bluuebunny/crossref_metadata_2025 huggingface dataset:
The Versatile Contact Nd:YAG Laser in Head and Neck Surgery: An in Vivo and Clinical Analysis
Authors: Brown Dale H.
Published: November 2003

Objective Lasers have been used in otolaryngology as a surgical instrument for more than 25 years, and the CO2 laser has emerged as the most widely employed surgical laser in use today. However, recent technological advances have made the Nd:YAG laser a challenger as an effective photothermal surgical tool.

Study Design and Methods This is a two‐part study. Tissue injury and healing profiles after application of both the CO2 and Nd:YAG lasers are compared using an in vivo rat tongue model. A prospective clinical review based on the experience of 327 operative cases spanning a 7‐year interval using the Nd:YAG laser, highlighting its various applications and associated complications, is detailed.

Results Comparable tissue and healing effects were noted with both lasers in the in vivo rat tongue model with no statistical differences. The clinical application of the laser showed wide versatility in the head and neck with a complication rate of 3%.

Conclusion The Nd:YAG laser has proved equivalent in tissue damage and healing to the CO2 laser. The Nd:YAG laser has proved itself to be an excellent and perhaps superior laser for use in head and neck surgery.
Candidate's Thesis: Polymer Chemotherapy for Head and Neck Cancer
Authors: Shikani Alan H. , Domb Abraham J.
Published: November 2003

Objectives To study a new method of delivery of chemotherapy for the treatment of squamous cell carcinomas (SCCs) of the head and neck, to evaluate the pharmacokinetics of four anticancer agents (cisplatin, fluorouracil [5‐FU], methotrexate [MTX], and paclitaxel) loaded into the biodegradable polymer, polyanhydride polymer poly(FAD:SA), and to evaluate the effectiveness and toxicity of the drug‐polymer combination against human SCCs, both in vitro and in vivo.

Study Design Poly(FAD:SA) was loaded with different chemotherapeutic drugs and its in vitro and in vivo drug release and tissue penetration characteristics were studied. The biocompatibility and toxicity of the polymer‐drug combination were determined. The effectiveness of the drug‐polymer was evaluated against three different human SCCs (larynx O11, pharynx FADU, and floor of mouth UM‐ SCC1) cultured in vitro and in nude mice carrying human SCC xenografts.

Methods The in vitro drug release pharmacokinetics of the drugs were performed using atomic absorption spectrometry for cisplatin and high‐pressure liquid chromatography for the 5‐FU, MTX, and paclitaxel studies. In vitro tumor cytotoxicity was assessed by growth assay. In vivo cytotoxicity was assessed by growth rate inhibition in a nude mouse model.

Results All four chemotherapy drugs demonstrated a continuous release that followed first‐order kinetics from the polymer. More than 95% of the MTX and 5‐FU, 70% of the cisplatin, and 20% of the paclitaxel was released within the 10 days of the assay. Tumor cytotoxicity revealed that the polymer was very effective against the human SCCs O11, FADU, and UM‐ SCC1 in vitro. When a small amount of polymer (1–2 g) was added to the cell culture and left for 7 days, 96.6% of the UM‐SCC1 cells, 86.9% of the FADU cells, and 94.6% of the O11 cells were killed. When the culture medium was then changed every 2 days to remove the effect of nutrient depletion or chemicals released by the degrading polymer, 74% of the UM‐SCC1 cells, 94.5% of the FADU cells, and 66.1% of the O11 cells were killed at 7 days. The tumor animal model was the nude mouse carrying human floor of mouth SCC xenografts. Different amounts of cisplatin were incorporated into the polymers (5% and 7% drug/polymer at a weight/weight [wt/wt] load). Thirty‐five days after implantation of the polymer in nude mice, the mean treated tumor size was 65.5% of controls in the 5% group and 31.8% in the 7% group. Seventy days after implantation the mean treated tumor size was 41.4% of controls in the 5% group and 38.1% in the 7% group, indicating a statistically significant delay of tumor growth compared with controls or with intraperitoneally injected cisplatin. The blank polymer was well tolerated by the mouse and had no effect on tumor growth.

Conclusions The study results indicate that polymer chemotherapy is effective against a variety of SCCs of the head and neck, both in vitro and in vivo, and may become a useful therapeutic option for head and neck cancer.
Allograft Dermal Implant (AlloDerm) in a Previously Irradiated Field
Authors: Dubin Marc G. , Feldman Michael , Ibrahim Hani Z. , Tufano Ralph , Evans Sydney M. , Rosenthal David , Wolf Patricia F. , Weber Randal S.
Published: November 2003

Objective To evaluate the integration of AlloDerm (LifeCell Corp., The Woodlands, TX) in a field exposed to external‐beam radiation (EBR) by analyzing graft thickness, fibroblast recellularization, and neovascularization.

Study Design Randomized control.

Methods Thirty‐six male Sprague‐Dawley rats (n = 36) were randomly assigned to four groups. One hind leg of each rat was exposed to 20 Gy of EBR; the other limb served as the nonirradiated control. Two weeks after irradiation, AlloDerm was implanted into both hind legs. Grafts were harvested at 3, 4, 6, and 14 weeks after implantation and underwent histological analyses.

Results There was no statistically significant difference in graft thickness, fibroblast count, or neovascularization between the grafts placed in the irradiated bed and the controls (n = 33, P = .332, P = .336, and P = .057, respectively). However, at week 3, fibroblast counts in the graft placed in the field exposed to EBR were significantly lower than those of controls (P = .019), although at week 14 the counts in the experimental limb were higher than those of the controls (P = .002). Graft thickness (P = .001) and fibroblast count (P < .004) were lower at week 14 than at earlier time periods for both the experimental and control grafts.

Conclusions In the rat model, graft thickness and neovascularization of the AlloDerm dermal implant do not appear to be adversely affected by a field that has received EBR. Fibroblast ingrowth may be hindered in the early postimplantation period but appears to normalize in the long term. Furthermore, overall graft thickness and fibroblast counts decrease over time, regardless of irradiation status.
Effect of Photodynamic Therapy on Revascularization of Fasciocutaneous Flaps
Authors: Belmont Michael J. , Marabelle Nicole , Mang Thomas S. , Hall Richard , Wax Mark K.
Published: November 2003

Objective Photodynamic therapy (PDT) may be used as an adjuvant intraoperative treatment to improve locoregional control. PDT has been shown both to delay wound healing and to have a deleterious effect on flap survival after a primary ischemic insult. This delay in wound healing may make the flap dependent on its pedicled blood supply for a prolonged period. Long‐term flap loss may be experienced. The effect of PDT on flap revascularization, with subsequent dependence on its vascular pedicle, is evaluated.

Study Design Randomized controlled trial using a rodent model.

Methods A rat fasciocutaneous flap was used. Study groups were as follows: group I received no treatment; group II received treatment with 630‐nm light; groups III and IV were given Photofrin (in group III, loupes without a fiberoptic light source were used for flap elevation, and in group IV, light source was employed); and group V was given Photofrin and 630‐nm light. Primary ischemic times of 2 or 4 hours were used. Vascular pedicles were ligated on postoperative day (POD) 5, 6, or 7, and percentage of flap survival was evaluated 7 days later.

Results With 2 hours of ischemia, revascularization was decreased in the PDT group on POD 6 (P < .05) and on day 7 (P < .005) when compared with the other groups. With 4 hours of ischemia, revascularization was decreased in the PDT group on PODs 5 (P < .001), 6 (P < .01), and 7 (P < .005).

Conclusion Intraoperative PDT decreases revascularization of a rat fasciocutaneous flap.
Interlocking Calvarial Bone Grafts: A Solution for the Short, Depressed Nose
Authors: Leach Joseph
Published: November 2003

Objectives/Hypothesis In patients severely affected with collapse of the nose, deprojection and upward rotation of the nasal tip are commonly seen. Traditional maneuvers to derotate and project the tip may be insufficient, because of the natural tendency of the nasal skin/soft tissue envelope to pull the tip in a cephalic and posterior direction. If the forces of scar contracture can be resisted, the tip and dorsum should remain adequately positioned.

Study Design Retrospective chart review of 20 cases.

Methods Using an open rhinoplasty approach, two strips of calvarial bone are fitted together in a tongue‐in‐groove fashion, and esthetics are analyzed. Rotation and projection are altered as indicated. A screw inserted at the indicated level along the caudal bone graft acts to prevent retrodisplacement of either the dorsal or caudal strut as scarring occurs.

Results The procedure has been used in 20 patients. Two patients had displacement of the dorsal bone graft. Two patients have been lost to follow‐up. Follow‐up in the remainder has ranged from 6 weeks to 4 and a half years. All have maintained adequate tip and dorsal projection without excess upward tip rotation. Bone grafts have undergone minimal resorption.

Conclusion The interlocking calvarial bone graft technique stabilizes the nasal tip and dorsum in such a way that resists the forces of contracture and provides improved esthetics and function.
Long‐Term Experience With Endoscopic Diagnosis and Treatment of Salivary Gland Inflammatory Diseases
Authors: Nahlieli Oded , Baruchin Abraham M.
Published: November 2003

Objectives To assess the efficacy of the sialoendoscopic technique for treatment of inflammatory salivary gland diseases. This report documents the authors' long‐term experience with sialoendoscopy and discusses the long‐term results of the procedure, technical issues, and varieties that they have utilized, as well as the advantages and limitations of this modality.

Study Design Retrospective clinicopathologic study of 236 patients who were endoscopically treated from 1994 to 1999 for suspected salivary gland obstructive disease.

Methods Endoscope employed was the third generation sialoendoscope (Nahlieli Sialoendoscope, Karl Storz, Tuttlingen, Germany).

Results Ten sialoendoscopies were immediate failures as a result of technical problems. In the remaining 226 glands, 170 had obstructions and 56 had sialadenitis without evidence of obstructions. The success rate was 83%. Multiple endoscopic findings were encountered. No severe complications were noted.

Conclusion This report demonstrates the efficacy and safety of sialoendoscopy as a promising new method for use in the diagnosis, removal, and postoperative management of sialolithiasis, sialadenitis, and other obstructive salivary gland diseases.
Treatment of Laryngeal Carcinomas by Laser Endoscopic Microsurgery
Authors: Moreau Pierre R.
Published: November 2003

Objectives To determine if laser endoscopic microsurgery is a reliable and appropriate approach in the treatment of laryngeal cancers.

Study Design Retrospective study of 160 patients treated from 1988 to 1996 at Liège. Analysis of indication, technique, and oncologic results.

Methods Glottic tumors were treated with either type I, type II, or type III cordectomy, with or without conservation of an inferior muscular band, and extended if necessary to all or part of the contralateral cord. For supraglottic cancers, an excision limited to a part of the vestibule, a trans‐preepiglottic resection, or a radical supraglottic resection was carried out.

Results Our corrected actuarial survival at 5 years was 97% for the 98 infiltrative glottic tumors and 100% for the 18 infiltrative supraglottic and 27 in situ carcinomas. No local recurrences were noted, in either the group of 118 infiltrating cancers (in whom two precancerous lesions were treated with a further laser excision), or in the 27 in situ carcinomas. Local control was thus 100%. One patient died of his cancer, with lung metastases after neck recurrence.

Conclusions Like Steiner and Rudert, this series demonstrates the oncologic validity of this surgical approach to the treatment of unadvanced glottic tumors. Unlike these authors' study, however, strict case selection, as in cases with significant involvement of the anterior commissure, has allowed us to avoid local recurrences and consequently to avoid salvage total laryngectomies. Our experience with supraglottic cancers is too small to confirm the oncologic validity of this type of surgery but seems promising.
Aging Effects on Motor Units in the Human Thyroarytenoid Muscle
Authors: Takeda Naoya , Thomas Giovana R. , Ludlow Christy L.
Published: November 2003

Objectives To determine whether age differences are present in the human laryngeal thyroarytenoid muscle that would indicate that different normative values would be needed for identifying motor unit abnormalities.

Study Design Twenty‐six consecutively recruited healthy subjects between the ages of 21 and 72 years participated in a laryngeal electromyography study.

Methods Bipolar needle electrodes were used to record motor unit action potentials from several locations in the right and left thyroarytenoid muscles of each subject. The duration of a motor unit was measured when at least 10 firings of the same motor unit could be identified. On the average, four units were measured per muscle.

Results In the subjects less than 60 years of age, motor unit duration did not increase significantly with age. However, motor units from subjects greater than 60 years of age had longer durations than those from subjects less than 60 years of age (P < .00005), and 25% of the units measured in subjects greater than 60 years of age had longer durations than any of the units measured in subjects less than 60 years of age. Further, the older subjects differed from each other in their mean unit durations (P < .0001). In subjects less than 60 years of age, significantly longer durations were found for units innervated by the longer, left‐side recurrent laryngeal nerve in comparison with the right‐side nerve (P = .005).

Conclusions Different mean and SD values should be used for patients less than and greater than 60 years of age and for the right and left sides, when evaluating motor units in the thyroarytenoid muscles.
Effects of Thyroplasty Type I on Vocal Fold Vibration
Authors: Omori Koichi , Slavit David H. , Kacker Ashutosh , Blaugrund Stanley M. , Kojima Hisayoshi
Published: November 2003

Objective To ascertain effects of medialization thyroplasty on vocal fold vibration in glottic incompetence dysphonia.

Study Design Quantitative videostroboscopic glottic measurements and vocal function study were perioperatively undertaken in 20 patients undergoing Isshiki's thyroplasty type I.

Methods In digitized images, the glottal area, glottal width, posterior glottal width, and amplitude over an entire glottal cycle were measured and normalized by membranous vocal fold length. The ratio of closed phase to total phase of vibratory cycle was calculated from the data of the glottal area and the glottal width at the middle point of the membranous vocal fold. Well‐accepted acoustic, aerodynamic, and perceptual measures analyzed vocal function.

Results Glottal area and glottal width were reduced after surgery. While preoperative closure of glottal area was incomplete in all 20 patients, incomplete closure was obtained in 16 patients after surgery. In these 16 patients, closure of glottal width at the middle point of the membranous vocal fold was complete, whereas a posterior glottal gap remained in 14 patients. Closed phase over one cycle of glottal width waveform and amplitude of vocal fold vibration were increased after surgery. Glottal area, glottal width, posterior glottal width, and closed phase over one cycle of glottal width waveform correlated with vocal function measures.

Conclusions Thyroplasty type I reduces a glottal gap and increases closed phase over one cycle and amplitude of vocal fold vibration, although a posterior glottal gap remains. With the improved glottic vibration, thyroplasty type I provides more efficient phonation in patients with glottic incompetence dysphonia.
Transcranial Magnetic Stimulation in Acute Facial Nerve Injury
Authors: Har‐El Gady , McPhee Joseph R.
Published: November 2003

Objective/Hypothesis Available electrodiagnostic tests that are used to evaluate facial nerve injury examine the nerve distal to the stylomastoid foramen; because most facial nerve injuries are within the temporal bone, the tests cannot evaluate the nerve at or across the injury site. The interpretation of these tests depends on the predictability (or unpredictability) of distal degenerative process. Transcranial magnetic stimulation may be able to stimulate the nerve proximal to the injury site. The hypothesis of the present study is that in cases of mild traumatic facial nerve injury where axonal integrity is maintained, proximal stimulation of the nerve using higher than normal stimulus intensities to “overcome” the block at the injury site result in recordable facial nerve activity.

Study Design A prospective controlled animal study comparing response to transcranial magnetic stimulation of the facial nerve in the following groups: mild injury, severe injury/transection, and control.

Methods We studied 44 facial nerves in 22 cats. Fifteen nerves were subjected to mild trauma. Five nerves were severely crushed, 2 nerves were completely transected, and 22 nerves were not traumatized. All nerves were examined with the transcranial magnetic stimulation system before the trauma, immediately after the trauma, and at 3, 8, and 12 weeks after trauma.

Results All nerves in the mild and severe trauma groups showed complete clinical paralysis immediately after trauma. The nerves in the mild trauma group showed significant increase in threshold as well as significant increase in latency for recordable facial muscle response to transcranial magnetic stimulation. Thresholds and latencies decreased gradually within 3 to 12 weeks and returned almost to preinjury levels. This paralleled the return of clinical facial muscle movement. In the severe trauma/transection group, the nerves had no facial muscle response to transcranial magnetic stimulation after trauma. Neither facial muscle response to transcranial magnetic stimulation nor facial muscle movements recovered.

Conclusions In cats transcranial magnetic stimulation can assess the integrity of the facial nerve after trauma and predict its potential for regeneration. This technique can excite the nerve proximal to the injury site and may play a role in the clinical evaluation of the acute traumatic facial nerve paralysis. It can be used immediately after trauma, because it does not depend on wallerian degeneration to occur.
An Animal Model for External Ear Canal Inflammation
Authors: Wright Charles G. , Pawlowski Karen S. , Roland Peter S. , Meyerhoff William L.
Published: November 2003

Objective To develop an animal model for testing efficacy of anti‐inflammatory drugs designed to treat external ear canal (EAC) disease.

Methods Histological and morphometric methods were used to characterize EAC inflammation produced by topical application of tetradecanoylphorbol acetate (TPA) in mice. The effects of both single and repeated TPA applications were studied. A treatment trial was performed to evaluate the effects of a ciprofloxacin/hydrocortisone suspension on TPA‐induced EAC inflammation. In 10 animals, two bilateral applications of TPA were made, spaced 24 hours apart. Immediately after the second TPA application, otic suspension was applied unilaterally four times over a 48‐hour period. The contralateral EACs were left untreated to provide TPA‐only controls.

Results Twenty‐four hours after a single TPA application, EAC skin showed polymorphonuclear (PMN) leukocyte infiltration, vascular dilation, and thickening of the dermis and epidermis. Dermal and epidermal thickening were more pronounced after two TPA applications and PMN leukocyte infiltration remained high 48 hours after a second TPA placement. After treatment with the otic suspension, PMN leukocyte counts were reduced by an average of 76% relative to EACs that received TPA only. There was also statistically significant reduction of dermal swelling and a trend toward reduced epidermal thickness. Vascular dilation was clearly reduced as well. EACs that received four applications of the suspension alone showed no adverse effects compared with those that received saline.

Conclusion TPA‐induced inflammation of the mouse EAC provides a suitable model for testing the therapeutic efficacy of anti‐inflammatory agents being considered for clinical use.
Reducing Post‐tonsillectomy Pain With Cryoanalgesia: A Randomized Controlled Trial
Authors: Robinson Simon R. , Purdie Gordon L.
Published: November 2003

Objective/Hypothesis To evaluate the use of cryoanalgesia in reducing post‐tonsillectomy pain.

Study Design A prospective, randomized double‐blind study of 59 consecutive patients (age range, 8–40 y) undergoing tonsillectomy for recurrent tonsillitis.

Methods All patients underwent bipolar tonsillectomy. At the completion of the tonsillectomy patients were randomly assigned to a control or a cryotherapy group. The cryotherapy patients had both their tonsillar fossa “supercooled” to between −20°C and −32°C for 1 minute. Patients recorded their pain using a visual analogue scale over the next 10 days. Patients were also monitored for postoperative complications, time until resumption of a normal diet, time back to work or school, and analgesic consumption.

Results The two groups were similar for age and sex. There was a 28.3% reduction in mean pain scores over the 10 days in the cryotherapy compared to the control group. This difference did not significantly depend on the day after operation or time of the day. Cryotherapy patients also returned to work or school, on average, 4 days earlier than controls. There was no significant difference in postoperative complications between the two groups.

Conclusion Cryotherapy is a new technique that significantly reduces post‐tonsillectomy pain without evidence of causing additional complications.
Postsurgical Prevertebral Abscess of the Cervical Spine
Authors: Talmi Yoav P. , Knoller Nachshon , Dolev Mark , Wolf Michael , Simansky David A. , Keller Nathan , Hadani Moshe , Ohry Abraham , Kronenberg Jona
Published: November 2003

Objectives Prevertebral abscess formation is an uncommon occurrence following cervical spine fusion surgery. Abscesses may present early or in a delayed fashion and require surgical drainage and long‐term antibiotic treatment. The issues of osteomyelitis and the need for plate removal remain unresolved.

Study Design A case series of six tetraplegic patients admitted for rehabilitation to the Chaim Sheba Medical Center (Tel Hashomer, Israel) is presented.

Methods Five patients were trauma patients; one patient underwent repeated procedures and irradiation for tumor of the cervical spine. All patients developed prevertebral abscesses after a mean period of 30 days from their fusion surgery. Computed tomography scan was used in all patients to establish the diagnosis and define the extent of the infective process. All patients underwent one or more drainage procedures. The plate was removed in two patients at 1 and 4 months.

Results Infection completely resolved in four patient and was refractory in one patient with malignant tumor, and a chronic small fistula remained in one case. Staphylococcus aureus was the main infective organism, but mixed infections were the rule. Even for a protracted course of infection, no significant osteomyelitis was encountered.

Conclusions Abscess formation after instrumentation of the neck may be more common than formerly recognized. Despite the prolonged course of disease and treatment, osteomyelitis is not a major concern. There is no automatic indication for plate removal to control infection, although plating may be safely removed after 10 to 12 weeks if the neck is explored and the cervical spine is stable. A high index of suspicion is warranted, and early recognition and diagnosis, prompt surgical drainage under general anesthesia, and long‐term antibiotic treatment are key for eradication of the infective process. Prophylactic antibiotics may be of value. Meticulous antisepsis and surgical technique should be maintained to reduce the incidence of these severe complications.
The Larynx During Exercise
Authors: Naito Akira , Niimi Seiji
Published: November 2003

Objectives To develop a system capable of observing the larynx during various body movements and to investigate the relation between upper limb movements and laryngeal closure, often referred as “airtrapping.”

Study Design An endoscope capable of observing the larynx during various body movements was developed and the laryngeal state was monitored during these movements in three subjects. The output of 12 subjects' forearms was recorded with and without laryngeal closure.

Results The larynx was observable even during extreme exercises such as horizontal bar exercises and vault exercises. Laryngeal closure was almost always seen during the beginning of maximum effort of the upper limbs. During constant effort, the state of the larynx varied. When the output of the upper limbs was compared with and without laryngeal closure, there was an average of 20% power loss.

Conclusions This study suggests four possible uses for this system. 1) The system could be useful to evaluate laryngeal disorders during exercise such as exercise‐induced laryngomalacia. 2) The results could be used to improve the pushing exercise, a voice therapy technique. 3) The status of patients with incomplete laryngeal closure in connection with the upper limbs could be evaluated more thoroughly. 4) The technique and equipment could be used to observe the larynges during normal vocal processes that require body movement.
Efficacy of Botulinum Toxin A for Treatment of Upper Esophageal Sphincter Dysfunction
Authors: Alberty Jürgen , Oelerich Michael , Ludwig Karl , Hartmann Sabine , Stoll Wolfgang
Published: November 2003

Objectives To investigate the efficacy of botulinum toxin A (BTA)–induced chemodenervation of the upper esophageal sphincter (UES) in patients with dysphagia and UES dysfunction.

Study Design Prospective clinical trial in 10 selected patients with pure UES dysfunction.

Methods In each patient 30 units of BTA were injected into the UES under brief general anesthesia. Videofluoroscopic swallowing study (VSS) was done and a clinical symptom score was determined before and after treatment.

Results On VSS relative opening of the UES improved in all patients (mean ± SD: 47 ± 14% before versus 71 ± 24% after treatment;P < .01). Hypopharyngeal retention or laryngeal penetration of barium was significantly reduced in four of seven patients. Clinical symptom scores improved in all patients. One patient was free of symptoms, mild dysphagia persisted in six patients, and moderate dysphagia persisted in three patients.

Conclusions Our results support the use of BTA in selected patients with pure UES dysfunction. Its efficacy is limited by the possibility of a persistent structural stenosis of the UES and the risk of BTA diffusion into the larynx or hypopharynx.
New Guidelines for Endoscopic Localization of the Anterior Ethmoidal Artery: A Cadaveric Study
Authors: Lee Wai Chung , Ming Ku Peter Ka , van Hasselt Charles Andrew
Published: November 2003

Objectives To determine objective data to improve the methods of identification of the anterior ethmoidal artery during endoscopic dissection.

Study Design Cadaveric dissection of adult human heads.

Methods A 0°, 4‐mm rigid endoscope was used to guide uncinectomy and frontoethmoidectomy. The location of the anterior ethmoidal artery was first determined visually and then confirmed by passing a needle through the anterior ethmoidal foramen from the orbit into the nose in all cases. The distances were endoscopically measured using a simple ruler between two nasal landmarks and the anterior ethmoidal artery.

Results Fifty‐six nasal fossae in 28 cadavers were dissected endoscopically. The median distance between the artery and the “axilla” formed by the anterior attachment of the middle turbinate to the lateral nasal wall was 20 mm (range, 17–25 mm), irrespective of the side. The measurement differed by less than 2 mm between the sides in the same individual. The median distance between the artery and the “axilla” formed by the medial and lateral crura of the lower lateral cartilage (superomedial edge of the nostril) was 62 mm (range, 55–75 mm) for both sides. The artery was found to be in direct alignment with the two “axillae” formed by the middle turbinate and the nostril edge.

Conclusions The distance between the ethmoidal artery and the axilla of the middle turbinate showed the least intraindividual and interindividual variations. The tip of the endoscope (or the ruler) points directly at the anterior ethmoidal artery in the fovea ethmoidalis when its edge is aligned with the two nasal landmarks. These simple guidelines can aid the identification of the artery in endoscopic frontoethmoidectomy.
Clinical Study and Literature Review of Nasal Irrigation
Authors: Tomooka Lance T. , Murphy Claire , Davidson Terence M.
Published: November 2003

Objectives/Hypothesis Nasal disease, including chronic rhinosinusitis and allergic rhinitis, is a significant source of morbidity. Nasal irrigation has been used as an adjunctive treatment of sinonasal disease. However, despite an abundance of anecdotal reports, there has been little statistical evidence to support its efficacy. The objective of this study was to determine the efficacy of the use of pulsatile hypertonic saline nasal irrigation in the treatment of sinonasal disease.

Study Design A prospective controlled clinical study.

Methods Two hundred eleven patients from the University of California, San Diego (San Diego, CA) Nasal Dysfunction Clinic with sinonasal disease (including allergic rhinitis, aging rhinitis, atrophic rhinitis, and postnasal drip) and 20 disease‐free control subjects were enrolled. Patients irrigated their nasal cavities using hypertonic saline delivered by a Water Pik device using a commercially available nasal adapter twice daily for 3 to 6 weeks. Patients rated nasal disease–specific symptoms and completed a self‐administered quality of well‐being questionnaire before intervention and at follow‐up.

Results Patients who used nasal irrigation for the treatment of sinonasal disease experienced statistically significant improvements in 23 of the 30 nasal symptoms queried. Improvement was also measured in the global assessment of health status using the Quality of Well‐Being scale.

Conclusions Nasal irrigation is effective in improving symptoms and the health status of patients with sinonasal disease.
Evaluating the Role of Magnetic Resonance Imaging Scans in the Surgical Management of Acoustic Neuromas
Authors: Hampton Susanne M. , Adler Julian , Atlas Marcus D.
Published: November 2003

Objective To assess the reliability of magnetic resonance imaging (MRI) in predicting the size and position of an acoustic neuroma, with particular reference to the intracanalicular portion.

Study Design Prospective study comparing the position of the tumor in the internal auditory canal on fast spin‐echo MRI with the actual position measured intraoperatively.

Methods The study was performed in a tertiary referral neurotology center, encompassing both the public and private health care systems. Fifteen consecutive patients admitted for acoustic neuroma removal via the translabyrinthine approach were studied. The main outcome measure was tumor position in the internal auditory canal expressed in millimeters, accurate to the nearest 0.5 mm.

Results The fast spin‐echo MRI was accurate within an error of 1 mm in predicting the lateral extent of the tumor in the internal auditory canal.

Conclusion Fast spin‐echo MRI can accurately predict the lateral extent of an acoustic neuroma and allow accurate planning of the surgical approach.
Structural Changes and Protein Expression in the Mastoid Bone Adjacent to Cholesteatoma
Authors: Cinamon Udi , Kronenberg Jona , Benayahu Dafna
Published: November 2003

Objective Cholesteatoma of the mastoid and middle ear causes erosion of nearby bone. In this study we examined the mastoid bone adjacent to cholesteatoma and compared it with normal mastoid bone. In particular, noncollagenous proteins, which have a special structural and functional role in bone, were addressed.

Study Design Nine mastoid specimens with cholesteatoma and four normal specimens obtained at surgery were examined.

Methods Histological and immunohistochemical methods were employed to evaluate the nature of structure and noncollagenous protein content changes in the mastoid bone affected by cholesteatoma.

Results The bone associated with cholesteatoma had structural changes as a noncontinuous periosteum, empty lacunae, irregular cement lines, and, specifically, the appearance of eosonophilic vesicles at the interface between the bone and cholesteatoma. Immunohistochemistry demonstrated that noncollagenous proteins were apparently absent in the affected mastoid bone. Bone remote from the cholesteatoma seemed normal.

Conclusions These findings demonstrate for the first time the changes in the noncollagenous protein content in the mastoid bone affected directly by cholesteatoma. These changes could be a result of a direct influence of cholesteatoma‐derived products on the osteoblast.
Genetic Analysis in the Diagnosis of Familial Paragangliomas
Authors: Petropoulos Anna E. , Luetje Charles M. , Camarata Paul J. , Keith Whittaker C. , Lee Graham , Baysal Bora E.
Published: November 2003

ObjectivesIn the management of two related patients with multicentric glomus jugulare tumors, given the incidence of 1:30,000 with approximately 20% familial cases, our objective was to review the genetic characteristics and inheritance patterns of these tumors and to determine what molecular genetic screening possibilities exist for the phenotypically normal family members. In addition, our aim was to review the incidence of various multicentric paraganglioma (PGL) tumor location combinations.

MethodsMolecular genetic linkage analysis testing was performed on the 2 patients and 14 other unaffected family members. We report the results of this screening and review the literature on the incidence and genetics of paragangliomas.

ResultsThe inheritance pattern in the literature demonstrates autosomal dominant transmission with maternal imprinting (inactivation). The proclivity for multicentric origin increases to 26% in familial cases, as reflected in our patients. In addition to the two patients, four unaffected family members demonstrated the presence of the disease haplotype at chromosome band 11q23, which indicates a very high likelihood of developing a paraganglioma, given the highly penetrant nature of the disease.

ConclusionsIt is clear that the familial PGL gene locus is situated at chromosome 11q23. The gene itself and its exact degree of penetrance, however, still await identification. Since early detection of paragangliomas reduces the incidence of morbidity and mortality, genotypic analysis as a screening tool in families of affected patients should play a front‐line diagnostic role, leading to more timely and cost‐effective patient management.
Head and Neck Cancer in Cardiothoracic Transplant Recipients
Authors: Pollard Jeffrey D. , Hanasono Matthew M. , Mikulec Anthony A. , Le Quynh T. , Terris David J.
Published: November 2003

Introduction There is an increased incidence of cancer in patients after organ transplantation. We reviewed a large series of cardiothoracic transplant recipients to determine the incidence and natural history of head and neck malignancy.

Methods A total of 1069 heart (n = 855), heart/lung (n = 111), and lung (n = 103) transplants were performed at Stanford University from January 1968 to February 1998. Demographic data, risk factors, and disease course were evaluated in patients who developed cancer. The mean length of follow‐up was 8.9 ± 5.2 years.

Results One hundred twenty patients (11.2%) developed 547 non‐lymphomatous malignancies. The mean number of malignancies per cancer patient was 4.6. The average time from transplantation to development of cancer was 63.1 months. A total of 50.5% of malignancies presented in the head and neck; 96.4% of these were cutaneous in origin and 3.6% were noncutaneous. Of cutaneous malignancies, 79.3% were squamous cell carcinoma and 15.9% were basal cell carcinoma. Cutaneous malignancies most commonly presented on the scalp, cheek, lip, and neck. Noncutaneous malignancies involved the oral cavity (5), thyroid (4), and parotid (1). Thirteen percent of cutaneous head and neck cancers behaved aggressively, requiring e‐tensive management including radical surgery, radiation, and/or chemotherapy. A total of 34.2% of cancer patients developed metastases and 54.9% of cancer patients died as a direct result of cancer. A total of 68% of cancer patients were smokers and 23.8% had significant alcohol use.

Conclusion Transplant recipients have an increased incidence of cancer presenting in the head and neck. Malignancies in transplant patients behave more aggressively than in the general population. Recognition of this aggressive biological behavior and heightened cancer surveillance should result in improved outcomes.
Patterns of Swallowing After Supraglottic Laryngectomy
Authors: Schweinfurth John M. , Silver Steven M.
Published: November 2003

Objective To understand the anatomical and physiological basis for early recovery of swallowing function after supraglottic laryngectomy.

Study Design Retrospective review.

Methods The records of nine patients who had undergone supraglottic laryngectomy at the Stratton Veteran's Administration Hospital (Albany, NY) between 1994 and 1998 were reviewed. Videofluoroscopic swallowing studies were obtained on all patients as early as was safely possible and were reviewed by a multidisciplinary team of physicians, nurses, and speech pathologists with regard to anatomical and functional differences between successful and unsuccessful recovery of swallowing function.

Results Five of nine patients resumed regular diets including thin liquids within 1 year of surgery; three patients remained dependent on enteral support. Swallowing success was most closely associated with short oropharyngeal transit time and an anterosuperior position of the larynx. Laryngeal positioning, tongue base mobility, and placement and coordination of the bolus for maximum swallowing efficiency can be improved with time and speech therapy.

Conclusions Factors that placed patients at significantly higher risk for aspiration included low laryngeal position and delayed oropharyngeal transit time. Tight lingual‐laryngeal closure did not completely prevent aspiration. At the time of the initial surgical procedure it may be important to position the laryngeal remnant as far superior and anterior under the tongue base as possible.
Intratumoral Hypericin and KTP Laser Therapy for Transplanted Squamous Cell Carcinoma
Authors: Chung Phil S. , Rhee Chung K. , Kim Kwang H. , Paek Woo , Chung Juliet , Paiva Marcos B. , Eshraghi Amir A. , Castro Dan J. , Saxton Romaine E.
Published: November 2003

Objectives/Hypothesis To test intratumoral photodynamic therapy (IPDT) as a new treatment for squamous cell carcinoma in a preclinical tumor model.

Study Design and Methods Human P3 squamous carcinoma cells were transplanted subcutaneously in athymic nude mice and allowed to grow into 300‐ to 500‐mm3 tumors. Hypericin dye at 1 μg/gm of body weight was injected intratumorally (IT) or intravenously (IV). After 4 hours hypericin biodistribution was assessed in ethanol extracts from tissues by fluorescence spectroscopy. IPDT also was tested by KTP laser fiberoptic insertion in tumors 4 hours after IT dye injection compared to KTP532 laser therapy alone (532 nm, 1W, 40–60 J, 0.6‐mm fiber).

Results Hypericin concentration in tissues was as follows: (IT vs. IV) for tumors (3660 vs. 135 ng dye/gm tissue), lung (760 vs. 6345), liver (75 vs. 935), blood (65 vs. 480) compared to skin (465 vs. 110) or muscle (335 vs. 80) adjacent to the squamous cell tumors. Four hours after dye injection, the tumor e‐hibited bright orange fluorescence when e‐cited by KTP 532‐nm green laser light. The IPDT‐treated tumors had a 3.32 ± 0.32‐mm radius of cell destruction when H&E‐stained sections were e‐amined compared with 2.5 ± 0.38 mm for the laser only control group (n = 10, P = .003).

Conclusions This pilot study indicates laser IPDT with hypericin induces a significant increase in tumor necrosis compared with laser alone and may be useful as a less invasive adjuvant treatment for recurrent or inoperable human squamous cell cancers of the head and neck.
Transforming Growth Factor‐β Type II Receptors and Smad Proteins in Follicular Thyroid Tumors
Authors: West Jeff , Munoz‐Antonia Teresita , G. Johnson Jean , Klotch Douglas , Muro‐Cacho Carlos A.
Published: November 2003

Objective Resistance to transforming growth factor (TGF)‐β–mediated cell growth inhibition is a well‐known pathogenic mechanism in epithelial neoplasia. TGF‐β signaling requires normal function of downstream mediators such as TGF‐β receptors (TβRs) and Smad proteins. The goal of this study is to investigate the expression of components of the TGF‐β signaling pathway in follicular tumors of the thyroid.

Study Design Twenty follicular thyroid neoplasms were classified as adenomas (11) or minimally invasive follicular carcinomas (9) according to current pathological criteria. Protein expression was evaluated to identify differences between benign and malignant tumors that could be used as an adjunct to histopathological analysis.

Methods Paraffin‐embedded tissue sections containing tumor and adjacent nonneoplastic parenchyma were analyzed by immunohistochemistry for the expression of TβR type II (TβR‐II) and Smad2, Smad4, Smad6, and Smad7. Expression of each protein in the tumor was compared with that of the corresponding adjacent nonneoplastic thyroid parenchyma.

Results TβR‐II expression was lost in 78% of the carcinomas. In the remaining 22%, TβR‐II was preserved but Smad2 expression was lost. In all conventional adenomas, however, TβR‐II expression was maintained. Furthermore, all tumors with normal expression of all proteins were adenomas.

Conclusions Downregulation of TβR‐II is a consistent abnormality in follicular carcinomas and can be used to differentiate minimally invasive carcinomas from adenomas. Also, downregulation of Smad proteins is another mechanism by which carcinomas can become independent from TGF‐β–mediated growth inhibition.
In Vivo Measurements of Temporal Bone on Reconstructed Clinical High‐Resolution Computed Tomography Scans
Authors: Chan Ling‐Ling , Manolidis Spiros , Taber Katherine H. , Anne Hayman L.
Published: November 2003

Purpose To retrospectively assess the accuracy of measurements of temporal bone anatomy made from reconstructed clinical high‐resolution computed tomography (HRCT) scans.

Methods Nine HRCT scans were performed on unselected clinical cases in which the subjects had a temporal bone study judged to be normal. The orbitomeatal line was prescribed for the direct axial sections. Variations in head position (rotation at the neck and lateral bending of the neck) were corrected by using the software supplied by the manufacturer. All measurements were done on standard 1‐mm axial sections and axial reconstructions obtained from 1‐mm coronal slices. The images were viewed at 4000 Hounsfield units (HU) window width and 1000 HU window level. Measurements (n = 3) made on 1‐mm direct axial HRCT scans were compared with the measurements made on reconstructed axial HRCT images from the same nine patients. These values were also compared with published cadaver data.

Results The measurements obtained from axial reconstructed and direct HRCT series approximated each other in each of the nine individual studies and also fell within the range of published cadaver values. They demonstrated the expected normal temporal bone variability between individuals.

Conclusion Useful anatomic approximations can be measured in vivo from reconstructed clinical HRCT images. Pitfalls are improper window settings, head tilt, and rotation. This protocol is widely available and can be implemented retrospectively from clinical HRCT scans.
DFNA9 Is a Progressive Audiovestibular Dysfunction With a Microfibrillar Deposit in the Inner Ear
Authors: Khetarpal Umang
Published: November 2003

Objectives Several mutations in the COCH gene were recently identified in American and European families with DFNA9, an autosomal dominant progressive sensorineural hearing loss with onset in high frequencies. Our preliminary vestibular studies in one American family indicated progressive vestibular dysfunction. More complete vestibular studies in European families have shown vestibular abnormalities in the affected individuals. Our temporal bone studies on two families with DFNA9 revealed, in addition to neurosensory degeneration, a unique acidophilic deposit in the membranous labyrinths of the affected individuals. The purposes of this study were 1) to further investigate the vestibular abnormalities in members of one American family for the purposes of genotype‐phenotype correlation and 2) to investigate the electron microscopic structure of the acidophilic deposit to obtain further insights into the pathogenesis of DFNA9.

Study Design Prospective analysis.

Methods Extensive vestibular testing was performed in some unaffected and affected members of a family with DFNA9. One temporal bone was analyzed by electron microscopy of celloidin‐embedded tissue.

Results and Conclusions The findings indicate progressive vestibular dysfunction in many of the patients affected with hearing loss. Thus, despite different mutations in the COCH gene , the American and European families manifest auditory and vestibular dysfunction. Electron microscopic analysis shows the spiral ligament to be enriched for a highly branched non‐banded microfibrillar substance that is decorated with glycosaminoglycan granules. Additionally, the spiral ligament lacks the 67‐nm‐thick straight periodically banded bundles of type II collagen that are normally abundant in this structure. A speculative pathogenetic model is proposed for this unique disease and its relationship with other late‐onset or adult‐onset audiovestibular diseases and Meniere's disease is investigated.