bluuebunny/crossref_metadata_2025 huggingface dataset:
Monitoring Occlusion And Accidental Extubation Of Tracheostomy Tubes In Children
Authors: Todres I. David , Shannon Daniel C.
Published: February 2017

Twelve infants and children with tracheostomies have been monitored for occlusion or accidental extubation in hospital and at home using a thermistor‐electronic monitor. The patients ranged from 1 month to 6 years of age and have been monitored for 1 to 16 months. The device sounds an alarm when it fails to sense the warming of air on expiration. It is electrically safe, simple to operate and has been well accepted by parents, The thermistor‐monitor has permitted the psychologic and economic advantages of earlier hospital discharge especially for the smaller infants. In two infants, and on three occasions in one, use of the device was life‐saving. The device is applicable for use in patients of any age, with endotracheal or tracheostomy tubes.
Guidelines For Prognosis In Head And Neck Cancer With Nodal Metastasis
Authors: Zoller Michae , Goodman Max L. , Cummings Charles W.
Published: February 2017

Patients with squamous cell carcinoma of the head and neck with cervical node metastasis were studied retrospectively to delineate the prognostic significance of certain clinical and histologic parameters. The patients were divided into radiated and non‐radiated groups for analysis purposes.

A good prognosis was found in non‐radiated patients with an active nodal plasmacytic inflammatory response. No prognostic information was obtainable in observing the inflammatory response of nodes altered by radiation effects.

Extranodal spread of the tumor indicated a poor prognosis for radiated and non‐radiated patients, being more significant in the non‐radiated ones.

Patients receiving preoperative radiation must be separated from nonradiated patients in evaluating host response parameters for prognostic purposes.
Meloplasty As An Office Procedure
Authors: Rafaty F. Mark
Published: February 2017

Meloplasty, the face‐lift operation, has become a very popular surgical procedure. The operation has been adapted as an office procedure and performed with increasing frequency demonstrating its acceptance.

This paper relates the experience of the author with 89 consecutive cases of meloplasty performed in a private office operating room. The report analyzes the following: 1. Patient selection and preoperative evaluation; 2. Equipment, supplies and room setup; 3. Operative technique; 4. Postoperative care of the patient, and; 5. Results.

Preoperative evaluation is particularly important in office operating room procedures for a successful outcome. Preoperative detailed history— with particular attention to cardiopulmonary and renal problems, allergies, medications and metabolic disorders—is obtained. A medical consultation in patients over 50 years of age is essential. A booklet explaining the purpose of the operation with a realistic description of its goals, limitations and possible complications is given to each patient. The booklet also includes information regarding the preoperative skin and hair preparation, postoperative care, convalescence, return to normal activities, etc.

The equipment and instruments are few and simple. The need for complete and proper emergency equipment to manage the possible untoward effects of premedication or anesthetic agents is discussed. It is emphasized that only surgeons with thorough experience with the procedure should perform the operation in the office setup.
Selective Reinnervation of Paralyzed Musculature in the Head and Neck: Functioning Autotransplantation of the Canine Larynx
Authors: Tucker Harvey M.
Published: February 2017

Previous work has demonstrated the possibility of reinnervation of paralyzed muscle groups in the head and neck by the nerve‐muscle pedicle technique. The ability to transplant a human larynx would be feasible if three problems could be overcome. The first of these is the reestablishment of blood supply, most of which problem has already been solved by the work of Ogura and others. The second is the need to restore function of the vocal cords sufficient to provide the necessary valve action of the larynx. It would then be able to maintain airway, prevent aspiration and restore some use of the voice. Previous work by the present author and others has demonstrated that the nerve‐muscle pedicle technique can theoretically be applied to reinnervate a transplanted larynx. The third problem, that of immunosuppression, remains to be solved.

The experiment reported in this paper successfully combines the first two of these criteria in reimplantation of totally excised canine larynges. It follows logically that, if a means of immunosuppression satisfactory for use in human beings who have recently had a malignant process could be found successful human laryngeal transplantation would be a realistic possibility.
Reversal of Deafness After Renal Transplantation in Alport's Syndrome
Authors: McDonald Thomas J. , Zincke Horst , Anderson Carl F. , Ott Norbert T.
Published: February 2017

Six patients (five men and one woman) with Alport's syndrome underwent successful renal transplantation (four received kidneys from cadaver donors and two received allografts from living, related donors) . One patient who had received a cadaver kidney had substantial hearing improvement and the others had stabilization of hearing.

Hearing loss in Alport's syndrome is progressive. The reversal of deafness in one of our patients and stabilization in the others made us wonder whether an inherited enzymopathy had been reversed, which then mitigated the deafness.
Eighty Percent of Cancer is Related to the Environment
Authors: Schneiderman Marvin A.
Published: February 2017

Five reasons lead us to believe that much of cancer is environmentally related: 1. Beginning with the work of Yamagiwa and Ichikawa in 1915, cancer has been produced in the laboratory under the control of man. 2. The trends of cancer incidence (and mortality) have been sharply up in some cases (lung), and sharply down in others (stomach, uterine cervix). 3. There are large differences in cancer among different parts of the world, and within the United States. 4. Migrants from one part of the world to another take on the rates of the part of the world to which they migrate. 5. Removal of known causes from the environment has been followed by reduced cancer incidence.

Environmental causes of cancer lie in both personal environment: cigarette smoking, use of alcohol, sexual habits, perhaps diet; and in the impersonal environment: industrial and occupational pollutants, water and air contaminants, pesticides, flame retardants, diet additives, drugs. A joint effort by persons and by governments can reduce the incidence of cancer.
Computerized Axial Tomography in the Preoperative Evaluation of an Angiofibroma
Authors: Duckert Larry G. , Carley Richard B. , Hilger Jerome A.
Published: February 2017

Computerized axial tomography (CAT) of the head provides the otolaryngologist with an effective diagnostic tool. This technique is particularly useful when used in the preoperative evaluation of head and neck pathology and may be used to define the extent of disease and to direct the surgical approach.

The case of a 16‐year‐old male with an extensive angiofibroma involving the paranasal sinuses and nasopharynx is presented as an example of CAT in preoperative planning of the surgical procedure. Computerized tomography was used initially to define the tumor margins. Serial CAT scans were also obtained at intervals during the patient's preoperative estrogen therapy. Evidence was obtained which suggests CAT may be used to monitor the effects of preoperative hormone management of angiofibromas and in the definition of the optimal time for surgery. In the case presented the final CAT scan provided a detailed and accurate description of the tumor margins which were confirmed at surgery. Our experience with a case of an extensive nasopharyngeal angiofibroma demonstrates the CAT scan to be a useful objective diagnostic method for preoperative planning.
Initial Adjuvant Therapy in Advanced Squamous Cell Carcinoma of the Head and Neck Employing Weekly High Dose Methotrexate with Leucovorin Rescue
Authors: Pitman Susan W. , Miller Daniel , Weichselbaum Ralph
Published: February 2017

Our initial experience with weekly high dose methotrexate with leucovorin rescue (MTX‐LCV), in advanced recurrent or metastatic squamous cell carcinoma of the head and neck with a 77% tumor response rate and high therapeutic index, prompted a trial of MTX‐LCV as initial adjuvant therapy in high risk nonmetastatic patients. Results in 11 patients are presented and confirm the high response rate to MTX‐LCV and the low incidence of myelotoxicity and mucositis, when concurrent urinary alkalinization is employed. Initial MTX‐LCV administration has not compromised subsequent optimum aggressive combinations of surgery and radiation therapy. Cytoreduction with MTX‐LCV may be safely used initially in combined therapy for high risk squamous cell carcinoma of the head and neck.
Submandibular Salivary pH as a Diagnostic Aid For Prognosis of Facial Palsy
Authors: Saito Haruo , Higashitsuji Hideo , Kishimoto Seiji , Miyamoto Kazuo , Kitamura Hiroyuki
Published: February 2017

The present paper aims at introducing a new method of testing the function of the chorda tympani with the aid of submandibular salivary pH. This method has several advantages: (1.) it enables the measurement of the function of only the paralyzed side; (2.) it accurately predicts the outcome of facial palsy at an early stage; and (3.) the method is simple and inexpensive.
Immunologic Detection of Acoustic Neuroma: Preliminary Report
Authors: Harker Lee A. , Nysather John , Katz Arnold
Published: February 2017

In an attempt to provide preoperative histologic identification of internal auditory canal and cerebellopontine angle tumors, and to attempt to detect small tumors and recurrent tumors, immunologic aspects of acoustic neuroma patients and control subjects were studied. Reactions based upon the interaction of patients' fresh lymphocytes in contact with acoustic neuroma antigens were studied by a leukocyte migration inhibition (LMI) assay and a locally developed refinement, the plasma effect assay. These were performed either preoperatively, postoperatively, or both, in 17 patients with surgically confirmed acoustic neuromas and in 24 control subjects. Preoperative tumor patients had a higher likelihood of having elevated LMI and plasma effect assay values than normals. False positive results were rare and the combination of the LMI and plasma effect assay decreased false negative responses to 20%. Meaningful conclusions must await more extensive testing, but it has been demonstrated that tumor associated antigens do exist on the membranes of schwannoma cells and that most patients with an acoustic neuroma mount a cell‐mediated immune response against these antigens.
Acoustic Neuroma Perspective, 1977
Authors: House William F.
Published: February 2017

Microsurgical techniques have now been applied to the problem of acoustic neuroma for 16 years. These 16 years have shown remarkable improvement in morbidity and mortality associated with acoustic neuroma.

An overview of the current status of treatment and some discussion of future needs for improvement will be discussed.
Postinflammatory Ossicular Fixation in Tympanoplasty
Authors: Kinney Sam E.
Published: February 2017

Postinflammatory ossicular fixation in chronic ear surgery is a common problem faced by the otologic surgeon. This thesis presents a review of the evolution of the three forms of postinflammatory ossicular fixation. The surgical techniques used to correct ossicular fixation are discussed. A detailed evaluation of 311 patients diagnosed as having clinical tympanosclerosis is presented.
Route to the Mastoid Antrum
Authors: Stool Sylvan E. , Riding Keith H.
Published: February 2017

The surgical route to the mastoid antrum is examined in its historical perspective. The contributions of an anatomist, Jacob Henle; a 19th century surgeon, MacEwen; and two 20th century surgeons, Jordan and Day, are discussed as examples of the many scientists and physicians who have contributed to the present state of the art in mastoid surgery.
Mastoiditis And Brain Hernia (Mastoiditis Cerebri)
Authors: Paparella Michael M. , Meyerhoff William L. , Oliviera Carlos A.
Published: February 2017

Ten patients with brain hernia occurring as an insidious complication of chronic mastoiditis coincidentally discovered at the time of surgery are described. Four had previous surgery, six did not. A history of trauma was otherwise absent. Cerebrospinal fluid otorrhea did not occur. Our method of management is described. Pathology and pathogenesis are discussed. Three patients had pedunculated brain hernias, while seven had diffuse (fungoid) herniation. Granulation tissue appeared as an important part of the disease process. These may represent abortive attempts at brain abscess formation since the widespread use of antibiotics. Pacchionian bodies may also play a role in the pathogenesis.
Function of The Eustachian Tube Related to Surgical Management of Acquired Aural Cholesteatoma in Children
Authors: Bluestone Charles D. , Cantekin Erdem I. , Beery Quinter C. , Stool Sylvan E.
Published: February 2017

A group of 12 children with acquired cholesteatoma had the ventilatory function of the Eustachian tube assessed by the inflation‐deflation technique. All had varying degrees of functional rather than mechanical obstruction of the Eustachian tube. In these children, the pathogenesis of acquired cholesteatoma appeared to be the result of the following sequence of events: functional Eustachian tube obstruction, high negative middle ear pressure, atelectasis of the tympanic membrane‐middle ear, a retraction pocket in either the posterosuperior or attic portion of the tympanic membrane, and adhesive otitis media. Tympanoplasty in these children was not successful. It is suggested that when the middle ear‐mastoidectomy cavity is allowed to remain open, then the bony portion of the Eustachian tube should be surgically closed to prevent postoperative reflux of nasopharyngeal secretions.
Sequential Rhytidectomy
Authors: Kamer Frank M. , Parkes Morey L.
Published: February 2017

An alternate technique of rhytidectomy is described. After adequate undermining, hemostasis and imbrication, the skin flaps are rotated and advanced with sequential tension in contrast to the use of bipolar or tripolar anchoring points. They are then trimmed and sutured in a step‐like sequential fashion starting at the temporal incision and proceeding around the ear to the occipital area. The technique has been used in over two hundred patients during a two‐year period. The results have been encouraging in eliminating dog‐ear formation, excessive tension on wound edges, and step deformities of the hair bearing tissues. A discussion of the advantages of the method and a comparison with other techniques is outlined.
Observations on 160 Patients with Peripheral Facial Paralysis Seen in Private Practice
Authors: McGovern Francis H. , Estevez Jose
Published: February 2017

Observations on 160 patients with peripheral facial paralysis are recorded. Of the 120 who had Bell's palsy 20 were treated with cromolyn sodium a mast cell degranulation inhibitor. Previous experimental work on the immunologic concept for Bell's palsy suggested that the triggering mechanism in Bell's palsy may be a massive mast cell degranulation within the fallopian canal. The successful control of the neural edema in a small number of patients appeared to warrant further trial with this agent.
The Osteotomy in Rhinoplasty
Authors: Farrior Richard T.
Published: February 2017

The purpose is to assist the surgeon in the selection of modifications for nasal osteotomies.

Details of the technique include: 1. Incision for osteotomy made perpendicular to the pyriform rim and modified incisions, intraoral or through the Weir incision. 2. Rasping of the lateral nasal vault prior to any osteotomies. 3. Removal of a modified beveled wedge of bone prior to the medial osteotomy, unroofing the bony dorsum to a higher level. 4. The medial osteotomy done prior to either the lateral or the intermediate osteotomy. The intermediate osteotomy is performed prior to the lateral. 5. “Complete” and “fading” medial osteotomies are utilized as indicated. 6. The lateral osteotomy may be relatively straight and low depending then on a transverse fracture or may be high and curved meeting the fading medial osteotomy. 7. A sub‐periosteal tunnel with the osteotome guard external to the bone is preferred to a submucosal tunnel.
Computerized Tomography of Paranasal Sinus Neoplasms
Authors: Jing Fao-Shan , Goepfert Helmuth , Close Lanny Garth
Published: February 2017

Computerized tomography represents a new and valuable diagnostic tool to the otolaryngologist and head and neck surgeon in several ever‐increasing aspects of his clinical practice. This report presents CT scans utilizing the E.M.I. 5005 body scanner on patients with neoplasms of the paranasal sinuses presenting to the Head and Neck Service of The University of Texas System Center M. D. Anderson Hospital and Tumor Institute. Only patients undergoing surgical resection of such lesions are included so that actual operative and surgical pathological findings can be used for critical comparison of diagnostic information derived from polytomography and computerized tomography. Seven illustrative cases are presented. In general, computerized tomography has been found to be equal to polytomography in assessing bone destruction or involvement by tumor, and superior to polytomography in determining accurately the soft tissue extent of disease. CT scanning, however, has been found to have limitations in the delineation of soft tissue disease in areas of high contrast in tissue density, and in the evaluation of possible intracranial tumor extension in isodense, avascular lesions.
Tympanometry in the Evaluation of Vascular Lesions of the Middle Ear and Tinnitus of Vascular Origin
Authors: Leveque Hubert , Bialostozky Franklin , Blanchard Cyrus L. , Suter Charles M.
Published: February 2017

The occurrence of vascular perturbations in the tympanogram in association with glomus tumors has previously been noted in the literature. We have broadened the scope of this method of diagnosis in the study of 3 glomus tympanicum and 3 glomus jugulare tumors, 1 dehiscent high jugular bulb, 1 aberrant carotid artery in the middle ear and 2 cases of pulsatile tinnitus of vascular origin. Analysis of illustrative tympanograms at standard and at increased sensitivity (x 20) obtained in these cases are presented. The following factors as they relate to the mechanism of recording the vascular perturbations are presented: air pressure and/or presence of fluid in the middle ear; compliance of the tympanic membrane and ossicular chain as affected by the mass, size and degree of vascularity of the mass and presence of extraneous sounds. A new method of recording the vascular perturbations utilizing a time‐base generator affixed to an X‐Y plotter is described. It is the purpose of this study to demonstrate the utility of obtaining tympanograms at standard and at increased sensitivity in the evaluation of vascular middle ear lesions and tinnitus of vascular origin.
Diatrizoate Meglumine (Hypaque) Treatment for Sudden Hearing Loss
Authors: Emmett John R. , Shea John J.
Published: February 2017

During the 24 month period ending in December 1978, 31 patients with sudden idiopathic sensorineural hearing loss were treated with vasodilators and Hypaque.

Fifteen patients met the treatment criteria of being treated within the first month following onset, no vertigo, and the hearing loss was not complete. Twelve patients (80%) had complete return of their hearing. Two patients (13%) had partial return of their hearing, and 1 patient (6%) had no response to treatment.

Of the 16 patients treated who did not meet the criteria, 6 patients (38%) had complete return of their hearing. Eight patients (50%) had partial return of their hearing and 2 patients (12%) had no return of their hearing.
The Surgical Treatment of Ménière's Disease
Authors: Shea John J. , Emmett John R. , Mooxe Robert E.
Published: February 2017

Ménière's disease is more common than was generally believed in the past. Stahle has calculated the incidence of Ménière's disease in Sweden. Using the same incidence for the United States, there ought to be 97,000 hospitalized inpatients with Ménière's disease of all ages in the whole population. The increased understanding of inner ear physiology and pathology during the past decade has changed the indication for operation towards an early intervention for preserving the hearing function.

For the purposes of analyzing results, patients with Ménière's disease were divided into the following classes according to the hearing loss only: 1. Near normal hearing (no more than 10 db loss at 500, 1,000, 2,000). 2. Ascending audiogram, fluctuating (500 more than 10 db more than 2,000). 3. Flat audiogram, fluctuating (500 not 10 db different than 2,000). 4. Flat audiogram, non‐fluctuating (500 not 10 db different than 2,000). 5. Other, more extreme hearing loss, non‐fluctuating (2,000 10 db more than 500).

In this study, 33 patients with early Ménière's disease had a subarachnoid endolymphatic shunt operation. Two patients belonged to Class 1 and 31 patients to Class 2. All had well‐visualized vestibular aqueducts on polytomography and most had a positive glycerin test done in conjunction with transtympanic electrocochleography.

During the first postoperative year, two patients in Class 2 improved to Class 1 (normal hearing). The other 29 in Class 2 remained in Class 2. None was worse as regards hearing. Most were completely relieved or improved as regards vertigo.

Early surgical drainage in Ménière's disease is effective and safe and should be performed prior to irreversible dilatation of the membranous labyrinth. Patients in Classes 3, 4, and 5, with excessive and widespread hydrops of the membranous labyrinth, should have a vestibular nerve section.
Tympanoplasty Using Formaldehyde Formed Fascia Grafts
Authors: Hicks George W. , Wright J. William , Wright J. William
Published: February 2017

The closure of total perforations of the tympanic membrane has always been more difficult than lesser eardrum defects. Postoperative anterior sulcus blunting and graft lateralization occur with greater frequency in this situation and thus compromise results. In 1975, Rodney Perkins developed and described a technique for the closure of such total perforations which involved the use of formaldehyde treated temporalis muscle fascia, shaped by means of a metal mold into the configuration of a normal tympanic membrane and medial end of the bony external ear canal. This formaldehyde formed fascia (FFF) graft impressed us with its adaptability and logic. This article is a review of 139 cases involving the use of formaldehyde treated grafts not only for closure of total perforations, but also for closure of total perforations with concomitant middle ear ossicular reconstruction. The postoperative nonperforation rate in this series is 96.4%; blunting and/or graft lateralization was absent in 94.2% of cases. Closures of the air‐bone gap to within 20 db occurred in 74% of cases with an overall gain in hearing for all cases of 84%. We believe that formaldehyde formed fascia grafts are an effective tool for the closure of total tympanic membrane perforations with or without concomitant ossicular chain reconstruction.
Hyperventilation and Vertigo
Authors: Monday Louise A. , Tetreault Leon
Published: February 2017

An electronystagmographic study was conducted on 19 normal subjects, in order to observe whether the subjective sensation of dizziness provoked by hyperventilation could be confirmed objectively by nystagmus. Each of them had two electronystagmograms, the first being a routine ENG and the second a repetition of the first, but with additional periods of 90 sec. of hyperventilation at certain precise pre‐determined moments of the test. Hyperventilation was not shown to have significant effect on the slow phase of post caloric nystagmus; however, it increased significantly (p = 0.061) the number of positions in which nystagmus was elicited. Hyperventilation would have such an effect in producing a certain degree of cerebral hypoxia through cerebral vasoconstriction and the Bohr effect.
Retromastoid Microsurgical Approach to Vascular Compression of the Eighth Cranial Nerve
Authors: Leclercq Toussaint A. , Hill Charles L. , Grisoli Francois
Published: February 2017

In our series of 10 patients, the age ranged between 31 and 69 years. Seven patients were followed for from 1–2½ years. Complaints consisted of tinnitus, vertigo, or both. Vegatative symptoms consisting of nausea or vomiting were minimal or absent. Audiometry revealed a varying neurosensory loss. Vestibular hypoexcitability was a common finding. Good discrimination appeared to indicate a vascular loop rather than hydrops. The neuroradiologic work‐up was unremarkable.

Treatment consisted of neurovascular decompression of the VIIIth nerve by microdissection. The approach used was a retromastoid incision with a bony removal limited to 20 mm. Cerebrospinal fluid withdrawal and lateral decubitus positioning permitted visualization of the VIIIth nerve without retraction of the cerebellum. Lack of bleeding, rapidity of procedure and benign postoperative course are emphasized.

The results on tinnitus and vertigo were satisfactory. No additional deficit was created by surgery. If the symptoms are significantly disabling, microsurgical exploration is indicated.
The Percentage of Cells in DNA Synthesis in Epidermoid Carcinomas of the Head and Neck: A Preliminary Report
Authors: Cinberg James Z. , Chang Tsueng H. , Bases Robert , Molnar John
Published: February 2017

The in vivo study of cell kinetics of squamous carcinomas of the head and neck is in its infancy. One cell kinetic parameter, the labelling index (LI), the percentage of cells actively replicating DNA, was estimated in carcinomas of the oral cavity (10), larynx (6) and pharynx (5) by an histochemical immunoglobulin technique developed recently in our laboratory: the antinucleoside antibody technique (ANIP‐LI). Data from earlier experiments using autoradiography (3H‐thymidine) have established that the enzyme‐antibody and isotopic techniques are equivalent.

The LI ranged from 1 to 30 with a mean of 13 in this group of tumors. The LI could not be evaluated for 14% (3/21) of the specimens. The 3 patients with tumors not suitable for ANIP‐LI had received a full course of radiotherapy and/or chemotherapy before they had entered our study. The higher the LI of the tumor, the greater the liklihood that the surgical stage would be higher than the clinical stage, most often as a result of clinically unrecognized lymph node metastasis. However, the number of tumors sampled was inadequate for a statistical trend to be identified.

The potential for the LI to be useful in the formulation of improved therapeutic strategies awaits the accumulation of more data from studies currently in progress.
Prognostic Indicators in Chemotherapy for Head and Neck Carcinoma: Alkaline Phosphatase Levels
Authors: Katz Arnold E. , Hong Waun Ki , Bhutani Rakesh , Berman Leonard D. , Blanchard Gordan J. , Koff Raymond S. , Shapshay Stanley M. , Strong M. Stuart
Published: February 2017

Serum alkaline phosphatase (AP), total bilirubin, total protein, serum albumin, and serum glutamic oxaloacetic transaminase (SGOT) were determined in 55 patients with biopsy proven carcinoma of the head and neck prior to their induction chemotherapy with cis‐platlnum and bleomycin. Of the 55 patients, 40 (73%) exhibited either a complete or partial response (tumor mass decreased by over 50%) to the chemotherapy.

Responses were noted more frequently in patients with elevated AP levels. Nine of the 10 patients (90%) with AP levels > 100 mU/m1 experienced a major response; whereas, only 8 of 16 patients (50%) with AP levels < 60 mU/m1 demonstrated a favorable response to the chemotherapeutic agents.

The source of the elevated AP levels has not yet been established. Possible sources include liver, bone, kidney, intestinal mucosa, or the tumor itself.

Total bilirubin, total protein, serum albumin, and SGOT levels did not differentiate the responders from the non‐responders as accurately as did the AP levels.
Randomized Preoperative and Postoperative Radiation Therapy for Patients with Carcinoma of the Head and Neck: Preliminary Report
Authors: Snow James B. , Gelber Richard D. , Kramer Simon , Davis Lawrence W. , Marcial Victor A. , Lowry Louis D.
Published: February 2017

Two hundred and ninety‐eight patients with squamous cell carcinoma of the oral cavity, oropharynx, supraglottic larynx, hypopharynx or maxillary sinus have been randomized for preoperative radiation therapy and surgery vs. surgery and postoperative radiation therapy plus, in the case of patients with lesions of the oral cavity and oropharynx, radical radiation therapy. Data have been analyzed on 243 patients in this interim report. The differences between the three groups with respect to local control and survival are not statistically significant at this time. Additional accrual and continued follow‐up are necessary to make definite treatment comparisons.
Venous Air Embolism in Head and Neck Surgery
Authors: Hybels Roger L.
Published: February 2017

Venous air embolism can occur under many circumstances, including head and neck surgery when the head is elevated. Embolized air obstructs the pulmonary outflow tract of the right ventricle or the pulmonary arterioles. Small volumes are tolerated or dispersed, but larger volumes can lead to severe physiologic changes. The Doppler precordial monitor is the most effective means of detection and should be used in major operations on the head and neck. Treatment methods are discussed and should be understood by all otolaryngologic surgeons.
Panel Discussion: Otolaryngologic Allergy. Its Diagnosis and Treatment
Authors: Curran Timothy L.
Published: February 2017

Ear, Nose, and Throat is traditionally a surgical specialty. Allergy, however, is involved in the symptoms of many ENT patients. The Rinkel Technique for diagnosis and treatment of allergy is available to the interested otolaryngologist. Only a small amount of office space is required for developing an allergy practice. A nurse or technician trained in the Rinkel method is essential. The results of allergy patients can be just as satisfying as surgical successes.
Immune Response of Guinea Pig Tympanic Membrane
Authors: Poliquin Jacques F. , Catanzaro Antonio , Robb James , Ryan Allen , Schiff Maurice
Published: February 2017

The authors present the results of their experiment on the immune response of the guinea pig tympanic membraneTM.

The first step was to develop an antiserum in the rabbit from the guinea pig tympanic membrane (RAGPTM). The lamina propria was used and IgG was identified as the main constituent of this antiserum. In their initial experiment, the RAGPTM IgG seemed to be specific to the acellular connective tissues of the respiratory tract and TM.

The experiment presented here is concerned with the immune response of the guinea pig tympanic membrane. The animals were sensitized by intracardiac injection with the antiserum, and within one hour the right TM was traumatized in diverse fashions (bacteriological, chemical, mechanical traumas). The left TM served as a negative control. Animals were sacrificed at 24 hours, 7 days and 21 days. Immunofluorescence staining, complement studies (C3) and immunoperoxidase techniques were used on the TM.

It appears that the GPTM can be antigenic in the rabbit. The right TMs of the sensitized guinea pigs reacted differently in the sense that there seems to be homing of the RAGTM IgG to the site of trauma and that the complement participates in the reaction at least in the first week. The lamina propria of the TM is the site of the immune response.

This work will need more elaborate studies but allows us to address different questions concerning the possible role of the combination of trauma and sensitization in conditions clinically involving the TM and middle ear.
The Surgical Closure of Nasoseptal Perforations
Authors: Goodman Wilfred S. , Strelzow Victor V.
Published: February 2017

Although nasoseptal perforations are uncommon — becoming even more so with early diagnosis and treatment of nasal trauma along with continuing refinements in septal surgery — a myriad of suggested techniques continue to exist for their closure. The conventional success rate is often unacceptably low so that Silastic® prostheses are now being used to relieve the symptoms of septal perforation.

The successful surgical closure of perforation of the nasal septum is still difficult. This treatment has been greatly facilitated by the use of the external rhinoplasty, without compromising the airway or causing cosmetic deformity. Supportive autogenous graft material is used routinely, while the perforation is closed using bilateral, bipedicled mucoperichondrial flaps.

This paper omits a complete discussion of etiology. The indications for surgical correction are discussed in detail. The main contraindication to attempting correction is the size and the position of the perforation. The paper is based on 7 years' experience during which period 18 patients have had this surgery. The technical details of the operation are described with the aid of diagrams and photographs.
Auditory Distortion
Authors: Reiter David
Published: February 2017

The auditory system responds to pulsatile energy flow from the environment. Compression and rarefaction of gaseous molecular mass is transduced into electromechanical forms, in order to produce an effect at the cortical level. For energy input to have consistent meaning, transduction must preserve information coded within the pattern of energy flow.

Distortion, or alteration of the original form, occurs in many ways throughout the chain of generation/transmission/reception/interpretation. Parameters of energy flow are discussed, and distortion of each parameter is presented in a context which permits the development of a distortion‐based analysis of common clinical problems in otolaryngology.
Maxillary Sinus Development in Patients With Cleft Palates as Compared to Those With Normal Palates
Authors: Robinson Harrell E. , Zerlin Gary K. , Passy Victor
Published: February 2017

Maxillary sinusitis appears to be more prevalent in the cleft palate population than in the normal population. The increase in sinusitis may be due to the fact that the maxillary sinus develops differently embryonically in cleft palate patients than in those patients with normal palates. A double blind study was done by measuring the maxillary sinus cephalometric x‐rays in cleft palate patients and then comparing them to patients with normally developed palates. The groups studied were 3 months to 20 years of age. It was concluded that in each of these groups there was no significant difference in size, shape, or rate of development of the maxillary sinus in cleft palate patients compared to the normal population. It is probable that the increased incidence of maxillary sinusitis in cleft palate patients is due mainly to the open palate with constant contamination of the nasal mucosa by food pushed into the nares and sinus ostia, resulting in maxillary sinusitis.
Surgical Management of Complex Maxillofacial Fractures
Authors: Kreutziger Keith L.
Published: February 2017

The surgical treatment of severe and complex maxillofacial injuries requires sophisticated modalities. Personal surgical principles of maxillofacial trauma management are delineated. Exploration of all fracture sites with direct reduction and fixation is the most satisfactory technique for best cosmetic and functional results. The maxillary buccal vestibule incision is stressed for routine use in midfacial fractures. A plea is made for utilization of this incision for exploration of the lateral wall of the maxilla, the nasal aperture, the zygomatic buttress, maxillary tuberosity and pterygoid area, the maxillary antrum and roof (or orbital floor), and the infraorbital rim. The extent of the injury can be ascertained and direct reduction and fixation obtained. Two case presentations illustrate the complex management of such injuries. Postoperative follow‐up demonstrates the cosmetic results and rehabilitation of properly managed cases.
History Of Medicine Jean Marc Gaspard Itard — 1774–1838
Authors: Chalat Ned I.
Published: February 2017

Here is the history of French physician and otologist, Jean Marc Gaspard Itard (1774–1838). As physician for the Institute for Deaf Mutes in Paris, Dr. Itard became responsible for the care and civilization of the “wild boy of Aveyron,” also known as, “The Wild Child” of the Truffaut movie. Their encounter became the first carefully recorded effort to train a culturally deprived individual on a one‐to‐one basis, or perhaps on any basis.

Dr. Itard's work leads directly through Dr. Sequin and Dr. Montessori to us today. If we now stand on the threshold of restoring hearing by implantation to the totally deaf, then the results we expect and the training programs we must follow will naturally take us back to the work of this physician of the French Revolution.
Head and Neck Manifestations of Uncommon Infectious Diseases
Authors: Holt G. Richard , Young William C. , Mattox Douglas E. , Aufdemorte Thomas , Gates George A.
Published: February 2017

Certain uncommon systemic infections may be present with head and neck manifestations either initially or during the course of the disease. A high index of suspicion is required on the part of the otolaryngologist with the subsequent procedures leading to the appropriate diagnosis. The manifestations of infectious diseases such as erysipelas, histoplasmosis, rabies, tetanus, botulism, and cysticercosis must be understood by the head and neck specialist. For successful management, many of the infections require prompt identification and initiation of therapy. Airway maintenance, ventilatory support, and medical chemotherapy may be required.
Zinc Requirements in Trauma and Inflammation
Authors: Boyette D. Morton
Published: February 2017

Delayed response in healing has been reported to be due to deficiencies in the trace mineral, zinc. Though trace elements are generally recognized as important in human nutrition, zinc is only recently receiving attention. The literature is scattered with many articles about zinc's use in trauma and inflammation. This paper is a review of some of the current knowledge of zinc and its use in trauma and inflammation.
Bacterial Flora of the External Canal in Diabetics and Non‐Diabetics
Authors: Salit Irving E. , Miller Bruce , Wigmore Margaret , Smith John A.
Published: February 2017

Diabetics are prone to severe Pseudomonas otitis externa, but it is unknown if this is due to abnormal colonization of the external auditory canal. The bacterial and fungal flora of 26 diabetics and 29 age‐matched controls was studied and found to be similar. Subjects with diabetes had more cerumen and a past history of more frequent external otitis than non‐diabetics. It is concluded that diabetics probably have more frequent and severe external otitis because of undefined abnormal host defense mechanisms and not because of enhanced colonization by pathogens.
Esophageal Perforation: Its Early Diagnosis and Treatment
Authors: Elleson Dale A. , Rowley Steven D.
Published: February 2017

Perforation of the esophagus is potentially the most lethal of any site in the gastrointestinal tract and is also the greatest therapeutic challenge. Although uncommon, esophageal perforation continues to occur even in the hands of very well‐trained and experienced endoscopists. The literature reports the incidence of instrumental esophageal perforation to be between 0.25% and 1%. A review of 374 consecutive rigid esophagoscopies at the Naval Regional Medical Center, Oakland, CA. over a three‐year period revealed three perforations for an overall incidence of 0.8%. This paper will review cases.
Cerebellopontine Angle Tumors: Bilateral Flocculus Compression as Cause of Associated Oculomotor Abnormalities
Authors: Nedzelski Julian M.
Published: February 2017

Oculomotor abnormalities of pursuit, OKN, gaze as well as saccade are frequently found in patients with large cerebellopontine angle tumors. Evidence is presented in support of the proposition that bilateral flocculus compression is likely responsible for the majority of oculomotor abnormalities noted in these patients. An hypothesis for the genesis of Bruns' as well as bilateral gaze paretic nystagmus is put forward. Successful tumor removal implies that pursuit and optokinetic nystagmus are more sensitive than the other oculomotor functions to the compressive effects of a cerebellopontine angle mass.
Diagnosis of Malignant Lymphomas of the Nasal Cavity, Paranasal Sinuses and Nasopharynx
Authors: Duncavage James A. , Campbell Bruce H. , Kun Larry E. , Toohill Robert J. , Hanson Gerald A. , Hansen Richard M. , Malin Thomas C.
Published: February 2017

The diagnosis of non‐Hodgkin's malignant lymphoma of the nasal cavity, paranasal sinuses, and nasopharynx was made in 15 patients over a 7 year period (nasopharynx, 9; nasal cavity, 3; maxillary sinus, 2; frontal sinus, 1). A wide variety of head and neck symptoms, often characteristic of benign disease, was reported ranging from 2 weeks to 4 months prior to presentation. Of the 15 cases, the original diagnosis was inconclusive in 6; 4 of the 6 required rebiopsy, while the diagnosis in the other 2 was confirmed on further pathologic consultation. Tissue marker studies, which have recently become available, were performed in 7 cases and were crucial in the diagnosis of 2. B‐cell lymphoma was diagnosed in the 7 patients who had tissue marker studies. Five patients had palpable cervical nodes, and none had distant adenopathy or masses. With further staging, 4 of the 15 patients were found to have disseminated disease. The paper emphasizes the need for early biopsy of suspicious lesions presenting in areas in which physical examination is limited. Recommendations are made for handling the biopsy specimen when malignant lymphoma is suspected, as well as for the evaluation of local and distant sites. The role of surgery is primarily diagnostic in patients with malignant lymphoma.
Tumor Mapping: New Rationales, Adjusted Techniques, Expanded Applications
Authors: Cinberg Jim Z. , Katlein Stanley B. , Vogl Steven E.
Published: February 2017

Eleven consecutive patients with cancers of the oropharynx (4), hypopharynx (4), and oral cavity (3) were endoscoped and “tumor mapped” with a modified tattoo solution before beginning non‐surgical antineoplastic therapy. The tattooed outlines were clearly visible at 7 weeks (5 patients after induction chemotherapy); at 14 weeks (2 patients after induction chemotherapy and radiotherapy); and between 12 and 16 weeks (4 patients after radiotherapy). The “tumor mapping” aided both the establishment of appropriate resection margins in cancers that had diminished in response to non‐surgical therapy and the recognition of a tumor's lack of response to nonsurgical antineoplastic treatment.
Juvenile Laryngeal Papilloma: Histologic And Photometric Evaluation Of Atypia
Authors: Bjelkenkrantz Kaj , Olofsson Jan , StÅL Olle , GröNtoft Otto
Published: February 2017

Juvenile papillomas are the most common proliferative laryngeal lesion in children. Atypia may be present but is difficult to interpret owing to the basically benign character of the lesion. A histologic and clinical classification of 23 cases of juvenile laryngeal papillomas was performed following the criteria suggested by Quick and co‐workers in 1979 and intended to enable the clinical course to be more accurately predicted.

The various histologic types of papillomas were characterized by single‐cell microdensitometry. The photometric study verified the increase in the relative width of the proliferative zone with the degree of atypia. Severe atypia was the only histologic type associated with hypertetraploid nuclei.

The frequent occurrence of mild atypia was unrelated to the clinical course. The moderate and severe degrees of atypia were more common during periods of relatively frequent operations. Severe atypia was rare but in one patient it heralded the development of invasive carcinoma.
Otolaryngologic Complications of Acute Porphyria
Authors: Lewis Michael , Kallenbach Jeremy , Zaltzman Mathew , Hockman Morris , Zwi Saul
Published: February 2017

The porphyrias are a group of diseases which may be complicated by acute neurological crises having serious morbidity and a high rate of mortality. We report a case of acute porphyria in which an acute neurological crisis, resulting in loss of laryngeal function, precipitated life‐threatening aspiration pneumonia.
Flap Reconstruction of the Upper Face: Free Flaps VS. Lower Trapezius Myocutaneous Flap
Authors: Krespi Yosef P. , Baek Se-Min , Surek Christopher L.
Published: February 2017

ABSTRACT. The immediate one‐stage reconstruction of the upper facial cutaneous defects were performed by using two different flaps. In the first representative patient a microvascular free flap was used; in a second case, the lower trapezius myocutaneous flap was used. Free flaps probably are ideal for the correction of such defects in one stage. This procedure requires specially trained surgical teams and longer operative time. A reliable alternative is the lower trapezius myocutaneous island flap. This offers a flap that is thin, hairless and of uniform thickness. The length and thickness of its pedicle allows excellent mobility and leaves no bulky neck deformity. Both these reconstructive techniques satisfy the need for viable replacement in large upper facial and scalp defects coupled with a satisfactory cosmetic outcome.
Nasolacriminal Dysfunction
Authors: Powell James B.
Published: February 2017

This investigation describes the normal function of the lacrimal drainage system of the eye. The intent of the presentation is to illustrate by clinical examples and pertinent literature, those alterations of normal function occurring from obstruction, trauma, or neoplasm. Sixty‐nine patients with lacrimal dysfunction are included; 19 are offered in detail to illustrate principles of surgical management. It is not within the scope of this discussion to examine any condition which may cause primary hyperlacrimation or hypolacrimation, but to discuss: 1. the role of trauma as a cause of lacrimal drainage dysfunction. 2. the role of surgery in the prevention of lacrimal dysfunction, and 3. the role of surgery in the restoration of function.

Among 18 patients with non‐traumatic obstruction treated by silicone stenting, previous multiple dilatations treatment was associated with a higher rate of failure than in those patients not previously treated by multiple dilatations. Forty percent of 96 patients with facial fractures of the medial orbit had obstructive nasolacrimal symptoms; 79% of the 96 patients' symptoms cleared spontaneously; 15% required treatment. No incidence of significant iatrogenic trauma (requiring surgical treatment) was found in reviewing 1292 cases of rhinoplasty, rhinoseptoplasty, blepharoplasty, or sinus surgery.

Normal function and physiology are reviewed. From the experiences of 69 patients emerge clinically proven methods of surgical management of lacrimal system obstruction. These methods are defined and then compared and contrasted to traditional methods and concepts. When there is disagreement or no consensus, alternate theories are discussed in attempting to explain those clinical conditions which seem to defy accepted principles.

This presentation includes cases which have been managed by surgeons other than the author and who have been trained in fields other than otolaryngology. The cases offered in detail have been managed by the author.