bluuebunny/crossref_metadata_2025 huggingface dataset:
Modified Facial Translocation Technique to Prevent Necrosis of Bone Graft
Authors: Hao Sheng‐Po
Published: November 2003

Objective To assess the efficacy of a modified facial translocation technique in preventing translocated facial bone graft from necrosis, which is the most common complication of facial translocation.

Study Design Prospective.

Methods A lateral nasal flap was preserved and transposed to resurface the inner surface of the translocated facial bone graft in a facial translocation approach to skull base tumors in 35 patients including 24 patients with radiation therapy between July 1998 and December 2000.

Results Only one patient had bone graft necrosis. Thirty‐four (97%) of 35 patients had intact mucosa covering the inner surface of the translocated facial bone graft. The outcome was not affected by preoperative or postoperative radiation therapy.

Conclusions A modified facial translocation technique using a lateral nasal flap to resurface the inner defect of the translocated facial bone graft significantly improved the viability of the translocated facial bone graft, especially in patients who underwent radiation therapy. The use of a lateral nasal flap does not interfere with the detection of early local recurrence.
The Contralateral Injury in Blunt Laryngeal Trauma
Authors: Sidle Douglas M. , Altman Ken W.
Published: November 2003

Objectives To present the unique case of a patient who sustained an ipsilateral and contralateral injury after external laryngeal trauma. The authors also explain the dynamics behind this type of injury.

Study Design Case report and brief literature review.

Methods A case report is presented of a patient who sustained both an ipsilateral and a contralateral injury after blunt laryngeal trauma. A brief review of the literature follows, including a description of proper management of this injury.

Conclusion The reader should garner an understanding of the dynamics of this type of injury and learn the basic management of a similar injury.
Tumor Volume Predicts Outcome for Advanced Head and Neck Cancer Treated With Targeted Chemoradiotherapy
Authors: Doweck Ilana , Denys Douglas , Robbins K. Thomas
Published: November 2003

Objectives/Hypothesis Just as tumor volume is a prognostic indicator for local disease control among patients with head and neck cancer of intermediate size treated with radiation therapy, we hypothesized a similar association for patients with advanced disease treated with chemoradiation therapy.

Study Design Retrospective analysis of primary and nodal tumor volume was correlated with prospectively collected treatment outcome measures.

Methods Sixty‐four patients with stage III‐IV disease who were treated with targeted intra‐arterial chemotherapy and radiation therapy (RADPLAT) were studied. Tumor volume was correlated with local disease control and survival.

Results Primary tumor volume correlated with local disease control and survival. The greatest risk for local failure was found among patients with primary tumor volume greater than 19.6 cc (93.8% vs. 57% [P = .001]). A nominal logistic regression analysis demonstrated primary tumor volume as being the only significant parameter related to local failure. Survival was only 14.1% among patients with primary tumor volume greater than 19.6 cc compared with 41.5% for patients with volumes less than 19.6 cc (P = .0018). A proportional hazard model indicated that the most significant and independent parameters associated with survival were primary tumor volume (P = .0007) and the site of the tumor (P = .05).

Conclusion Tumor volume is the most important factor predictive of treatment outcome among patients with advanced head and neck cancer and should be used to stratify favorable versus unfavorable patient subsets.
Outpatient Intravenous Antibiotics for Chronic Rhinosinusitis
Authors: Gross Neil D. , McInnes Renae J. A. , Hwang Peter H.
Published: November 2003

Objective/Hypothesis Peripherally inserted central catheter (PICC) lines have greatly facilitated the use of intravenous antibiotics in outpatient medical practice. Otolaryngologic applications for home intravenous therapy through PICC lines have not been well characterized to date. The purpose of the study is to describe indications and complications related to outpatient intravenous antibiotic therapy in patients with chronic rhinosinusitis.

Study Design Retrospective cohort study.

Methods Chart review of patients with chronic rhinosinusitis who were treated at an academic rhinology practice with outpatient intravenous antibiotics over a 3‐year period.

Results Fourteen patients receiving, in all, 16 courses of intravenous antibiotic therapy through PICC line were identified. The average patient age was 51 years (age range, 36–74 y). The primary indication for intravenous antibiotic use was the treatment of resistant pathogens (50%). The most common organisms treated were Staphylococcus epidermidis, Staphylococcus aureus, and Pseudomonas aeruginosa. Other indications included gastrointestinal intolerance of oral antibiotics and extranasal complications of sinusitis. Eighty‐eight percent of patients (14 of 16) were able to complete the entire prescribed course of therapy. Three (19%) catheter‐related complications occurred, including thrombophlebitis and deep venous thrombosis. All three complications required removal of the PICC line; one of these patients underwent successful reinsertion of a second catheter and completion of treatment.

Conclusions Peripherally inserted central catheter line delivery of home intravenous antibiotics can be a well‐tolerated adjunct to surgery in the outpatient treatment of chronic rhinosinusitis. Resistant infections, intolerance to oral antimicrobials, and extranasal complications of sinusitis are indications for PICC line therapy. Catheter‐related complications can be significant and must be considered in patient selection.
Otolaryngology Residents' Objectives in Entering the Workforce
Authors: Kay David J. , Lucente Frank E.
Published: November 2003

Objectives To determine the priorities of current otolaryngologists‐in‐training in considering their first employment opportunities.

Study Design Twenty‐one‐item survey measuring the importance of various first job issues, with all items scored on a five‐point Likert‐type ordinal scale.

Methods The resident membership of the American Academy of Otolaryngology—Head and Neck Surgery was anonymously surveyed by means of mail‐in questionnaires. Results were stratified by years of training.

Results Responses from 242 of 1174 mail‐in surveys (21% response rate) exhibited a wide distribution of responses for all 21 questions. The availability of free time to spend with one's family was regarded by more than half of the respondents to have the highest overall importance. As years of training increased, priorities shifted toward geographic location, away from issues such as the on‐call schedules. The availability of research time and resources received the overall lowest priority, with more than half of the respondents ranking it as only somewhat important or lower.

Conclusions Otolaryngologists‐in‐training feel strongest about the availability of free time to spend with their families as they finish formal training and consider employment opportunities. By acknowledging the concerns of graduating residents, including the ability to pursue their primary interests when they start working, we can better adapt conditions to create a more comfortable and stable entry into the workforce.
The Use of Malleus Allografts in Ossiculoplasty
Authors: Vercruysse Jean‐Philippe , Offeciers F. Erwin , Somers Thomas , Schatteman Isabelle , Govaerts Paul J.
Published: November 2003

Objective To assess the functional performance of remodeled malleus allografts in a malleus‐footplate assembly in terms of hearing results and mid long‐term stability.

Study Design A retrospective study of 60 consecutive patients who underwent a malleus allograft ossiculoplasty from 1993 until 2000. In all cases the incus and the stapedial arch were missing as the result of cholesteatoma (49), chronic otitis (5), incus necrosis resulting from stapes prosthesis (5), and congenital ossicular malformations (1). In all cases malleus allografts were remodeled to form a malleus‐stapes assembly.

Results The audiometric results, using such an ossiculoplasty, revealed an overall median gain of 18.3 dB at 2 months, 22.3 dB at 6 months, and 25 dB 1 year postoperatively on Fletcher frequencies. An air‐bone gap closure within 20 dB was achieved in 81% of all cases 1 year postoperatively. No cases of extrusion have been seen in our series.

Conclusion Our findings suggest that malleus allografts are capable of generating good and stable funcitonal results as malleus‐stapes assembly.
Rathke Cleft Cyst: Diagnostic and Therapeutic Considerations
Authors: Kasperbauer Jan L. , Orvidas Laura J. , Atkinson John L. D. , Abboud Charles F.
Published: November 2003

Objective To highlight diagnostic and therapeutic issues about Rathke cleft cysts for otorhinolaryngologists.

Study Design Retrospective.

Methods We retrospectively reviewed data collected on Rathke cleft cysts between 1978 and 1998: presenting symptoms, visual acuity, surgical treatment, complications, recurrences, and effect on daily activity.

Results Twenty‐nine patients were diagnosed with a Rathke cleft cyst (11 male and 18 female patients; mean age, 46 y). The most common presenting symptom was head pain (55%). The majority (59%) of cases demonstrated suprasellar extension on preoperative imaging, with pituitary dysfunction identified in 66%. Recurrence occurred in eight patients (28%). Postoperative visual function improved or remained stable in all patients. Persistent pituitary dysfunction required hormonal supplementation in seven patients (24%). Only one patient with an astrocytoma in addition to a Rathke cleft cyst did not maintain the ability to perform normally on an assessment of activities of daily living, a striking contrast to patients with craniopharyngioma.

Conclusions Conclusions were as follows: 1) Rathke cleft cysts must be considered as sources of head pain and pituitary dysfunction. 2) Persistent or recurrent cyst formation occurs in approximately one‐third of the patients. Recurrence may take many years, and follow‐up imaging is recommended for at least a decade. 3) Maintenance of the ability to perform the activities of normal daily living can be expected after surgical management. 4) Most Rathke cleft cysts can be managed through transnasal exposure of the sella. 5) Packing the sella may result in predisposition to recurrent cyst formation.
Screening for Second Primary Lung Cancer After Treatment of Laryngeal Cancer
Authors: Ritoe Savitri C. , Krabbe Paul F. M. , Jansen Margriet M. G. , Festen Jan , Joosten Frank B. M. , Kaanders J. Hans A. M. , van den Hoogen Frank J. A. , Verbeek André L. M. , Marres Henri A. M.
Published: November 2003

Objectives/Hypothesis As a result of smoking, patients who have received curative treatment for laryngeal cancer run a high risk of developing lung cancer. Therefore, these patients enter a screening program that aims to detect lung cancer at an asymptomatic stage. The study evaluated whether screening for lung cancer by means of regular chest x‐ray examinations contributed to prolonging survival.

Study Design A longitudinal follow‐up study was performed to analyze the survival of patients who had received curative treatment for squamous cell laryngeal cancer and developed lung cancer during the follow‐up period.

Methods Patients with lung cancer were divided into two groups: 1) patients with asymptomatic screen‐detected lung cancer and 2) patients with complaints indicating lung cancer, whose tumor was detected in the interval between screening examinations by chest x‐ray films.

Results In the complete group of patients with laryngeal cancer, no prognostic factors could be identified for developing lung cancer. There was no prolongation of survival in the screen‐detected asymptomatic lung cancer patients. The median survival of both groups was 56 months (P = .57). The date of detection of the lung cancer was clearly brought forward by screening; a difference of 8 months was found between the median detection date of the two groups (P <.001). There was no difference in tumor‐specific mortality between the two groups.

Conclusion Screening by chest x‐ray examination to detect lung cancer in an asymptomatic stage after curative treatment for squamous cell laryngeal cancer does not improve survival for patients who develop lung cancer.
Effect of 23 Valent Pneumococcal Polysaccharide and Haemophilus influenza Conjugated Vaccines on the Clinical Course of Otitis Media With Effusion
Authors: Kiliç Rahmi , Şafak Mustafa A. , Özdek Ali , Göçmen Hakan , Kiliç Dilek , Samim Erdal
Published: November 2003

Objective To determine if there is any clinical effect of 23‐valent pneumococcal and Haemophilus influenza type B conjugate vaccine on prognosis of otitis media with effusion.

Method All children who have middle ear effusion despite long‐standing antibiotherapy with a beta lactamase stable agent were offered for tympanostomy tube insertion between February 1999 and December 2001. Patients who accepted the surgical intervention were operated under general anesthesia and a Shepard grommet‐type tympanostomy tube was inserted. Those who refused the surgical intervention were vaccinated with 23‐valent pneumococcal and Haemophilus influenza type B conjugate vaccine. State of the middle ear effusion was evaluated at the end of the 12th month in the vaccine group and 1 month after the myringotomy site was healed in the tympanostomy tube insertion group.

Results Twenty‐six children in the vaccine group and 37 children in the tympanostomy tube insertion group proved the inclusion criteria at the end of study. Complete or partial resolution of middle ear effusion was observed in 73.1% of 26 children in the vaccine group and 59.5% of children in the tympanostomy tube insertion group. There was no significant difference between the two groups.

Conclusion Vaccination against Streptococcus pneumonia and Haemophilus influenza type b seems to aid resolution of middle ear effusion in children with otitis media with effusion.
Minimally Invasive Parathyroidectomy: The Role of Radio‐Guided Surgery
Authors: Shaha Ashok R. , Patel Snehal G. , Singh Bhuvanesh
Published: November 2003

Objectives Objectives were to review our current experience with radio‐guided parathyroid surgery and to compare various techniques of minimally invasive parathyroidectomy.

Study Design 1) To review our recent experience of radio‐guided gamma probe localization during surgery for primary hyperparathyroidism and 2) to compare the intraoperative findings with the preoperative sestamibi scan.

Methods Analysis was made of the 10 most recent surgical procedures for primary hyperparathyroidism at a single institution to compare the operative localization with preoperative sestamibi scan and to determine the radioactivity in the tissue removed during surgery, such as parathyroid adenoma, normal parathyroid gland, thyroid tissue, or lymph nodes.

Results The sestamibi scan was able to localize the enlarged parathyroid gland in eight patients. Although gamma probe was helpful in localizing the parathyroid gland, the identification of an enlarged parathyroid gland was directly based on the preoperative findings of sestamibi scan. In the remaining two patients, the intraoperative gamma probe was not helpful.

Conclusions The major advantage of gamma probe in the series was to evaluate the radioactivity in the tissue that was removed and to determine whether it was an enlarged parathyroid gland, lymph node, thyroid tissue, or fatty tissue. The radio‐guided surgery did not add substantially to the surgical procedure in patients in whom the sestamibi scan had localized the enlarged parathyroid gland preoperatively.
Treatment of Isolated Sphenoid Sinus Inflammatory Disease by Endoscopic Sphenoidotomy Without Ethmoidectomy
Authors: Kieff David A. , Busaba Nicholas
Published: November 2003

Objectives/Hypothesis Isolated chronic sphenoid sinusitis is a rare entity. The study was conducted to determine the efficacy of endoscopic sinus surgery with partial middle turbinectomy and without ethmoidectomy in treating isolated sphenoid opacification from inflammatory and infectious disease.

Study Design Case series of 20 patients generated by retrospective review of 307 consecutive patients who underwent surgical treatment for chronic rhinosinusitis.

Methods The medical records were reviewed for pertinent demographic, symptom, radiographic, and endoscopic data preoperatively, interoperatively, and postoperatively. All patients in the series underwent computed tomographic image–guided endoscopic sphenoid sinus surgery with partial middle turbinectomy.

Results The study population consisted of 12 male and 8 female patients between 28 and 75 years of age. Headache (15 patients) and/or postnasal drip (14 patients) were the presenting symptoms in 17 of the patients. Three patients were asymptomatic. Surgical findings included inspissated secretions (15 patients), fungal debris (2 patients), and mucopyoceles (3 patients). The 17 patients with preoperative symptoms were symptom free by 12 weeks postoperatively and have remained so with follow‐up ranging from 12 months to 3.25 years (mean follow‐up, 23.1 mo). There were no operative complications in the series.

Conclusions Endoscopic sphenoid sinus surgery without ethmoidectomy is effective for treating isolated sphenoid sinus opacification associated with inflammatory or infectious sinus disease. Partial middle turbinectomy at the time of surgery facilitates the approach, as well as postoperative cleaning and surveillance.
Correlation of pH Probe–Measured Laryngopharyngeal Reflux With Symptoms and Signs of Reflux Laryngitis
Authors: Noordzij J. Pieter , Khidr Aliaa , Desper Ellen , Meek Robert B. , Reibel James F. , Levine Paul A.
Published: November 2003

Objectives/Hypothesis Laryngitis secondary to gastric acid reflux is a prevalent, yet incompletely understood, otolaryngological disorder. Further characterization of the relationship between symptoms and signs and reflux severity is needed.

Study Design Prospective clinical trial.

Methods Forty‐two consecutive, nonsmoking patients with one or more reflux laryngitis symptoms were recruited to complete a symptom questionnaire, videostrobolaryngoscopy, and 24‐hour, dual‐sensor pH probe testing. Twenty‐nine patients had more than four episodes of laryngopharyngeal reflux, and the remaining 13 served as control subjects. Symptom scores were produced by multiplying the severity by the frequency for the following: hoarseness, throat pain, “lump‐in‐throat” sensation, throat clearing, cough, excessive phlegm, dysphagia, odynophagia, and heartburn. Endoscopic laryngeal signs included erythema and edema of the vocal folds and arytenoids, and interarytenoid irregularity.

Results Symptom scores varied significantly, with throat clearing being greater than the rest. None of the symptoms, except heartburn, correlated with reflux (laryngopharyngeal and esophageal) severity. Patients with worse laryngopharyngeal reflux were found to have worse esophageal reflux. Endoscopic laryngeal signs were rated as mild, on average, and did not correlate with laryngopharyngeal reflux severity. The number of laryngopharyngeal reflux episodes (per 24 h) ranged from 0 to 40 (mean number, 10.6 episodes).

Conclusions Throat clearing was the most intense symptom in the present group of patients with proven reflux laryngitis. Dual‐sensor pH probe testing could not predict the severity of patient's reflux laryngitis symptoms or signs. Only the heartburn symptom correlated with laryngopharyngeal and esophageal reflux.
Congenital Dacryocystocele Associated With Intranasal Cysts: Diagnosis and Management
Authors: Shashy Ronald G. , Durairaj Vikram , Holmes Jonathan M. , Hohberger George G. , Thompson Dana M. , Kasperbauer Jan L.
Published: November 2003

Objective To improve the diagnostic and therapeutic database for congenital dacryocystoceles.

Study Design/Methods Retrospective case study of 10 patients with dacryocystoceles treated in an academic integrated tertiary care practice. Management and outcomes are compared to previous reports in the literature.

Results Between the years 1990 and 2001, 10 patients were diagnosed with dacryocystoceles. Seven were females, and 3 were males. Age ranged from 1 to 75 days. Nine of 10 had a unilateral dacryocystocele, and 1 had bilateral dacryocystoceles. Epiphora was reported in 8 patients. Preoperatively, dacryocystitis, facial cellulitis, or both were present/developed in 2 patients. Symptoms of airway obstruction were present in 3 neonates. Surgery was performed in 9 of 10 patients and was a combined ophthalmology/otolaryngology surgery in 7 cases. Two patients were treated with probing only. Intranasal cysts were identified in all 7 patients who underwent a combined approach. Three of 7 patients had bilateral intranasal cysts. Follow‐up ranged from 9 months to 10 years (mean, 5 years). Complete resolution was observed in 9 patients. One patient had postoperative nasolacrimal duct obstruction 2 months postoperatively, presenting with mucopurulent drainage and cellulitis. The existing literature often suggests conservative management as a treatment option.

Conclusion True dacryocystoceles are a relative rarity. The literature describes a variable natural course of these lesions with resultant controversy in their management. The current results demonstrate successful treatment in 6 of 7 patients with an early combined surgical approach and 2 of 2 patients treated by probing alone. The high failure rate with conservative management, reported in the literature, supports early surgical intervention.
Transnasal Endoscopic Closure of Cerebrospinal Fluid Leaks
Authors: Chin Gregory Y. , Rice Dale H.
Published: November 2003

Objectives/Hypothesis To demonstrate an effective method for transnasal endoscopic closure of anterior skull base fistulas that does not involve lumbar drains or fat packing.

Study Design Retrospective.

Methods We reviewed the charts of 36 patients who had 37 anterior skull base defects that were repaired endoscopically between 1993 and 2001.

Results Thirty‐three defects were successfully closed on the first attempt. Three were successfully closed on the second attempt. One large defect was repaired by neurosurgery after a failed endoscopic attempt. Our results are similar to those of other published series.

Conclusion Our method is effective and does not require adjuvant procedures or prolonged hospital stays.
p53 and Cyclin D1 as Prognostic Factors in Squamous Cell Carcinoma of the Larynx
Authors: Vielba Raquel , Bilbao Juan , Ispizua Angel , Zabalza Iñaki , Alfaro Jesús , Rezola Ricardo , Moreno Enrique , Elorriaga Jon , Alonso Ibón , Baroja Antonio , de la Hoz Carmen
Published: November 2003

Objectives/Hypothesis Proteins p53 and cyclin D1 play a crucial role in cell cycle control. Protein p53 mutations are one of the most common genetic alterations in human cancer, and cyclin D1 gene amplification has been found to be associated with poor prognosis in different types of tumors. Functional alterations of these proteins may play an important role both in the carcinogenesis of squamous carcinomas of the head and neck and in the clinical evolution of these tumors. The objective of the present study was to evaluate whether the presence of p53 and/or cyclin D1 proteins (detected by immunohistochemical analysis) could serve as relevant variables for the assessment of the prognosis of laryngeal squamous cell carcinoma.

Study Design Retrospective multicentric study.

Methods Paraffin‐embedded biopsy specimens from 62 human epidermoid laryngeal carcinomas were randomly selected. The expression of p53 and cyclin D1 was examined by means of immunohistochemical analysis with a view to evaluating whether there is a correlation between the aberrant expression of these proteins and disease prognosis.

Results In the sample, the presence of immunohistochemically detectable p53 is associated with shorter survival and disease‐free intervals, as shown in Kaplan‐Meier survival curve analysis. Indeed, multivariate statistical analysis revealed that the accumulation of p53 is an independent prognostic factor, which is associated with shorter survival. This association was not evident in the case of cyclin D1.

Conclusion A more precise prognosis of patients with laryngeal epidermoid carcinomas could be achieved by taking into account the presence of p53 (as assayed by immunohistochemical analysis) in biopsy tissue .
Salvage Frontal Sinus Surgery: The Endoscopic Modified Lothrop Procedure
Authors: Wormald Peter John
Published: November 2003

Objectives/Hypothesis Until recent years, the osteoplastic flap with frontal sinus obliteration has been the gold standard for recalcitrant frontal sinusitis. The present series evaluated the role of the endoscopic modified Lothrop procedure, which has recently been advocated as an alternative.

Study Design Prospective non‐randomized interventional case series.

Methods The study prospectively assessed 83 consecutive patients who underwent endoscopic modified Lothrop procedure. The mean age was 52.4 years (SD = 13.6 y) with a male‐to‐female ratio of 3:1. Patients had a mean of six previous sinus surgical procedures with 17 patients having undergone previous frontal sinus obliteration with mucocele formation. Seventy‐six patients (91%) had frontal pain or headache as their primary presenting symptom, with 72 having nasal discharge. There were 14 patients who presented with 17 complications of frontal sinus disease. There were eight erosions of the posterior table of the frontal sinus with extension of the mucocele intracranially, seven orbital complications, and one cerebrospinal fluid leak. Twenty‐four patients (30%) had fungus cultured from their sinuses at the time of surgery.

Results Six of the 83 patients (7%) developed frontal ostium stenosis resulting in a 93% primary success rate after an average follow‐up of 21.9 months (SD = 6.1 mo). These patients all underwent a revision modified Lothrop procedure and had a patent frontal ostium at their last review. Twenty‐one patients (25%) developed recurrent symptoms, which were managed medically. Of these 21 patients, 9 with previously diagnosed fungal sinusitis developed mucosal changes again in their frontal sinuses, but their ostia have remained patent. Four patients have had recurrent infections in the frontal sinuses, and three patients with aspirin‐sensitive asthma and polyps have developed polyps again in their frontal sinuses. Five patients continued to have frontal pain without radiological evidence of further frontal disease. No patients required an osteoplastic flap procedure.

Conclusion The endoscopic Lothrop procedure is a successful short‐term management option for recalcitrant and complicated frontal sinusitis caused by a wide range of diseases.
Vestibular Neuronitis in Pilots: Follow‐up Results and Implications for Flight Safety
Authors: Shupak Avi , Nachum Zohar , Stern Yoram , Tal Dror , Gil Amnon , Gordon Carlos R.
Published: November 2003

Objectives To report our experience over the past 12 years with the evaluation and follow‐up of pilots with vestibular neuronitis and to discuss points relevant to flight safety and the resumption of flying duties.

Study Design A retrospective, consecutive case series.

Methods Eighteen military pilots with vestibular neuronitis were examined and followed up. A complete otoneurological workup was performed, including both physical examination and laboratory evaluation. The latter included electro‐oculography (EOG) and a rotatory chair test using the smooth harmonic acceleration protocol.

Results The mean patient age was 35 ± 6 years (range, 23 to 42 y), and the average follow‐up period was 20.5 ± 12.8 months (mean ± standard deviation [SD]; (range, 11 to 48 mo). Electro‐oculography caloric test on presentation documented significant unilateral hypofunction in all patients. Thirteen of the 18 patients (72%) had abnormal smooth harmonic acceleration test results. None of the pilots reported any symptoms on follow‐up. However, five (28%) had positive otoneurological examination findings, and eight (44%) still had significant caloric lateralization (>25%). The average caloric hypofunction was reduced from 67.8% ± 29.3% at onset to 40% ± 16% (mean ± SD, P <.05, paired t test). Seven of the patients (39%) had additional electro‐oculography findings beyond caloric hypofunction. These included spontaneous, positional, and positioning nystagmus. Smooth harmonic acceleration disease on follow‐up was documented in eight patients (44%), five of whom had canal paresis. Eleven patients (61%) demonstrated residual vestibular damage on follow‐up. In 6 of these 11 cases (55%), the laboratory evaluation revealed vestibular deficits otherwise undiagnosed by the bedside test battery.

Conclusions The vestibular system plays a central role in orientation awareness and is often challenged by flying conditions. The finding that approximately 60% of pilots who have had vestibular neuronitis continue to show signs of vestibular malfunction, despite apparent clinical recovery, emphasizes the need for a complete vestibular evaluation, including specific bedside testing and laboratory examinations, before flying duties can be resumed.
Petrous Anatomy for Middle Fossa Approach
Authors: Sennaroglu Levent , Slattery William H.
Published: November 2003

Objective The objective was to describe the relationship of anatomical landmarks required for the middle fossa approach to lesions of the petrous apex and internal auditory canal (IAC). Landmarks for safe identification of the IAC are defined, as are two zones (safe zones I and II) anterior and posterior to the IAC.

Study Design Temporal bone anatomical study.

Methods Ten temporal bones underwent high‐resolution computed tomography followed by wet bench dissection. A set of 39 different distances between vital structures was measured, where possible, from both radiology films and under the microscope. Mean, median, minimum, and maximum measurements of all distances were determined. Angular measurements were made using a specially designed instrument.

Results Measurements were made in an anatomical position to mimic the middle fossa surgical technique. Measurements are presented for the superior surface of the temporal bone from the sigmoid sinus and inner table to vital structures, from the anterior and posterior petrous apex, and from the IAC.

Conclusions Petrous apex anatomical knowledge is required for the safe middle fossa approach to the IAC and petrous apex. Two safe zones are defined that should prevent damage to the cochlea and the superior semicircular canal.
Mesenchymal Chondrosarcoma of the Sinonasal Tract: A Clinicopathological Study of 13 Cases With a Review of the Literature
Authors: Knott P. Daniel , Gannon Francis H. , Thompson Lester D. R.
Published: November 2003

Objectives/Hypothesis Mesenchymal chondrosarcoma of the sinonasal tract is a rare, malignant tumor of extraskeletal origin. Isolated cases have been reported in the English literature, with no large series evaluating the clinicopathological aspects of these tumors.

Study Design Retrospective review.

Methods Thirteen patients with sinonasal mesenchymal chondrosarcoma were retrieved from the Otorhinolaryngologic—Head and Neck Registry of the Armed Forces Institute of Pathology.

Results Nine women and 4 men (age range, 11 to 83 y; mean age, 38.8 y) presented with nasal obstruction (n = 8), epistaxis (n = 7), or mass effect (n = 4), or a combination of these. No patients reported prior head and neck irradiation. The maxillary sinus was the most common site of involvement (n = 9), followed by the ethmoid sinuses (n = 7) and the nasal cavity (n = 5). Tumors had an overall mean size of 5.1 cm. Microscopically, the tumors displayed a small, blue, round cell morphology appearance arranged in a hemangiopericytoma‐like pattern with foci of cartilaginous matrix. All cases were managed by surgery with adjuvant radiation therapy (n = 4) and/or chemotherapy (n = 3). The overall mean survival was 12.1 years, although five of six patients who developed local recurrences died of disease (mean survival, 6.5 y). Six patients were alive and disease free (mean survival, 17.3 y), and two patients were lost to follow‐up.

Conclusions Mesenchymal chondrosarcoma of the sinonasal tract is an aggressive tumor with a predilection for young women. The pattern of growth and scarcity of cartilaginous matrix result in frequent misdiagnosis. Recurrence develops in approximately one‐third of patients and seems to predict a poor prognosis. Aggressive, exenterative surgery combined with adjuvant therapy appears to yield the best clinical outcome.
Proximity of Carotid Canal Wall to Tympanic Membrane: A Human Temporal Bone Study
Authors: Hasebe Seishi , Sando Isamu , Orita Yorihisa
Published: November 2003

Objective The objective was to examine the possible risk of injury to the internal carotid artery during procedures in the middle ear, including myringotomy.

Study Design Histopathological morphometric study of human temporal bones.

Methods One hundred forty‐two human temporal bone specimens obtained from 92 individuals without any known ear disease were prepared for light microscopic study. Using 83 bones that were available for measurement, the thickness of the carotid canal wall (CCW), which is the medial wall of the bony portion of the eustachian tube, was measured. Using 15 bones selected for three‐dimensional measurement, the closest distance from CCW to the anterior tympanic annulus was measured. Using all 142 temporal bone specimens, the CCW was examined to detect the presence of partial dehiscence. In one case, the images of CCW dehiscence and its surrounding structures were reconstructed by a personal computer.

Results The thickness of the CCW was 0.00 to 0.73 mm (average thickness, 0.24 mm [±0.12 mm]). The distance from the CCW to the anterior tympanic annulus was 1.8 to 8.1 mm (average distance, 4.9 [±1.7 mm]). Dehiscence of CCW was observed in 7 (4.9%) of 142 temporal bone specimens. The reconstructed image showed that the posterior half of the dehiscence of CCW could be seen from the external ear canal.

Conclusions The CCW was found to be extremely thin or even dehiscent in some cases, rendering the internal carotid artery vulnerable during transtympanic procedures. The study's findings emphasized the need for judicious care when operating in the anterior mesotympanum.
Chronic Tinnitus Resulting From Head or Neck Injuries
Authors: Folmer Robert L. , Griest Susan E.
Published: November 2003

Objectives The main objectives were 1) to determine the percentage of cases of chronic tinnitus in a specialized clinic that resulted from head or neck injuries; 2) to describe the characteristics of this population; and 3) to compare patients with head or neck trauma with patients whose tinnitus onset was not associated with head or neck injuries.

Study Design Retrospective analysis of tinnitus clinic patient data.

Methods Detailed questionnaires were mailed to 2400 patients before their initial appointment at the Oregon Health and Science University Tinnitus Clinic (Portland, OR). All of the patients experienced and received treatment for chronic tinnitus. Patient data were entered into a database and later analyzed.

Results Two hundred ninety‐seven patients (214 male and 83 female patients) reported that their chronic tinnitus started as a result of head or neck injuries. Compared with patients whose tinnitus onset was not associated with trauma, patients with tinnitus associated with head or neck trauma were younger; had better hearing thresholds; experienced headaches more frequently; reported greater difficulties with concentration, memory, and thinking clearly; were more likely to experience current depression, but not lifetime depression; rated their tinnitus as louder on a 1‐to‐10 scale; matched their tinnitus to louder sounds on the right side; and had higher Tinnitus Severity Index scores.

Conclusions Tinnitus is a significant symptom that commonly occurs as a result of head or neck trauma. The fact that tinnitus resulting from head or neck injuries tends to be more severe (and is often accompanied by a greater number of co‐symptoms) than tinnitus resulting from other causes should be taken into account by clinicians treating these patients.
Orbital Complications in Endoscopic Sinus Surgery Using Powered Instrumentation
Authors: Graham Scott M. , Nerad Jeffrey A.
Published: November 2003

Objectives/Hypothesis Powered dissection is increasingly used in endoscopic sinus surgery. Although it has certain clear advantages over conventional instrumentation, powered dissection also presents special liabilities. The objectives of the report are to highlight the special dangers of powered instrumentation near the orbit, to suggest techniques that might minimize these risks, and to review the management of orbital injuries.

Study Design Case series.

Methods A retrospective review was performed of patients who were referred to our institution with orbital injury complicating endoscopic sinus surgery in which powered instrumentation had been used. Patient demographics, status as revision or primary surgery, degree of intraoperative blood loss, indications for surgery, intraoperative findings, the complication sustained, time of recognition of the complication, immediate and delayed treatment, and clinical course were obtained from the clinical records.

Results Three patients had medial rectus muscle injuries. In addition to the medial rectus injury, one patient also had blindness, probably from an orbital hemorrhage. One patient underwent orbital exploration in an unsuccessful attempt to reattach the ends of the medial rectus muscle. One patient had continuing diplopia, but declined orbital exploration or strabismus surgery.

Conclusions Intraoperative orbital complications that might be of minor consequence with conventional instrumentation can have dramatic sequelae when powered dissection is used. Special care must be exercised in using powered instrumentation.
Analysis of the Relations Between the Shape of the Reconstructed Tongue and Postoperative Functions After Subtotal or Total Glossectomy
Authors: Kimata Yoshihiro , Sakuraba Minoru , Hishinuma Shigeyuki , Ebihara Satoshi , Hayashi Ryuichi , Asakage Takahiro , Nakatsuka Takashi , Harii Kiyonori
Published: November 2003

Objectives/Hypothesis For reconstruction after subtotal or total glossectomy, both preserving the larynx and maintaining postoperative swallowing and speech functions can greatly improve quality of life; however, postoperative functional results are often unstable. Our experiences suggest that insufficient flap volume in the oral area and postoperative prolapse of the preserved larynx affect postoperative function. The objective was to investigate the relations of the shape of the reconstructed tongue to postoperative swallowing and speech functions.

Study Design The shape of the reconstructed tongue was classified on the basis of magnetic resonance and intraoral inspection as protuberant, semi‐protuberant, flat, or depressed. Speech intelligibility was evaluated, and body weight, which might affect the shape of the transferred flap, was measured before and after surgery.

Methods Thirty patients who had undergone subtotal or total glossectomy and subsequent reconstruction were reviewed.

Results We found that speech intelligibility (P <.001), food (P <.01), and deglutition (P <.003) scores were significantly lower in patients with flat or depressed tongues than in patients with semi‐protuberant or protuberant tongues. Weight loss after surgery was significantly greater in patients with depressed tongues than in other patients (P <.013). Our results indicate that postoperative function is related to the shape of the reconstructed tongue.

Conclusions We suggest that 1) wider and thicker flaps, such as rectus abdominis musculocutaneous flaps, be used; 2) flaps be designed to be approximately 30% wider than the defect; 3) laryngeal suspension be used to prevent prolapse of the transferred flap; and 4) careful general management and sufficient nutrition are important in the early postoperative period.
Palatal Reconstruction With the Palatal Island Flap
Authors: Moore Brian A. , Magdy Emad , Netterville James L. , Burkey Brian B.
Published: November 2003

Objectives/Hypothesis The management of palatal defects resulting from the extirpation of benign and malignant lesions uses a variety of methods, with the optimal techniques allowing maximal postoperative function with minimal morbidity. The palatal island flap is an effective, reliable technique for reconstructing postablative oral cavity defects.

Methods All patients who underwent palatal resections for benign or malignant lesions at a tertiary care, referral‐based head and neck cancer center since 1995 were eligible. Ten patients were identified whose surgical defects were reconstructed with palatal island flaps. The cases were reviewed for the symptomatology, tumor features, defect size, perioperative and postoperative management, complications, and impact on palatal function.

Results Ten patients ranging in age from 18 to 81 years underwent palatal island mucoperiosteal flaps after resection of a variety of benign and malignant tumors, most arising from minor salivary glands. The defects ranged in size from 5 to 15 cm2, with extension into the floor of the nose in four cases and to the skull base in two. Nine patients were discharged on a regimen of oral diet, and no patient manifested permanent velopharyngeal insufficiency, speech impairment, or airway compromise. Follow‐up ranged from 3 months to 6 years, with an average follow‐up of 18.5 months. Delayed donor site re‐epithelialization required debridement in one case, and two patients required obturation of small oronasal fistulae.

Conclusion The palatal island mucoperiosteal flap provides an effective means of reconstructing hard and soft palate defects with few complications and low morbidity.
Vestibular Evoked Myogenic Potentials in Brainstem Stroke
Authors: Chen Chia‐Hung , Young Yi‐Ho
Published: November 2003

Objectives/Hypothesis Despite its widespread application in the posterior fossa tumor, the study of vestibular evoked myogenic potential (VEMP) in cases of posterior fossa stroke remains scarce. The purpose of the study was to establish the role of VEMP in patients with brainstem stroke.

Study Design Retrospective study.

Methods Patients with acute vertigo were admitted and underwent a battery of auditory vestibular tests including caloric and VEMP tests; then they were surveyed by magnetic resonance imaging scan. Seven patients (two men and five women) were demonstrated as having brainstem stroke, including infarction in five patients and hemorrhage in two.

Results Clinical manifestations consisted of dizziness/vertigo in all patients, spontaneous nystagmus in five (71%), and ataxia in three. No patients had experienced conscious change or conventional neurological deficits (eg, long tract signs). Electronystagmography revealed abnormal findings on eye tracking test in 100% of patients, on optokinetic nystagmus test in 71% of the patients, and on caloric testing in 10 ears (71%), including absent ice‐water caloric test response in 7 ears and canal paresis in 3 ears. Vestibular evoked myogenic potential testing displayed normal response in 3 ears and abnormal response in 11 ears (79%), including absent vestibular evoked myogenic potentials in 8 ears and delayed vestibular evoked myogenic potentials in 3 ears. When results of both caloric testing and VEMP test were combined, the abnormal rate increased to 93% (13 of 14 patients).

Conclusions Caloric testing assesses the vestibulo‐ocular reflex, which passes upward through the upper brainstem, whereas VEMP testing evaluates the sacculocollic reflex, which travels downward through the lower brainstem. Hence, in evaluating the extension of brainstem stroke, both caloric and VEMP testing should be performed.
Reversible Canal Wall Down Mastoidectomy for Acquired Cholesteatomas: Preliminary Results
Authors: McElveen John T. , Chung Andy T. A.
Published: November 2003

Objectives The educational objectives were to discuss a new technique to manage acquired cholesteatomas and to compare this with standard approaches used for cholesteatoma removal. The study objective was to determine the feasibility of using a new approach, the reversible canal wall down approach, in conjunction with bone cement to remove acquired cholesteatomas and, potentially, preserve the ossicular chain.

Study Design Retrospective review of five patients who underwent resection of their acquired cholesteatomas using a technique that maximizes exposure, yet preserves the posterior canal wall and, potentially, the ossicular chain.

Methods In the setting of a tertiary otological referral center, five consecutive patients with acquired cholesteatomas underwent reversible canal wall down surgery. Four patients were male (ages, 41, 53, 26, and 10 y), and one patient was a woman [age, 51 y]). A reversible canal wall down mastoidectomy approach was used in the patients. Main outcome measures were intraoperative findings with respect to cholesteatoma removal and postoperative clinical examination, including postoperative audiograms.

Results Five patients had dry ears postoperatively. One patient initially had granulation tissue forming on the posterior ear canal. This eventually resolved. The patients who had a postoperative audiogram after cholesteatoma resection with ossicular chain preservation noted an improvement or stabilization in their hearing.

Conclusions Using the reversible canal wall down approach in conjunction with bone cement, one is able to obtain excellent exposure of the cholesteatoma and, potentially, preserve the ossicular chain. This approach may be particularly useful in revision cholesteatoma surgery or in cases of acquired cholesteatoma in which the surgeon may be able to preserve the ossicular chain.
Nontraumatic Atlantoaxial Subluxation (Grisel Syndrome): A Rare Complication of Otolaryngological Procedures
Authors: Yu Kathy K. , White David R. , Weissler Mark C. , Pillsbury Harold C.
Published: November 2003

Objective At the conclusion of the report, the readers should be able to recognize the rare complication of adenotonsillectomy of Grisel syndrome, discuss its pathogenesis, and provide early, effective treatment.

Study Design Analysis of the clinical presentation, plain radiographs, computed tomography scans, and magnetic resonance imaging scans of a child with Grisel syndrome after adenotonsillectomy.

Methods Retrospective study of the case record and a review of the literature regarding the pathogenesis, treatment modalities, outcome, and prognosis after early and delayed treatment of Grisel syndrome.

Results Pathophysiology of atlantoaxial subluxation revolves around the periodontoid vascular plexus that drains the posterosuperior pharyngeal region. Infectious and inflammatory emboli cause synovial engorgement, weakening paraspinal ligaments. Radiological studies play an important role in diagnosis. Treatment consists of cervical immobilization, muscle relaxants, analgesics, and antibiotics. Full resolution is expected with early conservative management. Failure to recognize the syndrome can lead to catastrophic results.

Conclusions Recognition of Grisel syndrome in addition to other rare complications of adenotonsillectomy requires a high index of suspicion. Early intervention is the critical factor for a positive outcome. However, delayed diagnosis is common and can result in catastrophic consequences, including neurological deficits, cosmetic deformity and, in rare instances, paralysis and death in the short term.