Faculty Bibliography

Restoration of the posterior maxilla involving sinus bone grafting demonstrates both surgical and prosthetic problems that treating clinicians should recognize and explain to patients prior to any invasive treatment. If a sinus graft is lost, the alternatives to treatment are explained. However, if the practitioners follow a step-by-step protocol and use retrievable prostheses, a long-term, favorable prognosis results.

BACKGROUND: Bilateral cleft lip-cleft palate is associated with nasal deformities typified by a short columella. The authors compared nasal outcomes of cleft patients treated with banked fork flaps to those of patients who underwent nasoalveolar molding and primary retrograde nasal reconstruction. METHODS: A retrospective review of 26 consecutive patients with bilateral cleft lip-cleft palate was performed. Group 1 patients (n = 13) had a cleft lip repair and nasal correction with banked fork flaps. Group 2 patients (n = 13) had nonsurgical columellar elongation with nasoalveolar molding followed by cleft lip closure and primary retrograde nasal correction. Group 3 patients (n = 13) were age-matched controls. Columellar length was measured at presentation and at 3 years of age. The number of nasal operations was recorded to 9 years. The Kruskal-Wallis and Tukey-Kramer tests were used for statistical analysis. RESULTS: Initial columellar length was 0.49 +/- 0.37 mm in group 1 and 0.42 +/- 0.62 mm in group 2. Post-nasoalveolar molding columellar length was 4.5 +/- 0.76 mm in group 2. By 3 years of age, columellar length was 3.03 +/- 1.47 mm in group 1, 5.98 +/- 1.09 mm in group 2, and 6.35 +/- 0.99 mm in group 3. Group 2 columellar length was significantly greater (p < 0.001) than that of group 1 and not statistically different from that of group 3 (p > 0.05). All group 1 patients (13 of 13) needed secondary nasal surgery. No nasoalveolar molding patients (zero of 13, group 2) required secondary nasal surgery. CONCLUSION: Nonsurgical columellar elongation with nasoalveolar molding followed by primary retrograde nasal reconstruction restored columellar length to normal by 3 years and significantly reduced the need for secondary nasal surgery.

BACKGROUND: Histologic diagnosis of mucosal melanoma of the head and neck is difficult, requiring immunohistochemical stains which are less reliable than in cutaneous lesions. PNL-2 is a novel marker that has not been examined in mucosal melanoma. METHODS: Nine formalin-fixed tissue sections of mucosal melanoma were stained with PNL-2, human melanoma black (HMB)-45, Melan-A, S-100, and microphthalmia transcription factor (MITF). RESULTS: Disease in all 9 patients arose from the sinonasal mucosa. Rates of diffuse positive staining with the 4 stains were PNL-2 (77.8%), HMB-45 (77.8%), Melan-A (50%), S-100 (87.5%), and MITF (40%). In 3 patients, PNL2 staining was superior to Melan-A or MITF. CONCLUSION: We report the first characterization of PNL-2 staining in head and neck mucosal melanoma. PNL-2 demonstrates high sensitivity for mucosal melanoma, likely superior to Melan-A and MITF, and comparable to HMB-45, with specificity superior to S-100. We advocate inclusion of PNL2 as an important adjunctive marker in the evaluation of these lesions. (c) 2008 Wiley Periodicals, Inc. Head Neck, 2008

Reconstruction of small and medium-sized defects of the nose poses a challenge to the facial plastic surgeon. Flaps for small to medium-sized defects most often are closed in single-staged procedures as opposed to larger-sized defects. A variety of techniques can be used including secondary intention, primary closure, full-thickness skin grafts, composite grafts, rhomboid flaps, bilobe flaps, dorsal nasal flaps, island flaps, and inferiorly based meliolabial flaps

OBJECTIVE: To assess word recognition and pitch-scaling abilities of cochlear implant users first implanted with a Nucleus 10-mm Hybrid electrode array and then reimplanted with a full length Nucleus Freedom array after loss of residual hearing. BACKGROUND: Although electroacoustic stimulation is a promising treatment for patients with residual low-frequency hearing,a small subset of them lose that residual hearing. It is not clear whether these patients would be better served by leaving in the 10-mm array and providing electric stimulation through it, or by replacing it with a standard full-length array. METHODS: Word recognition and pitch-scaling abilities were measured in 2 users of hybrid cochlear implants who lost their residual hearing in the implanted ear after a few months. Tests were repeated over several months, first with a 10-mm array, and after, these patients were reimplanted with a full array. The word recognition task consisted of 2 50-word consonant nucleus consonant (CNC) lists. In the pitch-scaling task, 6 electrodes were stimulated in pseudorandom order, and patients assigned a pitch value to the sensation elicited by each electrode. RESULTS: Shortly after reimplantation with the full electrode array, speech understanding was much better than with the 10-mm array. Patients improved their ability to perform the pitch-scaling task over time with the full array, although their performance on that task was variable, and the improvements were often small. CONCLUSION: 1) Short electrode arrays may help preserve residual hearing but may also provide less benefit than traditional cochlear implants for some patients. 2) Pitch percepts in response to electric stimulation may be modified by experience

OBJECTIVES: This study compares normal and pathologic voices using a novel voice analysis algorithm that examines pitch deviation during connected speech. The study evaluates the clinical potential of the algorithm as a mechanism to distinguish between normal and pathologic voices using connected speech. METHODS: Adult vocalizations from normal subjects and patients with known benign free-edge vocal fold lesions were analyzed. Recordings had been previously obtained in quiet under controlled conditions. Two phrases and sustained /a/ were recorded per subject. The subject populations consisted of 10 normal and 31 abnormal subjects. The voice analysis algorithm generated 2-dimensional patterns that represent pitch deviation in time and under variable window widths. Measures were collected from these patterns for window widths between 10 and 250 ms. For comparison, jitter and shimmer measures were collected from sustained /a/ by means of the Computerized Speech Lab (CSL). A t-test and tests of sensitivity and specificity assessed discrimination between normal and abnormal populations. RESULTS: More than 58% of the measures collected from connected speech outperformed the CSL jitter and shimmer measures in population discrimination. Twenty-five percent of the experimental measures (including /a/) indicated significantly different populations (p < .01%). CONCLUSIONS: The results demonstrate that the algorithm distinguishes between normal and abnormal populations by use of samples of connected speech

OBJECTIVE: To review and summarize the current literature on transnasal esophagoscopy, and to compare information with conventional esophagoscopy. DATA SOURCES: Medline (Ovid), book chapters. REVIEW METHODS: A thorough review of the literature using the Medline database was performed with the following search terms: esophagoscopy, transnasal esophagoscopy, ultrathin endoscopy, and esophagoscope. RESULTS: The literature seems to support the equivalence of transnasal esophagoscopy and conventional esophagoscopy in image quality and diagnostic capability. It also points to some potential advantages of transnasal esophagoscopy. CONCLUSIONS: Transnasal esophagoscopy is a useful tool for accurate diagnosis and can be used in a variety of office procedures

We have shown previously that auditory experience regulates the maturation of excitatory synapses in the auditory cortex (ACx). In this study, we used electron microscopic immunocytochemistry to determine whether the heightened excitability of the ACx following neonatal sensorineural hearing loss (SNHL) also involves pre- or postsynaptic alterations of GABAergic synapses. SNHL was induced in gerbils just prior to the onset of hearing (postnatal day 10). At P17, the gamma-aminobutyri acid type A (GABA(A)) receptor's beta2/3-subunit (GABA(A)beta2/3) clusters residing at plasma membranes in layers 2/3 of ACx was reduced significantly in size (P < 0.05) and number (P < 0.005), whereas the overall number of immunoreactive puncta (intracellular + plasmalemmal) remained unchanged. The reduction of GABA(A)beta2/3 was observed along perikaryal plasma membranes of excitatory neurons but not of GABAergic interneurons. This cell-specific change can contribute to the enhanced excitability of SNHL ACx. Presynaptically, GABAergic axon terminals were significantly larger but less numerous and contained 47% greater density of glutamic acid decarboxylase immunoreactivity (P < 0.05). This suggests that GABA synthesis may be upregulated by a retrograde signal arising from lowered levels of postsynaptic GABA(A)R. Thus, both, the pre- and postsynaptic sides of inhibitory synapses that form upon pyramidal neurons of the ACx are regulated by neonatal auditory experience