September 2006

The intranasal ethmoidectomy procedure is in questionable repute at this time. The reasoning behind its waning popularity is historical and primarily due to the poor results obtained in the pre‐antibiotic era. Two schools of thought regarding the procedure were present in this earlier era: one dedicated to the preservation of the middle turbinate and the other concerned with its entire removal. 5,6,7 Shortly before the emergence of antibiotics, a third school developed, led by some of the leaders of the more destructive procedure, showing preference for an external approach. 10 Descendants of the more conservative school, namely those dedicated to the preservation of the middle turbinate, are the only ones still actively and enthusiastically endorsing the intranasal method. 1,2

An intranasal approach is described which attempts to leave intact the medial wall of the middle turbinate. It is this structure that is felt to be the crucial landmark necessary to perform a safe and effective procedure. Several steps that are felt to be essential to this technique are outlined in detail. Avoiding the sphenoid sinus, especially in reference to opening up the ostium of the sphenoid sinus, is advocated. It is felt that the normal nasal anatomy can be restored by the proper application of this technique. The need for more effective and intensive measures, corticosteroids, antibiotics, and antihistamine‐decongestant medication, is stressed, especially in the postoperative state. It is recognized that it is impossible to treat an underlying allergy with a knife or forceps.

The indications for utilization of this procedure are many and are listed. When a space expanding lesion, such as a neoplasm, mucocele, mucopyocele, or osteoma is encountered, then a primary external approach is advocated; likewise, when an isolated sphenoid sinus problem is suspected, then external, a transantral, or a transseptal approach is preferred. In the remaining problems, especially in the more difficult ones, involving the paranasal sinuses, either in the acute or chronic state, with or without complications, the intranasal ethmoidectomy technique is felt to be the key procedure in the initial approach to these problems. If this method of approach appears to be ineffective, then one can resort to the more elaborate external techniques that are commonly being performed.

Five cases are reported in detail, illustrating some of the areas where this procedure is effective. The most common utilization is for the alleviation of obstructive nasal polyposis, with or without concommitant sinusitis. Radiographic improvement in many of these cases may prove to be an objective perimeter to gauge the type of surgery. This procedure also supplies an important link in the development of a more standardized or uniform approach to the more difficult problems involving the paranasal sinuses.
Traumatic perforations of the tympanic membrane: Observe or repair?
Authors: Armstrong B. W.
Published: September 2006

Traumatic perforations of the tympanic membrane deserve the same careful attention as any other injury, and healing should not invariably be left to chance. Sometimes early repair is clearly indicated. A foreign object rupturing the posterosuperior quadrant may cause obscure damage to the ossicular chain, a perilymphatic leak, or leave an unsuspected foreign body in the middle ear. All very large traumatic perforations and all perforations in the posterosuperior quadrant should be repaired promptly to reduce the incidence of permanent impairment. Small perforations in less vulnerable quadrants can be treated in the traditional expectant manner. Steroid‐containing ear drops inhibit healing and are contraindicated in the‐treatment of traumatic perforations.
Symposium on trauma in otolaryngology. I. Injuries to the facial nerve.
Authors: McCabe Brian F.
Published: September 2006

Facial nerve injuries are important to recognize in terms of etiology and degree of loss of facial function. The first examiner after the injury has an important function to serve because his observations may be crucial to definitive management. The mode of injury gives insight into management. A knowledge of the physiology of nerve repair is helpful in determining the optimum time of neurorrhaphy. There are nuances in operative technique which are helpful in gaining maximum return of facial nerve function when repair is necessary.
Early mastication in fractures of the body and angle of the mandible
Authors: Spector Gershon J.
Published: September 2006

Thirty‐two patients with fractures of the body and/or angle of the mandible were divided randomly into an experimental group (17 patients) and control group (15 patients). Open and closed reductions were performed as indicated. Mastication was initiated in the control group at six to eight weeks and in the experimental group two to three weeks after surgery. Postoperatively the patients were followed four to 18 months. There was no objective difference noted in the end results of the two groups studied.
The altered metabolism of the full thickness skin graft
Authors: Wullstein H. L. , Wullstein S. R.
Published: September 2006

Different kinds of experiments in vitro and in animals and out of a large number of biopsies taken from patients with free skin graft after shorter or longer, even some years of interval proved

Water and electrolytes metabolism in free skin grafts isthe prime condition for its undisturbed taking. This beginning was demonstrated already 15 minutes after transplantation, full scale is' reached before one hours time.

Early disturbances during this time and during the restart of further functions of the metabolism in the first 24 and 48 hours period which are not severe enough for the loss of the graft are the cause for late disturbances lasting many years of more or less severe kind. They may be of atrophic or hypertrophic nature. Their histologic nature is demonstrated.
The superior laryngeal nerve and the interarytenoid muscle in humans: An anatomical study
Authors: Rueger Ramiund S.
Published: September 2006

The course and distribution of the rami perforantes of the superior laryngeal nerve was studied in 12 human larynges. Dissections utilized a Zeiss operating microscope. All branches were found to perforate the muscle; none terminated in the muscle. This eliminates anatomically any possibility of motor supply to the mterarytenoid muscle from the superior laryngeal nerve. The rami perforantes also contribute to mucosal innervation on the posterior surface of the larynx.

Histologic studies of whole fetal larynges corroborated the findings from the dissections.

No evidence of innervation across the midline was found. No extra‐laryngeal division of the recurrent laryngeal nerve into abductor and adductor branches was found. A ganglion around the superior laryngeal nerve was described.
Sialoangiography: X‐Ray visualization of major salivary glaoonds
Authors: White Irving L.
Published: September 2006

Sialoangiography is demonstrated to be useful in the diagnosis and evaluation of inflammatory processes, and tumors of the major salivary glands and their areas. Parenchymal changes as well as space occupying lesions within the glands, and tumors exerting pressure from outside the gland are shown to manifest their specific changes by their effect upon the ducts, with pathognomonic alterations and distortion of the ducts or normal architecture of the ductal system.

Intrinsic duct changes are all due to ductal obstruction and a wide variety of causes is shown.

The normal findings, including minor anatomical variations is contrasted with abnormal sialoangiographic findings. These abnormalities are evidenced by changes in the duct morphology and the course of the ducts altered by the presence of intrinsic, extrinsic, or deep lobed tumors.

The technique of sialoangiography is discussed. The author's method is outlined, including specific views and special methodology.
Quantitative cytochemistry of the organ of corti, dissection, weight determination and analysis of single outer hair cells
Authors: Thalmann R. , Thalmann I. , Comegys T. H.
Published: September 2006

A method is described for the dissection of single outer hair cells in the freeze‐dried state. The average dry weight of outer hair cells from the third and fourth cochlear turn in the guinea pig is of the order of one nanogram, with variations depending upon the precise location. The measured dry weight is in line with the wet weight estimated from the volume of living outer hair cells maintained under iso‐osmotic conditions. The lipid fraction of outer hair cells amounts to about 21 percent of the dry weight. Average ATP levels in outer hair cells of the upper two turns range between 12–15 mmoles/kg dry weight, with no significant difference between rows or turns.
An animal model for presbycusis
Authors: Crowley David E. , Schramm Victor L. , Swain Ronnie E. , Maisel Robert H. , Rauchbach Erol , Swanson Sylvia N.
Published: September 2006

Cochlear microphonics (CM) and masked and unmasked VIIIth nerve action potentials (AP) were measured in rats at ages of one, six, 12, 18 and 24 months in order to explore an animal model for presbycusis. These rats were raised in quiet surroundings and were given no antibiotics. Mean CM 1 microvolt sensitivity levels showed a 7 db augmentation from one month to one year followed by a 13 db decline from one to two years of age. Similarly, unmasked AP amplitudes increased from one to 12 months, then declined through 18 to 24 months. Masked AP amplitudes demonstrated a similar growth and decline with age, showing the greatest losses in those AP components originating from the high frequency regions of the basilar membrane.
Diversity of mucus staining characteristics of human salivary glands
Authors: Yarington C. T.
Published: September 2006

This report describes the development of the science of histochemistry as it relates to the salivary glands. Using standard histochemical techniques, seven salivary glands were studied in detail, demonstrating the variety of secretory products produced by these glands and the multi‐potential shared by both the secreting cells and the ductal epithelium.
Nerve excitability test in facial palsy: Limitations in its use, based on a study of 130 cases
Authors: May Mark
Published: September 2006

Based upon a study of 130 cases of facial paralysis, the nerve excitability test was found to have limitations.

Test results are based upon observing muscle response to an electrical stimulus. This observation is dependent upon a cooperative patient who' does not flinch or pull away, and it is difficult to interpret in a crying child. The test instrument is subject to mechanical failure and must be administered in a standardized fashion. False‐negative responses have been observed but overcome by modifying the method of performing the test and employing the salivary flow test. Nerve excitability is of limited value in cases evaluated within three days after onset because of the delay‐between nerve injury and alteration of the test; also, it is useless in prognosticating once electrical excitability is lost, since it may not return even after noticeable facial muscle function is noted. The test has limited application in cases of bilateral and recurrent facial palsy. Attention is directed to these limitations, and suggestions are made to overcome them.
The mature nose
Authors: Parkes Morey L. , Kamer Frank M.
Published: September 2006

The concept of rhinoplasty of the mature nose is presented. As an isolated procedure or in conjunction with other facial plastic procedures, shortening the length of a drooping nose can give the effect of a more youthful appearance. The anatomy and physiology of the nose as it ages is discussed and if understood by the surgeon, these patients need no longer be rejected because of their age. Technical consideration are important, and the use of the modified rim incision, high septal transfixion and lobule rotation is suggested. An analysis of 30 cases over a noe year period is documented to support this thesis.
Gene dosage effect in expression of blood group antigens
Authors: Chen Li‐Tsun , Davidenas Joseph A. , Ruth Roal F.
Published: September 2006

Chicken blood cells were investigated with respect to the distribution of A blood group antigens on the cell membrane surface via the fluorescent antibody technique. A direct gene‐blood group antigen relationship was found. Erythrocytes from chickens homoqygous for A6 antigen fluoresced more intensely than those from birds heterozygous for the antigen. The respective intensities, approximating a 2:1 ration, idicate a direct gene dosage effect in the expression of at least these antigens. This novel finding disccussed with respect to the possible molecular constitution of and blodd group antigens in other species (e.g., human). This finding has important iplications leading to the understanting of the nature of blood group antigens and the specific role they play in reconstructive surgery.
Comprehensive care of bilateral maxillary fractures
Authors: Stone John W.
Published: September 2006

Facial injuries are an increasingly frequent clinical problem. The opportunity for a successful with present methods is excellent; thus, the gaauntlet to the facial surgeon.

Accurate detailed injury analysis and records are essential for satisfactory results.

Step wise surgical procedures working anatomically from within outward in an organized adequately equipped surgical setting have been stressed.

Meticulous postoperative care combined with appropriate consultation eases the surgeon's burden and reduces untoward sequelae.

Complications were minimal in this series. Dental injuries were frequent and required long term rehabilitation.

Improvement is required in the care of comminuted nasal‐ethmoid‐orbit fractures. Transnasal wiring passed through the nasal structures and external padded splints helps but is not foolproof.

Severe ocular injuries were disturbingly common. Our capabilities for visual restoration have severe limitations.

This review of facial injury care is but the prologue before the future conquest of scar maturation processes, the development of adhesives for bone fragment reduction fixation, and the ready replacement of flesh, bone, and special sense organs. We are continuing to build on timeless laws of careful analysis, accurate reduction, and solid fixation utilizing stable structures.
Tracheal agenesis with broncho‐esophageal fistula
Authors: Hong Soo Wung , Baran Gerry M. , Schnaufer Louise , Stool Sylvan E.
Published: September 2006

Intubation of the esophagus during efforts to resuscitate a newborn may result is disaster; (FN1) however, in one disease this may be the only method of providing an airway. This communication reports our experience with a newborn infant who had an unusual tracheal abnormality, and emphasizes the findings which aid in the diagnosis.
Surface tension lowering susbtance of the eustachian tube in non‐suppurative otitis media: An experiment with dogs
Authors: Birken Eric A. , Brookler Kenneth H.
Published: September 2006

A surface tension lowering substance (STLS) lining the Eustachian tube was recently identified. STLS was Postulated to prevent the adherence of the tubal surface and allow for the facile opening by the tubal musculature.

In Order to determie the role of STLS, non‐suppurative otitis media was produced in dogs by injecting polytetrafluoethylene paste immediately posterior to the torus tubarius. The presence of STLS was ascertained and found not to be diminished by experimentally produced non‐suppurative otitis media; however, in one case, purulent otitis media was produced, and STLS was absent. This situtation was analogous to teh fate of STLS of the lung (surfactant) during pneumonia.

The possible causes for these observed results were postulated. The role of STLS in Eustachian tubal function was delineated.
Capillary constriction in cochlear and vestibular tissues during intense noise stimulation
Authors: Lipscomb David M. , Roettger Ruby L.
Published: September 2006

Capillary constriction in vestibular and cochlear tissue of rats was noted in response to stimulation with high level sound. Reduction of internal capillary diameter appeared to be caused by the thickening of capillary walls by the accumulation of nuclear masses. This constriction of blood flow is considered to be one factor in noise trauma reactions.
Chronic Secretory Otitis Media: Etiologic factors and pathologic mechanisms
Authors: Lamp Clyde B.
Published: September 2006

Negative pressure in the nasopharynx generated by sniffling, sucking or swallowing during nasal obstruction is an etiological factor for chronic secretory otitis media. Thick effusion which is the result of tubal disease is also a contributing factor for the persistence or recurrence of secretory otitis. The flutter valve is really two one‐way valves opposing each other in the Eustachian tube activated by redundant mucosa and an aggregate of mucoid secretion. Successful management of chronic secretory otitis media should not only include those popular measures previously described, but als the elimination of self‐applied negative pressure and the complete removal of thick effusion from the middle ear and entire Eustachiam tube.
Symposium on tympanoplasty.: I. Results of modified type v tympanoplasty
Authors: Gacek Richard R.
Published: September 2006

Modified Type V tympanoplasty has been used in this series to improve hearing in unsuccessful Type IV tympanoplasties and also to preserve cochlear function and possibly to improve hearing in cases where the oval window has been inadvertently opened during chronic ear surgery. Modified Type V tympanoplasty refers to removal of the stapes footplate with replacement by adipose tissue in the oval window. A tympanoplasty graft is then placed over the tissue graft and hearing achieved by round window protection with an air‐containing hypotympanum. The concept of modified Type V. tympanoplasty has been described by Del Villar,1 Paparella,2,3 Sato,5 and Proctor4 previously. Results from these previous authors have been somewhat variable, and this series is presented in an attempt to evaluate this procedure more clearly. Modified Type V tympanoplasty was, therefore, performed on 20 ears, 14 of these on ears that had previous Type IV tympanoplasty with unsuccessful hearing levels. The remaining six ears received the Type V tympanoplasty at the initial surgery, usually because of inadvertent fracture or avulsion of the stapes footplate. Thirteen ears achieved a significant improvement in hearing with an average gain in air conduction of about 19 decibels for the speech frequencies. The average improvement in the conductive component of the hearing loss was 22.4 db, while no loss of bone conduction or discrimination followed. Five cases obtained no change in hearing and retained bone conduction and discrimination scores so that amplification was still possible. Two instances of sensori‐neural loss were incurred: one a total loss of auditory function in a previously dry ear, while a partial loss of function with still useful discrimination score was present in the second case, one that had been wet at the time of surgery.

The results indicate that the modified Type V tympanoplasty is a useful procedure to improve hearing in unsuccessful Type IV tympanoplasties, where the probable reason for the poor hearing result is stapes fixation with fibrous tissue, tympanosclerosis, or otosclerosis. Modified Type V tympanoplasty may also be used to preserve cochlear function at mastoid surgery where the stapes footplate has been inadvertently fractured or avulsed. In addition, hearing improvement may also be obtained in these instances where modified Type V is performed emergently during mastoid surgery.
Causes of elevated perilymph protein concentrations
Authors: Silverstein Herbert , Naufal Pierre , Belal Azziz
Published: September 2006

Fifty‐seven of 800 human temporal bones were found to have eosinophilic perilymph precipitates. The most common etiological factor was blockage of the internal auditory canal (20 cases). Acute bacterial labyrinthitis (nine cases) and subarachnoid hemorrhage (five cases) were also associated with perilymph precipitates. Small amounts of precipitate were also observed in 20 of 110 temporal bones without evidence of ear pathology. Experimental introduction of serum proteins into the cat's perilymphatic space confirms that eosinophilic perilymph precipitates may represent increased quantities of protein in the perilymphatic spaces; however, no correlation could be made between the quantity of precipitate observed and the concentration of the protein in the perilymph. The finding of increased perilymph protein above 1,000 mg/100 ml during a diagnostic inner ear tap (labyrinthotomy) is good evidence for the presence of an acoustic neurinoma. An associated peripheral VIIth never paralysis should alert the clinician to the possibility of a metastatic carcinoma of the internal auditory canal.
Radiopertechnetate flow study: A valuable adjunct to brain scanning in the differential diagnosis of cerebello‐pontine angle tumors
Authors: Lamoureux Jacques , Bertrand Robert A. , Vezina Jean L.
Published: September 2006

Twenty‐seven surgically proven acoustic neuromas were studied pre‐operatively with conventional brain scanning. Nine lesions were not diagnosed. Lesions less than 2.0 cm in diameter were not visualized (five patients). Lesions larger than 3.0 cm were all detected (15 patients). Lesions ranging in size from 2.0 to 3.0 cm were detected half of the time (six patients, seven lesions).

Fourteen radiopertechnetate flow studies were performed in our last 10 patients with acoustic neuromas. All were negative. A case of meningioma in the cerebello‐pontine angle and a case of arteriovenous malformation in the posterior fossa were visualized on conventional scan. The flow studies were positive and demonstrated patterns suggestive of the nature of the lesions. Flow study appears a valuable adjunct to brain scanning in the differential diagnosis of cerebello‐pontine angle tumors.
Ataxia secondary to labyrinthine fistula
Authors: Healy Gerald B. , Strong M. Stuart , Feldman Robert G.
Published: September 2006

In patients presenting with severe gait disturbance, the otolaryngologist is not likely to consider labyrinthine disease as a possible cause.

During the past few years there have been several reports of sudden deafness secondary to mechanical rupture of the inner ear windows. The clinical picture has usually been one of sudden deafness with tinnitus and vertigo. Mild ataxia was noted in three out of 18 reported cases.

A case is presented of a 59‐year‐old female with a two month history of severe ataxia. Seven years previously she had had head trauma without fracture. Examination revealed marked ataxia, positive Rhomberg, positional vertigo and nystagmus and a 45 db mixed hearing loss. Tympanotomy revealed subluxation of the stapes with a fistula at the antero‐inferior margin of the footplate. Stapedectomy and soft tissue closure of the oval window were carried out. Postoperatively, the patient had no further ataxia or vertigo, and her hearing remained unchanged for 18 months.

Three of the 18 reported cases also had given a history of head trauma with or without skull fracture, and two patients had had positional vertigo.

The explanation of the positional vertigo in a case of labyrinthine fistula is not evident; perhaps gravity in the affected ear down position facilitates a flow of perilymph through the fistula with resulting distortion and stimulation of the cristae.

Conclusion. In the future, peripheral labyrinthine disease such as a fistula should be suspected in cases which present with ataxia and episodic vertigo of obscure etiology. A tympanotomy may be necessary to establish the diagnosis and to allow correction of the pathology.
Specific vessel ligation for epistaxis: Survey of 60 cases
Authors: Rosnagle Robert S. , Yanagisawa Eiji , Smith Howard W.
Published: September 2006

In a survey of 60 cases of internal maxillary artery ligation, only six therapeutic failures were encountered. Causes of failure were incorrect selection of vessel (four cases), and inadequate ligation of the artery (two cases). Initial identification of the bleeding site may be hampered by profuse bleeding or by anatomical obstruction, but correct localization will result in higher success rate for the procedure. Certain areas of the nose may receive blood from more than one artery. In these instances, ligation of both the internal maxillary and anterior ethmoid artery may be necessary.

No relationship can be found in the series between hypertension and massive epistaxis. Neither did epistaxis predispose the hypertensive patient to imminent death.

Hospitalization for treatment of massive epistaxis is shortened by specific vessel ligation as compared to posterior packing. Complications from the procedure cōnsists of cheek numbness in three cases and epiphora in one case. Care must be taken when isolating the vessels to avoid massive bleeding.

Vessel ligation is an acceptable and effective means of controlling massive epistaxis.
Symposium on maxillo‐facial trauma. IV. Pitfalls in the treatment of mid‐facial trauma
Authors: Smith Howard W.
Published: September 2006

The overall treatment of severe mid‐facial trauma calls for specialized knowledge and experience in an anatomical area shared by a number of surgical specialties. Increasing specialty board requirements and changing respect for anatomical boundaries among the various specialties make the mid‐facial area a bone of contention in medical centers with a limited volume of facial trauma cases. The need to share this educational resource is recognized; however, its distribution may be considered an educational pitfall among those more clinical in nature.

The following clinical examples in the treatment of mid‐facial trauma have been briefly discussed and illustrated:

1. Serious hematoma formation unrecognized or underestimated.

2. Magnitude of facial bone injury unappreciated by initial observation of the patient and review of preliminary X‐rays.

3. Poor selection of airway for delivery of general anesthesia.

4. Unnecessary use of wire suspension for facial fracture immobilization.

5. Failure to establish centric occlusion.

6. Unrecognized inter‐canthal trauma.

7. Impacted nasal fracture unreduced by closed reduction efforts and left untreated.

8. Treatment of soft tissue injuries without regard for facial skeletal injuries.

9. Vital structures discarded at time of initial treatment.

10. Failure to replace missing dental elements early to avoid contracture.

The trend towards introduction of lesser trained personnal in the intial treatment phase of facial traumam, coupled with the trend towards prepaid health group care suggests that the errors of treatment are likely to persist and in all probability to increase.
Mediastinoscopy: Application for hilar adenopathy
Authors: Welsh Louis W. , Welsh John J.
Published: September 2006

Mediastinoscopy is the primary technique for the diagnosis of disorders limited to the mediastinum which are of lymphatic origin. The procedure is safe and yields sufficient tissue for tissue analysis. Information secured from tomography of the mediastinum is discussed, and the immediate advantages of frozen tissue study assist the surgeon in procuring appropriate material. A review of the lymphomas and sarcoidosis as they appear in the mediastinum is presented. Contraindications to surgery are listed, and its role in the overall appraisal of the endoscopist cited.
Reversible sensori‐neural hearing loss associated with sickle cell crisis
Authors: Urban George E.
Published: September 2006

A 20‐year‐old black male, semicomatose in a sickle cell anemia crisis, regained consciousness with no evidence of useable clinical hearing. The patient had had no previous history of abnormal hearing or ear pathology prior to this crisis. Audiometric evaluation revealed a severe binaural sensori‐neural hearing loss. Within 11 days after regaining consciousness, the air conduction threshold averages went from levels of 65 db ISO for the left and 81 db ISO for the right to 27 db ISO for the left and 50 db ISO on the right. Speech audiometry was initially unobtainable because of the severe losses. By day 11 the speech scores were as follows: Left Ear, SRT 26 db, 88 percent discrimination. Right Ear, SRT 50 db, 38 percent discrimination. Three months later the patient had improved to the point that the air conduction thresholds averages were 15 db for the left and 39 db for the right. Speech testing thresholds had improved to SRT 14 db. 96 percent discrimination on the left and SRT 38 db, 68 percent discrimination on the right. It is postulated that the mechanism responsible for this severe hearing loss is a reversible ischemia of the stria vascularis with secondary organ of Corti hypoxia as a direct result of the sickle cell crisis.
Subglottic hemangioma of the larynx treated with steroid therapy
Authors: Overcash Kelly E. , Putney F. Johnson
Published: September 2006

Previous experience with different modes of therapy of subglottic hemangioma have not been entirely satisfactory. Response of hemangiomas in general and specifically subglottic hemangiomas in infants to steroid therapy prompted this mode of therapy in two infants. Because of the possible late complications of radiation therapy to the head and neck area of children, a safer modality might avoid these possible complications. One patient with a biopsy proven cavernous hemangioma was decannulated six months following prednisone therapy. The second case, with histologically proven capillary hemangioma, did not have as great an initial response to steroid therapy.

External signs of a Cushingnoid syndrome developed in both cases and improved with no residual effects on tapering doses of medication.
A new technique for micro‐laryngeal surgery in infants
Authors: Carden Edward , Ferguson George B.
Published: September 2006

General anesthesia for microsurgery on the larynx in infants poses many problems if one is to provide good operating conditions for the surgeon and adequate safety for the infant. In the technique presented here the infants were anesthetized with inhalational agents, then a 16‐gauge plastic catheter was placed between the cords. With the infant paralyzed the lungs were ventilated with close to 100 percent oxygen by intermittently blowing oxygen at high pressure from the catheter. Anesthesia and paralysis were maintained with intravenous agents. The surgeon operated with a virtually unobstructed field. The child was adequately ventilated and the possibility of inhalation of blood or debris was minimized, as was the likelihood of the spread of neoplastic conditions down the trachea.
Intratympanic injection of steroid for treatment of facial paralysis
Authors: Bryant Frank L.
Published: September 2006

Corticosteroids administered systemically have been used with varying degrees of success in the treatment of idiopathic facial paralysis. There is reason to believe that this drug exerts a beneficial influence based on the work of numerous investigators. On the basis of existing dehiscences along the course of the facial nerve and exposure of the chorda tympani nerve, such abnormalities might well be sites of entrance for insult to these nerves; likewise, they might serve as portals for direct medication. Such medication, a corticosteroid, might thus be introduced intratympanically. Seven earlier cases were so treated with complete recovery in six cases and 75 percent recovery in the seventh. Three more cases are reported, all with good and prompt recovery. No untoward side effects were noted.
Radiographic evaluation of the prevertebral space
Authors: Cole T. Boyce , Baylin George
Published: September 2006

The prevertebral space as seen on the lateral soft tissue X‐ray is discussed. Variations of normal in the child and adult are reviewed. Normal anatomy may give a false impression of pathology such as air in the ear canal, lung apices, and cervical esophagus. Overlying shadows of other structures, namely, the ear, styloid, stylohyoid ligament, calcified anterior arch of the atlas in a child, calcification in the cricoid signet and cartilago triticea also may be confusing. Physiological changes with crying or swallowing in the child at times appear as pathology. The primary pathological changes seen on X‐ray are air in the tissue spaces, foreign bodies, tumor formation, erosion or proliferation of bone, fractures, deformities of the spine such as reversal of the normal curvature or slippage of the vertebrae, and displacement of the fat line. It must be kept in mind that X‐rays are only one additional tool for making a diagnosis and cannot be substituted for a thorough history and physical examination.

The normal with many of its variations as well as a considerable number of pathological changes are illustrated.
Positive angle myelograms without acoustic neuroma
Authors: Wright Ronald E. , Turner John S.
Published: September 2006

The early diagnosis of acoustic neuroma has become largely dependent on positive angle myelograms combined with audiometric and neurological tests; however, one can discover instances of false positive myelograms as mentioned in the literature by Valvassori, Hanafee, Scanlon, Penfield, Rydell and others. We feel it is important to review this topic and are reporting four cases of false positives. In our cases, three were explored with the findings of a normal anatomical variation in the size of the internal auditory canal, an adhesive arachnoid band, and a possible viral neuronitis, resulting in nonfilling of the internal canal. The fourth patient was found to have multiple sclerosis as the etiology of her symptoms, but no explanation for her abnormal angle myelogram has been found.

Our incidence of false positive myelograms was 7.8 percent of myelograms done by the Emory University Medical Center since 1969. We feel it is important for all neuro‐otologic surgeons to realize that this can occur and why.
Normal variations in size and neoplastic changes of skull foramina
Authors: Calcaterra Thomas C. , Cherney Edward F. , Hanafee William F.
Published: September 2006

Operability of head and neck cancers is usually limited by extension to the base of the skull. Intracranial extension occurs by tumor growth along the perineurium of cranial nerves and along blood vessels or by direct bone erosion. Skull involvement usually is determined by radiologic evidence of destruction or enlargement of skull foramina.

Of particular importance to the head and neck surgeon are those foramina that serve as possible conduits for intracranial extension of cancers of the maxillary and ethmoid sinuses, nasopharynx, palate, and face. Not infrequently disparity in size from the contralateral foramina, or absence of a particular foramina, will be interpreted as substantial evidence of intracranial tumor extension.

The purpose of this study was to determine within individuals the normal diameter variations between pairs of the foramen ovale, foramen rotundum, pterygoid canal, and infraorbital canal. One hundred fifty tomograms of the anterior skull area were studied and classified into tumor and non‐tumor groups. The frequency of nonvisualization and the range of normal size of each foramina were recorded.
Diving induced sensori‐neural deafness: Prophylactic use of heparin and preliminary histopathology results
Authors: Mccormick James G. , Philbrick Thomas , Holland Walter , Harrill James A.
Published: September 2006

Penner9 and Jaffe10 have postulated that hypercoagulation, embolic, and thrombotic problems may precipitate sudden deafness by affecting the microcirculation of the inner ear. These syndromes have been found to occur in decompression sickness11 and deafness and vestibular attacks are known to occur with diving.4 In our laboratory, we were able to demonstrate severe cochlear potential losses in guinea pigs with the induction of decompression sickness. The problem was largely prevented by the prophylactic administration of heparin.

Preliminary study of the temporal bones of a guinea pig with a severe post‐dive vestibular attack and loss of cochlear potential function showed the presence of hemorrhage in the perilymph of the auditory and vestibular system.

The above results are interpreted as evidence that hypercoagulation, embolic and thrombotic problems may precipitate a loss of cochlear dysfunction — most likely in a diving situation and potentially in cases of sudden deafness not related to diving.
Incidence of head and neck metastases from genito‐urinary neoplasms
Authors: Flocks R. H. , Boatman D. L.
Published: September 2006

The important genito‐urinary malignancies have been reviewed and categorized as to the incidence of head and neck dissemination. The relative incidence in our institution was found as follows: adrenal, 6 percent; kidney, 6 percent; renal pelvis and ureter, none; bladder, 4.3 percent; prostate, 1 percent; testicle, 13 percent; and penis, 2.5 percent.
The effect of adult thymectomy in dogs on the immunosuppressive activity of antilymphocyte serum (als)
Authors: Mogi Goro , Harvey Joseph E. , Ogura Joseph H.
Published: September 2006

In the series of our studies on antilymphocyte serum (ALS) as an immunosuppressive agent in transplantation of the canine larynx, the use of ALS in thymectomized dogs was attempted for the purpose of increasing the immunosuppressive effects of ALS.

Immunoglobulin G (IgG) was purified by DEAE‐cellulose batch production method from the high titer horse anti‐dog thymocyte plasma (ATP) and low titer ATP, respectively. A skin allograft assay was used to measure the immunosuppressive activity.

Adult thymectomy previous to administration of the high titer‐IgG and low titer‐IgG, respectively, did not augment the immunosuppressive effect of these ATP‐IgG's.
Partial temporal bone resection for basal cell carcinoma of the external auditory canal with preservation of facial nerve and hearing
Authors: Goldman Nelson C. , Hardcastle Brian
Published: September 2006

A 44‐year‐old retired naval airman with recurrent basal cell carcinoma of the external auditory canal underwent a partial temporal bone resection with preservation of the facial nerve and reconstruction of his hearing mechanism. The morbidity associated with radical temporal bone resection was avoided. Useful hearing was obtained by myringostapediopexy with staged split thickness skin grafting. The patient's postoperative appearance is enhanced by wearing of a prosthesis.
Orbital apex syndrome due to sinus infection
Authors: Kronschnabel Edward F.
Published: September 2006

Orbital extension of acute paranasal sinus infection seems to be an occurrence of increasing frequency and increasing severity in the past few years. This recurrence of an old phenomenon is happening despite medical specialization, due to alteration of bacteria biology due to generation‐long use of antibiotics. Alteration of host responses due to use of steroids is also responsible. Over‐reliance on diagnostic aids alters clinical judgment. Especially important is the fact that, in the most serious complication, cavernous sinus thrombophlebitis, one can be misled by fundoscopic examination, inasmuch as the state of the disk is not a reliable index.

Six case records are used to illustrate various degrees of orbital content involvement, including blindness and meningitis complications. Early diagnosis of the spread of infection, vigorous antibiotic therapy, and surgical drainage when necessary are required. Steroid use is apparently ineffective and possibly erroneous, and anticoagulant‐anti‐inflammatory agents of an older era are probably more reliable when life and sight are threatened.
An electrical stimulation study on the afferent fibers in the facial nerve of cats and the contralateral facial muscle response
Authors: Binns Philip M.
Published: September 2006

Electrical stimulation studies on the exposed facial nerve in cats have demonstrated a contralateral facial muscle response. This has been assessed by direct observation, electromyography, conduction times, photography and cinematography. A series of facial nerve transection experiments have been performed. It has been shown that afferent fibers are distributed with the distal facial nerve and pass through the stylomastoid foramen. These afferent fibers leave the facial nerve in the vertical portion of the facial nerve in the mastoid by an anastomotic branch which is thought to communicate with the Xth nerve.
Hemangioendothelioma of the mastoid bone
Authors: Joachims Henry Z. , Cohen Yoram
Published: September 2006

A case of hemangioendothelioma in the mastoid bone and ear is presented. This tumor is very rare in the skull and has never been reported in the ear. The presenting symptoms were purulent discharge and loss of hearing in the involved ear.

Excision of the tumor was followed by irradiation, and the patient is well and free from disease three years postoperatively.
Acute epiglottitis due to systemic lupus erythematosus
Authors: Toomey James M. , Snyder G.Gordon , Maenza Ronald M. , Rothfield Naomi P.
Published: September 2006

Epiglottic involvement in systemic lupus erythematosus may produce the clinical and laryngoscopic manifestations of acute epiglottitis. This complication is most likely to occur during acute exacerbations of the underlying disease.

Other reported laryngeal manifestations of SLE include mucosal ulceration and hemorrhagic bullae, diffuse edema, corditis, cord tumor, laryngitis sicca, chronic hyperplastic laryngitis, cricoarytenoid arthritis or vocal cord paralysis.

The larynx may be significantly affected by lupus erythematosus in as many as one‐third of all cases.
Angiosarcoma of the premaxilla
Authors: Karmody Collin S. , Kim Cheong Ha
Published: September 2006

Angiosarcomas are comparatively rare neoplasms that present more commonly in the head and neck. Treatment of these tumors has been generally unsatisfactory because of a tendency to local recurrence regardless of the modality of therapy used. A case of anfiosarcoma involving the soft tissue of the premaxilla is presented. This was treated with carefully controlled radiation. The results have been highly satisfactory with preservation of facial tissue and with no evidence of recurrence after 40 months. The relevant literature is discussed.
Rhabdomyosarcoma of the ear‐mastoid
Authors: Deutsch Melvin , Felder Herman
Published: September 2006

The authors present five cases of rhabdomyosarcoma of the ear‐mastoid region and review the literature (73 cases) in an attempt to determine why therapy is so frequently unsuccessful. Spread to the nasopharynx and cranial cavity accounts for a significant proportion of “local failures”; also cervical node metastases occur in a significant number of cases. The authors recommend postoperative radiotherapy, at least 5,000 rads in five weeks (NSD = 1575 rets) to a large volume comprising the primary site, nasopharynx, a generous portion of the ipsilateral mid and posterior cranial cavity, and upper ipsilateral neck. Chemotherapy is also an important adjuvant in the management of these patients.
Surgical results of orbital decompression for malignant exophthalmos
Authors: Ogura Joseph H. , Lucente Frank E.
Published: September 2006

During the past 75 years, several procedures for surgical correction of malignant exophthalmos have been described. In 1948, Ogura and Walsh first employed the transantral approach for decompression of the orbital contents into the ethmoid and maxillary sinuses. This technique requires controlled incision of the orbital periosteum to balance the eyes.

In 120 patients described, recessions ranged from 2 to 12 mm. The eyes were balanced within 1 mm in 75 percent of patients. Preoperative visual acuity was usually preserved or improved except in patients who presented with panophthalmitis. Among the adjunctive ophthalmologic procedures required were levator tenotomy, tarsorrhaphy, entropion and ectropion repair, corneal transplants, and muscle‐balancing operations.

There have been no instances of cerebrospinal fluid leak, meningitis, or optic nerve trauma. One patient bled from an aneurysm of the anterior cerebral artery during surgery. Two patients developed sinusitis postoperatively and two others required revisions in order to achieve a more satisfactory result.
Electrocochleography with retardates
Authors: Lyons George D. , Berlin Charles I. , Lousteau Ray J. , Ellis Michael S. , Yarbrough William M.
Published: September 2006

Our experience with an application and technique for electrocochleography, specifically in retardates, is reported. A case is presented in detail; that is, a mongoloid child with many overlapping otological and audiological diagnostic problems. With the combined use of cochleography and tympanometry much of this diagnostic confusion was resolved and management was simplified. This technique is also compared with late evoked cortical audiometry.
An oscillographic study of an objective tinnitus
Authors: Keller A. P.
Published: September 2006

A young girl with a normal audiogram and an audible clicking ear sound was seen. The sound was recorded, analyzed by oscilloscopic methods and found to be of a ringing pattern with a pulse lasting about 4 milliseconds and having a pulse frequency of one to two per second, averaging about 1.8/sec. The sound was abated by the use of a tranquilizer and the patient has returned to normal. A possible explanation of the noise mechanism is suggested, and it is hoped that the oscilloscopic analysis of recordable ear noises as employed in this case will be undertaken by other otolaryngologists so that eventually enough data will be assembled to give us a better understanding of the etiology of these sounds.
Facial analysis in patient evaluation for physiologic and cosmetic surgery
Authors: Patterson Carl N. , Powell Donald G.
Published: September 2006

The paper presents some of the anatomic and artistic relationships that must be known, appreciated and used by the reconstructive facial surgeon.

The utilization of some of the instruments of artistic measurement for facial analysis are presented.

The size, location, angulation and relationship of the ears, eyes, lips, nose and chin are specifically described. Demonstrative cases are presented.
Wire mesh foundation for methyl methacrylate cranioplasty
Authors: Sessions Roy B. , Wolfe S. Kenneth , Moiel Richard H. , Cheek William R.
Published: September 2006

Alloplastic materials have essentially replaced metal plates for frontal cranioplasty. Methyl methacrylate (Cranioplast, acrylic, etc.) is the most widely used of the plastic materials. Despite its many advantages, this plastic implant is vulnerable to trauma, with resulting fragmentation, and in certain cases, brain injury. The placement of a wire mesh foundation through which the semisolid methyl methacrylate is poured creates a well anchored implant which does not fragment when fractured. Two case reports of such reconstruction are presented.