bluuebunny/crossref_metadata_2025 huggingface dataset:
Relation of lymph‐node metastasis to histopathologic appearance in oral cavity and oropharyngeal carcinoma: A case series and literature review
Authors: Rasgon Barry M. , Cruz Raul M. , Hilsinger Raymond L. , Sawicki John E.
Published: October 2006

A number of histopathologic parameters in squamous cell carcinoma of the oral cavity and oropharynx have been identified as having a statistically significant correlation with regional lymph‐node metastasis. These parameters have been inconsistent and not readily reproducible.

In an attempt to confirm these parameters, a retrospective analysis of 22 patients with Tl to T4 squamous cell carcinoma of the oral cavity and oropharynx was performed. Initially, these patients were managed with either wide local excision or surgical excision of the primary tumor combined with radical neck dissection. There was a minimum of 3 years of follow‐up.

Chi‐square contingency tables and Fisher's Exact Test were used to correlate histopathologic parameters with lymph‐node metastasis. Statistically significant correlations were found for tumor thickness and inflammatory infiltrate.
Update of the cincinnati experience in pediatric laryngotracheal reconstruction
Authors: Cotton Robin T. , Gray Steven D. , Miller Robert P.
Published: October 2006

Surgical endeavors in the field of laryngotracheal reconstruction in children have received much interest in the past 15 years. A unique experience with laryngotracheal reconstruction in 203 children is reviewed. The majority (194) of the cases were classified as acquired; only nine were classified as congenital. Excluded from the study were those cases of stenoses managed en‐doscopically, all resections and end‐to‐end anastomoses, all anterior cricoid split procedures, and all cases of anterior glottic stenosis repaired by a laryngeal keel. The degree of stenosis was graded into four categories. Five different methods of laryngotracheal reconstruction were used depending on the pathologic lesion in the larynx and trachea. Of the 203 children, 186 (92%) were decannulated. The results support the use of laryngotracheal reconstruction in children with grades 2, 3, and 4 laryngeal stenosis.
Theoretical and practical implications for plasmapheresis in autoimmune inner ear disease
Authors: Luetje Charles M.
Published: October 2006

Immune‐mediated inner ear disease, by convention called autoimmune inner ear disease (AIED), has established clinical profile guidelines for diagnosis. Treatment consists of steroid and/or cytotoxic drug immunosuppression. The role of plasma‐pheresis (PMP) in the treatment of AIED has not been defined. Lack of a precise serological marker prevents accurate immuno‐logical understanding. Definition is, of course, difficult in a disease whose natural history is not well delineated.

Successful use of PMP in one steroid and cytotoxic drug intolerant patient with AIED led to its use in a total of eight patients. The rationale for PMP was based on its known effectiveness in other autoimmune diseases and thus, its potential use in AIED. Improved auditory function occurred in 6 of the 8 patients, 3 of whom have been followed for over 3 years. Three of the six no longer require immunosuppressant medication. PMP can be used as an alternative or adjunctive therapy in AIED. These preliminary results suggest PMP can stabilize or improve auditory and vestibular symptoms in selected patients. Its use as a first line therapy followed by cytotoxic immunosuppres‐sants bears consideration.
Effects of stimulation by cochlear implant on the cochlear nerve
Authors: Terr Leonid I. , Sfogliano Guiseppe A. , Riley Solomon L.
Published: October 2006

Degeneration of the cochlear nerve before and after placement of the cochlear implant might influence the efficacy of the device. We examined histological characteristics, including the caliber of the cochlear nerve fibers of the central segment proximal to the porus acusticus, in three profoundly deaf patients. Two of them used a cochlear implant for many years longer in one ear than in the other, and one used an implant in one ear only. No qualitative or quantitative differences between the two sides were found. However, in all three cases we found that the cochlear nerves on both sides were substantially degenerated. These results indicated no noticeable effects of stimulation by the cochlear implant on the central portion of the cochlear nerve.
Complete post‐traumatic ptosis: A mechanism for recovery?
Authors: Arden Richard L. , Moore Grant K.
Published: October 2006

Traumatic blcphnroptosis, although considered relatively rare, is an entity which demands recognition if one is to achieve optimal results. Reports of levator injury following orbital, ocular, and adnexal surgery, as well as in cataract and blepharo‐plasty procedures, are well described. In most cases eventuating in complete ptosis, levator disinsertion is the anatomic correlate, the ptosis is usually permanent, and surgical intervention is often indicated.

We have observed two cases of transient, complete post‐traumatic ptosis which have recovered by 6 weeks with expectant management. We believe this entity to be more pervasive than the current literature seems to reflect and emphasis is placed on nonoperative therapy. This paper reviews the anatomical considerations relevant to the function of the levator complex as well as the possible mechanisms for its injury.
Acoustic rhinometry: Evaluation of the nasal cavity with septal deviations, before and after septoplasty
Authors: Grymer L. F. , Pedersen O. F. , Hilberg O. , Elbrønd O.
Published: October 2006

We introduce acoustic rhinometry as a new, objective method to assess the geometry of the nasal cavity. The cross‐sectional area of the nasal cavity as a function of distance from the nostrils was obtained. A group of 21 patients with septal deformities was examined with acoustic rhinometry preoperatively and postoperatively. These values were compared with those of 21 normal control subjects.

The minimal cross‐sectional area (MCA) is located in the anterior part of the nose, and it shifts anteriorly under the effect of decongestion. The preoperative value of MCA is related to the location and severity of the anterior septal deformity. Postoperative smaller MCA found in the opposite side of that narrowed by a severe anterior septal deformity may be explained by the impact of septoplasty without reduction of a hypertrophic tur‐binate. A highly significant relation between MCA and the subjective feeling of nasal patency, before and after surgery, suggests that MCA is a valuable parameter to express nasal patency. Correction of posterior septal deformities is found to increase significantly the cross‐sectional area posteriorly. The effect of decongestion in the postoperative values, however, suggests that the mucosa contributes even more to the cross‐sectional area of the posterior part of the nose.

Acoustic rhinometry seems very suitable for evaluation of the nasal cavity in cases where septoplasty and turbinoplasty is considered, as well as for the postoperative evaluation.
Rhabdomyosarcoma of the ear and temporal bone
Authors: Wiatrak Brian J. , Pensak Myles L.
Published: October 2006

Rhabdomyosarcoma, the most common soft tissue sarcoma of childhood, involves the temporal bone in approximately 7% of reported cases. Until recently, the outcome of this disease was always fatal. The recent Intergroup Rhabdomyosarcoma Study Group (IRS‐I) reported on the efficacy of multimodality therapy consisting of multiagent chemotherapy, radiation, and surgical resection when indicated.

Twelve patients with rhabdomyosarcoma involving the temporal bone were treated between 1966 and 1988. Three patients were treated according to the IRS‐I protocols and the remaining nine patients received various combinations of treatment modalities. Ten patients succumbed to their disease, most with distant metastases or intracranial extension. Two patients are alive; one at 5½ years and one at 19 years.

It is apparent that, although survival for rhabdomyosarcoma in general has improved with the use of IRS‐I protocols, prognosis remains poor for disease involving the temporal bone and other parameningeal sites.
Safety of total thyroidectomy: Review of 100 consecutive cases
Authors: Tovi Ferit , Noyek Arnold M. , Chapnik Jerry S. , Freeman Jeremy L.
Published: October 2006

During a 6‐year period (June 1982 to June 1988), 100 consecutive total thyroidectomies were performed at Mount Sinai Hospital, University of Toronto, for benign and malignant disease. There were five permanent complications: one deliberate sacrifice of the recurrent laryngeal nerve and four cases of persistent hypoparathyroidism. Four of these five complications occurred in extracapsular carcinoma and resulted from oncologic wide‐field resection and/or deliberate sacrifice. One patient with benign disease suffered initially transient hypoparathyroidism which has now become permanent. Interestingly, two patients actually underwent deliberate sacrifice of a recurrent laryngeal nerve; one patient has made a surprising recovery at 16 months postoperative and now has full vocal cord mobility.

Our experience suggests that the morbidity of total thyroidectomy relates primarily to the stage of malignancy and extracapsular extension, necessitating en bloc excision accompanied by additional lymph node dissection. The low incidence of permanent complications in benign thyroid disease suggests the feasibility of total thyroidectomy as the operation of choice when surgeons are familiar with the technique and indications.
Lymphokine‐activated killing of autologous and allogeneic short‐term cultured head and neck squamous carcinomas
Authors: Leess Fred R. , Bredenkamp James K. , Lichtenstein Alan , Mickel Robert A.
Published: October 2006

Interleukin‐2‐(IL‐2)‐activated lymphocytes have been shown to kill a variety of continuously cultured allogeneic (nonself), natural killer cell‐sensitive and resistant cell lines, and some autologous (Belt) tumor cells. Lymphokine‐activated killer (LAK) cytotoxicity of autologous head and neck squamous cell carcinoma (HNSCC) cells has not been previously demonstrated, and efforts to demonstrate this have been hampered by the lack of a reliable and reproducible method of obtaining satisfactory tumor targets. In this study, fresh tumor cells were enzymatical‐ly dissociated, enriched by adherence to plastic, and used in a 3‐hour chromium‐51 cytotoxicity assay. Peripheral blood lymphocytes (PBLs) were incubated for 3 days with or without added IL‐2. IL‐2‐activated PBLs showed significant cytotoxicity against autologous and allogeneic targets, while only low levels of tumor lysis occurred with unstimulated PBLs. These findings suggest the possible use of IL‐2‐activated lymphocytes in the adoptive immunotherapy of HNSCC patients.
Recovery of inspiratory abduction of the paralyzed vocal cords after bilateral reinnervation of the cricoarytenoid muscles by one single branch of the phrenic nerve
Authors: Baldissera F. , Cantarella G. , Marini G. , Ottaviani F. , Tredici G.
Published: October 2006

The aim of this study was to provide the bilateral reinnervation of the posterior cricoarytenoid (PCA) muscles by the superior root of the right phrenic nerve. In six adult cats, the right phrenic root was anastomosed to the distal stump of the transected recurrent laryngeal nerve (RLN) on the same side. The RLN adductor branch was then cut and anastomosed to a nerve graft whose end was carried contra‐laterally and sutured to the left RLN or to the left PCA muscle.

The phrenic fibers regrowing along the RLN abductor branch reinnervated the right PCA muscle and restored the inspiratory abduction of the right vocal cord in all the animals. In five of the six cats, the fibers regenerated through the RLN adductor branch and the graft reached the left PCA muscle and also restored the inspiratory opening of the larynx on the left side.

Histological nerve examination revealed a fairly symmetrical distribution of the regenerated phrenic axons to the right and left PCA muscles.
Modulation of middle ear immune response by gut immunization
Authors: Bresnick Stephen D. , Ryan Allen F.
Published: October 2006

Swallowing of upper respiratory pathogens which may at another time be involved in otitis media with effusion (OME) undoubtedly occurs in many patients. In order to explore the possible immunologic consequences to the middle ear (ME) of such gut exposure, guinea pigs were fed antigen either before or after systemic sensitization. A ME immune response was then elicited by ME antigenic challenge. Feeding before systemic sensitization induced systemic tolerance and blunted both the ME immune response and immune‐mediated OME. Feeding after systemic sensitization amplified ME immunity and increased immune‐mediated OME. Gut immunization, therefore, provides a potent modulation of ME immune response. Depending upon its timing, pathogen swallowing could produce immune hyporesponsiveness, with lowered resistance to infection but reduced immune‐mediated inflammation. Alternatively, swallowing could result in immune hyperre‐sponsiveness, with increased resistance but also increased inflammation.
Infectious adult croup
Authors: Deeb Ziad E. , Einhorn Kenneth H.
Published: October 2006

From January 1980 to December 1987, seven patients with acute inflammatory swelling of the subglottic space were treated. Their ages ranged from 25 to 73 years. Medical history and symptomatology are similar to those characteristic of laryngotracheobronchitis (croup) in the pedi‐atric age groups (i.e, an antecedent common cold followed by a barking cough and varying symptoms of upper airway obstruction). Physical findings before and after treatment were confirmed and documented by anteroposterior radiographs of the neck. Three patients required airway intervention but there were no deaths. To our knowledge there are no previous reports in the English literature describing this entity in adults. The purpose of this presentation was to introduce physicians, in general, and otolaryngologists, in particular, to this potentially serious infection. Our limited experience suggests that the pathogenesis and management of croup in adults are very similar to those in children.
Optic nerve decompression via the lateral facial approach
Authors: Knox Barton E. , Gates George A. , Berry Susan M.
Published: October 2006

Two cases of visual loss after lateral orbital wall fracture are presented: one with retrobulbar hematoma and evidence of optic nerve compression who failed to respond to lateral canthotomy and high‐dose corticosteroid administration, and the second with immediate, total blindness associated with fracture of the bony optic canal. In both, extradural decompression of the orbit and optic nerve was achieved through the lateral facial approach1 with partial return of visual acuity and without surgical complications.

The role of orbital and optic nerve decompression in the management of patients with blindness following orbital trauma is controversial. Orbital decompression may be of value for cases of post‐traumatic visual loss unresponsive to medical management. If optic nerve injury is suspected as the cause, the additional step of decompression of the optic nerve is a logical but unproven procedure. The indications for optic nerve decompression are not established and should be considered only within the context of the specific needs of the individual patient.
Delayed spontaneous return of hearing after acoustic tumor surgery: Evidence for cochlear nerve conduction block
Authors: Kveton John F.
Published: October 2006

Unlike the eventual resolution of facial paralysis in most patients with intact facial nerves, delayed hearing return after acoustic tumor resection is rare. This discrepancy in recovery has been ascribed to the inherent resilience of the facial nerve (a special visceral efferent nerve) to injury versus the cochlear nerve (a special somatic afferent nerve). In the presence of an intact cochlear nerve, hearing loss has been attributed to transection or spasm of the internal auditory artery or to direct mechanical trauma to the cochlear nerve during manipulation of the tumor. The possibility of a reversible conduction block in the cochlear nerve has not been considered. A review of three instances of delayed spontaneous hearing recovery several months after acoustic tumor resection suggests that a conduction block phenomenon can exist. This report describes the patho‐physiology and the possible intraoperative predisposing features of this condition.
Atypical findings in cephalic herpes zoster polyneuritis: Case reports and radiographic findings
Authors: Golden Lindsay I. , Deeb Ziad E. , Defries Hugh
Published: October 2006

The purpose of this presentation is to report six patients who were seen because of multiple cranial nerve deficits occurring within a clinical picture of herpes zoster of the head and trunk. The clinical behavior, diagnostic methods, treatment, and outcome of the patients in this series are reviewed. The vagus and cochleovestibular nerves were affected in all of the patients. Three patients had radio‐graphic evidence of a mass in the nasopharyngeal region. Malignancies were ruled out by repeated biopsies.
Tracheoesophageal speech: With and without tracheostoma valve
Authors: Zanoff Donald J. , Montague James C. , Drummond Sakina , Krueger Kathleen , Wold Donald
Published: October 2006

The tracheostoma valve, developed by Blom and Singer1 combines the advantages of pulmonary air for phonation with hands‐free speech. Patients have anecdotally reported “more normal speech” with the use of the valve. This study was designed to objectively determine if speech acoustic and temporal measures existed between tracheoesophageal puncture using the valve, and those without the valve prosthesis, during speech production among the same subjects.

The speech samples of nine male Iaryngectomees were recorded with and without the valve. Six speech acoustic and temporal measures were calculated and compared under both speaking conditions. No statistically significant differences were found between the two speaking conditions for the six tasks measured. However, other advantages and disadvantages were observed and reported under the valve condition.
Surgical therapy of obstructive sleep apnea in children with severe mental insufficiency
Authors: Seid Allan B. , Martin Peter J. , Pransky Seth M. , Kearns Donald B.
Published: October 2006

Obstructive sleep apnea is the underlying cause of a variety of pediatric maladies, including pulmonary hypertension and failure to thrive. In children, unlike adults, obstruction secondary to lymphoid hyperplasia is often encountered; adenotonsillectomy restores airway patency. Patients who fail this procedure, such as children with cerebral palsy and associated muscular hypotonia, may face tracheotomies. We report on 10 pediatric patients with severe mental insufficiency and obstructive sleep apnea in whom palatal hypotonicity and lack of adenotonsillar hypertrophy was identified. Uvulopalatopharyngoplasty was performed in conjunction with adenotonsillectomy to enlarge the diameter of the nasopharyngeal inlet with successful resolution of the obstructive symptoms in eight patients. The remaining two children required more surgery. This procedure is presented as a possible alternative to tracheotomy in selected patients.
Inner ear autoantibodies in patients with rapidly progressive sensorineural hearing loss
Authors: Harris Jeffrey P. , Sharp Patricia A.
Published: October 2006

Recognition of immune‐mediated sensorineural deafness that responds to immunosuppressive therapy has led to a search for a diagnostic assay to identify inner ear autoantibodies. Without a confirmed diagnosis of autoimmune disease, many patients have undergone inappropriate immunosuppressive treatment or developed irreversible inner ear damage.

Serum from patients with progressive sensorineural hearing loss (N=54), ulcerative colitis (N=5), normal controls (N=14), and animals with experimental autoimmune sensorineural hearing loss (EASNHL) were analyzed by Western blot against fresh bovine inner ear antigen preparations. The hearing loss group (19 [35%]) showed a single‐or double‐band migrating at 68,000 molecular weight (MW), differing from the normal group (1 of 14 [7%]) which showed a similar band (P = .031).

Upon analysis by two‐dimensional gel electrophoresis both the EASNHL guinea pigs and a patient reacted against identical components of inner ear antigen. These results suggest an autoimmune basis for disease in patients reacting against the 68,000 MW antigen.
Tracheobronchial aspiration of foreign bodies in children: A study of 94 cases
Authors: Steen Kay H. , Zimmermann T. H.
Published: October 2006

Over the last seven years, there has been an increase in the number of children admitted to our hospital because of aspirated foreign bodies. An inhaled foreign body can become a serious matter if it results in acute respiratory distress or if it remains unrecognized for a long period in the bronchial system. Then, as a result of inflammatory tissue reactions, it can be extracted only with great difficulty. Of our 94 children with foreign body aspiration, 24% had been treated initially on the basis of a different diagnosis. In 30% of all cases, the children were admitted more than 3 days after aspiration. One third of the patients already had signs of marked inflammation on admission. Early treatment, under general anaesthesia, proved to be safe even for small babies. Bronchoscopic examinations should not last more than approximately 1 hour. All children who had complications after bronchoscopy (6%) recovered fully after treatment, except for one child who died of respiratory failure. A diminution of complications in children with inflammatory signs on admission was observed when they were treated before the operation with antibiotics and methylprednisolone.
Spectral analysis of airflow sounds in patent versus occluded tracheostomy tubes: A pilot study in tracheostomized adult patients
Authors: Rao Avasarala Jagannadha , Niwa Hideto , Watanabe Yusuke , Fukuta Shigeji , Yanagita Noriyuki
Published: October 2006

Cannula occlusion is a life‐threatening postoperative complication of tracheostomy. Current management largely relies on nursing care for prevention of fatalities because no proven mechanical, machine‐based support monitoring exists. The objective of this paper was to address the problem of monitoring the state of cannula patency, based on analysis of airflow acoustic spectral patterns in tracheostomized adult patients in the patent and partially occluded cannula. Tracheal airflow sounds were picked up via a condenser microphone air‐coupled to the skin just below the tracheal stoma. Signal output from Mic was amplified, high‐pass filtered, digital tape‐recorded, and analyzed on a mainframe computer. Although airflow frequencies for patent cannulae were predominantly low‐pitched (0.1 to 0.3 kHz), occluded tubes had discrete high‐pitched spectral peaks (1.3 to 1.6 kHz). These results suggest that frequency analysis of airflow sounds can identify a change in the status of cannula patency.
Oral ofloxacin as treatment of malignant external otitis: A study of 17 cases
Authors: Levy Rudy , Shpitzer Thomas , Shvero Jacob , Pitlik Silvio Daniel
Published: October 2006

Seventeen patients with malignant external otitis were treated with oral ofloxacin. Their mean age was 69 years. Seven of the patients were diabetic.

Paeudomonas aeruginosa, sensitive to ofloxacin (Kirby‐Bauer method, inhibition zone ≥22 mm), was isolated from the external auditory canal in all patients. Ofloxacin (200 mg b.i.d.) was given to the patients for 12 to 39 days. Two patients also received additional parenteral antibiotic therapy. Subjective and objective improvement occurred in all patients during treatment, and complete resolution was documented in all patients, with one exception. Only one patient suffered recurrence 2 weeks after discontinuation of antimicrobial therapy. The results of our study suggest that oral ofloxacin is an effective treatment for malignant external otitis caused by Paeudomonas aeruginosa.
Laryngeal findings in short rib polydactyly syndrome: Case report and embryological correlations
Authors: Knapp Calvin H. , Santin‐Hodges Antonio , Cole Randolph R.
Published: October 2006

Short Rib Polydactyly Syndrome (SRPS) is a group of rare congenital disorders characterized by polydactyly, short limbs, and short ribs. Infants with type I SRPS (Majewski syndrome) may exhibit dysgenesis of the larynx, which is manifested by epiglottic hypoplasia. Photographic documentation of laryngeal findings obtained at autopsy in an affected infant is provided. To our knowledge, such photographic documentation has not been previously published.

Normal laryngeal development is reviewed, based on the Carnegie system of staging. The developmental errors leading to SRPS are thought to occur at 33 to 48 days of fetal life (Carnegie stages 15 through 19).
Management of tumors arising in the parapharyngeal space
Authors: Carrau Ricardo L. , Myers Eugene N. , Johnson Jonas T.
Published: October 2006

Tumors originating in the parapharyngeal space are rare. During the period of January 1977 to July 1989, 51 patients underwent surgery for parapharyngeal space tumors at the University of Pittsburgh's Eye and Ear Hospital. Eighty percent of the parapharyngeal space neoplasms were benign; 20% were malignant. Fifty‐seven percent (31/54) were of neurogenic origin, 30% (16/54) were of salivary origin, and 13% (7/54) were of miscellaneous origin. The use of computed tomography scan and magnetic resonance imaging, and selective use of angiography, allowed us to ascertain the location, size, vascularity, and relation of parapharyngeal space tumors to surrounding anatomical structures. Imaging techniques established the site of origin of these tumors with 96% accuracy. This information was essential in planning surgical approaches and predicting prognoses. Details of the surgery, morbidity, and outcome of these patients are presented.
Adjuvant methotrexate‐5‐fluorouracil for extracapsular squamous cell carcinoma in cervical metastasis
Authors: Johnson Jonas T. , Myers Eugene N. , Sigler Barbara A. , Wagner Robin L. , Mayernik David G. , Nolan Teresa A.
Published: October 2006

A trial of surgery, irradiation, and adjuvant chemotherapy was offered to patients with extracapsular spread of squamous cell carcinoma in cervical metastases. Following surgery and irradiation, methotrexate, 5‐fluorouracil, and Ieucovorin were administered 18 times over 6 months.

Fifty patients undertook chemotherapy, while 47 patients declined further therapy. Comparison of the two groups according to stage, site, and Karnofsky performance status demonstrated no significant differences. The number of nodes encountered and the number and percentage of nodes with extracapsular spread were similar in the two groups.

The minimum 5‐year adjusted survival for patients undergoing adjuvant chemotherapy is 54% (20 of 37 patients), while survival of patients who failed to undertake adjuvant chemotherapy was 17% (5 of 30 patients). These data suggest the efficacy of methotrexate‐5‐fluorouracil adjuvant chemotherapy and support the need for a prospective randomized clinical trial.
Hearing preservation following suboccipital removal of acoustic neuromas
Authors: Kemink John L. , Telian Steven A. , Larouere Michael J. , Kileny Paul R. , Hoff Julian T.
Published: October 2006

Advances in the diagnosis and intraoperative management of acoustic neuromas have greatly reduced the incidence of neurologic deficits following their removal. Ninety‐three patients underwent acoustic tumor removal during a 4½‐year period, and hearing preservation was attempted in 20 cases. Hearing was preserved in 65% of the entire series, and excellent results were obtained in tumors less than 1.5 cm. No patient with a tumor greater than 1.5 cm had serviceable hearing preserved when total tumor removal was performed. Two patients, one with neurofibromatosis and one with an acoustic neuroma in an only‐hearing ear, had planned partial tumor removal with preservation of hearing. Preoperative auditory brainstem response results were not predictive of postoperative hearing preservation. Intraoperative auditory brainstem response monitoring demonstrated that loss of wave V consistently correlated with loss of hearing postoperatively, whereas persistence of wave V (with a latency prolongation not exceeding 3.00 ms) was predictive of successful hearing preservation regardless of latency increases.
Anterior cranial base reconstruction: Role of galeal and pericranial flaps
Authors: Snyderman Carl H. , Janecka Ivo P. , Sekhar Laligam N. , Sen Chandra N. , Eibling David E.
Published: October 2006

Reconstruction of surgical defects in 30 patients undergoing surgery of the anterior cranial base was performed using pericranial, galeopericranial, and galeal scalp flaps. Twenty‐seven patients had resection of neoplasms, the majority of which were malignant. Fifty‐seven percent of patients received prior therapy consisting of surgery and/or radiotherapy. Adequate healing of the cranial base was noted in all cases without persistent cerebrospinal fluid leaks, meningitis, or brain herniation. Mucosalization of the intranasal surface was noted. No skin grafts were used. At a median follow‐up of 13 months, 67% of patients were alive with no evidence of disease.

The pericranial, galeopericranial, and galeal flaps are highly reliable, versatile, and well suited for reconstruction of the anterior cranial base.
Otitis media with effusion and chronic upper respiratory tract infection in children: A randomized, placebo‐controlled clinical study
Authors: Otten Floris W. A. , Grote Jan J.
Published: October 2006

This study was performed to investigate the course of spontaneous recovery from otitis media with effusion in children with chronic rhinosinusitis treated in various ways. One hundred forty‐one children between 3 and 10 years of age were selected for the presence of chronic rhino‐sinusitis and unilateral or bilateral otitis media with effusion.

The children were assigned at random to one of four treatment groups, i.e., placebo, amoxicillin combined with xylometazoline hydrochloride nose drops, maxillary sinus drainage, or a combination of the latter two forms of therapy. The follow‐up period was 6 months. Drainage of the maxillary sinus had no effect on either the recovery of the chronic upper respiratory tract infection or otitis media with effusion. Amoxicillin combined with xylometazoline nose drops had no significant effect on recovery from the upper respiratory tract infection, but did have a small but significant effect on recovery from otitis media with effusion. However, the general tendency of the upper respiratory tract and ears to recover was poor. Persistence of the chronic upper respiratory tract infection during the follow‐up period proved to be a negative prognostic factor with respect to cure of otitis media with effusion.

Children with chronic rhinosinusitis as defined in this study appear to have a high risk of developing chronic otitis media with effusion. The results of the study are discussed.
Nasal antral windows in children: A retrospective study
Authors: Muntz Harlan R. , Lusk Rodney P.
Published: October 2006

A retrospective study of 39 patients with 46 sets of bilateral nasal antral windows was undertaken to assess the effect of this procedure on chronic sinusitis in children. All patients had symptoms of sinusitis for at least 3 months with plain radiographic documentation of maxillary sinus disease. Only medical failures were surgical candidates. Forty percent of the patients were improved at 1 month, but the success rate at 6 months decreased to 27%. It was necessary to repeat the nasal antral window procedure because of recurrent or persistent sinusitis in 7 of 39 patients. An additional 11 patients required endoscopic ethmoidectomy and maxillary antrostomy. Based on this experience, the nasal antral window procedure does not appear to be effective in treating chronic sinusitis in children.
Endoscopic sinus surgery in children with chronic sinusitis: A pilot study
Authors: Lusk Rodney P. , Muntz Harlan R.
Published: October 2006

This pilot study assessed the safety and preliminary data on the efficacy of endoscopic ethmoidectomy in children with chronic sinusitis. A total of 168 patients were evaluated for chronic sinusitis, and 31 were deemed appropriate candidates for ethmoidectomy. All patients were medical management failures. Twenty‐six percent of the patients had asthma, 23% had some immune deficiency, 23% had allergies, and 2 patients (1%) had cystic fibrosis. All patients were followed for at least 1 year postoperatively. The only surgical complication was minor middle meatal scarring that developed in two patients. Overall, 71% of the patients were considered normal by their parents 1 year postoperatively. Of the 24 patients who did not have an underlying systemic disease (immune deficiency or cystic fibrosis) postoperatively, 80% were considered normal by their parents, 12% were improved but continued to have some symptoms, and 8% had unsatisfactory results. Seven children with underlying systemic disease had to undergo revision ethmoidectomy for persistent symptoms.
Curvularia/Drechslera sinusitis
Authors: Killingsworth Stephen M. , Wetmore Stephen J.
Published: October 2006

Sinusitis due to unusual fungal pathogens is thought to occur primarily in immunocompromised individuals. However, the fungi Curvularia, Drechslera, and others produce sinusitis in healthy young adults. The signs and symptoms produced by these organisms are usually considered to be complications of sinusitis. Of the three cases that we report, two manifested decreased visual acuity, and the third presented with acute onset of seizures. Computed tomography scans were helpful in delineating the extent of disease and in following the results of therapy. Aggressive surgical treatment is necessary; indeed, two of our cases required a second operation to eradicate all disease. If histopathology shows tissue invasion by the fungus, intravenous am‐photericin B is recommended. Fungal cultures and smears should be obtained when healthy patients present with complications of sinusitis.
Benign lesions of the larynx: Should the laser be used?
Authors: Shapshay Stanley M. , Rebeiz Elie E. , Bohigian R. Kirk , Hybels Roger L.
Published: October 2006

The use of the carbon dioxide (CO2) laser in the treatment of patients with benign laryngeal lesions, excluding respiratory papillomatosis, has been questioned because of potential adverse thermal effects on surrounding tissue. We question whether wound healing and subsequent quality of voice would be better if the surgeon used the “cold technique” with microlaryngeal instruments. Since the advent, in 1987, of a small‐spot (0.3 mm) CO2 laser micromanipula‐tor and more precise microlaryngeal instruments, we have redefined our use of the CO2 laser for benign laryngeal lesions. Over the past 4 years, in a series of 68 consecutive patients with vocal cord nodules, polyps, polypoid changes, or granulomas, the CO2 laser was useful for mucosal micro‐flap dissection techniques and for vascular lesions. Smaller pedunculated lesions, such as vocal cord nodules, were more efficiently removed with the new microlaryngeal instrumentation. The combined selective use of a microspot CO2 laser at low‐power settings (1 to 3 W), with 0.1‐second pulses, and with precise microlaryngeal instruments will give the best results.
The nasogastric tube syndrome
Authors: Sofferman Robert A. , Haisch Carl E. , Kirchner John A. , Hardin Nicholas J.
Published: October 2006

The nasogastric tube can produce sudden, life‐threatening bilateral vocal cord paralysis and is often an unrecognized cause of this clinical entity. The pathophysiologic mechanism is thought to be paresis of the posterior cri‐coarytenoid muscles secondary to ulceration and infection over the posterior lamina of the cricoid. Since our initial report of this entity in 1981, several cases have been photo‐documented. Study of whole organ sections of an involved larynx have demonstrated the histopathology. Diabetic renal transplant patients appear to be particularly susceptible to the condition, due to prolonged gastroparesis and requirement for nasogastric tube drainage. Esophagoscopy should be performed promptly in these patients when pha‐ryngodynia, hoarseness, or evolving stridor present in the postoperative period.
Embryology of the facial nerve and its clinical applications
Authors: Sataloff Robert Thayer
Published: October 2006

Although many studies have investigated facial nerve development, most have been limited by available specimens and have not provided a comprehensive description of the development of this important structure. Even the best and most comprehensive articles on this subject have not systematically integrated the descriptions of facial nerve embryology with a summary of the development of other otologic structures. This study describes the parallel development of the facial nerve and ear, emphasizing practical applications for the otologic surgeon. The validity of these predictions has been tested through surgical procedures on patients with malformed ears.
Familial vocal cord dysfunction associated with digital anomalies
Authors: Hawkins Donald B. , Liu‐Shindo Maisie , Kahlstrom Emily J. , Maclaughlin Eithne F.
Published: October 2006

Familial vocal cord dysfunction is a rare condition that has been reported in only a few instances. This is a report of identical male twins, both of whom had congenital bilateral abductor vocal cord paresis associated with finger deformities. The vocal cord paresis progressed to paralysis that required tracheotomy, then returned to a slowly resolving paresis during which the vocal cords had incoordinated motion generally known as synkinesis. Another male sibling and the mother had a history of stridor during infancy and finger deformities. Several other relatives had digital abnormalities, and an infant first cousin with finger abnormalities required a tracheotomy for vocal cord paralysis.
Long‐term results with a simple surgical treatment of bilateral vocal cord paralysis
Authors: Geterud Ake , Ejnell Hasse , Stenborg Rune , Bake Björn
Published: October 2006

Since 1979, we have treated patients suffering from bilateral vocal cord paralysis with laterofixation of one vocal cord, a simple and comparatively atraumatic method. To evaluate the long‐term results of this method of laterofixation, 11 consecutive patients were examined at least 5 years postoperatively regarding breathing capacity, voice function, and swallowing ability. Breathing capacity was assessed by determination of orolaryngeal (upper) airway resistance and spirometry. Voice function was judged by two listening panels. Swallowing ability was studied by barium contrast radiography. Postoperative improvement of breathing capacity was, in most cases, found to be long lasting. Furthermore, there was no deterioration of voice function, nor were there aspiration problems during the postoperative follow‐up period. We suggest this method of laterofixation as the treatment of choice in patients suffering from breathing difficulties due to bilateral vocal cord paralysis.
Auditory‐evoked responses in benign intracranial hypertension syndrome
Authors: Sismanis Aristides , Callari Richard H. , Slomka William S. , Butts Frank M.
Published: October 2006

In this study, auditory brainstem‐evoked responses were conducted on 28 patients with otologic symptoms (pulsatile tinnitus, hearing loss, aural fullness) secondary to benign intracranial hypertension syndrome. Abnormalities consisting mainly of prolonged interpeak latencies were detected in one third of these patients. It is speculated that the pathophysiologic mechanisms responsible for these auditory brainstem‐evoked abnormalities are stretching‐compression of the cochlear nerve and brainstem caused by the intracranial hypertension and/or primary edema of the same structures due to the benign intracranial hypertension syndrome itself. Normalization or improvement was noticed in the majority of the patients after management. Since the number of patients in this study is small, it is felt that the diagnostic and prognostic value of this test needs further evaluation.
Angioedema from angiotensin converting enzyme inhibitors: A cause of upper airway obstruction
Authors: Gannon Timothy H. , Eby Thomas L.
Published: October 2006

Angiotensin‐converting enzyme (ACE) inhibitors have several side effects of concern to the otolaryngologist. Angioedema is a rare, but potentially lethal adverse effect when associated with upper airway obstruction. Four cases of ACE‐inhibitor‐induced angioedema, three with significant upper airway obstruction, are reported.

Angioedema secondary to ACE inhibition appears to be mechanism based. The probable link is the potentiation of bradykinin, which results in vasodilation, increased vascular permeability, and angioedema. Since angioedema can progress to upper airway obstruction, otolaryngologists must be aware of this association. The differential diagnosis and treatment of this adverse effect is discussed, as well as a review of ACE inhibitors and other causes of angioedema.
Intraoral‐extramaxillary sinus approach for ligation of the maxillary artery: An anatomic study with clinical correlates
Authors: Stepnick David W. , Maniglia Anthony J. , Luke Bold E. , Victor Maniglia J.
Published: October 2006

Surgical control of severe epistaxis is usually reserved for cases refractory to more conservative techniques. We present our experience with intraoral ligation of the maxillary artery as it courses through the buccal fat pad before it enters the pterygopalatine fossa and branches posterior to the maxilla. This technique has been found useful in the control of nasal hemorrhage as well as an adjunct to other surgical procedures, such as removal of benign and malignant neoplasms involving the maxilla and paranasal sinuses. This technique was used for ligation of the maxillary artery in 20 patients.

The artery was readily identified in some cases, but required more extensive dissection in others; therefore, an anatomic study in 18 preserved and fresh cadaver specimens was undertaken to investigate the variability of the maxillary artery in the region of the buccal fat pad. There appeared to be significant variation in the distance from the buccal mucosal incision site, as well as variation in the relationship to the pterygoid muscles. This relationship to the pterygoids explains the occasional difficulty in locating the artery for ligation.

This technique represents a reasonable alternative to the more traditional transantral approach to ligation of the maxillary artery, as long as the surgeon understands the anatomy of the region, its variations, and where the artery may be located if not immediately apparent. No major complications have been experienced.
The efficacy of brainstem auditory evoked potentials in acoustic tumor surgery
Authors: Kveton John F.
Published: October 2006

As the identification of patients with small acoustic neuromas and salvageable hearing increases, intraoperative auditory nerve monitoring has been used increasingly in an attempt to improve the hearing preservation rate. Far‐field recordings obtained by brainstem auditory evoked potentials (BAEP), at times enhanced by electrocochleography, have become a standard method of intraoperative auditory nerve assessment. To evaluate the usefulness of this monitoring technique, the hearing preservation results of a series of unmonitored acoustic tumor removals were compared to a series of patients monitored via the standard brainstem auditory evoked potentials. With comparable average tumor sizes, 4 of 7 unmonitored patients had hearing preserved at preoperative levels compared to 4 of 9 monitored patients. Neither preoperative BAEP assessments nor absolute tumor size were predictive of hearing preservation. This report brings into question the effectiveness of far‐field intraoperative BAEP monitoring during acoustic tumor resection and suggests that direct auditory nerve monitoring may be more appropriate.
Flexible nd: Yag laser palliation of obstructive tracheal metastatic malignancies
Authors: Castro Dan J. , Saxton Romaine E. , Ward Paul H. , Calcaterra Thomas C. , Oddie James W. , Layfield Lester J. , Lufkin Robert B.
Published: October 2006

Flexible NdtYAG endoscopic laser surgery may become an effective new modality for palliation in patients with obstructive endotracheal metastatic malignancies. We report the results of the treatment of two patients with severely obstructing intraluminal tracheal metastatic melanoma and medullary thyroid carcinoma, using the neodymium‐YAG laser via the flexible fiberoptic bronchoscope. Both patients complained of significant dyspnea, orthopnea, cough, and hemoptysis and were not candidates for rigid bronchoscopy because of underlying medical contraindications and anatomical problems. Multiple treatment sessions were used with treatment intervals of 1 to 2 weeks. All treatments were performed in the operating room under sedation, without intubation, with topical lidocaine and standard superior laryngeal nerve block. Successful relief of airway obstruction with complete regression of the endotracheal masses was achieved and no recurrences were seen after 9 months' follow‐up. Flexible Nd:YAG laser bronchoscopy offered an alternative for the relief of obstructing endotracheal or bronchial malignancies in patients in whom the rigid bronchoscope could not be passed. It seemed to prolong survival in selected cases, and provided definite improvement in quality of life.
Artificial restoration of voice. I: Experiments in phonatory control of the reinnervated canine larynx
Authors: Broniatowski Michael , Davies Charles R. , Jacobs Gordon B. , Jasso Jerome , Gerrity Ross G. , Nosé Yukihiko , Tucker Harvey M.
Published: October 2006

Coordinated electronic pacing of implanted nerve pedicles into paralyzed laryngeal muscles has allowed selective dynamic control of abduction, adduction, and elongation of the vocal cords. Modifications of the original circuit in a cervical muscle model has added fine tuning to basic “all‐or‐none” pacing. Rehabilitation of phonation illustrated the sophisticated nature of voice and the need for restoration of fine tuning. Five mongrel dogs received nerve‐muscle pedicles into the thyroarytenoideus, cricothyroideus, and posterior cricothyroideus after denervation of one hemilarynx. Following appropriate reinnervation time, pedicles and intact recurrent laryngeal nerves were injected with currents of variable amplitudes and pulse widths to achieve graded vocal fold control while air was blown intratracheal‐ly towards the glottic chink. Videoscopic and spectral analyses indicated that artificial phonation could be restored to frequencies measured in the normal state. These experiments suggested that rehabilitation of the impaired voice by servocontrol might eventually be feasible.
Indications of the carbon dioxide laser in tracheobronchial pathology of the infant and young child: 14 cases
Authors: Garabedian Eria‐N , Denoyelle Francoise , Grimfeld Alain , Lacombe Hervé
Published: October 2006

Fourteen children aged between 6 months and 7 years (mean age = 3.5 years) were treated by CO2 broncholaser in the ENT Department of Trousseau Hospital.

Three groups of diagnostic indication were identified: 1. Granulomas treated after mucosal trauma (tracheotomy, foreign body). 2. Granulomas due to pulmonary and/or lymph node tuberculosis. 3. Adhesions and stenosis secondary to neonatal ventilation.

The operative and anesthetic technique is described in detail, together with any possible adverse events.

The CO2 broncholaser appears to be a technique of choice in this age group, in which the narrowness of the airways makes any endoscopic procedure difficult. The broncholaser allows the early treatment of obstructive tracheobronchial pathology with its risks of severe ventilatory sequelae.