摘要:

AbstractModified Type V tympanoplasty has been used in this series to improve hearing in unsuccessful Type IV tympanoplasties and also to preserve cochlear function and possibly to improve hearing in cases where the oval window has been inadvertently opened during chronic ear surgery. Modified Type V tympanoplasty refers to removal of the stapes footplate with replacement by adipose tissue in the oval window. A tympanoplasty graft is then placed over the tissue graft and hearing achieved by round window protection with an air‐containing hypotympanum. The concept of modified Type V. tympanoplasty has been described by Del Villar,1Paparella,2,3Sato,5and Proctor4previously. Results from these previous authors have been somewhat variable, and this series is presented in an attempt to evaluate this procedure more clearly. Modified Type V tympanoplasty was, therefore, performed on 20 ears, 14 of these on ears that had previous Type IV tympanoplasty with unsuccessful hearing levels. The remaining six ears received the Type V tympanoplasty at the initial surgery, usually because of inadvertent fracture or avulsion of the stapes footplate. Thirteen ears achieved a significant improvement in hearing with an average gain in air conduction of about 19 decibels for the speech frequencies. The average improvement in the conductive component of the hearing loss was 22.4 db, while no loss of bone conduction or discrimination followed. Five cases obtained no change in hearing and retained bone conduction and discrimination scores so that amplification was still possible. Two instances of sensori‐neural loss were incurred: one a total loss of auditory function in a previously dry ear, while a partial loss of function with still useful discrimination score was present in the second case, one that had been wet at the time of surgery.The results indicate that the modified Type V tympanoplasty is a useful procedure to improve hearing in unsuccessful Type IV tympanoplasties, where the probable reason for the poor hearing result is stapes fixation with fibrous tissue, tympanosclerosis, or otosclerosis. Modified Type V tympanoplasty may also be used to preserve cochlear function at mastoid surgery where the stapes footplate has been inadvertently fractured or avulsed. In addition, hearing improvement may also be obtained in these instances where modified Type V is performed emergently during mastoid surg

ISSN:0023-852X    

DOI:10.1288/00005537-197304000-00001

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractPermanent restoration of hearing with neither conductive nor sensorineural impairment is the goal of functional reconstruction in tympanoplasty. Many changes and modifications of technique have occurred to accomplish these ends in the past 10 years.1,2The purpose of this paper is to present the technique used by members of the Otologic Medical Group and to comment on the use of homograft ossicles in over 700 cases.

ISSN:0023-852X    

DOI:10.1288/00005537-197304000-00002

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractA series of seven cases of subglottic hemangioma in infants ranging in age from three weeks to 18 months is being presented. These cases were treated between 1958 and 1972. There was no sexual preponderance, four cases being male and three female. All cases presented with severe upper respiratory obstruction requiring immediate tracheoscopy and tracheotomy. Two cases presented with simultaneous cutaneous hemangiomata of the back. Careful post‐tracheotomy observation is stressed to insure adequate pulmonary ventilation. Repeat bronchoscopy for aspiration of retained secretions and removal of a polyp at the tracheostomy was necessary in one case. Blood gas analysis for PCO2 and Po2 to determine extent of chronic hypoxia is recommended; also chest X‐rays may reveal evidence of cardio‐megaly, especially of the right ventricle as seen in chronic pulmonary hypertension secondary to alveolar hypoventilation.Gradual involution of the hemangioma after 12 months of age is to be expected. In those cases with associated cutaneous lesions, the resolution of the skin lesion may be used as a guide to determine the extent of resolution of the tracheal lesions. Lateral X‐rays of the trachea and barium studies of the upper esophagus are helpful to demonstrate the extent of the subglottic mass and also the degree of involvement of the party wall between the esophagus and trachea.One dose of radiotherapy was administered in only one case.Careful repeat tracheoscopy is recommended prior to decannulation to insure an adequate airway. Cortico‐steroids and cryotherapy were not used in these cases.All infants survived, and two of the more recent cases have not been de‐cannula

ISSN:0023-852X    

DOI:10.1288/00005537-197304000-00003

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractFifty‐seven of 800 human temporal bones were found to have eosinophilic perilymph precipitates. The most common etiological factor was blockage of the internal auditory canal (20 cases). Acute bacterial labyrinthitis (nine cases) and subarachnoid hemorrhage (five cases) were also associated with perilymph precipitates. Small amounts of precipitate were also observed in 20 of 110 temporal bones without evidence of ear pathology. Experimental introduction of serum proteins into the cat's perilymphatic space confirms that eosinophilic perilymph precipitates may represent increased quantities of protein in the perilymphatic spaces; however, no correlation could be made between the quantity of precipitate observed and the concentration of the protein in the perilymph. The finding of increased perilymph protein above 1,000 mg/100 ml during a diagnostic inner ear tap (labyrinthotomy) is good evidence for the presence of an acoustic neurinoma. An associated peripheral VIIth never paralysis should alert the clinician to the possibility of a metastatic carcinoma of the internal auditory cana

ISSN:0023-852X    

DOI:10.1288/00005537-197304000-00004

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractTwenty‐seven surgically proven acoustic neuromas were studied pre‐operatively with conventional brain scanning. Nine lesions were not diagnosed. Lesions less than 2.0 cm in diameter were not visualized (five patients). Lesions larger than 3.0 cm were all detected (15 patients). Lesions ranging in size from 2.0 to 3.0 cm were detected half of the time (six patients, seven lesions).Fourteen radiopertechnetate flow studies were performed in our last 10 patients with acoustic neuromas. All were negative. A case of meningioma in the cerebello‐pontine angle and a case of arteriovenous malformation in the posterior fossa were visualized on conventional scan. The flow studies were positive and demonstrated patterns suggestive of the nature of the lesions. Flow study appears a valuable adjunct to brain scanning in the differential diagnosis of cerebello‐pontine angle

ISSN:0023-852X    

DOI:10.1288/00005537-197304000-00005

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractIn patients presenting with severe gait disturbance, the otolaryngologist is not likely to consider labyrinthine disease as a possible cause.During the past few years there have been several reports of sudden deafness secondary to mechanical rupture of the inner ear windows. The clinical picture has usually been one of sudden deafness with tinnitus and vertigo. Mild ataxia was noted in three out of 18 reported cases.A case is presented of a 59‐year‐old female with a two month history of severe ataxia. Seven years previously she had had head trauma without fracture. Examination revealed marked ataxia, positive Rhomberg, positional vertigo and nystagmus and a 45 db mixed hearing loss. Tympanotomy revealed subluxation of the stapes with a fistula at the antero‐inferior margin of the footplate. Stapedectomy and soft tissue closure of the oval window were carried out. Postoperatively, the patient had no further ataxia or vertigo, and her hearing remained unchanged for 18 months.Three of the 18 reported cases also had given a history of head trauma with or without skull fracture, and two patients had had positional vertigo.The explanation of the positional vertigo in a case of labyrinthine fistula is not evident; perhaps gravity in the affected ear down position facilitates a flow of perilymph through the fistula with resulting distortion and stimulation of the cristae.Conclusion.In the future, peripheral labyrinthine disease such as a fistula should be suspected in cases which present with ataxia and episodic vertigo of obscure etiology. A tympanotomy may be necessary to establish the diagnosis and to allow correction of the path

ISSN:0023-852X    

DOI:10.1288/00005537-197304000-00006

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractIn 1970, cryosurgery was reported as effective treatment for chronic rhinitis.1Since that time, several hundred patients have been treated with better results, almost no complications, and simplification of the techniques. Improved equipment, selection of patients, probe application, replacement of Freon with Nitrous Oxide as the cooling agent, and prevention of complications have been reported.5Similar success has been reported by colleagues here and in England.4Subjective and objective evaluation after three to four years suggests the superiority of this technique. While relief of obstruction is almost certain, even in the few patients for whom more than one treatment has been necessary, rhinorrhea and sneezing are not always relieved by simply destroying diseased mucosa. More recently, as a result of reports of relief of the latter symptoms by vidian nerve section,2,3patients have been treated with a “hooked” nasal probe positioned on branches of the nerves at the spheno‐palatine foramen, either at the time of turbinectomy or later. The latter procedure is not considered to destroy the nerves permanently and is considered a “treatment” because nerves regenerate. At present cryosurgery is frequently used when mucosal disease results in “failure” of nasal septal surgery and as a complement of conventional reconstructive surgery. Relatively inexpensive Nitrous Oxide cryoprobes should make the technique available for most otol

ISSN:0023-852X    

DOI:10.1288/00005537-197304000-00007

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractIn a survey of 60 cases of internal maxillary artery ligation, only six therapeutic failures were encountered. Causes of failure were incorrect selection of vessel (four cases), and inadequate ligation of the artery (two cases). Initial identification of the bleeding site may be hampered by profuse bleeding or by anatomical obstruction, but correct localization will result in higher success rate for the procedure. Certain areas of the nose may receive blood from more than one artery. In these instances, ligation of both the internal maxillary and anterior ethmoid artery may be necessary.No relationship can be found in the series between hypertension and massive epistaxis. Neither did epistaxis predispose the hypertensive patient to imminent death.Hospitalization for treatment of massive epistaxis is shortened by specific vessel ligation as compared to posterior packing. Complications from the procedure cōnsists of cheek numbness in three cases and epiphora in one case. Care must be taken when isolating the vessels to avoid massive bleeding.Vessel ligation is an acceptable and effective means of controlling massive epistaxis

ISSN:0023-852X    

DOI:10.1288/00005537-197304000-00008

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractRecognition of various types of zygomatic fractures and their postreduction stability is essential for correct diagnosis and proper treatment of zygomatic fractures.It should be fully recognized that the zygoma, upon dislocation, may rotate around a vertical or longitudinal axis, and may be displaced medially, laterally, posteriorly or inferiorly, and that postreduction stability differs considerably depending upon the direction of rotation or displacement of the fractured zygoma.Diagnosis of the type of zygomatic fracture can be made on the three X‐ray views: Waters, submentovertical and Caldwell. The Waters view is the best single view for evaluation of zygomatic fractures. It should be noted, however, that posterior displacement of the zygoma may not be well shown in this view, because the zygoma is often displaced along the course of the X‐ray beam. The submentovertical view is indispensable for zygomatic arch fracture (Type II), posterior displacement (Type Vc), and medial and lateral rotation of the zygoma around the vertical axis (Type III, a and b). The Caldwell view is an important view for Type IV fractures which rotate around the longitudinal axis, and Type V fractures with medial (Va), lateral (Vb), and inferior (Vd) displacement. Diagnosis of zygomatic fractures should not depend upon the Waters view alone.Classical Temporal Approach.This approach is simple and most effective for depressed arch fractures but not effective for displacement or rotation of the zygomatic body. Elevation of the zygoma via this route may be hazardous for medial displacement (Type Va) and medial rotation around the vertical axis (Type IIIa).Transbuccal elevationis recommended as the standard initial method for all types of zygomatic fractures except for arch and rim fractures. This approach is particularly effective for posterior displacement (Type VC) and lateral rotation around the vertical axis (Type IIIb).Direct transorbital elevationvia infraorbital and zygomatico‐frontal incisions should be used when the zygoma is impacted and cannot be reduced or when the fractured zygoma is unstable after reduction. This approach should also be used when there is a suspected blow‐out fracture of the orbit. This approach is particularly useful for fractures rotated around the vertical or longitudinal axis (Type III and IV) as well as for inferior displacement of the zygoma (Type Vd).Supraorbitalelevation via an eyebrow incision is an effective method for posterior displacement Type Vc), but not for lateral or inferior displacement (Type Vb and Vd) or fractures rotated around the longitudinal axis of the zygoma (Type IV).Direct interosseous wiringis the most dependable and effective method of fixation of the zygoma.As a guide to treatment of zygomatic fractures, the Rowe and Killey classification is superior to the widely accepted Knight and North classification. The author proposes a modified Rowe and Killey classification which will more readily help to predict the postreduction stability and thus help to select the method of treatment according to the type of f

ISSN:0023-852X    

DOI:10.1288/00005537-197304000-00009

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY

摘要:

AbstractThe overall treatment of severe mid‐facial trauma calls for specialized knowledge and experience in an anatomical area shared by a number of surgical specialties. Increasing specialty board requirements and changing respect for anatomical boundaries among the various specialties make the mid‐facial area a bone of contention in medical centers with a limited volume of facial trauma cases. The need to share this educational resource is recognized; however, its distribution may be considered an educational pitfall among those more clinical in nature.The following clinical examples in the treatment of mid‐facial trauma have been briefly discussed and illustrated:1. Serious hematoma formation unrecognized or underestimated.2. Magnitude of facial bone injury unappreciated by initial observation of the patient and review of preliminary X‐rays.3. Poor selection of airway for delivery of general anesthesia.4. Unnecessary use of wire suspension for facial fracture immobilization.5. Failure to establish centric occlusion.6. Unrecognized inter‐canthal trauma.7. Impacted nasal fracture unreduced by closed reduction efforts and left untreated.8. Treatment of soft tissue injuries without regard for facial skeletal injuries.9. Vital structures discarded at time of initial treatment.10. Failure to replace missing dental elements early to avoid contracture.The trend towards introduction of lesser trained personnal in the intial treatment phase of facial traumam, coupled with the trend towards prepaid health group care suggests that the errors of treatment are likely to persist and in all probability to

ISSN:0023-852X    

DOI:10.1288/00005537-197304000-00010

出版商:John Wiley&Sons, Inc.    

年代:1973

数据来源: WILEY