bluuebunny/crossref_metadata_2025 huggingface dataset:
Extraglandular warthin's tumors
Authors: Fantozzi Rchard D. , Bone Robert C. , Fox Robert
Published: October 2006

Warthin's tumor or papillary cystadenoma lymphomatosum {PCL) represents a clinically significant entity, not because of pernicious behavior, but because its cytohistological characteristics tell us much about the development and morphology of the parotid region. Three cases operated on in which PCL developed in an extraglandular location from the parotid, formed the basis for a series of observations on what is known about: 1. etiology of PCL; 2. the nature of the lymphocytic components; 3. the relatively high incidence of bilateral and multiple occurrence, as well as male predominance. These studies employed immunohistological techniques using a series of monoclonal antibodies.
Central projections of primary vestibular fibers in the bullfrog: I. The vestibular nuclei
Authors: Kuruvilla Alexander , Sitko Stefan , Schwartz Ilsa R. , Honrubia Vicente
Published: October 2006

The central projections of the vestibular end organs in the bullfrog Rana calesbeiana were analyzed by using horseradish peroxidase labeling of the primary vestibular afferents. Separate extracellular injections were made of Lhe anterior branch, the posterior branch, the ampullary nerve of each of the three semicircular canals, and the branch to the saccule.

The anterior and posterior branches of the bullfrog eighth nerve, each contalning both vestibular and auditory fibers, merge and enter the braln stem as a single nerve root. The thin caliber fibers of the anterior branch enter the braln stem on the ventral‐posterior aspect of the nerve and immediately divide dichotomously into ascending (rostral) and descending (caudal) branches. The thick caliber fibers of the anterior branch enter the brain stem on the ventral‐anterior aspect of the eighth nerve and traverse medially into the alar plate before dividing into ascending and descending branches. The primary afferent fibers of the vestibular nerve innervate an ipsilateral area of the brain stem which extends caudally from the rhombencephalon at the level of the twelfth nerve nucleus and rostrally up to and including the cerebellar nucleus and the cerebellum. The following vestibular nuclei can be identified by the fact that they receive primary vestibular afferents: the ventral vestibular nucleus, medial vestibular nucleus, descending vestibular nucleus, superior vestibular nucleus, and cerebellar nucleus. The dorsal (acoustic) nucleus, which receives primary auditory input, also receives afferents from the saccule. In addition to these nuclei, the cerebellum and the reticular formation receive significant primary input from the various vestibular receptors. The primary vestibulo‐cerebellar fibers terminate mainly among the granular cells of the lobus auriculuris and of the corpus cerebelli on the ipsilateral side. Each of the three semicircular canals projects into the cerebellum, while no such projection was observed in the saccular nerve preparations. Fibers from each of the three semicircular canals project to all of the vestibular nuclei. Heavily labeled large neurons, presumably vestibular efferents, are seen in the ipsilateral reticular formation, adjacent to the seventh motor nucleus.
Carcinoid of the larynx: A report of three cases and a review of the literature
Authors: Blok Philip H. H. M. , Manni Johannes J. , Van Haelst Urbain J. G. M. , Van Den Broek Paul , Slooff Joop L.
Published: October 2006

Carcinoid tumors arc among the exceptional neoplasms of the larynx. The laryngeal carcinoid was first described in 1969 by Goldman, et al.' Only 16 cases could be traced from the literature. This paper describes three additional cases. In one patient, the tumor infiltrated the laryngeal tissues and metastasized to the cervical lymph nodes and breast. In the second case, the polypoid lesion could be excised completely. The third case was initially diagnosed as undifferentiated squamous cell carcinoma. The diagnosis of carcinoid was made a few years later when a metastasis was removed. The presence of intracellular membrane bound neurosecretory granules and positive argyrophilia in the Grimelius stain are characteristic. In half of the cases described in the literature, the tumor was initially misdiagnosed as undifferentiated carcinoma. The treatment of choice is surgical removal which may be curative. The literature is reviewed.
Management of nonperitonsillar abscesses of the head and neck with needle aspiration.
Authors: Herzon Frld S.
Published: October 2006

Ten patients in a three‐year period with various abscesses of the head and neck (nonperitonsillar) were treated with needle aspiration as the primary surgical modality. Eight were successfully managed with antibiotics and needle aspiration alone. Two required incision and drainage. Three patients had large volume abscesses (greater than 10 cc). Two of these resolved with multiple needle aspirations. These data suggest that certain nonperitonsillar abscesses of the head and neck may be successfully managed with needle aspiration and antibiotics.
Management of carotid artery transection resulting from a stab wound to the ear.
Authors: Harris Jeffrey P. , Anterasian George , Shackford Steven , U Hoi S. , Brahme Folke J.
Published: October 2006

Emergency treatment of penetrating injury to the internal carotid artery at the skull base and within the temporal bone is difficult due to problems of exposure and control of this vessel. A successful method of management of a patient whose carotid artery was completely transected by a stab wound to the ear is presented. This involved gaining proximal vascular control in the neck and distal control intracranially. Indications for extracranial‐intracranial vascular bypass procedures are discussed.
Complications of laser surgery for laryngeal papillomatosis.
Authors: Wetmore Stephen J. , Michael Key J. , Suen James Y.
Published: October 2006

Carbon dioxide laser surgery has become the treatment of choice for laryngeal papillomatosis. The purpose of this study was to determine the type, incidence, and severity of complications that occur with laser microlaryngoscopy for a disease that often requires multiple operations.

Forty patients with laryngeal papillomatosis underwent a total of 222 carbon dioxide laser laryngoscopies over the 6 1/2‐year period from June 1977 through December 1983. The results showed that 13 patients sustained a total of 23 separate complications. Intraoperative complications consisted of one episode of bilateral pneumothorax and one episode of cervical subcutaneous emphysema, both associated with the use of jet ventilation anesthesia, and one episode of a loosened tooth in a child with carious teeth. The delayed complications consisted of 10 patients with anterior laryngeal webbing, 2 patients with posterior webbing, 6 patients with laryngeal edema or fibrosis, and one episode each of prolonged dysphagia and tracheal foreign body. No airway fires occurred. Only 2 of 28 patients who had 5 or fewer laser laryngoscopies developed complications, but 11 or 12 patients undergoing 6 or more laser operations had complications. In summary, although the incidence of life threatening complications was low, the occurrence of minor complications such as small anterior glottic webs and persistent edema was relatively high, especially in those patients who required multiple laser laryngoscopies.
Delayed effects of ionizing radiation on the ear
Authors: Bohne Barbara A. , Marks James E. , Glasgow Glenn P.
Published: October 2006

The question of damage to the ear from exposure to ionizing radiation was addressed by exposing groups of chinchillas to fractioned doses of radiation (2 Gy per day) for total doses ranging from 40 to 90 Gy. In order to allow any delayed effects of radiation to become manifest, the animals were sacrificed two years after completion of treatment and their temporal bones were prepared for microscopic examination. The most pronounced effect of treatment was degeneration of sensory and supporting cells and loss of eighth nerve fibers in the organ of Corti. Damage increased with increasing dose of radiation. The degree of damage found in many of these ears was of sufficient magnitude to produce a permanent sensorineural hearing loss.
External auditory canal dysplasia: CT evaluation
Authors: Swartz Joel D. , Popky George L. , Wolfson Robert J. , Marlowe Frank I. , Vernose Gerard V. , Hampel Avraham
Published: October 2006

Dysplasias of the external auditory canal can be evaluated with high resolution CT using proper technique. Images are studied to determine the type of atresia (membranous or bony) nnd the thickness of the associated atretic plate (if present). Other findings sought include the degree of pneumatization, the status of the fenestrae, the size of the tympanic cavity, and the location of both the mandibular condyle and the facial nerve canal.
Rheumatoid arthritis of the cricoarytenoid joints: A case of laryngeal obstruction due to acute and chronic joint changes
Authors: Jurik Anne Grethe , Pedersen Ulrik , Nørgárd Åge
Published: October 2006

A 63‐yenr‐old female with severe rheumatoid arthritis and respiratory obstruction with stridor due to cricoarytenoid (c.a.) arthritis is described. Low voltage radiography of the neck revealed erosive changes in the c.a. joints. At laryngoscopy the arytenoids were fixed in adduction, and there were signs of active arthritis. Corticosteroid therapy was instituted with remarkable effect on the obstruction. After the active arthritis had subsided, there remained limited arytenoid mobility with a glottic chink of about 5 mm, but no laryngeal symptoms.
Sudden airway obstruction due to a benign hemangioendothelioma of the larynx
Authors: Nakashima Tsutomu , Watanabe Yusuke
Published: October 2006

Sudden airway obstruction can be caused by laryngeal impaction of pedunculated tumors in the upper aerodigestive tract. We experienced a case of sudden airway obstruction due to a rare benign hemangioendothelioma of the larynx in a 13‐yeur‐old male. Emergency tracheotomy was performed and the tumor was removed using direct laryngoscopy. Pathologically, the reticulum stain showed that the proliferating cells were inside the capillary sheaths. The usefulness of the reticulum stain was stressed for pathological diagnosis of hemangioendothelioma.
Croup and epiglottitis: A radiologic study
Authors: Stankiewicz James A. , Bowes Anita King
Published: October 2006

Because of the controversy regarding the benefits of the lateral neck and chest radiographs in the evaluation of croup and epiglottitis, a two‐part retrospective study was initiated. Part I consisted of a retrospective chart review of 44 patients with a final diagnosis of croup and epiglottitis. Part II consisted of the 42 Interal neck and chest x‐rays from patients in part I presented to six radiologists who knew only the patients age and the history of respiratory distress. Two hundred forty‐six responses were obtained.

The results of the part I study showed that 64% of patients with documented epiglottitis had a positive radiologic diagnosis. Only 33% of patients with croup had a positive radiologic diagnosis and importantly 27% had a diagnosis of possible epiglottitis.

The results of part II showed 38% of the documented epiglottitis patients had a positive lateral neck radiograph. The croup patients had a lateral neck and/or chest x‐ray positive in 38%. Of interest, 24% had readings consistent with possible epiglottitis.

Based on this two‐part study, it is our conclusion that the lateral neck and chest x‐ray may be unreliable and inaccurate in the diagnosis of croup and epiglottitis. Caution and good clinical judgement should be utilized when interpreting these x‐rays.
Neurotropic melanoma of the head and neck
Authors: Gentile Richard D. , Donovan Donald T.
Published: October 2006

Neurotropic melanoma is a lesion which simulates a cutaneous fibrous tumor whose clinical course is characterized by local infiltration, multiple recurrences, and commonly by metastasis. Like adenoid‐cystic tumors of the head and neck, the neurotropic melanoma has a predilection for perineural invasion and extension along peripheral nerves. Its microscopic picture is characterized by atypical “neuroma‐like” patterns of Schwann cells and spindle cells, by poorly defined margins, and by neurotropism. Lentigo malignant melanoma (LMM) is a precursory lesion. The neurotropic melanoma is of particular interest to the head and neck surgeon because in the less than 50 reported cases of this rare tumor the preponderant sites were head, neck, and lip.

We report two cases of neurotropic melanoma of the head and neck which demonstrate the characteristic perineural invasion of cranial nerves and extension along cranial nerves to the central nervous system. The clinical and pathologic features of the neurotropic melanoma are reviewed and the key diagnostic and therapeutic considerations in these patients are discussed.
Dilemmas in the management of chronic nasal and sinus inflammatory diseases of unknown etiology
Authors: Duncavage James A. , Durkin Gretchen E. , Lehman Roger H. , Toohill Robert J.
Published: October 2006

The diagnostic criteria and therapeutic regimens for upper airway necrotizing diseases such as Wegener's granulomatosis, polymorphic reticulosis, and the recently described idiopathic midlinc destructive disease have been better defined and clarified in the past decodes. Despite an improved understanding of the various disease processes, there continues to be difficulty in establishing an early diagnosis before proceeding with prompt treatment to minimize loss of function and cosmetic deformity. To achieve these goals, we have expanded the indications for the use of the cytotoxic drug, cyclophosphamide, in those patients whose clinical and histologic presentations are suggestive of Wegener's granulomalosis, but in whom a specific diagnosis has not been confirmed by biopsy specimen. We have seen ten patients with upper airway lesions of a chronic inflammatory nature over the past six years at the Medical College of Wisconsin affiliated hospitals. Only three of these have had a definitive histopathologic diagnosis of Wegener's granulomatosis made prior to the initiation of cytotoxic therapy. Six have undergone treatment under our expanded criteria without a prior definitive diagnosis. Five of these have had arrest of the disease process, and one has had no response to therapy. One patient was not treated. There have been no serious side‐effects from cyclophosphamide therapy in these patients.
Sudden hearing loss and cerebellopontine angle tumors
Authors: Pensak Myles L. , Glasscock Michael E. , Josey Anne Forest , Jackson C. Gary , Gulya Aina Julianna
Published: October 2006

Lesions of the cerebellopontine angle may cause a sudden hearing loss. To illustrate and reaffirm the importance of a thorough neurotologic evaluation we performed a retrospective review of the audiologic and clinical data available on 506 patients with proven lesions of the cerebellopontine angle. Seventy‐seven patients (15.2%) were found to have a history commensurate with sudden hearing loss. We reviewed the relevant audiologic data as well as the clinical circumstances of this select patient population.
Caustic ingestion in adult patients
Authors: Schild Joyce A.
Published: October 2006

Sixteen adult patients who ingested caustic substances were seen from 1977 through 1984. All patients underwent endoscopy to determine the site and severity of burns; mild hyperemia to severe, penetrating necrosis was detected in each patient. Ten ingestions were intentional, 4 accidental, and 2 questionably accidental. Morbidity and mortality were high, especially in patients who ingested caustic materials intentionally. A protocol for treatment with steroids and antibiotics was followed in half the patients studied. Those patients who completed this regime tended to have moderately severe burns. Caustic ingestion in adults must be viewed as a problem different from that of accidental ingestion in children. Since most adult caustic ingestions are intentional, the injuries are worse, more deaths result, and more severe scars causing permanent disability are a frequent outcome.
A study of endotracheal tube injury to the subglottis
Authors: Whited Robert E.
Published: October 2006

An endotrachal tube presses against distinct pressure points within the airway. These areas are the shaft of the tube against the arytenoids and posterior cricoid and the cuff‐tube tip in the trachea. An ulcerative injury occurs at these interfacing points from motion occurring between tube and tissue. Minimizing this inherent movement is possible by tube modification and, in the presented animal model, prevents injury.
Efficacy of bronchoscopic carbon dioxide laser surgery for benign strictures of the trachea
Authors: Ossoff Robert H. , Tucker Gabriel F. , Duncavage James A. , Toohill Robert J.
Published: October 2006

There have been conflicting reports in our literature concerning the efficacy of bronchoscopic carbon dioxide laser surgery for the treatment of benign strictures of the trachea. We have examined our experience in the management of this disease over a 2 1/2‐year period; in all cases, our initial management was performed utilizing the rigid, ventilating bronchoscope with the universal endoscopic coupler and carbon dioxide laser.

Eight of 14 patients were successfully managed in this study; retrospective analysis of our results revealed that the presence of one or more of the following four factors was extremely important in predicting an unfavorable prognosis of patients with tracheal stenosis managed endoscopically with the carbon dioxide laser: 1. loss of cartilaginous support; 2. stenosis length greater than 1 cm; 3. circumferential scarring; and 1. carinal involvement.
Long‐term adaptive changes of the vestibulo‐ocular reflex in patients following acoustic neuroma surgery
Authors: Jenkins Herman A.
Published: October 2006

A series of 26 patients undergoing translabyrinthine acoustic neuroma surgery was evaluated pre‐ and postoperatively using rotatory vestibular testing. Patients were tested immediately prior to surgery and followed long‐term at frequent intervals for periods of one week to two years, depending on availability and length of time postoperative. Rotatory testing was performed at multiple frequencies of 0.0125, 0.05, and 0.2 Hz, and the vestibulo‐ocular reflex was measured using electro‐oculographic techniques. Dependent variables of the slow component of the vestibulo‐ocular reflex were derived by computer analysis, including gain, phase, DC bias, ampullopetal and ampullofugal responses of the remaining labyrinth, and asymmetry. These variables changed in a predictable fashion as related to the reciprocal of time. Results of this data are fitted with a linear statistical model, validating the changes.
Functional versus organic vocal cord paralysis: Rapid diagnosis and decannulation
Authors: Myears Donald W. , Martin Richard J. , Eckert R. Christa , Sweeney Maurine K.
Published: October 2006

Functional versus organic vocal cord paralysis can be difficult to differentiate at times. If a tracheostomy has already been performed, the distinction can be made by the use of intratracheal pressure monitoring while the patient is being sedated. If the problem is functional then rapid decannulation can be accomplished as described in this report.
Thyroid cartilage flap reconstruction of the larynx following vertical partial laryngectomy: A preliminary report in two patients
Authors: Burgess Lawrence P. A. , Quilligan Jay J. , Yim Donald W. S.
Published: October 2006

Reconstruction of the larynx following vertical partial laryngectomy may be undertaken with many techniques. Methods using soft tissue employ readily accessible structures within the operative field with straight forward reconstructive designs. However, decannulation is often delayed, and variable degrees of atrophy must be planned for. Methods using cartilage may lead to early decannulation without long‐term atrophy as a problem. However, grafts or flaps are less accessible, and reconstructive designs are often complex. In addition, chondritis may be a significant problem, especially in radiated patients.

A supraglottic thyroid cartilage flap is described that is readily accessible and maintains its blood supply from external and internal perichondrium, as well as internal mucosa. Its use is reserved for unilateral glottic lesions without supraglottic spread. Experience with this technique is described in two patients.
Teratoma of the tongue: A case report and literature review
Authors: Antoine Gregory A. , White Joseph D. , Heffner Dennis K. , Case Christopher
Published: October 2006

Teratomas of the tongue are extremely rare neoplasms, with only five reported cases in the literature. We report an additional case here and review the literature on this rare entity.
Diagnosis and treatment of iatrogenic cerebrospinal fluid leak and brain herniation during or following mastoidectomy
Authors: Neely J. Gail , Kuhn John R.
Published: October 2006

Iatrogenic brain herniation, with meninges (meningoencephalocele) or without meninges (encephalocele), following mastoidectomy is rare. However, the seriousness of the complication and the potential for its prevention necessitate periodic review and emphasis.

In this study, 6 patients with small iatrogenic dural injury during mastoidectomy, 1 patient with postoperative large encephalocele, and 2 patients with three spontaneous meningoencephaloceles are reviewed.

These cases, and the literature, support the following: 1. A dural injury is necessary for herniation. 2. If the arachnoid remains intact, a meningoencephalocele results with the potential for cerebrospinal fluid leak into the middle ear and recurrent meningitis. 3. If the arachnoid is not intact, an encephalocele results which presents predominantly as a mass without a cerebrospinal fluid leak. 4. The dura and arachnoid may be torn during mastoidectomy, resulting in an immediate cerebrospinal fluid leak that can go easily unrecognized. Taking time to carefully inspect any area of dural exposure obviates this oversight. 5. A satisfactory technique of tegmen and duralarachnoid repair in these ten cases is described.
Vocal cord polyps: Biochemical and histologic evaluation
Authors: Steinberg Bettie M. , Abramson Allan L. , Hirschfield Larry , Kahn Leonard B. , Freiberger Ida
Published: October 2006

The stratified squamous epithelium covering vocal cord polyps can vary from normal to hyperplastic and keratinized. We have analyzed the histology and cytokeratins of 11 of these polyps. Cytokeratins were separated on one‐dimensional SDS‐acrylamide gels to determine molecular weights. There was significant heterogeneity in the cytokeratins present in the different polyps. Comparison of histologic findings and cytokeratin content showed a correlation between extent of keratinization and presence of high molecular weight cytokeratins. We conclude that the epithelium of vocal cord polyps exhibit patterns of cytokeratins characteristic of both hyperproliferation and abnormal states of differentiation, which are mirrored by histologic variations, and that vocal cord polyps are a heterogenous group of benign lesions.
Counseling before laryngectomy
Authors: Berkowitz Jessica Fuchs , Lucente Frank E.
Published: October 2006

Counseling of laryngectomy patients was studied by a questionnaire survey among 294 fellows of the American Society for Head and Neck Surgery and otolaryngology house officers (77% attendings and 23% residents). Seventy‐nine percent of respondents spent less than one hour counseling patients. Subjects emphasized during preoperative counseling included: extent of surgery, loss of speech, alternatives to surgery, immediate postoperative disfigurement, possible effects of surgery on life expectancy, and possibility of recurrence. At least 24% of physicians were unwilling to discuss the psychosocial effects laryngectomy.

Ninety‐five percent of respondents often or always included family members in preoperative counseling sessions. The speech pathologist was utilized by at least 80% of the respondents to help with preoperative counseling. Differences in counseling practices between attendings and residents are discussed.
Laryngopyocele as a cause of airway obstruction
Authors: Weissler Mark C. , Fried Marvin P. , Kelly James H.
Published: October 2006

Symptomatic laryngoceles are unusual lesions. Laryngopyoceles are even more unusual, with a total of 32 cases reported in the world literature. Two cases of laryngopyocele presenting as airway obstruction are described along with a review of the anatomy, etiology, clinical course, and management of this lesion. An argument is made supporting the resection of the symptomatic laryngocele to prevent the rapid respiratory obstruction that may occur in the presence of a laryngopyocele.
Operative complications of tracheoesophageal puncture
Authors: Silver Frederick M. , Gluckman Jack L. , Donegan J. Oliver
Published: October 2006

Tracheoesophageal puncture is not a complex procedure; nevertheless, significant complications are possible. In the last four years we have performed this procedure in 47 patients. Seven of them (15%) sustained significant complications related to the procedure. These included three cases of mediastinitis and sepsis, although surgical drainage was not required. Three other patients developed cellulitis of the trachea and root of the neck, centered around the tract through the party wall; one patient suffered a fracture of the cervical spine. Eight lesser complications also occured.

Tracheoesophageal puncture's simplicity and effectiveness surpass those of any other surgical procedure for voice restoration. However, our experience demonstrates that, as with any operation, the technique may be associated with significant operative complications.
Staging parameters for cancers of the head and neck: A multi‐factorial analysis
Authors: Jacobs John R. , Spitznagel Edward L. , Sessions Donald G.
Published: October 2006

Utilizing a multi‐variate computer based analysis technique, the 1,400 case head and neck tumor registry of Washington University was examined for possible staging variables as an alternative to the current TNM system. Site, age, characteristics of surgical margins, and absence of neck node metastasis were identified as being predictive of nonrecurrence of cancer. A computer model utilizing the variables was compared to the current TNM system and found to be somewhat better (71.2% vs. 65.2%) in accuracy of prediction of nonrecurrence of cancer. Further analysis suggests that future improvements in predictive ability of the model will have to await the identification of new variables such as those that might arise from the current work in areas of flow cytometry or human stem cell cultures.
Otogenic complications with an intact tympanic membrane
Authors: Samuel Julian , Fernandes Carlos M. C.
Published: October 2006

A review of 21 cases of complications of acute otitis media with a hyperemic, dull, bulging but intact tympanic membrane is presented. All cases had a retroauricular swelling.

In 10 cases, a subperiosteal abscess was found, 1 of them complicated with a posterior fossa abscess, 2 had meningitis, 3 had Bezhold's abscess, 2 had thrombosis of the lateral sinus, 1 had a cerebellar abscess, 1 had cerebellitis, and 2 presented with facial nerve palsy. Ninety percent of the patients were below the age of 13.

An incomplete course of antibiotic treatment was found to have been given in seven cases (30%) prior to admission. Surgical therapy consisted of a cortical mastoidectomy and a wide myringotomy. Ventilating tubes were inserted in three patients. The mastoid radiography demonstrated cloudiness, and CT scan was performed in six patients with suspected intracranial complications.

The present study stresses that an intact tympanic membrane with minimal changes may be regarded by the medical profession with a low index of suspicion and can lead to severe otogenic complications. The disease can be masked by an improper antibiotic therapy.
Natural killer cell activity in patients with carcinoma of the larynx and hypopharynx
Authors: Wustrow Thomas P. U. , Zenner Hans‐Peter
Published: October 2006

Natural killer (NK) cells have recently gained much attention as potential effector cells in antitumor and antiviral immune defense mechanisms. The role of NK cells in patients with squamous cell carcinoma has not yet been described. In our study of larynx and hypopharynx cancer patients, no correlation was found with the extent of the disease expressed by the TNM classification or the TNM staging. Furthermore, no change of the spontaneous natural killer cell mediated K562 lysis was shown in advanced malignant disease or in the postoperative period up to 24 months following surgery. When the NK cell activity was compared with two control groups of healthy volunteers, aged 20 to 30 or 55 to 65 years, both with high alcohol and tobacco consumption, no alterations of the killing capacity for K562 targets were observed during aging, with or without a tumor.

NK cell cytotoxicity was significantly lower in tumor draining lymph nodes of the neck than the values found in peripheral blood. In cancer patients as well as in healthy donors, the spontaneous killer cell activity was significantly enhanced by incubation with β‐interferon. The differences, however, between natural killing in peripheral blood and lymph nodes were increased in the head and neck cancer population mainly by an overall reduced NK cell cytolysis in the tumor draining lymph nodes. Although none of the lymph nodes used was infiltrated by malignant cells as seen under microscopic examinations, the diminished NK cell activity in laryngeal and hypopharyngeal cancer patients seems to be caused by factors or the presence of locoregional suppressor cells capable of reducing natural cell mediated immunity.
Oculopharyngeal muscular dystrophy: Recent ultrastructural evidence for mitochondrial abnormalities
Authors: Pratt Michael F. , Meyers Peter K.
Published: October 2006

Oculopharyngeal muscular dystrophy is a rare, autosomal dominant disorder which has been traced through 11 generations of a French Canadian family. The classic presenting complaints are palpebral ptosis and oropharyngeal dysphagia. The dysphagia is usually progressive and leads to repetitive regurgitation, increased alimentation time, and weight loss. Immunologic studies generally reveal elevated levels of IgA and IgG, while manometry demonstrates poor pharyngeal contraction. The dysphagia is frequently relieved by cricopharyngeal myotomy. We present two case reports and also a new ultrastructural finding of abnormal metallic mitochondrial inclusions. This finding has not been previously described in this disorder.
Nasal polypectomy and sinus surgery in patients with asthma and aspirin idiosyncrasy
Authors: English G. M.
Published: October 2006

This study attempted to determine whether or not nasal and sinus surgery had a beneficial or deleterious effect upon the asthma of patients with nasal polyps and aspirin idiosyncrasy. There were 205 patients in this study. A classification system was devised to provide a means of determining the severity of asthma before and after surgery. The data indicate that surgery does improve the patient's asthma for relatively long periods of time.
Hearing aids poststapedectomy: Incidence and timing
Authors: Smyth G. D. L. , Hassard T. H.
Published: October 2006

Ninety‐four percent of 508 patients operated on between 1960 and 1975 have been followed‐up at yearly intervals. Their status as of 1977 was assessed in order to determine their mean duration of socially adequate hearing levels and to relate the type of surgical procedure to the interval between operation and hearing aid requirement. Postoperative hearing losses due to conduction and sensorineural deficits resulted in preoperative bone/postoperative air gaps greater than 10 dB in up to 40% of large fenestra operations and in 15% of small fenestra operations at 5 years. On average, a large fenestra ear would require amplification at 13 years and a small fenestra ear at 21 years postoperatively.
Melanoma of the larynx
Authors: Reuter Victor E. , Woodruff James M.
Published: October 2006

Primary laryngeal melanomas (LM) are rare. In a review of all mucosal melanomas of the head and neck (MMHN) at Memorial Hospital from 1949 to 1983 we identified only three such cases. Review of the literature shows that LM usually involve the supraglottic larynx of elderly males. Although survival is as poor as for other MMHN, local recurrence is less frequent, even when primary therapy consists of more conservative surgical procedures than total laryngectomy.
Inverting papilloma of the nose and paranasal sinuses
Authors: Segal Karl , Atar Eli , Mor Cilia , Har‐El Gadi , Sidi Jack
Published: October 2006

A series of 30 patients with inverted papillomas of the nose and/or the paranasal sinuses is presented. The inverted papilloma is a rare tumor with an overall incidence varying from 0.5% to 4% of all primary nasal tumors. The incidence of inverted papilloma is much more common in the fifth to seventh decades.

An association between inverted papilloma and carcinoma is well established. In the large series of patients, the incidence of malignancy associated with inverted papilloma ranges from 1% to 13%, and in our series 10%.

Treatment of inverted papilloma is always surgical. The incidence of recurrence is directly related to the method of surgical treatment. Among our 20 patients who were treated by limited surgery, there was recurrence in 14 cases (70%). By contrast, medial maxillectomy and ethmoidectomy via lateral rhinotomy reduced the recurrence rate dramatically. In our opinion this approach is the surgery of choice in the treatment of inverted papilloma.
Role of aerobic and anaerobic microorganisms in chronic suppurative otitis media
Authors: Papastavros Theodore , Giamarellou Helen , Varlejides Stratos
Published: October 2006

This study reports results of cultures of drainage from 119 cases with chronic otitis media. Mixed infections were found to occur 30 times more frequently among cholestcatomatous cases compared to noncholesteatomatous. A significant association was found between prior use of gentamicin ear drops and bacterial resistance to the drug.

The role of aerobes and anaerobes in mixed infections of cholesteatomatous ears is discussed. The relevant literature is critically reviewed and the mechanisms of synergistic anaerobic infections of the ear are summarized. The need for animal studies of bacterial pathogenicity and parallel human studies of response to rational medicinal treatment is stressed.
Postoperative evaluation of sleep apnea after uvulopalatopharyngoplasty
Authors: Wetmore Stephen J. , Scrima Lawrence , Snyderman Nancy L. , Charles Hiller F.
Published: October 2006

Uvulopalatopharyngoplasty (UPPP) is an operation that is frequently performed for the treatment of obstructive sleep apnea (OSA). While UPPP usually eliminates or decreases snoring and often reduces excessive daytime sleepiness, the decrease in the number of episodes of apnea and hypopnea, and the improvement in oxygen saturation (SaO2) have been less predictable. We compared preoperative and postoperative polysomnography (PSG) in 27 patients with OSA and found that no single PSG parameter could accurately reflect the changes in respiration seen after UPPP. We suggest that a combination of indices including the apnea index, the apnea and hypopnea index, the frequency and severity of decreases in SaO2, and the lowest SaO2 be used to assess the effect of UPPP. Using this combination we determined that 30% of our patients were markedly improved, 33% were somewhat improved, and 37% were unimproved. To rely soley on the patient's subjective improvement often results in overestimating the therapeutic results of surgery, whereas to rely only on one PSG parameter may underestimate or overestimate the degree of improvement.
Esophageal perforations: the role of computerized tomography in diagnosis and management decisions
Authors: Endicott James N. , Molony Timothy B. , Campbell Gregory , Bartels Loren J.
Published: October 2006

External drainage is indicated when a neck abscess results from esophageal or hypopharyngeal perforation.

Diagnosis, extent of disease, and timing of abscess drainage have traditionally challenged the surgeon in management of the perforated esophagus or hypopharynx. Diagnosis and management decisions are enhanced by use of computerized tomography (CT) as an adjunctive study.

Five specific case presentations feature diagnosis and management.
Bacterial infections of the orbital and periorbital soft‐tissues in children
Authors: Spires James R. , Smith Richard J. H.
Published: October 2006

Periorbital soft‐tissue bacterial infections are relatively common during childhood and with appropriate antimicrobial therapy usually resolve quickly. Orbital soft‐tissue infections, in contrast, are rare and frequently cause serious morbidity. Two hundred forty‐one children with periobital or orbital soft‐tissue infections have been hospitalized since 1962 and constitute the data base for this study. Two hundred twenty‐six children, half under 1 year of age, had periorbital soft‐tissue infections. Response to antimicrobials was prompt and only two children (1%) developed complications. True orbital infections occurred in the remaining 15 children, three of whom were under 6 years of age. Eleven children had orbital cellulitis, 3 had subperiosteal abscesses, and 1 had cavernous sinus thrombosis. Antecedent sinusitis was present in 12 cases and, in seven, effective treatment required surgical drainage in addition to intensive antimicrobial therapy. Three children (20%) developed significant complications.
Comparative study of otologic surgery in outpatient and hospital settings
Authors: Dickins John R. E.
Published: October 2006

The results of nine years' experience with 1,750 otologic surgical procedures are reviewed; 1,110 of these procedures were performed in an outpatient surgical setting and 640 procedures were performed in a general hospital. The results and complications are compared between these two settings. This study includes tympanoplasty, stapedectomy, mastoidectomy, labyrinthectomy, and other otologic procedures. The study is not concerned with minor procedures such as myringotomy. A detailed analysis of results for each type of procedure compares hearing results, graft take rates, and the occurrence of complications in both outpatient and inpatient settings. No significant differences are seen between the results or complications of outpatient and inpatient procedures, thus supporting the use of outpatient surgical settings for most standard otologic procedures.
Cartilage grafting in facial reconstruction with special consideration of irradiated grafts
Authors: Donald Paul J.
Published: October 2006

The search for the perfect facial implant for reconstruction of the face continues. Cartilage, once thought to be an undesirable graft material because of its propensity for absorption, has regained popularity in the past decade. Various preparation techniques have been employed to ensure graft sterility and diminished absorption. An improved understanding of cartilage structure and physiology has shed considerable light on the host‐graft relationship.

Gamma irradiation is a time‐honored method of preservation. An experiment was undertaken to investigate the physiology of irradiated cartilage grafts following prolonged implantation on the facial skeleton of sheep and dog. Merthiolate® preserved grafts were used as controls.

Direct observation, histochemical techniques, autoradiography, and transmission electron micrography were used to determine chondrocyte viability and matrix composition.

It was surprising to note that following implantation of 16 to 72 months, complete resorption was seen in 87.7% of the irradiated grafts and in 43.8% of the Merthiolate®stored controls. Many of the grafts acquired chondrocytes from the host and produced new proteoglycan matrix as well as undergoing some degree of ossification. A comparison to the clinical situation in humans is made.
Extended experimental and preliminary surgical findings with autologous fibrin tissue adhesive made from patient's own blood
Authors: Siedentop Karl H. , Harris David M. , Ham Kevin , Sanchez Ben
Published: October 2006

A surgical tissue adhesive can be made from the patient's own blood. We have been refining the procedures for manufacturing autologous fibrin tissue adhesive to facilitate its use in the operating room and to increase its bonding strength. Fibrin tissue adhesive efficacy depends on fibrinogen concentration. We found that fibrinogen precipitation using the ammonium sulfate method produced the highest concentration. Bonding power was compared with that of the commercial glue 10 minutes and 30 minutes after glueing two pieces of 1 x 1 cm2 human dura together. Bonding strength of the autologous product was close to that of the commercial product. Comparisons of fibrinolysis inhibition time of autologous fibrin tissue adhesive and commercial glue in experiments on rats over a period of one hour to six days after subcutaneous injection are described.

Preliminary surgical experiences using autologous glue in middle ear surgery are presented.
Indications for tracheoesophageal puncture speech rehabilitation
Authors: Mcconnel Fred M. S. , Duck Sigsbee W.
Published: October 2006

Many methods of speech rehabilitation after total laryngectomy have been attempted and abandoned. As experience increased with the tracheoesophageal puncture technique, we found it to be a reliable and reproducible form of speech rehabilitation when certain criteria are met. This study reviews our experience and analyzes the reasons for failure in those populations. Factors analyzed include the evidence of hypopharyngeal stenosis, patient education, XRF, and the flanged prosthesis versus the nonflanged prosthesis. The indications for this type of speech rehabilitation procedure are presented based on our findings.
Prognostic implications of perineural spread in squamous carcinomas of the head and neck
Authors: Soo Khee‐Chee , Carter Richard L. , O'Brien Christopher J. , Barr Lester , Bliss Judith M. , Shaw Henry J.
Published: October 2006

The occurrence and prognostic implications of perineural spread were examined in 239 patients with mucosal squamous carcinomas of the head and neck. Perineural spread was demonstrated in resections from 64 patients (27%), the majority having primary tumors at one of three sites: buccal cavity, larynx, and pharynx. Perineural spread near nodal metastases was uncommon. There was no evidence that perineural involvement was more commonly associated with large tumors or less differentiated ones. No association was established between perineural spread and coexistent lymph node deposits in the surgical resections. Perineural spread was, however, shown to be a statistically significant prognostic factor for an increased incidence of subsequent locoregional recurrence and for decreased survival.
Prospective screening for multiple tumors of the upper aerodigestive tract: A simple routine procedure
Authors: Lau W. F. , Siu K. F. , Wei W. , Lam K. H.
Published: October 2006

Detection of a second primary at the time of initial work‐up of patients with head and neck cancers has an important bearing on management planning. In a 12‐month period, a series of 105 patients with an index head and neck primary (skin malignancies excluded) of the squamous cell type were subjected to the following screening procedure. Under topical anesthesia, with the patient in the sitting position, a small‐size flexible bronchofiberscope (Olympus B3R) was introduced through the nose. As the scope was advanced, the nasal cavity, nasopharynx, oropharynx, hypopharynx, and larynx were examined. The tracheobronchial tree was also examined if the chest x‐ray showed abnormal findings. The endoscope was then passed down to examine the esophagus, with oxygen insufflated via the biopsy channel at a rate of 1 liter per minute.

The index primary sites included the tongue (20), alveolus (7), floor of mouth (2), palate (4), buccal mucosa (3), hypopharynx (17), and larynx (52). There was little patient discomfort and no complication. Nine patients (8.5%) were found to have simultaneous primary tumors including two patients with triple primaries and one with quadruple lesions. The additional tumors were in the following sites: esophagus (6), tonsil (2), floor of mouth (1), nasopharynx (1), bronchus (1), palate (1), and oropharynx (1). The treatment plans were changed in all nine patients with the discovery of multiple tumors.

It is concluded that the panendoscopic screening in the manner described is simple, safe, and convenient and the information is contributory to treatment planning.
Combined rotary door flap and epiglottic laryngoplasty for reconstruction of large laryngotracheal defects in dogs
Authors: Eliachar Isaac , Levine Sam , Broniatowski Michael , Sebek Bruce , Tucker Harvey M.
Published: October 2006

Reconstruction of large laryngotracheal defects may require simultaneous application of more than one surgical technique. This paper reports the advantages gained by combining epiglottic laryngoplasty with the myocutaneous sternohyoid muscle rotary door flap. The two procedures complement each other in achieving structural and functional rehabilitation of extensive defects in the larynx and trachea. Avoidance of intraluminal stents and use of a tracheostomy procedure that does not require an indwelling cannula have yielded improved results.
Magnetic resonance imaging of the fetal temporal bone
Authors: Isaacson Glenn , Mintz Marshall C. , Sasaki Clarence T.
Published: October 2006

Magnetic resonance imaging (MRI) is a powerful new tool for the study of human anatomy and pathology. By various MRI techniques, the structure of the middle and inner ears of aborted 20‐week fetuses is defined and compared to gross anatomic sections. MRI's potential for evaluating temporal bone development and diseases of the ear is discussed.
Plastic bronchitis
Authors: Liston Stephen L. , Porto Dennis , Siegel Leighton G.
Published: October 2006

Plastic bronchitis is an uncommon disease of children characterized by the formation of long, branching bronchial casts. Of three children with such bronchial casts, one developed status asthmaticus and coughed out a complete cast of the tracheobronchial tree. One other child also had a course of desensitization for allergies. Two children presented with what was originally thought to be pneumonitis, but when chest x‐rays were taken, one child was suspected of having an inhaled foreign body, and the other had complete opacification of one lung. When these two children were examined bronchoscopically the tracheobronchial tree was found to be filled with white, cheesy material. This material was extremely hard to remove bronchoscopically as the material was too soft to grab with forceps but too thick to suction. The material extended all the way down into the tertiary bronchi, and in one child multiple bronchoscopies were necessary to remove this material, and even so he developed bronchiectasis. The pathologic examination of these casts showed layers of inspissated mucus and inflammatory cells.
Urogenital tract carcinoma metastatic to the head and neck
Authors: Hessan Howard , Strauss Melvin , Sharkey Francis E.
Published: October 2006

A 9‐year review of our experience with head and neck metastases from 845 urogenital tract tumors of the kidney, prostate, bladder, testicle, spermatic cord, penis, urethra, and ureter was performed. Thirty‐one (3.7%) of these tumors developed metastases to the cervical and supraclavicular lymph nodes, scalp, thyroid gland, thyroid cartilage, parotid gland, retroorbit, mandible, nasal cavity, and paranasal sinuses. Unusual cases and a review of the literature are presented. The frequency of such metastases to the head and neck from various primaries, diagnostic application of current immunohistochemical methodology, and therapeutic alternatives are emphasized.