bluuebunny/crossref_metadata_2025 huggingface dataset:
Small Cell Undifferentiated Carcinoma of the Submandibular Gland with Neuroendocrine Features
Authors: de Vicente Rodríguez Juan Carlos , Forcelledo Manuel F. Fresno , Vallejo Gonzalo Hernández , Gutiérrez Luis M. Junquera , Arranz Juan S. López
Published: October 2014

This article reports the clinical, histopathologic, and immunohistochemical findings in a case of small cell undifferentiated carcinoma of the submandibular gland. The tumor was composed of anaplastic cells slightly larger than lymphocytes without ductal differentiation. On immunohistochemical analysis, the tumor contained cells that reacted positively with antibodies to cytokeratin, neuron-specific enolase, synaptophysin, and chromogranin. The present case supports the hypothesis that small cell undifferentiated carcinomas of the salivary glands arise from presumed multipotential ductal stem cells. When this tumor entity is located on the salivary glands, it appears to behave less aggressively than when it is a primary tumor of the bronchial tree.
Glottic Closing Force: Impact of Thyroplasty on Vocal Cord Paralysis in a Pig Model
Authors: Sasaki Clarence T. , Hundal Jagdeep S. , Riley James T. , Eberhardt Peter R. , Ross Douglas A.
Published: October 2014

Reflex glottic closure is an essential component of a normal swallow. A lesion of the unilateral recurrent laryngeal nerve weakens this reflex response, affecting the essential protective functions of the larynx and potentially resulting in aspiration pneumonia, sepsis, or death. Thyroplasty has been advocated to reduce glottic incompetence due to unilateral vocal cord paralysis (UVCP). Although medialization thyroplasty has traditionally been evaluated in terms of its phonatory effect, its role in improving protective glottic closure has never been studied. The present study was designed to evaluate the effect of UVCP and thyroplasty type I on the glottic closing force (GCF). Five male Yorkshire pigs weighing approximately 40 kg were used in this study. Both internal superior laryngeal nerves were simultaneously stimulated with bipolar platinum-iridium electrodes, and the force of evoked glottic closure was measured with a pressure transducer positioned between the vocal cords. Initial pressure readings (GCF) obtained with bilaterally intact recurrent laryngeal nerves served as a control. The GCF was then measured after the right recurrent laryngeal nerve was sectioned to simulate the conditions of UVCP. Finally, thyroplasty type I was performed on the affected side, and the GCF was measured again to evaluate its quantitative effect on reflex glottic closure. The mean GCF was reduced by UVCP to approximately 22.5% (49.71 mm Hg) of the control GCF (220.25 mm Hg). Thyroplasty enhanced the GCF to 57.7% (127.08 mm Hg) of the control GCF. These measures underscore the profound effect that UVCP exerts on the GCF and the limitations of vocal cord medialization in fully restoring it.
Stapes Surgery in Osteogenesis Imperfecta in Finland
Authors: Kuurila Kaija , Pynnönen Seppo , Grénman Reidar
Published: October 2014

We present the surgical findings and audiometric results of ear surgery performed between 1961 and 2002 on 33 Finnish patients (43 operations) with osteogenesis imperfecta (OI). The mean age at the time of the first operation was 30.1 years. The typical surgical findings were a thick, fixed, or obliterated footplate, thick and vascular mucosa with an excessive tendency to bleed, and elastic, fractured, or atrophic stapes crura. As compared with previous studies, the hearing gain was poorer and the remaining postoperative gap was greater for the 43 operations analyzed. The results of this nationwide study, however, may not be directly comparable with operative results of non-population studies. On the other hand, the hearing gain in our study was better in university hospitals than in central hospitals and, furthermore, was comparable with that of previous studies after surgery performed by a single surgeon in a university hospital. Conductive hearing loss related to OI may be successfully treated with surgery in most patients. The rarity of the disease, leading to small annual numbers of operations, the variable surgical findings, and the profuse bleeding tendency of the middle ear, as well as the audiometric results in this study, support centralization of ear surgery in OI patients.
Repair of Chronic Subglottic Stenosis with Autogenous Thyroid Cartilage
Authors: Varvares Mark A. , Montgomery William W.
Published: October 2014

Chronic subglottic stenosis continues to be a difficult management problem. Conservative management with bougienage, laser therapy, mitomycin-C, and/or steroid injections frequently fails. Definitive resection of the subglottis with thyrotracheal anastomosis has increased in popularity, but carries significant operative risks and postoperative complications. In the past 9 years, we have used a modification of a technique to successfully widen the subglottis, which we previously published 20 years ago. By a laryngocrico-tracheofissure approach, the cricoid cartilage is split vertically, both anteriorly and posteriorly. Cartilage grafts, obtained from the upper thyroid laminae anteriorly, are inserted in these splits. The posterior graft is fixed in place with specially designed pins, which improves graft fixation by adding rigidity and shortens the procedure. The repair is held in place for 3 to 4 weeks with either a silicone T tube or a conforming laryngeal stent. The charts of 21 consecutive patients treated with open repair of chronic subglottic stenosis were reviewed. The overall decannulation rate was 95%. We conclude that autogenous grafting is a useful tool in the treatment of chronic subglottic stenosis. Posterior cartilage graft fixation with our pin technique offers a significant advantage over suture fixation by improving graft stability and decreasing operative time, and has a high rate of decannulation.
Phase 2 Study of Intratumoral Cisplatin and Epinephrine Treatment for Locally Recurrent Head and Neck Tumors
Authors: Duvillard Christian , Romanet Philippe , Beaudouin Nathalie , Cosmidis Alain , Chauffert Bruno
Published: October 2014

Local relapses of head and neck tumors are not often eligible for surgical and/or radiotherapy retreatment, and the efficacy of systemic chemotherapy is poor. A greater accumulation and efficacy of anticancer drugs with lower systemic toxicity is theoretically obtained with intratumoral chemotherapy. In experimental studies, epinephrine has been shown to increase the concentration and antitumor effect of intratumoral cisplatin. Fourteen patients with locally recurrent head and neck tumors (median age, 58.7 years) were included in this phase 2 trial. Recurrent tumors (squamous cell carcinomas) were located on the tongue, oral pharynx, or cervical nodes. Prior therapy was surgery and/or radiotherapy with or without intravenous chemotherapy. Inclusion criteria included an Eastern Cooperative Oncology Group/World Health Organization performance status of 0, 1, or 2, an anticipated survival of >3 months, adequate cardiac, kidney, liver, and bone marrow function, and no coagulopathy or carotid invasion. Fifty intratumoral injections of cisplatin-epinephrine (average, 3.6 injections per patient; range, 1 to 5 injections) were given to the 14 patients from November 1998 to July 2000. Patients were treated with cisplatin (1 mg/mL; maximum dose, 50 mg) at an injection volume corresponding to the tumor volume (1 mL/cm3 of tumor; maximum volume, 50 mL). Epinephrine was added at a concentration of 0.02 mg/mL. Intratumoral injections were repeated every 2 to 3 weeks at different locations in the tumors to obtain a homogeneous distribution. Tumor response was evaluated by clinical examination and computed tomography. Eight objective responses were registered among the 14 patients. Four were complete responses, and 4 were partial responses. The average time to disease progression was 11.5 ± 8.9 weeks. Local adverse effects were transient pain, swelling, and erythema at the site of the injection. No nephrotoxicity, neurotoxicity, or ototoxicity was observed. Intratumoral injection of cisplatin and epinephrine in an aqueous solution has a definite antitumor activity in recurrent head and neck cancer with acceptable local tolerance and no major systemic toxic effects except for transient tachycardia and high blood pressure at the time of injection.
Injection Laryngoplasty with Calcium Hydroxylapatite Gel Implant in an in Vivo Canine Model
Authors: Chhetri Dinesh K. , Jahan-Parwar Babak , Bhuta Sunita M. , Hart Stephen D. , Berke Gerald S.
Published: October 2014

The ideal injectable agent for vocal fold medialization is biocompatible, durable, sized to prevent phagocytosis and migration, and formulated for easy injection and does not adversely affect the viscoelastic properties of the vocal fold. We tested a cohesive implant of calcium hydroxylapatite (CaHA) particles in a gel carrier in an in vivo canine model of phonation. Six dogs underwent unilateral recurrent laryngeal nerve section and injection laryngoplasty of the paralyzed vocal fold with a CaHA implant. The six follow-up examinations were performed at 1,2, 3, 6, 9, and 12 months, and the larynx and bilateral neck lymphatic system were harvested for histologic analysis. The CaHA implant adequately medialized the vocal fold to regain glottal closure. The mucosal waves remained unaltered from baseline. The implant remained soft in the larynx and did not migrate to the neck lymphatic system. A localized foreign body giant cell reaction was present on histologic evaluation, but not acute or other chronic inflammation. A size analysis revealed no resorption of the CaHA particles. A decrease in medialization was noted at all follow-up intervals related to resorption of the aqueous-based gel carrier. The CaHA implant appears to be relatively safe and suitable for injection laryngoplasty.
Recurrent Syncope as Presenting Symptom of Burkitt's Lymphoma at the Carotid Bifurcation
Authors: Arapakis Iakovos , Fradis Milo , Schipper Jörg , Ridder Gerd Jürgen , Maier Wolfgang
Published: October 2014

Burkitt's lymphoma is rare outside of Africa, and head and neck manifestations of this disease are even more uncommon. We report a case of Burkitt's lymphoma localized at the bifurcation of the right common carotid artery in a 64-year-old man. The presenting symptoms were recurrent syncopes that necessitated a pacemaker, followed by a rapid onset of cranial nerve palsies. The tumor had infiltrated cranial nerves IX, X, XI, and XII and was resected by selective neck dissection. The patient was subsequently treated with a chemotherapeutic regimen consisting of a combination of cytosine arabinoside, vincristine, ifosfamide, prednisone, and an intrathecal application of methotrexate. He also underwent external-beam irradiation of the neck. The patient has been followed up for a period of 42 months and has no evidence of recurrent disease. Repeated diagnostic testing and a coordination of multiple disciplines can speed diagnosis and therapeutic management. The current literature is reviewed and discussed.
Extracorporeal Shock Wave Lithotripsy of Submandibular Stones: Evaluation after 10 Years
Authors: Zenk Johannes , Bozzato Alessandro , Gottwald Frank , Winter Mathias , Iro Heinrich
Published: October 2014

The use of extracorporeal shock waves in the treatment of submandibular stones is a minimally invasive approach for the treatment of this disease. Its clinical significance has been determined in a long-term retrospective study, performed as follow-up to the short-term results. From 1989 to 1994, 197 patients (88 female, 109 male; age range, 8 to 83 years) with symptomatic, sonographically detectable concretions of the submandibular gland were treated with extracorporeal shock wave lithotripsy. The review analysis was completed retrospectively in 2002 and included 191 patients with complete data. The period under review ranged from 8 to 13 years, with an average of 10.5 years. Altogether, 67 of the 191 patients (35%) either were free of stones or had no more symptoms from the residual sialoliths. Another 15% had a significant improvement in their symptoms and required no further therapy. The remaining 95 patients (50%) had residual stones; they had no symptoms in the short review period, but have had symptoms since. The therapeutic success was not influenced by the stone size, but rather by the stone location within the gland. After therapy, no severe side effects were identified. Extracorporeal shock wave lithotripsy is a possible treatment for stones in the submandibular gland. In combination with other gland-preserving methods, it now forms part of a multitherapeutic approach that renders submandibulectomy unnecessary in the majority of cases.
Clinical Features of Bilateral Progressive Hearing Loss Associated with Myeloperoxidase-Antineutrophil Cytoplasmic Antibody
Authors: Takagi Dai , Nakamaru Yuji , Furuta Yasushi , Maguchi Shiroh , Fukuda Satoshi
Published: October 2014

In this study, we analyzed the clinical features, diagnostic criteria, treatment, and outcome of atypical bilateral progressive hearing loss associated with myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA). The evaluation was made by audiogram and laboratory data in 6 cases treated at Hokkaido University Hospital. We measured MPO-ANCA by enzyme-linked immunosorbent assay; the result was positive in all cases. The hearing loss developed bilaterally and progressed to total deafness within several weeks. The onset of hearing loss was not simultaneous in the 2 ears. Methylprednisolone pulse therapy was effective in 9 ears. Three ears showed no improvement; 2 of the 3 ears had already exhibited total deafness at the first visit. After the treatment. the titer of MPO-ANCA decreased in all patients. The level of MPO-ANCA should be tested in patients with bilateral progressive hearing loss of unknown origin and can be used as a marker of the disease's activity.
Malleus Removal and Total Cartilage Reinforcement in Intact Canal Wall Tympanoplasty for Cholesteatoma
Authors: Martin Christian , Timoshenko Andrei P. , Bertholon Pierre , Martin Caroline , Prades Jean-Michel
Published: October 2014

This study analyzes the morphological and hearing results obtained from intact canal wall cholesteatoma surgery by removing the malleus, reinforcing the whole tympanic membrane with cartilage, and performing an ossiculoplasty with a hydroxyapatite prosthesis. The results were compared to those obtained in intact canal wall cholesteatoma surgery by preserving the malleus manubrium, partially reinforcing the tympanic membrane with cartilage, and predominantly using an ossicle to perform the ossiculoplasty. One- or two-stage intact canal wall procedures were performed in 390 adult patients (416 ears) who had a nonoperated middle ear cholesteatoma. Recurrent and residual cholesteatoma rates were evaluated. Hearing results were analyzed according to the Committee on Hearing and Equilibrium Guidelines of the American Academy of Otolaryngology—Head and Neck Surgery. There was a statistically significant decrease in the recurrence rate in patients who had total cartilage reinforcement of the tympanic membrane versus patients who had partial tympanic membrane cartilage reinforcement. This technique using a hydroxyapatite prosthesis for ossiculoplasty gave good hearing results.
Blood Flow in the Ears of Patients Receiving Cochlear Implants
Authors: Nakashima Tsutomu , Sato Eisuke , Hattori Taku , Tominaga Mitsuo , Sone Michihiko , Sugiura Makoto
Published: October 2014

We measured cochlear blood flow (CBF) in 55 patients who received cochlear implants, using a laser-Doppler probe placed over the site of drilling in the cochlear bony wall. The subjects included 29 patients with congenital deafness of unknown cause, 8 with idiopathic progressive sensorineural hearing loss, 4 with postmeningitic deafness, 3 with Waardenburg's syndrome, 3 with congenital cytomegalovirus infection, and 8 whose deafness had other causes. There was a wide range of CBF values in patients with congenital deafness of unknown cause. In the patients with idiopathic progressive sensorineural hearing loss, the CBF was significantly lower in patients more than 40 years old. Intracochlear calcification following meningitis appears to be associated with a reduced CBF.
Immune-Mediated Disorders Associated with Idiopathic Sudden Sensorineural Hearing Loss
Authors: Toubi Elias , Halas Kathlyn , Ben-David Jackob , Sabo Edmond , Kessel Ahron , Luntz Michal
Published: October 2014

Different immune disorders are involved in the development of sudden sensorineural hearing loss (SSNHL). This includes a wide spectrum of immune-mediated disorders such as immune complexes, production of autoantibodies to the inner ear proteins, production of anticardiolipin (aCL) antibodies, and cellular immune defects. Some studies have also found an elevation of total IgE levels and a type 1 immune reaction. Our objective was to establish the association of “idiopathic” SSNHL (ISSNHL) with various autoantibodies, and to analyze the persistence over time of existing aCL and anti–β2 glycoprotein 1 (anti–β2 GP1) antibodies in such patients. Finally, we sought to establish a possible association between ISSNHL and total IgE elevation and whether this elevation is due to a specific type I immune reaction. In this prospective follow-up study, 51 patients considered as having ISSNHL were compared with 35 age-sex matched healthy volunteers over a 3-year period. All participants were tested for serum antinuclear antibodies, antithyroid antibodies, aCL, and rheumatoid factor. All patients who were positive for aCL antibodies were reanalyzed 3 months later for aCL antibody persistence and for the coexistence and persistence of anti-β2 GP1 antibodies. Skin prick tests were performed in patients in whom total IgE was elevated. Antinuclear antibodies were positive in 9 of 51 (17%) and antithyroid antibodies in 11 of 51 (21%) ISSNHL patients, as compared to 1 of 35 (3%) and 2 of 35 (6%), respectively, in the control group. Rheumatoid factor was positive in 6 of the 51 patients (12%) and in none of the control group. Positive aCL antibodies were present in 16 of 51 patients (31%), 6 of whom (12%) were also positive for anti–β2 GP1 antibodies. Three months later, aCL antibodies persisted in 7 patients (14%), and anti–β2 GP1 in 4 patients. Only 2 of the normal subjects (6%) were positive for aCL antibodies, which persisted in only 1 of them (3%). The level of total IgE was elevated in 14 of 51 patients (27%), in contrast to 3 of 35 controls (8%). Six of them (42%) demonstrated a positive skin test to at least 1 allergen, but only 3 presented allergy symptoms. Our findings support the reported existence of multiple immune-mediated disorders in patients with ISSNHL. The lack of aCL antibody persistence in as many as half of our patients strongly suggests that transient phenomena (eg, viral infection) may trigger aCL antibody activity. However, the presence of aCL antibodies, especially in conjunction with anti–β2 GP1 antibodies, suggests that in some patients, SSNHL is included among the rare symptoms of the antiphospholipid syndrome.
Changes in Cochlear Blood Flow Due to Endotoxin-Induced Otitis Media
Authors: Sone Michihiko , Tominaga Mitsuo , Hayashi Hideo , Nakashima Tsutomu
Published: October 2014

The purpose of this study was to elucidate the influence of otitis media on blood flow in the lateral wall of the cochlea by means of a model of endotoxin-induced otitis media. The cochlear blood flow (CBF) following lipopolysaccharide inoculation into the middle ear cavities of rats was measured by laser-Doppler flowmetry and compared with that of untreated ears. After this evaluation, the influence on CBF of concomitant use of a nitric oxide synthase inhibitor was also investigated. The first day after inoculation, the CBF of treated ears decreased significantly. This decrease recovered gradually between the 7th and 14th days. With concomitant use of a nitric oxide synthase inhibitor, the decrease in CBF was prevented to some extent. The results showed a functional influence upon CBF by endotoxin-induced otitis media. The significance of prophylactic use of the drug is also discussed in regard to the effect on CBF following otitis media.
Use of Injectable Hydroxyapatite in the Secondary Setting to Restore Glottic Competence after Partial Laryngectomy with Arytenoidectomy
Authors: Lee Bryant , Woo Peak
Published: October 2014

Hydroxyapatite cement is a calcium phosphate putty, approved by the US Food and Drug Administration, that solidifies in 20 minutes and gains bone-like stability after 4 to 6 hours. It has been used for craniofacial reconstruction, spinal stabilization, and ossicular reconstruction. This is the first report of use of injectable hydroxyapatite to rebuild soft and hard tissue defects of the larynx after partial laryngeal surgery. Hydroxyapatite was injected in 4 patients to address glottic incompetence after partial laryngectomy. The patients were dependent on tracheotomy and/or gastrostomy tubes. Some had failed prior corrective surgeries. All of the operations were performed endoscopically and gave immediate improvement of glottic incompetence. All 4 patients reported improved symptoms. Three were able to have gastrostomy tubes removed, 1 was decannulated, and 1 had improved voice. In conclusion, hydroxyapatite injection is a technically simple procedure to restore glottic competence that may obviate the need for an open procedure.
Cricoid Regeneration Using in Situ Tissue Engineering in Canine Larynx for the Treatment of Subglottic Stenosis
Authors: Nakamura Tatsuo , Magrufov Akhmar , Omori Koichi , Kanemaru Shinichi , Hiratsuka Yasuyuki , Kojima Hisayoshi , Shimizu Yasuhiko
Published: October 2014

The purpose of the present study was to evaluate the efficacy of cricoid regeneration via in situ tissue engineering in a canine larynx for the treatment of subglottic stenosis. As the tissue scaffold, a Marlex mesh tube coated by collagen sponge was used for a rigid airway framework and for tissue regrowth around the tube. On 5 dogs, the larynx was exposed and the anterior third of the cricoid cartilage was resected. The tube was anastomosed to the lower edge of the thyroid cartilage and to the first tracheal cartilage. By postoperative endoscopic examination at 3 to 7 months, no airway obstruction was observed in any of the dogs. There was granulation tissue in 2 dogs and slight mesh exposure in 1 dog, but they were asymptomatic. Confluent regeneration of the epithelium over the scaffold and good incorporation of the scaffold mesh into the host tissue were observed after surgery.
Use of the Palmaz Stent in the Treatment of Severe Tracheomalacia
Authors: Geller Kenneth A. , Koempel Jeffrey A. , Wells Winfield J. , St John Maie A. R.
Published: October 2014

To present our experience with the use of the Palmaz stent in treating cases of severe, life-threatening tracheomalacia, and to report our experience with the use of tracheal stents in patients who have concomitant tracheotomies, we performed a retrospective study in a tertiary-care children's hospital. Nine patients with multiple congenital anomalies including severe tracheomalacia required placement of a Palmaz stent to prolong life. The congenital anomalies included congenital heart disease, congenital lung disease, meningomyelocele, laryngotracheoesophageal cleft, and tracheoesophageal fistula. Three of the patients had concomitant tracheotomies. Each patient had placement of one or more Palmaz stents in the trachea and/or bronchus. Four patients died, and 5 patients are still alive. Three of the 4 patients who died had concomitant tracheotomies and died of complications associated with significant tracheal hemorrhage. The fourth died of pulmonary complications following repeated episodes of pneumonia. None of the 5 patients who are still alive had a concomitant tracheotomy. The Palmaz stent is a useful tool for treating life-threatening tracheomalacia as a final resort in this difficult patient population; however, the use of these stents may lead to subsequent hemorrhage and death, especially in patients with tracheotomies, so their use must be carefully considered.
Management of Isolated Extrapulmonary Tuberculosis in a Pregnant Patient
Authors: Clark Perrin C. , Yencha Myron W. , Hart A. Kristina E.
Published: October 2014

The worldwide incidence of tuberculosis is increasing, largely as a consequence of both the increasing prevalence of human immunodeficiency virus and the emergence of drug-resistant strains. The pulmonary system is typically the primary site of involvement by this infectious disease; however, extrapulmonary disease does occasionally occur. Although uncommon, neck involvement can occur. The usual presentation is bilateral adenopathy from pulmonary dissemination. Tuberculous cervical adenitis in the absence of pulmonary findings is rare. A concurrent diagnosis of pregnancy complicates the treatment of the infected patient. We present a case of isolated, unilateral tuberculous cervical adenitis in a pregnant patient and discuss the multidisciplinary approach necessary for the appropriate management of this unique situation.
“Bleeding Polyp” of the Nasal Septum: An Uncommon Lesion in Adults
Authors: Lazar Calin Constantin , Costentin Bertrand , Marie Jean-Paul , François Arnaud , Dehesdin Daniele
Published: October 2014

Inflammatory hemangioma of the nasal septum, known as “bleeding polyp,” is an uncommon lesion in adults. We report the case of a 20-year-old woman who presented with left nasal hemangioma revealed by unilateral epistaxis and obstruction. The patient had a medical history of septoplasty performed 5 years earlier. This benign tumor can be spontaneous or posttraumatic and occurs in young postpubertal adults or patients over 40 years of age, without a sex preponderance. The site of origin is most frequently the cartilaginous septum. The appearance and clinical signs often mimic malignancy, and a biopsy for histologic confirmation of the diagnosis is crucial. The capillary hemangioma is more frequently observed than the cavernous type. This tumor does not present spontaneous involution, and treatment is based on a surgical excision including the mucosa and the underlying perichondrium, after computed tomographic and/or nuclear magnetic resonance examination.
Varicella-Zoster Virus Dna Level and Facial Paralysis in Ramsay Hunt Syndrome
Authors: Furuta Yasushi , Aizawa Hiroshi , Sawa Hirofumi , Ohtani Fumio , Fukuda Satoshi
Published: October 2014

We have investigated whether the copy number of varicella-zoster virus (VZV) in saliva correlates with the clinical symptoms in patients with Ramsay Hunt syndrome. A real-time quantitative polymerase chain reaction assay was used to examine the VZV DNA copy number in saliva samples from 37 patients. We detected VZV DNA in 6 of the 7 patients with oropharyngeal zoster lesions (86%) and in 17 of the 30 patients who had zoster lesions only on the skin (57%). Patients with oropharyngeal zoster lesions had a high VZV load in their saliva, and the difference between the copy number in patients with oropharyngeal zoster lesions and those without was around 10,000 copies per 50 μL. In addition, patients with oropharyngeal zoster lesions showed worse recovery of facial function than those without. It seems that the VZV DNA level in saliva reflects the kinetics of viral reactivation in the facial nerve, as well as in the oropharyngeal epithelium, in patients with Ramsay Hunt syndrome.
Total Facial Paralysis after Vestibular Schwannoma Surgery: Probability of Regaining Normal Function
Authors: Jain Yogesh , Falcioni Maurizio , Taibah Abdelkader , Agarwal Manoj , Sanna Mario
Published: October 2014

The aim of the present study was to ascertain the precise fraction of vestibular schwannoma cases that recover to normal function after postoperative total facial nerve paralysis and to compare our results with those presented in the literature. This was a retrospective case review of 631 cases. Among the 132 cases with immediate postoperative facial nerve palsy (House Brackmann [HB] grade VI), only 2 (1.5%) recovered to normal function (HB grade I). In an attempt to compare our results with those of other series in the literature, we found a large variation in the incidence of recovery of this group of patients to grade I, ranging from 0% to 50%. Our analysis of the reported data revealed widely varying methods of data collection and presentation, making a scientifically valid comparison particularly difficult. According to our data, complete (HB grade I) or near-complete (HB grade II) facial nerve function recovery from an immediate postoperative grade VI palsy is extremely rare.
Biphasic Ceramics and Fibrin Sealant for Bone Reconstruction in Ear Surgery
Authors: D'Arc Maurice Bagot , Daculsi Guy , Emam Nadya
Published: October 2014

Bone reconstruction is still a matter of concern in middle ear surgery despite the large number of surgical techniques proposed. A composite made of biphasic calcium phosphate ceramic granules mixed with human fibrin sealant, forming a moldable material that is easy to set for bone reconstruction, has been used with success over a 16-year period for reconstruction of the posterior canal wall or for mastoid obliteration. In a retrospective series of 72 ears with long-term follow-up (average follow-up of 46 months), regular microscopic examination, and computed tomographic controls, we have evaluated this bone reconstruction technique for radical mastoidectomy cavities or the closed technique. The bone reconstruction material provided an immediate anatomic reconstruction that remains stable and is well tolerated over the long term. A slight leakage of granules in the meatus was initially observed in several patients with transient aseptic otorrhea. Fifty-seven ears were followed up for 1 year or more. Satisfactory clinical results with complete regression of the mucous membrane disease were found in 82.4% of the patients, with perfect stability of the material in 65%. We did not observe any cases of recurrent cholesteatoma in or behind the filling material. Eighteen biopsies were performed between 8 and 84 months after surgery during a second surgical step performed for functional purposes or for recurrent cholesteatoma; 17 of the 18 cases showed osteointegration of the filling material. After a 16-year experiment, we consider this technique to be a highly satisfactory procedure that could be extended to other situations of bone reconstruction.
Horizontal Canal Benign Positional Vertigo
Authors: Hornibrook Jeremy
Published: October 2014

The existence of horizontal canal benign positional vertigo (BPV) was predicted from temporal bone studies in 1973, but was not clinically confirmed until later. In this series of 300 patients with BPV, 35 (12%) were identified as having the horizontal canal variant. The essential features are the onset of vertigo when the patient assumes a supine position and bidirectional horizontal nystagmus as the head is turned from side to side. In one third it appeared as a canal “conversion” in patients undergoing repositioning treatment for posterior canal BPV. The mechanism can be canalithiasis or cupulolithiasis. Repositioning treatment is a 360° horizontal head and body rotation that has a high success rate if the symptomatic ear is correctly identified.
Effect of Fibrin Matrix and Vascular Endothelial Growth Factor on Reepithelialization of Orthotopic Murine Tracheal Transplants
Authors: Govindaraj Satish , Gordon Ronald , Genden Eric M.
Published: October 2014

To determine whether the administration of vascular endothelial growth factor (VEGF) alone and in combination with fibrin matrix accelerates murine tracheal allograft reepithelialization, we randomly assigned 40 age-matched mice to 5 experimental groups. BALB/c tracheal grafts were transplanted orthotopically into allogeneic C57BL/6 recipients. The recipients were immunosuppressed with cyclosporine (25 mg/kg per day) and treated with a single topical dose of fibrin matrix, a single topical dose of VEGF, or a single topical dose of a combination of VEGF and fibrin matrix. Thirty-five and 50 days after transplantation, a mixed lymphocyte reaction was performed to assess adequate immunosuppression and the grafts were assessed for rejection, rate and quality of allograft reepithelialization, and cartilage viability. The administration of a combination of fibrin matrix and VEGF to tracheal allografts demonstrated an increased rate of reepithelialization and increased density (37% ± 2.9%) of morphologically normal ciliated pseudostratified epithelium when compared with an immunosuppressed control group (29.3% ± 9.1%) 35 days after transplantation. The treated allografts demonstrated no significant change in cartilage viability or rejection. We conclude that the administration of fibrin matrix and VEGF to immunosuppressed tracheal allografts improves the rate and density of tracheal allograft reepithelialization. Carrier-bound growth factors may represent a novel approach to accelerating tracheal allograft reepithelialization and decreasing the need for prolonged immunosuppression following tracheal transplantation.
Indications and Outcomes of Adenoidectomy in Infancy
Authors: Shatz Anat
Published: October 2014

Adenoid hypertrophy is one of the most common causes of pediatric obstructive sleep apnea. Although adenoidectomy is the only effective treatment for adenoid hypertrophy, it is rarely performed in infants less than 1 year old. This study reports on the successful use of adenoidectomy in 24 infants less than 1 year old with a triad of upper airway obstruction symptoms, findings of obstructing adenoids, and obstructive sleep apnea (but no other anomalies). This is a retrospective case series reviewing each infant's clinical data, including presenting symptoms (with special emphasis on apnea episodes), physical examination findings, and results of other investigations such as polysomnography, endoscopy, pH-metry, and echocardiography. With careful preoperative and postoperative monitoring, the 24 infants underwent adenoidectomy without complications. After the procedure, all showed marked improvement with complete disappearance of symptoms of upper airway obstruction, failure to thrive, and gastroesophageal reflux disease. Adenoidectomy was found to be sufficient and curative for such infants.
Prevention of Hanging Columella in Open Rhinoplasty
Authors: Hafezi Farhad , Naghibzadeh Bijan
Published: October 2014

In this article we discuss the anatomy of the nasal base and explain the causes of postoperative hanging columella, distinguishing this entity from similar deformities with which it can be confused. We suggest measures that could be helpful in preventing this deformity. We performed external-approach rhinoplasty with the dome suturing method in 82 consecutive patients (64 women and 18 men) from 17 to 44 years of age (mean age, 22 years). Comparative measurements of the alar-columellar complex were made before and after operation. Among the 48 patients with conventional tip suturing (38 women and 10 men), 19 true hanging columellae were detected. In the 34 patients with a modified dome approximation (26 women and 8 men), no more than 5 cases of true deformity were diagnosed.
Bilateral Changes in Cortical Motor Representation of the Tongue after Unilateral Peripheral Facial Paralysis: Evidence from Transcranial Magnetic Stimulation
Authors: Rödel Ralph M. W. , Markus Holger , Tergau Frithjof , Laskawi Rainer
Published: October 2014

Motor evoked potentials of the lingual muscles due to focal cortical transcranial magnetic stimulation were investigated in 5 patients with unilateral total facial paralysis with regard to amplitude as a function of the coil position on the interaural line. Maximum bilateral responses could be obtained at mean stimulus positions of about 6 to 8 cm lateral to the vertex. In comparison with healthy subjects, the patient group had significantly smaller mediolateral calculated centers for ipsilateral and contralateral responses. At the optimum stimulus positions, the patients' mean motor evoked potential amplitudes were significantly lower than those in healthy subjects. These alterations could be observed on both cortical hemispheres, but were more pronounced for the hemisphere contralateral to the side of facial paralysis. Thus, we provide strong evidence of bilateral changes in lingual cortical motor representation following facial paralysis with an invasion of the facial motor area by the tongue motor representation.
Translation of the Dizziness Handicap Inventory into Chinese, Validation of it, and Evaluation of the Quality of Life of Patients with Chronic Dizziness
Authors: Poon Dora Mei Ying , Chow Lawrence Chun Kuen , Hui Yan , Au Dennis Kin Kwok , Leung M. Chin Pang
Published: October 2014

The aims of this study were 1) to translate the Dizziness Handicap Inventory (DHI) into Chinese and to validate it and 2) to use the Chinese DHI and the Chinese (Hong Kong) Short Form-36 Health Survey (Chinese [HK] SF-36) to evaluate the quality of life (QoL) of patients with chronic dizziness. Seventy-one patients with 6 months of dizziness due to vestibular dysfunction were evaluated initially, 7 days later (n = 49), and after 7 months of medical treatment (n = 17). The Chinese DHI has been shown to retain good test-retest reliability (intraclass correlation coefficient range, 0.64 to 0.87) and internal consistency (Cronbach α coefficient > 0.7) as compared to the original DHI and has a moderate responsiveness (0.54). We find the Chinese DHI to be a valid tool for evaluation of QoL of Chinese patients with dizziness. Low mean scores on the Chinese DHI and Chinese (HK) SF-36 signify that chronic dizziness has a considerable impact on the QoL of these patients.
Primary Cricotracheal Resection with Thyrotracheal Anastomosis for the Treatment of Severe Subglottic Stenosis in Children and Adolescents
Authors: Alvarez-Neri Hiram , Blanco-Rodriguez Gerardo , Penchyna-Grub Jaime , Gonzalez Ruth , Porras-Hernandez Juan D. , Rutter Michael J.
Published: October 2014

Severe subglottic stenosis in children is best managed by laryngotracheal reconstruction or cricotracheal resection (CTR). We describe clinical outcomes with CTR and end-to-end anastomosis in pediatric patients with severe subglottic stenosis in a tertiary-care pediatric teaching hospital in Mexico City. We prospectively followed up all consecutive patients younger than 18 years of age with a Myer-Cotton grade 3 or 4 subglottic stenosis who underwent CTR between May 1, 2000, and March 31, 2003. The frequency of each clinical outcome was calculated. Twenty-two patients (16 boys [72.7%] and 6 girls [27.3%]) were included. The mean age at operation was 4.6 years (range, 11 months to 16 years). Eighteen patients (81.8%) required primary CTR, and 4 (18.2%) required extended CTR. Seventeen (77.3%) had grade 3 stenosis, and 5 (22.7%) had grade 4 stenosis. Six (27.3%) had associated clinical conditions, and 3 (13.6%) had associated vocal cord mobility defects. All were tracheostomy-dependent at presentation, and none had undergone previous airway surgery. Ten (45.5%) underwent one-stage surgery, and 12 (54.5%) had a concomitant temporary tracheotomy. No intraoperative complications occurred. Seventeen patients (77.3%) developed postoperative granulation tissue requiring endoscopic resection. The mean follow-up was 1.2 years (range, 2 months to 2.8 years). No deaths occurred. Fifteen children (88.2%) with grade 3 stenosis and 5 (100%) with grade 4 stenosis were decannulated, for an overall decannulation rate of 90.9%. Partial cricoid resection with end-to-end anastomosis has been a feasible procedure with reproducible successful results among our patients. We conclude that CTR performed as a primary procedure is an effective treatment for the management of severe subglottic stenosis in children.
Natural Killer T-Cell Lymphoma of the Tongue
Authors: Cho Kwang-Jae , Cho Seok-Goo , Lee Dong-Hee
Published: October 2014

Lymphoma, which represents about 5.4% of all neoplasms and, more significantly, 19% to 28% of malignant neoplasms, is the most common nonepithelial malignancy of the head and neck area in Koreans. Natural killer T-cell (NK/T-cell) lymphoma is a lymphoma of putative natural killer cell lineage. NK/T-cell neoplasms are generally rare, but they are more common in people of East Asian, Mexican, or South American descent. These neoplasms are highly aggressive and show a strong association with Epstein-Barr virus. The preferential site of extranodal NK/T-cell lymphoma is the nasal cavity, and there has been no report of NK/T-cell lymphoma developing from the tongue. We encountered a rare case of NK/T-cell lymphoma of the tongue, which we report with a review of the literature.
Chronic Recurrent Multifocal Osteomyelitis
Authors: Wedman Jan , van Weissenbruch Ranny
Published: October 2014

We report what is, to our best knowledge, the first case of chronic recurrent multifocal osteomyelitis (CRMO) in which the frontal and sphenoid bones were involved. Characterized by a prolonged and fluctuating course of osteomyelitis at different sites, CRMO is self-limited, although sequelae can occur. The diagnosis is one of exclusion. It is important to publish cases like this, because the recognition of CRMO can prevent aggressive surgical and medical treatment.
Supracricoid Hemilaryngopharyngectomy in Patients with Invasive Squamous Cell Carcinoma of the Pyriform Sinus
Authors: Kama Romain , Brasnu Daniel , Hans Stéphane , de Mones Erwan , Garcia Dominique , Laccourreye Ollivier
Published: October 2014

Supracricoid hemilaryngopharyngectomy (SCHLP) was performed in 147 patients over a 19-year period for previously untreated invasive squamous cell carcinoma of the pyriform sinus. With a minimum of 3 years' follow-up, the current retrospective series was designed to document the incidence, risk factors, and consequences of local recurrence following SCHLP. Before operation, 97.4% of patients had an induction chemotherapy regimen. A complete clinical response and a complete histologic regression were noted in 21.7% and 16.8% of patients, respectively. A significant statistical relationship (p = .0001) was noted between complete clinical response and complete histologic regression. Postoperative radiotherapy was used in 49.8% of patients. The overall local recurrence rate was 8.2%. The 5-year actuarial (Kaplan-Meier life-table method) local control estimate was 90.4%. As a function of T stage, the 5-year actuarial local control estimates were 96.2%, 91.1%, 92.9%, and 62.6% in patients with tumors classified as T1, T2, T3, and T4a, respectively. On univariate analysis, the overall local recurrence rate varied significantly, from 5.3% to 55.6% if the apex of the pyriform sinus was invaded (p = .02), 6.9% to 18.7% if the posterior pharyngeal wall was invaded (p = .03), and 6.3% to 60% if the margins of resection were positive (p = .02). In a stepwise regression model, positive margins of resection (odds ratio, 8.4; 95% confidence interval, 2.2 to 32.2; p = .002) and invasion of the apex of the pyriform sinus (odds ratio, 6.1; 95% confidence interval, 1.1 to 33.3; p = .04) were the variables statistically associated with an increased risk of local recurrence. Local recurrence resulted in a statistically significant increased risk of nodal recurrence (p = .005) and death (p < .004). The overall laryngeal preservation rate was 91.2%. From an oncological perspective, these results suggest that SCHLP should become a major tool in the armamentarium of the head and neck surgeon and should be integrated into future trials aimed at organ preservation in patients with invasive squamous cell carcinoma of the pyriform sinus.
Loss of Fhit Expression in Squamous Cell Carcinoma and Premalignant Lesions of the Larynx
Authors: Yuge Tadashi , Shibahara Junji , Nibu Kenichi , Tayama Niro , Kondo Kenji , Sugasawa Masashi
Published: October 2014

The tumor suppressor gene FHIT (fragile histidine triad) at chromosomal position 3p14.2 is altered by deletions in human tumors. The frequency and specificity of its inactivation vary among carcinomas, but few articles have referred to premalignant lesions such as dysplasia. We studied the expression of FHIT in a series of squamous cell carcinomas and premalignant lesions of the larynx. We observed 36 laryngeal carcinoma biopsy specimens and 70 dysplasia biopsy specimens. We studied FHIT expression in carcinoma and dysplasia with the immunohistochemical ABC (avidin–biotinylated peroxidase complex) method. Loss of FHIT protein was observed in 42% of the squamous cell carcinomas and 23% of the premalignant lesions. There was no significant difference among the three grades of dysplasia in FHIT expression. These findings of loss of FHIT protein expression, not only in squamous cell carcinoma, but also in premalignant lesions, indicate that FHIT alterations play an important role in the early events of carcinogenesis.
Fine Structure Histopathology of Labyrinthitis Ossificans in the Gerbil Model
Authors: Tinling Steven P. , Nabili Vishad , Brodie Hilary A.
Published: October 2014

Labyrinthitis ossificans (LO) is the pathological deposition of new bone within the lumen of the cochlea and labyrinth. This process occurs most commonly as a result of infection or inflammation affecting the otic capsule. Trauma and vascular compromise can also lead to neo-ossification within the otic capsule. The mechanism that regulates this process remains unestablished. This study details the end-stage histopathology in high-resolution plastic thin sections. Twenty Mongolian gerbils were infected by intrathecal injection of Streptococcus pneumoniae type 3 followed by subcutaneous penicillin G procaine (8 days) and were painlessly sacrificed 3 months later. The cochleas were serially divided and sectioned for light and electron microscopy. Sixteen of 20 animals (27 of 40 cochleas) demonstrated LO. Cochlear damage was most extensive in the vestibule and basal turn and decreased toward the apex, which often appeared normal. The histopathologic findings consisted of 1) new bone, calcospherites, osteoid, and fibrosis without dense connective tissue or osteoblasts extending from the endosteal wall into the lumen of the vestibule and scala tympani; 2) areas of dense connective tissue and osteoid enclosed by epithelial cells conjoined with the organ of Corti, stria vascularis, spiral ligament, and vestibular (Reissner's) membrane; and 3) partial to complete loss of the organ of Corti, spiral ligament cell bodies, stria vascularis, and spiral ganglion cells. Osteoblastic activity was not demonstrated in end-stage ossification in LO in the gerbil model. Neoossification appears to occur by calcospherite deposition along collagen-like fibrils within osteoid. The destruction of the organ of Corti, spiral ganglion cells, stria vascularis, and cells of Reissner's membrane and the spiral ligament occurs even in the absence of ossification of the cochlear duct.