摘要:

ObjectiveTo differentiate tumor relapse from postirradiation sudden deafness (PISD) in patients with nasopharyngeal carcinoma (NPC).Study DesignA retrospective study from December 1991 to November 1999.SettingUniversity hospital.PatientsTwenty-five irradiated NPC patients with sudden deafness were investigated. All patients received local examination of ears, nose, nasopharynx, and throat fields, as well as a battery of audiologic and neurotologic tests.ResultsThree patients with sudden deafness within 3 years after irradiation received a diagnosis of tumor relapse. Magnetic resonance imaging revealed cerebellopontine angle metastasis in one and intracranial invasion in two. Comparison of the remaining 22 NPC patients who had PISD showed that the mean interval between the completion of irradiation to the onset of sudden deafness was 10 ± 5 years.ConclusionMagnetic resonance imaging should be performed to exclude intracranial relapse if sudden deafness develops in a patient with NPC within 5 years after irradiation.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo assess the safety and efficacy of upper eyelid gold weight implants in managing paralytic lagophthalmos and to compare two surgical techniques for their insertion.Study DesignRetrospective case series.SettingTertiary referral center.PatientsOne hundred four patients had a gold weight implanted for paralytic lagophthalmos between 1982 and 1996 at the Royal Prince Alfred Hospital in Sydney. Each patient had more than 2 years of follow-up of lid load function.Main Outcome MeasuresThe effectiveness of gold weights in reanimating eyelid closure, mean duration of gold weight retention, reasons for removal, and complications resulting from a gold weight; these outcomes were also compared using two surgical techniques for gold weight insertion.ResultsOne hundred three patients maintained corneal integrity. At the time of assessment, 46 patients had had their lid loads removed from their eyelids, and 58 lid loads remained in situ. Of the lid loads that were removed, 78% were because the facial nerve had recovered. The remaining 22% were removed because of cosmetic dissatisfaction (7 patients), the lid load becoming too superficial (6 patients), migration (3 patients), partial extrusion (1 patient), and ptosis resulting from too heavy a weight (1 patient).ConclusionGold weights are well tolerated and effective in managing paralytic lagophthalmos. An open surgical technique with direct suture fixation of the gold weight to the tarsal plate produced fewer complications than inserting the lid load into a prefashioned tissue pocket in the preseptal space through a small lateral skin incision.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Study DesignA scholarly review of over 70 original papers from the late 19th and early 20th centuries.ResultsAlthough many neurotologists consider vestibular nerve section to be a recent innovation, eighth nerve division dates back to the dawn of intracranial surgery. Although surgery of peripheral nerves (e.g., repair after injury) is ancient, intracranial nerve surgery began in the latter part of the 19th century with fifth nerve division for tic douloureux. By analogy, it was reasoned that hyperactivity of the eighth nerve (initially tinnitus and later vertigo) could be relieved by dividing this nerve. In 1898, Fedor Krause (1856–1937) of Berlin attempted the first eighth nerve section. This patient, as did many during this era, died shortly after the operation. Most of the survivors had facial palsy. These innovative early surgeons used a variety of approaches, including the suboccipital, middle fossa, and transtemporal routes. After an initial burst of excitement during the first decade of the century, poor results led to few procedures being performed through the second and third decades. Throughout this era, there was much debate about the relative merits of labyrinthectomy (introduced by Milligan and Lake in 1904) as opposed to eighth nerve division. In the late 1920s, the prolific Walter E. Dandy (1886–1946) of Baltimore repopularized eighth nerve section and ultimately performed 607 procedures between 1927 and 1946. Although Dandy achieved a high vertigo control rate and reduced the mortality rate to <1%, he had a high rate of facial nerve weakness (9.1% transient, 4.2% permanent). Remarkably, the latter outcome was never published in his numerous papers on the subject, but was first revealed in a 1951 retrospective survey, which appeared some 5 years after his death. Selective division of the vestibular fibers was introduced by Kenneth G. McKenzie (1892–1963) of Toronto in 1931. At least 11 sizable series appeared in the literature before the introduction of microsurgical vestibular nerve section by William F. House (b. 1923) of Los Angeles in 1960.ConclusionsThe introduction and progressive refinement of eighth nerve section played a central role in the evolution of operative neurotology. Many of the most vigorous debates of recent years (e.g., the choice of operative route, the optimal site of division, and the relative role of inner ear surgery vs. nerve surgery) have antecedents in the controversies of the distant past.

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1531-7129    

出版商:OVID    

年代:2001

数据来源: OVID