bluuebunny/crossref_metadata_2025 huggingface dataset:
Lymphatics of the floor of the mouth and neck: Anatomical studies related to contralateral drainage pathways
Authors: Ossopp Robert H. , Sisson George A.
Published: October 2006

An anatomical study was made to determine the role of the regional lymphatic drainage pathways in contralateral flow from the floor of the mouth in the dog. Microsurgical techniques were used to cannulate and perfuse a lymphatic vessel. Following a two hour infusion, bilateral radical neck dissections were performed. An efferent upper jugular communicating pathway was repeatedly identified which crossed the midline and drained into the contralateral subdigastric group of nodes. These studies demonstrate a precise role for the regional lymphatic drainage pathways in contralateral flow from the floor of the mouth.
Surgical rehabilitation following anterior resection for oral cavity carcinoma
Authors: Donald Paul J.
Published: October 2006

Resection of large tumors located in the anterior aspect of the oral cavity is commonly complicated by problems of functional disturbance and esthetic aberration. Oral incompetence with defects in swallowing and inadvertant drooling are often major hurdles to overcome. The cosmetic deformity produced by the loss of support of the anterior floor of mouth and tongue due to the resected mandibular arch provides one of the most challenging reconstructive exercises facing the head and neck surgeon. Surgical rehabilitation is most adequately achieved by a consideration of each physiological defect produced by the surgical alteration of each anatomical entity in the lower third of the face. Reestablishment of mandibular arch continuity is the keystone of the reconstructive effort; however, procedures that improve lip support, lingual mobility, and alveolar ridge enhancement are vital features in the rehabilitation of a functioning esthetically acceptable oral and perioral region.
Treatment results of combined high‐dose preoperative radiotherapy and surgery for oropharyngeal cancer
Authors: Rabuzzi Daniel D. , Mickler Andrew S. , Clutter Donald J. , Chung Chung T. , Sagerman Robert H.
Published: October 2006

Fifty‐eight patients receiving planned high‐dose preoperative radiotherapy followed by en bloc oro‐mandibular‐cervical resection for oropharyngeal cancer were reviewed. These patients received continued close observation and care from both the Otolaryngology and Radiotherapy services. In light of the ongoing controversy of preoperative vs. postoperative radiotherapy, we present our data demonstrating the value of preoperative radiation.

An overall tumor control rate of 66% was achieved, with an adjusted survival rate of 62%. This was not only for early lesions, but also in patients having advanced (T3, T4) tumor and/or nodal disease (N1–4). These figures are somewhat higher than expected from the literature. A review and discussion of the surgical complications are also presented.
A comparison of combined modalities and single modality in the management of advanced head and neck tumors
Authors: Gillis T. M. , Shapshay S. M. , Hong W. K. , Pennachio J. , Simpson G. T. , Strong M. S.
Published: October 2006

Advanced head and neck cancer patients can be managed by single modality or combined modalities, Between 1976 and 1979, three treatment groups were retrospectively identified. One group received induction chemotherapy, surgery, and postoperative radiation therapy. The second group received chemotherapy followed by radiotherapy. The third group was treated during the same time period with radiation alone. These groups were matched with respect to age, site of primary tumor, nodal status, absence of metastatic disease, and no prior cancer treatment.

The combined modality groups were initially treated with two doses of cis‐platinum and a bleomycin infusion. Evaluation of tumor response was done 2 weeks following chemotherapy; 24 patients had surgery and postoperative radiation, 23 had radiotherapy without surgery and 24 patients were treated with radiotherapy alone.

Median survival was 22 and 13 months respectively for the 2 combined modality groups and 4.7 months for the radiotherapy group. Disease‐free survival was a projected value of 40 and 35 months for the combined modality groups and an actual 3 months for the radiotherapy group.

Combined modality treatment with chemotherapy and surgery and/or radiotherapy offers a higher response rate and prolonged survival than radiotherapy alone.
Breast carcinoma metastasizing to the cervical esophagus
Authors: Biller Hugh F. , Diktaban Theodore , Fink Warren , Lawson William
Published: October 2006

Tumor metastasis to the esophagus is rare. While breast carcinoma metastasizing to the thoracic esophagus has been described, there are no reported cases of spread to the cervical esophagus. Two patients, having had mastectomy for breast carcinoma several years previously, presented with cervical esophageal obstruction secondary to metastatic disease.

Tumor resection with cervical esophageal reconstruction is advocated for palliation. The details of the history, diagnosis and surgical technique are presented.
Transantral sphenopalatine artery ligation
Authors: Simpson George T. , Janfaza Parviz , Becker Gary D.
Published: October 2006

Posterior epistnxis from branches of the sphenopalatine artery can be rapidly and effectively controlled by a new ligation technique. The sphenopalatine artery or its branches arc directly ligated as they exit the sphenopalatine foramen to enter the nose, completely avoiding the pterygomaxillary fossa. The vessels are exposed via a transantral approach, through the posterior portion of the medial antral wall. The mucoperiosteum of the lateral wall of the nose (medial antral wall) is preserved, elevated medially and posteriorly and used to tense the sphenopalatine vessels, bringing them into view and accessible for ligation at the foramen. Advantages of this technique include direct, specific ligation of the end vessels; ease and speed of operation; and avoidance of complications associated with the pterygomaxillary space. The technique was defined in multiple dissections of anatomic specimens and has been successful to date in 14 cases of severe posterior epistaxis.
Nuclear scanning in necrotizing progressive “malignant” external otitis
Authors: Parisier Simon C. , Lucente Frank E. , Som Peter M. , Hirschman Sholom Z. , Arnold Leon M. , Roffman Jeffrey D.
Published: October 2006

The usefulness of radionuclear scanning in the treatment of 18 patients with necrotizing progressive “malignant” external otitis is discussed. A Tc 99‐m bone scan, a valuable test since results are positive in early cases of osteomyelitis of the temporal bone and base of skull, showed increased uptake in all 18 patients. In 6 patients, Ga‐67 citrate scans were obtained at the start of therapy and at 5–6 week intervals thereafter. The serial gallium scans were useful in evaluating the effectiveness of therapy since the uptake decreased with control of infection.
“How i do it” — Head and neck and plastic surgery: A targeted problem and its solution: Excision of zenker's diverticulum using auto‐suture technique
Authors: Vered Israel Y. , Rosen Gabriel , Resnick Semion
Published: October 2006

The one‐stage transcutaneous hypopharyngeal diverticulectomy has become the accepted procedure for treating most of Zenker's diverticula. Myotomy of the crico pharyngeus is simultaneously done as a safeguard for sac recurrence.

Experience of our general‐surgical colleagues with stapling devices has inspired us to use auto‐suture technique for the resection of Zenker's diverticulum.
The anterior tympanomeatal angle in tympanoplasty: Surgical techniques for the prevention of blunting.
Authors: Farrior Jay B.
Published: October 2006

The surgical repair of the anterior tympanic membrane with reconstruction of the vibrating anterior tympanomeatal angle is particularly difficult because of problems with graft separation, recurrent perforations, scar formation and blunting. The multilayer tympanoplasty technique anchors the structural layer of the drum to the annulus, by fixing the underlay fascial graft to the overlay graft, and reduces scar formation and blunting by immediate epithelial coverage of the vibrating anterior tympanomeatal angle.

The purpose of this paper is to describe the multilayer sandwich graft tympanoplasty technique that has been effective in reconstructing the anterior tympanic membrane with preservation of the vibrating anterior tympanomeatal angle.
Endolymphatic shunt: An evaluation by test results.
Authors: Pappas Dennis G.
Published: October 2006

Failure in the endolymphatic shunt operation for Meniere's disease is reportedly 30% or more. The fact that many patients have relief from their symptoms following this surgery offers validity to the procedure. Pure tone audiograms and sinusoidal harmonic acceleration (rotary chair or rotary test, RT) were used concurrently to evaluate end‐results of this operation in 31 patients with Meniere's disease.

RT shows parameters of phase and labyrinthine preponderance (LP) calculated by a computer. LP was determined by separately integrating the total slow‐phase output of the vestibulo‐ocular reflex (VOR) to the left and right and converting the differences to percentages. Irritative and destructive lesions in Meniere's disease may be accurately resolved using this technique. It was not possible to predict with any accuracy the irritative‐destructive parameter using pure tone audiometry. Patients who had irritative lesions fared better with the shunt operation. An analysis of these patients is made with RT.
Masked mastoiditis.
Authors: Holt G. Richard , Gates George A.
Published: October 2006

With the advent of broad‐spectrum antibiotics, the clinical course of middle ear disease has been altered. One result has been the occasional suppression of the presenting signs and symptoms of mastoiditis secondary to acute middle ear disease, causing the clinician to have a false sense of security following apparent resolution of the middle ear infection. The course may be so insidious that the first awareness of the mastoiditis may be following presentation of an intracranial complication such as meningitis, lateral sinus thrombosis, or brain abscess.

The authors report 9 patients seen in the past 5 years with masked mastoiditis, ranging in age from 4 months to 43 years. The presenting symptoms were all vague and non‐classical; however, intracranial complications of meningitis, facial paralysis, brain abscess, and papilledema were present on admission in 7 patients, and another 2 patients had unsuspected epidural abscess upon surgical exploration. The mastoid radiographs were uniformly positive, while the CT scan was positive in 3/9 patients. All patients recovered following mastoidectomy and intracranial therapy except one patient who expired after brain herniation. The clinician is urged to maintain a high suspicion of masked mastoiditis in the high‐risk patient, including newborn, diabetic, elderly, immunosuppressed or debilitated patients.
105 Patients operated upon for cerebellopontine angle tumors — experience using combined approach and co2 laser.
Authors: Gardner Gale , Robertson Jon H. , Clark W. Craig
Published: October 2006

In Memphis, TN, we have treated surgically 105 patients with cerebellopontine angle tumors. In reporting that experience here, we place major emphasis on the use of two surgical aids: a combined surgical approach and the CO2 laser. Diagnostic techniques are also discussed, along with data management, postoperative results, and complications.
Flexible fiberoptic bronchoscopy and laryngoscopy in infants and children
Authors: Nussbaum Eliezer
Published: October 2006

A pediatric flexible fiberoptic bronchoscope was employed in the examination and/or therapy of 164 infants and children ranging in age from 1 day to 16 years. Ninety‐two bronchoscopies and 72 laryngoscopies were performed without any mortality or significant morbidity; 78% of laryngoscopies and 35% of bronchoscopies were performed in children under 2 years of age. The instrument was helpful in terms of diagnosis, as a tool for aspirating secretions and resolving atelectasis, and as a guide for surgical intervention.

It is concluded that flexible fiberoptic bronchoscopy is a safe procedure in small infants and children and serves as an important aid in the diagnosis and therapy of disorders of the respiratory tract in this age group. However, caution should be expressed in its use in children with compromised ventilation, bradycardia or bleeding diathesis. Moreover, in suspected foreign body aspiration, the rigid‐open tube bronchoscopy should be employed.
Vertical eye deviation and nystagmus inhibition during mental tasking
Authors: Goebel Joel A. , Stroud Malcolm H. , Levine Laurence A. , Muntz Harlan R.
Published: October 2006

Twenty subjects with no vestibular complaints and normal otoscopic exams were stimulated with 44°C water for 5 minutes in one ear and their nystagmus was recorded by vertical and horizontal electro‐oculography. Changes in vertical eye position and nystagmus inhibition were correlated during periods of mental tasking, relaxation, and voluntary eye elevation. The results showed an average of 42° eye depression with mental tasking during irrigation. In addition, mental arithmetic had a “releasing” effect on horizontal nystagmus. Elevation of the eyes on command, however, produced marked irregularity in the horizontal tracings, simulating inhibition. Almost every subject had an apparent vertical deflection on ENG with eye closure. These findings suggest a mechanical component to the phenomenon of inhibition as well as an active central mechanism.
Eye tracking abnormalities in patients with cerebrovascular disease
Authors: Konrad Horst R. , Rybak Leonard P. , Ramsey Don E. , Anderson Darrel R.
Published: October 2006

Ten patients with disequilibrium, ataxia, and cerebrovascular abnormalities were studied using computer aided eye tracking and vestibular function tests.

The patients had severe abnormalities in smooth pursuit (decreased gain) and saccade tests (increased delay, decreased accuracy). Optokinetic responses were less affected. The gain of the vestibulo‐oculomotor reflex was sometimes affected. Patients with eye tracking abnormalities frequently had symptoms of difficulty reading and watching television. When the lesion was asymmetrical, abnormal eye tracking tests usually pointed to the side of the lesion.

Computer aided eye tracking tests are a useful adjunct to the evaluation of the patient with suspected vascular disease. They help to locate areas of central nervous system dysfunction, and produce an objective measurement of the severity of impairment.

Conversely, when impairment of the smooth pursuit or saccade system is detected in patients being evaluated for disequilibrium, an assessment of the patients' cerebrovascular system should be considered.
Symposium on endolymphatic hydrops: Meniere's syndrome and otitis media
Authors: Spector Gershon J. , Paparella Michael M. , De Sousa Luis Carlos , Mancini Fernando
Published: October 2006

We here present a clinical study of 37 patients with Meniere's syndrome. Meniere's syndrome can occur subsequent to and in some cases simultaneously with chronic otitis media. When otitis media which has occurred many years earlier in childhood becomes inactive, leading to sequelae of Meniere's later in life, full‐blown Meniere's symptom‐complex with vertigo tends to occur; whereas when active chronic otitis media accompanies Meniere's, cochlear Meniere's syndrome tends to predominate. Endolymphatic hydrops is described in pathological cases of labyrinthitis and in 11 human temporal bone cases where there is evidence of chronic otitis media in the absence of visible labyrinthitis. A discussion of pathogenic factors includes considerations of quantity of endolymph due to hypodevelopment of the endolymphatic duct and sac related to mastoid hypocellularity and otomastoiditis in childhood and to other endolymphatic malabsorptions and also considerations of endolymph quality which can influence endolymph production as well as absorption.
Symposium continued: Tack operation for idiopathic endolymphatic hydrops: An update
Authors: Cody D. Thane R. , Mcdonald Thomas J.
Published: October 2006

This paper discusses an analysis of two groups of patients who underwent a tack operation for incapacitating recurrent attacks of vertigo due to idiopathic endolymphatic hydrops. Group I consisted of the first 140 patients operated on by one of the authors (D.T.R.C.). All were followed up for at least 5 years after the operation. However, between the 63rd and 166th postoperative months, 12 patients died of unrelated causes, and an additional 26 patients were lost to follow‐up between the 70th and 119th postoperative months. The analysis was based on the condition of these patients up to the time of their death or the time that they were last contacted. The mean postoperative follow‐up for the 140 patients was 12 years 9 months, and the range was 63 to 197 months.

Group II consisted of 150 consecutive patients who had a tack operation performed by several consultants and residents in the Department of Otorhinolaryngology at the Mayo Clinic, and the opportunity for follow‐up of at least 5 years existed for all patients. The patients who were lost to follow‐up in the first 56 postoperative months were excluded from the analysis unless at the time they were last seen the operation had not controlled their vertigo, in which case the results were classified as failures. On this basis, 22 patients (15%) were excluded from the study, so that 128 patients remained in the analysis. The mean postoperative follow‐up for this group was 9 years 4 months, with a range of 56 to 182 months.

The following conclusions were reached. Vertigo was satisfactorily controlled in 79% of the patients in the two groups. Hearing was improved or maintained in 66% of the patients in Group I and 60% of the patients in Group II. A moderate‐to‐profound sensorineural hearing loss occurred in 34% of the patients in Group I and 40% of the patients in Group II. We consider the tack operation the conservative operation of choice in the management of idiopathic endolymphatic hydrops.
A ten year statistical follow‐up of 245 consecutive cases of endolymphatic shunt and decompression with 328 consecutive cases of labyrinthectomy
Authors: Brown James S.
Published: October 2006

The etiology of Meniere's disease is unknown and the treatment is empirical and at best controversial. The goals of treatment are hearing preservation and the control of vertigo. Between 1956 and 1971, a total of 5,208 cases of Meniere's disease was seen. Medical treatment was effective in 4,530 cases (87%), while surgery was employed in 677 cases (13%).

The surgical procedures were divided into 1. a conservative group where useful hearing was still present and 2. a destructive group where no useful hearing existed.

The conservation operation employed was a procedure on the endolymphatic sac, while the destructive procedure was a labyrinthectomy. In a small series of cases where these procedures failed to control the vertigo, a middle cranial fossa vestibular nerve section was done.

This review of our experience summarizes the efficacy of each procedure in reaching the stated goals of hearing preservation and the control of vertigo.
Surgical management of vestibular meniere's disease with endolymphatic mastoid shunt
Authors: Miller Gale W. , Welsh Randall L.
Published: October 2006

The early stages of Meniere's disease may consist only of vestibular symptoms. These patients with vertigo alone may be incapacitated by this condition. A great many of these patients are unresponsive to medical therapy and tend to progress to cochleovestibular disease. Early surgery on such individuals may decrease vertigo and give the added benefit of preserving hearing

This paper reports the results of endolymphatic mastoid shunts performed on 24 patients with normal hearing who had medically uncontrolled vestibular Meniere's disease. The patients underwent surgery between 1978 and 1981, and each has been followed for at least 1 year. Vertigo was decreased or abolished in 21 of 24 patients (87%). Hearing remained unchanged in 19 of the 24 patients (79%) and was mildly impaired postoperatively in 4 (16.7%). Only 1 patient had moderate postoperative hearing loss. Of the 5 patients with reduced hearing, 4 had improvement of vertigo. There were no cases of surgically‐induced deafness.
Oncogenes: Preliminary studies in head and neck cancer
Authors: Friedman William H. , Rosenblum Barry , Loewenstein Paul , Thornton Helen , Katsantonis George , Green Maurice
Published: October 2006

DNA has been extracted from squamous cell carcinomas of the larynx, base of tongue, and nasopharynx. These tumors were excised from patients at the St. Louis University Medical Center and processed at the Institute for Molecular Virology of the St. Louis University Medical Center. NIH/3T3 cells were transfected with the DNAs from these cancers. Malignant, transformed foci of NIH/3T3 cells have been observed. These foci have been cloned and grown in quantity. The cloned foci have been injected into nude mice with the production of highly malignant sarcomas. DNA extracted from these sarcomas has shown homology with human DNA on hybridization analyses of both nasopharynx and tongue cancer. Further hybridization studies are being conducted on the larynx cancer‐induced sarcomas and on the DNAs taken from the original transformed foci of NIH/3T3 cells transfected with squamous cell cancers of the larynx, nasopharynx, and tongue base. Our preliminary results indicating the presence of human sequences in the mouse sarcomas support the hypothesis that human cellular transforming gene(s) may be present in the DNA isolated from the head and neck cancers. Additional studies will include repetitive retransfection of NIH/3T3 cells, molecular cloning of putative oncogenes, and DNA sequence analysis of the cloned oncogenes. It is hoped that identification of putative oncogene sequences will result in the identification of the proteins coded for by the specific nucleotide sequences responsible for malignant cellular transformation by DNA extracted from head and neck tumors.
Management of aneurysms of the petrous portion of the internal carotid artery by resection and primary anastomosis
Authors: Glassock Michael E. , Smith Peter G. , Bond Arthur G. , Whitaker Samuel R. , Bartels Loren J.
Published: October 2006

Intrapetrosal internal carotid artery aneurysms are distinctly uncommon lesions which are difficult to diagnose and treat. With the evolution of the infratemporal fossa approach, direct surgical management of these aneurysms is possible. Application of this technique is detailed in a case report. A discussion of alternate therapeutic modalities and a review of aneurysmal pathophysiology and diagnosis are included.
Sleep apnea following bilateral excision of carotid body tumors
Authors: Zikk Daniel , Shanon Eliahu , Rapoport Yoram , Samuel Joram
Published: October 2006

A patient is described who developed apnea, hypertention, and tachycardia following the excision of bilateral carotid body tumors. Hypertension and tachycardia resulted, most probably, from bilateral ablation of the carotid sinus and/or the nerve of Hering. These phenomena have been described in the literature. The pathogenesis of the apneic attacks may be related to the ablation of the peripheral sensory organs (both carotid bodies), interference with the function of the respiratory automatic control system, and impaired control of ventilation during non‐REM sleep. Temporary unilateral paralysis of the hypoglossal nerve with partial airway obstruction possibly represented a mechanical trigger. The apneic attacks subsided but bouts of hypertention and tachycardia persist.
Reliability of frozen section diagnosis in head and neck neoplasms
Authors: Remsen Kenneth A. , Lucente Frank E. , Biller Hugh F.
Published: October 2006

To evaluate the reliability of frozen section diagnosis we reviewed a series of 1146 consecutive frozen sections performed during a 5‐year period. The frozen section diagnosis was then compared to that found on paraffin section and the results categorized into 12 regions in the head and neck.

We found an overall reliability of 96%. The total percentage of false positive and false negative results were 0.35% and 3% respectively. Frozen section diagnosis was most accurate on the submandibular gland (no errors), nose and paranasal sinuses (no error), followed by the thyroid gland (0.8% error). Areas in which frozen section diagnoses were least accurate included the nasopharynx (12.5% error) and the oropharynx (8.7% error). We conclude that frozen section diagnosis is highly accurate in most regions of the head and neck.
Epidermoid cyst of the frontal bone masquerading as frontal sinusitis
Authors: Abedi Esrafil , Frable Mary Ann
Published: October 2006

Epidermoid cysts occur whenever two epidermal surfaces fuse together during early intrauterine life and an ectodermal implant is retained deep to the surface. They are very slow growing and symptoms may not occur till middle age. The authors present a patient whose symptoms of frontal headache were mistaken for frontal sinusitis for over 10 years. The patient's symptoms were completely relieved by surgical excision of an epidermoid cyst of the frontal bone.
Bone conduction evaluation related to mastoid surgery
Authors: Hornung Shmuel , Ostfeld Ervin
Published: October 2006

The bone conduction threshold changes of 97 patients (100 ears) who underwent mastoid surgery were determined by comparing the last preoperative audiogram with the 1 year postoperative audiogram. Three types of mastoid surgery were evaluated: Radical mastoidectomy, modified radical mastoidectomy, and intact wall atticomastoidectomy. The average three speech frequency preoperative bone conduction threshold was 17.4 dB (S.D. 11.5) in the radical mastoidectomy group, 10.1 dB (S.D. 9.6) in the modified radical mastoidectomy group, and 10.7 dB (S.D. 8) in the intact wall atticomastoidectomy group.

The difference between the average three speech frequency preoperative bone conduction threshold of the radical mastoidectomy group differed significantly when compared to the modified radical mastoidectomy or intact wall atticomastoidectomy group.

The postoperative average three speech frequency bone conduction threshold did not change significantly following the three surgical procedures evaluated.
Chondrosarcoma of the nasal septum: A report of an uncommon lesion
Authors: Nishizawa Shinji , Fukaya Takashi , Inoye Kenbun
Published: October 2006

Chondrosarcoma of the nasal septum is an uncommon lesion. Review of the English literature reveals only 14 cases. This paper reports an additional case observed in a Japanese series of seven cases. The clinical features are reviewed, and a most effective treatment with minimum side effects is organized by an interdisciplinary group of specialists in surgery, radiotherapy and regional chemotherapy.
Mandibular lingual releasing approach to oral and oropharyngeal carcinomas
Authors: Stanley Robert B.
Published: October 2006

Resection of a carcinoma of the oral cavity or oropharynx requires adequate exposure for direct visual and bimanual examination. Transoral resection of tumors of the oral cavity using the “pull‐through” procedure can be difficult due to interference by the circumoral tissue and mandibular arch. Exposure of carcinomas involving the base of tongue may require mandibulotomy or lateral mandibulectomy even when margin control does not mandate removal of the jaw. Alternatively, surgical techniques routinely used for exodontia and periodontal surgery can be applied to the creation of a mandibular lingual mucoperiosteal flap that allows for the entire tongue and floor of mouth to be delivered into the neck. Oral cavity and base of tongue lesions can then be resected with excellent direct visual and palpable control of margins, but without lip splitting, mandibulotomy or mandibulectomy.
Extended single transverse neck incision for composite resections: An update of technique and results
Authors: Becker Gary D.
Published: October 2006

A composite resection for carcinoma of the upper aerodigestive tract was performed on 42 patients using a single transverse neck incision for the neck dissection, and an extension of this incision for inclusion of the primary lesion. This incision satisfies all the criteria that should be considered when designing a flap. Surgical exposure was adequate, no skin necrosis occurred, compatibility with reconstructive procedures was excellent, and resultant cosmetic deformity was minimal.
Laryngeal carcinoma — or is it laryngeal blastomycosis?
Authors: Payne James , Koopmann Charles F.
Published: October 2006

A patient is described who was evaluated for persistent hoarseness. Although an initial diagnosis of squamous cell carcinoma of the larynx was made, review of the pathology slides revealed pseudoepitheliomatous hyperplasia, acanthosis, and what appeared to be a fungal infection. After a detailed work‐up was initiated the patient was treated successfully with ketoconazole for a blastomycosis infection of the larynx. The literature relative to blastomycosis infections of the respiratory larynx is reviewed. The authors emphasize that patients who show evidence of acanthosis and pseudoepitheliomatous hyperplasia along with the diagnosis of squamous cell carcinoma should be suspected as having a potential fungal infection.
Head and neck presentations of acquired immunodeficiency syndrome
Authors: Rosenberg Richard A. , Schneider Kenneth L. , Cohen Noel L.
Published: October 2006

Since December 1980, over 2,000 cases of acquired immunodeficiency syndrome (AIDS) have been reported. The charts of 72 patients admitted to the New York University Medical Center with a diagnosis of AIDS were reviewed with particular emphasis on presenting signs, symptoms and laboratory values. Symptoms tended to be non‐specific and most often resembled an upper respiratory infection. Over 95% of the patients presented with either diffuse adenopathy, oral or facial lesions consistent with Kaposi's sarcoma, white oral lesions, or anergy. Laboratory findings included leukopenia, increased erythrocyte sedimentation rate, thrombocytopenia and anemia. The in‐hospital mortality rate was 26%.

The current status of our knowledge concerning AIDS is reviewed and discussed. The frequency and types of presenting signs and symptoms in the head and neck are reported in order to alert the otolaryngologic community to this entity.
Reconstruction of the hypopharynx following extensive loss of mucosa
Authors: Sambataro G. , Oldini C. , Mazzola R. F.
Published: October 2006

Mucosal loss of the hypopharynx, following pharyngostome or wide resection of carcinoma, poses problems for repair. The authors emphasize a reconstructive procedure based on the use of three elements combined together in various ways: residual strip of mucosa of the posterior pharyngeal wall, a musculomucosal pedicled flap obtained from the base of the tongue, a pectoralis major musculocutaneous flap. Thus any defect of the hypopharynx can be repaired in one stage. The safety of the procedure is well tested with good clinical results and lack of complications.
Velo‐pharyngo‐laryngeal myoclonus: Evaluation of objective tinnitus and extrathoracic airway obstruction
Authors: Toland A. Daniel , Porubsky Edward S. , Coker Newton J. , Adams H. Gregory
Published: October 2006

Velo‐pharyngo‐laryngeal myoclonus, the rapid, rhythmic contraction of muscles of the pharynx and larynx, is a rare neurological manifestation of numerous disease processes affecting the cerebellum.

In its most common form, palatal myoclonus, this disease frequently presents to the otolaryngologist as objective tinnitus. Impedance audiometry provides a useful means of verifying suspected palatal myoclonic activity through recorded changes in the middle ear pressure, as mediated by muscle activity at the proximal portion of the eustachian tube.

A very rare case of velo‐pharyngo‐laryngeal myoclonic with clonic contraction of the laryngeal adductors and subsequent extrathoracic airway obstruction is presented. Tracheostomy provided immediate symptomatic relief of dyspnea.
Chondrosarcoma of the head and neck
Authors: Finn Douglas G. , Goepfert Helmuth , Batsakis John G.
Published: October 2006

A review of 23 cases of chondrosarcoma of the head and neck is presented. The sites of involvement include the gnathic bones, paranasal sinuses and orbit, nasopharynx, base of skull, larynx and the cervical spine. Histologic grading of the neoplasms into I, II, and III, primarily dependent on deviation from phenotypic cartilage and mitoses, afforded excellent correlation with prognosis and survival. While increasing size of the chondrosarcoma is not always associated with higher grade tumors, rapidly growing and extensive neoplasms are usually grade II or III chondrosarcoma.
Mechanisms of nasal obstruction in sleep
Authors: Cole Philip , Haight James S. J.
Published: October 2006

Pathophysiological aspects of the nasal and pharyngeal airways are discussed with particular reference to breathing disorders in sleep. Hypotonus of dilator muscles in sleep permits the pharynx to comply with inspiratory pressures. If airflow resistances are increased by nasal disease, complete inspiratory obstructive closure of the pharynx and apnea can result from nasal breathing in sleeping subjects. Recumbency increases resistive swelling of inflamed nasal mucosa. Furthermore in patients with normal mucosa and unilateral nasal obstruction, contralateral recumbency induces contralateral obstruction which increases resistance to nasal breathing; and in either dorsal or lateral recumbency the congestive phase of the spontaneous nasal cycle acts in a similar way. Examples of breathing disorders in sleep and impaired quality of sleep in patients with obstructive mucosal disease and both bilateral and unilateral structural abnormalities arc cited.
Laryngospasm induced pulmonary edema
Authors: Mcgonagle Martin , Kennedy Thomas L.
Published: October 2006

Two case reports of laryngospasm‐induced pulmonary edema following general anesthesia are presented. Therapy consisted of immediate reintubation, application of positive pressure ventilation, and diuresis. This phenomenon should be recognized rapidly with appropriate therapy instituted immediately to avoid other complications. Preventive measures are discussed and a modified protocol of the management is outlined.
Degloving approach for total excision of inverted papilloma
Authors: Sachs Michael E. , Conley John , Blaugrund Stanley , Rabuzzi Daniel D. , Price John
Published: October 2006

Inverted papilloma, because of its insidious and aggressive clinical course, must be completely excised. Previously, the customary procedure advocated for this goal was a lateral rhinotomy. The degloving approach, which consists of lifting the soft tissues from the mid portion of the face, thereby furnishing unlimited exposure to the pyriform fossae and the lateral nasal walls, offers an excellent alternative to the lateral rhinotomy technique.

The degloving procedure involves no external scarring and improves the visibility of the total operative field. En bloc dissection of the lateral nasal wall is then accomplished and extended to include a sphenoethmoidectomy or partial excision of the medial orbital wall, as dictated by the extent of disease.

The procedure has been performed by the authors in 46 cases, and has proved to be an extremely valuable technique, displaying excellent cosmetic and functional results with minimal complications.
Central presbycusis
Authors: Welsh Louis W. , Welsh John J. , Healy Michael P.
Published: October 2006

The phenomenon of central presbycusis has been investigated employing a central auditory battery in elderly individuals with essentially normul hearing. The studies indicate a progressive loss in central auditory competence measured by simultaneous binaural challenges and frequency and temporal distortion tests. The rate of failure is related to age, on the whole, but there is increasing variability from the normals with seniority. The hearing disability in noise or speech competitive environments is explained by these data. Auditory disabilities related to poor articulation and rapid speech presentation are identified by other tests in the battery. Central presbycusis, in addition to the peripheral form, does exist and further compounds the hearing disorder in many elderly.
Tape attachment therapy for correction of congenital malformations of the auricle: Clinical and experimental studies
Authors: Muraoka Michinari , Nakai Yoshiaki , Sasaki Takaharu , Ohashi Yoshihiro , Maruoka Kenichi , Furukawa Masayoshi
Published: October 2006

After the auricular cartilage of 5‐week‐old rabbits was bent and fixed by suture, the cartilage increased in thickness in a short period of time. The thickness was maximal 6 weeks later and slightly greater than that of the control cartilage 12 weeks later. At this stage, the auricle was fixed in curved form. There was no difference in the morphology of cartilage cells between the bent group and the control.

Tape attachment therapy is very simple. We propose that surgical treatment should be designed after a few months of tape attachment therapy.

In the present work, the effect of taping was graded good in 4 cases of Stahl ear, 1 case of atypical cryptotia, and 2 other cases. In 2 cases of cup ear the result was fair, but this deformity with marked auricular aplasia was not curable by this conservative treatment.
Conservation surgery for cancer of the larynx in the elderly‐
Authors: Alajmo Ettore , Fini‐Storchi Omero , Agostini Vittorugo , Polli Gianni
Published: October 2006

The postoperative course was evaluated for 458 consecutive patients, all over the age of 56 years, who had undergone laryngeal conservation surgery in the last 10 years. One hundred seventy‐one patients aged 66 and over made up the “elderly” group and 287 patients, aged between 56 and 65 years formed the control group.

It was confirmed that cordectomy and frontolateral laryngectomy are feasible even in elderly patients. Bronchopneumonia is the most frequent and serious complication after supraglottic laryngectomy. Therefore this operation should be performed in the elderly patient only after a thorough evaluation of cardiac and respiratory function. Prophylactic neck dissection should not be done for No necks and the second therapeutic neck dissection in N2 cancers should be staged 6 or more weeks later. Hemilaryngopharyngectomy and subtotal reconstructive laryngectomy with cricohyoidpexis are not advisable in elderly patients.
Intramuscular hemangioma of the head and neck
Authors: Wolf Gregory T. , Daniel Fred , Krause Charles J. , Kaufman Roger S.
Published: October 2006

Intramuscular hemangiomns are unusual tumors in the head and neck region that occur most frequently in the masseter muscle and are often confused with parotid neoplasms. Four cases are described and the literature reviewed. The diagnosis and management of these tumors are discussed in view of the fact that accurate preoperative diagnosis is unusual and tumor recurrence rates high. Increased awareness of the clinical presentation of intramuscular hemangiomas should enhance diagnostic accuracy and facilitate optimal treatment planning.
Reconstruction of large fronto‐orbital defects with dacron® polyurethane custom prosthesis and autogenous bone
Authors: Stanley Robert B. , Shih Tyson
Published: October 2006

Reconstruction of large defects of the frontal bone and bony orbit may be required following trauma or ablative tumor surgery. Autogenous bone or alloplastic implants used alone may prove inadequate due to difficulties obtaining symmetric contours with bone and lack of strength and resistance to infection with alloplastic materials. These problems can be overcome with the combined use of a prefabricated Dacron® polyurethane mesh prosthesis (Osteo‐Mesh, Xomed, Inc.) to establish contour of the forehead and superciliary ridges, and underlying split‐rib grafts to protect the brain and isolate the paranasal sinuses. This technique is not indicated for small frontal defects, but it should be considered for use by the head and neck surgeon who is faced with the challenge of reconstructing a major fronto‐orbital defect.
Microsurgical application of freeze‐dried arterial allografts
Authors: Pratt Michael F. , Schneider James , Galey Frank R.
Published: October 2006

Arterial allografts of 1.0 mm diameter and 1.0 cm length were freeze‐dried and placed into the femoral arteries of 15 Sprague‐Dawley albino male rats in order to study patency and tissue reactions of the host. Patency in the first three postoperative days was determined by monitoring viability of the epigastric island flap. All grafts were patent during this early postoperative period. Fourteen of the subjects were surgically explored after 2 months of observation. At that time, 13 (93%) remained patent. Histopathological studies, and transmission and scanning electron microscopy were used to analyze the specimens. These data demonstrated that freeze‐dried arteries are remodeled by the host, but do not induce a cellular immune reaction. Dependable freeze‐dried microarterial allografts have potential future application in clinical microvascular surgery.
Post‐tympanostomy otorrhea
Authors: Gates George A. , Avery Christine , Prihoda Thomas J. , Richard Holt G.
Published: October 2006

Otorrhea is the most common complication of surgical drainage of the tympanum for the treatment of chronic secretory otitis media. Otorrhea present at the first postoperative visit may be due to the operative procedure, the underlying disease process, or both. After analyzing data from 525 operations on 1045 ears of 396 children with chronic secretory otitis media, and finding an over‐all incidence of immediate postoperative otorrhea of 3.4%, we conclude that preparation of the ear canal with povidone iodine and the postoperative prophylactic use of an antimicrobial‐corticosteroid topical preparation provides optimal control of postoperative wound infection. Sporadic increases in the incidence of postoperative otorrhea may be due to extrinsic factors such as outbreaks of upper respiratory infection.
Temporal bone showing polyarteritis nodosa, otosclerosis, and occult neuroma
Authors: Adkins Warren Y. , Ward Paul H.
Published: October 2006

The clinical and general histopathologic manifestations of systemic vasculitis of the polyarteritis nodosa type are well known. Although hearing loss associated with polyarteritis nodosa has been reported, only two temporal bone studies are available. The findings in a 60‐year‐old man with well‐documented hearing loss who had rheumatoid arthritis, polyarteritis nodosa, and otosclerosis are presented. Polyarteritis nodosa extensively involved the subarcuate arteries and arteries of the facial canal. There were decreased nerve fibers to and sensory cells in the crista of the semicircular canals and macula of the utricle and saccule. Focal and diffuse atrophy of the stria vascularis and decreased cellularity in the spiral prominence and ligament were present. There was a loss of outer hair cells. Otosclerosis involved the left and right oval window niches (bilateral stapedectomy had been performed). There was a small Antoni type A neuroma of the superior division of the vestibular nerve on the left.
Primary cutaneous lymphoma of the head and neck
Authors: Fisher Samuel R. , Burton Gary V. , Murray John C. , Borowitz Michael , Crocker Ian R.
Published: October 2006

One hundred three patients with Stage I and II extranodal primary lymphomas of the head and neck were reviewed. Six patients (5%) presented with cutaneous lesions, five with single site and one with multiple sites of involvement. Histopathology was malignant lymphoma (ML) large cell (3), ML small cleaved cell (1), ML small lymphocytic (1), and ML mixed large and small cell (1). Five of six patients relapsed following initial treatment. Four patients were treated with primary radiation therapy, three of which had relapses outside the treatment area. One patient was treated with intralesional steroid injection and also recurred outside the treated area. One patient was treated with radiation and chemotherapy and recurred outside the treatment area. Three patients are alive without disease, two died of disseminated disease, and one died of unrelated causes.

Isolated cutaneous presentation of head and neck lymphoma is uncommon. Radiation therapy appears to have been curative in one patient with localized disease. Four patients recurred outside the radiation portals despite careful staging, suggesting that systemic therapy may be necessary for disease control.
Laryngotracheal trauma: a protocol approach to a rare injury
Authors: Gussack Gerald S. , Jurkovich Gregory J. , Luterman Arnold
Published: October 2006

Laryngotracheal trauma is rare and complications are frequent. Twelve major series totalling 392 cases have been published over the past decade, with complication rates as high as 40%. We have treated over 30,000 trauma victims at our Level I Trauma Center over the past 5 years, of which 109 had neck injuries, but only 12 suffered cervical laryngotracheal trauma. The mechanism of injury was penetrating in eight and blunt trauma in four. The time to tracheostomy decannulation varied from 7 to 60 days. Airway patency was assured without stenosis or significant granulation tissue in 10 of the 12 patients. Three patients suffered permanent voice changes. Based on review of the 392 previously reported cases and a critical analysis of our 12 cases, a detailed management algorithm is proposed.
Primary adenocarcinoma of the temporal bone with posterior fossa extension: case report
Authors: Gulya Alna Julianna , Glasscock Michael E. , Pensak Myles L.
Published: October 2006

Primary adenomatous tumors of the middle ear and mastoid are rare. We recently cared for a man with a far‐advanced primary adenocarcinoma of the middle ear and mastoid. Complete tumor removal was accomplished by a modified infratemporal fossa approach and was supplemented with postoperative radiation therapy. The postoperative complications of aspiration pneumonia and cerebrospinal fluid (CSF) leakage through the wound stimulated subsequent incorporation of temporary gastrostomy and CSF shunting into our surgical procedure. Now, 23 months after surgery, the patient is without evidence of recurrent disease. His case illustrates our approach to the management of such extensive temporal bone lesions as well as some of the potential problems which may be encountered.
A rare manifestation of metastatic adenocarcinoma
Authors: Yeatman Timothy J. , Seagle Michael B. , Cassisi Nicholas J.
Published: October 2006

We report a very rare case of adenocarcinoma metastatic to the epiglottis and cervical lymph nodes that presented clinically with symptoms of dysphagia. The method of diagnosis, including recent advances in the evaluation of head and neck metastases, is discussed.
Severity of sleep apnea as a predictor of successful treatment by palatopharyngoplasty
Authors: Caldarelli David D. , Cartwright Rosalind , Lilie Jamie K.
Published: October 2006

As awareness and understanding of obstructive sleep apnea has increased so has the number of treatments for this disorder. Options include surgical procedures: tracheostomy, palatopharyngoplasty(PPP), and mandibular advancement. Other treatments are medication, nasal CPAP, Tongue Retaining Device, and a position alarm. With these numerous choices available, it is important that reliable indicators be developed to guide treatment choice. And although PPP surgery is a one‐time intervention with possibility of permanent correction, reports of percentages of successful treatment have varied widely from 85% to 0%. This has led us to investigate predictors of successful treatment.

Twenty‐two patients treated with PPP following their diagnosis by standard clinical polysomnography were restudied an average of 8 weeks later. When 11 successful cases were compared to 11 unsuccessful cases, successes were found to be initially more severely apneic (X AI=90.55 versus 49.45).

Palatopharyngoplasty appears to be most appropriate for the sleep apnea patient whose apnea index is 70 or above and less effective for milder cases.