bluuebunny/crossref_metadata_2025 huggingface dataset:
Tongue reconstruction: Concepts and practice
Authors: Haughey Bruce H.
Published: October 2006

Total or subtotal tongue resection results in the potential for severe speech and swallowing disruption and life‐threatening aspiration. This report documents the development of a new design for latissimus dorsi flaps used in tongue reconstruction. In order to create a contractile muscle sling which will raise the neotongue toward the palate for speech and swallowing, the flap is harvested with muscle fibers oriented transverse to its long, skin component axis. The flap is then transferred to the oral and oropharyngeal defect and sutured at the level of the mandibular angle to the remaining muscles of mastication. Conventional microvascular anastomosis for free flaps is followed by end‐to‐end reanastomosis of the hypoglossal nerve stump to the nerve to latissimus dorsi. The skin component is set into the floor of mouth with a curved wedge resected anteriorly, raising a mound to assist with articulation.

Fourteen such reconstructions have been performed on patients undergoing glossectomy for cancer. If not invaded by cancer, the glottic larynx was preserved, and the decannulation rate was 80% at a median postoperative interval of 3.2 weeks. Seventy percent of patients achieved oral intake with pureed food or better, and upward motion of the flap was documented by video swallowing studies. Articulation was particularly good.

This innervated latissimus dorsi flap design therefore is a viable method for rehabilitation after total or subtotal glossectomy.
The vertebrate larynx: Adaptations and aberrations
Authors: Kirchner John A.
Published: October 2006

The complex anatomy of the vertebrate larynx shows a steady progression from the simple slit on the floor of the lungfish's pharynx to the fine‐tuned mechanism of the human vocal apparatus. The frog's larynx acts as a check valve to prevent collapse of the lungs during a dive, since the animal has no rib cage. The crocodile's laryngeal framework has acquired an epiglottic analogue which fits snugly into the nasopharynx and protects the lower respiratory tract from inundation while the animal drowns its prey. The snake's larynx lies intraorally and can be extended beyond the lower teeth while the reptile leisurely swallows its prey intact. The mammal has acquired a cricothyroid joint, allowing its membranous vocal folds to be stretched during phonation. In Homo sapiens, vocal performance has reached its highest degree of versatility, with a vocal fold capable of adjustment in length, tension and shape. In the course of organic evolution, man appears to have chosen the ability to speak and sing over the security that an intranarial epiglottis would have given him.

“In Wisdom hast Thou made them all”—Inscription on John Hunter's tomb, Westminster Abbey
MRI evaluation of the sphenoid sinus after transsphenoidal approach to the pituitary
Authors: Stickney Kathleen O'Leary , Weymuller Ernest A. , Mayberg Marc
Published: October 2006

The transsphenoidal approach to the pituitary (TSA) is currently the most common approach used to treat pituitary tumors. The surgical technique necessitates an incomplete stripping of sphenoid sinus mucosa. Long‐term postoperative magnetic resonance imaging (MRI) evaluation of the sphenoid sinus has not been reported. A retrospective review of patients undergoing a TSA at the University of Washington Hospitals was performed. Preoperative scans were compared with postoperative scans done during three time intervals. Group 1 had scans at 1 to 12 weeks postoperatively; 10 of 10 patients had sinus effusions. Group 2 had scans at 6 to 18 months postoperatively; 22 of 31 had mucosal abnormalities. Group 3 had scans at 2 to 3 years; 7 of 9 were abnormal. MRI evaluation indicates that a majority of patients have both acute and chronic sphenoid sinus abnormalities after TSA.
Endoscopic treatment of supraglottis and hypopharynx cancer
Authors: Zeitels Steven M. , Koufman James A. , Kim davis R. , Vaughan Charles W.
Published: October 2006

Transoral excision of supraglottic and hypopharynx cancer as a single modality is effective when lesions are selected for small size and endoscopic accessibility. Excisional biopsy with clear margins of larger supraglottic tumors in combination with postoperative radiotherapy provides an excellent treatment alternative for selected lesions in patients who are not candidates for open surgery. In this preliminary report, 45 cases using this minimally invasive approach are reviewed outlining oncologic rationale and functional advantages.

A large bore tubed laryngoscope or the adjustable bivalve supraglottiscope was used along with a carbon dioxide laser in all cases. In 22 of the 45 patients (mostly TI), local en bloc excision of the primary cancer was performed as sole treatment on selected lesions of the supraglottis and hypopharynx. There were no local recurrences, however, 1 patient developed a neck recurrence and was salvaged by neck dissection.

Twenty‐three of the 45 patients had more extensive primaries (mostly T2, T3) and N0 necks. Transoral excisional biopsy was followed by full‐course radiation therapy to the primary site and both necks. All 23 were followed a minimum of 2 years, and the median follow‐up period was 58 months. Clear margins were obtained in 16 of 23, and there were no recurrences in the larynx. Two of 16 did fail in the neck and died despite neck dissection. Seven of 23 patients had positive margins and, despite full‐course radiotherapy to the primary site and both necks, 5 of 7 failed locally or regionally. Two of the 7 died of their disease despite open salvage surgery. Therefore, 4 of 23 patients who underwent transoral excision of larger lesions followed by full‐course radiotherapy died of recurrent cancer.
Eustachian tube compliance in cleft palate a preliminary study
Authors: Takahashi Haruo , Honjo Iwao , Fujita Akihiko
Published: October 2006

With the use of the tubal compliance test and the forced response test (FRT), the compliance and ventilatory functions of the eustachian tube (ET) were examined in 19 children with otitis media with effusion (OME) and cleft palate, in 31 children with OME but without cleft palate, and in 19 individuals with traumatic perforation of the eardrum without history of other otological disease (controls). The tubal compliance results in the group with both cleft palate and OME were significantly higher than the results obtained with the controls, but did not differ significantly from the results obtained with the patients with OME but without cleft palate; this indicated that the ETs of those patients with OME and cleft palate, and the ETs of those patients with OME but without cleft palate, appeared to be more collapsible than the ETs of normal subjects. It was speculated that such an aerodynamic property of the ET observed in the group with OME and cleft palate and in the group with OME but without cleft palate may be due mainly to possible inflammatory condition of the tubal mucosa rather than to abnormal anatomy or to an abnormal physical property of the framework (such as cartilage) of the ET.
Tracheal reconstruction using an epithelial equivalent
Authors: Duff Brian E. , Wenig Barry L. , Applebaum Edward L. , Yeates Donovan B. , Wenig Bruce M. , Holinger Lauren D.
Published: October 2006

The application of a rapidly vascularized epithelial equivalent that inhibits wound contraction would have great potential in the prevention and repair of tracheal stenosis. An animal model was developed to simulate the effects of circumferential tracheal injury and an autologous epithelial equivalent was created from a fibroblast‐collagen matrix and subsequently implanted in the traumatized site in an attempt to prevent stenosis. Postinjury physiologic and histologic evaluation revealed near‐normal mucosal flow analysis in the treated sites and an area of less than 20% stenosis versus 95 + % in controls. This study's findings indicate that tracheal stenosis can be limited by the use of an epithelial equivalent.
Preliminary report: Endoscopic versus external surgery in the management of inverting papilloma
Authors: McCary W. Scott , Gross Charles W. , Reibel James F. , Cantrell Robert W.
Published: October 2006

Since January 1977, twenty‐four patients with inverting papilloma of the nose and paranasal sinuses have been treated at the University of Virginia. Two patients had bilateral disease, for a total of 26 surgically treated sides. Patients were aged from 10 to 83 years, and 71% were male. Most tumors originated on the lateral nasal wall, with 62% involving the adjacent sinuses. Nineteen sides were treated by external approach and 7 were treated intranasally. There was a total of 5 recurrences in 4 patients and no associated squamous cell carcinomas. Seven patients were treated with endoscopic excision (4 primary tumors and 3 recurrences). There have been no recurrences since endoscopic treatment. These preliminary data give further evidence that endoscopic excision is a viable surgical option for many inverting papillomas.
Three‐dimensional models for head and neck tumor treatment planning
Authors: Eisele David W. , Richtsmeier William J. , Graybeal John C. , Koch Wayne M. , Zinreich S. James
Published: October 2006

The authors have evaluated two types of practical maxillofacial model systems useful to the head and neck surgeon: 1. plastic mandibular model generated by three‐dimensional computerized tomography (CT) reconstruction, and 2. dental impression model of the maxilla. The first model is expensive and technology intensive; the second is simple but limited. Both three‐dimensional models offer several advantages: 1. they provide segmental mandibular relationships that are not known because of oncologic restrictions or previous surgery; 2. they allow preoperative reconstructive planning including prosthesis fabrication and visualization of tumor extent not obvious by two dimensional imaging; and 3. they provide a permanent record for future needs or reconstructions. The disadvantages include cost, time, and possible inaccuracies secondary to image artifacts. We find both models to be of significant practical value in selected head and neck tumor patients.
Arytenoid motion evoked by regional electrical stimulation of the canine posterior cricoarytenoid muscle
Authors: Sanders Ira , Rao Frank , Biller Hugh F.
Published: October 2006

Anatomical studies have demonstrated that the posterior cricoarytenoid muscle in the dog is composed of three bellies. These bellies are termed vertical, oblique, and horizontal on the basis of their orientation. The purpose of this study was to show whether each of these bellies can move the vocal fold in different ways. Ten anesthetized dogs underwent laryngectomies while paralyzed with curare. The posterior cricoarytenoid muscles were then exposed by dissecting the overlying esophageal mucosa. Electrical stimulation was applied to each belly, and the motion of the arytenoid cartilage was measured. Because the oblique belly overlies the vertical belly, they were usually stimulated together. It was found that the vertical and oblique bellies rock the arytenoid backwards while sliding it laterally, thus causing a maximal dilation of the airway. The horizontal belly caused a swiveling motion of the arytenoid. It is proposed that the vertical and oblique bellies normally cause vocal fold abduction during respiration, while the horizontal belly primarily is used to adjust finely the position of the vocal process during phonation. Because the human posterior cricoarytenoid is also composed of separate bellies it, too, may have distinct functions.
Rapid tumor cell proliferation after induction chemotherapy in oropharyngeal cancer
Authors: Bourhis J. , Wilson G. , Wibault P. , Janot F. , Bosq J. , Armand J. P. , Luboinski B. , Malaise E. P. , Eschwege F.
Published: October 2006

Tumor cell kinetics were studied in vivo in a series of 97 patients with oropharyngeal cancer. The duration of S phase (tS), the labeling index (LI), and the potential doubling time (Tpot) were obtained by flow cytometry measurements of a tumor biopsy obtained after intravenous injection of 200 mg 5‐bromodeoxyuridine to the patient. The mean LI was 9.7% (standard deviation [SD], 5.4), the mean tS was 10.1 hours (SD, 3.6), and the mean Tpot was 4.6 days (SD, 3.5). No significant relationship was found between the Tpot or LI and the size of the tumor, nodal status, histological grade, or the site of the primary within the oropharynx. Conversely, aneuploid tumors had longer tS (P<.001), higher LI (P<.001), and shorter Tpot (P<.05) than the diploid tumors. The mean LI and Tpot of the tumors obtained after induction chemotherapy were significantly higher and shorter, respectively, than those measured before any treatment. The data strongly suggest that rapid tumor cell proliferation frequently occurs in oropharyngeal cancer which had responded poorly to chemotherapy.
Odontogenic keratocysts: A study of 50 patients
Authors: Anand Vinod K. , Arrowood John P. , Krolls Sigurds O.
Published: October 2006

The odontogenic keratocyst (OKC) is a locally aggressive neoplasm with rates of recurrence reported as high as 60%. Correlation between histopathology and the likelihood of recurrence remains a subject of controversy. In this review of the authors' experience in treating 50 patients with OKC between 1977 and 1993, 58 specimens were studied to correlate the likelihood of recurrence with the presence of the following histologic features—parakeratosis, orthokeratosis, satellite cysts, epithelial rests, or epithelial proliferation. Orthokeratinized cysts were associated with a higher recurrence rate than in previously reported studies. Disruption of the epithelial lining in the resected specimen was found to be a primary determinant of recurrence.
Fate of liposuctioned and purified autologous fat injections in the canine vocal fold
Authors: Mikus Joseph L. , Koufman James A. , Kilpatrick Scott E.
Published: October 2006

Injection of autologous fat obtained by liposuction has been reported as an augmentation technique for vocal fold paralysis. Unfortunately, it is not known whether this technique is associated with long‐term graft survival.

The purpose of this study, using a canine model, was to determine the volume of viable injected fat grafts when the tissue was harvested and processed by two different methods: 1. by liposuction alone, and 2. by “purification,” i.e., excision of adipose tissue, followed by tissue homogenization and centrifugation in a buffering solution.

The results of this study confirm that injected fat grafts survive long‐term; however, the average volumetric “take” was only about 20%. Surprisingly, significantly more liposuctioned fat survived than grafts prepared by the purification method (P<.05). At 12 weeks, there was relatively little inflammation present in the tissues surrounding the injected fat, suggesting a stable fat graft volume.
Laryngeal function in postpolio patients
Authors: Driscoll Brian P. , Gracco Carol , Tierney Elizabeth , Sasaki Clarence T. , Coelho Carl , Goldstein Jonathan , Oshima Kiyoshi
Published: October 2006

Of the 250,000 survivors of the polio epidemics, approximately 25% experience progressive muscle weakness known as postpolio syndrome (PPS). Laryngeal function in postpolio patients previously has not been studied. This paper presents data detailing laryngeal function in a group of postpolio patients who had been evaluated for swallowing complaints. Nine patients underwent comprehensive history and physical exam, acoustical voice analysis, and laryngeal videostroboscopic endoscopy. Three patients underwent laryngeal electromyography (EMG) evaluation. Results indicated some degree of phonatory or laryngeal deficit in all subjects. Subjects with dysphagia also demonstrated vocal fold paralysis. EMG revealed decreased recruitment and increased amplitude, findings consistent with EMG studies in skeletal muscle in postpolio patients. Results suggest that postpolio patients who complain of swallowing difficulties are at risk for laryngeal pathology.
Qualitative and quantitative immunoglobulin production by specific bacteria in chronic tonsillar disease
Authors: Koch R. James , Brodsky Linda
Published: October 2006

Tonsillar tissue lymphocyte (TTL) function as measured by immunoglobulin production was assessed in vitro in 60 tonsils, 51 diseased and 9 normal controls. The diseased specimens were from children (aged 3 to 10 years) clinically classified as having recurrent tonsillitis (RT), idiopathic tonsillar hyperplasia (ITH), or recurrent tonsillitis with hyperplasia (RT/H). TTLs were challenged with intact, heat‐inactivated bacteria found in the core of diseased tonsils—Streptococcus pyogenes (SP) and Haemophilus influenzae type B (HIB) as well as the dominant bacterium (DB) grown from that particular tonsillar core. The phytomitogen, leukoagglutinin (LA), was used as a nonspecific activator. Qualitative immunoglobulin production was assessed for the immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA) classes. Immunoglobulin‐specific production was quantified at the basal level, and at 2, 4, and 6 days following stimulation.

Stimulation with HIB produced the greatest amount of IgG and IgM in TTLs from control tonsils. The DB was a relatively weak stimulator of normal (control) TTLs, yet produced relatively brisk IgG responses in the RT and ITH categories. It did, however, yield only marginal IgM secretion in these groups. IgA was consistently produced after stimulation in diseased TTLs, yet was not elicited from normal TTLs. The aforementioned findings suggest a differential qualitative and quantitative immunoglobulin response for healthy, recurrently infected, and hyperplastic tonsils. Lymphocyte hypofunction along with structural changes associated with hyperplasia may be central to the etiology of chronic tonsillar disease. The tonsillar immunologic response in disease and health is discussed.
Transoral laser resection with staged discontinuous neck dissection for oral cavity and oropharynx squamous cell carcinoma
Authors: Eckel Hans Edmund , Volling Peter , Pototschnig Claus , Zorowka Patrick , Thumfart Walter
Published: October 2006

Transoral laser resection of oral cavity and oropharynx squamous cell carcinoma (OOSCC) is a widely accepted approach in the absence of cervical lymph node metastases. This study investigated the results of transoral laser surgery and discontinuous neck dissection (ND) for OOSCC with clinically obvious or suspected cervical node metastases.

One hundred seventeen patients with infiltrating oral carcinoma were treated for cure with transoral resection of the primary and staged ND. Twenty‐nine primaries were classified as T1, 50 as T2, 35 as T3, and 3 as T4. Lymph node metastases were identified in the ND specimen of 36 patients. All patients were followed for a minimum of 3 years unless they died. Estimated tumor‐related survival after 5 years is 81% for stage I and II disease of the oral cavity, 86% for stage I and II disease of the oropharynx, 73% for stage III disease of the oral cavity, 65% for stage III disease of the oropharynx, and 21% for stage IV disease of the oral cavity and the oropharynx. Local and regional control of cancer was achieved in 72 (62%) of the 117 patients. Forty‐five local and regional recurrences were diagnosed during the follow‐up period. Two patients died of distant metastases with no evidence of local or regional recurrence.

The combination of transoral laser resection and staged ND for the treatment of OOSCC seems to offer satisfactory cure rates for a selected group of patients. These two minor surgical interventions cause less morbidity than commando‐type surgery and lead to low perioperative mortality and morbidity.
Prognostic significance of prostaglandin E2 production by mononuclear cells and tumor cells in squamous cell carcinomas of the head and neck
Authors: Milanovich Michelle R. , Snyderman Carl H. , Wagner Robin , Johnson Jonas T.
Published: October 2006

Prostaglandin E2 (PGE2) has been implicated as a cause of immunosuppression in patients with head and neck cancer. To determine the relative contribution of tumor cells and mononuclear cells to PGE2 levels in vivo, tumor cells and tumor‐infiltrating mononuclear cells (TIMC) were isolated from fresh tumor biopsy specimens of 23 patients with squamous cell carcinoma of the head and neck (SCCHN) by using enzymatic digestion and differential gradient centrifugation. Peripheral blood mononuclear cells (PBMC) and lymph node mononuclear cells (LNMC) from metastatic and nonmetastatic lymph nodes were also isolated. Cell fractions were cultured for 24 hours, and PGE2 levels of supernatant were determined by radioimmunoassay. PGE2 production by LNMC was significantly decreased compared to tumor cells, TIMC, and PBMC (P =.0002). LNMC from metastatic lymph nodes produced significantly higher levels of PGE2 (P =.02) compared to nonmetastatic lymph nodes. Although T stage was not correlated with PGE2 production by TIMC or tumor cells, advanced N stage (N1–3) was associated with decreased PGE2 production by TIMC (P =.006). These results suggest that both tumor cells and TIMC are sources of PGE2 in tumor tissues of patients with SCCHN and that decreased PGE2 production by host inflammatory cells may have clinical significance in the development of cervical metastases.
Sinonasal papillomas: A report of 82 cases in copenhagen county, including a longitudinal epidemiological and clinical study
Authors: Buchwald Christian , Franzmann Maria‐Benedicte , Tos Mirko
Published: October 2006

The present epidemiological and clinical study comprises 82 patients with sinonasal papillomas diagnosed from 1975 to 1993. Histology showed 58 cases of inverted papillomas including 5 cases of associated carcinoma, 19 cases of exophytic papilloma, and 5 cases of columnar cell papilloma. The incidence of sinonasal papillomas in Copenhagen County was 0.74 per 100,000 inhabitants per year. The inverted and columnar cell papillomas were typically located in the middle meatus with a varying degree of involvement of the adjacent sinuses. The exophytic papillomas were predominantly located multicentrically on the nasal septum. Good results of treatment, especially with regard to inverted papillomas, were not correlated to the aggressiveness of surgery. A lateral rhinotomy with medial maxillectomy was performed as primary surgery in 28 patients. In 50% of these patients there were recurrences. The preliminary results of endonasal endoscopic surgery revealed a high success rate, i.e., no recurrences in 5 cases so far. The septal papillomas were typically resected by a simple endonasal procedure. There were recurrences in 66% of these cases. The midfacial degloving procedure may be advocated instead of or as a supplement to the lateral rhinotomy if the tumor cannot be visualized sufficiently by endoscopy. Smoking may dispose to sinonasal papillomas.
Carotid body tumors: A review of 30 patients with 46 tumors
Authors: Netterville James L. , Reilly Kathleen M. , Robertson David , Reiber Mark E. , Armstrong William B. , Childs Prudence
Published: October 2006

Minimal morbidity occurs with resection of most carotid body tumors (CBT). With larger tumors significant injury to the cranial nerves has been reported. In order to assess the operative sequelae rate, 30 patients with CBT were reviewed. Sixteen patients either presented with bilateral carotid body tumors or had previously undergone a resection of the contralateral carotid body tumors, for a total carotid body tumor count of 46. Sixteen patients demonstrated a familial pattern while 14 were nonfamilial. Within the familial group, 14 of 16 presented with multiple paragangliomas as compared to 6 of 14 in the nonfamilial group. Tumor size ranged from 0.8 to 12 cm. Vascular replacement occurred in 2 of 20 patients with tumors <5.0 cm, compared with 5 of 9 with tumors >5.0 cm. Four patients lost cranial nerves with the resection: superior laryngeal nerve (SLN), 4; cranial nerve X, 1; cranial nerve XII, 1. Ten patients developed baroreceptor failure secondary to bilateral loss of carotid sinus function. First‐bite pain occurred in 10 of 25 operative patients. Cranial nerve loss can be minimal with resection of carotid body tumors, however, baroreceptor failure and first‐bite pain are postoperative sequelae that are often disregarded in the postoperative period.
The use of positron emission tomography for early detection of recurrent head and neck squamous cell carcinoma in postradiotherapy patients
Authors: Bailet Jeffrey W. , Sercarz Joel A. , Abemayor Elliot , Anzai Yoshimi , Lufkin Robert B. , Hoh Carl K.
Published: October 2006

Positron emission tomography (PET) has recently proved to be highly sensitive in detecting known extracranial head and neck squamous cell carcinomas when compared to computed tomography and magnetic resonance imaging (MRI). The ability of PET to detect early subclinical recurrent squamous cell malignancies in patients who received primary radiotherapy was evaluated. A new PET‐MRI coregistration technique was used to determine precise anatomic tumor location, enabling directed biopsies to confirm the presence of malignancy, and to plan additional therapeutic strategies. Ten patients underwent PET evaluation with intravenous [18F]‐fluorodeoxyglucose and received postradiotherapy MRI scans. In all cases, PET accurately detected the presence of recurrent disease despite negative or equivocal MRI scans and indeterminate clinical examinations. PET appears to be highly effective in detecting early recurrent head and neck squamous cell malignancies in postirradiated patients.
Flow cytometric analysis of primary and metastatic squamous cell carcinoma of the oral cavity and oropharynx
Authors: Syms Charles A. , Eibling David E. , Mccoy J. Philip , Barnes Leon , Emanuel Benjamin , Fowler Craig , Wagner Robin , Johnson Jonas T.
Published: October 2006

This research was supported in part from grants from the Mary Hillman Jennings Foundation and the John R. McCune Charitable Trust.

A retrospective analysis of formalin‐fixed, paraffin‐embedded tissue from patients with histologically confirmed metastatic squamous cell carcinoma was performed using flow cytometry. Ninety‐eight sets of specimens from previously untreated patients with an oral cavity or oropharyngeal tumor and a simultaneous cervical metastatic deposit were analyzed. Normal mucosa and cervical lymph nodes were processed identically and run as controls. All patients underwent surgical resection at Wilford Hall USAF Medical Center or The Eye and Ear Hospital of Pittsburgh between 1980 and 1986. The specimens from 94 patients were technically adequate for interpretation. Diploid histograms in both the primary and metastatic tumors were present in 49 (52%) of 94 patients. Aneuploid histograms in either the primary or metastatic tumors were noted in 45 (47%) of 94 patients. In this group of 45 patients, the primary tumor and cervical metastasis were both aneuploid in 21 (46%), and aneuploid histograms occurred with equal incidence in either the primary or metastasis in the remaining 24 cases. No statistically significant prediction of survival could be made from any correlation with the histograms of either the primary or metastasis. The potential technical problems and limitations of flow cytometry in the determination of DNA content of formalin‐fixed, paraffin‐embedded tissue and the selection of patients with advanced disease warrant caution in the interpretation of results.
Internal jugular vein thrombosis following functional neck dissection
Authors: Leontsinis Timothy G. , Currie Andrew R. , Mannell Aylwyn
Published: October 2006

Twenty‐five patients on whom 27 functional neck dissections were performed for upper aerodigestive tract squamous carcinoma were prospectively investigated to determine the frequency of venous thrombosis on the side of the neck dissection. Retrograde venography, performed within 1 month postoperatively, was used to determine the status of the internal jugular vein.

Nineteen veins were patent at venography, but ipsilateral occlusion was demonstrated in 8. In 5 of the 8 patients, venous thrombosis followed major wound sepsis or fistula formation. No causes for the remaining 3 cases of internal jugular vein thromboses were identified. Possible mechanisms for “spontaneous” internal jugular vein occlusion following functional neck dissection are endothelial trauma, reduction in venous flow during anesthesia, and the altered coagulability profile of some cancer patients.

The finding that functional neck dissection does not always maintain patency of the internal jugular vein is especially important when surgical treatment to the opposite side of the neck is planned, as the surgeon may be faced with an unexpectedly complicated postoperative course.
Effects of endolymphatic duct occlusion on the structure and function of the endolymphatic sac in the adult guinea pig
Authors: Lee Alice J. , Parker David A. , Gladstone Hayes B. , Hradek Gary , Schindler Robert A.
Published: October 2006

The endolymphatic sac (ELS) has been shown to respond rapidly to sudden disruptions in fluid balance such as labyrinthectomy or systemic administration of hyperosmolar agents. The present study was designed to determine the ELS response to slower changes in fluid dynamics by occluding the endolymphatic duct (ELD), thereby interrupting the longitudinal flow of endolymph to the ELS. Morphologic studies and autoradiographic techniques were used to evaluate the effects of ELD obstruction on the structure and function of the ELS after 48 hours. There were no significant changes in cellular morphology and a slight decrease in the incorporation of radiolabeled glucose when compared with normal ELS cells. We conclude that it is rapid change in fluid balance that triggers the ELS response, which is not seen with disruption of longitudinal flow.
The cricothyroid muscle does not influence vocal fold position in laryngeal paralysis
Authors: Koufinan James A. , Walker Francis O. , Joharji Ghazi M.
Published: October 2006

The status of the cricothyroid muscle, which is innervated by the superior laryngeal nerve, is believed to influence the vocal fold position in laryngeal paralysis. It is believed that isolated lesions of the recurrent laryngeal nerve generally result in the paralyzed vocal fold assuming a paramedian position but that with lesions of both the superior and recurrent laryngeal nerves, a more lateral (intermediate or cadaveric) vocal fold position can be expected.

Twenty‐six consecutive patients with unilateral vocal fold paralysis underwent transnasal fiberoptic laryngoscopy (TFL) and laryngeal electromyography (LEMG). By TFL, the vocal fold positions were paramedian in 8 patients, intermediate in 7, and lateral in 11. By LEMG, 13 patients had isolated recurrent laryngeal nerve lesions and 13 patients had combined (superior and recurrent laryngeal nerve) lesions.

There was no correlation between the vocal fold position and the status of the cricothyroid muscle, i.e., the status of the cricothyroid muscle by LEMG did not predict the vocal fold position nor did the vocal fold position by TFL predict the site of lesion. In addition, we investigated the possibility that the degree of thyroarytenoid muscle recruitment (tone) might correlate with vocal fold position, but no relation was found. We conclude that 1. the cricothyroid muscle does not predictably influence the position of the vocal fold in unilateral paralysis; 2. thyroarytenoid muscle recruitment (tone) does not appear to influence vocal fold position; and 3. still unidentified and unknown factors may be responsible for determining vocal fold position in laryngeal paralysis.
A comparative diagnostic study of head and neck nodal metastases using positron emission tomography
Authors: McGuirt W. Frederick , Williams Daniel W. , Keyes John W. , Greven Kathryn M. , Watson Nat E. , Geisinger Kim R. , Cappellari James O.
Published: October 2006

A prospective study was conducted to compare the accuracy of clinical examination, computed tomography (CT), and positron emission tomography (PET) in identifying head and neck squamous cell carcinoma metastatic to cervical lymph nodes. The findings in the necks of 49 patients evaluated by clinical examination and CT were compared to the findings in the same necks by PET, a newly available metabolic imaging modality. Pathology specimens were available for 45 of the necks. The findings of PET and CT correlated in 84% of cases. In the cases that did not correlate, CT proved correct in four of five cases. PET (82%) and CT (84%) were comparable and were both better than clinical examination (71%) in correctly identifying the presence or absence of metastatic disease.
Comparison of surgeries for removal of primary vestibular inputs: A combined anatomical and behavioral study in rats
Authors: Li Hongyan , Godfrey Donald A. , Rubin Allan M.
Published: October 2006

Unilateral removal of Scarpa's ganglion and neurectomy of the peripheral vestibular nerve branches were compared in rats as methods to eliminate primary vestibular input. Ocular nystagmus was consistently observed after both types of lesion, but it completely disappeared within 4 to 7 days. Imbalance and rotation were more serious and prolonged after ganglionectomy than after peripheral neurectomy. Corresponding with these differences in symptoms were differences in terminal degeneration. After ganglionectomy, degenerated axons and terminals were distributed throughout all terminal regions of primary vestibular fibers on the lesioned side, while after peripheral neurectomy, the degeneration was more limited. The results of this study suggest that vestibular ganglionectomy is a more successful approach than peripheral vestibular neurectomy for removing the primary vestibular input.
Incisionless otoplasty
Authors: Fritsch Michael H.
Published: October 2006

Otoplasty is a continually evolving procedure that significantly and beneficially alters the patient's facial appearance. Multiple techniques have been and are currently in use. A new method for partial or total correction of the “lop” protuberant ear deformity is described, the basis for this technique being percutaneous placement of retention sutures. Percutaneous placement leads to an incisionless otoplasty technique. Depending on the ear deformity, the incisionless technique may be used alone or in conjunction with other methods.
The influence of arterial insufficiency and venous congestion on composite graft survival
Authors: Henrich Douglas E. , Lewis Roy S. , Logan Thomas C. , Shockley William W.
Published: October 2006

A rabbit auricular amputation model was used to study the relative effects of arterial insufficiency (AI) and venous congestion (VC) on composite graft survival. The percentage of graft survival was significantly greater for the AI group (45.8%) than for the VC group (15.9%) 2 weeks postoperatively. The percentage of graft survival at 3 weeks for the VC, AI, and no‐ligation groups were not statistically different. All three groups were statistically different from the control group, which had both the central artery and vein ligated. The VC group also exhibited significantly more graft edema, as measured by maximal graft thickness, than the other three groups.

The impact of AI and VC on composite graft survival is investigated and discussed. These results suggest that venous congestion is more detrimental to early graft survival than arterial insufficiency.
Preoperative identification of benign versus malignant parotid masses: A comparative study including positron emission tomography
Authors: McGuirt W. Frederick , Keyes John W. , Greven Kathryn M. , Williams Daniel W. , Watson Nat E. , Cappellari James O.
Published: October 2006

Various diagnostic tools were used in 26 patients with parotid masses to determine their value in preoperative malignant or benign categorization. These tools were positron emission tomography (PET), clinical examination, fine‐needle aspiration biopsy (FNAB), computed tomography (CT), and magnetic resonance imaging (MRI). PET identified all 26 lesions and all 12 malignant lesions, but made the correct categorization in only 69% of cases. Thus, it was not as good as the more conventional diagnostic methods, their correct categorizations being 85% (clinical), 87% (CT/MRI), and 78% (FNAB) in the same patients.
The effects of chronic otitis media with effusion on the measurement of transiently evoked otoacoustic emissions
Authors: Amedee Ronald G.
Published: October 2006

Otoacoustic emissions (OAEs) are low‐level acoustic sounds of cochlear origin that can be recorded from the external auditory canal under well‐controlled conditions. They are a natural by‐product of normal auditory physiology and may be divided into two general categories: spontaneous and evoked emissions. These emissions provide an objective, non‐invasive measurement of cochlear function that is accurate, rapid, and simple to perform. The clinical utility of OAEs has been extensively described in both normally hearing subjects and subjects with sensori‐neural hearing loss. The primary clinical applications of these emissions appear to be in neonatal screening and ototoxic monitoring.

In this study, the effects of middle ear effusion on the production of evoked OAEs in children were assessed using preoperative tympanometric and otoacoustic emissions testing. The study subjects were children with a history of chronic otitis media who had otoscopic findings suggestive of middle ear effusion. An attempt was made to correlate the type of middle ear effusion found at surgery with the presence or absence of preoperative otoacoustic emissions.

Statistical analysis indicated that the type of effusion in the middle ear does affect the presence or absence of emissions. These results tend to refute previous notions that OAEs are not measurable if the tympanogram is abnormal or fluid is present in the middle ear space. A review of the pertinent literature in included, along with a general description of the types of OAEs and their clinical significance.
Usher's syndrome type 3 in Finland
Authors: Pakarinen L. , Karjalainen S. , Simola K. O. J. , Laippala P. , Kaitalo H.
Published: October 2006

Usher's syndrome, type 3 (USH3) is characterized by progressive hearing loss. Usher's syndrome, type 3 has been supposed to be rare, occurring in 2% to 4% of all patients with Usher's syndrome. In a nationwide study we collected data on 229 patients with Usher's syndrome in Finland. Definite cases of USH3 were found in 30 (13%) of the 229 patients. An additional 61 patients had clinical evidence of earlier progression of their hearing impairment. We suggest that 91 (40%) of the 229 patients with Usher's syndrome represent cases of USH3.
Insulin receptors on the endolymphatic sac: An autoradiographic study
Authors: Kinght Lindsey C. , Saeed Shakeel R. , Hradek Gray T. , Schindler Robert A.
Published: October 2006

Light microscopic autoradiographs were prepared of isolated guinea pig endolymphatic sac (ES) tissue incubated with iodine (I)‐125‐labeled insulin (insulin I 125). These demonstrated specific binding of the insulin I 125 to receptor in the ES. Receptor‐mediated endocytosis of the insulin‐receptor complex is postulated to occur, and the relevance of insulin receptors in the ES is discussed, with particular emphasis on the previously observed synthesis of hyaluronan from glucoses by the ES.
Overexpression of the p53 gene in primary and metastatic head and neck carcinomas
Authors: Sauter Edward R. , Ridge John A. , Klein‐Szanto Andres , Track Bruce , Cleveland Deborah , Whitley Karl V. , Mohr Rose M.
Published: October 2006

The p53 gene has been correlated with disease progression in a number of human malignancies, and p53 abnormalities are found in a high percentage of head and neck squamous cell carcinomas. The objectives of this study were 1. to correlate p53 expression with disease progression in squamous cell carcinoma of the head and neck (SCCHN), and 2. to determine whether there are site‐specific differences in p53 expression. Primary lesions and/or lymph node metastases from 147 patients with invasive SCCHN were immunostained for p53 overexpression. Expression of p53 was similar (42% versus 43%) in primary lesions and lymph node metastases. Expression also did not vary significantly by site in the head and neck. In conclusion, increased p53 expression did not correlate with disease progression in our series of patients with invasive SCCHN. The finding of a lack of increased expression with disease spread to lymph nodes supports the belief that p53 alterations occur early in head and neck carcinogenesis.
Treatment of nasopharyngeal inlet stenosis following uvulopalatopharyngoplasty with the co2 laser
Authors: Duyne Jenny Van , Coleman Jack A.
Published: October 2006

This report looks at outpatient treatment of nasopharyngeal inlet stenosis, a more commonly seen postoperative complication of uvulopalatopharyngoplasty (UPPP). It does not study the effectiveness of the UPPP for treatment of obstructive sleep apnea syndrome (OSAS). The authors evaluated six patients who had a UPPP for OSAS, all of whom developed stenosis in the nasopharyngeal inlet ranging from 14 mm to complete closure. Two patients had failed rotation flap repairs. The carbon dioxide laser was used to treat these patients in the office under a local anesthesia in a staged manner. We now have patients from 3 months to 12 months follow‐up who have had stenosis treated successfully. We believe that the postoperative complication of nasopharyngeal inlet stenosis after UPPP can be treated in a safe and cost‐effective manner in the office setting.
Cochleosacculotomy for the treatment of meniere's disease in the elderly patient
Authors: Kinney William C. , Nalepa Nancy , Hughes Gordon B. , Kinney Sam E.
Published: October 2006

Cochleosacculotomy is a surgical option for the treatment of incapacitating vertigo in elderly patients with Meniere's disease. This procedure was performed in nine patients (mean age: 73 years) for control of vertigo and/or drop attacks. The average follow‐up period was 29 months. Vertigo was controlled in eight of nine patients, hut hearing worsened in all but one patient. No patient developed a transient increase in vertigo in the postoperative period. Cochleosacculotomy should be considered in elderly patients with recurrent vertigo and severe non‐fluctuating sensorineural hearing loss who would otherwise be candidates for labyrinthectomy.
Autologous collagen vocal fold injection: A preliminary clinical study
Authors: Ford Charles N. , Staskowski Paul A. , Bless Diane M.
Published: October 2006

This preliminary study reports the first use of injectable autologous collagen for vocal fold augmentation. In previous studies, the authors showed cross‐linked bovine collagen to be effective in more than 150 patients with glottic incompetence, particularly those with focal defects or scarred or atrophic vocal folds. However, concerns about possible adverse immunologic responses to the bovine material have limited its use.

The authors studied eight patients with difficult vocal fold pathology, including sulcus vocalis, atrophy, and scarring secondary to trauma and cordectomy. Skin was harvested under local anesthesia, processed into a naturally cross‐linked injectable form (Autologen®), and injected using indirect laryngoscopy. Voice production was evaluated prior to the injection and at intervals after the injection, using subjective, perceptual, aerodynamic, acoustic, and videostroboscopic assessments.

The results indicate that autologous collagen is comparable to injectable bovine collagen in the management of several difficult glottic insufficiency problems and that the likelihood of a hypersensitivity response is negligible. Unlike bovine collagen preparations, Autologen does not require breakdown of the natural collagen molecule, so it is anticipated that this material will be better tolerated and more stable over time.
Maturational influences on suppression of vocal cord function by anesthesia
Authors: Handler Steven D.
Published: October 2006

Vocal cord abduction is a complex action that occurs with inspiration and is controlled by the respiratory center in the brainstem. A study was conducted to evaluate the maturational influences on the effect of anesthesia on vocal cord movement. Rabbits aged 15, 30, 45, and 60 days were used to study this problem. The animals were equilibrated to varying concentrations of halothane, and vocal cord movements were documented.

In all age groups the vocal cord motion increased with increasing concentration of halothane. The amount of vocal cord movement also increased with the increasing age of the animal. These effects, however, were independent of each other. There did not appear to be any interaction between the concentration of halothane and the age of the animal. These findings are discussed in light of the apparent absence of active vocal cord motion observed in some children under a general anesthetic.
Auricular cartilage versus costal cartilage as a grafting material in experimental laryngotracheal reconstruction
Authors: Heatley Diane G. , Clary Randall A. , Lusk Rodney P. , Garner Frederick T.
Published: October 2006

Auricular cartilage has been used clinically as an alternative material to costal cartilage for implantation during laryngotracheal reconstructive surgery. Little information is available concerning the healing characteristics or the durability of these two types of graft. The authors of this study examined the rate of epithelialization and the survival of cartilage in a rabbit model of anterior tracheal wall reconstruction and directly compared auricular and costal cartilage grafts. Auricular cartilage was found to epithelialize faster than costal cartilage. Both types of graft survived well after implantation. The superior healing characteristics of auricular cartilage make it a desirable material for laryngotracheal reconstruction.
The Extended Abbé Flap
Authors: David Kriet J. , Cupp Craig L. , Sherris David A. , Murakami Craig S.
Published: October 2006

Large upper lip defects that include the surrounding aesthetic subunits of the midface are difficult to reconstruct. Abbé flaps have been a popular method of dealing with small upper lip defects but, as classically described, they are insufficient for larger defects. We performed cadaver injections to evaluate the vascular territory supplied by the inferior labial artery with particular attention to the submental area. Extended Abbé flaps were then designed and used in combined upper lip and midfacial reconstruction. Three cases and guidelines for the use of the extended Abbé flap are presented.
Cochlear implant results: A comparison of live‐voice and videotaped tests
Authors: Gray Roger F. , Wareing Michael J. , Court Ivy
Published: October 2006

The Cambridge Cochlear Implant Programme has so far implanted the Ineraid multichannel cochlear implant in 16 profoundly deaf adult patients; there has been a 9‐month or longer follow‐up period with these patients. We have evaluated these patients by open‐set Bamford‐Kowal‐Bench (BKB) Standard Sentence List testing in two different delivery strategies, live‐speaker testing by the same speaker and highresolution videotaped testing. The performance in lip reading both before and 9 months after implantation has been tested, as well as performance with the implant alone and with the implant in conjunction with lip reading at the 9‐month stage. We have compared the performance in these two delivery strategies and have found a significantly better performance in the live‐speaker tests that is attributable to slower and perhaps more sympathetic delivery. We have also found evidence of a ceiling effect in the performance of the implant with lip reading in the live‐speaker mode and, of greater importance, a floor effect in the performance of the implant alone with the videotaped test. These results and the implications for a complementary role of these two test‐delivery modes are discussed.