bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changing etiology of vocal fold immobility
Authors: Benninger Michael S. , Gillen John B. , Altaian Jerald S. 
Published: November 2003

AbstractHypothesis: Vocal fold immobility is a sign of underlying disease. When the etiology remains unclear, evaluation may become time consuming and costly, and directed work‐up imperative. This study examined the hypothesis that the etiologies of vocal fold immobility are changing, with extralaryngeal malignancies and nonthyroidectomy surgical trauma having become more common causes. Methods: A retrospective review of consecutive patients with vocal fold immobility who had an adequate workup to determine the etiology. Results: Three hundred ninety‐seven cases with a determined etiology were identified, yielding 280 unilateral and 117 bilateral immobilities. The largest single category in unilateral immobility was nonlaryngeal malignancy—69 patients (24.7%)—80% of which were pulmonary or mediastinal, followed by 67 patients (23.9%) with immobility secondary to surgical trauma. Thyroidectomy accounted for only 8.2%. The leading cause of bilateral immobility was surgical trauma—30 patients (25.7%)—21 (18%) of whom had thyroidectomy. Acute and chronic intubation injuries accounted for 21 unilateral (7.5%) and 18 bilateral (15.4%) cases. Conclusions: These data indicate a changing etiology of vocal fold immobility, with growing percentages of extralaryngeal malignancies and surgery‐related injuries. These findings have implications for the timing and method of management based on anticipated outcome.
Split calvarial graft cranioplasty for the prevention of headache after retrosigmoid resection of acoustic neuromas
Authors: Feghali Joseph G. , Elowitz Eric H. 
Published: November 2003

AbstractObjective: This study describes the technique and efficacy of split calvarial graft cranioplasty for the reconstruction of retrosigmoid/suboccipital defects following surgery for acoustic neuromas. Study Design: A prospective study of the technique of split calvarial graft cranioplasty, its postoperative healing, and incidence of postoperative headache. Methods: The technique requires splitting of the craniotomy bone flap into outer and inner table bone grafts. The combination of both bony grafts allows the coverage of a wider area of posterior fossa dura. This technique was used in 18 patients. All patients were followed for a minimum of 6 months. Eleven of 18 patients were followed for 1 year or longer. Four patients had three‐dimensional computed tomography of their skull and area of split calvarial bone graft. Results: One of 18 patients had a persistent disabling headache at 1 year postoperatively. A natural contour of the retrosigmoid area was achieved in all patients. Three‐dimensional computed tomography scan, obtained 6 months postoperatively, showed total coverage of the retrosigmoid area and fusion of the bone flap to the surrounding skull. Conclusion: The technique of split calvarial grafting of posterior fossa defects is a feasible, safe, and effective way of separating the nuchal musculature and posterior fossa dura. The technique also allows the restoration of the contour and bony covering of the retrosigmoid area. The technique is a simple alternative to other types of cranioplasties aimed at reducing the incidence of postoperative headache in patients with acoustic neuromas. Laryngoscope, 108:1450–1452, 1998
Lipomas of the internal auditory canal and cerebellopontine angle
Authors: Bigelow Douglas C. , Eisen Marc D. , Smith Peter G. , Yousem David M. , Levine Richard S. , Jackler Robert K. , Kennedy David W. , Kotapka Mark J. 
Published: November 2003

AbstractObjective: To evaluate lipomas of the internal auditory canal (IAC) and cerebellopontine angle (CPA). Study Design: Retrospective review. Methods: Review of a multi‐institutional series of 17 lipomas of the IAC/CPA, combined with a Medline review of the 67 cases reported in the world literature. Results: This series of 17 IAC/CPA lipomas is the largest reported series to date, bringing the total number of documented cases to 84. There appears to be a nearly 2:1 male to female predominance. Sixty percent were leftsided lesions, and three were bilateral. Hearing loss, dizziness, and tinnitus were the most common presenting symptoms. Surgical resection was performed in 52 (62%) of these lesions; however, total tumor removal was accomplished in only 17 (33%), which is most likely because of the fact that these tumors tend to have a poorly defined matrix and a dense adherence to neurovascular structures. Sixty‐eight percent of patients experienced a new deficit postoperatively, 11% were unchanged, and only 19% improved with no new deficit. Only one documented case of tumor growth was identified; however, the reported follow‐up was short (average, less than 3 years). Conclusion: With the magnetic resonance imaging techniques now available, lipomas can be reliably differentiated from other masses within the CPA and IAC, so histopathologic diagnosis is rarely necessary. Because of the potential for significant morbidity with resection of these lesions, we believe that conservative follow‐up is the best treatment option for patients with these rare lesions. Surgery is indicated only when significant progressive or disabling symptoms are present. Laryngoscope, 108:1459–1469, 1998
Intraoperative brachytherapy, laryngopharyngoesophagectomy, and gastric transposition for patients with recurrent hypopharyngeal and cervical esophageal carcinoma
Authors: Wilson Lynn D. , Chung Joyce Y. , Haffty Bruce G. , Cahow Elton C. , Sasaki Clarence T. , Son Yung H. 
Published: November 2003

AbstractObjective: To evaluate the role of laryngopharyngoesophagectomy (LPE), intraoperative 125I brachytherapy (IOBT), and gastric transposition (GT) in patients with recurrent carcinoma involving the hypopharynx, or cervical esophagus. Methods: Between 1988 and 1994 a total of 21 patients were managed with LPE/IOBT/GT. All patients had documentation of recurrent disease at the hypopharynx or cervical esophagus and had previously been treated with external‐beam radiation (EBRT) to a total median dose of 60 Gy. Median age was 67 years, with 17 male patients and four female. IOBT was performed in all cases with permanent 125I implantation. Medical records were retrospectively reviewed. Overall survival, local control, and complications were evaluated. Median follow‐up was 6 months. Results: The median activity of 125I was 36 mCi, with a median dose of 80 Gy to the region at risk. Fifteen patients had lymph node dissections performed in conjunction with LPE, and 10 patients had nodal involvement on pathologic examination. Margins were microscopically positive in nine patients, and lymphvascular space invasion noted in 13. Actuarial survival at 1 and 3 years was 32% and 14%, respectively, with patients alive and with local control at 6, 24, 36, and 48 months, (negative margins). Actuarial local control at 1 and 3 years was 63%. Complications included fistula in five patients, facial edema in four, protracted facial pain in two, cervical abscess in one, and mucosal hemorrhage in one. Conclusion: Patients with recurrent carcinoma of the hypopharynx or cervical esophagus after EBRT have an extremely poor prognosis. LPE, IOBT, and GT may provide very good local control for all candidates and prolonged survival for a small percentage of patients with an acceptable risk profile. Laryngoscope, 108:1504–1508, 1998
Tracheostomal stenosis revision with simultaneous tracheoesophageal puncture
Authors: Wax Mark K. , Touma B. Joseph , Ramadan Hassan H. 
Published: November 2003

AbstractObjectives/Hypothesis:Vocal rehabilitation of patients who have undergone laryngectomy is best accomplished by a tracheoesophageal puncture. Optimal function of the prosthesis requires an adequate stoma. Patients with tracheostomal stenosis require revision of the stoma if vocal rehabilitation is to take place. Revision and tracheoesophageal placement are usually done as two separate procedures. Creating a tracheoesophageal fistula at the time of stomal revision has not been addressed in the literature.Study Design:Prospective analysis and follow‐up of 10 patients undergoing simultaneous tracheoesophageal puncture and stomal revision for tracheostomal stenosis between 1991 and 1996.Methods:Ten patients were reviewed. An inferiorly based V‐Y advancement flap was used so as not to interfere with the tracheoesophageal puncture. All patients had received radiation prior to revision and tracheoesophageal puncture. Patients were followed for a minimum of 2 years (range, 2–6 y; median, 3 y).Results:All patients maintained an adequate stoma without stenting. Eight of ten patients (80%) developed and maintained good tracheoesophageal speech. Two patients had their speech fistulas removed. There were no intraoperative or postoperative complications.Conclusions:Creation of a tracheoesophageal fistula at the time of stomal revision allows for vocal rehabilitation with a single visit to the operating room.Laryngoscope, 108:1509‐1513, 1998
Th‐2 type cytokine receptors in allergic rhinitis and in response to topical steroids
Authors: Wright Erin D. , Christodoulopoulos Pota , Small Peter , Frenkiel Saul , Hamid Qutayba 
Published: November 2003

AbstractObjectives: Th‐2 type cytokine production (inter‐leukin‐4 [IL‐4] and interleukin‐5 [IL‐5]) has been demonstrated to play a significant role in the pathophysiology of allergic rhinitis (AR), and the treatment of AR with topical corticosteroids has been shown to reduce the expression of Th‐2 type cytokines in vivo. However, the contribution and expression of Th‐2 type cytokine receptors in AR and their response to corticosteroid treatment remain to be clarified. Objectives of the current study are 1. To examine the expression of the cytokine IL‐4 and IL‐5 receptors (IL‐4R and IL‐5R) in a nasal allergen challenge model and to contrast this with the expression of the receptor for the Th‐1 type cytokine, interferon‐gamma receptor (IFN‐γR), and 2. to examine the effects of pretreatment with topical corticosteroid before allergen challenge on the expression of these same receptors. Study Design: Randomized prospective study involving 14 ragweed‐allergic subjects evenly divided between placebo and corticosteroid pretreatment. Methods: Immunocytochemistry (alkaline phosphatase‐antial‐kaline phosphatase labeling [APAAP] technique) was used to stain nasal biopsy specimens before and after allergen challenge. Antibodies used included anti‐CD3, CD4, CD8, MBP, IL‐4R, IL‐5R, and IFN‐γR. Results: Following allergen challenge, we observed a significant increase in the Th‐2 type cytokine receptors (IL‐4R and IL‐5R; P < .05), as well as a significant decrease in the expression of the Th‐1 type cytokine receptor (IFN‐γR; P < .05). Pretreatment with topical corticosteroids before nasal allergen challenge resulted in decreased expression of IL‐4R (P < .05) and IL‐5R (P < .05) and increased expression of IFN‐γR (P < .05). Further, IL‐4R and IL‐5R expression correlated with eosinophil infiltration in the tissues. Conclusions: We have demonstrated that in AR, cytokine receptors for IL‐4, IL‐5, and IFN‐γ follow a similar pattern to their ligands. In addition, pretreatment with topical corticosteroids was shown to alter the cytokine receptor expression pattern from a Th‐2 profile more toward a Th‐1 profile. Laryngoscope, 108:1528–1533,1998
Fluoroscopically placed percutaneous gastrostomies in the head and neck patient
Authors: Myssiorek David , Siegel David , Vambutas Andrea 
Published: November 2003

AbstractObjective: At our institution, percutaneous gastrostomy tubes have been inserted under fluoroscopic guidance (fluoroscopic cutaneous gastrostomy [FPG]), thereby avoiding the need to traverse the pharynx and esophagus with a large‐bore esophagoscope. For this reason, placement in the postoperative patient does not jeopardize the surgical reconstruction. Methods: Thirty‐five patients underwent percutaneous gastrostomy placement under fluoroscopic guidance. These included 12 patients whose cervical esophagus could not be entered safely because of a lesion in the head neck, 11 patients who had recently undergone resection of a head and neck cancer with pharyngeal reconstruction where traditional percutaneous enteral gastrostomy (PEG) placement was contraindicated, and two patients with postoperative fistulae. Results: Thirty‐four of 35 patients underwent successful gastrostomy or gastrojejunostomy placement. One patient had an intrathoracic position of the stomach, and one patient required repeat placement because the tube dislodged 5 days after insertion. No tube occluded. Conclusions: Percutaneous gastrostomy under fluoroscopic guidance (FPG) is an effective, safe method for access for prolonged enteral feeding of the patient whose cervical esophagus cannot be accessed for a variety of reasons. It also allows the safe placement of a gastrostomy catheter when the patient' postoperative course becomes complicated and prolonged enteral nutrition is required. Laryngoscope, 108:1557–1560, 1998
Balanced orbital decompression for graves' ophthalmopathy
Authors: Shepard Kimberly G. , Levin Peter S. , Terris David J. 
Published: November 2003

AbstractObjective/Hypothesis: Surgical management of Graves' ophthalmopathy is an alternative to medical therapy with corticosteroids or external beam radiotherapy. Orbital decompression has commonly been performed via a transantral approach to the medial orbital wall and floor. Although an endoscopic approach to these walls has been described, a balanced approach (incorporating a lateral decompression by an ophthalmology team) is desirable. Study Design: Retrospective review. Methods: Endoscopic medial decompression and extended lateral decompression were accomplished in 18 orbits (11 patients); inferior decompression was performed in 11 of these. Five additional procedures were performed. Results: Exophthalmos improved by a mean of 4.6 mm. All patients who underwent decompression for vision loss had improved vision after surgery. Exposure keratitis improved in six of six orbits. Two of five patients undergoing orbital decompression for vision loss developed postoperative diplopia, which was successfully treated with strabismus surgery or prism glasses. There were no other significant complications. Conclusions: The endoscopic approach to the medial orbital wall is an important component of balanced orbital decompression for patients with Graves' ophthalmopathy. Balancing the decompression and preserving the medial orbital strut between the ethmoid cavity and the orbital floor may minimize the risk of diplopia. Laryngoscope, 108:1648–1653, 1998
Complications of phonosurgery: Results of a national survey
Authors: Rosen Clark A. 
Published: November 2003

AbstractObjective: Medialization laryngoplasty (ML) and arytenoid adduction (AA) have become common treatments for vocal fold paralysis. The widespread use of these procedures has required many surgeons to learn these new surgeries through postgraduate education sources. Little is known regarding the efficacy of the learning methods and the types and incidence of complications in a large number of surgeons' experience. Method: A survey consisting of 23 questions regarding complications of ML and AA was sent to 7364 otolaryngologists. Results: A 33% response rate resulted in 2436 returned surveys of which 43% stated they performed ML and/or AA (n = 1039). The survey represents 14,621 cases of ML. The average respondent performed 12 ML in the past 5 years. Forty‐two percent of the respondents reported experience with one or more major complication. Airway complications requiring intervention occurred more frequently following AA than ML. The most common major complications were implant migration and failure to improve voice quality. The ML revision rate was 5.4% and the reported voice quality following revision was positive in 90% of cases. A statistically significant difference in major ML complication rate was found between surgeons with experience doing fewer than 10 MLs and those with experience doing more than 10 MLs. Similar findings showed that a higher major complication rate occurred for surgeons performing fewer than two MLs per year compared with counterparts who average two or more MLs per year. A near 1% implant extrusion rate was found. Most of the extrusions occurred into the airway. Conclusions: This is a study of the use and complications of ML/AA based on more than 14,000 procedures. Wide‐spread use of ML for vocal fold paralysis was found. A notable rate of poor voice quality following ML/AA was identified and led to a 5.5% revision rate for ML. Revision ML resulted in an improved voice quality in more than 90% of the reported cases. There appears to be a “learning curve” for performing ML as well as an increased complication rate for those surgeons who perform fewer than two MLs per year and have a total career experience of fewer than 10 procedures. These findings suggest that ML may result in increased complications if the surgeon is not experienced or does not perform the surgery regularly. Laryngoscope, 108:1697–1703, 1998
A retrospective analysis of airway endoscopy in patients less than 1‐month old
Authors: Ungkanont Kitirat , Friedman Ellen M. , Sulek Marcelle 
Published: November 2003

AbstractObjectives: To review the authors' experience with neonates who underwent endoscopy over an 8‐year period. Study Design: Retrospective review in a tertiary care children's hospital. Methods: Sixty‐two neonates who underwent endoscopy were reviewed. Results: Common indications for endoscopy were stridor (56%), apnea/cyanotic episodes (30%), and feeding difficulty (23%). Laryngeal abnormalities were the most frequent finding, including laryngomalacia (19%), glottic edema (19%), and vocal cord paralysis (13%). Pierre Robin sequence was the most common associated anomaly. Forty‐eight neonates (77.4%) had more than one endoscopic finding. Gastroesophageal reflux diagnosed by barium swallow or esophageal pH monitoring was found in 34%. Gastroesophageal reflux was the only identified etiologic factor in four cases. Computed tomography and magnetic resonance imaging provided less information than endoscopy. Conclusions: Endoscopy in symptomatic neonates can determine etiology of distress most of the time. Multiple diagnoses were found in 77.4% of the neonates, emphasizing the need for a thorough aerodigestive tract examination. Concomitant diagnoses including gastroesophageal reflux, congenital heart disease, and pulmonary disease were found in 87.1% of neonates. Neonates have a higher likelihood of having multiple lesions in the aerodigestive tract as compared with older infants or children. Laryngoscope, 108:1724–1728, 1998
Is there a correlation between vascular loops and unilateral auditory symptoms?
Authors: Makins Anita E. , Nikolopoulos Thomas P. , Ludman Catherine , O'Donoghue Gerard M. 
Published: November 2003

AbstractObjectives: To assess whether contact of a vascular loop formed by the anterior inferior cerebellar artery (AICA) with the eighth cranial nerve correlated with unilateral auditory symptoms so as to produce a “vascular compression syndrome.” Study Design: Prospective evaluation of patients with unilateral auditory symptoms using magnetic resonance imaging (MRI) scans to identify contact of a vascular loop with the eighth cranial nerve. Methods: One hundred twelve patients with idiopathic unilateral auditory symptoms (42 women and 70 men, mean age of 51 years) were evaluated with MRI. Location of the vascular loop and contact with the eighth cranial nerve were assessed in each case. The asymptomatic contralateral ears of the patients were used as controls. A power analysis had determined the size of the sample to be studied. Results: The arterial loop was found to be in contact with the eighth cranial nerve in 28 (25%) of the 112 symptomatic ears and in 24 (21.4%) of the asymptomatic (control) ears. The statistical analysis revealed that the difference was not statistically significant. Conclusion: The results suggest that radiologic demonstration of contact between a vascular loop formed by the AICA and the eighth cranial nerve on MRI scans should be considered a normal anatomic finding and should not, on its own, be used to support the diagnosis of a “vascular compression syndrome.” Laryngoscope, 108:1739–1742, 1998
Airway management in children with major craniofacial anomalies
Authors: Sculerati Nancy , Gottlieb Marc D. , Zimbler Marc S. , Chibbaro Patricia D. , Mccarthy Joseph G. 
Published: November 2003

AbstractObjectives: Delineation of clinical characteristics affecting the airway in a cohort of craniofacially deformed children. What factors differ between patients requiring and those not requiring surgical airway intervention? What factors predispose to the need for tracheotomy? When can decannulation be expected if tracheotomy is required? What interventions aid decannulation? Study Design: Five‐year retrospective chart review at tertiary center. Methods: Two hundred fifty‐one patients met the following entry criteria: enrollment in the New York University Institute of Reconstructive and Plastic Surgery's Craniofacial Clinic and admission to Tisch Hospital in Manhattan for surgery from 1990 to 1994. Hospital, clinic, and departmental office records were reviewed. All patients had major craniofacial bony anomalies and underwent administration of general anesthesia at least once. Results: Nearly 20% of all children required tracheotomy (47/251). Craniofacial synostosis patients (Crouzon, Pfeiffer, or Apert syndrome) had the highest rate of tracheotomy (48% [28/59]). Mandibulofacial dysostoses patients (Treacher Collins or Nager syndrome) had the next highest rate (41% [28/59]). Patients with oculo‐auriculo‐vertebral sequence were less likely to undergo tracheotomy (22% [9/41]). Children with craniosynostosis rarely required a surgical airway, unless there was marked associated facial dysmorphism (1% [1/72]). The duration of cannulation was related to the age at tracheotomy in a bimodal distribution. Generally, tracheotomies required before age 4 years remained for several years, whereas those placed after age 4 were removed after several weeks. The presence of a cleft palate correlated with reduced risk for tracheotomy, but the presence of a ventriculoperitoneal shunt correlated with an increased risk for tracheotomy. Procedures selectively used to improve the airway included midface advancement, mandibular expansion, tonsillectomy and adenoidectomy, uvulopalatopharyngoplasty, anterior tongue reduction, and endoscopic tracheal granuloma excision. Conclusions: The likelihood for surgical airway management is related to specific craniofacial diagnosis. The length of tracheal cannulation is greatest for infants and young children who manifest severe airway compromise, often because of nasal obstruction in combination with other anatomic factors. Early tracheotomy is advocated for these patients to promote optimal growth and development. Choanal atresia is often misdiagnosed in these infants; nasal obstruction is actually secondary to midface retrusion. Staged surgical interventions can allow eventual successful decannulation in nearly all cases of craniofacial syndromes.