bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of topical oral antibiotics in head and neck prophylaxis: Is it justified?
Authors: Kirchner J. Cameron , Edberg Stephen C. , Sasaki Clarence T.
Published: October 2006

Systemic antibiotic therapy is widely used for prophylaxis in major head and neck surgery, hut the efficacy of topical oral antibiotic therapy has not been adequately investigated. A pilot, placebo‐controlled, double‐blind crossover study using six healthy adult male volunteers was performed to assess the influence of topical clindamycin on oral flora. Samples of saliva were cultured for aerobic and anaerobic bacteria immediately before, and at 1‐ and 4‐hour intervals after, rinsing the mouth with a solution of either placebo or clindamycin. Quantitative analysis demonstrated significantly reduced levels of both aerobic and anaerobic bacteria after use of the topical antibiotic at both the 1‐ and 4‐hour intervals.

It is postulated that topical clindamycin, by reducing concentrations of oral flora, may also reduce the incidence of regional infection following major upper aerodigestive tract surgery.
Laryngeal paraganglioma: Update on diagnosis and treatment
Authors: Konowitz Paul M. , Lawson William , Urken Mark L. , Som Peter M. , Breakstone Beth A. , Biller Hugh F.
Published: October 2006

Sixty‐one cases of laryngeal paraganglioma have been reported in the world literature. Histologic and clinical similarities between this neuroendocrine neoplasm and other organoid laryngeal tumors have led to uncertainty regarding the malignant potential and prognosis of this entity. Immunohistochemical assays have identified biogenic amines and hormonal peptides in these tumors which may prove useful as diagnostic markers. Computed tomography (CT) scanning demonstrates an enhancing lesion and can determine the location and extent of the tumor. The generally small size and constant blood supply of the laryngeal paraganglioma make preoperative angiography unnecessary. Accordingly, intraoperative ligation of the arterial blood supply negates the need for embolization. Partial laryngectomy remains the mainstay of treatment. A case is reported of a patient with a paraganglioma of the larynx who was unsuccessfully treated by laser excision and required surgical resection.
The immunology of tonsils in children: The effect of bacterial load on the presence of b‐ and t‐cell subsets
Authors: Brodsky Linda , Moore Linda , Stanievich John F. , Ogra Pearay L.
Published: October 2006

Tonsil core specimens of 54 children, (3 to 12 years) with clinical evidence of chronic tonsillitis and/or “idiopathic” tonsillar hypertrophy, were studied for the effect of the magnitude of aerobic bacterial load on tonsil size and the absolute numbers of B‐ and T‐cell subsets. Tonsillar core specimens obtained from ten children with no history of ear, nose, or throat infections and normal appearing tonsils served as controls.

The findings of this study indicate that tonsil size was directly proportional to the mean bacterial load in colony forming units/g tonsil (CFU/g) even in the absence of a clinical history of infection (p < 0.01). A mean bacterial load of 2.4 ± 2.1 × 104 CFU/g tonsil was seen in diseased tonsils as compared to 1.6 ± 2.4 × 104 CFU/g tonsil in normal controls (p < 0.01). Hemophilus influenzae (type B and non‐B), Staphylococcus aureus, Streptococcus pneumoniae and Streptococcus pyogenes were the most common pathogens recovered in the largest numbers from diseased tonsils; control tonsils harbored few bacteria in their cores.

The absolute number of immunocompetent cells/g tonsil including T‐helper, T‐suppressor and B‐cells (S‐Ig+), were significantly greater in diseased tonsils than in controls (p < 0.001). Increasing microbial load (CFU/g tonsil) correlated with increased numbers of T‐helper (p < 0.01) and B‐cells (p < 0.01).

These data strongly support a bacterial etiology for chronic tonsillitis as well as “idiopathic” tonsillar hypertrophy. Bacterial induced proliferation of immunocompetent cells may be one underlying mechanism for chronic tonsillar disease in children.
Paranasal sinus malignancy: A comprehensive update
Authors: Sisson George A. , Toriumi Dean M. , Atiyah Raja A.
Published: October 2006

A retrospective analysis of 60 cases of paranasal sinus cancer in patients admitted between 1970 and 1985 was undertaken. Forty‐six tumors originated in the maxillary sinus, and 14 originated in the ethmoid sinuses. Computed tomography, magnetic resonance imaging, and endoscopic sinus examination aided in early diagnosis of sinus cancer. Computed tomography aided in staging tumors; Caldwell‐Luc alone was inadequate for staging tumors invading deeper sites such as the orbits or pterygoid muscle. There were 15 early (T1 or T2) and 31 advanced (T3 or T4) maxillary sinus cancers. Multimodality therapy incorporated radiation, surgery, and chemotherapy. The 5‐year survival rate was 49%. We prefer preoperative radiotherapy for advanced lesions and postoperative radiotherapy for early lesions. The use of preoperative radiation therapy has increased our globe salvage rate. All but one of the patients who developed recurrent disease showed recurrence at the primary site prior to developing regional or distant metastasis. Radiation therapy, combined with aggressive surgical management to remove all tumor, provided the best survival rates in advanced lesions.
Otolaryngologic problems in cardiac transplant patients
Authors: Ganzel Toni M. , Brohm Judy , Nechtman Carl M. , Ganzel Brian L. , Klein Jon B. , Gray Laman A.
Published: October 2006

Cardiac transplantation is now a well‐accepted treatment for selected patients who have end‐stage heart disease. Of the 38 patients who underwent cardiac transplants at our center from August 1984 through August 1987, 27 received consultation for otolaryngologic problems. Eleven patients had sinonasal complications; 8 had laryngotracheal complications; 4 had otologic complications; 2 had oropharyngeal complications; and 2 had a combination of more than one of the above complications. Of these otolaryngologic disorders, 63% were infectious in etiology. Development of otolaryngologic infections generally did not correlate with either higher doses of maintenance immunosuppression or with treatment of an acute rejection episode, which requires increased immunosuppression. Otolaryngologists should be aware of the sinonasal, laryngotracheal, oropharyngeal, and otologic disorders that can occur in cardiac transplant patients.
Toy weapons and firecrackers: A source of hearing loss
Authors: Gupta Deepak , Vishwakarma S. K.
Published: October 2006

Although acoustic injury as a result of exposure to noisy toys and firecrackers has been reported previously, most of these studies have been conducted on adults. The purpose of this prospective study, conducted at the time of Deepawali, an Indian festival of fireworks, was two‐fold: 1. to measure the acoustic output of representative samples of toy weapons and firecrackers and the intensity level at critical spectator points from the site of emission; and 2. to determine the auditory statue of a cross section of the target population, involving 600 participants from various age groups, before and after exposure to firecracker noise at Deepawali.

The average sound level at a distance of 3 m was 150 dB, thus exceeding the damage risk criterion for adults (i.e., 130 dB peak level). An average 30 dB persistent sensorineural hearing loss was found in 2.5% of the target population as a result of toy weapon/firecracker noise during Deepawali. The 9‐to 15‐year‐old age group was most affected. A judicious approach in the manufacture and use of toy weapons and firecrackers, in addition to legal restraints, is advocated.
Severe versus profound sensorineural hearing loss in children: Implications for cochlear implantation
Authors: Brookhouser Patrick E. , Worthington Don W. , Kelly William J.
Published: October 2006

The advent of cochlear implants for children has stimulated interest in the specific sensory deficits and communicative capabilities of children with severe or profound bilateral sensorineural hearing loss. Appropriate management of these children and their families requires an appreciation of the multifaceted developmental and educational challenges confronting deaf children, even after cochlear implantation. Evaluation results from 200 children with bilateral sensorineural deafness (63 severe/137 profound, anacusic, and fragmentary) reveal significant differences between these two subpopulations. Within the profoundly impaired group, important differences were also noted in the children's ability to benefit from conventional amplification, depending on residual hearing at or above 1000 Hz. Strategies for assessing auditory function and aided benefit in severely and profoundly hearing‐impaired children must involve a pediatric test battery, serial evaluations, and parental cooperation/support. When selecting candidates for cochlear implantation, it is inappropriate to categorize severely hearing‐impaired children with those children having profound sensorineural losses. Even profoundly impaired populations are not homogeneous, and rehabilitation potential with conventional amplification must be determined on an individual basis, over time.
The effect of cosmetic rhinoplasty on nasal patency
Authors: Adamson Peter , Smith Oakley , Cole Philip
Published: October 2006

Fifty patients who primarily desired cosmetic improvement underwent nasal airflow studies using posterior rhi‐nomanometry before and after reduction rhinoplasty. There was no significant difference in nasal resistance before and after surgery. This study demonstrates that neither subjective nor objective nasal obstruction follows reduction rhinoplasty, despite the potential for a decreased cross‐sectional area of the valve region.
Computer‐aided 3‐D temporal bone anatomy for cochlear implant surgery
Authors: Takahashi Haruo , Sando Isamu
Published: October 2006

To define anatomical relationships important in cochlear implantation, computer‐aided three‐dimensional reconstruction and measurement of middle and inner ear structures in six normal temporal bones were performed. Our findings were as follows: 1. When viewed from the posterior hypotympanotomy (facial recess) approach, the inferior 10% to 30% of the round window (RW) membrane was visible in only half the cases. 2. The most inferior portion of the basal turn of the scala tympani was not only inferior but also slightly anteriorly behind the RW membrane in more than half the cases. 3. The shortest distances from the aperture of the RW niche and from the margin of the RW to the stapes head were 2.38 ±0.33 and 2.15 ±0.22 mm, respectively. 4. The distance between the RW and the most inferior portion of the basal turn scala tympani was 5.15 ± 0.34 mm. 5. The direction of the electrode advancement lay at a sharp angle to the inferior part of the RW (mean 31.9 ± 3.6 degrees). 6. The direction from the RW to the most inferior portion of the basal turn scala tympani lay 16.0 ± 5.3 degrees anteroin‐ferior to the direction of the advancement of the electrode to the RW. 7. The distance between the margin of the RW and the basilar membrane of the cochlea was 0.58 ±0.10 mm at the superior aspect of the RW, and was 1.23 ±0.12 mm at the lateral aspect of the RW. 8. Dissecting away less than 1 mm (mean 0.7 ±0.27 mm) of the RW margin inferiorly or infero‐laterally was enough to permit straight insertion of the electrode in most cases.
Lipoinjection for unilateral vocal cord paralysis
Authors: Mikaelian Diran O. , Lowry Louis D. , Sataloff Robert T.
Published: October 2006

Injection of Teflon® paste is a commonly accepted procedure to improve the caliber of voice in unilateral vocal cord paralysis. There are several drawbacks to Teflon injection, among them respiratory obstruction (from overinjected Teflon) and unsatisfactory voice quality (Teflon causes stiffness of the vocal folds).

This paper is a preliminary report on lipoinjection instead of Teflon injection into a paralyzed vocal fold. Fat appears to impart a soft bulkiness to the injected cord, while allowing it to retain its vibratory qualities. It is autologous material and can be retrieved if excessively overinjected. The fate of autologous fat injected into a paralyzed vocal cord remains unknown. Most of the literature on lipoinjection concerns repairs of depressed scars or breast augmentation. Our longest follow‐up has been 12 months. Three patients have had this procedure, and the results appear to be very encouraging.
Malignant nerve sheath tumors of the head and neck: A combined experience from two university hospitals
Authors: Bailet Jeffrey W. , Abemayor Elliot , Andrews James C. , Rowland John P. , Fu Yao‐Shi , Dawson Douglas E.
Published: October 2006

Malignant schwannoma is an aggressive neoplasm whose cell of origin and histologic characteristics remain controversial. Despite advances in diagnostic techniques, the natural history of this tumor remains uncertain. The charts of all patients with malignant schwannoma who were treated at the UCLA Center for the Health Sciences and the University of Iowa Hospital and Clinics were retrospectively reviewed. Sixteen patients received surgery and radiotherapy in combination or as sole therapy. Irrespective of treatment modality, prognosis was poor with an overall survival of 15%. Recent advances in imaging and histologic techniques that assist in establishing the diagnosis and delineating tumor location are discussed. In addition, the literature pertaining to malignant schwannoma of the head and neck is reviewed.
Clinical assessment of postural stability following vestibular nerve section
Authors: Cass Stephen P. , Kartush Jack M. , Graham Malcolm D.
Published: October 2006

Little is known about the recovery of postural control in patients following acute vestibular loss. This paper reports on the results of moving‐platform posturography to assess the recovery of postural stability in 24 patients following vestibular nerve section. Posturography was abnormal prior to surgery in 17% of the patients. Seven days following surgery, 44% of the patients demonstrated vestibular deficit patterns, while 56% of the patients had normal posturography. Posturography was normal in all patients 1 month following surgery. Abnormal posturography was subsequently noted in 21% of the patients between 3 and 20 months following surgery. Each of the patients with abnormal preoperative posturography subsequently demonstrated abnormal late postoperative posturography. These results suggest that perioperative posturography may be useful in the evaluation and counseling of patients considering ablative vestibular surgery.
Preservation of the facial nerve in the management of recurrent pleomorphic adenoma
Authors: Samson Michael J. , Metson Ralph , Wang C. C. , Montgomery William W.
Published: October 2006

Whether to preserve or sacrifice a facial nerve involved with benign neoplasm is one of the most difficult intraoperative decisions confronting the head and neck surgeon. We reviewed 21 cases of recurrent pleomorphic adenoma treated with subtotal excision and facial nerve preservation, followed by postoperative radiation therapy. Of the 17 patients with microscopic residual tumor at completion of surgery, 16 (94%) remain free of recurrence with an average follow‐up of 5.9 years. Only one of four patients (25%) with a large postoperative tumor load remains free of disease. Facial nerve function is normal in 20 of 21 patients. Preservation of the facial nerve with postoperative irradiation should be considered as an alternative to nerve sacrifice in selected cases of recurrent pleomorphic adenoma.
Site of airway obstruction in patients with obstructive sleep apnea before and after uvulopalatopharyngoplasty
Authors: Metes A. , Hoffstein V. , Mateika S. , Cole P. , Haight J. S. J.
Published: October 2006

This study describes a simple method, based on a movable catheter technique, for use during routine polysomnography to identify the site of obstruction, and this has been applied to 51 patients with suspected sleep apnea. The obstruction was found to be retropalatal in 30, retrolingual in 7, and could not be determined in 14 patients (12 had no sleep apnea, 1 did not sleep, and 1 had central sleep apnea). Twelve of these patients had uvulopalatopharyngoplasty with preoperative and postoperative polysomnograms to determine the site of obstruction. The preoperative obstruction was retropalatal in nine and retrolingual in three. Postoperatively, four patients (one with retrolingual obstruction and three with retropalatal obstruction) no longer had sleep apnea. In the remaining eight patients, the site of obstruction was unchanged from the preoperative one. Several conclusions result: 1. the movable catheter technique offers a simple way to determine the site of obstruction in patients with significant obstructive sleep apnea, 2. most such patients obstruct in the retropalatal region, and 3. preoperative localization of the site of obstruction to the retropalatal region does not seem to improve the surgical outcome of uvulopalatopharyngoplasty.
Hashimoto's thyroiditis and carcinoma of the thyroid: Optimal management
Authors: Sclafani Anthony P. , Valdes Marie , Cho Hyun
Published: October 2006

Several authors have noted a high incidence of thyroid carcinoma in patients with Hashimoto's thyroiditis (HT), and some have even considered HT a premalignant condition. The authors evaluated all patients with surgically proven HT at Beth Israel Medical Center in New York from 1985 through 1990. Of these 48 patients, 8 (17%) had thyroid carcinoma in addition to HT. No statistically significant difference between patients with and without concurrent carcinoma was noted in the percentage of patients with a dominant mass, irregular thyromegaly, compressive symptoms, suspicious fine needle aspiration biopsies (FNABs), or a cold nodule on thyroid scintigraphy. However, patients with neither a positive FNAB nor a cold nodule were much less likely to have carcinoma than patients with one or both of these tests positive (0% vs. 26%, P±.05). A management scheme for patients with HT is proposed to adequately and efficiently evaluate and treat patients for concurrent thyroid carcinoma.
Nodal size of metastatic squamous cell carcinoma of the neck
Authors: Friedman Michael , Roberts Nancy , Kirshenbaum Gary L. , Colombo James
Published: October 2006

The preoperative use of computed tomographic (CT) scanning continues to be the best diagnostic method for preoperative detection of metastatic neck disease. Current accepted criteria for CT diagnosis of nodal disease are not uniform, although nodal size, nodal grouping, and central necrosis correlate strongly with malignancy. To assess the relationship of nodal size and malignancy, a multicenter study was designed to evaluate the nodes from 100 neck dissections. Sixty‐nine positive neck dissections were analyzed, and every node was measured. The relationship of central necrosis was also compared with node size. Our results showed that CT scanning continues to provide a reliable picture of the histologic status of lymph nodes. Using the criterion of central necrosis or node size larger than 1 cm, only 7% of necks had nodal disease that would have been missed by CT interpretation. This study supports the continued use of preoperative CT evaluation for metastatic neck disease.
Orthotopic laryngeal transplantation: Is it time?
Authors: Berke Gerald S. , Block Robert M. , Sloan Steven , Sercarz Joel , Ye Ming
Published: October 2006

The notion of returning phonatory and respiratory function by transplanting larynges has fascinated and challenged the minds of laryngologists for many years. In the past, the problems of revascularization, tissue rejection, and physiologic vocal fold motion have stymied the success of research in this area. Today, advances in microvascular surgery, graft versus host response, and selective reinnervation have made laryngeal transplantation a theoretical, if not a practical reality. Despite this progress, serious ethical and fiscal considerations remain unresolved. This report will discuss these advances as well as concerns and will present the current UCLA laryngeal physiology laboratory experience with canine laryngeal transplantation.
Motor innervation of the eustachian tube muscles in the guinea pig
Authors: Hecht Craig S. , Gannon Patrick J. , Eden Avrim R.
Published: October 2006

The brainstem location of motoneurons innervating eustachian tube‐associated muscles in the adult guinea pig was determined using intramuscular injections of the neural tracer horseradish peroxidase (HRP). Following HRP injections into the tensor veli palatini and the eustachian tube belly of the medial pterygoid muscle, an ipsilateral column of HRP‐labeled motoneurons was present medial to the dorsolateral division of the trigeminal motor nucleus. Following HRP injection into the levator veli palatini, labeled motoneurons were present in the ipsilateral dorsal division of nucleus ambiguus. The locations of the tensor veli palatini and levator veli palatini motoneurons are similar to those found in studies of other animals. A distinct eustachian tube belly of the medial pterygoid muscle was also identified. This sub‐belly had a motoneuron pool distinct from the main medial pterygoid muscle group. The authors have provided the gross anatomical and neuroanatomical substrates upon which future studies of eustachian tube function in the guinea pig may be based.
pitfalls in evaluation of photosensitizing agents: An example with q‐switch II dye
Authors: Eton Darwin , Ahn Samuel , Shim Veronica , Kitada Shinishi , Elis Duncan G. , Lee David
Published: October 2006

Photosensitizing agents potentiating laser therapy should have limited toxicity, no mutagenicity, stable spectral characteristics, and acceptable solubility when administered in vivo. Q‐Switch II dye (QII) has been shown by others to be an effective chromophore for photodynamic therapy at 1051 nm in fibroblast cell culture. The objective of this study was to determine the spectral stability of QII in biological media and then to localize QII after administration in vivo.

Spectral evaluation was performed between 250 and 1100 nm. QII dissolved in dimethyl sulfoxide (DMSO) rapidly lost its spectral characteristics, including its 1051‐nm peak, when contacting water, minimal essential medium, human serum, organ surfaces, and intracellular fluid. One minute following intramuscular (IM) injection of 0.1 mg QII in 0.2 mL of DMSO, the dose precipitated as a discrete mass which was excised and reconstituted in DMSO. A new spectral pattern was seen, with no absorption between 850 and 1100 nm. Following intravenous (IV), (IM), or intraperitoneal (IP) injection, QII was not detected in any organ.

Q‐Switch II dye is not a suitable chromophore for in vivo photodynamic therapy at 1051 nm. Previous cell culture reports to the contrary did not account for the QII spectral change caused by biological media. Simple rapid assays are described to avoid this pitfall.
Cloning and sequencing of genomic DNA extracted from archival human temporal bone sections
Authors: Kerner Marc M. , Wackym Phillip A. , Popper Paul , Tabor David E. , Grody Wayne W.
Published: October 2006

Cloning techniques allow the engineering and production of highly purified DNA. Further advances in molecular biology have provided the means to identify DNA sequences in a rapid fashion. Sequencing methods can identify mutations, deletions, polymorphisms, or confirm a known genetic sequence. The use of these techniques in clinical medicine has made it possible to accurately diagnose infectious diseases and determine the molecular etiology of many genetic disorders and malignancies.

In this study, DNA extracted from archival, celloidin‐embedded temporal bone sections has been cloned and sequenced using these techniques. We amplified, cloned, and sequenced varicella‐zoster viral DNA extracted from archival temporal bone sections from patients who had herpes zoster oticus. The application of cloning and sequencing techniques to DNA extracted from archival temporal bones provides the methodology to study temporal bone pathology at the molecular level.
The turbulent noise ratio: An estimation of noise power of the breathy voice using PARCOR analysis
Authors: Mori Kazunori , Blaugrund Stanley M. , Yu Jong Daw
Published: October 2006

The degree of turbulent noise in the breathy voice of 25 patients with incomplete glottal closure was determined by PARCOR (PARtial autoCORrelation) analysis. From 10,000 acoustic data points, 44 PARCOR coefficients were calculated to form the residue wave which is representative of the glottal source. The power difference between the residue wave and the original acoustic wave was calculated in order to define a new measurement of acoustic power termed the turbulent noise ratio (TNR). The 25 patients were studied before and after Isshiki thyroplasty type I (IttI). The TNR became smaller in 24 of these patients following IttI, and corresponded closely with acoustic (Fukazawa's Br‐Index), aerodynamic (Isshiki's AC/DC ratio), mean airflow rate during phonation, and videolaryngostroboscopic findings. Data affirm that the TNR accurately reflects the degree of turbulent noise at the glottal source.
Pathogenesis of peritonsillar abscess
Authors: Passy Victor
Published: October 2006

The pathogenesis of peritonsillar abscess is described in textbooks as being a direct communication and progression of acute exudative tonsillitis. Little study has been done on the true etiology and pathogenesis of peritonsillar abscess. This paper focuses on the pathogenesis of peritonsillar abscess. A group of salivary glands (Weber's glands) proven to be located in the supratonsillar space have been shown to be implicated in the pathogenesis of peritonsillar abscess. A review of peritonsillar abscess has been undertaken, and evidence has been presented to support the premise that the true cause for peritonsillar abscess is not necessarily an extension of an acute exudative tonsillitis, but an abscess formation of Weber's salivary glands in the supratonsillar fossa.
High relative risk of a second pulmonary cancer in patients affected by laryngeal cancer: Differences by specific site of occurrence and lung cancer histotype
Authors: Silvestri Furio , Bussani Rossana , Cosatti Carla , Bosatra Andrea
Published: October 2006

The frequency of a second primary lung tumor in patients affected by laryngeal cancer has been evaluated on the basis of 128,532 biopsies and 27,753 autopsies carried out from January 1, 1979 through December 31, 1988.

Among these cases, 432 laryngeal cancers and 44 synchronous or metachronous pulmonary cancers have been detected (7 during life, 37 at autopsy).

The highest risk of developing a lung tumor has been evidenced in patients affected by supraglottic cancer during the first 2 years of follow‐up (relative risk [RR]: 32.56 for supraglottic patients versus 5.55 for glottic patients). This is particularly true of patients affected by multicentric supraglottic tumors (RR: 62.5).

A significant hyperfrequency of undifferentiated lung cancers also has been noted in supraglottic patients (RR: 45.45 for supraglottic versus 14.28 for glottic patients).

The information provided by autopsy allows for a more realistic and detailed outlining of the issue of tumor multiplicity, stressing the importance of strict preventive and follow‐up protocols.
Prevalence of facial canal dehiscence and of persistent stapedial artery in the human middle ear: A report of 1000 temporal bones
Authors: Moreano Edwin H. , Paparella Michael M. , Zelterman Daniel , Goycoolea Marcos V.
Published: October 2006

A total of 1000 temporal bones were used to study the prevalence of facial canal dehiscence and of persistent stapedial artery in detail. Of the temporal bones studied, 560 (56%) contained at least one facial canal dehiscence. There was a 76.3% prevalence of bilaterality of this canal wall gap. The most common site of dehiscence was the oval window area. The concept of microdehiscence of the facial canal is introduced. One third of the temporal bones observed had a microdehiscence of the facial canal, usually located at the oval window area (74.9%) and found bilaterally 40% of the time. The authors found a 0.48% prevalence (5 out of 1045) of persistent stapedial artery. This is the first histological study of temporal bones to report a prevalence of this vascular anomaly.
Traumatic pseudoaneurysm of the intracavernous ICA presenting with massive epistaxis: Imaging diagnosis and endovascular treatment
Authors: Han Moon Hee , Chang Kee Hyun , Han Man Chung , Sung Myung Whun , Min Yang Gi , Han Dae Hee
Published: October 2006

Traumatic pseudoaneurysm of the intracavernous internal carotid artery (ICA) is a very rare cause of epistaxis but is a life‐threatening clinical situation when left untreated. The authors have experienced four cases of traumatic pseudoaneurysm involving the intracavernous ICA. Delayed massive epistaxes developed 1 to 8 months after trauma and initial transient epistaxis in all four patients. Three of the cases were successfully managed by the detachable balloon occlusion (DBO) of the ICA along with the aneurysm openings. In one case, a large pseudoaneurysm destroying a large area of the central skull base with peripheral blood clot was demonstrated on computed tomography, magnetic resonance imaging, and angiography; this patient died due to massive epistaxis before the trial of DBO. Imaging findings of pseudoaneurysms involving the intracavernous ICA in the four cases are described, and the role of endovascular treatment is discussed.
Airway obstruction in hemophilia (factor VIII deficiency): A 28‐year institutional review
Authors: Bogdan Charles J. , Strauss Melvin , Ratnoff Oscar D.
Published: October 2006

Life‐threatening airway compromise is rarely reported as a major complication of coagulation disorders. However, before adequate factor‐replacement therapy became available, this complication was often fatal. A retrospective review of all patients with classic hemophilia admitted to our institution from 1964 through 1992 was performed. The records of 147 patients who had a total of 1804 admissions were examined. Fifteen episodes of airway obstruction occurred. Additionally, 6 cases of potential airway compromise and 5 cases of airway‐endangering oropharyngeal bleeding were identified. Tracheotomy was performed in 5 patients; 1 fatality occurred before modern replacement products were available. Patients with this disorder have a 13% chance of some form of airway‐endangering event with an 8% chance that it will be immediately life‐threatening. Tracheotomy and subsequent decannulation are safe procedures in these patients.
Intraluminal flame spread in tracheal tubes
Authors: Wolf Gerald L. , Sidebotham George W. , Stern Jeffrey B.
Published: October 2006

Intraluminal combustion in polyvinyl chloride tracheal tubes was investigated. Two flame types were observed: intraluminal and downstream. The flame‐spread velocity, burning rate, and equivalence ratio of the intraluminal flame were determined. The products of the intraluminal flame were analyzed, revealing compounds capable of further combustion.

Below a certain oxidant flow rate, the tubes do not ignite. At low flow rates that support a flame, the burning rate is minimal and the equivalence ratio reveals no fuel available for the downstream flame, suggesting that ignition of tracheal tubes is least likely in the absence of intraluminal flow.

We conclude that the downstream flame is the flame type that is most dangerous and that the intraluminal flame is the generator of fuel and ignition energy for the downstream flame.
Relationship of biopsy and final specimens in evaluation of tumor thickness in floor of mouth carcinoma
Authors: Karas David E. , Baredes Soly , Chen Thomas S. , Karas Shawky F.
Published: October 2006

A number of studies have suggested that tumor thickness may be a valuable prognostic indicator in the evaluation of head and neck cancers. This study examined the relationship between tumor thickness measured in preliminary biopsy specimens with the final specimens obtained in 31 patients patients with floor of mouth epidermoid carcinoma. There was a significant statistical correlation between biopsy and final specimens. The Pearson's product‐moment correlation coefficient was 0.58, which corresponded to a significance level of P<.0005. The results of this study showed that those patients who had biopsies with a thickness less than or equal to 1 mm were likely to have final specimens with a thickness less than 2 mm. All patients with a thickness greater than 2 mm had a final specimen with a thickness greater than 3.5 mm. Modification of current biopsy techniques may result in values more predictive of final thickness measurements.
Intraoral ultrasound evaluation of peritonsillar abscess
Authors: Strong E. Bradley , Woodward Paula J. , Johnson Leland P.
Published: October 2006

Peritonsillar cellulitis and peritonsillar abscess are similar clinical entities with markedly different methods of treatment. Therefore, accurate diagnosis is paramount to appropriate treatment.

This pilot study was designed to evaluate the sensitivity and specificity of intraoral ultrasound as a noninvasive method of differentiating abscess from cellulitis. Sixteen consecutive patients suspected of having peritonsillar abscess were prospectively evaluated with intraoral ultrasound. The results were confirmed with imaging or surgical drainage.

Correct diagnoses were made in 9 (90%) of 10 abscesses and in 5 (83%) of 6 cases of cellulitis. Our results suggest that, while there is a learning curve for intraoral ultrasound, it is an accurate, noninvasive, and inexpensive tool to differentiate abscess from cellulitis. We believe that this will be a clinically useful technique in the future.
Orbital osteology: A study of the surgical landmarks
Authors: Mcqueen Chapman T. , Diruggiero Douglas C. , Campbell Jeffrey P. , Shockley William W.
Published: October 2006

This study was conducted to re‐examine the osteological anatomy of the orbit. Previous studies examined dried human skulls; this study looks at cadaveric specimens in a population that more closely resembles the population in the United States. Measurements were made of the bony orbit to define safe distances for surgical intervention and to identify distances to intraorbital fissures, canals, and foramina. Safe distances to the optic nerve were identified by subtracting 5 mm from the shortest measured specimen. The safe distances were as follows: medial quadrant, 29 mm; inferior quadrant, 39 mm; superior quadrant, 38 mm; and lateral quadrant, 36 mm. Staying close to the bony wall, not exceeding these parameters, and careful identification of anatomical structures should keep the surgeon from inadvertent damage to the intraorbital structures.
Nervus intermedius function after vestibular schwannoma removal: Clinical features and pathophysiological mechanisms
Authors: Irving Richard M. , Viani Laura , Hardy David G. , Baguley David M. , Moffat David A.
Published: October 2006

The results of facial nerve outcome following vestibular schwannoma removal have generally ignored the sensory component of the nerve. This lack of reporting occurs partly because the distress relating to these functions is less obvious to the surgeon, and partly because the facial nerve grading systems currently used do not include the functions of the nervus intermedius.

We have estimated the frequency and nature of abnormalities of nervus intermedius function following vestibular schwannoma removal using a retrospective questionnaire. Questionnaires were mailed to 257 patients and correctly completed and returned by 224 (87%) of the patients.

Prior to surgery 5 (2%) of the patients complained of crocodile tears, 9 (4%) noted dryness of the eye, and 15 (6%) complained of an abnormality of taste. Postoperative crocodile tears occurred in 98 (44%), an absence or significant reduction in the production of tears was noted in 162 (72%), and a taste abnormality, either a significant reduction or an alteration in character, was noted in 107 (48%). The onset of crocodile tears approximated to a bimodal distribution, and the recovery of nervus intermedius functions was variable.

This study has demonstrated that nervus intermedius abnormalities are common following vestibular schwannoma removal. It also documents their natural history and discusses the underlying pathophysiological mechanisms. We suggest that appropriate preoperative counseling be given to all patients undergoing surgery and that the functions of the nervus intermedius be included in the surgical reporting of facial nerve results in cerebellopontine angle surgery.
Surgical treatment of cervicofacial nontuberculous mycobacterial adenitis in children
Authors: Tunkel David E. , Brian Romaneschi K.
Published: October 2006

Fifteen children with nontuberculous mycobacterial adenitis of the head and neck underwent surgical treatment between July 1991 and July 1994. Fineneedle aspiration for biopsy and culture allowed early diagnosis in nine children. Positive cultures grew Mycobacterium auium‐intracellulare complex in 12 children and M. chelonei in one child. Total excision was performed in 10 cases with combinations of lymphadenectomy and salivary gland excision. Curettage was used to successfully treat five children. One patient required local flap coverage for primary wound repair. Two patients required more than one surgical procedure. Our approach to early diagnosis and surgical treatment of cervicofacial nontuberculous mycobacterial adenitis is presented.
Vocal fold medialization using autologous cartilage in a canine model: A preliminary study
Authors: Guay Marc E. , Miller Frank R. , Bauer Thomas W. , Tucker Harvey M.
Published: October 2006

Unilateral vocal fold paralysis can alter phonation. Medialization of the vocal fold using cartilage augmentation dates to the early 1950s. Improved phonation after cartilage chordal augmentation has been reported, but no study has as yet documented cartilage viability or size in this setting over time.

The authors of this study evaluated thyroid alar cartilage as a medializing material in three mongrel dogs. Grafts were inserted lateral to the inner thyroid perichondrium at the vocal fold level via a window in the thyroid cartilage. Changes in weight, size, and volume were assessed 6 months after implantation. The average graft weight declined by 15%, and the average square area declined by 3%. Importantly, the average volume maintained was 87%. The grafts remained rigidly fixed to the thyroid cartilage in their placement positions. Histologic examination documented minimal resorption. The data suggest that thyroid alar cartilage is a viable filler in type I thyroplasty procedures.
Bacteriology of sinusitis in human immunodeficiency virus‐positive patients: Implications for management
Authors: Upadhyay Sanjiv , Marks Steven C. , Arden Richard L. , Cohn Arnold M. , Crane Lawrence R.
Published: October 2006

The bacteriology of sinusitis in human immunodeficiency virus (HIV)‐infected patients has been only sporadically reported. In this study, we report the results of cultures taken from 12 HIV patients with refractory chronic sinusitis who underwent surgery.

Nine of the 12 patients had positive cultures with 16 isolates and 5 patients having multiple isolates. Five of the 12 patients grew out atypical or opportunistic infections not responsive to standard medical therapy, including 3 patients with cytomegalovirus, 1 with Aspergillus fumigatus, and 1 with Mycobacterium kansasii.

These results suggest the need for aggressive medical care for HIV‐infected patients with sinusitis and early intervention for tissue cultures in patients who do not respond to standard antibiotic regimens.
Preoperative identification of patients at risk for delirium after major head and neck cancer surgery
Authors: Weed Harrison G. , Lutman Christopher V. , Young Donn C. , Schuller David E.
Published: October 2006

This study was performed to determine preoperative criteria for identifying patients at risk for delirium after major head and neck cancer surgery. The authors prospectively evaluated 138 consecutive patients undergoing head and neck cancer surgery lasting more than 2 hours at the Arthur G. James Cancer Hospital and Research Institute, Ohio State University, Columbus, from July 1993 through May 1994.

Postoperative delirium developed in 24 of 138 patients (17%; 95% confidence interval 11% to 24%). The strongest univariate predictors of delirium were living alone (P=.005), the American Society of Anesthesiologists class (P=.003), and the preoperative white blood cell count (P<.0001). A predictive model for delirium using five criteria mdash age of 70 or more years, alcohol abuse, poor cognitive status, poor functional status, and markedly abnormal serum sodium, potassium, or glucose level mdash stratified the patients into three cohorts with an increasing risk of postoperative delirium (i.e., 9%, 19%, and 25%).
Functional outcome after surgery for prevention of pharyngospasms in tracheoesophageal speakers. Part I: Speech characteristics
Authors: Blom Eric D. , Hamaker Ronald C. , Pauloski Barbara Roa
Published: October 2006

The speech characteristics of 29 patients with primary tracheoesophageal puncture who received either a pharyngeal constrictor myotomy, a unilateral pharyngeal plexus neurectomy, or a unilateral pharyngeal plexus neurectomy with drainage myotomy limited to the cricopharyngeus were studied. All patients used a Blom‐Singer low‐pressure voice prosthesis. Audio recordings of each patient speaking with both the Blom‐Singer tracheostoma valve and manual occlusion of the tracheostoma were recorded at 3 weeks, 6 months, and 12 months after surgery. The three surgical variations were equally effective at preventing pharyngospasms; only 1 patient (10%) in each group had some loss of fluency during the 12 month study period. Neurectomized patients produced significantly higher fundamental frequencies during reading than did patients in the other groups. Residual resting tone in the neurectomized pharyngoesophageal segment may contribute to more favorable speaking frequencies in this group.
The natural history of globus pharyngeus
Authors: Rowley H. , O'Dwyer T.P. , Timon C.I. , Jones A.S.
Published: October 2006

While globus pharyngeus is a common disorder, accounting for 3% to 4% of new otolaryngology outpatient referrals, few long‐term follow‐up studies have been conducted on patients with this condition. The authors of this study followed 74 patients with a diagnosis of globus pharyngeus for an average of 7 years, 7 months (range: 7 years to 8 years, 10 months). During the follow‐up period, 55% of patients were asymptomatic and 45% of patients had persistent symptoms.

An in‐depth analysis of features at clinical presentation failed to reveal any reliable prognostic indicators. A number of patients developed other conditions during the follow‐up period, but no patient developed upper aerodigestive tract malignancy. This study represents the longest follow‐up of globus patients to date and, to the authors' knowledge, is the first to address the issue of malignancy in globus.
Nodal inclusion cysts of the parotid gland and parapharyngeal space: A discussion of lymphoepithelial, aids‐related parotid, and branchial cysts, cystic warthin's tumors, and cysts in sjogren's syndrome
Authors: Som Peter M. , Brandwein Margaret S. , Silvers Adam
Published: October 2006

The purpose of this report is to examine the computed tomography scans, magnetic resonance images, and pathologic findings in 44 patients, 42 of whom had inclusion‐type cysts of the parotid and parapharyngeal space of varying etiologies. Two additional cases of cystic changes in the benign lymphoepithelial lesion (BLEL) of Sjogren's syndrome are highlighted here, since they had unusually large cystic components mimicking acquired immunodeficiency syndrome‐related parotid cysts (ARPCs).

A retrospective examination identified 18 ARPCs, 3 lymphoepithelial cysts (LECs), 13 cystic Warthin's tumors, 8 branchial cysts, and 2 cases of cysts in patients with Sjögren's syndrome (BLEL), all of whom had imaging studies and pathologic confirmation. There were 30 men and 14 women with an age range of 25 to 72 years (median, 46.82 years). Any similarities in the imaging appearances were noted, as were any differences in pathologic detail.

On imaging, only the cystic Warthin's tumors had any focal wall nodularity; the other cysts had smooth walls. When multiple parotid cysts were present, the distinguishing feature between ARPCs and cysts in BLEL (and some cystic Warthin's tumors) was the presence of diffuse cervical adenopathy in patients with ARPCs. Imaging usually could not differentiate between a solitary parotid LEC, a branchial cyst, and some cystic Warthin's tumors. Extraparotid lesions were either branchial cysts or cystic Warthin's tumors.

Physicians should be aware of the variety of different inclusion‐type cysts that may occur in the parotid gland and parapharyngeal space, all of which may have similar imaging appearances. Although imaging clearly identifies these cysts and may suggest a specific diagnosis, it must always be remembered that the precise diagnosis remains in the province of the pathologist.
A quantitative and qualitative exploration of client‐therapist interaction and engagement in treatment in an alcohol service
Authors: Macdonald James , Cartwright Alan , Brown Gary
Published: October 2006

Studies have suggested that differences in the effectiveness of therapists may be related to the therapist's ability to maintain a facilitative stance in the face of client resistance or hostility. The current study, examined a sample of audiotaped sessions from Hyams, Cartwright, and Spratley's (1996) study of engagement in an alcohol treatment service in an attempt to see whether the therapists' effectiveness at engaging clients in treatment was related to client‐therapist interaction in assessment interviews. It was hypothesized that there would be (1) more overall negative interpersonal behaviour (2) more negative interpersonal behaviour by the therapist and (3) more negative interpersonal complementarity in interviews where the client failed to engage. Structural Analysis of Social Behaviour was used to assess the interpersonal behaviour of clients and therapists in three case comparisons, each of which focused on an engage and a non‐engage case provided by one of three participating therapists. An additional series of follow‐up qualitative case studies was carried out on the interviews where the client failed to engage. The results were mixed, with the qualitative analyses providing more support for the hypotheses than the quantitative analysis. It was concluded that problematic interpersonal processes might be harder to gauge in assessment sessions than later on in therapy and methodological recommendations were made for enhancing the likelihood of detecting problematic processes in future studies.