摘要:

AbstractOne hundred fifty‐seven consecutive nasal surgery cases were followed for a minimum of one year or more. Ten cases were considered to have unsatisfactory mechanical airways, caused either by return of the original pathology (alar collapse or atrophic rhinitis) or by inadequate mechanical results.Nineteen cases in which the mechanical airways were satisfactory had soft tissue obstruction secondary to chronic inferior turbinate congestion.The effects of nasal allergy and the trauma of postnasal packing on chronic congestion of the turbinates are tabulated according to the type of surgery performed and results discusse

ISSN:0023-852X    

DOI:10.1288/00005537-197703000-00001

出版商:John Wiley&Sons, Inc.    

年代:1977

数据来源: WILEY

摘要:

AbstractThe repair of the caudal end of a severely deviated septum has been a challenge since the beginning of septum surgery. In the time of Freer and Killian, a caudal and dorsal strip was always left. Frequently, the most obvious portion of the septal deformity, the caudal end, was undisturbed and the deformity persisted. Metzenbaum, Fomon and Cottle described procedures designed to correct this problem.The procedure described in this presentation utilizes the maxilla‐pre‐maxillary approach to the septum. The laporotomy of the rhinoplasty procedure is used to expose the upper lateral cartilages. These cartilages are submucously uncovered and separated from the dorsal margin of the septal cartilage. This provides complete exposure of the line of fracture usually responsible for the extreme deflection of the caudal end of the septal cartilage.A strip of cartilage including the line of fracture is removed. The caudal end is attached to the mucoperichondrium of the right side and now is completely mobile. The caudal end is placed over the maxillary spine and sutured in position by a chromic cat gut suture from the prespine fascia through the caudal edge of the septal cartilage. The upper lateral cartilages are sutured to the dorsal margin of the septum acting as a splint to hold the sections of cartilage straight and immobile until the tissues h

ISSN:0023-852X    

DOI:10.1288/00005537-197703000-00002

出版商:John Wiley&Sons, Inc.    

年代:1977

数据来源: WILEY

摘要:

AbstractA retrospective study of carcinomain situof the larynx at the British Columbia Cancer Institute indicates that radiotherapy, using a tumoricidal dose of Co 60, is the treatment of choice for this condition.Between 1940 and 1972, 43 patients with carcinomain situof the vocal cords were seen. A follow‐up of five years or more was possible in 28 of these cases. Twenty‐two were treated primarily with a tumoricidal dose of radiotherapy. Twenty‐one of the 22 were free of disease for at least five years.This study, therefore, shows a five‐year cure rate of almost 100 percent for patients treated with radiotherapy. It also brings out two further points regarding carcinomain situof the larynx; namely, an apparent increase in its incidence, and the presence of co‐existing invasive carcinoma in some cases. We feel that since the incidence of laryngeal carcinoma has not increased, this apparent increase probably represents a greater awareness by both the pathologist and the clinician. We have also achieved more accurate diagnosis since the introduction of routine microlaryngoscopy. The single radiotherapy failure in our series was due to failure to diag: Nose co‐existing invasive carcinoma. This would seem to be the most likely cause of similar failures reported in the literature.Carcinomain situshould be managed as follows:1Any patient found to have carcinomain situon laryngeal biopsy must have careful microlaryngoscopy with examination of the hypopharynx, larynx, subglottic larynx, and upper trachea.2If the lesion is small and confined to one cord, complete stripping of that cord is indicated.3If both cords are abnormal, stripping and/or careful multiple biopsies are essential.4If a small localized lesion is found, repeat cord stripping is performed in one month.5If any biopsy reveals invasive carcinoma, the patient must not be classified as a case of carci

ISSN:0023-852X    

DOI:10.1288/00005537-197703000-00003

出版商:John Wiley&Sons, Inc.    

年代:1977

数据来源: WILEY

摘要:

AbstractThe patient presenting with a mass lesion of the parotid gland is frequently found to have a mixed tumor of salivary tissue origin. However, less common lesions occur in the anatomical region of the parotid gland. These pathological entities deserve consideration in the differential diagnosis.This report presents nine patients with unusual lesions occurring in the parotid region. These lesions include cervicofacial actinomycosis, branchial cleft cyst, parapharyngeal tumors, bony lesion of the mandible, non‐parotid origin malignant tumor, and metastatic malignant tumors. Each class of lesions demonstrated is also discusse

ISSN:0023-852X    

DOI:10.1288/00005537-197703000-00004

出版商:John Wiley&Sons, Inc.    

年代:1977

数据来源: WILEY

摘要:

AbstractAnatomical or physiological airway obstructions during sleep, of which the patient is unaware, cause daytime sleepiness at first, then signs of decreasing mental function, and eventually in some individuals, pulmonary and systemic hypertension. A few of these patients had been recognized before, the Pickwickian syndrome and in children with cardiac problems and large tonsils. The majority, however, present as sleep disorders. This paper describes our surgical experience with improving the airways of 19 children and adults with daytime somnolence.

ISSN:0023-852X    

DOI:10.1288/00005537-197703000-00005

出版商:John Wiley&Sons, Inc.    

年代:1977

数据来源: WILEY

摘要:

AbstractAs a result of increased use of prolonged endotracheal intubation, complications of intubation are now being seen more often. Stenosis of the airway may develop at the level of the glottic or subglottic larynx, or in the trachea. Discussions of management do not always distinguish clearly between laryngeal stenosis and tracheal stenosis. Yet, these are two separate entities. Discussions of laryngeal stenosis usually deal with subglottic stenosis, with less emphasis on obstruction at the glottic level.Of 20 patients, 14 adults and six children, with stenosis of the larynx secondary to intubation, we were successful in establishing adequate airways in 16. An analysis of these 20 patients leads to the following conclusions:1Scarring in the glottic posterior commissure between the arytenoid cartilages is a frequent cause of laryngeal stenosis after intubation.3Endoscopic management can be successful in many cases if it is started early enough, and repeated as often as is necessary. The earlier it is begun, the better the results will be.3Indwelling stents which are extremely valuable in laryngeal stenosis from external trauma, may not be as useful in stenosis from endotracheal tube trauma.

ISSN:0023-852X    

DOI:10.1288/00005537-197703000-00006

出版商:John Wiley&Sons, Inc.    

年代:1977

数据来源: WILEY

摘要:

AbstractThree cases of mucormycosis are presented; two with unusual aspects: One with previously unreported involvement of the mandible, and one presenting as a cavernous sinus thrombosis.Review of the literature reveals a limited number of survivors. Survival in two of the cases presented here suggests that early diagnosis, aggressive therapy with surgery, and amphotericin B should improve the prognosis.

ISSN:0023-852X    

DOI:10.1288/00005537-197703000-00007

出版商:John Wiley&Sons, Inc.    

年代:1977

数据来源: WILEY

摘要:

AbstractTo study the problem of cranial neuropathies in sinus disease the in‐patient experience at the University of California, San Francisco, and San Francisco General Hospitals was reviewed. The incidence of cranial nerve involvement in acute and chronic sinus inflammations was low (8 percent and 4 percent respectively). The incidence in neoplastic disease of the sinuses was considerably higher (32 percent). Cranial neuropathies occurred in inflammatory disease more frequently when associated with mucopyocele, mucormycosis, and orbital cellulitis. In both inflammatory and neoplastic disease, when cranial nerve deficits occurred, there was a high predelication for sphenoid sinus involvement. Several instructive case histories are included. The important anatomy of the cavernous sinus region and of the orbital apex as it pertains to this problem is discusse

ISSN:0023-852X    

DOI:10.1288/00005537-197703000-00008

出版商:John Wiley&Sons, Inc.    

年代:1977

数据来源: WILEY

摘要:

AbstractClinicians have been aware of the problem of post‐stapedectomy peri‐lymph fistulas for some time. The existence of non‐surgical oval and round window fistulas has been known and was first described in detail by Fee in 1968. This paper concerns a small series of patients with spontaneous and traumatic perilymph fistulas. Five oval window fistulas and one round window fistula are reported. Clinical features, audiometric, radiographic and vestibular findings are discussed.The etiology of traumatic and spontaneous fistulas is not well understood, but seems to bear a relationship to sudden increases in intracran‐ial pressure transmitted to the inner ear through the cochlear aqueduct. Middle ear pressure changes, as seen in acoustic or barotrauma, may also cause these leaks.Indications for surgery and techniques of perilymph fistula identification and repair are discussed in the paper. Surgical correction led to relief of vertigo in 80 percent of patients in this series, and significant hearing improvements were seen in 50 percent of the patients.In evaluating patients with sudden sensori‐neural hearing loss, or persistent vestibular symptoms following head or ear trauma, the otologist should keep in mind the possibility of a perilymph fistula and actively investigate these patients. Evidence presented in this paper and in the literature suggests that identification and correction of spontaneous and traumatic perilymph fistulas can lead to resolution of vestibular symptoms and improved hearing in a significant number of patients with thes

ISSN:0023-852X    

DOI:10.1288/00005537-197703000-00009

出版商:John Wiley&Sons, Inc.    

年代:1977

数据来源: WILEY

摘要:

AbstractAuditory symptoms (hyperacusis, tinnitus, decreased hearing) have long been recognized to accompany herpetic or idiopathic facial paralysis. Twenty‐nine percent of 1,080 patients with idiopathic facial paralysis and 37 percent of 172 with herpes zoster oticus facial paralysis had auditory symptoms. Abnormal related sensori‐neural hearing loss was documented in only 11 of these 377 patients with auditory complaints. All of the 11 had a diagnosis of herpes zoster oticus.Sensori‐neural hearing loss occurs in only about 6.5 percent of patients with herpes zoster facial paralysis, and no confirmed case of such loss in idiopathic facial paralysis has been reported. In patients presenting with sensori‐neural hearing loss accompanying facial paralysis believed to be idiopathic, herpes zoster should be suspected even in the absence of vesicles. Factors favorable for recovery of auditory function include age 64 years or younger, mild initial hearing loss, a cochlear pattern of hearing loss, and absence of vertigo. Recovery of auditory function does take place; however, a high‐tone sensori‐neural loss may persist except in young

ISSN:0023-852X    

DOI:10.1288/00005537-197703000-00010

出版商:John Wiley&Sons, Inc.    

年代:1977

数据来源: WILEY