摘要:

AbstractThe transsphenoidal approach to the pituitary (TSA) is currently the most common approach used to treat pituitary tumors. The surgical technique necessitates an incomplete stripping of sphenoid sinus mucosa. Long‐term postoperative magnetic resonance imaging (MRI) evaluation of the sphenoid sinus has not been reported. A retrospective review of patients undergoing a TSA at the University of Washington Hospitals was performed. Preoperative scans were compared with postoperative scans done during three time intervals. Group 1 had scans at 1 to 12 weeks postoperatively; 10 of 10 patients had sinus effusions. Group 2 had scans at 6 to 18 months postoperatively; 22 of 31 had mucosal abnormalities. Group 3 had scans at 2 to 3 years; 7 of 9 were abnormal. MRI evaluation indicates that a majority of patients have both acute and chronic sphenoid sinus abnormalities after TS

ISSN:0023-852X    

DOI:10.1288/00005537-199401000-00001

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractFifty‐two patients who had otitis media with effusion associated with head and neck malignancies were identified and studied retrospectively. Forty‐three of the patients underwent myringotomy and tube for treatment of the effusion. Ten (23%) of the 43 patients had either multiple infections or continuous otorrhea necessitating tube removal. The patients identified as having the highest rate of serious complications following myringotomy and tube were those individuals who had nasopharyngeal carcinoma, with 6 (55%) of 11 patients in this group having suffered major infections during the study. Myringotomy and tube is a satisfactory treatment for most patients who have effusions as a result of non‐malignant etiologies; however, infections were more common and more severe in the study group than those anticipated in noncancer patients. Expectant management and the use of amplification in selected cases may prove to be a viable alternative in patients with unilateral effusion and/or relatively mild sym

ISSN:0023-852X    

DOI:10.1288/00005537-199401000-00002

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractIn the past, there has been no consistent, objective method of following patients undergoing botulinum toxin injections for treatment of laryngeal dystonia. Herein, the application of translaryngeal resistance measurements to 15 dysphonic patients is described. Laryngeal resistance is calculated from analysis of translaryngeal pressure and airflow during the utterance/pi/, and found to fall predictably after successful toxin injection. In our series of patients, laryngeal resistance dropped by 69.1% after initial toxin injection. The changes in resistance over time correlate with subjective impressions of voice quality. Translaryngeal resistance measurements can be used objectively to follow patients longitudinally after injection and to collect objective data for analysis. No previously described measurements have met all these criteria. Laryngeal resistance measurement is an ideal method of documenting the results of botulinum toxin injection for the treatment of focal laryngeal dystonia.

ISSN:0023-852X    

DOI:10.1288/00005537-199401000-00003

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractSeven patients who received pharyngeal flaps for velopharyngeal incompetence (VPI) were studied to assess the effect of the procedure on nasal airway size. The findings suggest that the pharyngeal flap does not significantly decrease the upper airway in all patients. The effect of the flap did not correlate with the type of cleft, and was most pronounced in the inspiratory phase of the breathing cycle. Reasons for this variable effect, assumed to be related to an already impaired nasal airway in most cleft patients, are discussed.

ISSN:0023-852X    

DOI:10.1288/00005537-199401000-00004

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe incidental finding of sulcus vocalis in surgical specimens of patients with laryngeal cancer prompted this review. Sulcus deformities were histologically identified in 28 (48%) of 58 whole‐mount coronal serial‐sectioned laryngeal specimens procured from laryngeal cancer patients. The lesions were analyzed, described, and graded. A control group of 20 larynges, obtained from autopsies of patients without known laryngeal pathology, were similarly processed, and whole‐mount histologic sections were studied. Four of these specimens (20%) also demonstrated sulcus deformities. In the control group, the shape and location of the sulci were similar, but the lesions were smaller than in the cancer group. The sulcus lesions revealed chronic inflammation of the subepithelial tissues with vascular ingrowth and fibrosis of the superficial lamina propria (Reinke's space); in the cancer group the sulcus was usually on the opposite vocal fold, where irritation from the tumor might be anticipated. Although the etiology of the sulci remains controversial, these findings suggest that irritation and inflammation might play a role in the pathogenesis of sulcus vo

ISSN:0023-852X    

DOI:10.1288/00005537-199401000-00005

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractPatients with localized damage to the taste system often experience no subjective change in real‐world taste experience. In an effort to understand this, eight patients who recently underwent acoustic neuroma removal were evaluated for taste loss. Localized taste testing showed that taste intensities decreased in the distribution of cranial nerve VII ipsilateral to tumor removal as expected, but asymmetries occurred for IX. Intensities were greater on the side contralateral to the tumor removal. In addition, palatal taste, also thought to be mediated by VII, was not totally abolished. It is concluded that cranial nerve IX is normally inhibited by cranial nerve VII in the taste network. When VII is damaged, this inhibition is abolished. This release of inhibition serves as a compensation mechanism that preserves normal taste experienc

ISSN:0023-852X    

DOI:10.1288/00005537-199401000-00006

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractAdductor laryngeal breathing dystonia (ALBD) is a rare disorder in which patients have persistent inspiratory stridor, usually normal voice, and cough. Physical exam is characterized by paradoxical movement of the vocal cords on inspiration. These patients have involuntary action‐induced spasms of the adductor laryngeal muscles on inspiration. There has been no uniformly satisfactory treatment for the disease. Speech therapy, psychotherapy, and pharmacotherapy have all had limited success.We report the successful use of botulinum toxin type A in seven patients with adductor laryngeal breathing dystonia. All patients received bilateral thyroarytenoid injections. All patients had toxin effect within 72 hours, reaching maximal effect within 2 weeks with sustained improvement for an average of 13.8 weeks. Adverse effects included breathy voice and mild choking on liquids. Both resolved, on average, within 2 weeks.This retrospective study supports the safe and effective use of botulinum toxin type A in the treatment of adductor laryngeal breathing dystoni

ISSN:0023-852X    

DOI:10.1288/00005537-199401000-00007

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe nerve supply of the human interarytenoid (IA) muscle has been controversial for more than a century. In this study the contribution of the recurrent and superior laryngeal nerves to the IA was investigated in 10 adult human larynges. The larynges were obtained from autopsies and processed with the modified Sihler's technique which clears soft tissue while staining nerve. The IA muscles were dissected off the specimens and transilluminated to demonstrate their nerve supply. The results demonstrated that all 10 IA muscles were bilaterally innervated by both recurrent laryngeal nerves (RLNs) as well as branches of both superior laryngeal nerves (SLNs). These nerves combined within the IA muscles to form a dense anastomotic plexus which was highly variable between specimens. The exact nature of the internal SLN neurons, whether motor or sensory, their innervation targets, or their function, were not discernible. Additional anatomic findings were the presence of large neural communications directly between the SLN and RLN, and smaller neural connections from side to side. All of these results disagree with currently accepted descriptions of laryngeal neuroanatomy.

ISSN:0023-852X    

DOI:10.1288/00005537-199401000-00008

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractCerebrospinal fluid (CSF) leak has been a constant and unresolved complication of acoustic tumor surgery. This study retrospectively reviews 381 primary acoustic tumor surgeries performed by a single, senior, neurotologist and neurosurgeon team from 1979 through 1991. There were 68 cerebrospinal fluid leaks in 66 patients (66/381; 17%). There was no significant difference in the incidence of CSF leak between the translabyrinthine group (21%) and the retrosigmoid transmeatal group (16%). Translabyrinthine leaks were evenly divided between rhinorrhea and the postauricular wound while retrosigmoid transmeatal leaks were predominantly rhinorrhea. Eleven of 14 translabyrinthine wound leaks responded to pressure dressing and suture. The remaining 3 ceased with continuous lumbar cerebrospinal fluid drainage. Ten of 14 cases of translabyrinthine rhinorrhea responded to continuous lumbar cerebrospinal fluid drainage, and those in whom it failed were cured with revision of the mastoidectomy/labyrinthectomy cavity. Twenty‐one of 28 cases of retrosigmoid transmeatal rhinorrhea responded to continuous lumbar cerebrospinal fluid drainage, and those in whom it failed were cured with extracranial, transmastoid revision. The incidence of cerebrospinal fluid leak was not influenced by age, sex, size of tumor, postoperative hydrocephalus, or the intraoperative use of autologous fibrin glue. Meningitis was an unusual complication, occurring in 3% of all patient

ISSN:0023-852X    

DOI:10.1288/00005537-199401000-00009

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractStenosis of the terminal tracheostome is a distressing complication of total laryngectomy. A retrospective analysis of 207 patients who underwent total laryngectomy is presented; an overall incidence of tracheostomal stenosis of 13% is reported. The incidence of tracheostomal stenosis is higher in females (26%), patients having immediate tracheoesophageal puncture (19%), pectoralis major myocutaneous flap pharyngeal reconstruction (26%), and tracheostomal infection (50%) which is shown to be significant (P<.05). However, on multivariate analysis, only female sex and tracheostomal infection are independent determinants. Recognition of these clinical factors identifies patients at increased risk of developing this complication and thus allows appropriate perioperative planning to minimize its incidence.

ISSN:0023-852X    

DOI:10.1288/00005537-199401000-00010

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY