摘要:

AbstractThyroid surgery in the pediatric age patient accounts for a small minority of all thyroid surgery. Batsakis and Nishiyama reported only 136 patients under the age of 18 who underwent thyroid surgery in 27 years at the University of Michigan.1In most series involving the pediatric age group, the majority of thyroid procedures are performed on adolescents.1–6Thyroid surgery in the young child requires special precautions in addition to those routinely associated with thyroidectomy in the adult.The techniques and perioperative management of the pediatric thyroidectomy employed at our institution has evolved as experience is gained. Our experience with five such patients with adequate follow‐up will be presen

ISSN:0023-852X    

DOI:10.1288/00005537-198509000-00001

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractFenestration of the horizontal semicircular canal enables the otologic surgeon to restore hearing in those patients with congenital conductive deafness who are not candidates for stapedectomy, ossicular reconstruction, or tympanoplasty. Since the development of stapedectomy, much of the finesse technique of fenestration surgery has been lost, and many otologic surgeons today are unfamiliar with the fenestration operation. The surgical technique for creating a permanently patent fenestra in the horizontal semicircular canal is described. The causes of failure in fenestration surgery are reviewed. Thirty‐three patients who have undergone fenestration for congenital conductive deafness over a 30‐year period, and 100 patients who underwent fenestration for otosclerosis in 1950, are reviewed to demonstrate patient selection and the efficacy of this operation in establishing long‐term hearing improv

ISSN:0023-852X    

DOI:10.1288/00005537-198509000-00002

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe history of the management of chronic ear disease with and without cholesteutoma is dominated by a canal wall down philosophy. The implication is that such an open procedure insures disease control and an uncomplicated future.In point of fact, problem canal wall down procedures can be fraught with as many seríous complications as their more controversial canal wall up counterpart is alleged to propagute. Such problem cavities most commonly result from poor execution of basic technique.The objective of this paper is to identify what constitutes a problem cavity and to describe the authors' techniques to avoid such difficulties. A technique has evolved which not only eradicates disease, but which is self‐cleansing and of minimal impact on the patient's lifestyle. The authors' experience with canal wall down procedures is review

ISSN:0023-852X    

DOI:10.1288/00005537-198509000-00003

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThis ten‐year study reviews 36 patients with complete clefts of the hard and soft palates treated with primary velar closure, bilateral myringotomies, and tubings performed when the infant was 12 to 15 months of age. The hard palate and prepalate were not closed until the child was at least 5 1/2, years of age. By early velar closure, a population with an almost 100% incidence of otitis media with effusion has been converted to a population with a 17% incidence of recurrent otitis media requiring repeat myringotomies and tubing

ISSN:0023-852X    

DOI:10.1288/00005537-198509000-00004

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractA review of 217 consecutive revision stapes operations performed during a ten‐year period revealed that the surgeon encounters more pathological variables than he does during primary operations. Hence, the technical solutions are less stereotyped and the net results less predictable.Prosthesis displacement, with or without incus tip erosion, was the most common primary cause of failure (82%). However, oval window problems such as footplate refixation, perilymph fistula, otosclerotic regrowth, and lateralized oval window membrane in 60% of cases often complicated prosthesis displacement.First revision operations in 174 cases resulted in postoperative bone‐air deficit of 10 dB or less in 65% of cases, much better than the 45% for second revision results, and the 25% for third revisions. These statistics provide our practice with a realistic prognosis when discussing revision stapes surgery with the individual surgical candid

ISSN:0023-852X    

DOI:10.1288/00005537-198509000-00005

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractLittle is known about the dynamic vasculature of the tympanic membrane, despite the fact that it is within easy view of the otolaryngologist. An understanding of its blood supply dynamics may lead to a better understanding of the tympanic membrane's physiological properties and response to surgery. Also, certain patterns of blood flow may correlate with disease entities and be of diagnostic value. Currently, we have done 30 fluorescein angiograms of the tympanic membrane. The fluorescein angiograms from a normal ear and from ears with several types of ear pathology are described.

ISSN:0023-852X    

DOI:10.1288/00005537-198509000-00006

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe trend toward treatment of parotid gland malignancies with planned combined surgery and postoperative radiation therapy is currently being followed by many centers, although prospective studies comfirming the efficacy of this treatment regimen have only recently begun. We have reviewed only our “high‐grade” histologic types: adenocarcinomas, malignant mixed tumors, high‐grade mucoepidermoid carcinomas, squamous cell carcinomas, and undifferentiated carcinomas. Acinic cell carcinomas, adenoid cystic carcinomas, and low‐grade mucoepidermoid carcinomas were excluded from study because of their different biologic behavior. Since 1974, we have employed the approach of surgical extirpation with preservation of the facial nerve when possible for all parotid tumors, combined with planned postoperative radiation therapy (50‐70 Gy).We reviewed the 37 cases of “high‐grade” parotid gland malignancies and compared the patients treated with the combined modality approach with our historical patients treated initially with surgery alone. Despite an apparent higher stage at presentation, our combined treatment group ultimately had significantly better local control (70%vs.20%), and an equivalent survival rate at five years.Tumor was present at the margin of resection in 14 (74%) cases treated with combined surgery and irradiation. The facial nerve was preserved in six of these patients with positive margins, and only one of these patients developed a local or regional treatment failure.In conclusion, our data confirms the efficacy of surgical exploration to determine the extent of disease and surgical resection, preserving facial nerve function if possible, followed by postoperative radiation therapy at adequate doses. Control of local‐regional disease was much improved by combined modality therapy as opposed to surgical resection alone, despite the prevalence of residual microscopic disease in the resection margins. Facial nerve function is optimally preserved by this approach of conservative surgery combined with postoperativ

ISSN:0023-852X    

DOI:10.1288/00005537-198509000-00007

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractIn 1982, we published a new technique to create a tracheoesophageal (TE) fistula, using the combination of an endotracheal tube and a flexible fiberoptic nasophoryngolaryngoscope. An even more simple technique using afenestrated metal Yankauer Tonsillar sactionis now introduced. This technique allows for the TE fistula to be made by any level of the tracheo‐esophageal junction. It is easily done with topical and local anesthesia with the patient sitting on the otolaryngology examination chair. The method described has been used in 25 consecutive cases with no complication

ISSN:0023-852X    

DOI:10.1288/00005537-198509000-00008

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractRhinometry has provided a quantitative and objective means of assessing nasal airway patency. Previous investigators have established normal nasal resistances for adults and newborn infants. Less material and no such normal references are available for the pediatric ages. In this study, nasal airway resistance is assessed by anterior rhinometric technique in 498 children ranging from four to 16 years of age. Collected nasal resistance data are found to vary inversely with age and fall in an almost linear fashion between already established normals of infancy and adulthood. As far as we can determine, pediatric age specific nasal resistance data with calculated standard deviations and 95% confidence levels have not been previously reported. Such data provides initial age specific reference points enabling the rhinologist to more objectively evaluate concerns regarding nasal obstructive problems in children.

ISSN:0023-852X    

DOI:10.1288/00005537-198509000-00009

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY

摘要:

AbstractForty patients with obstructive sleep apnea (OSA) were either treated by submucous resection, alone or by palatopharyngoplasty (PPP). Before surgery, each patient underwent a thorough sleep evaluation for the diagnosis of OSA.Of the 23 patients treated by submucous resection alone, eight had more than a 50% reduction in their apnea index and were considered successfully treated. Of the remaining 15, ten received a supplemental tongue retaining device (TRD). Five of the ten were markedly improved. The overall success rate in this group was 57%.Of the 17 patients treated by submucous resection and PPP, ten were treated successfully. Six of the remaining seven patients were subsequently treated with a TRD, which was successful in four. The overall success rate in this group was 82%.

ISSN:0023-852X    

DOI:10.1288/00005537-198509000-00010

出版商:John Wiley&Sons, Inc.    

年代:1985

数据来源: WILEY