摘要:

AbstractElectronystagmography and rotary vestibulnr testing are of definite but limited value in screening the dizzy patient. Objective identification of a vestibular abnormality is valuable, but there is an additional need to appraise the functional capacity of those suffering central or peripheral disorders causing spatial disorientation or disequilibrium. Records of 175 patients undergoing posturography in the author's practice over a 1‐year period were reviewed. Diagnosis was established by conventional neurotologic means including computerized electronystagmography. Abnormal results on posturography were identified by criteria established through the national users group of Equi‐Test participants. There were 112 peripheral cases with 50 (45%) abnormal on posturography, in contrast to 53 central patients with 38 (72%) abnormal. Posturography establishes a functional level of balance in certain peripheral and central disorders and provides limited but significant aid to assist in distinguishing between the

ISSN:0023-852X    

DOI:10.1288/00005537-198210000-00004

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractMany cochlear implant recipients have some measurable hearing prior to implantation. Animal studies have demonstrated some loss of viable neural elements resulting from both mechanical insertion trauma and long‐term electrical stimulation. The effect of implantation of a long intracochlear multichannel electrode array and subsequent electrical stimulation on residual hearing was evaluated.Forty consecutive cochlear implant recipients were assessed by audiometry at the Colorado Ear Clinic between July 1985 and June 1988. Twelve of these patients (30%) had some measurable residual hearing before implantation, although all had profound hearing loss, with no understanding of speech. All patients received a multichannel cochlear implant with all 22 electrodes inserted in each patient by an experienced cochlear implant surgeon.Audiometric testing was repeated between 2 and 24 months after implantation. Pure‐tone threshold responses in the implanted ear were significantly reduced postimplant, while puretone threshold responses in the nonimplanted ear were sta

ISSN:0023-852X    

DOI:10.1288/00005537-198210000-00005

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractSnoring is a common obnoxious disturbance in human society. Although considered a mere nuisance by most, it can have significant social and medical effects. Snoring has caused marriage breakdown and murder. It can lead to hypertension, heart failure, and the obstructive sleep apnea syndrome.Since Ikematsu developed palatopharyngoplasty (PPP) in 1952 and Fujlta introduced it to North America in 1981, numerous reports have alluded to its efficacy in the management of snoring.From June 1986 to February 1988, 110 PPP operations were performed at The Wellesley Hospital, University of Toronto. Of these, 58 patients responded to review and questionnaire. Elimination or improvement of their snoring was reported by 75.9% of patients. Complications encountered are discussed.We conclude that palatopharyngoplasty (PPP) is a safe and effective technique in the treatment of problematic snoring.

ISSN:0023-852X    

DOI:10.1288/00005537-198210000-00006

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractFree autogenous osseous and soft tissue grafts were used for the immediate, one‐stage reconstruction of central craniofacial injuries involving the frontal sinus in 95 patients with wounds contaminated by either skin or nasal bacteria. Graft removal and delayed reconstruction were necessary in only one patient who suffered an infection in the first postoperative week. To date, no delayed complications are known to have occurred in any patient. As anticipated, long‐term follow‐up has been erratic (6 weeks to 5 years) and only suggestions rather than definite guidelines for the management of the sinus component of the injury can be made. However, this group of patients clearly demonstrates that multiple free autogenous grafts can be safely used for the acute reconstruction of contaminated central craniofacial fractures that are intimately related to the intracranial struc

ISSN:0023-852X    

DOI:10.1288/00005537-198210000-00007

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractThis study was undertaken to determine whether the application of a standardized chemical peel with an occlusive tape dressing to an acutely raised skin flap (as in combining rhytidectomy with chemical peel) affects skin flap viability. Thirty‐six 4‐cm x 4.cm dorsal skin flaps were raised on guinea pigs and sutured back into place. Eighteen of these flaps were simultaneously treated with a single application of Baker's solution and a 24‐hour occlusive tape dressing. A mean of 3.1 cm2of the non‐peeled flaps necrosed, compared with 6.3 cm2of the peeled flaps, a statistically significant increase in tissue loss in flaps that were simultaneously chemically peeled. We conclude that application of Baker's solution with an occlusive tape dressing to an acutely raised skin flap impairs skin flap viability and may result in skin flap n

ISSN:0023-852X    

DOI:10.1288/00005537-198210000-00008

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractMicrovascular techniques offer important alternatives for reconstructive head and neck surgery. To test the viability of freeze‐dried allografts, a pilot experimental study was performed using the rabbit model. Freeze‐dried preserved arterial allografts were implanted into femoral artery defects in eight subjects. After 6 weeks, all grafts were harvested and prepared for histologicol and electron microscopic analysis. Immediate patency was 100%. One subject was excluded on the third postoperative day. Of the seven remaining grafts, three (43%) were patent at 6 weeks. These results are comparable to previous data obtained using freeze‐dried arterial allografts in the some animal model. Although further investigation is required, this pilot study suggests possible future application of cryopreserved vascular microg

ISSN:0023-852X    

DOI:10.1288/00005537-198210000-00009

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractPosterior nasal epistaxis is a challenging problem for the oto‐laryngologist, particularly when patients are critically ill after significant blood loss. The purpose of this paper is to describe a new radiologic technique designed to enhance the treatment of acute nasal hemorrhage. Seven patients with posterior nasal epistaxis underwent portable, computerized, digital subtraction angiography before embolization. Results are presented, and the advantages and limitations of this approach are compared and contrasted with those of nasal packing and arterial ligation. We conclude that this new procedure permits rapid location of the bleeding source and safe, rapid placement of a maxillary arterial catheter for hemostasis by embolizatio

ISSN:0023-852X    

DOI:10.1288/00005537-198210000-00010

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractOne common vascular anomaly that causes airway obstruction in neonates and infants is innominate artery compression of the trachea. A great deal of controversy exists regarding the effect of this anatomic variant on symptom production. Several cases are presented that demonstrate the unique features of innominate artery compression of the trachea:1. Innominate artery compression can occur in adolescent patients.2. Flow volume loops are an effective method of documenting airway compromise in this condition.3. Exercise intolerance should be considered as a relative indication for surgical intervention in these patients.4. Reimplantation of the innominate artery is a viable surgical alternative in the treatment of affected patients.5. Telescopic bronchoscopy during surgical correction of this condition will ensure that there has been successful correction of the tracheal compression.6. Urgent repair is advocated in patients who experience periods of apnea.

ISSN:0023-852X    

DOI:10.1288/00005537-198210000-00011

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractSeveral researchers have made progress toward determining the cause of hemifacial spasm, tinnitus, and episodic vertigo. During the past 5 years, we have encountered a vascular loop in six of 36 patients who were undergoing retrolabyrinthine vestibular neurectomy for recurrent disequilibrium and vertigo. In five of these six patients, disequilibrium improved after neurectomy.This report describes the clinical symptomatology and the results of preoperative cochleovestibular testing for those patients found intraoperatively to have a vascular loop and suspected neurovascular compression syndrome. Audiograms, although varied, characteristically did not demonstrate the low‐frequency sensorineural hearing loss characteristic of Meniere's disease. No preoperative marker, with the single exception of computed tomography pneumocisternography, dependably predicted the presence of a vascular loo

ISSN:0023-852X    

DOI:10.1288/00005537-198210000-00012

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY

摘要:

AbstractTransposition of the spinal accessory (XI) and facial (VII) nerves has been used successfully in reanimation of facial paralysis, but because of the severity of symptoms associated with denervation of the trapezius muscle, this technique has largely been abandoned. Hypoglossal‐facial (XII‐VII) nerve anastomosis has now become a more favored procedure; however, the resultant hemiglossal atrophy carries some morbidity.Transposition of the sternocleidomastoid (SCM) branch of the accessory nerve as a way to avoid shoulder paralysis was reported more than 20 years ago with initially excellent results, yet few follow‐up studies have been done.Twenty‐one fresh cadaver dissections of the accessory nerve‐SCM branch and facial nerve were performed to determine if adequate numbers of fascicle groups and sufficient proximal nerve length are available for an adequate end‐to‐end anastomosis without nerve interposition grafting.This paper presents our anatomic and histologic findings to support the use of proximal SCM nerve anastomosis to distal facial nerve in facial reanimation. When feasible, the use of this technique to correct facial paralysis is encouraged rather than hypoglossal‐to‐facial nerve a

ISSN:0023-852X    

DOI:10.1288/00005537-198210000-00013

出版商:John Wiley&Sons, Inc.    

年代:1989

数据来源: WILEY