bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasound‐Guided Interstitial Nd: YAG Laser Treatment of Voluminous Hemangiomas and Vascular Malformations in 92 Patients
Authors: Werner Jochen A. , Lippert Burkard M. , Gottschlich Stefan , Folz Benedikt J. , Fleiner Bernd , Hoeft Steffen , Rudert Heinrich
Published: November 2003

In many cases voluminous vascular anomalies of the head and neck region are still treated with conventional surgery, although neodymium:yttrium‐aluminum‐garnet (Nd:YAG) laser therapy offers a valuable treatment alternative. Ninety‐two patients with voluminous hemangiomas and vascular malformations were treated with interstitial Nd:YAG laser therapy (power density, 1300 to 3300 W/cm2), partly complemented by a noncontact‐mode Nd:YAG laser light application (energy density, 1000 to 2500 J/cm2). The vascular tumors had a diameter of more than 3 cm in at least two dimensions. Treatment was carried out under ultrasound and manual control. Nearly 60% of the patients (n = 55) showed a complete clinical regression. Thirty‐three patients (35.8%) had a partial regression and were satisfied with the treatment outcome. Four patients were treated unsuccessfully with the laser, and three of them subsequently underwent conventional surgery. Only nine of the 92 patients (9.8%) showed cosmetic or functional impairments. The results of this first consecutive series study with a retrospective clinical evaluation of the interstitial Nd:YAG laser therapy of voluminous hemangiomas and vascular malformations in a large patient group demonstrate a high effectiveness of this novel therapy modality.
Reconstruction After Temporal Bone Resection
Authors: Gal Thomas J. , Kerschner Joseph E. , Futran Neal D. , Bartels Loren J. , Farrior Jay B. , Ridley Marion B. , Klotch Douglas W. , Endicott James N.
Published: November 2003

Reconstruction of soft tissue defects after temporal bone resection can vary from simple closure of the external auditory canal to complex flap coverage of extensive defects. Between 1987 and 1996, 34 patients underwent lateral skull base resections and reconstruction for invasive carcinoma of the temporal bone. Seven underwent sleeve resection and/or radical mastoidectomy. Sleeve resection was managed with tympanoplasty, canalplasty, or obliteration of the external auditory canal (10). There were 24 lateral temporal bone resections and four subtotal temporal bone resections. Larger defects created by lateral and subtotal temporal bone resections required closure with a combination of temporalis flaps and local rotational cutaneous flaps (13). Lower island trapezius flaps (five), free flaps (four), and pectoralis major flaps (two) were also used. Indications and efficacy of each method are discussed, and treatment outcomes are presented.
Influence of Size and Etiology of Glottal Gap in Glottic Incompetence Dysphonia
Authors: Omori Koichi , Slavit David H. , Kacker Ashutosh , Blaugrund Stanley M.
Published: November 2003

This study investigates the relationship between glottal gap and vocal function in patients with glottic incompetence dysphonia. Twenty patients with vocal fold paralysis (VFP), 17 patients with vocal fold atrophy (VFA), and five patients with sulcus vocalis (SV) were examined. Glottal gap area at the most closed point of vibration was measured using digitized videostroboscopic images. Glottal gap area was correlated with acoustic and aerodynamic measures of vocal function. Patients with VFP had the largest glottal gaps and had significantly worse vocal function than did the patients with VFA or SV. Regardless of groups, however, where glottal gap size was similar, there was no difference in vocal function. Therefore vocal function was mainly influenced by glottal gap size, not by whether glottic incompetence was the result of VFP, VFA, or SV.
Pediatric Bilateral Facial Paralysis
Authors: Smith Vanessa , Traquina Diana N.
Published: November 2003

Bilateral facial paralysis is an unusual clinical entity that occurs in less than 1% of patients with facial paralysis. In children bilateral facial paralysis is even more rare, and establishing its etiology can be challenging. Four pediatric patients ranging in age from 3 to 17 years are presented who developed bilateral facial paralysis as a result of acute otitis media, Lyme disease, recurrent central nervous system leukemia, and acute disseminated encephalomyelitis. The diagnosis and treatment of pediatric bilateral facial paralysis are reviewed, as well as the pertinent literature.
Imaging Destructive Lesions of the Petrous Apex
Authors: Chang Phillip , Fagan Paul A. , Atlas Marcus D. , Roche James
Published: November 2003

Cholesterol granuloma and cholesteatoma are the two most common destructive lesions of the petrous apex. Arachnoid cyst is less common. These three expansile lesions are often indistinguishable on clinical grounds. Cholesterol granulomas can be treated effectively through internal drainage into the mastoid cavity or middle ear. Cholesteatomas, however, are managed by more aggressive and complicated removal, which often mandates the sacrifice of hearing. Symptomatic arachnoid cysts are amenable to simple surgical drainage. Therefore, accurate preoperative recognition on computed tomography (CT) and magnetic resonance imaging (MRI) is important in planning proper treatment. Thirteen cases of destructive lesions of the petrous apex are analyzed. The authors' experience illustrates that the “typical” CT and MRI radiographic features are diagnostic in some cases, but not in all. In this study the pathologic findings have been correlated with the radiologic features on both MRI and CT.
Diagnostic Value of the Preoperative Sestamibi Scan in Intraoperative Localization of Parathyroid Adenomas: A Case Study
Authors: George Elaina F. , Komisar Arnold , Scharf Stephen C. , Ferracci Adrienne , Blaugrund Stanley
Published: November 2003

A retrospective chart review of 43 patients who underwent technetium 99m (Tc‐99m) sestamibi scans from June 1995 to January 1997 was performed. Only those who underwent subsequent parathyroid exploration with excision were included in the study. Twenty subjects (13 women and seven men) were included in the study. Ages ranged from 21 to 84 years (mean, 58 years). All patients had laboratory values and clinical findings consistent with primary hyperparathyroidism. Two patients had preoperative magnetic resonance imaging (MRI) scans (one patient with recurrent disease), and one had a preoperative computed tomography (CT) scan. The remaining patients had the sestamibi scan as the only preoperative localization study. There were 18 pathologic diagnoses of parathyroid adenoma and two of parathyroid hyperplasia. Sestamibi failed to correctly identify the location of the parathyroid lesion in two cases. In 18 cases the preoperative sestamibi scan correctly localized the lesion, a predictive value of 90%. We conclude that the Tc‐99m sestamibi scan is an accurate preoperative tool that can be used as a single modality to localize parathyroid adenomas.
Regulators of Proliferation and Apoptosis in Carcinoma of the Larynx
Authors: Whisler Laura C. , Wood Nancy B. , Caldarelli David D. , Hutchinson James C. , Panje William R. , Friedman Michael , Preisler Harvey D. , Leurgans Sue , Nowak Jan , Coon John S.
Published: November 2003

Expression of interrelated gene products regulating cell proliferation and apoptosis may be disordered in squamous cell carcinoma (SCC) of the larynx compared with normal squamous mucosa. Certain of these abnormalities, alone or in combination, may be of prognostic significance in low‐stage carcinomas of the larynx. A retrospective study of archival material was made. Expression of the Bcl‐2 family of apoptosis‐related genes (bcl‐2, bcl‐X, mcl‐1, and bax) and the proliferation‐ and apoptosis‐related genes p53 and cyclin D‐1 were determined in 40 low‐T‐stage laryngeal carcinomas and in uvular epithelium from patients without SCC. Among the antiapoptotic members of the Bcl‐2 family, Bcl‐X and Mcl‐1 showed more intense and widespread staining than Bcl‐2 itself in both normal squamous mucosa and SCC. The well‐ordered expression patterns of Bcl‐2‐related proteins found in normal epithelium were lost in SCC, and patterns of expression varied widely among individual tumors. Also, mean expression levels for Bax and cyclin D‐1 were significantly lower than in normal epithelium (P = .036 and P = .009, respectively), whereas expression of p53 was higher in tumors (P = .034). Expression of Bcl‐X and Mcl‐1 was greater in poorly differentiated than in well‐differentiated tumors (P = .014 and P = .031, respectively). No associations were seen between marker expression patterns and clinical outcome in this group of patients. Bcl‐x and Mcl‐1 appear to be the most abundantly expressed antiapoptotic proteins of the Bcl‐2 family in both normal squamous mucosa and SCC of the larynx. Multiple genes regulating proliferation and apoptosis are expressed abnormally in laryngeal SCC compared with normal epithelium. In particular, loss or measurable decrease in expression of the proapoptotic protein Bax in tumors may contribute to the deranged growth control of SCC. Further study is needed to evaluate the prognostic significance of particular patterns of disordered expression of proteins regulating proliferation and apoptosis in SCC of different head and neck sites.
The Cerebellopontine Angle: Does the Translabyrinthine Approach Give Adequate Access?
Authors: Fagan Paul A. , Sheehy John P. , Chang Phillip , Doust Bruce D. , Coakley Darragh , Atlas Marcus D.
Published: November 2003

A long‐standing but unfounded criticism of the translabyrinthine approach is the misperception that this approach does not give adequate access to the cerebellopontine angle. Because of what is perceived as limited visualization and operating space within the cerebellopontine angle, some surgeons still believe that the translabyrinthine approach is inappropriate for large acoustic tumors. In this study, the surgical access to the cerebellopontine angle by virtue of the translabyrinthine approach is measured and analyzed. The parameters are compared with those measured for the retrosigmoid approach. This series objectively confirms that the translabyrinthine approach offers the neurotologic surgeon a shorter operative depth to the tumor, via a similar‐sized craniotomy. This permits superior visualization by virtue of a wider angle of surgical access. Such access is achieved with the merit of minimal cerebellar retraction.
Effects of Chronic Electrical Stimulation on Spiral Ganglion Neuron Survival and Size in Deafened Kittens
Authors: Araki Susumu , Kawano Atsushi , Seldon H. Lee , Shepherd Robert K. , Funasaka Sotaro , Clark Graeme M.
Published: November 2003

We have studied spiral ganglion cell (SGC) survival and soma size in neonatally pharmacologically deafened kittens. They were implanted with a four‐electrode array in the left cochlea at 100 to 180 or more days of age. Eight animals were chronically stimulated approximately 1000 hours over approximately 60 days with charge‐balanced, biphasic current pulses; three were unstimulated controls. Using three‐dimensional computer‐aided reconstruction of the cochlea, the SGC position and cross‐sectional area were stored. SGC position was mapped to the organ of Corti by perpendicular projections, starting from the basal end. The basal region of the cochlea was divided into three 4‐mm segments. SGC survival (number per 0.1 mm of the length of the organ of Corti) and soma size for stimulated cochleae were compared statistically with implanted but unstimulated cochleae. There was no evidence of an effect of electrical stimulation on SGC survival under this protocol and with this duration. On the other hand, the cell size on the stimulated side was significantly larger than the control side in the middle segment (4 to 8 mm from the basal end). SGCs undergo a reduction in size after prolonged auditory deprivation; however, these changes may be partially moderated after chronic intracochlear electrical stimulation.
A Prospective Quality of Life Study of Patients With Laryngeal Carcinoma by Tumor Stage and Different Radiation Therapy Schedules
Authors: Hammerlid Eva , Mercke Claes , Sullivan Marianne , Westin Thomas
Published: November 2003

This study was designed to prospectively monitor the quality of life of laryngeal cancer patients, to compare the quality of life of patients with small tumors with that of patients with large tumors, and to test any quality of life difference in patients with small tumors treated with conventional versus hyperfractioned accelerated radiation therapy. Patients having had a laryngectomy within the study year were also analyzed separately. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ‐C30), the EORTC Head and Neck Module (H&N‐37), and the Hospital Anxiety and Depression (HAD) scale were administered six times during 1 year. These questionnaires were found to be suitable for measuring laryngeal cancer patients' quality of life longitudinally. The questionnaires were sensitive to differences in quality of life for small versus large tumors and showed that hyperfractioned accelerated radiation therapy was advantageous compared with conventional radiation therapy with respect to quality of life at the 1‐year follow‐up.
Cephalometric Parameters After Multilevel Pharyngeal Surgery for Patients With Obstructive Sleep Apnea
Authors: Yao Mike , Utley David S. , Terris David J.
Published: November 2003

Cephalometric studies have shown narrowing in the upper airway at multiple levels in patients with obstructive sleep apnea. Uvulopalatopharyngoplasty (UPPP), mandibular osteotomy with genioglossus advancement, and hyoid myotomy with advancement address narrowing in the retropalatal and retrolingual regions. In an effort to relate postoperative clinical changes to anatomic changes, cephalometric studies were performed on 44 patients who underwent multilevel pharyngeal surgery (UPPP, genioglossus advancement, hyoid myotomy with advancement). Both preand postoperative radiographs were available for 23 of these patients. The posterior airway space (P = .09), minimal posterior airway space (P = .04), posterior uvular space (P = .06), mandibular plane‐to‐hyoid distance (MP‐H) (P = .06) and central incisor‐to‐tongue base distance (P = .02) all improved after surgery. None of the measurements of the posterior airway were significantly different between responders and nonresponders. The degree of collapse of the palate on modified Müller maneuver was highly correlated with the severity of sleep apnea as measured by the respiratory disturbance index; the collapse of the lateral pharyngeal walls was moderately correlated; and collapse of the base of tongue was not correlated. Cephalometric radiographs may reflect the anatomic changes that result from upper airway surgery for sleep apnea, but these changes are not useful for assessing surgical efficacy. The modified Müller maneuver, however, may represent a more predictive evaluation.
Tracheal Autotransplantation: A Reliable Reconstructive Technique for Extended Hemilaryngectomy Defects
Authors: Delaere Pierre R. , Poorten Vincent Vander , Goeleven Ann , Feron Michel , Hermans Robert
Published: November 2003

Objectives: Current surgical treatment for a glottic cancer with significant subglottic extension is a total laryngectomy. The objective of this study was to expand laryngeal conservation procedures by using a reconstructive technique that allows for the repair of hemicricolaryngectomy defects.

Study Design: After resection of the ipsilateral thyroid, cricoid, and arytenoid for advanced T3 glottic cancer, the laryngeal defect was reconstructed by means of an autotransplanted segment of trachea in four patients. The reconstruction consisted of a transferable patch that was constructed from a segment of revascularized cervical trachea.

Methods: During a 14‐day period, a 4‐cm segment of cervical trachea was wrapped by a free radial forearm fascial flap. In the second stage, the glottic cancer was removed and the cervical trachea was isolated on its fascial blood supply and transformed into a patch that was used to repair the extended hemilaryngectomy defect. Two different patch designs were used. Two patients underwent reconstruction with a patch augmented at the glottic level (group A); two patients underwent reconstruction without glottic augmentation on the patch (group B). Tracheal continuity was restored by an end‐to‐end reanastomosis. The postreconstruction morphology of the two patch designs was compared with the preoperative laryngeal morphology.

Results: The autotransplantation technique led to complete restoration of the subglottic airway lumen in all four patients. Although the anterior‐posterior glottic diameter was reduced by 36% in group A patients and by 43.5% in group B patients, a sufficient glottic airway lumen was obtained. The glottic sphincteric function was restored in both groups.

Conclusions: Tracheal autotransplantation may be used reliably to repair hemicricolaryngectomy defects. Augmentation of the patch at the level of the glottis is not essential for successful rehabilitation.
Computer‐aided endoscopic sinus surgery
Authors: Anon Jack B.
Published: November 2003

Objectives: To examine four different types of computer‐aided endoscopic sinus surgical devices—the ISG Viewing Wand, the ISG infrared OptoTrak, the IGT FlashPoint 5000, and the VTI InstaTrak—with emphasis on their accuracy and ease of use. Study Design: Prospective study utilizing laboratory experiments and intraoperative data collection. Methods: A review of the literature is presented. Patients undergoing endoscopic sinus surgery during the study period were enlisted under FDA protocols with IRB consent. Groups of patients had surgery performed with each of the above devices—except the FlashPoint 5000. Accuracy measurements were recorded, and user and operating staff comments about ease of use were collected. The FlashPoint 5000 was used exclusively in the laboratory setting, where accuracy measurements were obtained on a cadaver skull. Results: The systems all demonstrated accuracy to within 2.00 mm. Ease of use was somewhat variable, but following a learning curve by the surgeon and operating department personnel, all of the units were considered to be relatively user friendly. Conclusions: Computer‐aided endoscopic sinus surgery appears to be the wave of the future. Nevertheless, the modern endoscopic sinus surgeon must have thorough training in the basic anatomy of the paranasal sinuses as well as the various surgical techniques.
Immune responses of adenoidal lymphocytes specific to haemophilus influenzae in the nasopharynx
Authors: Sakamoto Naoko , Kurono Yuichi , Suzuki Masashi , Kerakawauchi Hideomi , Mogi Goro
Published: November 2003

Objectives: Investigate immune responses of adenoidal lymphocytes against outer‐membrane protein P6 purified from nontypeable Haemophilus influenzae (HI). Clarify the role of adenoids in regulating the colonization of HI in the nasopharynx. Study Design: Microbiological and immunological examinations of adenoids obtained from 21 children, 15 boys and five girls, from 1 to 13 years of age (median, 5 y), suffering from adenoidal hypertrophy complicated by otitis media with effusion (OME). Methods: The incidence of HI in adenoids was compared with the number of P6‐specific immunoglobulin (Ig) A–secreting cells in adenoids, determined by enzyme‐linked immunoassay. Results: Quantitative culture assay showed significant correlation between the numbers of HI in adenoids and those in nasopharyngeal secretions (NS). In children aged 5 years and younger, the numbers of P6‐specific IgA‐secreting cells in adenoids were significantly correlated with IgA antibody titers in NS (r = 0.68, P < .05). The numbers of P6‐specific IgG‐ and IgA‐secreting cells were lower in children aged 6 years and older than in children aged 5 years and younger. Furthermore, the number of P6‐specific IgA‐secreting cells was significantly increased in HI‐negative subjects when compared with HI‐positive subjects (P < .05). Conclusions: Adenoids play an important role as an effector site of the mucosal immune system in the upper respiratory tract. IgA immune responses in adenoids are responsible for the clearance of HI from the nasopharynx. Key Words: Haemophilus influenzae, adenoid, nasopharyngeal secretion, P6, IgA.
Topical gentamicin and ethacrynic acid: Effects on cochlear function
Authors: Conlon Brendan J. , McSwain S. David , Smith David W.
Published: November 2003

Objective: To determine whether concurrent intravenous administration of the loop diuretic ethacrynic acid potentiates the toxicity of the aminoglycoside antibiotic gentamicin applied topically on the round window. Study Design: The authors studied the effects on cochlear sensitivity of co‐administered intracardiac ethacrynic acid (40 mg/kg) and high‐dose topical gentamicin solution (100%) applied to the round window. Comparisons were made with animals receiving ethacrynic acid plus systemic gentamicin (100 mg/kg); topical gentamicin alone; systemic gentamicin alone; and intravenous ethacrynic acid alone. Methods: Experiments were carried out on pigmented guinea pigs weighing 400 to 500 g. Changes in cochlear function were characterized by monitoring shifts in compound action potential (CAP) thresholds by use of chronic indwelling electrodes implanted at the round window, vertex, and contralateral mastoid. Results: After 20 days animals receiving ethacrynic acid in combination with topical gentamicin to the round window failed to demonstrate a significant deterioration in cochlear sensitivity, whereas all animals receiving systemic gentamicin plus ethacrynic acid experienced profound increases in CAP thresholds. Conclusions: This study supports the contention that ethacrynic acid potentiates aminoglycoside ototoxicity by facilitating the entry of the antibiotics from the systemic circulation into the endolymph. In addition, this study answers important clinical concerns regarding the safety of the use of topical aminoglycoside agents in combination with loop diuretics.
Intravenous delivery of 5′‐iododeoxyuridine during hyperfractionated radiotherapy for locally advanced head and neck cancers: Results of a pilot study
Authors: Epstein Alan H. , Lebovics Robert S. , Van Waes Carter , Smith Judy , Okunieff Paul , Cook John A.
Published: November 2003

Objectives: Locally advanced cancers of the head and neck require aggressive treatment, often with limited effectiveness and significant toxicity and morbidity. This pilot study was designed to assess tolerance using combined hyperfractionated radiotherapy and the halogenated pyrimidine radiosensitizer 5′‐iododeoxyuridine (IdUrd). Study Design: This was a prospective single‐arm study open to patients with advanced head and neck cancers that had a poor chance of control with conventional radiation therapy. Patients were treated with hyperfractionated radiation therapy at standard doses in combination with an IdUrd infusion and observed for tumor response and normal tissue tolerances. Methods: Radiation therapy was delivered in fractions of 1.2 Gy or 1.5 Gy twice daily to a total dose in the range of 70 to 76 Gy. IdUrd was delivered as an intravenous infusion (1000 mg/m2 per day) for a maximum of 14 days at the beginning and then again during the middle of the radiotherapy. Results: Twelve patients with advanced squamous cell lesions were enrolled and 11 were observed to have complete clinical remissions. Seven patients remained clinically free of local disease at the time of death or most recent follow‐up. Acute toxicities, usually hematologic or mucosal, were severe and all patients required treatment modifications and considerable supportive care. Conclusions: Although a high rate of response was achieved using this regimen, the toxicities are prohibitive. The kinetic profile of IdUrd incorporation suggests the need for future studies using repetitive short courses of IdUrd.
Round window atresia in association with congenital stapes fixation
Authors: Pappas Dennis G. , Pappas Dennis G. , Hedlin Gary
Published: November 2003

Objective: To document an association of round window atresia with congenital stapes fixation, discuss the diagnostic role of computed tomography, and implicate the clinical significance of these anomalies. Study Design: Retrospective chart review and review of the literature. Results: The authors report three pediatric cases of round window atresia. All cases presented with hearing loss of a conductive nature (two cases bilateral, one unilateral). Two patients underwent middle ear exploration, demonstrating stapes fixation and the absence of a round window. Stapedectomy was performed in both cases without postoperative hearing improvement. Subsequent revision stapedectomy was also unsuccessful in one of these cases. The unoperated case represents the fraternal twin of one patient. In all cases, computed tomography scanning demonstrated findings consistent with atresia of the round window niche without cochlear anomaly. Conclusions: An association of round window atresia and congenital stapes fixation is apparent. The mechanism of the conductive hearing loss following stapedectomy remains poorly understood. Computed tomography imaging and surgical confirmation are probably both necessary to establish the diagnosis of round window atresia.
Photodynamic therapy and the treatment of head and neck neoplasia
Authors: Biel Merrill A.
Published: November 2003

Objective: To present the theory, technique, and results of photodynamic therapy for the treatment of oral, laryngeal, and head and neck cancers. Study Design: Retrospective review of the literature of more than 500 patients with head and neck cancer treated with photodynamic therapy, as well as a retrospective review of the author's 107 patients treated with photodynamic therapy for head and neck neoplasia between 1990 and 1997. Methods: The literature was retrospectively reviewed, as were patient records, and tabulaled for age, sex, site, and staging of lesions, with special focus on post‐photodynamic therapy treatment outcome, long‐term disease‐free survival, and complications. Results: Twenty‐five patients with carcinoma in situ and T1 squamous cell carcinoma of the true vocal cord who underwent photodynamic therapy treatment for cure obtained a complete response after a single photodynamic therapy treatment. Only one patient has had recurrence to date, with a cure rate to 79‐month follow‐up of 95%. Twenty‐nine patients with carcinoma in situ and T1 recurrent squamous cell carcinomas of the oral cavity and tongue were treated. All obtained a complete response after a single photodynamic therapy treatment; however, five patients developed local recurrence with follow‐up to 70 months, for an 80% cure rate. A review of 217 patients with early squamous cell carcinomas of the head and neck treated with photodynamic therapy in the literature demonstrated an 89.5% complete response rate. The most common complication in these patients was limited prolonged skin photosensitivity without any permanent sequelae. Conclusions: Photodynamic therapy is effective for treating carcinoma in situ and T1 squamous cell carcinoma of the larynx and oral cavity and may be of benefit as an adjuvant intraoperative treatment of stages III and IV tumors of the head and neck in conjunction with surgery and radiation therapy to improve cure rates. Further controlled studies need to be performed to further demonstrate the effectiveness of photodynamic therapy and the treatment of head and neck cancers.
Laser and cisplatinum for treatment of human squamous cell carcinoma
Authors: Paiva Marcos B. , Graeber Ines P. , Castro Dan J. , Suh Michael J. , Paek Woo H. , Eshraghi A. Amir , Saxton Romaine E.
Published: November 2003

Objective: Interstitial laser therapy (ILT) with the neodynuumiyttrium‐aluminum‐garnet (Nd:YAG) (1064 nm) laser via fiberoptics is becoming a more precise, minimally invasive alternative for thermoablation of unresectable or recurrent head and neck neoplasms, but recurrence is often seen at the margin. Combining intratumor chemotherapy with interstitial laser should be most effective using drugs activated by thermal energy. The objective of the current study was to test intratumor cisplatinum (cis‐diaminedichloroplatinum [CDDP]) injections given in conjunction with laser therapy as an experimental approach for improved treatment of squamous cell carcinoma (SCC).Methods: Human SCC tumors were grown as subcutaneous transplants in nude mice and injected with CDDP (0.4 to 1.2 mg/g) in water or in collagen‐based gel carrier with epinephrine (epi‐gel) followed by ILT via 0.6‐mm fiberoptics coupled to an Nd:YAG laser (1064 nm/180 J).Results: Tumors injected with CDDP epi‐gel exhibited a partial response with two‐ to fourfold tumor delay compared with aqueous drug or untreated SCC transplants during 10 weeks' follow‐up. Combined drug and laser therapy significantly (P< .01) decreased tumor volume, with recurrence in only 25% of animals tested compared with 78% tumor regrowth after ILT alone.Conclusion: These initial results suggest that laser chemotherapy may become an effective treatment for advanced head and neck cancer.
Relationships between otitis media sequelae and age
Authors: Daly Kathleen A. , Hunter Lisa L. , Levine Samuel C. , Lindgren Bruce R. , Giebink G. Scott
Published: November 2003

Objectives: To explore relationships between age and sequelae in two groups of children treated with tympanostomy tubes for chronic otitis media with effusion (OME). Study Design: Cross‐sectional study of sequelae among children, adolescents, and adults at 4 years and 9 to 23 years after tympanostomy tube treatment. Methods: Group I was examined with otomicroscopy, tympanometry, and audiometry two to four times a year as part of a prospective study, and they were evaluated 4 years after initial tube treatment for this study. Group II received tubes while participating in a chronic OME study, but participants were not followed prospectively after treatment. Nine to 23 years after tube treatment, they were examined with otomicroscopy, tympanometry, and hearing screening. Results: Among the 5− to 28− year‐old subjects, cholesteatoma (⩽1%) and perforation (⩽2%) were rare. In Group I, tympanosclerosis increased with age (P < .01), and OME (flat tympanograms) decreased with age in Group II (P < .01). The older cohort was more likely to have severe retractions (18% vs. 4%, P = .02), hearing loss (21% vs. 10%, P < .01), and severe atrophy (24% vs. 0%, P < .01) than the younger cohort, but they were less likely to have flat tympanograms (2% vs. 12%, P < .01). Conclusions: Although OME became less prevalent with age, important sequelae (severe atrophy, severe tympanic membrane retraction, hearing loss, cholesteatoma, and chronic perforation) may develop in children with chronic OME as they become adolescents and young adults. Long‐term prospective studies are important in defining the progression of sequelae in these children.
Sinus lateralis in endoscopic ethmoidectomy
Authors: Picerno Nicolette A. , Bent John P.
Published: November 2003

Objective: To characterize the anatomy of the sinus lateralis and enable a more accurate and safe approach to endoscopic ethmoidectomy. Study Design: An anatomic study of 33 cadaver heads providing a prospective evaluation of 50 ethmoid sinuses. The sinus lateralis, in particular, was thoroughly examined and typical variations were classified into four categories. A technique using the sinus lateralis as a critical landmark is described which allows calculated removal of anterior ethmoid cells in a posterior‐to‐anterior direction, avoiding inadvertent entry into the posterior ethmoid. Prospective evaluation of this technique in 12 pediatric patients found it to be safe and particularly useful for neophyte endoscopic surgeons. Methods: Endoscopic examination of 50 cadaver sinuses using 0−, 30−, and 70‐degree, 4‐mm telescopes to dissect the anterior ethmoid. The characteristics of each sinus lateralis were documented. To confirm the endoscopic findings, we grossly examined each specimen. Results: Four different categories of sinus lateralis formation were identified: type I (n = 22), posterosuperior extension to skull base; type II (n =15), posterior extension to sphenoid face; type III (n = 8), abrupt termination posterior to ethmoid bulla; and type IV (n = 5), extension into posterior ethmoid through dehiscent basal lamella. Conclusions: The sinus lateralis is a consistent feature of the anterior ethmoid. Type I and II patterns are most conducive to the aforementioned technique. Type III is the most difficult to identify endoscopically, whereas type IV is most apt to encourage an unplanned posterior ethmoidectomy. Regardless of the chosen ethmoidectomy technique, careful assessment of the sinus lateralis should enable more accurate and safe removal of ethmoid disease with reduced complications.
Spectral analysis of photoplethysmograms from radial forearm free flaps
Authors: Stack Brendan C. , Futran Neal D. , Shohet Michael J. , Scharf John E.
Published: November 2003

Objective: Photoplethysmography utilizes a green‐light‐emitting diode to transmit light into a tissue. Reflected light from hemoglobin in dermal capillary red blood cells is received by a photo detector and is analyzed as light intensity along a frequency spectrum. This method of analysis allows for the removal of “noise” above (stray light and alternating current [AC]) and below (room vibrations and respiratory motion) the peak signal (1 to 2 Hz) and results in a means to distinguish between perfused and non‐perfused tissues. Methods: Twenty‐two of 30 consecutive radial forearm free flap (RFFF) patients were enrolled in an approved human studies protocol to collect descriptive data for RFFFs that were perfused, arterial occluded, and venous occluded. The protocol was performed following completion of flap elevation and prior to pedicle ligation, flap inset, and microvascular anastomoses. Six 90‐second measurements per flap were obtained (n = 132), processed by fast Fourier transform (FFT), and analyzed by blinded reviewers to determine their state of perfusion. Signal was collected 5 minutes after the onset or release of individual vessel occlusion. Results: The reviewers' interpretations were compared with the status of the pedicle and analyzed for sensitivity (0.96), specificity (0.95), and positive predictive value (0.98). Conclusions: FFT analysis of photoplethysmograms from RFFF patients provides an accurate and rapid means for determining RFFF pedicle vessel patency. Photoplethysmography may provide a clinically useful tool for postoperative perfusion monitoring of free flaps in the future.
The recurrent laryngeal nerve: Related vascular anatomy
Authors: Moreau Sylvain , De Rugy Marc Goullet , Babin Emmanuel , Salame Ephrem , Delmas Pierre , Valdazo Andre
Published: November 2003

This study was based on 34 recurrent laryngeal nerve dissections after arterial casting with red‐colored latex. The aim was to provide specific information about the perineural microvasculature. This study established the following points: 1. a great anatomic variability does exist; 2. the laryngeal nerve is usually in relation to the posterior branch of the inferior thyroid artery; and 3. this vascular branch is sometimes replaced with a vascular network. In all cases, this microvascularization must be preserved during thyroid surgery. Key Words: Recurrent laryngeal nerve, anatomy, inferior thyroid artery.
Long‐term hearing results following vestibular surgery in meniere's disease
Authors: Wazen Jack J. , Spitzer Jaclyn , Kasper Craig , Anderson Blake
Published: November 2003

Objectives: The purpose of this study is to evaluate the long‐term hearing changes following vestibular surgery in patients with Meniere's disease. Study Design: This is a retrospective analysis of patients operated on in a tertiary referral center setting. Methods: Preoperative, postoperative, and 3‐ to 9‐year postoperative audiograms were analyzed in two patient groups. Twenty‐one patients underwent posterior fossa vestibular neurectomy (VN) and five, mastoid endolymphatic sac decompression and shunt (ELS). All frequencies, four‐frequency pure‐tone averages (PTAs), spondee thresholds, and speech recognition scores were compared for operated ear against nonoperated ear of VN subjects. The results were subjected to a covariance analysis. VN and ELS patients whose hearing deteriorated from “serviceable” (PTA ≤70 dB hearing level) and speech recognition ≤30%) to nonserviceable status were compared using nonparametric statistics. Results: Progressive hearing loss beyond the rate of change of the normal contralateral ear was evident in all patients. Serviceable hearing dropped from 81% to 43% of patients an average of 4 years following VN. Conclusions: VN patients have significant hearing deterioration over time in the operated ear. This finding suggests that continued postoperative medical management is necessary for patients undergoing VN. Laryngoscope, 108:1470–1473, 1998
Clinical update on type II first branchial cleft cysts
Authors: Sichel Jean‐Yves , Halperin Doron , Dano Itzhak , Dangoor Eric
Published: November 2003

Objective: To describe clinical and radiological signs of type II first branchial cleft cyst in order to facilitate diagnosis. Method: Report of three cases of first branchial cleft cyst type II (one of them in association with ipsilateral agenesis of the parotid gland) and review of the literature. Results: Two clinical signs are described: the location of the sinus opening in the neck, which is situated in a triangle limited by the external auditory canal above, the mental region anteriorly, and the hyoid bone inferiorly, and the presence in some cases of a myringeal web that runs from the floor of the external auditory canal to the umbo. In addition, imaging with computed tomography and magnetic resonance of the parotid area may be helpful in confirming the diagnosis. Laryngoscope, 108:1524–1527, 1998
Childhood pseudohypacusis in patients with high risk for actual hearing loss
Authors: Radkowski Diana , Cleveland Sandra , Friedman Ellen M.
Published: November 2003

Objective:While pseudohypacusis or nonorganic hearing loss is a well‐recognized phenomenon in adults, it is the aim of this report to heighten the physician' awareness of the occurrence of nonorganic hearing loss in pediatric patients. The medical and otologic histories of 18 cases identified consecutively between 1983 and 1991 at The Children' Hospital, Boston, Massachusetts, were retrospectively reviewed. In these selected cases an analysis of the audiometric configuration, age range, and sex distribution is undertaken. This review highlights the need to rule out pseudohypacusis even in pediatric cases where suspicion is low. A precedent trauma was the presenting complaint in a high percentage of our patient population. This association has not been previously reported in the pediatric literature. While the severity of the traumatic incident was often minor, extensive medical and surgical investigations had been considered before the identification of nonorganic hearing loss.Study Design:A retrospective chart analysis of patients identified with pseudohypacusis over a 7‐year period. Methods: A tertiary care children' hospital in an urban community. Eighteen consecutively identified patients examined by a staff audiologists at a tertiary care children' hospital. A specific battery of standard audiologic testing with the goal of detecting pseudohypacusis in children.Results:Successful if additional interventions such as exploratory tympanotomy were avoided.Conclusions:Pseudohypacusis was identified in 18 patients with a majority having an antecedent history of trauma. Additional interventions were canceled upon the detection of true threshold values. A high index of suspicion of pseudohypacusis in children and an organized standardized battery of audiologic testing will facilitate early identification of these patients and will avert inappropriate interventions.Laryngoscope, 108:1534–1538, 1998
Genotypic analysis of tumor suppressor genes PTEN/MMAC1 and p53 in head and neck squamous cell carcinomas
Authors: Henderson Ying C. , Wang Eric , Clayman Gary L.
Published: November 2003

Objectives: Tumor suppressor gene mutations in both p53 and PTEN/MMAC1 genomic DNA have been detected in many types of cancer. The purpose of this study was to investigate the presence and importance of PTEN/MMAC1 mutations in squamous cell carcinomas. Methods: Exons of each gene were amplified after polymerase chain reaction (PCR) using genomic DNA derived from cell lines of squamous cell carcinoma of the head and neck (SCCHN) and snap‐frozen biopsy specimens from primary established head and neck tumors. The amplified and purified DNA was then sequenced directly. Result: As anticipated, point mutations of the p53 gene were found in 80% of cell lines examined. A single base mutation in codon 151 was found in six of 10 cell lines studied. PTEN/MMAC1 gene mutations were found in neither the cell lines tested nor the tumor biopsy samples. Conclusion: This study, as well as a large volume of data, confirms that mutations of the p53 gene are frequent events in head and neck cancer cell lines. Although PTEN/MMAC1 gene mutations have been found in a variety of carcinomas, this gene was not found to be mutated in SCCHN cell lines or in primary squamous cell carcinomas of the head and neck. This information is useful for further studies of mutations in these cell lines. Laryngoscope, 108:1553–1556, 1998
Quality of life and voice in patients with laryngeal carcinoma: A posttreatment comparison of laryngectomy (salvage surgery) versus radiotherapy
Authors: Finizia Caterina , Hammerlid Eva , Westin Thomas , Lindström Jörgen
Published: November 2003

Objectives: This study was designed to compare the voice and the quality of life (QOL) of laryngeal cancer patients receiving treatment with radical radiotherapy with or without laryngectomy as salvage surgery. We also compared the patients' own perceptual ratings of their voice to the perceptual ratings of a group of listeners. Study Design: Two groups of laryngeal cancer patients were studied. Methods: Fourteen irradiated laryngeal speakers with preserved larynx were matched with 14 salvage surgery laryngectomized patients speaking with tracheoesophageal prosthesis (TEP). To measure patients' QOL, we used the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ‐C30), the EORTC Head and Neck module (EORTC QLQ‐H&N35), the Hospital Anxiety and Depression scale (HAD) and a study‐specific questionnaire. For the perceptual speech evaluation we used visual analog scales. Results: The perceptual ratings of speech intelligibility, voice quality, and speech acceptability showed a significant difference between the treatment groups. Both the patients who received treatment with radiotherapy and the listeners rated the irradiated laryngeal voices higher than the tracheoesophageal speech. The laryngectomized patients scored significantly better than the patients treated with radical radiotherapy on the question about hoarseness. No other significant difference was found for the QOL functions and symptoms. Conclusion: When patients treated with radiotherapy were compared with patients treated with laryngectomy as salvage surgery, QOL was similar, only small differences being found in the perceptual speech evaluation. Laryngoscope, 108:1566–1573, 1998
18FDG‐PET for the assessment of primary head and neck tumors: Clinical, computed tomography, and histopathological correlation in 38 patients
Authors: Paulus P. , Sambon A. , Vivegnis D. , Hustinx R. , Moreau P. , Collignon J. , Deneufbourg J. M. , Rigo P.
Published: November 2003

Objectives: To evaluate the clinical usefulness of FDG‐PET (fluoro‐2‐deoxy‐glucose‐positron emission tomography) in the detection of lymph node involvement and recurrences in patients with head and neck cancer. Study Design: Retrospective review of 38 patients with biopsy‐proven head and neck cancers who underwent clinical, computed tomography (CT), and FDG‐PET examinations. Twenty‐five patients were studied prior to therapy and 13 patients were evaluated for disease recurrence. Methods: All patients were operated and clinical data, CT, and FDG‐PET results were correlated with histopathological findings. Results: All primary tumors in 25 patients were detected, with the exception of one small superficial localization of the epiglottis. Histopathological examination showed lymph node involvement in 10 patients; PET detected lymph node involvement in five. FDG‐PET found one case of nodal disease not identified by clinical and CT examination. With so few cases, this could be anecdotal. Five false‐negative results (microscopic lymph node involvement) and two false positives were noted. Twelve of 13 patients with recurrent disease were correctly identified with FDG‐PET. FDG‐PET was the only imaging technique to identify local recurrence in two patients and lymph node involvement in two others. One false‐positive result occurred in a patient with a foreign body granuloma. Conclusions: FDG‐PET is a useful diagnostic modality for the detection of recurrent tumors and, in selected cases, precise lymph node involvement. The best way to further investigate the utility of clinical FDG‐PET is in the follow‐up of treated patients. Key Words: FDG‐PET, head and neck cancer, lymph node metastases, recurrent disease. Laryngoscope, 108:1578–1583, 1998
Surgical salvage after failed radiation for paranasal sinus malignancy
Authors: Curran Aongus J. , Gullane Patrick J. , Waldron John , Irish Jonathan , Brown Dale , O'Sullivan Brian , Cummings Bernard
Published: November 2003

Objective: To comment on the role of surgical salvage following failed initial treatment for paranasal sinus malignancy. Design: A retrospective analysis of one hundred eighty patients treated at The Princess Margaret Hospital, Toronto, from 1976 to 1993. Materials and Methods: Thirty‐four of 95 patients (36%) who failed initial treatment underwent surgical salvage. Initial therapy in this group was radiation only (n = 27) and combined therapy (n = 7). Patient, tumor, and surgical data were recorded. There were 23 T4, three T3, six T2, and two T1 carcinomas. Survival, recurrence rates, and the influence of a variety of variables on outcome were analyzed. Results: Two‐ and 5‐year overall actuarial survival calculated from the date of diagnosis was 54% and 35%, respectively. Two‐ and 5‐year overall actuarial survival calculated from the date of salvage surgery was 44% and 22%, respectively. Advanced age (P <.004), patients with T4 category disease (P <.04), and squamous cell carcinomas (P <.049) correlated with poorer outcome on univariate analysis. Local failure was the most common cause of death (n = 13; 65%). Conclusion: Salvage surgery has a limited role in the management of persistent or progressive disease following failure of initial treatment. Careful postradiation surveillance with endoscopic biopsy under general anesthesia and immediate surgical resection when appropriate may improve the salvage rate. Laryngoscope, 108:1618–1622, 1998