摘要:

AbstractThe procedure, irradiated mandibular autografts, for primary reconstruction, is presented with an immediate success rate of 88%. Eight cases have undergone primary mandibular reconstruction with the tumorous mandible irradiated to 10,000 rads in a single dose. The longest follow‐up is 2 3/4 years. The autograft has proven to be an ideal implant. Major resections of the mandible in conjunction with large myocutaneous flaps have been reconstructed utilizing this implan

ISSN:0023-852X    

DOI:10.1288/00005537-198107000-00001

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractBecause of the growing awareness of metastatic disease in head and neck patients, a protocol including radioisotope scans was begun through the Baylor Department of Otolaryngology at the Houston V.A. Hospital in an attempt to identify these patients preoperatively. Out of 198 death charts reviewed, only 3 had positive preoperative scans and only one of these was clinically significant. Chest X‐rays identified more preoperative metastatic disease than the radioisotope scans. Twenty percent of patients had second primaries, which was more than the number of patients dying with distant metastatic disease. Only 5% of these patients died of metastatic disease with local control. Local control with follow‐up for second primaries should be the primary objective of the surgeon. Radioisotope scans were of no significant value in evaluating preoperative metastatic dise

ISSN:0023-852X    

DOI:10.1288/00005537-198107000-00002

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractThe wide variation in reported success rates in endolymphatic sac surgery has been the subject of much controversy in literature. This series is a follow‐up of additional cases done since 1976 that were previously reported with 55% relief of vertigo on relatively long‐term follow‐ups of 24 months to 10 years. This present series is an additional 30 endolymphatic shunts that were done since that time. This group of patients as a rule had their disease for a shorter period of time. It is interesting that the long‐term relief of vertigo in this series is 70%. This is considerably better than the initial series of 66 patients previously reported. It is postulated that there are some benefits to earlier surgery in endolymphatic hydrops before the endolymphatic sac lumen becomes obliterated with fibrous tissue. It is always possible that the shorter follow‐up period in this group of patients also adds to this statistical im

ISSN:0023-852X    

DOI:10.1288/00005537-198107000-00003

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractThis is a 16 year experience report on the author's wide flange ventilation tube, used for permanent or severe chronic Eustachian tube dysfunction. Two hundred and twenty‐eight implants in 198 ears of 126 patients were adequately followed. A small series of 13 Paparella implants is included.Patient age ranges from 6 months to 72 years. Tube longevity up to elective removal averaged 51.2 months (longest — 159 months). Average longevity for tubes removed for uncontrolled complications was 34.6 months (longest — 162 months). Comparable figures for the Paparella tube are 15 and 31 months.There were 249 complications in 228 Per‐Lee tube implants and 12 in 9 Paparella tube implants; 69.6% of Per‐Lee tubes and 100% of Paparella tubes were associated with complication. Per‐Lee tube complications occurred from 1 to 162 months after implantation. The most common was infection (68.6% of all complications). The others included bleeding (10.9%), peritubal drum atrophy (11.7%), extrusion (4.8%), tissue growth into the tube (0.8%), tube migration into the middle ear (1.2%), squamous epithelial invasion (1.2%), and obstruction for other causes (0.8%); 75 infections and 8 bleeding episodes required tube removal. The drum did not heal in 14 and 2 cases respectively. Peritubal drum atrophy, an important complication, occurred 29 times and led to 14 unhealed perforations; 12 tubes (5%) extruded leaving 4 drums unhealed. Squamous epithelium invaded the middle ear three times; in one instance it was due to the tube. A total of 49 permanent perforations (24.8% of 198 ears) occurred including those remaining after elective tube removal. This compares with a 2% or less incidence with a grommet and other standard tubes. Since long‐term ventilation is sought, this outcome is less serious than one suspects. Follow‐up hearing data was available for 7 unhealed and 32 healed drums. For unhealed drums (mostly anterior perforations) the average SRT was 7.1 db. The average SRT for healed drums was 11 1b. Other approaches to long‐term ventilation are discussed, specifically Wright's Eustachian tube prosthesis and laser myringotomy. Both approaches seem unreliable. If permanent ventilation is desired, a permanent perforation resulting from a long‐term ventilation tube would seem to be a

ISSN:0023-852X    

DOI:10.1288/00005537-198107000-00004

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractHearing air dispensing within an otolaryngological/audiological clinic is a well accepted fact, and offers total hearing care in a professional setting. The effectiveness of such a program as to wearing habits and acceptance of services rendered, to my knowledge, has not been studied. This paper discusses data obtained from a questionnaire sent out to 1100 hearing aid patients. The questionnaire was designed to study satisfaction with clinic services and costs, acceptance and adjustment, communication abilities and wearing habits.Statistical analysis was performed by the Department of Biometry at LSU Shreveport. The information received is valuable in determining when hearing aids are most helpful and least helpful and brings out some factors which should influence one in determining who should and should not be fitted with amplification.

ISSN:0023-852X    

DOI:10.1288/00005537-198107000-00005

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractThe introduction of computerized axial tomography (C.T.) in 1973 completely changed the diagnostic evaluation of acoustic neuromas. Seventy to eighty percent of all acoustic neuromas can be diagnosed with intravenous enhanced C.T. scan. Acoustic tumors with a diameter of less than 1.5 cm., however, are not consistently seen on C.T. scan. Twenty‐six consecutive patients were evaluated by C.T. scan with air contrast posterior fossa myelography (C.T. air cisternography). Nineteen studies were normal, with complete air filling of the internal auditory canal. Surgically verified acoustic neuromas were demonstrated in four patients. Two studies were inconclusive and there was one false positive. Other than headaches, there is no morbidity associated with this technique. C.T. air cisternography should be considered as the definitive study for evaluating patients for acoustic neuromas who have normal intravenous contrast enhanced C.T. scans. This study reports the first intracanalicular tumor diagnosed with this techniqu

ISSN:0023-852X    

DOI:10.1288/00005537-198107000-00006

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractIn the past 22 years, 27 patients have undergone total obliteration of the mastoid, middle ear, and external auditory canal. Most of the patients had severely diseased ears, many with multiple previous operations. When performed for chronic otorrhea, the operation resulted in a dry ear in all but two cases, though healing was prolonged in some. Secondary revisions for hearing were unsuccessful.We review the indications for this procedure and the experience of others who have used similar techniques. Though seldom indicated, the mastoid obliteration operation results in a dry ear in almost all patients.

ISSN:0023-852X    

DOI:10.1288/00005537-198107000-00007

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractSinger and Blom have recently reported a new surgical method for speech rehabilitation of the alaryngeal patient. The method consists of a tracheoesophageal puncture (TEP) followed 2 to 3 days later by insertion of a silicone “duckbill” prosthesis which acts as a one‐way valve allowing pulmonary air to enter and vibrate the esophagus but preventing aspiration.Along with more rapid acquisition of speech, the advantage of tracheoesophageal speech over esophageal speech is the greater volume of air flow through the vibrating segment of the esophagus, which allows smoother and more prolonged speech.Thirteen of our 18 patients (72%) who have undergone TEP are currently using tracheoesophageal speech. The complications associated with this procedure include the TEP tract closing, tracheal mucositis, stenosis of the tracheostoma, aspiration of the prosthesis, esophageal tear, and aspiration from the esophagus.Although we have encountered several problems, we enthusiastically endorse this procedure since it provides oral communication which is comparable to, and in many cases better than, that of the majority of esophageal spe

ISSN:0023-852X    

DOI:10.1288/00005537-198107000-00008

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractSince 1974, 28 ears have been surgically explored for suspected perilymphatic fistulae. Of the 28 explored ears, 23 were proven to have fistulae. Eighteen of these surgically proven fistulae were from nonsurgical injuries; 5 were poststapedectomy. Mode of injury, patient descriptive data, duration of the fistulae, as well as method and tissue used to correct the leak are examined. The low morbidity of surgically exploring suspected ears with the high percentage of positive findings leads the authors to encourage surgical exploration.

ISSN:0023-852X    

DOI:10.1288/00005537-198107000-00009

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY

摘要:

AbstractLife threatening infections of odontogenic or upper airway origin may extend to potential spaces formed by fascial planes of the lower head and upper cervical area. The incidence of these “space infections” has been greatly reduced by modern antibiotic therapy. However, serious morbidity and even fatalities continue to occur.Two cases of deep neck infection, (one of odontogenic and one tonsillar in origin) with subsequent mediastinitis, empyema, pericarditis and ultimate survival are reported. One case of deep neck infection, (of odontogenic etiology) and suppurative thrombophlebitis of the internal jugular vein with ultimate fatal outcome is also reviewed.Review of the literature reveals only one previous case report of a survivor of an odontogenic deep neck infection complicated by mediastinitis, empyema and pericarditis. The anatomy, etiology and treatment of complications of these “space infections” of the head and neck are briefly r

ISSN:0023-852X    

DOI:10.1288/00005537-198107000-00010

出版商:John Wiley&Sons, Inc.    

年代:1981

数据来源: WILEY