bluuebunny/crossref_metadata_2025 huggingface dataset:
Oncocytic neoplasms of salivary glands: An ultrastructural study
Authors: Johns Michael E. , Regezi Joseph A. , Batsakis John G.
Published: September 2006

The oncocyte is a peculiar cell found in the aging parotid gland. A precise definition of oncocytic tumors is now available using histochemical and electron microscopic techniques. Oncocytic carcinomas are very rare; only a handful have been cited in the literature. This is the first description of the electron microscope features of oncocytic carcinomas we can find in the literature.

The cells of these carcinomas are characterized by mitochondrial hyperplasia, pleomorphism and atypism. The cells contained few other sub‐cellular organelles and no myofilaments or glycogen as previously described in benign oncocytomas. In additon to these electron microscopic features, the clinical presentation, treatment, and biologic course of these three cases of oncocytic carcinoma and two cases of benign oncocytoma will be presented.
Tracheotomy in acute supraglottitis (epiglottitis) : The treatment of choice
Authors: Fearon Blair , Cinnamond Michael
Published: September 2006

The provocative title of this presentation has been chosen quite deliberately, knowing full well that the subject of management of patients with severe airway obstruction is a very controversial one. The views expressed do not necessarily represent those of all of the staff dealing with these problems at the Hospital for Sick Children.
Verrucous carcinoma of the larynx
Authors: Ryan Robert E. , Desanto Lawrence W. , Devine Kenneth D. , Weiland Louis H.
Published: September 2006

Verrucous carcinoma, because of its oftentimes unusual clinical appearance, may be misdiagnosed if there is not good communication between the surgeon and the pathologist. We have reviewed our series of 20 cases of verrucous carcinoma from 1964 through 1974 and have analyzed the results of our therapy. We have concluded that verrucous carcinoma is a slow‐growing, locally invasive lesion that does not metastasize to the cervical lymph nodes. Radiation therapy does not seem to be an effective method of treatment; the recurrence rate is high. Conservative laryngeal surgery is the preferred method of treatment in these patients and should prevent loss of life and spare laryngeal function.
Conservation laryngeal surgery in the elderly patient
Authors: Tucker Harvey M.
Published: September 2006

In the 100 years since Bilroth first undertook a total laryngectomy, general improvements in the prevention and management of childhood and adult disease have led to continuing increase in life expectancy to the point that, in many developed countries, 25% or more of the population is over the age of 65. Although many of these individuals are in otherwise reasonable health, major head and neck procedures are often not performed in favor of radiation therapy for cure, even for lesions that would otherwise be considered amenable to surgery in younger patients, on the grounds that the patient is too old to tolerate the necessary procedure. The same argument has been employed in favoring total laryngectomy over subtotal procedures in the older patient.

Review of the author's experience (27 cases) with conservation laryngeal surgery in patients over the age of 65 at the time treatment was undertaken reveals that such procedures are well tolerated in this age group. There were no mortalities and an overall complication rate of 11.1% resulted. These findings compare favorably with complication rates reported for similar patients and surgery in the under 65 age group and strongly suggest that chronologic age alone need not be a contraindication to such surgery.
Transnasal microsurgical correction of choanal atresia
Authors: Caldarelli David D. , Friedberg Stanton A.
Published: September 2006

Experience with the transnasal microsurgical correction of bilateral congenital choanal atresia is presented. Four case reports are presented to illustrate the advantages of this surgical approach utilizing standard otosurgical instruments and supplemental fiberoptic nasopharyngeal visualization.
An endoscopically‐introducible t‐tube for tracheal stenosis
Authors: Duvall Arndt J. , Bauer William
Published: September 2006

Five cases of tracheal stenosis are presented, and aspects of etiology and pathophysiology of the disease are discussed. A new soft, flexible T‐tube is described along with a method of endoscopic introduction. Although many patients with tracheal stenosis will eventually need tracheal reconstruction, stenting may be definitive in selected cases.
Surgical treatment of chronic suppurative parotitis. a critical review
Authors: Nichols Richard D.
Published: September 2006

Chronic suppurative parotitis, manifest by recurrent acute parotid enlargement and purulent sialorrhea, is usually seen with sialolithasis, sialectasis, or duct strictures. These conditions have a common pathophysiology, the predisposition to infection associated with fluid stasis.

Chronic suppurative parotitis can usually be successfully treated with conservative mechanical and medical measures. Occasionally the disease is severe enough to require vigorous surgical treatment. Parotidectomy is currative and provides tissue to confirm the diagnosis. Because of concern about risk to the facial nerve in parotidectomy, tympanic neurectomy and parotid duct ligation—which theoretically cause atrophy of the gland by interruption of secretomotor nerves or pressure effects—are advocated as alternative treatment.

Basic physiological and clinical studies do not confirm that tympanic neurectomy consistently interrupts all secretomotor nerves to the gland nor that parasympathetic denervation can induce complete atrophy of the gland. Studies of parotid duct ligation also do not conclusively demonstrate that this procedure will induce complete atrophy of the gland. There is a suggestion that it may have some role in protecting an already functionless gland from ascending infection.

Published studies indicate that parotidectomy is the most effective treatment for this disease, and that the risk of permanent facial injury after the operation is slight.

A review of 86 consecutive parotidectomies is reported. Fourteen of the surgical specimens showed inflammatory pathology and 6 of the patients had frank chronic suppurative parotitis preoperatively. The patients with chronic parotitis are asymptomatic 2 to 7 years after parotidectomy and there was no instance of permanent facial paresis after operations done for inflammatory disease.

Parotidectomy is the treatment of choice for chronic suppurative parotitis when it is resistant to conservative measures. Operations such as tympanic neurectomy and parotid duct ligation, which approach the disease in an indirect manner, are not founded on carefully considered basic or clinical information and are of questionable effectiveness. The risk of permanent facial nerve paresis following parotidectomy for inflammatory disease is an important question. Our review indicates that the risk is well within acceptable limits.
Glomus intravagale
Authors: Conley John J. , Clairmont Albert A.
Published: September 2006

Glomus intravagale (paraganglioma of the nodose ganglion and/or vagus nerve) is an unusual tumor. There are approximately 45 cases reported in the literature; the authors report four more cases. This tumor may be associated with other paragangliomas of the head and neck, such as carotid body tumors, and may metastasize to regional lymph nodes, although the histology always appears benign.
“Practical suggestions on facial plastic surgery — how i do it” protic duct transfer in xerophthalmia
Authors: Alonso William A.
Published: September 2006

Xerophthalmia, or dry eye, is an old human affliction. Among the many causes are trachoma, surgical or traumatic destruction of the lacrimal gland, and paralysis of the greater superficial petrosal nerve after Bell's palsy or from the presence or removal of an intracranial posterior fossa tumor. The technique of parotid duct transfer is a well established effective means to rehabilitate the dry eye. A method of parotid duct transfer is described.
Development and degeneration of hearing in the c57/b16 mouse: Relation of electrophysiologic responses from the round window and cochlear nucleus to cochlear anatomy and behavioral responses
Authors: Mikaelian Diran O.
Published: September 2006

In disorders of the auditory organ associated with hearing loss, a correlation of the anatomical, behavioral and electrophysiological studies furnishes the investigator several parameters of study to better comprehend the hearing mechanism and the various anatomical structural dysfunctions that relate to the hearing loss.

Mice are interesting to study because they carry several types of genes for hereditary deafness. Until recently, it was very difficult to train mice for behavioral hearing threshold testing; however, having developed such a method, the next step was to study the normal mice in these three parameters and extend the studies to mice with hereditary hearing loss. The type of mouse studied in this research was the C57/b16 strain which carries such a gene.

The results of the studies indicate that the results of the behavioral and electrophysiological studies relate well to each other, and that light microscopic studies (if taken alone) do not furnish us with the actual functional capability of the structures of the inner ear.

It is recommended (and it would be most valuable) that efforts should be made to collect and study human temporal bones with all three parameters of study for a better understanding of the structures of the human inner ear. Reference is made and recommendations given as to the parameters of studies while performing human electrocochleography.
Radiation therapy of the nasopharynx: A 30 year view
Authors: Loeb William J.
Published: September 2006

A 15 to 30 year follow‐up study has been made of radium therapy to the nasopharynx for Eustachian tube obstruction and serous otitis, with a review of the relevant literature. No malignancies or other complications have been seen or recorded. Objective evaluation leads to the conclusion that this is a safe, effective treatment modality. In spite of this it has been discontinued because of public fear and pressure. A judgement reached for this reason, ignoring scientific medical facts, contains the seeds of decline of quality and effectiveness of medical care.
The double‐membrane break syndrome in sudden hearing loss
Authors: Simmons F. Blair
Published: September 2006

Some patients with sudden hearing loss actually have two membrane breaks, one at the oval or round window and one further inside the cochlea. One may heal spontaneously and the other not, or both, or neither. It is very likely impossible to detect this early from the threshold audiogram, because the intracochlear breaks allows endolymph and perilymph mixing which spreads over much of the anatomically normal cochlea causing diffuse loss of function. This theory is illustrated by three case histories.
“How i do it” — Plastic surgery: Practical suggestions on facial plastic surgery: Technique for construction of facial moulage
Authors: Keenan Joseph P. , Ruiz Jose W. , Snyder G. Gordon
Published: September 2006

The ability to construct a facial moulage is a valuable skill which should be in the armamentarium of every facial plastic surgeon. Recently, there appears to have been a lessening of interest in teaching this skill. Many descriptions of this task have not been adequate to meet the needs of a surgeon, who wished to construct a moulage, without previous training in this technique.

This paper has been written in the hope of filling this void. It will enable one to construct good facial moulages. This technique is simple, practical and useful. It is important to realize that multiple techniques have been used by different people for many years.
Immunologic aspects of otologic disease: An overview
Authors: Schiff Maurice , Yoo T. J.
Published: September 2006

The immunologic explosion has now reached the field of otology. By having better techniques to measure the changes at cellular and molecular levels, it is now possible to devise experiments to show morphologic anatomic changes as well as functional changes.

The demonstration in 1980 (M.S.) that tympanosclerosis could be induced immunologically represents a concrete advancement in immunologic thinking in conceptualization of otologic disease.

In 1974, one of the authors (M.S.) published work dealing with the treatment of vasculitis of immunologic origin for sudden hearing loss. This was aimed at inhibiting the complement cascade from starting its destructive action. Recently, the immunologic challenge in animals demonstrated by changes in the inner ear was shown by one of the authors (T.J.Y.). Such changes were compatible with labyrinthine hydrops, or Meniere's disease, otosclerosis, and sensorineural hearing loss and vestibular dysfunction.
Acute epiglottitis in the adult
Authors: Deeb Ziad E. , Yenson Anthony C. , Defries Hugh O.
Published: September 2006

Acute epiglottitis may be fatal when diagnosis is delayed. The literature stresses data that does not help to predict impending airway obstruction in patients who present with a sore throat, the most consistent presenting symptom among patients with acute epiglottitis. In this review of 80 cases of epiglottitis in adults, almost all patients who presented within eight hours from onset of symptoms required airway intervention, while the majority of those who presented more than eight hours after onset of symptoms never developed acute upper respiratory obstruction and were treated medically or had supportive treatment only. Artificial airway was indicated in all patients who had drooling. There were no fatalities in this series, however, we recommend keeping all patients with acute epiglottitis in an intensive care unit for at least 24 hours after admission.
Revision sphenoidethmoidectomy
Authors: Eichel Berkley S.
Published: September 2006

In 1981, a series of 226 intranasal ethmoidectomy (INE) procedures was reported with a complication rate of 1.8%. Special attention has subsequently been directed to the surgical failures; namely, recurrent nasal polyposis which accounted for approximately 17%. The reason for recurrence in most instances was felt due to failure to do n more thorough posterior ethmoidectomy and enter and clean out the sphenoid sinuses. Subsequently, in all revision cases where a more thorough sphenoidethmoidectomy (RSE) was performed, the overall long‐term success rate raised to better than 90%. Attention to skeletonizing the middle turbinate by stripping mucosa and leaving a thin bony shell is an important technical factor. An attempt is made to leave some of this bony skeletonized medial wall of the middle turbinate as it represents the most crucial landmark in doing the surgery via the intranasal route.

There still remains approximately 8% to 10% of this patient population with nasal polyposis and sinusitis of such severity that surgery has offered only a temporary measure of relief. In dealing with this group it may be necessary to see these patients postoperatively at four to six‐week intervals, carefully suctioning the ethmoid labyrinth and occasionally doing minor office “touch‐up” ethmoidectomy‐polypectomy procedures to clean off redundant mucosa or early polyposis. This paper is written to offer a compromise to the two schools of intranasal ethmoidectomy surgery as to the necessity of removing or not removing the middle turbinate in its entirety.
Surgery for correction of bilateral choanal atresia
Authors: Samuel Julian , Fernandes Carlos M. C.
Published: September 2006

A transnasal approach was employed in 28 neonates (26 blacks and 2 whites) with bilateral choanal atresia. In each patient the atresia was perforated microsurgically with the drill, followed by insertion of a Portex endotracheal tube for a period of three months. By this method a satisfactory nasal respiration was established immediately. Removal of the posterior part of the vomer is crucial to the successful result.

During the follow‐up, one death was recorded in a microcephalic neonate, unrelated to the operation and another four patients required repositioning of the tube under general anesthesia. We feel that the above technique is simple and definitive with negligible complications.
Reconstruction of the eustachian tube and the anterior tympanum: Planned staged tubo‐tympanoplasty
Authors: Murata Kiyotaka , Ohta Fumihiko
Published: September 2006

A new technique is demonstrated in the management of chronic otitis media with inflammatory stenosis of the Eustachian tube. Bone exposure of the Eustachian tubal orifice and peritubal air cells was followed by placement of a long T‐shaped solid silicone plate in this area. Postoperative care was taken to ensure wound healing in the same way as after radical mastoidectomy. At the second stage surgery the Eustachian tube and pretympanum were found to have developed with an intact mucous membrane. A middle ear space with or without reconstruction of the posterior meatal wall and obliteration of mastoidectomy cavity could easily be rebuilt. A sound pressure transformer mechanism could be established at the second stage surgery.
Swimming unprotected with long‐shafted middle ear ventilation tubes
Authors: Lounsbury Benjamin F.
Published: September 2006

Patients, parents, and physicians are all concerned about the risks of swimming unprotected with middle ear ventilation tubes. The risks have not previously been carefully quantified or correlated with the degree of swimming activity. In this study, 53 children with tympanometrically proven patent long‐shafted tubes were allowed to swim unprotected. They suffered six middle ear infections that were clearly caused by swimming. Five of these infections occurred in divers. The rate of infections for divers was approximately one per 100 days of swimming activity. The rate for non‐divers was approximately one per 600 days. Unprotected swimming was well accepted by almost all parents and patients. The need for earplugs for all children who swim with long‐shafted ventilation tubes is questioned.
Identifying the sexually abused deaf child: The otolaryngologist's role
Authors: Brookhouser Patrick E. , Sullivan Patricia , Scanlan John M. , Garbarino James
Published: September 2006

As a primary physician for most deaf children, the otolaryngologist must be able to identify signs and symptoms of sexual abuse. Child sexual abuse is a topic of national concern as epidemiologic data indicate more than 100,000 American children become victims annually. This paper provides an overview of the incidence, demographic characteristics, risk factors, and dynamics of child sexual abuse within both the general handicapped and, specifically, the hearing imparied populations. Strategies for identifying the sexually abused hearing impaired child are delineated including the physical appearance and behavioral manifestations of child victims, as well as the characteristics of abusive caretakers and perpetrators. Case summaries are presented which illustrate these characteristics. A national center specializing in the evaluation and treatment of abused handicapped children is described.
Sudden sensorineural hearing loss following manipulation of the cervical spine
Authors: Brownson Richmond Jay , Zollinger William K. , Madeira Tony , Fell David
Published: September 2006

Review of the otolaryngologic literature reveals no reports of sudden sensorineural hearing loss resulting from manipulation of the cervical spine. Indeed, in previously reported cases of vertebrobasilar artery injury following spinal manipulation, hearing loss has received little attention. Two patients with sudden sensorineural hearing loss following cervical spine manipulation are presented. The audiologic findings and cerebral arteriograms are reviewed and treatment is discussed. A review of the anatomy and pathophysiology is also included, and a possible mechanism of injury to the vertebral artery is proposed.
Electrically evoked potentials in cochlear implant subjects
Authors: Miyamoto Richard T.
Published: September 2006

A series of experiments was performed to study electrically evoked potentials as indicators of subject response to cochlear implantation. 1. Brain stem evoked responses to electrical stimulation were compared to those obtained by acoustic stimulation in guinea pigs. The response pattern was similar and was independent of the site of placement of the stimulus electrode (cochlear base or apex) or of the extracochlear ground electrode (eustachian tube or temporalis muscle) when evoked electrically. 2. Electrically evoked middle latency responses were recorded and compared to subjective behavioral thresholds in patients who had received a single channel cochlear implant (House‐Urban). The behavioral responses to the same stimuli were similar. 3. Electrically evoked auditory brain stem responses were studied in single channel cochlear implant subjects (3M/House). When evoked electrically, potential latencies were shorter and interpeak intervals narrower than acoustically evoked potentials.
A comparison of auditory brain stem evoked potentials in hyperlipidemics and normolipemic subjects
Authors: Ben‐David Y. , Pratt H. , Landman L. , Fradis M. , Podoshin L. , Yeshurun D.
Published: September 2006

Twenty‐five hyperlipidemic, neurologically and audiologically asymptomatic patients were compared to 20 normolipemic control subjects regarding different interpeak latency differences (IPLD) of auditory brain stem evoked potentials (ABEP). ABEP were recorded in response to click stimuli presented at a rate of 10/sec and 55/sec. The net effect of increasing stimulus rate (ISR) on IPLD of ABEP was significantly greater in the hyperlipidemic patients for IPLD (V‐I) and IPLD (III‐I). ISR of ABEP indicates a trend of subclinical impairments of brain stem function in hyperlipidemic patients, probably due to ischemia accelerated by their condition.
Absorbable gelatin film verses silicone rubber sheeting in orbital fracture treatment
Authors: Parkin James L. , Stevens Michael H. , Stringham James C.
Published: September 2006

Orbital floor fractures can result in herniation of orbital tissues and impairment of ocular function. In this experimental study, orbital defects were created surgically in cats. The gross and histologic healing of these defects was compared among animals implanted with silicone rubber sheeting or absorbable gelatin film and animals that received no implants. Both implanted animal groups demonstrated enhancement of healing. The absorbable gelatin film showed less migration, less inflammatory response, and improved healing. This animal study supports the use of absorbable gelatin film in the surgical management of orbital fractures.
Single dose amoxicillin treatment of acute otitis media
Authors: Puczynski Mark S. , Stankiewicz James A. , O'Keefe J. aul
Published: September 2006

A double blind study comparing a single dose of amoxicillin versus a 10‐day course of amoxicillin in the treatment of acute otitis media (AOM) was undertaken. All children diagnosed with AOM in a pediatric clinic were requested to participate. After tympanocentesis was performed, patients were randomly assigned to receive either amoxicillin (100 mg/kg) followed by placebo every 8 hours for 10 days or placebo followed by amoxicillin (40 mg/kg/D) for 10 days. Patients returned to clinic on days 3 and 10 post‐treatment.

Seventeen patients were enrolled: 7 received single dose therapy and 10 received 10 days of therapy. There were no failures in the control group and 3 failures in the single dose group (day 5, day 6, and 11) (p=0.05). Middle ear isolates included: S. pneumoniae 7, H. influenzaa 4, B. catarrhalis 1, and no pathogen in 5. Due to the significant number of failures in the treatment group, the study was prematurely terminated.

Our study shows that single‐dose amoxicillin is not adequate treatment for AOM.
Multichannel intracochlear electrodes: Mechanism of insertion trauma
Authors: Kennedy David W.
Published: September 2006

Cochlear damage from electrode insertion, a potential cause of further neural degeneration, is a major concern in the use of intracochlear electrodes. A study was undertaken to evaluate mechanisms by which damage may occur. Fresh human temporal bone preparations were created to allow direct intracochlear observation during round window insertion of a free‐fitting multichannel intracochlear electrode array. The path taken by the electrode, point of first resistance, and any resulting damage were documented.

Tips of study electrodes in this preparation tended to embed in the outer wall of the scala tympani. The integrity of the basilar partition was largely maintained during insertion when this was stopped at the point of first resistance. However, insertion beyond the point of first resistance typically resulted in widespread damage to intracochlear structures.
Intraoperative real‐time monitoring of brain stem facial evoked response (BFER)
Authors: Hammerschlag P. E. , Berg H.M. , Cohen N.L. , John E. R. , Prichep L. S. , Ransohoff J.
Published: September 2006

Injury to the facial nerve is of concern in surgery of cerebellopontine angle tumors. The crossed acoustic reflex provides a way to monitor the ipsilateral facial nerve with the auditory stimuli delivered to the contralateral side. Using the method of optimum digital filtering, it is possible to monitor the resulting brain stem facial evoked response (BFER) in real time. This paper presents preliminary experiences in more than 18 such operations monitored using this method. This preliminary study demonstrates a trend for a high (88.8%) correlation between BFER and postoperative facial nerve function. Identical latencies from simultaneous BFER and facial nerve recordings along with findings after facial nerve transection suggest that some portion of the complex BFER waveform derives from facial nerve depolarization.
Experimental autoimmune sensorineural hearing loss
Authors: Harris Jeffrey P.
Published: September 2006

Alterations in host immunity result in a number of disorders affecting multiple organ systems, including the inner ear. The mechanism of injury is poorly understood; as such, this study investigated whether an experimental model of autoimmune sensorineural hearing loss (ASNHL) could be established. Animals were immunized with heterologous inner ear antigen and then evaluated for evidence of evolving inner ear autoimmunity. These animals uniformly developed antibodies to inner ear antigen in their sera and perilymph and 12 of 38 ears showed significant increases in action potential thresholds. Histopathological lesions consisted of loss of cochlear neurons, perivascular plasma cell infiltrates, edema, and extravasation of erythrocytes. These findings are characteristic of autoimmune injury and suggest the establishment of an experimental model of ASNHL in which to further investigate this clinical disorder.
A prospective evaluation of speaking tracheostomy tubes for ventilator dependent patients
Authors: Sparker Ann W. , Nevlud Gail N. , Watkins Carol N. , Robbins K. Thomas , Jahrsdoerfer Robert A.
Published: September 2006

The effectiveness of speaking tracheostomy tubes for ventilator dependent patients has not been clearly established. Only a few reports by authors using the device are available. We describe our experience with 23 patients who were evaluated for insertion of the speaking tracheostomy tube. Nineteen patients were determined to be appropriate candidates and we observed significant benefits from its use in 15 of these patients. The major problems were air leaks around the cuff, nonavailability of smaller sizes, and dependence on an assistant during its use. Careful screening is important when selecting candidates for the device since inappropriate selection may cause further frustration and a sense of failure for the patient.
Discrepancies between clinical and histopathologic diagnoses in T3 pyriform sinus cancer
Authors: Tani Mitsutake , Amatsu Mutsuo
Published: September 2006

The various ways in which pyriform sinus cancer extends to laryngeal structures were analyzed by whole‐organ serial‐sectioning. The problems regarding vocal cord fixation (T3) by this cancer are discussed.

This study found that vocal cord fixation in pyriform sinus cancer is due mainly to the involvement of the intrinsic laryngeal muscles and not to the involvement of the arytenoid cartilage or the cricoarytenoid joint.

A tumor originating in the medial wall tends to extend medially and to invade the intrinsic laryngeal muscles. This causes vocal cord fixation (T3) before classification as T2. However, a tumor originating in the lateral wall extends laterally beyond the thyroid ala (T4) with a mobile cord. Therefore, it is suggested that the T classification of the vocal cord fixation (T3) of pyriform sinus cancer may not reflect the actual cancer involvement.
A comparison of retrosigmoid iac, retrolabyrinthine, and middle fossa vestibular neurectomy for treatment of vertigo
Authors: Silverstein Herbert , Norrell Horace , Haberkamp Thomas
Published: September 2006

A new procedure, the retrosigmoid internal auditory canal (IAC) vestibular neurectomy has been developed and presented. It involves a 3‐cm retrosigmoid craniotomy removing the posterior wall of the IAC to the singular canal, with transection of the superior vestibular nerve and posterior ampullary nerve. This produces a complete denervation of the vestibular labyrinth and preserves the patient's hearing. All ten patients with Meniere's disease had their vertigo cured. Hearing was preserved to within II dB of the preoperative pure tone average in 9 of 10 cases. There were no serious complications, no cases of facial paralysis, and no cases of total hearing loss. These results compare favorably with the MFVN and the RVN. The retrosigmoid IAC vestibular neurectomy is an important improvement in the evolution of vestibular neurectomy for the treatment of vertigo.
Polymorphous low‐grade adenocarcinoma of the tongue
Authors: Kennedy Kevin S. , Healy Katheleen M. , Taylor Robert E. , Strom C. G.
Published: September 2006

Primary adenocarcinoma of the oral cavity is an infrequently encountered problem. Adenocarcinomas are distinctive lesions which can be subclassified according to their tissue growth patterns or histomorphology. The polymorphous low‐grade adenocarcinoma of the oral cavity is usually of minor salivary gland origin. We present an unusual case of polymorphous low‐grade adenocarcinoma of the tongue and add this case to the existing two previous reports in the literature. A review of the current literature concerning this tumor is included. Treatment presently consists of complete local excision followed by radiation therapy.
Langerhans' cell histiocytosis of the head and neck
Authors: Anonsen Cynthia K. , Donaldson Sarah S.
Published: September 2006

Langerhans' cell histiocytosis has been accepted by many to replace the term Histiocytosis X, describing a poorly defined continuum of diseases involving neoplastic proliferation of histiocytes. Twenty‐four cases of histologically confirmed Langerhans' cell histiocytosis with head and neck involvement were seen between the years 1970 to 1986, and charts were reviewed retrospectively. Control of local osseous disese was successful using radiation therapy in 100% of those cases with follow‐up. Surgical curettage of bone lesions was successful in a small number of cases. Chemotherapy alone or in combination with radiation appeared to enhance survival in patients with recurrent disease or multisystem involvement. Sixteen of the 24 patients (67%) are disease free with a mean follow‐up of 6 years. Prompt diagnosis and careful follow‐up are important to improve survival and prevent complications.
Hyperfrequency of pulmonary cancer in a population of 415 patients treated for laryngeal cancer
Authors: Christensen Per‐Henrik , Joergensen Karsten , Munk Jens , Oesterlind Anne
Published: September 2006

Four hundred fifteen patients with laryngeal cancer were treated mainly by primary irradiation from 1965 to 1983, at the Radium Centre of Odense. By December 31, 1983, a total of 32 patients had developed pulmonary cancer. The Danish Cancer Registry calculated the expected number of pulmonary cancer in a population of the same composition from the same period of time and the same geographical locale. A statistically significant hyperfrequency of pulmonary cancer among males was found, most pronounced among supraglottic cases: 6.73. Furthermore, a cumulative estimation of the risk of developing pulmonary cancer as a function of follow‐up revealed a risk of 26% during the first 14 years of follow‐up. The only effective way to solve the problem is to stop smoking.
Outcome of locally advanced stage III and IV head and neck cancer treated by surgery and postoperative external beam radiotherapy
Authors: Kumar P. Pradeep , Good Roger R. , Yonkers Anthony J. , Epstein Barry E. , Ogren F. Paul , Moore Gary F.
Published: September 2006

An uncontrolled retrospective analysis of 76 patients with locally advanced Stage III and Stage IV squamous cell carcinoma of the oral cavity, oropharynx, pyriform sinus, suproglottic larynx, glottic larynx, and hypopharynx, who were treated in a uniform manner by surgical resection and 6,600 rad postoperative external beam radiotherapy, revealed relatively high 2‐year and 4‐year adjusted survival rates of 76% and 68%, respectively. Complication rates were acceptable (8%). The advantages of this treatment approach for locally advanced head and neck cancers compared to treatment by surgery alone are discussed.
Diagnostic and therapeutic efficiency in croup and epiglottitis
Authors: Hodge Kenneth M. , Ganzel Toni M.
Published: September 2006

Croup and epiglottitis continue to be potentially life‐threatening diseases in children. Early distinction is imperative as definitive treatment differs significantly.

To determine the correlation of various clinical features, x‐rays, and laboratory tests with diagnosis and management planning, a retrospective chart analysis of 194 children with croup (N=169) and epiglottitis (N=25) was performed.

The clinical history and physical findings were most important in differential diagnosis. Patient age, lateral neck x‐ray, and white blood count (WBC) strongly correlated with diagnosis. Counter immunoelectrophoresis (CIE) results did not alter therapy. No blood cultures were positive unless the patient had: 1. WBC over 15,000 with more than 10 stabs, 2. WBC over 20,000, or 3. WBC with more than 20 stabs. Ampicillin resistent H. influenzae occurred in 21% of positive blood cultures. Capillary blood gases did not correlate with clinical need for intubation.

It is suggested that a selective evaluation of patients with epiglottitis and croup can be performed in a more cost‐effective manner without sacrifice in patient care.
Combined otolaryngological and neurosurgical approach in treating sinus fractures
Authors: Denneny James C. , Davidson William D.
Published: September 2006

Frontal sinus injury in patients with closed head trauma is significant. Fractures of the anterior and posterior table as well as injury to the nasofrontal duct system requiring exploration, and often times obliteration of the frontal sinus, are not uncommon. Some patients present with frontal sinus damage along with intracranial pathology that requires craniotomy for treatment of the intracranial problem. In these patients, the neurosurgeon typically performs a bifrontal scalp flap to expose the cranium.

A bone flap that transects the superior margin of the frontal sinus is then elevated and removed. This allows direct visualization of the anterior and posterior sinus walls and both nasofrontal ducts, subsequently facilitating reduction of fractures, debridement, and obliteration or ablation, if necessary, without creating another bone flap. The surgeon gets an overall picture of the sinus without the added trauma associated with the creation of an osteoplastic flap.
Early vocal cord carcinoma in obese patients: A surgical lesion
Authors: Moore Dennis M. , Juillard Guy J. F. , Ward Paul H.
Published: September 2006

Early epidermoid carcinoma of the vocal cord is treated successfully by radiation therapy with high 5‐year survival rates, low morbidity, and preservation of excellent voice quality in most cases. Typically, surgery is reserved for salvage of radiation failure and provides overall 5‐year survival rates of 98% and 90% for T1 and T2 lesions, respectively. The extremely obese patient, often with a short neck and excessive amounts of subcutaneous fat, is difficult for both radiotherapist and surgeon to diagnose and treat. The recent observation of an unusually high rate of radiotherapy failure in a cluster of obese patients with early vocal cord cancer called attention to this problem. Because the larynx is near the thoracic inlet in obese patients, they are not suitable for administration of radiotherapy by accurate opposed lateral portals. The patients reported herein were treated entirely with anterior oblique portals. Of the five obese patients who underwent primary radiation therapy for early vocal cord cancer, three developed recurrent disease (60%) and a fourth developed a severe perichondritis requiring tracheostomy. Two patients with recurrent disease were successfully salvaged with total laryngectomy, while the third patient refused surgery and died 2 years later. The sixth patient was treated by partial laryngectomy with imbrication reconstruction and is alive and without evidence of disease 2 years following surgery.

Recurrence rates and complication rates following primary radiation therapy for early vocal cord cancer appear to be unacceptably high in obese patients treated with anterior oblique portals. Therefore, we recommend primary conservation laryngeal surgery for obese patients with early vocal cancer who cannot undergo “standard” radiotherapeutic techniques.
Hypoglossal‐facial nerve anastomosis and electromyographic feedback rehabilitation
Authors: Hammerschlag Paul E. , Brudny Joseph , Cusumano Robert , Cohen Noel L.
Published: September 2006

Electromyographic (EMG) feedback has been proposed to enhance rehabilitation following hypoglossal‐facial nerve anastomosis. Sixteen of 25 patients who underwent hypoglossal‐facial nerve anastomosis with and without postoperative EMG rehabilitation were videotaped for evaluation of facial movement by four observers unaware of these patients' rehabilitation therapy. Using a House Facial Nerve Grading System and intragroup comparison, a trend discernible in this preliminary study indicates a chance for better facial function with EMG feedback rehabilitation.
Head and neck findings in pediatric acquired immune deficiency syndrome
Authors: Williams Michael A.
Published: September 2006

Since the initial reports of an immune deficiency syndrome affecting certain segments of the adult population (homosexual males, bisexual males, intravenous drug abusers, prostitutes, hemophiliacs, Haitian immigrants), a specific group of pediatric patients with an identical immunologic picture has been identified.

This report describes the head and neck findings seen in a group of these pediatric patients. Ninety percent were microsomic. Developmental delay occurred in 90%. Inflammatory ear disease occurred in 80%. Lymphocytic interstitial pneumonia and mucocutaneous candidiasis each occurred in 80%, cortical atrophy in 60%, cervical adenopathy in 40%, and parotid enlargement in 30%. The otolaryngologist may be called upon to evaluate patients with pediatric acquired immune deficiency syndrome (PAIDS), and therefore, should be familiar with the head and neck manifestations of this disease.
Persistence of injectable collagen in the human larynx: A histopathologic study
Authors: Ford Charles N. , Gilchrist Kennedy W. , Bartell Thad E.
Published: September 2006

This is a report of the histologic findings in a human larynx that had undergone collagen injection for glottic insufficiency 14 months prior to autopsy. The patient's management before augmentation with collagen included extended supraglottic laryngectomy, radiation therapy, and Polytel® injection. Connective tissue changes secondary to other forms of treatment were apparent bilaterally and changes limited to the site of collagen injection were identified.

There have been reports of persistence of injected collagen in the canine larynx at 1 year but this is the only study documenting persistence in a human subject. The implant appeared homogeneous and was easily distinguished from host collagen and the reactive fibrosis associated with particulate Polytel®. These findings are similar to those observed in the canine model and suggest that there is persistence of injected collagen in the human larynx.
Swimming and tympanostomy tubes: A prospective study
Authors: Becker Gary D. , Eckberg Theodore J. , Goldware Ross R.
Published: September 2006

To prevent ear infection, many physicians advise their patients to avoid water after insertion of tympanostomy tubes. This advice is a logical extension of the supposition that contaminated water entering the middle ear through the tube may cause an infection.

While tympanostomy tubes have been in widespread use for over 30 years, very few prospective clinical trials have evaluated their use while swimming. This study evaluated 85 patients with tympanostomy tubes divided into three groups: swimming without earplugs, swimming with earplugs, and no swimming. The infection rates were 16%, 30%, and 30% in the three groups, respectively. We conclude that swimming without earplugs does not result in an increased incidence of middle ear infections.
Thyroglossal duct cysts that mimic laryngeal masses
Authors: Slotnick David , Som Peter M. , Giebfried Joseph , Biller Hugh F.
Published: September 2006

Thyroglossal duct cysts are the most common nonodontogenic cysts to occur in the neck, and they often are situated in close proximity to the larynx. Despite this, they almost never present as an intralaryngeal mass. Three cases are cited in which intralaryngeal examination suggested that a larynx lesion was present. In two cases, a submucosal supraglottic mass was seen, while in the third case, the thyroid cartilage was eroded and a laryngeal malignancy was suspected. The role of CT in diagnosing and mapping these tumors is discussed.
On buying a telescope for videolaryngoscopy
Authors: Painter Colin , Komiyama Sohtaro
Published: September 2006

The purpose of this article is to compare aspects of the performance of three widely‐used rigid laryngoscopy telescopes.

The Nagashima SFT‐I, Wolf 4450.57, and Karl Storz 8702 D were used with a JVC GX‐N8U camera and Panasonic PV 8600 VCR to make recordings of a one‐tenth‐inch grid at various distances between the lens and the grid and at two telescope holding angles.

Measurements were made of the anteroposterior and mediolateral viewing fields at all distances and holding angles on maximum and minimum zoom.

The telescopes were compared for viewing field, lens angle effects, holding angle effects, plane distortion effects, effects due to lens distance, color, edge definition, focus control, light source compatibility, stroboscopic use, cross‐sectional diameter, fogging, and cost.

An overview enables laryngologists to assess their needs before buying.
Endolymphatic mastoid shunt for meniere's disease: Do results change over time?
Authors: Goldenberg Robert A. , Justus Molly A.
Published: September 2006

In 1983, results of a 5‐year study using the endolymphatic mastoid shunt for treatment of Meniere's disease were reported. Forty‐eight patients were followed for between 1 and 5 years postoperatively, and 81% obtained satisfactory relief of vertigo. In the present analysis, 24 of these patients responded to a questionnaire, participated in a direct interview, and completed audiometric evaluations at 7 to 11 years after surgery. Eighty‐three percent of these patients reported satisfactory relief of their vertigo. Results for hearing, tinnitus, and limitation of activities also varied little between the initial study and this longer‐term follow‐up. Studies with shorter follow‐up appear valid in predicting longer‐term results. These findings support the American Academy of Otolaryngology—Head and Neck Surgery's recommendation of a 2‐year follow‐up period for reporting results of therapy for Meniere's disease.
Changes in auditory function associated with 2‐cyano‐butyl‐acrylate adhesive implanted in the middle ear of experimental animals
Authors: Zikk Daniel , Rapoport Yoram , Himelfarb Mordechai Z.
Published: September 2006

The effects on auditory function caused by the implantation of 2‐cyano‐butyl‐acrylate adhesive in the middle ear was investigated in experimental animals. Auditory brain‐stem responses to click stimuli were used to measure hearing thresholds prior to and following implantation of 2‐cyano‐butyl‐acrylate adhesive in the middle ear of guinea pigs. A permanent and deep threshold shift observed at 2 months in 62% of the examined animals, suggested that this tissue adhesive is an ototoxic middle ear implant material and should not be considered in reconstructive middle ear surgery. The functional data correlate well with some of the previous morphological observations.
Conservative management of adult epiglottitis
Authors: Wolf Michael , Strauss Bernardo , Kronenberg Jona , Leventon George
Published: September 2006

A 10‐year retrospective study of 30 adults suffering from acute epiglottitis is reported. Two clinical forms of onset were noted: gradual and accelerated. Abscess formation was present in 27% of cases. None of the patients required intubation or tracheotomy. In contrast to the accepted interventionist approach in children, conservative management in adults is recommended.
A technique for reembedding celloidin sections for electron microscopy
Authors: Portmann Didier , Fayad Jose , Wackym Phillip A. , Shiroishi Hiroko , Linthicum Fred H. , Rask‐Andersen Helge
Published: September 2006

A new technique for reembedding celloidin sections of human temporal bones for transmission electron microscopy is described. It consists of four steps: 1. loosening of celloidin sections from glass slides with use of xylene and dissection of the area of interest, 2. removal of celloidin with use of clove oil, 3. staining with 1% osmium tetroxide and 1% tannic acid, and 4. embedding in epoxy resin.

Autolytic changes were seen due to poor fixation. TEM of reembedded celloidin sections of optimally fixed tissue revealed that the celloidin‐embedding procedure affected ul‐trastructural preservation to some degree. This included less well‐preserved cell membranes and some increased electron density of the cytosol decreasing the EM resolution of intracytoplasmic organelles. The technique allows TEM analysis of the intact labyrinth at all regions in the same specimen without dissection of the fragile tissue components of the membranous labyrinth. This might make the technique useful for processing freshly fixed human inner ear tissue and temporal bones for ultrastructural histo‐pathological analysis.
Titanium elastic nailing of fractures of the femur in children
Authors: Moroz L. A. , Launay F. , Kocher M. S. , Newton P. O. , Frick S. L. , Sponseller P. D. , Flynn J. M.
Published: September 2006

Between 1996 and 2003 six institutions in the United States and France contributed a consecutive series of 234 fractures of the femur in 229 children which were treated by titanium elastic nailing. Minor or major complications occurred in 80 fractures. Full information was available concerning 230 fractures, of which the outcome was excellent in 150 (65%), satisfactory in 57 (25%), and poor in 23 (10%). Poor outcomes were due to leg-length discrepancy in five fractures, unacceptable angulation in 17, and failure of fixation in one. There was a statistically significant relationship (p = 0.003) between age and outcome, and the odds ratio for poor outcome was 3.86 for children aged 11 years and older compared with those below this age. The difference between the weight of children with a poor outcome and those with an excellent or satisfactory outcome was statistically significant (54 kg vs 39 kg; p = 0.003). A poor outcome was five times more likely in children who weighed more than 49 kg.