bluuebunny/crossref_metadata_2025 huggingface dataset:
Subcutaneous pedicle flap reconstruction of lower nasal defects
Authors: Toomey James M.
Published: October 2006

Large defects of the thick, immobile lower nasal skin are most optimally reconstructed by use of the single stage, reliable and cosmetically acceptable subcutaneous pedicle flap. Skin incisions are minimized and are easily placed in natural skin lines. The donor defect is closed directly.

Grafts, other local flaps or regional flaps present the disadvantages of less ideal color or contour match, reduced flap mobility, restricted available skin, additional or more obvious donor site scarring or distortion, or unnecessary complexity.
Thymic cysts in the neck
Authors: Strome Marshall , Eraklis Angelo
Published: October 2006

The etiologic considerations in head and neck lesions rarely include the diagnosis of thymic cysts. A correlative summary of three new cases was analyzed with respect to the already existing body of data. A classification of thymic cysts, their embryogenesis, clinical signs, and appropriate pre‐operative studies were stressed. The gross and microscopic histopathology was reviewed with the conclusion that in many instances normal thymus was included in the surgical specimen. Given our increasing knowledge regarding thymic function, it was stressed that heightened awareness of this clinical entity should enable preservation of the normal thymus gland.
Normal opaque cerebellopontine cisternogram
Authors: Clemis Jack D. , Curtis Arthur W.
Published: October 2006

An attempt has been made through this study to establish a tumor suspect pool of 100 patients, each one highly suspect because of a single or usually several strong clinical indicators of a retrocochlear lesion. In turn each patient has been proven tumor negative by virtue of a normal opaque cerebellopontine cisternogram. This has given us a unique opportunity to critically reassess the clinical indications of VHIth nerve tumor from a reverse or negative viewpoint.

All data from these patients has been carefully analyzed in relation to indication for opaque cisternography, clinical symptomatology, pure tone audiometry, special auditory tests, tomograph of the internal auditory canal, vestibular function, final etiologic diagnosis, and the associated ves‐tibular aqueduct findings.

This, paper parallels our earlier study of 121 surgically proven schwan‐nomas1 providing a total tumor suspect pool of 221 patients with a comparable tumor positive‐tumor negative distribution.
Anatomical variations of the stylohyoid complex and their clinical significance
Authors: Chandler James R.
Published: October 2006

Anatomical variations of the styloid process and its ligaments may be responsible in some patients for vague symptoms referrable to the throat and neck. On occasions, they result in some diagnostic and therapeutic quandaries. The anatomy is reviewed and five case reports used to illustrate typical and unusual problems.
The homograft myringoplasty and the lamina propria of the tympanic membrane
Authors: Greenfield Elliott C.
Published: October 2006

The lamina propria of the tympanic membrane is composed of a unique system of radial and nonradial fibers which contribute importantly to its function. Over 1000 patients have undergone operations for the transplantation of the homograft tympanic membrane. Animal experiments have been presented to determine whether or not the fiber system of the lamina propria of the tympanic membrane is preserved in the homograft tympanic membrane. In conjunction with this, a small series of experiments was conducted to determine the appearance of the fiber system in perforations that heal spontaneously. Current knowledge concerning the function of the fiber network is discussed. The results of the present study indicate that the lamina propria fiber network is at least partially preserved in the homograft tympanic membrane and that the fiber network of the lamina propria is not reconstituted in spontaneously healed tympanic membranes.
Ganglion cell populations in normal and pathological human cochleae. Implications for cochlear implantation.
Authors: Otte Jorge , Schuknecht Harold F. , Kerr Alan G.
Published: October 2006

A histological study of 100 hearing ears showed that some capability for speech discrimination requires at least 10,000 spiral ganglion cells. The spiral ganglion cell populations were then estimated in another group of 62 ears which were profoundly deaf for a variety of causes and it was found that 45% of these met the criterion of having 10,000 ganglion cells. The ganglion cell populations were largest in ears deafened by sudden deafness, Meniere's Disease, and ototoxic drugs; they were somewhat less for those with vascular occlusion, temporal bone fracture, otosclerosis, and cochlear dysplasias; they were least in those with measles, bacterial labyrinthitis and congenital syphilis. The data is of relevance in the selection of patients for cochlear implantation.
Gelfoam paste injection for vocal cord paralysis: Temporary rehabilitation of glottic incompetence.
Authors: Schramm Victor L. , May Mark , Lavorato Alfred S.
Published: October 2006

Vocal cord paralysis frequently results in open glottic incompetence with aspiration, an ineffective cough, and poor voice production. Glottic competence can be restored temporarily by injecting the true vocal cord with Gelfoam paste. This clinical use of Gelfoam for temporary rehabilitation is indicated in: 1) situations in which paralysis may be temporary, 2) patients for whom an open operative procedure must be delayed, and 3) circumstances in which it is desirable to determine the effect of vocal cord injection prior to placement of nonabsorbable material. The injection of Gelfoam paste results in minimal tissue reaction. Absorption is gradual over a period of six to ten weeks, allowing time for some glottic compensation. The injection may be repeated without adverse effects until the paralysis resolves or intervention of a permanent nature is indicated.
Recurrent laryngeal nerve pathology in spasmodic dysphonia.
Authors: Bocchino Joseph V. , Tucker Harvey M.
Published: October 2006

Since it was first described in 1871, spasmodic (spastic) dysphonia has been considered a disease of psychogenic origin. Unsupported theories of possible organic etiology have appeared sporadically in the literature. In 1976 sectioning of the recurrent laryngeal nerve for patients with this disease was reported with resultant improvement in voice production. This was attempted because the spasmodic dysphonic has, in effect, already compensated vocal cords bilaterally. It was reasoned, therefore, that if one of these was paralyzed the patient would immediately be converted to a state approximating that of a well‐compensated unilateral vocal cord paralysis which situation, as is well known, usually carries with it a fairly good voice. A controlled study to evaluate the efficacy of this surgical approach has been undertaken at the Cleveland Clinic during the past year.

In an attempt to elucidate the possible organic etiology of spasmodic dysphonia, a section of nerve was removed in every case and examined by both light and electron microscopy. Special stains for myelin were also used on the light microscopy specimens. Demyelinization has been found in most of the cases examined by electron microscopy. Possible correlation between this disease entity and other cranial nerve syndromes of unknown etiology is noted. Such conditions as trigeminal neuralgia, glossopharyngeal neuralgia, blepharospasm, hemifacial spasm, and even possibly Bell's palsy may exhibit a similar etiology.
Carcinoma of the larynx: Lymph node reaction patterns.
Authors: Gilmore Bennie B. , Repola David A. , Batsakis John G.
Published: October 2006

In a double‐blind retrospective analysis, sections of lymph nodes removed at the time of laryngectomy and homolateral neck dissection were microscopically examined to assess the histopathological manifestations of an immune response. Contrary to an earlier study, no strong correlation appears to exist between the host response as manifested by the lymphnode morphology and survival or metastases. The question of preoperative irradiation altering the lymph node's ability to respond effectively is raised and puts in jeopardy such a morphological assessment in patients who have received preoperative radiotherapy.
Letterer‐siwe disease. Presentation as an otologic problem.
Authors: Karmody Collin S. , Moloy Peter J.
Published: October 2006

Letterer‐Siwe disease is one of the three clinical syndromes that are collectively known as histiocytosis X. This is the most aggressive form of histiocytosis and is frequently fatal. Recently, however, early treatment with chemotherapeutic agents and steroids has prolonged survival and has even resulted in remission of a number of cases. This paper draws attention to a persistent external otitis as an early symptom of Letterer‐Siwe disease and identifies, histologically, involvement of the external auditory canal.
A comparison of fenestration of the horizontal canal and stapedectomy in the opposite ear
Authors: Masciotra Nicholas J. , Caparosa Ralph J.
Published: October 2006

The Lempert one stage horizontal semicircular canal fenestration was the surgical procedure of choice for otosclerosis from 1939 to 1954. Subsequently, mobilization and stapedectomy replaced fenestration.

In the offices of Drs. Day, Jordan, and Caparosa, the horizontal semicircular canal fenestration was performed from 1940 to 1955; the mobilization, two years; and, thereafter, the stapedectomy. A significant number of patients have had fenestration on one side and stapedectomy on the opposite ear.

Fifty patients seen consecutively were reviewed. Reliable office audiological testing has been available only in the more recent years; and, therefore, audiological statistical comparison has limited reliability. It is felt, however, that a review of these patients and the study of their surviving hearing results is a worthwhile inferential comparison.
Symposium: Cochlear implant, 1978—fact or supposition. Traumatic intracochlear electrode implantation
Authors: Schindler Robert A. , Bjorkroth Birgitta
Published: October 2006

The success of intracochlear electrode implantation hinges on the ability of peripheral auditory neurons to survive long‐term interface with an electrode array and prolonged electrical stimulation. Histopathological studies have been conducted on a series of neomycin sulphate otointoxicated cats to assess the long‐term effects of electrode implantation on an impaired cochlea (analogous to potential human sensory deaf implant candidates).

The results of these studies may be summarized as follows: 1. Long‐term electrode implantation can be achieved without significant loss of primary auditory neurons using an electrode array embedded in Silastic which is molded to conform to the basal scala tympani if surgical implantation has not disrupted the basilar membrane or osseous spiral lamina. 2. A fibrous tissue matrix forms around the Silastic, displacing perilymph and effectively sealing the electrode at the round window preventing perilymph fistula. 3. While osteoneogenesis will occur whenever the periosteum of the bony labyrinth is disrupted, the molded Silastic sheathing prevents electrode displacement by small areas of new bone formations. 4. Traumatic electrode insertion, with fracture of the osseous spiral lamina or rupture of the basilar membrane, produces severe loss of neural elements in the region of injury and extensive new bone formation preventing satisfactory electrical stimulation.

The findings suggest that long‐term cochlear implantation is feasible in sensory deafened animals using Silastic sheathed electrode arrays which have been molded to conform to the basal scala tympani provided the integrity of the scala tympani, osseous spiral lamina and basilar membrane is maintained.
A method for refixation of the multifractured respiratory cranium
Authors: Wullstein Horst L. , Baumann Ralph R.
Published: October 2006

So‐called Tantalum‐Visors are used to refixate the multifractured facial skeleton, torn off the base of the skull by trauma, in a three dimensional way to avoid dishface and pseudotelorismus. These visors are kept in storage: a small model—glabella visor, and a large one—zygomatic visor. Of both types, a bigger one is for the head of a male, a smaller for a female and still smaller for youth, because it is impossible to make an individual mold immediately following an accident.
Optokinetic nystagmus: A comparative study of two stimulators
Authors: Nieberding Paul H.
Published: October 2006

The neural mechanisms for optokinetic nystagmus (OKN) may be clinically relevant to the two methods used to detect these abnormalities. If one subscribes to the cortical (macular) theory, visual fixation is always involved and results by conventional drum rotation or by pursuit of a moving light source ought to be the same. Conversely, if OKN can be the result of peripheral vision and subcortical pathways, results with the drum (which does not require macular vision) and moving light (which does) ought to be different.

Both the drum and moving light methods were compared on a sample of 514 patients.

Both methods compared equally in eliciting abnormal responses in patients with an established diagnosis and in correlation with calibration, gaze, and false positive responses. The drum was superior in the remainder of comparisons.
Histamine, norepinephrine and serotonin content of nasal polyps
Authors: Bumsted Robert M. , El‐Ackad Tarek , Smith J. Montgomery , Brody Michael J.
Published: October 2006

Histamine, norepinephrine and serotonin were assayed and localized by fluorescence histochemistry in normal mucosa and nasal polyps because of their possible role in the development of inflammation and edema. Histamine was present in greater concentration in nasal polyps than in normal mucosa. Norepinephrine was present primarily in the base of nasal polyps and in greater concentration than in normal mucosa. Patients with aspirin sensitivity and asthma had much lower histamine concentrations in their nasal polyps than all other patients with nasal polyps. A proposal for a possible mechanism of formation of nasal polyps based on vascular and inflammatory mechanisms and incorporative roles for histamine and norepinephrine is presented.
Vestibular and oculomotor disturbances in pathology of the fourth ventricle
Authors: Katsarkas Athanasios
Published: October 2006

Positional nystagmus of the central type and gaze paretic (gaze evoked) nystagmus have been reported in pathology of the posterior fossa. It has also been reported that positional nystagmus of the central type is only infrequently accompanied by vertigo and nausea.

In this paper five cases are discussed which showed positional nystagmus of the central type and/or gaze paretic nystagmus. All cases showed severe vertigo, nausea and vomiting in the provocative head position. In four out of five cases the pathology was found to be in the area of the IVth ventricle. On the basis of recent neurophysiologic data an attempt is made to explain the manifestations of this pathology. It is concluded that positional nystagmus of the central type is presumably due to pathology of the IVth ventricle area. Also, that this type of nystagmus may be accompanied by severe vertigo, nausea and vomiting.
Bilateral vocal cord paralysis following general anesthesia
Authors: Nuutinen Juhani , Kärjä Juhani
Published: October 2006

A rare case of bilateral vocal cord paralysis after orotracheal intubation and inhalation anesthesia, in surgery not in relation to the neck, is presented. There was no obvious cause for the paralysis and possible etiological factors are discussed. Overextension of the neck during intubation is suspected of being the etiological agent causing stretching of both the vagus nerves. Normal laryngeal function returned after two months.
The differential diagnosis of the mass in the neck. A fresh look
Authors: Miller Daniel , Ervin Thomas , Weichselbaum Ralph , Fabian Richard L.
Published: October 2006

A diagnosis of undifferentiated carcinoma by light microscopy in a neck node biopsy is insufficient to come to a conclusive answer as to the type of tumor with which one is dealing. The fact that undifferentiated carcinoma by light microscopy may very well be a histiocytic lymphoma with a different mode of treatment and an increasingly improved cure rate has changed the mode of evaluation in arriving at a diagnosis of the node in the neck with no visible primary in the upper aerodigestive tract.
Medial canthoplasty: Early and delayed repair
Authors: Duvall Arndt J. , Foster Craig A. , Lyons Dean P. , Letson Robert D.
Published: October 2006

Naso‐orbital trauma can cause medial orbital wall disruption and detachment of the medial canthal ligament. Damage to the nasolacrimal drainage apparatus, cerebrospinal fluid rhinorrhea and frontal sinusitis can occur. Twelve cases of naso‐orbital trauma have been reviewed. There is a high incidence of associated injury to adjacent structures. Medial canthal ligament separation was missed acutely in a number of cases leading to the necessity of delayed repair. Important diagnostic and therapeutic points are stressed in the acute and delayed management, particularly medial canthal ligament separation. A wire to intranasal button technique for the delayed repair of traumatic telecanthus is presented.
Patterns of velopharyngeal valving in normal and cleft palate subjects: A multi‐view videofluoroscopic and nasendoscopic study
Authors: Croft Charles B. , Shprintzen Robert J. , Rakoff Saul J.
Published: October 2006

The mechanism of velopharyngeal valving in normal subjects and patients with velo‐pharyngeal insufficiency (VPI) has been the subject of keen debate. The authors have studied 80 normal subjects and 500 patients at the Center for Craniofacial Disorders using direct nasopharyngoscopy and multi‐view videofluoroscopy to ascertain the patterns and mechanism of velopharyngeal valving. Multiple patterns of valving were found in both populations and were characterized as “coronal,” “sagittal,” “circular,” and “circular with Passavant's ridge.” The incidence of the differing patterns of closure were surprisingly similar in frequency in both normal and pathologic populations. The importance of these diagnostic methods is discussed in relation to treatment of patients with VPI, particularly in designing the type and level of pharyngoplasty.
Mentoplasty — A clinical analysis of alloplastic implants
Authors: Binder William J. , Kamer Frank M. , Parkes Morey L.
Published: October 2006

Different types of alloplastic implants are currently being utilized in performing mentoplasty. A review of the literature points out the number of prostheses that have been used. Each type of material has inherent physical properties which determine its characteristics for use as a chin implant. The type of implant and method selected in chin augmentation depends upon accurate preoperative evaluation and full understanding of the properties of alloplastic substances.

Five hundred and thirty‐nine cases of chin augmentation utilizing different materials and methods were reviewed over a nine year period. The limitations of mentoplasty as well as the advantages, disadvantages, and in selected cases, the indications for the use of a particular implant are discussed.
Cholesterol granuloma presenting as an isolated middle ear tumor
Authors: Miglets Andrew W. , Booth Jack B.
Published: October 2006

Patients with cholesterol granuloma of the middle ear cleft will usually present with a secretory otitis media, and exhibit evidence of diffuse disease within the mastoid upon roentgenographic evaluation. The following patient with an isolated middle ear cholesterol granuloma presented with signs and symptoms more closely resembling a glomus tumor.
Radical irradiation for carcinoma of the pyriform sinus
Authors: Million Rodney R. , Cassisi Nicholas J.
Published: October 2006

Radiation therapy is sometimes prescribed as an alternative to partial or total laryngo‐pharyngectomy in the initial management of carcinoma of the pyriform sinus. Forty‐two patients were irradiated for cure and have a follow‐up period of 2‐14 years. Local control by irradiation alone was 11 of 14 for T1, 6 of 10 for T2, 3 of 6 for T3, and 1 of 7 T4. Three T2 failures were salvaged by laryngopharyngectomy for an ultimate control of 9 of 10 for T2.

Management of the neck is critical since 79% of the patients presented with clinically positive necks, and many had substantial neck disease. Complete or partial neck dissection was added after irradiation on an individualized basis. In spite of the extensive degree of neck disease, only three patients died of uncontrolled neck disease with the primary controlled.

The two‐year absolute survival for Stages I and II was 83%, Stage III 62% and Stage IV 52%. The five‐year absolute survival for Stages I and II was 66%, Stage III 38%, and Stage IV 10%.

Complications of irradiation, neck dissection, and surgical salvage procedures are reviewed.
The use of radioisotope scans in the preoperative evaluation of epidermoid carcinoma of the head and neck.
Authors: King Austin I. , Johnson Paul E.
Published: October 2006

Because of the growing awareness of metastatic disease in head and neck patients, a protocol including radioisotope scans was begun through the Baylor Department of Otolaryngology at the Houston V.A. Hospital in an attempt to identify these patients preoperatively. Out of 198 death charts reviewed, only 3 had positive preoperative scans and only one of these was clinically significant. Chest X‐rays identified more preoperative metastatic disease than the radioisotope scans. Twenty percent of patients had second primaries, which was more than the number of patients dying with distant metastatic disease. Only 5% of these patients died of metastatic disease with local control. Local control with follow‐up for second primaries should be the primary objective of the surgeon. Radioisotope scans were of no significant value in evaluating preoperative metastatic disease.
Long‐term middle ear ventilation.
Authors: Per‐Lee John H.
Published: October 2006

This is a 16 year experience report on the author's wide flange ventilation tube, used for permanent or severe chronic Eustachian tube dysfunction. Two hundred and twenty‐eight implants in 198 ears of 126 patients were adequately followed. A small series of 13 Paparella implants is included.

Patient age ranges from 6 months to 72 years. Tube longevity up to elective removal averaged 51.2 months (longest — 159 months). Average longevity for tubes removed for uncontrolled complications was 34.6 months (longest — 162 months). Comparable figures for the Paparella tube are 15 and 31 months.

There were 249 complications in 228 Per‐Lee tube implants and 12 in 9 Paparella tube implants; 69.6% of Per‐Lee tubes and 100% of Paparella tubes were associated with complication. Per‐Lee tube complications occurred from 1 to 162 months after implantation. The most common was infection (68.6% of all complications). The others included bleeding (10.9%), peritubal drum atrophy (11.7%), extrusion (4.8%), tissue growth into the tube (0.8%), tube migration into the middle ear (1.2%), squamous epithelial invasion (1.2%), and obstruction for other causes (0.8%); 75 infections and 8 bleeding episodes required tube removal. The drum did not heal in 14 and 2 cases respectively. Peritubal drum atrophy, an important complication, occurred 29 times and led to 14 unhealed perforations; 12 tubes (5%) extruded leaving 4 drums unhealed. Squamous epithelium invaded the middle ear three times; in one instance it was due to the tube. A total of 49 permanent perforations (24.8% of 198 ears) occurred including those remaining after elective tube removal. This compares with a 2% or less incidence with a grommet and other standard tubes. Since long‐term ventilation is sought, this outcome is less serious than one suspects. Follow‐up hearing data was available for 7 unhealed and 32 healed drums. For unhealed drums (mostly anterior perforations) the average SRT was 7.1 db. The average SRT for healed drums was 11 1b. Other approaches to long‐term ventilation are discussed, specifically Wright's Eustachian tube prosthesis and laser myringotomy. Both approaches seem unreliable. If permanent ventilation is desired, a permanent perforation resulting from a long‐term ventilation tube would seem to be an acceptable result.
Complications of space infections of the head and neck.
Authors: Wills Paul I. , Vernon Rowland P.
Published: October 2006

Life threatening infections of odontogenic or upper airway origin may extend to potential spaces formed by fascial planes of the lower head and upper cervical area. The incidence of these “space infections” has been greatly reduced by modern antibiotic therapy. However, serious morbidity and even fatalities continue to occur.

Two cases of deep neck infection, (one of odontogenic and one tonsillar in origin) with subsequent mediastinitis, empyema, pericarditis and ultimate survival are reported. One case of deep neck infection, (of odontogenic etiology) and suppurative thrombophlebitis of the internal jugular vein with ultimate fatal outcome is also reviewed.

Review of the literature reveals only one previous case report of a survivor of an odontogenic deep neck infection complicated by mediastinitis, empyema and pericarditis. The anatomy, etiology and treatment of complications of these “space infections” of the head and neck are briefly reviewed.
Middle ear ventilation with the castelli membrane tube.
Authors: Plotkin Roger P.
Published: October 2006

This report evaluates the use of the Castelli type membrane tympanostomy tube in combination with adenoidectomy or adenotonsillectomy. One hundred and sixty two ears were studied.

Children with mucoid or seromucoid fluid only were included. The ears were unprotected during swimming, bathing, etc. The average length of intubation was 7 months; 7 1/2% developed middle ear problems with the tubes in place and 7% developed external ear problems. All of these complications were treated without residua.
Management of the ear canal seborrhea with cerumen
Authors: Storrs Lloyd A.
Published: October 2006

For the past 20 years, the author has been treating recurrent chronic seborrheic dermatitis with a suspension of human cerumen in glycerine. The cerumen is obtained from healthy children and young adults in which there is an over‐production which requires removal. If the cerumen contains debris it is not used. The collected cerumen is suspended in 50% glycerine and left for several weeks to sterilize. It is then strained through a fine filter having been heated so that its is workable. The material is dispensed to the patient in a small dropper bottle and the patient is instructed to place two drops in the external ear canal once a week.

The chronicity of seborrheic dermatitis must be explained carefully to the patient and the necessity for avoiding water, cosmetics and other materials must be stressed. The patient must be made aware that the cause of the condition is unknown and that periodic inspection of the ear canal is necessary in addition to the topical application of the cerumen suspension.
Mycobacterial cervical lymphadenopathy: 1981 update
Authors: Appling Douglas , Miller Robert H.
Published: October 2006

Scrofula or tuberculous cervical lymphadenopathy is a well known disease dating back thousands of years. In spite of antituberculous chemotherapy and public health measures, scrofula persists and is seen not infrequently among the recent immigrants to the United States from Southeast Asia and Mexico. Cervical lymphadenopathy may arise from infections with mycobacteria other than Mycobacterium tuberculosis. These infections may resemble one another, but it is important to make a distinction between them, for their clinical courses and treatments are different. A tuberculous infection usually responds very well to antituberculous chemotherapy, but a nontuberculous mycobacterial one may require surgical intervention for resolution of the problem. We would like to reawaken an awareness of this distinction and hope this paper will aid the reader in understanding the diagnosis and treatment of scrofula and nontuberculous mycobacterial cervical lymphadenopathy. The subject is reviewed, and illustrative cases are presented.
Nasopharyngeal hemangioma causing airway obstruction in infancy
Authors: Strauss Melvin , Widome Mark D. , Roland Peter S.
Published: October 2006

The clinical presentation, diagnostic evaluation, and treatment of a 3‐month‐old infant with symptomatic airway obstruction caused by a nasopharyngeal hemangioma is discussed. The pathophysiology of nasopharyngeal airway obstruction in the infant and the clinical management of hemangiomas of the head and neck are reviewed.
Liposarcoma of the neck. Report of a case
Authors: Kaplan Robert , Bratcher Glenn O. , Freeman Douglas , Seid Allan B. , Cotton Robin
Published: October 2006

A case of lipoblastic liposarcoma of the neck is presented. The case is that of a 5‐year‐old female who underwent a modified neck dissection with a good result. A review of the literature reveals that this is an extremely rare tumor of the neck. It is usually found in the lower extremities, predominantly in adult males. Surgery is the treatment of choice.

Lipoblastic liposarcoma is an extremely rare tumor when it occurs in the pediatric neck. Hudson and Saunders in their studies have shown that only 3 patients with this tumor have been reported since 1944. When a 5‐year‐old female presented with this primary neck mass, questions of diagnosis and treatment were raised. The following case report and discussion will demonstrate the diagnostic methods as well as the course of therapy followed in this type of lesion.
Abnormal insulin levels and vertigo
Authors: Proctor Conrad A.
Published: October 2006

Fifty patients with unexplained vertigo (36) or lightheadedness (14) are evaluated, all of whom had abnormal ENGs and normal audiograms. Five hour insulin glucose tolerance tests were performed on all patients, with insulin levels being obtained fasting and at one‐half, one, two, and three hours.

The results of this investigation were remarkable. Borderline or abnormal insulin levels were discovered in 82% of patients; 90% were found to have either an abnormal glucose tolerance test or at least borderline insulin levels.

The response to treatment in these dizzy patients was also startling, with appropriate low carbohydrate diets improving the patients' symptoms in 90% of cases.

It is, therefore, apparent that the earliest identification of carbohydrate imbalance with an insulin glucose tolerance test is extremely important in the work‐up of the dizzy patients.
Test battery assessment of auditory perceptual dysfunction in children
Authors: Musiek Frank E. , Geurkink Nathan A. , Kietel Stephanie A.
Published: October 2006

Seven central auditory tests were administered to 22 children, 8 to 10 years of age, considered as having auditory processing deficits. Analysis of the results indicated some tests to be significantly more sensitive than others in detecting auditory processing problems. Findings also demonstrated the advantages of a test battery over a single test and the value of employing central auditory tests for the detection of auditory processing difficulties in children. In addition, considerations for proper test battery construction are discussed in light of the results from this study.
Proximal intratemporal facial nerve in bell's palsy surgery. A study correlating anatomical and surgical findings
Authors: Goin Donald W.
Published: October 2006

This paper deals with the surgical approaches to that part of the intratemporal facial nerve lying proximal to the cochleariform process and focuses on two issues: the advisability of disarticulating the ossicular chain to reach this area and the accessibility of the labyrinthine segment via the transmastoid, extralabyrinthine, subtemporal route.

Relevant anatomical features, which are based on 39 gross temporal bones, 47 histologic sections, and 10 cadaveric specimens are first considered. In the head specimens, it was possible to attempt exploration of the entire nerve with the transmastoid, extralabyrinthine, subtemporal operation and then remove the labyrinth to gauge the adequacy of this approach as an avenue to the labyrinthine segment.

These anatomical findings, their bearing on the questions at hand, and the author's clinical experience are incorporated into descriptions of the operations currently in vogue for exploring the proximal nerve in patients with Bell's palsy.
Electrophysiologic analysis of auditory, vestibular and brain stem function in chronic renal failure
Authors: Hutchinson James C. , Klodd David A.
Published: October 2006

Utilizing audiometry, acoustic reflex threshold and reflex decay testing, electronystagmography and the brain stem auditory evoked response, cochlear‐vestibular and brain stem function in chronic renal failure has been investigated. After elimination of the etiologic factors known to affect — or possibly affect — such function, a clinically significant abnormality of auditory, vestibular and brain stem function was not noted.
Auditory brain stem response and central auditory test findings for patients with brain stem lesions: A preliminary report
Authors: Musiek Frank E. , Geurkink Nathan A.
Published: October 2006

Basic audiologic data, as well as five selected measures of the auditory brain stem response, and results from seven central auditory tests were obtained from ten adult subjects with a variety of brain stem lesions. The ABSR measures included latency, waveform morphology, amplitude ratio, presentation rate and intensity function. The central tests administered were competing sentences, rapidly alternating speech, binaural fusion, staggered spondaic words, dichotic digits, frequency patterns and low pass filtered speech. Both procedures (ABSR and C.A.T. battery) were highly sensitive to brain stem lesions in the study group as a whole, but showed some limitations for individual subjects. The data also indicated the value of employing a test battery and multiple electrophysiologic measures as opposed to single indices of auditory performance. Findings on individual central tests and ABSR measures are reported, as well as data on laterality effects.
Comparison of SMAS plication with smas imbrication in face lifting
Authors: Webster Richard C. , Smith Richard C. , Papsidero Michael J. , Karolow Wayne W. , Smith Karen F.
Published: October 2006

Undermining and imbricating the superficial musculoaponeurotic system (SMAS) have been advocated by many recent authors to enhance the results of face lifting procedures. Because all undermining has dangers, we compared in 5 fresh cadavers and 15 patients the immediate operative effects on the labial commissures, buccolabial grooves, submental areas, and cervicomental regions of undermining and imbrication with those of plication without any undermining. Closures were made on both sides and with each technique with the layers pulled to their limit of stretch. We found no significant difference between the two methods in the effects on the areas mentioned.

Disproven by this study is the theory that undermining and imbricating of the SMAS by itself will permit, at the time of surgery, greater displacement of esthetically important landmarks than will mere SMAS plication without undermining.
Five years experience using the intact canal wall tympanoplasty with mastoidectomy for cholesteatoma: Preliminary report.
Authors: Kinney Sam E.
Published: October 2006

Many advances have occurred in the treatment of acute suppurative inflammation of the middle ear; however, the problem of chronic otitis media with cholesteatoma still persists today. This paper deals with the author's experience over 5 years using the intact canal wall tympanoplasty with mastoidectomy treatment in chronic otitis media with particular emphasis on the treatment of cholesteatoma both in adults and children.

From May 1, 1976 to May 1, 1981, 204 ears were operated on for chronic otitis media with the tympanoplasty with mastoidectomy technique. Of this group, 104 ears were operated on using the intact canal wall technique when there was cholesteatoma present. The major emphasis of this paper will be to evaluate those ears with cholesteatoma.

The technique of the procedure used and modifications that have been made are outlined with particular reference as to why modifications were made as problems arose while observing this group of patients.

The results of this study suggest that there is a greater incidence of recurrence of cholesteatoma using the intact canal wall technique in children than in adults. It is believed that this higher rate is due to ongoing eustachian tube difficulties present in children. It is also felt that the intact canal wall technique does provide a better chance of auditory functional rehabilitation than an open cavity ear procedure. The problem of residual cholesteatoma still exists using the intact canal wall procedure; however, the problem seems to be well taken care of using a planned two‐stage procedure. This is particularly necessary because two‐thirds of all residual cholesteatoma was found to be in the middle ear.

The conclusions of the study suggest that a planned two‐stage intact canal wall tympanoplasty with mastoidectomy can accomplish the goals of cholesteatoma surgery, i.e., control of the disease and improved functional results. It is felt that, if cholesteatoma recurs in a child, the revision operation should be converted to a properly performed open cavity procedure. It was felt that the anatomic removal of the posterior bony canal wall in an open cavity procedure does not render an ear safe from further problems.
Fine‐Needle aspiration biopsy revisited.
Authors: Frable Mary Ann Smith , Frable William Jackson
Published: October 2006

Between November 1972 and December 1981, 1303 fine needle aspiration biopsies were performed on pntients with head and neck masses at the Medical College of Virginia, Virginia Commonwealth University. The results of 649 lymph node, 227 salivary gland, 286 thyroid, and 41 miscellaneous aspiration biopsies are reviewed. No radical treatment resulted from false positive diagnoses and no patient delay in treatment occurred because of false negative reports.

Techniques for performing the procedure are briefly reviewed. Cost containment is stressed, particularly the savings that occur when the diagnosis is not neoplastic.

Future developments and uses of the procedure are discussed.
Adductor spastic dysphonia: Three years after recurrent laryngeal nerve resection
Authors: Aronson Arnold E. , De Santo Lawrence W.
Published: October 2006

The voices of 33 patients, ages 44 to 79 years, were assessed otter recurrent laryngeal nerve resection for adductor spastic dysphonia. Voice improvement was noted in all patients 24 hours after surgery: in 97% at 1 month, 97% at 6 months, 82% at 1 year, 70% at 1 1/2 years, 58% at 2 years, 52% at 2 1/2 years, and 36% at 3 years. Of the 64% with failed voices by 3 years, 48% were worse than before surgery. Of the 36% whose voices remained improved, 58% were worse than at any previous period and 42% were better. Failures among women (77%) were considerably higher than among men (36%). Except for one patient, none of the patients with improvement achieved a normal voice. Patients with improvement had varied types and degrees of dysphonia: breathiness, hoarseness, diplophonia, and falsetto pitch breaks. The voices of some patients approached normalcy. A high percent of patients had voice tremor and regular voice arrests on vowel prolongation, signaling that the spastic dysphonia may have been related to essential (voice) tremor and that the spastic dysphonia returned because of increased severity of the neurologic tremor. We conclude that recurrent laryngeal nerve surgery for adductor spastic dysphonia has long‐term limitations and that the differential diagnosis between neurologic and psychogenic types is imperative prior to therapeutic decision making.
Delayed failure of myocutaneous flaps in head and neck reconstruction
Authors: Cho Hyun T. , Mignogna Frank , Garay Kenneth , Blitzer Andrew
Published: October 2006

Since the concept of myocutaneous flap reconstruction of the head and neck region was introduced it has opened a new approach to surgical management in this area. This flap not only reduced the number of operations as compared to “staged procedure,” but also reduced the costs of medical care. We are, however, experiencing significant failures as the applications of this flap are extended. This paper reviews our experience with myocutaneous flaps in 15 partial and total failures.

An evaluation of these failures reveals that most occurred 1 1/2 to 3 weeks after reconstruction. The factors predisposing to failure seem related more to technical errors rather than to general factors. Diabetes, peripheral vascular disease, malnutrition and low hemoglobin, and low blood pressure were not major contributors to the failures in our series. Local factors predisposing to failure of myocutaneous flaps can be divided into two large categories — arterial failure and venous failure.

In our series of unsuccessful myocutaneous flaps, the major factors appeared to be venous stasis leading to arterial insufficiency. All failures had developed after the initial critical period of flap survival (7–10 days). The following techniques showed an especially high rate of failure: 1. SCM — myocutaneous flap to resurface floor of mouth. 2. Tubed pectoralis myocutaneous flap to reconstruct pharynx and esophagus. 3. Flaps developed with very narrow vascular pedicles. Individual cases representing delayed failure are presented.
The infratemporal fossa approach for nasopharyngeal tumors.
Authors: Fisch Ugo
Published: October 2006

The technique and results of the infratemporal fossa surgical removal of carcinomas and juvenile angiofibromas of the nasopharynx are presented. Effective palliative removal of T4 and radical removal of T1 and T2 nasopharyngeal carcinomas was achieved. A classification of juvenile nasopharyngeal angiofibroma is presented. The infratemporal fossa approach allows radical removal of type III tumors and subtotal removal of type IV tumors. If residual tumor has to be left back in the cavernous sinus, irradiation is used to stop further growth of the tumor. If radiotherapy fails the neurosurgical removal of the intracranial portion of the tumor is indicated.
Symposium: The nose versus the environment
Authors: Ballenger John J.
Published: October 2006

Relatively little is known of the effect of the environment on the nose and pathogenesis of nasal disease. Basic to the acquisition of such knowledge is an appreciation of normal nasal physiology and, importantly, the mucociliary transport system (MTS). So, following a short introduction of this physiology, the panel members will discuss some important aspects of the environment and ultrastructure of the cilia on the MCT, and in so doing provide some new insights on the pathogenesis of nasal disease.
Anterior approaches to the cervical spine
Authors: Sherk Henry H. , Pratt Lindsay
Published: October 2006

Excellent exposure of the cervical spine from C4 to T1 can be attained with the standard anterior approach which utilizes a longitudinal or transverse incision to gain access to the anterior border of the sternocleidomastoid which, along with the trachea, esophagus, and carotid sheath, is retracted. Blunt dissection anterior to the sheath exposes the prevertebral fascia and the anterior aspect of the spine from C4 to T1. Occasionally surgery in the lower cervical spine necessitates detachment of the sternal head of the sternocleidomastoid. Anterolateral approaches to the upper cervical spine and base of the skull often require partial release of the sternocleidomastoid from the mastoid process and retraction of the carotid sheath and hypoglossal and spinal accessory nerves. If these retropharyngeal approaches do not provide sufficient access to the base of the skull and C1 and C2, a transoral approach, possibly with mandible and tongue splitting, can be useful. Infection is a consideration in transoral surgery, however, and this approach is indicated only in special circumstances.
Complications associated with the surgical treatment of cholesteatoma
Authors: Pratt Lindsay L.
Published: October 2006

The surgical complications associated with a cholesteatoma are predictable preoperatively depending upon the location of a cholesteatoma. If the patient has as attic cholesteatoma the surgeon can anticipate postoperatively a dry ear, minimal chance of persistent or recurrent cholesteatoma, satisfactory hearing restoration, and, although a mastoidectomy is usually necessary, the size of the mastoid cavity in an adult can be extremely small.

If a patient has a middle ear cholesteatoma the surgeon can anticipate postoperatively a relatively high incidence of moist ears, persistent or recurrent cholesteatoma, and an unsatisfactory hearing result. However, seldom will the creation of a mastoid cavity be necessary as rarely will mastoidectomy be required.

Although most of the children before puberty in the study had middle ear cholesteatomas, all children — regardless of the location of cholesteatoma — had a higher incidence of surgical failure than did the adults.
Tetracycline induced esophageal ulcers. A clinical and experimental study
Authors: Carlborg Björn , Lindqvist Christina , Densert Ove
Published: October 2006

Medication with oral drugs has not been considered as a cause of esophageal lesions in the general literature of esophageal disease. This study demonstrates 40 patients with complaints of sudden onset of intense retrosternal pains and odynophagia during treatment with oral tetracyclines. All patients had distinct circumferential ulcers in the esophagus. Medical history, barium swallows, esophagoscopy, biopsies and esophageal manometry revealed no other apparent etiology but a local corrosive effect of the tetracyclines. Experimental tests on the esophagus of the cat verified a severe local corrosive effect of the tetracyclines. Another tetracycline, lymecycline, not reported previously to induce esophageal lesions in man, was significantly less ulcerogenic than doxycycline and oxytetracycline.

Drug induced esophageal ulcerations are likely to be more numerous than previously suspected. The experimental model used appears to be sound for investigating ulcerogenic potentials of orally administered drugs.
Malignant fibrous histiocytoma in the maxillary sinus. Xanthoma‐like change of the tumor after radiotherapy
Authors: Sasaki Ryoji , Sakai Shun‐Ichi , Itoh Mahito , Murata Masami , Honda Mitsuya , Aozasa Katsuyuki
Published: October 2006

A case of malignant fibrous histiocytoma (MFH) in the right maxillary sinus is reported. Patient was a 30‐year‐old male, and was diagnosed as pleomorphic type of MFH by biopsy before therapy. The tumor shrunk and changed into xanthoma‐like tumor after radiotherapy. A case like the present case has not been reported previously in the literature.
Tracheostome construction during laryngectomy —a method to prevent stenosis
Authors: Lam K. H. , Wei W. I. , Wong J. , Ong G. B.
Published: October 2006

A new technique for construction of the tracheostome at the time of total laryngectomy is described. It involves making an X‐shaped incision on the lower skin flap and four slits on the divided trachea. The result is a serrated suture line at the tracheocutaneous junction. The incidence of stenosis in 116 patients who did not have this method of construction was 31%. Sex difference and previous irradiation was not found to be related to the occurrence of stenosis. Of 25 patients who had the new method of tracheostome construction, only one patient had to wear a tube until she died at 7 months. The rest, followed up for at least 9 months, did not have stenosis. It is concluded that this new method of tracheostome construction will reduce the incidence of stenosis.