bluuebunny/crossref_metadata_2025_split huggingface dataset:
The 11th Nerve Syndrome in Functional Neck Dissection
Authors: Salerno Grazia , Cavaliere Matteo , Foglia Alessandra , Pellicoro Dora Parente , Mottola Giampiero , Nardone Massimiliano , Galli Vieri 
Published: November 2003

AbstractObjectives Assessment of the incidence of shoulder joint disability and evaluation of the role of a personal postoperative physical rehabilitative protocol therapy in reducing pain and shoulder dysfunction and improving the quality of life (QOL) of patients who have undergone functional neck dissection (FND) associated with total laryngectomy.Setting, Design, and Outcome Measures Sixty laryngectomees who had undergone FND were divided into two groups (A and B). Group A received physical therapy after surgery. Clinical evaluation was done according to the Constant modified questionnaire, including physical assessment of passive and active shoulder movement and information regarding patients' QOL. Bilateral quantitative electromyography (Q‐EMG) of scapulohumeral muscles was carried out on all patients. Results were evaluated by Student t test and multivariate analysis to find out which variables were important in predicting pain and return to work.Results Six months after surgery, the patients in group A had better results concerning passive forward elevation (P = 0), shoulder active motility (P = 0), pain (P <.001), working and recreational activity (P = 0), and score of Constant (P = 0) compared with the patients in group B. From a multivariate analysis of clinical parameters important in predicting pain, significant predictors (P <.01) were shown to be global shoulder active motility, active forward elevation, abduction, active external rotation, internal rotation hand to back, working and recreational activity, and score of Constant. Regarding return to work, a significant predictor (P <.01) was the score of Constant. Electromyography work‐up showed deterioration in early postoperative periods and improvements in late postoperative periods.Conclusion The post‐surgical variable clinical picture of shoulder disability is related not only to the accessory nerve injury, but also to the secondary glenohumeral stiffness resulting from the scapulohumeral girdle muscles weakness and postoperative forced immobility. Physical therapy aimed to early recover passive motion and to avoid the occurrence of joint fibrosis has been shown to have a real contributory role in decreasing shoulder complaints and improving the patients' QOL.
A Method to Repair Auricular Defects After Perichondrial Cutaneous Grafting
Authors: Stucker Fred J. , Sanders Kenneth W. 
Published: November 2003

AbstractObjective To describe and illustrate the technique for closing the auricular bowl defect after perichondrial cutaneous grafting. The postauricular flip‐flop flap is used for this purpose.Study Design A retrospective clinical study of 354 patients using the perichondrial cutaneous graft for various reconstructions of the face and then performing the postauricular flip‐flop flap procedure.Methods The perichondrial cutaneous graft is a reliable, versatile graft that possesses unique properties for reconstructive surgery of the face. The postauricular flip‐flop flap is our particular technique for closure of the donor site wound after using the perichondrial cutaneous graft. It is a relatively simple procedure that has predictable results. We used this technique in patients ranging in age from 7 days to 92 years and noted excellent cosmetic results and rare complications.Results Two patients had failure of the perichondrial cutaneous graft. Two patients had partial necrosis of the postauricular flip‐flop flap. Two patients had dehiscence of the postauricular closure.Conclusion The postauricular flip‐flop flap is a reliable method to repair the donor site after perichondrial cutaneous grafting.
Intra‐arterial Effects of Cisplatin on Microvascular Anastomoses in the Rat Model
Authors: Gurushanthaiah Deepak , Knoblock Ron , Haller Jeffrey R. 
Published: November 2003

AbstractObjective To evaluate the patency of microvascular anastomoses in arteries exposed to intra‐arterial cisplatin.Study Design Animal model.Methods The common iliac artery of 15 rats was injected with 150 mg/m2 cisplatin. Five rats were injected with the same volume of saline serving as physiological controls. The ipsilateral femoral artery was transected and anastomosed using microsurgical technique within 3 to 5 days. A Doppler probe was used before and after the anastomosis to assess blood flow. The vessel was re‐examined on postoperative day 5. Pulsatile blood flow and the presence or absence of a Doppler signal was recorded at this time. Vessels were harvested to include the anastomosis site and fixed for histological evaluation. The contralateral femoral artery was also harvested for comparison.Results All femoral artery anastomoses in the experimental and control arm had good, pulsatile blood flow by microscopic evaluation. No thrombosed vessels were visualized, and Doppler signals remained strong at all vessel anastomoses. Histological analysis of the vessels revealed a trend toward increased inflammatory infiltrate in the walls of the vessels treated with cisplatin. We did not appreciate a functional decrease in lumen size.Conclusions Selective catheterization intra‐arterial cisplatin chemotherapy does not affect the patency of vessels following a microvascular anastomosis in the rat model. The trend toward increased inflammatory response in the vessel walls may suggest the need for closer monitoring in patients treated with intra‐arterial chemotherapy.
Risk—Benefit Analysis of Using the Middle Fossa Approach for Acoustic Neuromas With >10 mm Cerebellopontine Angle Component
Authors: Satar Bulent , Jackler Robert K. , Oghalai John , Pitts Lawrence H. , Yates Philip D. 
Published: November 2003

AbstractObjectives To evaluate hearing preservation and facial nerve (FN) outcome in the middle fossa (MF) approach for acoustic neuromas with a cerebellopontine angle (CPA) component >10 mm.Study Design Retrospective review of 193 patients.Patient Population Patients were grouped according to tumor size: intracanalicular tumors (IC; 64), 1 to 9 mm CPA extension (42), and 10 to 18 mm CPA extension (47). Additionally, a group of 40 patients (tumor size 10–18 mm CPA extension) who had undergone a translabyrinthine (TL) approach was studied to assess comparative FN outcome. Hearing and FN function were measured 1 year postoperatively. We defined the success at functional hearing preservation as AAO–HNS class B or better and good FN outcome as House‐Brackmann grade II or better.Results For IC tumors and those with up to 9‐mm CPA extension, there was no significant difference in the rate of functional hearing preservation (62.2% vs. 63.1%, P = .931) and good FN outcome (93.7% vs. 97.6%, P = .358). For tumors of 10‐ to 18‐mm CPA extension, the rate of hearing preservation (34%) was lower than the other groups (P = .006 and P = .009). In this group, the rate of good FN outcome was lower compared with the IC and 1‐ to 9‐mm tumors (80.8% vs. 93.7%, P = .037 and 97.6%, P = .012). The rate of good FN outcome following the TL approach in a comparable cohort of patients was 100% (P = .003 in comparison with 10–18 mm tumor resected with the MF approach).Conclusions When considering surgical options, patients with >10‐mm tumors should be advised that choosing the MF approach for hearing preservation carries a somewhat higher risk of persistent FN dysfunction.
Metastatic Renal Cell Carcinoma to the Head and Neck
Authors: Pritchyk Keith M. , Schiff Bradley A. , Newkirk Kenneth A. , Krowiak Edward , Deeb Ziad E. 
Published: November 2003

AbstractObjectives The objectives of the study were to present four cases of renal cell carcinoma (RCC) metastatic to the head and neck, to recognize the appearance on radiographic studies, to understand the importance of preoperative embolization, and to review the results of treatment.Study Design Retrospective review of patients diagnosed with metastatic RCC to the head and neck.Methods The records of four patients diagnosed with metastatic RCC at a tertiary medical center over a 5‐year period from 1996 to 2001 were reviewed and analyzed for demographic and outcomes data.Results Metastatic RCC to the head and neck was seen in the following locations: nasal cavity, lower lip, hard palate, tongue, and maxillary sinus. Presenting signs were loose upper molars, dysphagia, nasal obstruction, lower lip lesion, recurrent epistaxis, and foul nasal drainage. Histological studies confirmed metastasis of RCC in all four patients. Treatment consisted of preoperative radiation therapy, embolization, and local excision with adjunct chemotherapy.Conclusions Metastatic RCC to the head and neck is rare but can have serious consequences if not recognized before biopsy. We present several treatment options with local excision as the primary mode of treatment.
Retropharyngeal Lipoma Causing Obstructive Sleep Apnea: Case Report Including Five‐Year Follow‐Up
Authors: Hockstein Neil G. , Anderson Timothy A. , Moonis Gul , Gustafson Karen S. , Mirza Natasha 
Published: November 2003

AbstractObjectives/Hypothesis Lipomas of the retropharyngeal space are rare and do not cause symptoms until they reach a large size. Although retropharyngeal lipoma is an uncommon entity, several reports of it appear in the literature, and the treatment has routinely been surgical excision. Such fatty tumors also carry the rare possibility of being liposarcomas, which further warrants their excision. We present the case of a lipoma of the retropharyngeal space extending from the nasopharynx to the superior mediastinum causing symptoms of obstructive sleep apnea. The patient had multiple medical problems and was on a regimen of anticoagulation therapy; therefore, he opted against surgical treatment. He has used continuous positive airway pressure and has been followed clinically and radiographically for 5 years. Radiographic follow‐up of a retropharyngeal lipoma after a needle biopsy confirming its benign nature is a legitimate means of management of this rare condition.Study Design Case report of a 64‐year‐old man presenting with this rare lesion.Methods Computed tomography‐guided needle biopsy of the mass was performed to obtain tissue diagnosis. Thereafter, the patient has been followed for 5 years with annual magnetic resonance imaging scans to determine growth or changes of the retropharyngeal mass.Results Fine‐needle aspiration of the mass revealed mature adipose tissue intermixed with fibroconnective tissue, consistent with lipoma. Based on this result, we opted to follow this patient with serial magnetic resonance imaging scans, which have shown no change in size. There has also been no change in the patient's symptoms.Conclusions Large lipomas warrant excision, especially when their location produces pressure symptoms. However, when surgical morbidity is high, fine‐needle aspiration biopsy and serial magnetic resonance imaging scans are a safe alternative.
Tympanosclerosis in the Rat Tympanic Membrane: An Experimental Study
Authors: Russell John D. , Giles J. J. 
Published: November 2003

AbstractObjectives/Hypothesis Tympanosclerosis is a pathologic condition affecting the middle ear and tympanic membrane. It is a common condition in humans, most notably after grommet insertion. However, the pathogenesis of this disease is unclear. The aim of this study was to investigate the development and progression of tympanosclerosis in the pars tensa of rat tympanic membranes at various time intervals after inducing sterile middle ear effusions.Methods Fifty‐six male‐specific, pathogen‐free CD Wistar rats (100–170 g) underwent unilateral eustachian tube obstruction. Contralateral ears served as controls. Only specimens from animals with sterile effusions were included in this study. Light and electron microscopic analysis was performed on the pars tensa of rats with induced effusions ranging from 1 to 12 months.Results Histologic changes consistent with tympanosclerosis were seen in the majority of animals with effusions from 3 months and greater. The process started in the submucosal connective tissue layer and progressed to involve all connective tissue sublayers. The extent of calcium deposition and fibrosis across the membrane was related to the duration of otitis media with effusion. Atrophy was not found in any specimens.Conclusions Tympanosclerosis is a progressive disorder, which appears to be the main response of the rat pars tensa to prolonged sterile otitis media with effusion. The extent of involvement of the different sublayers of the pars tensa was closely related to the duration of otitis media with effusion. We propose that this new rat model for prolonged otitis media with sterile effusion is therefore a suitable animal model for the study of tympanosclerosis in the pars tensa.
Modified Facial Translocation Technique to Prevent Necrosis of Bone Graft
Authors: Hao Sheng‐Po 
Published: November 2003

AbstractObjective To assess the efficacy of a modified facial translocation technique in preventing translocated facial bone graft from necrosis, which is the most common complication of facial translocation.Study Design Prospective.Methods A lateral nasal flap was preserved and transposed to resurface the inner surface of the translocated facial bone graft in a facial translocation approach to skull base tumors in 35 patients including 24 patients with radiation therapy between July 1998 and December 2000.Results Only one patient had bone graft necrosis. Thirty‐four (97%) of 35 patients had intact mucosa covering the inner surface of the translocated facial bone graft. The outcome was not affected by preoperative or postoperative radiation therapy.Conclusions A modified facial translocation technique using a lateral nasal flap to resurface the inner defect of the translocated facial bone graft significantly improved the viability of the translocated facial bone graft, especially in patients who underwent radiation therapy. The use of a lateral nasal flap does not interfere with the detection of early local recurrence.
The Contralateral Injury in Blunt Laryngeal Trauma
Authors: Sidle Douglas M. , Altman Ken W. 
Published: November 2003

AbstractObjectives To present the unique case of a patient who sustained an ipsilateral and contralateral injury after external laryngeal trauma. The authors also explain the dynamics behind this type of injury.Study Design Case report and brief literature review.Methods A case report is presented of a patient who sustained both an ipsilateral and a contralateral injury after blunt laryngeal trauma. A brief review of the literature follows, including a description of proper management of this injury.Conclusion The reader should garner an understanding of the dynamics of this type of injury and learn the basic management of a similar injury.
Tumor Volume Predicts Outcome for Advanced Head and Neck Cancer Treated With Targeted Chemoradiotherapy
Authors: Doweck Ilana , Denys Douglas , Robbins K. Thomas 
Published: November 2003

AbstractObjectives/Hypothesis Just as tumor volume is a prognostic indicator for local disease control among patients with head and neck cancer of intermediate size treated with radiation therapy, we hypothesized a similar association for patients with advanced disease treated with chemoradiation therapy.Study Design Retrospective analysis of primary and nodal tumor volume was correlated with prospectively collected treatment outcome measures.Methods Sixty‐four patients with stage III‐IV disease who were treated with targeted intra‐arterial chemotherapy and radiation therapy (RADPLAT) were studied. Tumor volume was correlated with local disease control and survival.Results Primary tumor volume correlated with local disease control and survival. The greatest risk for local failure was found among patients with primary tumor volume greater than 19.6 cc (93.8% vs. 57% [P = .001]). A nominal logistic regression analysis demonstrated primary tumor volume as being the only significant parameter related to local failure. Survival was only 14.1% among patients with primary tumor volume greater than 19.6 cc compared with 41.5% for patients with volumes less than 19.6 cc (P = .0018). A proportional hazard model indicated that the most significant and independent parameters associated with survival were primary tumor volume (P = .0007) and the site of the tumor (P = .05).Conclusion Tumor volume is the most important factor predictive of treatment outcome among patients with advanced head and neck cancer and should be used to stratify favorable versus unfavorable patient subsets.
Outpatient Intravenous Antibiotics for Chronic Rhinosinusitis
Authors: Gross Neil D. , McInnes Renae J. A. , Hwang Peter H. 
Published: November 2003

AbstractObjective/Hypothesis Peripherally inserted central catheter (PICC) lines have greatly facilitated the use of intravenous antibiotics in outpatient medical practice. Otolaryngologic applications for home intravenous therapy through PICC lines have not been well characterized to date. The purpose of the study is to describe indications and complications related to outpatient intravenous antibiotic therapy in patients with chronic rhinosinusitis.Study Design Retrospective cohort study.Methods Chart review of patients with chronic rhinosinusitis who were treated at an academic rhinology practice with outpatient intravenous antibiotics over a 3‐year period.Results Fourteen patients receiving, in all, 16 courses of intravenous antibiotic therapy through PICC line were identified. The average patient age was 51 years (age range, 36–74 y). The primary indication for intravenous antibiotic use was the treatment of resistant pathogens (50%). The most common organisms treated were Staphylococcus epidermidis, Staphylococcus aureus, and Pseudomonas aeruginosa. Other indications included gastrointestinal intolerance of oral antibiotics and extranasal complications of sinusitis. Eighty‐eight percent of patients (14 of 16) were able to complete the entire prescribed course of therapy. Three (19%) catheter‐related complications occurred, including thrombophlebitis and deep venous thrombosis. All three complications required removal of the PICC line; one of these patients underwent successful reinsertion of a second catheter and completion of treatment.Conclusions Peripherally inserted central catheter line delivery of home intravenous antibiotics can be a well‐tolerated adjunct to surgery in the outpatient treatment of chronic rhinosinusitis. Resistant infections, intolerance to oral antimicrobials, and extranasal complications of sinusitis are indications for PICC line therapy. Catheter‐related complications can be significant and must be considered in patient selection.
Otolaryngology Residents' Objectives in Entering the Workforce
Authors: Kay David J. , Lucente Frank E. 
Published: November 2003

AbstractObjectives To determine the priorities of current otolaryngologists‐in‐training in considering their first employment opportunities.Study Design Twenty‐one‐item survey measuring the importance of various first job issues, with all items scored on a five‐point Likert‐type ordinal scale.Methods The resident membership of the American Academy of Otolaryngology—Head and Neck Surgery was anonymously surveyed by means of mail‐in questionnaires. Results were stratified by years of training.Results Responses from 242 of 1174 mail‐in surveys (21% response rate) exhibited a wide distribution of responses for all 21 questions. The availability of free time to spend with one's family was regarded by more than half of the respondents to have the highest overall importance. As years of training increased, priorities shifted toward geographic location, away from issues such as the on‐call schedules. The availability of research time and resources received the overall lowest priority, with more than half of the respondents ranking it as only somewhat important or lower.Conclusions Otolaryngologists‐in‐training feel strongest about the availability of free time to spend with their families as they finish formal training and consider employment opportunities. By acknowledging the concerns of graduating residents, including the ability to pursue their primary interests when they start working, we can better adapt conditions to create a more comfortable and stable entry into the workforce.
The Use of Malleus Allografts in Ossiculoplasty
Authors: Vercruysse Jean‐Philippe , Offeciers F. Erwin , Somers Thomas , Schatteman Isabelle , Govaerts Paul J. 
Published: November 2003

AbstractObjective To assess the functional performance of remodeled malleus allografts in a malleus‐footplate assembly in terms of hearing results and mid long‐term stability.Study Design A retrospective study of 60 consecutive patients who underwent a malleus allograft ossiculoplasty from 1993 until 2000. In all cases the incus and the stapedial arch were missing as the result of cholesteatoma (49), chronic otitis (5), incus necrosis resulting from stapes prosthesis (5), and congenital ossicular malformations (1). In all cases malleus allografts were remodeled to form a malleus‐stapes assembly.Results The audiometric results, using such an ossiculoplasty, revealed an overall median gain of 18.3 dB at 2 months, 22.3 dB at 6 months, and 25 dB 1 year postoperatively on Fletcher frequencies. An air‐bone gap closure within 20 dB was achieved in 81% of all cases 1 year postoperatively. No cases of extrusion have been seen in our series.Conclusion Our findings suggest that malleus allografts are capable of generating good and stable funcitonal results as malleus‐stapes assembly.
Rathke Cleft Cyst: Diagnostic and Therapeutic Considerations
Authors: Kasperbauer Jan L. , Orvidas Laura J. , Atkinson John L. D. , Abboud Charles F. 
Published: November 2003

AbstractObjective To highlight diagnostic and therapeutic issues about Rathke cleft cysts for otorhinolaryngologists.Study Design Retrospective.Methods We retrospectively reviewed data collected on Rathke cleft cysts between 1978 and 1998: presenting symptoms, visual acuity, surgical treatment, complications, recurrences, and effect on daily activity.Results Twenty‐nine patients were diagnosed with a Rathke cleft cyst (11 male and 18 female patients; mean age, 46 y). The most common presenting symptom was head pain (55%). The majority (59%) of cases demonstrated suprasellar extension on preoperative imaging, with pituitary dysfunction identified in 66%. Recurrence occurred in eight patients (28%). Postoperative visual function improved or remained stable in all patients. Persistent pituitary dysfunction required hormonal supplementation in seven patients (24%). Only one patient with an astrocytoma in addition to a Rathke cleft cyst did not maintain the ability to perform normally on an assessment of activities of daily living, a striking contrast to patients with craniopharyngioma.Conclusions Conclusions were as follows: 1) Rathke cleft cysts must be considered as sources of head pain and pituitary dysfunction. 2) Persistent or recurrent cyst formation occurs in approximately one‐third of the patients. Recurrence may take many years, and follow‐up imaging is recommended for at least a decade. 3) Maintenance of the ability to perform the activities of normal daily living can be expected after surgical management. 4) Most Rathke cleft cysts can be managed through transnasal exposure of the sella. 5) Packing the sella may result in predisposition to recurrent cyst formation.