bluuebunny/crossref_metadata_2025 huggingface dataset:
Recurrent bell's palsy: Analysis of 140 patients
Authors: Pitts David B. , Adour Kedar K. , Hilsinger Raymond L.
Published: October 2006

Of 1,700 patients with facial paralysis seen in a retrospective study from 1969 through 1977 and 280 patients seen prospectively from 1983 through 1986, 7.1% had recurrence of Bell's palsy. In this group, the frequency of ipsilateral recurrence was equal to that for contralateral recurrence. The mean age at onset of Bell's palsy was 33.0 years; Bell's palsy recurred a mean of 9.8 years later. Recurrent facial paralysis did not indicate a worse prognosis for recovery regardless of which side was affected. There was no statistical difference between results for male patients or female patients, nor was there a statistically significant sex predominance, except in the age group 10 to 19 years. In our results, computed tomography (CT) scan in patients with recurrent Bell's palsy detected no facial‐nerve neuroma. Of 77 patients followed a mean of 33 years after the first episode (range, 2.8 to 60 years), none showed progressive facial‐nerve dysfunction or any signs of tumor. We conclude that an ipsilateral recurrence of facial paralysis without documented evidence of a tumor does not warrant a transmastoid decompression of the facial nerve. The results of our analysis were verified prospectively as well as retrospectively. A new classification system is introduced for ease of computer analysis and for simplified discussion of recurrent facial paralysis.
Osteoradionecrosis of the temporal bone: A surgical technique of treatment
Authors: Ma K. H. , Fagan P. A.
Published: October 2006

Osteoradionecrosis of the temporal bone is a well‐documented complication of radiotherapy to the ear, with potentially lethal complications. Three cases of advanced disease, treated surgically, are presented. In two of these, subtotal petrosectomy with blind‐sac closure of the external auditory canal was carried out via an anterior approach. The enclosed space was obliterated with pedicled temporalis muscle. Primary healing took place. One case was similarly obliterated using a prolonged posterior incision. The wound broke down, requiring a microvascular free flap for closure.

Radiotherapy jeopardizes the viability of skin flaps. An anterior incision bases the flap behind on the occipital and postauricular arteries. When radiotherapy has been used, this incision has theoretical and practical advantages over a standard posterior incision.
Radiotherapy of the resected mandible following stainless steel plate fixation
Authors: Scher N. , Poe D. , Kuchnir F. , Reft C. , Weichselbaum R. , Panje W. R.
Published: October 2006

There is general concern among otolaryngologists that irradiation of a stainless steel prosthesis used in mandibular reconstruction may cause irradiation overdosage to adjacent tissues.

A tissue‐equivalent plastic/steel model, simulating the characteristics of a stainless steel, reconstructed mandible, was irradiated and measurements were made with a parallel plate ionization chamber.

The results of our measurements show that irradiation of an implanted steel plate results in an overdosage (120%) “in front” and an underdosage (80%) “behind” the steel plate.

The regions of overdosage and underdosage are 2 to 3 mm thick. The overall dose modification is greatly reduced when two opposing fields are used. We conclude that irradiation of a stainless steel, reconstructed mandible with a 6‐mV photon beam through opposing fields does not significantly alter the amount of radiation delivered to surrounding tissues.
Radiation therapy for carcinoma of the hypopharynx with special reference to nodal control
Authors: Teshima Teruki , Inoue Toshihiko , Chatani Masashi , Miyahara Hiroshi , Satot Takeo
Published: October 2006

From October 1977 through December 1983, 61 patients with carcinoma of the hypopharynx were treated with radiation therapy (RT) and surgery or with RT alone. Five‐year survival rates by N‐stage, according to the TNM classification by UICC (1978), were 52% for NO cases, 23% for N1, and 17% for N2–3 (N1 us. N2–3, not significant). For N1–3 cases, corresponding figures by level of cervical nodal involvement by UICC (1978) were 29% for level 3 cases, 15% for level 2, and 8% for level 4 (level 3 vs. level 4, p < 0.04). Therefore, the level of cervical nodal involvement was a more useful prognosticator for patients with nodal metastasis than the N‐stage. Effective nodal control for patients with clinically positive nodes (N1–3) was obtained with a combination of neck node dissection and RT of 50 Gy or more. For NO cases, elective RT of 50 Gy or more, encompassing an adequate field, was required.
Dopamine in paragangliomas of the glomus jugulare
Authors: Azzarelli Biagio , Muller Jans , Miyamoto Richard , Purvin Valerie , Felten Suzanne
Published: October 2006

Glomus jugulare tumors have the ability to synthesize, store, and secrete biogenic amines. Although the majority of these tumors remain endocrinologically silent, on rare occasions they present either as a pheochromocytoma or with a carcinoid syndrome. We report a 20‐year‐old male with two intracranial tumors: an intrasellar neoplasm and a glomus jugulare tumor. Catecholamine catabolites in the urine were not increased, and blood pressure was always normal. The pituitary tumor was an adenoma, immunostaining positive for prolactin. The second patient, a 29‐year‐old hypertensive male, with a glomus jugulare tumor, had increased vanillylmandelic‐acid excretion. In both cases, the paraganglioma tumor cells contained numerous dense‐core vesicles (125 to 380 nm in diameter) in electron microscopy, and showed intense fluorescence by the sucrose‐potassium phosphate‐glyoxylic acid method. Using high‐performance liquid chromatography and microspectrofluorometry we were able to establish the presence of large amounts of dopamine in the cytoplasm of the tumor cells.
Thyeoid cartilage flap reconstruction of the larynx following vertical partial laryngectomy: An interim report
Authors: Burgess Lawrence P. A. , Yim Donald W. S.
Published: October 2006

A supraglottic thyroid cartilage flap was used to reconstruct vertical partial laryngectomy defects in seven patients, including three radiation failures. Local control was maintained in six of seven patients, with one radiation failure recurring in the subglottis and anterior neck skin. Reconstructively, the radiation failures healed more slowly, but all patients were decannulated in 1 to 4 weeks with normal deglutition.

The majority of the ipsilateral arytenoid was preserved in two patients. In the first case, the thyroid cartilage flap was shortened and sutured to the cut surface of the arytenoid. This patient later developed laryngeal stenosis. In the second case, a muscle flap was used to reconstruct the cord, and the thyroid cartilage flap was used externally. This was successful, and we prefer this modification of the Bailey procedure when the arytenoid is preserved.
The use of fibrin glue for the repair of experimental csf rhinorrhea
Authors: Nishihira Shigeki , Mccaffrey Thomas V.
Published: October 2006

Surgical repair of cerebrospinal fluid rhinorrhea requires the production of a seal able to resist cerebrospinal fluid pressure during the period of healing. Direct suturing, packing with muscle and fat grafts, and coverage with mucosal or muscle flaps have been effective in repairing most CSF leaks. Fibrin glue may enhance the results of a CSF leak repair by providing better adhesion of the graft and improving the initial seal during healing. A study was performed on 36 rats to assess the effectiveness of fibrin glue in repairing experimentally produced CSF leaks. CSF rhinorrhea was produced by creating a defect in the anterior cranial fossa through the region of the cribriform plate. There were four treatment groups: 1. no treatment control; 2. fibrin adhesive alone; 3. muscle packing alone; and 4. fibrin glue with muscle packing. The CSF leaks were evaluated 3 weeks after operation. Persistent CSF leakage was noted in 89% of group 1, 55% of group 2, 33% of group 3, and 22% of group 4. The reduced CSF leakage in the muscle plus fibrin glue group suggests that fibrin glue, by its adhesive sealing properties, enhances the results of muscle packing alone for the treatment of cerebrospinal fluid rhinorrhea.
Motor‐evoked potentials of tongue musculature in dogs
Authors: Estrem Scott A. , Haghighi Siavash , Levy Walter J. , Wertheimer Richard , Kendall Mary
Published: October 2006

Transcranial brain stimulation by either electrical or noninvasive magnetic stimulation has produced motor responses of limb musculature. However, recordings from muscles innervated by cranial nerves have not previously been reported.

A right‐sided craniotomy was performed in 18 dogs. An electric stimulus was delivered to the motor cortex via surface electrodes and evoked EMG responses were recorded from the tongue musculature to determine conduction time.

Magnetic stimulation of the motor cortex yielded EMG latencies similar to those obtained by electrical direct cortical stimulation, thus demonstrating the potential of magnetic stimulation in intraoperative and outpatient clinical evaluation of hypoglossal nerve disorders. For the first time, it appears possible to noninvasively stimulate the cranial nerves proximal to the point of injury and to evaluate more central conduction pathways.
Evaluation of noninvasive eustachian tube function tests in normal adults
Authors: Mcbride Timothy P. , Derkay Craig S. , Cunningham Michael J. , Doyle William J.
Published: October 2006

A causal association between eustachian tube (ET) dysfunction and otitis media (OM) has been documented. We present normative data for eustachian tube function (ETF) in an otologically normal population of 107 college‐age subjects using two noninvasive methods: nine‐step tympanometric testing and sonotubometry. The results show a 78% agreement between the two methods when one test session was performed. The nine‐step test showed a 52% repeatability rate on three sequential test sessions while the sonotubometry test showed a 34% repeatability rate. The combined tests showed a 34% agreement for the three sequential tests.

The findings reveal that the combination of the two tests identify 96% of normal subjects as having at least some tubal function present. Although both tests provide similar information regarding the presence of tubal opening, the sonotubometry method is more physiologic. Additional information shows that the average category of the nine‐step test in a normal population was category 2, the mean duration of tubal dilation was 0.40 seconds, and the mean middle‐ear pressure was ‐12 mm H2O.
Variability of the thymidine labeling index in squamous cell carcinoma of the head and neck
Authors: Greenberg Bernard , Woo Linda , Blatchford Steven , Aguirre Maria , Garewal Harinder
Published: October 2006

Tritiated thymidine (3HTdR) labeling is the standard technique for determining the kinetic activity of tumors. This method has been used to label multiple sections of tumor specimens obtained from seven patients with advanced squamous cell carcinoma of the head and neck. Considerable variability was observed in the labeling index in different sites from the same specimen. To reduce the large sampling error due to heterogeneity, we recommend that an average value be determined from multiple sections when employing this technique.
Endolymphatic sac surgery in congenital malformations of the inner ear
Authors: Jackler Robert K. , Luxford William M. , Brackmann Derald E. , Monsell Edwin M.
Published: October 2006

A retrospective analysis of 40 patients (49 ears) with congenital progressive sensorineural hearing loss who underwent endolymphatic sac surgery was performed. The inner ears were radiographically abnormal in 57% of operated ears. In the remaining cases, subtle malformations beyond the resolving power of radiographic studies were suspected. Early postsurgical hearing loss (defined as a loss >10 dB in three‐tone average or >15% in speech discrimination score) was found in 29% of operated ears (14/49). However, only two of these patients lost all of their residual hearing postoperatively (2/49 or 4%). An enlarged endolymphatic sac was noted at surgery in 50% of those with significant postoperative hearing losses. Longer‐term stability of hearing was assessed in 22 patients with bilateral inner‐ear pathology who underwent surgery on one side only. A comparison of the hearing fate of the operated and nonoperated ears suggested no benefit from the surgical intervention when compared to the natural history of the disease. Based upon this experience, endolymphatic sac surgery for the purpose of hearing stabilization in patients with congenital malformations of the inner ear is no longer recommended.
Histopathology of the facial nerve after longitudinal temporal bone fracture
Authors: Eby Thomas L. , Pollak Anita , Fischy Ugo
Published: October 2006

The temporal bone histopathology in a patient who suffered repeated head trauma and a longitudinal temporal bone fracture shows unusual features associated with the facial nerve. In the distal meatal segment, a type of traumatic neuroma was found with disorganized nerve bundles and distinct areas of Schwann's cell proliferation but lacking fibrosis. Periosteal new bone formation in the labyrinthine segment narrows the fallopian canal and protrudes into the nerve, which completely fills the canal. The tympanic and mastoid segments of the nerve show severe degeneration of nerve fibers and an increase in connective tissue between fascicles. An attempted facial nerve decompression did not reach the area of primary pathology in the labyrinthine and meatal segments of the nerve, which could have been exposed by the transtemporal supralabyrinthine approach.
Long‐term airway sequelae in a pediatric burn population
Authors: Calhoun Karen H. , Deskin Ronald W. , Garza Carlos , Mccracken Melinda M. , Nichols Ray J. , Hokanson James A. , Herndon David N.
Published: October 2006

All admissions to the Shriner's Burn Institute in Galveston over a 5‐year period were reviewed. One hundred of 1,092 patients admitted (92%) required airway support (endotracheal intubation or tracheostomy) for more than 24 hours. All clinical variables relating to general presentation and airway care were tabulated. Children who required open airway operations for resolution of acquired airway defects were analyzed separately. No predictive factors could be identified. Guidelines for optimal airway management in the burned child are reviewed.
Topical vital staining of human squamous cell carcinoma xenografts in nude mice
Authors: Porter William C. , Estrem Scott A. , Bickel John T.
Published: October 2006

ABSTRACT. We propose a method for visually enhancing residual cutaneous carcinoma in excision sites using topical stains. Utilizing nude mice, topical stains were applied to fresh wound beds containing partially resected human squamous cell carcinoma xenografts. Fifteen of 18 tumors were visually enhanced using topical 1% acridine orange and ultraviolet light, while none of the seven tumors stained with 0.25% dihematoporphyrin ether and ultraviolet light were enhanced. Of the stains tested, only acridine orange proved to visually enhance tumor tissue in a fresh wound bed. This study establishes the concept of direct wound staining as an aid in the excision of cutaneous cancers.
Vagaries of thyroglossal duct cysts
Authors: Topf Paul , Fried Marvin P. , Strome Marshall
Published: October 2006

The thyroglossal duct cyst is the most common congenital cyst found in the neck, classically presenting as a paramidline mass in a healthy young adult. Fifty‐three cases managed at the Brigham and Women's Hospital and Boston's Beth Israel Hospital over the past 10 years were reviewed. The unique presentation of papillary adenocarcinoma in TGDCs and findings in the elderly population are discussed. These cases represent both diagnostic and therapeutic challenges. The existing literature is correlated with our data, providing a treatise on management.
Effects of laser irradiation on immature olfactory neuroepithelial explants from the rat
Authors: Mester Andrew F. , Snow James B.
Published: October 2006

The photobiological effect of low‐output laser irradiation on the maturation and regeneration of immature olfactory bipolar receptor cells of the rat was studied. The maturation and regeneration of the receptor cells of rat fetuses were quantified in neuroepithelial explants with morphometric analysis. The number of explants with outgrowth and the number and length of neuritic outgrowths were determined on a regular basis for 12 days. Explants in the experimental group were irradiated with a helium‐neon laser using different incident energy densities (IED). Explants in the fluorescent light control group were exposed to fluorescent light for the same periods of time as those in the experimental group were exposed to laser irradiation. Explants in another control group were not exposed to laser or fluorescent light irradiation. The IED of 0.5 J/cm2 laser irradiation has been found to increase significantly the number of explants with outgrowth and the number and length of the outgrowths. Other laser IEDs or fluorescent light irradiation did not influence maturation or regeneration.
Head and neck cancer associated with bloom's syndrome
Authors: Berkower Alan S. , Biller Hugh F.
Published: October 2006

Bloom's syndrome (BS) is an autosomal recessive growth disorder associated with chromosomal breaks and rearrangements. Affected individuals exhibit a significantly elevated rate of cancer at an early age. Twenty‐seven percent of patients with BS have malignant neoplasms at a mean age of 20.7 years.

Since the first description of BS in 1954, five cases of primary head and neck cancer have been identified in the first 103 patients, including two tongue carcinomas and three laryngeal carcinomas. The patients ranged in age from 26 to 34 and included smokers and nonsmokers. The presenting symptoms and histology were identical with those of non‐Bloom's syndrome patients.

Head and neck cancer represents approximately 6% of all human tumors. This is in contrast with an 18% incidence rate of head and neck cancer among all cancers observed in BS patients. The head and neck surgeon should consider BS in the differential diagnosis of young cancer patients.
Carcinoma of the cervical esophagus treated with radiation therapy
Authors: Mendenhall William M. , Parsons James T. , Vogel Stephen B. , Cassisi Nicholas J. , Million Rodney R.
Published: October 2006

This is an analysis of 34 patients with carcinoma of the cervical esophagus treated with radiation therapy with curative intent at the University of Florida between September 1966 and May 1985. All patients have a minimum 2‐year follow‐up and 28 (82%) have at least 5 years of follow‐up. Patients were staged according to the recommendations of the AJCC. Patients who died within 2 years of treatment with the primary site continuously disease‐free were excluded from the local control analysis; all patients were included in the analysis of complications and survival. Irradiation resulted in control of the primary lesion in 1 of 2 patients who presented with T1 lesions, in 4 of the 12 patients with T2 lesions, and 3 of 17 patients who presented with T3 lesions. One patient with a T3 lesion that recurred locally was successfully salvaged by an operation. The 5‐year absolute survival rates by stage were as follows: no patients with stage I lesions survived; of 11 stage II patients, one survived; and of 16 stage HI patients, three survived. Interestingly, all four of the 5‐year survivors were women.
Herpes zoster oticus: Treatment with intravenous acyclovir
Authors: Dickins John R. E. , Smith J. Thomas , Graham Sharon S.
Published: October 2006

Herpes zoster oticus generally has a poor prognosis, leaving many patients with permanent facial nerve dysfunction. This preliminary report describes results in seven patients treated for zoster; all were given intravenous acyclovir. Patients were infused with 10 mg/kg every 8 hours over a 7‐day hospitalization period. Five of the seven patients showed some return of facial function at the time of discharge. At follow‐up, 4 patients had achieved a House grade I result, 1 patient a grade II, and 2 patients a grade III. Reasons for the differences in final results are discussed, along with a recommended regimen for treatment.
Granular cell tumors of the head and neck
Authors: Alessi David M. , Zimmerman Marilyn C.
Published: October 2006

Granular cell tumors have a predilection to occur in the head and neck. Thirty granular cell tumors have been diagnosed during the past 26 years at UCLA; 13 of which presented in the head and neck. Of these 13 cases, 10 were correctly diagnosed on the primary pathological specimen, which included one fine‐needle aspirate and three frozen sections. Four cases required diagnostic confirmation with electron microscopy or histochemistry. The tongue accounted for more than one third of the cases. Three lesions exhibited locally aggressive behavior, but none of the tumors metastasized. Initial treatment was wide local excision in all but one case; recurrence was noted in two cases. Fine‐needle aspiration can be used to provide preoperative diagnosis of granular cell tumors. Wide local excision with histologically confirmed clear margins provides definitive treatment.
Angiolipoma of the parotid: Case report and review
Authors: Reilly James S. , Kelly David R. , Royal Stuart A.
Published: October 2006

An angiolipoma is a benign adipose tissue tumor that can occur as either a circumscribed or an infiltrating lesion and represents up to 17% of all lipomas. Most angiolipomas occur in teenagers and young adults, and are rarely described in younger children. Angiolipoma generally arises on the extremities or trunk, and it is unusual when found in the head and neck. An angiolipoma of the parotid region was suspected in an infant girl after contrast‐enhanced computerized tomographic scan, and was confirmed when the mass was surgically excised. The clinical characteristics, radiological appearance, and histopathology of angiolipoma are discussed.
Bioactive glass ceramic in ossicular reconstruction: A preliminary report
Authors: Niparko John K. , Kemink John L. , Graham Malcolm D. , Kartush Jack M.
Published: October 2006

Current techniques for ossicular reconstruction include ossicular autografts and homografts, and plastic and ceramic prostheses. Experimental testing of ceramic materials has led to the development of a nonporous, bioactive form of glass ceramic (Ceravital) for tympanoplastic reconstruction. To determine the clinical usefulness of these implants, Ceravital ossicular reconstructions were evaluated in 37 patients treated at the University of Michigan Medical Center during an 18‐month period. Thirty‐two patients (86%) with chronic ear disease underwent Ceravital ossicular reconstruction with tympanoplasty with or without mastoidectomy. Five other patients (14%) underwent ossicular reconstruction—2 for congenital anomalies, 2 for temporal bone trauma, and 1 patient for glomus tympanicum removal. Patient follow‐up ranged from 2.2 to 3.8 years, with a mean follow‐up period of 2.9 years. Prosthesis extrusion occurred in one case (3%). Mean preoperative and postoperative (2‐year) pure tone air‐bone gaps were 41.6 dB and 21.3 dB, respectively. Hearing was improved in 35 of 37 patients (95%). Postoperative pure tone air‐bone gap was closed to 20 dB or less in 23 patients (62%). Hearing gains were greater with partial rather than total reconstructions (p=0.14) and significantly greater with intact canal wall rather than canal wall down tympanoplasties (p<0.05). Initial results obtained with the Ceravital ossicular prosthesis compare favorably with those obtained using other methods of alloplastic reconstruction. These preliminary data suggest that Ceravital is an effective alternative prosthetic material for ossicular reconstruction.
Vocal cord mobilization by posterior laryngoplasty
Authors: Jarrard Goodwin W. , Isaacson Glenn , Cameron Kirchner J. , Sasaki Clarence T.
Published: October 2006

Laryngeal obstruction due to fixation of the vocal cords by scar tissue in the posterior commissure is a serious complication of endotracheal intubation. Until recently, operative procedures, including unilateral arytenoidectomy, were recommended for the relief of such obstruction. Because arytenoidectomy adversely affects voice quality, alternative procedures designed to open the airway by restoring vocal cord mobility have been attempted with some success.

We report our experience with six consecutive patients, five of whom had previously required tracheotomy for relief of airway obstruction from posterior glottic stenosis. In all patients, the operative procedure included a midline thyrotomy, excision of the posterior commissure scar tissue, and stenting. Vocal cord motion returned to normal or near normal in all six patients, and all have been decannulated. Subjective evaluation of voice quality was the same or improved postoperatively.

Our experience suggests that restoration of an adequate airway in patients with posterior glottic stenosis can be achieved without sacrificing an arytenoid cartilage and voice quality.
Cisplatin ototoxicity in guinea pigs with special reference to toxic effects in the stria vascularis
Authors: Kohn Sarah , Pratt Hillel , Robinson Eliezer , Nir Izhak , Fradis Milo , Podoshin Ludwig , Zidan Jamal
Published: October 2006

The toxic effects of cisplatin (cis‐diamminedichloroplatinum [II]) on the organ of Corti are well established. Few and conflicting data on this drug's effects on the stria vascularis exist. The present study presents animal experiments on the toxic effects of cisplatin in the stria vascularis and in the organ of Corti. Cisplatin‐induced toxicity in albino and pigmented guinea pigs was evaluated morphologically and functionally, using light and transmission electron microscopy as well as auditory brainstem‐evoked potentials on the organ of Corti and the stria vascularis. The results showed variability in hearing thresholds, ranging from no change to hearing loss of 30 dB, and prominent damage in the organ of Corti and in the stria vascularis. The toxic effects to both the organ of Corti and the stria vascularis should be considered when cisplatin is used in chemotherapy.
Combined treatment in carcinoma of the nasopharynx
Authors: Souhami Luis , Rabinowits Milton
Published: October 2006

From October 1982 to August 1984, 30 previously untreated patients with biopsy‐proven carcinoma of the nasopharynx, stage III (26.5%) and stage IV (73.5%), received combined radiotherapy (6,000 to 7,000 cGy over a period of 7 to 7.5 weeks) and chemotherapy (mitomycin‐C 10 mg/M2, IV; 5‐fluorouracil 750 mg/M2, IV; and methotrexate 30 mg/M2, IV) concomitantly. There were 20 males and 10 females, with a median age of 40 years. Minimal follow‐up duration was 24 months. Actuarial overall survival rate at 48 months was 49%. Complete local response was achieved in 75% of the patients, with 31% of the cases failing distantly. The complication rate was high and included severe mucositis, xerostomia, and septicemia (fatal in two cases). Despite high local disease control, survival rate did not increase. A randomized trial is urgently needed to establish whether or not combined treatment is of value in advanced carcinoma of the nasopharynx.
Speech segment duration measurements in adult speakers with repaired cleft palate and hypernasality
Authors: Leder Steven B. , Lerman Jay W. , Alfonso Peter J.
Published: October 2006

Consonant closure duration, vowel duration preceding word‐final stop consonants, and total VCVC utterance duration were measured in order to investigate if normal durations in these variables were exhibited in subjects with cleft palate and hypernasality. The data revealed no significant differences among three adult subject groups (noncleft, repaired cleft with mild hypernasality, and repaired cleft with severe hypernasality) on any of the duration measurements investigated, suggesting that speech timing for these features were not significantly altered by the presence of the nasal air leak. Speakers in the two hypernasal groups, however, showed smaller differences between vowel durations in voiced and voiceless stop environments than did speakers without cleft palate. There were significant differences among groups in durational cues between vowel types and between voicing features of stop consonants, both of which were in agreement with previous research.
Surgery and postoperative external irradiation for head and neck cancer recurrent after surgery alone
Authors: Ampil Federico L.
Published: October 2006

The radiotherapeutic salvage of recurrent head and neck carcinoma after definitive surgery was retrospectively studied in 20 patients treated between 1972 and 1985. These individuals had external beam megavoltage irradiation for subclinical (n=7) or gross (n=13) disease. The conventionally applied total dose ranged from 4,600 cGy to 7,000 cGy (mean 6,000 cGy). Overall 2‐ and 5‐year crude survival rates were 25% and 5%, respectively. Regional recurrence was more frequent than local disease. The latter was associated with a better prognosis. As expected, radiotherapy was relatively more effective for minimal (than for bulky) disease. In conclusion, the prognosis for recurrent head and neck carcinoma remains poor despite local therapy.
Isolated uvulitis secondary to marijuana use
Authors: Guarisco J. Lindhe , Cheney Mack L. , Lejeune Francis E. , Reed Hollis T.
Published: October 2006

Isolated uvulitis is a rarely reported disease. Known etiologies include bacterial infection and trauma following the use of instrumentation in the airway. Three cases of isolated uvulitis secondary to heavy marijuana smoke inhalation are reported. Specific recommendations regarding diagnosis and treatment of this disorder are made.
The difference in tumorigenicity between epstein‐barr virus (EBV) genome‐positive and genome‐negative epithelial hybrid cell lines derived from the human nasopharynx
Authors: Takimoto Toru , Tanaka Saichiroh , Umeda Ryozo , Sato Hiroshi , Ogura Hisashi
Published: October 2006

An epithelial/hybrid cell line was previously established (A2L/AH) by the fusion of 8‐azaguanine‐resistant epithelial cells (Ad‐AH) with Epstein‐Barr virus (EBV)‐transformed lymphoblastoid cells (A2L), as a nasopharyngeal carcinoma (NPC) model cell line in vitro. However, the A2L/AH cells were nontumorigenic in nude mice during early passage levels.

In this study, an EBV genome‐negative clone and two EBV genome‐positive clones of the A2L/AH cells have been successfully cloned. We have continued to culture these three clones, as it is possible that EBV may disturb mechanisms that regulate tumorigenicity when cells are grown in vitro for long periods of time. Two EBV genome‐positive A2L/AH clones have become tumorigenic in nude mice after long periods in culture, whereas EBV genome‐negative A2L/AH cells were nontumorigenic after the same period of time. The data suggest that EBV may be associated with tumorigenicity in nude mice, at least in part.
Fulminant drechslera sinusitis in an immunocompetent host
Authors: Pratt Michael F. , Burnett John R.
Published: October 2006

Mycotic infections of the paranasal sinuses are rare. Sinusitis caused by Drechslera spicifera, a common saprophytic dematiacious fungus, has previously been reported in only three immunocompetent patients. Aggressive growth characteristics were not described in any of these reports. The case of a young immunocompetent pregnant woman with fulminant sinusitis caused by Drechslera spicifera is presented. The tumor, which invaded both orbits and the anterior cranial fossa, was rapidly progressive during pregnancy. After delivery of the baby, a combined craniofacial approach was used to excise the sinus mass while adjacent normal tissues were preserved. The pathophysiology and mycology of this uncommon sinus pathogen are reviewed. This case emphasizes the need for prompt surgical intervention to avoid potentially life‐threatening complications from a fulminant mycotic process in the paranasal sinuses. Indications for postoperative chemotherapy with amphotericin B are discussed.
Evaluation of the monothermal caloric test
Authors: Bhansali Sanjay A. , Stockwell Charles W. , Bojrab Dennis I. , Schwan Sabina A.
Published: October 2006

In 1970, Torok reported that patients with labyrinthine disease showed vestibular recruitment and that patients with retrolabyrinthine disease showed vestibular decruitment on the monothermal caloric test. Other investigators have failed to confirm these findings; however, their studies did not precisely replicate Torok's test procedure. Following Torok's procedure exactly, the monothermal caloric test was administered to normal individuals and to patients with well‐documented vestibular lesions. Nine of ten normal persons showed normal responses and one person showed borderline decruitment. Six of eight patients who had lesions of the vestibular nerve or central vestibular pathways showed decruitment. Two patients with active Meniere's disease showed recruitment and one showed asymmetry. Two patients with Meniere's disease who had undergone endolymphatic sac operations showed normal responses. These findings support Torok's claim that the monothermal caloric test discriminates between labyrinthine and retrolabyrinthine vestibular pathology.
Ciprofloxacin for the treatment of chronic ear disease
Authors: Piccirillo Jay F. , Parnes Steven M.
Published: October 2006

The treatment of chronic ear disease is often difficult and frustrating. Patients typically present with a history of chronic, persistent otorrhea that has failed to respond to multiple topical and oral antibiotics. Organisms that are resistant to multiple antibiotics are common. Ciprofloxacin has been shown to be effective against a wide range of gram‐negative and gram‐positive organisms. To evaluate the role of ciprofloxacin in the treatment of chronic ear disease, 21 patients who failed routine therapy for chronic ear disease were prospectively treated with oral ciprofloxacin. Prior to therapy, all ear cultures grew Pseudomonas aeruginosa, Staphylococcus aureus or other gram‐negative organisms. Ninety‐five percent of patients completing therapy showed either improvement or cure. Only one patient failed to improve. Ciprofloxacin has been shown to be effective in the management of chronic ear disease.
Is the nasal cycle an artifact? The role of asymmetrical postures
Authors: Haight James S. J. , Cole Philip
Published: October 2006

Both the nasal cycle and postural asymmetries between the lateral halves of the body will cause the patent cavity of the nasal airway to change sides. Therefore, the cycle might result from adjustments of posture during prolonged periods of nasal resistance measurements.

Posterior rhinometric measurements of unilateral nasal resistance were made three times for 5 to 7 hours on a patient in whom 11 periods of lateral recumbency had not induced nasal resistance changes. A nasal cycle was observed. It is concluded that the cycle is not the product of asymmetrical body pressures.
The use of pentoxifylline in a pig random skin flap model
Authors: Knox Robert D. , Pratt Michael F. , Adkins Warren Y. , Flick James T.
Published: October 2006

Pentoxifylline, the first drug in a new class of rheologic agents, has enhanced skin flap survival in previous rat models. In an attempt to find an animal model more similar to the human, a trial using a pig skin flap model was undertaken. Experimental animals received oral pentoxifylline for 21 days. Random skin flaps were elevated on the 14th day, and flap viability was determined on the 21st day. Similar flaps were raised on control animals. Serum fibrinogen levels, platelet aggregation studies, and erythrocyte flexibilities were measured in both groups. No improvement in flap viability or rheologic properties of the blood were shown in the pentoxifylline‐treated animals. Although no enhancement of skin flap survival was demonstrated, future studies are warranted. Implications for future investigation and clinical application are discussed.
The effect of cetirizine on early allergic response
Authors: Naclerio Robert M. , Proud David , Kagey‐Sobotka Anne , Freidhoff Linda , Norman Philip S. , Lichtenstein Lawrence M.
Published: October 2006

A double blind, placebo‐controlled, cross‐over study was performed to determine the effect of cetirizine, an H1 antihistamine, on the immediate nasal allergic response. Ten persons underwent nasal challenge with antigen after premedication with 20 mg of cetirizine or placebo QD for 2 days. The response was monitored by counting the number of sneezes and by measuring the levels of histamine, prostaglandin D2, leukotriene C4, albumin, and TAME‐esterase activity in recovered nasal lavages. The results showed a significant reduction in sneezing and in the amounts of recovered albumin, TAME‐esterase activity, and leukotriene C4 but no reduction in the amounts of recovered histamine and prostaglandin D2. These results suggest that cetirizine does not inhibit mast cell activation but inhibits the consequences of the released histamine on H1 receptors: sneezing and increased vascular permeability. The results further suggest that mast cell release of histamine is the direct result of antigen stimulation, as opposed to reflex activation, and that other cells in addition to mast cells generate leukotrienes during the early allergic response.
Systemic vasculitis: A temporal bone histopathologic study
Authors: Yoon Tae H. , Paparella Michael M. , Schachern Patricia A.
Published: October 2006

Systemic vasculitis includes a broad spectrum of disorders that may involve blood vessels of any size in any organ system. Systemic vasculitis is associated with immunopathogenic mechanisms. Sixteen temporal bones from eight persons were studied to determine histopathologic changes that occur in systemic vasculitis. Three persons had Wegener's granulomatosis, two had polyarteritis nodosa, and three had systemic lupus erythematosus. Otitis media was seen in 15 ears, with ten ears showing chronic middle ear changes and two showing fibrotic inner ear changes. In Wegener's granulomatosis, granulation tissue was observed around the eustachian tube and protympanum, and in polyarteritis nodosa, inflammatory cell infiltrate and thickened blood vessels were observed around the facial nerve. Although sensorineural hearing loss has been described clinically in systemic lupus erythematosus, the present report describes findings in temporal bones, including severe fibrosis and new bone formation throughout the inner ear.
Clinical results with a percutaneous bone‐anchored hearing aid
Authors: Abramson Maxwell , Fay Thomas H. , Kelly James P. , Wazen Jack J. , Liden Gunnar , Tjellstrom Anders
Published: October 2006

During a 2‐year period ending in July 1987, nine patients were implanted with a percutaneous bone‐anchored hearing aid developed at the University of Gothenburg and Chalmers University of Technology, Sweden. Patient selection was based on the presence of conductive or mixed hearing loss in patients who are unable to wear a conventional hearing aid because of infection or ear canal problems. Patients had speech discrimination scores of at least 60% for phonetically balanced monosyllables (CID lists) at 40 dB above threshold, and a pure tone bone conduction average of 45 dB hearing loss or better.

Patients were evaluated in sound field, preoperatively and postoperatively using warble tones, speech reception threshold, speech discrimination, and synthetic speech identification. The patient's unaided hearing and hearing with a bone‐anchored hearing aid were compared with the patient's hearing with a standard bone conduction hearing aid.

Signal to noise ratio testing with the synthetic speech identification test demonstrated that the bone‐anchored hearing aid was comparable to a standard bone conduction aid. There were no complications in our series. Five patients who reported otorrhea with conventional hearing aids experienced no otorrhea after implantation. Patient satisfaction, as assessed by questionnaire, revealed that all patients preferred the bone‐anchored hearing aid to previously worn hearing aids.
Isolated sphenoid sinus disease
Authors: Pearlman Steven J. , Friedman William H. , Potter Guy D. , Lawson William , Biller Hugh F.
Published: October 2006

Forty‐three cases of isolated sphenoid sinus disease were reviewed. In 33 cases, headache was a presenting symptom. Seven of 29 cases of inflammatory disease and nine of 13 patients with tumors of the sinus presented with cranial nerve findings. When nonspecific visual disturbances were eliminated, two of 29 cases of inflammation and eight of 13 cases of tumors of the sphenoid sinus had cranial nerve deficits. Ten of 12 CT scans performed on patients with tumors of the sinus demonstrated bony erosion or perisinus extensions. This was not found in any of the 27 scans of patients with inflammatory disease. A thorough cranial nerve examination and a CT scan should be performed early in patients who present with vague and unusual headaches.
Head and neck manifestations of histiocytosis‐X in children
Authors: Dinardo Laurence J. , Wetmore Ralph F.
Published: October 2006

The clinical presentation and course of 100 children aged 6 months to 22 years who had histiocytosis‐X and were treated at the Children's Hospital of Philadelphia from 1974 to 1987 were reviewed. Sixty‐three percent of patients presented with complaints referable to the head and neck. Lesions of the skull occurred most frequently, followed by cephalic rash, osseous mandibular destruction, enlarged neck nodes, and gingival disruption. Overall, during the course of the disease, 82% of the children with histiocytosis‐X developed head and neck manifestations. There were ten deaths in this series, all associated with diffuse or multifocal disease. Interestingly, four of these patients presented with cephalic rash as a harbinger of diffuse and eventually fatal illness. The method of diagnosis and management of histiocytosis‐X is discussed.
Malignant germ cell tumors of the head and neck in childhood
Authors: Stephenson Jeffrey A. , Mayland Diane M. , Kun Larry E. , Etcubanas Erlinda , Thompson Elizabeth I. , Gross Charles W.
Published: October 2006

From 1962 through 1987, four children were diagnosed at our institution with primary germ cell malignancies of the extracranial head and neck regions. Ages of the children ranged from 2 to 44 months. Histologic findings included 2 yolk sac carcinoma (endodermal sinus tumor), 1 malignant teratoma with nephroblastoma (Wilm's tumor), and 1 malignant teratoma with neuroblastoma (primitive neuroectodermal) components. Complete clinical and surgical staging was performed to rule out additional sites of disease. All patients initially underwent either biopsy or, when technically feasible, resection. Three patients received combination chemotherapy and two received irradiation. Three patients died of progressive disease. One patient who had yolk sac carcinoma of the temporomandibular region is alive and free of disease 40 months after therapy. Complete surgical resection is indicated for teratomatous tumors, if technically feasible. The malignant components of these tumors are sensitive to both chemotherapy and irradiation and combined therapy may be beneficial.
Further studies on growth characteristics of epstein‐barr virus (EBV) genome‐positive and ‐negative epithelial hybrid cell lines
Authors: Takimoto Toru , Tanaka Saichiroh , Ishikawa Shigeru , Masuda Koh , Umeda Ryozo
Published: October 2006

Differences in tumorigenicity between the Epstein‐Barr virus (EBV) genome‐negative and ‐positive epithelial A2L/AH hybrid cell lines have been described recently. Further differences in growth characteristics of the two epithelial hybrid cells have since been examined. Differences were found in doubling time and cloning efficiency in agarose of the two cell lines. In addition, the EBV genome‐negative epithelial hybrid cell line (cl‐654), unlike the EBV genome‐positive epithelial hybrid cell line (cl‐1), failed to grow in the unmanipulated nude mice, but was successfully transplanted in 60Co‐irradiated nude mice. The histopathologic findings of tumors induced by the inoculation of cl‐654 cells in nude mice showed more differentiated carcinoma than the findings of tumors induced by cl‐1 cells.

The data suggest that EBV is associated with an alteration of cell differentiation in epithelial cells as well as tumorigenicity in nude mice.
Embolization in the treatment of epistaxis after failure of internal maxillary artery ligation
Authors: Breda Stephen D. , Persky Mark S. , Weiss Michael , Choi In Sup
Published: October 2006

Internal maxillary artery ligation is effective in treating epistaxis. Occasionally a patient may continue to hemorrhage after this procedure. Evaluation of postoperative angiograms reveals several factors accounting for the failure of internal maxillary artery ligation. These factors include incomplete ligation of vessels, alternative dominance of vessels, and reconstitution of flow through collaterals. Eleven such patients have been successfully treated with angiography and embolization. There was one complication of skin slough in the region of the columella. Embolization is a useful modality in the management of these difficult cases.
Experimental replacement of the cervical esophagus in rats with a jejunal free transplantation
Authors: Uchida Léo , Harii Kiyonori
Published: October 2006

Hypopharynx and cervical‐esophageal reconstruction after malignant‐lesion removal has been a challenging problem for head and neck surgeons. The reconstructive technique has been developed over the years through several ingenious methods of replacement. As a result of recent refinements in microvascular anastomosis techniques, many studies concerning one‐stage, immediate cervical‐esophagus reconstruction have been reported.

An experimental study on esophageal reconstruction has been developed using a free intestinal transplantation in two distinct strains of rats. One of the groups consisted of a heterogeneous population of Wistar rats and the other an inbred Lewis strain. In our study the Wistar group reacted as in allograft transplantations and developed an immunological rejection process. The Lewis strain reacted according to isogenic transplantations. The surviving rats were killed and microscopical studies of the reconstructed esophagus were performed.

This study is a low‐cost, practical experimental model to achieve a better knowledge of the behavior of the transplanted organs.
Cytologic diagnosis of the maxillary sinus reevaluated
Authors: Nishioka Keiko , Masuda Yu , Yanagi Eriko , Yuen Koji , Ogura Yoshio , Tanaka Toshio
Published: October 2006

Preoperative cytologic diagnosis of the maxillary sinus was performed on 57 patients by examining of solutions obtained by local washing following sinus puncture. There were 6 cases of cancer (5 squamous cell carcinomas and 1 adenoid cystic carcinoma), 1 malignant melanoma, 1 odontoma, 8 aspergillosis, 1 inflammatory pseudotumor, 9 odontogenic maxillary sinusitis and conventional chronic sinusitis in residual cases. There were 2 false‐negative cytologies in the 7 cases of malignant tumor (i.e., 1 adenoid cystic carcinoma and 1 squamous cell carcinoma). The significance and usefulness of the cytologic approach to preoperative diagnosis of malignancies, including malignant melanoma and fungal infection were discussed.