bluuebunny/crossref_metadata_2025 huggingface dataset:
Sphenoid wing meningioma occurring as a lateral orbital mass.
Authors: Leipzig Bruce , English Jim
Published: October 2006

The differential diagnosis of a mass presenting in the lateral aspect of the orbit with bony erosion and involving the skin includes many malignancies, predominantly sarcomas. A total evaluation of the mass to include histopathologic characteristics and the true extent of the disease is critical to proper management of the patient.

A 68‐year‐old man was referred for therapy with a diagnosis of fibrosarcoma. Evaluation of the disease revealed contiguous tumor from the right temporal region into the posterior orbit, with displacement of the globe and extension intracranially. During operation a frozen section analysis of the tumor was also interpreted as fibrosarcoma. A craniofacial resection was performed, including orbital exenteration and resection of a large 10 × 12 cm segment of attached dura. There was no evidence of extension into the brain. Final pathologic evaluation of the tumor was meningioma rather than fibrosarcoma. This unusual presentation of a meningioma has never been reported in the medical literature. The difficulty with interpretation of the original biopies will be discussed, as well as the management of this case.
Curved laryngotelescope.
Authors: Saito Shigeji , Fukuda Hiroyuki , Kitahara Satoshi , Isogai Yutaka
Published: October 2006

The purpose of this paper is to report on a newly developed curved laryngotelescope whose shape allows for smooth insertion through the oral and to the laryngeal cavity. Its principle of image processing involves lenses and prisms, which results in the maximum magnification of x6. Therefore, it is very useful for microscopic examination. We can obtain a clearer picture by this device than by conventional laryngoscopes. Examination with this laryngotelescope is easily performed after only topical application of a local anesthetic and patients experience less pain.
Stridor and obstructive sleep apnea in Shy‐Drager syndrome treated by laryngofissure and cord lateralization.
Authors: Kenyon G. S. , Apps M. C. P. , Traub M.
Published: October 2006

A patient with obstructive sleep apnea due to Shy‐Drager syndrome, who has been successfully managed by cord lateralization, is presented. This has allowed successful rehabilitation of the patient without prejudicing subsequent surgery, and appears to be an effective procedure in this rare condition.
Head and neck manifestations of the chronic graft vs. host disease
Authors: Medina Jesus E. , Frame Robert , Nguyen Lu , Toth Bela , Luna Mario A.
Published: October 2006

Bone marrow transplantations are being used with increasing frequency in the treatment of patients with leukemia and aplastic anemia. The graft‐vs.‐host disease (GVHD) is a serious complication that affects long‐term survivors following bone marrow transplantation. It is the result of an immunologic reaction mounted by the grafted reticuloendothelial cells against the tissues of the recipient, and it affects multiple organ systems. Involvement of the skin and mucosal surfaces of the head and neck region, in particular the oral cavity, occurs in a large number of patients with GVHD. In this report we present four patients with GVHD in whom mucosal lesions and infections of the head and neck region were prominent features. Our observations indicate that the clinical and histological characteristics of these lesions vary according to the time elapsed from the onset of the disease. Therefore, clinical examination of the head and neck region and biopsy of the oral mucosa are important not only in the diagnosis of the GVHD, but also in the evaluation of its progress and response to treatment.
Office videofiberoptic laryngoscopy
Authors: White James F. , Knight Robert E.
Published: October 2006

Precise photographic documentation is of significant importance for proper diagnosis and management of physiological and pathological conditions of the larynx. Since the fiberscope serves an important role in the daily practice of laryngologists, its value is greatly enhanced when coupled with a video camera. Fiberoptic videolaryngoscopy permits instant and simultaneous voice and visual recordings for later study. The procedure is most useful for analysis of respiration, phonation, singing, and other laryngeal functions such as glottic closure, swallowing, and protective‐compensatory movements. The procedure also allows investigation of various pathological conditions. The purpose of this paper is to present the authors' method of fiberscopic videolaryngoscopy and its relevant clinical implications. Advantages and disadvantages of the procedure are discussed.
Coexistence of systemic lupus erythematosus and parotid hypertrophy. A case report and literature review
Authors: Seung Hong I. , Romano Thomas J.
Published: October 2006

A patient with systemic lupus erythematosus and marked diffuse bilateral parotid swelling is described. Special staining techniques were required to demonstrate a lymphoplasmacytic infiltrate in the otherwise normal appearing acinar tissue. This finding suggests that a humoral, rather than a cellular, mediated immune process is responsible for the parotid hypertrophy in this patient.
Posterior choanal atresia: A syndromal disorder
Authors: Bergstrom Lavonne , Owens Othella
Published: October 2006

Posterior chonnal atresin has n significant incidence of associated defects. Recently a constellation of defects, bearing the acronym of CHARGE, has been described. Us entities are (ocular) Coloboma, Heart defects, Atresia chonnae, Retarded growth and development, Genital hypoplasia and Ear anomalies or hearing loss. Some of these have been previously noted.

There are 26 patients in this series, none having the entire CHARGE association, but 7 had several; 3 of the 7 had bilateral choanal atresia. One other patient had a chromosomal defect with an associated heart defect. Two patients had cardiac and other visceral defects. Seven had base of skull abnormalities, 3 of whom had elements of CHARGE, and 9 had congenital hearing loss. Five were normal.

CT scan suggests a growth disturbance of the basicranium in some of the patients.
Wound amylase levels as an early indicator of orocutaneous fistulae
Authors: Larsen Laura Rood , Schuller David E.
Published: October 2006

The formation of an orocutaneous fistula following ablative head and neck surgery is a common complication. Early fistula detection could permit prompt management, hopefully preventing further wound breakdowns.

Amylase is quantitatively the most prominant enzyme in saliva. This study prospectively evaluated whether the amylase content of wound drainage could predict the formation of an orocutaneous fistula earlier than clinically evident. Patients undergoing procedures that required postoperative wound drainage represented the study population. Baseline serum and salivary amylase determinations were obtained. The drainage was assayed for amylase content twice daily. Wound amylase values were then correlated with the patient's clinical course.

Results showed wound amylase had a downward trend in uncomplicated postoperative courses. An upward trend of wound amylase was correlated with early fistulization. No pattern was identified in patients with delayed fistulae.
T3 glottic cancer: Options and consequences of the options
Authors: Desanto Lawrence W.
Published: October 2006

This report is a review of 106 Stage III glottic cancers treated surgically from January 1971 through December 1980. For analysis of recurrence and cause of death, the patients were assigned to four subgroups us well as considered as n single group. The subgroups were T3, N(), transglottic, all T3 glottic cancers regardless of prior treatment, and all T3 glottic cancers without prior treatment. Of the entire group, 8% either were not dead or had died of something other than cancer; 91% of patients with T3, N() cancers without prior treatment either were alive or had died of another cancer. In the other subgroups the survivorship was between 80% and 91% with the exception of those with transglottic cancers. The findings in this study are discussed in light of the current controversies related to the stage of disease, particularly the issue of radical radiation with surgery for salvage for T3 glottic cancer.
Effect of kainic acid upon N1 latency
Authors: Kusakari Jun , Arakawa Eiichi , Ohyama Kenji , Rokugo Masaaki , Inamura Naoki
Published: October 2006

Although the N1 latency of whole nerve action potential is one of the important pieces of information obtained from ECochG, there are some conflicting opinions as to whether or not it is prolonged in scnsorineural hearing loss. Kainic acid (KA) is known to destroy neurons selectively through an action at glutamatergic synapses. Therefore, a model of “neural deafness” was made by perfusing the scala tympani with KA solution. The effect of KA upon cochlear microphonics was minimal. Although the N1 amplitude was markedly suppressed by KA, the N1 latency was neither prolonged nor shortened. The result obtained in the present study strongly suggests that the N1 latency is not prolonged in “neural deafness.”
Columella‐labial chances in solution of rhinoplastic problems
Authors: Smith Richard C. , Webster Richard C. , Kazda George
Published: October 2006

The nose relates intimately to the upper lip. As in all facial cosmetic surgery, anatomic and aesthetic diagnosis of the deformity is essential to providing the best treatment possible in a particular patient. Within a reasonable range, changes may be made easily in the columella‐labial area. Often these changes enhance the results of typical rhinoplastic maneuvers and make safer and more predictable the results of the rest of the rhinoplastic surgery.

Techniques for altering the columella‐labial region are presented. Examples arc shown demonstrating diagnostic, aesthetic, and therapeutic aspects.
Cogan's syndrome: Audiovestibular involvement and prognosis in 18 patients
Authors: Mcdonald Thomas J. , Vollertsen Randall S. , Younge Brian R.
Published: October 2006

The experience at the Mayo Clinic with 18 patients who had Cogan's syndrome is reviewed. Typically, the illness began with systemic symptoms. The ocular and audiovestibular symptoms included ocular discomfort and redness, photophobia, and fluctuating sensorineural deafness with imbalance. Each patient had interstitial keratitis; the ocular symptoms periodically recurred but responded to therapy. Thirteen patients who had fluctuating bilateral sensorineural deafness subsequently suffered total bilateral deafness. Two patients who are unilaterally deaf have good residual hearing. Two other patients regained hearing within normal limits after treatment with corticosteroids. No hearing symptoms were observed in one patient who had severe vertigo and whose condition is stable. Seventeen patients had vertigo: 11 have no labyrinthine function, 1 had absent responses on vestibular testing initially but currently demonstrates good responses, and the 5 others have remained stable with diminished vestibular function. If Cogan's syndrome is diagnosed early and treatment with corticosteroids is initiated promptly, hearing can be stabilized; otherwise, the prognosis for auditory function is poor.
Mondini's dysplasia with recurrent meningitis
Authors: Herther Craig , Schindler Robert A.
Published: October 2006

This report describes the diagnosis and surgical management of two patients with similar inner ear malformations resulting in recurrent otitic meningitis. Each patient had a meningocele presenting through the oval window associated with Mondini's anomaly. Details of radiographic diagnosis and surgical management strategies will be discussed and long‐term follow‐up presented.
Lateral sinus thrombosis: A sometimes unexpected diagnosis
Authors: Hawkins Donald B.
Published: October 2006

Lateral sinus thrombosis, a frequent complication of ear infections in preantibiotic days, is seldom seen today. When it does occur, it is usually in a patient with a known history of a chronic ear infection. Two patients are described with septic pulmonary emboli from inapparent lateral sinus thrombosis. Lateral sinus thrombosis should be suspected in any patient with chills, fever, neck paln, and septic pulmonary emboli.
Computerized axial tomography versus complex motion as a predictor of surgical findings in middle ear and mastoid cholesteatoma
Authors: Lewis Donald R. , Thompson David H. , Mocnik Jack , Fetter Theodore W. , Shelby John H.
Published: October 2006

In order to evaluate the efficacy of polytomogrnphy and computerized tomography in the prediction of surgical findings in cases of suspected cholesteatoma of the middle ear and mastoid, we evaluated preoperatively 52 ears by both radiographic methods. We utilized a check list of 14 radiological signs or surgical findings to generate measures of sensitivity and specificity. The strengths of each radiographic method are outlined and the considerable weaknesses in predictive value are discussed.
Facial biomechanics: The standards of normal
Authors: Burres Steven A.
Published: October 2006

To quantify facial motor function during mimetic expressions, two new techniques were introduced in this study: linear measurement (LM) of skin landmarks and integrated eleclromyography (iEMG) of the facial musculature. Based on data from 30 normal subjects, three indices were derived to estimate total maximum motion, total maximum iEMG output, and the relationship between iEMG activity and motion. In three different facial expressions, plots of the logarithm of the iEMG value versus percent Displacement (pD) of skin landmarks had a high correlation (total mean r = 0.95). The normal LM and iEMG standards constitute a data base against which facial biomechanical properties in various pathologic states can be interpreted. In the course of data analysis, several interesting characteristics of facial function were identified.
Effect of amplification on the intelligibility of speech produced with an electrolarynx
Authors: Verdolini Katherine , Skinner Margaret W. , Patton Timothy , Walker Phillip A.
Published: October 2006

The purpose of this study was to look at the effect of orolabial amplification on the intelligibility of speech spoken with a neck model electrolarynx for two distance conditions, three noise conditions, and in relative quiet. A speaker using a neck model electrolarynx read single‐answer questions to six listeners. The questions were read with and without amplification at 1.5 and 2.5 m distance, in relative quiet as well as in 66 dB, 72 dB, and 76 dBSPL (A‐weightcd) prerecorded cafeteria noise. The results of the study showed that speech‐to‐noise ratios were improved for amplified speech, with improvement in intelligibility for speech spoken in moderate background noise (66 and 72 dBSPL). The effect of the “buzz” of the artificial larynx is reduced, and speakers are better understood in moderate background noise with this amplification system.
A study of post‐intubation laryngeal dysfunction
Authors: Whited Robert E.
Published: October 2006

A canine model of intubation has been established to further investigate the laryngeal injury occurring from an indwelling endotracheal tube. Ulcerations are produced by the shaft of the tube as it rubs and presses against the contact points in the cricoarytenoid region. This injury results in a progressive soft tissue inflammatory response in the posterior larynx. The injury and the associated tissue response leads to a limited arytenoid excursion which manifests functionally as alrway compromise and aspiration in the postex‐tubntion phases.
A comparison of speech using artificial larynx and tracheoesophageal puncture with valve in the same speaker
Authors: Merwin Gerald E. , Goldstein Lewis P. , Rothman Howard B.
Published: October 2006

Postlnryngectomy speech rehabilitation more frequently includes surgical‐prosthetic methods since the introduction of a low morbidity tracheoesophageal puncture technique und a one‐way alrflow valve. This study compares speech using an artificial larynx and, in one case, esophageal speech with speech using a tracheoesophageal puncture and valve in the same speaker. Using nonprofessional listeners, speech was rated for intelligibility and preference. Voice spectrograms were employed for measurement of rate, fundamental frequency, and intensity. While no statistically significant differences were found in mean fundamental frequency or intensity, the rate of post‐tracheoesophageal speech was considerably faster. In addition, when individual speakers are compared with themselves, post‐tracheoesophageal speech is significantly more intelligible and preferred by nalve listeners. We conclude that using the tracheoesophageal puncture with valve should be strongly considered in total laryngectomy patients whose present mode of communication is unsatisfactory.
Squamous cell carcinoma in the immunosuppressed patient: Fanconi's anemia.
Authors: Kaplan Michael J. , Cantrell Robert W. , Sabio Hernan , Wanebo Harold J.
Published: October 2006

The association of immunosuppression and head and neck cancer is supported by numerous reports demonstrating impaired cell‐mediated immunity, depressed T‐cell function, decreased lymphocyte responsiveness, and elevated circulating immune complexes.

Fanconi's anemia (FA) is a rare autosomal recessive syndrome characterized by progressive pancytopenia, skeletal abnormalities, hyperpigmentation, and other congenital anomalies. Increased chromosomal instability and defective DNA repair have been uniform findings. Several reports suggest associated immune deficiencies. There is an increased frequency of leukemia, hepatocellular carcinoma, and squamous cell carcinoma (SCC), including six cases of head and neck SCC.

We reported a young girl with FA who developed SCC of the tongue. Initial studies suggest low lymphocyte counts, but normal lymphocyte responsiveness. More precise characterization of the immune system defects in malignancy prone, genetically determined syndromes may provide clues for the diagnosis and treatment of patients with the more usual but more variable risk factors for SCC of the head and neck.
Meningitis and sensorineural hearing loss.
Authors: Baldwin Robert L. , Sweitzer Richard S. , Freind Deborah B.
Published: October 2006

A 12 month retrospective study was conducted on 54 children discharged from the Children's Hospital, Birmingham, Alabama, with a diagnosis of generalized meningitis, a major cause of post‐natal sensorineural hearing loss (SNHL). Of these high risk patients, 38 or 70% had Hemophilus influenza meningitis and fully 40% of those children tested audiometrically were determined to have SNHL. Becnuse there would appear to be an increase in SNHL in the post meningeal population, all children with a diagnosis of Haemophilus influenza, pneumococcal, or meningococcal meningitis should have an audiological workup, preferably prior to discharge from the hospital.
Arteriovenous malformations and vascular anatomy of the upper lip and soft palate.
Authors: Hassard A. D. , Byrne B. D.
Published: October 2006

Arteriovenous malformations (AVM) are a difficult clinical problem. These lesions may be extensive and diffuse and frequently prove refractory to the usual surgical methods of treatment. This paper presents three unusual AVMs of the orofacial region. Two were acquired AVMs of the upper lip, one involving columella; the third was a congential AVM of the soft palate. Complete surgical excision, following embolization, is the most successful therapy of traumatic AVM of the upper lip at this time. In addition, the blood supply of the upper lip and columella is presented, as it was found in ten cadaver dissections.
Supraglottic laryngectomy: Series report and analysis of results
Authors: Burstein Fernando D. , Calcaterra Thomas C.
Published: October 2006

Forty‐one consecutive patients who underwent suprnglottic laryngectomy at UCLA were reviewed. All of the operations were performed by or under the direct supervision of the same surgeon (T.C). The majority (68%) had advanced squamous cell carcinoma (Stage III‐IV). Approximately one half received radiation therapy as part of planned combined therapy. The overall tumor‐free survival, with a two‐year minimum follow‐up period, was 90%. The most common site of tumor recurrence was neck metastasis. There were four laryngeal recurrences, three of which were salvaged with completion laryngectomy. There was only one completion laryngectomy for severe aspiration. The favorable results in this series are attributed to frozen section control of surgical margins, surgical or radiation therapy treatment of cervical lymph nodes at risk for metastatic disease, and the employment of surgical techniques designed to minimize aspiration.
Furosemide ototoxicity: Clinical and experimental aspects
Authors: Rybak Leonard P.
Published: October 2006

Furosemide is an ototoxic diuretic. Furosemide injection is followed by a rapid, but reversible decrease of the Endocochlear potential and eighth nerve action potential with a more gradual decrease of the endolymph potassium concentration. In contrast to the reversible effects of furosemide alone on the cochlea, the combination of Kanamycin with furosemide resulted in irreversible changes in cochlear function which were associated with elevated levels of kanamycin in the blood and perilymph of the experimental animals. There was a striking similarity between the blood level measured by high pressure liquid chromatography at the time of recovery of auditory function in experimental animals and the ototoxic blood levels proposed by others in clinical literature. These findings help to provide a pharmacologic basis for the clinical observation of furosemide‐induced hearing loss.
Snoring: An acoustic monitoring technique
Authors: Wilson Kent , Mulrooney Thomas , Gawtry Randall R.
Published: October 2006

Snoring is a significant symptom of upper airway obstruction which has not been measured and quantified in a clinically useful manner. A technique to determine acoustic level, frequency, and duration of snoring is reported. Four case studies illustrate the utility of this method. It is recommended that acoustic monitoring be included in the polysomnographic assessment of selected sleep disorder patients.
Laryngeal pacemaker. II. Electronic pacing of reinnervated posterior cricoarytenoid muscles in the canine
Authors: Broniatowski Michael , Kaneko Satoru , Jacobs Gordon , Nose Yukihiko , Tucker Harvey M.
Published: October 2006

A fully reliable means of rehabilitating patients with bilateral vocal cord paralysis has not yet been developed. In order to improve upon existing solutions to this problem, the authors have recently described a laryngeal pacemaker, initially tested through stimulation of a cross‐over nerve‐muscle pedicle from one sternohyoid muscle to the other in the canine. Afferent stimuli, initiated through elongation of the airway during inspiration, were detected by a linear strain gauge sutured to the tracheal rings and appropriately amplified. The current report deals with the application of this concept to pace a nerve‐muscle pedicle reinnervating the posterior cricoarytenoid muscle. Videoscopie and cinematographic documentation of electrically paced abduction of the reinnervated vocal fold, synchronous with inspiration, was clearly demonstrated. Only miniaturization of an implantable electronic amplifier remains to permit an attempt at pacing of the paralyzed larynx in humans.
The pitfalls of limiting eng testing to patients with vertigo
Authors: Keim Robert J.
Published: October 2006

A high incidence of patients who do not experience vertigo with unilateral vestibular disease has been observed. Recognizing that many clinicians perform electronystagmographic vestibular testing on only patients who describe vertigo, a retrospective study of 229 patients was designed to study the potential pitfalls of this practice. The results confirm a preliminary study and show that 66% of the patients described no vertigo. Included were 13 intracranial lesions of which only one had the classic symptom. Differences in cortical perception and adaptation are postulated as factors responsible for these and other observations relative to caloric stimulation, torsion swing testing, and the presence of spontaneous nystagmus.
Central projections of primary vestibular fibers in the bullfrog. II. Nerve branches from individual receptors
Authors: Suarez Carlos , Kuruvilla Alexander , Sitko Stefan , Schwartz Ilsa R. , Honrubia Vicente
Published: October 2006

The fibers from the nerves innervating each of the three semicircular canals and the saccule were labeled by injecting horseradish peroxidase extracellularly into these nerves. The projections into the various veslibular nuclei of each receptor were studied in transverse sections of the brain stem throughout the vestibular nuclear area. All five vestibular nuclei receive primary afferents throughout their areas. There are differences in the projection patterns of the canals. In the superior and ventral vestibular nuclei, the location of the projections depends on the crista injected. The anterior canal projects ventrally, the horizontal canal centrally, and the posterior canal more dorsally. Each canal, however, sends fibers to all areas, with overlap of fibers from the different cristae. The cerebellar nucleus receives uniform innervation from the three canals. The medial vestibular nucleus in the rostral and caudal areas receives only thin fibers from each canal, with considerable overlap. The descending nucleus in the rostral and caudal areas receives innervation from the cristae, also with considerable overlap, but with greater intensity in the ventral part of the caudal portion of the nucleus. Each crista sends fibers to the cerebellar granular layer and to the base of the cerebellar Purkinje cell layer. These fibers also innervate the reticular formation below the entry zone of the eighth nerve. The saccule innervates both the dorsal (acoustic) and the ventral nuclei, the latter in the most dorsal position. The innervation of the utricle could be ascertained only in the middle section of the descending and the medial nuclei, an area which does not receive significant innervation from the cristae. Primary afferent fibers course in the vestibular tract, forming a longitudinal bundle lateral to the vestibular nuclei. In the bundle the larger fibers are medially situated.
Functional tracheoesophageal shunt for vocal rehabilitation after laryngectomy
Authors: Li Shu‐Ling
Published: October 2006

A new one‐stage surgical technique for postlaryngectomy vocal rehabilitation was applied to 19 patients with advanced carcinoma of the larynx. The technique consists mainly of the construction of a tracheoesophageal shunt and the creation of a tracheocsophageal flap to cover the shunt preventing entry of food into the trachea.

Fifteen of the 19 patients developed useful speech. Slight leakage of liquids into the trachea occurred in four patients. This is avoided by having the patient bend his head down during deglutition.

This technique can be performed in a wide variety of clinical situations and restores effortless speech without any special training.
Hearing results in tympanoplasty
Authors: Wehrs Roger E.
Published: October 2006

Recent reports from Scandinavian authors have put forth the concept that hearing improvement following tympanoplasty is seldom satisfactory and difficult to obtain. This view is contradictory to the experience of most American authors. A study, therefore, was undertaken to evaluate the hearing results obtained by this author through the use of homograft material in middle ear and mastoid reconstruction.

These hearing results are categorized according to time periods, types of reconstruction, and materials used. The hearing statistics are all taken from audiograms obtained one year or more postoperatively. These correspond with the type of reconstruction employed such as an intact ossicular chain, absence of the malleus, absence of the superstructure of the stapes, or both. Other categories include tympanoplasty with mastoidectomy or reconstruction of the posterior canal wall with homograft knee cartilage.

The surgical techniques are not discussed in this article because they have been detailed in previous publications.
Predictive value of laryngeal electromyography in patients with vocal cord paralysis of neurogenic origin
Authors: Parnes Steven M. , Satya‐Murti Saty
Published: October 2006

Laryngeal electromyography can provide prognostic information when evaluating patients with vocal cord dysfunction. Twentyfour patients were studied to determine the predictive capacity of this test. Six patients had bilateral vocal cord paralysis, constituting a total of 30 vocal cords examined.

Sixteen of these cords had decreased or absent motor unit potentials, fibrillations, or positive waves. None of these patients recovered function. Fourteen cords demonstrated either normal motor unit or polyphasic potentials. Return of mobility was evident in 11 of these cords. The combined total was 27 of 30 cords correctly predicted, demonstrating a 90% accuracy rate.
Cricopharyngeal myotomy: A review of surgical results in patients with cricopharyngeal achalasia of neurogenic origin
Authors: Berg Howard M. , Persky Mark S. , Jacobs Joseph B. , Cohen Noel L.
Published: October 2006

Cricopharyngeal myotomy is an effective procedure for the treatment of swallowing disorders due to dysfunction of the upper esophageal sphincter and pharyngeal musculature. Eight patients with documented pharyngeal and sphincteric dysfunction have undergone myotomies with significant improvement in swallowing associated with restoration of oral feeding without aspiration in 5, while 3 patients have not improved. The preoperative work‐up and evaluation is discussed as well as criteria that may identify those patients most likely to benefit from this treatment.
Facial paralysis in lyme disease
Authors: Clark Jane R. , Carlson Roy D. , Pachner Andrew R. , Sasaki Clarence T. , Steere Allen C.
Published: October 2006

Lyme disease is a multisystemic illness caused by a tick‐borne spirochete. Once considered unique to the Connecticut coastline, thousands of cases are now documented throughout the United States, northern Europe, and Australia.

Unilateral and bilateral facial paralysis may occur in up to 11% of patients with Lyme disease. This paper reviews the clinical course, distinguishing features, and outcome of 124 such palsies in 101 patients seen between 1975 and 1984. The 99.2% spontaneous recovery rate demonstrates the unequivocally excellent prognosis of this palsy and confirms that operative intervention is not indicated.

The otolaryngologist should consider this etiology in all otherwise idiopathic facial paralyses, especially when presenting in summer months in endemic areas, or when bilateral. Positive Lyme disease spirochete titers are helpful in the diagnosis. We believe antibiotics should be given to patients with this facial palsy in order to treat any other concurrent manifestations of the illness and to prevent subsequent complications.
True vocal cord paralysis following intubation
Authors: Cavo John W.
Published: October 2006

True vocal cord paralysis may follow endotracheal intubation and be the result of peripheral nerve damage. This damage can occur as the result of compressing the nerve between an inflated endotracheal tube cuff and the overlying thyroid cartilage.

A series of anatomic dissections defined the likely site of injury to be at the junction of the vocal process of the arytenoid cartilage and the membranous true vocal cord approximately 6 to 10 mm below the level of the cord.

Cuff pressures were monitored during anesthetics. Analysis of the results indicated that nitrous oxide diffuses into endotracheal tube cuffs causing a substantial increase in the intracuff pressure.

We have concluded that true vocal cord paralysis which follows endotracheal intubation is usually temporary. The solution to the problem lies in its prevention and several methods are described whereby it may be avoided.
The use of osteosynthesis in immediate and delayed mandibular reconstruction
Authors: Komisar Arnold , Shapiro Barry M. , Szporn Monroe , Danziger Eliot , Cobelli Neil
Published: October 2006

Principles of osteosynthesis utilizing dynamic compression plating have been used in immediate and delayed mandibular reconstruction in five patients. Intermaxillary fixation was not used. Follow‐up ranged from eight to 14 months. Four of five patients have viable bone grafts at the present time. One bone graft has been lost due to infection. We feel mandibular reconstruction based on principles of osteosynthesis helps to rapidly restore cosmesis and function with minimal morbidity.
Computerized database of drug interactions: A paradigm for resolving a communication gap in otolaryngology
Authors: Lucente Frank E.
Published: October 2006

The tremendous increase in the number of prescription and non‐prescription drugs available to physicians and patients increases the likelihood for adverse drug interactions. This study addresses the feasibility of using contemporary computer technology to provide the physician with the most up‐to‐date information in order to prevent such adverse reactions. The study involved three stages: 1. determination of physician attitudes regarding the use of the database; 2. creation of a database applicable to otolaryngology; and 3. testing of the database in office practice. The study demonstrated that many physicians were unsatisfied with their ability to remain conversant with the literature regarding drug interactions and that they were receptive to the notion of using computers for this purpose. It further demonstrated that a database could be constructed by an otolaryngologist for use in office practice and that the database contained other clinically useful information.
PLATE FIXATION FOR OPEN MANDIBULAR FRACTURES
Authors: Klotch Douglas W. , Bilger Joan R.
Published: October 2006

Eighty‐one patients with mandibular fractures were treated between November 1978 and November 1983. Twenty‐six of these patients had 47 comminuted open fractures treated with rigid internal fixation utilizing AO compression plating.

No infected nonunion, osteomyelitis, or plate extrusion occurred. Occlusal relationships of remaining dentition were maintained with normal mandibular function in all patients.

Rigid internal fixation is an excellent method for stabilizing and repairing comminuted open mandibular fractures. The technique provides immediate return of mandibular function which may be critical in the management of the polytraumatized patient.
The giant cholesterol cyst of the petrous apex: A distinct clinical entity
Authors: Graham Malcolm D. , Kemink John L. , Latack Joseph T. , Kartush Jack M.
Published: October 2006

The giant cholesterol cyst (GCC) of the petrous apex may now be considered a distinct clinical entity and should be considered in the differential diagnosis of lesions of the midcranial skull base.

This benign cystic lesion of the petrous apex gradually enlarges and may produce progressive bone erosion and serial neurologic deficits of the cranial nerves within the temporal bone and jugular foramen.

We report here five instances of this lesion (3 patients with unilateral and 1 patient with bilateral petrous apex lesions) and describe the natural history, diagnostic evaluation, pathology, and surgical management.
The tailored CT evaluation of persistent facial nerve paralysis
Authors: Harnsberger H. Ric , Davis R. Kim , Parkin James L. , Osborn Anne G. , Smoker Wendy
Published: October 2006

The clinical, radiographic, and pathologic records of 39 patients with peripheral facial nerve dysfunction seen from October 1981 through July 1984 are reviewed. The extent of preradiologic clinical localization of suspected lesions and their subsequent pathologic confirmation is correlated to the number, sequence, and type of radiographic evaluations performed.

Based on this review, an imaging protocol for patients with clinically occult lesions of the peripheral facial nerve is presented.
Spontaneous enophthalmos from chronic maxillary sinusitis
Authors: Wesley Ralph E. , Johnson John J. , Cate Ronald C.
Published: October 2006

Spontaneous enophthalmos has been reported to occur after demineralization of the orbital floor from chronic maxillary sinusitis. We report a 24‐year‐old female who developed spontaneous enophthalmos without demineralization of the orbital floor. A contracture from the maxillary sinus apparently pulled the orbital floor downward. Release of the fibrous tissue through a combined orbital and sinus approach produced satisfactory correction of the enophthalmos without the use of alloplastic implants. This case suggests that fibrotic contraction in the maxillary sinus pulling the floor of the orbit downward can produce spontaneous enophthalmos without boney destruction.
Myocutaneous fenestration in sleep apnea patients
Authors: O'Leary Michael J. , Farrell George
Published: October 2006

We present a patient with severe obstructive sleep apnea syndrome (OSAS), including O2 desaturations to 11%, who was successfully managed with myocutancous fenestration tracheostomy.

The myocutaneous fenestration technique employs bilateral horizontal skin‐platysma advancement flaps sutured directly to a trachecal fenestra created between rings two to four. It conforms ideally to the unique physical and psychological demands of the sleep apnea patient. Rapid healing time and minimal granulation tissue, combined with a permanently functional, yet reversible and minimally disfigurative stoma, highlight the advantages of the technique over standard tracheostomy. The myocutaneous fenestration tracheostomy is uniquely applicable to the surgical treatment of patients with moderate to severe obstructive sleep apnea.
Management of facial palsy caused by birth trauma
Authors: Bergman Ira , May Mark , Wessel Henry B. , Stool Sylvan E.
Published: October 2006

We present a newborn with a unilateral complete facial palsy caused by birth trauma, and discuss the differential diagnosis, pathophysiology, and management of this common, usually benign, condition. This child made a rapid, complete, spontaneous recovery despite a severe initial injury. Surgical exploration of the facial nerve should be considered only for infants with complete paralysis, clinically and electrophysiologically, who demonstrate no improvement by 5 weeks of age.
A finite element model of skin deformation. I. Biomechanics of skin and soft tissue: A review
Authors: Larrabee Wayne F.
Published: October 2006

Skin flap design has traditionally been based on geometric models which ignore the elastic properties of skin and its subcutaneous attachments. This study reviews the theoretical and experimental mechanics of skin and soft tissues (I) and proposes a mathematical model of skin deformation based on the finite element method (III). Finite element technique facilitates the modeling of complex structures by analyzing them as an aggregate of smaller elements.

This paper gives the results of an animal model developed to study the deformation and mechanical properties of skin, including its viscoelastic properties (hysteresis, creep, and stress relaxation). A new skin extensometer, constructed with digital stepper motors and controlled with a microcomputer, is described to measure these properties for both skin and its subcutaneous attachments. Deformation grids quantitated from photographs with a digitalizing tablet are presented, and computer software is introduced to standardize and analyze them (II). The mathematical model is used to simulate wound closures such as the ellipse and rectangular advancement flap. In addition, a series of mathematical experiments performed to simulate deformation of a strip of skin are described; the relationships between the various elastic constants are investigated; and a comparison of these simulations with actual deformation is presented. Limitations of the model and areas for future investigation are discussed (III).
Changes in caloric nystagmus induced by vasodilating drugs
Authors: Baldwin R. L. , Formby C.
Published: October 2006

Systemic blood flow, blood flow to the peripheral skin, middle ear, and temporal bone, and that to the inner ear of normal volunteers was manipulated selectively through the use of vasodilator drugs. The effect of selective vasodilation was monitored via changes in the temporal course of the slow‐phase velocity of nystagmus evoked by bithermal caloric irrigation. Drug influenced eye velocities were compared with control values measured before drug administration. Eye velocities measured after niacin (a peripheral vasodilator) administration generally were greater than control values, whereas eye velocities measured after papaverine (a central vasodilator) and histamine (a systemic vasodilator) administration typically were less than control values. These findings, with the exception of the cool caloric/niacin condition, are consistent with a model of vestibular dynamics and measurements of cochlear blood flow in animal models.
Multiple primary neoplasms in patients with salivary gland or thyroid gland tumors
Authors: Johns Michael E. , Shikhani Alain H. , Kashima Haskins K. , Matanoski Genevieve M.
Published: October 2006

The exact risk of multiple primary neoplasms in patients with salivary gland or thyroid gland malignancies is difficult to ascertain from the data available in the literature. This study examines, retrospectively, 198 patients with a first malignancy of the salivary gland and 186 patients with a first malignancy of the thyroid gland, treated over a 10‐year period. Fourteen cases of second tumors were found in the first group and 29 cases in the latter. Patients whose second neoplasm was a skin cancer or who had a previous neoplasm at a site other than those selected for study were excluded. The risk of a second tumor was compared to the expected number of second cancers from the Combined National Cancer Institute Registry Data, and the results indicated an increased risk in males with a first malignancy of the salivary gland and in both men and women with a first thyroid malignancy. The salivary glands, larynx, and colon were the most common sites of second tumors after a first salivary cancer. The adrenals, brain, lymphatic system, and breast were the most common site after a first thyroid cancer. The previously reported association of cancers of the thyroid and the breast in females is confirmed here in men and women. The excess of brain tumors and lymphomas has not been reported previously.
Compression plates in the treatment of advanced anterior floor of mouth carcinoma
Authors: Papel Ira D. , Price John C. , Kashima Haskins K. , Johns Michael E.
Published: October 2006

Advanced anterior floor of mouth squamous cell carcinoma has been traditionally treated with wide excision in conjunction with mandibulectomy and radical neck dissection. This has resulted in significant mandibulofacial defects with functional and cosmetic significance. Efforts at primary reconstruction in the past using bone grafts, osteomyocutaneous flaps, and other methods have yielded unsatisfactory results. A history of prior irradiation has made this problem even more refractory.

We present a series of 11 patients who underwent composite resection for advanced anterior floor of mouth carcinoma (T2‐T4), with primary reconstruction using a dynamic compression plating system in conjunction with local and regional tissue flaps. The clinical courses, complications, and surgical techniques are discussed.

The issues of reconstruction at primary treatment, irradiation with a metal plate in the field, and the early restoration of oral function are addressed. Experience in this series shows that compression plates can be an effective method of primary reconstruction for advanced anterior floor of mouth lesions.
Laryngoplasty for vocal cord medialization: An Alternative To Teflon®
Authors: Koufman James A.
Published: October 2006

Laryngeal framework surgery, using a Silastic®implant placed between the thyroid cartilage and inner thyroid perichondrium for vocal cord medialization, offers an exciting new surgical option to intracordal Teflon®injection for the relief of symptomatic unilateral vocal cord paralysis. A series of 11 patients who have undergone medialization laryngoplasty is presented. The advantages, technical details, and results of surgery are discussed.
Mediastinitis occurring as a complication of odontogenic infections
Authors: Levine Toni M. , Wurster Carl F. , Krespi Yosef P.
Published: October 2006

Mediastinitis occurring from a descending odontogenic infection occurs rarely. The diagnosis is sometimes difficult to make and is often delayed until the patient is in extremis. The physical examination is often nondiagnostic, but may include brawny edema of the neck and chest. CT scanning provides the most accurate diagnostic information. The treatment is always surgical, in combination with appropriate antibiotics. Five patients with mediastinitis secondary to odontogenic infections are presented, and the technique of transcervical drainage of the anterior and posterior mediastinum is reviewed.
Light dosimetry in animal models: Application to photodynamic therapy in otolaryngology
Authors: Werkhaven Jay , Harris David M. , Krol Glenn , Hill James H.
Published: October 2006

Photodynamic therapy (PDT) for treatment of head and neck cancer uses a photoactive compound that is illuminated with 630 nm (red) light. The effectiveness of PDT depends on the penetration of light into tissue that is both tissue and wavelength dependent. The characterization of the optical properties of an animal oral mucosa and skin has been done to determine the amount of light below these tissues available to be used for photodynamic therapy. The tissue absorbance of visible light from 400 nm to 700 nm has been determined in vitro for hamster cheek pouch mucosa and for athymic mouse skin. The pattern of absorbance is similar for both tissues and demonstrates greater transmission at the longer wavelengths. The diffuse transmittance of light in vivo for these animal models was measured with an interstitial fiberoptic probe. At 630 nm the diffuse transmittance for nude mouse skin averages 10% of the incident light energy, and that for the hamster mucosa almost 50% of the incident light energy.
A systematic approach to the surgical management of acoustic neuroma
Authors: Glasscock Michael E. , Kveton John F. , Jackson C. Gary , Levine Samuel C. , Mckennan Kevin X.
Published: October 2006

Contemporary otomicrosurgical techniques have made total removal of acoustic tumor with preservation of the seventh and sometimes the eighth cranial nerves possible. The four approaches currently used in acoustic tumor surgery are the middle cranial fossa, the translabyrinthine, the suboccipital, and the combined translabyrinthine‐suboccipital. This review examines the surgical results in the removal of more than 600 acoustic tumors and outlines a rationale for the choice of approach. Tumor size on computed tomographic scan and auditory reserve establish the parameters used in planning the surgical procedure. The translabyrinthine exposure is used most frequently followed by the combined translabyrinthine‐suboccipital. The middle fossa and suboccipital approaches are used when preservation of hearing is attempted. Total removal of tumor was accomplished in more than 99% of patients with a mortality rate of less than 1%. Anatomic preservation of the facial nerve, which is directly related to tumor size, was achieved in more than 80% of patients. Preservation of hearing is unlikely when the tumor is larger than 2 cm; anatomic preservation of the cochlear nerve was successful in 73% of hearing preservation procedures.