摘要:

AbstractThe charts of 65 pediatric patients with the diagnosis of retropharyngeal abscess were reviewed. These represented a 36‐year experience with the disease. The findings were compared with those documented at the turn of the century and were also compared with findings over the last four decades. The data suggests that retropharyngeal abscess may be occurring later in childhood and may not always be preceded by a major detectable infection. Classic diagnostic findings of retropharyngeal bulge and neck stiffness were present in less than half of the patients. Gram‐negative and anaerobic organisms are being documented on culture more frequently than in the past. We theorize that liberal use of oral antibiotics prior to admission may have brought about these chan

ISSN:0023-852X    

DOI:10.1288/00005537-198806000-00001

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractA retrospective review is presented of 72 patients who sustained frontal sinus fractures (FSF) and were subsequently treated by the department of otolaryngology/head and neck surgery between the years of 1974 and 1986.Eighty‐four percent of FSF occurred in males and 71% were a result of motor vehicle accidents. Only 24% remained conscious at the time of trauma, and in only one third of the cases was there no other facial fracture. Seventy‐six percent of FSF involved both the anterior and posterior walls—a figure that possibly reflects the referral patterns to a hospital that is a major regional trauma center.Patients were treated with a variety of procedures including cranialization (42%), osteoplastic flap and fat obliteration (30%), open reduction and internal fixation of the anterior wall (20%), osteoplastic flap and sinus ablation (6%), and intersinus septectomy (1%).Some difficulty was encountered in documenting sustained follow‐up, which ranged from 2 months to 9 years, and averaged 22 months. Nine percent of patients died in the post‐trauma period. Minor complications were relatively common, but major complications occurred in only 10% of patients. Four patients (6%) suffered meningitis (although the portal of infection was not necessarily through the frontal sinus); one patient (1%) suffered severe pain over the sinus and forehead for at least 12 months after surgery; and a mucocele developed in four pati

ISSN:0023-852X    

DOI:10.1288/00005537-198806000-00002

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractThe Membrane Rupture Theory states that the acute attack of Meniere's disease occurs when endolymph, with its high potassium ion concentration, escapes into the perilymph and surrounds the first‐order neuron. Initially, this causes partial depolarization of the nerve and an increased resting discharge, followed by complete depolarization. Clinically, one would expect an initial irritative nystagmus (toward the affected side) followed by a paralytic nystagmus (toward the unaffected side). To confirm this, the guinea pig perilymphatic space was perfused with an artificial endolymph solution. The results confirmed an irritative/paralytic sequence of nystagmus that differs from the pattern of spontaneous nystagmus observed with ENG monitoring during the acute attack of Meniere's disease. Early in the attack, one observes a paralytic nystagmus followed by a secondary nystagmus beating toward the affected side (similar to an irritative nystagmus) as the patient recovers. This raises questions about the validity of the Membrane Rupture Theor

ISSN:0023-852X    

DOI:10.1288/00005537-198806000-00003

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractAn estimated 40 million Americans suffer from tinnitus, and approximately 20% of these sufferers feel that the quality of their life is significantly impaired by this symptom. Despite thorough evaluation, the underlying etiology in the majority of these patients remains obscure or conjectural. Most of these patients will, however, benefit from consultation and avoidance of caffeine, nicotine, and salt, while others require biofeedback, amplification, masking, and even psychotherapy. On rare occasions, physicians are presented with a patient complaining of unilateral tinnitus of undetermined etiology who, in spite of a thorough evaluation and all conventional therapies, continues to be severely handicapped by that symptom. Early findings suggest that these patients may be suffering from vascular loop compression of the cochlear division of the eighth cranial nerve. When patients are carefully selected, retrosigmoid decompression of that vascular loop has provided gratifying relief.

ISSN:0023-852X    

DOI:10.1288/00005537-198806000-00004

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractA supraglottic thyroid cartilage flap was used to reconstruct vertical partial laryngectomy defects in seven patients, including three radiation failures. Local control was maintained in six of seven patients, with one radiation failure recurring in the subglottis and anterior neck skin. Reconstructively, the radiation failures healed more slowly, but all patients were decannulated in 1 to 4 weeks with normal deglutition.The majority of the ipsilateral arytenoid was preserved in two patients. In the first case, the thyroid cartilage flap was shortened and sutured to the cut surface of the arytenoid. This patient later developed laryngeal stenosis. In the second case, a muscle flap was used to reconstruct the cord, and the thyroid cartilage flap was used externally. This was successful, and we prefer this modification of the Bailey procedure when the arytenoid is preserved.

ISSN:0023-852X    

DOI:10.1288/00005537-198806000-00005

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractFour unusual cases of pseudotumor, which had clinical and radiographic findings suggesting neoplasia, are presented. One involved the maxillary sinus, destroying the lateral wall, and extending to the infratemporal fossa and the orbit. The second presented as an enlarging lacrimal gland tumor with ipsilateral parotid adenopathy, and the third as a large parapharyngeal mass that was diagnosed as a lymphoma on aspiration cytology. The fourth case documented the rare occurrence of a congenital pseudotumor, manifesting as proptosis in a neonate and thought to be a fibrosarcoma on frozen section study. Aggressive pseudotumors must be distinguished from malignancy to avoid unnecessary surgery or irradiation. Some cases can be distinguished from neoplasms by their dramatic response to oral steroid therapy, and others by characteristic features on CT or MRI. Due to the diverse cellular proliferation, aspiration cytology is infrequently helpful and diagnosis can be difficult on frozen section study. An approach to the diagnosis and management of pseudotumors is detailed.

ISSN:0023-852X    

DOI:10.1288/00005537-198806000-00006

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractA retrospective review of 88 cases of foreign body aspiration was undertaken. The patients ranged in age from 5 months to 73 years; the peak incidences of foreign body aspiration occurred in children less than 3 years of age and in adults older than 50 years. Sixty‐one of the 88 patients were male. Physical examination was abnormal in 61% of patients. The most common radiographic abnormality was inspiratory‐expiratory abnormality, seen in 27% of patients. Rigid endoscopy under general anesthesia was the preferred method for removal of the aspirated material. Multiple foreign bodies were found in 5% of the patients. Tracheobronchial foreign bodies should, therefore, be strongly suspected in susceptible patient populations who present with a suggestive history, even when no physical or radiographic evidence can be seen. Patients should be carefully examined for multiple foreign bodies at the time of rigid endoscopic remo

ISSN:0023-852X    

DOI:10.1288/00005537-198806000-00007

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractA patient with adult‐onset recurrent respiratory papillomatosis (RRP), initially diagnosed at age 28 years, was treated with radiation therapy due to the rapid regrowth of lesions. Following 6 years of apparently inhibited growth, papilloma recurred, and squamous carcinoma was diagnosed from a laryngeal biopsy. A spontaneous laryngocutaneous fistula developed, and laryngectomy was performed 14 years after irradiation.The laryngectomy specimen was snap frozen and representative tissues were stored frozen for viral studies. The larynx was whole‐organ sectioned for histologic examinations; residual papilloma, as well as carcinoma, was observed. Koilocytosis and other virus‐associated histologic changes were also found.HPV capsid antigen was present in papilloma, carcinoma, and clinically normal epithelium. HPV nucleic acids, conforming to HPV type 6, were present in keratin pearls and dysplastic cells.According to prior reports, carcinoma developing in preexisting papilloma arises from juvenile‐onset RRP. Irradiated papilloma develop cancer at about 10 years, and the patients rarely survive. Nonirradiated cases develop cancer after 30 years, and some develop papilloma in the hypopharynx and trachea, but most patients survive. Irradiation is not an obligatory precursor for malignant transformation of cancer; however, until now there have been no case reports of favorable outcome after irradiation of pa

ISSN:0023-852X    

DOI:10.1288/00005537-198806000-00008

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractSurgical repair of cerebrospinal fluid rhinorrhea requires the production of a seal able to resist cerebrospinal fluid pressure during the period of healing. Direct suturing, packing with muscle and fat grafts, and coverage with mucosal or muscle flaps have been effective in repairing most CSF leaks. Fibrin glue may enhance the results of a CSF leak repair by providing better adhesion of the graft and improving the initial seal during healing. A study was performed on 36 rats to assess the effectiveness of fibrin glue in repairing experimentally produced CSF leaks. CSF rhinorrhea was produced by creating a defect in the anterior cranial fossa through the region of the cribriform plate. There were four treatment groups:1.no treatment control;2.fibrin adhesive alone;3.muscle packing alone; and4.fibrin glue with muscle packing. The CSF leaks were evaluated 3 weeks after operation. Persistent CSF leakage was noted in 89% of group 1, 55% of group 2, 33% of group 3, and 22% of group 4. The reduced CSF leakage in the muscle plus fibrin glue group suggests that fibrin glue, by its adhesive sealing properties, enhances the results of muscle packing alone for the treatment of cerebrospinal fluid rhinorrhea.

ISSN:0023-852X    

DOI:10.1288/00005537-198806000-00009

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY

摘要:

AbstractTranscranial brain stimulation by either electrical or noninvasive magnetic stimulation has produced motor responses of limb musculature. However, recordings from muscles innervated by cranial nerves have not previously been reported.A right‐sided craniotomy was performed in 18 dogs. An electric stimulus was delivered to the motor cortex via surface electrodes and evoked EMG responses were recorded from the tongue musculature to determine conduction time.Magnetic stimulation of the motor cortex yielded EMG latencies similar to those obtained by electrical direct cortical stimulation, thus demonstrating the potential of magnetic stimulation in intraoperative and outpatient clinical evaluation of hypoglossal nerve disorders. For the first time, it appears possible to noninvasively stimulate the cranial nerves proximal to the point of injury and to evaluate more central conduction pathway

ISSN:0023-852X    

DOI:10.1288/00005537-198806000-00010

出版商:John Wiley&Sons, Inc.    

年代:1988

数据来源: WILEY