bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reconstruction of the Entire Ossicular Conduction Mechanism
Authors: Battaglia Alex , McGrew Benjamin M. , Jackson C. Gary 
Published: November 2003

AbstractObjectives/Hypothesis Stapes fixation combined with fixation, absence, or malformation of the malleus‐incus complex requires an uncommon surgical reconstruction and offers a unique combination of challenges and hazards. This situation may occur in the presence of severe tympanosclerosis, otosclerosis, congenital ossicular malformations, and revision surgery for either stapedectomy or chronic ear disease. In previous reports, this procedure has been grouped with total ossicular reconstruction without much distinction. However, the challenges unique to this problem deserve special consideration. The present report offers a treatment plan for a group of patients requiring reconstruction of the entire ossicular conduction mechanism including removal of the stapes footplate.Study Design Retrospective review.Methods Three thousand three hundred fifty (3350) charts of patients requiring total ossicular replacement prostheses (TORPs) were reviewed. Of this group of patients, only 21 of 3350 patients from 1977 to 1999 required TORP placement and removal of the stapes footplate. The patients were followed for an average period of 50 months.Results Hearing results indicated an overall improvement in the air–bone gap of 10 dB, with 52% achieving an air–bone gap of less than 20 dB. Of the 21 cases, 5 revision surgeries were performed. Three were performed because of a displaced TORP (14.2%). and 2 were performed because of extruded TORPs (9.5%).Conclusions Reconstruction of the entire ossicular conduction mechanism including removal of the stapes footplate can be successfully achieved with improvement of the air–bone gap of less than 20 dB. Hearing results and extrusion rates are comparable to reported results of TORP placement on a mobile footplate. Successful stapedectomy and simultaneous ossicular chain reconstruction can be performed as a single or staged procedure. Special attention is paid to avoid intrusion of the prosthesis into the vestibule.
Cellular Telephone Use and Risk of Intratemporal Facial Nerve Tumor
Authors: Warren Hillary G. , Prevatt Angela A. , Daly Kathleen A. , Antonelli Patrick J. 
Published: November 2003

AbstractObjectives/Hypothesis Microwave radiation exposure from cellular telephone use has been implicated in the development of intracranial tumors. The intratemporal facial nerve (IFN) is exposed to higher levels of cellular telephone radiation than intracranial tissues. The purpose of the study was to determine whether cellular telephone use is associated with an increased risk of IFN tumors.Study Design Case‐control using a structured telephone survey at an academic, tertiary‐care referral center.Methods Patients with IFN tumors (n = 18) were case‐matched with patients treated for acoustic neuroma (n = 51), rhinosinusitis (n = 72), and dysphonia or gastroesophageal reflux disease (n = 69). Risk of facial nerve tumorigenesis was compared by extent of cellular telephone use and other risk factors.Results The odds ratio of developing an IFN tumor was 0.6 (95% CI, 0.2–1.9) with any handheld cellular telephone use and 0.4 (95% CI, 0.1–2.1) with regular cellular telephone use. No factors were associated with an increased risk for IFN tumor development.Conclusions Regular cellular telephone use does not appear to be associated with a higher risk of IFN tumor development. The short duration of widespread cellular telephone use precludes definite exclusion as a risk for IFN tumor development.
Transnasal Endoscopic Medial Maxillectomy for Inverting Papilloma
Authors: Sadeghi Nader , Al‐Dhahri Saleh , Manoukian John J. 
Published: November 2003

AbstractObjective To describe the new technique of transnasal endoscopic medial maxillectomy.Study Design Study design included application of the new technique in the management of five patients with inverting papilloma; retrospective review of five patients who had lateral rhinotomy with medial maxillectomy for inverting papilloma; comparison of transnasal endoscopic medial maxillectomy to open medial maxillectomy for scope of resection, margin control, operative time, and surgical access; and detailed description of transnasal endoscopic medial maxillectomy.Methods Charts were reviewed and tabulated for operative time, duration of follow‐up, and recurrence. Pathology reports were reviewed for number and orientation of the specimens and for margin control.Results Operative time was shorter for patients managed with transnasal endoscopic medial maxillectomy. All patients with transnasal endoscopic medial maxillectomy had one large, well‐oriented specimen with margin control. There was no recurrence in either group.Conclusions Transnasal endoscopic medial maxillectomy providing full access to the maxillary and ethmoid sinuses is described in detail. Transnasal endoscopic medial maxillectomy is an effective, reproducible technique with less operative time and morbidity and, possibly, better pathological tumor mapping than open medial maxillectomy for selected patients. Maxillary sinus involvement with inverting papilloma is not a contraindication for this technique. Strong illumination, superior resolution, and angled visualization, coupled with exact osteotomies, make transnasal endoscopic medial maxillectomy an efficacious technique for inverting papilloma with extension limited to the maxillary and ethmoid sinuses.
Long‐Term Hearing Outcome in Patients Receiving Intratympanic Gentamicin for Ménière's Disease
Authors: Wu Iee Ching , Minor Lloyd B. 
Published: November 2003

AbstractObjective To determine the long‐term hearing outcome in patients with intractable vertigo caused by unilateral Ménière's disease who were treated with intratympanic injection of gentamicin.Study Design The study was a longitudinal analysis of hearing and control of vertigo in patients with unilateral Ménière's disease who received intratympanic gentamicin.Methods Pure‐tone thresholds and speech discrimination scores on audiometry were analyzed, along with the control of vertigo. Criteria described in 1995 by the American Academy of Otolaryngology—Head and Neck Surgery (AAO‐HNS) were used. Patients treated with intratympanic gentamicin had “definite” Ménière's disease and had intractable vertigo despite optimal medical therapy, no symptoms suggestive of Ménière's disease in the contralateral ear, and serviceable hearing in the contralateral ear. The study analyzed the outcomes of 34 patients for whom follow‐up data were available for periods greater than 24 months after intratympanic gentamicin.Results Complete control of vertigo (AAOHNS Class A) was obtained in 90% of the patients. Profound sensorineural hearing loss occurred as a result of gentamicin injection in 1 of the 34 patients (3%). When data from all patients were grouped together, hearing was improved in 5 (15%), unchanged in 23 (68%), and worse in 6 (17%) patients. This distribution of hearing outcome is similar to that in patients whose symptoms of Ménière's disease were managed with medical measures. Recurrent vertigo developed in 10 patients (29%) at an interval of 4 to 15 months after initially complete control. Treatment with additional intratympanic injection(s) of gentamicin did not result in a change in hearing.Conclusion The risk of hearing loss in patients treated with infrequent intratympanic injection(s) of gentamicin is low.
Technical Refinements and Precautions During Ionomeric Cement Reconstruction of Incus Erosion During Revision Stapedectomy
Authors: Chen Douglas A. , Arriaga Moisés A. 
Published: November 2003

AbstractObjective The study describes the technical precautions and short‐term hearing results of fast‐setting ionomeric cement (SerenoCem) for managing incus erosion in revision stapedectomy.Study Design Observational and retrospective chart review.Methods Consecutive patients undergoing ionomeric cement incus reconstruction during revision stapedectomy had surgery on an ambulatory basis in a tertiary care referral center. Main outcome measures included technical details, precautions, and recommendations for handling this new material and 6‐week hearing outcomes comparing preoperative and postoperative air‐conduction and bone‐conduction thresholds.Results A small amount of ionomeric cement on the tip of otological picks applied to the incus remnant successfully reconstitutes the original length of the long process of the incus. In revision stapedectomy, a crimp‐on prosthesis may be placed on the cement‐lengthened incus. Six‐week postoperative audiograms demonstrated significant closure of the air–bone gap in operated cases. Our experience in a failed case leads us to recommend that the setting time for the cement be increased to no less than 20 minutes as opposed to the manufacturer's recommendation of 10 minutes. Also, revision stapedectomy was more likely to be successful when the prosthesis was placed to the incus remnant and stabilized with cement, rather than placing the prosthesis on the cement itself.Conclusions Ionomeric cement permits direct reconstruction of a pathologically shortened incus in revision stapedectomy. Surgeons must be aware of precaution and limitations of this new material. Preliminary results indicate significant hearing improvement with this technique when appropriate precautions are taken.
Stapes Prosthesis Attachment: The Effect of Crimping on Sound Transfer in Otosclerosis Surgery
Authors: Huber Alexander M. , Ma Furong , Felix Heidi , Linder Thomas 
Published: November 2003

AbstractObjectives/Hypothesis Although in stapes surgery successful hearing improvement may be achieved in the majority of patients, unsatisfactory closure of the air–bone gap can be recorded. One of many reasons for unexpected failures of stapes surgery may be the insufficient crimping of a stapes prosthesis onto the incus. The objectives of the study were to assess the amount of sound transmission loss in response to the quality of prosthesis crimping and to identify a required loop attachment pattern to obtain good sound transmission results.Study Design Experimental.Methods A temporal bone model was developed to measure the sound transmission properties between incus and prosthesis on 17 fresh human temporal bones. The attachment of a titanium stapes piston was assessed without crimping, followed by loose crimping and tight fixation to the incus, using scanning laser Doppler interferometry, endoscopic photography, micro grinding technique, and scanning electron microscopy. An algorithm had to be developed to simulate acoustical stimulation using electromechanical stimulation.Results Optimal tight crimping of the stapes piston revealed consistent good sound transfer function ranging from 0 to 7 dB loss, and loss remained, on average, at 2 dB. The mean transmission losses for conditions of loose crimping and no crimping were surprisingly small (within 10 dB). However, these unusual crimping conditions allowed a wide range of losses up to 28 dB. A close coupling at least at two opposite points was obligatory to obtain consistently good results.Conclusions Perfect hearing reconstruction necessitates ideal crimping of a prosthesis to obtain consistently good results. However, the final functional gain depends on many different intraoperative and postoperative factors.
Radiation Following Surgery for Oral Cancer: Impact on Local Control
Authors: Magge Keshav T. , Myers Eugene N. , Johnson Jonas T. 
Published: November 2003

AbstractObjectives The use of postoperative radiation therapy (RT) is commonly used in the treatment of patients with high‐risk squamous cell carcinoma of the head and neck. However, few data exist that quantitate the incremental benefit of RT when administered following surgery. The retrospective study was designed to measure the incremental benefit of adjuvant RT after surgery on control of the primary lesion when compared with patients undergoing surgical therapy alone for squamous cell carcinoma of the oral cavity.Study Design Retrospective chart.Methods Previously untreated patients with squamous cell carcinoma of the floor of mouth or oral tongue who were treated between 1974 and 1998 were eligible for study. A minimum follow‐up of 2 years was required. Tumor site, stage, and RT data were correlated with local control.Results Patients with missing or incomplete data and those lost to follow‐up or dead as a result of intercurrent disease with follow‐up of less than 2 years were censored. A group of 211 patients who could be evaluated was available for the study. Radiation therapy was administered postoperatively to 58 patients, and 153 patients were treated with surgery alone. In the group treated with combined therapy, the average irradiation dose was 5850 cGy; this group included 35 patients who received more than and 16 who received less than 5700 cGy.Conclusions The incremental benefit in terms of control of tumor at the primary site for patients receiving postoperative RT was between 0% and 7%. Surgery alone controlled 80% to 85% of primary tumors. The dose of postoperative RT did not correlate with local control.
Inhibition of Epidermal Growth Factor Receptor Signaling Decreases p63 Expression in Head and Neck Squamous Carcinoma Cells
Authors: Matheny Keith E. , Barbieri Christopher E. , Sniezek Joseph C. , Arteaga Carlos L. , Pietenpol Jennifer A. 
Published: November 2003

AbstractObjectives/Hypothesis Both the epidermal growth factor receptor (EGFR) and the p53 homologue p63 are overexpressed in a significant number of cases of head and neck squamous cell carcinoma (HNSCC). Epidermal growth factor receptor and p63 both possess oncogenic properties, including the potential to increase cell proliferation and antagonize apoptosis. ZD1839 (“Iressa”) is an adenosine triphosphate–competitive inhibitor specific to the EGFR tyrosine kinase currently under evaluation as a chemotherapeutic agent in HNSCC. The objective was to investigate whether p63 expression is decreased after treatment of HNSCC cells with ZD1839. Downregulation of p63 by ZD1839 would identify a potential molecular relationship between EGFR signaling and p63 and could provide insight into the mechanism of action of ZD1839.Study Design In vitro examination of p63 expression after ZD1839 treatment.Methods A human HNSCC cell line, SCC‐012, was treated with varying doses of ZD1839. p63 protein and messenger RNA levels were analyzed by Western and Northern blot analyses. The effect of ZD1839 on SCC‐012 cell cycle was analyzed by flow cytometric analysis.Results In SCC‐012 cells there was a dose‐dependent decrease in p63 protein and messenger RNA levels over the course of ZD1839 treatment. Levels of phosphorylated MAPK decreased and p27KIP‐1 levels increased after ZD1839 treatment. ZD1839 treatment induced a twofold increase in G1‐phase cells and a 3.5‐fold decrease in S‐phase cells consistent with growth arrest.Conclusion ZD1839 downregulates p63 expression at the messenger RNA level, suggesting that p63 is a downstream target of EGFR signaling.
Otoplasty: An Analysis of Technique Over a 33‐Year Period
Authors: Stucker Fred J. , Vora Neil M. , Lian Timothy S. 
Published: November 2003

AbstractObjective To compare the merits of otoplasty technique with a diverse patient population as experienced spanning a period greater 30 years.Study Design A review of a series of otoplasty cases that occurred in two distinctly different clinical settings during a 33‐year period.Methods A retrospective analysis of 211 patients undergoing otoplasty from 1969 to 1982 in a military hospital setting was compared with 118 patients receiving otoplasty from 1982 to 2002 in a university/private practice setting. The patient population consisted of 180 adults and 149 children.Results Otoplasty patients in the military setting were primarily adults, whereas those in the university/private practice setting were primarily children. In the adult population, 98.9% of patients required use of lateral conchal cartilage resection combined with a mattress suture technique. In the pediatric population, all patients required use of a mattress suture technique and in 83.2% of selected cases limited lateral conchal cartilage resection was required.Conclusion Otoplasty technique involving lateral conchal cartilage resection, mattress suture fixation, or a combination of both is applicable to diverse patient populations.
Videofluoroscopic Swallow Studies in Unilateral Cricopharyngeal Dysfunction
Authors: Halum Stacey L. , Merati Albert L. , Kulpa Judith I. , Danielson Susan K. , Jaradeh Safwan S. , Toohill Robert J. 
Published: November 2003

AbstractObjectives/Hypothesis Although the cricopharyngeus muscle is a ring‐like structure, unilateral cricopharyngeal dysfunction can produce significant dysphagia. This entity has not been well described in the literature. The aims of the study were to identify the characteristic findings on videofluoroscopic swallow studies in patients with dysphagia secondary to unilateral cricopharyngeal dysfunction, to note the associated vagal nerve injury, and to evaluate patient outcomes following ipsilateral cricopharyngeal myotomy.Study Design Retrospective clinical investigation.Methods The clinic charts, electromyographic tests, videostroboscopic examinations, and videofluoroscopic swallow studies were reviewed from a series of patients who presented to our institution from 1993 to 2001 with dysphagia and findings on videofluoroscopic swallow studies suggestive of unilateral cricopharyngeal dysfunction on posterior–anterior view. In patients treated with ipsilateral cricopharyngeal myotomy, postoperative findings on swallow studies and patient outcomes were also reviewed.Results Eighteen patients demonstrated findings characteristic of unilateral cricopharyngeal muscle dysfunction on videofluoroscopic swallow study. The common feature was a unilateral shelf‐like barrier at the cricopharyngeus on the posterior–anterior view with pooling of liquid bolus in the ipsilateral pyriform sinus and episodic shunting to the contralateral side. Eight patients did not have evidence of cricopharyngeal dysfunction (ie, cricopharyngeal bar) on lateral films. Of the 18 patients, 14 had histories consistent with vagal injury secondary to trauma (n = 2), neoplastic involvement (n = 7), iatrogenic injury (n = 2), or central nervous system disease (n = 3). Results of videostroboscopic examinations demonstrated vocal fold motion impairment in 14 patients, and electromyographic test results confirmed unilateral vagal injuries in those who underwent electromyographic testing (n = 6). In the remaining 4 of 18 patients, videostroboscopic examinations demonstrated normal vocal fold abduction but impaired lengthening with a posterior glottic gap, and electromyographic test results (n = 4) indicated unilateral superior laryngeal nerve involvement. Of the 15 patients treated with ipsilateral cricopharyngeal myotomy, 1 patient required postoperative esophageal dilations for an esophageal stricture distal to the cricopharyngeus, whereas the remaining 14 patients had functional resolution of their dysphagia.Conclusion In patients presenting with dysphagia and evidence of unilateral vagal injury, careful assessment of posterior–anterior view on videofluoroscopic swallow study should be included to evaluate for unilateral cricopharyngeal dysfunction.
A Murine Model of Cholesteatoma‐Induced Bone Resorption Using Autologous Dermal Implantation
Authors: Sudhoff Holger , Liebehenz Yvonne , Aschenbrenner Jessica , Jung Jae , Hildmann Henning , Dazert Stefan 
Published: November 2003

AbstractObjective To investigate a novel murine model for dermal implant–induced osteolysis analogous to bone resorption observed in middle ear cholesteatoma.Study Design Animal experiment.Methods We placed autologous dermal implants on the surface of mouse calvaria. The calvaria were examined at days 1, 3, 5, 7, and 14 after implantation by histological study and tartrate‐resistant acid phosphatase immunohistochemical processing to detect osteoclasts.Results Dermal implants showed a significantly increased osteoclast density compared with control samples. The dermal implant tissue remained viable and produced a robust, localized inflammatory osteolytic response on the adjacent calvarial surface. Osteoclasts were predominantly found on the surface of the calvarium with the greatest osteoclast density seen at 5 to 7 days after implantation.Conclusion The mouse model is expected to be a useful tool for investigating the pathogenesis of localized inflammatory bone resorption related to cholesteatoma.
Endonasal Laser Dacryocystorhinostomy: Its Role in Anticoagulated Patients
Authors: Smithard A. , Wynne D. , Bingham B. J. G. , Jones N. S. 
Published: November 2003

AbstractObjective To report the results of endoscopic laser‐assisted dacryocystorhinostomy in anticoagulated patients.Study Design A retrospective study of 16 consecutive anticoagulated patients with distal nasolacrimal duct obstruction treated by endoscopic laser‐assisted dacryocystorhinostomy.Methods A case note review was made of all patients treated with endoscopic laser‐assisted dacryocystorhinostomy who were taking coumadin in two centers between 1993 and 2000. The parameters of age, gender, indications for surgery, surgical findings, complications, and outcome were analyzed. The mean follow‐up time was 14 months (range, 9–26 mo).Results Fifteen of the 16 patients who were treated had an eventual successful outcome, but 6 patients required revision surgery. The patient whose symptoms were not improved was shown to have functional epiphora. No patient had a problem with primary or secondary epistaxis, and no patient required admission. A major benefit was the lack of disruption of anticoagulant therapy.Conclusions Endoscopic laser‐assisted dacryocystorhinostomy is a safe, efficient technique for the relief of distal nasolacrimal duct obstruction in anticoagulated patients. Not only does it avoid any disruption to their anticoagulant therapy, but it also can be performed as an outpatient procedure.
Ipsilateral Full‐Thickness Forearm Skin Graft for Covering the Radial Forearm Flap Donor Site
Authors: Shiba Keisuke , Iida Yumiko , Numata Tsutomu 
Published: November 2003

AbstractObjectives/Hypothesis The technique of the ipsilateral full‐thickness forearm skin graft for covering the defect of radial forearm free flap (RFFF) improves aesthetic impairment at the recipient and donor sites by split‐thickness skin graft repair and omits the need to make an extraoperative site for harvesting the skin graft. However, in this technique, the RFFF is limited in size. In the present study, we considered a model of the forearm and calculated the possible size of the RFFF for using this technique.Methods The calculation was conducted under assumptions that the isosceles‐triangle skin graft is elevated as its height is twice the RFFF length in the direction of the forearm axis and that the forearm skin defect can be primarily closed with a width shorter than one‐fourth of the wrist circumference. The calculation revealed that this technique is feasible when the RFFF width, that is, the length vertical to the forearm axis, is shorter than half of the wrist circumference. We repaired the RFFF defect using this technique in 15 patients with head and neck cancer in whom the RFFF size conformed to the above‐mentioned condition.Results When the RFFF width was shorter than half of the wrist circumference and the isosceles‐triangle skin graft was elevated as its height was twice the RFFF length, the RFFF defect could be repaired using this technique in all 15 patients.Conclusion The above‐mentioned condition (that the RFFF width is shorter than half of the wrist circumference) is useful for determining whether or not the technique of ipsilateral full‐thickness forearm skin graft can be used for covering the RFFF defect.