bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subglottic Stenosis Associated With Wegener's Granulomatosis
Authors: Gluth Michael B. , Shinners Patrick A. , Kasperbauer Jan L. 
Published: November 2003

AbstractObjective To evaluate the outcomes of subglottic stenosis in patients with Wegener's granulomatosis.Study Design Retrospective chart review.Methods A retrospective chart review was undertaken to review all patients evaluated in an otolaryngology—head and neck surgery department between 1993 and 2001 for active symptoms attributed to subglottic stenosis who had undergone cytoplasmic staining antineutrophil cytoplasm antibody and perninuclear staining antineutrophil cytoplasm antibody testing and who had a clinical diagnosis of Wegener's granulomatosis.Results Twenty‐seven patients were identified with Wegener's granulomatosis and subglottic stenosis. Among these, 11 of 27 (40.7%) underwent tracheotomy; 13 of 27 (48.1%) required multiple surgical procedures. A history of open laryngotracheal repair was present in 7 of 27 patients (25.9%). CO2 laser resection and dilation was used in 12 of 27 patients (44.4%). Three of 27 patients (11.1%) had a tracheotomy at last follow‐up. Patients were followed for an average duration of 76.8 months (6.4 y) from the onset of symptoms attributed to subglottic stenosis. All patients who underwent open laryngotracheal reconstruction had successful decannulation.Conclusions Wegener's granulomatosis is a necrotizing vasculitis that can involve the subglottis. Our approach to airway management in these patients involves a tracheotomy if obstruction occurs during acute inflammatory activity. We recommend minimizing airway manipulation during episodes of systemic disease activity. Once control of the disease process is obtained, consideration is given to either an endoscopic or an open approach based on the extent of stenosis. Either laryngotracheal reconstruction or CO2 laser resection and dilation may be undertaken with safety and should result in favorable outcomes.
Complete Laryngotracheoesophageal Cleft: Complicated Management Issues
Authors: Chitkara Ajay E. , Tadros Monica , Kim H. Jeffrey , Harley Earl H. 
Published: November 2003

AbstractObjectives/Hypothesis Laryngotracheoesophageal clefts are rare developmental anomalies of the upper aerodigestive tract. They range in severity from being virtually asymptomatic throughout life (type I) to being incompatible with life (type IV). The timing of diagnosis is crucial to the successful treatment of severe clefts. Treatment is complicated and requires a multiteam approach. The case report discusses the elements involved in diagnosing and treating this severe airway anomaly.Study Design Case report.Methods Review of a case at a tertiary care center.Results A case of a complete laryngotracheoesophageal cleft with left‐side pulmonary agenesis in a newborn is reported. Rigid bronchoscopy revealed a common tracheoesophageal lumen from the larynx to the stomach with a single bronchus supplying the right‐side lung. Management of this patient included establishment and maintenance of a tenuous airway, maintenance of nutrition, and anesthetic and surgical planning for upper aerodigestive tract reconstruction.Conclusions Although severe laryngotracheoesophageal clefts are rare, they require prompt, team‐oriented management for the best outcome possible. The diagnosis, sustenance, and treatment options of these patients depend on varied and complicated factors, which are discussed.
The Superior Petrosal Triangle as a Constant Anatomical Landmark for Subtemporal Middle Fossa Orientation
Authors: Miller Robert Sean , Pensak Myles L. 
Published: November 2003

AbstractObjectives/Hypothesis Anatomical landmarks including the arcuate eminence and the superficial petrosal nerve serve as orienting landmarks for middle fossa dissection. However, because of considerable variation among patients, these landmarks are not always readily identifiable. We expand on a previously described method for identifying the head of the malleus as a constant anatomical landmark to optimize exposure when employing a middle fossa approach.Methods We completed an anatomical study using 10 preserved human cadaveric temporal bones to define the anatomical relationship among the root of the zygoma, the posterior–lateral lip of the foramen spinosum, and the bony tegmen over the head of the malleus. Subsequently, 5 fresh whole human cadaveric heads (10 temporal bones) were dissected using a surgically oriented anterior petrosectomy–middle fossa approach to evaluate the consistency of localizing the head of the malleus.Results We defined the superior petrosal triangle as a stable anatomical relationship. Our cadaveric data demonstrated that the distance from the root of the zygoma to the head of the malleus was 18.7 mm (SD = 1.7 mm) and the distance from the foramen spinosum to the head of the malleus was 19.2 mm (SD = 1.0 mm). The intersection of an arc transcribed 19 mm from the root of the zygoma and an arc transcribed 19 mm from the foramen spinosum localized the head of the malleus within 2.5 mm (SD = 2.4 mm).Conclusions The landmarks defined by the superior petrosal triangle represent a means to localize the bony tegmen over the head of the malleus. Identification of the head of the malleus as a landmark in middle fossa surgery when other landmarks are not recognizable optimizes patient safety and surgeon confidence during complex surgical procedures.
Expression of Extracellular Matrix Metalloprotease Inducer in Laryngeal Squamous Cell Carcinoma
Authors: Rosenthal Eben L. , Shreenivas Satya , Peters Glenn E. , Grizzle William E. , Desmond Renee , Gladson Candece L. 
Published: November 2003

AbstractObjectives/Hypothesis Head and neck cancer tumor cell invasion is responsible for both local destruction and distant metastasis. Invasion is largely mediated by matrix metalloproteases that are thought to be induced by tumor cell derived extracellular matrix metalloprotease inducer (EMMPRIN) in surrounding fibroblasts. We hypothesize that EMMPRIN is overexpressed in laryngeal cancer.Study Design Retrospective analysis of patients with supraglottic laryngeal cancer.Methods Total protein immunoblotting and immunohistochemical analysis of normal and malignant tissue were performed to determine EMMPRIN expression. EMMPRIN immunoreactivity in 33 patients was correlated with clinicopathological features and survival.Results Whole‐tissue lysates of tumors (n = 8) and metastatic lymph nodes (n = 2), but not normal skin (n = 8) or mucosa (n = 6), expressed significant amounts of EMMPRIN by immunoblotting. EMMPRIN membrane immunoreactivity (transmembrane EMMPRIN score) was associated with nodal positivity (P = .07), and it was a borderline significant predictor of survival (Hazards Ratio = 2.4; 95% CI, 0.88–6.55). As a categorical variable, higher transmembrane EMMPRIN score was associated with higher mortality.Conclusions The present study helps to establish EMMPRIN as a widely expressed protein in dysplastic mucosa and supraglottic laryngeal cancer, but not in normal epithelial counterparts.
Parotid Carcinoma: Impact of Clinical Factors on Prognosis in a Histologically Revised Series
Authors: Godballe Christian , Schultz Joyce H. , Krogdahl Annelise , Møller‐Grøntved Ågot , Johansen Jørgen 
Published: November 2003

AbstractObjective To analyze clinical data and possible prognostic factors of patients with primary carcinoma of the parotid gland.Study Design A retrospective study was made of 85 patients with suspected parotid cancer who were admitted to the Center of Head and Neck Oncology at Odense University Hospital (Odense, Denmark) from 1975 to 1994.Methods Patient records were retrospectively reviewed and tabulated for relevant clinical parameters. A complete revision of histological examination was performed by the same pathologist and the tumors were classified according to the 1991 international guidelines from the World Health Organization. Five tumors (6%) did not fulfill the criteria of malignancy and were reclassified as benign. In another five cases the assumed primary parotid carcinomas were found to be metastatic disease from cancers of the breast, prostate, skin, and lungs. Ten patients (12%) were excluded from the analysis, leaving 75 individuals for the study.Results Twenty‐four percent of patients were classified as T1, 32% as T2, 15% as T3, and 28% as T4. One patient (1%) was not classifiable (TX). Regional lymph node metastases were found in 17 cases (23%). Two of these were classified as N1 (3%), 2 as N2A (3%) and 13 as N2B (17%). Four patients were registered as not classifiable (NX) (5%). No patients were classified as N3. Distant metastases were found in four patients (5%) (one patient had bone and liver metastases and three patients had lung metastases). Five‐year recurrence‐free survival of the entire study group was 63%, disease‐specific survival was 69%, and crude survival was 52%. In univariate analysis, tumor size, histological appearance, T status, stage, the presence of lymph node metastases, distant metastases, pain, and facial nerve dysfunction had a significant influence on survival.Conclusions A thorough histological revision is pivotal in retrospective parotid carcinoma studies, and tumor size; histological appearance; T, N, and M status; stage; facial nerve dysfunction; and pain from the face and/or neck seem to be significant prognostic indicators for patients with primary parotid carcinoma.
Surgery of the Inner Ear With Hearing Preservation: Serial Histological Changes
Authors: Smouha Eric E. 
Published: November 2003

AbstractObjectives/Hypothesis Surgery of the inner ear can result in hearing preservation under certain conditions, but the mechanisms responsible for hearing preservation or loss are not well understood. The specific aim of the study is to examine histological sections obtained at different time intervals after varying degrees of surgical entry into the inner ear, to understand how the cochlea is protected. The hypothesis is that internal partitioning occurs.Study Design Histologic examination of guinea pig inner ears by light microscopy.Methods Guinea pigs underwent lateral semicircular canal transection and plugging, ampullectomy, or vestibulotomy, and tone‐burst auditory brainstem response thresholds at 2, 8, and 24 kHz were measured at intervals before and after surgery. Animals were killed after 1, 3, 7, or 21 or more days, and temporal bones were examined histologically.Results The histological response to surgical trauma consists of fibrosis and varying amounts of inflammation near the site of surgical entry. Cochlear hair cells are nearly always preserved, even when hearing loss occurs. Extension of the inflammatory response to the cochlea is associated with greater degrees of hearing loss.Conclusion The guinea pig inner ear is capable of withstanding surgical trauma to the semicircular canals and vestibule without complete loss of cochlear function. Fibrosis creates an effective partition between the site of surgical entry and the rest of the inner ear. Cochlear preservation might be enhanced if the inflammatory response can be contained.
Dietary Antioxidant Intake in Patients at Risk for Second Primary Cancer
Authors: Steward David L. , Wiener Frida , Gleich Lyon L. , Falciglia Grace 
Published: November 2003

AbstractObjectives To analyze dietary antioxidant intake for head and neck cancer patients at risk for development of second primary cancers.Study Design Prospective observational study.Methods Twenty‐four patients underwent three random, unscheduled, 24‐hour dietary recalls over a 15‐day period within 6 to 60 months after successful treatment for stage I or II oral cavity squamous cell carcinoma.Results The study sample had a lower mean daily dietary intake of fruits and vegetables and antioxidant nutrients, including vitamins A, C, E, and total carotenes than age‐ and sex‐matched historic control subjects (all P < .05 except vitamin A). A positive linear correlation was noted between daily servings of F&V and dietary intake of vitamins A, C, E, and total carotenoids (all P < .05 except vitamin A). Compared to current recommendations, the study sample had lower mean daily dietary intake of vitamins A, C, and E (P = .81, .06, and <.01) and servings of fruits and vegetables (P < .01). When vitamin supplements were included in the analysis, mean daily intake exceeded recommended dietary allowance (RDA) for vitamins A, C, and E (all P < .05).Conclusion This study suggests that patients treated for early‐stage oral cavity carcinoma, at risk for second primary cancers, have a statistically significant deficiency in dietary (food) sources of antioxidant nutrients when compared with both historic control subjects and cur‐rent recommendations. Vitamin supplementation significantly exceeded current RDAs. Because increased fruit and vegetable intake, but not vitamin supplementation exceeding RDA, is associated with reduced cancer risk, physicians may consider recommending at least five daily servings of fruits and vegetables as an alternative to vitamin supplementation.
Otolaryngological Manifestations of Cleidocranial Dysplasia, Concentrating on Audiological Findings
Authors: Visosky Ann Marie B. , Johnson Jacob , Bingea Becky , Gurney Theresa , Lalwani Anil K. 
Published: November 2003

AbstractObjectives/Hypothesis Cleidocranial dysplasia is an autosomal dominant skeletal syndrome characterized by open skull sutures and clavicular hypoplasia or aplasia. It results from mutations in the transcription factor CBFA1 required for osteoblast differentiation and normal bone formation. Therefore, mutations in CBFA1 would be expected to cause conductive or sensorineural hearing loss, or both. The objective of the study was to evaluate the auditory function and head and neck manifestations of patients with cleidocranial dysplasia.Study Design Case series.Methods Patients with cleidocranial dysplasia who were identified from the case records of the Craniofacial Anomalies Center at the University of California San Francisco (San Francisco, CA) gave medical and developmental history, underwent a general physical examination and a thorough head and neck examination, and completed a comprehensive audiological evaluation.Results Four families with eight affected individuals in all and one sporadic case were studied. The nine patients showed highly variable expression of abnormalities. Head and neck examination demonstrated abnormal cranial sutures, broad nasal root, clavicular hypoplasia or aplasia, and abnormally high arched palate. Although seven of nine patients showed eustachian tube dysfunction, recurrent otitis media in childhood requiring surgical intervention was not common. Hearing loss was present in three of nine patients (33%). One patient had a 40‐dB mixed hearing loss, the second had a 25‐dB low‐frequency conductive hearing loss, and the third had a 45‐dB high‐frequency sensorineural hearing loss.Conclusion In patients with cleidocranial dysplasia, eustachian tube dysfunction, conductive hearing loss, and sensorineural hearing loss are common because of structural and functional changes of the temporal bone and palate. Therefore, patients with cleidocranial dysplasia should be evaluated routinely by an otolaryngologist and undergo complete audiological testing.
Predictive Factors in Pediatric Stapedectomy
Authors: Welling D. Bradley , Merrell James A. , Merz Meredith , Dodson Edward E. 
Published: November 2003

AbstractObjective/Hypothesis The objective of the study was to investigate predictive factors in the postoperative hearing outcomes in pediatric stapedectomy.Study Design Retrospective case series. The study was performed in a tertiary academic otological practice.Methods The outcome of 66 stapedectomies in children 17 years of age and younger were analyzed according to the 1995 American Academy of Otolaryngology—Head and Neck Surgery Committee on Hearing and Equilibrium guidelines. Factors evaluated included patient age, underlying diagnosis (tympanosclerosis, otosclerosis, congenital fixation), type of footplate graft and type of prosthesis used, associated ossicular abnormalities, and revision surgery.Results The mean postoperative air–bone gap following stapedectomy in children with tympanosclerotic footplate fixation (24.9 dB [±11 dB]) was significantly worse than in patients with an underlying diagnosis of congenital stapes fixation (15.7 dB [±9 dB]) or otosclerosis (13.1 dB [±3 dB]) (P = .024). Revision stapedectomy was also associated with a poorer outcome, but patient age and prosthesis and graft type did not contribute to the outcome in a statistically significant manner.Conclusions Pediatric patients with stapes fixation resulting from tympanosclerosis showed poorer outcomes from stapedectomy than patients with congenital or otosclerotic fixation. Outcomes for congenital or otosclerosis fixation more nearly matched the outcomes in the literature for adult series.
Revision Stapes Surgery: The Malleus to Oval Window Wire‐Piston Technique
Authors: Kohan Darius , Sorin Alexander 
Published: November 2003

AbstractObjective To determine the effectiveness of the malleus to oval window wire‐piston revision stapes surgery technique.Study Design A retrospective analysis of 243 stapes procedures performed by the senior author over a 10‐year period identified 15 revisions. Five patients underwent a malleus to oval window wire‐piston technique. All patients were followed for at least 6 months. The surgical outcome including audiologic data and complications are noted.Methods Stapes surgery was performed on an ambulatory basis by way of a transcanal approach under local anesthesia with monitored sedation by the same surgeon using a laser technique and a stapes wire‐piston prosthesis.Results Among revision stapes procedures, there was no significant difference in the air‐bone gap closure or complication rate between the incus to oval window and the malleus to oval window techniques. The average preoperative air‐bone gap in all revisions was 32 dB, whereas the mean postoperative gap was 10 dB hearing loss.Conclusions In experienced hands, revision stapes surgery using the malleus to oval window stapes wire‐piston prosthesis is safe and effective.
Tympano‐Ossiculoplasty Utilizing the Spiggle and Theis Titanium Total Ossicular Replacement Prosthesis
Authors: Neff Brian A. , Rizer Franklin M. , Schuring Arnold G. , Lippy William H. 
Published: November 2003

AbstractObjective Since 1993, titanium prostheses have been used in Europe as a biocompatible implant for ossicular reconstruction. More recently, the titanium ossicular prosthesis has become more widely available in the United States as a newer means of surgical restoration of hearing. We will review the hearing results of patients who have undergone tympano‐ossiculoplasty using a titanium total ossicular replacement prosthesis (TOP). We will compare these results to our previously published results using the porous polyethylene TOP.Methods Retrospective review in a tertiary otologic practice.Results Eighteen patients underwent tympano‐ossiculoplasty with a titanium TOP. Among these patients, 10 cases involved revision of a previously placed ossicular prosthesis. Hearing results showed that 16 of 18 patients (89%) had closure of the postoperative air‐bone gap to within 20 dB, and the average air‐bone gap improvement was 23 dB. The average follow‐up time was 8 months (range, 2–21 months). The results of this initial evaluation compare favorably with the results that we obtained using a porous polyethylene TOP in which 67% of 133 patients closed the air‐bone gap to within 20 dB.Conclusion We have recently begun using the titanium TOP, which has resulted in improved postoperative hearing when compared with the porous polyethylene TOP. In the future, longer follow‐up and increased patient numbers will strengthen our conclusions.
Long‐Term Follow‐Up of Pediatric Recurrent Respiratory Papillomatosis Managed with Intralesional Cidofovir
Authors: Pransky Seth M. , Albright James T. , Magit Anthony E. 
Published: November 2003

AbstractObjective Cidofovir is an acyclic nucleotide phosphonate antiviral medication that has been used intralesionally for the treatment of severe respiratory papillomatosis (RRP) in pediatric patients. The long‐term efficacy of this medication was assessed in 11 children with severe RRP who previously required operative debulking every 2 to 6 weeks to maintain airway patency.Study Design Clinical case series.Results Ten of these children have completed therapy. Five are disease free over a mean follow‐up period of 51.6 months. Five other patients with active RRP decreased their mean severity scores from 17.8 (range 11–26) to 4.0 (range 2–6) and no longer require cidofovir. One patient continues to receive cidofovir for recurrent disease after an initial favorable response. Throughout the 6‐year observational period, no patients demonstrated any adverse effects, laboratory abnormalities, or evidence of carcinogenesis.Conclusion Intralesional cidofovir is a useful adjunct for managing children with tenuous airways caused by previously uncontrolled papilloma.
Lipotransfer as an Adjunct in Head and Neck Reconstruction
Authors: Ducic Yadranko , Pontius Allison T. , Smith Jesse E. 
Published: November 2003

AbstractObjectives To present our technique of lipotransfer and to evaluate a single center's experience in the use of lipotransfer as an adjunct to head and neck reconstruction.Study Design A retrospective review of all patients undergoing lipotransfer over a 5‐year period by the senior author was undertaken. A total of 23 patients with a minimum follow‐up of 1 year were available for analysis.Methods Patient records were retrospectively reviewed to assess functional (in the case of palate augmentation) and esthetic outcomes.Results Twenty‐three patients undergoing lipotransfer as part of their reconstructive effort included (1) eight patients undergoing temporal fossa augmentation following temporalis muscle flap reconstruction for extirpative skull base surgery, (2) six patients undergoing facial defect augmentation following traumatic atrophy, (3) three patients undergoing palatal augmentation for correction of velopharyngeal insufficiency, and (4) six patients undergoing soft tissue augmentation following flap reconstruction of the face. Twenty of the 23 patients had excellent maintenance of graft volume. An adequately vascularized recipient bed appears to be an important factor in determining ultimate graft survival using our technique.Conclusions Lipotransfer of the head and neck represents a simple, effective adjunctive technique providing for large amounts of readily available, well‐tolerated soft tissue filler material. Patient selection is important, specifically in regard to determining that there is adequate vascularity of the recipient bed.