bluuebunny/crossref_metadata_2025 huggingface dataset:
Preschool Otologic and Audiologic Screening
Authors: Hopkinson Norma T. , Schramm Victor L.
Published: April 2016

A study of otologic and audiologic screening of preschool children including tympanometry, acoustic reflexes, and pure‐tone screening was carried out at school sites. Subsequent pure‐tone threshold tests and otolaryngologic examinations were carried out in a hospital setting.

Complete data are available on 1,335 subjects, ages 3 through 5 years. Results are reported in comparison with those of an earlier Pittsburgh screening study.1 The results of the earlier study showed that loss of hearing sensitivity could not be predicted by the otologic findings, and conversely, the otologic findings could not be predicted by the air conduction thresholds. The results of the present study showed a contribution by tympanometry and acoustic reflexes. The results are evaluated in terms of screening effectiveness in these age groups. One of the recommendations combines an interpretation of certain large negative tympanometric peak pressures (TPP) along with the absence of acoustic reflexes to certain stimuli. The method is more efficient than other aspects of middle ear measurement or of pure‐tone screening.

The efficiency of each procedure is documented. Summary matrices are used to show the effectiveness of each test compared to all other tests in the identification of subjects with hearing or middle ear dysfunction. A protocol for screening evaluation and otologic referral is suggested to effect a balance between over‐referral and correct identification.
Sterile Preparation of the External Auditory Canal with Povidone‐Iodine
Authors: Balkany Thomas J. , Berman Stephen A. , Watson William J.
Published: April 2016

Sterile preparation of the external auditory canal is usually not undertaken, although the external auditory canal provides surgical access for several procedures involving the tympanic membrane, middle ear, and vestibule. This is due to the rarity of postoperative wound infections, as well as difficulty in sterilizing the external auditory canal.

Four antiseptic solutions commonly used for operative preparation were tested to determine their potential for sterilizing the external auditory canal. Povidone‐iodine solution was effective in sterilizing 90% of the external auditory canals of children and adults. This simple technique may find clinical use in surgical procedures involving the external auditory canal.
Pediatric Jaw Fractures: Indications for Open Reduction
Authors: Krausen Anthony S. , Samuel Martin
Published: April 2016

Jaw fractures in children are generally managed without major surgical intervention. Closed reduction usually is sufficient to restore normal anatomy and function. The one inviolate principle is early treatment.

During the past three years, four pediatric jaw fractures that required open reduction were treated. This mode of treatment was necessitated by the limitations imposed by pediatric dental anatomy and by the type of fractures encountered. In at least 24 months of follow‐up, no dental problems have been seen.
Fenestration Tympanoplasty: An Adjunctive Technique for Hearing Restoration
Authors: Blatt Irving M.
Published: April 2016

Two‐staged fenestration tympanoplasty is a form of total tympanoplasty type V that incorporates the mastoidotympanomastoidectomy (radical mastoidectomy) and revives the Lempert horizontal semicircular canal fenestration operation. It is valuable when the usual and customary single or two‐staged tympanoplasty procedures fail to conserve or restore hearing in the operative management of otitic disease.

Two‐staged fenestration tympanoplasty is also indicated in audiometric failure tympanoplasties, in oval window surgery failures in the absence of supporting ossicles and in the presence of a fibrosed or sclerosed oval window, and in severe otitic oval window‐round window‐posterior tympanic recess‐tympanic orifice eustachian tube infection, which can only be completely removed by the mastoidotympanectomy.

Total tympanoplasty type V as described here has produced serviceable hearing for human conversation and the speech frequencies to the 15‐dB to 25‐dB levels, and a 20 dB average in 19 of 21 patients operated on for a 90% success rate.
Bleomycin
Authors: Lester Eric P. , Matz Gregory J.
Published: April 2016

Chairman's Comments: The Otolaryngology Drug Capsule, a popular part of the Academy's publication, the Perceived, is being transferred to otolaryngology and head and neck surgery at the request of the editors of the Journal. This capsule is sponsored by the Committee on Drugs—Otolaryngology and represents a continuing effort by its membership.

In this issue the clinical pharmacology of the useful antitumor drug, Bleomycin, is reviewed by Eric P. Lester, MD, and Gregory J. Matz, MD, from the University of Chicago.
Angiosarcoma of the Head and Neck
Authors: Cochran John H. , Fee Willard E.
Published: April 2016

Angiosarcomas are uncommon tumors of the skin and soft tissues, but occur in endothelial cells of almost any internal organ. When they occur in the skin, the head and neck are the most common sites of origin. Nothing is pathognomonic about their clinical presentation, and the pathologic diagnosis can only be established by biopsy. The frequent multicentric nature of the tumor and propensity for extensive subcutaneous spread require wide treatment fields, whatever the modality of therapy, and account for the low survival reported. Four cases and their outcome are reported, with only one patient achieving an apparent cure following irradiation therapy. Based on experience and extensive review of the literature, a best therapeutic approach cannot be recommended. Since the outlook for cure is so unfavorable, there appears to be a need for cooperative studies using surgery, Irradiation, and perhaps, chemotherapy.
Cutaneous Basosquamous Carcinoma of the Head and Neck: A Comparative Analysis
Authors: Schuller David E. , Berg John W. , Sherman Gary , Krause Charles J.
Published: April 2016

Considerable debate has taken place concerning cutaneous basosquamous carcinomas. Some authors believe they are merely a variant of basal cell carcinoma, based on the apparent rare occurrence of metastases. This comparative study of 33 cases of basosquamous, 1, 7% cases of basal cell, and 736 cases of squamous carcinomas arising in the head and neck demonstrates that the basosquamous lesion has the potential to recur and to metastasize, which is similar to squamous cell lesions. An aggressive primary treatment program is recommended.
Implications of Ewald's Second Law for the Evaluation of Vestibular Function
Authors: Kim Young S. , Lau Clifford G. Y. , Jenkins Herman A. , Honrubia Vicente
Published: April 2016

The significance of Ewald's second law in the evaluation of the vestibulo‐ocular reflex (VOR) was Investigated using the transfer characteristics of the vestibular and VOR systems in normal rabbits and rabbits in which one horizontal semicircular canal had been blocked. The transfer characteristics of the vestibular system were derived from the experimental results reported by Goldberg and Fernandez in 1971. A comparison was made of the properties of the bilateral and monolateral VOR systems with the predictions of a piecewise linear model of the vestibular system. The data received quantitatively collaborate the prediction of Ewald's second law as ft applies to the VOR responses.
Olivocochlear Bundle Activity Recorded in Awake Cats
Authors: Banks William F. , Saunders James C. , Lowry Louis D.
Published: April 2016

Multi‐unit activity was recorded in awake cats from the crossed olivocochlear bundle (COCB). Miniature stainless steel concentric electrodes were chronically implanted onto the floor of the fourth ventricle of six animals. There was no activity at the electrode tip in anesthetized animals, while in awake cats a great deal of unit activity could be seen. A correlation between COCB activity and ongoing behavioral activity such as scratching, grooming, yawning, vocalizing, or orientation could not be established. It was found, however, that the multi‐unit responses in the COCB statistically increased their firing rate during acoustic stimulation, and a 500‐Hz tone was found to be most effective. The electrode locations were histologically confirmed. The present results are similar to other data that describe unit activity in the olivocochlear bundle of decerebrate cats. The capacity to record from this fiber tract in awake animals, however, provides a new tool for studying the peripheral efferent pathway of the auditory system.
Some Tips on Face‐Lifting
Authors: Anderson Jack R. , Johnson Calvin M.
Published: April 2016

The face‐lift operation is not difficult for the well‐trained otolaryngologist. However, as in every surgical procedure, there are certain techniques that facilitate its performance and improve results. This paper discusses some of these techniques that have been developed during the past 20 years.
Moire Topography in Facial Plastic Surgery
Authors: Karlan Marc S. , Madden Michael
Published: April 2016

Moire topography, a form of biostereometrics, is a technique that provides one‐step contour maps. Facial measurements so obtained may be useful in reconstructive surgery.
The Tenacity of The Frontal Sinus Mucosa
Authors: Donald Paul J.
Published: April 2016

A number of persons in other surgical disciplines express a blatant disregard for the potential dangers of frontal sinus mucosal entrapment. Although bone removal is universally recommended by the otolaryngologic proponents of ablative procedures in the frontal sinus, no comprehensive explanation has been proffered to justify this dictum.

To this end, 27 cats had simple excision of the frontal sinus mucosa to see if it is necessary to bur away the inner table of bone to completely eliminate all vestiges of mucosa. Mucosal regrowth was seen in 72%, and suppurative infection, in 17% of the sinuses. Burring away of the frontal sinus inner table must then be considered as an essential part of any ablative procedure of the frontal sinus.
Posterior Cranial Fossa and Temporal Bone Meningioma in a Child, Appearing as a Neck Mass
Authors: Maniglia Anthony J. , Page Larry K.
Published: April 2016

Meningiomas are usually benign lesions that rarely involve the temporal bone and rarely occur in children or adolescents. A case of a posterior cranial fossa and temporal bone meningioma in a 9‐year‐old girl is presented; no similar case was found in the world literature.
Radiation‐Induced Carcinoma in a Hemangioma
Authors: Fredrickson John M. , Haight J.S.J. , Noyek Arnold M.
Published: April 2016

A case of squamous cell carcinoma arising in repeatedly irradiated buccal hemangioma is reported, and the surgical techniques used in reconstructing the cheek and lips are described.
Ganglioneuroma of the C4, C5 Interspace
Authors: Norris Charley W.
Published: April 2016

Neurogenic tumors in the neck region are relatively infrequent with the exception of those involving the cranial nerves. A case of a ganglioneuroma or neurofibroma involving the nerve root of C4, C5 interspace is reported. The tumor appeared as a mass within the neck with a slight amount of pain in the shoulder and upper arm upon palpation. Surgical exploration revealed a mass superficial to the foramen and erosion of the foramen. Roentgenograms taken in the region demonstrated an extradural mass that was subsequently removed by laminectomy. Postoperatively, the patient did quite well. Surgical excision is the treatment of choice. Preservation of the nerve should be accomplished if at all possible.
Malignant Fibrous Histiocytoma of The Larynx
Authors: Keenan Joseph P. , Snyder G. Gordon , Toomey James M.
Published: April 2016

Fibrous histiocytoma is a rare mesenchymal tumor. The origin is believed to be a pleuripotential cell, histiocytic in type, which can evolve into a facultative fibroblast under certain conditions. A case of a malignant fibrous histiocytoma in the subglottic larynx is reported. At present, the clinical behavior and degree of malignancy cannot be predicted. It appears that wide, local excision of the tumor with a margin of normal tissue is the treatment of choice. Regional block dissection of lymph nodes is not indicated unless clinically palpable nodes are present.
Radiation‐Induced Carcinoma of the Temporal Bone
Authors: Applebaum Edward L.
Published: April 2016

A case of a patient in whom carcinoma of the right temporal bone developed 39 years after a series of injections of radium chloride is presented. Carcinomas of the temporal bone and paranasal sinuses are a complication of radium administered therapeutically or ingested accidentally by watch dial painters.
Catastrophic Necrosis of The Neck
Authors: Conley John J. , Baker Daniel C.
Published: April 2016

This case report illuminates the high possibility of catastrophic complications in the lateral neck, the vagaries associated with the preoperative therapeutic information, the technical effort to gain maximum surgical security, and the overwhelming complications associated with chemotherapy, irradiation, and surgical intervention.
Chondrosarcoma of The Nasal Septum Extending into The Maxillary Sinus
Authors: Peppard Sean B. , Matz Gregory J.
Published: April 2016

A case of chondrosarcoma of the nasal septum extending into the maxillary sinus is presented. These cartilaginous tumors are rare in the head and neck, with only 21 reported in the maxilla and four in the nasal septum. Careful histologic analysis is required for correct diagnosis. The present case was treated with an en bloc ethmoidectomy and medial maxillectomy, followed by fast neutron radiation therapy. The therapeutic program is analyzed for opportunity to provide an excellent chance of cure.
Basal Cell Carcinoma of The Temporal Bone
Authors: Parkin James L. , Stevens Michael H.
Published: April 2016

A case of a 57‐year‐old man with a 25‐year history of untreated basal cell carcinoma of the ear is presented. The lesion resulted in auricular destruction and temporal bone invasion. This case emphasizes the potential destructive ability of basal cell carcinoma. Extensive resection and reconstruction were required for control.
Multiple Simultaneous Paragangliomas of The Head and Neck in Association with Multiple Retroperitoneal Pheochromocytomas
Authors: Bogdasarian Ronald S. , Lotz Preston R.
Published: April 2016

A patient in whom multiple, familial, catecholamine‐secreting head and neck paragangliomas and retroperitoneal pheochromocytomas were identified is reported. There were at least nine primary and possibly five recurrent neoplasms, the most reported in a single patient.

In patients with family history of pheochromocytoma or paraganglioma or with multiple tumors, careful laboratory and angiographic studies are indicated to discover additional lesions.
Malignant Parapharyngeal Schwannoma (Neurilemmoma)
Authors: Shapiro Myron J. , Rickert Robert R.
Published: April 2016

A malignant parapharyngeal neurilemmoma developed in a 45‐year‐old woman who had had a benign solitary neurilemmoma removed from the same area nine years previously. Incomplete excision was achieved through a mandibulotomy approach.

Malignant schwannoma usually is associated with neurofibromatosis and has a poor prognosis, spreading along the nerve of origin or by blood stream. Small localized tumors should be treated aggressively by surgery.

The possibility that a previously benign schwannoma underwent malignant transformation must be considered.
Element Content of Intracochlear Fluids, Outer Hair Cells, and Stria Vascularis as Determined by Energy‐Dispersive Roentgen Ray Analysis
Authors: Ryan Allen F. , Wickham M. Gary , Bone Robert C.
Published: April 2016

Roentgen ray spectrometry was used to obtain element spectra from isolated samples of perilymph, endolymph, outer hair cells, and stria vascularis obtained by microdissection from the freeze‐dried inner ears of chinchillas. The spectra of perilymph and endolymph residues indicated that no cross‐contamination of the two cochlear fluids occurs during freeze‐drying or sampling. The spectra of outer hair cells suggested that the extracellular fluid in the organ of Corti spaces is similar to perilymph in its ionic content. The spectra of stria vascularis samples indicated low sodium and high phosphorus contents. Energy‐dispersive roentgen ray analysis of freeze‐dried inner ears appears to be a promising method for low‐contamination measurement of ion distribution in the cochlea.
The Pyridine Scale for Clinical Measurement of Olfactory Threshold: A Quantitative Reevaluation
Authors: Sherman Allen H. , Amoore John E. , Weigel Vivian
Published: April 2016

Serial dilutions of pyridine in water are employed for measuring the olfactory detection thresholds of patients. Experimental precautions are described that improve the precision and accuracy of the method. Existing data on the sensitivities of hyposmic patients are confirmed, but the sensitivities of normal subjects and of hyperosmic patients are believed to have been substantially overestimated in some earlier publications. Routine clinical applications of the revised pyridine odor threshold test are discussed. In the authors' experience, the average cystic fibrosis patient is slightly hyposmic, and some cases of pituitary tumor are accompanied by a 100,000‐fold hyperosmia.
Vasodilating Agents in Augmentation of Skin Flap Survival
Authors: Toomey James M. , Conoyer J. Michael , Ogura Joseph H.
Published: April 2016

Skin flap necrosis is a serious problem in reconstructive head and neck surgery. Currently, the only clinically effective means of preventing flap necrosis is delay. Hypothesized mechanisms of delayed and experimental methods of increasing flap survival are discussed. Investigative data supporting the use of phentolamine to augment flap survival are presented.
Further Observations on the Fate of Pedicle Osteocutaneous Grafts
Authors: Canalis Rinaldo F.
Published: April 2016

Recent work has shown that pedicle osteocutaneous grafts retain their viability and participate actively in the restructuring of transferred bone. The present study investigates two aspects of this process: (1) whether or not healthy recipient bone is needed for the survival of these grafts and (2) the degree of periosteal involvement in osteogenesis. Six adult dogs were used. Pedicle osteocutaneous grafts were constructed using the anterior table of the frontal sinus. Rotation of these flaps allowed implantation of the bone transplant into the ipsilateral parietal muscle. Free bone grafts were used as controls and were implanted in the contralateral muscle. Specimens were removed at variable intervals between 8 and 40 weeks after operation. All free grafts were reabsorbed. Pedicle‐assisted bone grafts retained their volume and exhibited marked periosteal osteogenesis that eventually produced enough new bone to replace the graft. These experiments provide strong evidence that bone restructuring in osteocutaneous grafts may be independent of recipient bone and that it depends almost exclusively on periosteal activity.
Infectious and Noninfectious Complications in Major Head and Neck Surgery
Authors: Yoder Milton G. , Krause Charles J. , Kwyer Thomas A.
Published: April 2016

The Hemovac drainage system was required postoperatively for 156 patients who had undergone major head and neck surgical treatment. This study distinguishes infectious complications from noninfectious complications by the aerobic and anaerobic cultures that were taken from the Hemovac line drainage and any subsequent complications. The 33% complication rate included only those of the head and neck and excluded general medical complications. Of the 52 patients having complications, 19 had infectious, 24 had noninfectious, and nine had both infectious and noninfectious complications.
Granular Cell Tumors of the Larynx
Authors: Agarwal Ramesh K. , Blitzer Andrew , Perzin Karl H.
Published: April 2016

Granular cell tumors of the larynx are uncommon lesions. Only 15 were identified at the Columbia‐Presbyterian Medical Center, New York, during the past 45 years. These tumors produce hoarseness usually and are identified as small keratotic, polypoid, or sessile nodules involving the glottic region (most often posterior glottis, arytenoid, or vocal process). These lesions can usually satisfactorily be treated by endoscopic excision. On histologic examination, pseudoepitheliomatous hyperplasia is frequently seen and may be misinterpreted as squamous cell carcinoma.
The Significance of Lysosomal Enzymes in Middle Ear Effusions
Authors: Bernstein Joel M. , Villari Elizabeth M. , Rattazzi Mario C.
Published: April 2016

Although lysosomal enzymes have been demonstrated in middle ear effusions by several investigations, the exact source of these enzymes and the role they play in the maintenance and progression of otitis media with effusion have not been thoroughly studied.

The source of lysososmal enzymes in middle ear fluids and their possible role in the inflammatory process in otitis media with effusion are explored.
The Role of Bacterial Enzymes in Inducing Inflammation in the Middle Ear Cavity
Authors: Lowell Seth H. , Juhn S. K.
Published: April 2016

Current knowledge of the pathophysiology of bacterial infections is elementary. The initial events leading to the invasion of host tissues are a matter of conjecture for many bacterial organisms. This is particularly true for pneumococci, the most frequent causative organisms of acute otitis media.

Bacterial enzymes may account for the initial disruption of host tissues, and this study explored their role in the infectious process. As a first step, pneumococcal cultures were analyzed, and significant levels of the enzymes lipase and hyaluronidase were demonstrated. Secondly, the presence of these enzymes in middle ear effusions was explored in an animal model of acute otitis media. The enzymes reached peak levels at seven days. The third and most important portion of the study examined the significance of these enzymes in producing inflammation and alterations in the middle ear cavity of normal experimental animals. This portion was a histologic comparison of temporal bone specimens and demonstrated that marked acute and chronic changes can be induced by placing solutions of these enzymes in the middle ear cavity. This study concludes that bacterial enzymes play an important role in the induction of acute otitis media.
The Penetration of Gentamicin and Neomycin into Perilymph Across the Round Window Membrane
Authors: Smith Bruce M. , Myers Martin G.
Published: April 2016

Many commonly employed otic drops contain aminoglycoside antibiotics that may be toxic to the inner ear. A variety of chemicals such as ionic solutions, certain anesthetics, and epinephrine have been shown to diffuse across the round window membrane into the perilymph. Twelve adult cats were studied in this experiment. The auditory bulla was exposed and solutions containing gentamicin or neomycin concentrations similar to that commonly used in otic drops were applied to the round window niche for 15 minutes and washed with saline solution. The gentamicin and neomycin concentrations in the round window niche wash and the perilymph were then assayed by a radioenzymatic method.

Concentrations of both antibiotics were observed in the perilymph. Thus, the round window membrane is a route through which these ototoxins may gain access to the inner ear.
The Wildervanck Syndrome: Cervico‐Oculo‐Acoustic Dysplasia
Authors: Eisemann Michael L. , Sharma Gopesh K.
Published: April 2016

The Wildervanck syndrome consists of the Klippel‐Feil deformity of the spine, eyeball retraction, lateral gaze weakness, and hearing loss. Conductive hearing loss, as well as a more frequently occurring sensorineural hearing loss, is caused by dysplasia of the inner ear. Typically, polytomograms demonstrate a bulbous vestibule and dilated lateral semicircular canals with basilar impression of the skull. The Duane's eyeball retraction phenomenon completes the syndrome; this may be explained either by misdirected innervation of the extra‐ocular muscles or by atrophy or fibrosis of the lateral rectus muscles.
Frontal Sinus Septectomy for Chronic Unilateral Sinusitis
Authors: Goode Richard L. , Strelzow Victor , Fee Willard E.
Published: April 2016

Frontal sinus trephination with removal of the intersinus septum has been found to be an effective therapy in selected cases of chronic unilateral frontal sinusitis; in addition, it may be combined with unilateral duct reconstruction in the treatment of chronic bilateral sinusitis. It may also be performed as a prophylactic measure when nasofrontal duct injury occurs during unilateral nasal or maxillary sinus surgery. The authors' experience with the procedure in 20 cases is described.
Fibrous Dysplasia of The Ethmoid Sinus
Authors: Powell Jeffrey P. , Liu Wu Yen , Rabuzzi Daniel D.
Published: April 2016

Fibrous dysplasia of bones comprising the paranasal sinuses is well recognized. Depending on the anatomic areas of the skull involved by this neoplasm, a combined approach for surgical removal may be necessitated. A case of a patient with fibrous dysplasia of the ethmoid sinus, possibly the first reported case of such change in the ethmoid bone itself, is presented. A two‐stage, combined otolaryngologicneurosurgical craniofacial resection was the method of treatment.
Aural Cholesteatoma Presenting as a Large Neck Mass
Authors: Hughes Gordon B. , Damiani Kathleen A. , Kinney Sam E. , Levine Howard L.
Published: April 2016

As preoperative assessment of the patient with a neck mass becomes increasingly sophisticated, differential diagnosis of the masses becomes more complex. The following unusual case of massive swelling in the neck as a result of aural cholesteatoma exemplifies best this complexity and the need for careful preoperative planning.
Prosthetic Replacement of Bilateral Maxillectomy
Authors: Kirchner John A.
Published: April 2016

A patient had an adenocystic carcinoma that involved both maxillary sinuses, the entire hard palate, and the lower third of both nasal chambers. Treatment consisted of bilateral maxillectomy and a split‐thickness skin graft applied to the inside of the cheeks. A dental obturator constructed to fit undercuts in the surgical cavity allowed speech and swallowing. Because the patient objected to the sunken appearance of the upper lip, she obtained the central incisor portion of her late husband's upper denture and bonded this segment to the dental appliance. This achieved satisfactory cosmesis.
Metastasizing Auricular Basal Cell Carcinoma
Authors: Bryarly Richard C. , Veach Stephen R. , Kornblut Alan D.
Published: April 2016

Basal cell carcinoma represents the most common skin cancer and involves the head and neck area in 80% to 85% of all patients treated. Despite their frequent occurrence, metastatic spread from these tumors is rare. This paper presents a case of a patient who had a metastasizing basal cell carcinoma. Despite control of primary disease by radical surgery and adjunctive irradiation, bony metastasis was found within nine months of therapy. Palliative therapy was given, but the patient died five months later. The pathophysiology of the metastasizing basal cell carcinomas is described, and a rationale for therapy presented.
‘Colonic Type’ Adenocarcinoma of the Nasal Cavity and Paranasal Sinuses
Authors: Salassa John R. , McDonald Thomas J. , Weiland Louis H.
Published: April 2016

Primary “colonic type” tumors of the nasal cavity and paranasal sinuses are adenocarcinomas with histologic features similar to those of colonic cancers. Their behavior is one of local invasion and recurrence. Unlike tumors of the colon, they rarely metastasize. Surgical resection by means of lateral rhinotomy with or without radiation is the treatment of choice. Prognosis is poor. This type of tumor should be recognized by pathologists and its implications should be known to head and neck surgeons.
Hemangiomas of the Sphenoid Sinus
Authors: Hayden Richard E. , Luna Mario , Goepfert Helmuth
Published: April 2016

A review of the literature reveals that primary tumors of the sphenoid sinus are rare. No vascular tumors of the sphenoid have been previously reported. Two patients with cavernous hemangiomas of the sphenoid sinus are presented, both of whom died of complications associated with the diagnostic biopsy. A review of the available routine and special diagnostic tests is presented. The importance of an awareness of vascular tumors in this region is stressed.
Intraoral Keloid: Complication of Forehead Flap
Authors: Reilly James S. , Behringer W. Hayman , Trocki Ira
Published: April 2016

Intraoral keloids are rare de novo, but can occur on transplanted skin. A case in which an unusual complication of forehead flap reconstruction resulted in the formation of a large keloid in the oral cavity is presented. Therapy is discussed.
Follicular Adenocarcinoma of the Thyroid in The Maxillary Sinus
Authors: Cinberg James Z. , Terrife Dessalyn
Published: April 2016

No reports of metastatic thyroid carcinoma in the maxillary, ethmoid, or sphenoid sinuses can be found in the literature. A woman with severe posterior epistaxis was examined recently. She had undergone a partial lobectomy for a thyroid tumor 16 years previously. Hemorrhagic thyroid tissue was in the maxillary sinus. The results of subsequent examinations indicated thyroid deposits in the lung and spine. The patient received radioactive iodine, 100 MCi. Her lung and spine deposits lysed, and she experienced no further epistaxis. Thyroid carcinoma's ability to metastasize to a paranasal sinus is documented here. Epistaxis after a thyroidectomy for cancer now must be considered an unusual clinical manifestation of metastatic spread, unless otherwise proved. The differential diagnosis of epistaxis must now include thyroid carcinoma metastatic to the sinonasal tract.
Laryngeal Reinnervation Using the Split‐Phrenic Nerve‐Graft Procedure
Authors: Crumley Roger L. , Horn Karl , Clendenning David
Published: April 2016

A new operative procedure for reinnervation of the paralyzed larynx is described. Initial successes in a series of animals have shown that use of the split‐phrenic nerve‐graft procedure results in functional abduction of the paralyzed vocal cord, while preserving innervation to the diaphragm. Electromyography, microlaryngoscopic movies, chest fluoroscopic examination, and nerve compound action potential recordings were all used to document these findings. This procedure appears to have several advantages over the neuromuscular pedicle operation described by Tucker.
Office Fiberoptic Laryngeal Photography
Authors: Tobin Howard A.
Published: April 2016

Fiberoptic direct laryngoscopy has been widely accepted as part of the office laryngeal examination, because it can provide photographs that can be used to document the examination. This is especially useful in serial examinations and in surgical cases for which a visual record of the preoperative and postoperative appearances add greatly to the medical record.
Meniere's Disease: Treatment with the Endolymphatic Subarachnoid Shunt, A Review of 125 Cases
Authors: Brackmann Derald E. , Anderson Robert G.
Published: April 2016

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

Detailed analysis of preoperative factors did not enable prediction of the likelihood of success in an individual case. The controversy regarding surgical therapy of Meniere's disease is discussed, and the conclusion that there is a role for endolymphatic sac surgery in the treatment of Meniere's disease is presented.
Effects of Furosemide and Ethacrynic Acid on The Endocochlear Direct Current Potential in Normal and Kanamycin Sulfate‐Treated Guinea Pigs
Authors: Asakuma Shinichiro , Snow James B.
Published: April 2016

The effects of loop diuretics on the endocochlear direct current (DC) potential and the effective electrical resistance of the cochlear partition were studied. The effective electrical resistance was increased, and the endocohlear DC potential was decreased. The decrease in the endocohlear DC potential must not be caused by breaks in the electrical insulation of the cochlear partition. With loop diuretics the endocochlear DC potential decreased less in guinea pigs treated with kanamycin sulfate than it did in the control group. Two interpretations of these phenomena are presented.
Use of Photoplethysmography to Determine The Survival Length of Skin Flaps
Authors: McCaffrey Thomas V. , Woods Robert D. , Kern Eugene B.
Published: April 2016

Photoplethysmography was used to evaluate 14 skin flaps in the pig. Eight skin flaps were 4×12 cm and were based dorsally. Six skin flaps were 4×18 cm and were based ventrally. All flaps were designed to undergo necrosis of the distal end. After elevation of the flap, blood flow to the skin flaps was estimated immediately by means of intravenously administered fluorescein. Photoplethysmography was used to determine blood flow to the skin flaps at 3, 24, 72, and 144 hours after elevation. Surviving length of the skin flaps was measured at nine days. Fluorescein accurately predicted the surviving length of the skin flaps. Photoplethysmography did not show a decrease in blood flow at the level of fluorescein penetration 3 or 48 hours after elevation. However, 72 and 144 hours after elevation, an abrupt decrease in blood flow was noted by photoplethysmography at the level of eventual skin necrosis.
Effects of Furosemide and Ethacrynic Acid on the Endocochlear Direct Current Potential in Normal and Kanamycin Sulfate‐Treated Guinea Pigs
Authors: Asakuma Shinichiro , Snow James B.
Published: April 2016

The effects of loop diuretics on the endocochlear direct current (DC) potential and the effective electrical resistance of the cochlear partition were studied. The effective electrical resistance was increased, and the endocohlear DC potential was decreased. The decrease in the endocohlear DC potential must not be caused by breaks in the electrical insulation of the cochlear partition. With loop diuretics the endocochlear DC potential decreased less in guinea pigs treated with kanamycin sulfate than it did in the control group. Two interpretations of these phenomena are presented.
Use of Photoplethysmography to Determine the Survival Length of Skin Flaps
Authors: McCaffrey Thomas V. , Woods Robert D. , Kern Eugene B.
Published: April 2016

Photoplethysmography was used to evaluate 14 skin flaps in the pig. Eight skin flaps were 4×12 cm and were based dorsally. Six skin flaps were 4×18 cm and were based ventrally. All flaps were designed to undergo necrosis of the distal end. After elevation of the flap, blood flow to the skin flaps was estimated immediately by means of intravenously administered fluorescein. Photoplethysmography was used to determine blood flow to the skin flaps at 3, 24, 72, and 144 hours after elevation. Surviving length of the skin flaps was measured at nine days. Fluorescein accurately predicted the surviving length of the skin flaps. Photoplethysmography did not show a decrease in blood flow at the level of fluorescein penetration 3 or 48 hours after elevation. However, 72 and 144 hours after elevation, an abrupt decrease in blood flow was noted by photoplethysmography at the level of eventual skin necrosis.
Coexisting Lentigo of the Larynx and Melanoma of the Oral Cavity: Report of a Case
Authors: Travis Lawrence W. , Sutherland Carl
Published: April 2016

A case is presented of coexisting malignant melanoma of the oral cavity and large benign lentigo of the pyriform sinus of the larynx. The absence of a pigmented lesion of the oral cavity in this patient suggests the possibility that lentiginous lesions of the larynx and oral cavity represent simultaneous invasion of these sites by melanocytes later undergoing malignant degeneration in the oral cavity. The histologic observations of these separate lesions are presented and compared. The literature is reviewed briefly. The widespread clinical opinion that malignant melanoma is a systemic disease is illustrated by this case.
Neonatal Airway Obstruction Secondary to Nasopharyngeal Teratoma
Authors: Rowe Lee D.
Published: April 2016

Neoplasms of the nasopharynx are rare in neonates and infants. The most common nasopharyngeal tumors encountered in this age group are teratomata—neoplasms containing multiple heterotopic tissues. Of the four basic histologic types, dermoids are most frequently seen. An unusual case of a true teratoma in a premature infant with severe upper airway obstruction is presented. An extensive review of the world literature confirms the rarity of this lesion.
Squamous Cell Proliferative Lesion of the Nasopharynx in a Newborn
Authors: Stillwater Lyle B. , Fee Willard E.
Published: April 2016

Nasopharyngeal tumors in the newborn are exceedingly rare. Typically, initial symptoms are breathing or eating difficulties. A case is presented of a patient in whom bleeding began following diagnostic passage of nasopharyngeal catheters. Surgical excision was required on the third day of life, and histologic review revealed a squamous cell proliferative lesion consistent with squamous cell carcinoma. The infant's postoperative course was uneventful. Specimens from a nasopharyngeal biopsy done six weeks later revealed only reactive lymphoid hyperplasia and at 6 months of age, the child's condition was normal. After review of the available literature and this patient's pathologic condition, it is believed that this lesion represents an otherwise un‐classifiable squamous cell proliferation previously not described.
Risk Factors in Multiple Carcinomas of the Lip
Authors: Baker Shan R.
Published: April 2016

Certain risk factors appear to separate subjects with repeated primary carcinomas of the lip from the general population of patients with carcinoma of the lip. Factors that were found statistically significant in increasing the chance of recurrent carcinoma of the lip include outdoor occupations requiring prolonged exposure to sunlight or the use of tobacco on a regular basis. Significant risk factors of a clinical nature include a positive serologic reaction for syphilis; the presence of leukoplakia, hyperkeratosis, or actinic cheilitis; or the presence of a basal cell or squamous cell carcinoma of the facial skin.
Temporal Bone Histopathologic Findings in Congenital Anomalies of the Oval Window
Authors: Harada Takehiko , Black F. Owen , Sando Isamu , Singleton George T.
Published: April 2016

The histopathologic findings in five temporal bones from three cases showing various stages of oval window development arrest are presented. The anomalies ranged from complete absence of the oval window to congenital cartilaginous fixation of the stapedial footplate. Surgical approaches for establishment of a new oval window must take into consideration the frequent association of facial nerve anomalies with anomalies of the oval window.
The Approximation of Audiometric Thresholds by Auditory Brain Stem Responses
Authors: McGee Therese J. , Clemis Jack D.
Published: April 2016

Auditory brain stem response (ABR) thresholds for tone pip stimuli were compared with audiometric thresholds for 63 ears to assess the feasibility of deriving audiograms with ABR techniques. Correlations between the two measures were highly significant, indicating a high degree of accuracy in assessing degree and configuration of hearing loss with ABR. Patients with conductive losses showed a simple one‐to‐one relationship between ABR and audiometric thresholds, while patients with cochlear losses did not. Possibly this is due to the effects of abnormal temporal integration or poor frequency selectivity in this latter group.
A One‐Stage Flap Reconstruction Following Resection for Stomal Recurrence
Authors: Biller Hugh F. , Krespi Yosef P. , Lawson William , Baek Se‐Min
Published: April 2016

The pectoralis major myocutaneous island flap has been used for a one‐stage reconstruction following ablative surgery for stomal recurrence. The skin island of this flap is supplied by the perforating musculature vessels of the thoracoacromial artery. The flap can be elevated primarily and is used in a one‐stage reconstruction. The new stoma is created in the center of the skin island, and the great vessels are covered by the pectoralis major muscle pedicle. The surgical technique as performed in seven successful cases is presented.
Tongue Base Minor Salivary Gland Tumor: Report of a Case with Mucoepidermoid and Acinous Cell Components
Authors: Wetmore Stephen J. , Fan Kang
Published: April 2016

A case of a large (5.5 cm), multilobulated, mucosa‐covered, minor salivary gland tumor of the base of the tongue that displayed morphologic features of both a mucoepidermoid carcinoma and an acinous cell tumor is described. Generally, each of these salivary gland tumors occurs only rarely at this site. A tumor with both these elements has not previously been reported.
Biomechanical Characteristics of the Human Trachea
Authors: Meyers Arlen D. , Bishop Harry E. , Peters Stan
Published: April 2016

Previous experiments using mercury‐in‐Silastic strain gauges in dogs revealed the trachea to be a dynamic organ. The cartilaginous rings and intercartilaginous membranes are unique in adapting to the physiologic demands of respiration, deglutition, and gravity. Alterations in tracheal biomechanics following segmental tracheal resection were also documented.

In the present study, a new device was used to measure the stress‐strain characteristics of the human trachea. The machine can be used to measure tension across trachea rings or the entire trachea. The results of these experiments indicate that the human trachea is a complex biomechanical organ and that it responds distinctively to stress.
Improved Survival Associated with Postoperative Wound Infection in Laryngeal Cancer: An Analysis of Its Therapeutic Implications
Authors: Schantz Stimson P. , Skolnik Emanuel M. , O'neill John V.
Published: April 2016

A retrospective analysis revealed improved survival rates in laryngeal cancer patients who had postoperative wound infection following total laryngectomy and radical neck resection. The overall five‐year survival rates were 44% in the infection group and 31% in the control group. On further analysis, the beneficial effect of infection was most evident in patients with stage III disease. Seventy‐three percent of these patients with wound infection were alive at five years, compared with 32% of the control group.

The protection from recurrent cancer in these patients afforded by the bacterial contamination may be secondary to activated immune mechanisms. The therapeutic implications of our findings suggest that the immune adjuvant is given at the time of surgical treatment rather than when tumor burden is far advanced. Only a few such protocols are under analysis presently.
Recurrent Carcinoma of the Larynx and the Hypopharynx
Authors: Jacobs John R. , Sessions Donald G. , Ogura Joseph H.
Published: April 2016

From a group of 765 patients treated primarily at Barnes Hospital (St Louis) for epidermoid carcinoma of the larynx and the hypopharynx, 799 cases of recurrent disease were identified. To define this group of recurrent carcinoma, the following study parameters were selected: initial site of lesion, initial pathologic condition, initial therapy, complications of therapy, site of recurrence, secondary treatment, and end results. Cause of death is detailed as a result of primary cancer (local, neck, distant, and mixed), complications of treatment, secondary cancer, or intercurrent disease. An attempt is made to correlate the data to understand this anomaly and its responses to therapy better.
Factors Influencing Tympanostomy Tube Function and Extrusion: A Study of 1, 127 Ears
Authors: Leopold Donald A. , McCabe Brian F.
Published: April 2016

Shepard, long polyethylene, and Reuter‐bobbin tympanostomy tubes were studied for longevity in the inferior and anterior quadrants of 1, 127 tympanic membranes. Factors that improved tube functioning time significantly for all or certain tube types included (1) general anesthesia; (2) “virgin” tympanic membranes (Shepard, Reuter‐bobbin), (3) age of 9 years or younger (Reuter‐bobbin), (4) normal or thin tympanic membranes (Reuter‐bobbin), and (5) middle ear fluid (Reuter‐bobbin for all types of fluid).

Negative correlations (or those not statistically significant because of such factors as sample size) for longevity of tube functioning time included (1) effect of multiple previous intubations in the same ear, (2) age over 10 years, and (3) quadrant of insertion. No significant difference in longevity was noted between normal patients and those with a repaired or unrepaired cleft palate deformity. The data suggest that the epithelial layer of the tympanic membrane influences the longevity of the tympanostomy tube function.
Retrolabyrinthine Surgery: A Direct Approach To The Cerebellopontine Angle
Authors: Silverstein Herbert , Norrell Horace
Published: April 2016

The direct route to the cerebellopontine (CP) angle through the ear (retrolabyrinthine approach) represents a significant advance in neuro‐otologic surgery. After incising the dura between the endolymphatic sac and the lateral venous sinus, a self‐retaining retractor is used to collapse the lateral sinus, which provides a wide exposure of the CP angle, with visualization of the 5th through 11th cranial nerves. The retrolabyrinthine approach is a safe and direct route to the CP angle and has advantages over the suboccipital approach. Vestibular neurectomy through the retrolabyrinthine approach is the most frequently performed procedure and has replaced middle fossa vestibular neurectomy in our practice.
Middle Fossa Vestibular Neurectomy: A Report of 373 Cases
Authors: Garcia‐Ibanez Emilio , Garcia‐Ibanez Jose L.
Published: April 2016

The surgical technique for vestibular neurectomy through the middle fossa approach is described. Surgical details, including the use of a new middle fossa retractor, are discussed. A variety of technical refinements have been made to improve and shorten the operation. The main surgical indication is for Meniere's disease. It has, however, also been used in other peripheral vestibular problems such as traumatic vertigo and vertigo secondary to previous ear surgery. Long‐term hearing and vestibular results using this approach for Meniere's disease have been encouraging. These results, in addition to the small incidence of postoperative complications, have made the operation extremely useful.
Seventh Nerve Spasm: Effect of Modification of Cholinergic Balance
Authors: Hughes Everett C. , Brackmann Derald E. , Weinstein Roy C.
Published: April 2016

The seventh cranial nerve spasms of the face and the eyelids, including essential blepharospasm, are usually intractable and sometimes disabling. Deanol acetamidobenzoate was compared with the anticholinergic orphenadrine for relief of these spasms. Deanol cured two of 16 (12%) subjects and improved a third. Orphenadrine was much more effective, improving the conditions of 16 of 26 (62%) subjects between 57% and 100%. A crossover double‐blind experiment showed high significance over a placebo.
Seventh Nerve Spasm: Effect of Modification of Cholinergic Balance
Authors: Hughes Everett C. , Brackmann Derald E. , Weinstein Roy C.
Published: April 2016

The seventh cranial nerve spasms of the face and the eyelids, including essential blepharospasm, are usually intractable and sometimes disabling. Deanol acetamido‐benzoate was compared with the anticholinergic orphenadrine for relief of these spasms. Deanol cured two of 16 (12%) subjects and improved a third. Orphenadrine was much more effective, improving the conditions of 16 of 26 (62%) subjects between 57% and 100%. A crossover double‐blind experiment showed high significance over a placebo.