bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood transfusions in surgery of the larynx and neck
Authors: Levine Steven B. , Kimmelman Charles P. , Zwillenberg Seth , Silberstein Leslie
Published: October 2006

Effective utilization of blood and blood products is an important consideration in elective surgical procedures. A cost‐effective process will maintain availability to the general population while supplying reasonable surgical needs. Removing stored blood from the general pool strains these resources and drastically increases cost.

To establish the first clinical model of study and to better predict blood requirements for elective surgery of the larynx and neck, medical records of 137 consecutive patients who underwent laryngeal surgery from January 1, 1981 to June 30, 1984 were reviewed. All patients had one or a combination of one of the following: radical neck dissection, total laryngectomy, hemilaryngectomy, and/or supraglottic laryngectomy. Data analyzed included estimated allowable blood loss, estimated intraoperative blood loss, as well as preoperative and postoperative blood hemoglobin concentrations.

Actual blood utilization was adjusted for individual patient need, and recommendations for appropriate blood screen and cross‐match were derived for each of the above surgical procedures. It was concluded that blood availability for the individual patient is best assessed by the surgeon.
Olfactory evoked potentials in the rat
Authors: Inokuchi Akira , Kimmelman Charles P. , Wang Hui‐E , Snow James B.
Published: October 2006

Routine clinical assessment of the integrity of the olfactory pathway using olfactory evoked potentials remains an elusive goal. One important difficulty arises from the uncertainty of the exact origin of the potentials: are they produced by olfactory or trigeminal elements? To resolve this problem, an animal model using the rat was developed. Amylacetate was used as an odorant stimulus, and potentials were measured and computer averaged after elimination of trigeminal and vomeronasal activity. A positive‐negative wave was recorded from the olfactory bulb surface, and a negative wave often followed by a positive wave was recorded from the surface of the cerebral cortex. Measurements from the scalp surface gave comparable results. Lesioning experiments of the olfactory pathway indicate that the evoked potentials recorded at the vertex originate in the ventral forebrain, specifically in the prepyriform cortex, olfactory tubercle, and anterior olfactory nucleus.
Major salivary gland tumors: Treatment results and prognostic factors
Authors: Tran Luu , Sadeghi Ahmad , Hanson David , Juillard Guy , Mackintosh Ralph , Calcaterra Thomas C. , Parker Robert G.
Published: October 2006

A retrospective review of 133 patients with major salivary gland carcinomas treated between 1955 and 1981 is presented. The majority of cases (104) originated in the parotid gland. The most common histological type was mucoepidermoid carcinoma (39 cases). Tumor‐free interval was longest for patients with acinic cell and mucoepidermoid carcinomas. In contrast, adenoid cystic carcinoma was poorly controlled, regardless of the form of treatment.

Initial control of primary major salivary gland tumors was inversely related to the presence of disease at the surgical margins. In cases with microscopic or gross disease at the surgical margins, postoperative radiation therapy controlled the tumor locally in 18 of 26 patients (69%). Postoperative radiation therapy was generally used only in cases with high‐grade histologies, advanced stages, or positive surgical margins. Of the patients treated with surgery alone, 53% achieved local control, as compared to 75% of the group which received postoperative radiation therapy. Although the difference was not statistically significant, we would have expected the combined therapy group to have a lower control rate due to more advanced disease.

There was a low salvage rate (22%) and a high incidence of distant metastasis (60%) in recurrent cases. The data indicates that complete surgical resection results in the best local control, with or without adjuvant radiation. When the surgical margin is inadequate and re‐excision not possible, adjuvant radiation therapy appears to have a role to optimize local control and survival.
Customized valve housing
Authors: Cantu Evangeline , Shagets Frank W. , Fifer Robert C. , Andres Carl J. , Newton Alan D.
Published: October 2006

Numerous remarkable advancements have been made in the area of voice prosthetics. A significant, persistent problem, however, has been the development of air leaks around the tracheostome housing. This problem is particularly apparent with patients having deeply recessed, irregular stomas. This paper describes a customized tracheostome valve housing that is fabricated to minimize or alleviate difficulties associated with maintenance of an airtight seal. Our experience with 12 patients revealed that they maintain adequate seals for 72 hours and enjoy the functional benefits provided by the customized housing.
Angiofibroma: Treatment trends in 150 patients during 40 years
Authors: Bremer J. William , Neel H. Bryan , Desanto Lawrence W. , Jones Gregory C.
Published: October 2006

A series of 150 patients with histologically confirmed angiofibroma examined from 1945 through 1983 was studied to contrast treatment methods and surgical approaches. From 1945 to 1955, treatment consisted primarily of radiation. From 1955 through 1971, the primary method of treatment was surgical removal; the lateral rhinotomy approach was used to expose the tumor and its extensions in most cases. From 1971 through 1983, all tumors were removed surgically. Trends in diagnosis, treatment, and adjunctive therapy at a single institution were evaluated. Specifically, the trends considered were operative approaches, blood replacement with and without hypotensive anesthesia, adjunctive measures such as hormonal therapy or tumor embolization, mortality, and morbidity. Lateral rhinotomy provides wide exposure of and access to the nose, nasopharynx, paranasal sinuses, elements of the skull base, temporal fossa, and infratemporal fossa. Surgical treatment, specifically the lateral rhinotomy approach and its extensions, is recommended as the best method of managing angiofibroma in most patients.
Preoperative parathyroid adenoma localization by the technetium‐thallium subtraction scan
Authors: Biller Hugh F. , Strashun Arnold , Goldsmith Stanley J. , Bergman Donald
Published: October 2006

The technetium‐thallium subtraction scintigram was utilized preoperatively in 14 consecutive patients explored for primary hyperparathyroidism. The scintigram accurately identified the site of a parathyroid adenoma in 12 of 13 patients.
Effects of tympanic membrane scars on tympanometry: A study in cats
Authors: Osguthorpe J. David
Published: October 2006

The efficacy of tympanometry in the diagnosis of ossicular abnormalities and the differentiation of such from eardrum scarring is controversial. This paper presents a study of the tympanometric effects of specific eardrum scars and ossicular abnormalities in cats. For both normal eardrums and healed myringotomies, a normal middle ear could be differentiated from stapes fixation or incudostapedial discontinuity using static immittance parameters and tympanogram morphology. Twenty percent myringectomy scars caused abnormal 660 Hz tympanograms but this effect could be distinguished from changes caused by a concomitant ossicular abnormality. The very low impedance of a 50% myringectomy scar resulted in tympanograms which could not be differentiated from an ossicular discontinuity alone. With this neomembrane, stapes fixation could not even be differentiated from an ossicular discontinuity. This study supports the view that tympanometry should be interpreted as part of a battery of tests which includes otoscopy, audiometry, and acoustic reflex measurements.
Angiosarcoma of the head and neck: Review of 11 cases
Authors: Panje William R. , Moran William J. , Bostwick David G. , Kitt Victor V.
Published: October 2006

In this report, 11 cases of angiosarcoma of the head and neck are reviewed. The patients ranged in age from newborn to 78 years; mean age was 64 years. There were eight men and three women. Sites of involvement included the scalp and forehead, cheek, nose and ethmoid sinuses, neck, and mandible. Surgery was the primary method of treatment. The 2‐year survival rate was 50% (5/10) and the 5‐year survival rate was 22% (2/9). Regional metastases were seen in 18% (2/11). We found that the tumors were poorly circumscribed and spread horizontally within the dermis for considerable distances, especially in the scalp. Total surgical excision using frozen section control before reconstruction may offer the best chance for control of disease.
Restoring abduction of paralyzed vocal cords in the cat using selective laryngeal reinnervation by phrenic motoneurons
Authors: Baldissera Fausto , Cantarella Giovanna , Marini Gabriella , Ottaviani Francesco
Published: October 2006

The aim of this work was to reestablish the respiratory function of the paralyzed larynx through reinnervation of the posterior cricoarytenoid (PCA) muscle by phrenic motoneurons.

In nine adult cats the adductor branch of the recurrent laryngeal nerve (RLN) of one side was cut and ligated, while the abductor branch was left intact. The whole RLN was then transected lower in the neck and its distal stump anastomosed to the upper branch of the phrenic nerve.

Periodical laryngoscopies under ketamine anesthesia assessed that the inspiratory abduction of the paralyzed vocal cord recovered within 45 days to 60 days in all cats. Abduction was caused by reinnervation of the PCA muscle from phrenic motoneurons, as demonstrated by electrophysiological and anatomical (retrograde transport of horseradish peroxidase) testings.
Experimental grafting of the round window membrane: Part I
Authors: Schachern Patricia A. , Paparella Michael M. , Goycoolea Marcos V.
Published: October 2006

The histology and permeability of cats' round window membranes were described following surgical grafting with gelatin foam or fascia. An increase in the thickness of the round window membrane due to fibrosis, neovascularization, and epithelial metaplasia was observed 2 months following grafting with gelatin foam. Grafting with fascia did not increase the thickness of the round window membrane, but did form a thick layer of granulation tissue adjacent to and overlying the round window membrane, with occasional adhesions between. The layer of granulation tissue consisted of cuboidal or columnar ciliated epithelial cells, fibrous tissue, lipid, and undigested grafted material. The granulation tissue did not always completely cover the round window membranes.

Horseradish peroxidase placed in the round window niche of cats with grafts on the round window membrane remained a significant distance further from the inner ear when compared to its migration through nongrafted membranes.
Sensorineural hearing loss associated with takayasu's disease
Authors: Siglock Timothy J. , Brookler Kenneth H.
Published: October 2006

This is a case report of sensorineural hearing loss associated with Takayasu's disease. Also known as ‘pulseless disease’ and ‘aortic arch syndrome,’ Takayasu's disease involves narrowing of the aortic arch and its branches. Although the etiology is unknown, it is suspected to be an autoimmune disorder. In the case presented, steroid therapy resulted in an improvement of hearing. On one relapse the hearing loss worsened before the sedimentation rate increased. We speculate that the hearing loss is due to an autoimmune process or an ischemia involving the inner ear. We further speculate that hearing loss may indicate subsequent worsening of the disease.
Cochlear patency problems in cochlear implantation
Authors: Jackler Robert K. , Luxford William M. , Schindler Robert A. , McKerrow William S.
Published: October 2006

Sensory deafness may be associated with partial or total obliteration of the cochlear scalae. Before undertaking cochlear implant surgery, a preoperative assessment of cochlear patency with high‐resolution computed tomography (CT) is indicated. To determine the accuracy of pre‐implant CT, a review of the radiographic and surgical findings in 36 implanted ears was performed. An abnormal CT scan was found to be a reliable predictor of compromised cochlear patency at operation. These findings help the surgeon to select the side most favorable for implantation and to anticipate problems that may be encountered during device insertion. A normal pre‐implant CT scan, however, does not exclude the possibility of compromised cochlear patency. A 46% false negative rate was encountered, presumably because subtle degrees of osseous or fibrous obliteration of the cochlea are beyond the resolution by current generation CT scanners.

In our opinion, the radiographic finding of cochlear ossification is not a contraindication to an attempt at cochlear implantation. The only assured way of determining the extent of cochlear patency is by performing an ‘exploratory cochleostomy’ with fenestration of the basal cochlear turn. Drilling anteriorly through an ossified basal scala tympani will often expose an adequate lumen and permit insertion of even a long multichannel electrode into a partially ossified cochlea. Nevertheless, it is essential that the implant team be prepared with devices appropriate for whatever existing or surgically created lumen may be available.
Bilateral omohyoid muscle flap reconstruction for anterior commissure cancer
Authors: Calcaterra Thomas C.
Published: October 2006

Partial laryngectomy for anterior commissure cancer often results in a shortened glottis which produces a high pitched strained voice and an inadequate airway lumen which requires permanent tracheostomy. Vocal fold vibration is impaired both by the shortened length and anterior scarring which profoundly affects the myoelastic properties of the larynx.

Many different methods of reconstructing the anterior commissure have been attempted with limited success and many require multiple procedures. A method of anterior commissure reconstruction employing bilateral omohyoid muscle flaps has been performed successfully in four patients. The omohyoid muscles and investing fascia are readily available during partial laryngectomy and can be tailored to reconstitute the anterior commissure. The myofascial flaps epithelialize rapidly and there is little tendency for anterior glottic stenosis. The sphincteric function of the larynx remains intact and the vocal quality surpasses other methods of reconstruction employed by the author.
Primary tracheoesophageal fistula procedure for voice restoration: The university of texas medical branch experience
Authors: Stiernberg Charles M. , Bailey Byron J. , Calhoun Karen H. , Perez Denice G.
Published: October 2006

Voice restoration for laryngectomees is challenging, but in recent years the tracheoesophageal (TE) fistula procedure using a oneway valved prosthesis has had relatively good success. The purposes of this study were to determine the success rate for the primary TE fistula procedure, analyze failures, and study methods for selection and training of these patients.

In a prospective study, 21 consecutive patients had primary TE fistula procedures performed over an 18‐month period. Thirteen of 20 who had adequate follow‐up developed fluent, intelligible speech using either duckbill or low‐pressure one‐way valves. Complications included one stomal infection and one paratracheal fistula. This experience has led 1. to development of a protocol for selection and training of patients for this procedure and 2. to the conclusion that the procedure can improve voice restoration success without an increase in morbidity.
Neonatal respiratory distress from rhinitis medicamentosa
Authors: Osguthorpe J. David , Shirley Reed
Published: October 2006

Rhinitis medicamentosa from topical vasoconstrictor abuse results in nasal obstruction which can be life‐threatening in neonates. Neonates are obligate nasal breathers, most learning oral respiration by 2 months of age. A neonate was started on topical phenylephrine at birth, and by 3 weeks of age was having multiple daily episodes of apnea and cyanosis. An evaluation documented edematous, obstructing nasal turbinates, as well as polycythemia, cardiomegaly, and prominence of the pulmonary vasculature. A nasopharyngeal airway alleviated the obstruction until the turbinates recovered, and the other abnormalities quickly resolved.
Increased spiral ganglion cell survival in electrically stimulated, deafened guinea pig cochleae
Authors: Lousteau Ray J.
Published: October 2006

For implanted electronic prostheses to function successfully in the deaf, residual spiral ganglion neurons are presumed to be necessary. Several studies have tried to determine the effects cochlear electrode implantation and electrical stimulation have on the neurons of the spiral ganglion. Little work has been published, however, on the trophic effects of electrical stimulation on cell survival after cochlear damage by ototoxicity. This report presents the results of an investigation to determine the effects of early intrncochlear electrical stimulation on spiral ganglion neuron survival after chemically induced deafness in young guinea pigs. A significantly larger number of spiral ganglion cells remained in stimulated ears 6 weeks after deafening than were seen in the unstimulated ears of the same animals. These results suggest that early implantation after acquired deafness may affect the success obtainable with electronic hearing prostheses.
Laryngeal modeling: Theoretical, in vitro, in vivo
Authors: Berke Gerald S. , Moore Dennis M. , Hanson David G. , Hantke David R. , Gerratt Bruce R. , Burstein Fernando
Published: October 2006

Because the larynx is situated anatomically in an area which is difficult to measure and visualize, theoretical, in vitro, and in vivo models are used in laryngeal research. Vocal fold vibration was studied in anesthetized dogs, while electrically stimulating independently the superior and recurrent laryngeal nerves under conditions of constant airflow. Photoglottographic (PGG), electroglottographic (EGG), and subglottic pressure signals were obtained while stroboscopically photographing the larynx. Specific points along PGG, EGG, and subglottic pressure waveforms were correlated with laryngeal events which occurred during vibration. The canine larynx, in an experimentally produced phonatory mode, vibrates in a two mass (upper and lower margin) system and appears comparable to modal human voice production. The recorded glottogrophic waveforms from experimentally produced phonation in the canine are similar to signals recorded from humans. However, observed differences can be related to anatomic differences.
Treatment of hypopharyngeal carcinoma: A 10‐year review of 1, 362 cases
Authors: Pingree Timothy F. , Davis R. Kim , Reichman Owen , Derrick Larry
Published: October 2006

A computer search of cancer patients enrolled in the Rocky Mountain Cancer Data System between 1973 to 1983 revealed 1, 362 patients with hypopharyngeal cancer, 1, 208 of whom could be staged by the American Joint Committee on cancer staging criteria. Stage I and II patients comprised 17.5% while 71% were either stages III or IV. The distant metastatic rate in advanced stage patients was 24%.

Survivals for all treated patients were 65% at 1 year, 33.5% at 3 years, and 25% at 5 years. Three‐year survivals were 54.5% for the surgery only group, 41.6% for the combined therapy group, and 17.7% for the irradiation only group. Five‐year survivals for the surgery only group were 39.8%, combined therapy, 31.8%, and irradiation only 11.5%. These figures are actuarially corrected.

Twenty‐two percent of combined therapy patients had preoperative irradiation versus 78% who had postoperative irradiation. There was no statistically significant difference seen between these two groups.
Sinonasal undifferentiated carcinoma: A distinctive and highly aggressive neoplasm
Authors: Levine Paul A. , Frierson Henry F. , Stewart F. Marc , Mills Stacey E. , Fechner Robert E. , Cantrell Robert W.
Published: October 2006

Eleven cases of sinonasal undifferentiated carcinoma were treated between 1975 and 1986. This distinctive neoplasm involved the orbital cavity in 6 of 11 patients (55%) and the cranial cavity in 7 of 11 patients (64%) at the time of presentation. Of the eight patients (73%) who died of disease, six died within 13 months after the diagnosis. One patient has no evidence of disease 10 months after therapy, and two are alive with disease after 15 and 22 months.
Endotracheal tube safety during laser surgery
Authors: Fontenot Ray , Bailey Byron J. , Stiernberg Charles M. , Jenicek John A.
Published: October 2006

The most morbid complication of laryngeal laser surgery is an endotracheal tube lire. The purposes of this study were to determine the efficiency of saline solution‐soaked cottonoid pledgets in protecting endotracheal tube cuffs from the laser beam and to evaluate the safety of four commonly used endotracheal tubes.

The method involved measurement of perforation times of saline‐soaked cottonoid pledgets with controlled variables of air exposure times and laser energy. The second part evaluated the safety and ignition properties of the red rubber, silicone, polyvinyl chloride, and Xomed Laser‐Shield® tubes by studying their perforation times and ignition properties under controlled oxygen concentrations.

The results revealed that saline‐soaked pledgets are very efficient in protecting endotracheal tube cuffs. The Laser‐Shield® tube was the safest one studied. It had the highest ignition threshold of the four tubes tested.
Pediatric maxillofacial trauma: Unique features in diagnosis and treatment
Authors: Gussack Gerald S. , Luterman Arnold , Powell Randall W. , Rodgers Keith , Ramenofsky Max L.
Published: October 2006

The purpose of this study was to review mechanisms, etiologies, associated injuries, and treatment of maxillofacial trauma in children and to compare them to similar adult injuries. Thirty blunt injuries (1984‐1986) comprised the children's group, and 176 injuries, the adult group. Multiple associated injuries were more common in children, the most frequent being CNS and orthopedic injuries. Detailed anatomy of mandibular fractures required pleuridirectional tomography in 63% of the pediatric cases compared to 12% in adults. In the children's group, the mandibular fractures were favorable in 56% of cases compared to 15% in adults. Children required shorter periods of intermaxillary fixation with no child requiring reapplication of fixation. Based on these comparisons, a protocol for the management of pediatric maxillofacial injuries has been developed.
Treatment of invasive aspergillus sinusitis with liposomal‐amphotericin B
Authors: Weber Randal S. , Lopez‐Berestein Gabriel
Published: October 2006

Invasive sinonasal aspergillosis is a severe and frequently fatal infection in immunosuppressed patients with hematologic malignancies.

Seven patients with sinonasal aspergillosis who failed to respond to conventional amphotericin B (AmpB) were treated with liposomal AmpB (L‐AmpB). AmpB was incorporated into multilamellar vesicles consisting of dimyristoyl phosphatidylcholine and dimyristoyl phosphatidylglycerol in a 7:3 molar ratio. Five patients had underlying hematologic malignancies, one patient had aplastic anemia, and one patient had no underlying disease. All patients had biopsy‐proven invasive Aspergillus sinusitis, and had failed conventional antifungal therapy including AmpB. Five patients were cured and two did not respond to treatment. Fever and chills were infrequent and, when they occurred, mild, and responded well to conventional management. No severe renal or central nervous system toxicity was observed. L‐AmpB is effective and less toxic than conventional AmpB in the treatment of invasive Aspergillus sinusitis.
Peripheral nerve regeneration: An experimental study
Authors: Janecka Ivo P.
Published: October 2006

The purpose of this study was to examine the regenerative potential of a rat sciatic nerve following surgical manipulation.

Single and double neurorrhaphies, nerve grafts and interposed vein grafts, in a nerve gap, were studied. Also, repairs of isolated nerve segments, without maintaining muscle connections, were examined.

In our model we found that a peripheral nerve would grow across a limited nerve gap through a vein graft conduit and would become histologically as well as electrically nearly indistinguishable from a normal nerve. This vein graft conduit compared well with a standard nerve graft. Measurements of axonal density revealed that the closest density to control was found in nerves repaired with a vein graft followed by a single epineural repair. Sciatic nerve segments which were repaired following transection but disconnected from their corresponding muscles, failed to attract regenerating axons.

This study demonstrates that the more complex the surgical repair, the greater the reduction of regenerated axons distal to the site of repair. It also supports the concept of the essential influence of a denervated muscle on regenerating axons.
Transient salivary gland hypertrophy in bulimics
Authors: Ogren Frederic P. , Huerter James V. , Pearson Paul H. , Antonson Clark W. , Moore Gary F.
Published: October 2006

Transient salivary gland hypertrophy is a reported clinical finding in patients with bulimia.1, 2 A retrospective chart review of 49 patients enrolled in the University of Nebraska Medical Center Eating Disorders Program with a diagnosis of bulimia showed 29% (14/49) had at some time either parotid and/or submandibular gland hypertrophy noted on physical exam. Resolution of the salivary gland enlargement occurred in all of our patients after treatment of their bulimia. Bulimia must, therefore, be considered in the differential diagnosis of salivary gland hypertrophy, and treatment should be directed at the underlying behavioral disorder.
Complications of endoscopic intranasal ethmoidectomy
Authors: Stankiewicz James A.
Published: October 2006

A consecutive series of 90 patients undergoing endoscopic intranasal ethmoidectomy was reviewed. There were 26 complications (29%) in 19 patients in this group. Eight complications (8%) including CSF leak, temporary blindness, and hemorrhage were considered major with the latter occurring most commonly. Synechiae were the most commonly occurring minor complications.

Endoscopic nasal sinus surgery performed by inexperienced operators carries with it the same risks and complications as traditional intranasal sinus surgery. Any surgeon who does not routinely perform traditional intranasal ethmoidectomy should accrue endoscopic experience through appropriate didactic training and multiple cadaver dissections (akin to otologic training).
Improvement of olfaction in laeyngectomized patients with the larynx bypass
Authors: Schwartz David N. , Mozell Maxwell M. , Youngentob Steven L. , Leopold Donald L. , Sheehe Paul R.
Published: October 2006

Hyposmia following laryngectomy is an often recognized phenomenon. A larynx bypass device was used to determine whether this olfactory deficit could be reversed simply by restoring nasal airflow. Odorant detection thresholds and confusion matrix identification tests were administered to laryngectomy and normal comparison groups. Data on nasal airflow characteristics with and without the bypass were also analyzed.

The results suggested that restoration of nasal airflow completely reversed the hyposmia for trigeminal nerve stimuli. However, the reversal of hyposmia was not complete for those odorants which primarily, if not exclusively, stimulate the olfactory nerve. This suggested that other factors may contribute to laryngectomy‐induced hyposmia for olfactory nerve stimuli.

Additionally, nasal airflow analysis revealed that confusion matrix identification scores were dependent upon inspiratory sniff flow rates with and without the larynx bypass.

It is argued that rehabilitation for the laryngectomee should include efforts to restore and maintain preoperative olfactory acuity.
Preservation of hearing in surgical removal of acoustic neuromas of the internal auditory canal and cerebellar pontine angle
Authors: Nadol Joseph B. , Levine Robert , Ojemann Robert G. , Martuza Robert L. , Montgomery William W. , De Sandoval Patricia Klevens
Published: October 2006

The surgical results in 69 patients with unilateral tumors of the cerebellopontine angle or internal auditory canal in whom total tumor removal was accomplished, and in whom an attempt was made to preserve hearing, are presented. The success rate of preservation of hearing and facial nerve function was correlated with the size of the tumor. Useful hearing, as defined by speech reception threshold no poorer than 70 dB and a discrimination score of at least 15%, was preserved in 73% of cases in which the tumor extension to the posterior fossa was no greater than 0.5 cm. In contrast, useful hearing was preserved in 22% of cases in which posterior fossa extension was greater than 2.5 cm. No significant correlation was found between preoperative evoked responses and success in preservation of hearing. The techniques and value of intraoperative monitoring of electrocochleogram (ECoG) and brain stem evoked response are discussed. A theory of pathogenesis of intraoperative hearing loss, based on correlation of changes in evoked responses and simultaneous surgical events, is presented.
Tuberculous otitis media: A clinical record
Authors: Yaniv Eitan
Published: October 2006

The clinical picture of tuberculous otitis media has changed since previously documented. In our series of 31 patients, it was found that severe conductive hearing loss, abundant pale granulations, and denuded malleus handle are constant findings and, in our opinion, are significant clinical features of the pathology. The disease can also manifest itself as an acute mastoiditis.

As regards to investigations, bacteriology is considered as being unreliable. This is attributed to secondary organisms interfering with the growth of the tubercle bacillus, as well as the fastidious nature of the bacillus itself. We regard histology as the most reliable means of attaining a definitive diagnosis.

Treatment was with a four drug antituberculous regime administered over 6 months. Streptomycin was excluded in all but one case due to its ototoxicity. We believe TB otitis media to be secondary to an established chronic otitis media in the majority of cases.
Venture jet ventilation for microlaryngoscopy: Technique, complications, pitfalls
Authors: Crockett Dennis M. , Scamman Franklin L. , Mccabe Brian F. , Lusk Rodney P. , Gray Steven D.
Published: October 2006

Our experience with Venturi jet ventilation as the method of anesthesia in 872 cases of microlaryngeal surgery is presented. Our indications and exact technique are presented, as well as a review of our complications. Possible pitfalls and their avoidance are discussed. With attention to detail and good clinical judgement on the part of anesthesiologist and surgeon, Venturi jet ventilation can be safe and efficient with minimal complications.
Anatomic reconstruction and functional rehabilitation of oromandibular defects with rigid internal fixation
Authors: Wenig Barry L. , Shikowitz Mark J. , Stern Jamie R. , Keller Alex J. , Casino Anthony J. , Pollack Jed M. , Pipman Yacov
Published: October 2006

Fifteen consecutive patients undergoing extensive surgery for head and neck cancer involving the oral cavity and oropharynx were reconstructed using the technique of rigid internal fixation combined with various vascularized flaps. The follow‐up ranged from 6 to 18 months.

Modifications in various myocutaneous or vascularized free flaps combined with an analysis of the radiation physics necessary to make this procedure a viable alternative for immediate and delayed mandibular reconstruction will be discussed. Consistently satisfactory functional and cosmetic results have been achieved.
Carotid artery resection and bypass for neck carcinoma
Authors: Biller Hugh F. , Urken Mark , Lawson William , Haimov Moshe
Published: October 2006

Twenty‐six patients were treated by carotid artery resection and vascular replacement for recurrent cancer of the neck. The incidence of postoperative neurologic sequelae was 7%. The absolute 12‐month disease‐free survival for metatastic squamous cell carcinoma was 25%. It is concluded that in selected patients, this aggressive surgical therapy is indicated.
Congenital subglottic hemangiomas: A treatment update
Authors: Wenig Barry L. , Abramson Allan L.
Published: October 2006

Congenital subglottic hemangiomas are rare lesions associated with a significant degree of morbidity and mortality. Although various methods of treatment have been proposed, no one single modality has yet been shown to be uniformly effective in treating this life‐threatening condition. Amongst the myriad of suggested treatments, the carbon dioxide laser, as originally proposed by Healy, et al.,1 appears to have the highest degree of success with the lowest incidence of complications. The purpose of this paper is to review a large experience at a single institution with the use of the carbon dioxide laser for treatment of congenital subglottic hemangiomas.
Localized injections of botulinum toxin for the treatment of focal laryngeal dystonia (spastic dysphonia)
Authors: Blitzer Andrew , Brin Mitchell F. , Fahn Stanley , Lovelace Robert E.
Published: October 2006

Spastic dysphonia is a condition producing a strain‐strangle phonation. We have previously classified most of these patients as having focal laryngeal dystonia, a disorder of central motor processing.

The initial success of recurrent nerve section in many of these patients has been followed by recurrence of symptoms in months to years. Bilateral involvement of the vocal cords with hyperfunction of the nonparalyzed vocal cord could explain these failures.

Injection of botulinum toxin (BOTOX) has been effective treatment for many focal dystonias. We have treated more than 100 patients with dystonia including five with laryngeal dystonia. All of the patients laryngeal had dramatic improvement after 48 to 72 hours; benefit lasted 3 to 9 months for each injection period. BOTOX injection can be performed on awake, ambulatory patients. Bilateral treatment and titration of dose can achieve the desired degree of weakness.
Dynamic compression plating in treatment of the fractured, edentulous mandible
Authors: Krebs Festus J.
Published: October 2006

The repair of a mandibular fracture in the edentulous patient can be a difficult surgical problem. A recent report of a large series of such cases by the University of Michigan disclosed a 20% rate of nonunion. Dynamic compression plating is particularly suited to the repair of fractures of the edentulous mandible as intermaxillary fixation is unnecessary, normal speech and diet are resumed immediately, and bone grafts can be used when necessary. This series of 36 plates used in the management of mandibular fractures in 24 edentulous patients is the largest series of its type reported thus far. No nonunion or other major complication occurred in this series.

Because nonunion, delayed union, and the problems associated with intermaxillary fixation were avoided in this series, it is suggested that compression plating is a highly effective method for repair of fractured edentulous mandibles.
The versatile midface degloving approach
Authors: Price John C. , Holliday Michael J. , Johns Michael E. , Kennedy David W. , Richtsmeier William J. , Mattox Douglas E.
Published: October 2006

The exposure obtained using the degloving approach is superb and the absence of resultant facial scar or deformity provides a dramatic new addition to the otolaryngologist's surgical repertoire. The advantages of the degloving technique in exposure of the midface, nasal cavities, paranasal sinuses, nasopharynx, skull base, and clivus have led to its increasing importance in the otolaryngology literature. Within 2 years of the technique's introduction in our department, it had been used 48 times for a wide variety of problems, including inverting papilloma, juvenile angiofibroma, chordoma and selected cases of fungal disease of the sinuses.

This article describes the procedure, reports the results from a panel of 48 patients, and discusses potential complications.

The authors' experience with this procedure indicates that it should become a procedure of choice for management of inverting papilloma and juvenile angiofibroma, as well as a major alternative method in many other circumstances.
The role of adenoids in the development of normal speech following palate repair
Authors: Gereau Sezelle A. , Shprintzen Robert J.
Published: October 2006

The controversy surrounding the various approaches to palate repair continues unabated. Issues which have been studied relative to the development of normal speech following palate repair have included surgical technique and the timing of surgery. However, regardless of the various refinements in surgery, a percentage of children require secondary surgery to resolve velopharyngeal insufficiency. To date, other factors which might be responsible for the development of normal speech have been ignored. The purpose of this report is to discuss the importance of the relative size of the adenoids in relation to the success or failure of primary palatoplasty. Velopharyngeal valving in noncleft (normal) children was also observed. Eight hundred fifty children with nonsyndromic clefts and 138 children with syndromic clefts were analyzed for speech results postpalatoplasty relative to adenoid size. One hundred normal children were also studied. The data suggest a strongly positive correlation between the incidence of hypernasal resonance postpalatoplasty and relative adenoid size in the cleft children. Velar‐adenoidal closure was consistently observed in both the cleft and normal children.
Hemilaryngectomy rescue surgery for radiation failure in early glottic carcinoma
Authors: Strauss Melvin
Published: October 2006

Radiotherapy for early glottic carcinoma has produced excellent results and low complication rates. Therefore, hemilaryngectomy and other forms of vertical partial laryngectomy have been used mainly for rescue therapy following radiation failure. Over a 9‐year period selective application of this approach was used in eight patients out of 122 laryngeal cancer surgeries performed. Five patients were T1N0 and three were T2N0 at the time of initial diagnosis and at the time of recurrence.

Three patients had healing problems postoperatively. Tracheal decannulation time was increased compared to patients who had hemilaryngectomy without previous radiotherapy. To date there has been no recurrence of carcinoma at any site with a mean follow‐up of 58 months in surviving patients.

This experience confirms reports which indicate that with careful selection, radiation failures for early glottic carcinoma can be rescued by hemilaryngectomy achieving excellent tumor control and moderately good preservation of laryngeal function.
Vocal cord abduction rehabilitation by nervous selective anastomosis
Authors: Attali J. P. , Henry C. , Urtassun A. , Traissac L. , Gioux M. , Vital C.
Published: October 2006

Laryngeal reinnervation procedures were performed on 15 dogs. An anastomosis was performed between a selected motor branch of the ansa hypoglossi and the posterior cricoarytenoid nerve. The results were analyzed endoscopically, electromyographically, and histologically. Results were satisfactory in 12 cases. The methods and results have been compared with those obtained using other reinnervation techniques.
Laryngeal/voice findings in patients with velopharyngeal dysfunction
Authors: D'Antonio Linda L. , Muntz Harlan R. , Province Michael A. , Marsh Jeffrey L.
Published: October 2006

It is reported frequently that individuals with palatal clefts have a high occurrence of laryngeal/voice symptoms. It has been speculated that vocal pathology in this population is the result of laryngeal compensation for abnormal velopharyngeal valving.

This paper describes the prevalence of laryngeal/voice findings in a group of 85 patients referred for multimethod evaluation of velopharyngeal dysfunction. Forty‐one percent of the patients had auditorily perceived voice symptoms and/or observable laryngeal abnormalities. Twenty‐one percent of the patients had vocal fold nodules or thickened vocal folds. There was no clear relationship between laryngeal/voice findings and nasoendoscopic or aerodynamic assessments of velopharyngeal dysfunction. However, there was a significant relationship between laryngeal/voice findings and estimated subglottal pressure. Patients with laryngeal/voice findings (with or without nodules) had average estimated subglottal pressure values which were outside the normal range more often than patients without laryngeal/voice findings.

These results suggest patients referred for assessment of velopharyngeal dysfunction should receive a comprehensive evaluation which includes screening laryngeal structure and function.
The temporal fossa in head and neck reconstruction: Twenty‐two flaps of scalp, fascia, and full‐thickness cranial bone
Authors: Matsuba Howard M. , Hakki Ayman R. , Little John W. , Spear Scott L.
Published: October 2006

We reviewed 22 consecutive flaps based on the blood supply of the temporal fossa. Our purpose was to demonstrate reliability of the vascular supply and to illustrate the versatility of these tissues for reconstruction of specialized structures, including eyelids, eyebrow, ear, lips, oral lining, orbit, and mandible.

For these complex problems, all but one patient required multiple‐stage surgery to obtain their final aesthetic and functional results. All flaps proved reliable and versatile. Their advantages include proximity to the reconstructive site, ease of bilateral reconstructions, and well‐camouflaged donor deficit. In particular, the ability to transfer vascularized full‐thickness cranial bone for total or bilateral mandibular reconstructions presents an additional possibility for this difficult problem. We conclude that the reconstructive potential of these flaps is limited only by the surgeon's ingenuity.
Long‐term implantation of a system of electrical stimulation of paralyzed laryngeal muscles in dogs
Authors: Bergmann Klaus , Gerhardt H.‐J. , Warzel H. , Eckhardt H.‐U. , Hopstock U. , Hermann V.
Published: October 2006

Electrical stimulation of the posterior cricoarytenoid muscle, synchronized with inspiration, was achieved in dogs utilizing a radio frequency stimulus triggered by a chest wall expansion transducer. This system brings about abduction of the paralyzed vocal cord for the entire duration of inspiration, which allows a normal flow of air through the larynx. The implantable part of that system was tested successfully in chronic experiments (up to 11 months) in dogs with experimental paralysis of the recurrent laryngeal nerve. We feel that the system may be suitable for pacing the paralyzed human larynx.
Vocal fatigue and dysphonia in the professional voice user: Bogart‐bacall syndrome
Authors: Koufman James A. , Blalock P. David
Published: October 2006

Over the past 5 years, the authors have treated 67 adult professional voice users with a musculoskeletal tension disorder involving the larynx and supporting structures and leading to vocal dysfunction. Common clinical features in both sexes were muscle tension in the neck, poor control of the breath stream, and an abnormally low‐pitched speaking voice. Most of the men sounded like Humphrey Bogart and the women like Lauren Bacall. These cases represent a discrete clinical vocal fatigue syndrome, the treatment of which is patient education and voice therapy.
Retrolabyrinthine vestibular neurectomy: A reevaluation
Authors: Mcelveen John T. , Shelton Clough , Brackmann Derald E. , Hitselberger William E.
Published: October 2006

Selective vestibular neurectomy is considered an effective means of relieving intractable vertigo while preserving hearing. In order to determine the effectiveness of the retrolabyrinthine approach to selective vestibular neurectomy, we evaluated 161 patients who underwent vestibular neurectomy between April 1981 and September 1985. Questionnaire responses indicated that 97% of the Meniere's disease patients and 68% of the non‐Meniere's disease patients experienced a substantial improvement or resolution of their vertiginous symptoms. Hearing was maintained within 10 dB of the preoperative level in the majority of the patients. Neurological complications were limited to 2 cases of meningitis which resolved with medical therapy, 7 cases of cerebral spinal fluid leaks, and 3 cases of complete sensorineural hearing loss. Based on this review, we concluded that retrolabyrinthine vestibular neurectomy continues to be a safe and effective approach to relieve ear‐related vertigo.
Induction of HLA‐DR antigen on human squamous carcinoma by recombinant interferon gamma
Authors: Koch Wayne M. , Richtsmeier William J. , Diaz Luis A. , Dugan Elizabeth
Published: October 2006

The antigen recognition system which plays the major role in immunologic attraction mechanisms, including graft rejection, is the class II major histocompatibility complex containing the HLA‐DR locus. Few types of cells constitutively express this antigen, as it is a potent immunological activating signal usually confined to antigen processing cells, activated lymphocytes, and endothelium. Using indirect immunofluorescence, we have observed induction of the HLA‐ DR glycoprotein in selected head and neck squamous cell carcinoma tissue cultures treated with recombinant interferon gamma. This occurs in concert with growth arrest and morphological changes after rHuIFN‐γ treatment. This report describes the induction of a surface antigen that may have profound prognostic significance. Understanding the kinetics of HLA‐DR induction will aid in the design and assessment of adoptive immunotherapy with rHuIFN‐γ.
Incidence of zenker's diverticulum with hiatus hernia
Authors: Gage‐White Linda
Published: October 2006

The concomitant occurrence of Zenker's diverticulum and hiatus hernia in several patients prompted an investigation to determine whether there is a statistically significant increased incidence of hiatus hernia in patients with Zenker's diverticulum.

Radiologic reports contained in 104 charts of patients from the University of Iowa with a diagnosis of Zenker's diverticulum were analyzed retrospectively for the presence of hiatus hernia. Radiologic reports contained in charts of a control group of patients, who had a barium swallow for work‐up of a head and neck malignancy, were also analyzed.

The control group had a 16% incidence of hiatus hernia, which was consistent with published data. The Zenker's diverticulum group had a 39% incidence of hiatus hernia, a statistically significant increase over the control group. The pathophysiology linking these conditions and the clinical implications of their relationship are discussed.