摘要:

AbstractRecent Interest in onlay cranial bone grafts has shown it to be a preferred technique in the reconstruction of facial defects. This paper reports seven patients in whom outer table cranial bone grafts were used to reconstruct posttraumatic facial deformities. These included orbital and zygomatic deformities (2 patients), maxillary defects (2 patients), mandibular defects (2 patients), and nasal deformity (1 patient). A brief review of the development of membranous bone grafting for maxillofacial reconstruction is given. Good cosmetic results were obtained in six of seven patients with no evidence of graft resorption. One patient required removal of the graft because of inadequate soft tissue coverage. No patient suffered any significant donor site morbidity. In summary, this technique is extremely useful in treating posttraumatic bony deformities of the facial skeleton. The excellent graft survival and ease in harvesting the graft make this technique preferable to traditional endochondral grafts taken from the iliac crest and rib.

ISSN:0023-852X    

DOI:10.1288/00005537-198711000-00001

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThis study compared the hearing outcome of canal‐up and canal‐down mastoidectomies for removal of cholesteatoma in 455 ears. An intact canal wall procedure was performed in 92 patients while the remainder (N=363) underwent a canal‐down operation.The hearing results for both procedures are dependent on the presence of the stapes superstructure. When the stapes superstructure was intact, 52% of the patients with canal‐up operations had an air‐bone gap of less than 20 dB. The corresponding figure for canal‐down cases was 37%. When there was no stapes superstructure, 54% of the canal‐up cases and 19% of the canal‐down cases obtained a similar ABG closure.Preserving the posterior external auditory canal wall results in slightly better hearing function. However, when the stapes superstructure is intact, the difference in hearing function is not remarkable, and must be weighed against the potential for residual disease or recurrence associated with cana

ISSN:0023-852X    

DOI:10.1288/00005537-198711000-00002

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThis prototype vented laryngeal stent incorporates a dome‐shaped, one‐way valve that allows articulation of transmitted vibrations to produce speech, while preventing aspiration and not interfering with deglutition. The stent is placed endoscopically and is used in conjunction with a T‐tube or a tracheostomy tube.The stent has been placed in seven patients for chronic aspiration, after partial laryngectomy, and with laryngotracheal reconstruction for stenosis. Aspiration pneumonia has not been seen in any patient after placement of the appropriate stent, with follow‐up of 2 to 6 months. One patient's swallowing improved and none deteriorated. All patients were able to phonate with the stent in place. No significant long‐term sequelae are apparent in three patients whose stents were removed after resolution of their primary

ISSN:0023-852X    

DOI:10.1288/00005537-198711000-00003

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractA consecutive series of 90 patients undergoing endoscopic intranasal ethmoidectomy was reviewed. There were 26 complications (29%) in 19 patients in this group. Eight complications (8%) including CSF leak, temporary blindness, and hemorrhage were considered major with the latter occurring most commonly. Synechiae were the most commonly occurring minor complications.Endoscopic nasal sinus surgery performed by inexperienced operators carries with it the same risks and complications as traditional intranasal sinus surgery. Any surgeon who does not routinely perform traditional intranasal ethmoidectomy should accrue endoscopic experience through appropriate didactic training and multiple cadaver dissections (akin to otologic training).

ISSN:0023-852X    

DOI:10.1288/00005537-198711000-00004

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe modified Lynch operation (Neel‐Lake) differs in several ways from the operation described by Lynch. The operation begins with an intranasal anterior ethmoidectomy. The agger nasi cells are removed by curetting forward between the frontal process of the maxilla and the septum. The middle turbinate, normal‐appearing mucosa of the frontal‐ethmoid complex, and frontal process of the superior maxilla are preserved. Bone removal is limited in most cases to the anterior floor of the frontal sinus, a portion of the lacrimal bone, and the bone over the anterior ethmoid cells. Another important difference is the use of soft, nonreactive material (thin Silastic® sheeting) to stent the nasal‐frontal passageway. Removal of all the mucosa of the frontal‐ethmoid‐sphenoid complex is unnecessary for a good postoperative result, and the remaining normal mucosa hastens the process of reepithelialization of the nasal‐frontal duct.The patients in our original study group have been observed for a period of 5 to 20 years (mean, 13.5 years) after the surgical procedure. This is the longest period of follow‐up for any group of patients reported in the literature. The incidence of failures increased from 7% (one duct) to 20% (3 of 15 ducts) after an additional 7 ye

ISSN:0023-852X    

DOI:10.1288/00005537-198711000-00005

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractHyposmia following laryngectomy is an often recognized phenomenon. A larynx bypass device was used to determine whether this olfactory deficit could be reversed simply by restoring nasal airflow. Odorant detection thresholds and confusion matrix identification tests were administered to laryngectomy and normal comparison groups. Data on nasal airflow characteristics with and without the bypass were also analyzed.The results suggested that restoration of nasal airflow completely reversed the hyposmia for trigeminal nerve stimuli. However, the reversal of hyposmia was not complete for those odorants which primarily, if not exclusively, stimulate the olfactory nerve. This suggested that other factors may contribute to laryngectomy‐induced hyposmia for olfactory nerve stimuli.Additionally, nasal airflow analysis revealed that confusion matrix identification scores were dependent upon inspiratory sniff flow rates with and without the larynx bypass.It is argued that rehabilitation for the laryngectomee should include efforts to restore and maintain preoperative olfactory acuit

ISSN:0023-852X    

DOI:10.1288/00005537-198711000-00006

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe surgical results in 69 patients with unilateral tumors of the cerebellopontine angle or internal auditory canal in whom total tumor removal was accomplished, and in whom an attempt was made to preserve hearing, are presented. The success rate of preservation of hearing and facial nerve function was correlated with the size of the tumor. Useful hearing, as defined by speech reception threshold no poorer than 70 dB and a discrimination score of at least 15%, was preserved in 73% of cases in which the tumor extension to the posterior fossa was no greater than 0.5 cm. In contrast, useful hearing was preserved in 22% of cases in which posterior fossa extension was greater than 2.5 cm. No significant correlation was found between preoperative evoked responses and success in preservation of hearing. The techniques and value of intraoperative monitoring of electrocochleogram (ECoG) and brain stem evoked response are discussed. A theory of pathogenesis of intraoperative hearing loss, based on correlation of changes in evoked responses and simultaneous surgical events, is presented.

ISSN:0023-852X    

DOI:10.1288/00005537-198711000-00007

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractMyringotomy and insertion of a grommet are effective in the management of middle‐ear effusion resulting from nasopharyngeal carcinoma. The procedure was carried out in 46 ears in 30 patients, resulting in significant improvement of hearing. The complication rate of the operative procedure is not negligible in this group of patients, and it is higher if the patients had received radiotherapy at the time of operatio

ISSN:0023-852X    

DOI:10.1288/00005537-198711000-00008

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe first case of epithelioid hemangioendothelioma involving the oropharynx is described. A 25‐year‐old woman developed a mass on the palate which was noted to enlarge during the first trimester of pregnancy. Biopsy revealed a cellular tumor initially considered to be of epithelial origin. Vascular differentiation of the tumor was confirmed, however, by positive lectin histochemistry for Ulex europaeus, by evidence of immunoreactivity for factor VIII‐related antigen, and by ultrastructural identification of endothelial features. The patient remains free of tumor 21 months after complete excision. Because of the potential for misdiagnosis, epithelioid hemangioendothelioma should be considered in the differential diagnosis of oropharyngeal malignancies. The effect of pregnancy on the development and growth of vascular tumors such as epithelioid hemangioendothelioma remains unce

ISSN:0023-852X    

DOI:10.1288/00005537-198711000-00009

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe clinical picture of tuberculous otitis media has changed since previously documented. In our series of 31 patients, it was found that severe conductive hearing loss, abundant pale granulations, and denuded malleus handle are constant findings and, in our opinion, are significant clinical features of the pathology. The disease can also manifest itself as an acute mastoiditis.As regards to investigations, bacteriology is considered as being unreliable. This is attributed to secondary organisms interfering with the growth of the tubercle bacillus, as well as the fastidious nature of the bacillus itself. We regard histology as the most reliable means of attaining a definitive diagnosis.Treatment was with a four drug antituberculous regime administered over 6 months. Streptomycin was excluded in all but one case due to its ototoxicity. We believe TB otitis media to be secondary to an established chronic otitis media in the majority of cases.

ISSN:0023-852X    

DOI:10.1288/00005537-198711000-00010

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY