bluuebunny/crossref_metadata_2025 huggingface dataset:
Raeder's syndrome associated with internal carotid artery dilation and sinusitis
Authors: Nolph Michael B. , Dion Mark W.
Published: October 2006

Raeder's syndrome consists of ipsilateral ptosis, miosis and facial pain with intact facial sweating. When not associated with other neurologic signs, the clinical course of this condition is self‐limited. Patients will have resolution of facial pain but persistence of miosis and ptosis. Treatment is symptomatic with arteriography reserved for those patients with protracted symptoms or atypical presentations. A case of Raedcr's paratrigeminal syndrome is presented with abnormal dilation of the subcavernous portion of the internal carotid artery thought to be secondary to inflammation of the adjacent sphenoid sinus. Facial pain and the abnormal dilation of the carotid artery resolved, but miosis and ptosis persisted. Because of the therapeutic indication and prognostic value, an awareness of Raeder's syndrome is stressed when evaluating patients with facial pain or possible Horner's syndrome.
Inverted papilloma: An analysis of 87 cases
Authors: Lawson William , Le Benger Jeffrey , Bernard Peter J. , Biller Hugh F. , Som Peter
Published: October 2006

A group of 87 patients with inverted papilloma, a locally aggressive benign sinonasol tumor, were treated over the past 15 years. Selection of therapy depends on an accurate radiographic assessment of the extent of tumor. The tumor's local aggressiveness, high rate of recurrence, associated malignancy, and multicentric tendency have led most workers to advocate radical surgical removal of the tumor by lateral rhinotomy and en bloc resection of the ethmoid labyrinth. Radiographic evaluation by computed tomography scanning and magnetic resonance imaging permits identification of a small group of patients who have limited lesions and may be candidates for conservative tumor resection by intranasal or transantral sphenoethmoidectomy.

Among our ten patients treated with conservative surgery, there was recurrence in one case (10%). Seventy‐five patients underwent rhinotomy and medial maxillectomy, with seven cases recurring (9%). The overall recurrence rate was 9% (8 of 87). Among the 87 cases, 5 patients had carcinoma (6%).

The literature is reviewed and the principles of case selection and management are discussed.
Squamous cell carcinoma of the paranasal sinuses: The cleveland clinic experience 1977–1986
Authors: Lavertu Pierre , Roberts Jay K. , Kraus Dennis H. , Levine Howard L. , Wood Benjamin G. , Tucker Harvey M. , Medendorp Sharon V.
Published: October 2006

Fifty‐four of 103 malignancies of the paranasal sinuses treated at the Cleveland Clinic Foundation between 1977 and 1986 were squamous cell carcinomas. Six arose from the ethmoid sinus and 48 from the maxillary sinus. Of the maxillary sinus patients, 11 presented with Tl or T2 lesions, 20 with T3, 16 with T4, and 7 of these had nodal disease. Treatment was surgery and/or radiation therapy. There was local recurrence in 25 of 48 maxillary sinus patients and in 1 of 6 ethmoid patients. Overall 5‐year survival was 38.2% in the maxillary sinus group: Tl, 100.0%; T2, 85.7%; T3, 31.8%; and T4, 6.7%. Three of six patients with ethmoid tumors were cured. There was a statistical trend for better prognosis in those patients presenting with ethmoid primaries, with early lesions, treated with both radiation and surgery, and with history of inverting papilloma. There were complications of treatment in 10 patients, four of which resulted in death. Local control was the major problem for these patients; therefore, early detection and aggressive local treatment are desirable.
Hearing levels of railroad trainmen
Authors: Clark William W. , Popelka Gerald R.
Published: October 2006

The hearing sensitivity of 9427 railroad train crew members, determined during the first year of a company‐wide hearing conservation program, was compared with hearing sensitivity in a control population not exposed to occupational noise. The hearing sensitivity of the trainmen did not differ significantly from that of the control population. Multiple regression analysis, which considered separately the effects of age and years of service, showed significant differences in hearing levels due to age, but no differences in hearing levels due to years of service. Evaluation of the data by risk categories developed by the National Institute for Occupational Safety and Health indicate that this group of trainmen had no risk of occupational noise‐induced hearing loss. These analyses, combined with studies of locomotive cab noise, show clearly that trainmen ore not typically exposed to hazardous occupational noise.
Acoustic characteristics of speech following uvulopalatopharyngoplasty
Authors: Murry Thomas , Bone Robert C.
Published: October 2006

Selective uvulopalatopharyngoplasty has resulted in the improved management of sleep apnea; however, the effect of the surgery on speech has not been systematically evaluated. In this study, the speaking fundamental frequency, reading rate, and first and second formants of the vowels of four patients were measured acoustically presurgically and postsurgically. The results indicate that the length of time needed to read a passage was reduced in all four patients 2 weeks following surgery compared to the presurgical duration.

In addition, the second formant of nine vowels studied was lower postsurgically. No changes in speaking fundamental frequency were found in three of the four patients; in the fourth, the speaking fundamental frequency was lower by approximately one semitone. Based on the reduced reading rates from the presurgical to the postsurgical conditions, changes in respiratory parameters in addition to vocal tract parameters warrant assessment when evaluating the speech of individuals prior to and following uvulopalatopharyngoplasty.
Management of the internal carotid artery in surgery of the skull base
Authors: Andrews James C. , Valavanis Anton , Fisch Ugo
Published: October 2006

Management of the internal carotid artery in skull‐base surgery can be a difficult problem when disease involves this vessel or resection is anatomically limited by it. The recent radiologic development of the detachable balloon catheter has permitted occlusion of the internal carotid artery in a controlled setting prior to any surgical procedure. An obvious prerequisite to using this technique is the demonstration of adequate collateral blood flow to the brain. Patients are evaluated with arteriography and temporary arterial balloon occlusion while monitoring physical signs and electroencephalography (EEG). Although usually performed preoperatively, internal carotid artery occlusion is needed intraoperatively on occasion. This essential adjuvant technique for the skull‐base surgeon will be detailed along with its indications and limitations in 24 patients.
Melanomas of the mucous membrane of the head and neck
Authors: Conley John J.
Published: October 2006

Melanoma of the mucous membrane is a rare condition and the most serious of all head and neck melanomas. Its highest incidence is in the oral cavity, followed by the nasal and pharyngeal cavities. It usually occurs during the fifth decade of life. In its early stages it is asymptomatic and often located in areas difficult to see upon visual examination and technically inaccessible. These facts lead to a delay in diagnosis, which reduces curability to 8%. In spite of these negative factors, there has been a significant improvement in the extension and quality of life for patients with melanoma of the mucous membrane. The biological characteristics of this disease are analyzed and a philosophy of management is offered.
Multiple synchronous and metachronous cancers of the upper aerodigestive tract: A nine‐year study
Authors: Panosetti Eugene , Luboinski Bernard , Mamelle Gerard , Richard Jean‐Marie
Published: October 2006

Three hundred fifty (42.1%) of these multiple cancers were considered synchronous, while 480 (57.9%) were classified as metachronous.

Fifty percent of the metachronous cancers occurred within 31 months after the first primary; the mean time between the first primary and the second primary was 45 months. Approximately 22% of second primaries were found more than 5 years after the initial tumor.

Five‐year survival rates were higher in metachronous cancers (55%) than in synchronous cancers (18%). Survival rates varied according to the treatment. In 49.4% of synchronous tumors the treatment had to be modified because of the presence of two cancers. In these patients, 5‐year survival rates were as low as 8%.

In synchronous cancers that required no modification of the treatment, the prognosis was better and the survival rate was 28%. The preferential anatomical location of the second synchronous and metachronous cancers is discussed for first primaries situated in the oral cavity (103 cases), the oropharynx (120 cases), the hypopharynx (92 cases), and the larynx (87 cases).

Second primaries in the esophagus were mostly synchronous cancers while, in the lung, second cancers were more frequently metachronous tumors.
Nasal polyps: Epithelium and goblet cell density
Authors: Larsen Per L. , Tos Mirko
Published: October 2006

The density of goblet cells was determined in 14 anterior and 15 posterior nasal polyps using the whole‐mount method. The specimens were then serial cut and the type of epithelium was determined in nine localities in each polyp. The goblet cell density was correlated to the epithelial type. Pseudostratified, cylindrical epithelium was the prevailing type, occurring in 62% of anterior localities and 78% of posterior localities. Transitional types of epithelium were found in 33% of the anterior and 19% of the posterior localities. Stratified squamous epithelium occurred in 5% and 3%, respectively. The goblet cell density was highest in hyperplastic pseudostratified epithelium, whereas it was four times lower in transitional epithelium and even lower in squamous epithelium. Marked differences in the distribution of epithelium and goblet cell density were found between anterior and posterior polyps, illustrating that the epithelium constantly changes under the influence of air current, contact with other polyps, infection, growth, and age of the polyp as well as other unknown factors.
Effect of ultrasonic nebulization of miraclid® on the proteolytic activity in tracheobronchial secretions of rats
Authors: Kosugi Tadayoshi , Nakamura Mariko , Noguchi Shuji , Wu Huang Guang
Published: October 2006

Experimental studies of acute inflammation of the tracheobronchial lumen of rats suggest that protease inhibitor increases in tracheobronchial secretions in order to control inflammation. Recent studies have shown that the polyvalent protease inhibitor, Miraclid®, derived from human urine, is useful for treating DIC and acute pancreatitis. In view of this information, local administration of Miraclid was expected to diminish acute inflammation of the respiratory tract by creating a favorable balance in the protease‐antiprotease system. Before the chemotherapeutic use of locally administered Miraclid, the inhibitory activity of Miraclid on various proteases was first estimated in vitro. Administration of Miraclid by means of ultrasonic nebulization was then investigated in rats. The results can be, summarized as follows. 1. During ultrasonic nebulization, the inhibitory activity of Miraclid on protease was decreased by means of mechanical stimulation in comparison to the activity before nebulization. 2. Compared to administration of physiological saline into the tracheobronchial lumen, administration of Miraclid by means of ultrasonic nebulization decreased the fibrinolytic activity in tracheobronchial secretions.
The clinical behavior of inverting papilloma of the nose and paranasal sinuses: Report of 112 cases and review of the literature
Authors: Phillips P. Perry , Gustafson Ray O. , Facer George W.
Published: October 2006

Between 1944 and 1987, 112 patients with inverting papilloma of the nasal cavity were treated. The average duration of follow‐up for this population was 6.2 years. The most common symptoms were nasal obstruction and history of previous surgery for nasal “polyps.” Recurrence rates were lower when treatment consisted of lateral rhinotomy with medial maxillectomy (14%) vs. transnasal operation with a sinus procedure (35%) or transnasal operation alone (58%). Recurrence rates between men and women were not significantly different when treatment methods were analyzed; however, a higher‐than‐expected association with tobacco usage was noted. Eight (7%) of the 112 patients had associated nasal carcinoma. Current treatment is lateral rhinotomy with medial maxillectomy to prevent troublesome and potentially malignant recurrent disease.
Hearing after retrolabyrinthine vestibular neurectomy
Authors: Wazen Jack , Markowitz Arlene , Donatelle Christine , Post Kalmon
Published: October 2006

Thirty‐four patients underwent vestibular neurectomies between September 1984 and January 1989. The first 15 patients operated on through January 1987 (and followed for a minimum of 2 years) were evaluated separately for long‐term hearing preservation and freedom from vertigo spells. Audiograms taken at 1 postoperative month revealed no change in the pure tone averages of 25 patients and showed improved hearing of 20 to 30 dB in 5 patients. Two patients sustained losses of 18.5 dB and 21 dB, respectively. The speech discrimination scores remained the same in 17 patients, improved in 9, and were reduced in 6. Audiograms performed 12 to 40 months postoperatively showed preservation of the pure tone averages and speech discrimination scores when compared with the earlier 1‐month postoperative audiograms in 73% of the patients. The speech discrimination scores, however, tended to fluctuate with the symptomatic course of each disease. Two patients developed major vertigo spells 1½ years following surgery. Postoperative ice‐caloric testing revealed no responses in 25 patients and markedly reduced responses in 6. There were no major complications or facial paralysis.

The retrolabyrinthine vestibular neurectomy is an effective way to control vertigo with preservation of hearing and an acceptably low incidence of complications and side effects.
Management of inverted papilloma
Authors: Myers Eugene N. , Fernau James L. , Johnson Jonas T. , Tabet Jean Claude , Barnes E. Leon
Published: October 2006

This paper updates a 1981 report on the management of inverted papilloma. In that report, routine lateral rhinot‐omy with en bloc resection of the lateral nasal wall, including the entire schneiderian membrane, was recommended. This report emphasizes the use of computed tomography scanning in management planning.

Of 33 patients with inverted papilloma treated between 1969 and 1987, 7 had associated squamous cell carcinoma. Twenty‐two patients with IP alone were treated with medial maxillectomy; however, 3 patients have been successfully treated with either a Caldwell‐Luc/ethmoidectomy or an external ethmoidectomy for localized disease. The use of computed tomography capable of higher resolution allowed preoperative determination of the extent of disease, enabling the surgeon to plan the surgery more precisely.

Patients were followed for an average of 9.6 years. Recurrent disease occurred in one patient (4%) following a lateral rhinotomy/medial maxillectomy approach.

The principles set forth in this series of patients remain the same as those previously described due to the unique characteristics of this tumor: its ability to destroy bone, its tendency to recur, and its association with malignancy. The technique of lateral rhinotomy and en bloc excision of the lateral nasal wall, followed by meticulous removal of all mucosa in the ipsilateral paranasal sinuses, remains the standard therapy.
Tonsillectomy and adenoidectomy: An inpatient or outpatient procedure?
Authors: Guida Robert A. , Mattucci Kenneth F.
Published: October 2006

Concern over the rising cost of health care has created a trend toward outpatient surgery. Because adenotonsillec‐tomy is such a frequently performed procedure, there is pressure on many otolaryngologists to do this operation on an ambulatory basis. A prospective study was undertaken to evaluate the incidence and severity of postoperative hemorrhage, protracted emesis, and fever at specified times within the first 24 hours after surgery.

Over a 1‐year period, 1000 tonsillectomy and/or adenoidectomy patients were studied. There was a 2.1% incidence of serious complications within the first 6 postoperative hours. The incidence of serious hemorrhage, fever, and protracted emesis was 0.7% each. The incidence of significant complications between the 6th and 24th postoperative hours was 1.7%. Hemorrhage occurred in 0.4% of the patients, fever in 0.7%, and protracted emesis in 0.6%. The total incidence of hemorrhage during this time period was 1.1%. There were no deaths.

The greatest percentage of complications occurred within the first 6 postoperative hours. Based on this study, outpatient tonsil and adenoid surgery should be followed by at least 6 hours of postoperative observation before discharge. The choice to perform ambulatory tonsil and adenoid surgery depends on the professional judgment of the operating physician based on this and other recent studies, the sophistication of the physician's ambulatory surgery center, and the medical and social background of the patient.
Vocal cord paralysis resulting from neck injections in the intravenous drug use population
Authors: Hillstrom Robert P. , Cohn Arnold M. , Mccarroll Kathleen A.
Published: October 2006

Intravenous drug use patients present to the head and neck surgeon when injections are directed “in the pocket,” or more appropriately, toward the internal jugular vein in the neck. The more common complications of this practice include the development of cellulitis, abscess, and venous thrombophlebitis and, potentially, pulmonary embolism and pseudoaneurysm of the carotid and subclavian arteries. Vocal cord paralysis as a result of neck injection in the intravenous drug‐using population is rarely described, and a review of the literature has yielded only two reports addressing this uncommon phenomenon.

During a 7½‐ year period between October 1981 and June 1989, nine patients presented to Detroit Medical Center with hoarseness, upper‐airway obstruction, or both following the injection of heroin or related substances into the neck. Otolaryngologic evaluation demonstrated unilateral or bilateral vocal cord paralysis coincident with recent neck injections. The clinical signs and symptoms, location of the injections, acute management, and subsequent complications are catalogued. Acute management of these patients consisted of airway assurance via tracheotomies when indicated and observation for the development of cellulitis, abscess, or more life‐threatening neurovascular complications. Follow‐up laryngeal examinations ranged from 4 months to 4½ years and found no demonstrable return of vocal cord function in any of the nine patients.
Randomized comparison of two chemotherapy, radiotherapy schemes for stage iii and iv unresectable squamous cell carcinoma of the head and neck
Authors: Merlano Marco , Rosso Riccardo , Sertoli Mario Roberto , Benasso Marco , Bacigalupo Almalina , Ardizzoni Andrea , Mereu Paola , Margarino Giovanni , Scala Marco , Vitale Vito , Corvog Renzo , Santi Leonardo , Grimaldi Andrea , Pallestrini Eugenio , Barbieri Marco , Accomando Emilio , Scasso Felice , Novella Vittorio , Moratti Maurizio , Sampietro Maurizio , Fracchia Paolo , Brema Fulvio
Published: October 2006

Between August 1983 and December 1986, 116 previously untreated patients with squamous cell carcinoma of the head and neck were randomized to receive induction chemotherapy followed by radiotherapy given in conventional fractions (55 patients, arm A) or an alternating chemotherapy and radiotherapy (3 courses of 20 Gy, 10 daily fractions each; 61 patients, arm B). The same chemotherapy was used in both arms: 6 mg/m2 vinblastine sulfate, hour 0; 30 mg bleomycin, hour 6; 200 mg methotrexate, hours 24 to 26; 45 mg leucovorin, hour 48. Forty‐five patients had stage III disease and 71 had stage IV disease. All patients were evaluated for survival, 112 for toxicity, and 105 for analyses of response and time from the start of treatment until progression of disease. At the end of the combined treatment, we observed an overall response rate of 52% in arm A and an overall response rate of 64.9% in arm B. The incidence of mucositis was more relevant in arm B compared to arm A (P >.00004). The difference in complete response, progression‐free survival, and survival was statistically significant, with an advantage for arm B (P >.03, P >.02, and P >.03, respectively). The analysis at a median follow‐up of 36 months (range = 19 to 59) demonstrates a higher effectiveness for the alternating program.
Vocal changes in patients undergoing radiation therapy for glottic carcinoma
Authors: Miller Susan , Solomon Beth , Sessions Roy B. , Harrison Louis B.
Published: October 2006

A prospective evaluation of vocal changes in patients receiving radiation therapy for T1 and T2 (AJC) glottic carcinoma was undertaken in January 1987. Vocal analysis was performed prior to radiotherapy and at specific intervals throughout the radiation treatment program. The voicing ratio was extrapolated from a sustained vowel /a / phona‐tion using the Visipitch interfaced with the IBM‐PC. Preliminary observations suggested three distinct patterns of vocal behavior: 1. reduced voicing ratio with precipitous improvement within the course of treatment, 2. high initial voicing ratio with reduction secondary to radiation induced edema, with rapid improvement in the voicing component after the edema subsided, and 3. fluctuating voicing ratio during and following treatment. Enrollment of new patients and a 2‐year follow‐up of current patients was undertaken.
Controlled laryngoplasty for vocal cord medialization: A technique using tissue expansion
Authors: Kuriloff Daniel B. , Blaugrund Stanley M. , Krespi Yosef P. , Goldsher Moshe
Published: October 2006

Laryngeal framework surgery has become an increasingly popular alternative to Teflon® injection for vocal rehabilitation. Vocal cord medialization requires custom tailoring of the implant's size and shape to optimize individual vocal quality, whether it be via the interposition of Silastic® implants between the thyroid ala and the inner thyroid perichondrium or through a cartilage window.

A new technique is described for vocal cord medialization using an implanted miniature tissue expander. Intra‐operative and postoperative vocal cord medialization was achieved in a canine model by controlled percutaneous filling of a remote injection valve. The implants were well tolerated and allowed continued control of vocal cord position for several weeks.

Using this technique, vocal quality can be fine‐tuned with a degree of precision not previously possible. The advantages, limitations, and technical aspects of expansion laryngoplasty are discussed.
HPV DNA Typing of adult‐onset respiratory papillomatosis
Authors: Duggan Maire A. , Lim Megan , Inoue Masafumi , Gill M. John
Published: October 2006

Respiratory papillomatosis is a recalcitrant, human pap‐illomavirus‐induced disorder of the upper airways. Using in situ hybridization and biotinylated deoxyribonucleic acid (DNA) probes, the type of human papillomavirus (HPV) in nine adults was determined both at presentation and during subsequent recurrences. Fifty‐three biopsies obtained from seven men and two women over a 10‐year period were examined for HPV 6, 11, 16 and 18. All patients had either type 6 or 11. One dual infection was found. Despite intensive therapy with lasers with or without alpha interferon, no elimination or change in viral type occurred. Despite identical histologies, the amount of HPV DNA present in a given patient's papillomata varied markedly. The results suggest that adult‐onset respiratory papillomatosis is due to HPV 6 and/or HPV 11, and that its recurrent nature, despite therapy, is due to persistence of a viral reservoir.
Cervicofacial mycobacterial adenitis in children: Endemic to san diego?
Authors: Pransky Seth M. , Kearns Donald B. , Seid Allan B. , Collins David L. , Krous Henry F. , Reisman Bruce K.
Published: October 2006

Nontuberculous mycobacteria (NTM) are an important cause of cervicofacial lymphadenitis in children. A dramatic increase has been seen in confirmed cases of NTM lymphadenitis in San Diego in the past few years. This report encompasses a span of 2 years 9 months, during which 22 children had confirmed NTM infection and another 14 had necrotizing granulomatous lymphadenitis in whom the specific diagnosis of NTM could not be made. This apparent increase in the prevalence of NTM as compared to previous reports in the literature suggests a possible endemic risk for NTM in the San Diego area. These cases are reviewed and our diagnostic and surgical approach to possible NTM infection is described. We also discuss possible explanations for the increasing occurrence of NTM in the San Diego area.
Spontaneous cervical and mediastinal emphysema
Authors: Parker Gregg S. , Mosborg David A. , Foley Richard W. , Stiernberg Charles M.
Published: October 2006

Subcutaneous cervical emphysema often appears as a result of surgery or trauma. However, when it occurs spontaneously, the patient may present with clinically impressive and dramatic features. The etiology is related to the rupture of terminal alveoli and dissection of air along the pulmonary vasculature. Exercise may contribute to the process by increases in intrathoracic pressure. Six cases of spontaneous cervical emphysema, all related to SCUBA diving training at a Naval facility, were recently seen at our institution. Proper management entails having a high index of suspicion for diagnosis, and then being able to identify potentially life‐threatening complications.
Middle fossa decompression of the internal auditory canal in acoustic neuroma surgery: A therapeutic alternative
Authors: Gadre Arun K. , Brackmann Derald E. , Kwartler Jed A. , House William E. , Hitselberger William E.
Published: October 2006

Unilateral acoustic neuromas in only‐hearing ears and bilateral acoustic neuromas (NF‐2) are separate entities, but both pose a common problem because surgical removal has the potential to leave the patient totally deafened.

A middle fossa decompression of the internal auditory canal (IAC) was performed in 8 patients (5 with NF‐2 tumors and 3 with neuromas in an only‐hearing ear). In 5 of the 8, the speech discrimination scores at the 6‐month follow‐up were better than preoperative scores. After 6 months, however, hearing regressed at variable rates. Although not a definitive therapeutic treatment, decompression of the IAC appears to improve and perhaps prolong useful hearing, which gains valuable time for rehabilitation. Rigid follow‐up by computed tomography scans or magnetic resonance imaging is essential.
Early complications of airway management in head‐injured patients
Authors: Lanza Donald C. , Parnes Steven M. , Koltai Peter J. , Fortune John B.
Published: October 2006

Head‐injured patients are frequently young, healthy individuals whose excellent medical condition is suddenly altered by trauma. The purpose of this study is to evaluate the early complications of airway management which occur in head‐injured patients and to determine if these are different from what has been reported in patients with chronic illnesses (i.e., diabetes, atherosclerosis, or immunosuppres‐sion).

Chart review of 52 head‐injured patients reveals an early complication rate of 61% for endotracheal intubation and 20% for tracheotomy. Discriminant analysis shows that increasing duration of intubation is the most significant factor in predicting airway management complications (P<0.008). The incidence of complications seen in head‐injured patients is similar to that of the chronically ill. Complications of endotracheal intubation are judged to be more severe than those of tracheotomy. Data from this study supports the early tracheotomy of severely head‐injured patients who are likely to require prolonged airway management.
Squamous cell carcinoma of the oropharynx: An analysis of 213 consecutive patients scheduled for primary radiotherapy
Authors: Johansen Lars Vendelbo , Overgaard Jens , Overgaard Marie , Birkler Niels , Fisker Anders
Published: October 2006

Radiotherapy was administered to 213 consecutively treated patients with oropharyngeal squamous cell carcinoma. The classification (Union Internationale Contre le Cancer, 1982) showed primary tumors (Tl, 13%; T2,51%; T3, 34%; T4, 2%) and regional lymph nodes (NO, 38%; Nl, 38%; N2, 4%; N3, 20%). The 10‐year actuarial value for local control was 48%; for regional control, it was 66%. Distant failure occurred in 20 patients. The 10‐year actuarially corrected survival rate was 40% (stage I, 57%; stage II, 51%; stage III, 43%; stage VI, 21%).

Locoregional tumor control was significantly influenced by irradiation parameters (total dose and treatment time), tumor volume, sex, and hemoglobin value. It is concluded that local control of the tumor while still in the T position is the parameter most crucial to success. This end point is currently being aimed at evaluating primary surgery and testing a radiation technique with larger total doses and shrinking fields and a new radiosensitizer, while at the same time investigating the influence of hemoglobin concentration.
“Tissue welding” with the argon laser in middle ear surgery
Authors: Mckennan Kevin X.
Published: October 2006

Over the past 10 years the argon laser has been recognized as a valuable adjunct to middle ear surgery. It has been used to vaporize and cut tissue and to coagulate micro‐bleeding. It has been used by many other surgical specialties to “weld” adjacent tissues together. This welding process appears to have a limited but helpful role in middle ear surgery. A pilot study of 30 surgical cases in which argon laser “tissue welding” has been used are reported. The benefits, limitations, and possible future implications are discussed.
Efficacy and morbidity of partial laryngectomy and postoperative radiation therapy
Authors: Wang Marilene B. , Calcaterra Thomas C. , Lavey Robert S.
Published: October 2006

In recent years, we have seen increasing use of partial laryngectomies for larger lesions that were previously treated by total laryngectomy. The resultant closer margins have made postoperative radiation therapy an important adjuvant treatment to conservation laryngeal surgery. We review the University of California, Los Angeles, experience with combination partial laryngectomy and postoperative radiation therapy between 1973 and 1987 for treatment of carcinoma of the larynx. Twenty‐four such patients who underwent partial laryngectomies and postoperative radiation therapy are examined. Techniques of treatment, complications, and the functional ability of the remaining larynx are discussed.

The locoregional control rate at 5 years was 80%. Risk factors associated with an increased risk of recurrence were positive margins, vascular invasion, and extranodal spread. There were no major problems with postoperative wound healing or airway management during the radiation treatment. Vocal and swallowing function were well preserved in most cases. We conclude that combination partial laryngectomy and radiation therapy permits preservation of laryngeal function without serious complications, and therefore is an effective treatment for selected patients with carcinoma of the larynx.
1990 ogura memorial lecture: Moral dilemmas in head and neck cancer
Authors: Harrison Sir Donald
Published: October 2006

Neither morality nor dilemma can be defined meaningfully in the concept of the practical management of head and neck cancer. Although both have important implications, particularly with regard to ethnic and social factors, they play a relatively minor role in determining management policy. With little knowledge of the intrinsic causes of cancer and with a treatment strategy limited to radiotherapy and surgery, our desire for cure must be tempered by concern to avoid any increase in patient privations. My philosophy, based upon the care of more than 3500 patients over almost 30 years, reflects some of the difficulties of applying the concept “do nothing that may cause harm,” while offering each patient the opportunity for long‐term cure.
The efficacy of comprehensive neck dissection with or without postoperative radiotherapy in nodal metastases of squamous cell carcinoma of the upper respiratory and digestive tracts
Authors: Leemans Charles R. , Tiwari Rammohan , Nauta Jos J. P. , Snow Gordon B. , Van Der Waal Isaac , Karim A. B. M. F.
Published: October 2006

Neck recurrence‐free curves corrected for local recurrence were compared for 494 patients who underwent 565 comprehensive neck dissections. In 42 dissections, no radi‐cality could be obtained. Of the 523 histologically radical dissections, examination revealed tumor in 352 cases. Patients in whom three or more positive nodes or extranodal spread in one or more nodes were found received postoperative radiotherapy. In the histologically NO group, the incidence of neck recurrence after 5 years was 3%; in the N+ group as a whole, it was 10%. Analysis of the influence of extranodal spread and the number of positive nodes showed that the group with one or two positive nodes without extranodal spread (that did not receive postoperative radiotherapy) did not statistically differ from the other groups.

This suggests that the results of the group with one or two positive nodes without extranodal spread can be improved by postoperative radiotherapy.
A new low‐resistance, self‐retaining prosthesis (Provox™) for voice rehabilitation after total laryngectomy
Authors: Hilgers Frans J. M. , Schouwenburg Paul F.
Published: October 2006

Prosthetic rehabilitation of voice after total laryngectomy has gained wide acceptance in the last 10 years. Several reliable voice prostheses have been developed and used successfully.

Priorities for further development of the methods and instruments for prosthetic voice rehabilitation have led to the design of a low‐resistance, self‐retaining voice prosthesis (ProvoxTM) and an adapted replacement method. The results obtained in 79 patients are described. In vivo airflow resistance ranged from 1.0 to 3.8 kPa (mean = 1.9 kPa). Speech quality was good in 91% of the patients. The self‐retaining properties of the prosthesis appeared to be satisfactory. The average device‐life was more than 5 months.

Replacement of the prosthesis with a new disposable guide wire was done quickly as an outpatient procedure. Maintenance of the prosthesis by the patient was simple. The new low‐resistance, self‐retaining ProvoxTM voice prosthesis and the modified replacement method appeared to further improve the results of prosthetic voice rehabilitation after total laryngectomy.
Carcinoma of the external auditory canal: An update
Authors: Shih Lucy , Crabtree James A.
Published: October 2006

This review is a continuation of the series of 35 cases of carcinoma of the external auditory canal originally reported by the senior author and colleagues. Eighteen additional cases have been evaluated and treated since 1976. Preopera‐tive high‐resolution computed tomographic scanning has replaced polytomography, and improved surgical skull base approaches have allowed for extended resections of advanced lesions. A revised classification for local and extensive lesions is presented. The prognosis for localized tumors treated by en bloc resection remains excellent, whereas prognosis for extensive lesions might be more dependent on histologic type and grade of tumor.
Fat myringoplasty in the Guinea pig
Authors: Gold Steven R. , Chaffoo Richard A. K.
Published: October 2006

Fat myringoplasty is a simple office technique for repairing tympanic membrane perforations. It involves wedging a piece of fat from the ear lobule into the perforation. A search of the literature failed to reveal any controlled studies on the efficacy of this method, which may allow patients to avoid more invasive procedures. Controlled perforations in guinea pig tympanic membranes were treated with fat my‐ringoplasties, paper patches, or no intervention. Four weeks following the procedures, ears were examined and photographed under the microscope and studied histologically. The fat myringoplasty healing rate exceeded the rates of both the control and paper‐patch groups. Results were stratified with respect to location and size of perforations. The results and histological studies suggest that controlled studies in humans are warranted.
Extended retrolabyrinthine transtentorial approach to petroclival lesions
Authors: Canalis Rinaldo F. , Black Keith , Martin Neil , Becker Donald
Published: October 2006

In this communication, an extension of the retro‐labyrinthine approach that has permitted safe, effective access to the petrous tip and clivus is presented. The basic technique involved complete mastoidec‐tomy, preservation of the middle and inner ear structures, removal of the sigmoid and middle fossa plates, middle and posterior fossa craniotomies, ligation of the superior petrosal sinus, and division of the ten‐torium. Nine cases that exemplified the versatility of this approach constituted the basis of this paper: 2 cholesteatomas, 2 basilar artery aneurysms, 2 chordomas, and 3 meningiomas. The indications for, and complications of, this method have been discussed.
Multichannel cochlear implant and electrically evoked auditory brainstem responses in a child with labyrinthitis ossificans
Authors: Lambert Paul R. , Ruth Roger A. , Hodges Annelle V.
Published: October 2006

Ossification of the cochlea following meningitis presents a surgical challenge. Electrode mapping, especially in the young child, is difficult given the uncertainty of electrode contact with viable neural elements. This paper reviews surgical technique and the use of auditory brainstem responses to map the electrodes.

A 4‐year‐old child deafened by meningitis at age 20 months had bilateral cochlear ossification by computed tomography. At surgery, a canal wall‐down mastoidectomy and closure of the ear canal were performed. A trough around the modiolus was drilled, and the electrode array was placed in it. Post‐operatively, the patient gave aversive or no responses to electrode stimulation. To assess electrode function, auditory brainstem responses to individual electrode activation were obtained under general anesthesia. Functioning electrodes could thus be selected for mapping. The patient now responds well to sound.
Rapid sequence treatment of advanced squamous cell carcinoma of the upper aerodigestive tract: A pilot study
Authors: Moloy Peter J. , Moran Edgar M. , Azawi Samar
Published: October 2006

A review of the literature suggested that prolonged treatment time may lessen the probability of cure for patients with advanced squamous cell carcinoma of the upper aerodigestive tract. To shorten treatment time, rapid sequence treatment (RST) was devised in which chemotherapy, surgery, and irrada‐tion were administered in a total treatment time of 8 weeks. Twelve patients were treated and followed 3 years or longer. Medical complications were minor. Osteonecrosis occurred in each of the first five patients and was the only major complication of the protocol. Surgical techniques were modified, and no additional patient developed osteonecrosis. No patient developed local or regional recurrence. Two patients developed distant metastases and three other patients developed second primaries. Absolute survival was 50%. Rapid sequence treatment is an aggressive and potentially hazardous protocol that yielded encouraging results in this pilot study.
Catastrophic otologic injury from oral jet irrigation of the external auditory canal
Authors: Dinsdale Robert C. , Roland Peter S. , Manning Scott C. , Meyerhoff William L.
Published: October 2006

Jet irrigation is an accepted method for removal of cerumen from the external auditory canal. Even at a submaximal power setting, oral jet irrigators can generate enough force to rupture the tympanic membrane. Parameters for safe use of these irrigators have never been established.

Three cases are reported in which, in addition to tympanic membrane rupture, oral jet irrigators caused ossicular disruption, round and oval window fistulae, and subluxation of the stapedial footplate. A prospective study performed on 25 fresh cadavers demonstrated a 6% incidence of tympanic membrane perforation when the power setting was one‐third full power or greater. Recommendations are made for safe use of oral jet irrigators for removal of external auditory canal cerumen.
Otologic sequelae after pneumococcal meningitis: A survey of 164 consecutive cases with a follow‐up of 94 survivors
Authors: Rasmussen Niels , Johnsen Niels Jon , Bohr Vilhelm A.
Published: October 2006

As part of a comprehensive study on sequelae after pneumococcal meningitis, 94 of 111 consecutive survivors were re‐examined 4 to 16 years after discharge. Twenty‐three patients had otological sequelae after pneumococcal meningitis. In these patients, 17 had hearing losses, 7 had tinnitus, 9 had vertigo, 13 had vestibular areflexia, 4 had loss of smell, and 3 had loss of taste. Among the patients with hearing loss, 4 were bilaterally deaf, 6 were unilaterally deaf, and 2 had mild and 5 had slight hearing losses. From correlations with extensive data from the medical records, preadmission antibiotic treatment appeared to protect from acousticovestibular damage. Purulent otitis media and otosurgical intervention did not correlate to the fatality rate or the development of sequelae. Acute purulent otitis media appeared as a concomitant manifestation, rather than the focus of pneumococcal meningitis.
Facial reanimation after acoustic neuroma excision: The patient's perspective
Authors: Schaitkin Barry M. , Young Tymon , Robertson J. Scott , Fickel Virginia , Wiegand David A.
Published: October 2006

Facial reanimation after acoustic neuroma excision is currently accomplished using a variety of surgical techniques. A multi‐institutional survey of patient perceptions of facial reanimation success was accomplished by mailing a questionnaire to 809 randomly selected members of the Acoustic Neuroma Association. Four hundred sixty patients who underwent 296 reanimation procedures responded. Facial to hypoglossal nerve anastomosis, tarsorrhaphy, and upper eyelid implants were most frequently performed. The patient's estimations of initial deficit, spontaneous recovery, and overall satisfaction with the reanimation procedures are discussed.
Surgical treatment of chronic otitis media and meniere's syndrome
Authors: Huang Tsun‐Sheng , Lin Ching‐Chen
Published: October 2006

Meniere's symptom‐complex in conjunction with chronic otitis media (COM) has occasionally been encountered in otologic practice. This study compares the effects of various surgical techniques on patients with COM and Meniere's syndrome, primarily on incapacitating vertigo. One group of patients with incapacitating vertigo received endolymphatic system drainage procedures, either endolymphatic sac surgery (83 patients) or cochleosacculotomy (12 patients) simultaneously with surgery for COM. Another group (14 patients) had surgery for COM only. A comparison of the results for vertigo control between the two approaches indicates a significant difference in success rate in favor of endolymphatic system drainage procedures (80% versus 20%).

COM is regarded as one of the causes of endolymphatic hydrops (EH). The results of this study seem to indicate both 1. the likelihood of the cause‐and‐effect relationship between COM and EH, and 2. the effectiveness of endolymphatic shunting procedures on control of incapacitating vertigo, thus supporting the contentions of other authors with regard to pathogenesis and sac enhancement in patients with COM and Meniere's syndrome.
The treatment of small acoustic tumors: Now or later?
Authors: Shelton Clough , Hitselberger William E.
Published: October 2006

Prior to the advent of microneurosurgery, the operative mortality for acoustic tumor removal was high and management often consisted of observation until sufficient symptoms warranted removal. The treatment of these tumors has evolved, and recent introduction of gadolinium‐enhanced magnetic resonance imaging (MRI) allows the diagnosis of very small intracanalicular acoustic tumors before hearing has been significantly affected. For such tumors, some surgeons advocate the premicrosurgical philosophy of observation rather than removal.

Our results of small acoustic tumor removal with attempt at hearing preservation were reviewed. From 1961 to June 1989, 39 acoustic tumors 0.5 cm or less were removed by the middle fossa approach. Measurable hearing was preserved in 67%, and facial function 1 year postoperatively was normal or nearly normal in 97%. There was no other permanent operative morbidity.

Given our results, early surgical removal of small acoustic tumors is advocated.
The oxygen and nitrous oxide indices of flammability of endotracheal tubes determined by laser ignition
Authors: Simpson Joseph I. , Wolf Gerald L. , Rosen Arie , Krespi Yosef , Schiff Gerald A.
Published: October 2006

This study determines the flammability of polyvinylchloride (PVC), red rubber (RR), and silicone (Si) endotracheal tubes in oxygen‐ and nitrous‐oxide‐enriched atmospheres. Flammability is measured by using the oxygen and nitrous oxide indices of flammability with laser ignition. The laser‐ignited oxygen (O2) index of flammability of the endotracheal tubes is: PVC, 0.25; RR, 0.19; Si, 0.20. The laser‐ignited nitrous oxide (N2O) index of flammability of the endotracheal tubes is: PVC, 0.45; RR, 0.37; and Si, 0.41. These results are similar to the previously reported O2 and N2O indices of flammability with propane‐torch ignition. This study validates the concept that the indices of flammability are useful measures of endotracheal tube flammability and are independent of the ignition source.
The embryonic development of the lateral nasal wall from 8 to 24 weeks
Authors: Bingham Brian , Wang Rong‐Guang , Hawke Michael , Kwok Peter
Published: October 2006

This histological study of 20 fetal heads aged between 8 and 24 weeks of gestation demonstrates and describes the embryonic development of the lateral wall of the nose. The three turbinates (inferior, middle, and superior) arise as soft‐tissue swellings (preturbinates) by 8 weeks' gestation. A cartilage capsule surrounds the nose at 8 weeks and by 9 weeks, medially directed flanges of cartilage have invaded all three preturbinates. The uncinate process arises from the medial surface of the lateral cartilaginous capsule and is first identifiable by 10 weeks. An “air space” progressively develops from 11 to 12 weeks lateral to the cartilaginous uncinate process and from this space, the embryonic channel to the maxillary sinus develops. The embryonic woven bone of the maxilla can be identified from 9 to 10 weeks and enlarges both absolutely and relatively to the nasal cavity, so that by 13 to 14 weeks, this expanding bone forms the lateral wall of the inferior meatus as the cartilaginous nasal capsule regresses.
Origin of malignant centrofacial granulomas: Surface markers and gene rearrangement of malignant cells
Authors: Cabane J. , Raphaël M. , Lamas G. , Mossalayi Djavad , Dubois A. , Chomette G. , Godeau P. , Marty‐Double C. , Rossi J. F.
Published: October 2006

Malignant centrofacial granuloma (MCFG) is a clinical entity characterized by a relentless ulceration of the upper airway involving the nose, palate, and face, without any demonstrable etiology. The origin of 11 cases were analyzed with the help of cell‐surface immunostaining in all and with T‐cell receptor gene (TCR) rearrangement in 3. The results show that most of the cases of MCFG are in fact T‐cell lymphomas with cell‐surface antigens (CD2, CD7, CD3) consistent with either early or mature T lymphocytes. However, some cases exhibit B‐lymphoid (CD19, CD20) or histiomonocytic (CD13, CD14) lineage‐specific markers. In conclusion, despite its remarkable clinical unity, MCFG is a heterogeneous group of neoplastic diseases, most but not all of which may be classified as T‐cell lymphoma.