bluuebunny/crossref_metadata_2025_split huggingface dataset:
Functional Outcome After Total Parotidectomy Reconstruction
Authors: Fee Willard E. , Tran Lynn E. 
Published: January 2004

AbstractObjectives/Hypothesis: The objective was to compare and contrast the functional and cosmetic outcomes of patients who underwent total parotidectomy with and without reconstruction using an inferiorly based sternocleidomastoid muscle flap.Study Design: Retrospective review in the setting of a university medical center.Methods: Twenty‐four patients underwent a total parotidectomy. Fifteen patients had reconstruction with an inferiorly based sternocleidomastoid muscle flap, and nine patients had no reconstruction. Clinical examination was performed independently by two head and neck surgeons and one aesthetician to evaluate cosmetic outcome, presence of gustatory flushing or sweating, and return of facial nerve and greater auricular nerve function.Results: With the mean follow‐up of 22 months, the group having reconstruction showed a better cosmetic outcome compared with the group without reconstruction. Objective testing for Frey syndrome demonstrated gustatory sweating in 20% of the group having reconstruction group versus 22% in the group without reconstruction. There was no difference in length of operation, hospital stay, or facial nerve function. Objective testing of facial sensation revealed that only 40% in the group having reconstruction had normal sensation to light touch compared with 78% in the group without reconstruction.Conclusion: The inferiorly based sternocleidomastoid muscle flap offers improved cosmetic results in patients undergoing total parotidectomy. However, there is a decreased return of greater auricular nerve function, probably attributable to relocation of the nerve stump anteriorly. Benefit was not seen in prevention of Frey syndrome measured objectively; however, the group having reconstruction had fewer clinical symptoms of gustatory sweating or flushing.
The Diagnostic Utility of Computed Tomography for Preoperative Localization in Surgery for Hyperparathyroidism
Authors: Gross Neil D. , Weissman Jane L. , Veenker Elizabeth , Cohen James I. 
Published: January 2004

AbstractObjectives/Hypothesis: Successful unilateral or minimal‐access parathyroid exploration and reoperative surgery of the parathyroid glands requires accurate preoperative localization of parathyroid disease. Although ultrasound and nuclear imaging techniques have an established role in this regard, the use of computed tomography (CT) for parathyroid exploration is not well understood. The purpose of the present study was to better define the diagnostic utility of CT in preoperative localization of the abnormal gland in surgery for hyperparathyroidism.Study Design: Retrospective cohort study.Methods: All parathyroid explorations performed at Oregon Health and Science University (Portland, OR) between 2000 and 2002 were reviewed. The study group was limited to patients with hyperparathyroidism in whom localization failed preoperatively using ultrasound and/or sestamibi scanning and subsequent investigation using CT imaging was performed. Operative, pathological, and imaging reports were then analyzed to assess the accuracy of CT imaging for localizing parathyroid disease.Results: Twenty‐two patients with hyperparathyroidism were investigated preoperatively using CT imaging. Parathyroid exploration was successful in all but one patient, leaving 21 patients in all in the cohort. The majority of cases (67%) were reoperative, and all patients had previously undergone inconclusive ultrasound and/or sestamibi scanning. Computed tomography correctly localized parathyroid disease in 18 (86%) of the 21 patients who underwent successful extirpation of parathyroid disease and was able to identify abnormal glands with equal utility in the neck and the chest.Conclusion: When ultrasound or sestamibi are unsuccessful, CT imaging can provide valuable preoperative localizing information before surgery for hyperparathyroidism, particularly in patients with recurrent or persistent disease.
Role of the Physician Versus the Patient in the Detection of Recurrent Disease Following Treatment for Head and Neck Cancer
Authors: Agrawal Amit , deSilva Brad W. , Buckley Brooke M. , Schuller David E. 
Published: January 2004

AbstractObjectives/Hypothesis: Objective evidence supporting current National Comprehensive Cancer Network guidelines regarding surveillance of patients treated for head and neck cancer is presently lacking. The study examines the relative role of current surveillance methods on disease detection in this patient population.Study Design: Prospective nonrandomized study.Methods: Clinical information was prospectively collected in a standardized format during 3645 encounters with patients with head and neck cancer over an 18‐month period. Data pertaining to visit history, symptom history, patient findings, physician findings, and disease status for each encounter were reviewed.Results: Of 3645 visits, disease recurrence or new primary tumor was documented in 180 encounters (5%). Salvage therapy was thought to be feasible in at least 65% of cases. Of these 180 recurrences or new primaries, there were 142 patients (79%) who had identified new symptoms or physical findings, or both, before the physician's examination. Most commonly reported was the presence of a neck mass (38%), progressive pain (27%), or other visible lesion or ulcer (14%). Patients with recurrence represented nearly 40% of all patients reporting new symptoms or findings (142 of 367). Conversely, recurrence was rare in the absence of reported symptoms or findings (1.2%). Surprisingly, despite patients reporting new symptoms or findings, physician evaluation most commonly occurred at the patient's routine surveillance visit rather than an earlier time point (104 of 142 [73%]).Conclusion: Self‐diagnosis of recurrent or new primary disease is extremely common by virtue of symptoms or findings noted by patients before interaction with the clinician. However, presence of symptoms or findings did not motivate the patients to seek earlier medical attention. In the absence of such symptoms, physician diagnosis of recurrence is uncommon. Given the significant social and economic impact involved in surveillance of patients with head and neck cancer, further prospective study to optimize the method and frequency of this type of clinical activity is warranted and planned.
Nasal Cerebrospinal Fluid Leaks: Critical Review and Surgical Considerations
Authors: Schlosser Rodney J. , Bolger William E. 
Published: January 2004

AbstractOtolaryngologists have assumed a major role in the evaluation and management of anterior skull base defects that result in cerebrospinal fluid (CSF) leaks and meningoencephaloceles. To achieve the best possible results for patients with CSF leaks, a thorough understanding of the underlying pathophysiology and a critical analysis of management principles and treatment options is essential. Surgical and medical management of these patients is highly individualized and depends on a number of factors, including etiology, anatomic site, patient age, and underlying intracranial pressure. This review article will highlight the history, physiology, pathophysiology, diagnosis, surgical techniques, and postoperative care relevant to nasal CSF leaks and encephaloceles.
Use of Sodium Fluorescein Solution for Detection of Cerebrospinal Fluid Fistulas: An Analysis of 420 Administrations and Reported Complications in Europe and the United States
Authors: Keerl Rainer , Weber Rainer K. , Draf Wolfgang , Wienke A , Schaefer Steven D. 
Published: January 2004

AbstractBackground: Localization of dural fistulas in the region of the anterior or lateral skull base may be difficult. For many years, a sodium fluorescein solution of 0.5 to 5% (2.5–50 mg) has been administered intrathecally by way of the lumbar space. However, fluorescein is not commercially available for this stated purpose in either Germany or the United States.Methods: Retrospectively, 420 fluorescein applications by the authors were retrospectively analyzed. Under the Freedom of Information Act, the United States Federal Drug Administration and the manufactures of fluorescein were queried for adverse reaction reports.Results: Four hundred twenty fluorescein applications in 305 patients could be evaluated. Mean age of recipients was 46.9 years, ranging from 1 to 82 years. At a concentration of 5% fluorescein, 26 patients on the day of surgery and 69, 37, 34, and 14 patients on days 2 through 4 suffered from minor side effects that may or may not have been related to this drug. Two of these patients had grand mal seizures, which were attributable to simultaneous intrathecal application of contrast medium. All other side effects were thought to be the result of a postspinal headache and related lumbar puncture. At a concentration of 0.5%, the intraoperative intrathecal administration of 0.5 to 2 mL of fluorescein followed by 4 to 5 days of lumbar drainage resulted in some degree of spinal headache without other complications. In both groups, no patient had sequelae longer than 4 weeks. An additional seven complications were reported to the Federal Drug Administration and the fluorescein manufacturers at doses of 100 to 700 mg.Conclusions: Complications from intrathecal application of fluorescein appears to be dose dependent. At concentrations of 5%, or preferably lower, side effects are transient. A grand mal seizure can be minimized when following the general cautions of lumbar puncture and dose. The patient should be supervised for 24 hours. A written informed consent from patients for use of fluorescein is recommended.
Pathology of the Olfactory Mucosa: Implications for the Treatment of Olfactory Dysfunction
Authors: Kern R C , Conley D B , Haines G K , Robinson A M 
Published: January 2004

AbstractObjective: The pathology of the olfactory mucosa is poorly understood; however, most cases of hyposmia and anosmia appear to be associated with a decline in the number of functioning mature olfactory sensory neurons (OSNs). Under normal conditions, OSNs undergo apoptotic cell death at a baseline rate likely secondary to their exposed location in the nose. Regeneration of mature OSNs from precursors in the epithelium allows the animal to maintain an adequate number of neurons necessary for olfactory sensation. In many cases of olfactory dysfunction, this balance is apparently disturbed, with a net loss of OSNs. The current study will examine normal and diseased olfactory tissue for the presence of data demonstrating that the preferred mechanism of OSN cell death is apoptotic in both health and disease. The potential therapeutic implications will be discussed.Study Design: Histologic analysis of human and animal olfactory tissue.Methods: Normal and diseased human and animal olfactory mucosa were assessed for immunohistochemical evidence of apoptosis.Results: Increased activity of the apoptotic effector enzyme caspase‐3 was demonstrated in diseased olfactory mucosa in comparison with normal controls.Conclusion: These results indicate that a common pathway may mediate OSN cell death from a diverse set of pathologic insults including aging, trauma, and sinusitis. Interference with this pathway of cell death is currently the subject of intense pharmacotherapeutic research for the management of stroke and meningitis. These drugs may ultimately prove useful in the treatment of clinical olfactory dysfunction.
The Effect of Electrocautery Versus Cold Scalpel Technique on the Incidence of Early Postoperative Tonsillar Pillar Dehiscence After Uvulopalatopharyngoplasty With Tonsillectomy
Authors: Altman Jerald S. , Senior Brent , Ransom Elizabeth 
Published: January 2004

AbstractObjectives/Hypothesis: The objective was to determine the effect of electrocautery versus cold scalpel technique on the incidence of early postoperative tonsillar pillar dehiscence after uvulopalatopharyngoplasty with tonsillectomy.Study Design: Prospective, randomized, matched‐pair trial of patients undergoing uvulopalatopharyngoplasty with tonsillectomy.Methods: Patients undergoing uvulopalatopharyngoplasty with tonsillectomy were randomly assigned to have the procedure performed with cold scalpel technique or with electrocautery. Thirty‐three patients were enrolled. Twenty‐seven patients returned for postoperative evaluation.Results: The overall incidence of tonsillar pillar dehiscence was 38.8%. The incidence of dehiscence was 44.4% in the electrocautery group and 33.3% in the cold dissection group.Conclusion: Preliminary data suggest that the use of electrocautery is not associated with an increase incidence of wound dehiscence compared with cold dissection. Tonsillar pillar dehiscence rate is high, regardless of dissection method.
Complications of Microdebrider‐Assisted Powered Intracapsular Tonsillectomy and Adenoidectomy
Authors: Sorin Alexander , Bent John P. , April Max M. , Ward Robert F. 
Published: January 2004

AbstractObjectives: To study complications of powered intracapsular tonsillectomy and adenoidectomy (PITA) in pediatric patients with obstructive sleep apnea (OSA).Study Design: Retrospective chart review and long‐term follow‐up in office or by telephone interview.Methods: We studied 278 patients who underwent PITA between September 2000 and October 2002. Outcome measures were postoperative bleeding, velopharyngeal insufficiency, need for hospital readmission, tonsil regrowth, and return of snoring or sleep apnea symptoms.Results: All 278 children treated by PITA had immediate resolution of symptoms of OSA. Complications were noted in 11 patients (3.9%). Nine patients (3.2%) experienced tonsil regrowth with snoring, two of whom evolved to a return of OSA that was definitively managed by means of a complete tonsillectomy. Two patients (0.7%) had selflimited bleeding. None of the patients developed persistent velopharyngeal insufficiency or required hospital readmission.Conclusions: Microdebriderassisted PITA is a safe and effective alternative for children otherwise treated with traditional tonsillectomy for symptoms of OSA due to adenotonsillar hypertrophy. This series suggests a 3.9% overall rate of complications, with the most common noted as tonsillar regrowth without recurrence of OSA. Prospective trials with longer follow‐up may define higher complication rates.
Effects of Tisseel and FloSeal on Primary Ischemic Time in a Rat Fasciocutaneous Free Flap Model
Authors: Partsafas Aaron W. , Bascom Daphne A. , Jorgensen Scott A. , Wax Mark K. 
Published: January 2004

AbstractObjectives: Free flaps are the technique of choice for reconstruction of defects resulting from extirpation of tumors of the head and neck. Advances in microsurgical technique have resulted in success rates of greater than 95%. Numerous intraoperative factors, ranging from technical issues to topically applied agents, can complicate the outcome of microsurgical free tissue transfer. Synthetic tissue adhesives and hemostatic agents are playing an ever‐increasing role in reconstructive surgery. The safety of these factors in free flap surgery has not been ascertained.Study Design: Animal Care Committee live rat model.Methods: Male Sprague‐Dawley rats were divided into three groups: group I, Control; group 2, FloSeal; group 3, Tisseel. In each group, a 3 × 6 cm ventral fasciocutaneous groin flap based on the left superficial epigastric artery was elevated and the experimental material applied beneath the flap and around the flap pedicle prior to suturing of the flap back to the wound bed. The experimental materials consisted of 0.2 mL saline in the control group, 0.5 mL FloSeal, and 0.2 mL Tisseel. In phase I of this study, the effect of each treatment on flap survival was assessed by survival at postoperative day 4. In phase II of the study, the effects of these agents on ischemic tolerance was investigated. Five rats in each treatment group were exposed to ischemic times of 6, 8, 10, and 12 hours. Survival of the flap was assessed 7 days after reversal of the ischemia. Probit curves and the critical ischemic time (CIT50) were calculated.Results: All flaps survived the 2‐hour period of ischemia and were viable at postoperative day 4. Flap survival from group 1 (Control), group 2 (FloSeal), and group 3 (Tisseel) at the various ischemic times was as follows: at 6 hours, 80%, 80%, and 80%, respectively; at 8 hours, 80%, 80%, 60%; at 10 hours, 60%, 33%, 40%; at 12 hours, 20%, 20%, 0%. The CIT50 for the Control, FloSeal, and Tisseel groups was 9.4, 9.0, and 7.0 hours, respectively.Conclusions: FloSeal, a thrombin‐based hemostatic agent, and Tisseel, a fibrin glue, displayed no adverse effect on flap survival in this model.
Cochlear Implantation in Children with Congenital Inner Ear Malformations
Authors: Buchman Craig A. , Copeland Benjamin J. , Yu Kathy K. , Brown Carolyn J. , Carrasco Vincent N. , Pillsbury Harold C. 
Published: January 2004

AbstractObjective/Hypothesis: To assess the audiologic and surgical outcomes for pediatric cochlear implant patients with inner ear malformations.Study Design: Retrospective review of 315 pediatric cochlear implant cases from 1994 to 2002.Methods: Twenty‐eight pediatric cochlear implant patients with known inner ear malformations determined on high‐resolution computed tomography (HRCT) of the temporal bone were the subjects of review. Results ofHRCTfindings, intraoperative findings, postoperative complications, and objective measures of both closed‐ and open‐set testing of speech perception were analyzed.Results: Patients with the constellation of an incompletely partitioned (IP) cochlea, enlarged vestibular aqueduct (EVA), and a dilated vestibule (i.e., Mondini's malformation) as well as those with an isolated EVA or partial semicircular canal aplasia have relatively good levels of speech perception. Patients with total semicircular canal aplasia, isolated IP, cochlear hypoplasia, or common cavity demonstrated lower levels of performance. Poor performance may be related to associated developmental delays rather than labyrinthine anatomy alone. Complications of surgery were relatively limited.Conclusions: Cochlear implantation can be successfully performed in children with inner ear malformations. These children and their parents can expect significant auditory benefits from this intervention. The various types of inner ear malformations may have quite different prognoses for good auditory performance.
Surgical Management of Complications after Hearing Aid Fitting
Authors: Kohan Darius , Sorin Alexander , Marra Stephen , Gottlieb Marc , Hoffman Ronald 
Published: January 2004

AbstractObjectives: Standard procedures for hearing aid fitting performed in accordance with established guidelines are well tolerated, safe, and effective. In this article, we present unusual complications after hearing aid fitting that required surgical management.Methods: Four otologists at a major university center with a combined 65 years of experience performed a retrospective analysis of their surgical practice. Six patients were identified that had encountered severe complications from improper earmold fitting that required surgical intervention.Results: One patient had a perforation of the tympanic membrane with earmold material found to have migrated into the middle ear cleft. The tympanic membrane healed spontaneously, resulting in persistent otalgia and a maximum air‐bone gap. The earmold cast was successfully removed by means of a tympanomastoidectomy. Two patients with presbycusis and normal ear canals developed eardrum perforations and conductive hearing deficits. In both patients, earmold material was found partially occupying the middle ear cleft and removed by way of a transcanal approach. Three patients with prior canal wall down mastoidectomy defects and narrow external ear canals required microtoscopy under general anesthesia or canaloplasty for removal of impacted material.Conclusion: Proper fitting of hearing aids performed by well‐trained medical professionals results in a very low incidence of significant complications. Perforation of the tympanic membrane with impaction of earmold material in the middle ear or mastoid bowl may occur and can be successfully managed by standard otologic surgical techniques.
Vertebrobasilar Occlusive Disorders Presenting as Sudden Sensorineural Hearing Loss
Authors: Sauvaget E , Kici S , Petelle B , Kania R , Chabriat H , Herman Ph , Huy P Tran Ba 
Published: January 2004

AbstractBackground: Isolated sudden sensorineural hearing loss (SSHL) has been rarely related to vertebrobasilar occlusive disorders (VBOD). This is an important issue for both neurologists and otolaryngologists, since the management and prognosis of this type of hearing loss widely differs from that of hearing loss from other causes.Objectives: To describe the clinical characteristics and report the incidence of SSHL related to VBOD.Methods: Retrospective analysis of clinical charts from 333 patients admitted for SSHL in a large ear, nose, and throat emergency tertiary care center from 1999 to 2002.Results: Four cases (1.2%) of VBOD as the unique cause of SSHL were diagnosed among 333 patients. The most typical features of these cases were the presence of one of the following characteristics: (1) bilateral SSHL, (2) associated occipital or posterior nuchal pain, and (3) the occurrence of delayed neurologic deficits. The underlying vascular disease affected the vertebral arteries: dissection in two cases and atherosclerosis in two other cases. The audiometric features of hearing loss were endocochlear in one case, of both types in one case, and unknown in two cases. Hearing recovered partially or completely.Conclusions: Our results confirm the low incidence of SSHL related to VBOD and show that the observation of endocochlear audiometric features cannot preclude a central cause in SSHL. The clinical presentation of our cases related to VBOD emphasize that a careful follow‐up of any patient with SSHL is warranted and that the presence of nuchal pain suggestive of arterial dissection in younger subjects, a past history of atherosclerosis or embolism in older patients, or the occurrence of delayed associated neurologic symptoms should be considered with particular caution in this situation.