bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative Electromyography for Identification of the Trapezius Muscle Innervation: Clinical Proof of a New Anatomical Concept
Authors: Kierner Antonius C. , Burian M. , Bentzien S. , Gstoettner W. 
Published: November 2003

AbstractObjective/Hypothesis There is still considerable controversy among surgeons on trapezius muscle innervation. In addition, the rate of unexpected postoperative trapezius pareses is unacceptably high. Recent anatomical findings might answer most of the questions. The objective of the present study was to clinically prove the recent anatomical findings, especially the concept of the innervation of the descending part of the trapezius muscle.Study Design Intraoperative electromyography of the spinal accessory nerve and its branches in the posterior triangle of the neck.Setting Intraoperative electromyography was performed during 17 modified radical neck dissections on 14 patients of both sexes ranging in age from 44 to 68 years (mean age, 56 y). Potentials were registered through pairs of needle electrodes placed in each of the three parts of the trapezius muscle. Intraoperatively, the spinal accessory nerve and its fine cranial branch passing toward the descending part of the muscle were identified and stimulated in the posterior triangle of the neck.Results Stimulation of the fine cranial branch of the spinal accessory nerve led to a clearly visible and recordable contraction in the descending part of the trapezius muscle in all patients. Stimulation of the main trunk of the spinal accessory nerve in the posterior triangle of the neck distal to the above‐mentioned branching led to a clearly visible and recordable contraction in the transverse and ascending parts of the muscle.Conclusions The results strongly support recent anatomical findings showing that, functionally, the most important descending part of the trapezius muscle is innervated by a fine single branch arising from the spinal accessory nerve in the posterior triangle of the neck. This may help to prevent more patients undergoing modified radical neck dissections from shoulder‐arm syndrome.
The ‘Butterfly’ Graft in Functional Secondary Rhinoplasty
Authors: Clark J. Madison , Cook Ted A. 
Published: November 2003

AbstractObjective To describe a surgical technique (the conchal cartilage “butterfly” graft) which, when used in properly selected patients, has been found to be a dependable method for alleviation of postrhinoplasty internal nasal valve dysfunction.Study Design Retrospective chart review.Methods Analysis of consecutive patients with weakness and/or collapse of the upper lateral cartilages following rhinoplasty. Seventy‐two patients (37 women and 35 men, age range 17–76 y) had severe nasal obstruction and were found to have indications for this procedure. All patients had undergone at least one rhinoplastic procedure. All patients were followed for a minimum of 2 years after surgery.Results All 72 patients experienced significant subjective improvement in relative nasal obstruction. Two patients (3%) reported less than total resolution of their difficulty breathing through their nose; the remaining 70 patients (97%) reported complete resolution of their nasal airway problems. No patients reported their postoperative nasal obstruction as the same or worse than their preoperative baseline. Sixty‐two patients (86%) reported improvement in the appearance of their nose, 8 patients (11%) felt that their appearance was unchanged, and 2 patients (3%) felt that the appearance of their nose was made worse by the procedure.Conclusions Patients presenting with nasal obstruction after rhinoplasty are frequently found to have collapse and/or weakening of their upper lateral cartilages with resulting nasal valve dysfunction. The conchal cartilage “butterfly” graft is a technique which, when properly performed during revision rhinoplasty, yields predictable functional and cosmetic results with minimal morbidity.
‘Defatting’ Tracheotomy in Morbidly Obese Patients
Authors: Gross Neil D. , Cohen James I. , Andersen Peter E. , Wax Mark K. 
Published: November 2003

AbstractObjectives/Hypothesis Standard‐sized tracheostomy tubes often fit morbidly obese patients poorly because of increased submental and anterior cervical girth. The surgeon has two options to overcome this problem: Modify the tracheostomy tube to fit the patient or recontour the neck to accommodate a standard tube. The purpose of the study was to assess the safety and morbidity of the latter technique, the “defatting” tracheotomy.Study Design Retrospective cohort study of 23 patients treated between 1994 and 2001 with cervical lipectomy and tracheotomy.Methods Medical charts were reviewed for indications, demographics, body mass index, tracheotomy‐related complications, and decannulation results.Results The average age of patients was 50 years (age range, 34–77 y). The mean preoperative body mass index was 55.9 (range, 39.2–73.5). Indications for the procedure were respiratory failure requiring chronic ventilation in 16 patients (70%) and obstructive sleep apnea in 7 (30%). Four patients died postoperatively from causes unrelated to tracheotomy. The mean follow‐up time of survivors was 23 months. The overall tracheotomy‐related complication rate was 43%. Four patients developed wound infections in the perioperative period, one patient developed a neck abscess, and one patient required neck exploration for control of hemorrhage. Four patients (22%) developed late complications including tracheitis (1), neck abscess (1), and stenosis of the tracheocutaneous tract (2). Eight patients (44%) ultimately had decannulation.Conclusions Defatting tracheotomy is a safe technique that allows for the placement of a standard tracheostomy tube in morbidly obese patients. It is associated with a high rate of minor infectious complications. Even so, we think that cervical lipectomy with tracheostomy tube placement is the preferred surgical option for this patient population.
The Efficacy of Corticosteroids in Postparotidectomy Facial Nerve Paresis
Authors: Lee Kimberly J. , Fee Willard E. , Terris David J. 
Published: November 2003

AbstractObjective To determine whether the administration of perioperative corticosteroids is effective in ameliorating facial nerve paresis after parotidectomy.Study Design Prospective, randomized, double‐blinded, placebo‐controlled clinical trial at a university medical center.Methods Patients scheduled for parotidectomy and who met inclusion criteria were invited to enroll in the protocol. They were stratified according to the anticipated surgery (superficial or total parotidectomy) and then received one of two doses of dexamethasone (0.51 or 1.41 mg/kg divided into three doses) or placebo solution immediately preoperatively and then every 8 hours for 16 hours postoperatively. The facial nerve was graded for proportion (percentage) of function at each of the four major regions (frontal, orbital, midface and upper lip, and lower lip). The early postoperative function and rate of return of function were compared among the treatment groups.Results Forty‐nine patients were enrolled and evaluated (18 in the control group, 16 receiving low‐dose dexamethasone, and 15 receiving high‐dose dexamethasone). No therapeutic advantage of dexamethasone treatment could be appreciated with respect to the degree of early postoperative nerve function (81.3% for control patients vs. 69.5% for dexamethasone‐treated patients [P = .239]). Similarly, the median time to recovery of complete facial nerve function was 60 days in the control group and was 150 days in the dexamethasone‐treated patients.Conclusions Dexamethasone administration in patients undergoing parotidectomy is not justified. Despite the relatively modest risk profile of dexamethasone, we were unable to demonstrate any benefit in patients who were treated with either low‐dose or high‐dose steroids compared with placebo‐treated patients in a randomized, controlled trial.
The Significance of Immunohistochemically Demonstrated Nodal Micrometastases in Patients With Squamous Cell Carcinoma of the Head and Neck
Authors: Rhee Dukhee , Wenig Bruce M. , Smith Richard V. 
Published: November 2003

AbstractObjectives/Hypothesis Patients with primary squamous cell carcinoma of the head and neck have a relatively high risk of occult lymph node metastases. Pathological demonstration of these metastases may be difficult, and the detection of such occult metastases may identify patients who are at an increased risk for early recurrence or reduced survival. Immunohistochemistry may be applied in the identification of occult metastases that may be missed on routine (H&E) histological examination. The aim of the study is to determine the prevalence and prognostic significance of immunohistochemically identified micrometastases in squamous cell carcinoma of the head and neck.Study Design A retrospective analysis of neck dissection specimens having no evidence of metastatic disease.Methods Lymph nodes from neck dissections performed on 10 patients with squamous cell carcinoma of the head and neck without conventional histological evidence of nodal metastases were subsequently stained for cytokeratins by the monoclonal antibody cocktail AE1/AE3 to detect micrometastases.Results Occult micrometastases were found in the lymph nodes 5 of 10 patients examined. There was no association between the site of primary tumor, or T tage, and the presence of occult metastases. Three of five patients found to have occult metastases developed recurrence in the neck, whereas only one of five patients with no evidence of micrometastases had regional recurrence. There was no significant discrepancy in the patient survival rate.Conclusions Metastatic tumor cells are frequently present in lymph nodes, even in patients without histological evidence of nodal metastases by conventional methods. The presence of micrometastases may identify patients at increased risk for recurrence and may indicate poorer prognosis. The true clinical significance of these occult metastases will be determined by a long‐term follow‐up.
Strategies for Prevention of Toxicity Caused by Platinum‐Based Chemotherapy: Review and Summary of the Annual Meeting of the Blood–Brain Barrier Disruption Program, Gleneden Beach, Oregon, March 10, 2001
Authors: Blakley Brian W. , Cohen James I. , Doolittle Nancy D. , Muldoon Leslie L. , Campbell K. C. , Dickey D. Thomas , Neuwelt Edward A. 
Published: November 2003

AbstractObjectives To summarize the findings relevant to otolaryngology from the annual meeting of the Blood–Brain Barrier Disruption Consortium in Gleneden Beach, Oregon, March 10, 2001.Study Design Summaries are provided by the speakers, as well as related data from the published literature. Findings in otology and oncology regarding ototoxicity that were discussed at the meeting are included.Results Data considered included physiological research, animal studies, and clinical trials that relate to platinum‐based chemotherapy and prevention of toxicity.Conclusions The dose‐limiting side effects of platinum‐based chemotherapy are preventable, but questions about the effect of the protective agents on oncological efficacy remain. Strategies for prevention of chemotherapy‐induced toxicity include temporal or anatomical separation of cisplatin or carboplatin from sodium thiosulfate, D‐methionine, or N‐acetyl‐cysteine. Clinical application of these methods has begun. The mechanisms presumably involve free radicals or drug conjugation, or both. Understanding the role of free radicals in medicine is likely to become important in the future.
Syndrome of Inappropriate Antidiuretic Hormone or Arginine Vasopressin Secretion in Patients Following Neck Dissection
Authors: Zacay Galia , Bedrin Lev , Horowitz Zeev , Peleg Michael , Yahalom Ran , Kronenberg Jona , Taicher Shlomo , Talmi Yoav P. 
Published: November 2003

AbstractObjectives/Hypothesis The syndrome of inappropriate antidiuretic hormone or arginine vasopressin secretion (SIADH) is a disorder in which release of antidiuretic hormone is independent of plasma osmolarity, resulting in fluid retention and development of dilutional hyponatremia. The incidence of SIADH following neck dissection was found to be 18% to 30% in two separate reports. The incidence of SIADH in a cohort of patients who underwent neck dissection was prospectively studied.Methods Eighty‐six patients were included in the study, along with a control group of 19 patients who underwent other neck procedures. Patient gender, age, physical condition (American Society of Anesthesiologists score), type of neck dissection, prior treatment, and smoking history were noted. Blood and urine osmolarity and sodium levels were sampled before surgery and during the first 24 hours after the surgery. These were recorded daily in cases with SIADH until the syndrome resolved.Results The incidence of SIADH was only 1.15% in patients before surgery. The syndrome developed in seven patients following neck dissection (8.14%) and in none of the patients in the control group. SIADH resolved within 72 hours at the latest. No association was found with patient gender, age, physical condition, or type or laterality of neck dissection. A statistically significant connection between the syndrome and history of smoking was noted (P <.05), and it was more commonly seen in patients with node‐positive necks (P = .1231).Conclusions SIADH following neck dissection may be less common than formerly reported. Previous studies have presented contradicting data concerning the influence of tumor recurrence or prior radiation therapy on its incidence. Our results indicate no such association. A statistically significant connection between smoking and the syndrome was found. No clinical symptoms developed in the patients with SIADH, but it seems prudent to suggest limiting fluid intake in the first postoperative 24 hours for patients following neck dissection.
Integrins in Head and Neck Squamous Cell Carcinoma Invasion
Authors: Dyce Orville H. , Ziober Amy F. , Weber Randal S. , Miyazaki Kaoru , Khariwala Samir S. , Feldman Michael , Ziober Barry L. 
Published: November 2003

AbstractObjective To relate the invasive properties of different squamous cell cancer cell lines to the function and expression of the integrins.Study Design A series of in vitro and in vivo experiments were designed to assess and compare integrin expression and function in two different head and neck squamous cell carcinoma cell lines.Methods Invasive properties of two squamous cell carcinoma cell lines (UM‐SCC‐1 and JHU‐022‐SCC) were assessed using an in vitro artificial matrix assay as well as an in vivo system with orthotopically implanted tumor cells in mice. Whole cell and surface expression levels of integrin subunits (alpha2, alpha3, alpha5, alpha6, beta1, and beta4) were determined for each cell line using Western blot analysis and flow cytometry. We compared the ability of JHU‐022‐SCC and UM‐SCC‐1 cells to bind the extracellular matrix elements collagen IV, fibronectin, laminin 5, and laminin10 using an in vitro adhesion assay. Contributions of the different integrins to the adhesive properties were determined by selective antibody blocking of different subunits.Results The UM‐SCC‐1 cell line is 50% more invasive in vitro and displays a greater propensity for perineural and lymphatic invasion in vivo. The UM‐SCC‐1 cells exhibited greater adherence to fibronectin than JHU‐022‐SCC cells. Alpha6 and beta4 expression is approximately twofold greater in the JHU‐022‐SCC cells. Alpha2, alpha3, and beta1 expression appears to be upregulated in UM‐SCC‐1 cells.Conclusion The UM‐SCC‐1 carcinoma cells are more invasive than JHU‐022‐SCC cells and may be related to differential expression of the integrins alpha6beta4, alpha3beta1, and alpha2beta1.
Inhibition of the c‐Jun N‐Terminal Kinase Signaling Pathway Influences Neurite Outgrowth of Spiral Ganglion Neurons In Vitro
Authors: Bodmer Daniel , Gloddek Bertrand , Ryan Allen F. , Huverstuhl Jochen , Brors Dominik 
Published: November 2003

AbstractObjectives Inhibitors of the c‐Jun N‐terminal kinase (JNK) signaling pathway have been demonstrated to protect hair cells of the auditory system and different types of neurons from various insults, and their use for future therapeutic applications has been proposed. In the study, we evaluated the effects of inhibition of the JNK pathway on process outgrowth from spiral ganglion neurons.Methods Spiral ganglion explants from rats (postnatal days 3–5) that were cultured on laminin were treated with neurotrophin‐3 and/or the JNK signaling pathway inhibitor CEP‐11004. Both neurite length and number of the explants were evaluated and statistically analyzed by analysis of variance.Results Inhibition of the JNK signaling pathway reduced process outgrowth from spiral ganglion explants. The reduction, both in length and number of neurites, was reversed by the application of neurotrophin‐3.Conclusions The results indicate that an intact JNK signaling pathway is important for process outgrowth of spiral ganglion neurons. However, neurotrophin‐3 stimulates process extension by a JNK independent pathway. Our results demonstrate that inhibition of the JNK pathway can have adverse effects on the extension of spiral ganglion neurons, but that the negative effects can be ameliorated by appropriate treatment.
Impact of Unilateral Sinus Surgery With Resection of the Turbinates by Means of Midfacial Degloving on Nasal Air Conditioning
Authors: Lindemann Jörg , Leiacker Richard , Sikora Thomas , Rettinger Gerhard , Keck Tilman 
Published: November 2003

AbstractObjective/Hypothesis One of the most important functions of the nose is the climatization of inspired air. The aim of the investigation was to determine the influence of radical sinus surgery with complete resection of the turbinates and the lateral nasal wall by means of midfacial degloving as treatment for inverted papilloma on the nasal humidification and heating of inspired air.Study Design Retrospective study.Methods Humidity and temperature were measured in the nasopharynx during normal respiration by means of a miniaturized thermocouple device and a humidity sensor for continuous detection. Eight patients after prior unilateral sinus surgery by means of midfacial degloving for a one‐sided inverted papilloma were enrolled into the study. The humidity and temperature data of the surgically treated side were compared to the values of the healthy side that was not surgically treated. Active anterior rhinomanometry and acoustic rhinometry were performed.Results At the end of inspiration, absolute humidity and temperature values in the nasopharynx were statistically significantly lower on the surgically treated side compared with the side that was not surgically treated.Conclusions Radical sinus surgery with resection of the turbinates by means of midfacial degloving seems to disturb the climatization of the inspiratory air in the nasal cavity. Reduced absolute humidity and temperature may contribute to crusting, bleeding, and nasal dryness as frequent complaints of patients after aggressive sinus surgery with resection of the turbinates.
Determining the Site of Airway Obstruction in Obstructive Sleep Apnea With Airway Pressure Measurements During Sleep
Authors: Demin Han , Jingying Ye , Qingwen Wang Jun Yang , Yuhua Lin , Jiangyong Wang 
Published: November 2003

AbstractObjective To determine the site(s) of upper airway obstruction in patients with obstructive sleep apnea syndrome (OSAS) and their changes during sleep with upper airway (UA) pressure measurement; and to analyze the correspondence between the UA pressure measurement and polysomnography (PSG).Method Thirty patients with OSAS underwent UA pressure measurement. The catheter with five solid‐state ultraminiature sensors was inserted through the patients' upper airway to the esophagus. The sensors were located at the nasopharynx, oropharynx, tongue base, hypopharynx, and esophagus. The lower limit of UA obstruction was determined by relying on the observed pressure pattern.Result 1) During inspiration, obstruction occurred associated with an increased negative inspiratory pressure inferior to the site of obstruction and a disappeared negative inspiratory pressure above the site of obstruction; 2) three patterns of obstruction were observed; 3) the site of obstruction was located at the site of the palate; 4) velopharyngeal obstruction and tongue–pharynx obstruction were all present; 5) nasopharyngeal obstruction velopharyngeal obstruction and tongue–pharynx obstruction were all present; and 6) peak inspiratory pressure differences between the normal breath and apnea were associated with the longest apnea interval (P <.05).Conclusion UA pressure measurement can evaluate the site of obstruction in patients with OSAS and their changes during sleep. Peak inspiratory pressure differences between normal breath and apnea can show the severity of OSAS.
Cross‐Linked Hyaluronan Used as Augmentation Substance for Treatment of Glottal Insufficiency: Safety Aspects and Vocal Fold Function
Authors: Hertegård Stellan , Hallén Lars , Laurent Claude , Lindström Elisabeth , Olofsson Katarina , Testad Per , Dahlqvist Åke 
Published: November 2003

AbstractObjective To examine safety aspects and vocal fold function after vocal fold augmentation with a cross‐linked hyaluronan derivative (hylan B gel) as compared with bovine collagen.Study Design A prospective, randomized trial.Methods Eighty‐three patients with glottal insufficiency were treated with injection augmentation with hylan B gel and bovine collagen and were examined at 1, 6, and 12 months after treatment. Seventy patients with unilateral vocal fold paresis (n = 35) or atrophy (n = 35) were randomly assigned to receive either hylan B gel (n = 47) or collagen (n = 23) injections into one vocal fold. Thirteen patients with glottal insufficiency caused by scar defects or paresis resulting from malignant disease were included in a nonrandomized group and were treated only with hylan B gel. Evaluations were made from patients' subjective ratings (visual analogue scales), digitized videostroboscopic measurements, phonetograms, maximum phonation time, and phonation quotients.Results Twelve months after injections, the patients' self‐ratings were significantly improved for both the hylan B gel and the collagen groups. In addition, the videostroboscopic measurements showed significantly improved glottal closure for both groups. However, for the hylan B gel group, vibration amplitude and glottal area variations were preserved, and this group showed significantly less resorption at the injected vocal fold edge. Furthermore, maximum phonation time had increased significantly for the hylan B gel patients (collagen, nonsignificant). No serious adverse events were observed; three patients injected with hylan B gel had temporary inflammation at the injection site, which resolved without sequelae.Conclusions The results showed that both hylan B gel and collagen can be safely used for injection treatment of glottal insufficiency. Both treatments resulted in significantly improved voice as rated by the patients. However, the patients treated with hylan B gel showed better vocal fold status and longer maximum phonation time at 12 months after treatment as compared with patients treated with collagen.