bluuebunny/crossref_metadata_2025 huggingface dataset:
Histopathology of the Uvula and the Soft Palate in Patients With Mild, Moderate, and Severe Obstructive Sleep Apnea
Authors: Berger Gilead , Gilbey Peter , Hammel Ilan , Ophir Dov
Published: November 2003

Objective To study morphometric and qualitative histopathologic changes of the soft palate and uvula in patients with mild, moderate, and severe obstructive sleep apnea.

Study Design A prospective, nonrandomized controlled study.

Methods The distal soft palate and uvula were excised during uvulopalatopharyngoplasty from 34 male patients with obstructive sleep apnea. Control specimens were retrieved from 7 male cadavers with no related disorders. All specimens underwent routine processing and the mid‐sagittal sections were studied. Morphometric analysis of the relative proportions of the tissue constituents was carried out. Also, a qualitative assessment was performed to detect possible pathologic changes.

Results The body mass index of patients was significantly higher from that of control subjects. The area fraction occupied by the tissue constituents of the distal portion of the soft palate and uvula in patients with mild, moderate, and severe obstructive sleep apnea and in control subjects was similar, with small and insignificant differences regarding the contents of glands, muscle, fat, blood vessels, and the epithelium. Only the connective tissue was significantly greater in patients with moderate obstructive sleep apnea than in those with severe obstructive sleep apnea and control subjects. The qualitative assessment of the specimens disclosed normal tissue architecture without evidence of destruction. Vascular engorgement, fibrosis, edema, inflammatory cell infiltration, and dilated glandular ducts were observed in a portion of patients and control subjects.

Conclusions The structure of the distal soft palate and uvula of patients with obstructive sleep apnea undergoes insignificant changes and is independent of the body mass index levels, indicating that the pathologic changes are probably the sequela of airway obstruction rather than its cause.
Microsurgical Anatomy of the Laryngeal Nerves as Related to Thyroid Surgery
Authors: Monfared Ashkan , Gorti Goutham , Kim Daniel
Published: November 2003

Objectives The objectives were to explore microsurgical anatomy of the superior and recurrent laryngeal nerves and their importance in thyroid surgery, and to examine areas of potential morbidity, means of identification, and arterial supply of the laryngeal nerves.

Study Design Descriptive analysis of anatomical features.

Methods Twenty‐one adult cadavers, some perfused with colored silicon, were dissected for the study project.

Results The right recurrent laryngeal nerve (RLN) branches off the vagus at the level of the subclavian artery and the left one at the level of the aorta. Both ascend parallel to the tracheoesophageal groove and innervate trachea, esophagus, and the inferior pharyngeal constrictors en route. The RLN has the highest probability to pass between the branches of the inferior thyroid artery on the right side and posterior to them on the left side. The RLN always passes posterior to the cricothyroid joint. The RLN is supplied by the branches of the inferior thyroid artery. The superior laryngeal nerve (SLN) branches into internal and external branches deep to the carotid bifurcation. The internal branch passes deep to the superior thyroid artery and descends toward thyrohyoid membrane. The external branch travels deep and parallel to the superior thyroid artery to innervate cricothyroid muscle. The internal branch is supplied by the superior laryngeal artery, and the external branch by the cricothyroid artery.

Conclusions The only consistent location of the RLN is when it passes posterior to the cricothyroid joint. Because of extreme variability of the inferior thyroid artery and the RLN, it is suggested that the artery be ligated either proximally or at its tertiary branches on thyroid capsule. The internal branch of the SLN is not potentially at risk during thyroidectomy unless the superior thyroid artery is ligated proximally. The external branch of the SLN accompanies the superior thyroid artery for most of its course and is at potential risk if the trunk of the superior thyroid artery is ligated outside the pretracheal fascia.
Association Between High Initial Tissue Levels of Cyclin D1 and Recurrence of Nasopharyngeal Carcinoma
Authors: Lai Jin‐Ping , Tong Cai‐Li , Hong Cheng , Xiao Jian‐Yun , Tao Zheng‐De , Zhang Zheng , Tong Wei‐Min , Betz Christian S.
Published: November 2003

Objectives/Hypothesis Cyclin D1 expression and the rate of apoptosis have been reported to serve as important prognostic indicators in human cancers. The purpose of the present study was to determine the prognostic significance of both initial cyclin D1 expression and the apoptotic index in nasopharyngeal carcinoma.

Study Design Cohort study.

Methods Cyclin D1 protein levels and apoptosis in tumors and their corresponding adjacent, histologically normal tissues were determined at the time of initial diagnosis using immunohistochemical staining, Western blot analysis, and in situ end labeling, respectively, in 64 patients with T1‐T4/N0‐N2, poorly differentiated squamous cell carcinoma of the nasopharynx. All cases were treated by routine radiation therapy with a total median dose of 70 Gy and followed up for 10 years.

Results High levels of cyclin D1 were found in 35 of 64 tumor specimens (54.7%); no cyclin D1–positive cells were determinable in normal epithelium of the nasopharynx. Rates of early local recurrence (within 5 y) were significantly higher (P <.01) for patients with high levels of cyclin D1 before radiation therapy (24 of 35 patients [68.6%]) as compared with patients with low or no expression (3 of 29 [10.3%]). Furthermore, patients bearing high levels of cyclin D1 had a poorer prognosis concerning 10‐year survival than the others (P <.001), whereas overexpression of cyclin D1 did not correlate with the initial TMN classification (P >.05). According to the rate of spontaneous apoptosis in tumors below or above the median, patients were divided into two groups. There was no statistically significant difference for the overall survival between the two groups (P >.05).

Conclusions The present study demonstrates that cyclin D1 can be used as an indicator of recurrence and subsequent prognosis in nasopharyngeal carcinoma after radiation therapy. At the same time, the apoptotic state before radiation therapy is of no value in predicting the prognosis of patients with nasopharyngeal carcinoma.
Observations on Conduction of Caloric Stimulation to the Middle Ear Cavity by Thermoscanning
Authors: Nishizawa Shinji
Published: November 2003

Objective To elucidate the ways in which caloric stimulation conducts and the temperature recovers on the temporal bone by the caloric stimulation test.

Methods Four cases examined temperature changes of the bony lateral semicircular canal eminence with thermal images by caloric stimulation tests. Changes in the heat distribution were observed by means of a Thermoscan (Nihondenki Sanei Thermotracer 6T67R, Tokyo, Japan).

Results The temperature began to decrease from the external canal and the decrease reached the posterior cranial fossa plate through the middle ear cavity while the stimulation continued. After the end of stimulation, the stimulation advanced in the direction opposite to the order in which it was transmitted and recovered in a manner resembling a mirror image despite the difference in speed.

Conclusions The way in which the caloric stimulation was conducted and the way in which the temperature recovered were in the opposite direction.
Differences in Endolymphatic Sac Mitochondria‐Rich Cells Indicate Specific Functions
Authors: Peters Theo A. , Tonnaer Edith L. G. M. , Kuijpers Wim , Cremers Cor W. R. J. , Curfs Jo H. A. J.
Published: November 2003

Objective/Hypothesis The purpose of the study was to examine the specific involvement of endolymphatic sac mitochondria‐rich cells in endolymph homeostasis.

Study Design Transmission electron microscopy and immunohistochemistry were performed on the endolymphatic sac of young adult rats, and two important developmental stages were also investigated.

Methods Ultrastructural characteristics of endolymphatic sac mitochondria‐rich cells were studied more concisely and compared with renal mitochondria‐rich cells (i.e., the intercalated cells). In addition, expression of cytokeratins 7 and 19 was determined.

Results Until birth, only one type of mitochondria‐rich cell is observed in the rat endolymphatic sac. In young adult animals, distinct differences in mitochondria‐rich cell ultrastructure in the endolymphatic sac enables classification into subtypes or configurations. Comparison of endolymphatic sac mitochondria‐rich cells with renal intercalated cells reveals striking similarities and provides additional information on their specific function in endolymph homeostasis. Furthermore, differences in cytokeratin expression are determined in endolymphatic sac mitochondria‐rich cells.

Conclusions Differences in morphology of endolymphatic sac mitochondria‐rich cells develop after birth and may reflect a distinct functional or physiological state of the cell. In analogy to renal intercalated cells, the distribution patterns of H+‐adenosine triphosphatase and Cl−/HCO3− exchanger may differ between subtypes. We propose that subtype A mitochondria‐rich cells, from which protruding A mitochondria‐rich cells are the activated state, are involved in proton secretion (apical H+‐adenosine triphosphatase) and thus are potential candidates for hearing loss accompanying renal tubular acidosis. Subtype B mitochondria‐rich cells are the most likely candidates to be affected in Pendred syndrome because of the assumed function of pendrin as apical Cl−/HCO3− exchanger.
Oropharyngeal Swallowing Variability
Authors: Kendall Katherine A.
Published: November 2003

Objectives/Hypothesis The pharyngeal phase of deglutition is considered to occur in a reflexive, preprogrammed fashion. Previous studies have determined a general sequence of events based on the mean timing of bolus transit and swallowing gestures. However, individual variability has not been studied. The purpose of the present study was to evaluate the amount of sequence variability that normally occurs during the oropharyngeal phase of deglutition.

Study Design Prospective analysis of conservative subjects.

Methods Dynamic swallow studies from 60 normal volunteers were evaluated, and event sequence variability was determined around two event sequences during swallowing of three bolus sizes.

Results There was found to be substantial variability in event sequences for all events analyzed. Variability was greater during a smaller bolus swallow.

Conclusions The evaluation of variability within the study group of individuals reveals the complexity of the swallowing mechanism and underscores the importance of not relying on general guidelines in evaluating the coordination of swallowing gestures in a given individual with dysphagia complaints.
Effect of Bacterial Endotoxin and Middle Ear Effusion on Ciliary Activity: Implications for Otitis Media
Authors: Mason Paul S. , Adam Elizabeth , Prior Matthew , Warner John O. , Randall Christopher J.
Published: November 2003

Objectives/Hypothesis Otitis media with effusion (OME) is the most common cause of childhood deafness. The pathogenesis is not fully understood, especially the reasons for failure of mucociliary clearance of the middle ear. It is not clear whether the cilia function normally in the middle ear and eustachian tube in the chronic phase of otitis media with effusion. However, impaired ciliary function in primary ciliary dyskinesia is known to be frequently associated with the development of otitis media with effusion. We hypothesized that endotoxin or the bacterial products in middle ear fluid in otitis media with effusion would adversely affect ciliary activity, thereby contributing to the pathogenesis of the disease.

Study Design Laboratory‐based study of human ciliary activity with reference to otitis media with effusion.

Methods We have studied the activity of human adenoidal cilia under various conditions. Ciliary activity in the presence of Haemophilus influenzae endotoxin additions (at varying concentrations) to cultured adenoidal explants has been measured. In addition, ciliary activity of these explants was also observed after addition of middle ear effusion aspirated from patients.

Results We have shown that endotoxin in concentrations far in excess of those found in the middle ear with chronic otitis media with effusion had no effect on ciliary activity. Furthermore, ciliary activity was completely unaffected by the presence of middle ear effusion.

Conclusion There is no evidence that ciliary activity is reduced by the constituents of middle ear fluid in chronic otitis media with effusion.
Long‐Term Follow‐up of Repair of External Nasal Deformities in Patients With Wegener's Granulomatosis
Authors: Congdon David , Sherris David A. , Specks Ulrich , McDonald Thomas
Published: November 2003

Objective Wegener's granulomatosis is a disorder of the upper airway, lungs, and kidneys characterized histologically by necrotizing granulomas and vasculitis. One common result of Wegener's granulomatosis is destruction of the framework of the nose, resulting in a saddle‐nose deformity. The study was initiated to determine the efficacy and safety of reconstructing external nasal deformities in these patients.

Study Design A retrospective review.

Methods We searched for all patients with Wegener's granulomatosis who underwent an external nasal reconstruction between the years of 1976 and 2000.

Results Thirteen patients met the search criteria. The average duration of follow‐up is 59 months (range, 10–177 mo). The initial surgery resulted in a satisfactory outcome in 10 of 13 patients (77%). Two of the patients who failed the primary surgery underwent successful revision rhinoplasty, and one chose not to undergo revision surgery. This resulted in a 92% (12 of 13) overall patient success rate. Ten of the 13 patients had an improvement in their nasal airway postoperatively, and the remaining three had no mention of postoperative airway in the record. The postoperative airway was not made worse in any of the patients operated on in the series. All of the patients had reconstruction when their Wegener's granulomatosis was in remission. Twelve of the 13 patients with an external deformity had a saddle‐nose defect. The remaining deformity was a defect of the alar rim. Sixteen surgeries were preformed in total (15 dorsal repairs [12 primary, 3 revisions] and 1 alar rim repair). The most common graft materials used in the reconstruction of the dorsal deformities were costal cartilage (40% [6 of 15]) and calvarial bone (27% [4 of 15]). The remaining dorsal defects were repaired with irradiated rib (1 of 15), irradiated dura (1 of 15), conchal cartilage (1 of 15), iliac crest (1 of 15), and bony septum (1 of 15). The alar rim defect was repaired using a composite auricular graft. The overall success rates by graft type were as follows: costal cartilage, 83% (5 of 6); calvarial bone, 75% (3 of 4); composite auricular, 100% (1 of 1); iliac bone, 100% (1 of 1); conchal cartilage, 100% (1 of 1); septal bone, 100% (1 of 1); irradiated rib, 0% (0 of 1); and irradiated dura 0% (0 of 1).

Conclusions Reconstruction of external nasal deformities in patients with Wegener's granulomatosis is safe. Surgery does not appear to either induce a flare‐up or accelerate the course of Wegener's granulomatosis. There may be a higher risk of failure in primary nasal dorsal repair in patients with Wegener's granulomatosis than in other patients undergoing dorsal augmentation. Irradiated materials in the series also appear to be more prone to resorption.
Fungal Mucoceles of the Sphenoid Sinus
Authors: Lee Jivianne T. , Bhuta Sunita , Lufkin Robert , Calcaterra Thomas C.
Published: November 2003

Objective The purpose of this study was to demonstrate that fungal mucoceles of the sphenoid sinus do not necessarily require an external approach for eradication of disease. We report 6 cases of fungal mucoceles of the sphenoid sinus seen at UCLA Medical Center from 1980–1999, 4 of which were successfully treated with endoscopic intranasal sphenoidotomy and the other 2 through either a transseptal or transantral approach.

Study Design and Methods Case series. The medical records of 6 patients with fungal mucoceles of the sphenoid sinus treated at UCLA Medical Center over a 20‐year period (1980–1999) were retrospectively reviewed.

Results Six patients diagnosed with fungal mucoceles of the sphenoid sinus were seen at UCLA Medical Center from 1980–1999. Endoscopic intranasal sphenoid sinusotomy was performed on 4 patients and a transseptal or transantral approach to the sphenoid sinus was used on the remaining 2 patients. No evidence of recurrent disease has been seen after up to 15 years of follow‐up.

Conclusions When diagnosed early, functional endoscopic intranasal sphenoidotomy represents an effective mode of treatment for patients with fungal mucoceles of the sphenoid sinus, obviating the need for more aggressive surgical approaches.
Endoscopic Management of the Frontal Recess in Frontal Sinus Fractures: A Shift in the Paradigm?
Authors: Smith Timothy L. , Han Joseph K. , Loehrl Todd A. , Rhee John S.
Published: November 2003

Objectives To evaluate alternative management strategies for anterior table frontal sinus fractures involving the frontal sinus outflow tract.

Study Design A prospective cohort of patients with anterior table frontal sinus fracture with frontal outflow tract involvement documented by computed tomography (CT) scan was examined between 1999 and 2001.

Methods A select group of patients with anterior table frontal sinus fracture involving the frontal outflow tract was treated with open reduction of bony fracture without osteoplastic obliteration of the frontal sinus. Serial CT scans were obtained starting at 8 weeks after injury. Patients with persistent frontal sinus obstruction after medical treatment underwent an extended endoscopic frontal sinusotomy or a modified endoscopic Lothrop procedure.

Results Fourteen patients sustained frontal sinus fractures and were treated during the study period. Seven patients were included in the modified treatment algorithm, with a mean follow‐up of 18 months. All patients had concurrent facial fractures: superior orbital rim (n = 5), naso‐orbital–ethmoid complex (n = 2), mandible (n = 2), and midface (n = 2). All 7 patients underwent open repair of the facial fractures. Postoperatively, 5 patients had spontaneous frontal sinus ventilation. Two patients, both of whom had naso‐orbito–ethmoid fractures, had persistent frontal sinus obstruction clinically and radiographically. These patients were successfully managed with an endoscopic frontal sinus procedure.

Conclusions A select group of patients with frontal sinus and outflow tract fracture may be managed with open repair of the anterior table fracture without obliteration. In these cases, suspected frontal outflow tract obstruction can be managed expectantly. Failed frontal sinus ventilation may require endoscopic frontal sinus surgery to reestablish mucociliary clearance.
Cell Proliferation and p27Kip1 Expression in Endophytic Schneiderian Papillomas
Authors: Schwerer Michael J. , Sailer Adrian , Kraft Klaus , Maier Heinz
Published: November 2003

Objective To clarify epithelial cell proliferation and p27Kip1 expression along the stepwise histological changes from endophytic schneiderian papillomas to associated carcinomas.

Study Design Retrospective investigation involved surgical specimens from 58 patients.

Methods Immunohistochemical assessment involved the nuclear Ki67 antigen expressed in proliferating cells. Further, the cyclin‐dependent kinase (cdk) inhibitor p27Kip1 was assessed. Binding of p27Kip1 to the cyclin E‐cdk2 complex inhibits this kinase, which results in cell cycle arrest. The expression rates of both proteins were compared between non‐papillomatous nasal mucosa, endophytic schneiderian papillomas, carcinoma in situ, and invasive squamous cell carcinomas. Statistics involved the Wilcoxon and Mann‐Whitney u tests. Significance was set at P <.05.

Results Comparable cell proliferation rates were observed between non‐papillomatous nasal mucosa and cylindrical cell papillomas. Significant increases in cell proliferation were found along the stepwise series of histological changes involving non‐papillomatous nasal mucosa, columnar epithelium in inverted papillomas, transitional and squamous metaplasia in inverted papillomas, and dysplastic inverted papillomas (P <.05, respectively). A tendency toward increased cell proliferation in carcinoma in situ compared with dysplastic inverted papillomas was present; however, this was not statistically significant. The expression rates of p27Kip1 were comparable between non‐papillomatous nasal mucosa and all histological subtypes within non‐dysplastic endophytic schneiderian papillomas. Significantly reduced p27Kip1 expression was found in surface cells in dysplastic compared with non‐dysplastic inverted papillomas, as well as in the total number of cells in carcinoma in situ compared with dysplastic inverted papillomas (P <.05, respectively).

Conclusions Inverted papillomas but not cylindrical cell papillomas show increased cell proliferation compared with non‐papillomatous nasal mucosa. Stepwise increases in cell proliferation accompany the consecutive histological changes within inverted papillomas. Among them, increased cell proliferation along with the development of dysplasia and carcinoma in situ is associated with reduced p27Kip1 expression.
Hypothesis: Research in Otolaryngology Is Essential for Continued Improvement in Health Care
Authors: Mathog Robert H.
Published: November 2003

The present report, in the form of a research proposal, is based on the hypothesis that research in otolaryngology is essential for continued improvement in health care. Examples of advances in otolaryngology as a result of research are noted, but for continued success, otolaryngology must maintain and find better ways to train clinically directed researchers. Traditional methods of training such as hands‐on experience, courses in the basic principles of research, protected time, and mentoring are discussed and evaluated. Barriers to success such as age, time, and debt are noted. Potential solutions are presented with an emphasis on integration of the research and clinical training. Success of faculty will continue to depend on laboratory and financial support, technical assistance, protected time, salary equivalent to other faculty, and accessibility of research funds. For research to gain support and enthusiasm and to keep it strong and productive, cost‐effectiveness and value must be recognized.
Objective Facial Motion Analysis in Patients With Facial Nerve Dysfunction
Authors: Linstrom Christopher J.
Published: November 2003

Objectives/HypothesisTo objectively measure facial motion at various facial landmarks using a video‐computer interactive system.

Study DesignClinical, prospective, non‐randomized.

MethodsA video‐computer interactive system, The Peak Motus Motion Measurement System, was used to study linear displacement at preselected facial landmarks in the normal and abnormal face. Subjects with normal facial function (n = 34) and patients with abnormal facial function (n = 26) from various etiologies were studied. The sites studied were marked with reflective beads. Of a larger repertoire of expressions, two expressions (eyes closed and closed‐lip smile) were studied in all subjects. The percent asymmetry in facial displacement between the sides of the face was calculated. The sensitivity of this measurement to facial dysfunction was evaluated. The presence of synkinesis was examined by quantifying the displacement at facial sites that were remote to the sites primarily involved in a given facial expression. Test–retest reliability of the percent asymmetry measurement was evaluated with the pairedttest.

ResultsThe video‐computer interactive approach used accurately detected and quantified gross and subtle changes in facial function. The sensitivity of the percent asymmetry measurement was 95% (both expressions) for patients with apparent facial dysfunction (House‐Brackmann rating >I/VI). In patients with facial nerve dysfunction, displacement on the presumably normal side was significantly excessive in 27% to 35%, depending on the expression. With this interactive computer‐video system, synkinesis was detected in 58% of the pathologic subjects during the eyes closed or closed‐lip smile expressions. The pairedttest indicated strong test–retest reliability (r= 0.73–0.99) of the percent asymmetry measurement.

ConclusionsThe present report indicates that this approach to the assessment of facial motion is sensitive to facial dysfunction. This computer‐video interactive system is able to quantify synkinesis. A grading system for the magnitude of synkinesis, based on the magnitude of the displacement at remote facial sites, is proposed. The common occurrence of excessive facial motion on the presumably normal side of affected individuals indicates that patients with facial paralysis often overcompensate by exaggerating the normal side in an effort to move the affected side. This system is of value in the objective measurement of normal facial function and may prove a useful tool to quantify the outcomes of various medical and surgical treatments for facial nerve dysfunction.
Rapid Elevation of Gentamicin Levels in the Human Labyrinth Following Intravenous Administration
Authors: Becvarovski Zoran , Michaelides Elias M. , Kartush Jack M. , Bojrab Dennis I. , LaRouere Michael J.
Published: November 2003

Hypothesis Adequate quantities of labyrinthine fluid can be sampled from the human labyrinth to perform quantitative analysis of medications. A rapid elevation of intralabyrinthine gentamicin levels after intravenous administration can be measured. A model for the sampling of human inner ear fluid in this manner is described.

Background The risk of aminoglycoside ototoxicity has been a long‐standing concern. The kinetics of gentamicin diffusion into the inner ear have been extrapolated to humans from various animal models. The validity of extrapolation to humans is unknown. We have developed a new model to measure the uptake of gentamicin in vivo.

Methods A single intravenous dose of gentamicin (80 mg) was given perioperatively to 13 patients undergoing translabyrinthine acoustic neuroma surgery. The lateral semicircular canal and vestibule were opened and a microsyringe was used to obtain a sample of labyrinthine fluid concomitant with a serum sample. The gentamicin concentration of the labyrinthine fluid and serum was analyzed using a standard chemistry analyzer.

Results After parenteral administration of gentamicin, fluid was obtained from the inner ear of 13 acoustic neuroma patients. Inner ear concentrations were between 1.0 and 3.8 mg/L. Serum gentamicin levels ranged from 1.2 to 10.5 mg/L.

Conclusions This method allows the sampling of intralabyrinthine fluid in humans. Gentamicin was noted immediately in the labyrinth after intravenous administration. This model may be expanded to measure other compounds given either by intravenous or transtympanic routes.
The Potential Pitfalls of Concurrent Rhinoplasty and Endoscopic Sinus Surgery
Authors: Millman Brad , Smith Ronald
Published: November 2003

ObjectiveAs the largest portion of the population is becoming middle aged and our society becomes increasingly interested in youth and appearance, so does the number of esthetic surgeries. Rhinoplasty is being performed with increased frequency in recent years. Many surgeons are performing rhinoplasty combined with endoscopic sinus surgery as a means to decrease operating times, healing times, as well as patient cost. Many surgeons may be unaware of several potential life‐threatening complications when these two safe procedures are performed concurrently.

Study DesignA rare but illustrative case depicting a serious complication of concurrent surgery. A retrospective review of our experience and an extensive literature review were performed documenting the type and incidence of minor and serious postoperative complications.

ResultsA case demonstrating multiple near‐fatal complications after rhinoplasty and endoscopic sinus surgery, which are two safe, commonly performed procedures when performed individually. A review of our 268 rhinoplasties performed between 1997 and 2001 demonstrated 11 cases with concurrent surgery. There were no complications noted in this population.

ConclusionWe conclude and agree with the literature that concurrent surgery is safe and effective.
Treatment of Simple Snoring Using Radio Waves for Ablation of Uvula and Soft Palate: A Day‐Case Surgery Procedure
Authors: Wedman Jan , Miljeteig Harald
Published: November 2003

Objective Uvulopalatoplasty, performed with high‐frequency radio waves, was evaluated as a treatment for social snoring.

Methods Forty male social snorers were included in this prospective, nonrandomized study. Patients' subjective complaints before, during, and 3 months after radio‐assisted uvulopalatoplasty were recorded on a visual analogue scale.

Results Complications were negligible. Snoring sounds and daytime tiredness reduced significantly. Considering effect and suffering during and after surgery, a high number of patients (93%) were willing to undergo the procedure again if necessary.

Conclusions The results of radio‐assisted uvulopalatoplasty (RAUP) seem to be similar to other surgical methods used to reduce snoring. The relative small investments needed and its simplicity makes RAUP a good alternative to known treatment strategies.
Management of T3N0M0 Glottic Carcinoma: Therapeutic Outcomes
Authors: Sessions Donald G. , Lenox Jason , Spector Gershon J. , Newland Donald , Simpson Joseph , Haughey Bruce H. , Chao K. S. Clifford
Published: November 2003

Background The best therapeutic approach for the treatment of T3N0M0 (stage III) glottic carcinoma is controversial.

Method A retrospective study of Tumor Research Project data were performed using patients with T3NOMO glottic squamous cell carcinoma treated with curative intent by seven different treatment modalities from January 1950 to December 1996 at Washington University School of Medicine/Barnes‐Jewish Hospital.

Results Two hundred patients with T3NOMO glottic carcinoma were treated using seven modalities: total laryngectomy (TL, n = 30), TL with neck dissection (TL/ND, n = 40), conservation surgery alone (CS, n = 22), radiation therapy alone (RT, n = 29), TL combined with RT (TL/RT, n = 31), TL and ND combined with RT (TL/ND/RT, n = 36), and CS combined with RT (CS/RT, n = 12). The overall 5‐year observed survival rate (OS) was 54% and the 5‐year disease‐specific survival rate (DSS) was 67%. The 5‐year DSS for the individual treatment modalities included TL, 65.4%; TL/ND, 76.5%; CS, 71.4%; RT, 56.5%, TL/RT, 51.9%; TL/ND/RT, 71.4%; and CS/RT, 80%. There was no significant difference in DSS for any individual treatment modality (P = .375). The overall local and regional control rate was 74% (148 of 200). The overall recurrence rate was 37.5% with recurrence at the primary site and in the neck of 19.5% and 11%, respectively. Recurrence was not related to treatment modality. The 5‐year DSS after treatment of recurrent cancer (salvage rate) was 35.8%. The incidence of distant metastasis was 11% and for second primary cancers it was 19.5%. There was no statistically significant difference in survival between necks initially treated (72%, 5‐y DSS) versus necks observed and later treated if necessary (70%, 5‐y DSS) (P = .797).

Conclusions The seven treatment modalities had statistically similar recurrence, complication, and survival rates. Patients with clear surgical margins have a significant survival advantage compared with patients with close and involved margins. Because postoperative radiation therapy in patients with positive margins did not improve survival, formal re‐resection of the site of the positive margin should be considered. In patients whose N0 neck was not treated electively, close follow‐up observation with meticulous examinations combined with appropriate treatment for subsequent neck disease resulted in a similar survival rate compared with those patients whose N0 necks were treated initially. Six‐year minimum follow‐up is recommended for early identification of primary and neck recurrence and for discovering expected second primary cancers. Patients treated with RT and CS had statistically similar rates of survival, maintenance of voice, and acquired permanent tracheal stoma. CS is a valid alternative to RT in treating highly selected patients with T3NO glottic carcinoma.
Neck Dissections: Predicting Postoperative Drainage
Authors: Urquhart Andrew C. , Berg Richard L.
Published: November 2003

Objectives Most head and neck dissections performed in conjunction with carcinomas of the upper aerodigestive tract require drain insertion. The time that the drains remain in place largely determines the duration of postoperative hospitalization. This study sought to retrospectively compare different neck dissections in terms of postoperative drainage and duration of hospitalization. We also sought to identify any correlation between total intraoperative blood loss and postoperative drainage.

Materials and Methods Radical, modified radical, and selective neck dissections performed in conjunction with resection of a carcinoma of the upper aerodigestive tract over a 3‐year period were evaluated. Total intraoperative blood loss at surgery, and amount and duration of postoperative drainage for each neck dissection were recorded.

Results Seventy‐nine neck dissections were performed on 52 patients, 27 (52%) of whom had bilateral neck dissections. Median drainage was 116.5 mL, 172 mL, and 319 mL for selective, modified radical, and radical neck dissections, respectively. Drainage differed significantly by type of neck dissection (P <.001). Drains remained in place a median of 4 days with no significant difference between different types of neck dissections. Drainage was clearly correlated with total intraoperative blood loss (Spearman correlation = 0.44, P <.001).

Conclusion The postoperative drainage per day was higher in radical neck dissections than modified radical neck dissections and lowest in selective neck dissections. This difference was not reflected in the duration that the drains would remain in place. Total intraoperative blood loss is a strong predictor of the amount and duration of postoperative drainage.
The 11th Nerve Syndrome in Functional Neck Dissection
Authors: Salerno Grazia , Cavaliere Matteo , Foglia Alessandra , Pellicoro Dora Parente , Mottola Giampiero , Nardone Massimiliano , Galli Vieri
Published: November 2003

Objectives Assessment of the incidence of shoulder joint disability and evaluation of the role of a personal postoperative physical rehabilitative protocol therapy in reducing pain and shoulder dysfunction and improving the quality of life (QOL) of patients who have undergone functional neck dissection (FND) associated with total laryngectomy.

Setting, Design, and Outcome Measures Sixty laryngectomees who had undergone FND were divided into two groups (A and B). Group A received physical therapy after surgery. Clinical evaluation was done according to the Constant modified questionnaire, including physical assessment of passive and active shoulder movement and information regarding patients' QOL. Bilateral quantitative electromyography (Q‐EMG) of scapulohumeral muscles was carried out on all patients. Results were evaluated by Student t test and multivariate analysis to find out which variables were important in predicting pain and return to work.

Results Six months after surgery, the patients in group A had better results concerning passive forward elevation (P = 0), shoulder active motility (P = 0), pain (P <.001), working and recreational activity (P = 0), and score of Constant (P = 0) compared with the patients in group B. From a multivariate analysis of clinical parameters important in predicting pain, significant predictors (P <.01) were shown to be global shoulder active motility, active forward elevation, abduction, active external rotation, internal rotation hand to back, working and recreational activity, and score of Constant. Regarding return to work, a significant predictor (P <.01) was the score of Constant. Electromyography work‐up showed deterioration in early postoperative periods and improvements in late postoperative periods.

Conclusion The post‐surgical variable clinical picture of shoulder disability is related not only to the accessory nerve injury, but also to the secondary glenohumeral stiffness resulting from the scapulohumeral girdle muscles weakness and postoperative forced immobility. Physical therapy aimed to early recover passive motion and to avoid the occurrence of joint fibrosis has been shown to have a real contributory role in decreasing shoulder complaints and improving the patients' QOL.
A Method to Repair Auricular Defects After Perichondrial Cutaneous Grafting
Authors: Stucker Fred J. , Sanders Kenneth W.
Published: November 2003

Objective To describe and illustrate the technique for closing the auricular bowl defect after perichondrial cutaneous grafting. The postauricular flip‐flop flap is used for this purpose.

Study Design A retrospective clinical study of 354 patients using the perichondrial cutaneous graft for various reconstructions of the face and then performing the postauricular flip‐flop flap procedure.

Methods The perichondrial cutaneous graft is a reliable, versatile graft that possesses unique properties for reconstructive surgery of the face. The postauricular flip‐flop flap is our particular technique for closure of the donor site wound after using the perichondrial cutaneous graft. It is a relatively simple procedure that has predictable results. We used this technique in patients ranging in age from 7 days to 92 years and noted excellent cosmetic results and rare complications.

Results Two patients had failure of the perichondrial cutaneous graft. Two patients had partial necrosis of the postauricular flip‐flop flap. Two patients had dehiscence of the postauricular closure.

Conclusion The postauricular flip‐flop flap is a reliable method to repair the donor site after perichondrial cutaneous grafting.
Intra‐arterial Effects of Cisplatin on Microvascular Anastomoses in the Rat Model
Authors: Gurushanthaiah Deepak , Knoblock Ron , Haller Jeffrey R.
Published: November 2003

Objective To evaluate the patency of microvascular anastomoses in arteries exposed to intra‐arterial cisplatin.

Study Design Animal model.

Methods The common iliac artery of 15 rats was injected with 150 mg/m2 cisplatin. Five rats were injected with the same volume of saline serving as physiological controls. The ipsilateral femoral artery was transected and anastomosed using microsurgical technique within 3 to 5 days. A Doppler probe was used before and after the anastomosis to assess blood flow. The vessel was re‐examined on postoperative day 5. Pulsatile blood flow and the presence or absence of a Doppler signal was recorded at this time. Vessels were harvested to include the anastomosis site and fixed for histological evaluation. The contralateral femoral artery was also harvested for comparison.

Results All femoral artery anastomoses in the experimental and control arm had good, pulsatile blood flow by microscopic evaluation. No thrombosed vessels were visualized, and Doppler signals remained strong at all vessel anastomoses. Histological analysis of the vessels revealed a trend toward increased inflammatory infiltrate in the walls of the vessels treated with cisplatin. We did not appreciate a functional decrease in lumen size.

Conclusions Selective catheterization intra‐arterial cisplatin chemotherapy does not affect the patency of vessels following a microvascular anastomosis in the rat model. The trend toward increased inflammatory response in the vessel walls may suggest the need for closer monitoring in patients treated with intra‐arterial chemotherapy.
Risk—Benefit Analysis of Using the Middle Fossa Approach for Acoustic Neuromas With >10 mm Cerebellopontine Angle Component
Authors: Satar Bulent , Jackler Robert K. , Oghalai John , Pitts Lawrence H. , Yates Philip D.
Published: November 2003

Objectives To evaluate hearing preservation and facial nerve (FN) outcome in the middle fossa (MF) approach for acoustic neuromas with a cerebellopontine angle (CPA) component >10 mm.

Study Design Retrospective review of 193 patients.

Patient Population Patients were grouped according to tumor size: intracanalicular tumors (IC; 64), 1 to 9 mm CPA extension (42), and 10 to 18 mm CPA extension (47). Additionally, a group of 40 patients (tumor size 10–18 mm CPA extension) who had undergone a translabyrinthine (TL) approach was studied to assess comparative FN outcome. Hearing and FN function were measured 1 year postoperatively. We defined the success at functional hearing preservation as AAO–HNS class B or better and good FN outcome as House‐Brackmann grade II or better.

Results For IC tumors and those with up to 9‐mm CPA extension, there was no significant difference in the rate of functional hearing preservation (62.2% vs. 63.1%, P = .931) and good FN outcome (93.7% vs. 97.6%, P = .358). For tumors of 10‐ to 18‐mm CPA extension, the rate of hearing preservation (34%) was lower than the other groups (P = .006 and P = .009). In this group, the rate of good FN outcome was lower compared with the IC and 1‐ to 9‐mm tumors (80.8% vs. 93.7%, P = .037 and 97.6%, P = .012). The rate of good FN outcome following the TL approach in a comparable cohort of patients was 100% (P = .003 in comparison with 10–18 mm tumor resected with the MF approach).

Conclusions When considering surgical options, patients with >10‐mm tumors should be advised that choosing the MF approach for hearing preservation carries a somewhat higher risk of persistent FN dysfunction.
Metastatic Renal Cell Carcinoma to the Head and Neck
Authors: Pritchyk Keith M. , Schiff Bradley A. , Newkirk Kenneth A. , Krowiak Edward , Deeb Ziad E.
Published: November 2003

Objectives The objectives of the study were to present four cases of renal cell carcinoma (RCC) metastatic to the head and neck, to recognize the appearance on radiographic studies, to understand the importance of preoperative embolization, and to review the results of treatment.

Study Design Retrospective review of patients diagnosed with metastatic RCC to the head and neck.

Methods The records of four patients diagnosed with metastatic RCC at a tertiary medical center over a 5‐year period from 1996 to 2001 were reviewed and analyzed for demographic and outcomes data.

Results Metastatic RCC to the head and neck was seen in the following locations: nasal cavity, lower lip, hard palate, tongue, and maxillary sinus. Presenting signs were loose upper molars, dysphagia, nasal obstruction, lower lip lesion, recurrent epistaxis, and foul nasal drainage. Histological studies confirmed metastasis of RCC in all four patients. Treatment consisted of preoperative radiation therapy, embolization, and local excision with adjunct chemotherapy.

Conclusions Metastatic RCC to the head and neck is rare but can have serious consequences if not recognized before biopsy. We present several treatment options with local excision as the primary mode of treatment.
Retropharyngeal Lipoma Causing Obstructive Sleep Apnea: Case Report Including Five‐Year Follow‐Up
Authors: Hockstein Neil G. , Anderson Timothy A. , Moonis Gul , Gustafson Karen S. , Mirza Natasha
Published: November 2003

Objectives/Hypothesis Lipomas of the retropharyngeal space are rare and do not cause symptoms until they reach a large size. Although retropharyngeal lipoma is an uncommon entity, several reports of it appear in the literature, and the treatment has routinely been surgical excision. Such fatty tumors also carry the rare possibility of being liposarcomas, which further warrants their excision. We present the case of a lipoma of the retropharyngeal space extending from the nasopharynx to the superior mediastinum causing symptoms of obstructive sleep apnea. The patient had multiple medical problems and was on a regimen of anticoagulation therapy; therefore, he opted against surgical treatment. He has used continuous positive airway pressure and has been followed clinically and radiographically for 5 years. Radiographic follow‐up of a retropharyngeal lipoma after a needle biopsy confirming its benign nature is a legitimate means of management of this rare condition.

Study Design Case report of a 64‐year‐old man presenting with this rare lesion.

Methods Computed tomography‐guided needle biopsy of the mass was performed to obtain tissue diagnosis. Thereafter, the patient has been followed for 5 years with annual magnetic resonance imaging scans to determine growth or changes of the retropharyngeal mass.

Results Fine‐needle aspiration of the mass revealed mature adipose tissue intermixed with fibroconnective tissue, consistent with lipoma. Based on this result, we opted to follow this patient with serial magnetic resonance imaging scans, which have shown no change in size. There has also been no change in the patient's symptoms.

Conclusions Large lipomas warrant excision, especially when their location produces pressure symptoms. However, when surgical morbidity is high, fine‐needle aspiration biopsy and serial magnetic resonance imaging scans are a safe alternative.
Tympanosclerosis in the Rat Tympanic Membrane: An Experimental Study
Authors: Russell John D. , Giles J. J.
Published: November 2003

Objectives/Hypothesis Tympanosclerosis is a pathologic condition affecting the middle ear and tympanic membrane. It is a common condition in humans, most notably after grommet insertion. However, the pathogenesis of this disease is unclear. The aim of this study was to investigate the development and progression of tympanosclerosis in the pars tensa of rat tympanic membranes at various time intervals after inducing sterile middle ear effusions.

Methods Fifty‐six male‐specific, pathogen‐free CD Wistar rats (100–170 g) underwent unilateral eustachian tube obstruction. Contralateral ears served as controls. Only specimens from animals with sterile effusions were included in this study. Light and electron microscopic analysis was performed on the pars tensa of rats with induced effusions ranging from 1 to 12 months.

Results Histologic changes consistent with tympanosclerosis were seen in the majority of animals with effusions from 3 months and greater. The process started in the submucosal connective tissue layer and progressed to involve all connective tissue sublayers. The extent of calcium deposition and fibrosis across the membrane was related to the duration of otitis media with effusion. Atrophy was not found in any specimens.

Conclusions Tympanosclerosis is a progressive disorder, which appears to be the main response of the rat pars tensa to prolonged sterile otitis media with effusion. The extent of involvement of the different sublayers of the pars tensa was closely related to the duration of otitis media with effusion. We propose that this new rat model for prolonged otitis media with sterile effusion is therefore a suitable animal model for the study of tympanosclerosis in the pars tensa.