bluuebunny/crossref_metadata_2025 huggingface dataset:
Patterns of Facial Nerve Synkinesis
Authors: Moran C. John , Neely J. Gail
Published: November 2003

Facial nerve synkinesis is an extremely distressing sequela of facial paralysis, and its prevention and treatment are less than adequate. Improved therapeutic interventions await better understanding of its pathogenesis.

In this study, 11 patients with synkinesis and 11 normal control subjects were quantitatively assessed using a new computer‐assisted, motion‐sensitive system. Two additional, informative cases presenting at the completion of the study are also briefly reported.

The observed synkinetic patterns appear predictable and nonrandom. In addition, these observations tend to raise doubts that the aberrant fiber regeneration hypothesis is the sole explanation of synkinesis. They further implicate facial nuclear hyperexcitability as an explanation in at least some cases of synkinesis.

Understanding these patterns enhances clinical detection and evaluation and may lead to a better knowledge of the fundamental pathophysiology of synkinesis and its prevention.
Acid‐Induced Laryngospasm in a Canine Model
Authors: Loughlin Christopher J. , Koufman James A. , Averill David B. , Cummins Michelle M. , Kim Yong‐Jae , Little John P. , Miller Inglis J. , Meredith J. Wayne
Published: November 2003

A canine model was used to investigate the efferent laryngeal responses to stimulation by topically applied acid and pepsin. Five adult mongrel dogs were studied. Electromyographic recordings from the thyroarytenoid muscle were measured with hooked‐wire electrodes as an acid solution (normal saline/hydrochloric acid at pH 6.0, 5.0, 4.0, 3.0, 2.5, 2.0, 1.5, and 1.0) was sequentially instilled into the larynx. Laryngospasm (tonic, sustained contraction of the thyroarytenoid muscle) occurred in all animals at pH 2.5 to 2.0 or less. Control substances such as neutral pH isotonic saline, hypotonic saline, hypertonic saline, water, and pepsin alone failed to produce laryngospasm. Next, solutions containing both acid (in the same pH range) and pepsin were tested. The laryngeal responses were similar to those of acid alone. The superior laryngeal nerves were sectioned bilaterally and the above experiments repeated. None of the test solutions produced laryngospasm; however, when capsaicin (1%) was instilled into the subglottis, laryngospasm occurred. Thus, chemoreceptors in the subglottis (supplied by the recurrent laryngeal nerves) appear to be responsive to capsaicin stimulation but not to acid stimulation. The data suggest that pH‐sensitive chemoreceptors in the canine larynx cause laryngospasm (when the pH of the test solution is 2.5 or less) and that these acid receptors are supplied by the superior laryngeal nerves.
Cricoarytenoid Joint Mobility After Chronic Vocal Cord Paralysis
Authors: Gacek Mark , Gacek Richard R.
Published: November 2003

Eleven whole organ laryngeal specimens (10 human and 1 dog) with a history of long‐standing (6 months to 17 years) paralysis were studied histopathologically for changes in the cricoarytenoid (CA) joints and the intrinsic laryngeal musculature. In 9 cases the paralysis was unilateral and in 2 bilateral. No evidence of CA joint ankylosis (fibrous/osseous obliteration of joint space or degeneration of articular surfaces) was seen in the specimens. The absence of CA joint ankylosis permits the efficacy of thyroplasty medialization procedures.
Auricular Reconstruction of Congenital Microtia (Grade III)
Authors: Aguilar E. Fred
Published: November 2003

The auricular deformity of congenital microtia (Grade III) is almost always associated with congenital atresia, an affliction that can cause devastating physical and psychological trauma in children. Auricular reconstruction for congenital microtia (Grade III) should provide a child with a reasonable facsimile of an ear through a limited number of surgical procedures, with minimum complications.

To achieve this result, the author developed the Integrated Auricular Reconstruction Protocol (IARP). The IARP consists of five stages: Stage I‐framework construction and placement; Stage II‐lobule creation; Stage III‐atresia repair; Stage IV‐tragal creation; and Stage V‐auricular elevation. Over a period of 5.5 years, the author performed 188 surgical procedures on 63 patients, completing 31 ears.

This thesis has four objectives. The first is to strongly recommend that a child with congenital microtia and atresia be seen as early as possible by both a plastic surgeon and an otologist. The second objective is to describe a protocol by which both defects can be corrected without endangering the integrity of either. The third objective is to advocate the involvement, from the very beginning, of not only the child but also the family‐a critical but often overlooked component of the treatment of congenital microtia and atresia. The fourth and final objective is to propose that plastic surgeons interested in auricular reconstruction dedicate themselves to the performance of at least 10 such reconstructions per year.
Virtual Endoscopy of the Paranasal Sinuses Using Perspective Volume Rendered Helical Sinus Computed Tomography
Authors: Gilani Sapideh , Norbash Alexander M. , Ringl Helmut , Rubin Geoffrey D. , Napel Sandy , Terris David J.
Published: November 2003

Our goal was to use three‐dimensional information obtained from helical computed tomographic (CT) data to explore and evaluate the nasal cavity, nasopharynx, and paranasal sinuses by simulated virtual endoscopy (VE). This was done by utilizing a new image reconstruction method known as perspective volume rendering (PVR). Thin‐section helical CT of the nasal cavity, nasopharynx, and paranasal sinuses was performed on a conventional CT scanner. The data were transferred to a workstation to create views similar to those seen with endoscopy. Additional views not normally accessible by conventional endoscopy were generated. Key perspectives were selected, and a video “flight” model was choreographed and synthesized through the nasal cavity and sinuses based on the CT data.

VE allows evaluation of the nasal cavity, nasopharynx, and paranasal sinuses with appreciation of the relationships of these spatially complex structures. In addition, this technique allows structural visualization with unconventional angles, perspectives, and locations not conventionally accessible. Although biopsies, cultures, and lavages routinely done with endoscopy cannot be performed with VE, this technique holds promise for improving the diagnostic evaluation of the nasal cavity, the nasopharynx, and the paranasal sinuses. The unconventional visual perspectives and very low morbidity may complement many applications of simple diagnostic endoscopy.
Particulate Matter in the Posterior Semicircular Canal
Authors: Welling D. Bradley , Parnes Lorne S. , O'Brien Blaize , Bakaletz Lauren O. , Brackmann Derald E. , Hinojosa Raul
Published: November 2003

The pathoetiology of benign paroxysmal positional vertigo (BPPV) is controversial. Particulate matter within the posterior semicircular canal has been identified intraoperatively in patients with BPPV but has also been reported in non‐BPPV patients at the time of translabyrinthine surgery (Parnes LS, McClure JA. Free‐floating endolymphatic particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope 1992;102:988‐92; Schuknecht HF, Ruby RRF. Cupulolithiasis. Adv Otorhinolaryngol 1973;20:434‐43; Kveton JF, Kashgarian M. Particulate matter within the membranous labyrinth: pathologic or normal? Am J Otol 1994;15:173‐6). The nature of the particulate matter remains unknown.

The purpose of this study was to prospectively examine the posterior semicircular canal of patients with and without a clinical history of BPPV for the presence of particulate matter. Seventy‐three patients without BPPV symptoms undergoing labyrinthine surgery (vestibular schwannoma excision or labyrinthectomy) and 26 patients with BPPV undergoing the posterior semicircular canal occlusion procedure were compared. Additionally, 70 archived temporal bones without a history of BPPV were examined microscopically for the presence of particulate matter within the lumen of the membranous labyrinth.

No particles were observed intraoperatively in any of the 73 patients without a history of BPPV. Particulate matter was observed in 8 of 26 patients at the time of the posterior semicircular canal occlusion procedure for intractable BPPV.

Of the 70 temporal bones examined, 31 did not show significant postmortem changes and also did not demonstrate cupulolithiasis or canalithiasis.

Particulate matter from within the membranous posterior semicircular canal was removed from one patient at the time of posterior semicircular canal occlusion for intractable BPPV symptoms and was examined by scanning electron microscopy. The particulate matter appeared morphologically consistent with degenerating otoconia.

These data show a statistically significant association between the presence of particles within the posterior semicircular canal in this study and the symptom complex of BPPV.
Liquid Household Bleach Ingestion in Children: A Retrospective Review
Authors: Harley Earl H. , Collins Millicent D.
Published: November 2003

Current literature and some standard reference textbooks fail to adequately delineate the management of liquid household bleach (sodium hypochlorite) as different from other caustic agents. A literature review and retrospective study were conducted to focus attention on the clinical course and the low potential for development of long‐term sequelae secondary to liquid household bleach ingestion in children. The records of 19 patients were reviewed. The mean age of children ingesting bleach was 24 months. Most children obtained the liquid from an open container such as a cup. There were no short‐ or long‐term sequelae.

We introduce an algorithm for the management of accidental ingestion of liquid household bleach in children. We conclude that in the United States accidental bleach ingestion in children is usually associated with a benign clinical course and usually does not require hospitalization, corticosteroids, or antibiotics unless there is severe dysphagia or signs of significant injury. Esophagoscopy may not be necessary, but fiberoptic examination of the pharynx and larynx should be included in the assessment of these children.
Intraotic Administration of Gentamicin: A New Method to Study Ototoxicity in the Crista Ampullaris of the Bullfrog
Authors: Carranza Angelica , Lopez Ivan , Castellano Philip , Hoffman Larry , Honrubia Vincente
Published: November 2003

A new method of local gentamicin administration was tested in the bullfrog inner ear to achieve ototoxic‐induced hair cell destruction. Gelfoam pledgets soaked with known amounts of gentamicin were inserted into the perilymphatic cisterna of the bullfrog through a ventral surgical approach. A dose of 1.20 mg gentamicin, consistent with a perilymphatic concentration of 65 μg/ml, resulted in the desired ototoxic‐induced hair cell damage, that is, complete hair cell destruction with minimal disruption of other components of the sensory epithelium. This study demonstrates that this is a useful and simple method to investigate the process of vestibular ototoxicity and hair cell regeneration, including aspects of hair cell destruction and repair.
Autologous Fat Injection into the Vocal Folds: Technical Considerations and Long‐Term Follow‐up
Authors: Shaw Gary Y. , Szewczyk Mark A. , Searle Jeff , Woodroof Janet
Published: November 2003

Numerous materials have been used over the years for vocal fold augmentation. Early use of bioreactive compounds, such as paraffin, gave way to relatively inert substances, such as Teflon. More recently biocompatible materials, such as collagen and autologous fat, have gained wider acceptance. Autologous fat, in particular, is an easily obtainable source for potential rehabilitation of scarred, paralytic, and atrophic vocal folds. However, long‐term systematic follow‐up has been lacking. Since 1991 we at the University of Kansas Center for Voice and Swallowing Disorders have employed autologous fat for vocal fold augmentation, primarily for either paralysis or repair of a volume‐deficient vocal fold segment. Twenty‐two patients have completed ≥1 year of follow‐up studies, including graded videolaryngostroboscopy, electroglottography, computerized acoustic analysis, and blinded perceptual analysis by two speech‐language pathologists. Statistically significant improvement was demonstrated in many parameters tested, frequently improving with time. Although the volume‐deficient group had more “normal” values, the paralysis group had greater improvement in many variables using fat injection. We conclude that while autologous fat injections of the vocal fold may have long‐term benefits, certain technical considerations and criteria of selection of patients are critical for success.
Localization of Inducible Heat Shock Protein mRNA in the Guinea Pig Cochlea with a Nonradioactive In Situ Hybridization Technique
Authors: Gower Verlia C. , Thompson Ann M.
Published: November 2003

Cell types of the guinea pig cochlea that contain mRNA of the inducible heat shock protein (HSP72) were determined with an in situ hybridization technique, using a biotinylated oligonucleotide probe. Staining was present in the spiral limbus, spiral prominence, stria vascularis, and organ of Corti (supporting, pillar, outer hair, and interdental cells). In sections digested with pepsin, only spiral ganglion cells stained. The pattern of staining was similar in normal and heat‐stressed animals. Therefore, HSP72 mRNA is present in many guinea pig cochlear cell types, some of which have not previously been shown to contain HSP72 protein. Differences in HSP72 mRNA and protein staining may be attributable to stress or processing techniques, but they may also suggest mechanisms unique to guinea pigs and primates, who normally express the inducible form of HSP.
In Situ Hybridization for Aspergillus and Penicillium in Allergic Fungal Sinusitis: A Rapid Means of Speciating Fungal Pathogens in Tissues
Authors: Perez‐Jaffe Liza A. , Lanza Donald C. , Loevner Laurie A. , Kennedy David W. , Montone Kathleen T.
Published: November 2003

Allergic fungal sinusitis (AFS) is a serious form of sinonasal fungal disease that is commonly associated with Aspergillus or Dematiaceous fungi. This study was performed to determine the incidence ofAspergillus or Penicillium in AFS by using in situ hybridization (ISH) for Aspergillus and Penicillium ribosomal RNA (rRNA). The Fontana‐Masson melanin stain (FMMS) was also used to detect pigmented fungi (A. niger and Dematiaceous fungi). ISH was performed on 26 patients: 17 AFS cases with histologic evidence of fungi, 5 AFS cases without histologic evidence of fungi, 3 cases of invasive fungal sinusitis (IFS), and 1 case of fungus ball. Nine AFS specimens with histologic evidence of fungi were ISH positive. Positivity was also noted in two of three IFS cases, while no staining was seen in the fungus ball and in six AFS specimens without fungi demonstrable by silver stains. Six ISH‐positive cases were FMMS positive, suggestingA. niger. Five ISH‐negative AFS specimens were FMMS positive, suggesting Dematiaceous fungi. In summary, many AFS patients in our institution demonstrate Aspergillus/Penicillium organisms. Ancillary techniques may help identify fungi responsible for AFS if cultures are negative or not performed. ISH for rRNA is a useful means for rapidly speciating fungi in human tissues.
Endoscopic CO2 Laser Excision of Large or Recurrent Laryngeal Saccular Cysts in Adults
Authors: Hogikyan Norman D. , Bastian Robert W.
Published: November 2003

Saccular cysts are uncommon disorders that represent cystic dilatation of the laryngeal saccule. They are distinguished from laryngoceles by their lack of lumenal continuity with the endolarynx, and the fact that they are not air filled. Voice change is the most common clinical presentation in adults, whereas airway compromise is more common in infants. Management recommendations range from observation of asymptomatic lesions, to endoscopic marsupialization or excision, to excision through a laryngotomy or the thyrohyoid membrane. The literature states that large or recurrent saccular cysts require the exposure afforded by a transcervical approach. This report describes complete endoscopic laser excision of large, symptomatic saccular cysts in seven adults. Four of the seven patients were referred with recurrent cysts after the failure of endoscopic marsupialization procedures. None required tracheotomy, and only three of seven were observed overnight in the hospital. Surgical technique with emphasis on complete excision, pre‐ and postoperative radiographic and surgical anatomy, and treatment outcome are discussed.
Benign Osteonecrosis of the External Ear Canal
Authors: Wolf Michael , Nusem‐Horowitz Sima , Zwas S. Tzila , Horowitz Ada , Kronenberg Jona
Published: November 2003

Benign osteonecrosis (BON) of the external ear canal (EEC), also termed as focal or circumscribed necrotizing lesion, is an infrequent phenomenon with distinctive features and of an obscure origin. Five patients with BON of the EEC presented with aggressiveness and extension of varying degree including involvement of the middle ear. It seems that the disease might have a self limited course (two patients) though, at times, extensive measures including hyperbarric oxygen therapy (one patient) should be applied.
Surgical Outcome in 87 Patients With Zenker's Diverticulum
Authors: Bonafede Joseph P. , Lavertu Pierre , Wood Benjamin G. , Eliachar Isaac
Published: November 2003

Surgical treatment of Zenker's diverticulum is controversial because many different procedures exist. We retrospectively reviewed 87 consecutive patients surgically treated for Zenker's diverticulum at a tertiary care institution from 1976 through 1993. Four surgical procedures were performed: cricopharyngeal myotomy alone (n = 16), excision (hand‐sewn) plus myotomy (n = 51), excision (stapler) plus myotomy (n = 11), and diverticulopexy plus myotomy (n = 9). There were three surgical mortalities (3.5%) and a complication rate of 24%. Eighty patients (92%) were available for follow up. Sixty‐eight patients (78%) reported excellent relief of symptoms, 10 (13%) reported improvement with occasional symptoms, and two (3%) described persistent dysphagia. No statistical difference in complication rate was found among surgical groups (P = 0.15). Myotomy alone patients had worse outcomes (P = 0.04) compared with the other surgical groups. Median follow‐up was 7.5 months.
Nasal Dermoid Sinus Cysts in Children
Authors: Denoyelle F. , Ducroz V. , Roger G. , Garabedian
Published: November 2003

Thirty‐six children with nasal dermoid sinus cysts were treated in the Department Pediatric Otolaryngology, Armand Trousseau's Children's Hospital (Paris, France) between 1974 and 1994. Ten of the patients presented with a midline cyst only, eight had nasal pits only, and 18 had combined cases. In six of the 36 patients, presurgical imagery indicated signs of intracranial extension of the tract, reaching the foramen caecum without intracranial mass. Three surgical techniques were used: an external rhinoplasty approach with medial crura section in 23 cases, a direct median approach in seven cases, and a paracanthal approach in six cases. Only two cases had meningeal adherences. Two superficial recurrences occurred within the 7‐year follow‐up period. Widening of the scar occurred in four children after verticomedian approach or nasal pit excision. The external rhinoplasty procedure with medial crura section results in a wide surgical approach, low recurrence rate, and good aesthetic results.
Preoperative Embolization in the Management of Neck Paragangliomas
Authors: Tikkakoski Tapani , Luotonen Jukka , Leinonen Sami , Siniluoto Topi , Heikkilä Outi , Päivänsalo Markku , Hyrynkangas Kalevi
Published: November 2003

Surgery of neck paragangliomas carries inherent risks of excessive blood loss and cranial nerve injury. Preoperative embolization has been used to lessen the morbidity of surgery. We sought to characterize our experience with preoperative embolization by evaluating safety, efficacy, and surgical data. During a period of 22 years (1974 to 1996), 19 consecutive patients with 27 histopathologically confirmed neck paragangliomas were surgically treated at the Oulu University Hospital. All patients underwent preoperative arteriography and 17 patients had cervical ultrasonography (US). Eleven patients with 15 tumors were operated on without embolization and nine patients with 12 tumors were preoperatively embolized with 150‐ to 250‐μm polyvinyl alcohol (PVA) particles. The mean blood loss during surgery in the nonembolized group was 1374 mL (range, 100 to 4500 mL) and the mean operation time was 4 hours and 48 minutes (range, 1.5 to 9 hours). In the embolized group the mean blood loss was significantly less (588 mL; range, 100 to 1800 mL; P = 0.04) and the mean operation time shorter (3 hours 24 minutes; range, 2 to 5 hours; P = 0.05). No embolic complications were recorded after the embolization. We conclude that preoperative embolization of neck paragangliomas 3 cm or greater in diameter with PVA particles is safe. Embolization to minimize operative bleeding facilitates surgery, shortens the operation time, and lessens the surgical risks.
Periauricular Cysts and Sinuses
Authors: Nofsinger Yoon Choi , Tom Lawrence W.C. , LaRossa Donato , Wetmore Ralph F. , Handler Steven D.
Published: November 2003

Periauricular cysts, sinuses, and fistulas occur commonly in the pediatric population. They arise from developmental defects of the first branchial cleft and first branchial arch. In most instances the diagnosis and management of these conditions are straightforward, but exceptional presentations sometimes occur. Failure to recognize these unusual cases may result in inadequate treatment and subsequent recurrence, and even if the correct diagnosis is made, surgical management of these lesions may be complicated. A series of 15 cases of periauricular congenital lesions is reviewed, of which three cases illustrating a diagnostic or surgical challenge are presented. The embryology, presentation, and management of these anomalies are discussed. This is one of the largest series of first branchial cleft anomalies reported in the literature, and our paper uniquely discusses first branchial cleft anomalies and preauricular sinuses together, with an emphasis on the surgical management of facial nerve, external ear, and middle ear involvement.
Midline Mandibular Osteotomy: An Analysis of Functional Outcomes
Authors: Riddle Seth A. , Andersen Peter E. , Everts Edwin C. , Cohen James I.
Published: November 2003

Although the oncologic validity and perioperative complications of midline mandibular osteotomy are well described, little attention has been directed toward the long‐term functional problems that may be associated with its use. Thirty‐one patients who had undergone this procedure were examined to assess postoperative sensation, temporomandibular joint (TMJ) function, occlusion, and cosmesis. The majority (27 of 31) patients had some sequclae but these were minor in nature. Twenty of 31 patients had abnormal sensation, 24 of 31 noted a changed occlusion, and 15 of 31 had signs or symptoms of TMJ myofascial pain. Although patients should be advised of the potential for functional problems with this procedure, they can be reassured that these are likely to be relatively minor in significance. If technically feasible and if an exact restoration of occlusion is a priority, a prefabricated lingual splint should be used.
Myofibroblast Accumulation Induced by Transforming Growth Factor‐β Is Involved in the Pathogenesis of Nasal Polyps
Authors: Wang Qiu Pin , Escudier Estelle , Roudot‐Thoraval Françoise , Samad Issam Abd Al , Peynègre Roger , Coste Andre
Published: November 2003

Myofibroblasts that express α‐smooth muscle actin(α‐SMA) are detected in many chronic inflammatory diseases. Transforming growth factor‐β (TGF‐β) is a potent inducer of myofibroblast accumulation in tissues. In this study, scattered myofibroblasts and TGF‐β were quantified and localized in nasal polyps (NPs) and normal nasal mucosa(NM). NPs were sampled in 16 patients during ethmoidectomy and NM was obtained from 10 control subjects during rhinoplasty. α‐SMA and TGF‐β were detected using immunohistochemistry and the numbers of labeled cells were quantified (α‐SMA and TGF‐β indices) and compared between NPs and NM. In eight NPs, in which the pedicle was preserved, α‐SMA and TGF‐β were evaluated and compared in the pedicle, central, and tip areas. Finally, TGF‐β expression was compared between low (zone 1), moderate(zone 2), and high (zone 3) zones of α‐SMA positivity. α‐SMA and TGF‐β indices were significantly higher in NPs than in NM. In the eight selected NPs, α‐SMA‐positive cells were significantly more abundant in the pedicle than in the central and tip areas, whereas TGF‐β‐positive cells were significantly more numerous in the pedicle than in the tip area. The number of TGF‐β‐positive cells was significantly higher in zone 3 than in zone 1 of α‐SMA positivity. Myofibroblasts, which are abundant in NPs but rare in NM, could be involved in the growth of NPs by inducing extracellular matrix accumulation. The local development of myofibroblasts in NPs could be controlled by TGF‐β, locally produced by inflammatory cells.
Hypopharyngeal Cancer Patient Care Evaluation
Authors: Hoffman Henry T. , Karnell Lucy H. , Shah Jatin P. , Ariyan Stephan , Brown G. Stephen , Fee Willard E. , Glass Andrew G. , Goepfert Helmuth , Ossoff Robert H. , Fremgen Amy M.
Published: November 2003

A survey was conducted to identify demographics and standards of care for treatment of hypopharyngeal squamous cell carcinoma in the United States. Data were accrued from voluntary submission of cancer registry and medical chart information from 769 hospitals representing 2939 cases diagnosed from 1980 to 1985 and 1990 to 1992. Clinical findings, diagnostic procedures employed, treatment practices, and outcome are presented. Overall, 5‐year disease‐specific survival was 33.4%, which segregated to 63.1% (stage I), 57.5%(stage II), 41.8% (stage III), and 22% (stage IV). Survival was best for patients treated with surgery only (50.4%), similar with combined surgery and irradiation (48%), and worse with irradiation only (25.8%). This analysis provides a standard to which current treatment practice and future clinical trials may be compared.
Anatomic Location of the Tongue Base Neurovascular Bundle
Authors: Lauretano Arthur M. , Li Kasey K. , Caradonna David S. , Khosta Rohit K. , Fried Marvin P.
Published: November 2003

Knowledge of the location of the hypoglossal/lingual artery neurovascular bundle (HLNVB) is essential in performing tongue base resections for neoplasm and for obstructive sleep apnea. Transoral and transcervical resections of the tongue base may be performed with greater exposure and certainty when the relationship of the HLNVB to local landmarks is understood; knowledge of the HLNVB allows resection of a larger amount of contralateral tongue base during partial glossectomy without violating the contralateral remnant tongue's blood supply. Ten cadaver heads were dissected to determine the position of the HLNVB with respect to soft tissue and bony landmarks at the tongue base. Our results indicate the position of the tongue base HLNVB is significantly inferior and lateral, that is, 2.7 cm inferior and 1.6 cm lateral to the foramen cecum, 0.9 cm superior to the hyoid bone, and 2.2 cm medial to the mandible. This inferolateral location allows the potential for aggressive tongue base resection without neurovascular compromise.
Nasal Reconstruction Using a Combination of Alloplastic Materials and Autogenous Tissues: A Surgical Alternative
Authors: Bikhazi Nadim B. , Chow Albert W. , Maas Corey S.
Published: November 2003

Re‐creation of a functional and aesthetically acceptable nose after partial nasal defect requires accurate reproduction of nasal lining, support, and coverage. Most authors recommend an approach to reconstruction with cantilevered bone grafting and paramedian forehead flap placement. The authors propose an alternative approach for selected patients with total or near‐total nasal defects combining both alloplastic and autogenous tissues. This method uses vitallium or titanium mesh for the dorsal framework formation, tissue‐expanded paramedian forehead flap for soft tissue coverage, and composite chondrocutaneous auricular grafts for tip reconstruction. Nine individuals underwent nasal reconstruction using this method. The indications, details, and potential advantages of this technique are described with accompanying photographic results. A flexible approach using a combination of alloplastic materials and autogenous tissues provides additional reconstructive options for individuals with total or near‐total nasal defects.
Hearing Results With Cartilage Tympanoplasty
Authors: Dornhoffer John L.
Published: November 2003

Cartilage has shown promise as a graft material to close perforations in the tympanic membrane (TM), particularly in cases of advanced middle ear pathology. Although it is similar to fascia, its more rigid quality tends to resist resorption and retraction. However, it is this rigid quality that has led many to anticipate a significant conductive hearing loss when using cartilage to reconstruct the TM. Because little has been reported in the literature comparing hearing results using cartilage with results using other grafting materials, this retrospective study was conducted to compare the hearing results of patients with cartilage tympanoplasty with results in patients who underwent revision tympanoplasty using perichondrium. Both series of patients had undergone type I tympanoplasty, and the middle ear pathology was considered to be similar between the two groups. TM closure was achieved in all 22 patients undergoing cartilage reconstruction, but three of the 20 patients undergoing perichondrium reconstruction had a recurrent perforation during the follow‐up period (approximately 1 year). The average pre‐ and postoperative puretone average air‐bone gap (PTA‐ABG) was 21.1 dB and 6.8 dB for the cartilage group and 17.9 dB and 7.7 dB for the perichondrium group, respectively. These gains in hearing were statistically significant (P < 0.001 in each case), but there was no statistically significant difference in hearing results between the two groups. Analysis of the PTA‐ABG as a function of percentage of TM reconstructed showed no statistically significant difference in hearing results due to percentage of cartilage used. These results indicate that cartilage tympanoplasty offers the possibility of a rigorous TM reconstruction with excellent postoperative hearing results.
Preoperative Temporal Bone Computed Tomography Scan and Its Use in Evaluating the Pediatric Cochlear Implant Candidate
Authors: Woolley Audie L. , Oser Allen B. , Lusk Rodney P. , Bahadori Robert S.
Published: November 2003

Preoperative computed tomography (CT) scan evaluation of the temporal bones in cochlear implant candidates plays a crucial role in determining candidacy and the side of implantation. The CT scans allow the surgeon to carefully review the anatomy of the inner ear and mastoid cavity in order to predict any potential difficulties or complications that may be encountered during the implant insertion. We retrospectively reviewed 50 preoperative CT scans of the temporal bone in children who have been successfully implanted. In these scans, we assessed the degree of mastoid pneumatization, cochlear anatomy and patency, size of the vestibular aqueduct, cochlear aqueduct, and internal auditory canal. We analyzed our findings and measurements and compared our results with the degree of difficulty noted in the insertion of the implant, the number of electrodes inserted in each case, and the overall complication rate. From this radiographic review, we have created a checklist for cochlear implant surgeons in order to highlight key features that need to be recognized in the temporal bone scan in preoperative evaluation of cochlear implant candidates.
Hearing Preservation After Acoustic Neuroma Resection With Tumor Size Used As a Clinical Prognosticator
Authors: Hecht Craig S. , Honrubia Vincent F. , Wiet Richard J. , Sims H. Steven
Published: November 2003

Three hundred sixty‐four patients referred to the Chicago Otology Group for acoustic tumor removal between 1981 and 1995 were reviewed in a retrospective fashion. Of this group, 60 patients were candidates for hearing preservation surgery and thus underwent one of two surgical approaches to remove the tumor and preserve hearing. Eighteen patients had tumor removal via the middle cranial fossa approach, and 42 patients had tumor removed via the retrosigmoid approach. Of the 42 patients who underwent retrosigmoid removal, 33% had hearing preserved overall. Of the 18 patients in the middle fossa group, 44% had hearing preserved overall. The average tumor size of patients with preserved hearing in the retrosigmoid group was 1.4 cm, and in the middle fossa group was 0.74 cm. Of significance was the fact that in both groups of patients with a tumor of 1.5 cm or less there was a 50% chance of hearing preservation. In the group of patients with tumors larger than 1.5 cm there was only a 16% chance of preserving hearing. We propose that these data can be used for better counseling of patients preoperatively as to the chances of hearing preservation and the type of approach appropriate for each case.
Sustained Release of Antibiotic From a Fibrin‐Gelatin‐Antibiotic Mixture
Authors: Park Moon Suh , Kim Yong Bok
Published: November 2003

To improve the therapeutic effect of antibiotics in the ear cavity postoperatively, a fibrin‐ and gelatin‐based drug delivery system was designed and in vitro efficacy was evaluated. Four kinds of fibrin clot were made from ampicillin, gentamicin, and ofloxacin, and biologic assay was performed usingBacillus subtilis. The fibrin‐gelatin‐gentamicin mixture demonstrated antibiotic activity for up to 120 hours against B subtilis. Gentamicin was found to be released more slowly from the fibrin‐gelatin mixture than from the fibrin mixture in this experiment. These results suggest that this device can be clinically used in a limited field such as postoperative care of ear infection.
Zenker's Diverticulum
Authors: Nguyen Hoang C. , Urquhart Andrew C.
Published: November 2003

Symptomatic Zenker's diverticula are usually treated with diverticulectomy and myotomy. Other, more conservative open procedures consist of diverticulopexy, imbrication, and myotomy alone. These more conservative procedures do not result in a breach of esophageal mucosa and should have more rapid postoperative recovery. We performed a retrospective chart review of all open surgical procedures performed at the Marshfield Clinic and St. Joseph's Hospital between 1975 and 1996. Using Wilcoxon's rank sum test, the conservative procedures were compared with the standard diverticulectomy for duration of hospitalization and length of time to resumption of oral intake. Fifty‐nine patients are reported. Statistically significant differences between the surgery groups were found for hospitalization (
P
< 0.001) and days to resumption of oral intake (
P
< 0.001). Conservative open surgical procedures for repair of Zenker's diverticula result in decreased hospitalization and earlier resumption of oral diet compared with diverticulectomy.
Perioperative Complications of Percutaneous Dilational Tracheostomy
Authors: Berrouschot Jörg , Oeken Jens , Steiniger Lutz , Schneider Dietmar
Published: November 2003

Percutaneous dilational tracheostomy (PDT) has replaced conventional tracheostomy for long‐term intubated patients in many intensive care units (ICUs). In a prospective study carried out between September 1994 and August 1996, 76 patients underwent PDT. In 41 patients, PDT was performed “blind.” In 35 patients it was executed with simultaneous bronchoscopic monitoring. The type and rate of complications of the two techniques were compared. Comparing the groups with and without bronchoscopy, the perioperative complication rate was equivalent (7% vs 6%); however, more severe complications occurred in the group without bronchoscopy (one death due to tension pneumothorax, two cases of perforating the rear tracheal wall) than in the group with bronchoscopy (two cases of intratracheal hemorrhage). PDT is a suitable bedside method for ICU patients undergoing long‐term ventilation. Simultaneous endoscopy minimizes the severity of complications.
100 Years of Frontal Sinus Surgery
Authors: Jacobs Joseph B.
Published: November 2003

The surgical treatment of chronic inflammatory frontal sinus disease over the past century has varied between intranasal and external procedures. There has been constant modification of these techniques; however, a single approach that will lead to relief of symptoms, eradication of disease with preservation of function, and a minimum of deformity has not yet been attained. The functional theory of sinus disease, the evolution of endoscopic techniques, and data provided by the computed tomography scan have renewed our interest in the anatomy of the lateral nasal wall and endonasal surgery. Extensive literature exists concerning the results of ethmoid, maxillary, and sphenoid endoscopic surgery. However, detailed information is not available on the treatment of inflammatory frontal sinusitis. The author presents the results of a retrospective analysis of a series of 101 patients with inflammatory frontal sinusitis who underwent endoscopic surgery that included the frontoethmoid complex. Results for improvement of symptoms as well as endoscopic findings are presented. Relief of symptoms was significant but did not correlate with postoperative endoscopic findings in patients with hyperplastic and polypoid sinusitis. Patients with anterior ethmoid cell encroachment on the frontal sinus outflow tract had a positive correlation between improvement of symptoms and postoperative endoscopic findings. Frontal recess stenosis was associated with a poor outcome. Anatomic obstruction of the frontonasal duct is most consistent with the functional theory of sinusitis.
Role of Middle Meatus Aspiration Culture in the Diagnosis of Chronic Sinusitis
Authors: Gold Steven M. , Tami Thomas A.
Published: November 2003

Although empiric antibiotic therapy is often used for sinusitis, the emergence of antibiotic resistance has increased the failure rate of this approach. Culture‐directed therapy usually increases treatment success, but traditional antral puncture is often accompanied by poor patient and physician acceptance. Endoscopically directed middle meatal aspiration culture is increasingly used in this setting, but studies have not convincingly demonstrated the validity of this technique. Both endoscopic middle meatal and direct antral cultures were performed during endoscopic sinus surgery. Cytologic examination was performed to confirm the presence of inflammatory cells. When culture results were compared in 21 specimen pairs, exact correlation was found in 18 (85.7%). Based on this study, endoscopically directed middle meatus aspiration culture appears to be a valuable alternative to antral puncture for guiding organism‐specific antibiotic therapy in sinusitis.
A Clinical and Histologic Comparison of Percutaneous Dilational Versus Conventional Surgical Tracheostomy
Authors: Stoeckli Sandro J. , Breitbach Thomas , Schmid Stephan
Published: November 2003

To directly compare percutaneous dilational tracheostomy (PDT) with conventional surgical tracheostomy, a prospective study was performed in 83 patients requiring tracheostomy for prolonged mechanical ventilation in the intensive care unit or after surgery for a large tumor in the upper respirodigestive tract. Median follow‐up was 355 days after PDT and 338 days after conventional tracheostomy. The overall morbidity rate was significantly lower with PDT than with conventional tracheostomy (6.4% vs 36.1%;
P
< 0.001). Compared with conventional tracheostomy, PDT was also associated with a significantly lower incidence of postoperative bleeding (2.1% vs 13.9%;
P
< 0.05) and postoperative wound infection (0% vs 22.2%;
P
< 0.001). There were no clinical signs of laryngotracheal stenosis in either group. In conclusion, PDT is a simple, fast, safe bedside procedure that is associated with significantly lower morbidity than standard surgical tracheostomy.
Tracheostomy Decannulation in Children: Approaches and Techniques
Authors: Gray Robert F. , Todd N. Wendell , Jacobs Ian N.
Published: November 2003

Various approaches and techniques are used in discontinuing tracheostomy in children. The variability in the use of resources is considerable. The objective of this study was to assess decannulation in children attended in a university‐affiliated children's hospital. A retrospective analysis was made of the medical records of patients who had both tracheostomy (n = 177) and decannulation (n = 30) from 1985 to 1994. Tracheostomies, placed at a mean age of 38 months, were discontinued (on the average) 22 months later. Most children underwent airway endoscopy in the operating room in preparation for decannulation. Twenty‐four children had downsizing, then capping of the tracheostomy as a functional trial. Six children underwent staged laryngotracheoplasty before decannulation. Two children had decannulation as part of a single‐stage laryngotracheoplasty. Attention to at least one comorbid factor (e.g., pulmonary, neurologic, or cardiac disease) was important in the decannulation of each patient in this series. The individualization of tracheostomy decannulation is necessary for children.
Perioperative Management of von Willebrand's Disease in Otolaryngologic Surgery
Authors: Shah Saurabh B. , Lalwani Anil K. , Koerper Marion A.
Published: November 2003

von Willebrand's disease (VWD) is the most common hereditary bleeding disorder. Unchecked or improperly managed, VWD‐associated hemorrhage can lead to catastrophic surgical outcome. Based on the authors' recent experience with 21 procedures in 12 patients, a contemporary protocol for successful perioperative management of VWD in otolaryngologic surgery is presented. In patients with VWD type 1 or 2a, desmopressin, a synthetic vasopressin analog, is administered both pre‐ and postoperatively to release von Willebrand factor (VWF) from storage sites. In type 2b or 3, a factor VIII concentrate rich in VWF is administered. In addition, a 10‐ to 14‐day course of intravenous and/or oral Amicar (Immunex Corp., Seattle, WA) may be prescribed postoperatively. Intraoperatively, the surgical laser is used to further decrease blood loss and augment hemostasis. This medical and surgical protocol minimizes the risk of hemorrhage and of transfusion‐related complications through the judicious use of preoperative and postoperative coagulation replacement products. Using these guidelines in a variety of otolaryngologic cases, the authors have had no bleeding complications at their institution.
Supraglottal Injection of Botulinum Toxin Type A in Adductor Type Spasmodic Dysphonia With Both Intrinsic and Extrinsic Hyperfunction
Authors: Schönweiler Rainer , Wohlfarth Kai , Dengler Reinhard , Ptok Martin
Published: November 2003

Patients with adductor type spasmodic dysphonia (SD) often exhibit both glottal and supraglottal hyperfunction. Based on the hypothesis that a “ventricular muscle” may contribute to the hyperfunction in these cases, eight patients with adductor type SD were treated with bilateral injection of botulinum toxin type A into the ventricular folds. Four weeks after injection, ventricular fold hyperfunction was absent in all cases. Number of voice breaks, standard deviation of fundamental frequency, and shimmer were significantly improved. Voice range profiles of the speaking voice were significantly extended in dynamic and frequency range. Side effects were a breathy phonation and mild swallowing difficulties without aspiration for about 1 week. Patients' self‐rating concerning strangled and breathy voicing demonstrated an interval of acceptable voice quality between 1 week and 4 months after injection in all cases. Results suggest that supraglottal injection in patients with SD of both glottal and supraglottal hyperfunction, as a new approach, can normalize supraglottal activity and improve glottal voicing. Based on our experience with other patients with adductor type of SD, this injection technique is as efficient as injection into the thyroarytenoid muscle. Nevertheless, it remains to be proved that a pathologic ventricular muscle activity is addressed by this technique or if it is based on spreading to the thyroarytenoid muscle.
Filtration of Particulates in the Human Nose
Authors: Schwab Jan‐Alexander , Zenkel Matthias
Published: November 2003

This report reviews the current theories on the deposition of inhaled particulates in the human nose. The inhalation of particulates represents a challenge to the upper respiratory tract. The concentration of airborne particulates and pollutants varies between occupational and nonoccupational exposure. Regional deposition of potentially hazardous inhaled material determines the local and systemic toxicity. In vitro experiments using casting and molding techniques with water dye models or laser Doppler anemometry indicate that nasal airflow is determined by the size of the nasal valve and the turbinates. The main airstream during inspiration passes through the lower nasal passage. Filtration capacity of the human nose can be expressed mathematically or experimentally. In vivo experiments applying monodisperse or polydisperse aerosols during single or multiple respiratory cycles have shown by using microscopic or laser‐optic identification that particles larger than 3µm have a maximum deposition in the anterior part of the nose (nasal valve). Particles smaller than 3 µm and larger than 0.5 µm are filtered by the nasal mucosa and transported by cilia propulsion to the nasopharynx. The filtration for particles smaller than 0.5 µm is low. They seem to pass easily into the lower respiratory tract. This knowledge has an impact on nasal septal surgery and rhinoplasty. By influencing the structure of the nasal valve and the lower turbinates, the filtration capacity of the nose can be significantly decreased.
Long‐term Experience With Endoscopic Staple‐Assisted Esophagodiverticulostomy for Zenker's Diverticulum
Authors: Scher Richard L. , Richtsmeier William J.
Published: November 2003

The authors have previously described the endoscopic staple‐assisted esophagodiverticulostomy (ESED) technique for treatment of Zenker's diverticulum. In the initial series of six patients, ESED was shown to be safe and effective in the short term, with a significant reduction in hospital stay and convalescence as compared with other surgical techniques. This report documents the authors' long‐term experience with ESED (average follow‐up, 9.3 months; range, 1.5 to 25 months) and discusses the long‐term results of this therapy, technical issues, and variations they have utilized, as well as the advantages and limitations of this approach. Thirty‐six patients with Zenker's diverticula have been treated from March 1995 to March 1997. In 34 of the patients, ESED was accomplished, resulting in successful resolution of preoperative symptoms in 32 (94%). Two patients had persistent dysphagia after initial ESED; a revision ESED was successfully performed without complication in both. Two patients were unable to be treated with ESED because of inability to expose the diverticulum with the Weerda laryngoscope. Oral liquid diet has been resumed, on average, 0.8 days after surgery (range, 0 to 4 days), with solid diet resumed by day 5 (range, 1 to 14 days). The average hospital stay has been 1.3 days (range, 1 to 4 days). There have been no postoperative deaths, infections, or airway difficulties. Perioperative morbidity to date has included one case of iatrogenic pharyngeal perforation, one postoperative fever, one transient true vocal fold paralysis, and two dental injuries, with no long‐term sequelae. The results support the use of ESED as the initial treatment of choice for patients with Zenker's diverticula.