摘要:

AbstractPatients who present to the regional specialist with localized manifestations of systemic disease provide especially interesting diagnostic problems. We present a patient who was seen initially for facial swelling, thought to be caused by carcinoma of the antrum; however, tissue for biopsy was compatible with osteitis fibrosa, giant cell reparative granuloma, or giant cell tumor of bone, lesions which have identical histopathologic features.There were no other radiographic abnormalities, but the diagnosis of hyperparathyroidism was suggested by persistent hypercalcemia without other clinical states to explain the abnormality and was confirmed by parathyroid exploration which revealed a large adenoma. Prior to operation, causes of hypercalcemia, such as malignant disease, the milk‐alkali syndrome, hypervitaminosis D, and others were ruled out by clinical evaluation.When the Brown tumor of the maxilla failed to regress following treatment of the primary disease it was necessary to remove the mass surgically to relieve nasal obstruction and achieve a more acceptable facial appearance.Brown tumors are seen occasionally in the skull and facial bones, but occurrence in the maxilla appears to be quite rare. Only six cases of isolated presentation of this abnormality in the maxilla have been cited. In each case this was an oral rather than a superior maxillary manifestation of the disease, the mass presenting from the superior alveolus or the hard palat

ISSN:0023-852X    

DOI:10.1288/00005537-197412000-00001

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractA review of 52 recent cases of Wegener's granulomatosis has clarified the clinical manifestations and has emphasized the otolaryngologist's role in its early diagnosis. All the cases satisfied the currently accepted criteria for the condition: the presence of primary necrotizing vasculitis in a patient with a typical clinical course. Among the 52 patients, 31 patients had nasal lesions. The typical manifestation was persistent nasal obstruction in a middle‐aged patient with no history of nasal disorder. In the early stages, intranasal examination may reveal only diffuse nasal mucosal swelling, without tissue destruction. Systemic symptoms are malaise, night sweats, intermittent pyrexia, and migratory arthralgias; an abnormally high sedimentation rate is also frequent. Later, the typical nasal findings are diffuse destruction of the mucosa and foul‐smelling crusts. The tissue underlying the crusts is extremely friable. Perforations of the nasal septum are also common. Adequate biopsy of representative tissue is important. The condition is treatable; currently, corticosteroids with or without cyclophosphamide are being used. Of the 52 patients, 31 are alive; 10 are dead, and current information is unavailable on 11 patients.Polymorphic reticulosis (PMR, lethal midline granuloma, or malignant midline reticulosis) was noted in 16 other patients during the same period. Differentiation between PMR and Wegener's granulomatosis is important because, although they can resemble each other clinically, they are morphologically distinct and respond to different forms of therapy (Wegener's granulomatosis to immunosuppressive drugs and PMR to irradiation).The otolaryngologist has an important role in the early diagnosis of Wegener's granulomatosis because of the high incidence of nasal involvement and because of the variations in clinical manifestations, which depend on the stage of the dise

ISSN:0023-852X    

DOI:10.1288/00005537-197412000-00002

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractMalignant hyperthermia is a pharmacogenetic disorder initiated by exposure to a variety of anesthetic agents. The reaction has assumed major importance to the otolaryngologic surgeon because: 1. approximately 20 percent of all reported reactions have occurred during anesthesia for ENT surgical procedures; 2. the disorder is being reported with increasing frequency; and 3. mortality associated with the reaction is greater than 60 percent. Susceptible patients appear to have a disorder of muscle, but because genetic penetrance and expression are limited, manifestations are often mild, and physical manifestations variably present. The authors suggest an approach leading to early detection of the susceptible patient.

ISSN:0023-852X    

DOI:10.1288/00005537-197412000-00003

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractA series of 100 consecutive cases of idiopathic Bell's palsy treated by facial nerve decompression are presented. These procedures were accomplished without injury to the facial nerve, hearing or balance and without the production of a mastoid cavity. One hundred percent normal facial function was the result in 22 patients with normal excitability subjected to facial nerve decompression. Sixty‐eight patients who had surgery after loss of nerve excitability obtained an average of 80 percent return of function with varying degrees of synkinesis in most cases. The decision regarding the nature and timing of treatment should be a subjective one, made after a careful analysis of the available facts and each patient's own circumstance. The availability of a promptly accomplished and precisely performed facial nerve decompression allows every patient to have a minimal risk of permanent facial deformit

ISSN:0023-852X    

DOI:10.1288/00005537-197412000-00004

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractRecording of the summation potential of the facial muscles with surface electrodes from a representative population of motor units after maximal stimulation of the facial nerve trunk (electroneuronography) has been found essential for selecting patients requiring surgery because of facial paralysis associated with a fracture of the petrous bone. The most common site of injury to the facial nerve in 10 transverse and 30 longitudinal fractures of the temporal bone has been found within the labyrinthine segment of the Fallopian canal. The problems encountered in the surgical repair of the facial nerve lesions are reviewed. In order to repair facial nerve injuries associated with fractures of the temporal bone the surgeon must be prepared to use the middle cranial fossa or the translabyrinthine approach in more than 90 percent of the cases.

ISSN:0023-852X    

DOI:10.1288/00005537-197412000-00005

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractA group of 32 patients with severe facial paralysis from 2 to 30 years and of different etiologies were studied. Various degrees of nerve and muscle atrophy were noted in this group. A new concept relative to the status of the paralyzed face, its nerve and muscle system and their capacity for rehabilitation was acquired.The treatment of long‐standing paralysis has been relegated to fascial stripping, muscle slings, tarsorrhaphies and face‐lift operations. This investigation indicates that the situation is not totally irreversible. The determinant factors are the number of surviving axones and the viability of the facial muscles supplied by them. Regardless of the electrical testing, the facial nerve never totally disappears nor do the facial muscles. On surgical exploration, the facial nerve and the posterior belly of the digastric muscle were always recognizable in varying degrees of atrophy and fibrosis. A range of 20‐90 percent of normal size was noted.Electron microscopy of the nerve and muscles demonstrated axone degeneration still taking place and muscle fibers present in cases 20‐30 years post injury to the nerve. The degree of atrophy and fibrosis was dependent upon the length of the paralysis. It was also noted that the degree of severity was less as the site of injury became more peripheral. This was probably related to the rich extratemporal nerve interconnections from the sympathetics, cervical plexus, and cranial nerves V and IX. These findings verified the existence of a subliminal system which is non‐functional, but in certain instances had the potential for rehabilitation.Some of the most interesting aspects of facial rehabilitation in longstanding facial paralysis are beginning to unfold themselves in the recognized potential of a regrowth of axones in a depleted but not annihilated facial nerve system by nerve crossover and nerve grafting techniques. When the peripheral facial nerve system is absent, nerve implantation into the residual mimetic muscles or transposed masticatory muscles is indicated. The introduction of masticatory muscles into the face to accommodate this neural regrowth, when mimetic muscle potential remains subclinical, adds a new neuromuscular facility in the rehab

ISSN:0023-852X    

DOI:10.1288/00005537-197412000-00006

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractThe possibility of rehabilitation of sensory deafness by a peripherally implantable prosthesis makes it very important to differentiate sensory from neural hearing impairment. We do this by a technique which we call electrical promontory testing, which includes measuring the electrical potentials generated in the auditory system and stimulating the inner ear electrically.Types of Sensori‐Neural Hearing Impairment.There are four or more types of sensori‐neural hearing impairment which in the past have collectively been termed sensori‐neural. They are: 1. sensory loss — deficiency in the hair cells; 2. neural loss — auditory nerve deficit; 3. brain stem loss — nuclear deficiency; and 4. central loss — auditory cortex defect.Method of Testing.Recording of the potentials evoked in the auditory system by the techniques of electrocochleography, brain stem audiometry and cortical evoked response audiometry is an important objective means of study of the auditory system. Characteristics of the potentials obtained such as wave form, latency, and amplitude help greatly in classifying types of partial hearing loss.In severe hearing loss no potentials are obtained from the auditory system. In these cases, a low‐voltage, low‐frequency electrical current is applied to the promontory.If the patient perceives an auditory sensation as a result of this stimulation, we believe that this demonstrates the presence of auditory neurons and the loss is classified as sensory. If an auditory sensation is not evoked, the deafness is classified as a neural or

ISSN:0023-852X    

DOI:10.1288/00005537-197412000-00007

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractCarcinoma of the tonsil is second in frequency to carcinoma of the larynx among malignant tumors of the upper air passages. Thirty‐six patients with squamous cell carcinoma of the tonsil were treated with 4,000–4,500 rads of preoperative radiation followed in four to six weeks by surgical excision of the primary tumor and in‐continuity neck dissection. The male to female ratio was five to one, and the majority of the patients was between 50 and 69 years of age. The most common symptom was a sore throat, and the duration was usually less than four months prior to the initial examination. The two‐year absolute survival rate is 56 percent and the determinate survival rate is 67 percent. All recurrences were evident by the second year. Factors associated with an unfavorable prognosis were the presence of a fixed node in the neck, a pathologic specimen containing two or more positive neck nodes, and involvement of the

ISSN:0023-852X    

DOI:10.1288/00005537-197412000-00008

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractA new and more rational therapeutic approach to the diagnosis and management of juvenile angiofibromas was formulated based upon the experiences in 35 cases.Preoperative angiography is essential in delineating the mass, and demonstrating extension into surrounding areas, and for delineation of the sources of blood supply to the tumor. Arteriography has shown 20 percent of the cases to have middle fossa extension, and that the size of the tumor in the nasopharynx does not necessarily represent the size and extent of the tumor and may be only the “tip of the iceberg.”The death of a patient with intracranial extension. The cessation of bleeding, and shrinkage of the tumor was demonstrated by pre and post therapy arteriography and scanning. Because of the success of the transpalatal surgical approach and the hesitancy of administering irradiation too, surgical excision is the treatment of choice in all cases that do not have intracranial extens

ISSN:0023-852X    

DOI:10.1288/00005537-197412000-00009

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY

摘要:

AbstractThe technique of external rhinoplasty is outlined. Having reviewed 74 cases, its advantages and disadvantages are discussed. Reluctance to use this external approach seems to be based on emotional rather than radical grounds, for its seems to be the procedure of choice for many problems.

ISSN:0023-852X    

DOI:10.1288/00005537-197412000-00010

出版商:John Wiley&Sons, Inc.    

年代:1974

数据来源: WILEY