Otolaryngology and head and neck surgery最新文献

The death rate of brain abscesses in a recently reported series is high, ranging from 36% to 50% of all cases. This paper reports experiences with ten cases of intracranial abscesses secondary to ear and sinus infections. Six of these abscesses are secondary to otitic infections with three of them located in the cerebellum. Two of the cerebellar abscesses are surgically drained through the temporal bone by the otologic surgeon, with close neurosurgical cooperation. Computerized axial tomography has revolutionized the treatment of intracranial abscesses optimizing the timing for medical and surgical management.

The purpose of this study was to assess the value of computerized axial tomography (CAT) in canine larynges that exhibit controlled surgical defects, and in 18 patients with biopsy-proved epidermoid carcinoma of the larynx who were studied prospectively. Five canine larynges with sequential surgical defects of 0 mm, 5 mm, 10 mm, and 15 mm were studied by CAT in order to evaluate our ability to identify defects in the thyroid cartilage. A 5-mm collimator with overlapping sections at 3-mm intervals and a 13-mm collimator with 5-mm overlapping sections were both used for each stage of the experiment. Results show significantly improved resolution with the 5-mm collimator compared with the 13-mm unit. In the human study group, results demonstrated excellent (100%) soft-tissue tumor site correlation. It appears from this study that we still lack a highly reliable radiographic technique for evaluating preoperatively with accuracy the integrity of the thyroid cartilage in the patient with carcinoma of the larynx.

The nutritional status of the patient with cancer of the head and neck is subject to multiple stress. The nutritional status of such a patient is an admixture of the patient's personal hygiene, his or her neoplasm, the treatment of his or her neoplasm, and the complications of such treatment. It has been suggested the restoration of positive nitrogen balance through aggressive nutritional hyperalimentation will restore immunocompetence, enhance the clinical response to treatment, and reduce the frequency of complications. Despite this anecdotal data, controlled studies are needed to show that significant benefit to the patient will justify the added costs of nutritional support in terms of manpower costs, additional days of hospitalization, and increased monies spent on elemental diets.

This review article summarizes the subject of neurolemmomas in and around the temporal bone and was written as a component paper for a symposium on surgery of the skull base. The paper primarily discusses solitary schwannomas of the facial nerve, vestibular schwannomas, and jugular foramen schwannomas relative to incidence, signs and symptoms, and preferential diagnostic and therapeutic options. General considerations such as multiple neurofibromatosis, current nomenclature, and malignancy are defined.

Cranial nerve injuries are common with skull base surgery. While injuries to the seventh and tenth cranial nerves can be corrected to satisfactory degrees, rehabilitation of the third, fourth, and sixth nerves is possible to only a limited degree. This study stresses the management of facial paralysis following skull base surgery and is based upon the author's experiences in dealing with 38 patients who suffered such a facial paralysis. The best results of rehabilitative surgical treatment were achieved with techniques that connect the central stump to the peripheral system. The time between nerve injury and repair was the most significant determinant of the success of the surgical procedure: when the nerve was repaired within three months of the injury, the best results were obtained; when the central stump was not available or the injury was more than two years old, repair was not as satisfactory. In the latter case the procedure of choice was the 12th-7th nerve hookup. Indications and results of facial nerve grafting, cross faciofacial nerve hookups, muscle swings, free muscle implantations, and eye reanimation techniques are discussed.

A thorough knowledge of the surgical anatomy of the sellar region is prerequisite to understanding the symptoms and the pathophysiology of diseases in this area. The differential diagnoses of sellar and parasellar lesions includes pituitary tumor, craniopharyngioma, carotid aneurysm, empty sellar syndrome, metastatic tumor, optic or hypothalamus glioma, meningioma, chordoma, mucocele, and bony tumor of the sphenoid sinus. The preoperative evaluation should encompass the consultations of an endocrinologist, an ophthalmologist, and a neurosurgeon.

IN a series of 1,354 cerebellopontine angle tumors treated at the Otologic Medical Group, approximately 10% were lesions other than acoustic neurinomas. Of the non-acoustic tumors, the majority were meningiomas, primary cholesteatomas, and neurinomas of other cranial nerves in the posterior fossa. Twenty-five other lesions were encountered; these rare tumors are the subject of this study. The benign tumors resemble acoustic neurinomas in appearance and in the method of treatment. Malignant tumors are characterized by rapid development of symptoms and are difficult to treat because of invasion of vital structures in the area.