bluuebunny/crossref_metadata_2025 huggingface dataset:
Myosin heavy chain composition in rat laryngeal muscles after denervation
Authors: Shiotani Akihiro , Flint Paul W.
Published: November 2003

Objectives: The effects of denervation on myosin heavy chain (MHC) expression in specific laryngeal muscles are characterized using gel electrophoresis. Observed temporal changes in MHC composition will then be used as a biologic marker in studies designed to develop strategies for laryngeal reinnervation and gene therapy. Study Design: Animal study using an adult rat model for laryngeal paralysis. Methods: In anesthetized rats the left recurrent and superior laryngeal nerve were divided. Animals were survived for 7, 14, 28, 90, and 180 days. Animals were euthanized and the thyroarytenoid (TA), vocalis (VOC), posterior cricoarytenoid (PCA), lateral cricoarytenoid (LCA), and cricothyroid (CT) muscle excised. Each muscle was processed for sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS‐PAGE) and densitometric measurements were obtained to determine composition of MHC fiber types. Results: The changes in relative MHC composition are described for each specific laryngeal muscle. In general, a decrease in type IIB and an increase in HA and IIX are seen after denervation. Expression of IIL in the denervated condition is variable and the relative change in type I is minimal. Conclusion: This study supports previous work using rat soleus muscle in which IIA/IIX expression is favored in conditions with decreased neuromuscular activity, and conversely, IIB expression is activity dependent. Expression of type I appears to be independent of neural activity. Further study will be undertaken to quantify expression of MHC components and to study factors modulating expression.
Nasal polyps in the olfactory cleft
Authors: Masaki Masami , Tanaka Yasuhiro
Published: November 2003

Objectives: Nasal polyps frequently arise from the middle meatus in patients with nasal polyposis, but caution is required when polyps are seen protruding from the olfactory cleft. The purpose of this study was to evaluate a method to achieve effective and safe access to the olfactory cleft, and to determine the actual incidence of polyps arising from the olfactory cleft in patients with nasal polyposis. Patients: Eighty‐four patients with bilateral or unilateral nasal polyps (n = 143) ranging in age from 16 to 72 years underwent endoscopic sinus surgery in the period from January 1994 to December 1996. Methods: To observe and gain access to the olfactory cleft, septoplasty combined with endoscopic sinus surgery was needed in patients with nasal polyposis. Results: The endoscopy during the combined septoplasty and endoscopic sinus surgery revealed that 36.4% (n = 52) of bilateral or unilateral nasal polyps (n = 143) arose from the olfactory cleft. Of 52 polyps of olfactory cleft origin, 45 (86.5%) arose from the superior turbinate and/or superior meatus, 32 (67.3%) from the medial side of the middle turbinate, 24 (46.2%) from the anterior face of the sphenoid sinus, and 17 (32.7%) from the mucosa of the nasal septum. Conclusions: These findings suggest that for surgeries of nasal polyposis an approach to the olfactory cleft as well as to the middle meatus is required.
The agony of nasal polyps and the terror of their removal 200 years ago: One surgeon's description
Authors: Cohen Jack
Published: November 2003

In previous times, nasal polyps could grow to enormous size, especially in cases of incomplete removal. Many patients suffered a lingering death from the disease or a faster one from surgical attempts at removal. John Bell's operative procedure for this condition is reviewed, showing how terrifying it must have been for the patient.
Prophylactic antibiotics in surgery for chronic ear disease
Authors: Hester T. Oma , Jones Raleigh O.
Published: November 2003

Objectives/Hypothesis: The role of prophylactic antibiotics in otologic surgery continues to be debated and perhaps misused. Prior studies have provided conflicting evidence with regard to the benefit obtained from the use of prophylactic antibiotics in surgery for chronic otitis media. The current study was designed to evaluate the role of prophylactic antibiotics in the outcomes of surgery for chronic ear disease. It was the authors' impression that there was no indication for prophylactic antibiotics in such surgery. Study Design: Randomized prospective study performed in a tertiary care facility. Methods: Patients who met inclusion criteria (n = 146) were randomly assigned to an antibiotic treatment group or a control group receiving no prophylactic antibiotics. Patients in the antibiotic treatment group were given preoperative intravenous antibiotics followed by oral antibiotics for 5 days after surgery. Patients were followed postoperatively and observed for clinical evidence of infection and graft failure. Results: There was no statistically significant difference between the two groups with regard to the incidence of postoperative infection or graft survival. Conclusions: The use of prophylactic antibiotics in surgery for chronic ear disease cannot be recommended based on the findings of this study.
Familial mondini dysplasia
Authors: Griffith Andrew J. , Telian Steven A. , Downs Catherine , Gorski Jerome L. , Gebarski Stephen S. , Lalwani Anil K. , Sheldon Susan
Published: November 2003

Objectives/Hypothesis: To determine the mode of inheritance of familial nonsyndromic Mondini dysplasia. Study Design: Correlative clinical genetic analysis of a single kindred. Methods: Clinical history, physical examination, audiologic analysis, computed tomography of the temporal bones, and cytogenetic analysis. Results: The male proband, three affected sisters, and an affected brother are offspring of unaffected parents. The mother and an unaffected brother have audiologic findings suggestive of heterozygous carrier status for a recessive hearing loss gene. Conclusions: Pedigree analysis indicates autosomal recessive inheritance in this family. The observed inheritance and clinical, audiologic, and radiologic findings are different from those previously described for another family with nonsyndromic Mondini dysplasia.1 The phenotype in this study family therefore represents a distinct subtype, indicating clinical and genetic heterogeneity of this disorder. This information should facilitate future molecular linkage analyses and genetic counselling of patients with inner ear malformations. Key Words: Mondini, sensorineural, hearing loss, familial, inner ear.
Management of thyroid carcinoma invading the aerodigestive tract
Authors: Bayles Stephen W. , Kingdom Todd T. , Carlson Grant W.
Published: November 2003

Objectives: To evaluate approaches to thyroid carcinoma invading the aerodigestive tract, with particular attention to well‐differentiated carcinomas. Study Design: Retrospective review of experience with thyroid carcinoma invading the aerodigestive tract over a 20‐year period at a tertiary referral hospital. Methods: The medical records of all patients with a diagnosis of thyroid cancer treated at Emory University Hospital, Atlanta, Georgia, from 1977 through 1997 were reviewed. Multiple clinical variables were analyzed including treatment, development of recurrence, and survival. Survival and time to local recurrence were determined by Kaplan‐Meier analysis, and statistical comparisons were made using log‐rank analysis. Results: Five hundred thirty‐six cases were identified; 28 patients (5.2%) were identified with invasive disease involving the aerodigestive tract. Histologic findings at the time of invasion included 15 well‐differentiated (WD) carcinomas and 13 poorly differentiated (PD) carcinomas. Eight of the 28 patients (5 WD, 3 PD) underwent surgical resection of some portion of the aerodigestive tract with curative intent. Ten patients (8 WD, 2 PD) underwent incomplete resection with tumor left adjacent to aerodigestive tract structures. All patients undergoing incomplete resection developed local recurrence. Six required salvage resection, as opposed to no recurrences in WD carcinomas following complete resection (P = .01). Survival at 5 years for WD carcinomas undergoing complete resection versus initial incomplete resection was 100% versus 50%, respectively (P = .27). Conclusion: Review of our experience shows that complete resection of thyroid carcinoma invading the aerodigestive tract can offer prolonged palliation, improved local control, and the opportunity for cure in selected patients.
Facial nerve outcome in lateral skull base surgery for benign lesions
Authors: von Doersten Peter G. , Jackson C. Gary , Manolidis Spiros , Pappas Dennis , Glasscock Michael E.
Published: November 2003

Objective:To statistically identify factors most important in affecting CN7 outcome in lateral skull base surgery for benign lesions.Study Design:A retrospective review of 217 nonmalignancy lateral skull base procedures from 1970 to 1995 at the Otology Group in Nashville.Methods:Charts were reviewed for epidemiology, histopathology, staging, type of CN7 mobilization (none, short, long, severance with reanastomosis, and resection), preoperative and postoperative CN7 function, surgery performed, and survival.Results:Average House‐Brackman (HB) scores for mobilizations were as follows: short, 1.65: long, 2.74: and grafting, 4.33. Factors found to affect outcome in a statistically significant fashion were preoperative HB score, staging, type of CN7 manipulation, and surgical approach. Meningiomas were found to have a worse outcome than glomus tumors.Conclusions:Complete resection of tumors should be performed with minimal manipulation of the facial nerve based on regional anatomy and tumor anatomy.Laryngoscope, 108:1480–1484, 1998
Further evidence for allergic pathophysiology in allergic fungal sinusitis
Authors: Manning Scott C. , Holman Marie
Published: November 2003

Controversy continues over whether allergic fungal sinusitis represents a true allergy, an infection, or a point somewhere along a spectrum between allergy and infection. The present study describes two experiments that add weight to the argument that allergic fungal sinusitis (AFS) is truly an immunologically mediated hypersensitivity and not a form of infection. In the first experiment, eight patients withBipolarisculture‐positive AFS were prospectively evaluated withBipolarisantigen skin testing and with inhibition radioallergosorbent (RAST) and enzyme‐linked immunosorbent assay (ELISA) forBipolaris‐specific IgE and IgG antibodies. TheBipolarisAFS cases were compared with 10 control patients with no history of AFS. All eight AFS cases demonstrated positive skin testing toBipolarisand in addition, all tested positive by RAST and ELISA for IgE and IgGBipolarisantibodies, respectively. In the control group one patient had a positive skin test, ELISA, and RAST and one additional patient had a positive ELISA only. Good correlation was noted between skin test, RAST, and ELISA results. In the second experiment, sinus mucosa from 14 AFS patients and 10 control patients with other forms of surgical sinus disease was analyzed by immunohistocytochemistry for the eosinophilic inflammatory mediators major basic protein (MBP) and eosinophil derived neurotoxin (EDN) and the neutrophil mediator neutrophil elastase. All AFS cases demonstrated evidence of eosinophilic mediator release, and MBP and EDN predominated over neutrophil elastase. In the control group eosinophil and neutrophil mediator release in sinus mucosa was equal. The two experiments support the concept that AFS is an antigen‐triggered, IgE‐ and IgG‐mediated hypersensitivity response with a late‐phase inflammatory reaction involving release of eosinophilic mediators.Laryngoscope, 108:1485–1496, 1998
Malignant neoplastic disease of the parotid lymph nodes
Authors: Schroeder Walter A. , Stahr William D.
Published: November 2003

Objectives: To review the management and outcome of patients with malignant neoplastic disease of the parotid lymph nodes excluding those with primary salivary gland tumors. Study Design: Retrospective review of 14 patients who had malignant parotid lymph nodes from metastatic cutaneous malignancies, direct extension from primary cutaneous malignancies, or lymphoproliferative disorders. Methods: Charts were reviewed from three institutions and tabulated for age, gender, histopathology, treatment, and outcome. Results: Fourteen patients met the criteria for study. Ten patients had neoplastic nodes from cutaneous malignancies. Seven involved squamous cell carcinoma, two were metastatic from melanoma, and one was metastatic from basal cell carcinoma. Four patients had involvement from lymphoproliferative disorders. Conclusions: Metastatic disease to the parotid nodes or direct extension to nodes from primary cutaneous malignancy demonstrates a poor prognosis in this series. Prognosis of lymphoproliferative disorder is more favorable. Laryngoscope, 108:1514–1519, 1998
Ki‐67 and p53 in T2 laryngeal cancer
Authors: Kropveld Arvid , Slootweg Pieter J. , Blankenstein Marinus A. , Terhaard Chris H. J. , Hordijk Gerrit J.
Published: November 2003

Objective: To study the relationship between the proliferative capacity, represented by the immunohistochemical labeling index (LI) of proliferation marker Ki‐67, and the p53 status, as in theory an intact p53 cell cycle checkpoint system should result in a lower proliferative capacity. Study Design: From a group of 128 patients with a T2 laryngeal carcinoma, presented from 1989 to 1993 at the University Hospital Utrecht, 20 patients with recurrent disease and 16 patients without recurrent disease were randomly selected. All patients received primary irradiation. Methods: Denaturing gradient gel electrophoresis and immunohistochemistry determined the p53 status. MIB‐1 staining was used to determine the Ki‐67 LI. Results: In 36% of specimens we found a p53 mutation with overexpression (LI, 31%). In 8% a p53 mutation without p53 overexpression was found (LI, 18%). Forty‐two percent showed no mutation but, nevertheless, overexpression (LI, 35%). Neither mutation nor overexpression was found in 14% (LI, 38%). No correlation exists between p53 status and proliferative capacity of tumors (analysis of variance [ANOVA]; P = .104). The proliferation rate as established with Ki‐67 LI positively correlates with response to radiotherapy (P = .006). Conclusions: 1. Overexpression of wild‐type p53 protein does not result in cell cycle arrest measurable by a lower Ki‐67 LI in comparison with cases overexpressing mutant type p53 protein. 2. A high Ki‐67 LI correlates with a favorable response to radiotherapy. Laryngoscope, 108:1548–1552, 1998
Computer‐assisted three‐dimensional reconstruction of head and neck tumors
Authors: Moharir Vik M. , Fried Marvin P. , Vernick David M. , Janecka Ivo P. , Zahajsky Janos , Hsu Liangge , Lorensen William E. , Anderson Mark , Wells William M. , Morrison Paul , Kikinis Ron
Published: November 2003

Objective: Because head and neck tumors reside in a complex area, having a three‐dimensional (3‐D) model of the patient's unique anatomical features may assist in the delineation of pathology. The authors describe a new computer technique of 3‐D anatomical reconstruction from two‐dimensional computed tomography (CT) and magnetic resonance (MR) data and discuss how it represents a step forward in the continuing evolution of 3‐D imaging. Study Design: The authors selected three patients with solitary head and neck tumors and reconstructed their anatomy in a 3‐D format for study. The tumors represented locations in the nose and central skull base (patient 1), temporal bone (patient 2), and neck (patient 3). Materials and Methods: MR and CT images from the individual patients were electronically transferred to workstations in the Surgical Planning Laboratory of the authors' institution. Registration (or fusion) was carried out between the MR and CT images. The desired anatomic components underwent segmentation (identification and isolation). Assembly of the segmented images was performed and the resulting structures were integrated to produce a 3‐D model. Results: 3‐D models of the following were constructed and displayed in an interactive format on high‐capacity computer workstations: 1) a skull base sarcoma with extension into the nasopharynx and nose; 2) an acoustic neuroma with internal auditory canal involvement; and 3) a metastatic recurrence of a tongue base squamous cell carcinoma in the posterior triangle of the right side of the neck with extension to the skull base. Conclusion: The authors' Surgical Planning Laboratory has developed a 3‐D reconstruction technique that has several new features. The models provided a very good 3‐D interactive representation of the tumors and patient anatomy. The need now exists to develop this method of 3‐D reconstruction of head and neck tumors for potential applications in treatment, research, and medical education. Laryngoscope, 108:1592–1598, 1998
Functional endoscopic sinus surgery training simulator
Authors: Rudman David T. , Stredney Don , Sessanna Dennis , Yagel Roni , Crawfis Roger , Heskamp David , Edmond Charles V. , Wiet Gregory J.
Published: November 2003

Objective/Hypothesis: To determine the efficacy of a haptic (force feedback) device and to compare isosurface and volumetric models of a functional endoscopic sinus surgery (FESS) training simulator. Study Design: A pilot study involving faculty and residents from the Department of Otolaryngology at The Ohio State University. Methods: Objective trials evaluated the haptic device's ability to perceive three‐dimensional shapes (stereognosis) without the aid of image visualization. Ethmoidectomy tasks were performed with both isosurface and volumetric FESS simulators, and surveys compared the two models. Results: The haptic device was 77% effective for stereognosis tasks. There was a preference toward the isosurface model over the volumetric model in terms of visual representation, comfort, haptic‐visual fidelity, and overall performance. Conclusions: The FESS simulator uses both visual and haptic feedback to create a virtual reality environment to teach paranasal sinus anatomy and basic endoscopic sinus surgery techniques to ear, nose, and throat residents. The results of the current study showed that the haptic device was accurate in and of itself, within its current physical limitations, and that the isosurface‐based simulator was preferred. Laryngoscope, 108:1643–1647, 1998
Management of malar folds in blepharoplasty
Authors: Farrior Richard T. , Kassir Ramtin R.
Published: November 2003

Objectives/Hypothesis:To define the anatomy and location of malar folds as distinguished from lower eyelid skin and orbital fat and to teach a new surgical technique for the management of the aging eye.Study Design:Retrospective report of a surgical procedure designed to address the malar folds.Methods:Analysis of preoperative and postoperative photographic documentation for surgical planning and long‐term result.Results:Patient satisfaction and lack of recurrence, without the requirement of direct excision, were noted in all patients studied.Conclusion:This presentation describes a new simple technique for the management of the folds and cutaneous and subcutaneous prominences that occur inferior to the lower eyelid skin. The operation addresses the correction by a combination of skin/muscle flap lower eyelid blepharoplasty with immediately subcutaneous (skin flap) elevations over the carefully delineated malar prominences; the removal of the deep fat that may or may not be associated with dehiscence of fat through the thin inferior fibers of the orbicularis muscle; and finally suspension of the remaining subcutaneous tissue and the muscle to the periosteum of the inferior orbital rim as well as suspension of the orbicularis muscle margin to the lateral orbital periosteum or the lateral canthal ligament area. The technique is designed to manage the more commonly found malar prominences but can be applied in the management of more pronounced festoons involving skin, muscle, and fat.Laryngoscope, 108:1659–1663, 1998
Bilateral radical neck dissection with unilateral internal jugular vein reconstruction
Authors: Dulguerov Pavel , Soulier Christian , Maurice Jean , Faidutti Bernard , Allal Abdelkarim S. , Lehmann Willy
Published: November 2003

Objective: To describe and evaluate the functional and oncologic results of one internal jugular vein replacement after bilateral radical neck dissection (RND). Study Design: A retrospective historical cohort study. Methods: Since 1972 all patients (n = 9) undergoing bilateral RND with resection of both internal jugular veins had a reconstruction of one internal jugular vein. In six cases the RNDs were staged, and in three cases the RNDs were performed simultaneously. In every case a vascular reconstruction was performed with an autologous vein graft. All patients received radiation therapy, in five patients before and in four patients after the vein grafting. Functional results were evaluated in terms of postoperative head and neck and neurologic complications. In some patients a Doppler scan was performed to assess vein patency. Oncologic results are reported as relapse‐free survival and mortality intervals. Results: In all patients the postoperative course was uneventful, without neurologic complications. Facial edema was noted in four patients, mild in three and moderate in one. Two patients are alive, with follow‐ups of 8 and 18 years. Seven patients are dead, two without evidence of recurrence, four with cervical recurrence after a mean survival of 10 months, and one after distant metastasis after a survival of 7 years. In patients with long‐term survival a Doppler scan confirmed the patency of the vein graft. Conclusion: The lack of operative complications and the absence of postoperative neurologic complications make a unilateral internal jugular vein replacement after bilateral RND attractive, although the oncologic results remain poor. Laryngoscope, 108:1692–1696, 1998
Functional magnetic resonance imaging of auditory cortex in children
Authors: Ulualp Seckin O. , Biswal Bharat B. , Yetkin F. Zerrin , Kidder Thomas M.
Published: November 2003

Objective: To obtain images of auditory cortex activation in children by using functional magnetic resonance imaging (FMRI). Methods: Seven healthy children (three girls and four boys), ages 6 to 10 years, were studied. Hearing evaluation was performed by puretone audiometry on the day of FMRI study. Brain imaging was performed on a commercial 1.5 T imager using a three‐axis local gradient coil. During scanning the children were instructed to lie still and avoid any lip, eye, jaw, or other facial movements. Subjects were asked to listen to a standard text presented in on‐off sequences. Functional images of the auditory cortex were acquired with FMRI technique. Functional imaging processing was done using cross‐correlation techniques with a coefficient of 0.5 (P < .0001). Results: Functional correlation images of the auditory cortex activation were obtained in six of seven children after image processing. All children showed activation in the superior temporal gyrus, Heschl's gyrus, planum temporale, frontal lobe, and parietal regions. There was no significant difference in the number and percentage of activated pixels on right and left auditory cortices. Conclusions: Functional images of auditory cortex activation were obtained in healthy children following binaural text presentation. Consistent activation was observed in primary and secondary auditory cortices with no hemispheric dominance. FMRI characteristics of the auditory cortex activation in healthy children should be established in order to study those with hearing impairment.
Safety of paranasal sinus surgery in patients with cystic fibrosis
Authors: Schulte Douglas L. , Kasperbauer Jan L.
Published: November 2003

Objective: Document the safety of paranasal sinus surgery in cystic fibrosis patients and review the changing trends in paranasal sinus surgery in the cystic fibrosis population. Study Design: Retrospective review. Materials and Methods: Chart review of cystic fibrosis patients who underwent paranasal sinus surgery from 1955 to 1997. Results: Indications for surgery included chronic sinusitis, nasal obstruction, purulent rhinorrhea, head pain, and pyocele. Average duration of anesthesia was 2.1 hours. The complication rate from general anesthesia was zero. Excessive bleeding and significant hypoxia did not occur. Conclusions: Paranasal sinus surgery and general anesthesia can be safely performed in cystic fibrosis patients. The indications for paranasal sinus surgery are changing from symptomatic nasal obstruction to pre‐lung transplantation care. Today, treatment has evolved to include placement of sinus catheters for direct topical instillation of antibiotics and consideration of maxillary and frontal sinus obliteration.
Long‐term follow‐up after subtotal parathyroidectomy in patients with renal failure
Authors: Yu Irene , Devita Maria V. , Komisar Arnold
Published: November 2003

Objectives/Hypothesis: The most appropriate type of surgery for hyperparathyroidism secondary to renal failure remains controversial. We report a 5‐year experience of patients with hyperparathyroidism secondary to end‐stage renal disease who underwent subtotal parathyroidectomy. We believe that this is the procedure of choice, offering several advantages over total parathyroidectomy with and without reimplantation. Study Design: Retrospective review. Methods: Review of 14 consecutive renal failure patients who underwent subtotal parathyroidectomy by one surgeon (A.K.) was performed. Follow‐up ranged from 4 to 54 months. All patients were receiving chronic maintenance dialysis. All patients came to surgery with clinical symptoms of parathyroid bone disease, elevated serum calcium levels (10.1–12.4 mg/dL), and intact parathyroid hormone levels (619–4160 pg/mL), despite maximal medical therapy. At exploration four glands were identified in all patients and three and a half were removed. Results: All patients experienced symptomatic relief postoperatively with normalization or near‐normalization of serum calcium concentration and intact parathyroid hormone concentrations. One patient developed recurrent disease 4 months after surgery, and on re‐exploration a supernumerary substernal gland was identified. A second patient developed recurrent symptoms 4 years after surgery and at the time of this writing was awaiting re‐exploration. Conclusions: All patients had either resolution of or marked improvement in their subjective complaints. There have been no cases of permanent hypoparathyroidism. We believe that subtotal parathyroidectomy is the best procedure for patients with refractory symptoms of secondary hyperparathyroidism.
Early postoperative calcium levels as predictors of hypocalcemia
Authors: Adams Jeff , Andersen Peter , Everts Edwin , Cohen James
Published: November 2003

Objective: Early, safe postoperative hospital discharge has become a priority in the current environment of cost containment and managed care. One determinant for this following operations of the thyroid or parathyroid glands is a stable postoperative calcium level. This study sought to determine whether early postoperative calcium levels could safely predict hypocalcemia following operations of the thyroid or parathyroid glands. Study Design: A retrospective chart review of 197 patients undergoing such operations was undertaken. Methods: The study population was divided into patients undergoing parathyroid exploration with removal of one or more glands for parathyroid disease (“parathyroid” group) and patients undergoing bilateral thyroid operations (“nonparathyroid” group). Postoperative calcium levels were plotted as a function of time, and the slope between the first two postoperative calcium levels examined. Results: A positive slope predicted normocalcemia in 100% of “nonparathyroid” and 90% of “parathyroid” surgeries. A negative slope was predictive in its magnitude. The nonparathyroid patients who developed postoperative hypocalcemia had an average slope significantly more negative (‐0.84% change/h) than patients remaining normocalcemic (‐0.49% change/h) (P = .03). Similarly, the parathyroid patients who became hypocalcemic had an average initial slope nearly twice as negative (‐1.4% change/h) as patients remaining normocalcemic (‐0.78% change/h) (P = .005). Conclusions: These results indicate that an initial upsloping postoperative calcium curve based on two early postoperative calcium measurements is strongly predictive of a stable postoperative calcium level, and a steeply downsloping initial calcium curve is worrisome for eventual hypocalcemia.
Pretreatment and midtreatment measurement of oxygen tension levels in head and neck cancers
Authors: Gabalski Edward C. , Adam Markus , Pinto Harlan , Brown J. Martin , Bloch Daniel A. , Terris David J.
Published: November 2003

Objective: Considerable evidence exists to suggest that tumor hypoxia results in radioresistance. Historically, it has been difficult to assess tumor oxygen tension levels reliably. These levels can now be assessed in head and neck malignancies using the Eppendorf Po2 histograph, which uses a fine‐needle electrode and a computerized micromanipulator. This technology was used to compare the pretreatment tumor oxygen tension level in lymph node metastases of patients with head and neck cancer to measurements taken during nonsurgical treatment after a partial response had been achieved. Study Design: Prospective study. Methods: Oxygen tension levels were measured in the cervical lymph nodes of 10 patients with biopsy‐proven head and neck squamous cell carcinoma and cervical metastases who were being treated with nonsurgical management. These levels were obtained using the Eppendorf pO2 histograph system. Measurements were taken before the start of treatment and were repeated when the size of the cervical metastatic node had decreased by 50%. Normal subcutaneous tissue was measured during the same session. The mean and median pO2 levels, as well as the percentage of measurements with pO2 less than 5 mm Hg were determined. Results: A mean of 72.6 measurements per session was taken from each lymph node. The median tumor pO2 measurement fell from a mean (±SD) of 13.9 ± 8.0 mm Hg to 7.3 ± 9.9 mm Hg. Even more dramatic, however, was the substantial increase in the percentage of values less than 5 mm Hg, a rise from 29% to 52%. Conclusions: While there is variability both in the pretreatment oxygenation of head and neck cervical metastases and in the change in tumor oxygen tension during treatment, there appears to be a decrease in the overall oxygenation of the tumors. The dramatic increase in very low oxygen measurements may reflect selective survival of radioresistant or chemoresistant hypoxic tumor cells. Cells at the very low level would be expected to be radiobiologically hypoxic (resistant to radiation‐induced cell kill).
Management of the N0 Neck During Salvage Laryngectomy
Authors: Wax Mark K. , Touma B. Joseph
Published: November 2003

Background: Radiotherapy is effective treatment for laryngeal carcinoma. Early‐stage laryngeal carcinoma has a low incidence of cervical metastasis. Patients initially clinically N0 usually remain N0 when they fail at the primary site. The incidence of subclinical metastasis in these patients is not well described. Watchful waiting or elective neck dissections are advocated. Objective: Examine the incidence of subclinical metastatic disease in patients undergoing elective neck dissections with salvage laryngectomy. Study Design: Prospective study (1991–1996) of patients who failed radiotherapy and underwent salvage laryngectomy with elective neck dissection. Methods: Thirty‐four patients underwent salvage laryngectomy with neck dissection (30 bilateral, 4 unilateral). All were clinically N0 at initial presentation and remained N0 at recurrence. Pathologic study of the neck dissection specimens was undertaken. Patients were followed for a minimum of 2 years (mean, 4 y). Results: The male‐to‐female ratio was 4.5:1, with a mean age of 62 years (range, 38 to 75 y). Metastatic disease was present in 6 patients (17%); 4 of 14 (28%) supraglottis and 2 of 20 (10%) glottic. Presence of disease in the neck according to stage at recurrence was as follows: T2, 2 of 12; T3, 3 of 14; and T4, 2 of 8. Neck disease was ipsilateral in 4 and contralateral in 2 patients (both supraglottic primaries). Conclusions: Subclinical cervical metastasis may be present in N0 laryngeal carcinoma patients who have recurrence following radiotherapy. Morbidity of a lateral neck dissection is minimal, with excellent control of the neck being possible. Supraglottic and advanced glottic (T3‐T4) patients may benefit the most.
Effect of Internal Maxillary Arterial Occlusion on Nasal Blood Flow in Swine
Authors: Weaver Edward M. , Chaloupka John C. , Putman Christopher M. , Roth Toni C. , Horky John K. , Sasaki Clarence T.
Published: November 2003

Objectives: The precise effects of therapeutic occlusion of the internal maxillary artery (IMA) on distal nasal mucosal perfusion are unknown. A better understanding of these effects has important implications regarding the rationale and expected efficacy of certain therapeutic interventions for epistaxis management. The authors developed an animal model to assess these issues. Study Design: The effects of “proximal” and progressively more “distal” occlusions of the IMA on nasal mucosal blood flow (NBF) were assessed in anesthetized swine using continuous laser Doppler flowmetry. The levels of arterial occlusion were selected to simulate clinical therapeutic occlusions used for the management of epistaxis. Methods: Nineteen swine were entered into one of four experimental groupings: proximal IMA occlusion using platinum micro‐coils (n = 6), mid‐grade distal IMA occlusion with polyvinyl alcohol particulate (PVA) suspensions (300 to 500 microns, n = 5), high‐grade distal IMA occlusion with polyvinyl alcohol particulate suspensions (50 to 150 microns, n = 5), and sham control (n = 2). Results: All embolizations resulted in acute decreases in average NBF from 120 mL/min per 100 g to 40 mL/min per 100 g (P <.05 for all groups). NBF returned to baseline in all three treated groups within 2 to 8 days after therapeutic embolization, depending on the level of occlusion (coils, 2 d; mid‐grade PVA, 2–3 d; high‐grade PVA, 8 d). Follow‐up angiography showed recanalization and collateralization as possible methods of reestablishing NBF. Conclusions: This study supports the rationale for performing distal IMA occlusion with transarterial particulate embolization, in order to provide a longer period of time of diminished NBF. This theoretically should promote hemostasis within an injured portion of the nasal mucosa by decreasing perfusion pressure within the capillary bed. However, the benefits of distal IMA embolization must be balanced against potential ischemic complications, as may be more commonly seen with high‐grade particulate embolization.
Gustatory Disturbance Due to Cerebrovascular Disorder
Authors: Onoda Keiko , Ikeda Minora
Published: November 2003

Objectives: Review three cases of unilateral gustatory disturbance due to central lesions caused by cerebrovascular disorders, describe clinical findings and the results of taste examinations, and discuss the central gustatory pathways in humans. Study Design: Retrospective review of three gustatory disturbance cases due to cerebrovascular disorders. Additional review of 12 cases with central gustatory disturbance that have been reported. Methods: Central lesions of three cases were examined by magnetic resonance imaging or computed tomography scan. Electrogustometry and a filter‐paper disk assay using taste solutions were performed in these cases for each of the bilateral gustatory nerves. Results: In one case of pontine infarct, gustatory disturbance ipsilateral to the lesion was found, and in one case of thalamic infarct and one case of internal capsular infarct, gustatory disturbance contralateral to the lesion was observed. Conclusions: Fifteen cases of unilateral gustatory disturbance due to central lesions, including the present cases, have been reported to our knowledge. Examination of these cases strongly suggested that the central gustatory pathways in humans ascend ipsilaterally from the solitary nucleus of medulla oblongata to the pons, and from the pons, cross to a higher position in midbrain and reach the thalamus contralaterally.
Nitric oxide synthase activity in human squamous cell carcinoma of the head and neck
Authors: Gavilanes Javier , Moro María A. , Lizasoain Ignacio , Lorenzo Pedro , Pérez Ana , Leza Juan C. , Alvarez‐Vicent Juan J.
Published: November 2003

Objectives: To test whether nitric oxide synthase (NOS) is expressed in primary otolaryngologic tumors and whether this expression is associated with the degree of malignancy. Study Design: Twenty‐six samples from the primary localization of human pharyngolaryngeal squamous cell carcinoma. Materials and Methods: the activity of calcium‐dependent and calcium‐independent NOS was analyzed by the conversion of L‐[14C]‐arginine into L‐[14C]‐citrulline. Results: NOS activity is below detectable levels in pharyngolaryngeal mucosa from noncancer patients. In the primary localization of the tumor, calcium‐independent NOS activity is maximal at early stages of tumor growth, whereas calcium‐dependent activity increases from early to advanced stages. Conclusions: These data suggest that tumor growth and malignancy is associated with a change in the enzymatic source of NO from calcium‐independent NOS to calcium‐dependent NOS isoform in primary localization. These data suggest that the inhibition of calcium‐independent NOS activity in early stages and/or inhibition of calcium‐dependent NOS activity in later stages could delay growth of solid tumors.
Cochlear Implantation in Auditory Neuropathy
Authors: Miyamoto Richard T. , Kirk Karen Her , Renshaw Julia , Hussain Debra
Published: November 2003

Objective: Auditory neuropathy is a recently described clinical entity characterized by sensorineural hearing loss in which the auditory evoked potential (ABR) is absent but otoacoustic emissions are present. This suggests a central locus for the associated hearing loss. In this study the results observed in a child with auditory neuropathy who received a cochlear implant are presented and compared with those of a matched group of children who were recipients of implants. Methods: A single‐subject, repeated‐measures design, evaluating closed‐set and open‐set word recognition abilities was used to assess the subject and a control group of matched children with implants who had also experienced a progressive sensorineural hearing loss. Results: The subject demonstrated improvements in vowel recognition (82% correct) by 1 year after implantation, which were only slightly lower than the control group. Consonant recognition and open‐set word recognition scores were significantly lower. Conclusion: Caution should be exercised when considering cochlear implantation in children with auditory neuropathy. As with conventional hearing aids, less than optimal results may be seen.
Management Options and Survival in Malignant Melanoma of the Sinonasal Mucosa
Authors: Lund Valerie J. , Howard David J. , Harding Laura , Wei William I.
Published: November 2003

Objective/Hypothesis: To determine whether surgery combined with radiotherapy confers any survival benefit on radical local excision alone in the management of mucosal malignant melanoma of the nose and sinuses. Study Design: Retrospective review. Methods: From a cohort of 72 patients treated between 1963 and 1996 within a single unit, complete data were available for 58 individuals who were examined to determine whether there was any significant statistical difference in local control and/or survival between those receiving surgery and those receiving combined surgery and radiotherapy. Results: There were 30 men and 28 women. Their ages ranged from 39 to 90 years (mean, 64 y). Twenty‐nine patients underwent surgery alone; 23 patients underwent surgery and radiotherapy; 6 patients received surgery and chemotherapy; and 3 patients received surgery, chemotherapy, and radiotherapy. Primary surgery included lateral rhinotomy (42 cases), maxillectomy (8 cases [orbital clearance in 3 cases]), craniofacial resection (3 cases), total rhinectomy (3 cases), and endoscopic clearance (2 cases). Survival ranged from 1 to 228 months with rapid patient loss due to local (and/or systemic) disease during the first 36 months, irrespective of the treatment modality. Overall 5‐year actuarial survival was 28%, and overall 10‐year actuarial survival 20%, with a median survival of 21 months. There was no statistical difference in local control or survival between patients receiving surgery alone and those receiving surgery and radiotherapy, irrespective of whether this treatment was given in the early part of the series (i.e., before 1983) or thereafter. The addition of chemotherapy had no impact on survival, nor did the site of the tumor, the surgical procedure, the presence of lymph node metastases or the age of the patient. Conclusion: In this large cohort of sinonasal melanoma, overall survival was poor and did not appear to be improved by the addition of radiotherapy.
Contralateral Hemilaryngotracheal Flap Reconstruction of the Hypopharynx in Pyriform Carcinoma Resection
Authors: Tai Shyh‐Kuan , Chang Shyue‐Yih
Published: November 2003

Objectives: To simplify the approach and reconstruction for advanced hypopharyngeal cancer, a modified technique—laryngotracheal fissure approach and laryngotracheal flap reconstruction—is presented. Study Design: Prospective. Methods: From August 1991 to December 1995, 44 consecutive patients with advanced hypopharyngeal cancer, mostly involving pyriform sinus, were operated on with this technique. The functional and oncologic results and complications were evaluated. Results: Reconstruction was completed by using the laryngotracheal flap in 75% of patients, while the other 25% required ddditional patch‐on pectoralis major myocutaneous flaps. Pharyngoesophageal stenosis occurred in one patient after radiotherapy and pharyngocutaneous fistula was noted in two. No local recurrence was noted. Seven cervical metastases developed in the follow‐up period and six over the contralateral neck not treated surgically. The 5‐year Kaplan‐Meier disease‐free survival was 46.8%. Conclusions: The authors' experience indicates that this is a simplified, radical treatment for most advanced hypopharyngeal cancer, with high applicability, good oncologic results, and low complication.
Three‐Dimensional Imaging of the Speaking Shunt in Patients With Near‐Total Laryngectomy
Authors: Su Chih‐Ying , Lui Chun‐Chung , Liao Ting‐Yi
Published: November 2003

Objectives: Near‐total laryngectomy with creation of a speaking shunt is generally considered suitable treatment for most T3 and some T4 laryngopharyngeal cancers. In some patients, poor speech production by the shunt can be problematic and usually means that a shunt lumen is stenotic or too small. Conventional axial computed tomography (CT) of the neck is of little value in predicting the shunt function and the patency of the shunt lumen. Such defect, however, can be better overcome if the spiral CT is used. Study Design: This study was designed to evaluate the dynamic speaking shunt by spiral CT and a three‐dimensional (3‐D) imaging model of the upper airway in 59 near‐total laryngectomees. Methods: During scanning, the patients were asked to make a single, 20‐second phonation. A high‐quality 3‐D surface model was then rendered at an independent workstation. The 3‐D model took on the appearance of the speaking shunt which could serve as a tracheopharyngeal fistulography. Results: 3‐D reconstruction of the images could clearly demonstrate the dynamic anatomy and patency of the speaking shunt. We found the 3‐D model to be of diagnostic value, particularly in the near‐total laryngectomy patients with stenotic shunts. The most common site of stenosis was at the top portion of the shunt. Conclusion: The 3‐D image findings of the shunts significantly improved the assessment and therapies of the patients undergoing revision surgeries of the shunt stenoses.
Protein C Deficiency in Microvascular Head and Neck Reconstruction
Authors: Ayala Carlos , Blackwell Keith E.
Published: November 2003

Objective: To determine the incidence of perioperative protein C deficiency in patients undergoing free flap reconstruction of cancer‐related defects in the head and neck. Study Design: Prospective case series. Intervention: Ten patients underwent microvascular reconstruction after surgical therapy of carcinomas of the oral cavity or oropharynx. Coagulation studies were determined in all patients 72 hours after surgery. Setting: Academic tertiary care medical center Results: Protein C deficiency was detected in 70% of patients. One free flap failure was attributed to protein C deficiency. Conclusions: Vitamin K–dependent clotting factors are frequently deficient during the postoperative period after major head and neck surgery, which may result in a state of hypercoagulability. Protein C deficiency should be considered as a possible cause of free flap thrombosis in patients who undergo microvascular head and neck reconstruction.
A Management Strategy for Vocal Process Granulomas
Authors: Havas Thomas E. , Priestley Jocelyn , Lowinger David S. G.
Published: November 2003

Objectives/Hypothesis: Review the roles of aggressive gastroesophageal reflux management and speech therapy in the treatment of patients with vocal process granulomas. Describe and assess our investigation and management protocol. Study Design: Retrospective review of 55 patients with 61 vocal granulomas treated according to a standard protocol at the Sydney Voice Clinic. Comparison with previous published series and review of the relevant literature pertaining to granulomas and to reflux. Description of laryngopharyngeal reflux grading, investigative modalities, and treatment regimen. Methods: Case notes were reviewed and tabulated for age, sex, diagnosis, predisposing factors for granuloma formation, grade of laryngopharyngeal reflux, investigations, treatment, resolution, and recurrence. All patients were followed up for at least 12 months after resolution. Results: Fourteen of the 61 granulomas occurred after intubation. Ten patients were professional voice users. Our assessment of the 55 granuloma patients revealed an incidence of 76% of gastroesophageal reflux disease in patients with and without known vocal fold trauma. There was a 50% recurrence rate following surgical excision. However, aggressive antireflux therapy, lifestyle modifications, and adjuvant speech therapy were successful in achieving resolution of most of the granulomas and preventing recurrence. In four patients, antireflux surgery was required and total resolution of the granulomas followed. Conclusions: Vocal process granulomas have perplexed laryngologists with their indeterminate pathogenesis and tendency to recur. Multiple surgical excisions and a variety of combined medical regimens have been used to treat granulomas with variable success. Recurrence after excision commonly occurs as the underlying causative factors have not been appropriately managed and may re‐establish the chronic inflammatory process. We found acid reflux to be a common factor in the majority of our patients with granulomas. Therefore treatment should focus on managing both reflux and any functional voice disease or disorder. The only indications for laryngeal surgery are to resolve diagnostic doubt or to treat acute airway compromise. Based on results, we suggest an algorithm for the investigation and management of vocal process granulomas founded on appropriate antireflux and speech therapy.