bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunomodulating Effects of Surgical Intervention in Tumors of the Head and Neck
Authors: Dietz Andreas , Heimlich Florian , Daniel Volker , Polarz Heinrich , Weidauer Hagen , Maier Heinz
Published: February 2003

The immunomodulating effect of primary surgical intervention in 33 patients with squamous cell carcinoma of the oral cavity, pharynx, and larynx was analyzed prospectively. An operation time of longer than 7 hours was significantly associated with a decrease of total lymphocyte counts, CD4+ T lymphocytes, and CD8+ T lymphocytes. The CD4/CD8 ratio as a marker for the downregulation of the cellular immune response was slightly decreased but still in the normal range. CD4+ lymphocyte counts increased within 7 days, and CD8+ lymphocytes increased 4 weeks after the operation. The in vitro stimulation of the lymphocytes was impaired for 1 to 4 weeks. Release of interleukins, interferon‐γ, and tumor necrosis factor‐α remained low despite the surgical trauma. The decreased lymphocyte counts, especially CD4+ and CD8+ lymphocytes, were significantly associated with duration of operation and volume of blood loss. Extension of trauma, age, type of anesthesia, and type of intensive care intervention were not associated with specific immunomodulating effects. However, these factors might be responsible for suppression of the immune system, which is expressed by lymphocyte depletion, lymphocyte dysfunction, and impaired upregulation of cytokine secretion.
Reconstruction of Lower Lip Defects aFter Tumor Excision: An Aesthetic and Functional Evaluation
Authors: LÓApez Alberto Costas , Ruiz Pilar Castro , Campo Francisco José Rodriguez , Gonzalez Francisco Diaz
Published: February 2003

We are presenting a new questionnaire to evaluate the functional and aesthetic aspects after reconstruction of defects of the lower lip resulting from tumor excision. The questionnaire is based on objective parameters with numerical values. The application of the questionnaire is carried out based on 2 different surgical techniques, which have been used in the Department of Oral and Maxillofacial Surgery of La Princesa University Hospital in Madrid. These techniques are used in the reconstruction of surgical defects and concern the location and percentage of the lip resection. These techniques are the rotation‐advancement flap by Yu and the rotation‐advancement in island flap by Colmenero et al. The defects are located laterally and they include 40% to 60% of the length of the lip, avoiding the commissure. There is also one case with a defect that is almost 100% of the length of the lip. According to the questionnaire, we conclude that in unilateral defects that exceed 50% (up to 70%), Yu's technique provides better results from an aesthetic and functional point of view than Colmenero's technique. In subtotal defects, bilateral Yu flaps provide optimum function, with good position of the scars. This is a technique to be considered when confronted with extensive defects of the lip that do not include the commissures.
The Nature of Juvenile Nasopharyngeal Angiofibroma
Authors: Liang Jiangang , Yi Zixiang , Lianq Ping
Published: February 2003

OBJECTIVE

The goal of this study was to investigate the nature of juvenile nasopharyngeal angiofibroma.

STUDY DESIGN

Twenty‐five excised tumors were studied morphologically to confirm the histopathologic features of the tumor.

METHODS

Paraffin sections of all tumor specimens were stained with hematoxylin‐eosin for elastic fiber, polyclonal antibody to factor VIII—related antigen and monoclonal antibodies to smooth muscle actin, estrogen receptor, and progesterone receptor. A quantitative assessment of the vascular component changes was also performed in 14 cases. Ultrathin sections of 5 tumors were studied electromicroscopically. Particular attention was paid to the progressive changes of both vascular and fibrous components as well as their mutual relationship.

RESULTS

(1) Beneath the endothelium of the vascular component, there was a thin layer of spindle cells; these cells had a positive reaction for smooth muscle actin, thus proving to be pericytes. (2) The actively proliferating site of the tumor was usually at the peripheral portion, with abundant vascular element lined by plump endothelial cells. (3) At the central and base locations, the growth of tumor tissue usually appeared to be in a relatively resting state. The vascular component decreased in amount as the extracellular collagenous fibers increased.

CONCLUSIONS

Because of the bicellular mixed composition of the vascular component and the tendency of synchronous maturation of both vascular and fibrous elements, it is suggested that juvenile nasopharyngeal angiofibroma is similar to most hemangiomas by nature and is likely a vascular hamartoma or a pathologic and reactive proliferation of vessels.
Factors Affecting Wound Infection Rates in Head and Neck Surgery
Authors: Coskun Hakan , Erisen Levent , Basut Oguz
Published: February 2003

PURPOSE

This study was planned with 2 goals in mind: to evaluate the efficacy of prolonged and 1‐day antibiotic regimens for prophylaxis and to evaluate the effect of various factors such as neck dissection, localization and stage of tumor, type of laryngectomy, and history of prior radiotherapy, tracheotomy, and diabetes mellitus on postoperative wound infection rates.

METHODS AND MATERIAL

In this study, 408 head and neck procedures (201 clean and 207 clean‐contaminated) performed at our institution were retrospectively reviewed.

RESULTS

Prolonged and 1‐day antibiotic regimens for both clean and clean‐contaminated procedures were similar in efficacy (7% vs 3% for clean procedures [P = 0.165] and 30% vs 28% for clean‐contaminated procedures [P = 0.777]). The wound infection rate was higher (13%) after clean radical neck dissections versus other clean procedures (1%) (P = 0.001). For clean‐contaminated procedures, factors affecting postoperative wound infection rates were performance of bilateral neck dissections (P = 0.014), disease stage (P = 0.002), type of laryngectomy (P = 0.002), and history of prior tracheotomy (P = 0.006).
Intranasal Anatomy of the Nasolacrimal Sac in Endoscopic Dacryocystorhinostomy
Authors: Wormald Peter John , Kew Jacqueline , Van Hasselt Andrew
Published: February 2003

Intranasal surface anatomy is fundamental to the technique of endoscopic dacryocystorhinostomy. In the current literature the lacrimal sac is described as being situated anterior to the anterior end of the middle turbinate with between 0% and 20% of the sac above the insertion of the middle turbinate on the lateral nasal wall (the axilla of the middle turbinate). The aim of this study was to use CT dacryocystograms (DCGs) and CT scans to establish the relationship of the lacrimal sac to the lateral nasal wall. Forty‐seven individual lacrimal sacs were measured in relation to the common canaliculus, and 76 were measured in relation to the insertion of the middle turbinate. Measurements taken from the long axis of the sac showed the mean height of the sac above the middle turbinate insertion was 8.8 mm (SD = 0.2, 95% Cl = 1.3) and below it was 4.1 mm (SD = 2.3, 95% Cl = 1.1). The average measurement of the sac above the common canaliculus on CT DCGs was 5.3 mm (SD = 1.7, 95% Cl = 0.56), whereas the average measurement below the common canaliculus was 7.7 mm (SD = 2, 95% Cl = 1.3) (n = 47 CT DCGs). The findings in this study show that a major portion of the sac is located above the insertion of the anterior end of the middle turbinate and, in addition, that a significant part of the sac lies above the entry point of the common canaliculus. Knowledge of these findings can ensure that the sac is adequately exposed during dacryocystorhinostomy by removal of sufficient bone and mucosa above the anterior insertion of the middle turbinate. (Otolaryngol Head Neck Surg 2000;123:307‐10.)
Tracheotomy Complications: A Retrospective Study of 1130 Cases
Authors: Goldenberg David , Ari Eliav Gov , Golz Avishay , Danino Joshua , Netzer Avriam , Joachims Henry Zvi
Published: February 2003

BACKGROUND

Tracheotomy is one of the most frequently performed surgical procedures in the critically ill patient. It is frequently performed as an elective therapeutic procedure and only rarely as an emergency procedure. Complications occur in 5% to 40% of tracheotomies depending on study design, patient follow‐up, and the definition of the different complications. The mortality rate of tracheotomy is less than 2%. Numerous studies demonstrate a greater complication and mortality rate in emergency situations, in severely ill patients, and in small children.

METHODS

A retrospective study of 1130 consecutive tracheotomies performed during 1 decade (January 1987 through December 1996) is presented. We studied the indications for surgery, the major complications of tracheotomy, and their treatment and outcome. We also noted the overall mortality rate and the specific complications that led to these deaths.

RESULTS

In total, 1130 tracheotomies were performed. Major complications occurred in 49 of the cases, and 8 deaths were directly attributed to the tracheotomy. The most common complication was tracheal stenosis, which occurred in 21 cases. Hemorrhage was the second most common complication, which occurred in 9 cases.

CONCLUSION

This is one of the largest series of consecutive tracheotomies compiled. We found a relatively low overall complication and mortality rate compared with other large series. Tracheal stenosis was the most common complication in contrast to other series. Our opinion is that this may reflect tracheal damage originally caused by prolonged intubation before the tracheotomy. We believe that all other complications of tracheotomy may be prevented or minimized by careful surgical technique and postoperative tracheotomy care.
Prevalence of Allergy in Meniere's Disease
Authors: Derebery M. Jennifer , Berliner Karen I.
Published: February 2003

OBJECTIVES:

The goal of this study was to determine the prevalence of allergy in a population of patients with Meniere's disease.

METHODS:

A survey was mailed to all patients with Meniere's disease seen at our institution from 1994 to July 1998 (n = 1490). As a control group, 172 patients with otologic problems other than Meniere's disease completed the same survey.

RESULTS:

Of 734 respondents with Meniere's disease, 59.2% reported possible airborne allergy, 40.3% had or suspected food allergies, and 37% had had confirmatory skin or in vitro tests for allergy. These prevalence rates were significantly higher than those found in the control group, of which 42.7% reported having or suspecting airborne allergies and 25% had or suspected food allergies (differences all significant at P ≤ 0.005).

CONCLUSION:

The prevalence of allergy appears to be much higher in patients with Meniere's disease than in the general population or the population of patients visiting an otologic clinic for other symptoms. (Otolaryngol Head Neck Surg 2000;123: 69‐75.)
Tympanic Membrane Perforation Repair Using Alloderm
Authors: McFeely William J. , Bojrab Dennis I. , Kartush Jack M.
Published: February 2003

BACKGROUND:

Some patients lack quality autologous tissue for tympanic membrane (TM) grafting. AlloDerm (LifeCell Corp, The Woodlands, TX) is a preserved allograft that has been effective in nonotologic applications.

OBJECTIVE:

The goal of this study was to investigate AlloDerm in the repair of chronic TM perforations. METHODS: Ten adult chinchillas underwent a controlled, 2‐stage procedure for creation and repair of bilateral TM perforations. Myringoplasties were performed. The control side (left) was repaired with autologous fascia; AlloDerm was used in all right ears. Grafts were assessed at 3 to 8 weeks.

RESULTS:

Complete TM perforation closure was noted in 9 of 10 (90%) control ears and 8 of 10 (80%) AlloDerm‐treated ears. Fascia and AlloDerm integrated consistently with host tissues. No variables demonstrated statistical significance.

CONCLUSIONS:

AlloDerm appeared to be an ideal substitute for grafting of the TM. It was equally effective as fascia. Clinical trials in human beings appear warranted. Potential health care savings are discussed.
Effects of Vestibular and Cerebellar Deficits on Gaze and Torso Stability During Ambulation
Authors: Crane Benjamin T. , Demer Joseph L.
Published: February 2003

We measured gaze, head, and torso stability during ambulation to determine how vestibulo‐ocular reflex dysfunction caused by unilateral vestibulopathy, bilateral vestibulopathy, and cerebellar dysfunction might affect image stabilization on the retina. Subjects were tested during standing, walking, and running on a treadmill. Gaze velocity, vestibulo‐ocular reflex gain, and head velocities were calculated from angular positions of the eye and head, as well as linear positions of the head and trunk. Mean gaze velocity with a visible, distant target was below 4°/second for all measurement conditions in control and vestibulopathic subjects. The performance of unilaterally vestibulopathic subjects was indistinguishable from that of control subjects except that the former had less vertical translation during walking. Bilaterally vestibulopathic subjects demonstrated less head translation than control subjects but had higher gaze velocity. In subjects with cerebellar dysfunction, gaze velocity was elevated by pathologic nystagmus, but head movements were similar to those of control subjects.
Growth‐Related Oncogene‐α Expression in Human Nasal Polyps
Authors: Klein Adam M. , Anderson Kathleen , Lafreniere Denis , Leonard Gerald , Kreutzer Donald
Published: February 2003

The cytokine growth‐related oncogene‐α (GRO‐α) is a potent mediator of leukocyte recruitment and proliferation in inflammatory diseases. We hypothesized that GRO‐α is produced in the inflammatory nasal polyp microenvironment. Evaluation of nasal polyps from 27 patients for distribution and content of GRO‐α antigen, by use of immunohistochemical techniques and ELISA, revealed its presence in all 27 tissue samples. It was found predominantly within the eosinophils and neutrophils, with tissue levels ranging from 34 pg/mg total protein (TP) to 1746 pg/mg TP with a mean value of 631 ± 98 pg/mg TP. Control tissues contained between 82 pg/mg TP and 316 pg/mg TP (mean 176 ± 38 pg/mg TP). These results were statistically significant (P < 0.03). Clinical correlations and statistical comparisons were calculated. These data suggest that GRO‐α may be an important factor in the recruitment and activation of leukocytes in nasal polyposis, making it a potential target for therapeutic intervention.
First Place—Resident Basic Science Award 1999: Effects of Leukotriene and Cyclo‐Oxygenase Inhibition on Adaptive Bone Remodeling in the Middle Ear
Authors: Sherman Bret E. , Chole Richard A.
Published: February 2003

Abnormal bone remodeling is associated with important otolaryngologic diseases. In such diseases, the mechanisms of osteoclastic control underlie the pathologic processes. It is known that strain applied to auditory bullae induces bone resorption—an effect mediated by prostaglandins and blocked by cyclo‐oxygenase inhibitors. It is also known that cyclo‐oxygenase inhibition shunts arachidonic acid into alternate metabolic pathways, mainly the lipoxygenase pathway with leukotriene production. The role of these metabolites in adaptive bone remodeling is unknown. Using the gerbilline bulla as a model, we infused BW755c (dual lipoxygenase/cyclo‐oxygenase inhibitor) and L‐663,536 (5‐lipoxygenase inhibitor) into animals undergoing middle ear pressurization. After 7 days, the bulla bones were harvested, and osteoclasts were quantified histomorphometrically. The results showed that neither treatment altered pressure‐induced resorption. However, BW755c significantly increased resorption in unpressurized bone when compared with control values. Because BW775c blocks both lipoxygenase and cyclo‐oxygenase pathways, the results suggest an alternate pathway in middle ear bone resorption.

Otosclerosis, cholesteatoma, Paget's disease of bone, osteogenesis imperfecta, and chronic otitis media are important otologic diseases with pathologies linked to inappropriate bone remodeling.1 In these diseases, the mechanisms of osteoclastic recruitment and activation must underlie the bone resorption associated with each condition. Numerous effectors have been implicated as modulating the local recruitment and activation of osteoclasts. One group of effectors, the metabolites of arachidonic acid (AA), has been shown to exert significant effects on osteoclastic bone resorption both in vivo and in vitro.2
Round Window Membrane Permeability to Transforming Growth Factor‐α: An in Vitro Study
Authors: Witte Mark C. , Kasperbauer Jan L.
Published: February 2003

OBJECTIVE:

Recent studies have identified the capacity of transforming growth factor‐α (TGF‐α) to stimulate mammalian labyrinthine hair cell regeneration after acute ototoxic damage. Augmenting hair cell regeneration with such growth factors may have a role in potentiation of recovery of cochlear function after hair cell injury. Transtympanic application of aqueous solutions to the round window membrane (RWM) has proved successful as a drug delivery route. The purpose of this study was to test the permeability of the mammalian RWM to TGF‐α in an inexpensive and reliable in vitro model.

METHODS:

Guinea pig RWM niches were harvested and transferred to a 2‐chamber apparatus, and TGF‐α was applied to the middle‐ear side of the chamber. ELISAs of TGF‐α were measured at intervals during a 96‐hour period.

RESULTS:

Aliquots taken during a 96‐hour interval demonstrated passage of TGF‐α in concentrations sufficient to stimulate hair cell regrowth.

CONCLUSIONS:

The apparatus allows study of RWM permeability to other substances and provides a basic model for study of RWM physiology. TGF‐α is able to pass through a mammalian RWM.
Efficacy of Immunotherapy Based on Skin End‐Point Titration
Authors: Krouse John H. , Krouse Helene J.
Published: February 2003

OBJECTIVE

The purpose of this study is to examine the efficacy of skin end‐point titration (SET) as a method of assessing skin responsiveness, selecting antigens, and initiating treatment for successful inhalant immunotherapy.

STUDY DESIGN

This study is a prospective, randomized, controlled, double‐blind investigation. Eighteen patients were randomly assigned to 1 of 2 groups: an experimental group treated for all positive antigens, and a control group treated for all positive antigens, with the exception of the study antigens. Quality of life was assessed with 3 dependent measures, and response to nasal challenge and nasal endoscopic evaluations were conducted. Ten patients completed the 6‐month study.

RESULTS

There were significant improvements in the emotional component of sinus‐related disability, in response to nasal challenge, and in the endoscopic appearance of the mucosa, regardless of patient group. There was a trend toward improved quality of life among experimental subjects.

CONCLUSIONS

SET‐based immunotherapy reduces self‐rated disability over time. In addition, SET‐based immunotherapy allows decrease in nasal reactivity and normalizes the endoscopic appearance of the nose.
Videostroboscopy of the Pharyngoesophageal Segment in Laryngectomy Patients Treated With Botulinum Toxin
Authors: Meleca Robert J. , Dworkin James Paul , Zormeier Michele M. , Simpson Mark L. , Shibuya Terry , Mathog Robert H.
Published: February 2003

OBJECTIVES:

The purpose of this investigation was to use videostroboscopy to study the physiologic and biomechanical effects of botulinum toxin (Botox) injection on the pharyngoesophageal segment (PES) in total laryngectomy patients with poor‐quality tracheoesophageal puncture (TEP) voice caused by PES spasm.

METHODS:

The following was a prospective study. Videostroboscopy of the PES and videotaped recordings of patients performing TEP voice tasks were conducted before and after Botox injection of the PES. Ratings of videostroboscopic and speech samples were performed by 3 blinded judges with extensive experience with this patient population.

RESULTS:

Perceptually, TEP voice was more fluent and less strained after injection. Videostroboscopically, patients demonstrated improved PES volitional control and mucosal wave characteristics after Botox injection.

CONCLUSION:

Botox injection in total laryngectomy patients with poor‐quality TEP voice caused by PES spasm provides improved physiologic and biomechanical function of the PES, as demonstrated for the first time videostroboscopically. These findings help explain the perceptual ratings of TEP voice improvement noted after Botox injection. Video‐stroboscopy can be used to provide diagnostic information to help confirm the clinical impression of PES spasm, as well as to document the effects of Botox injection on PES function.
Ossiculoplasty in Canal Wall Down Mastoidectomy
Authors: Berenholz Leonard P. , Rizer Franklin M. , Burkey John M. , Schuring Arnold G. , Lippy William H.
Published: February 2003

OBJECTIVE:

The aim of this study was to evaluate the initial and longer term success of closing the air‐bone gap (ABG) to 20 dB in ossiculoplasty with canal wall down mastoidectomy.

METHODS:

This study was conducted at a private otologic practice. Patients included those who underwent ossiculoplasty from 1989 to 1996 with canal wall down mastoidectomy, whether primary or revision (33 from a total of 387 tympanomastoidectomies). Outcome measures included ABG closure, long‐term hearing stability, mastoid appearance, extrusion, and sensorineural hearing loss.

RESULTS:

Almost 64% of ABGs were closed to within 20 dB. The mean pure‐tone average improvement was 12.3 dB. The mean PTA hearing decline in the years after surgery was slightly less than 1 dB/year.

CONCLUSION:

Hearing improvement with a stable long‐term hearing result is possible with canal wall down mastoidectomy. The potential for hearing gain is greatest for patients having larger preoperative ABGs. (Otolaryngol Head Neck Surg 2000;123: 30‐3.)
Efficacy of Uvulopalatopharyngoplasty in Unselected Patients with Mild Obstructive Sleep Apnea
Authors: Senior Brent A. , Rosenthal Leon , Lumley Alicia , Gerhardstein Rebecca , Day Ryan
Published: February 2003

OBJECTIVES

Uvulopalatopharyngoplasty (UPPP) is widely used as a first‐step procedure for the surgical management of obstructive sleep apnea (OSA) syndrome but best manages obstruction occurring at the level of the oropharynx alone and not the hypopharynx. Previous publications have noted mediocre results with use of this procedure in unselected patients with OSA, but less clear is the effectiveness of this procedure in the unselected patient with mild OSA (respiratory event index [REI] 5‐25). Using objective and subjective criteria, we retrospectively analyzed the results of UPPP in patients with mild OSA.

METHODS

We examined 37 patients with mild OSA (REI 13.5 ± 5.1, range 5.6‐23.1) who had been operated on during 1996 with UPPP with or without tonsillectomy and/or septoplasty. Follow‐up polysomnography was obtained in 25 (68%) an average of 40.5 weeks after surgery and compared with findings before surgery. Subjective assessment of sleepiness was performed with the Sleep‐Wake Activity Inventory.

RESULTS

Ten patients (40%) had a postoperative reduction in the REI of more than 50%, comparable with the improvements reported in those with more severe apnea. Those who did not have a reduction in REI after surgery actually saw an increase in average REI from 16.6 ± 5 to 26.7 ± 18.4. Similarly, subjective assessment of sleepiness with the Sleep‐Wake Activity Inventory showed no statistically significant improvement after surgery.

CONCLUSION

Overall, these results indicate that UPPP alone in the unselected patient provides little benefit in the management of mild OSA, similar to findings for more severe OSA. Surgeons must use great care in discerning the level of obstruction in the patient with mild OSA to tailor the appropriate retropalatal and/or retrolingual procedures and thereby achieve excellent surgical outcomes.
Surgical Management of Carotid Body Tumors
Authors: Wang Steven J. , Wang Marilene B. , Barauskas Tanya M. , Calcaterra Thomas C.
Published: February 2003

OBJECTIVE

The goal was to review our experience in the management of carotid body tumors at a tertiary referral center.

METHODS

A retrospective review was performed of patients at University of California‐Los Angeles Medical Center in whom carotid body tumor was diagnosed between 1973 and 1998.

RESULTS

Twenty‐nine patients with 36 carotid body tumors were identified. Thirty‐five operations were performed. Seventeen patients underwent preoperative embolization. The blood loss for these patients was less than for those without embolization. Five patients had preoperative cranial nerve deficits. Neurologic deficits were noted in 41% of patients immediately after surgery. In 24% of patients, the deficits were permanent.

CONCLUSION

Surgical resection is the treatment of choice for carotid body tumors. Embolization immediately before surgery decreases blood loss and facilitates tumor removal. In our series, the risk of new postsurgical cranial nerve deficits was small. Observation of these tumors is not recommended because progressive growth is associated with increased risk of neurologic deficits.
Second Place—Resident Clinical Science Award 1999 Laryngeal Chemoreflex Severity and End‐Apnea Pao2 and Paco2
Authors: Heman‐Ackah Yolanda D. , Goding George S.
Published: February 2003

OBJECTIVE

The laryngeal chemoreflex (LCR) is a model for investigating the sudden infant death syndrome. The severity of the LCR‐induced response may vary. This study examines the conditions under which recovery from the LCR‐induced apnea occurs.

METHODS

Twenty‐five piglets underwent normoxic laryngeal stimulation (Pao2 > 70 mm Hg); 11 then underwent hypoxic stimulation (Pao2 50‐65 mm Hg). Cardiovascular and respiratory responses were recorded.

RESULTS

Recovery Pao2 was lower during profound responses (Pao2 = 45.9 ± 12.8 mm Hg) than during moderate (Pao2 = 54.9 ± 7.5 mm Hg) and mild (Pao2 = 60.6 ± 10.3 mm Hg) responses (analysis of variance [ANOVA], P = 0.05). Recovery Paco2 did not vary (ANOVA, P > 0.05). Blood pressure and O2 saturation declined at faster rates with increasing severity of response (ANOVA, P < 0.05 for both).

CONCLUSIONS

Resumption of respiration after LCR‐induced apnea is associated with a consistent level of Paco2. The severity of the response is associated with recovery Pao2 levels.
Osteoradionecrosis of the Maxillary‐Orbital Complex After Neutron Beam Radiotherapy
Authors: Marunick Mark T. , Bahu Samer J. , Aref Amr
Published: February 2003

OBJECTIVE

Neutron beam radiotherapy (NRT) has been advocated for treatment of malignant salivary gland tumors and adenoid cystic carcinoma of the paranasal sinuses. The purpose of this study is to determine whether primary or adjuvant NRT results in a significantly increased rate of osteoradionecrosis (ORN) of the maxillary‐orbital complex (MOC).

STUDY DESIGN AND SETTING

All patients who received primary or adjuvant NRT involving the MOC and/or maxillofacial prosthetic rehabilitation at Wayne State University from 1992 to 1997 were evaluated (n = 9).

RESULTS

ORN did not develop in any of the 5 patients who received primary NRT. All 4 patients who received adjuvant NRT after surgical resection had ORN involving the MOC within the irradiated fields.

CONCLUSION

The reported trend of ORN after definitive surgery and NRT shows a markedly increased complication rate.

SIGNIFICANCE

The use of adjuvant NRT after definitive surgical resection involving the MOC should be considered with great caution.
New Approach for Cochlear Implantation: Cochleostomy Through the Middle Fossa
Authors: Colletti Vittorio , Fiorino Francesco G. , Carner Marco , Sacchetto Luca , Giarbini Nadia
Published: February 2003

The middle fossa approach was used in 11 patients with profound bilateral hearing loss for insertion of a cochlear implant. Fibroadhesive otitis media (n = 1), bilateral cavity radical mastoidectomy (n = 1), autoimmune inner ear disease (n = 2), previous cranial trauma (n = 1), genetic prelingual deafness (n = 5), and otosclerosis (n = 1) were the causes of deafness. A cochleostomy was performed on the most superficial part of the basal turn, and the electrode array was inserted up to the cochlear apex. Speech perception tests (1‐9 months after cochlear implant activation) yielded better results in these patients compared with a homogeneous group of postlingually deaf patients operated on through the traditional transmastoid route. Insertion of the implant through the middle fossa cochleostomy furnishes the possibility of stimulating areas of the cochlea (ie, the middle and apical turns) where a greater survival rate of spiral ganglion cells is known to occur, with improvement of information regarding the formants relevant for speech perception. (Otolaryngol Head Neck Surg 2000;123:467‐74.)
Image‐Guided Functional Endoscopic Sinus Surgery
Authors: Olson Garth , Citardi Martin J.
Published: February 2003

INTRODUCTION

Computer‐aided surgery (CAS) technology in functional endoscopic sinus surgery (FESS) has engendered considerable discussion.

OBJECTIVE

The goals of this study were to describe CAS preoperative planning (software‐based CT image analysis) and to develop intraoperative CAS strategies for endoscopic sinus surgery.

STUDY DESIGN

Between October 1, 1997, and December 31, 1998, the StealthStation (Sofamor Danek, Memphis, TN) was used in 61 FESS cases, and a retrospective review of the findings was performed. The indication for surgery in all instances was chronic rhinosinusitis refractory to medical management. The StealthStation was used to review all CT scans before surgery. Anatomic fiducial registration supplemented by contour mapping was used.

RESULTS

Localization accuracy was estimated to be within 2 mm or better. The StealthStation was used for both CT image review and intraoperative localization. CAS was useful in the frontal recess, sphenoethmoid region, posterior ethmoid system, and skull base area. CAS was deemed helpful in situations where the surgical anatomy was altered by previous surgery and extensive inflammatory disease (polyposis, fungal sinusitis, and pansinusitis).

CONCLUSION

The paradigm of image‐guided FESS surgery, which integrates CAS into FESS, will serve to increase surgical effectiveness and decrease surgical morbidity. (Otolaryngol Head Neck Surg 2000; 123:188‐94.)
Evaluation of Posttonsillectomy Hemorrhage and Risk Factors
Authors: Wei Julie L. , Beatty Charles W. , Gustafson Ray O.
Published: February 2003

BACKGROUND

A 13‐year retrospective study was undertaken to determine the incidence of posttonsillectomy hemorrhage, to evaluate potential risk factors, and to assess the efficacy and safety of ambulatory tonsillectomy.

METHODS

From January 1985 to December 1997, 4662 patients underwent tonsillectomy at our institution. Ninety patients with posttonsillectomy bleeding were identified. For each patient with posttonsillectomy bleeding, 2 nonbleeding control subjects were selected and matched by age and sex to evaluate potential risk factors.

RESULTS

Age was the only factor found to be statistically significant among the bleeding patients and the control group. The highest incidence (3.61%) of posttonsillectomy hemorrhage occurred in patients 21 to 30 years of age. In our experience, secondary hemorrhage was more common than primary hemorrhage, presenting most frequently on postoperative days 5 to 7.

CONCLUSIONS

The incidence of posttonsillectomy bleeding in this review was 1.93%, and about half (47%) of the patients with posttonsillectomy hemorrhage returned to the operating room for hemorrhage control. The highest incidence (3.61%) of posttonsillectomy hemorrhage occurred in patients 21 to 30 years of age. Patients with posttonsillectomy hemorrhage, regardless of management, had a 12% incidence of subsequent hemorrhage. We found no difference in the incidence of posttonsillectomy bleeding between outpatient and inpatient procedures.
Fibromatosis of the Head and Neck: A Challenging Lesion
Authors: Siegel Noah S. , Bradford Carol R.
Published: February 2003

Fibromatosis is a histologically benign fibrous neoplasm that arises from the musculoaponeurotic tissues of the body. It can have significant morbidity when it occurs in the head and neck region because of the proximity of vital structures. This review article considers the etiology, demographics, pathology, natural history, and various treatment modalities for this lesion. Therapeutic guidelines are provided.
Migration of Intradural Epidermoid Matrix: Embryologic Implications
Authors: Kountakis Stilianos E. , Chang C.Y. Joseph , Gormley William B. , Cabral Fernando R.
Published: February 2003

The migratory behavior of acquired cholesteatoma matrices (those arising from the tympanic membrane) has been described previously. This tissue is derived embryologically from the first branchial groove and represents the only migratory epithelium arising from the branchial groove system. If the matrix from a cerebellopontine angle (CPA) epidermoid tumor exhibits migratory behavior similar to that of acquired cholesteatomas, a first branchial groove site of origin for CPA epidermoids would be supported. Intradural CPA epidermoid cells were grown in a—minimum essential medium. The cultures were examined daily, and cell mass migration rates were measured. It was observed that intradural epidermoid tumor matrix harvested from the CPA exhibited migration in vitro. Its migratory properties were indistinguishable from those of acquired cholesteatomas, which are embryologically derived from the first branchial groove. These data support the theory that purely intradural epidermoids are derived from cells of the first branchial groove.
Growth and Development of the Human Cricoid Cartilage: An Immunohistochemical Analysis of the Maturation Sequence of the Chondrocytes and Surrounding Cartilage Matrix
Authors: Mankarious Leila A. , Goetinck Paul F.
Published: February 2003

OBJECTIVE

The goal was to determine maturational changes in the human cricoid cartilage.

STUDY DESIGN

The study involved immunohisto‐chemical staining of collagen II (a marker of proliferating chondrocytes), matrilin‐1 (a marker of post‐proliferative chondrocytes), and collagen X (a marker of hypertrophic chondrocytes). Specimens included uninjured human cricoid cartilages at 18 and 41 weeks' gestation and 1, 4, and 13 years postpartum.

RESULTS

This study demonstrated that type II collagen peaks in concentration at approximately 41 weeks' gestation. Matrilin‐1 is present in progressively lower concentration in the central core of the cricoid ring, but the peripheries of the ring contain the protein in relatively high concentration. Type X collagen is not expressed in the age groups tested.

CONCLUSIONS

These biochemical markers lend further support to a chondrocyte proliferative phase that slows between 1 and 4 years of age. Chondrocytes then enter a phase histologically similar to the hypertrophic phase but are biochemically different than hypertrophic chondrocytes destined for endochondral ossification.
Is Tracheotomy Decannulation Possible in Oxygen‐dependent Children?
Authors: Picerno Nicolette A. , Bent John P. , Hammond Jeffrey , Pennington Weems , Guill Margaret F. , Hudson Valera L. , Deane Daniel A.
Published: February 2003

OBJECTIVE

The goal was to determine whether decannulation can be safely achieved in children with persistent oxygen requirements.

DESIGN

The study was a prospective evaluation of 12 oxygen‐dependent children at a tertiary care academic children's medical center.

METHODS

Twelve tracheotomy‐dependent children with persistent oxygen requirements were evaluated for decannulation. Patients requiring more than 35% FiO2 were not considered. Direct laryngoscopy and bronchoscopy were performed in all patients. Two required single‐stage laryngotracheoplasty to correct subglottic stenosis, 1 required tracheal resection, and 7 required removal of suprastomal granulation tissue. Oxygen was administered after decannulation through a nasal cannula.

RESULTS

Decannulation was successful in 92% (11 of 12) of patients. At final follow‐up, oxygen requirements decreased in 58% of patients after decannulation.

CONCLUSIONS

Decannulation can be successful in children who remain oxygen dependent; conversion to a more physiologic airway may be an adjunct to reducing or eliminating their oxygen demand.
Factors Related to Outcome of Salvage Therapy for Isolated Cervical Recurrence of Squamous Cell Carcinoma in the Previously Treated Neck: A Multi‐Institutional Study
Authors: Krol Bryan J. , Righi Paul D. , Paydarfar Joseph A. , Cheng Elbert T. , Smith Ronald M. , Lai Daniel C. , Bhargava Vaibhav , Piccirillo Jay F. , Hayes John T. , Lue Allen J. , Scher Richard L. , Weisberger Edward C. , Wilson Keith M. , Tran Lynn E. , Rizk Nabil , Pellitteri Phillip K. , Terris David J.
Published: February 2003

OBJECTIVE

The goal was to identify factors associated with the outcome of salvage therapy for patients with isolated cervical recurrences of squamous cell carcinoma in the previously treated neck (ICR‐PTN).

STUDY DESIGN AND SETTINGS

A tumor registry search for ICR‐PTN patients was performed at 7 participating institutions, and the charts were reviewed. Kaplan‐Meier plots for survival and time until rerecurrence were used to evaluate the significance of associated variables.

RESULTS

Median survival and time until re‐recurrence were both 11 months. Survival was better in patients with the following characteristics: nonsurgical initial neck treatment, negative initial disease resection margins, no history of prior recurrence, ipsilateral location of the ICR‐PTN relative to the primary, and use of surgical salvage.

CONCLUSIONS

By pooling the experience of 7 US tertiary care medical centers, we have identified 5 factors that are associated with outcome of salvage therapy for ICR‐PTN.

SIGNIFICANCE

Consideration of these factors, as well as the reviewed literature, should facilitate patient selection for salvage protocols.
Student Research Award 1999: Comparative Contrast of Voice Measurements
Authors: Klein Sandra , Piccirillo Jay F. , Painter Colin
Published: February 2003

Currently, a variety of objective and subjective measures are available to describe voice and voice function. Despite these various tools, there is no standard measure of voice function that incorporates both objective and subjective measures. The goal of this research was to study the relationship between objective, subjective, and patient‐based measures of voice function. Objective voice function was measured with 4 laboratory‐based parameters (sub‐glottic pressure, airflow at the lips, maximum phonation time, and vocal efficiency), subjective function with the GRBAS (grade, rough, breathy, asthenic, strained) scale, and patient‐based function according to an overall global rating of quality. The objective and subjective measures were significantly related to each other (P < 0.05); the objective and patient‐based measures were also related (P = 0.019), but the subjective and patient‐based measures were not related. We demonstrate a significant relationship between some but not all measures of voice function. We believe that subjective measures provide additional valuable information not obtained from objective measures alone.
Otogenic brain abscess: Review of 41 cases
Authors: Sennaroglu Levent , Sozeri Bulent
Published: February 2003

Forty‐one patients in whom otogenic brain abscess was diagnosed and has been treated since 1968 are presented. Sixty‐five percent of the patients were between 5 and 15 years of age. All patients had chronic otitis media, and 95% had cholesteatoma. Abscess was located in the temporal lobe in 54%, in the cerebellum in 44%, and in both locations in 2% of the cases. Most patients had radical mastoidectomy and evacuation of the abscess through the mastoidectomy (61%). In addition to mastoidectomy, burr hole drainage was used in 20% and craniotomy in 15%. The most common microorganism involved was Proteus. Overall mortality in this series is 29%, but after 1976, when CT became available for the diagnosis and follow‐up, the mortality rate was reduced to 10%.
Controlled Multicenter Study on Chronic Suppurative Otitis Media Treated with Topical Applications of Ciprofloxacin 0.2% Solution in Single‐Dose Containers or Combination of Polymyxin B, Neomycin, and Hydrocortisone Suspension
Authors: Miró Nuria ,   The Spanish Ent Study Group
Published: February 2003

Otic drops of either ciprofloxacin 0.2% solution (CIP) or a combination of polymyxin B, neomycin, and hydrocortisone suspension (PNH) were administered for 6 to 12 days to patients (14‐71 years old) with chronic suppurative otitis media in a randomized, nonblinded, multicenter clinical trial. Two hundred thirty‐two enrolled patients were analyzed for efficacy on a “per protocol” basis. The most frequently identified causal agents were Staphylococcus aureus (28% of the patients), Pseudomonas aeruginosa (19%), and Staphylococcus sp (9%). Clinical success was observed in 91% and 87% of the CIP‐and PNH‐treated patients, respectively. At 1‐month follow‐up, 4% of CIP and 6% of PNH patients showed a relapse of otorrhea. Bacteriologic eradication was seen in 89% and 85% of patients in the CIP and PNH groups, respectively. At 1‐month follow‐up, reinfection or recurrence of infection appeared in 3 patients in the PNH group and in 1 patient in the CIP group. Both treatments were well tolerated. The most frequently reported adverse events were pruritus, stinging, and earache. Audiometric tests did not show changes attributable to study drugs in any but 1 patient in the PNH group. This clinical trial shows that topical 0.2% ciprofloxacin solution in single‐dose containers is effective and well tolerated in patients with chronic suppurative otitis media.
Extended Lateral Rhinotomy Incision for Total Maxillectomy
Authors: Vural Emre , Hanna Ehab
Published: February 2003

An extended lateral rhinotomy incision for total maxillectomy, which avoids postoperative lower eyelid complications, is described. Advantages of the extended lateral rhinotomy incision for total maxillectomy are discussed in comparison with the classic Weber‐Fergusson incision. (Otolaryngol Head Neck Surg 2000;123:512‐3.)
Reduced‐Time‐Window Sestamibi Scanning for Nonlocalized Primary Hyperparathyroidism
Authors: Kacker Ashutosh , Scharf Steve , Komisar Arnold
Published: February 2003

BACKGROUND

Technetium Tc 99m sestamibi scan is the standard of care for localizing parathyroid adenomas.

METHODS AND MATERIAL

We performed a retrospective, single‐institution study of 111 consecutive patients with primary hyperparathyroidism who underwent standard sestamibi scan for localization of a parathyroid lesion. A revised protocol of reduced‐time‐window sestamibi scan was used in nonlocalized patients. The protocol was composed of single‐view scans at 15, 30, 45, and 120 minutes and tomograms at 60 minutes.

RESULTS

Thirty‐five patients underwent surgery at our institution. Thirty‐one had adenomas, and 4 had hyperplasia. Three of 31 patients did not show localization on the standard scan and underwent reduced‐time‐window scans, which localized 2 more adenomas. These were confirmed at the time of surgery.

CONCLUSION

We suggest that all patients with a high degree of suspicion for a parathyroid adenoma, which is not visualized by a standard scan, undergo a reduced‐time‐window scan.
Assessment of the Airway in Obstructive Sleep Apnea Syndrome with 3‐Dimensional Airway Computed Tomography
Authors: Bhattacharyya Neil , Blake Simon P. , Fried Marvin P.
Published: February 2003

OBJECTIVE

The goal was to evaluate 3‐dimensional airway CT for upper airway assessment in obstructive sleep apnea syndrome (OSAS).

DESIGN

Airway CT was obtained and 3‐dimensional airway models were constructed prospectively for 40 patients with OSAS and 10 controls. Airway dimensions were correlated with polysomnography, and comparison was made between patients with and without OSAS.

RESULTS

OSAS patients had a mean respiratory distress index of 51.9 events per hour. The mean minimum cross‐sectional area (XSA) in the neutral position was 67.1 mm2. Minimum XSA decreased in both the inspiratory and expiratory phases to 16.3 mm2 and 15.0 mm2, respectively (P < 0.001). Complete airway obstruction occurred in 1 or more phases of respiration in 28 patients. Neither airway XSA nor length of obstruction correlated with sleep apnea parameters. No statistically significant differences in airway dimensions were found between OSAS and control patients.

CONCLUSIONS

Airway CT demonstrates dynamic airway obstruction in OSAS but does not correlate well with clinically important disease parameters.
Telomerase Assay and Nested Polymerase Chain Reaction from Nasopharyngeal Swabs for Early Noninvasive Detection of Nasopharyngeal Carcinoma
Authors: Kerekhanjanarong Virachai , Sitawarin Surachai , Sakdikul Sairoong , Saengpanich Supinda , Chindavijak Somjin , Supiyaphun Pakpoom , Voravud Narin , Mutirangura Apiwat
Published: February 2003

The main purpose of this study was to analyze sensitivity and specificity of combining nested polymerase chain reaction for detection of Epstein‐Barr virus (EBV) genome and telomerase assay for identifying nasopharyngeal carcinoma (NPC). Eighty patients with NPC and 27 healthy control subjects were included in this study; 97.5% and 94.9% of NPC patients were positive for EBV genome and telomerase activity, respectively. When nasopharyngeal swabs were tested, 95.7% presented the EBV genome and 85.5% were positive for telomerase expression. The sensitivity for counting either positive result of these two techniques was 100%. Among the 27 control subjects, only 6 and 5 cases were positive for EBV DNA and telomerase activity, respectively. This indicated a specificity of 92.6% when both positive results were included. At present, early diagnosis of NPC requires multiple biopsy specimens, especially to identify subclinical cases. Because this study showed a very high sensitivity for detecting NPC from swabs when combining the telomerase assay and nested polymerase chain reaction technique, this noninvasive technique may be a good candidate for screening of subclinical NPC, especially before multiple biopsy specimens are obtained.
Increased Expression of Major Basic Protein (MBP) and Interleukin‐5 (IL‐5) in Middle Ear Biopsy Specimens from Atopic Patients with Persistent Otitis Media with Effusion
Authors: Wright Erin D. , Hurst David , Miotto Deborah , Giguere Chantal , Hamid Qutayba
Published: February 2003

BACKGROUND

Molecular biologic evidence to support an etiologic role for allergy in the pathogenesis of persistent otitis media with effusion (OME) is lacking.

OBJECTIVE

The goal of this article was to document expression of allergy‐associated Th‐2‐type cytokines and inflammatory cells in the middle ear mucosa of children with persistent OME.

METHODS

With immunocytochemistry (CDS, major basic protein) and in situ hybridization (interleukin‐5 mRNA), middle ear biopsy specimens from 7 children with persistent OME were stained. Nonatopic stapedectomy patients with no history of otitis media served as controls (n = 7).

RESULTS

There was a statistically significant (P < 0.05) difference in expression of CDS, major basic protein, and interleukin‐5 between experimental and control subjects. All 8 OME patients proved to be atopic by ELISA testing.

CONCLUSIONS

Type I allergy involving a Th‐2‐type cytokine and cellular profile may be a contributing factor in the persistence of OME in atopic children.

SIGNIFICANCE

The middle ear may serve as a target organ for allergic inflammation, suggesting that appropriate allergy management may be a useful adjunct to the management of OME.