摘要:

AbstractLaryngeal reinnervation with the ansa cervicalis has been proposed as a treatment for human unilateral vocal fold paralysis (UVFP). This study tested the assumption that results from reinnervation could be improved if combined with medialization surgery. Six canine subjects underwent recurrent laryngeal nerve section and reinnervation with a branch of the ansa cervicalis. After reinnervation, vocal function was assessed before and after arytenoid adduction. Although laryngeal function improved significantly following reinnervation, results were significantly enhanced by the addition of medialization surgery. The implications for the treatment of human unilateral vocal fold paralysis are discussed.

ISSN:0023-852X    

DOI:10.1288/00005537-199410000-00001

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractForty‐six patients with malignant melanoma metastatic to cervical or parotid lymph nodes with an unknown primary site were treated at UCLA Medical Center from 1964 through 1991. Treatment consisted of parotidectomy and/or neck dissection with or without adjuvant therapy. The initial presentation was a cervical mass in 74% and a parotid mass in 26% of patients. Metastasis distal to the head and neck nodal basins developed in 22% of patients.Involvement of more than four cervical or parotid nodes resulted in a significant increase in distant metastasis (P>.01). Adjuvant therapy was found to have no significant effect on survival rates. However, age at the time of diagnosis influenced the survival rates. The significance of the improved survival of these patients as compared to those with a known primary melanoma is discusse

ISSN:0023-852X    

DOI:10.1288/00005537-199410000-00002

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractDistant metastases (DMs) occurred in 83 (11.4%) of 727 retrospectively studied head and neck cancer patients. Primary tumor location and initial treatment did not influence DM development; larger primaries (P<.04) or more extensive neck disease (P<.007) more often caused DMs. Initial diagnosis to DMs averaged 11.7 months (range, 0 to 60 months), with 84% diagnosed within 24 months. With the exception of laryngeal primaries, no facet of tumor, host, or initial treatment influenced where or how rapidly DMs developed. Lung was the most common DM site (83.4%), then bone (31.1%) and liver (6.0%). Survival with DMs averaged 4.3 months (range, 1 day to 2.7 years); 86.7% died within 1 year. This report yields the following conclusions:1.Initial tumor size and neck disease are the only predictors of DMs.2.DMs usually occur within 2 years of the initial diagnosis.3.Lung is the most common DM site, making chest x‐ray the most effective DM screen.4.Survival with DMs is usually less than a yea

ISSN:0023-852X    

DOI:10.1288/00005537-199410000-00003

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractA modification of the liberatory maneuver was used to treat 25 patients with benign paroxysmal positional vertigo (BPPV). The modified liberatory maneuver relieved symptoms without recurrence in 11 (44%) patients. A partial response was noted in 6 (24%) patients, and there was no improvement in 8 (32%) patients. Follow‐up ranged from 1 to 20 months (median 4.0 months). Patient age was not predictive of response to treatment. Duration of symptoms before treatment, however, was greater in nonresponders (median 15.5 months) than in complete (median 5.0 months) or partial (median 3.5 months) responders. The modified liberatory maneuver takes approximately 5 minutes to perform and provides effective treatment in two thirds of patients who suffer from BPP

ISSN:0023-852X    

DOI:10.1288/00005537-199410000-00004

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractIn this experiment, the adductory properties of three intrinsic laryngeal muscles (the thyroarytenoid [TA], lateral cricoarytenoid [LCA], and interarytenoid [IA]) were studied and quantified. Using an in vivo canine laryngeal model, a recently developed “tensionometer” was used to measure the adductory force produced by each of these muscles at the vocal process of the arytenoid. Isolated muscle activation was obtained by stimulating selective terminal branches of the anterior division of the recurrent laryngeal nerve. Results indicate that the LCA is the strongest adductory muscle, followed by the TA and the IA Videolaryngoscopy revealed that LCA contraction causes adduction of the vocal fold and vocal process, with the predominant effect on the process. TA stimulation leads primarily to adduction of vocal fold, and the IA adducts mainly the vocal process. Implications of these findings are discus

ISSN:0023-852X    

DOI:10.1288/00005537-199410000-00005

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractCongenital aural atresia is an unusual anomaly that is difficult to surgically correct. Altered anatomical landmarks, especially of the facial nerve, and variability of the middle ear configuration, contribute to the difficulty of the procedure. In addition, the unpredictable healing process can make for variable outcomes. Choosing appropriate candidates for surgical repair minimizes risks and enhances patient care.This report reviews the outcome with evaluation and management of 17 patients with congential aural atresia. Surgical techniques for repair, including use of a hydroxylapatite canal wall prosthesis to help reconstruct the posterior canal wall are described. As expected, patients with less severe anomalies had better postoperative hearing results. Lateralized tympanic membrane, canal stenosis, and meatal narrowing were complications encountered. The anatomy and embryology of the ear and facial nerve are reviewed to assist surgeons in safe, successful surgery.

ISSN:0023-852X    

DOI:10.1288/00005537-199410000-00006

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe electrical acoustic reflex threshold (EART) has been shown to be a reliable estimate of behavioral comfort levels in both child and adult cochlear implant patients. The purpose of this study was to investigate the potential for using EARTs for programming the Nucleus cochlear implant. EARTs and behavioral comfort levels were obtained from 7 adult implant patients. Two programs or “maps” were made for each patient, one based on behavioral comfort levels and one based on EARTs. Performance on open set tests of speech recognition was measured with each map. Mean data suggest that speech perception is similar with both maps. Analysis of individual data revealed that, whereas 2 subjects performed better with the C‐level maps, the remaining 5 subjects tended to perform either better with the EART map or equally well with both maps. These results suggest that EARTs may be an adequate substitute for comfort levels when programming the implant for patients who are unable to make reliable psychophysical judg

ISSN:0023-852X    

DOI:10.1288/00005537-199410000-00007

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractIntraoperative tumor spill or inadequate resection may be associated with an increase in the recurrence rate of pleomorphic adenoma. An attempt was made to determine the recurrence rate when such factors were identified at the time of operation. From 1970 through 1989, 17 cases were identified in which there was a question of intraoperative tumor spill or inadequate resection of a salivary gland pleomorphic adenoma. Patients were either observed or given postoperative irradiation with a mean follow‐up of 7.4 years. The overall initial local recurrence rate was 24%, and all recurrences were successfully salvaged. Inadequate resection, particularly enucleation, was predictive of local recurrence, but tumor spill was not. Postoperative irradiation after inadequate resection appeared to decrease the probability of recurrence. We conclude that recurrence of pleomorphic adenoma is not increased by tumor spill as compared with inadequate resectio

ISSN:0023-852X    

DOI:10.1288/00005537-199410000-00008

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractHuman parvovirus B19 (HP‐B19), the etiologic agent of the common childhood illness erythema infectiosum, has been implicated in systemic immune disorders. Patients presenting with sensorineural hearing loss and/or dizziness, not readily categorized, were evaluated for immune‐mediated inner ear disease. Appropriate serologic studies including parvovirus B19 antibody titers were conducted. Thirty patients with suspected immune‐mediated inner ear disease were treated with corticosteroid trial for 5 to 7 days, then reexamined with repeat audiogram and/or vestibular testing. Seventeen patients with clinical response were treated with long‐term corticosteroids and cyclophosphamide. Six patients had positive HP‐B19 immunoglobulin M (IgM) titers and 8 patients had positive parvovirus immunoglobulin G (IgG) titers. All 14 patients responded to therapy. Parvovirus B19, therefore, is a possible etiology of immune‐mediated inner

ISSN:0023-852X    

DOI:10.1288/00005537-199410000-00009

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY

摘要:

AbstractThe recurrent laryngeal nerve (RLN) stimulator has been implanted on a limited basis since 1988 for control of spasmodic dysphonia. A similar vagus nerve stimulator has been implanted in a larger series of patients to control epilepsy. The safety and tolerability of these two stimulators were evaluated. In 113 patients implanted with the vagus nerve stimulator, the complication rate was 0.9%. All patients were monitored for vital signs, electrocardiographic changes, and adverse effects. The absence of changes in vital signs and electrocardiograms during vagal stimulation establishes the safety of this treatment. Since placement of the electrode around the vagus nerve is an easier surgical technique than placement deep to the RLN, it seems reasonable to change the technique to implant the stimulator on the vagus in patients with spasmodic dysphonia.

ISSN:0023-852X    

DOI:10.1288/00005537-199410000-00010

出版商:John Wiley&Sons, Inc.    

年代:1994

数据来源: WILEY