bluuebunny/crossref_metadata_2025 huggingface dataset:
A technique for pharyngeal reconstruction in heavily irradiated patients
Authors: Jenkins Herman A. , Canalis Rinaldo F. , Ward Paul H.
Published: October 2006

A technique for esophageal reconstruction using a staged deltopectoral tubed, pedicled flap has been highly successful in irradiated patients. The basic principle involves use of the neck skin as the posterior wall and the dorsal and lateral aspects of the tubed flap to form the anterior and lateral walls of the newly constructed pharynx. The ventral surface forms the cutaneous covering. The submental area and base of tongue are used for implantation of the distal end of the flap, taking advantage of the abundant blood supply of this area. It is a fail‐safe method of reconstruction, particularly applicable in cases in which the local skin is of poor quality.
Tracheoesophageal space abscess
Authors: Fee Willard E. , Wilson George G.
Published: October 2006

Two cases of a newly described complication of endotracheal intubation are presented with a discussion of the pathophysiology, clinical symptoms, and treatment evaluation. Treated late, bilateral arytenoid fixation associated with subglottic stenosis is the eventual outcome. Reconstructive efforts in one patient have allowed decannulation two years after onset of his disease following bilateral arytenoidectomy. No reconstructive efforts were attempted in the second patient because of her basic underlying disease process. Early recognition is important and exploratory laryngotracheal‐fissure advocated for suspected cases in order to perhaps decrease the devastating consequences of late treatment.
Tympanostomy tubes, their use, abuse, and cost‐benefit ratio
Authors: Armstrong Beverly W. , Armstrong Robert B.
Published: October 2006

Tympanostomy tubes are employed when middle ear ventilation is indicated, particularly when other forms of treatment have failed. Few other uses have broad acceptance. Any other insertion of a ventilating tube implies abuse, either through error in diagnosis or deliberate misapplication. Hard statistical data relating to abuse are impossible to obtain, but ample illustrations can be cited.

The cost‐benefit ratio is difficult to assess. Cost of a myringotomy and tube versus the cost of a tympanomastoidectomy was determined in four geographic areas. These figures, however, do not reveal how many ears were spared and how much hearing was conserved by tympanostomy tubes. Informed, diligently aggressive use of tympanostomy tubes offers greater potential to avoid serious middle ear disorders and complications than any other single modality.
Flap reconstruction in patients with head and neck cancer: Techniques and results
Authors: Levine Laurence A. , Sessions Donald G. , Ogura Joseph H.
Published: October 2006

Patients who are treated by surgery, radiotherapy, or any combination thereof may suffer from complications in wound healing or tumor recurrence which necessitate reconstruction or repair utilizing tissue brought in from other parts of the body.

The majority of patients, who required flap reconstruction for primary repair or for a complication of their surgery, had their primary lesion in the supraglottic larynx or inferior hypopharynx. More than two‐thirds of the flaps elevated were for fistula repair. Five year survival in this group of patients was lower than in those patients with uncomplicated postoperative courses, although the quality of live for the survivors in both groups was not significantly different.
The use of synthetic implant material in osteoplastic frontal sinusotomy
Authors: Barton Richard Thomas
Published: October 2006

The use of homologous fat in obliterating frontal sinus operations has proved to be a satisfactory technique. It does entail, however, a separate procedure to obtain the graft. Furthermore, the implanted fat has a tendency to shrink or absorb in varying degrees.

Proplastr̀ has been used in a series of osteoplastic frontal sinus operations. The implant block is a highly porous preparation of Teflonr̀ fluorocarbon polymer and vitrous carbon fibers. It can be easily carved into desired shapes or it may be implanted in pieces. The porosity of the substance permits in‐growth of connective tissue. Eight obliterating frontal sinus procedures using the osteoplastic flap technique and implanting the synthetic material are reported. There have been no failures to date after 1 to 5 years follow‐up.
Adenocarcinoma of the ethmoid following radiotherapy for bilateral retinoblastoma
Authors: Rowe Lee D. , Lane Richard , Snow James B.
Published: October 2006

Adenocarcinoma of the ethmoid sinus is rare, representing only 4‐8% of malignancies of the paranasal sinuses. An extraordinary case of papillary adenocarcinoma of the ethmoid sinus arising 30 years following high‐dose radiotherapy for bilateral retinoblastoma is presented.

Retinoblastoma, though occurring only once in every 23,000 to 34,000 births, is the most common malignant intraocular tumor of childhood. Second fatal mesenchymal and epithelial primaries have been described in 8.5% of patients with bilateral retinoblastomas previously treated with radiotherapy; however, papillary adenocarcinoma arising within the paranasal sinuses has not been reported. Histologically, the findings of a papillary pattern of poorly differentiated, mucicarmine‐staining cells enclosing gland‐like spaces, and the absence of pseudorosettes, melanin, mesenchymal and peripheral neural elements supports an epithelial origin of this tumor.

Aggressive treatment including partial maxillectomy, radical pansinusectomy, radical neck dissection followed by regional radiotherapy and systemic chemotherapy failed to prevent the development of fatal hepatic metastases. The high incidence of second fatal primary neoplasms in patients with bilateral retinoblastomas receiving radiation suggests an innate susceptibility that may add to the risk of radiotherapy. Careful long‐term head and neck surveillance is mandatory if early aggressive management of these extremely lethal tumors is to be successful.
Reconstruction of the base of the tongue and lateral pharyngeal wall
Authors: Yarington C. Thomas
Published: October 2006

A technique for reconstruction of the lateral pharyngeal wall, with a buccal mucosal rotation flap is presented for use in patients following extensive resections of the lateral pharyngeal wall with partial mandiblectomy. Reconstruction of the base of the tongue, utilizing midline tongue flaps and/or the epiglottis, is also illustrated. These innovative techniques frequently obviate forehead and chest flaps, aid in vocal rehabilitation, and allow single stage resection and reconstruction in nonradiated patients.
Stapedius reflex quantification in acoustic tumor patients
Authors: Mangham Charles A. , Lindeman Roger C. , Dawson Warren R.
Published: October 2006

This investigation is a human application of previously reported work from our laboratories on experimental acoustic tumor effects on the stapedius reflex in monkeys. In this study, the contralateral stapedius reflex was elicited in human controls and in subjects with an acoustic tumor. Acoustic impedance was recorded on magnetic tape for offline analysis of reflex threshold, latency, rise, amplitude, decay, and relaxation.

Typical tumor effects on threshold and decay were observed. Most important was the demonstration that decay measured at 20 db SL was more sensitive and more specific for tumor than decay measured at the conventional 10 db SL. Stapedius reflex latency, rise, and amplitude were more sensitive to the presence of a tumor than were measures of threshold and decay. These data indicate that qualification of the reflex will increase the utility of the test.
Manometric measurement of eustachian tube ventilatory function
Authors: Mccurdy John A.
Published: October 2006

Although initial manometric studies of Eustachian tube ventilatory function in both normal and abnormal ears suggested that this technique provided an accurate physiologic assessment of ventilatory function, recent studies have questioned the physiologic nature of these tests. In an effort to clarify this controversy, the tubal ventilatory capacity of 51 ears in which Eustachian tube function was clinically normal was assessed manometrically. Similar measurements were made in 18 ears in which Eustachian tube function was clinically normal except for a complaint of aural fullness. This group showed poorer ventilatory function than normal ears, but the most striking result was the inability of over 50% of the normal group to equilibrate negative pressure to a level within the normal range of 0 to—50 mm H2O. It is postulated that Eustachian tube ventilatory function exhibits a range of individual variability such as is characteristic of other biologic systems.
Bell's palsy: Surgery based upon prognostic indicators and results
Authors: May Mark , Blumenthal Frank , Taylor Floyd H.
Published: October 2006

We studied 164 patients with Bell's palsy prospectively over the six‐year period between August 1974 and June 1980. We found that the results of measuring tear production, sub‐mandibular salivary flow, the response to maximal stimulation, and evoked electromyography gave us sufficient information to group these patients according to prognosis —either unfavorable or favorable — for spontaneous return of facial function. When the test results were 26% or more of normal, 90% of the patients had complete recovery of function; these patients were given a favorable prognosis on the basis of the results of tests described above.

The natural history of Bell's palsy in patients with an unfavorable prognosis could be improved if a transmastoid facial nerve decompression to the labyrinthine segment were performed. The results were better with this approach than with supportive or steroid therapy or transmastoid vertical‐horizontal surgical decompression of the facial nerve.
Central vestibular projections of primary cervical fibers in the frog
Authors: Suarez Carlos , Garcia Cristina , Tolivia Jorge
Published: October 2006

The origin of cervicovestibular inputs was documented in frogs, as well as the number of fibers, site of projection, and their distribution within the nuclei. The first spinal nerve in 15 frogs was labeled with extracellular injections of horseradish peroxi‐dase. The brain stem and the posterior root were sectioned serially. The trajectories of the fibers in the central nervous system were reconstructed, and the number and diameters of the fibers in the posterior root were determined. The average number of fibers in the first posterior root was 143 ±6.2, their number decreasing exponentially with increased diameter. After entering the spinal cord the fibers were located in the dorsal funiculus. The thick and medium‐sized fibers coursed medially in relation to the thin ones, giving collaterals to the spinal cord and to the obex region. The thinnest fibers projected to the reticular formation and nucleus of the solitary tract. Only collaterals from fibers of medium and thick caliber reached the vestibular area in their trajectory to the cerebellum (spinocerebellar fibers). All the vestibular nuclei received collaterals and endings from the spinocerebellar fibers, the ventral nucleus being the most innervated. The total number of branches for the vestibular area, however, was very small. The results of this experiment are correlated with physiological and anatomical findings described in the literature.
Beta‐2‐microglobulin as the main component of primary amyloidosis located in the larynx
Authors: Án‐Ogazón O. Galv , Terán L. A. , Fernandez J. , Pasquel P.
Published: October 2006

A case of primary amyloidosis located in the larynx in which Beta‐2‐microglobulin (β2m) was the main component of the tissue is presented.

Indirect immunofluorescence performed with monoclonal anti‐human β2m antibody (BBM1) showed a positive reaction, as did Congo red stain, and both patterns were similar.

A significant increase in serum β2m was observed; however, the clinical condition associated with this elevation remains unclear.

We suggest that β2m is not only the main component of secondary amyloidosis in terminal nephropathy patients undergoing hemodialysis for prolonged periods, but that it could be part of the structure of other types of amyloid—either primary or secondary.
Malignant transformation of a nasopharyngeal angiofibroma
Authors: Makek Miro S. , Andrews James C. , Fisch Ugo
Published: October 2006

The malignant transformation of a nasopharyngeal angiofibroma is a rare occurrence. This report describes the development of a fibrosarcoma in a patient over a 20‐year period after four surgical procedures and two courses of radiation therapy to control a nasopharyngeal angiofibroma. A review of the literature revealed similar descriptions of this problem. Radiation likely plays a major role in causing the malignant change. An initial complete surgical excision can prevent recurrence of a nasopharyngeal angiofibroma as well as sarcomatous transformation. With the availability of surgical procedures that can completely and safely resect almost all nasopharyngeal angio‐fibromas, radiation therapy can be avoided.
External septorhinoplasty in children
Authors: Crysdale William S. , Tatham Brian
Published: October 2006

External septorhinoplasty was performed on 15 patients over n 12‐year period in a general pediatric otolaryngology practice. It is the operation of first choice when there is significant dorsal nasoseptal pathology. Good cosmetic and functional results are obtained by full dissection of the nasoseptal pathology, judicious resection of thickened deformed cartilaginous and osseous tissues, and repositioning of a suitable nasoseptal fragment anteriorly in the midline.
Dermabrasion in facial surgery
Authors: Farrior Richard T.
Published: October 2006

Surgical planing or dermabrasion has many uses in facial aesthetic and reconstructive surgery but often is an underutilized technique. The purpose of this paper is to familiarize the head and neck and facial plastic surgeon with some of these uses extending from trauma to rejuvenation of the aging face. Detail will be presented regarding analysis For conditions where dermabrasion is indicated and in dealing with modifications of surgical technique. The author feels that dermabrasion is the treatment of choice for scars and acne and favors it over chemabrasion or chemical peel even for fine rhytids because the depth of dermabrasion can be precisely controlled and varied according to the location of and the degree of scarring or faciul wrinkles. It offers early and predictable healing without concern for the penetration and absorption of chemical elements (especially phenol). Dermabrasion may be combined with other procedures such as scar revisions, dermal shaves, and de‐epithelization of flaps.
Carotid arteriospasm
Authors: Osguthorpe J. David , Adkins Warren Y.
Published: October 2006

Arteriospasm can rcsult from manipulation or fresh blood around an artery. This myogenic reflex can spread to obliterate collateral flow and can last from minutes to days. Ischemic strokes from carotid spasm ensue ncurosurgical procedures, endarterectomies, and even chiropractic manipulation. The diagnosis and prevention of arteriospasm are presented, and a patient who has carotid arteriospasm following excision of a branchial cleft cyst is detailed. If the vessel constriction is noted at surgery, topical application of a local anesthetic is effective. Transfusion, hydration, oxygenation, and maintenance of blood pressure are the cornerstones of nonoperative therapy.
Evaluation of nmr versus ct for parotid masses: A preliminary report
Authors: Schaefer Steven D. , Close Lanny G. , Maravilla Kenneth R. , Suss Richard A. , Merkel Marie A. , Burns Dennis K.
Published: October 2006

Twelve patients with various parotid masses were prospectively studied by both nuclear magnetic resonance (NMR) imaging and intravenously enhanced computed tomography (CT). These imaging techniques were then correlated with the disease process and clinical relevance of both forms of imaging assessed. Our results suggest high resolution, spin‐echo NMR offers several advantages over CT, and is likely to become the preferred method of evaluating a parotid mass.
The method and management of thyroid surgery in the pediatric patient
Authors: Bryarly Richard C. , Shockley William W. , Stucker Fred J.
Published: October 2006

Thyroid surgery in the pediatric age patient accounts for a small minority of all thyroid surgery. Batsakis and Nishiyama reported only 136 patients under the age of 18 who underwent thyroid surgery in 27 years at the University of Michigan.1 In most series involving the pediatric age group, the majority of thyroid procedures are performed on adolescents.1–6 Thyroid surgery in the young child requires special precautions in addition to those routinely associated with thyroidectomy in the adult.

The techniques and perioperative management of the pediatric thyroidectomy employed at our institution has evolved as experience is gained. Our experience with five such patients with adequate follow‐up will be presented.
Velar closure and ear tubings as a primary procedure in the repair of cleft palates
Authors: Frable Mary Ann , Brandon Gilbert Theodore , Theogaraj S. Dawson
Published: October 2006

This ten‐year study reviews 36 patients with complete clefts of the hard and soft palates treated with primary velar closure, bilateral myringotomies, and tubings performed when the infant was 12 to 15 months of age. The hard palate and prepalate were not closed until the child was at least 5 1/2, years of age. By early velar closure, a population with an almost 100% incidence of otitis media with effusion has been converted to a population with a 17% incidence of recurrent otitis media requiring repeat myringotomies and tubings.
High‐grade malignancies of the parotid gland: Effective use of planned combined surgery and irradiation
Authors: Matsuba Howard M. , Thawley Stanley E. , Levine Laurence A. , Smith Peter G. , Devineni V. Rao
Published: October 2006

The trend toward treatment of parotid gland malignancies with planned combined surgery and postoperative radiation therapy is currently being followed by many centers, although prospective studies comfirming the efficacy of this treatment regimen have only recently begun. We have reviewed only our “high‐grade” histologic types: adenocarcinomas, malignant mixed tumors, high‐grade mucoepidermoid carcinomas, squamous cell carcinomas, and undifferentiated carcinomas. Acinic cell carcinomas, adenoid cystic carcinomas, and low‐grade mucoepidermoid carcinomas were excluded from study because of their different biologic behavior. Since 1974, we have employed the approach of surgical extirpation with preservation of the facial nerve when possible for all parotid tumors, combined with planned postoperative radiation therapy (50‐70 Gy).

We reviewed the 37 cases of “high‐grade” parotid gland malignancies and compared the patients treated with the combined modality approach with our historical patients treated initially with surgery alone. Despite an apparent higher stage at presentation, our combined treatment group ultimately had significantly better local control (70% vs. 20%), and an equivalent survival rate at five years.

Tumor was present at the margin of resection in 14 (74%) cases treated with combined surgery and irradiation. The facial nerve was preserved in six of these patients with positive margins, and only one of these patients developed a local or regional treatment failure.

In conclusion, our data confirms the efficacy of surgical exploration to determine the extent of disease and surgical resection, preserving facial nerve function if possible, followed by postoperative radiation therapy at adequate doses. Control of local‐regional disease was much improved by combined modality therapy as opposed to surgical resection alone, despite the prevalence of residual microscopic disease in the resection margins. Facial nerve function is optimally preserved by this approach of conservative surgery combined with postoperative radiation therapy.
Obstructive sleep apnea: Variations in surgical management
Authors: Caldarelli David D. , Cartwright Rosalind D. , Lilie Jamie K.
Published: October 2006

Forty patients with obstructive sleep apnea (OSA) were either treated by submucous resection, alone or by palatopharyngoplasty (PPP). Before surgery, each patient underwent a thorough sleep evaluation for the diagnosis of OSA.

Of the 23 patients treated by submucous resection alone, eight had more than a 50% reduction in their apnea index and were considered successfully treated. Of the remaining 15, ten received a supplemental tongue retaining device (TRD). Five of the ten were markedly improved. The overall success rate in this group was 57%.

Of the 17 patients treated by submucous resection and PPP, ten were treated successfully. Six of the remaining seven patients were subsequently treated with a TRD, which was successful in four. The overall success rate in this group was 82%.
Coexisting otosclerosis and meniere's disease: A diagnostic and therapeutic dilemma
Authors: Sismanis Aristides , Hughes Gordon B. , Abedi Esrafil
Published: October 2006

The coexistence of otosclerosis and Meniere's disease is well documented; however, otosclerosis may not be recognized in patients presenting mainly with Meniere's symptoms and, therefore, treatment may not be effective.

In this paper, eight patients with otosclerosis and Meniere's disease are presented. The diagnosis of coexisting otosclerosis and Meniere's was initially missed in most of these patients. Medical and surgical treatment had been unsuccessful. Diagnostic and therapeutic guidelines for management of these patients are discussed.

Our preliminary conclusions are: 1. otosclerosis should be diagnosed in patients with Meniere's disease, especially when bilateral or when suggested by clinical and/or laboratory findings, and 2. the addition of sodium fluoride to diet‐diuretic management of such patients appears effective.
Multiple symmetrical lipomatosis in a patient with hürthle cell carcinoma of the thyroid: A case report
Authors: Rhoads Daniel D. , Dixon Anita E. , Taylor Sarah A.
Published: October 2006

Multiple symmetrical lipomatosis is a rare disorder of fat distribution which generally affects middle age men of Mediterranean origin. Hürthle cell carcinoma is an uncommon variety of follicular carcinoma which invades locally and metastasizes hematogenously to bone, lung, and other distant organs. This report describes a patient who developed multiple symmetrical lipomatosis after undergoing total thyroidectomy for Hürthle cell carcinoma of the thyroid. Type IV hyperlipidemia, hyperuricemia, frequent ethanol usage, and macrocytosis were features previously associated with multiple symmetrical lipomatosis which were present in this patient. Fourteen years after the initial surgery, metastatic Hürthle cell carcinoma was detected in the superior mediastinum. The location of the metastasis and the long disease free interval are unusual features of this case. A possible association between Hürthle cell carcinoma and multiple symmetrical lipomatosis is considered.
Perichondrial‐cartilage island graft in one stage tympano‐ossiculoplasty
Authors: Mikaelian Diran O.
Published: October 2006

A one stage reconstruction of the tympanic membrane and the ossicular chain using a composite graft of tragal perichondrium with cartilage is described (Type III tympanoplasty). The long‐term results in 18 operated cases reveals closure of the air‐bone gap to within 0 to 10 dB in 72% of the cases.

The above procedure used autologous graft material, does not disturb the remaining middle ear structures, can be performed under local anesthesia, and in most cases is done on an outpatient basis.
Carcinoma of the tonsillar region
Authors: Mizono Gary S. , Boles Roger , Diaz Richard F. , Fu Karen K.
Published: October 2006

A retrospective analysis of 171 patients with carcinoma of the tonsillar region is presented. The majority of patients (79%) presented with stage III and IV disease. Three year determinate survival was 81% ‐ T1, 74% ‐ T2, 59% ‐ T3, and 20% ‐ T4. The presence of nodal disease decreased survival by one half.

Radiotherapy alone was highly successful in controlling early T1 and T2 lesions of the tonsillar fossa. Surgery alone or combined radiotherapy and surgery was more successful than radiotherapy in controlling early T1 and T2 lesions of the tonsillar pillar. More advanced T3 and T4 lesions also did poorly with radiotherapy alone. An analysis of these results and a review of the literature is presented.
High‐field magnetic resonance imaging of paranasal sinus inflammatory disease
Authors: Moore James , Potchen Michael , Waldenmaier Nancy , Sierra Arlene , Potchen E. James
Published: October 2006

Magnetic resonance imaging using a 1.5 tesla magnet and a spin echo technique has revealed a remarkably intense signal from abnormal tissue in the human paranasal sinuses. Inflammatory disease in the maxillary, sphenoid, ethmoid, and frontal sinuses has been detected and demonstrated with greater clarity than any other available technique. The pathophysiologic basis for the intense signal has not been defined. These observations do, however, provide an opportunity to discover, clarify, and study paranasal sinus disease. Acute upper respiratory disease, allergic episodes, and the effect of drug treatment based on the MR signal and pathology can now be investigated with this technique. In addition, this may form a basis for assessing the epidemiology of paranasal sinus pathology.
Value of magnetic resonance imaging in assessing bone destruction in head and neck lesions
Authors: Virapongse Chat , Mancuso Anthony , Fitzsimmons Jeffrey
Published: October 2006

We utilized low‐field magnetic resonance imaging (MRI) to evaluate 12 patients with head and neck lesions and suspected skull base or facial bone destruction. All except one had high resolution computed tomography (CT). MRI was performed on a 0.15 tesla (low‐field) resistive unit, with routinely good resolution due mainly to the use of specially designed rf receiver coils (surface coils). T1 and T2 weighted spin echo images were performed in all cases. In three instances axial, coronal, and sagittal images were done. All CTs were done with high resolution techniques on state‐of‐the‐art equipment. Comparison of the CT and MR images (at low‐field strength) showed that MRI's main strength lies in its freedom to perform images in any plane and to visualize intracranial lesions with early brain involvement. Otherwise, the two modalities are comparable. Bone destruction seen on CT was always detectable on MRI, although CT is clearly superior in resolving bone detail. MRI is recommended when direct coronal CT scans are not obtainable to evaluate superiad tumor extension. The improved visualization of nasopharyngeal soft tissue and cavernous sinus region is likely to make MRI the examination of first choice in evaluating lesions of the nasopharynx, skull base, and cavernous sinus.
The nasal bossa: a complication of rhinoplasty
Authors: Kamer Frank M. , Churukian Michael M. , Hansen Lori
Published: October 2006

A study of 1,033 consecutive rhinoplasties was undertaken to focus on etiology and treatment of nasal bossa. Of the 2% that developed bossa, the only consistent, statistically significant etiology factor was that of preoperative nasal asymmetry. There was no correlation with skin or cartilage characteristics. Those tips requiring alteration by the delivery technique were five times more likely to develop bossa than those treated by cartilage split or retrograde techniques. The surgical dilemma of treatment by either augmentation of the lesser side or resection of the bossa was discussed.
Frontal sinus fractures: Some problems and some solutions
Authors: Shockley William W. , Stucker Fred J. , Gage‐White Linda , Antony Sam O.
Published: October 2006

Head trauma can result in serious injuries leading to life‐threatening situations. Often accompanying these injuries are fractures involving the frontal sinus. Some fractures are subtle and difficult to diagnose, while others are massive and difficult to treat. The experience at this institution in the management of frontal sinus fractures is examined. Particular emphasis is placed on the problematic cases. These include fractures that were nearly overlooked, those that were associated with massive CSF leaks, and those which were extensively comminuted. In treating some of the most severe compound injuries, a frontalis myofascial flap has been used successfully to “plug” the site of CSF leakage. The review will include the types of fractures encountered, associated injuries, errors in diagnosis, the treatment rendered, and the complications which resulted. As encountered in other studies relating to trauma, adequate follow‐up has been a serious shortcoming. The protocol presently used in the management of these injuries will be outlined.
The role of needle aspiration biopsy in the selection of patients for thyroidectomy
Authors: Cohen Jason P. , Cho Hyun T.
Published: October 2006

Fine needle aspiration (FNA) biopsy is gaining in popularity among all diagnostic tests used in the evaluation of patients for thyroidectomy. Its safety and accuracy have been well documented, but criteria regarding when FNA is appropriate are lacking. We retrospectively reviewed our experience with 408 consecutive patients evaluated for thyroid surgery. Two hundred seventy‐three ultimately underwent thyroidectomy; 100 of these had preoperative FNA. An additional 135 patients underwent FNA without surgery. Patients who benefited from FNA were those in whom cytologic findings led to surgery for otherwise unsuspected malignancy (15), and those with asymptomatic benign nodules who avoided unnecessary thyroidectomy on the basis of FNA findings (96). FNA is superfluous when clinical conditions mandate surgery. These include nodules that arouse clinical suspicion of malignancy, massive nodules that cause aerodigestive tract compression or cosmetic disfigurement, and nodules extending into the mediastinum. All patients with asymptomatic, clinically benign thyroid nodules should undergo FNA biopsy, as approximately 50% can anticipate significant benefit from the procedure.
The effect of hydroxyl radical scavenging on acute axial‐random skin flap survival
Authors: Hayden Richard E. , Paniello Randal C. , Bello Steven L. , Yeung Cecil S. T.
Published: October 2006

Dimethyl thiourea (DMTU), a known hydroxyl radical scavenger, was tested for its ability to improve survival in acute island skin flaps. Rats receiving 500 mg/kg DMTU 1 hour after flap elevation showed a 23.5% improved survival over saline controls. The role of the hydroxyl radical in ischemia/reperfusion injury, and its proposed mechanism, is discussed.
Depressed pmnc blastogenic response in patients with cancer of the head and neck: A study of il‐2 production, il‐2 consumption, and il‐2 receptor expression
Authors: Eskinazi Daniel P. , Perna John J. , Ershow Abby G. , Clifford Mihail R.
Published: October 2006

Approximately two thirds of patients with head and neck cancer have been shown to have peripheral mononuclear cells that exhibit a lowered blastogenic response to the T‐cell mitogens, concanavalin A and phytohemagglutinin. To investigate the possible mechanisms of this phenomenon, we measured the amount of activated T‐cell lymphokine interleukin‐2 present in the supernatant of concanavalin A‐or phytohemagglutinin‐stimulated peripheral mononuclear cells taken from patients with squamous cell carcinoma of the upper aerodigestive tract. Concentrations were found that were similar to those of healthy subjects. The rate of interleukin‐2 consumption and the degree of interleukin‐2 receptor expression also were similar for patients and controls. In the course of these experiments, it was noted that differences in blastogenic response between patients and controls were abolished when, 24 hours after the beginning of either concanavalin A or phytohemagglutinin stimulation, the culture supernatant was removed and replaced by fresh medium, containing recombinant interleukin‐2 to further sustain cell growth. This suggests that the lower blastogenic response found in patients with head and neck cancer is not due to global immune unresponsiveness, but instead, is caused by selective cell dysfunction(s), which may include the production of a suppressor factor following concanavalin A or phytohemagglutinin stimulation.
Regeneration of the eighth cranial nerve. III. Central projections of the primary afferent fibers from individual vestibular receptors in the bullfrog
Authors: Newman Anita , Suarez Carlos , Kuruvilla Alexander , Honrubia Vicente
Published: October 2006

The projection site in the central nervous system of individual end‐organ branches of regenerated vestibular nerves was documented in bullfrogs. The eighth cranial nerve was surgically sectioned in 12 bullfrogs (Rana catesbeiana) and allowed to regenerate. Horseradish peroxidase was used to label the primary vestibular afferent fibers from the whole nerve (one frog) and the whole anterior branch (two frogs), and the individual receptor end‐organ branches to the anterior semicircular canal (three frogs), the horizontal semicircular canal (three frogs), and the sacculus (three frogs). A sufficient number of fibers from the individual receptors were labeled in nine specimens to allow a description of their central projection pattern.

The overall pattern of central projections of the regenerated nerves was similar to the pattern of normal nerves. In the eighth nerve root proper and in the area proximal to the vestibular nuclei, fibers from the anterior semicircular canal were ventral, fibers from the sacculus and posterior branch were dorsal, and fibers from the horizontal semicircular canal were in an intermediate position. In ventral, superior, and descending vestibular nuclei, a projection pattern was also identifiable in some specimens. The fibers of the anterior semicircular canal projected ventral to the fibers of the horizontal semicircular canal, with fibers from the posterior branch more dorsal. The saccular fibers projected to the dorsal aspect of the ventral nucleus and the ventral aspect of the dorsal nucleus.

For the most part, projections in the regenerated specimens, as verified histologically, were comparable to individual end‐organ projections previously identified in normal frogs. The only major discrepancy between the findings from the regenerated specimens and those from normal frogs was in the position of the vestibular tract and the innervation to the medial nucleus. The regenerated vestibular tract was shifted laterally in the brain stem. Regenerated thick and thin fibers were intermixed in the tract and projected to the medial nucleus. Normally, the thin fibers are lateral to the thick fibers in the tract.

Therefore, the regenerated afferent fibers of the vestibular nerve selectively reinnervated the vestibular nuclei, and the fibers to the individual end‐organs selectively reinnervated particular parts of the nuclei. In addition, the thick and thin regenerated fibers preserved the type of bouton endings normally found. The regenerated thick fibers had rare boutonsen passantand a great number of collaterals, while the thin fibers had numerous boutonsen passantand only a few collaterals. The previously observed functional recovery of regenerated fibers appears to be due to a normal distribution of fibers in the central nervous system and not due to plastic changes needed to correct abnormal reinnervation.
Stomal complications and airflow line problems of the communi‐trach I® cuffed talking tracheotomy tube
Authors: Leder Steven B. , Astrachan David I.
Published: October 2006

There have been no reports of stomal complications and airflow line problems associated with a cuffed talking tracheotomy tube. However, the results of this study showed that stomal complications, in the form of pressure necrosis and wound extension, and problems with airflow line kinking occurred with a 40% and 80% frequency, respectively. Solutions to both difficulties arc discussed.
A new surface electrode for recording from the posterior cricoarytenoid muscle
Authors: Fujita Mihoko , Ludlow Christy L. , Woodson Gayle E. , Naunton Ralph F.
Published: October 2006

A new pharyngeal surface electrode for recording posterior cricoarytenoid muscle activity through the hypopharyngeal mucosa has been evaluated. The electrode was passed through one nasal passage into the hypopharynx. Correct electrode location was verified by increased activity during inhalation, with decreased activity during phonation. The procedure was evaluated in 45 subjects, 10 normal speakers and 35 patients with dysphonia. Accurate recordings were obtained in 25 subjects (56%). Problems encountered were lack of pharyngeal descent, electrode dysfunction, and signal interference due to phonatory vibration or interarytenoid activity. Signal validity was evaluated in four normal speakers with accurate electrode placement. Significant (p≤0.001) increases in PCA activity occurred during tasks requiring vocal fold abduction. The electrode proved to be a useful, noninvasive clinical tool for recording PCA activity in some patients.
Temporal bone findings in a case of bilateral meniere's disease treated by parenteral streptomycin and endolymphatic shunt
Authors: Khetarpal Umang , Schuknecht Harold F.
Published: October 2006

A patient with bilateral Meniere's disease who had progressive hearing loss and intractable vertigo was treated at ages 60 and 62 with parenteral streptomycin to ablate ves‐tibular function, and at age 74 by a left endolymphatic shunt procedure. He was confined to a wheelchair because of ataxia from age 75 until the time of his death at age 81. Both temporal bones show congenitally hypoplastic endolymphatic sacs and severe endolymphatic hydrops consistent with Meniere's disease. There was atrophy of the striae vasculares and loss of cochlear neurons consistent with presbycusis. A loss of hair cells in the cristae and saccules was consistent with streptomycin ototoxicity. In the left ear the Silastic® strip that was intended to function as an endolymphatic shunt into the mastoid lies encased in fibrous tissue and failed by 4.5 mm to reach the hypoplastic endolymphatic sac.
Stereotactic radiosurgery for squamous cell carcinoma of the nasopharynx
Authors: Kondziolka Douglas , Lunsford L. Dade
Published: October 2006

Stereotactic radiosurgery using the gamma unit represents a unique neurosurgical treatment method for the management of selected intracranial vascular malformations and tumors. During a closed‐skull single‐session procedure that focuses 201 individual beams of gamma irradiation, a high‐radiation dose is delivered to the lesion, with a steep dose fall‐off peripherally. In order to maintain accuracy of delivery, the target must remain fixed in space; hence the skull is engaged by rigid external fixation during treatment. In this report, we document the first ex‐tracranial lesion treated with radiosurgery, a recurrent squamous cell carcinoma of Rosenmuller's fossa, and discuss the possible role of radiosurgery in carefully selected head and neck malignancies.
A histopathological study of the relationship between otitis media and mastoiditis
Authors: Schachern Patricia , Paparella Michael M. , Sano Shinichi , Lamey Sherry , Guo Yengha
Published: October 2006

From a total of 1408 human temporal bones, 229 with otitis media or mastoiditis were selected; other contributing diseases were excluded. Of this group, 19.2% had an obstruction of the aditus ad antrum with pathologic tissue, usually granulation tissue. Although pathologic fluid and tissue were usually distributed throughout the middle ear and mastoid, in some cases, the most severe conditions were restricted to the mastoid. Pathologic conditions were more severe in cases with obstruction. An interesting observation was that columnar epithelial cells, goblet cells, and mucoid effusion were not observed in the mastoid, suggesting a restriction of secretory cells to the middle ear proper. It appears that obstruction of the aditus ad antrum contributes to the pathogenesis and accentuates pathologic conditions in otitis media.
Central nervous system changes associated with noise‐induced hearing loss: An electron microscopic and freeze‐fracture study of the chick nucleus magnocellularis
Authors: Mattox Douglas E.
Published: October 2006

This investigation assessed the effects of noise‐induced hearing loss on the avian nucleus magnocellularis, the homologue of the mammalian cochlear nucleus.

Fifteen‐day‐old chicks were exposed to high‐intensity broad‐band noise (132 dBA) for 24 to 72 hours. Hearing loss was documented with auditory brainstem response recordings and scanning electron microscopy of the basilar papilla. Nucleus magnocellularis was assessed with thin‐section electron‐microscopy and freeze‐fracture techniques.

Freeze‐fracture preparations of noise‐exposed animals showed a decrease in synaptic vesicle fusion sites at the synaptic active zone, a decrease in reuptake of presynaptic membrane by coated vesicles, and a shift of the preferential fracture plane at the synapse from the presynaptic membrane to the postsynaptic membrane.

These findings support the hypothesis that the effects of noise are not limited to the auditory periphery, but that transneuronal changes extend into the auditory central nervous system.
Effects of persistent perilymph fistula on the inner ear
Authors: Kaseki Yumiko , Nakashima Tsutomu , Fukuta Shigeji , Suzuki Toru , Yanagita Noriyuki
Published: October 2006

To study the effects of a persistent perilymph fistula on the cochlea, a small cannula was inserted into the scala tympani of the basal turn of cochlea in guinea pigs. A month later, cochlear morphology and blood flow were studied using either histological evaluation or the microsphere surface preparation technique. Some animals showed no cochlear morphologic changes or no cochlear blood‐flow reduction, even if tubal patency was maintained and perilymph leakage lasted for 1 month. This suggests that a prolonged perilymph fistula, per se, causes no permanent cochlear damage. However, in some animals, hair cell damage and cochlear blood‐flow disorders were observed. These observations and the causes of hearing loss in clinical cases of perilymph fistula were studied.
The recurrent laryngeal nerve in relation to the inferior constrictor muscle of the pharynx
Authors: Wafae Nader , Vieira Magno Cèsar , Vorobieff Antonina
Published: October 2006

The point of penetration of the recurrent laryngeal nerve into the larynx is recognized as the most frequent site of injury to the nerve during surgical procedures of the thyroid gland. The anatomical relationships of 25 right and left recurrent laryngeal nerves in 25 anatomical blocks from formalin‐fixed human corpses have been studied.

In 34 cases (68%), the recurrent laryngeal nerve penetrated into the larynx below the lower fibers of the inferior constrictor muscle of the pharynx (type 1 of penetration). In the remaining 16 cases (32%), the nerve crossed through those muscle fibers to penetrate into the larynx (type 2 of penetration).

The thyroid gland was found to involve the recurrent laryngeal nerve at the penetration point into the larynx in 19 of 50 cases (38%).
A methodological study of hemilaryngeal phonation
Authors: Jiang Jack Jiaqi , Titze Ingo R.
Published: October 2006

An excised hemilarynx setup was developed. The phonatory characteristics of nine excised canine larynges were examined. The left vocal fold of each larynx was then removed and substituted with a vertical plexiglass plate. The larynges were phonated again. Recordings were made of phonation threshold pressure, sound pressure level, average glottal flow, fundamental frequency, and amplitude of vocal fold vibration as observed with a video stroboscope. Measurements were made over a range of subglottal pressures. For the hemilarynx, simultaneous recordings of intraglottal pressure and vocal fold contact area were also made. It was found that amplitude and frequency of vocal fold vibration of the hemilarynx, as well as rates of change of amplitude and frequency as a function of subglottal pressure, were similar to those of the full larynx. Also similar were phonation threshold pressures and ranges of subglottal pressure over which the larynges phonated. The average airflow of the hemilarynx was approximately half that of the full larynx, and the sound pressure level, under similar conditions, was one fourth (about 6 dB less) in the hemilarynx.
Use of bone for obliteration of the nasofrontal duct with the osteoplastic flap: A cat model
Authors: Owens Michael , Klotch Douglas W.
Published: October 2006

The management of the frontal sinus remains controversial for traumatic and inflammatory disease. The osteoplastic flap with fat obliteration has become the treatment standard, although late failures with infection and mucocele formation may arise. Theories for mucocele formation include regrowth of residual mucosa from the sinus and ingrowth of mucosa from a nonobliterated nasofrontal duct.

A study to evaluate the means of nasofrontal duct obliteration was developed. Three cat groups were evaluated at 1,2, and 3 months. Group 1 had the duct and sinus obliterated with fat. Group 2 had the duct obliterated with bone and the sinus with fat. Group 3 had only the duct obliterated with bone. There was no mucosal ingrowth in any of the sinuses for the intervals studied. In group 1, fat volume was seen to decrease over time with replacement by fibrous tissue within the duct. Groups 2 and 3 developed progressive obliteration of the duct with new bone formation.

One may infer that fat obliteration alone does not provide a predictable stable situation as fat atrophies within the duct and may allow mucosal ingrowth. Bone obliteration was shown to be progressive within the duct from osteogenesis. This is the first experimental model to correlate clinical observations of the use of bone for sinus obliteration.

This study concluded that bone obliterates the nasofrontal duct better than the accepted standard of fat, independent of the material used to obliterate the sinus.
A treatment for primary ciliary dyskinesia: Efficacy of functional endoscopic sinus surgery
Authors: Parsons David S. , Greene Bradley A.
Published: October 2006

Primary ciliary dyskinesia (PCD) is an inherited disorder manifested in children as chronic otomastoiditis, recurrent pneumonia, and chronic sinusitis. The failure of the ciliary beat pattern to effectively function in the respiratory tract produces stasis of secretions with secondary inflammation, edema, and infection. The authors report three young children with PCD who presented with variable severities of symptoms. Each had the aforementioned respiratory tract problems. The child with the most severe symptomatology was treated with a variety of medical options, including long‐term gamma globulin injections, but hospitalizations persisted twice per month because of severe sinopulmonary illness. All three of the children underwent functional endoscopic sinus surgery (FESS). In addition, two children received pressure equalization (PE) tubes. One child required a revision procedure. Their surgical outcomes are discussed. Follow‐up of FESS in three children with this disorder shows a marked improvement in symptomatology with a decreased incidence of hospitalization and a somewhat decreased need for medical therapy.