bluuebunny/crossref_metadata_2025 huggingface dataset:
Reinnervation of the Trapezius Muscle
Authors: Eisele David W. , Hillel Allen D. , Trachy Ronald E. , Little J. W.
Published: November 2015

The eleventh cranial nerve shoulder syndrome, which results from denervation of the trapezius muscle, contributes significantly to the postoperative morbidity of radical neck dissections. Multiple techniques exist for the reinnervation of muscles that have injured motor nerves. Reinnervation of denervated trapezius muscles was examined in the New Zealand white rabbit by use of three techniques of reinnervation: (1) neuromuscular pedicle transfer of the accessory nerve from the trapezius muscle, (2) direct accessory nerve implantation, and (3) neuromuscular pedicle transfer of the accessory nerve from the sternocleidomastoid muscle. The reinnervated trapezius muscles were examined grossly by direct nerve stimulation, electrophysiologically by evoked electromyography, and histologically by enzymatic muscle staining and silver‐reducing nerve staining. The gross, electrophysiologic, and histologic results confirmed successful reinnervation of the trapezius muscle within 6 weeks of operation. No significant difference was observed between the various techniques of reinnervation.
Facial Paralysis: Traumatic Neuromas Vs. Facial Nerve Neoplasms
Authors: Snyderman Carl , May Mark , Berman Michael A. , Curtin Hugh D.
Published: November 2015

Traumatic neuromas (TN) are benign proliferations of neural tissue that may occur without disruption of the facial nerve. The clinical presentation, as well as the radiographic appearance, may suggest neoplastic involvement of the facial nerve. Histologically, they may closely resemble neurilemomas (Schwannomas) or neurofibromas. Three cases of TN of the facial nerve associated with facial paralysis are presented here. Unlike previously reported cases, these tumors were not associated with chronic inflammatory middle ear disease. TN must be considered in the differential diagnosis and treatment of facial paralysis.
Active Head‐Movement Analysis of Cisplatin‐Induced Vestibulotoxicity
Authors: Kitsigianis Geli‐Ann , O'Leary Dennis P. , Davis Linda L.
Published: November 2015

The vestibulo‐ocular reflex (VOR) acts to maintain a clear and stationary image of the visual world during movements of the head. Accurate measurement of the VOR is therefore an important clinical method for evaluation of the vestibular system. We applied a new method of computerized vestibular testing, the Vestibular Autorotation Test (VAT), which is based on 18 seconds of active head movements. The VAT was used to prospectively study the horizontal VOR of nine patients with cancer who were being treated with cisplatin. Patients were instructed to move their heads in the horizontal plane in synchrony with audible clicks of a linearly increasing frequency range, from 0.5 to 6.5 Hz. Electro‐oculographic (EOG) eye movements and head velocity were monitored and digitized to compute horizontal VOR gain and phase from 2 to 6 Hz. Patients were tested with the VAT before the initial cisplatin treatment, and then before each subsequent cisplatin treatment. The pretreatment gains and phases were compared with those obtained after the final cisplatin treatment. Results showed decreased VOR gains at 3.1 Hz, 3.9 Hz, and 5.1 Hz, and increased phase lags at 3.1 Hz and 3.9 Hz. We conclude that VAT analysis of the horizontal VOR at frequencies 3 to 5 Hz is useful for detection and monitoring of cisplatin vestibulotoxicity.
The Effect of Fibrin Tissue Adhesive on the Middle and Inner Ears of Chinchillas
Authors: Wood Arthur P. , Harner Stephen G.
Published: November 2015

The purpose of this study was to examine potential toxic effects of fibrin tissue adhesive to the middle and inner ears. Using the chinchilla as our experimental model, we placed fibrin sealant on either the footplate or the round window membrane in one ear, and placed similar amounts of normal saline in the same area of the opposite ear. In addition, the fibrin adhesive was used to anchor a fascia lata graft for myringoplasty. Both fibrin adhesive and normal saline produced mild reactions in the middle and inner ears when they were placed on the round window membrane; little reaction occurred when fibrin adhesive was placed on the oval window or when it was used for myringoplasty.
Composite Resection Reconstruction: Split‐Thickness Skin Graft—A Preferred Option
Authors: Zieske Larry A. , Johnson Jonas T. , Myers Eugene N. , Schramm Victor L. , Wagner Robin
Published: November 2015

In dealing with reconstruction of the oral cavity postcomposite resection, many options are available. Maximization of function with minimization of complications, physiologic sequelae, and cost must be considered. Fifty consecutive patients who underwent composite resections and were reconstructed by split‐thickness skin grafts were analyzed. Factors examined included: number of blood units transfused, disease status vs. stage, length of hospital stay, complications, use of prosthetic devices for aiding in swallowing and speech production, and patient diet at discharge. This evaluation and literature review revealed that the amount of tissue resection was considered to be the most significant functional determinant, followed by maintenance of residual tissue mobility. The use of a split‐thickness skin graft was believed to give excellent results for the previously mentioned parameters and is our preferred method for reconstruction of composite resection defects that do not require tissue bulk as in anterior mandible defects, anticipated mandible reconstruction, total or near‐total glossectomy, or very massive defects.
Prophylactic Submental Skin Incision after Tight Mucosal Closure in Total Laryngectomy
Authors: Bergman Justin A. , Bleier Howard
Published: November 2015

In this article, we will discuss prophylactic submental skin inclsion‐performed after tight mucosal closure‐in total laryngectomy; we will suggest means of avoiding incisional breakdown and pharyngocutaneous fistula.
A Postoperative Audiometric Evaluation of Cochlear Implant Patients
Authors: Rizer Franklin M. , Arkis Peter N. , Lippy William H. , Schuring Arnold G.
Published: November 2015

As the benefits of the cochlear implantation become more defined, many investigators hope that these devices can be offered to patients with a lesser degree of hearing loss. Accordingly, it is necessary to investigate the audiometric thresholds in the implanted ear after surgery. Preservation of the residual hearing after implantation would support the claims that surgery and the presence of a cochlear implant do not adversely affect the implanted ear.
Surgical Management of Osteoradionecrosis of the Temporal Bone
Authors: Kveton John F.
Published: November 2015

The surgical management of osteoradionecrosis of the temporal bone has met with limited success because of the difficulty in accurate assessment of the viability of nonnecrotic bone intraoperatively. Failure to resect all nonviable bone results in recurrence of a necrotic focus. With the use of hyperbaric oxygen therapy to stabilize marginal bone and oral tetracycyline to label viable bone preoperatively, removal of all nonviable bone can be accomplished. Postoperatively, a second course of hyperbaric therapy enhances wound healing, thus assuring a successful outcome. This article details a successful systematic approach that was developed to resect a necrotic focus In the temporal bone of a 10‐year‐old boy who had undergone a full course of radiotherapy for treatment of a rhabdomyosarcoma.
The Effect of Cochleostomy on the Development of Endolymphatic Hydrops—Morphologic Changes in the Rabbit Cochlea
Authors: Dimitrov E. A. , Duckert L. G. , Lonsbury‐Martin B. L. , Martin G. K.
Published: November 2015

The present study was designed to examine the effects of cochieostomy on the development of endolymphatic hydrops in the rabbit. Fistulization of the cochlear partition and simultaneous obstruction of the endolymphatic duct was performed in one group of animals (n = 13). Rabbits in two other groups underwent either cochleostomy (n = 6) or endolymphatic duct obstruction (n = 6) alone. Animals were terminated at 1‐, 4‐, and 6‐week Intervals and the cochleas were examined with the light microscope to document the presence or absence of hydrops, or were evaluated with the scanning electron microscope to assess sensory‐cell damage. Hydrops was observed In 67% of the animals In the combined duct‐obstruction/cochleostomy group, In 100% of the duct‐obstruction alone group, and In 0% of the cochleostomy alone group. Widespread sensory‐cell degeneration was observed with the scanning electron microscope in the combined and the cochleostomy alone groups.
The Effects of Sinus Bacteria on Human Ciliated Nasal Epithelium in Vitro
Authors: Ferguson Jonathan L. , McCaffrey Thomas V. , Kern Eugene B. , Martin William J.
Published: November 2015

The mechanisms by which bacteria colonize and damage ciliated epithelium are important in understanding the pathophysiology of rhinitis, sinusitis, and otitis. Bacteria that have the ability to impair mucociliary clearance would be at an advantage in establishing infection of ciliated surfaces. This study investigates the effect of Hemophilus Influenzae, Streptococcus pneumoniae, Brahmanella catarralis, and Staphylococcus epidermidis on the ciliary activity of normal ciliated nasal epithelium in human beings. Ciliary activity of the nasal epithelium in the presence of each pathogen was assessed for more than 240 minutes with a photometric method of ciliary beat frequency (CBF) measurement. H. influenzae exerted significant effects on ciliary activity, with a 46% decrease in the CBF by 4 hours (with bacteria‐containing broth) and a 32% decrease with bacteria‐free filtrate. S. epidermidis decreased CBF by 44% with the bacterial broth. A sterile cell‐free filtrate had no significant effect. S. pneumoniae and B. catarralis had no significant effect on CBF within a 240‐minute period. H. influenzae and S. epidermidis disrupted normal synchronous ciliary motion, causing adjacent cilia to beat at different rates.
An Endostomal Tracheostomy Tube for Leakproof Retention of the Blom‐Singer Stomal Valve
Authors: Barton Darlene , DeSanto Lawrence , Pearson Bruce W. , Keith Robert
Published: November 2015

Patients in whom fistula speech has developed after laryngectomy usually have to occlude their stoma with a finger to talk. This prevents the air that is needed to activate the fistula from being exhaled through the stoma. In order to free the hand, Blom and Singer devised a diaphram‐valved stomal device known as the tracheostoma valve. This device snaps into a flexible retention housing that must be carefully cemented to the skin. Some patients who have undergone near‐total laryngectomy (and others with tracheo‐esophageal voice prostheses) are unable to use their devices because the moisture and pressure around their stomas break the seal. Since air that is used to produce voice with the valve tends to lift the housing away from the stoma, a better housing design would assure that this motion would improve the seal.
Head and Neck Squamous Cell Carcinomas Associated with Human Papillomaviruses and an Increased Incidence of Cervical Pathology
Authors: Lee Norris K. , Ritter Diane B. , Gross Abby E. , Myssiorek David J. , Kadish Anna S. , Burk Robert D.
Published: November 2015

Human papillomaviruses (HPVs) have been identified in benign and cancerous epithelial lesions of the femal genital tract. They have also been identified in papillomata and cancers of the upper aerodigestive tract. This study investigates the hypothesis that lesions of the cervicovaginal area are more common in women with cancers of the head and neck region. The presence of HPV in lesions of both regions is examined. Seven female patients with cancer of the upper aerodigestive tract had DNA analysis of their carcinoma specimens. HPV type 16 was found in two of the seven (28%). Fourteen female patients with upper aerodigestive tract cancers had Papanicolaou smears to search for cytologic evidence of HPV infection, and cervicovaginal lavages to analyze DNA from exfoliated cervical cells. Five of thirteen (38%) Papanicolaou smears revealed koilocytotic atypia and three of these patients had HPV DNA types 16 or 18 identified in the cervical lavage. The incidence of cervical atypia noted is 13‐fold greater than average. One patient had HPV type 16 in both her supraglottic cancer and in her cervicovaginal lavage. Evidence of HPV infection at two separate anatomic sites suggests a systemic susceptibility to HPV infection.
Obstructive Sleep Apnea, Continuous Positive Airway Pressure, and Surgery
Authors: Powell Nelson B. , Riley Robert W. , Guilleminault Christian , Murcia German Nino
Published: November 2015

Patients with obstructive sleep apnea (OSA) who have undergone upper airway surgery could be expected to improve if surgery alleviated some or all of the anatomic obstructions, or continue to desaturate at preoperative levels if the surgery was not corrective. Factors such as morbid obesity, general anesthesia recovery, and operative edema can potentially cause desaturations below preoperative levels. Because of this risk, patients with severe OSA have been considered for protective tracheostomy. The findings of our study suggest that selected patients who would have been past candidates for protective tracheostomy while undergoing surgery for severe OSA can, as an alternative, be considered for immediate postoperative use of nasal continuous positive airway pressure (CPAP). Ten surgical patients with severe OSA who elected surgical treatment were successfully treated with CPAP immediately after extubation and postoperatively to assist with airway patency and hemoglobin saturation. Postoperative followup included monitoring of continuous pulse oximetry, cardiac activity, and intermittent arterial blood gases. Preoperatively, all ten patients had marked decrease in oxygen desaturation levels during sleep, with a mean nadir oxygen saturation (SaO2) to 51.5%. after surgery, all patients in this group maintained SaO2 levels to no lower than 90%, with a mean SaO2 level of 93% while using CPAP on room air (FlO2 21%)
Complications of Translabyrinthine Vs. Suboccipital Approach for Acoustic Tumor Surgery
Authors: Mangham Charles A.
Published: November 2015

This study presents the operative results of surgeons with experience in both the translabyrinthine and suboccipital approaches to acoustic tumor removal for the purpose of resolving some of the controversy among centers favoring one approach over the other. The subjects were 171 patients with acoustic tumors who were treated at Virginia Mason Clinic from 1975 to 1986. The translabyrinthine approach was used in 64% of cases, the suboccipital approach in 35%, and the middle fossa approach in 1%. There were minor differences in morbidity and mortality between approaches. These data did not favor one approach over another. In an exploratory analysis, we found that the morbidity with a planned two‐stage translabyrinthine‐suboccipital removal was greater than the morbidity with a one‐stage removal.
Perilymphatic Hypertension
Authors: Paparella Michael M. , Schachern Patricia A. , Goycoolea Marcos V.
Published: November 2015

A syndrome termed perilymphatic hypertension is described as being seen in a small subset of patients with sudden sensorineural hearing loss. A patent or semipatent cochlear aqueduct or modiolus are considered precursors to this condition. Perilymphatic hypertension is believed to predispose to perilymphatic fistula, which may be part of the process of resolution. The pathogenesis for perilymphatic hypertension and fistula are hypothesized and discussed. Treatment for this subset of patients consisted of paracentesis of the round window membrane followed by grafting, with improvement of hearing in certain patients. In no instance did hearing subsequently decrease.
Software for Logging of Surgical Cases
Authors: Burgess Lawrence P.A. , Hessel Craig R.
Published: November 2015

A compiled database program is described to log surgical cases for otolaryngologists. It provides a time‐efficient mechanism to manage a large database and also generates reports in two formats. In the first format, patient demographics, surgeons, and procedures are printed. In the second format, numerical tallies of performed procedures are listed.
Flap Reconstruction Techniques in Conjuncttivorhinostomy
Authors: Arden Richard L. , Mathog Robert H. , Nesi Frank A.
Published: November 2015

Dacryocystorhinostomy is usually the standard approach to treat epiphora caused by lower lacrimal tract obstruction. When the pathologic condition lies in the upper lacrimal passage, however, alternate bypass or reconstructive options must be considered. Conjunctivodacryocystorhinostomy, using the Jones tube, can effectively bypass the upper tract, but the technique may be complicated by granulation tissue formation, infection from unapposed mucosal flaps, and inefficient passage of tears through scar as a result of healing by secondary intention. Canaliculodacryocystorhinostomy affords the advantages of a physiologic reconstruction, but is limited by availability of sufficient canaliculus, requires a lengthy and tedious dissection, and must be performed using a microsurgical approach. We describe an alternate technique of conjunctivorhinostomy that provides total lacrimal bypass and has the advantages of bipedicled mucosal flap apposition, temporary stenting, and symptomatic improvement of epiphora. Several case examples illustrate the indications, advantages, and disadvantages of this technique.
An analysis of the retrolabyrinthine vs. the retrosigmoid vestibular nerve section
Authors: Glasscock Michael E. , Thedinger Britt A. , Cueva Roberto A. , Jackson C. Gary
Published: November 2015

Vestibular neurectomy is gaining widespread acceptance as a primary means of controlling medically refractory vertigo. However, debate continues over the adequacy of vestibular neurectomy within the cerebellopontine angle, long‐term control, and the most appropriate surgical approach. To address these issues, we retrospectively reviewed 118 patients who underwent vestibular neurectomy between October 1984 and January 1988. Forty‐two patients who underwent a retrolabyrinthine approach and 44 patients who underwent a retrosigmoid approach completed a written questionnaire and provided a recent audiogram. According to American Academy of Otolaryngology‐Head and Neck Surgery guidelines, complete or substantial vertigo control was achieved and maintained in 95% of patients in both surgical groups. Hearing, tinnitus, and fullness results over the long term are variable. The advantages and disadvantages of the various vestibular neurectomy approaches will be detailed. On review of our results and surgical experience, we now prefer the retrosigmoid approach.
The “plateau effect” of cis‐platinum‐induced hearing loss
Authors: Myers Steven F. , Blakley Brian W. , Schwan Sabina , Rintelmann William F. , Mathog Robert H.
Published: November 2015

Cis‐platinum‐induced hearing loss has been reported to exhibit a “plateau effect” over the 2 to 8 kHz range. We examined serial audiometry data from 27 patients treated with cis‐platinum. Although a plateau at 60 to 70 dB HL often occurred, this hearing loss was clearly exceeded in a number of patients. We identified 14 patients with sufficient cis‐platinum‐induced sensorineural hearing loss to evaluate a plateau limit to hearing loss over the 4 to 8 kHz range. Half of these 14 patients had hearing losses that exceeded the plateau level. More severe 4 to 8 kHz hearing losses did not correlate with number of treatments, cumulative dosages of cis‐platinum, pre‐existing hearing loss, radiation therapy, other chemotherapeutic agents, or even hearing losses below 4 kHz. Although cis‐platinum therapy can induce a plateau of moderate hearing impairment for some patients over the 4 to 8 kHz range, a significant proportion of patients will experience more severe hearing impairment in this range, even after only one or two courses Of cis‐platinum.
Historical ties between otolaryngology‐head and neck surgery and space medicine
Authors: Alford Bobby R. , Atkins James H.
Published: November 2015

Otolaryngologist‐head and neck surgeons have been involved in the development of aviation and space medicine since the beginning of this century. In the late 1910s, otolaryngologists revised the physical examination for pilots, organized “Boards of Medical Examiners” to test pilot applicants, coined the term “flight surgeon,” and helped organize the Medical Research Laboratories at Hazelhurst Field in New York. These laboratories were transformed into the School of Aviation Medicine at Brooks Field, Texas, which was relocated to Randolph Field, Texas, in 1934. During World War II, the director of research at the school was Colonel Paul A. Campbell, MD, an otolaryngologist. In 1959 the school moved back to Brooks Air Force Base and was renamed the Aerospace Medical Center. In 1962, Dr. Campbell served as the director. Since manned space flight began in the 1960s, there have been many joint research efforts between principal investigators in otolaryngology‐head and neck surgery and NASA. Currently, many otolaryngologist‐head and neck surgeons serve as consultants and advisors to many of NASA's standing committees. The space environment offers a new frontier for specialty development and research in otolaryngology‐head and neck surgery.
A modified neoglottis procedure: Update and analysis
Authors: Brandenburg James H. , Cragle Stephen P. , Rammage Linda A.
Published: November 2015

In recent years, various techniques have been introduced for construction of an epithelium‐lined shunt between the trachea and the esophagus or hypopharynx. We described a rigid neoglottis in a prelimlinary report of 12 cases in which the upper tracheal rings were used to construct the epithelium‐lined tract. This study reports the cases of 22 additional patients and offers an in‐depth analysis of additional demographics, complications, and long‐term speech results that quantify the vocal characteristics of neoglottic speakers. Results indicate rapid postoperative speech rehabilitation in nearly all patients, good long‐term speech results (mean followup, 52 months), and low morbidity. There was a low incidence of local recurrence and stenosis, and 26 of 34 patients had either no aspiration or occasional asymptomatic aspiration of small amounts of liquid. This modified neoglottis procedure should be considered for patients who need voice restoration after laryngectomy.
Comparison of computerized tomography and magnetic resonance imaging for the postoperative assessment of residual acoustic tumor
Authors: Cass Stephen P. , Kartush Jack M. , Wilner Harvey I. , Graham Malcolm D.
Published: November 2015

Ten patients with surgically confirmed residual cerebellopontine angle neuromas, imaged by both computerized tomography (CT) with iodine contrast and magnetic resonance (MR) with and without gadolinium enhancement, are reviewed to identify the strengths and limitations of MR as compared with CT imaging. MR imaging offers superior anatomic resolution in multiple imaging planes without ionizing radiation, but it is expensive and has adverse effects on some patients. CT imaging offers good anatomic resolution, but in only one or two planes. CT is both less expensive and generally well tolerated, but allergy to the iodine contrast is not uncommon. The cases presented demonstrate the adequacy of CT imaging of residual tumor. However, in some cases MR imaging provided important additional detail. MR imaging also demonstrated postoperative changes within the brain stem and cerebellum. In our experience, CT imaging remains a satisfactory, unambiguous approach to the assessment of known postoperative residual cerebellopontine angle neuromas. MR imaging provides superior resolution, however, and should be used when better definition of tumor detail is needed for management decisions or when multiple follow‐up scans are anticipated, so that the exposure to ionizing radiation is limited. MR is also useful to investigate postoperative neurologic dysfunction. Postoperative changes and residual tumors are more difficult to interpret on MR than on CT. Guidelines are proposed to help distinguish residual tumor from postoperative changes and scarring.
Internal maxillary artery variability in the pterygopalatine fossa
Authors: Morton Anthony L. , Khan Anjum
Published: November 2015

The third segment or pterygopalatine branch of the internal maxillary artery has variable branching in the pterygopalatine fossa. This variability in branching can lead to failure in controlling persistent nasal epistaxis by transantral ligation. Although the surgical approach has been previously studied, a systematic classification of this branching has not been previously reported. Through the performance of serial cadaver dissections in the PPF, we have demonstrated the anatomic course and variations of this third segment and offer a relatively simple classification system.
Protective effect of electrical stimulation in the deafened guinea pig cochlea
Authors: Hartshorn Duane O. , Miller Josef M. , Altschuler Richard A.
Published: November 2015

The effect of chronic intrascalar electrical stimulation on the spiral ganglion cell survival of the ototoxically deafened guinea pig was investigated. Immediately after ototoxic drug administration, unilateral sinusoidal (1 kHz) charge‐balanced electrical stimulation on a 50% duty cycle was administered for 2 hours per day, 5 days per week, at intensities from 0 (control) to 400 μAmp via an implanted scala tympani electrode. The relationship of electrically evoked middle latency response (EMLR) to stimulation protocol and cell survival was studied. At 9 weeks post‐drug treatment, the animals were killed and temporal bones were prepared for morphometric analysis of spiral ganglion cell density. The subjects showed essentially complete elimination of outer hair sensory cells, with minimal remaining inner hair cells confined to apical turns. Variable loss of spiral ganglion cell populations was observed, which related to electrical stimulation. In animals that received daily unilaterally electrical stimulation, statistically significant increases in survival of spiral ganglion cells were observed in the stimulated ear, compared to the nonstimulated ear—particularly in basal cochlear regions near the electrode. Spiral ganglion cell density was a function of stimulation current intensity level. Moreover, the slope of the amplitude input/output (I/O) function of the EMLR was found to be dependent on stimulating current level. The effect of stimulation on induced survival may be dependent on a number of mechanisms, including metabolic effects of direct activation of “deafferented” spiral ganglion cells. These data support the suggestion that implantation may provide optimal benefits when performed shortly after deafness.
Is Melanoma Changing?
Authors: Conley John
Published: November 2015

Nine hundred ninety‐five cases of melanoma of the head and neck were divided into two groups so that certain comparisons could be made concerning the behavior of melanoma over a 55‐year period. One hundred twelve melanomas of the occular system were excluded from this review. The first group consisted of 660 melanomas seen during a period from 1932 to 1972. The second group consisted of 223 melanomas seen during a period from 1973 to 1987. Thirteen parameters, including sex, age, distribution, pre‐existing mole, amelanotic melanoma, delay in diagnosis, classification, levels, local recurrence, regional metastasis, systemic metastasis, morbidity, and survival, were studied to assess the behavior and the variations. There is no question that the most important aspect of the favorable changes that have occurred are because of earlier diagnosis and better management by a larger group of well‐trained specialists. There are some subtler changes that could possibly indicate biologic alterations, but this requires more time and study to substantiate.
Growth and histopathology of human head and neck squamous cell carcinoma implanted intraorally in nude mice
Authors: Sales Elizabeth W. , Fitch Kathleen A. , Sudetic Pamela A. , Schechter Gary L. , Faulconer Robert J. , Somers Kenneth D.
Published: November 2015

A human squamous cell carcinoma (SCC) from the floor of the mouth (FOM) was implanted by a needle aspiration technique in the FOM site of athymic nude mice. Mice were killed at 3‐week intervals, and the oral cavity, mandible, and neck were sectioned and examined histologically. Tumor growth was observed in 65% of the animals, with histologic features consistent with the engrafted human invasive SCC. These features included invasion of connective tissue in 92%, invasion of muscle in 77%, invasion and destruction of bone in 54%, and vascular invasion in 15% of the mice. In contrast, FOM tumor implanted subcutaneously on back sites of nude mice was totally encapsulated by fibrous connective tissue with evidence of capsular invasion. SCC from other head and neck sites showed similar locally invasive growth after intraoral implantation in nude mice. The results demonstrate the invasive characteristics of human head and neck SCC grown in the homologous oral cavity site in nude mice and support the nude mouse as a biologically relevant in vivo model in the investigation of the biologic characteristics and therapy of head and neck carcinoma.
The use of fine‐needle aspiration in the diagnosis of metastatic pulmonary adenoid cystic carcinoma
Authors: Pitman Martha Bishop , Sherman Mark E. , Black‐Schaffer W. Stephen
Published: November 2015

Nine patients with a history of adenoid cystic carcinoma (ACC) arising in the head and neck and in whom transthoracic fine‐needle aspiration (FNA) was performed to investigate pulmonary lesions are described. FNA yielded a definitive diagnosis of metastatic ACC in all cases. In six of the nine patients, the pulmonary metastases were asymptomatic. Lung lesions were discovered up to 19 years after primary tumor presentation, and in two, pulmonary spread was the only evidence of recurrent disease. On the basis of the FNA diagnosis, these two patients were treated surgically for their isolated pulmonary metastases, and are disease free at 107 and 139 months. Six of the nine patients received radiation or chemotherapy; one initially refused treatment. Thoracotomy was avoided in these patients on the basis of the FNA diagnosis. All are alive with disease at 25 to 246 months. The metastatic tumors were indistinguishable cytologically from two primary pulmonary ACCs that were available for comparison. Our experience suggests FNA is a useful tool in the diagnosis of ACC in pulmonary material—one which obviates the need for thoracotomy with its associated morbidity.
Endoscopic surgery for lacrimal obstruction
Authors: Metson Ralph
Published: November 2015

Intranasal access to the lacrimal drainage system has been greatly enhanced with the advent of endoscopic nasal surgery. This technique has been used for the treatment of recurrent lacrimal obstruction after failed external dacryocystorhinostomy (DCR) in 12 patients. Improved intranasal visualization with the endoscope allowed easy identification and opening of the lacrimal sac, with no need for a skin incision. Obstructing intranasal pathology, including adhesions from previous DCR, an enlarged middle turbinate, and ethmoid sinus disease, was readily identified and corrected. There were no intraoperative complications. Lacrimal obstruction was completely relieved in nine of 12 patients (75%), with a followup of 7 to 25 months. Endoscopic revision DCR should be considered in patients with recurrent epiphora after external DCR.
Quest for the aberrant vessel
Authors: Milczuk Henry A. , Flint Paul W. , Eskridge Joseph M. , Cummings Charles W.
Published: November 2015

In most cases of posterior epistaxis, the terminal branches of the internal maxillary artery (IMA)—principally the sphenopalatine artery—are believed to be the source of hemorrhage. However, we recently treated three patients in which unexpected or aberrant vascular anatomy resulted in persistent posterior epistaxis.
Effect of glycerol and mannitol on perilymphatic PO2 in guinea pig cochlea
Authors: Yoshida Masafumi , Uemura Takuya
Published: November 2015

The effects of glycerol and mannitol on partial oxygen pressure (PO2) in perilymph were studied with a polarographic technique in the guinea pig cochlea. Following a transient reduction immediately after the intravenous injection of each drug, the oxygen tension increased to reach a peak 5 to 10 minutes later, and then decreased gradually. The magnitude and duration of the PO2 increases were larger after the administration of glycerol than after that of mannitol. These results corresponded well with the clinical experience that glycerol was more effective than mannitol in improving hearing in Meniere's disease. The increase of PO2 in the cochlea, therefore, is considered to be one of the possible contributory factors for the improvement of hearing in patients with Meniere's disease after glycerol administration.
Prediction of bithermal caloric response from monothermal stimulation
Authors: Keith Robert W. , Pensak Myles L. , Katbamna Bharti
Published: November 2015

The use of either cold or warm caloric stimulation alone as a screening tool for unilateral weakness has been suggested as a means of both shortening testing time and reducing patient discomfort. The validity of the monothermal caloric test must be well established before it can be routinely used in clinical situations. The purpose of this investigation was to re‐evaluate the monothermal caloric test by examining the correlations between unilateral weakness derived from bithermal caloric stimulation compared to monothermal caloric results using either warm or cool stimulation alone. A retrospective analysis of 200 patients indicated significant correlations between bithermal and monothermal unilateral weakness for patients with unilateral weakness of <15% and >30% for both warm and cool water stimulation. For patients with 15% to 30% unilateral weakness, the bithermal and monothermal calorics were significantly correlated for only the cool condition. When predicting normal or >20% unilateral weakness, either of the monothermal calorics have >85% efficiency, with specificity >94% and sensitivity >64%. However, the false‐negative rate is 29% for warm and 36% for cool calorics. The high rate of false‐negative findings indicates that screening tests have no place in a diagnostic battery, especially in view of the implications for missing significant pathology.
Perilymphatic fistula: Analysis of free amino acids in middle ear microaspirates
Authors: Woodson B. Tucker , Fujita Shiro , Mawhinney Thomas P. , Schweitzer Vanessa G. , Peterson Edward L.
Published: November 2015

High‐performance liquid chromatography was used to determine 19 free amino acid concentrations in perilympyh, serum/plasma, and red blood cell intracellular fluid. Significant differences were found between perilymph and these fluids. Free amino acid analysis was then used to quantitatively analyze middle ear microaspirates in order to test the hypothesis that perilymph is a potential source of clear fluid in perilymphatic fistulas (PLF). Fourteen unknown samples from patients with visually identified PLF, including patients with no identifiable otic capsule defect, were studied. Six samples on amino acid pattern analysis were correlated most similarly with perilymph (rrho> 0.95). Four of these six samples were scored on the basis of quantitative amino acid values as similar to perilymph. However, three samples of clear fluid were more similar to serum/plasma than to perilymph on both amino acid pattern and quantitative amino acid score analysis. These results objectively suggest perilymph as a potential source of clear fluid in some patients with a diagnosis of PLF. Not all clear fluid observed In the middle ear, however, is potentially perilymph.
Epiglottic laryngoplasty after hemilaryngectomy for glottic cancer
Authors: Nong Huitu , Mo Wei , Huang Guangwu , Chen Ling , Guo Yangchun
Published: November 2015

Epiglottic laryngoplasty is technically feasible as a one‐stage procedure with excellent functional results. Although the Kambič‐Sedlaček‐Tucker (K‐S‐T) technique of glottic reconstruction offers early extubation with an adequate airway, a subsequent wide neoglottis may increase the chance of aspiration and a poor voice. To better restore the laryngeal functions of closure and phonation, we made some modifications on the original K‐S‐T technique as follows: (1) One of the lateral margins of the epiglottis with the aryepiglottic fold is sutured to the arytenoid region of the cricoid rather than a thyroid cartilage remnant. A neo‐arytenoid is formed. (2) The other lateral margin of the epiglottis with the aryepiglottic fold is sutured to the cut edge of the false and true cord instead of a thyroid ala remnant. Therefore both margins of the epiglottis with the aryepiglottic folds are lowered as much as possible to the level of the glottis. A new pseudocord is formed. (3) A cartilage cut is made at the anterior aspect of the epiglottis, leaving its laryngeal surface of mucoperichondrial intact. A new anterior commissure with a sharp angle is shaped by this maneuver. Nineteen hemilaryngectomies with modified epiglottic laryngoplasty have been performed by members of the Department of Otolaryngology of Guangxi Medical College since 1984. Results in this series are fairly good and indicate that the modified epiglottic laryngoplasty is effective in enhancing functional results in terms of respiration, deglutition, and phonation.
Facial nerve monitoring in acoustic tumor surgery
Authors: Kwartler Jed A. , Luxford William M. , Atkins James , Shelton Clough
Published: November 2015

Anatomic and functional preservation of the facial nerve during acoustic tumor surgery remains a primary goal. Intraoperative electromyographic facial nerve monitoring with auditory feedback has enabled the surgeon to more readily achieve this goal. We compared a group of monitored translabyrinthine acoustic tumor removals (N = 89) to a similar unmonltored group (N = 155) in regard to facial nerve function. Function was assessed immediately postoperatively, at time of discharge, and at 1 year postoperatively using the House six‐point scale. Results were grouped as satisfactory, intermediate, or poor and were analyzed by tumor size. Facial nerve results were better at all time intervals in the monitored groups, although the difference was not statistically significant at the 1‐year interval. There was no difference between monitored and unmonitored patients in the subgroups with tumors smaller than 2.5 cm in diameter. This study supports the usefulness of intraoperative facial nerve monitoring in improving facial nerve results, particularly in larger tumors.
Radiotherapy of advanced laryngeal cancer using three small fractions daily
Authors: Bradley Patrick J. , Morgan David A.L.
Published: November 2015

Since 1983, we have treated advanced (UICC stages 111 and IV) squamous carcinomas of the larynx by primary radiotherapy, using three small fractions a day, 3‐4h interfraction interval, 5 days per week. The early patients received doses per fraction of 1.5 Gy, and a total dose of approximately 70 Gy, given as a split‐course over 6 to 7 weeks. While overall tumor control and laryngeal preservation was good, a number of severe late radiation reactions were seen. The schedule was then modified, with a reduction in the fraction size to 1.1 Gy, the total dose to 60 Gy, and the overall time to 4 weeks, with omission of the mid‐treatment “split.” Since 1986, we have treated 26 patients in this way. Acute reactions are brisk, but rapidly healing. loco‐regional control was achieved in 22 patients, only one of whom has relapsed to date, in a solitary node, salvaged by radical neck dissection. Four have died of uncontrolled loco‐regional malignancy, and three of intercurrent disease while in clinical remission. No serious late morbidity has been observed in surviving patients, and vocal quality is good in the majority. These results suggest that this hyperfractionated and accelerated radiotherapy schedule may offer an acceptable nonsurgical, voice‐preserving treatment for advanced laryngeal carcinoma; it can be used in a normally working radiotherapy department.
Successful treatment of selected cases of abductor spasmodic dysphonia using botulinum toxin injection
Authors: Ludlow Christy L. , Naunton Ralph F. , Terada Sumiko , Anderson Barbara Jean
Published: November 2015

Ten patients with abductor spasmodic dysphonia, who exhibited spasmodic bursts and heightened activity of the cricothyroid muscle during speech, were selected for participation. Between 5 and 20 U of botulinum toxin type A were injected into both right and left cricothyroid muscles. Six patients benefited substantially, whereas four did not. Acoustic analyses of voice patterns showed similar changes to the clinical impressions. Significant group improvements were found in sentence duration while selected patients improved in the proportion of their speech that was voiced and the duration of their voiceless consonants. Those patients with abductor spasmodic dysphonia and other muscle abnormalities in addition to the cricothyroid and with constant breathiness did not benefit.
Hydrocephalus in the Patient with Acoustic Neuroma
Authors: Steenerson Ronald L. , Payne Nettleton
Published: November 2015

Hydrocephalus can occur in conjunction with large acoustic neuromas. Cerebral tentorial herniation and brainstem compression can be a complication of surgical excision. Three cases of hydrocephalus and acoustic neuroma are presented and therapeutic options are discussed. Ventriculoperitoneal shunting 1 to 2 weeks before translabyrinthine or suboccipital excision of acoustic neuroma is recommended.
Completion Thyroidectomy in the Management of Well‐Differentiated Thyroid Carcinoma
Authors: Wax Mark K. , Briant T. David R.
Published: November 2015

Completion thyroidectomy is the removal of any thyroid tissue that remains after less than total thyroidectomy. At our center, completion thyroidectomy is used when, on permanent sectioning, a frozen section diagnosis is revised from benign to malignant. We reviewed our experience with completion thyroidectomy to examine its indications and complications. We found that the carcinoma was misdiagnosed in 32 of 244 (13%) of cases. Twenty‐five of these were initially designated follicular adenomas. The completion proved to be no more technically difficult than a routine hemithyroidectomy. There was one case of permanent hypoparathyroidism (3%). Transient vocal cord palsy occurred in one patient (3%) and transient hypocalcemia occured in five patients (15%). Complete recovery occurred in all six of these patients. Focal areas of residual carcinoma were found in 8 of 32 (25%) of glands removed at completion. We found completion thyroidectomy to be a safe procedure with minimal morbidity. We recommend its use in those instances of well‐differentiated thyroid carcinoma in which the frozen section diagnosis differs from the permanent section.
Pseudomonas Otitis Media after Eustachian Tube Obstruction
Authors: Antonelli Patrick J. , Juhn Steven K. , Goycoolea Marcos V. , Giebink G. Scott
Published: November 2015

Previous experiments have shown that Pseudomonas aeruginosa may infect the middle ears of chinchillas by way of the eustachian tube and that chinchillas with acute otitis media (AOM) are more susceptible to pseudomonas infection than animals without AOM. The purpose of this experiment was to examine the effects of otitis media with effusion (OME), induced by means of eustachian tube obstruction, on middle ear susceptibility to nasal inoculation of P. aeruginosa. Chinchilla eustachian tubes were obstructed with silicone rubber sponge bilaterally; OME developed in eight animals (11 ears)—three bilaterally and five unilaterally—and persisted for 6 months. Ten chinchillas with normal eustachian tube function served as controls. All animals were nasally inoculated with 5 times 104 colony‐forming units of P. aeruginosa. Pseudomonas otitis media developed in eight of 11 OME ears with effusion, none of five ears without OME, and four of 20 control ears (X2 = 11.782, p = 0.003). Therefore, P. aeruginosa can infect the middle ear by way of the eustachian tube. Tubal dysfunction may lead to the development of chronic suppurative otitis media by increasing tubotympanic susceptibility to opportunistic pathogens.
Effect of Asymmetric Vocal Fold Stiffness on Traveling Wave Velocity in the Canine Larynx
Authors: Sloan Steven H. , Berke Gerald S. , Gerratt Bruce R.
Published: November 2015

The vocal fold (VF) traveling wave is essential to normal voice production. The present investigation describes a new method to determine traveling wave velocity (TWV) in the in vivo canine phonatory model. This method synchronizes photoglottographic and electroglottographic waveforms with videostroboscopic images to determine the duration of time the traveling wave moves between two tattoos placed a known distance apart between the upper and lower margins of each VF. Using this method, we compared the TWV of a paralyzed VF with the TWV of the contralateral, electrically stimulated VF during phonation in two canines. In addition, the presumed VF stiffness asymmetry in the simulated acute recurrent laryngeal nerve paralysis state was confirmed by measuring Young's modulus of each VF. The results indicated that the TWV of the paralyzed VF averaged 55% of the TWV of the normal, stiffer VF when the glottal gap was small and entrainment occurred. This study demonstrated the feasibility of quantifying traveling wave motion in asymmetric VF stiffness disorders. The potential use of TWV in human beings as a target to optimize the phonosurgical results in asymmetric VF stiffness disorders is discussed.
Preconditioning: A New Technique for Improved Muscle Flap Survival
Authors: Mounsey Robert A. , Pang Cho Y. , Forrest Chris
Published: November 2015

Musculocutaneous regional and distal flaps have become an important tool available to the head and neck surgeon. Vascularized autogenous muscle transplants allow single‐stage reconstruction of complex defects. Ischemic muscle necrosis is a well‐recognized complication with serious potential morbidity. It has been shown that myocardial muscle is protected from ischemic damage by brief periods of coronary artery occlusion and reperfusion subsequent to prolonged ischemia. This is called preconditioning. To our knowledge, this technique has never been extrapolated to skeletal muscle. This article presents a discussion of preconditioning and the potential benefits of this new technique as a means to enhance skeletal muscle survival to sustained normothermic global ischemia. Theories behind ischemic muscle injury are presented. A review of the development of preconditioning in myocardial muscle is discussed. Experimental models used to investigate this phenomenon are also presented. In addition, results of our laboratory investigations using the latissimus dorsi porcine model are discussed. Preconditioning is a new, nonpharmacologic means to improve muscle flap survival. This simple technique may have great clinical application in reducing ischemic muscle necrosis in regional and distal muscle transplantation.