bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Laryngotracheitis in the Rat Induced by Sendai Virus: The Influx of Six Different Types of Immunocompetent Cells Into the Laryngeal Mucosa Differs Strongly Between the Subglottic and the Glottic Compartment
Authors: Jecker Peter , McWilliam Andrew , Marsh Amanda , Holt Patrick G. , Mann Wolf J. , Pabst Reinhard , Westermann Jürgen
Published: November 2003

Objectives Acute laryngotracheitis is a disease in which mainly the subglottic area is infected, whereas adjacent parts of the larynx, especially the narrow glottic fold, remain unaffected. The reason for the difference between these two directly adjacent regions is unknown. Therefore, in the present study the influx of dendritic cells, neutrophils, T and B lymphocytes, natural killer cells, and macrophages into the mucosa of different laryngeal compartments was investigated after Sendai virus infection in the rat. The aims were to study both the influx of immunocompetent cells and the adhesion of the pathogen and to correlate them to the different reactions of the laryngeal areas during pseudocroup.

Methods Acute laryngotracheitis was induced by intranasal application of Sendai virus in brown Norway rats. This virus is exclusively pneumotropic in rodents and belongs to the parainfluenza virus type 1, the main pathogen of acute laryngotracheitis in children. The numbers of dendritic cells, neutrophils, T and B lymphocytes, natural killer cells, and macrophages were determined in the supraglottic, glottic, subglottic, and tracheal mucosa on days 2, 5, 7, and 14 after virus application. Furthermore, the nucleoprotein of the virus and major histocompatibility complex (MHC) Class II expression were detected immunohistologically on the laryngeal epithelium.

Results All cell subsets entered the laryngeal mucosa during inflammation. The highest influx was detected among dendritic cells subglottically. This was accompanied by a strong virus adhesion and MHC Class II expression on the subglottic epithelium. In contrast, only a few immunocompetent cells entered the adjacent glottic mucosa, and on the glottic epithelium staining for virus nucleoprotein and MHC Class II expression was weak.

Conclusions The inflammatory response of the laryngeal mucosa shows great regional differences in this animal model during experimental viral infection. The response was characterized by a strong subglottic and a weak glottic reaction. A possible reason for this difference might be region‐specific viral adhesion on the epithelium of the laryngeal areas, as well as differences in MHC Class II expression. Thus, these data agree with the clinical observation during acute laryngotracheitis and may explain why the subglottic part of the larynx is affected preferentially during pseudocroup. The molecular mechanisms mediating the different reactions await clarification.
Pott's Puffy Tumor and Epidural Abscess Arising From Dental Sepsis: A Case Report
Authors: Chandy Binoy , Todd John , Stucker Fred J. , Nathan Cherie‐Ann O.
Published: November 2003

Objective To present an unusual case of two uncommon cranial complications of frontal sinusitis: Pott's puffy tumor and epidural abscess arising from frontal sinusitis of dental origin, and also two systemic complications of sinusitis: septicemia and empyema, all occurring in an immunocompetent patient.

Study Design A 21‐year‐old man presented with a scalp swelling and epidural abscess. Magnetic resonance imaging and computed tomographic scans revealed unilateral opacification of the frontal sinus and an epidural abscess with a direct connection to the scalp abscess. Further history revealed that his symptoms occurred coincidentally with a tooth extraction 2 months before, and he was hospitalized soon after the tooth extraction for sepsis and a lung abscess.

Methods A combined neurosurgical and otolaryngologic approach was required to treat the sinusitis and the associated epidural and scalp abscess.

Results Cultures returned as Streptococcus intermedius from all three sites. The patient was free of disease at the 3‐month follow‐up.

Conclusions Odontogenic maxillary sinusitis is well documented; however, there is little reported of frontal sinusitis arising from dental disease. The prevalence of sinusitis of dental origin will be reviewed, including the microbiology of this particularly virulent organism that persisted despite earlier treatment with ampicillin. Also, the current thoughts on management of these cases will be discussed with particular reference to local therapy for sinusitis in addition to systemic treatment with antibiotics.
Preoperative Computed Tomography Diagnosis of Non‐Recurrent Inferior Laryngeal Nerve
Authors: Watanabe Akihito , Kawabori Shinichi , Osanai Hirofumi , Taniguchi Masanobu , Hosokawa Masao
Published: November 2003

Objective The non‐recurrent inferior laryngeal nerve (NRILN) is a nerve anomaly that is associated with the developmentally aberrant subclavian artery. Thus, it is possible to predict NRILN by preoperative diagnosis of an aberrant subclavian artery. Preoperative recognition of the NRILN should be advantageous in the prevention of intraoperative nerve damage. The purpose of this study was to assess the possibility of diagnosis of an aberrant subclavian artery by computed tomography (CT) of the neck, which is often performed before thyroid surgery.

Methods We retrospectively studied the preoperative CT films from 594 thyroid or esophageal surgery patients treated in our hospital between May 1995 and December 2000. An NRILN was identified intraoperatively in 6 of these patients, and a right recurrent inferior laryngeal nerve (RILN) was observed in 588 of these patients. We evaluated whether the brachiocephalic artery could be identified on the CT scan and classified the positional relationship between the right subclavian artery and the tracheoesophagus into three types.

Results The brachiocephalic artery was identified on the CT films in 158 cases, all of which were cases of RILN. The right subclavian artery was detected on the ventral side of the membranous wall of the trachea in all 588 RILN cases, whereas it was detected on the dorsal side in all 6 NRILN cases.

Conclusions It was possible to predict an aberrant subclavian artery by identifying the brachiocephalic artery and position of the right subclavian artery on the CT film of the neck. When an anomaly of the subclavian artery is thus preoperatively detected, NRILN can be preoperatively predicted, which likely will enable prevention of vocal cord paralysis.
Proportion of Heritable Paraganglioma Cases and Associated Clinical Characteristics
Authors: Drovdlic Carrie M. , Myers Eugene N. , Peters June A. , Baysal Bora E. , Brackmann Derald E. , Slattery William H. , Rubinstein Wendy S.
Published: November 2003

Objective/Hypothesis To determine the heritable proportion of paraganglioma (PGL) and identify clinical features associated with heritable PGL.

Study Design Patients diagnosed with head and neck PGLs, identified retrospectively through clinical otolaryngology practices and/or participation in previous PGL research studies, were given a medical and family history questionnaire.

Methods Questionnaire information was used to classify participants as having “heritable” or “non‐heritable” cases of PGL. Classification of the participants identified through otolaryngology clinics was used to estimate the heritable proportion of PGL. Statistical analysis was performed to identify significant differences in the clinical characteristics of the heritable versus non‐heritable groups.

Results Among the otolaryngology clinic population, 35% were classified as having heritable PGL. Individuals with heritable PGL were younger on average than those with non‐heritable PGL. The majority of non‐heritable participants were female, but there was an equal gender ratio among the heritable participants. Individuals diagnosed with a carotid body tumor (CBT) were 5.8 times more likely to be classified as heritable than those diagnosed with PGL at other anatomic locations.

Conclusions Approximately 35% of individuals who present to an otolaryngologist with a head and neck PGL have inherited a predisposition for this growth. Among individuals diagnosed with head and neck PGL, those diagnosed with CBT are 5.8 times more likely to have an inherited predisposition than those diagnosed with PGL at other anatomic locations.
Adhesion Molecules as Prognostic Factors in Nasopharyngeal Carcinoma
Authors: Shnayder Yelizaveta , Kuriakose M. Abraham , Yee Herman , Chen Fang‐An , DeLacure Mark D. , Xue Xiao Nan , Jagirdar Jaishree
Published: November 2003

Objective/Hypothesis To identify the significance of molecular markers in determining the risk of recurrence and distant metastases in nasopharyngeal carcinoma.

Study Design In this retrospective case study, we evaluated archival nasopharyngeal carcinoma specimens for patterns of expression of E‐cadherin, β‐catenin, c‐erb‐B2, and Ki‐67, which have been demonstrated to be important in other tumors.

Methods Fifty‐four cases of nasopharyngeal carcinoma were identified, with a maximum follow‐up of 13 years. The histopathological sections were stained using an automated immunohistochemical stainer (NexES, Ventana Medical Systems, Tucson, AZ) for E‐cadherin (Zymed Laboratories [San Francisco, CA] and Transduction Laboratories [Lexington, KY] clones), β‐catenin (Zymed), c‐erb‐B2 (Ventana Medical Systems), and Ki‐67 (Novocastra, Burlingame, CA). The numbers of positively staining cells were scored as follows: 0%, 1% to 33%, 34% to 66%, or greater than 67%.

Results E‐cadherin (Zymed) stained positively in only one case. The Transduction Laboratories clone demonstrated a spectrum of staining in all cases, from complete to disrupted to no identifiable membranous staining. The staining was consistently absent at the advancing tumor border, regardless of stage. The loss of β‐catenin expression did not correlate with that of E‐cadherin or with clinical outcomes. No staining was identified for c‐erb‐B2. Ki‐67 staining was variable and did not correlate with clinical outcomes.

Conclusions Altered expression or loss of E‐cadherin, or both, may result in loss of function, particularly at the infiltrating edge, with resultant loss of cell polarity, cell migration, and eventual metastasis. The interpretation of E‐cadherin staining depends on antibody source. In contrast to recent studies, β‐catenin expression is not altered and c‐erb‐B2 expression not identified, suggesting that these markers are not important in the prognosis of nasopharyngeal carcinoma.
Chemoradiation for Metastatic SCCA: Role of Comorbidity
Authors: Hathaway Bridget , Johnson Jonas T. , Piccirillo Jay F. , Snyderman Carl H. , Wagner Robin L. , Labriola Suzanne , Myers Eugene N.
Published: November 2003

Objectives A previous study of 371 patients with extracapsular spread (ECS) of cervical metastases from squamous cell carcinoma (SCCA) of the head and neck revealed a survival advantage for patients treated with adjuvant chemoradiation, compared with those treated with surgery and radiation or surgery alone. While all patients in the study were offered adjuvant chemotherapy, only 35% selected this option. Comorbidity was identified as a reason for declining chemotherapy. Recently, Piccirillo demonstrated that the Modified Medical Comorbidity Index (MMCI) is a valid instrument to classify and quantify severity of comorbidity. We applied this instrument to previously reported patients with ECS to determine 1) how comorbidity affected treatment selection, 2) whether the survival advantage of adjuvant chemoradiation persisted after controlling for comorbidity, and 3) the impact of comorbidity on outcome.

Study Design This was a nonrandomized, retrospective study.

Methods Patients in the initial study underwent resection of the primary tumor and neck dissection. Eligible patients elected to receive chemoradiation, radiation, or no further treatment. Comorbidity scores were assigned according to the MMCI. Data were analyzed according to disease‐specific survival and overall survival.

Results The study population consisted of 330 patients. More severe comorbidity was related to higher overall mortality rates after controlling for treatment. Adjuvant chemoradiation resulted in improved disease‐specific and overall survival compared with adjuvant radiation after adjusting for severity of comorbidity.

Conclusions These results substantiate the benefits of adjuvant chemoradiation for patients with SCCA of the head and neck. Furthermore, these results reinforce the importance of comorbidity as a prognostic indicator for this population of patients.
MRI Detection of Cervical Metastasis From Differentiated Thyroid Carcinoma
Authors: Gross Neil D. , Weissman Jane L. , Talbot J. Michael , Andersen Peter E. , Wax Mark K. , Cohen James I.
Published: November 2003

Background With the advent of the use of serum thyroglobulin as a marker for the recurrence of well‐differentiated thyroid cancer (WDTC) after total thyroidectomy, clinicians are increasingly faced with the diagnostic dilemma of detecting the site of recurrence in thyroglobulin‐positive patients with normal clinical examinations. The high protein content of this thyroglobulin may make it specifically detectable by magnetic resonance (MR) imaging.

Objective To determine the ability of MR imaging to detect the presence of metastatic WDTC in cervical lymph nodes.

Study Design Retrospective cohort.

Methods Blinded review by two independent head and neck radiologists of 34 head and neck MR scans obtained from 26 patients with thyroid cancer (12 with primary disease and 14 with recurrent disease) all of whom subsequently underwent surgical removal of the lymph nodes considered at risk by imaging.

Results The average overall percent sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MR imaging were 95%, 51%, 84%, 78%, and 83%, respectively. The concordance between the two radiologists was 69%. There was no overall difference in the ability of the MR scan to detect the presence of disease in the upper jugular, lower jugular, or paratracheal nodal stations. However, it was more useful for papillary carcinoma (PPV 86%, accuracy 85%) than for follicular carcinoma or the follicular variant of papillary carcinoma (PPV 63%, accuracy 67%).

Conclusion MR imaging is a sensitive and accurate technique for the detection of WDTC, particularly papillary carcinoma, metastatic to cervical lymph nodes. However, the lower specificity of this modality precludes its use as a screening tool.
Reconstruction of Pharyngeal Defects Using AlloDerm and Sternocleidomastoid Muscle Flap
Authors: Sinha Uttam K. , Chang Kristi E. , Shih Charles W.
Published: November 2003

Objective To report our experience in reconstructing pharyngeal defects that cannot be closed primarily, using acellular dermal matrix (AlloDerm, LifeCell Corp., Branchburg, NJ) and sternocleidomastoid (SCM) muscle flap.

Study Design Prospective, nonrandomized, nonblinded study in the setting of an academic tertiary care medical center.

Methods Fourteen patients underwent reconstruction of through‐and‐through defects of partial pharyngectomy for squamous cell carcinoma using AlloDerm graft. Primary closure of the defects was not possible because of substantial loss of pharyngeal tissue. The graft was reinforced with superiorly based SCM muscle flap in 10 patients. The remaining four patients did not receive any flap. Eleven lesions involved the lateral pharyngeal wall, and three were piriform sinus lesions. Patients were followed for a period ranging from 3 to 20 months. Outcome measures were determined on several parameters including graft take rate, evidence of graft contracture, postoperative complications, resumption of diet, intelligibility of speech, and decannulation. All patients were evaluated by a speech pathologist by means of a bedside swallowing examination. Five patients had videofluoroscopic studies. The three patients with piriform sinus lesions underwent videostroboscopic examination to assess vocal cord function.

Results There was a high success rate for graft take. Two patients developed postoperative fistulas that resolved with conservative management . One of the 10 patients with SCM flap and one of the 4 patients without SCM flap developed fistulas. Clinically significant graft contracture or pharyngeal stenosis was not observed in any patients. All patients resumed oral intake. Ten patients resumed a normal diet, two tolerated a soft diet, and two could take purees. Decannulation was successful in all patients. Two of the three patients with piriform sinus lesions had vocal cord palsies after surgery resulting in breathy dysphonia. They underwent type I thyroplasty for vocal rehabilitation. All patients had intelligible speech.

Conclusions Thick AlloDerm, reinforced with SCM muscle or cervical soft tissue, provides a useful alternative option for reconstruction of pharyngeal defects that cannot be closed primarily. It is safe and effective and provides excellent functional outcomes.
The Occurrence of Sleep‐Disordered Breathing Among Patients With Head and Neck Cancer
Authors: Friedman Michael , Landsberg Roee , Pryor Shepherd , Syed Zubair , Ibrahim Hani , Caldarelli David D.
Published: November 2003

Objective To identify the incidence of obstructive sleep apnea (OSA) in patients treated for head and neck cancer. Obstructive sleep apnea is a relatively common and highly morbid condition that affects 9.1% of male and 4% of female middle‐aged adults. 1 Patients who have been successfully treated for head and neck cancer may often have a partially obstructed upper airway which is functional during the day, but collapses during sleep.

Study Design/Methods Twenty‐four patients successfully treated for tumors of the tongue‐base, pharynx, or supraglottic larynx were enrolled. Through OSA‐related questionnaires, physical examination, and polysomnography, the incidence of OSA in this patient population was determined and compared with that of the general population.

Results The incidence of OSA (91.7%) in this head and neck cancer patient population was found to be significantly (P = .001) higher than that of the general population. (In a random sampling of middle‐aged adult males between the ages of 30 and 60 years old with a respiratory disturbance index (RDI) >15, the prevalence was previously reported to be 9.1%. 1) Sixteen of 24 patients (72.7%) had clinically defined symptoms of sleep apnea. Ten of 24 patients (41.7%) received radiation therapy; all had an RDI >15. Eleven of the 14 patients (78.5%) who did not receive radiation therapy also had an RDI >15. Eight patients (33.3%) continue to regularly use continuous positive airway pressure with significant improvement in symptoms.

Conclusions Identification and treatment of OSA may be an important factor in improving quality of life for patients with head and neck cancer.
Cystic Hygroma/Lymphangioma: A Rational Approach to Management
Authors: Kennedy Thomas L. , Whitaker Mark , Pellitteri Phillip , Wood W. Edward
Published: November 2003

Objective To outline a rational approach to the management of cystic hygroma based on the authors' experience, the natural history of the disease, and the results of surgical treatment.

Study Design and Methods A retrospective review of all patients with the diagnosis of lymphangioma or cystic hygroma from 1958 to 2000 was performed.

Results Seventy‐four patients were identified with 46 cases confined to the cervicofacial region. Surgical excision was performed on 60 of the 74 cases involving all regions of the body and 34 of the 46 patients with head and neck lesions. The location of the malformation is the most important determinate for surgical success. While surgical excision was the main treatment modality, 11 of 12 untreated patients were noted to improve, with 8 patients showing complete resolution.

Conclusions In the treatment of lymphangiomas, the physician should be experienced in the management of such lesions, be aware of spontaneous resolution, and recognize the limitations and potential harm of surgery in certain instances.
Aesthetic Comparison of Wound Closure Techniques in a Porcine Model
Authors: Tritle Nathan M. , Haller Jeffrey R. , Gray Steven D.
Published: November 2003

Objective To compare various commonly used closure techniques and their esthetic results. Also to look for differences in cost, time, and ease of use among the methods.

Design A prospective comparison in a porcine skin model with a blinded assessment of outcomes.

Methods Thirty 6‐cm, full‐thickness skin incisions were made on the back of two domestic white swine. Undermining was accomplished, and buried simple, interrupted, absorbable, braided (Polysorb, US Surgical) subdermal sutures were placed in a uniform fashion in each wound. The skin was then closed using one of the following five methods: running subcuticular 4‐0 nylon, running subcuticular 4‐0 absorbable monofilament (Biosyn, US Surgical), tissue glue (Dermabond, Ethicon), adhesive tape, or running subcuticular nylon with intradermal injection of hyaluronic acid. Nonabsorbable sutures and tape were removed on postoperative day 7, and photographs were taken at regular intervals during a 12‐week healing period. Biopsies were taken from wounds in each group at 2 weeks and 12 weeks for histologic comparison. Independent observers evaluated the photographs, and an independent histologist evaluated the biopsies to look for differences in inflammation and scar formation. The surgeons who performed the wound closure rated the ease of use and amount of time required for each technique.

Results Adhesive tape closure was faster and easier to perform. There were no significant differences among the adhesive tape, nylon, or absorbable suture groups regarding cosmetic appearance throughout the study period. The tissue glue wounds had more of a tendency to dehisce. Adhesive tape is less expensive than the other methods when material costs and operating room time are considered.

Conclusion Adhesive tape closure of surgical wounds is cosmetically acceptable, convenient, and saves both time and material costs. We recommend it as an alternative for closure of neck incisions.
Cortical Representation of the Orbicularis Oculi Muscle as Assessed by Transcranial Magnetic Stimulation (TMS)
Authors: Roedel Ralph M. W. , Laskawi Rainer , Markus Holger
Published: November 2003

Objectives To analyze characteristic features and details on motor‐evoked potentials (MEPs) of the orbicularis oculi muscle resulting from cortical transcranial magnetic stimulation (TMS) in normal subjects as a basis for further investigations on motorcortical representation in patients presenting with facial nerve diseases.

Study Design MEPs of the orbicularis oculi muscle resulting from focal cortical TMS with a figure‐8‐shaped coil were investigated in 17 healthy subjects with special regard to amplitude and onset latency as a function of the coil position on the head surface along the interaural line and in the anterior–posterior direction. The results were then compared with our data on lower‐lip mimetic muscles and on the frontalis muscle obtained in previous studies.

Results Bilateral reproducible responses could be observed at coil positions varying from 1 to 13 cm lateral to the vertex. During moderate muscle activation, maximum responses (mean amplitude 0.75 ± 0.44 mV contralateral, 0.74 ± 0.36 mV ipsilateral) were obtained at a mean stimulus position of 8.6 ± 1.6 cm lateral and 2.0 ± 2.2 cm anterior to the vertex for contralateral responses, and of 8.6 ± 2.0 cm lateral and 2.8 ± 2.4 cm anterior to the vertex for ipsilateral responses, respectively. Voluntary muscle activation by forced eye‐closure was associated with a further increase in mean amplitudes. At rest, bilateral responses could be elicited in 15 subjects (88.2%). During moderate muscle activation, the shortest mean onset latencies were obtained at the optimum stimulus position on the interaural line, both for contralateral (10.2 ± 1.3 ms) and ipsilateral (10.6 ± 1.5 ms) MEPs. Comparing our data on the orbicularis oculi muscle with those obtained on lower‐lip muscles and on the frontalis muscle, there was a considerable overlap of coil positions from which reproducible MEPs could be elicited in all three groups of mimetic muscles, but with the orbicularis oculi area being placed between forehead and lower‐lip motorcortical areas.

Conclusions A statistically significant separation of the cortical representation areas of forehead, orbicularis oris, and lower‐lip mimetic muscles is possible by focal cortical TMS reflecting a kind of somatotopic organization of the face‐associated motorcortex. Compared with the results on lower‐lip and forehead muscles, orbicularis oculi muscle responses show characteristics of both.
Bolus Transit and Airway Protection Coordination in Older Dysphagic Patients
Authors: Kendall Katherine A. , Leonard Rebecca J.
Published: November 2003

Objectives/Hypothesis The intent of this study was to identify and characterize abnormalities of bolus pharyngeal transit and airway protection in a group of elderly patients with dysphagia.

Study Design A retrospective analysis of dynamic videofluoroscopic swallowing studies performed in patients over the age of 65 was carried out. The study was limited to individuals with no obvious medical or surgical cause of dysphagia.

Methods Pharyngeal bolus transit times were determined and compared with those from 60 young normal control subjects and 23 elderly control subjects. The timing of airway closure was analyzed in terms of bolus position in the pharynx.

Results Prolonged bolus transit times were identified in 61% of patients investigated and 65% of elderly control subjects. Overall, the onset of airway closure was appropriate for the position of the bolus in the pharynx but was slow to achieve completion. Elderly control subjects were found to elevate the larynx early in the swallow. Delayed airway closure was identified as a contributor to aspiration in some dysphagic subjects.

Conclusions Pharyngeal transit of the bolus may be prolonged in elderly individuals. Swallowing coordination mechanisms appear to be intact in the majority of elderly patients with dysphagia, but gestures may be weak and ineffective. Early laryngeal elevation may be an effective strategy to avoid aspiration.
Dynamic Laryngotracheal Closure for Aspiration: A Preliminary Report
Authors: Broniatowski Michael , Grundfest‐Broniatowski Sharon , Tyler Dustin J. , Scolieri Paul , Abbass Fadi , Tucker Harvey M. , Brodsky Sheryl
Published: November 2003

Objectives/Hypothesis An estimated 500,000 patients per year in the United States. are affected by stroke‐related dysphagia. Approximately half experience aspiration, which can lead to pneumonia or death. Aspiration may result from many factors, including delayed transport of the bolus, faulty laryngeal elevation, and poor coordination or inappropriate timing of vocal cord closure. Interventions carried out to protect the lungs are usually irreversible, destructive to the upper airway, and rarely prevent the need for enteral tube feeding.

Study Design We present a report of the first implantations of a new device in an FDA‐approved study to restore dynamic laryngotracheal separation. Two stroke patients needing tracheostomy were selected based on chronic aspiration verified by clinical and radiologic criteria (modified barium swallow [MBS]).

Methods The left recurrent laryngeal nerve was exposed and electrically stimulated to verify vocal fold adduction. Huntington Medical Research Institute Bipolar Helical Electrodes were then implanted around the nerve. The leads were tunneled and linked to a NeuroControl™ Implantable Receiver–Stimulator placed subcutaneously on the chest wall. Activation of the stimulator was performed through an external transmitter linked by induction.

Results The device was successfully triggered intra‐ and postoperatively. Serial flexible fiberoptic endoscopies and MBS demonstrate that aspiration is systematically arrested using low levels of electrical stimulation (42 Hz, 48–100 μsec, 1 mA).

Discussion This pioneering work has shown that aspiration can be controlled without airway damage for a wide population of neurologically impaired patients because it appears more physiological than standard therapies.

Conclusion Based on the first two patients, paced laryngotracheal separation is clinically effective in controlling aspiration.
Lipoinjection Augmentation of the Soft Palate for Velopharyngeal Stress Incompetence
Authors: Klotz Darrell A. , Howard John , Hengerer Arthur S. , Slupchynskj Oleh
Published: November 2003

Objectives/Hypothesis Velopharyngeal stress incompetence in professional musicians is an uncommon but potentially career‐ending problem. Pharyngeal flaps, V‐Y palatal pushback procedures, Teflon or collagen injection of the posterior pharyngeal wall, and speech therapy have all been used to address this problem. The ideal procedure for this subset of patients with velopharyngeal incompetence (VPI) with high‐pressure, mild VPI would be one that combines low morbidity and an expedient recovery for the busy musician. We describe an approach of endoscopically assisted autologous lipoinjection of the soft palate.

Study Design A retrospective review of our experience treating high‐pressure stress VPI in two professional musicians.

Methods Literature review and retrospective chart review.

Results Two musicians underwent autologous lipoinjection of the soft palate for stress VPI. Patients resumed full play within 2 weeks of the operation with no serious complications. There has been no recurrence of the VPI after 18 and 12 months of follow‐up, respectively.

Conclusions Velopharyngeal stress incompetence in musicians is an uncommon disorder. Velopharyngeal incompetence in these patients may not present as in a typical manner with hypernasality but may go undiagnosed for years mistakenly rationalized as a declining performance ability rather than a curable structural problem. The performance demands of professional musicians necessitate a timely solution to their VPI. More precise and limited contouring of palatal bulk can be achieved through the lipoinjection technique than compared with traditional palatal V‐Y pushback or a standard pharyngeal flap. Lipoinjection of the palate can be performed as an outpatient procedure with only minor discomfort and an expedient recovery for the career musician.
Mandibular and Temporomandibular Joint Arthropathy in the Differential Diagnosis of the Parotid Mass
Authors: Klenoff Jason R. , Lowlicht Roger A. , Lesnik Thomas , Sasaki Clarence T.
Published: November 2003

Objective To increase awareness of temporomandibular joint and mandibular disease in the overall evaluation and diagnosis of the parotid mass.

Study Design We describe clinical presentations of pigmented villonodular synovitis and synovial chondrocalcinosis of the temporomandibular joint, as well as osteoma of the mandible, as they may initially suggest primary neoplasms of the parotid gland.

Conclusions Preauricular swelling is a common presenting symptom for patients visiting an otolaryngologist. Often this symptom is suggestive of a parotid mass. However, lesions of the temporomandibular joint and mandible may also present in this fashion.
Incidence of Reflux in Young Children Undergoing Adenoidectomy
Authors: Carr Michele M. , Poje Christopher P. , Ehrig Deborah , Brodsky Linda S.
Published: November 2003

Objective To compare the incidence of gastroesophageal reflux disease (GERD) in children under 2 years of age who have symptomatic adenoid hypertrophy requiring surgical removal or who have otitis media with effusion requiring ventilation tube insertion without adenoidectomy.

Study Design Retrospective chart review.

Setting An academic pediatric otolaryngology unit.

Patients All children under age 2 undergoing adenoidectomy (Ad group) between January 1998 and May 2000 were compared with children in the same age range having ventilation tube insertion without adenoidectomy (VT group).

Main Outcome Measures Whether a diagnosis of GERD was made, how it was made, GERD treatment, and resolution of symptoms were compared.

Results There were 95 children in the Ad group and 99 in the VT group. GERD incidence was significantly higher in the Ad group where it was 42% versus 7% in the VT group (P <.001). In the Ad group, 88% of children age 1 or less had GERD, and 32% of those older than 1 had GERD diagnosed. In the VT group, 14% of patients age 1 or less and 2% of those older than 1 had a diagnosis of GERD.

Conclusions Children under age 2 with symptomatic adenoid enlargement requiring adenoidectomy have a significantly higher incidence of GERD than children in the same age group presenting with otitis media requiring ventilation tube insertion.
Magnetic Resonance Imaging–Guided Fine‐Needle Aspiration Biopsies of Retropharyngeal Lesions
Authors: Maghami Ellie G. , Bonyadlou Shahram , Larian Babak , Borges Alexandra , Abemayor Elliot , Lufkin Robert B.
Published: November 2003

Objective The retropharyngeal space is a deep neck space susceptible to a host of disease processes. Surgical access to this space is technically difficult and associated with potential morbidity. An image‐guided fine‐needle aspiration (FNA) biopsy, if proven accurate and safe, would be of great benefit as an alternative diagnostic approach to this space. This study reports on the use of magnetic resonance imaging (MRI)–guided FNA for diagnostic evaluation of retropharyngeal lesions. Technical details of needle systems, approach to this space, and reliability of this method are described.

Study Design This is a prospective study of 14 patients with retropharyngeal lesions who underwent MRI‐guided FNA biopsy at the University of California at Los Angeles Center for the Health Sciences between October 1989 and October 1998.

Methods A 0.2‐tesla open magnet was used to obtain magnetic resonance images of each retropharyngeal lesion. After standard skin preparation a coaxial needle system was used to reach and sample the lesion. In most instances, the specimen was immediately stained and examined by a cytopathologist for adequacy before removing the patient from the scanner.

Results Eleven of 14 (78%) patients had diagnostic aspirations; only 2 of these 11 patients required additional surgical biopsy for more specific histological characterization of their lesions before definitive treatment recommendations were given. All aspiration procedures were well tolerated and without any complications.

Conclusion We have demonstrated that MRI‐guided approach to the retropharynx is feasible, safe, and sensitive enough to obviate the need for open biopsies in a large percentage of patients.
Use of Bacteriologic Studies in the Outpatient Management of Peritonsillar Abscess
Authors: Cherukuri Sreekant , Benninger Michael S.
Published: November 2003

Objective To examine whether obtaining bacterial Gram stain and aerobic/anaerobic cultures alters management of patients with peritonsillar abscess.

Study Design Retrospective study.

Materials and Methods A total of 221 cases of suspected peritonsillar abscess from July 1990 to February 1999 were analyzed with regard to outcomes and management patterns of those who had bacteriologic studies performed and those who did not.

Results Pus was aspirated in 153 (69%). Eighty‐two had bacterial studies performed whereas 71 did not. Of patients that followed up, all patients had complete resolution in the first group based on initial management. Three patients of the latter group had a complicated course secondary to dehydration and antibiotic noncompliance (P = .24). Of the 82 cultures sent, sensitivities were conducted on only 17 (21%). Nine of 17 grew organisms that were penicillin‐resistant. No patient in the study had any treatment decisions based on microbiologic studies.

Conclusion In the routine management of peritonsillar abscess, bacteriologic studies are unnecessary on initial presentation. They should be reserved for patients with a high likelihood of infection by resistant organisms, i.e., diabetics, immunocompromised patients, and patients with recurrent peritonsillar abscess.
Frontal Sinus Obliteration With Hydroxyapatite Cement
Authors: Petruzzelli Guy J. , Stankiewicz James A.
Published: November 2003

Objective To evaluate the efficacy hydroxyapatite cement as an alternative to autologous fat in the obliteration of the frontal sinus after trauma or chronic suppuration.

Methods Single institution, nonrandomized, prospective analysis of patients treated in an academic, tertiary care center. Patients were followed with physical examinations and were monitored for recurrent infections, which would have necessitated removal of the implant. Follow‐up radiographs were obtained at 12 months. Standard surgical techniques were used to obliterate the frontal sinus with the addition of the placement of a vascularized pericardial flap along the frontal sinus floor.

Results Eleven patients underwent hydroxyapatite frontal sinus obliteration. There were 2 women and 9 men in the series with age ranges from 33 to 82 years (mean, 48 y). Three patients underwent obliteration for trauma and 8 for chronic infections with or without mucopyocele. The mean follow‐up is 27 months (range, 3.3–37 mo). No patient has developed clinical or radiographic evidence of recurrent frontal sinusitis and at this point no implants have been removed. Nine of 11 patients (91%) report complete resolution of all symptoms.

Conclusion Hydroxyapatite cement had demonstrated efficacy in full‐thickness reconstruction of frontal sinus defects. The pericranial flap may provide a barrier to prevent infection of the implant in the face of acute ethmoid sinusitis. Hydroxyapatite cement offers the advantages of no donor site morbidity and the potential for complete osseointegration.
Nuclear Factor‐Kappa B Activation in the Nasal Polyp Epithelium: Relationship to Local Cytokine Gene Expression
Authors: Takeno Sachio , Hirakawa Katsuhiro , Ueda Tsutomu , Furukido Kyosuke , Osada Rika , Yajin Koji
Published: November 2003

Objectives A panel of cytokines has been found to be important for eosinophil accumulation and activation in nasal polyps. The aims of this study were to ascertain whether the activation of nuclear factor‐kappa B (NF‐κB) occurred in the polyp epithelium, and to examine the relationship between the degree of activation and local cytokine gene expression.

Study Design/Methods: Nasal polyp specimens were obtained from 26 untreated patients. The proportion of nuclear translocation of the NF‐κB p50 subunit in the polyp epithelium was quantitatively analyzed by a combination of fluorescent immunohistochemistry and a laser scanning confocal microscope image system. The levels of GM‐CSF, IL‐5, IL‐8, IL‐16, and eotaxin mRNA expression in the same speci‐mens were measured using reverse transcription‐polymerase chain reaction.

Results Both cytoplasmic and nuclear localization of the p50 subunit was observed mainly in the epithelial layer in all specimens. The percentages of epithelial cells with nuclear translocation ranged from 4.5% to 40.5% (median, 18%). Significant correlations were observed between the degree of epithelial NF‐κB activation and the levels of IL‐8, IL‐16, and eotaxin mRNA expression (r = 0.468, 0.47, and 0.739, respectively).

Conclusion The activation of NF‐κB in the nasal polyp epithelium is responsible for the recruitment of inflammatory cells, particularly eosinophils, through the initiation of the transcriptional pathway of the related cytokines. The increased NF‐κB activity in the polyp epithelium may reflect hypersensitivity to unknown stimuli.
Prognostic Significance of the Proline Form of p53 Codon 72 Polymorphism in Nasopharyngeal Carcinoma
Authors: Tsai Ming‐Hsui , Lin Chia‐Der , Hsieh Yao‐Yuan , Chang Florence Chi‐Chen , Tsai Fuu‐Jen , Chen Wen‐Chi , Tsai Chang‐Hai
Published: November 2003

Objectives/ Hypothesis An important tumor suppressor gene, p53, plays a role in the regulation of cell progression and prevention of carcinogenesis. Mutated p53 is related to cell progression and malignancy. We aimed to evaluate the association between nasopharyngeal carcinoma and p53 polymorphism.

Study Design Case control study.

Methods All individuals were divided into two groups: nasopharyngeal carcinoma (n = 50) and non–nasopharyngeal carcinoma groups (n = 59). Their p53 codon 72 polymorphisms (arginine [Arg] homozygotes, heterozygotes, proline [Pro] homozygotes) were detected by polymerase chain reaction. Associations between nasopharyngeal carcinoma and p53 polymorphism were evaluated.

Results Distributions of various p53 polymorphisms significantly differed between the two groups. We noted a dominant presentation of Pro homozygotes in the nasopharyngeal carcinoma population over that in the non–nasopharyngeal carcinoma population. Proportions of Pro homozygotes and heterozygotes and Arg homozygotes were 32%, 28%, and 40% in the nasopharyngeal carcinoma population and were 13.5%, 44.1%, and 42.4% in the non‐nasopharyngeal carcinoma population, respectively.

Conclusions An association exists between nasopharyngeal carcinoma and p53 codon 72 polymorphism. The p53 Pro homozygotes are to a higher risk of development of nasopharyngeal carcinoma.
Telemedicine: Teleproctored Endoscopic Sinus Surgery
Authors: Burgess COL Lawrence P. A. , Syms Mark J. , Holtel CDR Michael R. , Birkmire‐Peters Deborah P. , Johnson MAJ Robert E. , Ramsey MAJ Mitchell J.
Published: November 2003

Objective/Hypothesis Teleproctored surgery projects a surgeon's expertise to remote locations. The objective of the present study was to evaluate the safety and feasibility of this technique as compared with the current standard of care.

Study Design Prospective.

Methods A study was conducted in a residency training program comparing conventionally proctored endoscopic sinus surgery cases with teleproctored cases, with the faculty surgeon supervising through audiovisual teleconferencing (VTC) in a control room 15 seconds from the operating room.

Results Forty‐two control patients (83 sides) and 45 teleproctored patients (83 sides) were evaluated. There were no internal differences between groups regarding extent of polypoid disease, revision status, procedures per case, degree of difficulty, general or local anesthesia, or microdebrider use. There were no cases of visual disturbance, orbital ecchymosis or hematoma, or cerebrospinal fluid leak. Orbital fat herniation and blood loss were equal between groups. Three teleproctored cases required faculty intervention: two for surgical difficulty, one for VTC problems. Teleproctored cases took 3.87 minutes longer per side (28.54 vs. 24.67 min, P <.024), a 16% increase. This was thought to be a result of nuances of VTC proctoring. Residents had a positive learning experience, with nearly full control of the operating suite combined with remote supervision through telepresence. Faculty thought such supervision was safe but had concerns regarding personal skills maintenance.

Conclusions Teleproctored endoscopic sinus surgery can be safely performed on selected cases with an acceptable increase in time. Teleproctored surgery with remote sites may continue to be safely investigated. Incorporating remote supervision through telepresence into the curriculum of surgical residency training requires further study.
Use of AlloDerm for Coverage of Radial Forearm Free Flap Donor Site
Authors: Sinha Uttam K. , Shih Charles , Chang Kristi , Rice Dale H.
Published: November 2003

Objectives To evaluate and discuss the role of acellular human dermal matrix (AlloDerm, LifeCell Corp., Branchburg, NJ) graft for coverage of radial forearm free flap donor site.

Study Design Prospective, nonrandomized study.

Methods Fifty‐two consecutive patients underwent harvest of 52 radial forearm fasciocutaneous free flaps. All 52 donor sites were covered by AlloDerm graft. Split‐thickness skin graft was not used to reinforce the acellular dermal graft in the series. Clinical phases of healing, duration of healing, and donor site complications were studied.

Results No donor site complications except seroma formation in five patients was noted. This was treated by conservative measures. Full range of hand motion was allowed in 3 days. Complete healing occurred within 8 to 12 weeks. Scar contracture after complete healing was minimum in all patients. Range of motion of the hand and fingers during flexion, extension, supination, and pronation was identical on the operated and nonoperated sides.

Conclusion AlloDerm graft is a viable alternative to split‐thickness skin graft for coverage of the radial forearm free flap donor site.
Topical Mitomycin C and Cephalosporin in Endolymphatic Sac Surgery
Authors: Huang Tsun‐Sheng
Published: November 2003

Objective To determine whether intraoperative topical application of the drug mitomycin C to the endolymphatic sac area in conjunction with endolymphatic sac ballooning surgery (ESBS) can safely achieve longer‐lasting relief from incapacitating, medically intractable Meniere symptom‐complex than ESBS alone.

Study Design/Method A retrospective study is presented of 142 cases of ESBS performed by the author between May 1998 and November 1999, in which a solution of mitomycin C diluted to 1 mg/mL of physiological saline was applied to the sac area for 5 minutes followed by irrigation with a cephalosporin antibiotic solution. The results of the 103 of 142 cases diagnosed as classic Meniere's disease or endolymphatic hydrops are given special attention, comparing them with the results of an earlier‐reported series of 109 cases of ESBS sharing the same diagnostic and result evaluation criteria but not using mitomycin C.

Results In terms of vertigo control, the comparative short‐term rates (<3 y) of complete/substantial control for the aforementioned 103‐case series and earlier 109‐case series are similar: respectively, 90.3% (after 1.5–3 years' follow‐up) versus 91.7% (after 2.5–3 years' follow‐up). In the 103‐case series, to date, there has been no recurrence of incapacitating vertiginous symptoms necessitating revision surgery, whereas in the 109‐case series, although there were likewise no cases necessitating revision surgery during the reported 2.5‐to 3‐year follow‐up period, at least 8 patients in that series are known to have undergone revision surgery at later dates. Hearing results were significantly better (P = .004) in the 103‐case series than the 109‐case series: respectively, 30.0% versus 12.8% hearing improvement.

Conclusions Preliminarily, the superior hearing results in the present series indicate that possible adverse effects of mitomycin C on the inner ear and endolymphatic system have been averted; and no recurrence of incapacitating symptoms to date offers hope that longer‐term efficacy of endolymphatic sac surgery using mitomycin C can be maintained.
Tutorials in Clinical Research: Part V: Outcomes Research
Authors: Stewart Michael G. , Neely J. Gail , Hartman James M. , Wallace Mark S. , Forsen James W.
Published: November 2003

Objectives This is the fifth in a series of sequential “Tutorials in Clinical Research.” The objective of the present report is to give the reader a broad overview of the field of outcomes research. This summary is intended to enable the reader to understand outcomes research methodology and to start the design of an outcomes research study.

Study Design Tutorial.

Methods The authors developed the report from available materials and refined it to be concise but complete for use by the practicing clinician.

Results We describe the basic steps of record‐based and patient‐based outcomes research, including development of a staging system, identification of comorbid conditions, and creation or identification of an outcomes instrument.

Conclusion Outcomes research is a unique methodology that uses patient‐based outcomes to assess the effectiveness of medical treatment.