Otolaryngology最新文献

Free dermal-fat-fascia grafts are used for subdermal augmentation in soft tissue or bony deficiencies resulting from surgical extirpation of cancer, congenitally arrested development, and trauma. The most important determinant for graft survival is the health of the recipient area and the volume of the graft. At least 70% resorption of these large grafts must be anticipated. Imitial overcorrection has some justification but may be self-defeating. Calcification of dermal-fat-fascia grafts, common in other areas of the body, does not appear to be a problem in the head and neck region. When possible, other types of augmentation procedures should be considered.

With the sole exception of the hair cells of the inner ear, where information is lacking, all special somatic afferent receptor cells have been shown to be dependent upon vitamin A for normal function. In view of the paucity of information on the role of vitamin A in the inner ear, three experiments were performed to examine this relationship. Temporal bone histopathology was studied in rats deprived of vitamin A. In a second experiment, vitamin A-deficient rats were maintained with vitamin A acid and the histopathology was studied under the light microscope. In the third experiment, a microfluorometric estimate of the content of vitamin A in the guinea pig cochlea was performed. A fluorescent compound with the exact spectral characteristics of vitamin A was found in the guinea pig cochlea at a concentration of 21.2 micrograms/gm, which is ten times the vitamin A concentration found in most other tissues.

Difficulty in assessment of potentiating interaction between noise-induced and kanamycin-induced injury of hearing is compounded by the great variability of intersubject response to the same drug dosage. However, in a given subject, response of the two cochleas to kanamycin intoxication may resonably be assumed to be symmetric. The present study was designed to utilize this similarity, in determining whether kanamycin intoxication would potentiate a normally subtraumatic noise stimulus. Under the experimental conditions outlined, it was found that after a dosage of 150 mg/kg/day of kanamycin given to a physiologic end point, normally subtraumatic noise caused consistent increas in hearing loss.

Eight hundred stapedectomies were analyzed to evaluate the long-term results with four prostheses. It was concluded that limitation of fenestra size played a most important part in the outcome of stapedectomy, especially in regard to the preservation of high-frequency bone conduction response over prolonged periods. Other advantages deriving from small fenestra stapedectomy included significantly fewer fistulae and severe sensorineural losses.

Amyotrophic lateral sclerosis is a progressive dengenerative neuromuscular disease of insidious onset. It involves upper and lower motor neurons and causes both spastic and atrophic muscular symptoms. More than one fourth of patients have complaints relating to the head and neck (bulbar palsy); thus, the otolaryngologist may be the first physician to see them. Predominant symptoms are slurred speech, hoarseness, dysphagia, and dyspnea. Muscular weakness, atrophy, and fasciculation are noted on examination. The course is relentless, and only 20% of patients survive five years after diagnosis.

A standard photoplethysmography, modified to differentiate between arterial and venous vasculature in skin tissue, has been used to measure arterial supply in 100 unipedicle skin flap in 25 pigs. A datum transform from a light intensity scale to a relative arterial blood density scale has been introduced and empirically labeled the vascular coefficient (VC). Statistical analysis of the VC data shows a significant difference between necrotic and surviving flap group mean data as early as 24 hours. Additional analysis in which a normal ogive was fitted to the sample VC data distributions suggests that statistically significant predictions of the probability of eventral flap necrosis can be made using VC measurements obtained immediately postoperatively. It is concluded that the modified photoplethysmograph, in conjunction with the VC data transform constitutes a usable measuring technique for skin flap viability prediction in the experimental animal.

Acute coalescent mastoiditis is an uncommon sequela of acute otitis media. It occurs principally in the well-pneumatized temporal bone. The findings of fever, pain, postauricular swelling, and otorrhea are classic. Cholesteatoma, on the other hand, being associated with chronic infection, usually occurs in the sclerotic temporal bone. The signs and symptoms are isidious in nature and consist of chronic discharge and hearing loss which result from its mass, bone erosion, and secondary infection. Of 17 consecutive cases of acute mastoiditis over a six-year period, four were atypical because they were complications of chronic otitis media and cholesteatoma, yet they had the physical findings of acute mastoiditis-subperiosteal abscess and purulent otorrhea, plus radiographic evidence of mastoid coalescence.

Only 12 cases of nasal hemangiopericytoma have been reported in the literature. Ten additional cases are presented herein. Surgical excision is the recommended treatment; cryosurgery was used in one of our patients. Four of the tem patients had recurrences, one of which proved to be malignant (with distant metastases to the lung) and was ultimately fatal.