bluuebunny/crossref_metadata_2025 huggingface dataset:
Lymphatics of the Submandibular Space
Authors: DiNardo Laurence J.
Published: November 2003

The detection and management of submandibular metastases are fundamental to the treatment of oral carcinoma. Detailed investigation of submandibular lymphatic anatomy and subsite predilection for metastases, as well as a comprehensive method for submandibular space dissection, have been lacking. This thesis explores submandibular lymphatic anatomy through a review of the literature and cadaver dissections. A standardized lymph node nomenclature and submandibular dissection technique are proposed. Also presented is a report on 41 consecutive patients with floor‐of‐mouth squamous cell carcinoma who were prospectively evaluated and treated. Pretreatment clinical and computed tomography (CT) examinations revealed the detection of submandibular metastases to be more difficult than for the remainder of the neck and not improved by the routine use of CT scanning. Management of the neck was either with surgery, which included complete bilateral level I dissections, or at least 2‐year follow‐up when left untreated. Overall, 39% of patients manifested submandibular disease. The majority of submandibular metastases in this study measured 1 cm or less and most commonly involved the perivascular (primarily prevascular) nodes followed by the preglandular and, previously ill‐defined, deep nodes. These findings are discussed with regard to the rationale for currently used neck dissections.
An Algorithm for Maxillectomy Defect Reconstruction
Authors: Davison Steven P. , Sherris David A. , Meland N. Bradly
Published: November 2003

A maxillectomy defect creates a communication from oral cavity to nasal cavity that may extend to the orbit. Functional deglutition and speech problems with a significant soft tissue deficit ensue. This paper defines the reconstruction options for the spectrum of inferior partial maxillectomy defects to midfaceorbital exonerations. Treatment protocols from maxillectomy patients treated in January 1991 to February 1996 at a major tertiary care institution were reviewed(n = 108). An ascension of care from dental obturator, nonvascularized graft, local flap, regional flap, and free tissue grafts (n = 28) is described. These data and experience were organized to provide a treatment algorithm to assist in presurgical planning for maxillectomy reconstruction.
Supracricoid Partial Laryngectomies in the Elderly
Authors: Laccourreye Ollivier , Brasnu Daniel , Périé Sophie , Muscatello Luca , Ménard Madeleine , Weinstein Gregory
Published: November 2003

A review of the postoperative course, complications, and functional outcome of 69 elderly patients (older than 65 years of age) consecutively managed with a supracricoid partial laryngectomy between 1977 and 1993 is presented. The tumors were glottic and supraglottic in origin in 53 and 16 patients, respectively. A cricohyoidoepiglottopexy, a tracheo‐cricohyoidoepiglottopexy, and a cricohyoidopexy were performed in 48, five, and 16 patients, respectively. Immediate laryngeal, cervical, and medical complications were noted in 5.8%, 10.2%, and 10.2% of patients, respectively. Supracricoid partial laryngectomies never resulted in perioperative or postoperative death. The 5‐year actuarial survival and local control estimates were 68%, and 93.9%, respectively. Late surgical complications included laryngocele, laryngeal stenosis, and pneumonia from aspiration‐related death in 4.3%, 4.3%, and 1.4% of patients, respectively. Completion total laryngectomy, permanent gastrostomy, and permanent tracheostomy were requested in 1.4%, 1.4%, and 2.9% of patients, respectively. Overall a 92.8% laryngeal preservation rate was achieved. Univariate analysis of the potential correlation of different factors with the mortality incidence and causes, the incidence and type of the various complications, and the incidence for postoperative aspiration is presented.
Multiple Primary Malignant Tumors in Patients With Head and Neck Cancer
Authors: Dhooge Ingeborg J. , De Vos Martine , Van Cauwenberge Paul B.
Published: November 2003

Multiple primary tumors are a known phenomenon in head and neck cancer. They are partially responsible for the limited improvement in survival of head and neck cancer during the past 20 years. Only a few prospective data have been published about the incidence of metachronous tumors. The authors prospectively studied 127 patients with squamous cell carcinoma of the head and neck. The overall incidence of second primary tumors was 13.5% (simultaneously, 3%; synchronously, 5.5%; and metachronously, 8%). More than 90% of the recurrences of the first primary tumor occurred within the first 2 years following primary treatment, but the second primary tumors continued to occur gradually in the course of follow‐up. Most of the second primary tumors were discovered because the patients developed symptoms (14/17). Survival after detection of the second primary tumor was poor. The development of a second primary tumor was of equivalent prognosis to a recurrence of the primary tumor. Future directives include the development of more adequate screening methods. Identification of potential early markers for the development of a squamous cell carcinoma at the level of the mucosa at risk and in serum could be of value for the early detection of individuals at risk.
The Odontogenic Keratocyst
Authors: Meara John G. , Shah Samir , Li Kasey K. , Cunningham Michael J.
Published: November 2003

The odontogenic keratocyst (OKC) is a jaw cyst with a proclivity for local invasion and recurrence. This 20‐year retrospective study was conducted to evaluate methods of treatment and recurrence rates. Forty‐nine patients were identified with an average age at presentation of 39.5 years. The molar region of either the mandible or maxilla was the principal primary location; the maxillary antrum was also a common site. The majority of cysts were unilocular and associated with adjacent dentition. Initial therapy was typically enucleation with or without extraction of associated teeth; seven cases of recurrent or second primary odontogenic keratocysts required more extensive surgery. Follow‐up ranged from 1 to 15 years with an average duration of 4.3 years. The overall recurrence rate was 35%, and the average time to recurrence 4 years. A recurrence rate of 60% was documented for patients with basal cell nevus syndrome or a family history thereof. Long‐term follow‐up is necessary following initial OKC treatment. The high rate of recurrence in patients with documented or suspected basal cell nevus syndrome suggests the need for more aggressive initial surgical management in this selected patient population.
Attenuation of Neomycin Ototoxicity by Iron Chelation
Authors: Conlon Brendan J. , Perry Brian P. , Smith David W.
Published: November 2003

Increasing evidence suggests that aminoglycoside ototoxicity is mediated by the formation of an aminoglycoside‐iron complex and that the creation of this complex is a preliminary step in generation of free radical species and subsequent hair cell death. In this study we have assessed the ability of the iron chelator deferoxamine to attenuate the hearing loss induced by an ototoxic dose of the aminoglycoside neomycin (100 mg/kg per day for 14 days). Experiments were carried out on pigmented guinea pigs weighing 250 to 300 g. Changes in auditory sensitivity were characterized by monitoring shifts in compound action potential(CAP) thresholds, recorded through indwelling electrodes implanted at the round window, vertex, and contralateral mastoid. Results show that animals receiving neomycin alone suffered a mean threshold shift exceeding 35 dB at all test frequencies (2.0, 4.0, and 8.0 kHz) 30 days after initiation of treatment. In comparison, all animals receiving cotherapy of neomycin and deferoxamine (150 mg/kg twice daily for 14 days) maintained their CAP threshold, suggesting significant protection from neomycin ototoxicity. A statistical comparison of treatment groups showed that in the animals receiving cotherapy with neomycin and deferoxamine, deferoxamine produced a significant protective effect against neomycin‐induced ototoxicity (P < 0.001). These results provide further evidence of the intrinsic role of iron in aminoglycoside ototoxicity and suggest that deferoxamine may have a therapeutic role in attenuating the cytotoxic action of aminoglycoside antibiotics.
Epistaxis Originating From Traumatic Pseudoaneurysm of the Internal Carotid Artery: Diagnosis and Endovascular Therapy
Authors: Chen Dasun , Concus Adriane P. , Halbach Van V. , Cheung Steven W.
Published: November 2003

Posttraumatic pseudoaneurysm of the internal carotid artery (ICA) is an uncommon but potentially fatal cause of epistaxis. Because the onset of delayed bleeding from the time of injury is variable, prompt diagnosis of cavernous ICA pseudoaneurysm is often a clinical challenge. The relative urgency to evaluate for this disease is highlighted by the morbid nature of this entity. Optimal management demands rapid recognition and treatment to give the best functional outcome. The authors present a case series of six patients with skull base ICA pseudoaneurysm. A unifying feature in the majority of patients is the development of delayed, massive epistaxis. The time course for presentation of delayed life‐threatening epistaxis ranged from 5 days to 9 weeks. Two patients exhibited the classic triad of unilateral blindness, orbital fractures, and massive epistaxis. All patients requiring intervention were successfully treated with endovascular embolization techniques that included detachable balloons and coils. The clinical and radiologic findings in this case series are presented. The relevant anatomy, diagnosis, and treatment of traumatic ICA pseudoaneurysm are reviewed. A contemporary treatment strategy is proposed.
Reflex Sympathetic Dystrophy of the Face: Current Treatment Recommendations
Authors: Arden Richard L. , Bahu Samer J. , Zuazu Marcos A. , Berguer Ramon
Published: November 2003

Reflex sympathetic dystrophy (RSD) of the face is an infrequently reported clinical pain syndrome characterized by dysesthesia, hyperalgia, hyperpathia, and allodynia. Treatment strategies, extrapolated from RSD and causalgia of the extremities, remain variable and poorly defined. Sympathetic blockade is generally the diagnostic and therapeutic treatment of choice; however, the frequency, timing, and duration of injections; need for neurolytic blocks; and role of sympathectomy are not well understood. The objectives of this report are to highlight the clinical behavior of facial RSD and contrast its essential differences from extremity RSD in response to standard treatment regimes. The case studies of two patients with this syndrome, following vascular surgery in the neck, are retrospectively reviewed with existent reported cases. Age, gender, etiology, symptoms, onset, triggers, and examination findings; timing, duration, and method of treatment; and outcome are summarized, forming the database for this study. Findings demonstrate an infrequent association of vasomotor and sudomotor changes with facial RSD, and lack of progression to a dystrophic or an atrophic stage, in contrast to extremity RSD. Furthermore, treatment response to sympathetic blockade is durable and less critically dependent on timing. The authors conclude that facial RSD has a favorable prognosis and should be managed conservatively with nonneurolytic stellate ganglion blocks, even when initiated as a delayed and repetitive injection series.
Diagnosis of Head and Neck Precancerous Lesions in an Animal Model Using Fluorescence Spectroscopy
Authors: Dhingra Jagdish K. , Zhang Xia , McMillan Kathleen , Kabani Sadru , Manoharan Ramasamy , Itzkan Irving , Feld Michael S. , Shapshay Stanley M.
Published: November 2003

Laser‐induced fluorescence (LIF) of tissues depends on their biochemical and histomorphologic characteristics. LIF spectroscopic properties of 9,10‐dimethyl‐1,2‐benzanthracene (DMBA)‐induced precancerous and early cancerous lesions in a hamster buccal pouch mucosa model were studied. Fluorescence spectra from neoplastic lesions showed a characteristic fluorescence peak in the red region of the visible spectrum centered between 630 and 640 nm when excited with 410‐nm light. Using this as a diagnostic criterion, 45 of 49 lesions studied were correctly diagnosed, including early dysplastic lesions. Follow‐up study of four dysplastic lesions over 2 weeks revealed an increase in red fluorescence intensity. The findings of these experiments suggest that LIF spectroscopy may be a valuable noninvasive technique not only for early diagnosis of head and neck cancer, but also to probe a possible biochemical surrogate biomarker in the follow‐up of suspected lesions.
Relative Accuracy of Fine‐Needle Aspiration and Frozen Section in the Diagnosis of Well‐Differentiated Thyroid Cancer
Authors: Mulcahy Maureen M. , Cohen James I. , Anderson Peter E. , Ditamasso John , Schmidt Waldemar
Published: November 2003

The need for and extent of thyroid surgery for a thyroid nodule is usually primarily based on fine‐needle aspiration (FNA) and frozen section diagnosis. The relative role of these modalities in 66 patients who had undergone FNA and subsequent thyroidectomy with frozen section was investigated. Cases that demonstrated discordance between FNA and frozen section (n = 22; 33%) were identified, and all slides were re‐reviewed by a cytopathologist using current established cytologic criteria. A change in diagnosis was made in 13 cases with an increase in accuracy of FNA from 71% to 88%. The accuracy of frozen section (92%) did not change appreciably with re‐review (94%). The accuracy of FNA and frozen section combined was found to be 98%. The rate of discordance decreased from 33% to 13% with re‐review. When strict histologic and cytologic criteria are applied, FNA and frozen section are accurate and complementary methods that help in determining the operative management of thyroid masses. However, when FNA yields a diagnosis of “follicular neoplasm,” frozen section is unlikely to change this diagnosis.
Lipoperoxidation As a Measure of Free Radical Injury in Otitis Media
Authors: Haddad Joseph
Published: November 2003

Free radical damage, as evidenced by lipoperoxidation, has previously been demonstrated to contribute to the inflammatory changes associated with acute otitis media. The present study was undertaken to evaluate whether lipoperoxidation continues to be present for a period of time after middle ear infection. Eighty‐two 300‐ to 400‐g guinea pigs were injected with Streptococcus pneumoniae in the left ear and sterile saline in the right ear as a control. Animals were examined and sacrificed on day 5, 10, 20, or 30; middle ear mucosa was harvested and assayed for lipid hydroperoxide content. A statistically significant increase in lipoperoxidation was seen at each time point studied, compared with controls. Lipoperoxidation was highest at days 5 and 10; a significant decrease was seen at days 20 and 30. Histologic sections of middle ear mucosa of two animals per group were prepared and evaluated for inflammation. These results demonstrate that lipoperoxidation may contribute to middle ear inflammation for a significant period of time after acute infection; the findings are discussed in light of other work on the role of free radicals in otitis media.
Hearing Results With the Dornhoffer Ossicular Replacement Prostheses
Authors: Dornhoffer John L.
Published: November 2003

The “ideal” prosthesis for ossicular reconstruction should, from a surgical standpoint, require easy manipulation, reduce surgeries to partial or total variants, and be constructed of stable, biocompatible material. From an acoustic standpoint, a prosthesis should weigh 10 to 40 mg, provide proper tension between the tympanic membrane (TM) and stapes, form less than a 30‐degree angle with the TM, and accommodate the malleus. Work was conducted with Smith & Nephew Richards, Inc. (Memphis, TN), to develop a partial ossicular replacement prosthesis (PORP) and a total ossicular replacement prosthesis (TORP) that combined the majority of these features. This retrospective study used a computerized otologic database to identify patients implanted with a Dornhoffer HAPEX PORP or TORP from June 1995 to March 1997. The surgical procedures utilizing these prostheses were primary cholesteatoma and revision surgery of previously performed modified or radical mastoidectomies complicated by poor hearing or chronically draining cavities. Preoperative and postoperative air and bone conduction four‐frequency (500, 1000, 2000, and 3000 Hz) puretone averages (PTAs) were used to calculate the PTA air‐bone gaps (ABGs). Results in 52 cases (follow‐up, 1 year) showed a statistically significant improvement in hearing (P < 0.05) for each group. Excellent hearing results (≤10 dB PTA‐ABG) were seen in 69% of PORP cases and in 35% of TORP cases, and good results (11 to 20 dB PTA‐ABG) were seen in 31% and 50% of PORP and TORP cases, respectively. Designing an ossicular replacement prosthesis with both surgical and acoustic factors in mind has led to encouraging short‐term hearing results.
Optimization of Speech Processor Fitting Strategies for Chinese‐Speaking Cochlear Implantees
Authors: Sun John C. , Skinner Margaret W. , Liu S. Y. , Wang Frances N.M. , Huang T. S. , Lin Tai
Published: November 2003

Objectives: To compare speech recognition performance in Chinese‐speaking cochlear implant patients with a speech processor program selected by the clinical audiologist in Taiwan and with a new speech processor program based on the Washington University clinical procedure developed by Skinner et al.

Study Design: Six adult Chinese‐speaking patients implanted with the Nucleus cochlear implant system participated in this study.

Methods: A fitting procedure developed in 1995 by Skinner et al. at Washington University School of Medicine was used to create a new speech processor program to optimize each patient's hearing in everyday life. Speech tests (vowels, consonants, tones, and words), sound‐field thresholds, and a self‐report questionnaire were used to evaluate each patient's performance with his or her previous speech processor program and a new one.

Results: Four of the six patients had significant changes from the previous to the new speech processor program. These changes were associated with improvement in score on at least one speech test, more sensitive sound field thresholds, and reported improvement in some everyday listening situations on the questionnaire.

Conclusions: These results suggest that use of this procedure with adult cochlear implantees may improve benefit in everyday life. Analysis of the speech test stimuli and patients' responses provides a basis for modification or creation of new Mandarin Chinese speech tests for preoperative and postoperative evaluation of adult cochlear implant patients.
Blood Distribution in the Facial Nerve in Temporal Bones Acquired From Cases With Subarachnoid Hemorrhage
Authors: Kishimoto Seiji , Saito Haruo
Published: November 2003

The objectives of this study, conducted in eight temporal bones from five autopsied cases of subarachnoid hemorrhage, were to delineate the communication between the cerebrospinal fluid space and each space of the epineurium, perineurium, and area surrounding the nerve fibers in the facial nerve and to identify the site of hypertonic diuretic solution infusion most likely to decrease the facial nerve swelling at the initial stage of facial palsy. In all eight specimens, blood cells had directly entered into each space from the labyrinthine segment of the facial nerve. The subarachnoid space extended to the first genu of the nerve. The genu, which is the site of the initial lesion in Bell's palsy, is concluded to be the most effective site of intracanal decompression of the facial nerve with hypertonic diuretic solution.
Mitochondrial DNA Deletion Is a Predisposing Cause for Sensorineural Hearing Loss
Authors: Ueda Narihisa , Oshima Takeshi , Ikeda Katsuhisa , Abe Koji , Aoki Masashi , Takasaka Tomonori
Published: November 2003

Composed of a postmitotic stable tissue, the inner ear is a target organ for mitochondrial DNA (mtDNA) mutation. To determine whether mtDNA mutation is a predisposing factor in patients with sensorineural hearing loss (SNHL), the authors assessed the mtDNA4977 deletion from 60 patients with SNHL and 47 normal control subjects. All cases had no past history of ototoxic or noise exposure, middle ear disease, or other known etiological factors for SNHL. DNA specimens extracted from peripheral blood leukocytes were used for detection of mtDNA4977 deletion by polymerase chain reaction. Patients with SNHL had a significantly higher rate of the mtDNA4977 deletion than did controls (75% vs. 30%, P < 0.0001). The detection rate of mtDNA4977 deletion was significantly increased with the deterioration of the hearing threshold. Aging did not influence the detection rate of mtDNA4977 deletion in either the control or SNHL group. The authors have described high detection rates of the mtDNA4977 deletion in patients with idiopathic bilateral SNHL and propose that at least some of the advanced SNHL cases should be categorized as mitochondrial oxidative phosphorylation diseases. This inference would offer novel possibilities for treatment and prevention of SNHL including presbycusis.
Pseudoepitheliomatous Hyperplasia Versus Squamous Cell Carcinoma of the External Auditory Canal
Authors: Gacek Mark R. , Gacek Richard R. , Gantz Bruce , McKenna Michael , Goodman Max
Published: November 2003

Four case reports are presented to demonstrate the clinical and histopathologic similarity of pseudoepitheliomatous hyperplasia (PH) to squamous cell carcinoma (SCC) in the external auditory canal (EAC). In all four cases the original report of SCC on a biopsy specimen of an EAC lesion was corrected on review to PH. In one patient conservative management resulted in resolution of the EAC lesion. A second patient underwent radiation therapy and partial temporal bone resection with no SCC found in the surgical specimen. A third patient's ear canal had healed with conservative treatment and repeated biopsy revealed no malignancy. After a 6‐year symptom‐free interval, she developed invasive SCC with bone involvement that required surgery and radiation treatment. A fourth patient underwent a sleeve resection of the skin of the EAC that proved to be PH, and no evidence of SCC was found. A thoughtful clinical history, careful physical examination, response to conservative treatment, and close communication with the pathologist should be exercised in the evaluation of EAC lesions.
Immunohistochemical Analysis of Proliferating Cells in a Sterile Labyrinthitis Animal Model
Authors: Chen Mien‐Chi , Harris Jeffrey P. , Keithley Elizabeth M.
Published: November 2003

Inflammatory reactions within the cochlea lead to the formation of fibrotic tissue and bone. To determine which cells are involved in the proliferation of the inflammatory response within the cochlea, sterile labyrinthitis was created by inoculating keyhole limpet hemocyanin (KLH) into the scala tympani of systemically sensitized animals. Cellular proliferation was assessed immunohistochemically using the monoclonal antibody Ki‐67. Proliferating cells were identified among inflammatory cells and fibroblasts within the matrix, as well as in endosteal cells lining the scala tympani. Inflammatory and potential osteoprogenitor cells were labeled as late as 6 weeks after inoculation, suggesting the absence of a strong immunosuppressive mechanism. Endosteal cells may proliferate and secrete the extracellular matrix used by the inflammatory cells to move within the cochlear scalae. They may also participate in the ossification of the inflammatory matrix.
Quantitative Cytology of Nasal Secretions With Perennial Allergic Rhinitis in Children: Comparison of Noninfected and Infected Conditions
Authors: Shinogi Jun , Majima Yuichi , Takeuchi Kazuhiko , Harada Teruhiko , Sakakura Yasuo
Published: November 2003

This study was performed to quantify the number of inflammatory cells in nasal secretions from pediatric patients with perennial allergic rhinitis under noninfected and infected conditions. Nasal secretions were obtained from seven children under both noninfected and infected conditions with perennial allergic rhinitis to house dust mites, and secondary quantitative cytology was performed on the secretions. The number of neutrophils under infected condition was significantly higher than that under noninfected condition (P < .05), whereas the number of eosinophils in infected condition was significantly lower than that in noninfected condition (P < .05). The ratio of eosinophil count to neutrophil count was more than 0.1 in noninfected condition. The ratio was significantly decreased in infected condition (P < .02). These results suggest that the distribution of inflammatory cells in the nasal mucus of children with allergic rhinitis would be modified under infected condition.
Malignant Transformation of Recurrent Respiratory Papillomatosis Associated With Integrated Human Papillomavirus Type 11 DNA and Mutation of p53
Authors: Rady Peter L. , Schnadig Vicki J. , Weiss Raymond L. , Hughes Thomas K. , Tyring Stephen K.
Published: November 2003

Recurrent respiratory papillomatosis (RRP), usually confined to the nasopharynx, trachea, and larynx, occasionally can progress to extensive bronchopulmonary disease. Most cases of bronchopulmonary and laryngeal papillomatosis are cytologically benign and do not undergo malignant transformation; however, squamous cell carcinoma (SCC) can arise in RRP in the absence of known risk factors such as radiation and smoking. In this study, the authors investigated molecular genetic alterations occurring in a case of metastasizing SCC that arose in long‐standing bronchopulmonary papillomatosis. Genomic DNA from tracheal papillomata, tracheobronchial papillomata, SCC of the lung, and a lymph node metastasis was extracted. The physical state of the human papillomavirus type 11 (HPV‐11) DNA was investigated by two‐dimensional gel electrophoresis. Molecular genetic alterations of the host genome were studied by direct sequencing of polymerase chain reaction‐amplified gene fragments and restriction fragment length polymorphism (RFLP) analysis. Episomal and integrated forms of HPV‐11 sequences were detected in histologically benign tumors, but only the integrated form of the viral DNA could be found in malignant tissue samples. Molecular genetic studies revealed that an allelic loss of the interferon‐β gene (IFNβ‐1) and an endogenous type of mutation of the p53 antioncogene were found only in the malignant lesions. Mutations were not observed in the ras, neu, or multiple tumor suppressor (MTS1/p16) genes in any specimens. The authors' data indicated that the p53 genetic mutation was associated with integration of HPV‐11 in histologically malignant lesions. This association may promote a progressive genetic instability that can lead to the development and clonal expansion of malignant lesions in RRP.
Contemporary Presentation and Management of a Spectrum of Mastoid Abscesses
Authors: Spiegel Jeffrey H. , Lustig Lawrence R. , Lee Kelvin C. , Murr Andrew H. , Schindler Robert A.
Published: November 2003

Background: The incidence of complications resulting from suppurative otitis media has significantly decreased since the introduction of antibiotics. At the start of the 20th century 50% of all cases of otitis media developed a coalescent mastoiditis. By 1959, the incidence had fallen to 0.4%. Recent studies suggest a current incidence of only 0.24%. Additionally, during the time of Friedrich Bezold (1824‐1908), 20% of patients with mastoiditis developed subperiosteal abscess. Interestingly, this has incidence increased; today nearly 50% of patients diagnosed with coalescent mastoiditis have subperiosteal abscess.

Objective: To review the contemporary presentation, diagnosis, and management of a spectrum of mastoid abscesses.

Design: Retrospective case series.

Setting: Hospitals associated with the Department of Otolaryngology/Head and Neck Surgery at the University of California, San Francisco.

Patients: Three patients with mastoid abscesses are reported. One patient displayed “classic” Bezold's abscess, with pus escaping the mastoid near the incisura digastrica and tracking along the digastric and sternocleidomastoid muscles into the neck. The second and third patients exhibited temporoparietal swelling secondary to mastoid abscess eroding the root of the zygomatic process, a complication noted by Bezold in 1908 as occurring “in only very rare cases.”

Results and Conclusions: Since only one third of patients show pathologic tympanic membrane changes, and since complaints of otalgia, fever, and tenderness are inconstant, subperiosteal mastoid abscess is frequently a delayed diagnosis. The clinical presentation, pathogenesis, and routes of abscess spread are presented with photographic and radiographic illustration. Medical and surgical management is reviewed, and methods for accurate diagnosis are emphasized.
Subglottic Injury, Gastric Juice, Corticosteroids, and Peptide Growth Factors in a Porcine Model
Authors: Yellon Robert F. , Szeremeta Wasyl , Grandis Jennifer R. , Diguisseppe Patricia , Dickman Paul S.
Published: November 2003

Objectives:To study the effects of mucosal injury, gastric juice, and corticosteroids and to determine the presence of peptide growth factors in the subglottic mucosa in a porcine model.

Study Design:Prospective cohort animal study.

Methods:In this model of subglottic injury, five groups (n = 5 each) of piglets were used. Injury was induced by electroeautery (acute), electrocautery plus repeated saline application (chronic), electrocautery plus repeated gastric juice application (chronic plus gastric juice), or repeated gastric juice application (gastric). Control piglets had normal saline applied repeatedly.

Results:Histopathologic findings for the gastric juice group included basal cell hyperplasia (80%), squamous metaplasia (80%), and mucosal ulceration (40%). Control piglets showed squamous metaplasia (80%) but no basilar hyperplasia or ulceration. Immunohistochemistry detected peptide growth factors and epidermal growth factor receptor (EGFR) in all groups. Decreased staining was most frequent in the acute injury group. Quantitative reverse transcriptase polymerase chain reaction (RT‐PCR) documented lower expression of EGFR in the gastric juice group (P= .01).

Conclusions:These findings suggest that peptide growth factors and EGFR are part of normal subglottic mucosal turnover. Noxious stimuli decrease production of these factors. Gastric juice had adverse effects documented by histopathology and molecular techniques.
Objective Measures of Laryngeal Function After Reinnervation of the Anterior and Posterior Recurrent Laryngeal Nerve Branches
Authors: Peterson K. Linnea , Andrews Robert , Manek Akshay , Ye Ming , Sercarz Joel A.
Published: November 2003

Previous research indicates that separate reinnervation of the anterior and posterior branches of the recurrent laryngeal nerve (RLN) can provide purposeful motion of the larynx, even after transplantation. This canine study was undertaken to better determine the results of RLN reinnervation after nerve transection distal to its bifurcation. This approximates ideal conditions for transplantation, because potential rejection and nerve branch mismatch are eliminated. Eight months after nerve repair, video, electromyographic, mechanical, and histologic data were collected on four canines. Results show return of appropriate motion without synkinesis, including purposeful abduction on endotracheal tube occlusion. Abductory function was weaker on the reinnervated side, but adduction was equal or stronger on the reinnervated vocal cord. These results indicate that this method of RLN reinnervation produces consistent, strong physiologic motion in the denervated larynx.
Posterior Laryngeal Clefts: Preliminary Report of a New Surgical Procedure Using Tibial Periosteum As an Interposition Graft
Authors: Garabedian Eréa‐Noël , Ducroz Vincent , Roger Gilles , Denoyelle Françoise
Published: November 2003

Objective: To present the preliminary results of a new surgical procedure for posterior laryngeal cleft repair.

Design: Retrospective study in an academic tertiary care center.

Method: The study included three male patients (age at surgery, 2, 13, and 14 mo). One presented with severe aspiration and cyanotic attacks, the two others with aspiration and recurrent chest infections. The types of laryngeal clefts included complete cleft of the cricoid with varying degrees of tracheal involvement but not further than the first six tracheal rings. Associated malformations included one VATER syndrome, one esophageal atresia, and one tracheoesophageal fistula. Surgery was performed under general anesthesia with nasotracheaI intubation. A vertical anterior laryngofissure was performed. The mucosal margins of the clefts were incised and then repaired in two layers with polyglactin sutures. The original feature of this procedure was the interposition of a small piece of tibial periosteum between the two layers. This fascia graft is known to be strong and resistant in cleft palate surgery.

Main Outcome Measure: Clinical and endoscopic follow‐up was used for evaluation of results.

Results: The three patients had successful laryngeal repair at a mean follow‐up of 6 months (range, 4‐14 mo).

Conclusion: The anterior laryngofissure provides a good surgical access to the cleft. The interposition of tibial periosteum allows durability of the cleft repair. A longer follow‐up is needed to confirm these preliminary results. A computed tomography scan study and a study on the rabbit are planned in order to evaluate the outcome of these periosteal grafts.
A 585‐nanometer pulsed dye laser treatment of laryngeal papillomas: Preliminary report
Authors: Mcmillan Kathleen , Shapshay Stanley M. , McGilligan J. Anthony , Wang Zhi , Rebeiz Elie E.
Published: November 2003

Objectives/Hypothesis: Standard management of recurrent respiratory papillomatosis (RRP) currently consists of CO2 laser microsurgical ablation of papillomas. Because of the recurrent nature of this viral disease, patients are often faced with significant cumulative risk of soft tissue complications. As a minimally traumatic alternative to management of RRP, we have investigated the use of the 585‐nm pulsed dye laser (PDL) to cause regression of papillomas by selective eradication of the tumor microvasculature. Study Design: Nonrandomized prospective pilot study. Methods: Patients with laryngeal papillomas were treated with the PDL at fluences of 6 J/cm2 (double pulses per irradiated site), 8 J/cm2 (single pulses), and 10 J/cm2 (single pulses), at noncritical areas within the larynx, using a specially designed micromanipulator. Lesions on the true cords were treated with the CO2 laser, using standard methodology. Results: Clinical examination of three patients treated to date showed that PDL treatment appeared to produce complete regression of papillomas. Unlike the sites of lesions treated by the CO2 laser, the epithelial surface at the PDL treatment sites was preserved intact. Conclusions: These preliminary results suggest the PDL may eradicate respiratory papillomas with minimal damage to normal laryngeal tissue. Further analysis of the ongoing study is required to demonstrate potential benefits of the technique.
Strap muscle neurovascular supply
Authors: Wang Robert C. , Puig Christine M. , Brown Deanna J.
Published: November 2003

Objectives/Hypothesis: Knowledge and preservation of the neurovascular supply to strap muscles, such as the sternohyoid (SH) muscle, used in laryngotracheal reconstruction are important in preventing loss of tissue and bulk from ischemia and/or denervation. Study Design: Arteriovenous and neural supply variations to the strap muscles were examined in cadaver specimens. Methods: Strap muscle neurovascular supply was studied in 16 cadavers, including one transparent corrosion cast specimen with injected vessels. Results: For the upper SH and upper belly of the omohyoid (OMO), the arterial supply consistently arose from a branch of the superior thyroid artery (STA) most commonly terminating at the cricothyroid membrane. The inferior SH was supplied by the inferior thyroid artery. The ansa cervicalis innervated the SH inferiorly with a branch below the loop. Each arterial branch to the muscles had an accompanying venous tributary. The corrosion cast specimen demonstrated that the arterial lumen diameters were almost threefold larger in branches entering the upper SH, compared with the lower SH or OMO. Small intramuscular arteries without axial supply were found within the middle third of the upper SH, the lower SH, and the upper OMO. Conclusions: It is possible to preserve neurovascular integrity in an inferiorly based SH flap. The superior and medial borders are released, with dissection of vascular supply laterally and deep to the muscle, and preservation of the inferior terminal ansa branch.
Nodal disease in purely glottic carcinoma: Is elective neck treatment worthwhile?
Authors: Yang Caroline Y. , Andersen Peter E. , Everts Edwin C. , Cohen James I.
Published: November 2003

Objective: Although there is a generalized understanding of the relatively low overall incidence of nodal disease from purely glottic carcinoma, the exact role for elective neck treatment in the management of this disease remains controversial. The purpose of this study was to identify the incidence of occult nodal disease (including paratracheal) in patients who have glottic carcinoma without significant extra‐glottic extension and to identify which patients are at risk for this. A retrospective chart review of 92 such patients who had either undergone neck dissection or been observed for a minimum of 2 years was performed. Results: For the 92 patients, neck treatment consisted of observation in 68 patients, paratracheal node dissection in four, unilateral neck dissection in four, unilateral neck dissection and excision of paratracheal nodes in 14, and bilateral neck dissection with paratracheal node excision in two. Of the 24 nodal dissections performed, four were positive for occult metastatic disease. No patient in the observation group developed nodal disease. Conclusion: The incidence of occult nodal disease in NO glottic carcinoma is low, 0% in early stage disease (T1–T2) and 19% in late stage disease (T3–T4). Nodes at highest risk included only the paratracheal, level II, and level III. Elective neck treatment should only be undertaken for advanced (T3–T4) disease and even then is of questionable benefit. If undertaken, it should have a low potential morbidity, such as selective neck dissection or radiation. Computed tomography was not useful in staging the neck for this subset of patients.
A functional anatomic study of the relationship of the nasal cartilages and muscles to the nasal valve area
Authors: Bruintjes Tjasse D. , Van Olphen Adriaan F. , Hillen Berend , Huizing Egbert H.
Published: November 2003

The functioning of the nasal valve area is largely determined by the stability and the mobility of the lateral nasal wall. To gain insight into the kinematics of the lateral nasal wall, we studied the functional anatomy of the nasal muscles and the intercartilaginous and osseous‐cartilaginous junctions. We performed gross and microscopic nasal dissection and serial sectioning in 15 human cadaveric noses. In addition, two noses were used for three‐dimensional reconstruction of the nasal cartilages. We conclude that the lateral nasal wall can be seen as made up of three parts. At the level of the osseous‐cartilaginous chain of bone, lateral nasal cartilage, and lateral crus, the lateral nasal wall is relatively stable, limited mobility being allowed by translation and rotation in the intercartilaginous joint and a coupled distortion of the cartilages. At the level of the hinge area the lateral nasal wall is supported by one or more accessory cartilages, embedded in soft tissue, and therefore much more compliant. The alar part of the nasalis muscle, which originates from the maxilla and inserts on these cartilages, may dilate the valve area by drawing this hinge area laterally. The third and most compliant part of the lateral nasal wall is the part that is not supported by cartilage, the ala. The dilatator naris muscle largely occupies the ala and is attached to the lateral crus; it opens the vestibule and nostril. The third nasal muscle that influences the lateral nasal wall is the transverse part of the nasalis muscle. It overlies the nose but is not attached to it. This muscle stabilizes the lateral nasal wall, in particular, the lateral nasal cartilage, the intercartilaginous junction, and the hinge area, by moving the nasal skin.
On the duality of the facial nerve ganglion
Authors: Gacek Richard R.
Published: November 2003

Objectives: Describe quantitatively the number of ganglion cells in the geniculate (G) and meatal (M) segments of the human facial nerve. Study Design: One hundred human temporal bone specimens that were sectioned horizontally and stained with hematoxylin and eosin were selected from a temporal bone collection on the basis of minimal artifact and absence of pathology involving the facial nerve. Methods: Cells with a nucleolus in all sections through the facial nerve were projected on tracing paper with a camera lucida and counted manually. A modified Abercrombie technique was employed to compute total cells in the G and M segments. Results: Ages of patients ranged from 1 month to 92 years; the male‐to‐female ratio was 56:44. The total number of cells in individual temporal bones ranged from 589 to 4183 (mean, 2162 cells). The range of cells in the G ganglion was from 66 to 4017 (mean, 1713 cells); in the M ganglion the number ranged from 0 to 2764 (mean, 448 cells). There was no correlation of total ganglion cell number to age or sex. The majority of cells were found in the G ganglion in 88% of temporal bones. In 8% temporal bones the majority of cells were in the M ganglion and in 4% the M and G ganglions contained an equal number of cells. Conclusions: The facial nerve sensory ganglion consists of two components: G and M. The G ganglion outnumbers the M component in the majority of temporal bones (88%). The M ganglion was equal to or greater in number than the G ganglion in 12% of temporal bones.
Variability of repeated facial nerve electroneurography in healthy subjects
Authors: Sittel Christian , Guntinas‐Lichius Orlando , Streppel Michael , Stennert Eberhard
Published: November 2003

Background: Facial electroneurography is an objective measurement of a muscle compound action potential. The amplitude ratio between the paretic and the normal side is used as a basis for estimating the prognosis of facial palsy. According to Esslen, the difference of amplitudes in healthy subjects is only 3%. Twenty healthy test persons were investigated with the aim of 1. reproducing the published data on the left‐right difference in normal test subjects and 2. determining whether the amplitude ratio is constant over time after repeated measurements. Study Design: Bilateral electroneurography was conducted on 20 healthy volunteers (age range, 23–36 y; 12 men, eight women). Two investigators performed four measurements at 1‐week intervals on every subject. Results: Mean amplitude ratio was 32.5%. Repeated measurements on the same individual differed considerably—from 0% to 80%. The 99% confidence interval computed from the data ranged from 26% to 39% amplitude ratio. Conclusion: The symmetry of facial evoked compound potentials postulated by Esslen and Fisch is not supported by these data. As have other investigators, the authors found significant left‐right differences in healthy subjects. Furthermore, they showed for the first time that the amplitude ratio is not constant in every individual at repeated measurements. In light of these data, prognosis of facial palsy based on electroneurographic data alone seems doubtful.
Surgical exposure of the fundus of the internal auditory canal: Anatomic limits of the middle fossa versus the retrosigmoid transcanal approach
Authors: Haberkamp Thomas J. , Meyer Glenn A. , Fox Mary
Published: November 2003

Objective: To define the anatomic limitations and advantages of the middle cranial fossa and the retrosigmoid transcanal approaches in the exposure of the fundus of the internal auditory canal (IAC). Study Design: A series of 15 cadaver temporal bone specimens were dissected and the measurements of the lateral recess of the IAC were made with a millimeter rule and rounded to the nearest quarter millimeter. Methods: Retrospective case review, surgical observation, review, and measurements recorded from magnetic resonance scans. Surgical observations and measurements recorded from cadaver specimens. Results: These results were compared with historical studies of the retrosigmoid transcanal approach. The results utilizing a combination of these approaches to remove acoustic neuromas at a tertiary referral center during the preceding 11 years are also presented. Previous studies have shown that for the retrosigmoid transcanal approach, it is impossible to expose 3 to 4 mm of the lateral recess of the IAC without violating the vestibule and/or the endolymphatic duct. This has led some authors to advocate the middle cranial fossa approach to the IAC when hearing preservation is a consideration. The current study shows that the falciform crest obscures the inferior half of the fundus. This creates a pocket that cannot be visualized, which on average is 1.82 × 2.33 mm. Conclusion: The fundus of the IAC cannot be completely exposed without violating the labyrinth through either the posterior fossa or middle fossa approach. The clinical implications of these studies are unknown at this time. Low recurrence rates are achieved with both approaches. The anatomic limitations of both approaches must still be considered when planning or performing these approaches, to minimize the risk of recurrence.
Sphincter pharyngoplasty: Speech outcome and complications
Authors: Sie Kathleen C. Y. , Tampakopoulou Dimitra A. , De Serres Lianne M. , Grass Joseph S. , Eblen Linda E. , Yonick Tracey
Published: November 2003

Objectives: To assess the speech outcomes and complications in children who had undergone sphincter pharyngoplasty (SP) for management of velopharyngeal insufficiency (VPI). Study Design: Retrospective chart review. Methods: Charts from patients who had sphincter pharyngoplasty between January 1993 and June 1996 were reviewed. Syndrome diagnosis and presence of repaired cleft palate were reviewed. Preoperative speech assessment, videofluoroscopic and nasopharyngoscopic evaluations, age at time of surgery, and postoperative speech assessments were reviewed for all patients. Postoperative videofluoroscopy and nasopharyngoscopy were performed for those patients who had persistent VPI. Obstructive sleep symptoms were also assessed. Results: Thirty patients were identified; six patients had no follow‐up evaluation, leaving 24 patients included in this study. Average follow‐up was 11.7 months (range, 2–35 mo). Velocardiofacial syndrome (VCFS) was the most commonly identified syndrome. Postoperatively, 15 of 24 patients (62.5%) had complete resolution of their VPI; five of 24 (20.8%) had significant improvement; one of 24 (4.2%) had minimal to no change; and three of 24 (12.5%) were hyponasal. Of the six patients with some degree of persistent VPI, three underwent revision surgery. All three patients had complete resolution of their VPI after revision surgery, resulting in an overall success rate of 18 of 24 (75%). Conclusions: Sphincter pharyngoplasty has wide application in the management of children with VPI, including those with VCFS. The procedure is readily modified to accommodate an individual patient's needs as determined by preoperative VPI evaluation. A modification of the procedure is described to minimize the risk of postoperative airway obstruction and hyponasality, both regarded as airway complications of sphincter pharyngoplasty.