bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of hereditary hemorrhagic telangiectasia by ND‐YAG laser photocoagulation
Authors: Shapshay Stanley M. , Oliver Peter 
Published: October 2006

AbstractHereditary hemorrhagic telangiectasia (Rendu‐Osler‐Weber disease) is an inherited abnormality of the vasculature characterized by abnormal subepidermal vessels. Frequent, sometimes severe, epistaxis often requiring blood transfusions is present in most patients. Septal dermatoplasty and estrogen have proved to be the most successful therapies. However, the frequency of failure in treatment has stimulated a search for an alternative therapy.The Nd‐YAG laser was used at low‐power settings (20‐25 W) to treat 6 patients with hereditary hemorrhagic telangiectasia, all of whom had been treated previously using other modalities. Laser photocoagulation diminished the frequency and severity of hemorrhage in 5 of 6 patients without complications (6 to 9 month follow‐up period). The Nd‐YAG laser may be used repeatedly when new accessible lesions arise, and it appears to be a useful therapeutic option for this disease that is difficult to treat.
Dissemination of squamous papilloma by surgical manipulation: A case report
Authors: Welsh Randall L. , Gluckman Jack L. 
Published: October 2006

AbstractThe occurrence of multiple squamous cell papilloma in the upper and lower aerodigestive tract is well documented. While apparent inoculation to other areas in the lower respiratory tract at the time of bronchoscopy or tracheotomy is a frequently described occurrence, there have, however, been no reports of transmission of papilloma outside the respiratory tract as a result of surgical manipulation.The purpose of this paper is to report a case of squamous papilloma of the external auditory canal and tympanic membrane which resulted from apparent inoculation at the time of surgery for nasal cavity and nasopharyngeal papillomas together with myringotomies. This supports the hypothesis that an infectious agent, e.g., a virus could be the causative agent and that inoculation to other sites as a result of manipulation is possible.In light of our experience with this case we recommend specific guidelines for the handling of these patients and the protection of surgeons, anesthesia and operating room personnel. Hopefully this report will heighten awareness of papillomas as a potentially transmittable entity to sites outside the respiratory tract, and encourage others to approach these clinical situations with caution.
Necrotizing fasciitis as a lethal complication of peritonsillar abscess
Authors: Wenig Barry L. , Shikowitz Mark J. , Abramson Allan L. 
Published: October 2006

AbstractAbscesses of the peritonsillar region rarely lead to serious complications. Incision and drainage, antibiotic therapy, and subsequent tonsillectomy is the accepted method of treatment.Two cases of fatal necrotizing fasciitis following peritonsillar abscess are presented. The entity of necrotizing fasciitis in the head and neck is discussed with respect to its presentation, diagnosis, and treatment.
Congenital laryngeal saccular cyst of the newborn
Authors: Abramson Allan L. , Zielinski Benjamin 
Published: October 2006

AbstractCongenital laryngeal saccular cysts of the newborn frequently cause severe dyspnea and upper respiratory tract obstruction. When confronted with this emergency situation necessary therapeutic action may consist of intubation, puncture or incision to reduce the volume of the cyst or tracheotomy.The CO2 laser was effectively used not only to incise the supraglottic saccular cyst but also to vaporize the lining.
Mandibulectomy without reconstruction can cause sleep apnea
Authors: Panje William R. , Holmes Douglas K. 
Published: October 2006

AbstractAnterior mandibulectomy can precipitate the development of sleep apnea. All head and neck tumor patients having had extensive composite anterior oral cavity resections should be evaluated for sleep apnea before decannulation of their tracheostomy tube. Subsequent flap and/or rigid reconstruction of the lower jaw appears to prevent the development of sleep apnea. Fascial sling suspension of the lower lip does not appear to prevent sleep apnea.
Primary radiation therapy for juvenile nasopharyngeal angiofibroma
Authors: Cummings Bernard J. , Blend Ralph , Fitzpatrick Peter , Clark Roy , Harwood Andrew , Keane Thomas , Beale Francis , Garrett Peter , Payne David , Rider Walter 
Published: October 2006

AbstractEvidence is presented of the effectiveness and relative lack of serious toxicity of external beam megavoltage radiation therapy (RT) as primary treatment for juvenile nasopharyngenl angiofibroma. The importance of careful radiological evaluation of tumor extent prior to irradiation is stressed, and only moderate dose RT is required.Fifty‐five patients have been treated by RT and followed for from 3 to 26 years. Forty‐four of 55 patients (80%) had permanent tumor control following a single course of 3000 cGy to 3500 cGy over 3 weeks. Surgical resection or a second course of RT controlled the tumor in all 11 patients in whom regrowth occurred. Angiofibromas involute slowly after RT so that 50% of patients still had visible masses in the nasopharynx 12 months after treatment, but only 10% had any visible abnormality 36 months after RT. Retreatment was necessary only if symptoms recurred, and continued follow‐up showed that most asymptomatic nasopharyngeal masses resolved completely.Acute and late toxicity rates were low. Two patients developed tumors in the head or neck following RT. There was no significant clinical impairment of growth or endocrine function.A single course of external beam megavoltage radiation to 3000 cGy in 3 weeks is an effective first treatment for patients with juvenile nasopharyngeal angiofibroma.
Medical and legal management of adult acute epiglottitis
Authors: Mcnelis Francis L. 
Published: October 2006

AbstractA case of acute epiglottitis without prior treatment in a 64‐year‐old hypertensive alcoholic male is reported. A correct diagnosis was made in the emergency room and tracheostomy deferred as airway seemed adequate. A trial course of medical therapy under close observation was felt indicated. A detailed history up to the time of death, 8 hours after admission, will be presented as well as the findings at post mortem.Nine months later the executor of the estate filed a S2 million malpractice suit against the defendant doctor and the defendant hospital for wrongful death. A pretrial deposition was held followed by an offer to settle. This was refused and a trial date set in Superior Court. One week before trial another offer to settle was mode by the plaintiff for S12,500 from each of the two defendants. This offer was accepted.
Hearing loss in early infancy: Incidence, detection and assessment
Authors: Riko Krista , Hyde Martyn L. , Alberti Peter W. 
Published: October 2006

AbstractAuditory evoked potential techniques have revitalized programs for early detection, quantification, and management of hearing loss. Some issues underlying the need for such programs, and their structure, are reviewed with reference to recently‐published guidelines. The prevalence of hearing loss in infancy is poorly understood; estimates depend on the type and degree of loss, the tests used, and their timing. Evidence that significant hearing loss can escape early detection continues to accumulate; delays are attributable to many factors, including insufficient awareness and deficiencies in conventional tests. High‐risk registers are valuable but imperfect tools, and should not be the sole avenue of early detection. Electrophysiologic tests, especially the auditory brain stem response, have a major role in early assessment. Attention to many technical and patient‐related factors is required, and frequencyspecific testing is feasible and informative.
The pectoralis myocutaneous flap for salvage of necrotic wounds
Authors: Price John C. , Davis R. Kim , Koltai Peter J. 
Published: October 2006

AbstractThe authors have utilized six pectoralis major myocutnneous flaps in attempts to salvage extensive necrotic wounds of the pharynx and neck. The flap was employed in the following situations: massive necrosis of the entire neck skin with both carotid artery systems exposed, radiation necrosis of the neck skin with exposure of carotid artery, dehiscence of gastric pull‐up from pharynx with resultant carotid exposure, failed trapezius flap in a radionecrotic oral cavity, and two cases of pharyngocutaneous fistula with extensive soft tissue necrosis.These flaps achieved healing in all cases. One death occurred 3 weeks following complete cutaneous healing secondary to a ruptured carotid pseudoaneurysm. One flap underwent total skin loss but the entirety of the muscle survived and the fistula was successfully closed with the back of the muscle being subsequently skin grafted. One case of dehiscence of the flap from oral mucosa resulted in a minor exposure of mandible with limited osteoradionecrosis controlled by topical means.This flap has performed extremely well in these precarious and difficult situations that previously may not have been salvageable. It has also been effective in abbreviating the required hospitalization and wound care. We conclude that the pectoralis myocutaneous flap should be the primary choice for the management of extensive postsurgical wound necrosis.
Immediate reconstruction after total laryngopharyngoesophagectomy and mediastinal dissection
Authors: Krespi Yosef P. , Wurster Carl F. , Sisson George A. 
Published: October 2006

AbstractAdvanced or recurrent carcinoma surrounding the tracheostoma in a previously laryngectomized patient is most effectively treated with transsternal radical dissection of the upper mediastinum and relocation of the trachea to the upper chest. The use of the pectoralis major myocutaneous flap, now enables the head and neck surgeon to perform immediate reconstruction and provide protection for the great vessels after mcdiastinal dissection for stomal recurrence. Formerly, patients with stomal recurrence also involving the cervical or upper thoracic esophagus were poor surgical candidates. Frequently, patients succumbed to their disease before the continuity of the digestive tract could be re‐established.Currently, at our institution, this vexing reconstructive problem is solved with immediate, one‐stage reconstruction. The esophagus is replaced by transposing the stomach through the posterior mediastinum and anastomosing to the tongue base, “gastric pull‐up.” The mediastinal defect is closed with the concomitant use of the pectoralis myocutaneous flap. The muscular portion of the myocutaneous flap provides excellent coverage for the great vessels of the upper mediastinum. Our experience with 39 patients who underwent this procedure between 1979 and 1983 is presented.
Clinician reliability in rating voice improvement after laryngeal nerve section for spastic dysphonia
Authors: Sapir Shimon , Aronson Arnold E. 
Published: October 2006

AbstractA recent study by Aronson and DeSanto (1983) showed that, although section of the recurrent laryngeal nerve to relieve adductor spastic dysphonia effected considerable improvement in nearly 100% of the voices immediately after surgery, within the next 3 years 64% had returned to their preoperative status or worse. These findings were based on ratings by one speech pathologist, and the study was not designed to measure the reliability of the rater's judgments.The experiment reported here was designed to repeat the Aronson and DeSanto study, with three raters instead of one and under more experimentally controlled conditions. Results show high intrajudge and interjudge reliability within and between the two studies. It is concluded that Aronson and DeSanto's original findings were reliable.
Tongue flap repair of postlaryngectomy hypopharyngeal stenosis
Authors: Calcaterra Thomas C. 
Published: October 2006

AbstractHypopharyngeal stenosis after total laryngectomy has been reported as high as 40%. The most consistent and important causal factor is the extent of the pharyngeal resection since cancers of the pyriform sinus and postcricoid region have the highest incidence of stenosis.Dilation is frequently unsuccessful in the management of postlaryngectomy hypopharyngeal stenosis probably because of its excessive length. The laterally‐based tongue flap is effective for repair of these stenoses because of its proximity, epithelial compatibility, and ample length. The technique, details, and successful use in three patients are presented.
Upper aerodigestive neoplasm perpetuated in the nude mouse
Authors: Fantozzi Richard , Bone Robert , Fernsten Philip , Walker Leslie 
Published: October 2006

AbstractThe ability to study and characterize squamous cell cancer of the upper aerodigestive system would be greatly facilitated by an in vivo model. The subsequent opportunity to observe cellular kinetics, membrane antigenicity and hence, potential response to chemotherapy, immunotherapy, radiotherapy, or a combination of these treatment modalities would most likely have early and significant clinical relevance. A multidisciplinary team of basic scientists and clinicians have developed a nude mouse colony for such investigational research. Melanoma and pulmonary squamous and pulmonary adenocarcinoma have been grown and successfully transferred. In addition, head and neck squamous cell carcinoma from multiple sites have also been successfully colonized. We present our experience with this interesting in vivo model and discuss problems in creating a nude mouse colony, techniques of successful tumor inoculation, ongoing maintenance of successful cell lines, and theoretical advantages for potential clinical investigations using this dynamic biologic system.
Mobilization of the fixated arytenoid in the stenotic posterior laryngeal commissure
Authors: Schaefer Steven D. , Close Lanny G. , Brown Orval E. 
Published: October 2006

AbstractStenosis of the posterior laryngeal commissure with arytenoid fixation following intubation trauma or laryngeal fracture poses a treatment dilemma. Over the past 2 1/2 years we have managed four patients with this problem by mobilization of the fixated cricoarytenoid joint, arytenoid‐pharyngeal mucosal advancement flap, brief splinting of the arytenoids in the fully abducted position, and early speech therapy. As of this time, three of the four patients have been both decannulated and have achieved adequate to near normal voices. Most significantly, the previously fixated arytenoids are now mobile, confirming the efficacy of the principles presented herein.
Solitary (unicameral) cysts involving the temporal bone
Authors: Nager George T. 
Published: October 2006

AbstractThe primary unicameral cyst which involves the temporal bone is very rare. Only about 30 patients have been reported in the literature during the past ten decades. The lesion is most frequently encountered in the first and second decade of life. In contrast to the other locations in the skeleton, it usually remains asymptomatic for a long time until it causes a deformity or dysfunction. The etiology has so far remained obscure. Its occasional association with malformations of the ears and nasopharynx and other developmental anomalies, its incidental bilateral occurrence, and certain histological aspects may suggest a congenital origin or a localized defect in bone formation and remodeling.
Cholesteatoma staging
Authors: Meyerhoff William L. , Truelson John 
Published: October 2006

AbstractManuscripts reporting results of surgery for chronic otitis media would be more meaningful if standardized nomenclature were used in describing the type of surgery performed and if standardized classifications were used for the disease process. Standardized nomenclature for surgery type and classifications for chronic otitis media exist. A classification for cholesteatoma, based on pathophysiology, location, eustachian tube function, ossicular defects, and presence or absence of complications is proposed. Congenital cholesteatoma is that which has its nidus of trapped squamous epithelium present at birth. Primary acquired cholesteatoma is associated with a defect in the pars flaccida, while secondary acquired cholesteatoma is associated with a defect in the pars tensa. Tertiary acquired cholesteatoma is defined as that which occurs behind a normal appearing tympanic membrane as the result of implantation or an antecedent middle ear inflammation.
Testing ciliary activity in patients with chronic and recurrent infections of the upper airways: Experiences in 68 cases
Authors: Burgersdijk Francis J. A. , De Groot John C. M. J. , Graamans Kees , Rademakers Louk H. P. M. 
Published: October 2006

AbstractThe clinical use of various tests of ciliary activity is uncertain and the purpose of this study is to assess the practical significance of the most current methods. Therefore, biopsy specimens of the nasal mucosa were investigated by means of phase contrast microscopy in 68 patients with chronic and recurrent infections of the upper airways. In 19 cases an absent or extremely weak ciliary activity could be demonstrated. Ultrastructurally, a characteristic pattern of defective dynein arms as observed in primary ciliary dyskinesia, was evident in only 3 out of these 19 patients. Measurements of the mucociliary transport velocity by means of intranasal Tc 99m labeled particles appeared to be unreliable in cases of severe nasal obstruction.In this study, phase contrast microscopy of biopsy material from the nasal respiratory epithelium appeared to have the most advantages: It is a practical and rather simple screening test in the assessment of ciliary activity.
Advances in oto‐immunology: New trends in functional pathology of the temporal bone
Authors: Veldman Jan E. , Meeuwsen Frits , Huizing Egbert H. 
Published: October 2006

AbstractBy using monoclonal and polyclonal antibodies against cell‐membrane receptors and cytoskeletal proteins, the cellular and tissue composition of any organ can be far better determined. This is illustrated in the tympanic membrane, middle ear mucosa, and cholesteatoma. Immunotechnology applied to the temporal bone is shown with an animal‐ototoxicity model. Antibodies to keratin and vimentin (i.e., to proteins of the fibrillar components that make up the cytoskeleton) stain specific tissue compartments. Langerhans' cell and T‐lymphocyte subsets predominate in a cholesteatoma. The normal human tympanic membrane is devoid of these cells. Gentamicin can be traced with a polyvalent anti‐gentamicin antiserum in serial sections of the cochlea and kidney. The drug accumulates in the outer hair cells and proximal tubular cells, respectively.A new technique of CT‐scanning, microslicing, plastic embedding, and semithin sectioning of undecalcified human temporal bone is described. Perspectives in applying immunotechnology to this method of human temporal bone processing are discussed.
Postoperative risks of pediatric tonsilloadenoidectomy
Authors: Carithers Jeffrey S. , Gebhart Don E. , Williams Jill A. 
Published: October 2006

AbstractTonsilloadenoidectomy is performed over 340,000 times per year in the United States, usually as a same day admission procedure with a postoperative overnight stay. Because of the current emphasis on reducing health care costs, many insurers are requiring the procedure of tonsilloadenoidectomy be performed on an outpatient basis, even though there is a lack of data supporting the safety of such a requirement.The charts of 2,944 pediatric patients who underwent tonsillectomy and/or adenoidectomy from January 1, 1983 to December 31, 1984 were reviewed. Analyses revealed predictive variables that could be used to identify patients with a low risk of complications. Nineteen percent of the patients could be released 4 hours postoperatively with an 8.1% chance of subsequent complications. No patients who underwent the combined procedure of tonsillectomy and adenoidectomy were in this group. Of the remaining patients, 0.4% could be released 6 hours after surgery, or 85.9% could be released 8 hours after surgery, or 98.2% could be released 10 hours after surgery, all with a less than 10% chance of subsequent complications. This study supports keeping tonsilloadenoidectomy patients at least 8 hours and possibly 10 hours after surgery to minimize the risk of complications after discharge.
The efferent supply of the trapezius muscle: A neuroanatomic basis for the preservation of shoulder function during neck dissection
Authors: Weisberger Edward C. 
Published: October 2006

AbstractThe hypothesis that there is an alternative motor input to the trapezius muscle through cervical spinal nerves is evaluated through a review of the literature and through experimental studies performed by the author.Electrophysiologic testing of the spinal accessory nerve and of the ventral rami of the cervical spinal nerves was performed in cats and humans. These studies indicated that motor potentials recorded in the trapezius muscle after stimulation of the ventral rami of cervical spinal nerves in general represented the spread of current to the contiguous portions of the spinal accessory nerve or directly to the trapezius muscle. Rarely did there seem to be evidence of motor innervation to the upper and lower trapezius by fibers conveyed by the ventral rami of cervical spinal nerves. The predominant motor input to the trapezius muscle is through the spinal accessory nerve.Subjective evaluation, objective strength testing, and electromyographic evaluation were performed on patients who had undergone neck dissections. Three types of neck dissection were employed. These were modified neck dissection with preservation of the spinal accessory nerve, radical neck dissection with sacrifice of the spinal accessory nerve, and reconstruction using a cable graft and classical radical neck dissection. Regarding all of the methods of evaluation and comparison, the patients who retained function of the spinal accessory nerve in the postoperative period fared better than those who had a classical radical neck dissection with sacrifice of the spinal accessory nerve. This again supports the concept that the most important and predominant motor supply to the trapezius muscle is through the spinal accessory nerve.All of this information was used to construct a model of the spinal portion of the accessory nerve and of the innervation of the trapezius muscle. The clinical implications of this model are stated.
Pharyngoesophageal myotomy for vocal rehabilitation of laryngectomees
Authors: Mahieu Hans F. , Annyas Albert A. , Schutte Harm K. , van der Jagt Eric J. 
Published: October 2006

AbstractPharyngoesophageal myotomy, performed in 16 laryngectomees to improve vocal rehabilitation, proved to have some negative side effects. Although no failures of speech rehabilitation using a button were consequently found, a considerable number of button assisted esophageal speakers had a breathy voice. Also, the number of poor injection‐esophageal speakers was much higher than in the group of nonmyotomized laryngectomees.A “normal” pseudoglottis could only rarely be identified by fluoroscopy in the myotomized group. A significantly lower intratracheal pressure appeared to be required for tracheo‐esophageal phonation after myotomy. To improve the slightly disappointing voice rehabilitation results of the myotomized laryngectomees, a modified myotomy is proposed.