bluuebunny/crossref_metadata_2025 huggingface dataset:
The mucoperiosteal flap in frontal sinus surgery. (the sewall‐boyden‐mcnaught operation.)
Authors: Baron Shirley H. , Dedo Herbert H. , Henry Charles R.
Published: September 2006

The problem with the Lynch operation for frontal sinus disease is the high incidence of failures (30 percent) due to the closure of the nasofrontal communication. It seems to us that the use of permanent (Dacron, described as recently as 1972) or temporary (Portex) indwelling tubes to preserve this communication is unreasonable when there is available an operation that requires no gadgets. This is the mucoperiosteal flap operation. This has several advantages over the osteoplastic flap‐fat obliteration procedure. It is performed through a Killian‐type incision through which surgical treatment of the ethmoid and sphenoid sinuses can also be done (not possible with the osteoplastic approach). It is less formidable and not deforming, and there is no concern about the possibility of developing secondary mucoceles. The incidence of failures is extremely low. The probable reason that it is not used more is that it is not well known.

It was demonstrated by Sewall and McNaught that an operative nasofrontal duct remains open if one side is epithelized. Sewall, in 1935, described a medially based mucoperiosteal flap to provide this epithelium. He described a Lynch type approach with a Killian incision. The lateral bony wall of the nose is removed carefully to the underlying mucoperiosteum. When a large enough area of the membrane is exposed, two cuts are made vertically and one horizontally, thus forming a flap, based on the septum, that eventually will be turned up into the frontal sinus after the proper surgery on the frontal sinus, the glabella, the anterior ethmoids and posterior ethmoids and sphenoid sinus, if necessary, is done. The flap is held in place with a Portex tube which is removed in seven days.

McNaught, in 1936, described a laterally based mucoperiosteal flap for use in cases with large frontal sinuses with narrow nasal vaults, and particularly those with bilateral involvement. He used Lothrop's operation for removing the interfrontal septum, all the nasal portion of the floor of both frontal sinuses, and the upper part of the anterior portion of the bony nasal septum, thus making a large opening into the nose. The opening is lined unilaterally or bilaterally with mucoperiosteal flaps based from the mucosa under the nasal process of the maxilla and cut from the nasal septum and then turned into the frontal sinus over the periosteum of the orbit after the frontoethmoidal surgery has been completed.

We believe that the mucoperiosteal flap operation is the best available for external surgery of the frontal sinus. The exception is in the large osteoma for which the osteoplastic flap operation is better.
Clinical evaluation of the hot caloric test as a screening procedure
Authors: Dayal Vijay S. , Farkashidy Joseph , Kuzin Betty
Published: September 2006

A clinical assessment of the relative values of the hot, the cold and the bithermal hot and cold caloric tests was carried out in a group of normals as compared to patients suffering from vestibular neuronitis, Ménière's disease, head injuries and acoustic neuromas. Results indicate that the hot or the cold test alone does not provide as much information as the bithermal test. A correlation of this result was made to the presence of a spontaneous nystagmus, positional nystagmus and directional preponderance. These forms of nystagmus present are unable to predict the indication for the hot caloric test alone. It is concluded that bithermal tests be continued until further progress on standardization and normal data are available for each of the three sets of tests, obtained separately.
The relationship between cochlea and kidney
Authors: Quick Cedric A. , Fish Alfred , Brown Carl
Published: September 2006

The not uncommon association in clinical practice of problems existing simultaneously in the kidney and ear, prompted a closer look at these two distant organs, revealing in fact that they may be comparable in a variety of ways.

Anatomical similarities were seen especially at the ultra‐structural level. Physiological mechanisms of fluid and electrolyte balance are present in both organs, and this common function is reflected in similar pharmacological actions of certain drugs. Congenital syndromes which have both renal and hearing defects have been the subject of much investigation attempting to relate a single etiological process in a common pathogenesis.

To investigate a possible existence of shared antigenicity the tools of immunochemistry and immunohistochemistry were employed in experimental studies comparing the kidney with the lateral cochlear wall. The experimental animals chosen were the rat and guinea pig. Anti‐rat sera and anti‐guinea pig sera were produced using the goat or rabbit respectively as the antibody producing animal. In order to produce the antisera, specimens of stria vascularis were dissected from the cochlea. The collected specimens were then placed in saline and Complete Freunds Adjuvant, emulsified and then injected into subcutaneous sites of rabbits. After about 10 days the blood was withdrawn and the serum extracted from the blood. This crude serum was then used in subsequent experiments as the anticochlea antibody (AC Ab). In a similar manner glomerular basement membrane antibody was prepared (AGBM Ab).

Two methods of immunofluorescent staining were used, namely, the indirect and direct method. In the indirect method, frozen sections of normal cochlea or renal tissue specimens were treated with the previously prepared AC Ab or AGBM Ab and then counterstained with Fluorescein labeled goat anti‐rabbit gamma globulin serum (GARG‐Fl). In the direct method tissue specimens from guinea pigs that had been injected with either AC Ab or AGBM Ab were stained directly with GARG‐Fl. In a third part of the experiments, the left cochlea from each animal injected with either AGBM Ab or AC Ab was taken for light histology.

The results of these experiments are summarized in Tables I, II, and III. Of marked significance in our studies is the observation that AC Ab is capable of staining renal tubular epithelium. This presents compelling evidence of antigenically similar epithelial components.

In conclusion, there is a fascinating similarity between the cochlea and the kidney. This similarity extends through a variety of modalities. There is even experimental evidence of a possibility of antigenically similar epithelial components.
Factors of clinical significance affecting wound healing
Authors: Dingman Reed O.
Published: September 2006

The success of surgical procedures is largely dependent upon an orderly process of repair and wound healing and although we do not recount these daily, understanding of the available knowledge will influence the attitudes, techniques, and philosophies of the surgeon and lead to better overall patient care. Some factors of wound healing are entirely beyond the control of the surgeon while many factors of technique and wound management affecting the process of wound healing are within the control of the surgeon and are of practical importance in every surgical procedure. This presentation reviews the current concepts of wound repair, mentions those over which we have little control, and points out factors over which the surgeon does exert an influence and relates these to optimal wound care and satisfactory wound healing.
Regeneration of the laryngeal sensory nerves
Authors: Satoh Isei , Harvey Joseph E. , Ogura Joseph H.
Published: September 2006

A study of reflex movements of the vocal cords induced by electrical stimulation of the mucous membrane of the larynx or by stimulating the internal branch of the superior laryngeal nerve (evoked EMG) in normal dogs was done. The internal branch was sectioned subsequently, and the progress of regeneration was studied over a period of months by the same techniques.

Return of reflex movement to the vocal cords and soft palate indicated that the nerve was completely regenerated between 60 and 75 days, and reinnervation of the mucous membrane was accomplished by 79 days. The evoked EMG induced by stimulation of the nerve showed abnormal threshold and wave form. Secretion of the laryngeal mucous membrane glands never returned during stimulation. These observations are discussed in relation to surgery of this area.
The glomus bodies (“paraganglia”) of the human larynx
Authors: Lawson William , Zak Frederick G.
Published: September 2006

Two pairs of glomic bodies (“paraganglia”) occur in the larynx as originally described by German authors. They were independently found in 18 of 25 serially sectioned adult larynges.

The superior laryngeal glomus is situated in the supraglottic larynx in the adult and neonate. The inferior laryngeal glomus is positionally more variable, usually occurring between the cricoid cartilage and the first tracheal ring in the adult and may extend to the thyroid gland.

Three neonatal larynges were also examined for comparison. The glomera show no developmental enlargement and appear histologically identical. No glomic tissue was found in neonatal tracheas.

Reports of laryngeal paraganglionic tumors or chemodectomas are reviewed and show anatomic correlation with the naturally occurring bodies.
Etiological factors in hearing loss in tangential missile wounds of the head
Authors: Adeloye Adelola , Singh S. P. , Awe M. A.
Published: September 2006

This communication compares the relative importance of acoustic trauma and of damage to the skull by missiles in the production of the hearing loss encountered among soldiers with tangential missile wounds of the head. Acoustic trauma produces a little deafness of a perceptive nature which is slightly worse in the right ear than in the left. By contrast, injury to the skull by missiles, in the absence of direct aural damage, produces marked perceptive deafness which is often bilateral and usually worse on the side of the head where the missile wound was sustained.
Effects of surface anesthesia on deglutition in man
Authors: MÅrnsson Ingemar , Sandberg Nils
Published: September 2006

The importance of sensitivity in the mouth, pharynx and esophagus upon swallowing was studied on 17 healthy volunteers. Intraluminal pressures of the pharynx, pharyngo‐esophageal sphincter and esophagus were synchronously recorded before and after surface anesthesia with lidocaine. Anesthesia of the mucous membrane in sectors of the oral cavity, pharynx or esophagus separately did not cause any objective changes, whereas simultaneous anesthesia of an area consisting of the soft palate, tonsillar pillars, tonsils, base of the tongue and pharynx, caused considerable changes upon swallowing: the coordination between the pharynx and sphincter was disturbed; dysphagia and coughing occurred. Similar dys‐coordinations have been reported earlier from patients with hypopharyn‐geal diverticulum but have not previously been shown experimentally. The changes are probably caused by the mucous membrane's anesthesia inhibiting the discharge of impulses from oropharyngeal receptors.
Noise‐induced inner ear damage in newborn and adult guinea pigs
Authors: Falk Stephen A. , Cook Reginald O. , Haseman Joseph K. , Sanders Gary M.
Published: September 2006

Two‐day (Group A), eight‐day (Group B), and eight‐month (Group C) old guinea pigs were exposed to 30 continuous hours of white noise at 119–120 db SPL. One month later pathology of the organ of Corti was evaluated and quantitated by use of the surface preparation technique. Percent cell damage was determined for outer hair, inner hair, outer pillar, and inner pillar cells at each of the four turns of the cochlea and for the cochlea as a whole. Comparisons of pathology of each cell type were made between groups.

Mean percent outer hair cell damage per cochlea (± 1 S.E.) was 23.72 ± 3.69 for Group A, 36.98 ± 5.76 for Group B, and 7.24 ± 1.75 for Group C. There was no significant difference in outer hair cell damage between Groups A and B. Outer hair cells of Group A were significantly more damaged than those of Group C when damage in the cochlea as a whole was considered due to significantly greater damage in Group A at three and one half turns; likewise, outer hair cells of Group B were significantly more damaged than those of Group C when damage in the cochlea as a whole was considered due to significantly greater damage in Group B at two and one half and at three and one half turns.

A similar effect was observed in terms of pathology of inner hair cells and pillar cells: there was a trend toward increased damage in animals of Groups A and B compared with C. Group C showed no outer or inner pillar cell damage, and only one of six animals had alterations in inner hair cells. In contrast, outer and inner pillar cells were damaged in Groups A and B, and four of six animals of Group A and six of eight of Group B showed inner hair cell damage.

Recent electrophysiological and audiometric studies are discussed which, with the results of the present study, indicate greater susceptibility of young cochleas when compared with older cochleas, to noise‐induced physiological and pathological alterations. It would seem medically prudent to take special precautions to avoid exposing newborns to excessive noise.
The rinne test: Its use in predicting magnitude of conductive hearing loss
Authors: White James F.
Published: September 2006

Rinne tests were done on 214 ears with various air‐bone gaps, using both steel and magnesium tuning forks, in the method described by Shambaugh. Predictability of air‐bone gap was evaluated, and found to be only moderately good. An air‐bone gap of 15 db or more can usually be demonstrated with use of the 256 fork but accuracy in determining the amount of gap between 15 db and 45 db is poor.
Auricular repositioning otoplasty
Authors: Gay Ellery C.
Published: September 2006

The purpose of this paper is to introduce a new, safe and logical extension of the older concepts of otoplasty. The main principle involved here is complete undermining of all of the auricular cartilage above the isthmus cartilaginis auris by severing the three ligaments and the three muscles that connect the ear to the head. The entire auricular cartilage can then be repositioned at a normal angle in relation to the side of the head more readily than with previously used techniques. The external auditory meatus is easily enlarged if necessary. The sutures connecting the eminence of the scapha to the soft tissues of the mastoid posterior to the external auditory canal produce an antihelix whose contour is softer, wider and has more flowing curves. The wide area of excess skin removed provides a large area for cicatricial adhesions from the ear to the skull; additionally, in difficult cases this technique may be readily modified by any of the older established methods of otoplasty.
A method for ventilating patients during laryngoscopy
Authors: Smith R.Brian , Babinski M. , Petruscak J.
Published: September 2006

A method of ventilating patients during laryngoscopy was described in 40 patients. The technique used a combination of a small endotracheal tube and a high pressure oxygen jet with general anesthesia. A plastic chest tube 3.5 mm internal diameter (I.D.) was used as an endotracheal tube. The patients were ventilated with intermittent high pressure oxygen jet (50 p.s.i.) using a 1.5 mm I.D. intravenous plastic catheter introduced into the end of the endotracheal tube. Three holes were made in the proximal end of the endotracheal tube to permit air entrainment which was measured. Anesthesia was obtained with sodium thiamylal and In‐novar®. Muscular relaxation was maintained with succinylcholine. Arterial blood gases were monitored and showed adequate ventilation in the majority of the patients. In 18 patients the endotracheal pressure was measured. In two instances the pressure was elevated (35 cm H2O). No postoperative complications occurred. This technique was useful, safe, and well accepted by the surgeons. The authors consider that this technique avoids the disadvantages of conventional endotracheal anesthesia as well as those of the ventilating laryngoscope. It is contraindicated in patients with poor lung and chest wall compliance, particularly the obese. Subsequent to this study, 85 additional patients were similarly anesthetized without complications.
Tympanic neurectomy: A review and an additional indication for this procedure
Authors: Friedman William H. , Swerdlow Richard S. , Pomarico James M.
Published: September 2006

Tympanic neurectomy has been performed on 13 patients. Four patients were treated for the Frey syndrome, four for parotitis, four for sialorrhea (bilateral tympanic neurectomy and unilateral chordatympaneurectomy in these patients), and one for aural pain. Twelve of 13 of these patients have good results from two to 23 months postoperatively. Two patients with cerebral palsy were treated successfully with bilateral tympanic neurectomy and unilateral chordatympaneurectomy. These are the first two patients reported to have undergone this procedure for cerebral palsy. Additional indications and a review of the subject is presented.
III. Organ culture of the mammalian inner ear: A tool to study inner ear deafness
Authors: Van De Water Thomas , Ruben Robert J.
Published: September 2006

Twelfth gestation day kreisler otocysts were explanted into an organ culture system and allowed to develop for nine days. The homozygotic (kr/kr) kreisler otocysts showed significant developmental differences when compared to the development that occurred in the organ culture specimens of the otocysts of its heterozygotic (+ /kr) litter mates. The differences in development observed in vitro were the same major developmental differences that had been observed in vivo. The phenotypic expression of the kreisler genome has expressed itself in vitro in the homozygotic kreisler otocyst.
The use of tissue adhesive (isobutyl cyanoacrylate) and topical steroid (0.1 percent dexamethasone) in experimental tympanoplasty
Authors: Kaufman Roger S.
Published: September 2006

Two main purposes in the present study were: 1. to determine the feasibility of using the tissue adhesive isobutyl 2‐cyanoacrylate in reconstructive middle ear surgery; and 2. to learn whether a potent topical corticosteroid (0.1 percent dexamethasone) would have beneficial anti‐inflammatory effects when placed in the tympanic cavity at the time of middle ear surgery.

Tympanoplastic surgery was performed on 26 cat ears and six squirrel monkey ears; the animals were followed for six weeks to nine months postoperatively.

The conclusions to be drawn from this experimental study are that presently the tissue adhesive isobutyl cyanoacrylate appears too toxic for use on the delicate middle ear structures; likewise, corticosteroids placed in the middle ear do not appear to have any beneficial effects in tympanoplasty surgery.
The medical and surgical treatment of nasal polyps
Authors: Myers David , Myers Eugene N.
Published: September 2006

The work of Kern and Schenck introduced the concept that the nasal polyp was allergic in origin. The ethmoid sinus mucosa is the most common target organ for this allergic reaction leading to the formation of polyps with subsequent nasal obstruction. Patients with nasal polyposis complain of nasal obstruction and may have hyperplastic sinusitis associated with this. This purulent infection compounds the problem of management in these cases.

A thorough history and physical examination is necessary to make this diagnosis. X‐ray examinations of the nose and paranasal sinuses are essential to formulate a rational plan of management. Therapy should include an allergic evaluation and a plan of allergic management.

Surgical management in the past has included nasal polypectomy as the chief mode of therapy in providing temporary relief of the nasal obstruction. Radical, destructive intranasal and paranasal sinus surgery has led to unnecessary and quite severe complications and mortality, and is to be condemned. Ethmoidectomy, and when indicated, a Caldwell‐Luc procedure will provide drainage of infection, removal of necrotic tissue and necrotic bone when hyperplastic sinusitis complicates the picture.

Intrapolyp injection of corticosteroids has proven of great benefit for less severe cases of nasal polyposis without infection. This treatment may need to be repeated in order to achieve the desired relief from nasal obstruction but is only active locally and does not produce systemic side effects. This mode of therapy may be supplemented by oral corticosteroids and by the use of systemic antibiotics.

Intranasal mechanical obstruction other than nasal polyps should be corrected by rational surgery to the nasal septum and turbinates. A thorough workup and evaluation is necessary for a plan of management and any therapy, whether medical or surgical, must be based on this type of thorough evaluation of the patient's problem.
Benign disease of the thyroid gland and vocal cord paralysis
Authors: Rueger Raimund G.
Published: September 2006

The incidence is about 0.7 percent of patients admitted for thyroid surgery.

It is caused mainly by compression of the nerve against the cervical spine or the trachea by a thyroid mass.

Other mechanisms may be stretching of the nerve, especially by retrosternal goiters, and inflammation and edema of the nerve trunk.

Rapid enlargement of the thyroid gland, or of a pre‐existing goiter, hoarseness, and a sensation of pressure are cardinal signs of an advanced thyroid malignancy, usually carrying a poor prognosis.

Five case histories were reported. All patients presented with all or most of these cardinal signs, yet their thyroid disease was proven benign at surgery. Two out of five patients regained motility of their previously paralyzed cords after surgery.
Dangers of succinylcholine in anesthesia
Authors: McStravog L. J.
Published: September 2006

This paper is written so that I may discuss some of the experiences I have encountered in the operating room with succinylcholine. It is my hope that this paper might stimulate your reading the anesthesiology journals for further knowledge of succinylcholine.

The chemical breakdown of succinylcholine by the body may be found in all of the anesthesiology journals. It has been established that succinylcholine can cause prolonged apnea. The usual figure given is one in 4,000 cases. My experience with prolonged apneas does not coincide with this figure. I personally feel that it occurs more often. The second complication of succinylcholine is cardiac arrest and the third malignant hyperthermia. I have never encountered either of these two conditions. The complications associated with the administration of succinylcholine can be avoided only if we have a basic understanding of the pharmacology of the drug, its side effects and the various conditions which will alter the normal response. This in turn will achieve the one thing we all strive for, a safe and sensible procedure for the patient.
Ethacrynic acid — Its reversible ototoxicity
Authors: Silverstein Herbert , Begin Richard
Published: September 2006

Six cats were intoxicated with an intracardiac injection of ethacrynic acid (30 mg/kg) while being anesthetized with open drop fluothane anesthesia. Twenty‐four hours later the cochlear microphonic and N1 potentials were present and reduced in amplitude, as compared to responses obtained at 48 hours and two and one half months. At 24 hours, 48 hours, and two and one half months mild edema and cystic change in the stria vascularis was noted.

From our experimental data it does not appear that a single intravenous dose of ethacrynic acid produces permanent depression of the electrical activity of the cochlea.
Laryngocele, laryngeal mucocele, large saccules, and laryngeal saccular cysts: A developmental spectrum
Authors: Desanto Lawrence W.
Published: September 2006

Several clinically different benign lesions can arise from the saccular appendage. The precise lesion at a given time depends on:1.the size of the saccule;2.whether free communication is possible between the appendage and the laryngeal lumen; and3.the presence or absence of inflammation. These lesions represent a spectrum of lesions in that clinical manifestations can vary from those of one type of lesion to another.

A tiny saccule of only a few millimeters in length, with its lumen isolated from the ventricle, presents as a cyst of the anterior ventricle. A larger appendage, also closed from the laryngeal lumen, presents as a cyst of the lateral larynx, the so‐called congenital cyst or lateral saccular cyst. This same cyst can extend into the neck through the thyrohyoid membrane. This cyst can be seen at any age but is most common in the newborn and infant.

An air sac or cyst (laryngocele) also can present as a small lesion of the anterior ventricle or as a larger sac within the lateral intrinsic larynx or can extend into the neck by way of the thyrohyoid membrane. Whether the growth is a mucus‐containing cyst or an air sac depends upon whether there is a communication with the air column of the larynx at the ventricle; a laryngopyocele is an infected air sac.

Recognition of the developmental spectrum of saccular lesions should simplify terminology.
Obliteration of vestibular and cochlear aqueducts in the guinea pig
Authors: Suh Ku Won , Cody D. Thane R.
Published: September 2006

The study involved 42 healthy adult guinea pigs placed into two major groups. In group A, only histologic studies were performed after obliteration of the right vestibular aqueduct, the cochlear aqueduct, or both the vestibular and cochlear aqueducts. In group B, hearing changes were monitored by repeated determination of averaged temporal response thresholds after the same obliterative operations as in group A. At the conclusion of the experiments, histologic studies of temporal bone were performed and hearing changes were correlated with the severity of disease found in the inner ear.

Histologic examination of 32 temporal bones from animals in which the vestibular aqueduct or both the vestibular and cochlear aqueducts were obliterated consistently demonstrated endolymphatic hydrops. The endolymphatic hydrops was usually progressive, and its severity was proportional to the length of time from the operation. Serial determination of averaged temporal response thresholds in 18 guinea pigs after these operations demonstrated a progressive deterioration in thresholds. The hearing loss was greater at the lower frequencies. The audiometric changes correlated positively with the severity of endolymphatic hydrops. No significant audiometric or temporal bone histologic changes were found after obliteration of the cochlear aqueduct.
Electrical promontory testing in differential diagnosis of sensori‐neural hearing impairment
Authors: House William F. , Brackmann Derald E.
Published: September 2006

The possibility of rehabilitation of sensory deafness by a peripherally implantable prosthesis makes it very important to differentiate sensory from neural hearing impairment. We do this by a technique which we call electrical promontory testing, which includes measuring the electrical potentials generated in the auditory system and stimulating the inner ear electrically.

Types of Sensori‐Neural Hearing Impairment.

There are four or more types of sensori‐neural hearing impairment which in the past have collectively been termed sensori‐neural. They are: 1. sensory loss — deficiency in the hair cells; 2. neural loss — auditory nerve deficit; 3. brain stem loss — nuclear deficiency; and 4. central loss — auditory cortex defect.

Method of Testing.

Recording of the potentials evoked in the auditory system by the techniques of electrocochleography, brain stem audiometry and cortical evoked response audiometry is an important objective means of study of the auditory system. Characteristics of the potentials obtained such as wave form, latency, and amplitude help greatly in classifying types of partial hearing loss.

In severe hearing loss no potentials are obtained from the auditory system. In these cases, a low‐voltage, low‐frequency electrical current is applied to the promontory.

If the patient perceives an auditory sensation as a result of this stimulation, we believe that this demonstrates the presence of auditory neurons and the loss is classified as sensory. If an auditory sensation is not evoked, the deafness is classified as a neural or more central loss.
The conservative management of the negro nose
Authors: Kamer Frank M. , Parkes Morey L.
Published: September 2006

The difficulties in obtaining an adequate result in the Negroid nose have been elucidated by other authors. Paucity of lobular cartilage; the flat dorsum; short columella; wide flaring nares; and skin that tends to keloid formation have led many surgeons to attempt radical surgical techniques to obtain rather limited results.

To circumvent the complications in the more radical procedures, a more conservative concept of an entirely intranasal operation without external skin incisions is outlined. This technique consists of tip rotation and lobular cartilage trimming; the use of a non‐absorbable basal bunching suture, and the placement of a dorsal implant without performing osteotomies.

A comparison with other techniques is made, as well as surgical aims, limitations and a discussion of results. Pertinent illustrations and photographs are presented.
Laryngeal microcirculation and pathways of cancer spread
Authors: Pearson Bruce W.
Published: September 2006

The microcirculation of the human larynx was studied in cleared anatomic specimens. The distribution of the endolaryngeal blood supply was constant enough to permit naming of the subdivisions of the superior and inferior laryngeal arteries. There was a remarkable correlation between arteriolar and capillary distribution and the laryngeal routes of cancer spread within the larynx. Compartmentalization of the larynx was not apparent. The paraglottic space was filled with blood vessels.
Use of thermography to evaluate the optimum time for surgery after preoperative radiation
Authors: Scruggs Hugh J. , EL‐Mahdi Anas M. , Teates Charles D. , Fitz‐Hugh G. S. Laughter , Constable William C.
Published: September 2006

At the University of Virginia Hospital, patients undergoing preoperative irradiation for carcinoma in the head and neck region are usually scheduled for surgery four to six weeks after completion of therapy. Since preoperative irradiation produces no significant difference in the operative difficulty or postoperative morbidity, it is assumed that the vascularity of the area has returned to the pre‐treatment level. Thermography is being used to quantitatively gauge the amount of vascularity and thus, help predict the optimum time for surgery.

Thermography is obtained at two‐week intervals after a pre‐treatment baseline and is carried out for eight weeks after completion of therapy. During therapy the vascularity as determined by thermography is noted to increase to a maximum at approximately three to four weeks or 3 to 4,000 rads. Following completion of treatment, the vascularity subsides gradually and returns to the pre‐treatment level at four to six weeks after completion of therapy.
The bifid uvula in ear, nose and throat practice
Authors: Saad Ezzat F.
Published: September 2006

Out of 2,000 consecutive ear, nose and throat patients, 44 were found with bifid uvulas. Five of the cleft uvulas were associated with submucous cleft palate, and eight were associated with short palates; however, dyslalia was evident in only one case. Compensation for the wide palato‐pharyngeal space can occur by hyperplasia of the nasopharyngeal tonsil and hypertrophy and increased mobility of the pharyngeal constrictors and Passavant's ridge.

On the other hand, otologic manifestations were complained of in 13 cases. The asymptomatic cases were examined under magnification and audiometrically and a further three cases were, then, diagnosed as secretory otitis media. Hypoplasia of the tensor palati is the probable explanation of otologic manifestations in bifid uvula
Laser excision of carcinoma of the larynx
Authors: Strong M. Stuart
Published: September 2006

The CO2 surgical laser and microscope assembly have been used to excise carefully selected T1 carcinomas of the membranous portions of the cord. Healing has been prompt and return of function satisfactory.

General anesthesia and suspension laryngoscopy have provided excellent definitions of the lesions; the laser has provided a precise method of dissection.

Initial results have been excellent and long term results will depend on the accuracy with which the margins of the tumor are defined and the presence or absence of the tendency of the larynx to produce multicentric disease.
Blue light endoscopy
Authors: Höurzeler Dietrich
Published: September 2006

The introduction of high intensity proximal light sources has greatly improved the already high standard in technique of endoscopy. They enable us to illuminate the periphery of the bronchi. The advantage of better illumination must, nevertheless, be paid for with a levelling of contrast, as the bright light outshines the fine differences (e.g., tubercles in the mucous membrane).

In order to heighten the contrast, first theoretical, then practical tests were carried out with different colored lights. Filters (red, green, yellow and light blue) were placed in front of the light source and the subjective perceptible changes in contrast examined. These tests showed that the light blue filter gave a heightened contrast between light and dark red as well as between yellow and red. Intra‐ and submucosal nodules, scars, metaplasias, hyper‐ and parakeratoses as well as precancerous conditions are more clearly visible in the mucous membrane. Circumscribed lesions are better seen and specimens for histological verification are more accurately located for biopsy. Foreign bodies are more easily grasped. The remaining filters heighten the contrast in special cases (such as mycosis and colored foreign bodies).

Individual filters or multifilter discs placed between the light source and the glass fiber light carrier are easy to manipulate, so that colored light can be employed in routine bronchoscopy in order to improve diagnosis.
Special considerations in epiglottitis in children
Authors: Scheidemandel Heinz H. E. , Page Russel S.
Published: September 2006

The often perplexing clinical findings in acute epiglottitis are produced by the relative absence of cyanosis and hypercapnia in the face of severe hypoxemia, since expiration and CO2 elimination are not impaired. A serious situation arises when intubation is unsuccessful. Six hundred otolaryngologists were polled to determine whether life‐saving tracheotomy in such a situation could be performed within the time limits.
Intratracheal thyroid
Authors: Myers Eugene N. , Pantangco Irineo P.
Published: September 2006

Ectopic thyroid tissue within the trachea (intratracheal or endotracheal tissue) is a rare cause of upper airway obstruction. The symptoms may be classical or, as in most cases in which the voice is not affected, the first sign may be a wheeze. This may result in the symptoms being mistaken for asthma. The presence of a submucosal upper tracheal mass is quite unusual. If one is familiar with the fact that thyroid tissue may occur in this location, then this diagnosis should be considered in patients with such symptoms, and the appropriate diagnostic studies and surgical management should be instituted. The present case report entailed a 56‐year‐dld female who was admitted to the hospital after having been treated for a year in an outlying area. She had increasing shortness of breath and wheezing and had been treated several times for asthma. Indirect laryngoscopy revealed an upper tracheal submucosal mass which was confirmed by direct laryngoscopy and by tomography. Biopsies were taken confirming nodular ectopic thyroid tissue.

The patient was operated on through a cervical incision and a tracheal flap was elevated in order to carry out a submucosal dissection of this mass. The patient has done well for more than a year following surgery, and histologically this lesion was benign in the thyroid tissue.
Localization of laryngeal motor neurons in the kitten
Authors: Gacek Richard R.
Published: September 2006

In a series of 12 newborn kittens, horseradish peroxidase (HRP) was used to trace retrograde axoplasmic flow in the motor neurons to laryngeal muscles. The animals were sacrificed 24 hours after injection of HRP into a specific laryngeal muscle, and the brain stems were stained for peroxidase. This clear‐cut colorimetric method permitted the localization of the motor neurons in two nuclei of the ipsilateral brain stem. These are the nucleus ambiguus and the retrofacial nucleus.

The primary source of laryngeal motor supply is the nucleus ambiguus. All the laryngeal muscles were represented here in two divisions. Adductor neurons were located in the dorsal division and were more loosely arranged in the lateral reticular formation. The abductor neurons of the posterior cricoarytenoid muscle formed the compact ventral division of the nucleus ambiguus and were fewer in number than adductor neurons by a factor of four to one.

Since the expiratory and inspiratory centers are also located dorsally and ventrally in the brain stem reticular formation, the motor cells of the nucleus ambiguus are conveniently arranged to receive their afferent input. This arrangement is probably the result of phylogenetic development of abductor laryngeal function and pulmonary function in lower forms.

A second source of laryngeal innervation is the retrofacial nucleus. This small nucleus is situated rostral to the nucleus ambiguus and is made up of small and medium‐sized neurons of at least two types. Only the cricothyroid (CT) and posterior cricoarytenoid (PCA) muscles were shown to have significant innervation from this nucleus. The CT neurons were located peripherally while the PCA cells occupied the central portion of the nucleus. The functional significance of this nucleus is unknown, but it is suggested that it may have something to do with the various types of muscle units that have been demonstrated physiologically in the CT and PCA muscles.
Etiologic factors in non‐suppurative otitis media
Authors: Brookler Kenneth H.
Published: September 2006

Two observations in non‐suppurative otitis media, namely the serous fluid and the tympanic membrane retraction, may have separate explanations as to the etiologic factors. The first is the obstruction of the collecting lymphatic tubules of the middle ear and eustachian tube as they drain to the retropharyngeal lymphatics. This leads to a transudation of fluid in the middle ear or serous fluid. The second observation, retraction of the tympanic membrane, may be due to an absence or significant reduction of the surface tension lowering substance (Surface Active Membrane) of the eustachian tube, preventing the transmission of air to the middle ear from the nasopharynx.
Granular cell myoblastomas
Authors: Frable Mary Ann , Fischer Ronald A.
Published: September 2006

Granular cell myoblastoma is an uncommon benign tumor. The diagnosis is rarely suspected preoperatively, and the clinician is frequently baffled or frightened by an unfamiliar diagnosis.

Twenty‐eight patients with the diagnosis of granular cell myoblastoma presented for treatment at Richmond Eye and Ear Hospital and the Medical College of Virginia Hospitals between January 1, 1952, and December 31, 1974. The authors believe that this is one of the largest series of cases reported in the world literature. The tumor presents most often in the fourth decade of life and about equally in the sexes. Of interest is the nearly 5:1 predominance in the Negro race compared to the Caucasian race.
Symposium: Contraindications to tympanoplasty: II. An exercise in clinical judgment
Authors: Glasscock Michael E.
Published: September 2006

The two primary symptoms of chronic ear disease are otorrhea and hearing loss. The goal of any tympanoplasty is to eradicate disease and improve hearing. These are the primary indications for this procedure. The success or failure of the surgery is influenced by many factors such as the age and general health of the patient, the extent and type of disease present, and whether the upper airway is functioning properly. Contraindications to tympanoplasty will vary from one surgeon to another depending upon his training, philosophy, experience, and surgical skill.

It is helpful to think of these contraindications as being either absolute or relative. Absolute contraindications consist of: 1. uncontrolled cholesteatoma; 2. malignant tumors; 3. unusual infections and/or extenuating circumstances; and 4. complications of chronic ear disease, such as meningitis, brain abscess, or lateral sinus thrombosis. Relative contraindications are less well defined: 1. eustachian tube insufficiency or non‐function; 2. the uncooperative patient; 3. the dead ear; 4. the better hearing or only hearing ear; 5. the elderly patient; 6. the young child; and 7. the repeated failure case.

The otologic surgeon must exercise good clinical judgment in selecting patients for tympanoplasty. This paper deals with some of the more common problems in decision making.
Familial laryngomalacia: A case report
Authors: Shulman Joel B. , Hollister David W. , Thibeault Donald W. , Krugman Mark E.
Published: September 2006

This report describes the hereditary occurrence of severe laryngomalacia in three of five siblings of a Mexican‐American family. The mother, who experienced respiratory difficulties in the first year of life, may also have been affected. All three affected children required neonatal tracheostomy, and two died of pulmonary complications. Histological studies of tracheal cartilage revealed distinct hypercellularity and histochemical staining abnormalities of the cartilaginous matrix without defects in skeletal cartilage.

Although laryngomalacia is not uncommon, this disorder previously has not been documented to occur as a familial trait, nor have distinct abnormalities of cartilage been associated with laryngomalacia. This report suggests that etiologic and pathophysiologic heterogeniety exists for the clinical syndrome of laryngomalacia.
Symposium: Methods of reconstruction in tympanoplasty: IV. Conchal perichondrium as a tympanic graft with maintenance of drum conization
Authors: Wright William K.
Published: September 2006

Tympanoplasty reconstruction of the eardrum approached normal anatomy and function with the use of connective tissue to replace the substantia media. Perichondrium taken from the concha is preferred because it lies flat and is easy to manipulate. Grafts placed on the outer surface of the remnant tend to lateralize with loss of drum conization. Grafts placed on the undersurface of the remnant do not have this disadvantage.
Maintenance of conization of the drumhead in tympanoplasty
Authors: Keller A. P.
Published: September 2006

Temporal fascia placed medially to the tympanic remnants with the malleus handle exteriorized has been used successfully in over 1,200 tympanoplasties with adequate conization of the drumhead produced in most cases.
Ossicular fixation to the tegmen
Authors: Singleton George T.
Published: September 2006

Two surgical techniques are presented for the treatment of ossicular fixation of the incus and malleus to the tegmen. One involves an atticotomy approach, the second a mastoid approach to the attic.
Stapes fixation in chronic middle ear disease
Authors: Shea M. Coyle
Published: September 2006

Rigid stapes fixation is not uncommonly found in chronic otitis media and can be caused by several conditions. Careful stapedectomy with some form of ossicular chain reconstruction is the treatment of choice, usually as a second stage procedure. Hearing results to date have been gratifying.
Symposium: Congenital anomalies of the middle ear: I. Epitympanic fixation of incus and malleus
Authors: Shea John J. , Tabb Harold G.
Published: September 2006

Epitympanic fixation of the incus and malleus may be surgically corrected by transcanal atticotomy and removal of the fixed incudomalleolar mass.

Restoration of serviceable hearing has resulted in five of six cases by repositioning the natural incus or using a homograft incus.
Symposium: Congenital anomalies of the middle ear: II. Vascular anomalies of the middle ear
Authors: Storrs Lloyd A.
Published: September 2006

Of all the abnormal situations that one encounters in performing a tympanotomy, probably the last one to be thought of is vascular anomalies, and yet, potentially, this is one of the most hazardous of anomalous problems with which we have to deal.

Most of the anomalies which have been reported concern the persistent stapedial artery. This artery arises from the stump of the second aortic arch (stapedio‐hyoid artery), it traverses the developing stapes bone, leaving behind a monument to its existence — the obturator foramen of the stapes. The artery exits from the middle ear along the horizontal portion of the facial nerve, traversing this area for a variable distance and then usually divides into an intra‐cranial branch and a sphenoidal branch. The stapedial artery in its development before its regression, gives rise to the anlage of many important cranial arteries. These vessels are usually anastomosed with and distributed by the branches of the internal maxillary artery and the ophthalmic artery. The hyoid artery is represented in the adult by the carotico tympanic artery.

Anomalies involving the internal carotid artery are much more rare. The anomalies that have thus far been reported are:

Absence of the internal carotids.

Aneurysms.

Unusual courses.

Venous anomalies are generally uncommon and are usually represented by an abnormally placed jugular bulb which can simulate a glomus jugulari tumor.
Traumatic esophagopericardial fistula
Authors: Edison Bruce D.
Published: September 2006

The pathological state of esophagopericardial fistula is a rare phenomenon. Its etiology may be either traumatic or disease induced. In either event, it is a most serious condition with a frequently fatal outcome. This case report concerns itself with an iatrogenic induced esophagopericardial fistula which was successfully treated by a thoracotomy and pericardotomy.
Lymphangiomatous macroglossia
Authors: Dinerman William S. , Myers Eugene N.
Published: September 2006

Lymphangiomatous macroglossia, or giant tongue, usually presents within the first two years of life. The tongue enlarges to the point of protrusion from the mouth with resultant ulceration and frank necrosis of the tip. There may be associated malocclusion and prognathia produced by the enlargement of the tongue.

The pathology and clinical manifestations of lymphangioma of the tongue are discussed in this paper, and a case report is presented.
One‐stage dermal pedicle flap reconstruction of the oropharynx (an experimental and clinical study
Authors: Kohut Robert I. , Small Ralph , Suesberry Wilbur , Bain Leslie , Akazawa Melvin , Bridger William
Published: September 2006

A single stage dermal pedicle graft method for reconstruction of oropharyngeal defects is presented. Its successful clinical use is described. The advantages of the method include large surface‐to‐surface anastomosis which appears to minimize breakdown secondary to hypovascularity of an irradiated recipient bed. Other advantages include its single stage feature, persistent blood supply, avoidance of external tubed pedicles and intermediate salivary fistulas. A histologic study in pigs preceded its clinical use in humans. Findings of both aspects of the study are discussed.
Sudden sensori‐neural hearing impairment: A report of 1,220 cases
Authors: Shaia Fred T. , Sheehy James L.
Published: September 2006

We reviewed the findings in 1,220 cases of sudden sensori‐neural hearing impairment encountered over a nine‐year period at the Otologic Medical Group. A thorough neuro‐otologic evaluation is indicated in each case. Ten patients had an acoustic tumor.

A vasodilator regimen was prescribed in 380 cases and resulted in hearing improvement in 40 percent. Favorable prognostic findings were a low tone loss and absence of vertigo.