bluuebunny/crossref_metadata_2025 huggingface dataset:
Histopathology of the olfactory pathway due to ischemia
Authors: Nakashima Tadashi , Kimmelman Charles P. , Snow James B.
Published: October 2006

Various agents, such as trauma, viral infections and neoplasms cause olfactory dysfunction. However, little is understood concerning the role of ischemia. An experimental model of brain ischemia was developed in the Mongolian gerbil, and the olfactory pathway was studied. This animal was chosen because of its incomplete circle of Willis, since poor patency of the circle of Willis is not an uncommon finding in the aging human. Ischemia was induced by unilateral ligation of one common carotid artery or temporary occlusion of both common carotid arteries. Under both circumstances, ischemic changes occurred in the lateral olfactory tract, the olfactory ventricle, and the olfactory tubercle. Damage is more severe with bilateral temporary occlusion than unilateral ligation. The olfactory bulbs and neuroepithelium, however, are resistant to ischemia.
Pseudomonas rhinosinusitis
Authors: Fried Marvin P. , Kelly James H. , Strome Marshall
Published: October 2006

Although rare in the otherwise healthy patient, pseudomonas rhinosinusitis is encountered most frequently in the immunocompromised host or severely traumatized patient. Intravenous antibiotic therapy in conjunction with aggressive surgical drainage is required. Two cases are documented that are typical of this philosophy. A third patient with isolated nasal involvement, because of multiple medical disabilities, was treated with local debridement and topical therapy alone and responded.
Histoplasmosis of the larynx
Authors: Donegan J. Oliver , Wood Michael D.
Published: October 2006

Granulomatous diseases caused by infectious agents are being seen more frequently than before. Infection with Histoplasma capsulatum is one such granulomatous disease. This condition may have protean manifestations, with involvement of the larynx of particular interest to the Otolaryngologist. Histoplasmosis of the larynx may present difficult diagnostic problems and may closely mimic carcinoma. A case of histoplasmosis of the larynx treated at the University of Cincinnati Medical Center is presented and used to highlight the mode of presentation and the management of this particular disease. The clinical presentation of histoplasmosis is discussed with emphasis on involvement of the upper aerodigestive tract. The diagnostic tests of practical value are outlined. Amphotericin B is the treatment for this disease entity.
Review of cyanoacrylate tissue glues with emphasis on their otorhinolaryngological applications
Authors: Ronis Max L. , Harwich John D. , Fung Ramona , Dellavecchia Michael
Published: October 2006

Cynnoacrylates were first synthesized by Ardis in 1949. However, it was not until Coover in 1959 discovered their adhesive properties that an interest arose in using these substances in surgical procedures.

Over the past two decades the use of cyanoacrylates has been varied and widespread among the surgical specialties. Methyl 2‐cyanoacrylate (Eastman 910 Monomer), Isobutyl‐cyanoacrylate (Bucrylate®), and 2‐cyano‐butyl‐acrylate (Histoacryl®) were the most widely used. Because of its tissue toxicity methyl 2‐cyanoacrylate was discarded. The consensus of various investigators was that the higher homologues, in particular Histoacryl® could be safely used in human applications.

The authors thought it would be important to ascertain how the academic departments of Otolaryngology perceived the role of cyanoacrylates within their specialty. A questionnaire was distributed to 115 academic centers: 47% of the departments responded and, of those, 34% indicated a current working knowledge of the cyanoacrylates. This response confirmed a very active interest in these tissue adhesives despite a lack of F.D.A. approval.

The otologic applications of these adhesives has been well documented, but the literature is devoid of studies using cyanoacrylates in other aspects of Otolaryngology. The authors feel that these adhesives (in particular Histoacryl®) have a role as an adjunctive technique in facial reconstructive and cosmetic surgery for autogenous cartilage grafting.

A study using rabbits was designed to determine if Histoacryl® could be used safely to overcome the technical difficulties (graft migration during healing and cartilage fracture during suturing) often encountered when performing autogenous onlay cartilage grafting. On the left ear of each rabbit, a cartilage graft was harvested and reimplanted at a second site on the same ear by suturing the perichondrium of the graft to the perichondrium of the donor site. On the right ear the graft was secured to the donor site with Histoacryl.®

The histological analysis of the rabbits' ears sacrificed at weekly intervals from 1 week to 1 month failed to demonstrate cartilage damage or tissue toxicity in the ears where Histoacryl® was used.

In conclusion, the authors contend that a role exists for the use of Histoacryl® as an adjunctive technique in facial reconstructive and cosmetic surgery. The study will be continued to assess the long‐term results of using Histoacryl® for autogenous onlay cartilage grafting.
Mononuclear phagocyte function in head and neck cancer: Depression of murine macrophage accumulation by low molecular weight factors derived from head and neck carcinomas
Authors: Balm Fons J. M. , Von Blomberg‐Van Deflier B. Mary E. , Drexhage Hemmo A. , De Haan‐Meulman Meeny , Snow Gordon B.
Published: October 2006

In earlier experiments chemotactic responsiveness of peripheral blood monocytes obtained from patients with head and neck cancers was found to be markedly depressed. In an attempt to attribute this defect in migration to an influence excited by low molecular weight factors of less than 25,000 daltons, derived from the tumor, Amicon filtrates of head and neck cancer cells were administered sub‐cutaneously to C3H mice 24 hrs. before the intraperitoneal injection of concanavelin A. Subsequent macrophage accumulation into the peritoneal cavity was quantified. A clear inhibition of macrophage infiltration was found, particularly when filtrates of poorly differentiated tumors were used. Injection of filtrates from healthy oral mucosa were negative, whereas mouse mammary carcinoma filtrates strongly inhibited accumulation.
Rhabdomyosarcoma of the head and neck
Authors: Newman Anita N. , Rice Dale H.
Published: October 2006

A retrospective review of all cases of rhabdomyosarcoma seen at UCLA was done. Survival prior to the advent of cyclic multidrug chemotherapy was compared to survival with this therapy. In the latter group, unlike other published series, survival was 100% better with gross total removal of disease as compared to biopsy only. All received at least 5000 rods.

Fifteen percent presented with regional nodal metastases. However 75% of these also had intracranial extension and all died. An additional 19% developed late regional nodal metastases; 80% of these also developed systemic metastases and all died. Survival in the absence of nodal disease was 41%.
Osteosarcoma and chondrosarcoma of the head and neck
Authors: Vener Jerome , Rice Dale H. , Newman Anita N.
Published: October 2006

Osteosarcomas and chondrosarcomas are rare malignant neoplasms in the head and neck. Eighteen cases seen at the UCLA Center for the Health Sciences are reviewed. Osteosarcomas of the maxilla tended to occur a decade later than those of the mandible or cranial bones. Several followed prior irradiation for retinoblastoma. Complete excision offers the only realistic chance for cure. Adjuvant therapy has little to offer these patients at this time.
Capsular significance in parotid tumor surgery: Reality and myths of lateral lobectomy
Authors: Donovan Donald T. , Conley John J.
Published: October 2006

Historically, parotid gland surgery has evolved from an operation of surgical enucleation to that of lateral lobectomy or total parotidectomy with facial nerve dissection. While the enucleation operation originally resulted in recurrence rates as high as 45% in some series, the technique of lateral lobectomy has resulted in recurrence rates of 2% in benign tumors. However, the currently recommended procedure of lateral lobectomy or total parotidectomy with facial nerve preservation for benign or low grade malignant tumors is not a pure en bloc resection in most cases, and in fact enucleation in part or total is often the reality of the operation. Tumor characterization, technical features, and operative findings of parotid gland surgery are examined in 100 consecutive cases. In over 60% of the cases, superficial or total parotidectomy with facial nerve preservation incorporated the principle of limited enucleation or capsular dissection at some point in the technique. The illusion that en bloc removal of parotid tumors with wide surgical margins is discredited. The reality of the procedure and the reasons for its success are examined.
Endoscopic photography of the ear, nose, and throat
Authors: Selkin Stuart G.
Published: October 2006

The ability to view and photograph the ears, nose, nasopharynx, hypopharynx, and larynx has been revolutionized by the advent of the flexible fiberoptic nasopharyngolaryngoscope. For the first time the otolaryngologist has a one‐instrument capability for examination and photodocumentation of the structures with which the specialty deals. This should not imply that the conventional means of examination should be relegated to museums, but rather that a new instrument has been added to the diagnostic armamentarium. The real visual images may be readily adapted for photography. The author will detail a straightforward and inexpensive method for obtaining high quality color transparencies, and color and sound video tapes.
Endolymphatic sac surgery in mondini's dysplasia: A report of 16 cases
Authors: Goin Donald W. , Rasband Rick W. , Mischke Robert E. , Weaver Marlin
Published: October 2006

This paper presents 12 patients (16 ears) with radiographic evidence of Mondini's dyplasia who underwent endolymphatic sac surgery. And additional 4 patients (7 ears) on whom surgery was not performed are included. Class I or II results were obtained in 81% of the ears. Pathophysiology, as it relates to the fluctuant nature of the hearing impairment, is discussed.
Cinegraphic observations of laryngeal function in parkinson's disease
Authors: Hanson David G. , Gerratt Bruce R. , Ward Paul H.
Published: October 2006

Thirty‐two unselected male patients with Parkinson's disease were examined by telescopic cinelaryngoscopy. Correlation of vocal abnormality and general neurologic symptoms with the laryngoscopic examination leads to the conclusion that the phonatory abnormalities noted in Parkinson's disease are related to rigidity in the phonatory posture of the larynx. The described dysfunctions correlated with the symmetry of trunk and limb rigidity in 100% of the patients.
Radiographic findings in progressive necrotizing “malignant” external otitis
Authors: Gold Scott , Som Peter M. , Lucente Frank E. , Lawson William , Mendelson Meryl , Parisier Simon C.
Published: October 2006

Twenty‐three cases of progressive necrotizing (malignant) external otitis were reviewed. Radiographic evaluation was correlated with clinical disease. CT scanning accurately demonstrated subtle foci of involvement in the skull base which may be clinically unsuspected or go undetected with other studies. Central skull base erosion indicates advanced disease and selects those patients requiring extended antibiotic therapy. Soft tissue thickening of the parapharyngeal space and roof of the nasopharynx also implies advanced disease requiring prolonged therapy. Soft tissue improvement can be visualized on CT. While CT scanning demonstrates the progression of bony disease, it cannot be used to follow resolution of central skull base osteomyelitis. Radionuclide scans provide information regarding the overall extent of the inflammatory process.
Interaction of fibrinolytic activity between the tracheobronchial secretion and circulating blood of rats
Authors: Kosugi T. , Takagi I. , Sueno K. , Sumi H. , Kinjo K. , Noda K. , Mihara H.
Published: October 2006

In order to clarify the origin and release mechanism of Plasminogen activator in the tracheobronchial secretion of rats, electrophoretic analysis of the secretion and studies on the effects of certain vosoactive drugs on the activator activity in the secretion were carried out.

Front the results of electrophoretic analysis of the tracheobronchial secretion in non‐treated rats, protease Inhibitor composed of glycoprotein was not contained in the secretion in contrast to the circulating blood, but a protein of low molecular weight like albumin in the circulating blood was contained in the secretion. Furthermore, after injection of noradrenalin, the blood pressure was temporarily elevated and the fibrinolytic activity of the euglobulin fraction in the circulatory blood was also increased. Subsequent to this elevation of fibrinolytic activity in the circulating blood, the fibrinolytic activity in the tracheobronchial secretion increased.

Based on these results, it is suggested that the increase of fibrinolytic activity in the circulating blood was due to increased release of Plasminogen activator from the vascular wall, and the increased fibrinolytic activity of the tracheobronchial secretion was caused by a consequent increased tronsudation of Plasminogen activator from the circulating blood into the tracheobronchial lumen.
Schwannomas of the jugular foramen
Authors: Crumley Roger L. , Wilson Charles
Published: October 2006

Schwannoma is an important entity in the differential diagnosis of the enlarged jugular foramen. Our recent experience with 4 consecutive large schwannomas over a 12‐month period is presented.

As these tumors are usually less vascular than glomus jugulare tumors, they are frequently more amenable to surgical extirpation. Radiologic clues to their identity include discrete borders and less angiographic vascularity when compared with glomus jugulare tumors.

Our operative treatment of these cases has evolved to include preoperative embolization with Ivalonr̀ sponge particles, followed by a lateral temporal bone resection in exposing the jugular foramen. A posterior fossa craniotomy is done as a second stage when necessary. This staging allows for less morbidity and greater chance for total tumor removal. The surgical technique and relevant anatomy are reviewed and illustrated.
Dermoid of the petrous apex
Authors: Behnke Ernest E. , Schindler Robert A.
Published: October 2006

Radioluccnt lesions of the petrous apex of the temporal bone are unusual, with an incidence of less than 1%. The differential diagnosis includes giant apical air cells, acquired cholesteatomas, congenital cholesteatomas or epidermoids, true dermoids and teratomas, and benign and malignant neoplasms. The authors present an extremely rare case of a true dermoid of the petrous apex which eroded into the clivus of the occipital bone, and discuss the differential diagnosis, symptomatology, and diagnostic work‐up.

Complete resection is the preferred management if it can be done easily and safely; however, since the lesions are usually unresectable and manifest few symptoms, a conservative surgical approach for diagnosis and decompression is urged. The authors discuss in detail a surgical approach which allows for preservation of function and hearing, as well as diagnosis and immediate decompression. Further surgical decompressions, when needed, can be easily, quickly, and safely achieved through the same surgical approach. A review of the medical literature has revealed no previously reported case of a true dermoid involving the petrous apex.
Tympanostomy tubes in children with hemophilia a
Authors: Liston Stephen L. , Berlinger Norman , Roger Edson J. , Hasegawa Duane K.
Published: October 2006

With proper teamwork between the hemotologist and otolaryngologist, children with hemophilia A and otitis media can obtain the benefits of tympanostomy tubes; 90% phenol applied topically to the tympanic membrane is a useful hemostatic agent. The technique may allow the hemophiliac child to undergo myringotomy and insertion of tympanostomy tubes without the use of blood products. There is evidence that the use of such blood products derived from pooled human plasma may be associated with the development of acquired immune deficiency syndrome (AIDS).
Transtympanic iontophoresis: Personal experience
Authors: Passali Desiderio , Bellussi Luisa , Masieri Simonetta
Published: October 2006

After having described the method of application used for iontophoresis and the results of previous studies carried out by other authors in the hope of finding a definite use for its clinical application, the authors present their personal experience carried out with the use of various chemical substances applied to both the guinea pig and to man. The chemicals taken into consideration were those used in the treatment of otitis media: anti‐inflammatory, antibiotic, and mucolytic products. Iontophoresis proved to be a simple and effective method for the treatment of certain middle ear diseases, and offered a more rapid recovery in comparison with subjects treated uniquely by traditional methods.
Treatment of the clinically negative neck in floor of the mouth carcinoma
Authors: Clifton Patterson H. , Dobie Robert A. , Cummings Charles W.
Published: October 2006

A retrospective study of 61 consecutive patients with floor of mouth carcinoma and a clinically negative neck was done to determine the value of elective treatment to the neck. Subsequent histologically proven nodal disease was analyzed according to initial treatment modality (23 surgical, 38 irradiation), stage (29 ‐ T1, 27 – T2, 5 – T3), hemi‐neck at risk (midline lesions placed both hemi‐necks at risk), and primary control for a minimum of 2 years (50 patients, 78 hemi‐necks at risk). Neck failures were classified by T stage, extent of neck treatment (upper neck or complete) and by primary control at the time of manifest neck metastasis. Of the hemi‐necks at risk with the primary controlled, 10% (17% of patients) developed nodal disease without complete neck treatment; 86% (6/7) of these patients were salvaged. The occult positive node incidence, conservatively calculated by elimination of all patients treated with elective partial or total neck irradiation, was 10% for patients with T1 and T2 lesins (7% for hemi‐necks at risk). Based on the clinical course of patients with primary control, only 1 patient (2%) might have benefited from initial complete elective neck treatment. These results suggest that elective neck treatment in early (T1 and T2, N0) floor of mouth carcinoma is of doubtful value. Supraomohyoid, rather than suprahyoid dissection, is recommended if surgical treatment of the neck is undertaken.
Evaluation of blocking mechanisms against immunological responses in patients with laryngeal carcinoma
Authors: Morra B. , Beatrice F. , Cavallo G. P. , Bussi M. , Di Fortunato V. , Poggio E. , Vercillino M. , Sartoris A. , Cortesina G.
Published: October 2006

The specific tumor‐induced leukocyte inhibition factor (LIF) production in laryngeal cancer patients has been investigated before and after the removal of adherent cells in order to evaluate the existence of a suppressor activity; 20 patients served as subject. The LIF production, after challenging the lymphocytes with 3MKC1 autologous tumor extracts, was significant in 12 patients and showed a further significant increase after the removal of adherent cells. In 3 patients with no previous significant LIF production, there was a conversion to significance when the adherent cells were removed. The other patients did not show any significant variation. These data seem to suggest the existence of a suppressor activity exerted by adherent cells in laryngeal cancer patients on LIF production.
Tumor‐forming acute myeloid leukemia with facial paralysis
Authors: Nishioka Keiko , Masuda Yu , Misaki Keizo , Tomotsu Takao , Kitajima Koichi , Tanaka Toshio
Published: October 2006

A 55‐year‐old male with acute myeloid leukemia, which had been well controlled for 2 years, developed a sudden onset of facial palsy. Otologic examinations proved the right mastoid bone to be infiltrated by leukemic cells, which formed a nonchloroma to occlude the right external auditory canal. The precise site for the right facial paralysis by tumor formation was found in the intrastapedial region of peripheral portion of the right facial nerve. Regarding the tumor formation in myeloid leukemia, its frequency (particularly among Japanese subjects), complications (particularly in otologic field), possible pathogeneses, and treatments were discussed.
Co2 laser in malignant lesions of the larynx
Authors: Annyas Albert A. , Van Overbeek Jos J. M. , Ramón Escajadillo J. , Hoeksema Paul E.
Published: October 2006

The CO2 laser is being used in several otolaryngology departments around the world. Clinical experience has shown that it is a unique surgical tool in the management of benign and in some malignant lesions of the larynx. Until now, little has been written about its indications in patients with carcinomas of the larynx.

The purpose of this paper is to present our experience with 58 patients with various premalignant and malignant lesions of the larynx in which the CO2 laser was employed as a curative or palliative debulking procedure.
Otosclerosis and endolymphatic hydrops.
Authors: Liston Stephen L. , Paparella Michael M. , Mancini Fernando , Anderson John H.
Published: October 2006

It has been postulated that otosclerosis may produce vertigo by several mechanisms. One mechanism is by causing endolymphatic hydrops. We present six temporal bones in which otosclerosis and endolymphatic hydrops coexist. We consider that there is a spectrumlike interrelationship between these two entities. At one end of the spectrum the relationship is coincidental, while at the other end of the spectrum we consider the massive amount of active otosclerosis to be a causative factor in the development of the endolymphatic hydrops.
Diagnosis and management of catecholamine secreting glomus tumors.
Authors: Schwaber Mitchell K. , Glasscock Michael E. , Jackson C. Gary , Nissen Alan J. , Smith Peter G.
Published: October 2006

The clinical and diagnostic features of catecholamine secreting glomus tumors are reviewed. Three cases are reported, including the first documented case of a dopamine secreting glomus jugulare tumor. Based on this experience, the authors have outlined the indications for selective venous catherization studies and for pharmocologic blockage in the management of these patients. In addition to routine urinary screening, a high index of clinical suspicion is needed to avoid the complications associated with catecholamine secreting tumors.
Facial paralysis in longitudinal temporal bone fractures: A review of 26 cases.
Authors: Lambert Paul R. , Brackmann Derald E.
Published: October 2006

The management of facial nerve injury resulting from temporal bone fracture continues to be a topic of discussion. The indications for surgery as well as the proper timing and extent of surgical exploration are the principal questions debated. This study reviews a large scries of patients (26), treated for facial paralysis following a longitudinal temporal bone fracture.

The most frequent site of injury was the area of the geniculate ganglion. The injury to the facial nerve was often severe. We recommend early exploration in these cases when electrical studies indicate a severe injury. In most cases a combined mastoid and middle fossa approach is required.
Histiocytosis X of the head and neck.
Authors: Jones Raleigh O. , Pillsbury Harold C.
Published: October 2006

Histiocytosis X is a general disease class for three less distinctive and overlapping states; namely, eosinophilic granuloma, Hand‐Schuller‐Christian disease, and Letterer‐Siwe disease. These conditions span a continuum from an isolated bony or soft tissue lesion to a fulminant, disseminated process. The head and neck are frequent sites of initial presentation for the more serious varieties. We present four cases of histiocytosis X with lesions in the temporal bone, skull, and mandible. Some patients had accompanying scalp lesions as well as other distal bony and soft tissue lesions. Treatment included radiation therapy, chemotherapy, and surgery. A rational discussion of new treatment modalities based on stage of the disease is presented. Utilization of CT scanning in the initial diagnosis and follow‐up is demonstrated. Management of troublesome otologic complications is also discussed.
The occlusal wafer: Simple technique for construction and its use in maxillofacial surgery.
Authors: Irving Steven P. , Costa Louis E. , Salisbury Paul Lee
Published: October 2006

The acrylic occlusal wafer is a thin piece of plastic which fits between and indexes the occlusal surfaces of the maxillary and mandibular teeth. This appliance has three functions: it positions the jaws relative to one another; it prevents sliding movement during intermaxillary fixation; and it prevents unwanted orthodontic movement during intermaxillary fixation from the pressure of intermaxillary wires or rubber bands on unsupported teeth. The role of the occlusal wafer is well established in orthognathic surgery where it is used as a key for setting the jaws when osteotomies are performed. It has been underutilized in trauma due to the time and technical expertise required for fabrication.

This paper describes a technique which can result in occlusal wafers of surgical quality in about 20 minutes, requires minimal laboratory equipment, and can be mastered by clincial personnel. Four cases are presented which illustrate the use of occlusal wafers and the indications for the device are discussed.
Surgical approaches to malignant tumors of the nasal septum.
Authors: McGuirt W. Frederick , Thompson James N.
Published: October 2006

Malignant tumors of the nasal septum arc rare, probably not more than 300 having been reported. Most of these tumors are epidermoid carcinomas; the second most common histologic type is melanoma. Unless diagnosed and treated early, these tumors are lethal. We report five cases, four carcinomas and one melanoma. We recommend a combined approach with early, wide surgical excision and postoperative irradiation therapy. Surgical considerations must include functional and cosmetic restoration as well as adequate excision of the tumor. Prosthetic appliances can be quite helpful in patients with large resections.
Laryngeal tuberculosis: Review of twenty cases.
Authors: Levenson Mark J. , Ingerman Milton , Grimes Cecil , Robbett William F.
Published: October 2006

Despite a dramatic reduction in incidence of laryngeal tuberculosis over the last three decades, tuberculous involvement still has to be considered in the differential diagnosis of laryngeal lesions. The majority of the 20 cases in our series consists of patients in whom the working diagnosis of carcinoma of the larynx was initially made. These patients presented with the chief complaint of hoarseness of several months duration, frequently associated with dysphagia, but in most cases with chest symptoms that were not prominent despite the fact that most of these patients had far advanced pulmonary tuberculosis.

This presentation consists of a detailed analysis of 20 cases, and a discussion of the incidence, pathogenesis, clinical presentation and management of laryngeal tuberculosis.
Synovial sarcoma of the larynx treated by partial laryngectomy
Authors: Quinn Harold J.
Published: October 2006

Synovial sarcomas of the head and neck are rare, fewer than 50 having been reported. Synovial sarcoma of the endolarynx is extremely rare, only one previously reported case appearing in English literature.

Contrary to earlier beliefs, this tumor does not arise from the synovial lining of joints and bursa but develops from pleuripotential mesenchymal cells through abnormal differentiation into synovial neoplasms. Microscopically the tumor is characterized by a biphasic pattern of pseudoepithelial cells and a spindle cell element with fibrosarcomatous appearance.

One additional case of synovial sarcoma of the endolarynx is reported. The tumor arose from the right subglottic area and presented submucosally. It was treated by extended frontolateral partial vertical (hemi) laryngectomy. The patient is alive and well 3 years after surgery. This case is the first reported to be successfully treated by partial laryngeal surgery alone. The histopathology of synovial sarcoma is reviewed and details of the biopsy and surgical technique are presented. This single case might suggest that early synovial sarcoma of the larynx is locally nonaggressive.
Hypopharyngeal stenosis
Authors: Mcconnel Fred M. S. , Duck Sigsbee W. , Hester T. Roderick
Published: October 2006

Hypopharyngenl stenosis after total laryngectomy is a relatively frequent complication. In our series we found that approximately 20% of total laryngectomies require treatment for hypopharyngeal stenosis. This presentation analyzed the factors that contribute to hypopharyngeal stenosis in a large series of patients treated at Emory University and affiliated hospitals. Analysis is presented on the effects of location of the cancer, extent of resection, radiation therapy, and methods of reconstruction. The highest incidence of hypopharyngeal stenosis was found in hypopharyngeal vs. endolaryngeal lesions. The surgical decision examined in this paper is whether a primary “tight closure” of the hypopharynx or a flap or graft reconstruction gives the best results with the lowest complication rate. The best treatment of hypopharyngeal stenosis is its prevention. This paper deals with the methods of identifying the surgical situation when one is most apt to have stenosis and suggest appropriate measures to prevent these complications.
Severe hospitalized croup: Treatment trends and prognosis
Authors: Postma Duncan S. , Jones Raleigh O. , Pillsbury Harold C.
Published: October 2006

We have reviewed 43 cases of severe croup admitted from 1977 to 1981 at North Carolina Memorial Hospital. All patients were treated with mist, 23 (54%) of 43 were treated with racemic epinephrine, but only 7 (16%) of 43 were treated with steroids. None of the 5 patients who required intubation received steroids. Nine (36%) of 25 patients available for at least 6 months of follow‐up had subsequent clinical diagnoses of asthma.

We have concluded that: 1. males with subglottic narrowing on x‐ray, high leukocyte counts, and no steroid treatment appear to have increased need for airway support; 2. while humidification and racemic epinephrine are accepted forms of treatment, steroids are still rarely used even in severe croup; 3. severe croup may be a signal for the later development of asthma. Because it is difficult to predict which patients with severe croup will need later airway management, we strongly recommend that all patients with croup requiring racemic epinephrine be treated with at least a single dose of 1.0 to 1.5 mg/kg of dexamethasone.
Actinomycosis: Diagnostic and therapeutic considerations and a review of 32 cases
Authors: Bennhoff David F.
Published: October 2006

Actinomycosis was at one time a common diagnosis in this country. It still is fairly common in some parts of the world. As the numbers of antibiotics and indications for their use have increased, the disease has almost become a medical rarity in the United States. This fact might be thought a paradox in view of the universal presence of the actinomyces organisms in every human mouth. However, it is perhaps not well recognized that the actinomyces are true bacteria, and that they are particularly sensitive to most of the common antibacterials in current usage. These facts have combined to decrease the clinical frequency of the disease as well as effectively reduce the opportunity for securing a satisfactory specimen for laboratory culture in suspected cases. Actinomycosis can present in a variety of forms and may mimic other infections or even neoplasms. The clinical pattern of remission and exacerbation of symptoms occurring in parallel sequence with initiation and cessation of antibiotic administration is a phenomenon which should increase suspicion for actinomycosis in any of its manifestations.
Nonspecific necrotizing petrositis: An unusual complication of otitis in children
Authors: Stamm Aldo Cassol , Pinto José Antonio , Cóser Pedro Luiz , Marigo Carlos
Published: October 2006

Three cases of an unusual form of suppurative chronic otitis media in children 2 and 3 years old are presented.

The clinical feature common to all cases was otorrhea, beginning at the first months of life, with a silent evolution to a complete peripheral facial paralysis. In one case the facial paralysis was bilateral.

The treatment applied was surgical: subtotal petrosectomy. The surgical findings were bloody granulation tissue, sequestering completely the otic capsule. The facial nerve was destroyed almost the total length of the Fallopian canal in all cases.

The histopathologic examination revealed a destructive and nonspecific chronic inflammatory process. The culture showed Gramnegative organisms, such as Pseudomonas aeruginosas and Proteus mirabilis.

Etiologic aspects involved in the process are discussed and the name non‐specific necrolizing petrosilis is suggested to individualize this rare form of otitis which, with morbidity, leads to severe complications such as facial paralysis and deafness.
Radiotherapy in sarcoidosis of the larynx: Case report and review of the literature
Authors: Fogel Thomas D. , Weissberg Joseph B. , Dobular Kenneth , Kirchner John A.
Published: October 2006

Sarcoidosis infrequently involves the larynx, but resultant airway obstruction will often prompt the need for therapeutic intervention. Systemic and intralesional corticosteroids as well as various surgical approaches have been advocated. We report a case of a 36‐year‐old man with biopsy proven laryngeal sarcoidosis. The patient became refractory to corticosteroids and was treated with megavoltage radiotherapy as an alternative to tracheostomy. A gradual and complete clinical recovery was observed. The radiation techniques are presented, and the literature regarding laryngeal sarcoidosis is reviewed. Megavoltnge radiotherapy is a viable treatment option in this disorder.
Growth of the human septal cartilage: Cell density and colony formation of septal chondrocytes
Authors: Vetter Ulrich , Heit Wolfgang , Heinze Eberhard , Helbing Gerhard , Pirsig Wolfgang
Published: October 2006

Human chondrocytes from 24 patients (5 to 52 years) with septal deviation were isolated in different areas of the septal cartilage. Cell density was counted, and the chondrocytes were grown in an assay system for determining the number of chondrocytes capable of proliferating.

High cell density and excellent proliferative capacity were found in the anterior free end of the septal cartilage in all age groups. The central area showed the highest growth index in childhood, and increasing cell density from childhood to puberty. Generally the growth index decreased with age in all septal areas. The results help to explain some clinical observations: increasing septal cartilage even in adults, growth of nasal tip in adults, regenerative potential of septal cartilage after injuries or surgery, importance of the central area for septal growth and surgery.
Xanthelasma palpebrarum
Authors: Parkes Morey L. , Waller Todd S.
Published: October 2006

The management of xanthelasma can be challenging, as evidenced by our own experiences as well as that of other physicians. Appreciating the difficulties is important, so as to inform the patient of the risks of recurrences after surgical excision and to plan the surgical procedure to prevent ocular complications such as ectropion. The patient with xanthelasma who desires a blepharoplasty is an especially interesting topic. A conservative approach, at times using staged excisions, as discussed in this article, will help achieve the desired result and assure patient satisfaction.
Intralabyrinthine schwannoma
Authors: Vernick David M. , Graham Malcolm D. , Mcclatchey Kenneth D.
Published: October 2006

The diagnosis of intralabyrinthine schwannoma has been made either accidentally at the time of surgery or at postmortem examination. Brain stem evoked response audiometry and computerized tomography do not add to our ability to make this diagnosis clinically. A case is presented of an intralabyrinthine schwannoma found at the time of transmastoid labyrinthectomy. The literature is reviewed and a composite clinical picture is presented.
Relationship of laryngeal dimensions to body size and gestational age in premature neonates and small infants
Authors: Schild Joyce A.
Published: October 2006

The larynges of 27 infants weighing between 250 gm and 9160 gm were studied. Twenty‐two neonates were from 24 to 40 weeks' gestational age. Five subjects died more than 6 weeks post partum but were included because of their small size. Relationships of larynx size to the standard clinical measurements of crown‐heel length, crown‐rump length, head circumference, and gestational age were developed. Cartilage size relationships to these measurements were found to be linear. Glottic length related linearly to crown‐rump length but related in a curvilinear way to crown‐heel length, head circumference, and gestational age. A guide to the choice of endotracheal tube sizes for small infants is suggested.
Modified tracheoesophageal diversion for chronic aspiration
Authors: Krespi Yosef P. , Quatela Vito C. , Sisson George A. , Som Max L.
Published: October 2006

Breakdown of the normal protective function of the larynx, either through primary laryngologic or neurologic causes, leads to chronic aspiration, recurrent pneumonitis and possibly death. In this paper we discuss the existing surgical treatments for chronic aspiration. Tracheal separation and trechcocsophageal diversion are discussed, as are the difficulties of using these procedures in patients with pre‐existing tracheostomies. A modification of trachcoesophageal diversion is presented whereby this procedure can now be utilized in those patients with pre‐existing tracheostomies. The modified tracheoesophageal diversion is performed in five patients successfully. Since most patients have already had tracheotomies in an attempt to control aspiration, we feel that our technique of modified trachcoesophageal diversion enables this group of patients to benefit from this procedure as well.
Radiographic classification of the vestibular and cochlear aqueducts: The paired correlation between normal and abnormal vestibular aqueduct and cochlear aqueduct anatomy
Authors: Arenberg I. Kaufman , Dupatrocinio Italo , Dreisbach James M. , Seibert Charles
Published: October 2006

Multidirectional tomography (MDT) can be useful in determining the caliber, shape, and course of the vestibular aqueduct (VA) and cochlear aqueduct (CA). Clinical decisions have been based on the findings from MDT. Unfortunately, the clinical utility of these observations has been confusing and controversial because similar MDT techniques were not used. This study will address some of the difficult questions and clinical controversies derived from MDT observations. This new perspective has evolved with the use of high resolution computed tomography (HRCT). An analysis of 750 petrous bones for the occurrence of the various types of VAs and CAs using Gado's classification, further vestibular aqueduct and a variation of Gado's classification for the cochlear classification is reported. The distribution of the possible paired types of VA and CA arc evaluated. MDT results indicate that the paired analysis in patients with inner ear dysfunction is not useful, cost effective, diagnostic, or of prognostic value. MDT can provide clinically valid observations of periaqueductal and perilabyrinthine pneumatization which is helpful in anticipating the size and position of the endolymphntic sac at the time of surgery for those few patients who may benefit from endolymphatic system surgery. However, when a comparison is made between MDT and CT of 60 ears in those same patients, the clinical limitations of MDT for inner ear diagnosis and prognosis became apparent. The future for HRCT scanning with reformatting holds potential for clinically meaningful visualization of inner and middle ear structures previously expected from MDT imaging.
Spontaneous cerebrospinal fluid otorrhea and rhinorrhea coexisting in a patient with meningitis
Authors: Brodsky Linda
Published: October 2006

Congenital (spontaneous) cerebrospinal fluid fistulae are uncommon, potentially dangerous, pathological conditions. Most present in childhood with repeated bouts of meningitis, although presentation in adulthood with an asymptomatic nasal mass has been well documented. Radiologic work‐up of the patient will usually reveal an abnormality in either the labyrinth or the base of the skull. A patient is presented who had both spontaneous cerebrospinal fluid otorrhea and rhinorrhea. Three anatomic defects were identified as potentially accountable: a round window fistula, a meningoencephalocele and an empty sella turcien.
Accuracy of fine needle aspiration biopsy in neck masses
Authors: Gertner R. , Podoshin L. , Fradis M.
Published: October 2006

One hundred thirty‐eight fine needle aspirations (FNA) of neck masses were performed during a four‐year period (1979‐1982). The pre‐existing literature was reviewed. An accuracy rate of 85% in FNA of neck masses was found, and a 100% accuracy rate in cases of benign tumors of the neck and developmental cysts of the neck was found.
Respiratory rhythmically regulated electrical stimulation of paralyzed laryngeal muscles
Authors: Bergmann Klaus , Warzel H. , Eckhardt H‐U. , Gerhardt H‐J.
Published: October 2006

Electrical stimulation of the posterior cricoarytenoid muscle, synchronized with inspiration, was achieved in dogs, utilizing a radio frequency stimulus triggered by a chest wall expansion transducer. This system brings about the abduction of the paralyzed vocal cord for the entire duration of inspiration, which allows a normal flow of air through the larynx. The stimulation system could be tested successfully in actual experiments in dogs with artificial paralysis of the recurrent laryngeal nerve. Its effectiveness could be proved through observation of the vocal cord movements (photographic documentation) and recording subglottic pressure variations. Transmission of stimulation energy is effected by electrical induction.
Transcutaneous teflon injection of the paralyzed vocal cord: A new technique
Authors: Ward Paul H. , Hanson David G. , Abemayor Elliot
Published: October 2006

Because of anatomical deformity, trismus, or for other reasons, it may on occasion be impossible to visualize a larynx by the usual laryngoscopy methods. Such difficulties in patients who have paralytic dysphonia may also make it impossible to effect improved vocal cord closure by the usual techniques of Teflon® injection. We have applied a new technique, detailed in this report, to these problem cases.

Following topical anesthesia of the nose, nasopharynx, and larynx, 1% Xylocaine is injected over the cricothyroid membrane. A flexible or telescopic laryngoscope connected to a television camera is introduced through the nose or oral cavity, respectively. A 16‐gauge spinal needle is introduced into the subglottic tracheal lumen via the cricothyroid membrane and directed into the undersurface of the paralyzed vocal cord under indirect visual control. Teflon® is then injected, monitored via the television image. Our early experience with this simple technique indicates that voice improvement is comparable to that expected using conventional transoral laryngoscopic techniques.
Cholesterol granuloma of the petrous apex
Authors: Gherini Stuart G. , Brackmann Derald E. , Lo William W. M. , Solti‐Bohman Livia G.
Published: October 2006

Cholesterol granuloma of the petrous apex is a newly recognized clinical entity distinct from cholesteatoma. Cholesterol granuloma usually produces symptoms of trigeminal, facial, and abducens nerve palsy and may not affect the auditory nerve. The characteristic computerized cranial tomographic (CCT) finding is a nonenhancing, smooth‐walled, expansile lesion that is isodense with brain tissue in a patient with bilaterally well pneumatized mastoids and petrous apices. Treatment is limited to drainage of the cyst and insertion of a stent for permanent aeration of the petrous apex.

Of ten cases of cholesterol granuloma of the petrous apex recently diagnosed at the Otologic Medical Group, the correct preoperative diagnosis was made in nine patients on the basis of CCT findings. Six of the nine patients had serviceable hearing preoperatively; serviceable hearing was maintained postoperatively in five patients.
Recognition of malleus handle fracture in the differential diagnosis of otologic trauma
Authors: Harris Jeffrey P. , Butler David
Published: October 2006

We have had the opportunity to cure for four patients who experienced barotrauma or implosive trauma to their ears. The differential diagnosis in these cases included ossicular injuries as well us possible perilymph fistulae. In euch of these cases there was a small conductive hearing loss which fluctuated and u high compliance tympnnogrnm. Careful otoscopy with the ald of pneumomassage revealed un isolated malleus handle (manubrium) fracture. Exploration of one ear was performed to rule out perilymph fistula und the diagnosis of malleus handle fracture was confirmed. Recognition of this injury preoperntively in these three other patients made exploration unnecessary. While injuries to the ossiculnr chain have been well‐described in the literature, isolated malleus handle fracture has not been previously reported.

The salient features of the presenting symptoms, diagnostic signs, und laboratory findings will be discussed and illustrated.
Transcanal management of benign middle ear lesions involving the anterior middle ear cleft
Authors: Sooy C. Daniel , Sooy F. A.
Published: October 2006

The anterior middle ear has always been a difficult area to visualize and access. This report reviews the experience with a new approach to gain exposure of the middle ear. This technique involves separating the entire pars flaccida from the handle of the malleus for better exposure and then replacing the drum. Four patients were treated in this fashion; one glomus tympanicum, two congenital cholesteatomas, and one benign adenoma. All patients benefited from improved exposure and resection. No patients had postoperative lateralization of the drum and hearing was maintained.
Otolaryngologio manifestations of posterior fossa arachnoid cysts
Authors: Hadley Mark N. , Grahm Thomas W. , Daspit C. Phillip , Spetzler Robert F.
Published: October 2006

Posterior fossa arachnoid cysts arc more common than previously reported. While they may present with symptoms of hearing loss, vertigo, and tinnitus, often they are associated with vague, nonspecific complaints such as headache, dizziness, or generalized unsteadiness. We present five cases of posterior fossa arachnoid cysts discovered in adult patients. Four of the five patients had nonlocalizing symptoms (three of those sought medical evaluations for persistent dizziness and/or headache). Two patients had prolonged symptoms despite medical evaluation and normal audiometrie testing before the correct diagnosis was made. We describe the case of our senior author (C.P.D.) in detail and include computerized tomographic and nuclear magnetic resonance studies outlining his pathology. A review of the management of these lesions is included.

Dizzy patients and those patients with nonspecific complaints referable to the inner ear or posterior fossa who have normal audiometrie testing, and in whom the index of suspicion is high, should have high resolution computerized tomography of the posterior fossa.