bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long‐Term Follow‐up of Repair of External Nasal Deformities in Patients With Wegener's Granulomatosis
Authors: Congdon David , Sherris David A. , Specks Ulrich , McDonald Thomas 
Published: November 2003

AbstractObjective Wegener's granulomatosis is a disorder of the upper airway, lungs, and kidneys characterized histologically by necrotizing granulomas and vasculitis. One common result of Wegener's granulomatosis is destruction of the framework of the nose, resulting in a saddle‐nose deformity. The study was initiated to determine the efficacy and safety of reconstructing external nasal deformities in these patients.Study Design A retrospective review.Methods We searched for all patients with Wegener's granulomatosis who underwent an external nasal reconstruction between the years of 1976 and 2000.Results Thirteen patients met the search criteria. The average duration of follow‐up is 59 months (range, 10–177 mo). The initial surgery resulted in a satisfactory outcome in 10 of 13 patients (77%). Two of the patients who failed the primary surgery underwent successful revision rhinoplasty, and one chose not to undergo revision surgery. This resulted in a 92% (12 of 13) overall patient success rate. Ten of the 13 patients had an improvement in their nasal airway postoperatively, and the remaining three had no mention of postoperative airway in the record. The postoperative airway was not made worse in any of the patients operated on in the series. All of the patients had reconstruction when their Wegener's granulomatosis was in remission. Twelve of the 13 patients with an external deformity had a saddle‐nose defect. The remaining deformity was a defect of the alar rim. Sixteen surgeries were preformed in total (15 dorsal repairs [12 primary, 3 revisions] and 1 alar rim repair). The most common graft materials used in the reconstruction of the dorsal deformities were costal cartilage (40% [6 of 15]) and calvarial bone (27% [4 of 15]). The remaining dorsal defects were repaired with irradiated rib (1 of 15), irradiated dura (1 of 15), conchal cartilage (1 of 15), iliac crest (1 of 15), and bony septum (1 of 15). The alar rim defect was repaired using a composite auricular graft. The overall success rates by graft type were as follows: costal cartilage, 83% (5 of 6); calvarial bone, 75% (3 of 4); composite auricular, 100% (1 of 1); iliac bone, 100% (1 of 1); conchal cartilage, 100% (1 of 1); septal bone, 100% (1 of 1); irradiated rib, 0% (0 of 1); and irradiated dura 0% (0 of 1).Conclusions Reconstruction of external nasal deformities in patients with Wegener's granulomatosis is safe. Surgery does not appear to either induce a flare‐up or accelerate the course of Wegener's granulomatosis. There may be a higher risk of failure in primary nasal dorsal repair in patients with Wegener's granulomatosis than in other patients undergoing dorsal augmentation. Irradiated materials in the series also appear to be more prone to resorption.
Fungal Mucoceles of the Sphenoid Sinus
Authors: Lee Jivianne T. , Bhuta Sunita , Lufkin Robert , Calcaterra Thomas C. 
Published: November 2003

AbstractObjective The purpose of this study was to demonstrate that fungal mucoceles of the sphenoid sinus do not necessarily require an external approach for eradication of disease. We report 6 cases of fungal mucoceles of the sphenoid sinus seen at UCLA Medical Center from 1980–1999, 4 of which were successfully treated with endoscopic intranasal sphenoidotomy and the other 2 through either a transseptal or transantral approach.Study Design and Methods Case series. The medical records of 6 patients with fungal mucoceles of the sphenoid sinus treated at UCLA Medical Center over a 20‐year period (1980–1999) were retrospectively reviewed.Results Six patients diagnosed with fungal mucoceles of the sphenoid sinus were seen at UCLA Medical Center from 1980–1999. Endoscopic intranasal sphenoid sinusotomy was performed on 4 patients and a transseptal or transantral approach to the sphenoid sinus was used on the remaining 2 patients. No evidence of recurrent disease has been seen after up to 15 years of follow‐up.Conclusions When diagnosed early, functional endoscopic intranasal sphenoidotomy represents an effective mode of treatment for patients with fungal mucoceles of the sphenoid sinus, obviating the need for more aggressive surgical approaches.
Endoscopic Management of the Frontal Recess in Frontal Sinus Fractures: A Shift in the Paradigm?
Authors: Smith Timothy L. , Han Joseph K. , Loehrl Todd A. , Rhee John S. 
Published: November 2003

AbstractObjectives To evaluate alternative management strategies for anterior table frontal sinus fractures involving the frontal sinus outflow tract.Study Design A prospective cohort of patients with anterior table frontal sinus fracture with frontal outflow tract involvement documented by computed tomography (CT) scan was examined between 1999 and 2001.Methods A select group of patients with anterior table frontal sinus fracture involving the frontal outflow tract was treated with open reduction of bony fracture without osteoplastic obliteration of the frontal sinus. Serial CT scans were obtained starting at 8 weeks after injury. Patients with persistent frontal sinus obstruction after medical treatment underwent an extended endoscopic frontal sinusotomy or a modified endoscopic Lothrop procedure.Results Fourteen patients sustained frontal sinus fractures and were treated during the study period. Seven patients were included in the modified treatment algorithm, with a mean follow‐up of 18 months. All patients had concurrent facial fractures: superior orbital rim (n = 5), naso‐orbital–ethmoid complex (n = 2), mandible (n = 2), and midface (n = 2). All 7 patients underwent open repair of the facial fractures. Postoperatively, 5 patients had spontaneous frontal sinus ventilation. Two patients, both of whom had naso‐orbito–ethmoid fractures, had persistent frontal sinus obstruction clinically and radiographically. These patients were successfully managed with an endoscopic frontal sinus procedure.Conclusions A select group of patients with frontal sinus and outflow tract fracture may be managed with open repair of the anterior table fracture without obliteration. In these cases, suspected frontal outflow tract obstruction can be managed expectantly. Failed frontal sinus ventilation may require endoscopic frontal sinus surgery to reestablish mucociliary clearance.
Cell Proliferation and p27Kip1 Expression in Endophytic Schneiderian Papillomas
Authors: Schwerer Michael J. , Sailer Adrian , Kraft Klaus , Maier Heinz 
Published: November 2003

AbstractObjective To clarify epithelial cell proliferation and p27Kip1 expression along the stepwise histological changes from endophytic schneiderian papillomas to associated carcinomas.Study Design Retrospective investigation involved surgical specimens from 58 patients.Methods Immunohistochemical assessment involved the nuclear Ki67 antigen expressed in proliferating cells. Further, the cyclin‐dependent kinase (cdk) inhibitor p27Kip1 was assessed. Binding of p27Kip1 to the cyclin E‐cdk2 complex inhibits this kinase, which results in cell cycle arrest. The expression rates of both proteins were compared between non‐papillomatous nasal mucosa, endophytic schneiderian papillomas, carcinoma in situ, and invasive squamous cell carcinomas. Statistics involved the Wilcoxon and Mann‐Whitney u tests. Significance was set at P <.05.Results Comparable cell proliferation rates were observed between non‐papillomatous nasal mucosa and cylindrical cell papillomas. Significant increases in cell proliferation were found along the stepwise series of histological changes involving non‐papillomatous nasal mucosa, columnar epithelium in inverted papillomas, transitional and squamous metaplasia in inverted papillomas, and dysplastic inverted papillomas (P <.05, respectively). A tendency toward increased cell proliferation in carcinoma in situ compared with dysplastic inverted papillomas was present; however, this was not statistically significant. The expression rates of p27Kip1 were comparable between non‐papillomatous nasal mucosa and all histological subtypes within non‐dysplastic endophytic schneiderian papillomas. Significantly reduced p27Kip1 expression was found in surface cells in dysplastic compared with non‐dysplastic inverted papillomas, as well as in the total number of cells in carcinoma in situ compared with dysplastic inverted papillomas (P <.05, respectively).Conclusions Inverted papillomas but not cylindrical cell papillomas show increased cell proliferation compared with non‐papillomatous nasal mucosa. Stepwise increases in cell proliferation accompany the consecutive histological changes within inverted papillomas. Among them, increased cell proliferation along with the development of dysplasia and carcinoma in situ is associated with reduced p27Kip1 expression.
Hypothesis: Research in Otolaryngology Is Essential for Continued Improvement in Health Care
Authors: Mathog Robert H. 
Published: November 2003

AbstractThe present report, in the form of a research proposal, is based on the hypothesis that research in otolaryngology is essential for continued improvement in health care. Examples of advances in otolaryngology as a result of research are noted, but for continued success, otolaryngology must maintain and find better ways to train clinically directed researchers. Traditional methods of training such as hands‐on experience, courses in the basic principles of research, protected time, and mentoring are discussed and evaluated. Barriers to success such as age, time, and debt are noted. Potential solutions are presented with an emphasis on integration of the research and clinical training. Success of faculty will continue to depend on laboratory and financial support, technical assistance, protected time, salary equivalent to other faculty, and accessibility of research funds. For research to gain support and enthusiasm and to keep it strong and productive, cost‐effectiveness and value must be recognized.
Objective Facial Motion Analysis in Patients With Facial Nerve Dysfunction
Authors: Linstrom Christopher J. 
Published: November 2003

AbstractObjectives/HypothesisTo objectively measure facial motion at various facial landmarks using a video‐computer interactive system.Study DesignClinical, prospective, non‐randomized.MethodsA video‐computer interactive system, The Peak Motus Motion Measurement System, was used to study linear displacement at preselected facial landmarks in the normal and abnormal face. Subjects with normal facial function (n = 34) and patients with abnormal facial function (n = 26) from various etiologies were studied. The sites studied were marked with reflective beads. Of a larger repertoire of expressions, two expressions (eyes closed and closed‐lip smile) were studied in all subjects. The percent asymmetry in facial displacement between the sides of the face was calculated. The sensitivity of this measurement to facial dysfunction was evaluated. The presence of synkinesis was examined by quantifying the displacement at facial sites that were remote to the sites primarily involved in a given facial expression. Test–retest reliability of the percent asymmetry measurement was evaluated with the pairedttest.ResultsThe video‐computer interactive approach used accurately detected and quantified gross and subtle changes in facial function. The sensitivity of the percent asymmetry measurement was 95% (both expressions) for patients with apparent facial dysfunction (House‐Brackmann rating >I/VI). In patients with facial nerve dysfunction, displacement on the presumably normal side was significantly excessive in 27% to 35%, depending on the expression. With this interactive computer‐video system, synkinesis was detected in 58% of the pathologic subjects during the eyes closed or closed‐lip smile expressions. The pairedttest indicated strong test–retest reliability (r= 0.73–0.99) of the percent asymmetry measurement.ConclusionsThe present report indicates that this approach to the assessment of facial motion is sensitive to facial dysfunction. This computer‐video interactive system is able to quantify synkinesis. A grading system for the magnitude of synkinesis, based on the magnitude of the displacement at remote facial sites, is proposed. The common occurrence of excessive facial motion on the presumably normal side of affected individuals indicates that patients with facial paralysis often overcompensate by exaggerating the normal side in an effort to move the affected side. This system is of value in the objective measurement of normal facial function and may prove a useful tool to quantify the outcomes of various medical and surgical treatments for facial nerve dysfunction.
Rapid Elevation of Gentamicin Levels in the Human Labyrinth Following Intravenous Administration
Authors: Becvarovski Zoran , Michaelides Elias M. , Kartush Jack M. , Bojrab Dennis I. , LaRouere Michael J. 
Published: November 2003

AbstractHypothesis Adequate quantities of labyrinthine fluid can be sampled from the human labyrinth to perform quantitative analysis of medications. A rapid elevation of intralabyrinthine gentamicin levels after intravenous administration can be measured. A model for the sampling of human inner ear fluid in this manner is described.Background The risk of aminoglycoside ototoxicity has been a long‐standing concern. The kinetics of gentamicin diffusion into the inner ear have been extrapolated to humans from various animal models. The validity of extrapolation to humans is unknown. We have developed a new model to measure the uptake of gentamicin in vivo.Methods A single intravenous dose of gentamicin (80 mg) was given perioperatively to 13 patients undergoing translabyrinthine acoustic neuroma surgery. The lateral semicircular canal and vestibule were opened and a microsyringe was used to obtain a sample of labyrinthine fluid concomitant with a serum sample. The gentamicin concentration of the labyrinthine fluid and serum was analyzed using a standard chemistry analyzer.Results After parenteral administration of gentamicin, fluid was obtained from the inner ear of 13 acoustic neuroma patients. Inner ear concentrations were between 1.0 and 3.8 mg/L. Serum gentamicin levels ranged from 1.2 to 10.5 mg/L.Conclusions This method allows the sampling of intralabyrinthine fluid in humans. Gentamicin was noted immediately in the labyrinth after intravenous administration. This model may be expanded to measure other compounds given either by intravenous or transtympanic routes.
The Potential Pitfalls of Concurrent Rhinoplasty and Endoscopic Sinus Surgery
Authors: Millman Brad , Smith Ronald 
Published: November 2003

AbstractObjectiveAs the largest portion of the population is becoming middle aged and our society becomes increasingly interested in youth and appearance, so does the number of esthetic surgeries. Rhinoplasty is being performed with increased frequency in recent years. Many surgeons are performing rhinoplasty combined with endoscopic sinus surgery as a means to decrease operating times, healing times, as well as patient cost. Many surgeons may be unaware of several potential life‐threatening complications when these two safe procedures are performed concurrently.Study DesignA rare but illustrative case depicting a serious complication of concurrent surgery. A retrospective review of our experience and an extensive literature review were performed documenting the type and incidence of minor and serious postoperative complications.ResultsA case demonstrating multiple near‐fatal complications after rhinoplasty and endoscopic sinus surgery, which are two safe, commonly performed procedures when performed individually. A review of our 268 rhinoplasties performed between 1997 and 2001 demonstrated 11 cases with concurrent surgery. There were no complications noted in this population.ConclusionWe conclude and agree with the literature that concurrent surgery is safe and effective.
Treatment of Simple Snoring Using Radio Waves for Ablation of Uvula and Soft Palate: A Day‐Case Surgery Procedure
Authors: Wedman Jan , Miljeteig Harald 
Published: November 2003

AbstractObjective Uvulopalatoplasty, performed with high‐frequency radio waves, was evaluated as a treatment for social snoring.Methods Forty male social snorers were included in this prospective, nonrandomized study. Patients' subjective complaints before, during, and 3 months after radio‐assisted uvulopalatoplasty were recorded on a visual analogue scale.Results Complications were negligible. Snoring sounds and daytime tiredness reduced significantly. Considering effect and suffering during and after surgery, a high number of patients (93%) were willing to undergo the procedure again if necessary.Conclusions The results of radio‐assisted uvulopalatoplasty (RAUP) seem to be similar to other surgical methods used to reduce snoring. The relative small investments needed and its simplicity makes RAUP a good alternative to known treatment strategies.
Management of T3N0M0 Glottic Carcinoma: Therapeutic Outcomes
Authors: Sessions Donald G. , Lenox Jason , Spector Gershon J. , Newland Donald , Simpson Joseph , Haughey Bruce H. , Chao K. S. Clifford 
Published: November 2003

AbstractBackground The best therapeutic approach for the treatment of T3N0M0 (stage III) glottic carcinoma is controversial.Method A retrospective study of Tumor Research Project data were performed using patients with T3NOMO glottic squamous cell carcinoma treated with curative intent by seven different treatment modalities from January 1950 to December 1996 at Washington University School of Medicine/Barnes‐Jewish Hospital.Results Two hundred patients with T3NOMO glottic carcinoma were treated using seven modalities: total laryngectomy (TL, n = 30), TL with neck dissection (TL/ND, n = 40), conservation surgery alone (CS, n = 22), radiation therapy alone (RT, n = 29), TL combined with RT (TL/RT, n = 31), TL and ND combined with RT (TL/ND/RT, n = 36), and CS combined with RT (CS/RT, n = 12). The overall 5‐year observed survival rate (OS) was 54% and the 5‐year disease‐specific survival rate (DSS) was 67%. The 5‐year DSS for the individual treatment modalities included TL, 65.4%; TL/ND, 76.5%; CS, 71.4%; RT, 56.5%, TL/RT, 51.9%; TL/ND/RT, 71.4%; and CS/RT, 80%. There was no significant difference in DSS for any individual treatment modality (P = .375). The overall local and regional control rate was 74% (148 of 200). The overall recurrence rate was 37.5% with recurrence at the primary site and in the neck of 19.5% and 11%, respectively. Recurrence was not related to treatment modality. The 5‐year DSS after treatment of recurrent cancer (salvage rate) was 35.8%. The incidence of distant metastasis was 11% and for second primary cancers it was 19.5%. There was no statistically significant difference in survival between necks initially treated (72%, 5‐y DSS) versus necks observed and later treated if necessary (70%, 5‐y DSS) (P = .797).Conclusions The seven treatment modalities had statistically similar recurrence, complication, and survival rates. Patients with clear surgical margins have a significant survival advantage compared with patients with close and involved margins. Because postoperative radiation therapy in patients with positive margins did not improve survival, formal re‐resection of the site of the positive margin should be considered. In patients whose N0 neck was not treated electively, close follow‐up observation with meticulous examinations combined with appropriate treatment for subsequent neck disease resulted in a similar survival rate compared with those patients whose N0 necks were treated initially. Six‐year minimum follow‐up is recommended for early identification of primary and neck recurrence and for discovering expected second primary cancers. Patients treated with RT and CS had statistically similar rates of survival, maintenance of voice, and acquired permanent tracheal stoma. CS is a valid alternative to RT in treating highly selected patients with T3NO glottic carcinoma.
Neck Dissections: Predicting Postoperative Drainage
Authors: Urquhart Andrew C. , Berg Richard L. 
Published: November 2003

AbstractObjectives Most head and neck dissections performed in conjunction with carcinomas of the upper aerodigestive tract require drain insertion. The time that the drains remain in place largely determines the duration of postoperative hospitalization. This study sought to retrospectively compare different neck dissections in terms of postoperative drainage and duration of hospitalization. We also sought to identify any correlation between total intraoperative blood loss and postoperative drainage.Materials and Methods Radical, modified radical, and selective neck dissections performed in conjunction with resection of a carcinoma of the upper aerodigestive tract over a 3‐year period were evaluated. Total intraoperative blood loss at surgery, and amount and duration of postoperative drainage for each neck dissection were recorded.Results Seventy‐nine neck dissections were performed on 52 patients, 27 (52%) of whom had bilateral neck dissections. Median drainage was 116.5 mL, 172 mL, and 319 mL for selective, modified radical, and radical neck dissections, respectively. Drainage differed significantly by type of neck dissection (P <.001). Drains remained in place a median of 4 days with no significant difference between different types of neck dissections. Drainage was clearly correlated with total intraoperative blood loss (Spearman correlation = 0.44, P <.001).Conclusion The postoperative drainage per day was higher in radical neck dissections than modified radical neck dissections and lowest in selective neck dissections. This difference was not reflected in the duration that the drains would remain in place. Total intraoperative blood loss is a strong predictor of the amount and duration of postoperative drainage.