bluuebunny/crossref_metadata_2025 huggingface dataset:
Craniofacial dysjunction: Otolaryngological point of view
Authors: Spector Gershon J. , Alonso William A. , Berkowitz Wallace P.
Published: September 2006

Since Le Forte's experiments in the 19th Century, craniofacial dysjunction (Le Forte III fracture) has been recognized as a serious facial injury. A multidisciplinary approach to the management of these patients is often required by concurrent injuries to the eye, brain, chest, abdomen and extremities. The otolaryngologist is particularly equipped to deal with the problems of hemorrhage and upper airway distress, as well as with the functional and cosmetic repair these injuries require. This paper reports the management of craniofacial dysjunction in 26 patients during a three‐year period. Facial damage in the majority of cases was more extensive than that originally described and classified by Le Forte as Type III. Most cases resulted from automobile collisions. Males in the third decade of life predominated. Four patients died before care could be instituted. All patients had severe epistaxis, midfacial flattening and malocclusion, and six required emergency tracheostomy. Marked comminution of the nasal bones and septum was present in all. Fractures of the maxillary sinus were common and 16 of 22 survivors sustained nasofrontal injury, with pseudohypertelorism noted in all. Abrasions and lacerations to the face occurred in 12. Frontal sinus fractures were present in 15 cases and mandibular fractures in six. Other findings included seven with skull fractures, eight with fractured teeth, three with lacrimal sac and duct tears, two with severe intraocular damage, six with CSF rhinorrhea and 15 with diplopia. Repair of the facial fractures was initiated within the first 10 days following injury. All patients required intermaxillary fixation of the dental arches. No instance of delayed malocclusion resulted. When feasible, internal cranial suspension was employed, but in three severely comminuted fractures, external traction utilizing a special head cap was necessary. Frontal sinus obliteration with fat by osteoplastic technique was necessary in 10 patients. Fifteen patients had orbital floor explorations. Delayed findings included epiphora in two cases, diplopia in one, pseudohypertelorism and a flattened nose in three; jagged facial scarring in one, and CSF rhinorrhea in one. Individual follow‐up periods varied from one year to three years. It is the management of these delayed findings during the long follow‐up period that this paper particularly emphasizes.
Evaluation of surgical techniques on nasal tip projection
Authors: Bortnick Eugene
Published: September 2006

One of the most distressing complications of rhinoplasty is the settling of the nasal tip leading to a fullness in the supratip area, the so‐called “polly‐beak” deformity.

An evaluation of the anatomical factors was carried out in the live patient and had two objectives in mind: to define the elements of nasal tip support and to evaluate some of the more popular surgical methods which are used to maintain or augment tip projection.

The three elements of tip support, commonly destroyed during rhinoplasty, are the relationship between the upper and lower lateral cartilages, the fibrous union of the tip cartilages with the septum, and the lowering of the nasal skeleton secondary to hump removal.

Since sacrifice of the superior margin of the alar cartilages is performed in most rhinoplasties, the fibrous overlapping relationship of the upper and lower cartilages is necessarily destroyed. Preservation of relationship of the mesial crural feet to the septum helps to maintain tip support without the necessity of cartilage struts and columellar sutures.

When a complete transfixion incision is employed, the most effective method to augment tip projection is by the division of the alar cartilages and the re‐approximation of the medial portions in the midline.
Homograft tympanic membrane in cats
Authors: Carder George A. , Cody D. Thane R. , Weiland Louis H.
Published: September 2006

A total of 91 cats were evaluated to determine the effectiveness and nature of closure of total tympanic membrane perforations with homografts preserved in buffered formaldehyde, 70 percent alcohol, benzalkonium in Tis‐U‐Sol (1:750 solution), or Cialit (1:5,000 aqueous solution). Controls consisted of unoperated ears, ears with partial and total perforations that were not grafted, ears in which the total tympanic membrane was removed and immediately replaced, and ears grafted with fresh homograft tympanic membranes.

The study revealed that the removal of the tympanic annulus was necessary to prevent spontaneous regrowth of a new tympanic membrane. The percentage of successful closures of tympanic membrane perforations according to the preservative was formaldehyde 50 percent, alcohol 50 percent, benzalkonium 45 percent, and Cialit 30 percent. The rate of successful closures with fresh autograft tympanic membranes was 40 percent and with fresh homografts 25 percent. The homografts preserved in formaldehyde or alcohol were more rigid and easier to handle than were those preserved in benzalkonium or Cialit.

The histologic findings were similar in ears that had developed a new tympanic membrane after grafting with preserved homograft tympanic membranes and in ears with fresh homografts or autografts. The graft served as an inert scaffold for the new tympanic membrane to grow across. Gelfoam used in the middle ear to support either a homograft or an autograft became incorporated into the new tympanic membrane and was associated with a foreign‐body reaction. There was, however, no evidence of an immunologic reaction to the homograft.
Malignant hyperthermia in the otolaryngologic patient
Authors: Pollock Richard A. , Turner John S.
Published: September 2006

Malignant hyperthermia is a pharmacogenetic disorder initiated by exposure to a variety of anesthetic agents. The reaction has assumed major importance to the otolaryngologic surgeon because: 1. approximately 20 percent of all reported reactions have occurred during anesthesia for ENT surgical procedures; 2. the disorder is being reported with increasing frequency; and 3. mortality associated with the reaction is greater than 60 percent. Susceptible patients appear to have a disorder of muscle, but because genetic penetrance and expression are limited, manifestations are often mild, and physical manifestations variably present. The authors suggest an approach leading to early detection of the susceptible patient.
Facial paralysis in fractures of the petrous bone
Authors: Fisch U.
Published: September 2006

Recording of the summation potential of the facial muscles with surface electrodes from a representative population of motor units after maximal stimulation of the facial nerve trunk (electroneuronography) has been found essential for selecting patients requiring surgery because of facial paralysis associated with a fracture of the petrous bone. The most common site of injury to the facial nerve in 10 transverse and 30 longitudinal fractures of the temporal bone has been found within the labyrinthine segment of the Fallopian canal. The problems encountered in the surgical repair of the facial nerve lesions are reviewed. In order to repair facial nerve injuries associated with fractures of the temporal bone the surgeon must be prepared to use the middle cranial fossa or the translabyrinthine approach in more than 90 percent of the cases.
Long‐standing facial paralysis rehabilitation
Authors: Conley John , Hamaker Ronald C. , Donnenfeld Hyman
Published: September 2006

A group of 32 patients with severe facial paralysis from 2 to 30 years and of different etiologies were studied. Various degrees of nerve and muscle atrophy were noted in this group. A new concept relative to the status of the paralyzed face, its nerve and muscle system and their capacity for rehabilitation was acquired.

The treatment of long‐standing paralysis has been relegated to fascial stripping, muscle slings, tarsorrhaphies and face‐lift operations. This investigation indicates that the situation is not totally irreversible. The determinant factors are the number of surviving axones and the viability of the facial muscles supplied by them. Regardless of the electrical testing, the facial nerve never totally disappears nor do the facial muscles. On surgical exploration, the facial nerve and the posterior belly of the digastric muscle were always recognizable in varying degrees of atrophy and fibrosis. A range of 20‐90 percent of normal size was noted.

Electron microscopy of the nerve and muscles demonstrated axone degeneration still taking place and muscle fibers present in cases 20‐30 years post injury to the nerve. The degree of atrophy and fibrosis was dependent upon the length of the paralysis. It was also noted that the degree of severity was less as the site of injury became more peripheral. This was probably related to the rich extratemporal nerve interconnections from the sympathetics, cervical plexus, and cranial nerves V and IX. These findings verified the existence of a subliminal system which is non‐functional, but in certain instances had the potential for rehabilitation.

Some of the most interesting aspects of facial rehabilitation in longstanding facial paralysis are beginning to unfold themselves in the recognized potential of a regrowth of axones in a depleted but not annihilated facial nerve system by nerve crossover and nerve grafting techniques. When the peripheral facial nerve system is absent, nerve implantation into the residual mimetic muscles or transposed masticatory muscles is indicated. The introduction of masticatory muscles into the face to accommodate this neural regrowth, when mimetic muscle potential remains subclinical, adds a new neuromuscular facility in the rehabilitation.
External approach to rhinoplasty
Authors: Goodman Wilfred S. , Charbonneau Paul A.
Published: September 2006

The technique of external rhinoplasty is outlined. Having reviewed 74 cases, its advantages and disadvantages are discussed. Reluctance to use this external approach seems to be based on emotional rather than radical grounds, for its seems to be the procedure of choice for many problems.
Feasibility of acupuncture as a treatment for sensori‐neural deafness in children
Authors: Rosen Samuel
Published: September 2006

Purpose of this study is to test the hypothesis that treatment by acupuncture can decrease the level of hearing loss in profoundly sensori‐neural deafness in children. Acupuncture treatments at sites recommended by Chinese colleagues were given five days per week for three weeks a month for six months. Thirty children received regular acupuncture, to a depth of 13 mm and 10 shallow acupucture, only 1–2 mm. Audiometric tests were performed weekly on each child at 8 points (125–8,000 Hz) plus SAT. At intervals bone conduction, SRT, and other audiometric tests were made. Treatments adhered closely to the recommendations of the Chinese colleagues; however, we set a six‐month pilot study rather than the extensive period (one to four years) which they follow.

Comparisons were made of the average level of hearing loss in the two groups at the beginning and at the end of the study at four key frequencies. Although there is a small improvement in seven of the eight averages, this does not represent any practical improvement in hearing. Detailed comparison for each of the 40 subjects fails to reveal any consistently maintained improvement.
Cell proliferation kinetics in tumors after treatments
Authors: Barendsen G. W.
Published: September 2006

Analysis of data on cell reproductive death, cell proliferation kinetics, tumor volume responses and tumor eradication probability after single and fractionated doses of radiation given to experimental tumors, can yield several conclusions which may be relevant for the interpretation of clinical data: 1. considerable differences are observed among various cell types with respect to intrinsic radiosensitivity, but no specific differences are demonstrated for cells from tumors as compared to cells from normal tissues; 2. cell survival curves measured by in vitro cloning techniques for cells irradiated in an experimental rat rhabdomyosarcoma are consistent with the observed probability of tumor eradication, and 3. after a sufficiently large dose of radiation and after two weeks of fractionated treatments, important changes in cell proliferation kinetics have been observed with respect to cell cycle, cell production rate and cell loss rate, which may significantly influence the time of recurrence as well as the probability of attaining tumor eradication.
Carcinogenesis of laryngeal carcinoma
Authors: Saffiotti Umberto , Kaufman David G.
Published: September 2006

Experimental models have been developed for the induction of carcinoma of the larynx and for the study of its pathogenesis. The hamster has been the animal of choice. Polynuclear hydrocarbons, administered intratra‐cheally, induce mostly squamous cell carcinomas. Diethylnitrosamine given systemically induces papillary tumors; some other N‐nitroso‐compounds given topically or systemically also induce laryngeal tumors, including carcinomas. Cigarette smoke inhalation induces preneoplastic and early neoplastic lesions of the larynx, including some invasive carcinomas. In vivo and in vitro methods have been developed for the morphological and biochemical study of target tissues in respiratory epithelial carcinogenesis to identify critical pathogenetic steps and their inhibition. These methods are now applicable to the in vitro study of human laryngeal epithelium and its susceptibility to cancer induction and prevention.
The enigma of post‐radiation edema and recurrent or residual carcinoma of the larynx
Authors: Ward Paul H. , Calcaterra Thomas C. , Kagan A. R.
Published: September 2006

Persistence of significant edema of the larynx beyond six months after completion of radiotherapy presents the lavyngologist with a diagnostic dilemma. Review of the results of 43 cases demonstrated a high incidence of residual or recurrent carcinoma. Based upon this experience earlier and frequent laryngeal biopsies are recommended for these cases.
Indirect laryngoscopy
Authors: Goldman Joseph L. , Roffman Jeffrey D.
Published: September 2006

Indirect laryngoscopy is one of the procedural methods used for achieving a histopathologic diagnosis of cancer of the larynx.

A chronologic historical summary of the development of mirror laryngoscopy is presented. The details of the procedure employed for obtaining a biopsy with the aid of topical anesthesia is discussed.
Ossiculotympanic transplantation
Authors: L. Smyth G. D. , Kerr A. G. , Pahor A. , Law K.
Published: September 2006

Continued investigations into current tympanoplasty problems have been carried out in the Eye and Ear Clinic, Royal Victoria Hospital, Belfast. Retrospective studies have been helpful in identifying some of the main problems responsible for many of our unsatisfactory results, both in the irradication of disease and the restoration of aural function. Prospective studies into the behavior of grafting materials for tympanic reconstruction in the experimental animal have led us to an overwhelming preference for natural materials as opposed to plastics or stainless steel. Both homologous and autologous bone and cartilage appear to offer good prospects in ossicular replacement techniques. The most satisfactory material we have used for repair of tympanic membrane defects continues to be either autologous or homologous temporalis fascia. The long‐term success of these materials in functional restoration is utterly dependent on continued aeration of the tubotympanic cleft.
Traumatic ophthalmoplegia: A complication of fractures of the zygomaticomaxillary complex. Review of etiology with report of an unusual case
Authors: Yee King F. , Cravens James , Kotler Robert
Published: September 2006

Ocular muscle imbalance is a common complication in fractures of the zygomaticomaxillary complex. Involvement can be direct; caused by entrapment of either the muscle or tendon in the fracture; or indirect, produced by central or peripheral damage to the cranial nerves supplying the muscles, massive orbital edema or hemorrhage. A case of complete paralysis of the extraocular muscles caused by a critical reduction of the size of the orbit as a result of fracture of the zygomaticomaxillary complex is described.
Voice following radiotherapy
Authors: Stoicheff Margaret L.
Published: September 2006

This study was undertaken to provide information on the voice of patients following radiotherapy for glottic cancer. Part I presents findings from questionnaires returned by 227 of 235 patients successfully irradiated for glottic cancer from 1960 through 1971. Part II presents preliminary findings on the speaking fundamental frequencies of 22 irradiated patients.

Normal to near‐normal voice was reported by 83 percent of the 227 patients; however, 80 percent did indicate persisting vocal difficulties such as fatiguing of voice with much usage, inability to sing, reduced loudness, hoarse voice quality and inability to shout. Amount of talking during treatments appeared to affect length of time for voice to recover following treatments in those cases where it took from nine to 26 weeks; also, with increasing years since treatment, patients rated their voices more favorably. Smoking habits following treatments improved significantly with only 27 percent smoking heavily as compared with 65 percent prior to radiation therapy. No correlation was found between smoking (during or after treatments) and vocal ratings or between smoking and length of time for voice to recover. There was no relationship found between reported vocal ratings and stage of the disease.

Data on mean speaking fundamental frequency seem to indicate a trend toward lower frequencies in irradiated patients as compared with normals. A trend was also noted in both irradiated and control groups for lower speaking fundamental frequencies in heavy smokers compared with non‐smokers or previous smokers. These trends would indicate some vocal cord thickening or edema in irradiated patients and in heavy smokers.

It is suggested that the study of irradiated patients' voices before, during and following treatments by means of audio, aerodynamic and acoustic instrumentation would yield additional information of diagnostic value on recovery of laryngeal function. It is also suggested that the voice pathologist could assist in evaluating and guiding patients in vocal usages during and following treatments.
Functional evaluation after partial resection in patients with carcinoma of the larynx
Authors: Padovan I. F. , Orešković M.
Published: September 2006

This paper presents the results of conservative operations on patients with laryngeal carcinoma in the ENT Department of the University Hospital “Dr. Mladen Stojanovic,” Zagreb, Yugoslavia, during the last 20 years. The authors have evaluated the functional results after partial vertical and horizontal surgical interventions on the larynx and after the reconstruction of the larynx following these operations. Functional analysis of the voice was performed by stroboscopic, indirect microlaryngostroboscopic and sonagraphic examinations of the laryngeal function, as well as by the spirometric analysis of the respiratory potential of these patients, especially the degree of obstruction of the upper respiratory tract and changes on the cardiovascular system. Attention has been given likewise to the examination of the act of swallowing, especially after horizontal partial resections of the larynx. Radiography and radiocinematography was used for these examinations. Based on this research the authors have formulated new conceptions and opinions about the voice generator.
Fiber‐optic video study of the post‐laryngectomized voice
Authors: Brewer David W. , Gould Leo V. , Casper Janina
Published: September 2006

Simultaneous video‐fluoroscopy and fiber‐optic video laryngoscopy was carried out on a series of eight laryngectomees. Previous concepts supported by an earlier report1 indicated that the folds of the rebuilt cricopharyngeal sphincter were seen to represent the primary source of sound vibration for voice production. Fold vibration was envisioned as an essential for sound production. Present findings present a challenge to the older concept.

The fluoroscopic studies showed a considerable variation in the vertical thickness of the sphincteric area — from several millimeters to as many as 10 centimeters. Mucus bubbles in rapid motion were easily visible immediately above the narrowest portion of the reconstructed cervical esophagus. Ingestion of barium only enhanced the visualization of this bubbling. Vibration of a long vertical area of the thin anterior and thicker posterior esophageal walls well above and well below this point was regularly noted.

Fiber‐optic visualization failed to show actual fold vibration at any time. Momentary opening of the food tract during air injection or intake, immediately prior to the onset of phonation, was seen on many occasions. During phonation, routinely, the anticipated pseudoglottic opening was obscured by bubbles of mucus or barium. These findings suggest that the air, when accumulated below the narrowest spot in the hypopharyngeal‐esophageal tract and when forced upward through a narrow opening, sets the accumulated mucus, not the mucous membrane, into vibration; further, that this vibration is of sufficient amplitude to transmit itself to both the anterior wall and the posterior wall of an extensive vertical portion of the neck.
Allergic secretory otitis media: An approach to management
Authors: Viscomi George J.
Published: September 2006

An allergic etiology should always be suspected in those children having recurrent secretory otitis media. These children often have a seasonal recurrence of middle ear effusion, a history of allergic disease in infancy or early childhood, and a family history of allergy. An approach to allergic management is presented. Inhalants are tested by the serial dilution titration technique and treated at optimum dose levels. Several food tests are used to detect offending foods. They are used in progressive fashion which utilized each technique to best advantage. Fifty allergic children with recurrent secretory otitis media, despite conventional surgical therapy, were treated for inhalant and food allergy for one year. There was a significant reduction in the recurrence of secretory otitis media and need for myringotomy.
Alcoholism in cancer of the head and neck
Authors: Lowry W. Sidney
Published: September 2006

One hundred patients with a diagnosis of head and neck cancer were investigated carefully for a history of alcoholism.

A majority of cases had a severe drinking problem; in fact, alcoholism was twice as common as initially anticipated. Patients were frequently able to hide the problem from their physician. Often the true diagnosis was obtained only by closely questioning relatives and friends.

Most patients with cancer of the tongue, tonsil and oro‐pharynx were alcoholic. About one‐half of the patients with supraglottic carcinoma were alcoholic. In the nasopharynx and true vocal cords, there was no association with heavy drinking.

The study is of epidemiological interest but also has implications in the management of the malignancy, depending upon the anatomic site involved.
Supraglottis carcinoma with extension to the arytenoid
Authors: Ogura Joseph H. , Sessions Donald G. , Ciralsky Robert H.
Published: September 2006

The analysis of supraglottic subtotal laryngectomy with removal of the entire arytenoid cartilage is presented in 59 patients. The survival rate in the patients was 75 percent for primary surgery.
Treatment of carcinoma of the base of the tongue and the larynx
Authors: Novack Alvin J.
Published: September 2006

Cancer of the base of the tongue and the larynx is usually treated primarily with irradiation to 6,000 rads. Persistence of tumor after irradiation is common and requires a logical, thoughtful approach designed to augment all tissues removed. Careful preoperative planning and the use of the lateral approach to the base of the tongue, in conjunction with pharyngostome and laryngostome formation allows wide resection of the cancer.

Preservation of the function of speech and swallowing, and preservation of the mandibular contour are important, and correlate closely with carotid artery protection.

Five different methods of approach to the problem are analyzed and presented.
Radical neck dissection
Authors: Conley John
Published: September 2006

Radical neck dissection has evolved into a standard surgical technique over the past century. It has been the most effective method of attempting to control suspected or gross metastasis to the cervical region. The technique embraces the en masse removal of all tissue elements in the space between the subdermis and the fascia colli. The perimeters of the dissection extend from the midline anteriorly to the anterior border of the trapezius muscle posteriorly, and from the clavicle to the mandible. The essential portion of this large mass of tissue is the cervical lymph system with its lymph nodes and afferent and efferent connecting vessels. Controllability of the cancer process is in direct proportion to the number of nodes involved, their size and their position in the neck. Complications in the routine radical neck dissection are minimal. Cure rates are influenced by the type, size and site of the primary cancer, the possibilities for adjunctive treatment such as radiotherapy and chemotherapy, and the, as yet, little understood immunological factors. The radical neck dissection has proven itself to be an essential tool in the management of cancer in the head and neck.
The problem of advanced supraglottic carcinoma
Authors: Siirala Urpo , Paavolainen Mikko
Published: September 2006

Sixty‐four cases of advanced supraglottic laryngeal carcinoma, and the possible therapeutic errors in these cases, have been analyzed. The available time for the investigation and treatment in these cases is short because of the ease and rapidity of spread of these tumors; thus, it is of great importance: that the nature, site and extent of the tumor is determined quickly; that the patient's general condition is determined and improved as far as possible and the patient receives treatment also for other diseases he may have; and that the tumor is radically eliminated whenever possible without delay.

The main causes of poor results have been: late admission for treatment; inadequate (too conservative) surgery; and development of metastases during preoperative treatment which includes radiation.
Laboratory diagnosis of laryngeal disease
Authors: Michaels Leslie
Published: September 2006

The most important method used in the laboratory diagnosis of laryngeal disease is histological examination of material removed at biopsy. Surgical and technical aspects of this procedure are discussed. A review of diagnoses made of laryngeal biopsies in a single year by the writer's laboratory is given together with a brief description of the pathology of the commonest non‐malignant conditions. The handling of laryngectomy and block dissection specimens in the laboratory is described. The parts played by the cytology, bacteriology and virology laboratories in laryngeal diagnosis are briefly reviewed.
Dna contents of individual cells from squamous cell carcinomas of the larynx and tongue
Authors: Jakobsson Per åke , Dick Killander P. , Silfverswärd Claes , Wersäll Jan
Published: September 2006

In previous work a new method of histologic grading of malignancy in squamous cell carcinomas of the larynx was described. It was based on morphologic criteria representing the tumor cell population itself and the tumor host relationship. Nuclear polymorphism was revealed to be a very important factor for determining prognosis. This method of histologic grading of malignancy was in this work further analyzed by cytophotometric DNA determinations on individual cells obtained by scraping the surface of squamous cell carcinomas of the larynx and the tongue. Increased heterogenous cellular DNA distributions were found in cases with high histological malignancy grading. Cells in the carcinoma cases with a normal epithelial morphology had the same DNA content as that of control cells of normal buccal mucosa. Cells with higher DNA values all had malignant or suspicious morphology.
Human middle ear corpuscles ‐ a light and electron microscopic study
Authors: Lim David , Jackson Daniel , Bennett Joseph
Published: September 2006

The human middle ear corpuscles originally described by von Troeltsch are examined by means of light microscopy in 124 subjects, and electron microscopy in 27 subjects. While the corpuscles are not observed in all 19 individuals under age six, and in all 20 adults who had a history of suppurative otitis media, an average of six corpuscles per temporal bone is found in 98 percent of 83 adult subjects who had no history of middle ear disease. Two‐thirds of the corpuscles are located in the mastoid, and the remainder in the middle ear. Often, they become bifurcated or trifurcated. Although light microscopy shows that the corpuscle is formed by lamellar capsules and a central core resembling pacinian corpuscles, electron microscopic study failed to confirm that this structure is a typical pacinian corpuscle. Subsequently, possible physiological significance of this corpuscle is discussed.
Cricopharyngeal myotomy in the treatment of dysphagia
Authors: Chodosh Paul L.
Published: September 2006

Deglutition is a complex neuromuscular act. Alterations in anatomy and physiology may lead to dysphagia. The role of the cricopharyngeus appears to be the keystone in the rehabilitation of many patients with dysphagia. This paper examines the physiology of swallowing as well as the patho‐physiology of its aberrations. Techniques and complications of cricopharyngeal myotomy are presented. Cases of dysphagia due to ablative surgery of the head and neck, dermatomyositis, cerebrovascular accidents, and cricopharyngeal achalasia in which cricopharyngeal myotomy was utilized, are reported. It would appear from this small number of cases, that cricopharyngeal myotomy is indicated in the rehabilitation of dysphagia in patients with varied disease states.
Hearing loss of acquired syphilis: Diagnosis confirmed by incudectomy
Authors: Nadol Joseph B.
Published: September 2006

Syphilis, both congenital and acquired, may cause sensori‐neural hearing loss. Congenital syphilis presents in two forms: early (infantile), and late (tardive). Acquired syphilis, both secondary and tertiary, may cause deafness.

The clinical course of the acquired and congenital forms are similar. Sensori‐neural hearing loss with low discrimination scores may affect both ears simultaneously or sequentially, and vestibular complaints are common. A clinical diagnosis can be made on the basis of history, the presence of other stigmata of syphilis, and serological tests, including the FTA‐ABS.

The histopathology of acquired and congenital forms is indistinguishable and is essentially twofold: first, syphilis may cause a meningo‐neurolabyrinthitis with round cell infiltration of the labyrinth and VIIIth nerve as the predominant lesion in early congenital syphilis and the acute meningitides of secondary and tertiary acquired syphilis. Second, syphilis may cause a perivascular round cell osteitis of the temporal bone with secondary involvement of the membranous labyrinth in both late congenital and acquired late latent or tertiary syphilis. Endolymphatic hydrops may be seen in both the congenital and acquired forms.

A case report of bilateral sequential sudden deafness due to acquired syphilis is presented. A histological diagnosis of syphilitic involvement of the temporal bone was made by incudectomy. Treatment with prednisone and penicillin over a three‐month period resulted in return of good cochlear function in one ear.
Adam politzer, otology and the centennial exhibition of 1876
Authors: Stool Sylvan E. , Kemper Marlyn J. , Kemper Bennett
Published: September 2006

The Centennial Exhibition of 1876 was held in Philadelphia. Among the exhibits was a collection of temporal bone dissections produced by Adam Politzer of Vienna. This exhibit included both normal and pathological temporal bones, and emphasized the relationship of the tympanic membrane to the middle ear, external canal and bony labyrinth.

At the close of the Centennial Exhibition the collection was purchased by the College of Physicians of Philadelphia. This collection and the congress associated with the Centennial had a tangible effect on the otology in this country.
Evaluation of unilateral exophthalmos with ultrasonography: Analysis of 258 consecutive cases
Authors: Dallow Richard L.
Published: September 2006

Ultrasound examination has emerged as a valuable technique for defining soft tissue abnormalities of the eye and orbit. As high frequency sound waves (5 to 20 megahertz) are projected through soft tissues, echoes are produced at tissue interfaces. These echoes are displayed on oscilloscopes as either one‐dimensional amplitude spikes (A‐mode ultrasonography), or as dots integrated into a two‐dimensional image representing a thin section through the entire orbit (B‐scan ultrasonography). A‐mode indicates tissue substance, while B‐scan illustrates tissue morphology.

With this technique, orbital tumors are clearly distinguished in terms of their location, size, and configuration, as well as the basic tissue type (cystic, solid, angiomatous or infiltrative). Other orbital processes are defined by ultrasonography also, including inflammatory conditions such as diffuse pseudotumor or cellulitis, congestive conditions such as dysthyroid exophthalmos, and orbital hemorrhage. Intracranial and vascular etiologies of exophthalmos have no specific ultrasound signs.

In a series of 258 consecutive patients with unilateral exophthalmos examined with ultrasonography, diagnosis of tumor was made in 26 percent (66 cases). Overall accuracy of orbital tumor diagnosis by ultrasonography was 94 percent in this series. Tumor localization, configuration, and extent indicated by the test aided in selecting surgical approaches. Other patients in the series were diagnosed ultrasonically as a variety of other entities, mostly inflammatory and dysthyroid exophthalmos. Normal ultrasound studies were found in 19 percent. None of these patients had subsequent diagnosis of tumor.

Diagnostic ultrasonography is capable of detecting orbital tumors and distinguishing them from inflammatory, congestive, and other causes of exophthalmos with a high degree of reliability. The test is painless, well tolerated, non‐invasive, and non‐toxic. It now has a prominent role in evaluation of any patient with exophthalmos.
Juvenile nasopharyngeal angiofibroma: Radiographic aspects
Authors: Sessions Roy B. , Wills Paul I. , Alford Bobby R. , Harrell James E. , Evans Robert A.
Published: September 2006

Because of consistent and unique radiographic features of JNA, it is not necessary, nor is it advisable, to biopsy these tumors to establish a diagnosis. In addition, the carotid arteriograms show the major feeding vessels to the lesion and also completely delineate the periphery of the tumor, thus establishing operability versus non‐operability. If a JNA is treated by radiotherapy, the changes effected can be followed by carotid arteriography.
Symposium: Management of tumors of the parotid gland: I. Correlation of the histopathology and clinical management of parotid neoplasms
Authors: Cocke Edwin W.
Published: September 2006

The successful management of swellings in the parotid gland region is dependent upon the establishment of a clinical and/or histologic diagnosis of the condition responsible for the production of the abnormal swelling.

All mobile parotid tumors are removed as an excisional biopsy with preservation of the facial nerve. A preoperative biopsy will not influence the subsequent management of these lesions.

An aspiration biopsy is employed to evaluate all primary, previously undiagnosed, non‐ulcerative parotid tumors suspected of being clinically malignant. An experienced pathologist views with confidence evaluation of solid material that has been carefully separated from the aspirated specimen.

It is our opinion that when the biopsy tract is removed with the tumor, there is less risk of surgical wound contamination by tumor than when there is an incisional biopsy or incomplete excision of the tumor for frozen or permanent section diagnosis.

One should not expect to derive as much information from an aspiration biopsy as may be derived from a formal incisional biopsy. If the histologic interpretation of the aspirated material is inconclusive, one may proceed to accept the added risk of an open biopsy.

If it is known preoperatively that the tumor is malignant, that it is other than a low grade cancer, and that the tumor should be treated surgically, management of the facial nerve and the cervical nodes may be anticipated. This may be accomplished by an aspiration biopsy.
Symposium: The Supra‐tip in rhinoplasty: A dilemma: II. Influence of surrounding structure and prevention
Authors: Wright William K.
Published: September 2006

One of the most annoying complications of rhinoplasty is the supra‐tip hump (pollybeak). Possible causes are failure to surgically compensate for:

1. The increased skin thickness above the tip.

2. Supra‐tip keloid tendency.

3. Overactive depressor septi muscles.

4. Loss of natural tip support by the upper lateral cartilages and septum.
Symposium: Contraindications to tympanoplasty
Authors: Taylor G. Dekle
Published: September 2006

A panel on contraindications to tympanoplasty connotes the need for self‐evaluation by the otologic surgeon. A polarity of opinion is developing among tympanoplastic surgeons. There are some who recognize few contraindications in these procedures in contrast to those who are very conservative. The panel has designated absolute and relative contraindications which must be determined according to the surgeon's dexterity and experience. A careful selection of patients in light of the relative contraindications is advocated.

The contributors to this panel jointly enumerated the following contraindications, absolute and relative, to tympanoplasty:

1. Extensive mucosal deficit (particularly with good hearing in opposite ear).

2. Absence of middle ear bony framework (postoperative radical mastoidectomy).

3. Non‐existence of stapedial superstructure (poor prognosis).

4. Fixation of footplate (poor prognosis).

5. Total eustachian tube obstruction.

6. Extensive tympanosclerosis.

7. Surgery on better hearing ear (except for compelling reason).

8. Surgery on only serviceable ear (except for compelling reason).

9. Minimum of discrimination is necessary (70–80 is borderline between good and bad prognosis).

10. Patients with small air‐bone gap are usually non‐candidates (surgery could make them worse).

11. Systemic diseases — i.e., tuberculosis, malignancy, diabetes, circulatory problems (obtain clearance from internist).

12. Post irradiation base of skull (interferes with healing).

13. Severe allergic disorders.

14. Chronic sinusitis.

15. Cleft palate.

16. Extensive cholesteatoma (particularly with inexperienced aural surgeon).

17. Avoid ear preferred by patient for hearing aid (a surgical accident might render ear useless).

18. Ear in which previous surgery has been associated with serious complications (i.e., facial nerve paralysis, cerebrospinal fluid leak, lateral sinus rupture).

19. Persistent wet ear after adequate local treatment (indicates eustachian tube problems and nasal pathology).

20. Tympanoplasty in children not too successful. Eustachian tube does not achieve sufficient growth (until age 10–14 years) to prevent recurrent middle ear infection. There is a high probability of spontaneous healing.

21. Age (under three or over 70).

22. Fibrosis of middle ear and extensive tympanosclerosis (insufficient blood supply for good healing).

23. Obliterative fibrosis of middle ear requiring space creating and adhesion preventing materials.

24. Mumps exposure.

25. Acute illness.

26. Acute traumatic perforation.

27. Perfect contralateral ear.

28. Real benefit unlikely.

29. Inability to remove epithelium at time of surgery.

30. Acute or chronic external otitis.

31. Unilateral congenital atresia.

32. Bilateral congenital bony atresia before age six.
Symposium: Contraindications to tympanoplasty. I. Absolute and relative contraindications
Authors: Bailey H. A. Ted
Published: September 2006

A brief history of the surgical technique of tympanoplasty is provided, emphasizing the underlying principles and goals as defined by Wullstein.

Based on clinical and surgical experience, a list of absolute and relative contraindications to tympanoplasty surgery is presented according to the presence or absence of active pathology.
Symposium: Contraindications to tympanoplasty: III. Contraindications for tympanoplasty
Authors: Parsons Richard C.
Published: September 2006

Absolute and relative, systemic and regional contraindications are discussed under the topics of systemic illness, mumps, age, wet ear, traumatic perforation, only ear, perfect contralateral ear, and benefit unlikely.
Ischemic paralysis of the facial nerve: A possible etiologic factor in Bell's palsy
Authors: Calcaterra Thomas C. , Rand Robert W. , Bentson John R.
Published: September 2006

Numerous causes of peripheral facial nerve paralyses have been described; however, none has satisfactorily explained the genesis of the most common type of paralysis, Bell's palsy. Two patients undergoing an experimental embolization of vascular intracranial tumors suffered a total peripheral facial nerve paralysis when occlusion of the middle meningeal artery had been accomplished. It is speculated that this paralysis resulted from ischemia of the horizontal portion of the facial nerve, an observation that has not previously been described and that might be applicable as well to the etiology of Bell's palsy.
Rhabdomyoma of the pharynx
Authors: Weitzel Gary J. , Myers Eugene N.
Published: September 2006

The occurrence of a large pharyngeal rhabdomyoma in an otherwise healthy adult male is discussed in this paper. This lesion, except for local symptomatology, is established as benign. A differential diagnosis, as well as the specific surgical approach to its removal, are also presented.
Fibrosarcoma of the head and neck in children
Authors: Swain Ronnie E. , Sessions Donald G. , Ogura Joseph H.
Published: September 2006

A retrospective study of 11 children with fibrosarcoma of the head and neck is presented. Six of these tumors are well differentiated, and three are poorly differentiated. Nine patients were followed for over six years and are available for treatment evaluation. The results of treatment indicate that patients with superficially located, well differentiated tumors occurring at sites where wide surgical margins can be obtained have the most favorable prognosis.
Construction of a practical and inexpensive air stimulator for caloric vestibular testing
Authors: Proctor Leonard R. , Metz Werner A. , Dix Rollin C.
Published: September 2006

An inexpensive and practical method for delivering air into the aural canal at a selected stable temperature is described. A water‐air heat exchanger utilizing the external circulation of a constant‐temperature water bath brings the temperature of the air stream to a chosen value. Measurements indicate stable air outflow temperatures are maintained when proper nozzle design and air flow rates are employed. The apparatus is easy to construct and has proven convenient and effective when used in the clinical vestibular laboratory.
Symposium: Methods of reconstruction in tympanoplasty: I. Management of fixation of malleolus head and incudal body in tympanoplasty
Authors: Pennington Claude L.
Published: September 2006

Depending upon the presence or absence of stapedial mobility, treatment of ossicular fixation will vary. Methods and indication to preserve the fixed malleolar head and neck are discussed and positive indications for removal of the incus are enumerated. A description of various surgical techniques of interposition of the incus between the mobile malleus and stapes to relieve stapes fixation and restore continuity are described in detail.
PlastiporeTM total ossicular replacement prosthesis
Authors: Shea John
Published: September 2006

In those ears in which the incus and/or malleus are missing or not suitable, a columella made of high density polyethylene sponge has proven to be very effective. Tissue readily grows into the large pores of this material so that it is well tolerated in the body. During the last six months 54 have been implanted with no rejection so far and a good hearing gain in 43 or 80 percent.
Triple ossicular fixation
Authors: Armstrong B. W.
Published: September 2006

A technique for overcoming conductive deafness secondary to fixation of all three ossicles is described in detail. This procedure is also applicable to previously fenestrated ears.
Symposium: Congenital anomalies of the middle ear: III. Congenital anomalies of the middle ear
Authors: Pou Jack W.
Published: September 2006

Congenital anomalies of the middle ear have been considered rare. The tremendous volume of middle ear surgery performed during the last 15 years has brought attention to numerous anomalies of the facial nerve, ossicles, and middle ear cleft, suggesting that middle ear anomalies are not as rare as once believed. This paper discusses anomalies of the descending and horizontal facial nerve which have been previously reported. The literature of anomalies of the ossicles is reviewed. A very rare anomaly of the carotid artery presenting in the middle ear is described and its surgical treatment outlined. Two anomalies of the middle ear associated with other branchial arch anomalies are reported and their treatment results discussed.
Symposium: Congenital anomalies of the middle ear: IV. Management of profuse perilymph leak
Authors: Shea John J.
Published: September 2006

Profuse perilymph leak during an otological operation can be controlled by inserting an epidural teflon cannula into the lumbar subarachnoid space and draining away the excess spinal fluid. After about 100 cc is removed the perilymph leak stops, and the oval window can be sealed with a living seal, such as vein, and the operation completed. The catheter is left in the subarachnoid space for about four days, with a bottle on the distal end positioned to remove no more than 150 cc of spinal fluid per day.

Results with two patients in which this maneuver was used to control profuse perilymph leak are reported.
Routine abscess tonsillectomy: Late results
Authors: Bonding Per
Published: September 2006

The late results of abscess tonsillectomy as a routine treatment of peritonsillar abscess were investigated. The material comprises 113 patients. Follow‐up was performed two to five years after the operation (bilateral dissection tonsillectomy under general anesthesia).

Symptoms of pharyngitis, recurrent or chronic, were present in 17 percent of the patients, in most cases without major objective changes in the throat. The incidence of these symptoms was highest — 70 percent — in patients past middle age without any history of trouble from the throat before the peritonsillar abscess.

Tonsil remnants were seen in 28 percent, but only 6 percent of the patients had new episodes of febrile throat infections.

The results are discussed. A reserved attitude to abscess tonsillectomy (and to interval tonsillectomy) is recommended for peritonsillar abscess in elderly patients without previous trouble from the throat.
Laryngeal suspension in head and neck surgery
Authors: Goode Richard L.
Published: September 2006

Nineteen cases with major resections of the head and neck were treated with laryngeal suspension and cricopharyngeal myotomy in an attempt to allow swallowing function postoperatively and avoid a total laryngectomy. Sixteen cases were available for evaluation. Eight cases (50 percent) were able to eat by mouth, 15 patients (94 percent )had a normal airway and 14 patients (87 percent) had intelligible speech.