bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic Pain and Cognitive Behavioral Therapy
Authors: Knoerl Robert , Lavoie Smith Ellen M. , Weisberg James
Published: November 2015

Cognitive behavioral therapy (CBT) is often used to treat chronic pain; however, more information is needed about what are the most efficacious dose and delivery methods. The aims of this review were to determine (a) which CBT doses, delivery methods, strategies, and follow-up periods have been explored in recent intervention studies of individuals with chronic pain and (b) whether the outcomes described in the selected studies were consistent with recommendations by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials. The CINAHL, EMBASE, PubMed, PsycInfo, and SCOPUS databases were searched for randomized controlled trials published from 2009 to 2015 testing CBT for adults with chronic pain. Thirty-five studies were included in this review. Results revealed that CBT reduced pain intensity in 43% of trials, the efficacy of online and in-person formats were comparable, and military veterans and individuals with cancer-related chronic pain were understudied.
A Review of the Efficacy of Systemically Administered Decongestants in the Prevention and Treatment of Otitis Media
Authors: Grundfast Kenneth M.
Published: November 2015

Studies designed to determine the efficacy of alpha‐adrenergic agents and antihistamines in the prevention and treatment of otitis media are reviewed. Although some studies demonstrate a pharmacologic rationale for use of decongestants, results of clinical trials fail to demonstrate conclusively that decongestant medication is effective as primary or adjunctive therapy for otitis media. The clinician is advised to await results of future studies before accepting the notion that the systemic administration of sympathomimetic agents and antihistamines is effective in the treatment of otitis media.
Intracranial Metastases of Squamous Carcinoma via the Mandibular Branch of the Trigeminal Nerve
Authors: Mattox Douglas E. , Brown Willis E. , Holt G. Richard , Story Jim L.
Published: November 2015

Squamous cell carcinoma commonly invades the perineural spaces of adjacent nerves; however, few cases of intracranial spread of tumor along this route have been reported. We present three cases of intracranial spread of squamous carcinoma along the mandibular branch of the trigeminal nerve. These cases illustrate the important clinical manifestations, difficulty of diagnosis, occasional unexpectedly long clinical course, and the difficulty of management of this problem.
Significance of Alkaline Phosphatase and Chemotherapy for Head and Neck Carcinoma
Authors: Burres Steven A. , Jacobs John R. , Peppard Sean B. , Al‐Sarraf Muhyi
Published: November 2015

As an adjunct to surgical treatment and radiation therapy, chemotherapy is becoming another major treatment for head and neck malignancies. While response rates have reached as high as 75% in some series, chemotherapy is time‐consuming, expensive, and not without risk to the patient. If a subpopulation that would benefit from its use could be identified, this new modality could be applied on a more rational and selective basis. Recent work has suggested a prognostic role for serum alkaline phosphatase in carcinoma of the head and neck. In an attempt to verify this work, a study of 101 patients treated with an induction chemotherapy protocol for squamous cell carcinoma of the head and neck was undertaken. Alkaline phosphatase and other variables possibly related to alkaline phosphatase were studied in detail. We are unable to verify a prognostic role for alkaline phosphatase.
Toynbee Revisited: Eustachian Tubal Sonograph
Authors: Wilson Heston L.
Published: November 2015

The eustachian tubal sonograph (ETS) is a modern electronic version of the Toynbee tube. It functions in two ways. It amplifies the sound of ingress of air into the middle ear when the subject swallows; thus the clinician is able to better assess the function of the eustachian tube. It also permanently records the pressure level and duration of the sound of air entering the tympanic cavity during deglutition. Hence the ETS represents an excellent test of eustachian tubal function.
Diagnosis and Management of Drop Attacks of Vestibular Origin: Tumarkin's Otolithic Crisis
Authors: Black F. Owen , Effron Morris Z. , Burns Denise S.
Published: November 2015

Erroneous signals of vestibular origin can cause sudden falls without warning. Drop attacks of vestibular origin in our experience most commonly occurred in patients with late or end‐stage endolymphatic hydrops (usually idiopathic, ie, Meniere's disease). Eponymically termed Tumarkin's otolithic crisis, drop attacks of vestibular origin must be distinguished from drop attacks due to cardiovascular abnormalities, seizure disorders, vertebral basilar arterial insufficiency (transitory brain stem ischemia), multiple sclerosis, and drug‐induced motor control disturbances. The treatment of choice for drop attacks of vestibular origin is either surgical ablation (labyrinthectomy) in the absence of serviceable hearing or middle fossa vestibular nerve section in order to preserve serviceable hearing.
Delicate Scissors for Neuro‐Otologic Surgery
Authors: Luetje Charles M.
Published: November 2015

Standard delicate Bellucci scissors are too short for translabyrinthine and middle cranial fossa nerve VIII sections, for separation of acoustic tumors from cranial nerve VII, and for other techniques requiring microscissors in neuro‐otologic surgery. A delicate scissors, 2 cm longer, has been designed allowing appropriate length. Sharp dissection in the plane between cranial nerve VII and acoustic tumors has improved postoperative facial function.
Office Head and Neck Photography
Authors: May Mark
Published: November 2015

Head and neck disorders may be documented photographically for record keeping by the office practitioner. These photographs serve as a repository of visual teaching aids. A photographic system consisting of the Olympus OM 2 camera, the OM 50 f‐3.5 auto‐macro lens, the flash OM T‐10 ring light, and the OM T‐10 power control, along with details of technique and a method of filing and retrieval, are presented in this report.
The Frey Syndrome: A Simple, Effective Treatment
Authors: Hays Leonard L. , Novack Alvin J. , Worsham Jerry C.
Published: November 2015

The benign but socially embarrassing problem of gustatory sweating and flushing (Frey syndrome) has been studied in the past in search of a simple but effective treatment. Twenty‐two patients participated in clinical trials of glycopyrrolate on an investigational basis, 17 of which have been followed up for four to five years. Double‐blind comparisons of the efficacy and side effects of topical scopolamine (solution and cream) and glycopyrrolate (roll‐on lotion, solution, and cream) are also presented. The use of 1% glycopyrrolate roll‐on lotion and cream were associated with an average of three days of complete control of gustatory sweating and a remarkably low incidence of side effects.
Thymic Cyst of the Neck with Prolongation to the Thymus Gland
Authors: Carpenter Robert J.
Published: November 2015

A cervical prolongation of the thymus gland occurring as an upper cervical mass in a pediatric patient is presented. Embryologic development and modes of presentation of thymic tissue in the neck are reviewed. Thymic cysts are uncommon but important entities because complete surgical removal may require dissection below the clavicle into the superior mediastinum.
Cervical Spine Hemangiomas: Report of a Case
Authors: Harmon J. Douglas , Beveridge Wayne , Gammal Taher EL , Coker Newton J.
Published: November 2015

A cervical spine hemangioma in a 32‐year‐old woman is reported. Because of herniation of the mass between the deep muscles of the posterior triangle, the clinical differential diagnosis was confusing. The lesion required a two‐stage procedure in conjunction with neurosurgical evaluation for total removal. The amount of bone destruction of the spine and exact location of the lesion are graphically displayed in a computed tomography (CT) scan of the neck. An arteriogram showing partial occlusion of the vertebral artery and a myelogram displaying extrinsic spinal cord compression, along with the CT scan, showed the full extent of the lesion.
Giant Cell Tumor of the Ethmoid Sinus: An Unusual Cause of Proptosis in a Child
Authors: Handler Steven D. , Savino Peter J. , Peyster Robert G. , Schatz Norman J.
Published: November 2015

Giant cell tumors (osteoclastoma) occur infrequently in the head and neck and are extremely rare in children. The occurrence of such a lesion in the ethmoid sinus of a 14‐year‐old girl is presented and discussed.
Otolaryngologic Manifestations of Hansen's Disease
Authors: Stevens Michael H. , Nielsen David R.
Published: November 2015

A Mexican migrant farm worker whose condition was previously undiagnosed was examined at the University of Utah Medical Center. He had an unusual peripheral neuropathy, ulcerative and nodular skin lesions, and multiple head and neck complaints. Results of the history, physical examination, and multiple biopsies led to the diagnosis of lepromatous leprosy. Although an uncommon disease in the United States, leprosy remains a common cause of head and neck pathologic conditions in many parts of the world and must be considered in the appropriate clinical setting.
Radiographic Evaluation of the Symptom‐Producing Adenoid
Authors: Crepeau Jerome , Patriquin Heidi B. , Poliquin Jacques F. , Tetreault Leon
Published: November 2015

Adenoid hypertrophy has several variable symptoms. In this study, symptoms were divided into minor and major. A lateral radiograph of the nasopharynx was performed in 114 patients to study the superior and antroadenoid diameters. With proper statistical analysis, a correlation was made between the various clinical groups (scores) and the adenoid measurements. Our results support Hibbert's findings that the antroadenoid width is a better indicator of the symptom‐producing adenoid than adenoid mass measurements with their loosely defined norms. A thorough history and physical examination remain paramount in the diagnosis and management of adenoid hypertrophy.
Experimental Induction of Squamous Metaplasia in the Dog Trachea with Cuffed Endotracheal Tubes
Authors: Severson James M. , Ketter Gary W. , Belson Thomas P. , Paegle Roland D. , Toohill Robert J.
Published: November 2015

Clinical reports cite the development of squamous metaplasia in tracheas following tracheostomy, laryngectomy, and cuffed intubation. The purpose of this study was (1) to develop an experimental model using the dog trachea and study the effects of prolonged cuffed intubation and (2) to determine whether squamous metaplasia is produced by prolonged contact of the endotracheal cuff with the tracheal mucosa. Modifications of widely used high‐volume, low‐pressure 8‐mm endotracheal tubes were made with the distal portion of the tube, its cuff, and the inflating catheter attached. This model formed an implantable cuffed tube approximately 8 cm in length. The dogs remained intubated for 14 days, at which time they were killed; seven animals were available for histologic study. Varying degrees of squamous metaplasia were produced in all animals.
Complications of Carotid Artery Replacement in Head and Neck Neoplasms
Authors: Koopmann Charles F. , Coulthard Stanley W. , Malone James M. , Weinstein Philip R.
Published: November 2015

Carotid artery involvement by neoplastic disease has grave prognostic implications. However, with the advent of postoperative radiation therapy and chemotherapy, carotid artery sacrifice and replacement is more widely performed. In this report the authors discuss their experience with preoperative and intraoperative evaluation of cerebral blood flow and complications of carotid artery replacement.
Open Reduction and Internal Fixation of Mandibular Fractures
Authors: Cohen James I. , Meyerhoff William L.
Published: November 2015

Open reduction and internal fixation of mandibular fractures by intraosseous wiring in conjunction with intermaxillary fixation remains the mainstay of mandibular fracture treatment despite the availability of newer methods. The principles of treatment are reviewed, including indications for use of this technique and its advantages and disadvantages. Various surgical techniques are also reviewed and key points in their application emphasized.
Semipermeable Membrane Tubes: A Prospective Study
Authors: Levinson Stephen R. , Gill Alan J. , Teich Linda
Published: November 2015

Four years ago, we introduced the use of Castelli membrane tubes into our practice. Although initial reports in the literature and restrictions on indications from the manufacturer on use were extremely cautionary, we were able, by careful intraoperative technique and the use of postoperative antibiotics, to expand the use of the membrane tube and offer it to our entire patient population. To document this, we used a prospective study of 124 consecutive ears receiving a membrane tube. Follow‐up study included clinical, audiometric, and tympanometric evaluation. We found the membrane tube to function extremely well in an extremely high percentage of ears, regardless of whether the ear contains serous or mucoid fluid. The advantages of membrane tubes include the lack of special care required, resultant high patient and parental acceptance, and the low incidence of draining ears with tubes in place.
Anatomic Considerations of the Medial Cuts in the Subtotal Temporal Bone Resection
Authors: Neely J. Gail , Forrester Michael
Published: November 2015

Eighteen temporal bones, 20 sets of polytomograms, and two sets of histologically sectioned temporal bones were studied and the literature was reviewed in order to describe the evolution and anatomic detail of the medial limits of the subtotal temporal bone resection used when malignant neoplasia has invaded the middle ear. An en bloc resection requires incisions medial to the pneumatized spaces involved. The anatomy of the lines of resection through the glenoid fossa, medial to the lateral wall of the carotid canal, through the cochlea, internal auditory canal, and jugular bulb, and just lateral to cranial nerves IX, X, and XI was described in detail. Regardless of the techniques employed, or the feasibility of the task, the concept of en bloc resection must conform to the anatomy of the region.
Prosthetic Rehabilitation Following Major Nasal Resection
Authors: Roscoe Gregory , Zini Ivo , Aramany Mohamed A. , Johnson Jonas T.
Published: November 2015

Treatment of extensive carcinoma of the external nose has as an objective the eradication of disease and rehabilitation of the patient. We review our experience with 15 patients treated with total and subtotal rhinectomy. Prosthetic rehabilitation offers prompt recovery of both cosmesis and function without morbidity. We conclude that prosthetic reconstruction of major nasal defects deserves consideration when rehabilitation following rhinectomy is required.
Pigmented Villonodular Synovitis of the Temporomandibular Joint
Authors: Rickert Robert R. , Shapiro Myron J.
Published: November 2015

A 39‐year‐old woman had a large asymptomatic left parotid mass that she had apparently not noticed. The clinical appearance suggested a parotid tumor. Aspirated tissue revealed numerous giant cells, histiocytes, and hemosiderin pigment. At surgical exploration a tumor was found deep to the facial nerve involving the temporomandibular joint, which had a brown‐stained roughened synovial membrane. The resected specimen histologically was a proliferative lesion composed of epithelioid histiocytes, spindle cells, and multinucleated giant cells. The appearance was typical of the family of lesions that includes pigmented villonodular synovitis, bursitis, and tenosynovitis (giant cell “tumor” of tendon sheath). In view of the origin from the temporomandibular joint, reinforced by a characteristic radiologic appearance, we interpret this as a case of pigmented villonodular synovitis. This is the fifth case reported from this site.
Acinic Cell Carcinoma of the Oral Cavity
Authors: Keane William M. , Denneny James C. , Atkins Joseph P. , McBrearty Francis
Published: November 2015

A rare case of acinic cell carcinoma of minor salivary gland origin within the oral cavity is reported in a 62‐year‐old woman. These tumors most commonly arise in the parotid gland and follow an insidious course requiring long‐term follow‐up. The gross and histologic features of the patient's tumor include pseudoencapsulation, mixed solid and acinar architecture, microcyst formation, and the presence of conspicuous diastase‐fast and PAS‐positive cytoplasmic granules, characteristic of lesions that have been called acinic cell carcinoma by a variety of authors. Surgical excision is the treatment of choice. However, following an incisional biopsy, the patient refused further surgical treatment and has remained clinically disease‐free three years postoperatively.
Subclavian Vein Thrombosis Associated with Central Venous Cannulation in Head and Neck Surgery
Authors: Harris Jeffrey P. , Calloway Craig A. , Gordon Bruce R.
Published: November 2015

This study reports our experience with eight cases of subclavian vein thrombosis in patients with head and neck cancer. The extent of patients’ underlying disease, surgical procedures or radiotherapy performed, relationship to central venous catheters, nature of the thrombosis, incidence of emboli, and therapy instituted are examined. Analysis of these cases reveals that 43% (three patients) developed pulmonary emboli despite therapy. Stage IV disease was present in 86% (seven) of the patients in this review. Specific recommendations regarding early recognition, diagnosis, treatment, and possible implications for head and neck surgical procedures are made.
Visually evoked slow eye movements, visual‐vestibular interaction, and infratentorial lesions
Authors: Wennmo Carsten , Henriksson Nils Gunnar , Hindfelt Bengt , PyykkÖ Ilmari , Magnusson MÅNs
Published: November 2015

The maximum velocity gain of smooth pursuit and optokinetic, vestibular, and optovestibular slow phases was examined in 15 patients with pontine, 10 with medullary, 10 with cerebellar, and 5 with combined cerebello — brain stem disorders. Marked dissociations were observed between smooth pursuit and optokinetic slow phases, especially in medullary disease. A cerebellar deficit enhanced slow phase velocity gain during rotation in darkness, whereas the corresponding gain during rotation in light was normal.
Medical Examination of the Sport Scuba Diver
Authors: Becker Gary D. , Parell G. Joseph
Published: November 2015

Prior to training, all scuba diving candidates must successfully complete a medical examination to determine their medical, physical, and psychological fitness for survival in a subaquatic environment. This article reviews the pecularities of the diving medical examination and the reasons for them, suggests absolute, relative, and temporary disqualifications from diving, and outlines a sport diving questionnaire and medical examination.
Facial Keratoacanthoma
Authors: Patterson H. Clifton
Published: November 2015

The keratoacanthoma is a common tumor of hair follicle origin that appears predominantly on sun‐exposed skin of elderly persons. Approximately 80% of the tumors arise on the face. It is characterized by the rapid growth of a painless, dome‐shaped, 10 to 25 mm solitary lesion with a central keratinous plug that undergoes spontaneous involution over 6 to 12 months, leaving behind a puckered scar. Alarming growth and early histologic appearance (pseudocarcinomatous infiltration, cell atypicality, mitoses) are suggestive of squamous cell carcinoma, but biologic behavior and tumor architecture confirm its benign nature. However, evidence that all keratoacanthomas regress is lacking, malignant transformation has been reported, and less than excisional biopsy may render a difficult histologic diagnosis either inconclusive or erroneous, even in expert hands. Excisional biopsy is recommended as expedient and definitive management that offers optimal prognosis. Local flap or full‐thickness graft closure affords cosmetic results that are superior to those provided by other treatment methods.
Sphenoethmoidal Mucoceles with Intracranial Extension
Authors: Close Lanny Garth , O'Conner William E.
Published: November 2015

Mucoceles of the paranasal sinuses are benign, expansile, locally destructive lesions that are thought to occur secondary to obstruction of the sinus ostia. Nasal and/or ocular signs and symptoms are the usual clinical manifestations of mucoceles arising in the ethmoid and sphenoid sinuses, and intracranial extension is rare. We describe three cases of widely destructive sphenoethmoidal mucoceles extending intracranially, with bone erosion and dural exposure in all cases and brain necrosis in one case.
Auditory Brain Stem Response Abnormalities in Patients with Bell's Palsy
Authors: Rosenhall Ulf , Edström Staffan , Hanner Per , Badr Gaby , Vahlne Anders
Published: November 2015

To evaluate the hypothesis of CNS involvement in Bell's palsy, the auditory brain stem responses (ABR) of 31 patients were studied. In nine of these patients ABR abnormalities were found. None of these patients showed evidence of dysfunction of the cochlear nerve. Six of the patients who had abnormal ABR were retested after they recovered from the facial paresis. Five of these patients showed persistent ABR abnormality, and one showed a normalization of the ABR. These results may be consistent with an injury at the brain stem level in some patients with Bell's palsy. The possible causative agent of a reactivation of a herpes simplex virus infection is discussed.
Retrolabyrinthine Vestibular Nerve Section: A Viable Alternative to the Middle Fossa Approach
Authors: McElveen John T. , House John W. , Hitselberger William E. , Brackmann Derald E.
Published: November 2015

Vestibular nerve section, whether by the middle fossa or retrolabyrinthine approach, is effective in relieving intractable vertigo while preserving hearing. However, the potential morbidity and technical difficulty of the middle fossa approach have limited its usefulness. In an attempt to determine if the two approaches produce comparable results, we evaluated 52 patients who underwent retrolabyrinthine vestibular neurectomy between April 1981 and March 1983 at the Otologic Medical Group. We compared their audiometric data and questionnaire responses with published data on patients who had a middle fossa vestibular neurectomy. Although differences between the two procedures do exist, the retrolabyrinthine method, with its 93% success rate in improving or resolving vertigo and its zero incidence of total sensorineural hearing loss, offers the surgeon a strong alternative to the middle fossa approach.
Quantitative Vestibular Testing
Authors: Baloh Robert W. , Sakala Susan M. , Yee Robert D. , Langhofer Laurn , Honrubia Vicente
Published: November 2015

Our standard rotational test battery includes tests of optokinetic nystagmus (OKN), the vestibulo‐ocular reflex (VOR), and visual‐vestibular interaction. Lesions of the peripheral vestibular system characteristically impair only the VOR, whereas lesions of the central system impair OKN and visual‐vestibular interaction. The pattern of abnormal responses can help localize lesions within the central vestibular pathways.
Analysis of Surgical Procedures in Patients with Vertigo
Authors: Silverstein Herbert , Silverstein David
Published: November 2015

The majority of patients with vertigo secondary to inner ear problems can be cured by surgery (80%). The results after neurectomy procedures such as cochleovestibular neurectomy or vestibular neurectomy appear to be much better (85%) than after the endolymphatic subarachnoid shunt procedure (70%). If hearing is worth saving, a conservative procedure should be used first in an effort to preserve the patient's hearing. If this fails, a cochleovestibular neurectomy will usually resolve the problem. At present we are using the retrolabyrinthine vestibular neurectomy as a primary procedure for Meniere's disease, reserving the cochleovestibular neurectomy for those in whom the vestibular neurectomy failed. In elderly patients it appears the Schuknecht cochleosacculotomy may have promise as a first procedure for control of vertigo.
Craniocervical Necrotizing Fasciitis
Authors: Spankus Elizabeth M. , Flint Paul W. , Smith Richard J.H. , Miller Robert H.
Published: November 2015

Craniocervical necrotizing fasciitis (CCNF) is a severe, progressive bacterial infection of the cervical fascia. The most significant manifestations of this disease are extensive fascial necrosis with widespread undermining of the surrounding tissues and extreme systemic toxicity. We are adding three cases to the 29 previously reported cases of CCNF. We will discuss the regional anatomy, focusing on the relationship of the cervical fascial planes to vital structures. Available data suggest that CCNF is a synergistic infection produced in most instances by a combination of facultative anaerobic and obligate anaerobic organisms. Although antimicrobial therapy should provide broad‐spectrum activity against mixed flora, treatment also includes aggressive excision and debridement of involved fascia, subcutaneous tissue, and necrotic skin.
Split‐Rib Graft for Reconstruction of the Mandible
Authors: Wersäll Jan , Bergstedt Hans , Körlof Bengt , Lind Magnus G.
Published: November 2015

Defects in the mandible after tumor surgery were reconstructed with split‐rib grafts in 23 patients. Twenty of the patients were preoperatively irradiated with fractioned radiotherapy, ranging from 40 to 85 gray. Partial sequestration appeared in five patients. The ingrowth of the transplant was examined with technetium scintigraphy. Satisfactory cosmetic and functional results were achieved in the great majority of the patients. Split‐rib grafting is recommended for reconstruction of the mandible as a safe procedure with little increased operation time and morbidity for the patient and good functional and cosmetic results.
The Otolaryngologist's Role in the Craniofacial Anomalies Team
Authors: Holt G. Richard , Watson M. Jane
Published: November 2015

The otolaryngologist has a multifaceted role on the craniofacial anomalies team. The diagnosis and treatment of hearing disorders, both congenital and acquired; maintenance of communication through adequate speech and hearing; management of the airway and deglutition; and reconstructive surgery of the head and neck are the primary responsibilities to children and adults with craniofacial anomalies. The complete evaluation and treatment of these disorders can be both very challenging and very rewarding.
Clinical Aspects of the Branchio‐oto‐Renal Syndrome
Authors: Smith Peter G. , Dyches Timothy J. , Loomis Robert A.
Published: November 2015

The branchio‐oto‐renal syndrome, first defined in 1976, is an autosomal dominant disorder characterized by anomalies of the external, middle, and inner ear in association with preauricular sinuses, branchial cleft anomalies, and varying degrees of renal dysplasia, including aplasia. Less frequently expressed phenotypic abnormalities include lacrimal duct aplasia and the stigmata of renal dysgenesis known as Potter facies. Although the precise incidence of the disorder is unknown, it may be more common than is generally appreciated and appears to be distinct from other autosomal dominant otobranchial syndromes. Features of the syndrome expressed in three members of a family are fully illustrated, and other reported cases are compared with these to emphasize the importance of prompt, comprehensive otologic, head and neck, uroradiologic, and genetic evaluation and management.
Expansion Hyoidplasty: 1983 First‐Place Resident Research Award: Clinical Category*
Authors: Patton Timothy J. , Ogura Joseph H. , Thawley Stanley E.
Published: November 2015

An inspiratory, circumferential, passive collapse of the hypopharyngeal lumen is the mechanism of airway obstruction in some patients with “idiopathic” obstructive sleep apnea syndrome. While permanent tracheotomy has resolved the obstruction and reversed the associated cardiopulmonary sequelae, it is not without complications. The expansion hyoidplasty was conceived as an alternative. The hyoid bone is trisected just medial to each lesser cornu, then held in an expanded position by a permanent brace. The greater cornua with attached middle constrictor and hyoglossus are moved laterally, while the body of the hyoid with attached geniohyoid and genioglossus shifts the base of tongue anteriorly. The procedure is potentially reversible. Twenty dogs were studied before and after hyoid expansion, 10 for superior hypopharyngeal pressure‐volume measurements and 10 for the closing‐pressure study. Pressure‐volume studies demonstrated a consistent expansion of the superior hypopharynx. Deglutition and laryngeal competence were not grossly affected. Reexamination of four animals in the closing‐pressure group 1 year postoperatively demonstrated stability of the hyoid expansion and no evidence of serious parahyoid tissue complications.
Does the Diagnosis of Depression in Head and Neck Cancer Mask Organic Brain Disease?
Authors: Adams Frank , Larson David L. , Goepfert Helmuth
Published: November 2015

Scant attention has been paid to emotional changes as possible symptoms of impaired cerebral functioning in cancer patients. A retrospective study was conducted to determine the variety of organic brain syndromes (OBS) that presented with depressive symptoms in 20 head and neck cancer patients. The impressions of referring surgeons were in error in 16 patients (80%). Twelve (60%) had unsuspected OBS, with treatment resulting in reversal of symptoms in almost half. Of the eight patients with functional disorders, four received a final diagnosis of depression. Head and neck surgeons should be aware that (1) emotional changes in their patients frequently reflect OBS, some potentially reversible, (2) because of the ages of the patients, senile dementia may be a more common occurrence in head and neck cancer than suspected, and (3) because of the difficulties of evaluating changes in higher mental functions, more neuropsychiatric consultations may be warranted for head and neck patients.
Management of Facial Angiofibromas in Tuberous Sclerosis: Use of the Carbon Dioxide Laser
Authors: Bellack Gary S. , Shapshay Stanley M.
Published: November 2015

Facial angiofibromas are estimated to occur in 90% of patients with tuberous sclerosis and can cause considerable cosmetic disfigurement, emotional distress, obstruction of vision, and hemorrhage when abraded. Postoperative wound management associated with skin grafting and dermabrasion is often difficult because patients are mentally retarded and noncooperative. Three patients with extensive facial angiofibromas were treated successfully with the carbon dioxide (CO2) laser, with follow‐up period ranging from 8 to 48 months. Uncomplicated wound healing occurred in each patient with minimal recurrence of lesions. Ablation with the CO2 laser is our treatment of choice for angiofibromas associated with tuberous sclerosis.
Extraparotid Warthin's Tumor
Authors: Snyderman Carl , Johnson Jonas T. , Barnes E. Leon
Published: November 2015

Papillary cystadenoma lymphomatosum (Warthin's tumor) is a benign, slowly growing tumor found almost exclusively in the parotid gland or periparotid lymph nodes. Our experience with 14 cases of extraparotid Warthin's tumor (EPWT) over 22 years is presented. All cases occurred in extraparotid lymph nodes and represented 8.0% of 176 Warthin's tumors accessioned during this time. Fourteen cases of EPWT occurred in 13 patients (seven men and six women) between 41 and 77 years old. Three of the 13 patients (23%) had associated Warthin's tumor of the parotid gland. One of these patients also had a metachronous EPWT presented as a contralateral cervical mass. EPWT was discovered incidentally in six patients (46%) undergoing neck dissections for malignancies of the head and neck. Four patients (31%) presented with clinically evident solitary cervical masses. The embryologic basis for such findings is discussed. EPWT is adequately managed by conservative excision.
Regenerated Middle Ear Mucosa after Tympanoplasty. Part I. Transmission Electron Microscopy
Authors: Gamoletti Roberto , Poggi Paola , Sanna Mario , Zini Carlo
Published: November 2015

The ultrastructural appearance of the regenerated middle ear mucosa—found at the second operation of staged intact canal wall tympanoplasty (ICWT) with mastoidectomy—has been evaluated with the transmission electron microscope. The regenerated epithelium showed all the morphologic characteristics of the normal middle ear mucosa: ciliated cells, noncillated cells, and secretory cells. All of these (Including goblet cells) have been found in the specimens. It is concluded that a normal middle ear mucosa regenerates to cover all denuded bone surfaces after the first operation of staged ICWT with mastoidectomy, when silicone rubber sheeting has been used to prevent adhesions and maintain an air‐containing middle ear space.
Three Dimensional CT Reconstruction for the Evaluation and Surgical Planning of Facial Fractures
Authors: Koltai Peter J. , Wood Gary W.
Published: November 2015

Despite advances in radiology—including CT scanning—the three‐dimensional (3D) nature of facial fractures must still be inferred by the spatial imagination of the physician. A computer system (Insight Phoenix Data Systems, Inc., Albany, N.Y.) uses CT studies as substrate for 3D reconstructions. We have used the insight computer for the evaluation and surgical planning of facial fractures of 16 patients with complex injuries. We present five illustrative cases, directly photographed from the computer monitor. Images can also be manipulated in real time by rotating or planar sectioning (functions best appreciated on video). The ability to cybernetically extract the facial skeleton from living subjects provides precise anatomic data previously unobtainable. The images are valuable for an accurate assessment of the relationship between the injured and uninjured sections of the face. We conclude that 3D reconstruction is an important advance in the treatment of facial fractures.
The effect of butyl 2‐cyanoacrylate on the middle and inner ear of the chinchilla
Authors: Chen Eaton , Harner Stephen G.
Published: November 2015

Butyl 2‐cyanoacrylate was placed on the oval and round window of the ear of the chinchilla and was also used as an adhesive for myringoplasty with autogenous muscle fascia. Butyl 2‐cyanoacrylate was found to be difficult to manipulate and moderately toxic to the middle ear; there were occasional significant reactions in the inner ear.
Coronal Sections of Larynges from Radiationtherapy Failures: A Clinical‐Pathologic Study
Authors: Brandenburg James H. , Condon Kenneth G. , Frank Terrence W.
Published: November 2015

Serial coronal sections of 89 wide‐field laryngectomies were examined. Twenty were specimens obtained from laryngectomies to treat patients for whom primary radiation therapy failed to cure early laryngeal cancer. These specimens were compared to 69 specimens from laryngectomies for T3, and T4, laryngeal cancers. The irradiation‐failure group showed a significantly greater invasion of cartilage and extension into subglottic areas. The extension of tumors along blood vessels and mucous glands appeared to contribute to the spread of tumors in the irradiation‐failure group. These findings have implications for the surgical management of irradiation failures in the treatment of laryngeal cancers.
CO2 Laser Management of Laryngeal Stenosis
Authors: Schmidt Frederic W. , Piazza Leonard S. , Chipman Terri J. , Campbell Bruce H. , Toohill Robert J.
Published: November 2015

The introduction of the carbon dioxide laser as an endoscopic surgical instrument has stimulated interest in its application for removal of stenotic lesions of the larynx. Clinical reports have indicated mixed results in the efficacy of this treatment modality. Nineteen large dogs received acute subglottic injuries from a high‐speed electric drill and electrocautery. All animals developed obstructing lesions from 7 to 21 days after injury. With at least weekly removal of granulation tissue and dilations, all animals developed mature subglottic and/or posterior commissure scars. Two animals required tracheostomy. The 15 animals in the experimental group underwent 16 laser procedures. Three animals had vaporization of one third of the scar, three of one half of the scar, and three had total circumferential vaporization. Five animals underwent microtrapdoor flap procedures. Of these, four had a single flap and one had three separate flaps created. In the remaining animal in the experimental group a glottic web developed, which was totally ablated. In one animal treated with a microtrapdoor flap procedure a posterior sinus tract also developed and was treated with laser ablation. The animals undergoing segmental resection of scar demonstrated no improvement in airway size. Those undergoing total resection experienced a worsening of the condition. Those undergoing microtrapdoor flap repair demonstrated moderate improvement in airway size. It can be concluded that (1) large areas of scar removal in the larynx by the CO2 laser will result in prompt recurrence and possible worsening of the scar and (2) smaller submucosal resection of the scar, with preservation of mucosa by the microtrapdoor flap technique, may be helpful in improving the airway.
Should the Membranous Labyrinth be Destroyed Because of Vertigo?
Authors: Roland Peter S. , Meyerhoff William L.
Published: November 2015

The purpose of this article is to determine if any change has occurred in the role labyrinthectomy plays in the therapeutic armamentarium of members of the American Neurotologlc Society. Questionnaires were sent to all members and 42% of these were returned. Analysis of the questionnaires suggests that labyrinthectomy still remains an important tool in the surgical management of vertigo, although it is less frequently employed now than 10 years ago. This seems to be the consequence of increased valuation of even minimal levels of residual hearing.
Collagen Grafts—Here Today and Gone Tomorrow
Authors: Donald Paul J.
Published: November 2015

The ongoing search for the perfect graft to fill out facial contour defects has frustrated reconstructive surgeons for years. The list of autogenous, homologous, heterologous, and alloplastic materials Is extensive. All implantable materials have one or more classical principal drawbacks: shrinkage, extrusion, infection, absorption, and/or deformation. One of the major mechanisms of graft unacceptability is the phenomenon of tissue immunity and graft rejection. This has traditionally been the major disadvantage of homografts and heterografts. The host's Immune system recognizes the Implant as “non‐self” an antibody‐antigen reaction is triggered—usually by the antigenic stimulation provided by the proteinaceous component of the graft, and the implant is rejected or destroyed. Conversely, autogenous grafts experience the problem of resorption by the action of macrophages and chronic inflammatory cells. The immunologic sterility of alloplastic grafts is an advantage, but the body often rejects even the most Inert materials by the process of chronic inflammation.
Total Temporal Bone Resection for Squamous Cell Carcinoma
Authors: Sataloff Robert Thayer , Myers Donald L. , Lowry Louis Dale , Spiegel Joseph R.
Published: November 2015

Because of unsatisfactory results in treatment of malignant conditions of the temporal bone, a technique for total en bloc resection of the temporal bone and carotid artery was reported by Graham et al. in 1984. The procedure involves resection of the internal carotid artery, cranial nerves VI through XII, and structures adjacent to the temporal bone. Experience with two additional cases led to numerous modifications in the recommended procedure, as reported by Sataloff and Myers. Additional clinical experience with this technique and its complications has resulted in further modification. Additional pitfalls and specific changes in technique from previous reports are discussed in detail, including a new procedure to assure the adequacy of contralateral venous outflow.
Electroneurography: Preoperative Facial Nerve Assessment for Tumors of the Temporal Bone
Authors: Kartush Jack M. , Niparko John K. , Graham Malcolm D. , Kemink John L.
Published: November 2015

Tumors of the temporal bone and cerebellopontine angle may be associated with subclinical facial nerve degeneration, despite clinically normal facial function. To determine if preoperative neurophysiologic testing might predict postoperative facial function after tumor surgery, preoperative facial electroneurography (ENoG) was performed in 82 patients with confirmed tumors of the temporal bone and cerebellopontine angle. In patients with acoustic neuroma, preoperative ENoG amplitude reduction varied directly with tumor size. In addition, a statistically significant association between impaired postoperative facial function and acoustic neuroma size greater than 2.5 cm was found. However, preoperative ENoG amplitude reduction did not accurately predict postoperative facial function. These findings suggest that factors, such as the type and size of tumor, the microanatomic relationship between the facial nerve and the neoplasm, and/or desynchronization of the evoked motor‐unit volley, may effect results obtained with ENoG in this setting.
Ensuring the Safety of Deaf Children in Residential Schools
Authors: Brookhouser Patrick E.
Published: November 2015

In 1983, 75,000 to 90,000 children and youth in the United States had hearing impairments severe enough to warrant some sort of special education, and 28% of that total (i.e., 21,000 to 25,000) were in residential schools. Deaf youngsters in institutional settings are at risk for maltreatment by surrogate caretakers—foster parents or institutional child care workers. Attempts to report the abuse may produce denials by institutional administrators who do not want to believe that children under their care have been abused or who fear serious personal and/or institutional consequences should the abuse report become public. Clearly, steps must be taken to ensure the safety of deaf children being educated in residential institutions. Health providers must assume a special responsibility for detecting and preventing abuse/neglect of handicapped children for whom they are providing medical care on a continuing basis. This article will explore relevant aspects of the present system for delivery of health services to deaf children, as well as present specific strategies for detection, documentation, and prevention of maltreatment of these particularly vulnerable children.
Verrucous Squamous Cell Carcinoma of the Larynx: Evidence for Increased Metastatic Potential after Irradiation
Authors: Edström Staffan , Johansson Sonny L. , Lindström Jörgen , Sandin Ingemar
Published: November 2015

Verrucous squamous cell carcinoma is a rare type of well‐differentiated squamous cell carcinoma with a characteristic morphologic appearance and specific clinical behavior. It has been claimed that this tumor may undergo dedifferentiation after radiotherapy; this will result in a more aggressive behavior. From 1968 to 1980, we have diagnosed and treated 569 squamous cell carcinomas of the larynx. Fourteen of them were reported to exhibit verrucous features macroscopically. These tumors were histopathologically reexamined. All 569 cases were stratified with regard to tumor stage (≤T2 N0 M0) and treatment (irradiation). Six patients of 340 were then diagnosed as having verrucous squamous cell carcinomas, according to the Ackerman criteria. The patients were followed for at least 5 years and regional metastases of poorly differentiated carcinoma developed in at least two patients in the verrucous carcinoma group within 2 1/2 years after full‐dose irradiation. Among the patients with nonverrucous carcinoma, this frequency was estimated to be 3%. This study provides evidence that metastatic spread that occurs after irradiation is approximately 10 times more frequent (p < 0.05) for T1–2 laryngeal verrucous carcinomas, as compared to the common type of squamous cell carcinoma.
Dynamic Rehabilitation of the Paralyzed Face: I. Electronic Control of Reinnervated Muscles from Intact Facial Musculature in the Rabbit
Authors: Broniatowski Michael , Ilyes Laszlo A. , Jacobs Gordon B. , Rosenthal David I. , Maniglia Anthony J. , Tucker Harvey M. , NosÉ Yukihiko
Published: November 2015

An entirely satisfactory solution to dynamic rehabilitation of the paralyzed facial musculature has not yet been found. Recent interest in selective reinnervation of the laryngeal musculature, synchronous with appropriate afferent information, has led us to propose that miniature strain gauges be placed on one or more muscles of facial expression on the intact side to channel electrical signals to the opposite corresponding facial musculature reinnervated via nerve‐muscle pedicles. In order to avoid introducing extraneous factors related to facial motion, this principle was first studied on crossover ansa hypoglossi nerve‐muscle pedicles in New Zealand white rabbits. Surgery was performed on a total of five animals that were under general anesthesia with xylazine and ketamine, through a midline neck incision. The animals were reexplored after 12 weeks, and after verification that reinnervation had taken place, a vertical incision was made under the external canthus, in order to expose the facial nerve. A miniature strain gauge was then sutured on the facial musculature and connected to a central modulating unit that was, in turn, linked to the nerve‐muscle pedicle via a monopolar electrode. Facial wiggle that resulted from direct electrical facial nerve stimulation caused synchronous contraction of all reinnervated strap muscles under study; this was documented on film and through facial and strap muscle activity tracings. Our next step will be to extend this principle to paralyzed facial muscles. If successful, this system could be miniaturized for long‐term implantation in human beings.
The Septal Translocation Procedure: An Alternative to Lateral Rhinotomy
Authors: Sofferman Robert A.
Published: November 2015

Lesions deep in the nasal vault with contiguous sinus involvement often require a lateral rhinotomy for exposure. This procedure affords excellent surgical access, but requires a significant external incision. An alternative sublabial technique, with dislocation of the nasal septum into the opposite nasal passage, provides excellent surgical exposure for these same lesions, while external facial incisions are avoided. The text outlines the surgical technique and representative uses in optic nerve decompression, inverted papilloma, giant rhinolith, angiofibroma, and a variety of nasosinus and nasopharyngeal malignant lesions.
Unilateral Loss of Peripheral Vestibular Function in Patients: Degree of Compensation and Factors Causing Decompensation
Authors: Katsarkas Athanasios , Segal Bernard N.
Published: November 2015

Unilateral surgical ablation of peripheral vestibular function has been suggested for the treatment of a number of diseases that involve vestibular dysfunction. The postoperative distressing symptoms usually subside with time, whereupon the patient is said to have clinically compensated. However, even in well‐compensated patients, the initial symptoms may reappear—under certain conditions that are briefly discussed (decompensation)—and, in addition, vestibular gaze stabilization deficits, (apparently permanent) appear whenever moderately rapid head movements are imposed. Thus, surgical ablation of unilateral peripheral vestibular function should not be considered “a treatment of choice,” and should be performed in only carefully selected cases.