bluuebunny/crossref_metadata_2025_split huggingface dataset:
Suppurative intracranial complications of sinusitis
Authors: Gallagher Richard M. , Gross Charles W. , Phillips C. Douglas 
Published: November 2003

AbstractObjectives: To familiarize the contemporary surgeon with the pathogenesis, diagnosis, and appropriate management of suppurative intracranial complications of sinusitis. Study Design: Retrospective chart review. Methods: All patients admitted to the University of Virginia Health Sciences Center with a diagnosis of intracranial suppuration between 1992 and 1997 were reviewed. Results: One hundred seventy‐six cases were identified, of which 15 patients had 22 suppurative intracranial complications of sinusitis. These were epidural abscess (23%), subdural empyema (18%), meningitis (18%), cerebral abscess (14%), superior sagittal sinus thrombosis (9%), cavernous sinus thrombosis (9%), and osteomyelitis (9%). Conclusions: The diagnosis of suppurative intracranial complications of sinusitis requires a high index of suspicion and confirmation by imaging. Central to the success of treatment is the management of the primary source of sepsis within the paranasal sinuses in combination with neurosurgical drainage and intravenous antibiotics. This approach has resulted in a mortality rate of 7% and morbidity of 13%, which compare favorably with previous series. Laryngoscope, 108:1635–1642, 1998
Selective role of partial XI‐VII anastomosis in facial reanimation
Authors: Griebie Matthew S. , Huff John S. 
Published: November 2003

AbstractObjectives: Review techniques available for transposition of an alternative motor neuron if end‐to‐end anastomosis or interposition nerve grafting cannot be accomplished when there has been a complete facial nerve loss. Describe the selective use of a partial spinal accessory‐facial nerve anastomosis and highlight cases when this may be a useful alternative. Describe the modifications of decompression of the facial nerve for tension‐free anastomosis and the use of the muscle pedicle for repair of cerebrospinal fluid leakage. Study Design: Report of three cases and a review of the literature. Methods: Charts were reviewed and indications for the procedure were analyzed. The degree of facial movement was recorded as well as the resolution of any cerebrospinal fluid leak. Results: The results varied between Class III and Class IV on the House‐Brackmann scale following initial complete paralysis. In the two cases in which spinal fluid leakage had occurred before surgery the leakage was resolved. No donor site morbidity was noted. Conclusions: The potential of low morbidity associated with the use of the sternocleidomastoid branch, along with the potential for delivering a vascularized muscle pedicle to the temporal bone region, makes selective use of this procedure a valuable addition to the multiple reconstruction options for the paralyzed face. Laryngoscope 108:1664–1668, 1998
Argon laser in difficult stapedotomy cases
Authors: Nissen Rick L. 
Published: November 2003

AbstractObjective: The success and safety of argon lasers in stapedotomy surgery is now well documented. This study reviews results in problematic situations in which the argon laser may be of particular advantage to successful completion of the stapedotomy procedure. Study Design: Retrospective chart review. Methods: A retrospective review of the author's most recent 200 stapedotomy cases was performed, identifying 32 patients who at surgery were either found to have a prolapsed dehiscent facial nerve (three cases), developed a floating footplate (eight cases), or were undergoing a revision stapedotomy (21 cases). Four‐frequency, pure‐tone average air and bone conduction thresholds were computed before and after surgery. Success was defined as closure of the air‐bone gap to within 10 dB, while an air‐bone gap within 20 dB was considered improvement. Results: Successful closure of the air‐bone gap was achieved in all eight patients with a mobilized footplate, in all three patients with a prolapsed dehiscent facial nerve, and in 43% of the patients undergoing a revision stapedotomy. The rate of improved air‐bone gap in the revision cases was 62%. In one revision stapedotomy patient a decrease in speech discrimination occurred. Otherwise, there were no cases of sensorineural hearing loss. Neither intraoperative nor postoperative dizziness was reported by any patient, and all were discharged on an outpatient basis. Conclusion: The argon laser was found to be safe, effective, and a valuable adjunct for the difficult stapedotomy cases when unexpected obstacles such as a prolapsed dehiscent facial nerve or a mobilized footplate are encountered, as well as for the planned, more difficult revision cases. Laryngoscope, 108:1669‐1673, 1998
Partial ossicular reconstruction in children: A review of 62 operations
Authors: Daniels Robert L. , Rizer Franklin M. , Schuring Arnold G. , Lippy William L. 
Published: November 2003

AbstractObjective/Hypothesis: The published experience and audiometric results with ossicular reconstruction in children are limited. To better understand the role of ossiculoplasty in children, audiometric results were examined for partial ossicular reconstructions performed on a pediatric population. Study Design: Retrospective. Methods: Sixty‐two partial ossicular reconstructions performed on a pediatric population were reviewed for audiometric results, prosthesis extrusion rates, and mechanisms of failure at revision. Comparison of techniques and prosthesis types: porous polyethylene partial ossicular replacement prosthesis (POP), Schuring ossicle cup (SOC), and modified Robinson prosthesis (MRP) were also evaluated. Follow‐up ranged from 6 to 72 months. Results: Six‐month hearing results showed postoperative air‐bone gaps less than or equal to 20 dB in 77% of cases. Successful results at 1 and 2 years were retained in 66% and 63% of cases, respectively. Results for POPs at 1 and 2 years were 78% and 89%. Results for SOCs at 1 and 2 years were 61% and 55%. The overall extrusion rate was approximately 3%. Conclusions: These results compare favorably with those from other, mostly adult, studies. Comparison of prosthesis types revealed generally stable long‐term results with few significant differences. Success with ossiculoplasty in children can be obtained by applying the same principles and approach to ossicular reconstruction as used in adults. Ossicular reconstruction in children remains a secondary goal after establishing a safe, dry, and stable ear. A discussion of techniques and comparative literature review are presented. Laryngoscope, 108:1674–1681, 1998
Hearing results of intratympanic steroid treatment of endolymphatic hydrops
Authors: Arriaga Moisés A. , Goldman Steve 
Published: November 2003

AbstractObjectives/Hypothesis: This study evaluated the effectiveness of a single application of steroids to the open middle ear in improving short‐term hearing in patients with Meniere's disease and cochlear hydrops. Study Design: Retrospective study in which each patient's pretreatment hearing served as the control compared with posttreatment hearing. Methods: Patients were treated with a single application of dexamethasone, 8 mg, in hyaluronan. Following tympanotomy and lysis of round window adhesions, steroids were placed in the round window niche with absorbable gelatin sponge and the remainder of the middle ear was then filled with the steroid solution. Systemic steroids were not administered. Audiograms were performed within 1 month before surgery and at least 1 month after surgery. Results: Between September 1996 and July 1997, 21 ears in 19 patients underwent intratympanic steroid treatment. The criterion for hearing change was a 10‐dB or greater change in pure‐tone average (PTA), or a 15% change in speech discrimination score (SDS). Of the 15 ears meeting inclusion criteria for this study, five (33%) demonstrated hearing improvement and three (20%) demonstrated hearing deterioration. Maximum improvement was a 38‐dB improvement in PTA and a 32% improvement in SDS. Conclusion: A single application of intratympanic dexamethasone/hyaluronan solution directly to the round window did not produce dramatic short‐term hearing improvement in patients with endolymphatic hydrops. Although the theoretical basis for intratympanic steroid treatment of endolymphatic hydrops is appealing, we urge close evaluation of the results of specific protocols of intratympanic steroid administration before widespread utilization of this treatment. The choice of steroid, route of administration, frequency of application, and need for simultaneous systemic administration require standardization to adequately assess the efficacy of this treatment. Laryngoscope, 108:1682–1685, 1998
Submandibular and lacrimal gland immunoglobulin in the C3H.MRL‐Faslpr autoimmune mouse model of sjögren's syndrome
Authors: Trune Dennis R. , Leedy Daniel A. 
Published: November 2003

AbstractObjective: To distinguish potential autoimmune and nonautoimmune mechanisms underlying the salivary gland inflammation seen in Sjögren's syndrome and normal aging. Study Design: Immunohistochemical studies were conducted on the lacrimal and salivary glands of 2‐ and 5‐month‐old C3H.MRL‐Faslpr autoimmune strain mice and age‐matched C3H/HeJ nonautoimmune controls. Methods: Glandular inflammatory foci, interstitial areas, and vasculature were stained for immunoglobulin G (IgG), immunoglobulin A (IgA), and complement to determine differences in their local immune parameter. Differences between the two strains were compared for immune changes attributable to autoimmune disease and between the two normal groups for normal aging changes. Results: Greater staining of IgG, IgA, and complement occurred in the inflammatory foci and interstitial areas of 5‐month‐old C3H.MRL‐Faslpr lacrimal and submandibular glands compared with 5‐month‐old controls. Normal mice showed some increased immunoglobulin staining with aging, but little or no complement in any glands. Conclusions: These differential findings suggest that the systemic autoimmune disease plays a more direct role in focal glandular inflammation in Sjögren's syndrome, whereas less severe immune mechanisms are involved in the inflammation of normal glands. Laryngoscope, 108:1729–1732, 1998
In vivo analysis of bacterial biofilm formation on facial plastic bioimplants
Authors: Malaisrie Sukit Christopher , Malekzadeh Sonya , Biedlingmaier John F. 
Published: November 2003

AbstractObjectives: This study examines the formation of biofilm on biomaterials commonly used in facial plastics and reconstruction including titanium, silicone, ionbombarded silicone (Ultrasil), e‐PTFE (Gore‐Tex), e‐PTFE with silver/chlorhexidine (Gore‐Tex Plus), and PHDPE (Medpor). Methods: These biomaterials were implanted subcutaneously in the dorsum of 11 guinea pigs after contamination with Staphylococcus aureus and examined with scanning electron microscopy after 7 days. Wounds were also inspected for infection and extrusion rates. Results: Results show biofilm formation on titanium, silicone, ion‐bombarded silicone, e‐PTFE, and PHDPE associated with high rates of extrusion and infection. Implants of e‐PTFE with silver/chlorhexidine, on the other hand, appeared resistant to biofilm formation and demonstrated significantly lower rates of extrusion and infection. Conclusions: Contamination of bioimplants in vivo leads to formation of bacterial biofilm on the surface of the biomaterial, causing infection, pus formation, and extrusion. The authors hypothesize that the antiseptic agents impregnated in the biomaterial form a protective coat of silver, chlorhexidine, and inflammatory cells that inhibits initial bacterial adhesion to the biomaterial surface. Laryngoscope, 108:1733–1738, 1998
Development of the tubotympanum in the rat
Authors: Mulder Jef J. S. , Kuijpers Wim , Peters Theo A. , Tonnaer Edith L.G.M. , Ramaekers Frans C.S. 
Published: November 2003

AbstractObjective: To investigate the relationship between the anatomical maturation of the middle ear and that of the eustachian tube and paratubal muscles in the rat. Design: Wistar rats ranging from gestational day 12 to postnatal day 40 were used. Methods: Tissue specimens were examined with routine light microscopy and electron microscopy. Epithelial differentiation was studied immunohistochemically with antibodies to different cytokeratins. Results: The epithelial lining of the tubotympanum showed differentiation‐related cytokeratin expression throughout the whole developmental period. The mucociliary epithelium reached mature features around birth. A dorsal extension and its framing cartilage started forming around 5 days after birth. This extension became lined by stratified nonciliated epithelium and attained maturity around 10 days after birth concurrently with the attachment of the dilatory muscles. This process was immediately followed by aeration of the middle ear cavity. Conclusions: The continuous expression of cytokeratins demonstrates that the epithelial lining of the tubotympanum is only derived from the embryonal endoderm. Furthermore, this study demonstrates that the eustachian tube shows a two‐stage postnatal development. First, the mucociliary system matures, providing protection/clearance when the animal starts respiration and swallowing. Subsequently, the dorsal part attains maturity. The features of the epithelial lining of the dorsal part of the eustachian tube and the coincidence of the maturation of this part with the attachment of the dilating muscle fibers and the aeration of the middle ear indicates that this part provides ventilation. These findings support the authors' hypothesis that different parts of the eustachian tube serve different purposes: clearance, protection and ventilation.
Relationship of Human Papillomavirus to Schneiderian Papillomas
Authors: Weiner Jordan S. , Sherris David , Kasperbauer Jan , Lewis Jean , Li Hongzhe , Persing David 
Published: November 2003

AbstractObjectives/Hypothesis: To classify a large group of Schneiderian papillomas (SPs) into their histologic subtypes and to determine the incidence of human papillomavirus (HPV) in each subtype.Study Design: Pathologic review and polymerase chain reaction–based (PCR‐based) examination of archived tissue.Methods: Slides of 114 tumors diagnosed as Schneiderian, inverting, fungiform, or cylindric cell papillomas, or any associated carcinomas, were examined by a head and neck pathologist. Using PCR, consensus primers for the L1 region of HPV were used to determine the presence of HPV in the tumors. This was also performed on normal turbinate control specimens.Results: Eighty‐two (78%) were the inverting subtype, 21 (20%) the fungiform subtype, and 2 (2%) the cylindric cell type. Nine tumors were diagnosed as either verrucous or squamous cell carcinoma. Eighty‐eight percent of the tumors had DNA of sufficient quality to be amplified using PCR. Of these, 5 of 69 (6.8%) inverting, 17 of 17 (100%) fungiform, and 0 of 2 cylindric cell papillomas were positive for HPV. One of nine (11.1%) cancers was positive for HPV. No normal turbinate tissue contained HPV. HPV types 6b and 11 accounted for all cases of fungiform papillomas. Of the five HPV‐positive inverting papillomas, three had HPV type 11 and two had HPV type 16. The single carcinoma containing HPV contained HPV type 18.Conclusions: The histologic subtype of SPs is important, as their etiologies appear to be different. HPV 6b and 11 appear to be involved in all cases of fungiform papillomas but are only rarely involved in cases of inverting or cylindric cell papillomas. HPV 16 may rarely play a role in cases of inverting papillomas, and HPV 16 and 18 may be involved in a subset of cases of carcinomas originating in an inverting papilloma.
Quality of Life Assessment in Patients Undergoing Head and Neck Surgery As Evaluated by Lay Caregivers
Authors: Deschler Daniel G. , Walsh Kathleen A. , Friedman Stephanie , Hayden Richard E. 
Published: November 2003

AbstractObjectives/Hypothesis: Rehabilitation following head and neck cancer surgery has steadily moved into the outpatient realm and become dependent on caregivers with no formal medical background (lay caregivers.) Satisfactory rehabilitation and quality of life (QOL) depend on successful relationships between patients and the lay caregivers. This study evaluates the QOL assessments of patients by themselves and their primary lay caregivers before head and neck surgery. Study Design: Institutional Review Board–approved study using validated QOL assessment instrument. Materials and Methods: The preoperative QOL status in 50 patients undergoing extensive head and neck surgery was evaluated using the self‐administered Medical Outcomes Survey Short Form 36 (SF‐36). The patient's primary lay caregiver (spouse, child, or friend) completed a similar questionnaire evaluating the patient's status. Results: Thirty‐three (66%) questionnaires were returned. Twenty‐five (50%) questionnaire sets were successfully completed by both parties and employable for comparison. Sixty percent of the caregivers were within the 90% confidence interval of the patient's assessment for six or more of the eight parameters evaluated by the SF‐36. Likewise, caregiver assessments for specific parameters were consistently congruent with patient evaluation, except for the parameters of bodily pain and general health, for which caregivers demonstrated a trend for overrating pain and underestimating general health. Caregivers of the same generation as the patient demonstrated significantly higher congruence (P = .007). Similarly, a trend for higher congruence was noted in patients with recurrent disease. Conclusions: The importance of the lay caregiver has increased in the era of greater outpatient rehabilitation. This pilot study indicates that QOL assessment by lay caregivers may be examined with existing instruments and highlights QOL parameters critical to both the head and neck surgery patient and his or her primary lay caregiver.
Stapes Surgery in a Residency Training Program
Authors: Mathews Shawn B. , Rasgon Barry M. , Byl Frederick M. 
Published: November 2003

AbstractObjectives: Determine parameters for successful stapedectomy and whether this procedure can be performed safely by residents in a teaching hospital.Study Design: Retrospective analysis of techniques and results for 71 stapedectomy procedures.Materials and Methods: Charts were reviewed for technique, audiological test results, complications, operative time, and anesthetic used.Results: Overall, closure of the air‐bone gap at 10 dB was achieved in 87% of patients. Use of general anesthesia and a laser‐assisted, small‐fenestra technique allowed residents to complete more operations. No severe sensorineural hearing loss was noted.Conclusions: Residents can safely and successfully perform stapes surgery using a laser‐assisted, small‐fenestra technique.
Thyroid Cartilage Fracture Repair in Rabbits: Comparing Healing With Wire and Miniplate Fixation
Authors: Dray Todd G. , Coltrera Marc D. , Pinczower Eric F. 
Published: November 2003

AbstractObjectives: Evaluate cartilaginous healing in rabbits in response to surgically created thyroid cartilage fractures. Compare healing between laryngeal fracture repair techniques. Study Design: Animal model. Materials and Methods: Laryngectomy specimens were analyzed at 10 weeks, following paired wire fixation (n = 7) and miniplate fixation (n = 7) of thyroid cartilage fractures. Results: Cartilaginous unions were present in all seven of the miniplated repairs, while fibrous unions were present in six of the wired repairs. The measure of distraction at the fracture site was significantly greater in the wired repairs compared with the plated repairs (P = .005). Furthermore, in five of seven miniplated repairs no distraction at the healed fracture site was present. Conclusions: The results demonstrate the ease, tolerability, and superiority of the miniplate fixation technique for the thyroid cartilage fractures, based on a rabbit model.
Long‐term follow‐up of juvenile nasopharyngeal angiofibromas: Analysis of recurrences
Authors: Herman Philippe , Lot Guillaume , Chapot René , Salvan Didier , Huy Patrice Tran Ba 
Published: November 2003

AbstractObjectives: Juvenile nasopharyngeal angiofibroma often recurs if the tumor is large. This report is a long‐term follow‐up of these cases. It establishes the prognostic values of tumor extensions, analyzes the anatomic factors involved in recurrences, describes the spontaneous evolution of remnants based on a radiographic follow‐up, and evaluates the pertinence of complex combined surgical approaches for invasive tumors and the value of complementary endoscopy. Study Design: Retrospective review of 44 cases treated between 1985 and 1996. Methods: Statistical analysis of the correlation between recurrence and tumor extension as evaluated by systematic analysis of 18 putative tumor extensions on preoperative computed tomography scans. Results: Invasion of the skull base affected two‐thirds of the patients, and the rate of recurrence was 27.5%. Extensions to the infratemporal fossa, sphenoid sinus, base of pterygoids and clivus, the cavernous sinus (medial), foramen lacerum, and anterior fossa were correlated with more frequent recurrence. Long‐term radiographic follow‐up revealed putative residual disease in nine asymptomatic patients: these remnants gradually involuted. Conclusions: The data in the current study emphasize the prognostic value of skull base invasion and the difficulty of complete resection of extended lesions. Tumor remnants detected in symptom‐free patients should be kept under surveillance by repeated computed tomography scan, since involution may occur. Recurrent symptoms may be treated by radiotherapy (30 Gy) rather than by extended combined procedures. Endoscopic surgery should be combined with surgery for better control of skull base extensions.
Plasma Adrenaline Concentrations During Functional Endoscopic Sinus Surgery
Authors: Anderhuber Wolfgang , Walch Christian , Nemeth Erika , Semmelrock Hans‐Jürgen , Berghold Andrea , Ranftl Günther , Stammberger Heinz 
Published: November 2003

AbstractObjectives/Hypothesis: Vasoconstrictors (i.e., epinephrine) are routinely applied before functional endoscopic sinus surgery (FESS) but may have significant cardiac side effects. The controversy concerning clinical application of adrenaline is discussed. Study Design: In a prospectively controlled study of 51 patients undergoing FESS we evaluated the absorption of adrenaline from standard cotton pledgets and submucous infiltration and the incidence of related side effects during surgery. Additionally, a control group of 12 patients undergoing tonsillectomy was investigated. Methods: Plasma adrenaline concentrations were measured 1) before anesthesia, 2) after intubation, 3) after nasal packing with adrenaline soaked pledgets (adrenaline 1:1000) and submucous infiltration with 2 mL lidocaine with adrenaline 1:100,000 in each side, and 4) at end of surgery. The catecholamines were determined with a Merck‐Hitachi Catecholamine Analyzer, model II (Merck, Darmstadt, Germany). Pulse, electrocardiogram (ECG), and blood pressure were monitored. Results: In the FESS group, we found a remarkable decrease in systolic (S) as well as diastolic blood pressure (D) (P < .001), whereas the heart frequency was unaffected during surgery. All patients in the adrenaline group showed significant increase in plasma adrenaline (AD) concentrations in the third and fourth sample (P < .001). The control group, however, showed a significant rise in blood pressure only at beginning of surgery (P < .001) with cardiac pulse and plasma adrenaline concentrations unaffected by surgery or anesthesia. The often described severe side effects of adrenaline in combination with general anesthesia were not seen in any of our patients. Conclusions: Although systemic absorption of locally injected vasoconstrictors occurs, adrenaline‐related side effects during FESS are extremely rare when the patient is monitored exactly.