bluuebunny/crossref_metadata_2025 huggingface dataset:
In vivo analysis of bacterial biofilm formation on facial plastic bioimplants
Authors: Malaisrie Sukit Christopher , Malekzadeh Sonya , Biedlingmaier John F.
Published: November 2003

Objectives: This study examines the formation of biofilm on biomaterials commonly used in facial plastics and reconstruction including titanium, silicone, ionbombarded silicone (Ultrasil), e‐PTFE (Gore‐Tex), e‐PTFE with silver/chlorhexidine (Gore‐Tex Plus), and PHDPE (Medpor). Methods: These biomaterials were implanted subcutaneously in the dorsum of 11 guinea pigs after contamination with Staphylococcus aureus and examined with scanning electron microscopy after 7 days. Wounds were also inspected for infection and extrusion rates. Results: Results show biofilm formation on titanium, silicone, ion‐bombarded silicone, e‐PTFE, and PHDPE associated with high rates of extrusion and infection. Implants of e‐PTFE with silver/chlorhexidine, on the other hand, appeared resistant to biofilm formation and demonstrated significantly lower rates of extrusion and infection. Conclusions: Contamination of bioimplants in vivo leads to formation of bacterial biofilm on the surface of the biomaterial, causing infection, pus formation, and extrusion. The authors hypothesize that the antiseptic agents impregnated in the biomaterial form a protective coat of silver, chlorhexidine, and inflammatory cells that inhibits initial bacterial adhesion to the biomaterial surface. Laryngoscope, 108:1733–1738, 1998
Development of the tubotympanum in the rat
Authors: Mulder Jef J. S. , Kuijpers Wim , Peters Theo A. , Tonnaer Edith L.G.M. , Ramaekers Frans C.S.
Published: November 2003

Objective: To investigate the relationship between the anatomical maturation of the middle ear and that of the eustachian tube and paratubal muscles in the rat. Design: Wistar rats ranging from gestational day 12 to postnatal day 40 were used. Methods: Tissue specimens were examined with routine light microscopy and electron microscopy. Epithelial differentiation was studied immunohistochemically with antibodies to different cytokeratins. Results: The epithelial lining of the tubotympanum showed differentiation‐related cytokeratin expression throughout the whole developmental period. The mucociliary epithelium reached mature features around birth. A dorsal extension and its framing cartilage started forming around 5 days after birth. This extension became lined by stratified nonciliated epithelium and attained maturity around 10 days after birth concurrently with the attachment of the dilatory muscles. This process was immediately followed by aeration of the middle ear cavity. Conclusions: The continuous expression of cytokeratins demonstrates that the epithelial lining of the tubotympanum is only derived from the embryonal endoderm. Furthermore, this study demonstrates that the eustachian tube shows a two‐stage postnatal development. First, the mucociliary system matures, providing protection/clearance when the animal starts respiration and swallowing. Subsequently, the dorsal part attains maturity. The features of the epithelial lining of the dorsal part of the eustachian tube and the coincidence of the maturation of this part with the attachment of the dilating muscle fibers and the aeration of the middle ear indicates that this part provides ventilation. These findings support the authors' hypothesis that different parts of the eustachian tube serve different purposes: clearance, protection and ventilation.
Relationship of Human Papillomavirus to Schneiderian Papillomas
Authors: Weiner Jordan S. , Sherris David , Kasperbauer Jan , Lewis Jean , Li Hongzhe , Persing David
Published: November 2003

Objectives/Hypothesis: To classify a large group of Schneiderian papillomas (SPs) into their histologic subtypes and to determine the incidence of human papillomavirus (HPV) in each subtype.Study Design: Pathologic review and polymerase chain reaction–based (PCR‐based) examination of archived tissue.Methods: Slides of 114 tumors diagnosed as Schneiderian, inverting, fungiform, or cylindric cell papillomas, or any associated carcinomas, were examined by a head and neck pathologist. Using PCR, consensus primers for the L1 region of HPV were used to determine the presence of HPV in the tumors. This was also performed on normal turbinate control specimens.Results: Eighty‐two (78%) were the inverting subtype, 21 (20%) the fungiform subtype, and 2 (2%) the cylindric cell type. Nine tumors were diagnosed as either verrucous or squamous cell carcinoma. Eighty‐eight percent of the tumors had DNA of sufficient quality to be amplified using PCR. Of these, 5 of 69 (6.8%) inverting, 17 of 17 (100%) fungiform, and 0 of 2 cylindric cell papillomas were positive for HPV. One of nine (11.1%) cancers was positive for HPV. No normal turbinate tissue contained HPV. HPV types 6b and 11 accounted for all cases of fungiform papillomas. Of the five HPV‐positive inverting papillomas, three had HPV type 11 and two had HPV type 16. The single carcinoma containing HPV contained HPV type 18.Conclusions: The histologic subtype of SPs is important, as their etiologies appear to be different. HPV 6b and 11 appear to be involved in all cases of fungiform papillomas but are only rarely involved in cases of inverting or cylindric cell papillomas. HPV 16 may rarely play a role in cases of inverting papillomas, and HPV 16 and 18 may be involved in a subset of cases of carcinomas originating in an inverting papilloma.
Quality of Life Assessment in Patients Undergoing Head and Neck Surgery As Evaluated by Lay Caregivers
Authors: Deschler Daniel G. , Walsh Kathleen A. , Friedman Stephanie , Hayden Richard E.
Published: November 2003

Objectives/Hypothesis: Rehabilitation following head and neck cancer surgery has steadily moved into the outpatient realm and become dependent on caregivers with no formal medical background (lay caregivers.) Satisfactory rehabilitation and quality of life (QOL) depend on successful relationships between patients and the lay caregivers. This study evaluates the QOL assessments of patients by themselves and their primary lay caregivers before head and neck surgery. Study Design: Institutional Review Board–approved study using validated QOL assessment instrument. Materials and Methods: The preoperative QOL status in 50 patients undergoing extensive head and neck surgery was evaluated using the self‐administered Medical Outcomes Survey Short Form 36 (SF‐36). The patient's primary lay caregiver (spouse, child, or friend) completed a similar questionnaire evaluating the patient's status. Results: Thirty‐three (66%) questionnaires were returned. Twenty‐five (50%) questionnaire sets were successfully completed by both parties and employable for comparison. Sixty percent of the caregivers were within the 90% confidence interval of the patient's assessment for six or more of the eight parameters evaluated by the SF‐36. Likewise, caregiver assessments for specific parameters were consistently congruent with patient evaluation, except for the parameters of bodily pain and general health, for which caregivers demonstrated a trend for overrating pain and underestimating general health. Caregivers of the same generation as the patient demonstrated significantly higher congruence (P = .007). Similarly, a trend for higher congruence was noted in patients with recurrent disease. Conclusions: The importance of the lay caregiver has increased in the era of greater outpatient rehabilitation. This pilot study indicates that QOL assessment by lay caregivers may be examined with existing instruments and highlights QOL parameters critical to both the head and neck surgery patient and his or her primary lay caregiver.
Stapes Surgery in a Residency Training Program
Authors: Mathews Shawn B. , Rasgon Barry M. , Byl Frederick M.
Published: November 2003

Objectives: Determine parameters for successful stapedectomy and whether this procedure can be performed safely by residents in a teaching hospital.Study Design: Retrospective analysis of techniques and results for 71 stapedectomy procedures.Materials and Methods: Charts were reviewed for technique, audiological test results, complications, operative time, and anesthetic used.Results: Overall, closure of the air‐bone gap at 10 dB was achieved in 87% of patients. Use of general anesthesia and a laser‐assisted, small‐fenestra technique allowed residents to complete more operations. No severe sensorineural hearing loss was noted.Conclusions: Residents can safely and successfully perform stapes surgery using a laser‐assisted, small‐fenestra technique.
Thyroid Cartilage Fracture Repair in Rabbits: Comparing Healing With Wire and Miniplate Fixation
Authors: Dray Todd G. , Coltrera Marc D. , Pinczower Eric F.
Published: November 2003

Objectives: Evaluate cartilaginous healing in rabbits in response to surgically created thyroid cartilage fractures. Compare healing between laryngeal fracture repair techniques. Study Design: Animal model. Materials and Methods: Laryngectomy specimens were analyzed at 10 weeks, following paired wire fixation (n = 7) and miniplate fixation (n = 7) of thyroid cartilage fractures. Results: Cartilaginous unions were present in all seven of the miniplated repairs, while fibrous unions were present in six of the wired repairs. The measure of distraction at the fracture site was significantly greater in the wired repairs compared with the plated repairs (P = .005). Furthermore, in five of seven miniplated repairs no distraction at the healed fracture site was present. Conclusions: The results demonstrate the ease, tolerability, and superiority of the miniplate fixation technique for the thyroid cartilage fractures, based on a rabbit model.
Long‐term follow‐up of juvenile nasopharyngeal angiofibromas: Analysis of recurrences
Authors: Herman Philippe , Lot Guillaume , Chapot René , Salvan Didier , Huy Patrice Tran Ba
Published: November 2003

Objectives: Juvenile nasopharyngeal angiofibroma often recurs if the tumor is large. This report is a long‐term follow‐up of these cases. It establishes the prognostic values of tumor extensions, analyzes the anatomic factors involved in recurrences, describes the spontaneous evolution of remnants based on a radiographic follow‐up, and evaluates the pertinence of complex combined surgical approaches for invasive tumors and the value of complementary endoscopy. Study Design: Retrospective review of 44 cases treated between 1985 and 1996. Methods: Statistical analysis of the correlation between recurrence and tumor extension as evaluated by systematic analysis of 18 putative tumor extensions on preoperative computed tomography scans. Results: Invasion of the skull base affected two‐thirds of the patients, and the rate of recurrence was 27.5%. Extensions to the infratemporal fossa, sphenoid sinus, base of pterygoids and clivus, the cavernous sinus (medial), foramen lacerum, and anterior fossa were correlated with more frequent recurrence. Long‐term radiographic follow‐up revealed putative residual disease in nine asymptomatic patients: these remnants gradually involuted. Conclusions: The data in the current study emphasize the prognostic value of skull base invasion and the difficulty of complete resection of extended lesions. Tumor remnants detected in symptom‐free patients should be kept under surveillance by repeated computed tomography scan, since involution may occur. Recurrent symptoms may be treated by radiotherapy (30 Gy) rather than by extended combined procedures. Endoscopic surgery should be combined with surgery for better control of skull base extensions.
Plasma Adrenaline Concentrations During Functional Endoscopic Sinus Surgery
Authors: Anderhuber Wolfgang , Walch Christian , Nemeth Erika , Semmelrock Hans‐Jürgen , Berghold Andrea , Ranftl Günther , Stammberger Heinz
Published: November 2003

Objectives/Hypothesis: Vasoconstrictors (i.e., epinephrine) are routinely applied before functional endoscopic sinus surgery (FESS) but may have significant cardiac side effects. The controversy concerning clinical application of adrenaline is discussed. Study Design: In a prospectively controlled study of 51 patients undergoing FESS we evaluated the absorption of adrenaline from standard cotton pledgets and submucous infiltration and the incidence of related side effects during surgery. Additionally, a control group of 12 patients undergoing tonsillectomy was investigated. Methods: Plasma adrenaline concentrations were measured 1) before anesthesia, 2) after intubation, 3) after nasal packing with adrenaline soaked pledgets (adrenaline 1:1000) and submucous infiltration with 2 mL lidocaine with adrenaline 1:100,000 in each side, and 4) at end of surgery. The catecholamines were determined with a Merck‐Hitachi Catecholamine Analyzer, model II (Merck, Darmstadt, Germany). Pulse, electrocardiogram (ECG), and blood pressure were monitored. Results: In the FESS group, we found a remarkable decrease in systolic (S) as well as diastolic blood pressure (D) (P < .001), whereas the heart frequency was unaffected during surgery. All patients in the adrenaline group showed significant increase in plasma adrenaline (AD) concentrations in the third and fourth sample (P < .001). The control group, however, showed a significant rise in blood pressure only at beginning of surgery (P < .001) with cardiac pulse and plasma adrenaline concentrations unaffected by surgery or anesthesia. The often described severe side effects of adrenaline in combination with general anesthesia were not seen in any of our patients. Conclusions: Although systemic absorption of locally injected vasoconstrictors occurs, adrenaline‐related side effects during FESS are extremely rare when the patient is monitored exactly.
Exploring Endoscopic Neck Surgery in a Porcine Model
Authors: Carreno Octavio J. , Wilson William R. , Nootheti Pavan K.
Published: November 2003

Objectives: This study uses a porcine model to establish the feasibility of performing endoscopic procedures in the neck using standard techniques currently being employed in preperitoneal endoscopy in the abdomen. Study Design; It is a pilot study presented as a case series. Methods: Ten animals were subjected to anterior deep cervical fascia dissection using standard endoscopic instrumentation. Results: Balloon dissection and CO2 insufflation poses a number of problems: CO2 gas dissection into the chest, CO2 gas embolism into the venous circulation, carotid artery occlusion, and limited visualization causing increased risk of injury to adjacent structures. Conclusion: These issues need to be dealt with before such a method could be employed safely in humans. However, with further research and development, endoscopic neck surgery may someday become a reality.
Safety and Biological Efficacy of an Adeno‐Associated Virus Vector–Cystic Fibrosis Transmembrane Regulator (AAV‐CFTR) in the Cystic Fibrosis Maxillary Sinus
Authors: Wagner John A. , Messner Anna H. , Moran Mary Lynn , Daifuku Richard , Kouyama Keisuke , Desch Julie K. , Manley Sara , Norbash Alexander M. , Conrad Carol K. , Friborg Sandra , Reynolds Thomas , Guggino William B. , Moss Richard B. , Carter Barrie J. , Wine Jeffrey J. , Flotte Terence R. , Gardner Phyllis
Published: November 2003

Objective: The host immune response and low vector efficiency have been key impediments to effective cystic fibrosis transmembrane regulator (CFTR) gene transfer for cystic fibrosis (CF). An adeno‐associated virus vector (AAV‐CFTR) was used in a phase I dose‐escalation study to transfer CFTR cDNA into respiratory epithelial cells of the maxillary sinus of 10 CF patients. Study Design: A prospective, randomized, unblinded, dose‐escalation, within‐subjects, phase I clinical trial of AAV‐CFTR was conducted. Patients: Ten patients with previous bilateral maxillary antrostomies were treated. Main Outcome Measures: Safety, gene transfer as measured by semiquantitative polymerase chain reaction (PCR), and sinus transepithelial potential difference (TEPD) were measured. Results: The highest level of gene transfer was observed in the range of 0.1–1 AAV‐CFTR vector copy per cell in biopsy specimens obtained 2 weeks after treatment. When tested, persistence was observed in one patient for 41 days and in another for 10 weeks. Dose‐dependent changes in TEPD responses to pharmacologic intervention were observed following treatments. Little or no inflammatory or immune responses were observed. Conclusion: AAV‐CFTR administration to the maxillary sinus results in successful, dose‐dependent gene transfer to the maxillary sinus and alterations in sinus TEPD suggestive of a functional effect, with little or no cytopathic or host immune response. Further study is warranted for AAV vectors as they may prove useful for CFTR gene transfer and other in vivo gene transfer therapies. A prospective, randomized, double‐blind, placebo‐controlled, within‐subjects, phase II clinical trial of the effect AAV‐CFTR on clinical recurrence of sinusitis will determine the clinical efficacy of AAV gene therapy for CF.
Analysis of HLA Antigens in Japanese Patients With Chronic Sinusitis
Authors: Takeuchi Kazuhiko , Majima Yuichi , Shimizu Takeshi , Ukai Kotaro , Sakakura Yasuo
Published: November 2003

Objectives: Genetic factors likely play a role in the etiology of chronic sinusitis and this disease is often associated with diffuse panbronchiolitis, which is strongly associated with HLA B54 antigen. The purpose of this study is to examine whether genetic factors are involved in the pathogenesis of chronic sinusitis. Study Design: Eighty‐two Japanese patients with intractable chronic sinusitis were selected on the basis of the following criteria: 1) persistent mucous or mucopurulent nasal discharge and/or postnasal dripping for longer than 3 years and 2) opacification in bilateral maxillary sinuses and ethmoid cells in plain X‐ray films. Methods: Both class I and class II HLA antigens were analyzed by conventional micro‐cytotoxicity assays in these patients and 176 healthy control subjects. Results: In class I antigens, B54 antigen significantly increased in the patient group (antigen frequency = 29.3%, relative risk = 3.23, corrected P value = .037) compared with normal control group (antigen frequency = 11.4%). For class II antigens, no antigens were significantly increased. Conclusion: These data indicate that certain genetic factors play a role in the etiology of chronic sinusitis.
Short‐term objective and long‐term subjective results of laser‐assisted uvulopalatoplasty for obstructive sleep apnea
Authors: Mickelson Samuel A. , Ahuja Anoop
Published: November 2003

Objectives: To determine the short‐term and long‐term effects of laser‐assisted uvulopalatoplasty (LAUP) on symptoms and polysomnographic measures in patients with obstructive sleep apnea syndrome (OSAS). Study Design: Prospective assessment of outcomes after LAUP in patients with OSAS. Methods: Fifty‐nine patients with OSAS underwent LAUP, and 36 completed postoperative sleep studies. Questionnaires ranking snoring and apneic symptoms were completed by the patient and bed partner before LAUP, 6 to 12 weeks after LAUP, and in the long term (>2 years). Results: The apnea index decreased from 14.4 to 5.8 (P = .0012), respiratory disturbance index (RDI) decreased from 28.1 to 7.9 (P = .0046), and the mean lowest oxyhemoglobin saturation increased from 80.6% to 84.0% (P = .055). The RDI was reduced to 10 or less in 44.4% of patients. Subjective questionnaires showed statistically significant improvements in snoring, morning fatigue, morning headaches, daytime somnolence, and daytime psychometric measures. The symptomatic improvement persisted in the long term. Conclusions: LAUP is an effective method for the management of OSAS. We have demonstrated short‐term improvement in polysomnographic measures and short‐term and long‐term improvement in subjective measures.
Intranasal verrucous carcinoma: Relationship to inverting papilloma and human papillomavirus
Authors: Orvidas Laura J. , Lewis Jean E. , Olsen Kerry D. , Weiner Jordan S.
Published: November 2003

Objectives: To establish the incidence, appearance, behavior, and appropriate treatment of intranasal verrucous carcinoma and determine its relationship to inverting papilloma and human papillomavirus (HPV). Study Design: Retrospective review of all cases of intranasal verrucous carcinoma seen at the Mayo Clinic from 1960 through May 1996. Methods: Retrospective chart review and data collection for age, sex, smoking history, location, association with inverting papilloma, treatment, recurrence, and follow‐up. Polymerase chain reaction (PCR) testing for the presence of HPV DNA was performed on all specimens. Results: Of the 13 patients identified, most presented with nasal obstruction (10) or a noticeable intranasal lesion (8). The maxillary sinus was the extranasal site most often involved. Five patients had verrucous cancer develop in an inverting papilloma, and one had squamous cell carcinoma with the verrucous component (a hybrid tumor). All but one patient underwent surgery as initial treatment; only one patient had preoperative radiation therapy. Surgical procedures ranged from local excision to a craniofacial resection. Follow‐up ranged from 2 months to 32 years (mean, 6.5 y). Four patients had a single recurrence and two tumors recurred a second time. No metastases developed and no one died from the tumor. In seven patients (10 specimens), DNA was successfully amplified for PCR testing, and no HPV DNA was detected. Conclusions: When verrucous tumors are discovered early, they can be treated effectively with wide local excision. In some cases, a more extensive procedure may be required. A possible role for HPV in the etiology of these tumors was not found.
Bone density measurements of the paranasal sinuses on plastinated whole‐organ sections: Anatomic data to prevent complications in endoscopic sinus surgery
Authors: Sprinzl Georg Mathias , Menzler Andreas , Eckel Hans Edmund , Sittel Christian , Koebke Juergen , Thumfart Walter Franz
Published: November 2003

Objective/Hypothesis: Although anatomic data regarding the gross anatomy of the paranasal sinuses are available, severe complications of endonasal sinus surgery (ESS) are frequently reported. To understand and to avoid these complications, density of bony walls of the paranasal sinuses were studied in this report. Special attention was given to the analysis of the bone density in regions where minor and major complications occur in ESS. Methods: Thirty cadaver heads were embedded in epoxy resin. The plastic blocks were sectioned with a diamond‐coated wire saw into 1.0‐mm thick, parallel slices in axial, coronal, and sagittal planes for 10 specimens each. The slices were x‐rayed and scanned with a computerized image analyzing system. For each specimen the bone density in 12 regions of interest was measured. Results: Besides the macroscopic examination of the plastinated specimens, a bone density analysis based on x‐ray films is presented. Lowest bone density was found at the lateral wall of the sphenoid sinus (3.31 ± 0.99 mm aluminum [Al]); highest density was measured at the roof of the sphenoid sinus (12.91 ± 1.75 mm Al). Overall bone density in female specimens was 0.41 mm Al (mean) lower than in male specimens. Conclusions: This study is the first to use plastinated whole‐organ serial sections and bone density images for the analysis of potential complications in ESS. The illustration of regions with minor and major bone density of the paranasal sinuses and the ethmoid floor as presented in this study may help the novice sinus surgeon to minimize the risks of ESS and to avoid severe complications.
Body mass index less than 28 kg/m2 is a predictor of subjective improvement after laser‐assisted uvulopalatoplasty for snoring
Authors: Rollheim Jan , Miljeteig Harald , Osnes Terje
Published: November 2003

Objective/Hypothesis: To investigate whether body mass index (BMI) can be used to predict subjective improvement of snoring after laser‐assisted uvulopalatoplasty (LAUP). Study Design: One hundred nineteen consecutive adult patients who had LAUP performed for socially disruptive snoring were contacted by mail 3 months after surgery and asked to complete a questionnaire with the following alternatives as to the effect of surgery on their snoring: no improvement (1); some improvement (2); moderate improvement (3); substantial improvement (4) and abolished snoring (5). Patients reporting to categories 3, 4, or 5 were referred to as responders and to categories 1 or 2 as nonresponders. Seventy patients (59%) completed the questionnaire. Methods: A one‐stage LAUP was performed with local anesthesia in an outpatient ear, nose, and throat clinic with a CO2 laser. Patients were divided into two categories with BMI above and below 28 kg/m2 at the time of surgery. Results: BMI correlated significantly with subjective postoperative improvement. (R = 0.29; P < .02; Pearson's correlation test). Odds ratio (OR) for success by BMI less than 28 kg/m2 compared to patients with BMI greater than 28 kg/m2 was 4.8 (95% confidence interval [CI]: 1.48–15.53). Conclusions: BMI is a simple, yet important predictor of subjective reduction of snoring after LAUP and should be considered before performing such surgery.
A retrospective study of contact granuloma
Authors: Ylitalo Riitta , Lindestad Per‐Åke
Published: November 2003

Objectives: This study evaluates the clinical features of contact granuloma and compares the results of voice therapy in operated versus unoperated cases. Study Design: Retrospective review of 123 patients with contact granuloma. Thirty‐six patients had undergone one or more surgeries before phoniatric consultation. After their final operation, 33 patients had recurrence. The three patients who were cured by operation were not studied further. The course of disease in the 33 patients with recurrence was compared with that of 87 patients who did not have surgery. Methods: The hospital records were reviewed concerning age, sex, symptoms, side of granuloma, and outcome of treatment. Results: The predominant symptoms were vocal fatigue, vocal discomfort, the need for excessive throat clearing, and hoarseness. The recurrence rate after operation was 92%. Twelve months after voice therapy, 35% of the operated group and 51% of the unoperated group were cured. The patients who had surgery had almost twice as many sessions of voice therapy as the unoperated group, and their mean recovery time was 17 months, compared with 8 months for the unoperated group. Conclusions: The recurrence rate after surgery was high. Surgery may prolong the recovery time. Subjective symptoms diminished during voice therapy, but we cannot confirm that it was beneficial for the healing process.
Preoperative permanent balloon occlusion of internal carotid artery in patients with advanced head and neck squamous cell carcinoma
Authors: Adams George L. , Madison Michael , Remley Kent , Gapany Markus
Published: November 2003

Objective/Hypothesis: To determine the value of preoperative balloon occlusion in predicting the safety of carotid artery resection in advanced recurrent head and neck squamous cell carcinoma. Study Design: Retrospective chart review of all cases undergoing planned carotid artery resection for recurrent disease at a major university hospital. Methods: If the carotid artery was encased, a nonemergent carotid artery balloon test occlusion was performed for 30 minutes. If the patient tolerated this, he or she underwent permanent carotid artery occlusion. Results: Twenty‐three patients were prospectively evaluated for resection. Three underwent emergent carotid artery ligation. Twenty others underwent nonemergent carotid artery test occlusion. Of these, 5 patients failed preoperative carotid artery balloon occlusion and 15 patients successfully underwent permanent carotid balloon occlusion. Although eight of these patients died of recurrent disease in less than 1 year, seven patients survived more than 1 year with two patients surviving more than 2 years. Conclusions: Preoperative carotid balloon occlusion predicted patients who could tolerate permanent occlusion. All patients eventually developed recurrent disease, but in 14 of the 15 patients, no hemorrhages occurred.
Upper neck (level II) dissection for N0 neck supraglottic carcinoma
Authors: Tu Gui‐Yi
Published: November 2003

Objectives: Elective neck dissection for the N0 neck in head and neck surgery is still controversial. This prospective nonrandomized study of N0 supraglottic carcinoma was designed to find an appropriate method of neck management. Study Design: Anatomical studies show that the first echelon of lymphatic drainage from the supraglottic larynx is toward the upper jugular nodes (level II). An upper neck dissection (UND) was applied and all the lymph nodes were sent for frozen section. If the subclinical metastasis was found, a modified neck dissection was performed. If the nodes harbored no foci of cancer, the patients were observed after surgery on the supraglottic lesions. Methods: Patient records of 142 patients with supraglottic laryngeal cancer (T1–4N0M0) were reviewed, with special attention paid to neck recurrences and survival rates. The cases were treated between 1976 and 1990 and all were observed for at least 5 years after the operation or until the time of death. Results: The UND specimens of 142 patients were negative for metastasis. The 5‐year survival rate for this group after surgery was 80.8%, according to the life table analysis. Fifteen of the 142 patients (10.6%) had neck recurrences during the period of observation within 5 years. The recurrence rate of this series with limited dissection on the neck was comparable with those reported in the literature after neck dissection, either radical or modified. Conclusions: There is no need for a comprehensive neck dissection for N0 supraglottic laryngeal cancer. A selective neck dissection such as UND (level II) or a supraomohyoid neck dissection (sparing the submandibular region) of level II and III will serve the purpose of radical neck treatment for the supraglottic cancer.
Hearing Preservation in Microvascular Decompression for Trigeminal Neuralgia
Authors: Rizvi Syed S. , Goyal Ravi N. , Calder H. B.
Published: November 2003

Objective/Hypothesis: Sensorineural hearing loss is a disturbing complication of microvascular decompression (MVD) for trigeminal neuralgia with an incidence of 1% to 23.8%. Cerebellar retraction with increasing I‐V interpeak latency (IPL) during intraoperative brainstem auditory evoked potentials (BAEP) has been identified as the chief cause of acoustic injury. This study was designed to eliminate cerebellar retraction by a modification of the standard suboccipital craniectomy.

Study Design: Nine consecutive patients undergoing surgery for trigeminal neuralgia were prospectively selected for this study between 1994 and 1995.

Methods: Preoperative and postoperative audiograms were obtained. Preoperative and intraoperative BAEPs were performed. The surgical modification describes initiating a partial mastoidectomy to enhance early recognition and delineation of the sigmoid and transverse sinuses crucial to maximizing the lateral extent of the craniectomy. The additional exposure gained by this technique allows for improved visualization of the brainstem without cerebellar retraction.

Results: All patients were relieved of neuralgic pain. Postoperative IPL values were not significantly different from preoperative values (4.9 ± 0.6 vs. 4.7 ± 0.3 ms). Maintaining IPL of less than 1.5 ms is considered critical for preventing injury to the auditory nerve. In this study the average increase in postoperative IPL was 0.25 ms for the ipsilateral ear and 0.1 ms for the contralateral ear.

Conclusions: The authors offer a surgical modification of the standard suboccipital craniectomy and furnish intraoperative neurophysiologic data to demonstrate how cerebellar compression can be eliminated and hearing preserved in MVD for trigeminal neuralgia.
Granisetron, Droperidol, and Metoclopramide for Preventing Postoperative Nausea and Vomiting After Thyroidectomy
Authors: Fujii Yoshitaka , Tanaka Hiroyoshi , Kobayashi Noriaki
Published: November 2003

Objectives/Hypothesis: Patients undergoing thyroidectomy may be especially at risk of experiencing postoperative nausea and vomiting (PONV). This study was undertaken to compare the efficacy and safety of granisetron, droperidol, and metoclopramide for preventing PONV after thyroidectomy.

Study Design: Prospective randomized, double‐blind study.

Methods: One hundred twenty female patients received granisetron 40 μg/kg, droperidol 20 μg/kg, or metoclopramide 0.2 mg/kg (n = 40, each) intravenously (IV) immediately before the induction of anesthesia. A standardized general anesthetic technique was employed throughout the procedure.

Results: The incidence of a complete response, that is, no PONV and no need for another rescue antiemetic during the first 3 hours (0 to 3 hours) after anesthesia was 90% with granisetron, 55% with droperidol, and 50% with metoclopramide, respectively; the corresponding incidence during the next 21 hours (3 to 24 hours) after anesthesia was 85%, 50%, and 45% (P < .05; overall Fisher's Exact probability test). No clinically important adverse events were observed in any of the groups.

Conclusions: Prophylactic therapy with granisetron is superior to droperidol or metoclopramide for preventing PONV after thyroidectomy.
Incidence of vestibular schwannomas
Authors: Tos Mirko , Charabi Samih , Thomsen Jens
Published: November 2003

Objective: To determine the incidence of vestibular schwannoma (VS) in Denmark in a period of 191/2 years. Study Design: Retrospective review of prospective registered data on all patients with VS operated on by the translabyrinthine, lateral suboccipital, or middle cranial fossa approach, as well as patients who were allocated to the “wait‐and‐scan” group. Methods: Charts were reviewed and tabulated for age, extrameatal tumor extension, and date of diagnosis. The available data were divided into three periods: June 1976 to June 1983, July 1983 to June 1990, and July 1990 to December 1995. Results: The number of newly diagnosed tumors in the first period was 278, corresponding to an incidence of 7.8 tumors/million population per year; in the second period 337, corresponding to an incidence of 9.4 tumors/million population per year; and in the third period 355, corresponding to an incidence of 12.4 tumors/million population per year. A significant increase in incidence of the newly diagnosed intracanalicular tumors in the second and third periods was observed. Conclusion: The increase in incidence of VS can probably be explained by the awareness among otolaryngologists of the diagnosis of VS and better access to computed tomography and magnetic resonance imaging scans. The observed increase in the diagnosis of the small and intrameatal tumor creates a clinical dilemma, whether to operate on tumors in this early stage or to allocate patients to the wait‐and‐scan group. This problem will still be relevant in the upcoming years, since the incidence of intrameatal and small VS is expected to increase.
Relationship between cochleovestibular disorders in hemifacial spasm and neurovascular compression
Authors: Van Hung Thai , Deguine Olivier , Esteve‐Fraysse Marie José , Bonafe Alain , Fraysse Bernard
Published: November 2003

Objective: To investigate the evolution of cochleovestibular symptoms before, during, and after microvascular decompression (MVD) of the facial nerve in hemifacial spasm.Study Design: Prospective study in patients with hemifacial spasm. Among our 13 patients who underwent MVD of the facial nerve from 1995 to 1997, 6 had associated cochleovestibular disorders confirmed by neurotologic tests.Results: In four of these patients, a concomitant compression of the eighth and facial nerves was found at surgery. Preoperative magnetic resonance angiography studies had shown three cases of this double neurovascular compression. Intraoperative auditory brainstem response monitoring showed that interposition of Teflon between vessel and facial nerve was highly critical to the auditory function. Auditory brainstem response monitoring was used to guide the surgeon during this critical phase. Surgery improved at least one cochleovestibular symptom in each patient.Conclusions: The authors propose two pathophysiologic hypotheses. First, the concomitant facial and cochleovestibular symptoms may be due to a hyperactivity of both the facial and vestibular nuclei. According to theories about cryptogenic hemifacial spasm, the origin of this hyperactivity could be an ectopic excitation focus. However, the two nerves may have different sites of ectopic excitation. According to the second hypothesis, a pulsatile compression of the facial nerve may be transmitted to the eighth nerve. This could take place even if only the facial nerve is in contact with a vascular loop.
A new technique for laser‐assisted uvulopalatoplasty: Decision‐tree analysis and results
Authors: Remade Marc , Betsch Christian , Lawson Georges , Jamart Jacques , Eloy Philippe
Published: November 2003

Objective: Report a new technique of laser‐assisted uvulopalatoplasty (LAUP) for snoring performed as a one‐stage procedure. Study Design: A decision‐tree was used in a prospective study of 89 patients from April 1994 to May 1997. It included a fiberscopy and Midler's maneuver, rhinomanometry, pH monitoring, computed tomography scan to measure the pharyngeal lumen, pulse oximetry, and polysomnography in case of sleep apnea syndrome was suspected. Methods: The authors performed their LAUP technique on 43 patients (48.5%) whose snoring was mainly caused by the velum. This technique consists of scarifying the velum by vaporizing the mucosa and the submucosa along a rectangle extending from the palatal dimple to the uvula and having a width of 1.5 to 2 cm. Vaporization of the palatal arches follows without exceeding the junction of the anterior and posterior pillars in height. The uvula is cut if necessary, preserving a length of at least 0.5 cm. The other patients underwent different procedures according to the cause of snoring. Results: There was no significant difference between LAUP and uvulopalatoplasty (UPPP) regarding pain. No permanent phonatory disorders and no regurgitation occurred. Satisfaction evaluated on a scale ranging from 0 to 10 was equivalent for the two techniques: mean value = 7.68 (±2.18) for LAUP and 8.60 (±2.27) for UPPP. The mean follow‐up was 17 months (range, 1–37 mo). Satisfaction was also identical for all techniques. Conclusion: Our LAUP technique combined with other procedures according to a decision‐tree is efficient and safe.
Acoustic neuroma surgery: Absent auditory brainstem response does not contraindicate attempted hearing preservation
Authors: Roberson Joseph B. , Jackson Lance E. , Mcauley James R.
Published: November 2003

Objective: Absence of auditory brainstem response (ABR) waveforms has been associated with a poor likelihood of hearing preservation following resection of acoustic neuromas. Our experience is reviewed for patients with absent preoperative ABR regarding hearing preservation, hearing improvement, and return of ABR.Study Design: Retrospective review of 22 cases of acoustic neuroma resection. Nine patients with absent preoperative ABR were identified. All underwent tumor resection utilizing intraoperative cochlear nerve action potential (CNAP) monitoring. Postoperative hearing results and ABR waveforms were examined.Methods: Charts were reviewed and tabulated for age, sex, tumor side, tumor size, preoperative and postoperative audiometric and ABR results, intraoperative monitoring results by ABR and CNAP, and surgical complications.Results: Hearing preservation was achieved in seven of nine patients (78%) with absent preoperative ABR, as well as six of seven patients (86%) with tumors less than or equal to 20 mm in greatest dimension. Although intraoperative ABR monitoring was not possible in any of these patients, CNAP monitoring was successful in all. Return of ABR waveforms was observed in four of the six patients (67%) tested from 3 to 22 months postoperatively. Four of the seven patients (57%) enjoyed improvement in hearing class as defined by the guidelines of the American Academy of Otolaryngology—Head and Neck Surgery.Conclusions: Absent ABR waveforms have not been a negative prognostic sign regarding hearing preservation. CNAP monitoring is possible in these patients and likely helps to minimize iatrogenic cochlear nerve trauma. Patients with no ABR waveforms have hope of hearing preservation and even improvement following acoustic neuroma resection performed utilizing CNAP monitoring and hearing preservation surgical techniques.Key Words: Acoustic neuroma, auditory brainstem response, cochlear nerve action potential, hearing preservation.
Double cartilage block ossiculoplasty in chronic ear surgery
Authors: Harvey Steven A. , Lin Sandra Y.
Published: November 2003

Objectives/Hypothesis: Multiple techniques of ossicular reconstruction have been advocated for hearing rehabilitation in the setting of chronic otitis media. No single method can adequately address the clinical spectrum of disease severity. In the situation of a severely diseased ear requiring a canal wall down (CWD) mastoidectomy in the presence of an intact stapes superstructure, the authors have employed a double cartilage block (DCB) ossiculoplasty. The technique and short‐term results are reviewed. Study Design: Retrospective chart review in a tertiary referral otologic practice. Methods: Twenty‐three patients underwent a CWD tympanomastoidectomy with DCB ossiculoplasty. Ages ranged from 6 to 85 years (mean, 36.1 y). The majority of ears were actively draining at the time of surgery (83%) and most procedures were revisions of prior mastoidectomies (74%). Audiometric data (mean postoperative follow‐up, 19.5 mo) were calculated according to 1995 American Academy of Otolaryngology–Head and Neck Surgery guidelines. Results: Audiometric results were available in 20 patients. The mean air‐bone gap (ABG) was 23.8 dB after surgery. Closure of the ABG to within 20 dB was achieved in 10 of 20 patients (50%). No cases of DCB extrusion have occurred to date. Conclusions: The DCB represents an excellent alternative to biocompatible prostheses for ossicular reconstruction in the setting of severe chronic ear disease. As with all methods of ossiculoplasty, long‐term follow‐up will be necessary to determine if this technique remains stable in the hostile environment in which it has been employed. Key Words: Double cartilage block, ossiculoplasty, chronic otitis media.
Reduced postoperative infections with an immune‐enhancing nutritional supplement
Authors: Snyderman Carl H. , Kachman Kim , Molseed Rd Laura , Wagner Robin , D'amico Frank , Bumpous Jeffrey , Rueger Robert
Published: November 2003

Objectives/Hypothesis: Malnutrition is a significant risk factor for postoperative infections in patients undergoing oncologic surgery. This study was undertaken to determine if perioperative nutritional supplementation with an immune‐enhancing formula is superior to standard formula in the prevention of postoperative infectious complications. Study Design: This was a prospective, randomized, double‐blind trial comparing perioperative nutritional supplementation with Impact and standard nutritional formulas. Methods: Following stratification, 136 patients undergoing oncologic head and neck surgery were randomly assigned to one of four treatment groups: preoperative/postoperative Impact, postoperative Impact, preoperative/postoperative standard formula, and postoperative standard formula. Outcome measures included laboratory evaluations of nutritional status, infectious and wound healing complications, and duration of hospitalization. Statistical analysis was performed using ξ2 or two‐tailed Fisher Exact Tests, when appropriate. Results: Intent‐to‐treat (P = .02) and actual therapy (P = .04) analyses revealed a significant decrease in the incidence of postoperative infectious complications (all sites) in patients who received Impact. There was no significant difference in wound healing problems or duration of hospitalization. Postoperative measures of nutrition status demonstrated a higher serum albumin (P = .05) in patients who received Impact compared with standard formula. Conclusions: Compared with standard formula, perioperative nutritional supplementation with Impact significantly reduced the incidence of infectious complications. The length of hospitalization was significantly prolonged in patients with postoperative infections, suggesting potential cost savings with the use of immune‐enhancing formulas such as Impact. Key Words: Nutritional supplements, malnutrition, head and neck cancer.
Influence of lateral osteotomies in the dimensions of the nasal cavity
Authors: Grymer Luisa F. , Gregers‐Petersen C. , Pedersen H. Baymler
Published: November 2003

Objectives: To elucidate the importance of placement of lateral osteotomy in rhinoplasty at a level above or below the insertion of the inferior turbinate at the pyriform aperture.Study Design: Controlled lateral osteotomies were performed in 16 cadaver noses. Eight of the lateral ostetomies were placed below (low) and eight were placed above (high) the insertion of the inferior turbinate. In all 16 noses medial osteotomies were performed. Dimensions of the nasal cavity were measured by acoustic rhinometry before and after the osteotomies.Methods: The total minimum cross‐sectional area (TMCA) and the cross‐sectional area at the pyriform aperture (TCA‐3.3) were calculated and the preoperative and postoperative values were analyzed statistically.Results: There was no significant difference in the reduction of cross‐sectional area in the group that underwent high lateral osteotomy compared with the group the underwent low lateral osteotomy. In both groups the TMCA was reduced, with 12% of the value (P= .001) before osteotomy, and the TCA‐3.3 was reduced, with 15% of the value before osteotomy (P= .000).Conclusions: After lateral and medial ostetomies a significant decrease in the anterior dimensions of the nose is observed. The decrease following osteotomy does not seem to be due to the placement of the lateral osteotomy at the pyriform aperture but rather to the detachment of the bony vault from the surrounding structures.Key Words: Lateral osteotomy, rhinoplasty, acoustic rhinometry, nose dimensions.