bluuebunny/crossref_metadata_2025 huggingface dataset:
Ossicular Abnormalities in Down's Syndrome
Authors: Balkany Thomas J. , Mischke Robert E. , Downs Marion P. , Jafek Bruce W.
Published: April 2016

Down's syndrome has been associated with hearing loss and otitis media. Because of difficulty in examination, however, there have been few detailed otologic studies on this population. An understanding of the nature and frequency of ear disease in Down's syndrome is important, since it is common and occurs in more than one in every 600 live births.

To define the aural manifestations of Down's syndrome, complete otologic and audiometric examination was performed on 107 consecutive patients. This included micropneumatic otoscopy, pure‐tone and speech audiometry, impedance tympanometry, and, in some cases, electronystagmography. Deficient hearing was found in 64% of these patients, and of these hearing losses, 83% were conductive.

Surprisingly, middle ear effusion or tympanic membrane perforation accounted for only 60% of the conductive hearing losses. This finding prompted us to examine five temporal bones of children with Down's syndrome. These histologic sections revealed middle ear abnormalities including fixation and superstructure deformity of the stapes and dehiscence of the fallopian canal. Operative findings in 16 procedures on patients with Down's syndrome and conductive hearing loss support those findings.
Predicting Postoperative Voice Characteristics of Spastic Dysphonia Patients
Authors: Izdebski Krzysztof , Shipp Thomas , Dedo Herbert H.
Published: April 2016

Current treatment of spastic dysphonia may involve unilateral RLN section preceded by a temporary chemical paralysis of one RLN as a diagnostic test. This study compared the immediate postchemical paralysis and postsurgical paralysis voice and speech qualities of 33 spastic dysphonic patients using perceptual, acoustic, and temporal measurements and found that following section of the RLN, there was a decrease in overpressure and aperiodicity, an increase in vocal range, and a reduction of breathiness. Vocal tremor and speech rate were variably affected. It appears that chemical paralysis of the RLN is a fairly accurate means of previewing the postsurgical voice.
Transposition of Infrahyoid Muscles to Replace Intrinsic Laryngeal Muscles: Technique and Long‐Time Observations on Return of Function
Authors: Harvey Joseph E.
Published: April 2016

The motor branches to the abductor and adductor muscles of the larynx were dissected unilaterally and Inserted separately into an infrahyoid muscle in six dogs. Sixty days later a strip of muscle nourished only by the nerve's vessels was transposed to replace submucosally extirpated intrinsic laryngeal muscles. After 36 months, three surviving dogs showed normal electrical activity in the transposed muscles but no effective motion of the affected cord.

Two dogs were treated similarly except that the entire cross section of the sternothyroid was transposed with vessels intact. At 12 months one of the dogs had essentially normal laryngeal function, which ceased upon section of the nerve. Six dogs had a cross section of the sternothyroid with vessels sutured into the larynx and concurrent insertion of motor branches into abductor and adductor regions of the muscle. At three years, one surviving dog had a normal range of motion on the experimental side and an excellent voice. Histologic sections showed predominantly normal fibers in the transposed muscle.

In another group, the sternohyoid was sectioned transversely and sutured to the muscular process of the arytenoid to function as the adductor muscles and received the adductor branch of the nerve. The sternothyroid was sectioned at midlength, the distal end of the proximal segment was turned craniad and sutured to replace the abductor muscle, and it received the abductor nerve. This procedure was abandoned since it embarrassed the blood supply of sternothyroideus, and was replaced with a procedure in which the sternothyroid muscle was sectioned free of the thyroid cartilage and moved dorsally substitute for the abductor muscle.

Correlation of visual and electromyographic observations strongly suggests that normal emg potentials may be recorded in reinnervated muscles with little or inappropriate mechanical function, as well as in those with normal function.
Further Study of the Surface Morphology of the Embryonic Mouse Cochlear Sensory Epithelia
Authors: Li Cheuk W. , Ruben Robert J.
Published: April 2016

Histologic development of the mammalian cochlea has been studied by many investigators. In 1978, Li reported on a preliminary scanning electron microscopic study of hair cell development in the embryonic mouse cochlea. The present study further examines the surface morphology of the embryonic cochlea.
A Conceptual Approach to Local Flaps
Authors: Krause Charles J.
Published: April 2016

Few procedures offer the surgeon a greater opportunity to exercise his surgical and aesthetic judgement than the design and implementation of local flaps about the head and neck. Considerations include skin color and texture match; adequacy of flap blood supply; size, location, and characteristics of the donor site defect; functional capability of the proposed flap; nature of skin tension lines created; and number of surgical procedures required. A systematic approach to local flap design and implementation is presented, and illustrations of the geometric principles involved are included.
Juvenile Spindle Cell Carcinoma
Authors: Potsic William P. , Raney R. Beverly , Buck Billy E. , Fischer Steven W.
Published: April 2016

Spindle cell carcinoma is an uncommon variant of squamous cell carcinoma that is rarely seen in children. The spindle cell pattern is frequently confused with sarcomas.

A case of spindle carcinoma in a 14‐year‐old boy is presented. He is the youngest patient, to the authors' knowledge, with spindle cell carcinoma of the maxilla.

Electron microscopic examination is helpful to define the epithelial nature of the spindle cells and can be performed on formalin‐fixed tissue. Electron microscopic examination is essential to formulate an optimal treatment plan.
Mesenchymoma of Larynx and Neck
Authors: Binns Philip M.
Published: April 2016

A case of mesenchymoma of the larynx and neck with respiratory obstruction is presented. Mesenchymoma is a rare lesion in the head and neck area in which fibrous tissue is accompanied by two other mesenchymal components, often with an infiltrating margin in benign forms. The majority appear in patients under 25 years of age, most commonly in the subcutaneous scalp, cheek, or tongue. There is a 20% recurrence rate. A malignant type also occurs. Wide surgical excision is the treatment of choice.
Malignant Schwannoma of the Trigeminal Nerve
Authors: Karmody Collin S.
Published: April 2016

Malignant schwannomas are rare in the head and neck, even though benign schwannomas of this area are common. A case of a malignant schwannoma of the fifth cranial nerve with symptoms of otalgia and serous otitis media is described.

About 20 such cases have been reported in the literature.
Teratoma of The Nasopharynx in The Newborn
Authors: Dekelboum Allen M.
Published: April 2016

Teratomas of the newborn are rare true neoplasms occasionally arising from the nasopharynx and causing respiratory obstruction. A case requiring immediate tracheostomy is presented along with its subsequent management and eventual extubation. A brief discussion of teratomatous tumors is given. This case represents the youngest patient to receive a tracheostomy.
Case Report: Cellular Medullary Carcinoma as Cervical Metastases of Undetermined Origin
Authors: Pearson Bruce W. , Unni Krishnan K. , Sizemore Glen W. , Norman Stanley G.
Published: April 2016

A healthy 27‐year‐old man with a lump in the lateral midneck was examined. Results of a recent biopsy performed elsewhere indicated amelanotic melanoma. A careful search for a primary integumentary or upper respiratory site of origin, including appropriate roentgenograms and a thyroid scan, was negative.

At right radical neck dissection, the pathologic diagnosis was expanded to include anaplastic carcinoma. Subsequent examinations of the head and neck were negative. The neck and upper aerodigestive system were subjected to a full course of radiotherapy.

Pathologic study of this tumor was continued. Electron microscopy indicated the tumor was epithelial, possibly of glandular epithelial origin.

A tumor nodule reappeared in the right tracheoesophageal groove. Surgery was performed and the nodule was removed. The right thyroid lobe was removed also and submitted for histopathologic study. A solitary microscopic tumor focus, presumably anaplastic thyroid carcinoma, was found within the thyroid. Further pathologic studies were undertaken. Eventually, amyloid deposits were discovered, and a final diagnosis of cellular medullary thyroid carcinoma was established. Further studies of this patient and his family for multiple endocrine adenoma have been negative.
Synovial Chondromatosis of the Temporomandibular Joint
Authors: Fee Willard E. , Windhorst Peter , Wiggins Robert , Pang Louis
Published: April 2016

Synovial chondromatosis is an uncommon disease of cartilaginous transformation of synovial membrane with formation of loose bodies within the joint space. A case involving the temporomandibular joint (TMJ) is presented. In the TMJ, this disorder occurs more often in females and is usually on the right side. Symptoms include preauricular swelling, pain, and tenderness. Radiographs of the TMJ may be normal, but frequently show multiple, partially calcified loose bodies within the joint. Treatment consists of removal of the loose bodies together with all affected synovium. If the meniscus is excised, reconstruction with a Silastic prosthesis is recommended.
Synergistic Effect of Alcohol on Epidermoid Carcinogenesis in the Larynx
Authors: Stevens Michael H.
Published: April 2016

Forty hamsters received weekly installations of benzopyrene into the larynx. Twenty of these also had 10% alcohol as their total liquid intake. Carcinoma of the larynx was seen in seven alcoholic vs two nonalcoholic hamsters, supporting the evidence in humans that alcohol is a factor in epidermoid carcinogenesis of the larynx.
Electron Microscopic Findings in Presbycusic Degeneration of the Basal Turn of the Human Cochlea
Authors: Nadol Joseph B.
Published: April 2016

Three human temporal bones with presbycusis affecting the basal turn of the cochlea were studied by light and electron microscopy. Conditions in two ears examined by light microscopy were typical of primary neural degeneration, with a descending audiometric pattern, loss of cochlear neurons in the basal turn, and preservation of the organ of Corti. Ultrastructural analysis revealed normal hair cells and marked degenerative changes of the remaining neural fibers, especially in the basal turn. These changes included a decrease in the number of synapses at the base of hair cells, accumulation of cellular debris in the spiral bundles, abnormalities of the dendritic fibers and their sheaths in the osseous spiral lamina, and degenerative changes in the spiral ganglion cells and axons. These changes were interpreted as an intermediate stage of degeneration prior to total loss of nerve fibers and ganglion cells as visualized by light microscopy.

In the third ear the changes observed were typical of primary degeneration of hair and supporting cells in the basal turn with secondary neural degeneration. Additional observations at an ultrastructural level included maintenance of the tight junctions of the scala media despite loss of both hair and supporting cells, suggesting a capacity for cellular “healing” in the inner ear. Degenerative changes were found in the remaining neural fibers in the osseous spiral lamina. In addition, there was marked thickening of the basilar membrane in the basal turn, which consisted of an increased number of fibrils and an accumulation of amorphous osmiophilic material in the basilar membrane. This finding supports the concept that mechanical alterations may occur in presbycusis of the basal turn.
Antigenicity of the Guinea Pig's Tympanic Membrane
Authors: Poliquin Jaques F. , Catanzaro Antonio , Robb James , Ryan Allen , Schiff Maurice
Published: April 2016

The immunogenicity of the middle ear constituents is a matter of prime importance. In this work, the authors were interested in the antigenicity of the guinea pig's tympanic membrane. They reached the conclusion, after developing an antiserum (IgG), that the tympanic membrane of the guinea pig can be antigenic in the rabbit. After purification and absorption, a cross‐reactivity remains between the tympanic membrane and the mucosae of the upper respiratory system.
Hearing Aid Performance Relative to Site of Lesion
Authors: McCandless Geary A. , Parkin James L.
Published: April 2016

This study investigated hearing aid acceptance and use as functions of the probable site of a lesion: conductive, cochlear, neural, and central as determined by an audiometric test battery. Results indicate significantly better acceptance of aids in conductive and cochlear disorders than in more central neural and central disorders.
Evidence for Intracochlear Impedance Changes Following Ethacrynic Acid Administration
Authors: Himelfarb Mordechai , Kroin Jeffrey , Strelioff David
Published: April 2016

The effects of intra‐arterial 30‐, 40‐, and 50‐mg/kg doses of ethacrynic acid upon cochlear function in guinea pigs were studied for periods of three to five hours. Cochlear potentials recorded in the first turn included the endocochlear potential, whole nerve response, cochlear microphonics, and summating potentials in scala media, scala tympani, and scala vestibuli. Evidence of organ of Corti damage at 50 mg/kg was found in addition to electrical impedance changes in the cochlear membranes at all dose levels.
Perilymph Fistulae: Variability of Symptoms and Results of Surgery
Authors: Thompson James N. , Kohut Robert I.
Published: April 2016

A perilymphatic fistula of a labyrinthine window may initially present with various cochlear or vestibular symptoms. Vestibular perilymph leaks can occur spontaneously with or without hearing loss and are most readily diagnosed by a positive Hennebert's sign. Surgical correction is indicated and should initially consist of grafting of the perilymph leak. A significant incidence of recurrence warrants further investigation of grafting materials and techniques.
Virtual Image of the Incus from a Saline Lens: An Aid to Safe Dissection of the Mastoid Antrum
Authors: Karlan Marc S. , Enoch Jay M.
Published: April 2016

Dissection of the antrum requires judicious visualization of the tegmen, horizontal canal, incus, and facial nerve. Inadvertent contact with the incus by the power drill may cause significant acoustic trauma. An effective “early warning device” accurately predicting exposure of the incus may be constructed with the saline irrigation fluid. The formation of the meniscus at the antrum permits visualization of the image of the incus around the corner of the bony canal wall overhang. A thin‐lens model of this phenomenon has been created for first‐order analysis of the optics, and it provides useful criteria for using this image. Image minification, displacement, and distortion were analyzed. A more complex model was then created to assess the impact of changing meniscus shape. The latter helped in understanding an added “swinging‐door effect” noted as the meniscus was altered. The model predicted accurately the phenomena as observed in the temporal bone preparation. Illustrative examples of the optics and photographic demonstrations of the phenomena are presented.
A Review of the Use of Avitene in Otolaryngologic Surgery
Authors: Johnson Leland P.
Published: April 2016

Chairman's Comments: Control of hemorrhage is a problem familiar to all otolaryngologists, whether the bleeding occurs post‐tonsillectomy, from spontaneous epistaxis, or from major head and neck surgery. Operating room aids in obtaining hemostasis include pressure, hot packs (to accelerate the coagulation process), ligatures, hot cautery, electrocoagulation, and a variety of pharmaceutical products. This latter group is reviewed by Leland P. Johnson, MD, from the Division of Otolaryngology at the University of Utah, particularly microfibrillar collagen hemostat (Avitene). Dr Johnson brings the uses and abuses of this expensive but often invaluable material into sharp focus. This information is prepared under the sponsorship of the Committee on Drugs—Otolaryngology of the American Academy of Otolaryngology.

George A. Gates, MD
Dysphagia in Laryngectomized Patients
Authors: Jung Timothy T. K. , Adams George L.
Published: April 2016

Records of 226 laryngectomies performed at the University of Minnesota Hospitals and Minneapolis Veterans Administration Hospital from 1967 to 1976 were surveyed, yielding 36 patients with significant dysphagia. The majority of these patients were treated with combined therapy of preoperative radiation followed by surgical intervention. They were evaluated by esophagographic and endoscopic examinations. Among this group of patients, 16 had a benign pharyngeal stricture, 14 had recurrent tumor, two had lower esophageal stricture, and four had malignant esophageal carcinoma.

Early detection of recurrent tumor is often difficult in a firm, woody radiated neck. Dysphagia may be the first sign of recurrence preceding obvious detectable recurrent tumors by several months. A barium swallow may show signs of early recurrence that may not be detectable by endoscopic examination. The radiographic evidence of recurrent tumor is described.
A First Branchial Cleft Anomaly Within the Parotid Gland
Authors: Koltai Peter J. , Winkelmann Paul E.
Published: April 2016

Although the parotid glands are affected more frequently by cysts and congenital lesions than other salivary glands, the benign multigerminal cyst arising from a duplication anomaly of the first branchial cleft within the parotid gland is extremely rare. Forty‐two cases of this unusual cause of parotid swelling have been reported in the literature. An example of a first branchial cleft anomaly appearing clinically as a parotid tumor is reported.
Alaryngeal Speech and Development of an Internal Tracheopharyngeal Fistula
Authors: Woods Robert D. , Pearson Bruce W.
Published: April 2016

Excellent speech can be produced by diverting expired pulmonary air to the pharynx through a tracheopharyngeal fistula. This study contributes basic information regarding the selection and fate of autogenous skin‐lined tubes created for this purpose in a standardized fashion in pigs. Our specific objectives were to determine (1) the best cutaneous autograft for constructing a 6‐ to 7‐cm skin‐lined tube, (2) the airflow resistance of surviving skin‐lined tubes, and (3) the effect of salivary contamination on the survival of tube grafts.
Endolaryngeal Neurofibromas
Authors: Supance John S. , Quenelle David J. , Crissman John
Published: April 2016

A neurofibroma in the larynx is quite unusual and is more likely to appear as a solitary, isolated lesion rather than a concomitant finding in von Recklinghausen's disease. A case is presented of a patient with residual endolaryngeal neurofibroma despite eight attempts at removal. The importance of complete extirpation during the initial operative procedure using frozen sections to guarantee clear surgical margins is advocated.
NASAL Manifestations of Allergic Granulomatosis and Angiitis (Churg‐Strauss Syndrome)
Authors: Olsen Kerry D. , Neel H. Bryan , Deremee Richard A. , Weiland Louis H.
Published: April 2016

The tetrad of bronchial asthma, nasal disease, eosinophilia, and systemic vasculitis is the main feature of allergic granulomatosis and angiitis. Twenty‐two of 32 patients (69%) with this disorder had nasal manifestations, including nasal polyps, thick crusts, rhinitis, sinusitis, and occasionally septal perforations. Histopathologic study of involved tissue from the nose or subcutaneous nodules in conjunction with clinical evaluation will aid in establishing the correct diagnosis. Treatment with corticosteroids favorably influences symptoms and prognosis.
Pemphigus Vulgaris, An Overlooked Disease in Young Adults
Authors: Ossoff Robert H. , Epstein Paul D. , Wollf Allan P. , Guinta John L.
Published: April 2016

Two cases of pemphigus vulgaris occurring in young men, aged 24 and 29, are presented. Prior to referral, each patient had persistent oral vesiculobullous and ulcerative mucous membrane lesions for at least six months and was treated with multiple courses of antibiotics and mouthwashes. On initial examination, both patients had the characteristic oral vesiculobullous lesions of pemphigus. A biopsy specimen of an intact vesicle confirmed the diagnosis.
The Vomeronasal Organ of Jacobson in the Human Embryo and Fetus
Authors: Kreutzer Erik W. , Jafek Bruce W.
Published: April 2016

The early morphogenesis of the vomeronasal organ of Jacobson is documented in the human embryo and early fetus using light and electron micrographs. Differences between its structure and that of the olfactory epithelium are discussed.
Malignant Fibrous Xanthoma of The Lip
Authors: Brandenburg James H. , Frank Terrence W.
Published: April 2016

Malignant fibroxanthoma is a most unusual tumor, especially when arising in the head and neck region. A patient with such a tumor arising in the lower lip is presented. This case was characterized by local recurrences, as well as regional and distant metastases. The differentiation between atypical fibroxanthoma and malignant fibroxanthoma is discussed.
Meniere's Disease: Treatment with the Endolymphatic Subarachnoid Shunt, a Review of 125 Cases
Authors: Brackmann Derald E. , Anderson Robert G.
Published: April 2016

A critical review of the results of treatment of 125 patients with Meniere's disease by the endolymphatic subarachnoid shunt is presented. Of the patients, 61% experienced improvement in vertigo. Hearing stabilized or improved in the majority of cases.

Detailed analysis of preoperative factors did not enable prediction of the likelihood of success in an individual case. The controversy regarding surgical therapy of Meniere's disease is discussed, and the conclusion that there is a role for endolymphatic sac surgery in the treatment of Meniere's disease is presented.
Corticosteroids in the Management of Laryngotracheobronchitis
Authors: Hawkins Donald B.
Published: April 2016

Chairman's Comments: A growing body of clinical evidence obtained in a scientific manner is supporting the efficacy of corticosteroids for initial treatment of viral croup. Donald B. Hawkins, MD, a member of the Committee on Drugs—Otolaryngology and a faculty member of the Department of Otolaryngology at the University of Southern California, review the results of these studies in a scholarly manner.

Dr Hawkins traces the development of the clinical experience with corticosteroids and clearly points out the differences between controls and treated patients in the respective studies. The Committee urges readers to review the articles and discuss the conclusions with their pediatric colleagues. The increased margin of safety afforded by the administration of corticosteroids to patients with laryngotracheobronchitis should be of interest to all physicians concerned with lowering the risk of airway obstruction in this common clinical disorder.

George A. Gates, MD
Microvascular Anastomosis: A Scanning Electron Microscopic Study
Authors: Mattox Douglas E.
Published: April 2016

The single most important factor determining the patency of a microvascular anastomosis is the surgical precision with which it is performed. Inaccurately placed sutures, damage of the intima, exposed media and adventitia, and stenosis of the lumen at the site anastomosis all contribute to decreased patency rates. The first 50 consecutive microvascular anastomoses performed by a single microvascular surgeon were analyzed in vivo and with the scanning electron microscope. The frequency and significance of various technical errors are discussed. Scanning electron microscopy is recommended as a convenient and quick technique for assessing the evenness and accuracy of intimal apposition in microvascular anastomosis.
Blunt and Penetrating Laryngeal Trauma: A 13‐Year Review
Authors: Trone Timothy H. , Schaefer Steven D. , Carder Henry M.
Published: April 2016

A 13‐year retrospective review of 53 patients with laryngeal trauma seen between 1965 and 1978 at the University of Texas Health Science Center at Dallas affiliated hospitals is presented. Patient management fell into four groups: observation following direct laryngoscopic examination or observation alone (7 patients), direct laryngoscopic examination and tracheostomy (5 patients), open reduction of fractures without stenting (14 patients), and open reduction of fractures with stenting (27 patients). These cases were analyzed according to initial signs and symptoms, duration between time of injury and surgery as pertains to success of management, indications for open reduction of laryngeal fractures, and associated injuries.
Contact Ulcers and Granulomas of the Larynx: New Insights into Their Etiology as a Basis for More Rational Treatment
Authors: Ward Paul H. , Zwitman Daniel , Hanson David , Berci George
Published: April 2016

Repeated analysis of cinephotographic and cinefluorographic studies, correlated with clinical observations, has helped elucidate the causes of contact ulcers. Habitual throat clearing, excessive glottic attack in initiation of speech, and, most important, acid regurgitation secondary to hiatal hernia are the causal factors of contact ulcers. Contact granulomas produced by intubation trauma and other granulomas are compared and discussed. The successful treatment of contact ulcers and granulomas is dependent on elimination of vocal abuse, cessation of throat clearing, and control of the factors that cause the irritation and throat clearing.
Treatment of Chronic Otitis Externa with Trichophyton, Oidiomycetes, Epidermophyton Antigen
Authors: Becker Gary D.
Published: April 2016

Chronic otitis externa may be a sensitivity (dermatophyte) reaction from a distant pathogenic superficial fungal infection, eg, tinea pedis and monilial vaginitis, which are often difficult to eradicate. Skin testing is done with a combined antigenic extract of TOE (Trichophyton; Oidiomycetes, ie, Monilia or Candida albicans; and Epidermophyton). The serial dilution titration method of skin testing is done, and the end point of reaction is determined. Treatment is begun on a weekly basis, with subcutaneous administration of 0.3 cc of a TOE extract two dilutions weaker than the end point Symptomatic improvement is usually noted within two to four weeks, with objective improvement within eight weeks. After a variable maintenance period, the injections are spaced at less frequent intervals.
Pediatric Infectious Cervical Lymphadenitis
Authors: Lane Richard J. , Keane William M. , Potsic William P.
Published: April 2016

Infectious cervical lymphadenitis is a frequently encountered problem in the pediatric population. The recent experience with infectious cervical lymphadenitis at the Children's Hospital of Philadelphia was reviewed. The most common etiologic agent was Staphylococcus aureus. ß‐Hemolytic streptococcus and mycobacterium were found in 15% and 6% of cases respectively. Other agents included pneumococcus, cat scratch, Toxoplasma gondii, actinomycosis, and mixed bacteroides and peptostreptococcus. Most patients responded to high‐dose intravenous antistaphylococcal penicillin. Needle aspiration proved successful in identifying the causal agent in a high percentage of cases. Aspiration was also beneficial in draining small abscess cavities. Surgical drainage was rarely necessary.
Follicular Lymphoid Hyperplasia of the Hard Palate Simulating Lymphoma
Authors: Harsany David L. , Ross Jon , Fee Willard E.
Published: April 2016

Follicular lymphoid hyperplasia of the hard palate is a slowly growing, soft, nontender swelling that may grow to involve the entire hard palate. The overlying mucosa is normal. This appearance naturally prompts biopsy, and both clinically and microscopically might be confused with lymphoma. Four case histories are presented with histologic description: normal palatal submucosal structures are replaced with benign reactive lymphoid tissue replete with well‐developed germinal centers. Surrounding these centers are dense populations of small, regular, bland lymphocytes. Minor salivary glands, except for some atrophied residue, are notably absent; also absent are the epimyoepithelial islands characteristic of the benign lymphoepithelial lesion (Mikulicz's disease). Etiologic factors remain obscure. One of our patients had two recurrences following local excision; in another patient nodules of benign lymphoid hyperplasia developed in the cheek and upper neck. These four patients are alive and free of any malignant process 4, 7, 9, and 12 years after the onset of their palatal swellings. We urge caution in distinguishing these lesions from palatal lymphoma, and recommend local excision as the treatment of choice.
Reconstructive Versatility of the Pectoralis Major Myocutaneous Flap
Authors: Strelzow Victor V. , Finseth Frederick , Fee Willard E.
Published: April 2016

The pectoralis major myocutaneous flap is presented in its two basic forms: a muscle flap carrying a skin paddle and the continuous skin‐muscle flap technique. The pertinent anatomy of the enveloping fascial planes is reviewed, stressing the increased latitude of safety afforded by elevating the vascular pedicle from the undersurface of the lateral muscle edge. The advantages of a deltopectoral flap outline in approaching the formation of the skin‐muscle paddle are introduced. Clinical applications, advantages, and disadvantages are discussed.
Immunologic Reactivity in Patients with Nasopharyngeal Carcinoma
Authors: Hsu Mow‐Ming , Wang Kuo‐Rong , Lynn Tsong‐Chou , Hsieh Ti , Huang Shu‐Chen , Tu Shin‐Mien
Published: April 2016

Immunologic reactivity was measured in 344 patients with nasopharyngeal carcinoma (NPC), before treatment, and in 398 age‐matched control subjects. The data recorded suggest that depressed cell‐mediated immunity in patients with NPC is a consequence rather than a cause of the disease. In order to reduce tumor burden in patients with NPC, radiation therapy with chemotherapy or immunopotentiation or both is recommended.
Cervical Mediastinal Thymic Parathyroid Cyst
Authors: Silver William E.
Published: April 2016

A case is presented to illustrate the actual location of cervical thymic cysts and to reconfirm their derivation, to review the embryology, and to identify this lesion as a possible differential diagnosis of neck cysts.
Acute Superior Laryngeal Nerve Palsy: Analysis of 78 Cases
Authors: Adour Kedar K. , Schneider Glenn D. , Hilsinger Raymond L.
Published: April 2016

Acute superior laryngeal palsy is often clinically unrecognized and frequently overlooked. Yet, this motor paralysis occurs more frequently than facial paralysis. Like acute facial paralysis, superior laryngeal palsy often occurs as part of a cranial polyneuritis that is probably related to herpes simplex virus reactivation. Rotation of the larynx and shortening of one vocal cord have been found in such diverse syndromes as vestibular neuronitis, migraine and tension headaches, unexplained cough, tinnitus aurium, globus hystericus, and carotidynia. Electromyographic studies suggest that laryngeal spasm may be caused by faulty regeneration of the superior, rather than the recurrent, laryngeal nerve.
Intralabyrinthine Acoustic Neurinomas
Authors: Babin Richard W. , Harker Lee A.
Published: April 2016

Two temporal bones are presented that contain acoustic neurinomas unsuspected during life and anatomically limited to the perilymphatic labyrinth. One tumor occupies the modiolus and scala tympani of the cochlea without involving the internal auditory canal. The other tumor originates in the fibers below the utricular macula and spares both the macula and the lamina cribrosa. Neither case demonstrates bone destruction. Even if these tumors had been suspected during life, tomograms would have been normal and the posterior fossa myelogram would have shown complete filling of the internal auditory canal.
Rare Tumors of the Cerebellopontine Angle
Authors: Brackmann Derald E. , Bartels Loren J.
Published: April 2016

In a series of 1,354 cerebellopontine angle tumors treated at the Otologic Medical Croup, approximately 10% were lesions other than acoustic neurinomas. Of the non‐acoustic tumors, the majority were meningiomas, primary cholesteatomas, and neurinomas of other cranial nerves in the posterior fossa. Twenty‐five other lesions were encountered; these rare tumors are the subject of this study.

The benign tumors resemble acoustic neurinomas in appearance and in the method of treatment. Malignant tumors are characterized by rapid development of symptoms and are difficult to treat because of invasion of vital structures in the area.
Generators of the Frequency‐following Response in the Guinea Pig
Authors: Yamada Osamu , Marsh Roger R. , Potsic William P.
Published: April 2016

Generators of the frequency‐following response (FFR) were assessed in 13 guinea pigs by cooling of the whole body and by experimental lesions of the brain stem. In the temperature study, the amplitude‐temperature function of the FFR contained a significant cubic component that was absent from that of the cochlear microphonic potential (CM) recorded from the round window. The phase shift of the FFR increased with decreasing body temperature. In experimental lesions of the brain stem, a significant phase shift of the FFR was obtained following contralateral postcollicular section. The FFR amplitude with transection of the auditory nerve was similar to that found before surgical sections of the brain stem. The duration of the FFR after the transection corresponded precisely to that of the round window CM. These results indicate that the origin of the FFR contains both nonneural (ie, cochlea) and neural (ie, involving the inferior colliculus) generators.
Acute Epiglottitis in Children
Authors: Briggs William H. , Altenau Mark M.
Published: April 2016

Hemophilus influenzae type B (30 cases), untyped (two cases), and type A (one case), and H parainfluenzae (one case) were recovered in blood cultures from 44 cultures of 53 children with acute epiglottitis. These patients were managed by observation, tracheotomy, or intubation, with intubation being the most satisfactory. Both ampicillin and chloramphenicol have been employed recently because of the emergence of ampicillin resistance, which was 18.7% of all cases in 1977.
Nutritional Assessment of the Head and Neck Cancer Patient
Authors: Lambert Matthew J.
Published: April 2016

Malnutrition is a common problem in patients with head and neck cancer. Its presence may lead to an increase in morbidity and mortality following an operation, chemotherapy, and radiation therapy.

A standard nutritional assessment will define the nature and degree of the nutritional deficiency while periodic reassessment will document the effects of nutritional support.
Whole Cell Preparation of Squamous Cell Carcinoma for Cytometric Analysis of DNA
Authors: Lampe Howard , Lapointe Henry , Cramer Harvey , Banerjee Diponkar
Published: April 2016

To date, analysis of the DNA content of head and neck squamous cell carcinomas has relied on the homogenation of the entire tissue specimen and subsequent staining and quantitation of the naked nuclei. This methodology does not make allowance for the extremely variable nature of these tumors with respect to their cellular composition. Further, by destroying the cytoplasm and cell membranes, this methodology makes it impossible to distinguish the DNA content of the tumor cells from that of the background stromal and inflammatory cells. The authors present a methodology for the selective exclusion of inflammatory cell infiltrates from the DNA analysis of these tumors. Using this technique, it has been found that exclusion of the inflammatory cells allows the investigator to look more specifically at the malignant cell population. This has been most helpful in those samples in which the tumor cells have been diploid or near‐diploid. With this technical refinement, the relationship between DNA ploidy and clinical prognosis may be more acurately asessed.
Preoperative Hemostatic Assessment of the Adenotonsillectomy Patient
Authors: Bolger William E. , Parsons David S. , Potempa Lynne
Published: April 2016

Intraoperative or postoperative hemorrhage in the patient who has undergone an adenotonsillectomy because of an unrecognized hemostatic defect may increase morbidity and can be potentially life‐threatening to the patient in what should be a “routine” procedure. Preoperative identification of occult hemostatic abnormalities, coupled with perioperative management directed at correcting the effects of the defects, should serve to reduce the incidence of this distressful complication. Routine use of preoperative laboratory screening tests for this purpose has been discouraged recently as a result of concerns over cost‐effectiveness and the low predictiveness of the tests for bleeding. Our experience with the routine use of a comprehensive hemostatic laboratory screening panel—which includes a bleeding time test—in the adenotonsillectomy patient population demonstrated that 11.5% of our patients had abnormal initial screening laboratory tests; these results were ultimately attributable to occult hemostatic defects. Clinical history, the universally recommended method of preoperative hemostatic assessment, failed to detect any previously unrecognized coagulation disorder. Laboratory screening improved preoperative detection of occult hemostatic defects and allowed for appropriate alterations in perioperative care. Our results with this approach are presented, along with illustrative case histories and a discussion of the current recommendations for preoperative laboratory screening of the hemostatic system, as found in a review of the literature.
The Incisor Absent Rat: An Animal Model for the Study of Otosclerosis
Authors: Kaniff Thomas E. , Schneider Gary , Matz Gregory J.
Published: April 2016

The incisor absent (ia) rat is introduced as an animal model for the study of otosclerosis. Previous animal models have failed to accurately reflect the dynamic nature of this disease. Auditory brainstem response testing suggested a conductive hearing loss in the incisor absent rat as compared to age‐matched normal controls. The hearing loss, which was manifested during puberty, was progressive in nature up to 18 weeks of age. Microscopic dissection of the middle ear revealed bony abnormalities of the ossicles and oval window in the incisor absent rat. Scanning electron microscopy of the ossicles demonstrated bony lesions at the incudostapedial Joint and stapes footplate. Histologic examination demonstrated thickened spongiotic bone involving the otic capsule and ossicles. The incisor absent rat model possesses an inheritable defect of the otic capsule and ossicles that results in a progressive conductive hearing loss. The genetically transmitted lesion appears histologically similar to otospongiosis. The bony pathology in the incisor absent rat is caused by defective osteoclasts and transplantation of bone marrow cells from normal rats to the incisor absent rats corrects the cellular abnormality. The incisor absent rat may represent the best animal model to date for the study of otosclerosis, its cause, and clinical treatment.
Bilateral Spontaneous Perilymph Fistulae: A Diagnostic and Management Dilemma
Authors: Sismanis Aristides , Hughes Gordon B. , Butts Frank
Published: April 2016

In this article, we present a case of bilateral perilymph fistulae. This entity is rare and always presents a diagnostic problem. Bilateral perilymph fistulae are more common in children and should be suspected when bilateral ear symptoms and congenital temporal bone radiographic anomalies are present. Previous trauma or barotrauma may be absent. When a patient manifests bilateral ear symptoms and a fistula has been identified and repaired in one ear, a second fistula should be suspected in the contralateral ear, especially if the fistula test is positive.
Inverted Papillomas and Associated Squamous Cell Carcinomas
Authors: Benninger Michael S. , Roberts Jay K. , Sebek Bruce A. , Levine Howard L. , Tucker Harvey M. , Lavertu Pierre
Published: April 2016

Inverted papillomas of the nose and paranasal sinuses are found to be associated with squamous cell carcinomas in a small percentage of cases. The records of forty‐six patients treated for inverted papillomas in these areas over a 10‐year period were reviewed. Eleven patients (24%) were found to have squamous cell carcinoma, and one carcinoma in situ, in relationship to the inverted papillomas. This is a much higher percentage than generally reported. Four of these patients were found to have inverted papillomas coincidentally in surgical specimens resected for squamous cell carcinoma. Patients with squamous cell carcinoma were found to be in older age groups, were more likely to manifest epistaxis than the more common unilateral nasal obstructive symptoms, and had less time between the onset of symptoms and presentation than those with inverted papillomas alone. The clinical presentation, treatment, and outcome of inverted papillomas and squamous cell carcinomas in association with inverted papillomas are discussed.
KTP laser stapedotomy: Is it safe?
Authors: Bartels Loren J.
Published: April 2016

Recent published concerns about the potential for visible light lasers to injure the inner ear have led to differing conclusions. While one has advised cautious application of a visible light laser, another eschewed visible light lasers in favor of the CO2 laser. Others have anguished over the efficacy of stapes surgeons as numbers of suitable candidates for otosclerosis surgery decline. In three years' experience with the KTP‐532 laser, 80 primary and revision stapedotomies have been completed by this author. The author's experience with low morbidity and high air‐bone gap closure rates are presented. The absence of apparent cochlear injury suggests that properly used KTP laser systems are safe. Competitive results were obtained with less than prolific numbers of stapes surgeries.
Expansion of the infant subglottis by external cricoid distraction: An animal model
Authors: Berkowitz Robert G. , Zalzal George H. , Chandra Roma
Published: April 2016

A technique is described to expand the subglottis by anterior cricoid split (ACS) combined with external cricoid distraction (ECD) using a posterior belly of digastric muscle sling. This technique was used on 5‐week‐old rats that were killed 6 weeks after surgery, and the larynges were examined histologically and compared with those of rats who underwent ACS alone. Information was available from ten animals in the ECD group and five in the ACS alone group. Separation of the cut ends of the cricoid was found to be maintained in all animals after ECD, the gap having been filled by fibrous tissue lined by respiratory epithelium. A lesser degree of cricoid separation was seen in the animals that underwent ACS alone.
Quantitative histochemical studies on the cat infrahyoid muscles
Authors: Hisa Yasuo , Malmgren Leslie T. , Lyon Michael J.
Published: April 2016

The intrinsic laryngeal muscles have been reported to be composed of muscle fibers that have unusual physiologic, morphologic, and biochemical characteristics, and it has been suggested that the relatively unique differentiation of these muscle fibers is the result of their specific activity patterns. Because the infrahyoid muscles are recruited for some of the same laryngeal functions, it was of interest to determine if they also included unusual fiber types. In order to examine this possibility, microdensitometry was carried out on type I, type IIA, and type IIB fibers in the cat sternohyoid, sternothyroid, and thyrohyoid muscles using histochemical techniques for a variety of enzymatic markers of oxidative and glycolytic capacity and for fiber size. It was found that the infrahyoid muscles were composed of muscle fibers having enzyme profiles generally similar to those of fiber types in the limb muscles.
Patient‐controlled analgesia (PCA) in head and neck surgery
Authors: Cannon C. Ron
Published: April 2016

Patients undergoing head and neck surgery often have significant pain because of the anatomic area involved, the nature of the surgery and trauma associated with the anesthesia and surgery, or the use of packing postoperatively. A patient‐controlled analgesia (PCA) infuser is available that allows the patient to direct delivery of their own analgesia. The physician orders the narcotic analgesic dose to be given, the interval between doses, and the total amount of analgesic to be delivered over 4 hours. The patient simply presses a button connected to the analgesic infuser, which delivers a predetermined intravenous dose of the particular analgesic. The infuser is then “locked out” for an interval of 10 to 15 minutes before the patient can direct another dose of medicine. This system allows the patients to initiate intravenous delivery of their narcotic analgesic, and maintain control of pain, using small incremental doses of the analgesic agent. This PCA pump has been used successfully in a number of patients undergoing various general, head and neck, and facial aesthetic procedures. The general concept of the PCA pump, guidelines for use, and contraindications are presented.
Maxillary sinus hypoplasia: Classification and description of associated uncinate process hypoplasia
Authors: Bolger William E. , Woodruff William W. , Morehead John , Parsons David S.
Published: April 2016

Maxillary sinus hypoplasia is an anomaly of the paranasal sinuses occasionally encountered by otolaryngologists. Although this entity has been previously reported, an association between maxillary sinus hypoplasia and anomalies of other paranasal sinus structures, such as the uncinate process, has not yet been described. Additionally, the literature lacks a system by which the various types of maxillary sinus hypoplasia can be classified using computerized tomographic (CT) imaging. Two hundred and two consecutive coronal sinus computerized tomographic scans from patients undergoing evaluation at our institution were analyzed to determine the prevalence of MSH and associated paranasal sinus anomalies. The overall prevalence of maxillary sinus hypoplasia was 10.4%. Three distinct patterns of hypoplasia were evident. Type I, characterized by a normal uncinate process, a well‐defined infundibular passage, and mild sinus hypoplasia, occurred in 14 patients (6.9%). Type II, characterized by absence or hypoplasia of the uncinate process, an ill‐defined infundibular passage, and soft‐tissue density opacification of a significantly hypoplastic sinus occurred in 6 patients (3.0%). Type III, characterized by absence of the uncinate process and a profoundly hypoplastic, cleft‐like sinus, occurred in 1 patient (0.5%). Recognition of associated anomalies of the uncinate process in patients with maxillary sinus hypoplasia undergoing sinus surgery is of utmost clinical significance because the uncinate process serves as a key landmark during functional endoscopic sinus surgery. Failure to recognize hypoplasia or absence of the uncinate process could lead to inadvertent intraoperative damage to the adjacent medial orbital wall.