bluuebunny/crossref_metadata_2025 huggingface dataset:
“How i do it” — head and neck a targeted problem and its solution: Bronchoscopy as an aid in the diagnosis of pneumonia in pediatric immunosuppressed patients. What to order
Authors: Dudley James P. , Martin William J.
Published: October 2006

Immunocompromised hosts constitute a special group of hospitalized adult and pediatric patients. Because of their depressed immunological defenses, they are subject to many kinds of infections and an increased morbidity and mortality associated with them. One of these infections is pneumonia. When pneumonia occurs, the rapid institution of appropriate therapy is necessary. Since the use of a chemotherapeutic agent is governed by the pathogenic microorganism and since those responsible are more diverse than those usually associated with pneumonia in immunocompetent patients, identification of the offending organisms is vital. The organisms associated with infections are viruses, fungi, parasites, gram‐negative organisms, Nocardia asteroides, and Mycobacterium tuberculosis. The serological identification of many of the pathogens, although frequently done, does not generally provide information which is helpful at the start of therapy. Adult patients are bronchoscoped under local anesthesia for the purpose of obtaining a transbronchial biopsy and tracheobronchial secretions since these patients often do not produce sputum; however, immunocompromised children are seldom bronchoscoped to obtain a biopsy. The following describes the method of bronchoscopy and the kinds of specimens to be obtained.
Heat exchange in the nose
Authors: Taylor Miles
Published: October 2006

Studies of the effects of nasal respiration on the lower respiratory tract, and on metabolic processes generally, have largely been confined to those occurring during inspiration. Expiration through the nose has equally profound effects and has been studied in detail in some animals.

Under certain circumstances both heat and water loss from the body can be altered by changes in the nasal mucosa. These changes appear to be under the control of the autonomic nervous system and are influenced by the need to balance heat loss with heat production.

The clinical and ecogeographical significance of these findings are discussed.
Rhinitis medicamentosa
Authors: Toohill Robert J. , Lehman Roger H. , Grossman Thomas W. , Belson Thomas P.
Published: October 2006

The diagnosis of rhinitis medicamentosa was made in 130 patients seen over a 10 year period from July 1967 to June 1977. There was an incidence of 1% in our otolaryngological practice. Patients had been taking the causal medication for an average of 21.4 months. There were 73 males and 57 females with the peak incidence in young and middle‐age adults. The primary offending medications were decongestant nasal sprays in 85 patients, decongestant drops in 33, and a combination of these drugs in 12 patients. The major reasons for self‐medication were 1. deviated nasal septum in 40 patients, 2. an acute upper respiratory infection in 33, 3. allergy in 18, 4. miscellaneous causes in 24 and 5. unknown in 15 patients. The initial management in addition to avoidance of the medication consisted of systemic antibiotics, decongestants, antihistamines, and sedatives depending on the severity of the rhinitis and the presence of secondary infection. Later treatment consisted of correction of the deviated septums, allergic management, and supportive care. Eight patients were considered to have complications of the disease by development of chronic ethmoiditis and nasal polyposis. The pharmacologic properties of the causal agents are thoroughly reviewed as they relate to the pathogenesis of this disease. It is felt that the ready commercial availability and limited clinical value of the topical nasal sprays and drops represents a certain risk to all patients using them.
Surgical correction of choanal atresia in the neonate
Authors: Lantz H. Joseph , Birck Herbert G.
Published: October 2006

The purpose of this paper is to present a technique of endonasal puncture and stenting for bilateral choanal atresia in the neonate that is easily performed and may be definitive. The procedure described is original only in its details, its broad principles are well known. A method of placing the nasal stent is reported that is particularly applicable in the premature, even as small as five pounds. No antibiotics or steroids are given in the postoperative period. Three months is the recommended duration of stenting.

Four patients were operated on using this technique, between July 1978 and August 1979; 3 were complete successes; 1 was a bilateral failure, but was re‐operated on and was then a unilateral success. Shortest follow‐up was 16 months.

We feel endonasal puncture and stenting of bilateral choanal atresia in the neonate can be definitive, and is the first procedure of choice.
The sublabial approach for extensive nasal and sinus resection
Authors: Allen George W. , Siegel Gordon J.
Published: October 2006

Excellent exposure of the structures of the middle third of the face can be obtained without external skin incisions by combining the basic incisions of rhinoplasty with a wide sublabial incision. In this way the bony structures of the middle third of the face can be completely uncovered. The interior of the nose and sinuses can be exposed simultaneously in the same field, and the perpendicular process of the palatine bone can be removed to provide unusually good access to the nasopharynx. Compared to lateral rhinotomy it is quicker both to open and to close, exposure is better, blood loss is less and there is no visible scar.
Clinical evaluation of meniere's disease
Authors: Meyerhoff William L. , Paparella Michael M. , Gudbrandsson Fridrik K.
Published: October 2006

A retrospective review of 211 consecutive patients with classic Meniere's disease was performed to determine the efficacy of diagnostic studies. The patients' ages averaged 47 years and ranged between 8 and 86 years. Females outnumbered males 1.3 to 1. Left and right ears were affected with equal frequency and, in 12% of patients, the disease was bilateral. Audiologic patterns were flat in 42%, rising in 7%, peaked in 32%, and sloping downward in the reMayning 19%. Electronystagmography was normal in 21% of the patients and demonstrated canal paresis in 65% and directional preponderance in 14%.

Studies of glucose metabolism were abnormal in 2 of the 204 patients tested. The 7 patients not tested had a previous diagnosis of diabetes mellitus. Thyroid function studies were abnormal in 1 of the 208 patients studied. The 3 patients not studied were known hypothyroid. FTA‐abs was positive in 12 patients and special radiographic studies of the petrous apex were normal in all cases.

Conclusions suggested by this study are that audiology, electronystagmography, and treponemal antigen tests for syphilis are cost effective in evaluating patients with Meniere's disease. Studies of glucose metabolism and thyroid function, however, are probably not indicated in patients without a history suggestive of a metabolic disorder and specialized radiographs of the petrous apex should be reserved for patients suspected of having acoustic neuroma.
The sha test in vestibular diagnosis
Authors: Rubin Wallace
Published: October 2006

Electronystagmography (ENG) organized and simplified the disorganized conventional vestibular evaluation. The addition of sinusoidal harmonic acceleration (SHA) to the vestibular evaluation has improved our capability for identifying subtle abnormalities, and even more important its use has enabled us to effectively monitor habituation and compensation (patient progress). This then allows us to monitor patient progress, confirm the patient's history, and in some cases even predict the course of the disease or injury.
Perilymph hypertension and the indirect measurement of cochlear pressure
Authors: Goode Richard L.
Published: October 2006

Perilymph hypertension has been shown to produce hearing loss in animal experiments and in at least two clinical situations: chronic cerebrospinal fluid (CSF) elevation and oval window “gushers.” Idiopathic perilymph hypertension may be a factor in other otologic conditions as well. The indirect measurement of increased cochlear pressure is discussed and a plea made for otolaryngologists and audiologists to consider such measurements in inner ear disease of obscure etiology in order to validate the concept that increased cochlear pressure is associated with ear disease other than Ménière's.
Nontuberculous mycobacterial infections of the face and neck — Practical considerations
Authors: Olson Nels R.
Published: October 2006

Cervicofacial nontuberculous mycobacterial (NTM) infections are a diagnostic and therapeutic dilemma which may be encountered by the Otolaryngologist. A review of the world's literature indicates that these infections are being diagnosed more frequently and that they far outnumber cervical infections by Mycobacterium tuberculosis. The organisms are ubiquitous. The portal of entry may be through a small defect in the skin or mucosa. They rarely, if ever, cause serious systemic illness.

Diagnosis is by culture of the organism, however, cultures are usually not available at the time the patient is treated. Treatment, then, must be based on the results of skin tests, examination of pus and tissue, a “typical clinical presentation,” and elimination of other diseases. The differential diagnosis is extensive.

This review reports 21 patients with proven or suspected NTM infections of the face and neck. Eight of these patients were treated by traditional methods utilizing complete excision and, in some cases, drug therapy. Eleven were treated by curettage alone, and two more by curettage and drugs. The results were excellent by all of these forms of treatment.

These findings support the proposition that curettage is a simple, safe, and effective method of treatmenting cervicofacial NTM infections and should be utilized as the primary treatment in all suspected or proven cases of this disease. The method does not exclude other forms of treatment being utilized if they should be required.
Retropharyngeal cellulitis
Authors: Schlossberg David , Fugate Jeffrey S.
Published: October 2006

Five cases of retropharyngeal infection in adults were seen over a nine month period. Diagnosis was suspected on clinical grounds and established by X‐ray. All five patients were treated successfully with antibiotics. A pre‐abscess stage of retropharyngeal infection, which does not require surgical drainage, may be more common than previously suspected. Clinical and microbiologic considerations are reviewed.
Respiratory distress after recurrent laryngeal nerve sectioning for adductor spastic dysphonia
Authors: Salassa John R. , Desanto Lawrence W. , Aronson Arnold E.
Published: October 2006

Adductor spastic dysphonia is a voice sign associated with various neurologic and psychologic disorders. Treatment of spastic dysphonin in selected patients is unilateral recurrent laryngeal nerve sectioning. Except for voice change or, in some patients, return of phonatory spasticity, there have been no long‐term sequelae or complications of this treatment. We describe three patients with adductor spastic dysphonia who underwent recurrent laryngeal nerve sectioning and who, 3 to 38 months later, suffered respiratory distress that required tracheostomy. The respiratory distress in all three patients was due to episodic jerky vocal cord hyperadductions that caused stridor during inspiration and expiration. These repetitive laryngospasms during respiration and phonation were progressive. Two patients needed an arytenoidectomy to achieve a useful voice, and all three required a permanent tracheostomy to alleviate in‐spiratory laryngeal obstruction.
Synchronous video recording of the pharyngeal airway and polysomnograph in patients with obstructive sleep apnea
Authors: Rojewski Thomas E. , Schuller David E. , Schmidt Helmut S. , Clark Robert W. , Potts Robert E.
Published: October 2006

A system of synchronous, simultaneous video recording of the laryngopharyngeal airway in patients with sleep disorders is described. Observations made during the study of 12 patients are reported. Repeated obstruction of the laryngeal inlet by collapse of the hypopharyngeal musculature is thought to be the primary pathological event in patients suffering with obstructive sleep apnea.
Panel discussion: Pathogenesis of otitis media. Bacteriology and immunology
Authors: Lim David J. , Demaria Thomas F.
Published: October 2006

Three features of otitis media with effusion (OME) are important in understanding its pathogenesis: 1. it is most common among children, when the eustachian tube is poorly developed; 2. it is most common during the winter months, when the common cold is prevalent; and 3. bacteria are found in a large number of middle ear effusions from OME patients. Although middle ear effusions are conventionally thought to be sterile, numerous recent investigations favor a bacterial pathogenesis of OME. Four possibilities can be considered: 1. bacteria are modified by antibiotics or antibodies, causing a lingering inflammation; 2. early antibiotic treatment may interfere with the development of local immunity; 3. bacterial antigen trapped in the middle ear causes immune injury leading to OME; and 4. bacterial endotoxin and inflammatory mediators cause middle ear effusions.
Panel discussion: Pathogenesis of otitis media. Current treatment of otitis media based on pathogenesis studies
Authors: Paparella Michael M.
Published: October 2006

Studies of pathogenesis of otitis media indicate clear cut categories including POM (acute purulent otitis media), SOM (serous otitis media), MOM (mucoid or secretory otitis media), COM (chronic suppurative otitis media) and sequellae with frequent overlap of types. One type of otitis media can lead to another type along a continuum. In this paper our concepts of treatment based on laboratory studies and clinical observation, both medical and surgical, are documented.
Scanning and transmission electron microscopic aspects of the nasal acilia syndrome
Authors: Dudley James P. , Welch Michael J. , Carney Jean M. , Stiehm E. Richard , Soderberg‐Warner Margaret
Published: October 2006

A 3‐month‐old boy was admitted with failure to thrive and persistent fevers. During a 4 month hospitalization for treatment of suspected sepsis, persistent purulent nasal discharge developed. Biopsies of his nasal mucosa on 3 separate occasions disclosed thinned respiratory epithelium and a complete absence of cilia when examined by electron microscopy (EM). Despite an initial granulocytopenia and a wide range in T‐cell numbers, he did not show any evidence of lower respiratory tract infection. A tracheal biopsy processed for EM demonstrated normal ciliated epithelium. This patient appears to have an unrecognized syndrome of normal tracheal cilia but absent nasal cilia.
The light reflex tip plasty: Surgical application of a new theory in tip esthetics
Authors: Fanous Nabil
Published: October 2006

What makes a tip appealing and attractive is not only the gross shape, but also the minor undulations of its surface. A new theory in tip esthetics is presented. Its surgical applications and its different uses are discussed.
Use of estrogen in treatment of familial hemorrhagic telangiectasia
Authors: Harrison D. F. N.
Published: October 2006

Within a 25 year period, 118 patients with a definitive diagnosis of familial hemorrhagic telangiectasia were treated for recurrent epistaxis. Twenty‐eight patients had dermoplasty but 67 patients received large dose estrogen therapy using ethinyl estradiol. The latter regime proved successful in every patient and the side effects and possible disadvantages of this treatment are considered in detail.
Surgery on patients with hemostatic disorders
Authors: Lekas Mary D. , Dibenedetto Joseph , Smith Peter S. , Kantesaria Kirtikant P.
Published: October 2006

Patients with hemostatic disorders about to undergo surgery present a special challenge for the otolaryngologist. The most common coagulation disorders constituting more than 90% of all patients seen with severe inherited bleeding defects are hemophilia and von Willebrand's disease (pseudohemophilia). Neither of these is an absolute contraindication for surgery. Hemophilia, a sex‐linked disorder, can be divided into two distinct classes: hemophilia A (classic hemophilia), a deficiency of factor VIII production, and hemophilia B (Christmas disease), a deficiency of factor IX production. Von Willebrand's disease is an autosomal dominant disorder consisting of a decrease in factor VIII activity plus a prolonged bleeding time and abnormal platelet aggregation with ristocetin.

Careful preoperative evaluation and early hospitalization are important for these patients. The close cooperation of a hematologist, monitoring availability and proper replacement of these factors, is essential. Careful postoperative attention should be directed at the maintenance of sufficient therapeutic levels of replacement therapy for a minimum of 7–10 days. We shall present cases of patients with inherited bleeding diatheses who underwent successful surgery at our institution. The use of Amicar® and Avitene® will also be presented.
Temporal bone encephalocele —diagnosis and treatment
Authors: Kamerer Donald B. , Caparosa Ralph J.
Published: October 2006

Encephaloceles of the temporal bone are encountered infrequently by the otolaryngologist and, therefore, may be misdiagnosed. Serious sequelae and central nervous system infections may result with inadequate management. A series of 15 recent cases are presented and discussed in relationship to etiology and surgical management. Transmastoid and middle cranial fossa approaches will be delineated along with the rationale and techniques for each. The use of pedicle and free tissue flaps, as well as autogenous bone and synthetics will be outlined.
Auditory function in acute severe head injury
Authors: Hall James W. , Huang‐Fu Musan , Gennarelli Thomas A.
Published: October 2006

There are few clinical neuro‐otologic investigations of acute head injury. We obtained impedance and auditory brain stem response measures for 25 acute head‐injured patients, usually within 76 hours following injury. All patients were comatose at the time of assessment. Impedance abnormalities were found for over three‐fourths of the patients. Generally, they were associated with transient, reversible dysfunction, such as high negative middle ear pressure. The acoustic stapedius reflex, however, was seldom observed, even in patients with apparently normal middle ear function.

Auditory brain stem response measures showed evidence of CNS dysfunction in 80% of the patients. Abnormalities ranged from prolonged latency and reduced amplitude of the wave V auditory brain stem response component to total absence of brain stem auditory activity. There was a relationship between auditory brain stem response findings and neurologic outcome at 1 month post assessment. Electrophysiologic auditory measures are clinically valuable in neuro‐otologic diagnosis and neurologic prognosis of acute, severe head injury.
Choanal atresia: A new embryologic theory and its influence on surgical management
Authors: Hengerer Arthur S. , Strome Marshall
Published: October 2006

Choanal atresia was first described in 1755 by Johann Roederer and continues to occur without a proven embryologic basis. Most authors have attributed the defect to persistence of the nasobuccal membrane, which leaves many unanswered questions. This paper proposes the embryologic cause to be a misdirection of the mesodermal elements originating in the neural crest cells. Recognizing this as the probable cause, 37 cases of choanal atresia are analyzed for a variety of factors, including their surgical approach and postoperative results. The clinical findings suggest the transpalatal approach offers a greater degree of success at all ages. This may be explained by the anatomic changes created by this congenital anomaly.
Experiments in laryngeal reinnervation
Authors: Crumley Roger L.
Published: October 2006

Laryngeal reinnervation surgical procedures were performed in 26 dogs. Nineteen animals comprise the data reported in this thesis.

Two different operative procedures were investigated, the ansa hypoglossi neuromuscular pedicle in 5 dogs, and the split phrenic nerve graft in 14 dogs. The studies were designed to evaluate whether either procedure resulted in inspiratory abduction of the vocal cord; and, if so, the mechanism by which abduction was produced.

Five dogs in Experiment 1 demonstrated similar results from the ansa hypoglossi neuromuscular pedicle procedure. Apparent vocal cord abduction was seen during hyperpnea from airway obstruction, but was abolished by superior laryngeal nerve transection, or detachment of the sternothyroid muscle. None of the nerves in the neuromuscular pedicles was electrically excitable.

Fourteen dogs in Experiment 2 underwent the split phrenic nerve graft operation. Vocal cord abduction, synchronized with inspiration, was noted in 5 animals. Two dogs had inspiratory abduction in quiet respiration. Electromyography, nerve action potentials, endoscopic motion pictures, and histologic study confirmed that posterior cricoarytenoid muscle reinnervation had occurred via the nerve graft from the phrenic nerve. Vocal cord abduction and electromyographic activity in the posterior cricoarytenoid muscle were abolished by transection of the nerve graft or the phrenic nerve.

Conclusions of the study include the following: 1. the neuromuscular pedicle procedure does not result in reinnervation of the posterior cricoarytenoid muscle the pedicle's nerve and muscle block. 2. The phrenic nerve procedure may result in reinnervation of the posterior cricoarytenoid via the nerve graft, and inspiratory abduction of the paralyzed vocal cord. Failure of the phrenic procedure to produce reinnervation appeared to be due toa.recurrent laryngeal nerve regeneration, or b. avulsion of the nerve graft due to swallowing and other laryngeal movements.
Management of bilateral acoustic tumors.
Authors: Hughes Gordon B. , Sismanis Aristides , Hays James W. , Glasscock Michael E. , Jackson C. Gary
Published: October 2006

Bilateral acoustic tumors, often felt to represent a central form of von Recklinghausen's disease, pose a particularly challenging problem to the otologist. This retrospective study reviews the evaluation and surgical results in 15 patients with bilateral acoustic tumors from whom 23 tumors were removed. Early diagnosis can be achieved by clinical awareness of the disease, thorough radiologic evaluation, and appropriate family screening. Total tumor removal with preservation of hearing is usually possible if the lesion is not larger than 1.0 cm. Total removal with hearing preservation is usually not possible if the lesion is larger than 2.0 cm. Hydrocephalus and additional tumors can complicate the overall clinical picture. Guidelines for appropriate management of bilateral acoustic tumors are based on tumor size, hearing sensitivity, and associated intracranial pathology.
Cisplatin vestibular ototoxicity: Preliminary report.
Authors: Black F. Owen , Myers Eugene N. , Schramm Victor L. , Johnson Jonas , Sigler Barbara , Thearle Patricia B. , Burns Denise Shamrock
Published: October 2006

Sixteen patients were monitored for vestibular ototoxicity while receiving cisplatin in dosages of 180 mg/M2. The incidence of preexisting vestibular functional abnormalities (31%) was higher than the incidence of ototoxicity (18%). Although the number of patients was not large enough for meaningful statistical comparison, the incidence of vestibular ototoxicity from cisplatin was low for the dosage levels employed.

Based upon the results of this study, the following recommendations are made for monitoring cisplatin vestibular ototoxicity.

1. All patients should receive vestibular tests prior to cisplatin administration. 2. Subjects, who have reduced (or asymmetric) vestibular function upon pretherapy testing, should be monitored at least weekly for any change in function while receiving cisplatin. 3. Subjects who are normal prior to therapy need to be tested only when cumulative doses exceed 400 mg.

The severe nausea and vomiting associated with cisplatin chemotherapy is not related to vestibular ototoxicity.
Bell's palsy: A 5 year review of 174 consecutive cases: An attempted double blind study.
Authors: Brown James S.
Published: October 2006

The etiology of Bell's palsy is unknown and present treatment is empirical and, at best, controversial.

Between 1973 and 1976, 174 consecutive cases were seen and clinically divided into a group with incomplete facial palsy and a group with complete facial palsy. The incomplete group consisted of 82 patients who were matched and treated alternatively with steroids or supportive treatment only. The return of function in each patient was tabulated and results in the two groups compared. Patients in this group have an excellent prognosis regardless of treatment. The complete facial palsy group consisted of 92 cases, who were matched according to age, sex, race and clinical picture and most importantly to the results of a series of tests designed to test the function of the affected facial nerve and its musculature. In this group 10 patients elected to have supportive treatment only, while 41 cases received cortisone and 41 matching patients underwent well planned decompression of the facial nerve.

The patients were assessed at 6 and 12 months by an independent clinician. They will be continued to be assessed for the next 5 years. The results of this study are reported in this paper.
Observations on the pathogenesis of chronic Non‐Specific pharyngitis and laryngitis
Authors: Ward Paul H. , Berci George
Published: October 2006

Repeated analysis of cinephotographic and cinefluorographic studies, correlated with clinical observations, have provided insight into the physiopathology of many cases of chronic non‐specific pharyngitis, laryngitis, contact ulcers, granulomas, and pachylaryngitis. Hiatal hernia and gastroesophageal‐pharyngeal reflux appear to be the cause of local irritation. Chronic coughing and habitual harsh throat clearing initiate the contact ulcers and granuloma formation. The successful treatment of this entire family of lesions is dependent upon elimination of vocal abuse and control of the factors that ore responsible for the chronic irritations.
Tinnitus aurium: Fact… or fancy.
Authors: Kauer John S. , Nemitz James W. , Sasaki Clarence T.
Published: October 2006

We have used the 14C 2‐deoxyglucose (2DG) technique to examine changes in metabolic activity in the auditory pathway of 29 guinea pigs after removal of the cochlea, removal of the middle ear ossicles, and after treatment with sodium salicylate. Three experiments were performed.

In the first experiment we examined the levels of neuronal activity at 1–2 hours to 42 days after unilateral and bilateral cochlear ablations. In this series of experiments, we observed a spontaneous increase in activity which appeared at 3–14 days in brain stem regions having major connections to the ablated cochlea.

In the second series, we performed unilateral and bilateral removal of the middle ear ossicles. These manipulations, in contrast to cochlear removal, caused little or no spontaneous increase on the side connected to the lesion when examined at either 1 day or 21 days. This observation suggested that the increased activity seen several days after cochlear removal was due to the process of deafferentation per se and not to the deafness which was caused by both cochlear and ossicle removals. These findings are consistent with the possibility that the spontaneous increase in metabolic activity seen after cochlear removal may be a reflection of the subjective sensation of tinnitus experienced by human beings after cochlear damage or VIIIth nerve section.

In the third experimental series, we administered sodium salicylate orally to animals. All animals had unilateral ossicle removal. This experiment was designed to determine whether high levels of a salicylate, known to produce tinnitus in human beings, could elicit increased activity in those animals which would normally have experienced a conductive hearing loss and, therefore, absent neuronal activity. In the animals examined to date after salicylate administration, an increase in 2DG uptake was observed. These preliminary data are consistent with the findings seen after cochlear ablation and further suggest that increased neuronal activity may reflect a tinnituslike phenomenon in the experimental animal.

We believe the findings from these three sets of experiments form the basis for development of an experimental animal model which can be used to study a profound otologic symptom about which there is yet no pathophysiological information. As such, these data represent a very important first step in developing a reasonable and successful therapeutic regimen for afflicted human beings.
“How i do it” — otology and neurotology. A specific issue and its solution. Surgical technique for open mastoid procedures.
Authors: Glasscock Michael E.
Published: October 2006

In mastoid surgery for chronic ear disease (with or without cholesteatoma), the removal of the posterior canal wall does not necessarily insure a “safe” ear. Open procedures are subject to many of the same complications that ore associated with the more controversial closed technique. In addition, if the canal wall down procedure is not performed with great care and under strict guidelines, the postoperative ear can be a continual nuisance to the patient.

The author has reached these conclusions based upon 20 years' experience in dealing with “problem cavities” created by himself and others. The purpose of this paper is to define the “problem cavity” and how to prevent it.
Cutaneous carcinoma of the head and neck: Management of massive and previously uncontrolled lesions
Authors: Levine Howard
Published: October 2006

Cutaneous basal cell and squamous cell carcinoma is the most common of malignant neoplasms. The etiology and natural history of these cutaneous neoplasms are related to actinic exposure, age, sex, hereditary factors, previous tissue injury, and chemical ingestion and exposure.

Identification of cutaneous basal cell and squamous cell carcinoma is important. There are several different histologic subtypes of basal cell carcinoma, and each behaves clinically in a different way.

There are several accepted methods of treatment including cryosurgery, electrodesiccation and curettage, radiotherapy, surgical excision and Mohs' histographic surgery. Each of these methods is reviewed.

The vast majority of cutaneous basal cell and squamous cell carcinomas are easily cured no matter what the treatment modality. However, about 10% of these tumors (30,000 new cases each year) are not cured. These tumors often become massive and uncontrollable.

Sixty patients met the criteria of being massive and/or uncontrollable. These criteria are 1. size 3 cms or greater, 2. involvement deeper than skin and subcutaneous fat, 3. four or more previous treatments without control, or 4. proven metastatic disease.

These patients with massive and/or uncontrollable tumors underwent treatment with either Mohs' histographic surgery followed by conventional surgery with total microscopic marginal control or conventional excision with total microscopic marginal control.

Of the 60 patients treated in this way, 53 are free of disease; 41 of these patients have been free of disease for more than 24 months.

Massive and/or previously uncontrollable tumors appear to be better controlled with total microscopic marginal control while preserving as much normal tissue as possible. This technique appears to allow preservation of important esthetic and functional tissue while excising the complete tumor with the greatest degree of certainty.
Head and neck cancer in women — a changing profile
Authors: Mcguirt W. Frederick
Published: October 2006

A progressive trend toward increased occurrence of head and neck cancer in women is reported. Over the most recent 6 year period, 533 newly diagnosed patients were referred for treatment of head and neck cancer; 169 (32%) were women. Review of their cases showed heavy use of tobacco and alcohol by many of these women patients. The acceptance of the use of these mucosal irritants and changing social mores in the tobacco belt society under study predate recent national trends of similar nature. Thus, the increased incidence of head and neck cancer in women reported here probably presages similar increases in that incidence nationwide.
Elusive head and neck carcinomas beneath intact mucosa
Authors: Mancuso Anthony A. , Hanafee William N.
Published: October 2006

This study presents 19 patients who had mucosally inapparent carcinomas of the upper aerodigestive tract demonstrated by computed tomography (CT). This group contains subpopulations that were identified both retrospectively and prospectively. During the same period 40 nasopharyngeal, 20 oropharyngeal‐tongue base, and over 100 laryngeal and hypopharyngeal carcinomas were studied; all had clinically obvious mucosal components. Nine of our 19 patients had strictly submucosal tumors and a variety of clinical presentations; 5 patients had strictly submucosal recurrence of treated carcinomas and 5 had mucosal lesions which were not identified on examinations by more than one practicing head and neck surgeon. Sixteen of the 19 tumors were confirmed histologically; in 3 others confirmation was by a combination of CT and clinical course.

CT can demonstrate the deep extent of aerodigestive tract carcinomas more accurately than physical examination and it can show mucosally inapparent disease. CT should be part of the staging work‐up in nearly all upper aerodigestive tract carcinomas and in patients suspected of harboring an unknown primary within this region.
Physiologic maxillary antrostomy — UPDATE
Authors: Sanderson Bruce A.
Published: October 2006

Physiologic antrostomy, as presented in this paper, is a procedure developed by the author using both old and new techniques. Indications and contraindications for the use of the physiologic maxillary antrostomy are listed. The osteoplastic flap (trapdoor) is used to enter the antrum. The nature of the lesions which can be handled through this approach are covered. The methods for removal of the lesions without removing the mucous membrane lining are given. The indications for removing this membrane are also presented. The methods are presented for the placing of the ventilation tube in the natural ostium.

A step by step description of the technique used to perform this type of surgery is presented. Using this method, surgery that is done in or through the maxillary sinus is simplified and the severe sequelae of the Caldwell‐Luc type of surgery are largely overcome.
Stereoscanning electron microscopy of argon laser excised laryngeal papilloma
Authors: Scully Peter A. , Stratton Clifford J. , Brophy John W.
Published: October 2006

Laryngeal papillomas were removed from two patients with the argon laser and examined by transmission electron microscopy (TEM), scanning electron microscopy (SEM), and stereoscanning electron microscopy (SSEM). Two techniques, lipid‐carbohydrate retention for TEM specimens and sonication for SEM, were applied in studying the papillomas. Lipid‐carbohydrate retention results were in agreement with previous work in papilloma ultrastructure. The char interface was observed with the sonication technique. Peripheral to the laser impact site, four zones were observed: 1. coagulation necrosis, 2. contracted epithelial cells, 3. minimally damaged epithelial cells, and 4. morphologically undamaged epithelial cells. In Zone 2, cells were violently popped‐off as heat was conducted through the epithelium. The potential for spread of papillomas is discussed and suction of the vapor plume recommended when removing laryngeal papillomas with the argon laser.
Bioactive glass ceramic: A new material in tympanoplasty
Authors: Reck Ralf
Published: October 2006

The practicability of the bioactive glass ceramic Cernvitnl® in ear surgery was tested in animals. The histological findings are presented. Over the last 3 years implants of bioactive glass ceramic were used in humans. Prostheses for the total or partial reconstruction of the ossicular chain and the reconstruction of the bony wall of the outer ear canal were fashioned. We have conducted about 300 tympanoplasties and 60 total or partial reconstructions of the bony wall of the outer ear canal. The otoscopic and functional results were satisfactory.
Infiltrating lipoma of the sternocleidomastoid muscle
Authors: Mattel Stephen F. , Persky Mark S.
Published: October 2006

Infiltrating lipomata are unusual benign tumors that have been rarely associated with the head and neck areas. We present the only known documented case of an infiltrating lipoma of the sternocleidomastoid muscle. The literature is reviewed and the characteristics of these lesions are discussed. The head and neck surgeon should include these interesting tumors in the differential diagnosis of head and neck masses and be aware that, because of a known propensity for recurrence, total surgical excision is the treatment of choice.
Wegener's granulomatosis
Authors: Mcdonald Thomas J. , Deremee Richard A.
Published: October 2006

A review of 108 patients with Wegener's granulomatosis clarified the diverse clinical manifestations and disclosed some of the less well‐known areas of involvement. Because of the frequency of nasal involvement in Wegener's granulomatosis, the otolaryngologist plays an important role in the early diagnosis and treatment.
Complications after surgery for otosclerosis
Authors: Storrs Lloyd A.
Published: October 2006

This study was based on a detailed review of 503 cases of otosclerosis that were operated upon by me from 1961 to 1968. The vicissitududes of anesthesia, disequilibrium, dead ears and unexpected emotional abberations as well as legal and technical problems are discussed. Stapedectomy has been one of the most rewarding and technically challenging procedures that has come along in my career so far in medicine.
Complications of the treatment of malignant external otitis
Authors: Lucente Frank E. , Parisier Simon C. , Som Peter M.
Published: October 2006

Malignant external otitis is an aggressive, potentially lethal infection of the temporal bone, the treatment of which is often fraught with complications. Among the reasons for these complications are the difficulty in assessing the extent of this disease, the uncertainty in determining the point at which treatment can be terminated, the toxic nature of the antibiotics used, and the technical difficulty of performing any surgery on the infected tissues. In those patients who receive inadequate initial therapy, the further extension of the disease itself represents a complication of treatment.
Complications after treatment of chronic maxillary sinus disease with caldwell‐luc procedure
Authors: Murray John P.
Published: October 2006

This short article deals with a review of the indications of the Caldwell‐Luc operation. It attempts to point out that the Caldwell‐Luc operation is not without complications and it is frequently associated with one or more of these. Various cases are sited illustrating this.

A study examining 70 consecutive patients treated surgically by the author and 2 associates from 1972–1975 was done. One‐fourth of these were treated with intranasal procedures alone. The remainder were treated with Caldwell‐Luc, and most Caldwell‐Lucs were performed for intrasinus disease. The surgical technique is described followed by the indications for each. The postoperative problems are discussed and were found to be significant with recurrent sinusitis being most common. The remaining complications are likewise discussed.

In summary, the Caldwell‐Luc operation has been employed for about 90 years for various indications. The indications expand with time; however, this seemingly benign operation is not without its incidence of complications and the morbidity is far greater than most of us often realize.
Complications of free tissue grafts for glottic reconstruction
Authors: Quinn Harold J.
Published: October 2006

Forty patients who underwent hemilaryngectomy and immediate glottic reconstruction, using free tissue grafts to construct a pseudocord, were studied. The overall complication rate was 18%. There were three minor complications and four major complications. These are reviewed in detail.
Complications after surgical management of the paralyzed larynx
Authors: Tucker Harvey M.
Published: October 2006

Patients suffering from uni or bilateral laryngeal paralysis frequently require surgical management for best possible rehabilitation. As with any surgical procedure the potential for complications or less than optimal results exists. The Otolaryngologist‐Head and Neck Surgeon who wishes to provide best possible care for his patient must understand not only the indications for these surgical procedures, but also the complications that may be expected, so that every possible effort can be made to avoid or minimize them.
Long‐term complications of radiotherapy confronting the head and neck surgeon
Authors: Strauss Melvin
Published: October 2006

Despite significant growth in the knowledge and application of radiation physics to human cancer therapy, there continue to be significant complications from such therapy. Selected cases are presented and discussed to illustrate the long‐term complications of radiotherapy which may arise when dealing with cancer in the head and neck.
Tumors arising from the glandular structures of the external auditory canal
Authors: Hicks George W.
Published: October 2006

Neoplasms in the external auditory canal (EAC) of ceruminous gland origin have been generally classified under the title of ceruminoma, which is inaccurate and misleading. There have emerged four distinct types of ceruminous gland tumors of the EAC. They are 1. ceruminous adenoma, 2. adenoid‐cystic carcinoma, 3. ceruminous adenocarcinoma, and 4. pleomorphic adenoma (mixed tumor). The natural course and clinical approach to these tumors can be determined by accurate histopathologic evaluation. This paper presents 10 cases of tumors of glandular origin in the EAC, 4 cases being ceruminous adenomas, 3 cases being adenoid‐cystic carcinomas, 2 cases being ceruminous adenocarcinoma, and 1 case of pleomorphic adenoma (mixed tumor). In reviewing these cases as well as those in the literature, a number of recommendations are suggested: 1. Identifying a tumor of the glandular structures of the EAC solely as a ceruminoma is no longer acceptable without accompanying histologic specificity. 2. Early wide excisional biopsy is imperative for diagnosis. 3. The signs and symptoms of the tumor do not always correlate with the histopathologic diagnosis and subsequent clinical behavior of these tumors. 4. Ceruminous adenoma and pleomorphic adenoma are benign tumors and are best treated only by wide local excision. 5. Adenoid‐cystic carcinoma and ceruminous gland adenocarcinoma are pernicious, malignant tumors which are best treated, in general, by an initial aggressive wide en bloc surgical resection or, if there is extension to the middle ear and temporal bone, by resection of the temporal bone and contiguous structures. 6. Postoperative irradiation has an essential role in managing these malignant tumors. 7. Five year survival rates for the malignant tumors do not reflect the biological behavior pattern of “late” local and distant recurrence and metastasis.
Surgery for nasal obstruction — Evaluation by rhinomanometry
Authors: Jalowayski Alfredo A. , Yuh Yih‐Shyh , Koziol James A. , Davidson Terence M.
Published: October 2006

Nasal obstruction is predominantly a subjective patient complaint. The physical examination of the nose for nasal obstruction is a subjective evaluation as well. While the history and physical examination are reasonable diagnostic indicators, an objective means of evaluation is needed. Rhinomanometry measures nasal obstruction objectively and reliably. Thirty‐six patients with nasal obstruction were evaluated by rhinomanometry before and after nasal surgery. The results are reported here. Rhinomanometry confirms the effectiveness of intranasal surgery. Using rhinomanometry, various techniques of intranasal surgery are evaluated, and several interesting observations are made.
Preoperative chemotherapy for hypopharyngeal carcinoma
Authors: Spaulding Monica B. , Kahn Anjum , Sundquist Nan , Lore John M.
Published: October 2006

Twenty patients with advanced squamous cell carcinoma of the hypopharynx received two courses of chemotherapy with cisplatinum, vincristine and bleomycin before undergoing surgery. The chemotherapy was well tolerated, with minimal toxicity and no intra or postoperative complications attributable to it. The response to the chemotherapy was dramatic with all but 2 patients exhibiting a greater than 50% tumor shrinkage.

Only 3 patients, all with positive surgical margins, received postoperative radiation therapy. Surgical salvage of recurrent lesions was performed on 2 patients who are now free of disease. With a median follow‐up of 20 months, 1 patient has died of recurrent disease, 3 have died of other causes, all others remain free of disease.
Prostatic and laryngeal malignancies: Common or uncommon multiple occurrence?
Authors: Wenig Barry L. , Abramson Allan L.
Published: October 2006

The presence of multiple primary malignancies involving the head and neck has been well documented. The majority of second primaries appear within the respiratory system. Few reports exist describing multiple primary malignancies involving the larynx and the prostate.

This paper reports on four cases of primary laryngeal and prostatic neoplasms. Physical findings and laboratory work‐up necessary for diagnosis of these lesions are reviewed.

The dilemma of the proper therapeutic course based on the histological grading and pathological staging is presented. Suggestions for treatment based on the prognosis of the disease that is present are offered.
Cervical tracheoesophageal fistula
Authors: Green Robert P. , Biller Hugh F. , Sicular Arthur , Wright Michael
Published: October 2006

Four unusual cases of cervical tracheoesophageal fistula (TEF) are presented. The incidence, diagnosis and treatment of cervical TEF are discussed. Surgically, if the location is above the level of T2 a cervical approach may be utilized.

The cases included a cervical “H” type TEF occurring in an adult. Congenital “H” type TEFs frequently occur in the neck. An adult presenting with a cervical “H” type TEF, having as an infant undergone repair of a thoracic TEF, is unique. Two layer closure of both trachea and esophagus with strap muscle interposition is preferred.

The other cases include a TEF secondary to metastatic breast carcinoma, one associated with a stomal recurrence, and an acquired TEF following laryngectomy.

Metastatic breast carcinoma resulting in a TEF is reported for the first time. Malignant TEF's are usually secondary to carcinoma of the esophagus, lung, or thyroid. Best palliation is achieved either by esophageal intubation, by colon bypass, or by gastric pull‐up with esophageal exclusion. Stomal recurrence with TEF following laryngectomy is treated with one‐stage resection and reconstruction with a pectoralis major myocutaneous flap and gastric pull‐up.

A patient 5 years post‐laryngectomy illustrates an acquired non‐malignant cervical TEF, a category which includes fistulas due to trauma, tracheotomy, or endotracheal tubes, instrumentation, and inflammatory disease. Prompt surgical closure as in congenital cases is the treatment of choice although select cases require medical therapy.