bluuebunny/crossref_metadata_2025 huggingface dataset:
Idiopathic Facial Paralysis: A Randomized, Prospective, and Controlled Study Using Single‐Dose Prednisone Versus Acyclovir Three Times Daily
Authors: De Diego Juan I. , Prim Maria P. , De Sarriá Maria J. , Madero Rosario , Gavilá Javier
Published: November 2003

In a prospective, controlled, and randomized study, we compared the outcome of 101 Bell's palsy patients treated with acyclovir (54 patients) or prednisone (47 patients). The acyclovir dosage was 2400 mg (800 mg three times a day) for 10 days, and prednisone was given as a single daily dose of 1 mg/kg of body weight for 10 days and tapered to 0 over the next 6 days. Minimum follow‐up was 3 months in all patients. Patients in the prednisone group had better clinical recovery than those treated with acyclovir. Less degree of neural degeneration was observed in the prednisone group compared with acyclovir patients. The incidence of sequelae was the same in both groups. According to these results, in a 10‐day treatment cycle acyclovir given 800 mg three times is not as useful as prednisone given 1 mg/kg of body weight once a day in patients with idiopathic facial nerve paralysis.
Changes in Immunostaining of Inner Ears After Antigen Challenge Into the Scala Tympani
Authors: Ichimiya Issei , Kurono Yuichi , Hirano Takashi , Mogi Goro
Published: November 2003

To study the mechanisms of immune responses and immune injuries in inner ears, labyrinthitis was induced by inoculation of keyhole limpet hemocyanin (KLH) into the scala tympani of systemically sensitized guinea pigs. Inner ears were then immunostained for KLH, immunoglobulin G (IgG), albumin, connexin26 (Cx26), and sodium‐potassium adenosine triphosphate (Na,K‐ATPase). Inflammatory cells containing KLH were observed in the scala tympani and in the collecting venule of the spiral modiolar vein (SMV). Spiral ligament, spiral limbus, and blood vessels including the SMV were diffusely positive for IgG and albumin. Immunoreactivity for Cx26 and Na,K‐ATPase was decreased compared with the normal ears in the fibrocytes of the spiral ligament. These results suggest that inflammatory cells and blood constituents could extravasate into the cochlea from blood vessels and that fibrocyte damage in the spiral ligament could cause cochlear dysfunction.
Three‐Dimensional Analysis of Cricoarytenoid Joint Motion
Authors: Wang Robert C.
Published: November 2003

The normal motion of the cricoarytenoid joint was characterized and analyzed in this study using seven fresh cadaver larynges mounted rigidly in an external fixator apparatus after radiopaque markers were attached to laryngeal landmarks. Fluoroscopic imaging and recording was performed of top, front, and side views while the arytenoid cartilages of each larynx were manipulated through the full range of motion from adduction to abduction. Computer video capture was performed of the recordings and editing of still frames accomplished to generate three‐dimensional plots of cricoarytenoid joint motion, which are shown in the manuscript.

Selective and varying sequential disconnection of muscular and ligamentous structures to the arytenoid cartilage was achieved to determine their contributions to cricoarytenoid joint motion limitations and stability. The vocalis ligament, cricoarytenoid ligament, and conus elasticus are most important in controlling abduction, whereas the posterior cricoarytenoid muscle and conus elasticus are crucial in limiting adduction. The vocalis ligament prevents posterior displacement of the vocal process, while the cricoarytenoid ligament and a newly described ligament, the posterior capsular ligament, restricts anterior vocal process migration. Another ligament, the anterior capsular ligament, is described, which limits backward arytenoid cartilage tilting and lateral movement of the arytenoid cartilage on the cricoid cartilage facet. Section of the vocalis ligament with underlying conus elasticus produced reducible lateral arytenoid cartilage subluxation.

Confirmation of cricoarytenoid joint facet relationships in full adduction and abduction was accomplished by fixation of the cricoarytenoid joints of one larynx in the two positions with adhesive, and subsequent exposure of the joint surfaces.

Review of literature detailing human laryngeal embryological development shows that the glottis and arytenoid cartilages are formed in adduction, which explains how cricoarytenoid joint ligaments collaborate to achieve accurate vocal process approximation in adduction despite side‐to‐side asymmetries of the cricoarytenoid joint structures in the same larynges.
Repair of Orbital Blow‐out Fractures With Nasoseptal Cartilage
Authors: Lai Amy , Gliklich Richard E. , Rubin Peter A.D.
Published: November 2003

The goals of reconstruction in orbital blow‐out fractures are to restore floor continuity, provide support of orbital contents, and prevent fibrosis of soft tissues. Although ease of use has popularized alloplasts, autogenous material provides greater biocompatibility and results in low rates of infection, extrusion, and migration. Nasoseptal cartilage is an easily accessible, abundant, autogenous source that provides support to the orbital floor and minimal donor site morbidity. Thirteen patients who presented with orbital blow‐out fractures underwent reconstruction with nasoseptal cartilage. Follow‐up at 3 months to 4 years shows one patient with persistent manifest enophthalmos requiring further augmentation. There were no recipient or donor site complications. Nasoseptal cartilage is an underutilized and superior material for reconstruction of orbital blow‐out fractures.
Influence of the Gas Exchange Function Through the Middle Ear Mucosa on the Development of Sniff‐Induced Middle Ear Diseases
Authors: Miura Makoto , Takahashi Haruo , Honjo Iwao , Hasebe Seishi , Tanabe Makito
Published: November 2003

To investigate the influence of gas exchange function through the middle ear mucosa on the development of sniff‐induced middle ear diseases, the authors examined the mastoid pneumatization among patients with sniffing habit using computed tomography, and also examined the change of negative middle ear pressure induced by sniffing using tympanogram. In 20 ears with cholesteatoma or adhesive otitis media, the areas of mastoid cavity measured at the level of the lateral semicircular canal were significantly smaller than those in 26 ears with otitis media with effusion (OME) or attic retraction and in eight normal ears with sniffing habit (P < .01 and P < .0001, respectively). In 26 ears with OME or attic retraction, the areas of mastoid cavity were significantly smaller than those in eight normal ears with sniffing habit (P < .0001). By contrast, in the four ears with sniff‐induced middle ear disease, the recovery of negative middle ear pressure in 5 minutes without swallowing was less than 10 mm H2O, whereas in all seven ears with normal eardrum, negative middle ear pressure recovered by more than 20 mm H2O in 5 minutes. These findings suggested that impairment of gas exchange function through the middle ear mucosa, as well as eustachian tube dysfunction, might be closely related to the development of sniff‐induced middle ear diseases.
Immunotherapy Decreases Seasonal Rise in Serum‐Soluble CD23 in Seasonal Allergic Rhinitis
Authors: Ohashi Yoshihiro , Nakai Yoshiaki , Tanaka Ayaki , Kakinoki Yasushi , Ohno Yoshiharu , Masamoto Tateo , Sakamoto Hirokazu , Kato Akifumi , Washio Yushi , Hayashi Motoyo
Published: November 2003

There is increasing in vitro evidence that soluble CD23 (sCD23) is capable of potentiating IgE synthesis, but the in vivo physiologic significance remains to be established. This study investigated the seasonal changes in sCD23 in patients with seasonal allergic rhinitis. It included 112 adult patients with seasonal allergic rhinitis due to Japanese cedar pollens and 20 nonatopic healthy volunteers. The 64 patients of the pharmacotherapy group were treated with nonsedating antihistamine tablets alone throughout the pollen season and the remaining 48 patients of the immunotherapy group continued to be treated with immunotherapy. Serum concentrations of sCD23 were measured in each patient, before and during the pollen season of 1996, by a sandwich enzyme‐linked immunosorbent assay. The serum levels of sCD23 in the pharmacotherapy group before the pollen season were significantly higher than those in the nonatopic group (P = .0130) and those in the immunotherapy group (P = .0316). Seasonal increase in sCD23 was significant in the pharmacotherapy group, irrespective of the clinical response (P < .0001). By contrast, sCD23 was not significantly increased in the good responders to immunotherapy (P = .1826), but was significantly increased in the poor responders to immunotherapy (P = .0052). A significant correlation between seasonal increase in rate in specific IgE and seasonal increase in rate in sCD23 was confirmed in both the pharmacotherapy group (r

s
= 0.321, P = .0107) and the immunotherapy group (r

s
= 0.474, P = .0012). In conclusion, seasonal rise in sCD23 is associated with and is probably involved in seasonal rise in specific IgE in patients with seasonal allergic rhinitis, and successful immunotherapy is capable of blunting seasonal increase in sCD23, thus resulting in attenuation of seasonal increase in specific IgE and clinical benefits during the pollen season.
New Laryngeal Muscle Weakness in Post‐Polio Syndrome
Authors: Robinson Lawrence R. , Hillel Allen D. , Waugh Patricia F.
Published: November 2003

The authors describe the clinical presentations of post‐polio laryngeal muscle weakness in three patients with prior polio infection who presented with new complaints including slowly progressive dyspnea, dysphagia, and/or hoarseness. Evaluations by laryngeal videostroboscopy and electromyography revealed vocal cord abductor and/or adductor weakness, recurrent posterior glottic web in one case, and, in the two patients who agreed to electromyography, evidence of prior denervation and reinnervation in laryngeal muscles. Treatment was directed at attempting to maintain an airway and optimize vocal quality. One patient benefitted from tracheostomy, one benefitted from vocal cord medialization, and one benefitted from resection of interarytenoid scarring. The authors conclude that diagnosis of laryngeal post‐polio syndrome is facilitated by laryngeal electromyography. Interventions directed at maintaining an appropriate airway and optimizing vocal quality may be helpful.
Prognostic Significance of Depth of Invasion in Cancer of the Larynx
Authors: Ylmaz Taner , Hoşal A. Şefik , Gedikoglu Gökhan , Turan Ergin , Ayas Kivanç
Published: November 2003

To determine the prognostic significance of depth of invasion in laryngeal cancer, the depth of invasion of tumor was measured with an ocular micrometer on the laryngectomy specimens of 94 surgically treated patients with T1, T2, and T3 laryngeal cancer and was expressed in millimeters. There was a significant negative correlation between the depth of invasion and disease‐free survival. The tumors with no clinical involvement of regional lymph nodes in neck (N0 neck) had significantly less depth of invasion than those with involvement (N+ neck). The tumors with pathologically confirmed cervical lymph node metastasis had significantly more depth of invasion than those without metastasis. For tumors with a depth of invasion equal to or greater than 3.25 mm, the rate of cervical metastasis in this study has always been significantly higher than for those with a depth of invasion less than 3.25 mm (P< .05). The mean depths of invasion for cases with and without recurrence were not significantly different. According to the multivariate analysis, depth of invasion (P= .047) and patient age (P= .113) significantly affected the disease‐free survival independently. The depth of invasion did not significantly affect the recurrence and the interval between surgery and the development of recurrence (P> .15). The depth of invasion should be measured in every laryngectomy specimen. The depth of invasion influences the cervical metastasis and disease‐free survival significantly but does not affect the recurrence rate. The depth of invasion plays an independent role in determining the disease‐free survival.
Pediatric Temporal Bone Fractures
Authors: Lee Dennis , Honrado Carlo , Har‐El Gady , Goldsmith Ari
Published: November 2003

Objective: To examine the etiology, presentation, and management of temporal bone fractures in children.

Study Design: Case control.

Method: Retrospective review of a level I pediatric trauma center from July 1, 1990 to November 1, 1996 identified 680 patients. Inclusion criteria of age less than 14 years and only blunt temporal bone trauma identified 122 patients, with 97 charts available for review. The criteria for temporal bone fracture consisted of both clinical and radiologic information. Only patients with temporal bone fractures confirmed by computed tomography, a complete otolaryngology examination, and audiometric evaluations were included in the study. The data were analyzed with the Kruskal‐Wallis analysis of variance (ANOVA) for examining the three separate age groups of fractures. Chi‐squared analysis was used to compare these data with previously published adult and pediatric temporal bone fracture series and to examine the three separate age groups of fractures.

Results: The review identified 72 children with 79 temporal bone fractures: 47 boys and 25 girls. The patients ranged from 6 months to 14 years of age, with a bimodal distribution of patients with peaks at 3 years and 12 years of age. The most common causes of fractures were motor vehicle accidents (47%), falls (40%), biking accidents (8%), and blows to the head (7%). Common presenting signs and symptoms included hearing loss (82%), hemotympanum (81%), loss of consciousness (63%), intracranial injuries (58%), bloody otorrhea (58%), extremity fractures (8%), and facial nerve weakness (3%). The most common causes of temporal bone fractures were falls and motor vehicle accidents. Forty‐two patients were noted to have bloody otorrhea and possible cerebrospinal fluid leak. Twenty‐four received intravenous antibiotics. No patient developed prolonged otorrhea or meningitis during hospitalization and the follow‐up period. The classification of fracture patterns was longitudinal, 54%; transverse, 6%; oblique, 10%; squamous, 27%; and other, 3%. Hearing loss was found in 59 patients, with conductive hearing loss being the most common finding in 56% of the patients, followed by sensorineural hearing loss in 17% and mixed hearing loss in 10%.

Conclusions: Pediatric temporal bone fractures are associated with falls and motor vehicle accidents. There is a high incidence of associated intracranial injuries and hearing loss, but facial nerve injuries are uncommon. Timely management minimizes complications.
Distortion‐Product Otoacoustic Emission Monitoring of Cochlear Blood Flow
Authors: Telischi Fred F. , Stagner Barden , Widick Michael P. , Balkany Thomas J. , Lonsbury‐Martin Brenda L.
Published: November 2003

Distortion‐product otoacoustic emissions (DPOAEs) have been shown to be ideally sensitive to interruptions of the cochlear blood flow. However, a 15‐ to 30‐ second latency typically occurs between cessation of circulation and measurable DPOAE level changes. DPOAEs can also be characterized by phase measures. The aim of the present study was to determine in 10 rabbits the effects on DPOAE phase of repetitively compressing the internal auditory artery. In contrast to the delays measured by DPOAE level, phase changes were detected 1 to 5 seconds after internal auditory artery compression. These data suggest that the essentially “real time” monitoring of cochlear function with DPOAE phase can be used to ensure hearing preservation during surgery involving the porus acousticus and skull base.
Supraselective Embolization in Intractable Epistaxis: Review of 45 Cases
Authors: Moreau Sylvain , De Rugy Marc Goullet , Babin Emmanuel , Courtheoux Patrick , Valdazo André
Published: November 2003

Epistaxis is a common and in most cases benign event. Severe or recurrent epistaxis, however, can present therapeutic problems. Forty‐five cases of supraselective embolization in intractable epistaxis are reported. The authors' success rate of 97%, similar to the success rates reported in the literature, confirms the effectiveness of this technique. Complications occurred in only 8% of the cases. One serious complication was neurologic. Percutaneous embolization is an effective option for managing intractable posterior nasal bleeding but is not recommended as an early form of treatment.
Postinflammatory Acquired Atresia of the External Auditory Canal: Treatment and Results of Surgery Over 27 Years
Authors: Becker Birgit C. , Tos Mirko
Published: November 2003

Postinflammatory, acquired atresia of the external auditory meatus is a relatively rare consequence of chronic otitis media or recurrent external otitis with an annual incidence of 0.6 cases per 100,000 inhabitants. Primary and late results after operative treatment of this condition in 53 ears over 27 years are presented. Perioperative findings are described, and an outline of applied surgical technique is given. Six patients had bilateral involvement. The male‐to‐female ratio was 1:2, median age at surgery was 46 years, and the median follow‐up period was 5 years (range, 4 mo to 13 y). In 11% of the cases, recurrent atresia developed. Early operation is recommended, because cholesteatoma behind the atresia was found in 9%. Hearing improvement has been considerable after removal of the atresia with primary closure of airbone gap within 20 dB in 90% of the cases.
Frequent Mutation of p16 in Squamous Cell Carcinoma of the Head and Neck
Authors: Lang Jas C. , Tobin Evan J. , Knobloch Tom J. , Schuller David E. , Bartynski Kevin J. , Mountain Rodney E. , Nicholson Roy , DeYoung Barry R. , Weghorst Christopher M.
Published: November 2003

RNA was isolated from 22 squamous cell carcinomas (SCCs) obtained from diverse sites within the head and neck and from matched normal tissue where available. Tissue samples were then screened for expression of RNA from tumor suppressor gene p16 by utilizing semiquantitative reverse transcriptase polymerase chain reaction (RT‐PCR) analysis. p16‐Specific PCR amplification products generated from tumor samples were subject to further analysis by direct DNA sequencing to determine if any tumor sample harbored a p16 mutation. The results show the presence of mutations in 10 of 22 (45%) of the tumor samples. Mutations comprise two identical point mutations, two small deletions (1 bp and 2 bp), one single‐nucleotide insertion, four larger deletions, and an insertion/deletion. No mutations in p16 have been identified by analysis of PCR products generated from normal matched tissue, suggesting that p16 alterations are generated by somatic mutation and are not germline in origin. All 22 samples were analyzed additionally by immunohistochemistry for nuclear expression of the retinoblastoma (RB) tumor suppressor gene product. Results show lack of RB nuclear expression in only one sample, suggesting that mutation of RB is an infrequent event in the development of SCC of the head and neck (SCCHN).
Efficacy of DHE photodynamic therapy for respiratory papillomatosis: immediate and long‐term results
Authors: Shikowitz Mark J. , Abramson Allan L. , Freeman Katherine , Steinberg Bettie M. , Nouri May
Published: November 2003

Objectives/Hypothesis: Recurrent respiratory papillomatosis is a potentially life‐threatening disease that affects both children and adults and can result in complete respiratory obstruction. Conventional therapies cannot prevent multiple recurrences. The authors have been evaluating photodynamic therapy (PDT) to treat this disease since 1988. This study compared the efficacy of PDT with dihematoporphyrinether (DHE) with traditional therapy. Study Design: This was a randomized prospective trial of DHE‐PDT. Patients were randomly assigned to receive one of two doses of DHE—3.25 mg/kg or 4.25 mg/kg body weight. They were compared with a concurrent control group. Disease extent was evaluated by direct laryngoscopy before treatment and over a 1‐year period following treatment. Results were also compared with two historical cohorts of patients treated with lower doses of DHE. Methods: Eighty‐one patients, ages 4 to 74 years, with moderate to severe recurrent disease were enrolled. Forty‐eight received PDT and 33 in the control group were treated with conventional therapy. Both PDT groups received 50 J laser light to activate the drug. Patients received an intravenous infusion of DHE as outpatients 48 to 72 hours before treatment. During direct laryngoscopy, light (630 nm) was delivered by an argon‐pumped dye laser. Tissue biopsies were analyzed for presence of human papillomavirus (HPV). Results: There was notable improvement with either drug dose over the first year. Those receiving 4.25 mg/kg DHE experienced a significantly larger decrease in papilloma growth rate. Three‐year follow‐up of a subset of patients confirmed that improvement was maintained. There was no impact of DHE‐PDT on persistence of HPV DNA. Conclusion: This therapy holds promise for the treatment of laryngeal papillomas.
Mastoid size and otitis media with effusion: Question of correlation
Authors: Ng Matthew , Linthicum Fred H.
Published: November 2003

Objectives/Hypothesis: To determine the incidence of otitis media (OME) with effusion on histologic examination in temporal bones with mastoid cavities reduced by the fenestration procedure for otosclerosis. Study Design: Temporal bone histologic study. Methods: Light‐microscopic examination of serially sectioned temporal bones. Results: The incidence of otitis media with effusion in temporal bones with prior fenestration operation was not any more frequent than the control group of temporal bones with surgically unaltered mastoid cavity. Conclusions: There is no increased incidence of otitis media with effusion in temporal bones with prior fenestration operation.
Anatomy and vascular perfusion territories of the superior thyroid artery in macaca mulatta
Authors: Pearl Adam W. , Gannon Patrick J. , Urken Mark L.
Published: November 2003

Objective: Currently, methods used to repair long segment tracheal stenosis are unreliable. Here, a new nonhuman primate model of tracheal transplantation is used based on its evolutionary proximity to humans. Study Design: Prospective dye perfusion study in Macaca mulatta. Methods: After anatomical characterization, Evan's blue solution was injected into the right superior thyroid artery unilaterally (n = 5). Staining of the tracheal vasculature was then examined. Results: In M mulatta, the superior thyroid artery branched from the lingual‐facial trunk and was 0.64 ± 0.18 mm in diameter. Dye staining was bilateral, with the ipsilateral side extending to 2.98 ± 0.58 cm and the contralateral to 2.88 ± 0.88 cm, 12.9 ± 3.45 rings (47% of trachea). Conclusions: The tracheal vasculature has extensive bilateral collateral vascular channels that may provide a graft survival advantage. Macaques may serve as a good model of tracheal transplantation because of the collateral vascularization of the trachea and the extensive tracheal segment supplied by the superior thyroid artery, and because the superior thyroid artery and vein are anastomosable.
Human papillomavirus and risk of oral cancer
Authors: Smith Elaine M. , Hoffman Henry T. , Summersgill Kurt S. , Kirchner H. Lester , Turek Lubomir P. , Haugen Thomas H.
Published: November 2003

Although human papillomavirus (HPV), a sexually transmitted virus, is established as a necessary cause for more than 95% of cervical carcinomas, the association with oral squamous cell carcinoma is less well delineated. The purpose of this study was to determine the frequency and types of HPV in squamous cells of a group of patients with newly diagnosed oral or pharyngeal cancer (n = 93) compared with an age‐and gender‐frequency‐matched control group of patients with no history of oral cancer (n = 205). HPV was evaluated from a mouth rinse collection of cells in the oral cavity and tested by 32P‐labeled HPV generic probes and DNA sequencing for HPV types. HPV was identified in 15% of the oral cancer cases but in fewer than 5% of the controls (P < .05). The risk of cancer associated with HPV infection was independent of tobacco and alcohol use (adjusted odds ratio [OR] = 3.70; 95% confidence interval [CI]: 1.47–9.32; P < .05). HPV types included similar and other types not identified previously in the genital tract. There was no statistically significant increased risk of cancer among former tobacco users (former vs. never users: adjusted OR = 0.67, 95% CI: 0.31–1.44, P < .05), but the risk was significantly increased for current users (current vs. never: adjusted OR = 2.63; 95% CI: 1.22–5.71; P < .05). Likewise, former alcohol users were not at increased risk of disease (former vs. never: adjusted OR = 1.78; 95% CI: 0.87–3.67), whereas current alcohol users were (current vs. never: adjusted OR = 2.57; 95% CI: 1.22–5.42; P < .05). HPV‐related genital lesions (14.3% vs. 10.6%), oral‐genital sexual behavior (42.4% vs. 45.2%), and number (11 or more) of sexual partners (23% v. 17%) were not significantly different between cases and controls. These data suggest that in addition to tobacco and alcohol, HPV plays a role in the development of oral cancer.
Stability of the cochlear implant array in children
Authors: Roland J. Thomas , Fishman Andrew J. , Waltzman Susan B. , Alexiades George , Hoffman Ronald A. , Cohen Noel L.
Published: November 2003

Objective: To determine cochlear implant electrode stability in the young patient. Electrode migration due to future skull growth was a concern that led to prohibiting implantation in children less than 2 years of age. Recently, the high level of performance achieved by young implantees has led to a re‐evaluation of this lower age limit, requiring an assessment of the effects of skull growth over time. Study Design: Prospective radiographic analysis of electrode position of cochlear implants in young children. Methods: Twenty‐seven children implanted with the Nucleus (Cochlear Corp., Denver, CO) or Clarion (Advanced Bionics Inc., Sylmar, CA) multichannel cochlear prostheses were subjects for this study. Follow‐up radiographic studies were obtained for a period of 1 month to 5 years after implantation. The age at time of implantation ranged from 14 months to 5 years. An intraoperative modified Stenver's view plain radiograph was obtained as a baseline. After implantation, on a yearly basis transorbital Stenver's and base views were obtained for comparative purposes. Additional radiographs were obtained whenever a change in performance or electrode map caused suspicion for extrusion. Electrode position was determined using a computer graphics enhancement technique whereby image contrast filters enhanced the visibility of the electrode array and surrounding bony structures. Results: An analysis of the data revealed no migration of the electrode array over time. Conclusions: The confirmation of the stability of the electrode array alleviates the concern of the effects of skull growth on cochlear implantation in young children.
The failing flap in facial plastic and reconstructive surgery: Role of the medicinal leech
Authors: Utley David S. , Koch R. James , Goode Richard L.
Published: November 2003

Objective: To review the use of the medicinal leech, Hirudo medicinalis, in salvaging the failing, venous‐congested flap. A protocol for the use of leeches is presented. Four illustrative cases of failing flaps (pectoralis major, midline forehead, and temporalis) are presented. Study Design: Literature review comprised of MEDLINE search 1965 to present. Retrospective review of four cases involving the management of the failing, venous‐congested flap. Methods: A retrospective review of four cases of failing, venous‐congested flaps was performed. Results: The authors' experience, as well as the data from the reviewed medical literature, demonstrates the importance of early intervention in order to salvage the failing, venous‐congested flap. Leeches are an immediate and efficacious treatment option. Conclusions: 1. Review of the literature indicates that the survival of the compromised, venous‐congested flap is improved by early intervention with the medicinal leech. H medicinalis injects salivary components that inhibit both platelet aggregation and the coagulation cascade. The flap is decongested initially as the leech extracts blood and is further decongested as the bite wound oozes after the leech detaches. 2. When a flap begins to fail, salvage of that flap demands early recognition of reversible processes, such as venous congestion. The surgeon must be familiar with the use of leeches and should consider their use early, since flaps demonstrate significantly decreased survival after 3 hours if venous congestion is not relieved. In the four cases presented, a standardized protocol facilitated early leech use and provided for the psychological preparation of the patient, availability of leeches, and an antibiotic prophylaxis regimen. 3. The complications associated with leech use can be minimized with antibiotic therapy, wound care, and hematocrit monitoring. 4. The use of the medicinal leech for salvage of the venous‐congested flap is a safe, efficacious, economical, and well‐tolerated intervention.
A longitudinal, functional study of peripheral nerve recovery in the mouse
Authors: Yao Mike , Inserra Michelle M. , Duh Michael J. , Terris David J.
Published: November 2003

Objectives: To verify the validity of the recently described sciatic functional index for mice to monitor neuronal functional recovery over time using a blinded, randomized, and controlled evaluation. Study Design: Surgery was performed on the left sciatic nerves of 62 C57/BL mice after randomly assigning them to one of four surgical groups: sham surgery, sciatic nerve crush, nerve transection without repair, and nerve transection followed by epineurial suture repair. Sciatic functional indices were measured before surgery and then after surgery at 10‐day intervals for 90 days, using a previously described formula. Results: Sham surgery did not affect nerve function when compared with preoperative values (P > .24). Crush surgery produced a reversible nerve injury that fully recovered after 20 days. Nerve transection without repair resulted in complete functional disability without recovery of function during the 90‐day follow‐up interval. When transected nerves were repaired, complete functional disability was noted at day 10, with subsequent functional recovery to 26% of function at day 30. This level of recovery persisted until the 60th postoperative day when muscle contractures resulted in progressive worsening of the index. There were statistically significant differences between the sciatic functional indices of each of the groups (P < .05). Conclusions: The previously described sciatic functional index for mice is an accurate indicator of the level of sciatic neuronal function during recovery. This index represents a method of evaluating neuronal function that may provide a better reflection of the recovery parameters that are important in clinical situations. The sciatic functional index will allow for study of sciatic nerve functional recovery in genetically engineered transgenic mice.
Doxycycline sclerosis of benign lymphoepithelial cysts in patients infected with HIV
Authors: Lustig Lawrence R. , Lee Kelvin C. , Murr Andrew , Deschler Daniel , Kingdom Todd
Published: November 2003

Benign lymphoepithelial cysts (BLCs) are a widely recognized cause of parotid gland swelling in HIV‐infected patients. Although they are neither invasive nor associated with malignant degeneration, BLCs can become large and disfiguring. Multiple modalities have been used to control these cysts, but no ideal treatment has been identified. The current study examines the efficacy of doxycycline as a BLC sclerosant in eight patients, and nine BLCs (bilateral BLC in one patient). Follow‐up ranged from 12 to 17 months in all cases. Doxycycline sclerosis controlled further cyst growth in 100% of cases with no serious complications. The BLCs became negligible or unnoticeable in two patients, and in six patients (seven BLCs) the cyst became fibrosed and showed no evidence of further growth over the follow‐up period. Although further studies are needed to determine the long‐term efficacy of this treatment modality, doxycycline sclerosis appears to offer a simple, safe, cost‐effective, office‐based therapeutic option for the treatment of BLCs in patients infected with HIV.
First results of clinical application of videokymography
Authors: Schutte Harm K. , Švec Jan G. , Šram František
Published: November 2003

Objectives: Stroboscopy is based on the assumption that the vibration of the vocal folds is stable and regular. Irregular vibrations, which are common in voice pathology, cannot easily be studied and described in a reliable way. Videokymography overcomes most of these drawbacks. Design: The use of the recently invented videokymography for studying vocal fold vibrations in patients is introduced. Method: Videokymography, using a modified CCD‐video camera, works in two modes: standard and high speed. In standard mode the vocal folds are displayed on a video monitor in the usual way, providing 50 images per second (or 60 in the National Television Standards Committee (NTSC) system). This is used for routine laryngoscopic and stroboscopic examination of the larynx. In high‐speed mode (nearly 8000 images per second) only one line from the whole image is selected and displayed on the x‐axis of the monitor; the y‐axis represents the time dimension. Results: All kinds of vocal fold vibrations, including those leading to pathological rough, breathy, hoarse, or diplophonic voice productions can be observed. Videokymography visualizes small left‐right asymmetries, open quotient differences along the glottis, lateral propagation of mucosal waves, and movements of the upper margin and, sometimes in the closing phase, the lower margin of the vocal folds. Conclusion: Videokymography is advantageous for a more accurate diagnosis of voice disorders. Videokymography provides a simple way to study irregular vibrations of the vocal folds. Information is directly available for further processing and allows a first‐time quantification of vibrations registered.
Differentiation and cathepsin D expression in human oral tumors
Authors: Brysk Miriam M. , Lei Gang , Adler‐Storthz Karen , Chen Zhuo , Horikoshi Toshio , Brysk Henry , Tyring Stephen K. , Arany Istvan
Published: November 2003

Objectives/Hypothesis: This study aimed to ascertain whether cathepsin D expression could be related to the stage of differentiation of oral tumors. Study Design: Human oral biopsies of 10 squamous cell carcinomas and of the corresponding perilesional normal tissues were used. The tumors had all been clinically graded as advanced stage but nonmetastatic; five were classified histopathologically as poorly differentiated. Methods: The gene expression of cathepsin D and keratin K13 in the biopsies was measured by reverse transcription polymerase chain reaction. Ratios of tumor‐to‐control readings helped compensate for sample variability. Results: Keratin K13, as a suprabasal cell marker, tended to confirm the histological grading of the tumors (but was not otherwise useful in distinguishing tumors from normal tissue). Substantial overexpression of cathepsin D was found in the poorly differentiated tumors. Conclusions: Cathepsin D overexpression is considered a prognostic indicator of metastasis. In this sample, it was also associated with dedifferentiation. Cathepsin D might serve as a valuable gauge in clinical exploration of the connection between dedifferentiation and metastasis.
Molecular temporal bone pathology: IV. Analysis of DNA template length using mitochondrial PCR primers
Authors: Wackym Phillip A. , Kerner Marc M. , Grody Wayne W.
Published: November 2003

The focus of this study was to identify, via molecular biology techniques, the length of the DNA templates present in individual archival celloidin‐embedded human temporal bone sections. Earlier studies have suggested that the maximum template length present in these tissues is on the order of 471 base pair (bp). Polymerase chain reaction (PCR) amplification of 92 bp, 121 bp, 471 bp, and 609 bp regions of mitochondrial DNA (mtDNA), extracted from single archival celloidin‐embedded human temporal bone sections, was used to assess the length of the template DNA extracted. These data are crucial to determine the limits of applying PCR technology to amplify specific genomic DNA targets located within the human inner ear. The results described should be of value to those investigators extracting DNA from archival individual human temporal bone sections for polymerase chain reaction assays of specific genetic alterations or infectious agents associated with temporal bone pathologies.
Palliative laser therapy for recurrent head and neck cancer: A phase II clinical study
Authors: Paiva Marcos B. , Blackwell Keith E. , Saxton Romaine E. , Calcaterra Thomas C. , Ward Paul H. , Soudant Jac , Castro Dan J.
Published: November 2003

Objectives: Laser therapy is becoming a more precise, minimally invasive alternative for tumor ablation. Recent reports confirm successful palliation of pain and functional disabilities in patients with advanced deep carcinoma of the head and neck using interstitial laser phototherapy (ILT). Study Design, Patients, and Methods: The current study describes an ongoing Phase II trial of neodymium/yttrium‐aluminum‐garnet (Nd:YAG) laser therapy for palliation of advanced head and neck cancer. A total of 40 advanced cancer patients have been entered into this protocol (25 men and 15 women). Results: Nineteen of these patients had no evidence of recurrence after ILT with an average follow‐up of 11 months (range, 2 to 24 mo). Currently, 19 of these patients are alive, 14 with tumor remission and six with persistent disease. A total of 79 tumor sites received ILT with 43 (54.5%) completely ablated. Stratified by tumor site, ILT led to a complete response in 21 of 24 in the oral cavity, eight of 28 neck tumors, four of 10 in skin, and 10 of 17 in other sites. The procedure was well tolerated in most cases and was repeated at intervals in patients with residual disease or recurrences for a total of 118 laser treatments (average, 2.95 treatments per patient). Conclusions: The results suggest that ILT can be performed safely and repeated as needed, and may be less costly than conventional surgery for head and neck cancer. However, additional follow‐up is needed to obtain convincing evidence of long‐term therapeutic benefits.
Dose‐related tissue effects of the CO2 and noncontact Nd:YAG lasers in the canine glottis
Authors: Sullivan Christopher A. , Rader Anne , Abdul‐Karim Fadi W. , Abbass Hassan , Mohr Rose M.
Published: November 2003

Objectives: The CO2 laser is the standard for control of recurrent respiratory papillomatosis because of its predictable action on laryngeal tissue. The noncontact neodymium:yttrium aluminum garnet (Nd:YAG) 1064‐nm laser is generally not used in the larynx owing to the lack of data on its tissue effects, and its potential lack of safety in the larynx. Combined Nd:YAG and CO2 laser treatments have been used safely in the tracheobronchial tree to eradicate recurrent respiratory papillomas. The objectives of this study were to describe and evaluate a method for applying the noncontact Nd:YAG laser to the larynx, to compare the tissue effects of the Nd:YAG, CO2, and combined Nd:YAG and CO2 lasers in the canine larynx, and to extrapolate canine tissue data to the human. Methods: The CO2, Nd:YAG, and combined Nd:YAG/CO2 lasers were applied to the glottis in four mongrel dogs. Laryngectomy was performed and the tissue was examined histologically. The nature and degree of tissue injury were analyzed relative to laser type and energy data. Results: In the canine larynx, the CO2 laser vaporized the surface epithelium and caused varying degrees of edema and necrosis of the lamina propria. The Nd:YAG laser did not cause ulceration but did show a greater degree of thermal damage to the lamina propria. Combined Nd:YAG/CO2 applications resulted in separation of the perimysial fibers from the muscle fibers of the vocalis muscle. Conclusion: These findings suggest that the noncontact Nd:YAG laser can be applied in a controlled fashion to the canine larynx at appropriate power densities. Anatomical differences between human and canine larynges are considered. Extrapolation to humans is proposed. Key Words: Laser, larynx, tissue effects, papillomatosis.
An objective analysis of the impact of lateral rhinotomy and medial maxillectomy on nasal airway function
Authors: Lueg Edgar A. , Irish Jonathon C. , Roth Yehuda , Brown Dale H. , Witterick Ian J. , Chapnik Jerry S. , Gullane Patrick J.
Published: November 2003

Objective: The lateral rhinotomy and medial maxillectomy procedure, while known to interrupt nasal valve supports, has not previously been reported to adversely affect nasal airway function. The purpose of this study was to utilize state‐of‐the‐art techniques to objectively analyze the impact of this procedure on nasal airway function. Design: The study design was retrospective and subject controlled. Methods: The study population was derived from an academic, tertiary‐referral, otolaryngology—head and neck surgery department with an estimated catchment population of 4 million people. Subjects included 21 consecutive, long‐term postoperative patients who had undergone lateral rhinotomy and medial maxillectomy for inverted papilloma. Objective measures included vestibular cephalometric measurements, airflow rhinomanometry, and acoustic rhinometry. Results: Statistically significant results reveal that although lateral rhinotomy and medial maxillectomy are associated with alar collapse, both overall nasal airflow and valve areas are increased. Conclusion: Lateral rhinotomy and medial maxillectomy does not adversely affect nasal airway function. This appears to be the result of concomitant resection of the functionally dominant inferior turbinate. This suggests that lateral rhinotomy performed in conjunction with operations not requiring inferior turbinectomy, such as anterior craniofacial resection, may adversely affect nasal airway function. Key Words: Lateral rhinotomy, medial maxillectomy, nasal airway function, airflow, rhinomanometry, acoustic rhinometry.
Direct bonded orthodontic brackets for maxillomandibular fixation
Authors: Utley David S. , Utley Jack D. , Koch R. James , Goode Richard L.
Published: November 2003

Objectives/Hypothesis: Mandibular fracture treatment often includes arch bar maxillomandibular fixation (MMF), either alone or in combination with open reduction/internal fixation (ORIF) techniques. The glove perforation rate associated with arch bar placement, the incidence of blood‐borne pathogen positivity in facial fracture patients, and the injurious effects of arch bars on dental enamel and gingiva have prompted the development of safer alternatives to arch bar MMF. This study evaluates the efficacy, ease of use, and safety profile of one such alternative: orthodontic direct bonded bracket fixation (MMF/DBB). Study Design: Prospective study of consecutive mandible fracture patients treated with MMF/DBB. Methods: Thirty‐two patients with mandibular fractures were evaluated from January 1994 to July 1997. Fourteen were appropriate for treatment with MMF/DBB (12 men and two woman; mean age, 24.6 ± 7.2 y; range, 16–42 y). Fracture sites included symphysis, angle, condylar neck, coronoid, and body. Nine patients underwent MMF/DBB alone; five underwent MMF/DBB with subsequent ORIF. Results: No infection, malocclusion, malunion/nonunion, or enamel/ gingiva injury occurred. Mean follow‐up was 6 months (range, 1–12 mo). Oral hygiene with MMF/DBB was superior to historical controls using arch bars. Conclusions: MMF/DBB can serve as the single treatment method with satisfactory results in patients with favorable, less complicated mandible fractures, although with increased experience, we have treated several more complex cases with MMF/DBB alone. In cases necessitating ORIF, MMF/DBB can be performed preoperatively to align fracture segments and reestablish occlusion. This facilitates placement of osteosynthesis plates and reduces ORIF operative time. MMF/DBB is an economical, safe technique that minimizes blood‐borne‐pathogen risk to the operative team, eliminates periodontal injury, facilitates postoperative dental hygiene, and is painless to apply and remove.
Three‐dimensional xenograft model of dysplastic human laryngeal mucosa
Authors: Shores Carol G. , Yarbrough Wendell G.
Published: November 2003

Objective: Development of new therapeutic interventions in head and neck squamous cell carcinoma (HNSCC) will be facilitated by a model system that incorporates the ease of manipulation found in current tissue culture systems while retaining the three dimensional architecture that defines these malignancies. Study Design: Original scientific investigation. Methods: We describe a modification of a normal respiratory mucosa model system which recreates premalignant mucosal histology. Grossly normal appearing human mucosa is harvested from laryngectomy specimens, the mucosal epithelium selectively removed by protease treatment and placed in conventional tissue culture. After 7 days, the cells are seeded into denuded rat tracheas, which are in turn implanted in flank pockets of athymic nu/nu mice. The tracheas are incubated for three weeks, removed and the mucosa examined histologically. Results: As originally described, normal pseudostratified squamous epithelium can be re‐established in this system.10 Using human dysplastic mucosa as a starting material, mucosal histologies of respiratory dysplasia, squamous metaplasia, squamous dysplasia and squamous carcinoma in situ can be established. Conclusion: This system will provide a paradigm for future therapeutic interventions to modify the progression of squamous metaplasia to dysplasia, carcinoma in situ and invasive squamous cell carcinoma. Key Words: Head and neck squamous cell carcinoma, xenograft model, dysplasia.
Predicting vocal outcome by means of a vocal endurance test: A 5‐year follow‐up study in female teachers
Authors: De Bodt Marc S. , Wuyts Floris L. , Van De Heyning Paul H. , Lambrechts Leen , Abeele Dirk Vanden
Published: November 2003

Objectives: Investigate whether vocal problems in future professional activities can be predicted by early laryngeal and phoniatric evaluation and whether a vocal endurance test can contribute to this evaluation. Study Design: Five‐year follow‐up study of 30 female education majors, initially documented with a standard voice assessment and a vocal endurance test. Measurements before and after vocal endurance testing were compared and related to the vocal outcome 5 years after the initial testing. Methods: Voice assessment included perceptual evaluation, airflow measurements, Fo and SPL measurements, voice range profile and laryngeal (stroboscopic) examination. The Standard Tolerance Test, as recommended by the Union of European Phoniatricians, was followed. This data set was completed with a questionnaire concerning the subjects' vocal behavior. This questionnaire was repeated 5 years later. Results: No significant differences were found for ENT scores (laryngostroboscopy) (P = .018). Logistic regression was used to determine a relationship between initial observations and the final outcome. Conclusions: The role of an endurance test as used in this study is negligible for the prediction of vocal outcome. A combination of laryngeal examination, maximum phonation time, and perceptual evaluation, assessed prior to the endurance test, reveals a prediction of the vocal outcome with a specificity of 90% and a sensitivity of 70%. Key Words: Voice, vocal outcome, vocal endurance test.