摘要:

AbstractBetween the years of 1978 and 1986 attempts have been made to save the hearing in 47 patients with unilateral pathologically confirmed acoustic neuromas. The middle fossa approach has been used in 32 cases and the suboccipital approach in 15 cases. Our review demonstrates an advantage using the suboccipital approach to excise most of these tumors. The success rate is higher (47%vs.31%) and complications fewer using the suboccipital route. Despite these findings the middle fossa approach may be preferable in selected tumors located laterally in the internal auditory canal.In an effort to better select patients for hearing conservation surgery, an analysis of preoperative data (demographics, audiometry, evoked auditory response testing, and tumor size) was performed. Although certain guidelines have evolved to more accurately select hearing conservation surgery candidates, we are still unable to do so reliably. Preoperative auditory brain stem response testing, however, may evolve as a useful indicator for a successful hearing operation. The findings of our preoperative data analysis, surgical results, and complications are reviewed.

ISSN:0023-852X    

DOI:10.1288/00005537-198707000-00001

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe histology and permeability of cats' round window membranes were described following surgical grafting with gelatin foam or fascia. An increase in the thickness of the round window membrane due to fibrosis, neovascularization, and epithelial metaplasia was observed 2 months following grafting with gelatin foam. Grafting with fascia did not increase the thickness of the round window membrane, but did form a thick layer of granulation tissue adjacent to and overlying the round window membrane, with occasional adhesions between. The layer of granulation tissue consisted of cuboidal or columnar ciliated epithelial cells, fibrous tissue, lipid, and undigested grafted material. The granulation tissue did not always completely cover the round window membranes.Horseradish peroxidase placed in the round window niche of cats with grafts on the round window membrane remained a significant distance further from the inner ear when compared to its migration through nongrafted membranes.

ISSN:0023-852X    

DOI:10.1288/00005537-198707000-00002

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThis is a case report of sensorineural hearing loss associated with Takayasu's disease. Also known as ‘pulseless disease’ and ‘aortic arch syndrome,’ Takayasu's disease involves narrowing of the aortic arch and its branches. Although the etiology is unknown, it is suspected to be an autoimmune disorder. In the case presented, steroid therapy resulted in an improvement of hearing. On one relapse the hearing loss worsened before the sedimentation rate increased. We speculate that the hearing loss is due to an autoimmune process or an ischemia involving the inner ear. We further speculate that hearing loss may indicate subsequent worsening of the

ISSN:0023-852X    

DOI:10.1288/00005537-198707000-00003

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractSensory deafness may be associated with partial or total obliteration of the cochlear scalae. Before undertaking cochlear implant surgery, a preoperative assessment of cochlear patency with high‐resolution computed tomography (CT) is indicated. To determine the accuracy of pre‐implant CT, a review of the radiographic and surgical findings in 36 implanted ears was performed. An abnormal CT scan was found to be a reliable predictor of compromised cochlear patency at operation. These findings help the surgeon to select the side most favorable for implantation and to anticipate problems that may be encountered during device insertion. A normal pre‐implant CT scan, however, does not exclude the possibility of compromised cochlear patency. A 46% false negative rate was encountered, presumably because subtle degrees of osseous or fibrous obliteration of the cochlea are beyond the resolution by current generation CT scanners.In our opinion, the radiographic finding of cochlear ossification is not a contraindication to an attempt at cochlear implantation. The only assured way of determining the extent of cochlear patency is by performing an ‘exploratory cochleostomy’ with fenestration of the basal cochlear turn. Drilling anteriorly through an ossified basal scala tympani will often expose an adequate lumen and permit insertion of even a long multichannel electrode into a partially ossified cochlea. Nevertheless, it is essential that the implant team be prepared with devices appropriate for whatever existing or surgically created lumen may be

ISSN:0023-852X    

DOI:10.1288/00005537-198707000-00004

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractPyoderma gangrenosum is an ulcerative skin disorder usually associated with an underlying systemic disease. Head and neck involvement is rare, but possibly more common than once thought. The etiology of this disease is unclear, but may be related to an abnormal immunologic response. There are no pathognomonic histologic or laboratory findings; the diagnosis is made by the clinical appearance of the lesions and disease course. Treatment consists of immunosuppression and local wound care in addition to a search for and treatment of an underlying primary systemic disorder. A case report and review of the literature is presented with discussion of common head and neck manifestations, the differential diagnosis, and treatment alternatives.

ISSN:0023-852X    

DOI:10.1288/00005537-198707000-00005

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractPartial laryngectomy for anterior commissure cancer often results in a shortened glottis which produces a high pitched strained voice and an inadequate airway lumen which requires permanent tracheostomy. Vocal fold vibration is impaired both by the shortened length and anterior scarring which profoundly affects the myoelastic properties of the larynx.Many different methods of reconstructing the anterior commissure have been attempted with limited success and many require multiple procedures. A method of anterior commissure reconstruction employing bilateral omohyoid muscle flaps has been performed successfully in four patients. The omohyoid muscles and investing fascia are readily available during partial laryngectomy and can be tailored to reconstitute the anterior commissure. The myofascial flaps epithelialize rapidly and there is little tendency for anterior glottic stenosis. The sphincteric function of the larynx remains intact and the vocal quality surpasses other methods of reconstruction employed by the author.

ISSN:0023-852X    

DOI:10.1288/00005537-198707000-00006

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractA transcervical extraoral approach was utilized to achieve exposure to the upper cervical spine in five patients, four of whom required bone graft placement. Excellent exposure was achieved in all patients, and the postoperative course was uncomplicated. The anterior extraoral approach is a reliable technique in treatment of pathology of the atlas and axis.

ISSN:0023-852X    

DOI:10.1288/00005537-198707000-00007

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractVoice restoration for laryngectomees is challenging, but in recent years the tracheoesophageal (TE) fistula procedure using a oneway valved prosthesis has had relatively good success. The purposes of this study were to determine the success rate for the primary TE fistula procedure, analyze failures, and study methods for selection and training of these patients.In a prospective study, 21 consecutive patients had primary TE fistula procedures performed over an 18‐month period. Thirteen of 20 who had adequate follow‐up developed fluent, intelligible speech using either duckbill or low‐pressure one‐way valves. Complications included one stomal infection and one paratracheal fistula. This experience has led1.to development of a protocol for selection and training of patients for this procedure and2.to the conclusion that the procedure can improve voice restoration success without an increase in mo

ISSN:0023-852X    

DOI:10.1288/00005537-198707000-00008

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractThe use of the carbon dioxide laser as an endoscopic microsurgical instrument has stimulated interest in treating laryngeal and tracheal stenosis. Dedo and Sooy (1984) reported a significant improvement in the management of posterior commissure, subglottic, and high tracheal stenoses with the use of a microtrapdoor flap. A recent laboratory investigation of this method supported the clinical efficacy of this technique. Six patients are evaluated in this report, three with posterior commissure stenosis and three with subglottic or high tracheal lesions. All six patients had a tracheotomy present or performed at the time of their surgical procedures, and each patient had only one procedure. All six had improved airways after the microtrapdoor flaps. Five have been decannulated and one patient with associated hypopharyngeal stenosis still has a tracheostomy because of mild aspiration, although the airway lumen is moderately unproved. It is felt that, as a group, the subglottic and high tracheal lesions respond to this technique better than the posterior commissure stenoses. Details of the technique are presented. This brief clinical report supports the efficacy of the microtrapdoor flap procedure in selected laryngeal and tracheal stenoses.

ISSN:0023-852X    

DOI:10.1288/00005537-198707000-00009

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY

摘要:

AbstractRhinitis medicamentosa from topical vasoconstrictor abuse results in nasal obstruction which can be life‐threatening in neonates. Neonates are obligate nasal breathers, most learning oral respiration by 2 months of age. A neonate was started on topical phenylephrine at birth, and by 3 weeks of age was having multiple daily episodes of apnea and cyanosis. An evaluation documented edematous, obstructing nasal turbinates, as well as polycythemia, cardiomegaly, and prominence of the pulmonary vasculature. A nasopharyngeal airway alleviated the obstruction until the turbinates recovered, and the other abnormalities quickly resolve

ISSN:0023-852X    

DOI:10.1288/00005537-198707000-00010

出版商:John Wiley&Sons, Inc.    

年代:1987

数据来源: WILEY