Faculty Bibliography

The severity of deafness can obscure the presence of other disabilities that may accompany genetic anomalies, such as occur in Alport and Usher syndromes. Recent advances in genetics have heightened attention to various disabilities and dysfunctions that may coexist with deafness. Failure to recognize these additional disabilities when they occur can misguide educational planning; may open the afflicted deaf person to failure to identify, diagnose, and manage potentially serious health conditions; and in some instances may even lead to loss of life. Of the many genetic conditions that have been identified, a few examples are cited to illustrate the need to inform parents, educators, and other caregivers about the importance of obtaining genetic information.

In previous works, the authors showed that using robot-assisted steerable electrode array insertions can significantly reduce the insertion forces compared to non-steerable electrode arrays. In addition to steering the electrode array, it is possible to change its angle of approach with respect to the scala tympani. This paper focuses on determining the relevance of changing the angle of approach of the electrode array by comparing steerable electrode array insertions using a two Degrees-of-Freedom (DoF) robot versus a four DoF robot. Optimal insertion path planning strategies are presented for both two and four DoF insertions. Simulation results and experiments show that the four DoF insertions can improve over two DoF insertions. Moreover, changing the angle of approach can further reduce the insertion forces. The simulation results also provide the workspace requirements for designing a custom parallel robot for robot-assisted cochlear implant surgery

PURPOSE OF REVIEW: The purpose of this article is to review the history of vocal fold injection augmentation and provide a thorough description of the percutaneous thyrohyoid approach to office-based vocal fold injection augmentation for the management of glottic incompetence. RECENT FINDINGS: A number of techniques for vocal fold injection augmentation have been developed since the first procedure was performed. Since vocal fold injection augmentation is performed without an open surgical approach, morbidity is reduced and the technique can be done in the outpatient setting. Accordingly, over the past decade there has been an effort to perfect techniques and to develop new materials and methods to make the procedure more effective and comfortable for the patient. SUMMARY: Recently, office-based vocal fold injection augmentation has gained significant popularity among laryngologists. While there are a variety of in-office injection techniques, the thyrohyoid approach, in the authors' opinion, is the simplest and best tolerated. This technique is effective and eliminates many of the shortcomings of the other approaches. This approach continues to be the 'workhorse' for in-office vocal fold injection augmentation in the senior author's practice. It is important, however, for any practitioner to be familiar with the other approaches, as this technique is not universally effective for all patients

Oral health care professionals could drastically improve the quality of life for patients with potentially malignant oral lesions by using a noninvasive test that could be used to detect cancer using saliva. Promoter DNA hypermethylation is a critical step in oral carcinogenesis and has a number of significant advantages over genetic and protein diagnostic markers. Methylight is a recently developed assay that rapidly quantifies promoter hypermethylation and could potentially be applied into a clinical setting

The aim of this study was to validate the published University of California San Francisco (UCSF) Oral Cancer Pain Questionnaire. To test for validity of the questionnaire, 16 patients with oral cancer completed the 8-item questionnaire immediately before and after treatment (surgical resection) of their oral cancer. For all 8 questions, the difference between mean preoperative and mean postoperative responses were statistically significant (P < .05), confirming the validity of the questionnaire to measure oral cancer pain. Internal consistency of the questionnaire was evaluated by using Cronbach's alpha, which provides an estimate of reliability based on all correlations between the items (questions) of the instrument (questionnaire). In the oral cancer pain questionnaire, questions 1, 3, and 5 evaluate the intensity, sharpness, and throbbing nature of pain when the patient is not engaged in oral function (talking, eating, and drinking). Questions 2, 4, and 6 measure the intensity, sharpness, and throbbing nature of pain during oral function. Cronbach's alpha for questions 1, 3, and 5 is 0.87 and Cronbach's alpha for questions 2, 4, and 6 is 0.94; values greater than 0.7 indicate reliability. In this study, we have validated the UCSF Oral Cancer Pain Questionnaire as an effective tool in quantifying pain from oral cancer. PERSPECTIVE: The study validates an oral cancer pain questionnaire. The questionnaire can be used to reliably measure pain levels before and after surgical resection in patients with oral cancer

Inflammatory myofibroblastic tumor is a recently characterized lesion, composed of exuberant myofibroblastic proliferation and an inflammatory component. Its etiology remains controversial, as to whether this represents a benign tumor with limited potential to recur or progress. Exaggerated response to trauma or infection has also been implicated. Only a few cases of laryngeal inflammatory myofibroblastic tumor have been described in English after it has been assigned the new name. The prototype lesion, inflammatory pseudotumor, has been best described in association with the lung but has also been reported involving various organs. We report 2 additional cases with a considerable variation in the presentation and histology of the lesion, thus expanding the morphological spectrum of the entity. Both lesions appeared aggressive in clinical presentation. One case had relatively more pleomorphic appearance and increased mitotic rate. Both lesions were surgically resected, and complete voice preservation was achieved. No postoperative complications or recurrence were noticed. This uncommon neoplasm may appear clinically as a large infiltrating mass and may be mistaken as a malignant growth. Conservative resection of the tumor may provide a cure with adequate voice preservation.

BACKGROUND: Minimally invasive esophagectomy (MIE) via thoracoscopy and laparoscopy have reduced the morbidity and mortality of total esophagectomy at experienced centers. MIE has not been evaluated in combination with major head and neck surgery, or in the otolaryngology literature. METHODS: Case series of 11 consecutive patients undergoing either open or MIE with an ablative neck procedure. RESULTS: Comparing 4 MIEs and 7 open operations, similar operative time, blood loss, and ICU and hospital length of stay were observed. There was one mortality in the open group. A 100% rate of major complications was observed in the MIE group. CONCLUSION: Our multidisciplinary team was unable to achieve improved outcomes in a series of head and neck surgical patients undergoing MIE. This result may represent an early stage of the learning curve for MIE, but may also be attributed to the escalated surgical requirements of head and neck patients

Penetrating trauma to the face and upper zone III of the neck may present unique challenges when the parotid gland and associated neurovascular structures are involved. We report a case of massive hemorrhage from penetrating neck trauma that necessitated emergency parotidectomy for vascular exposure. Facial nerve repair was also necessary, underscoring the importance of this approach not only for successful vascular control but also for preservation of nearby vital structures. The management of penetrating trauma to the parotid region,and relevant anatomy, are discussed

OBJECTIVE: To evaluate the clinical presentation, operative findings, and surgical management of patients with spontaneous middle fossa encephalocele (SMFE) and cerebrospinal fluid (CSF) leakage repaired using a middle fossa craniotomy (MFC) approach. STUDY DESIGN: Retrospective. SETTING: Tertiary referral center. PATIENTS: Fifteen consecutive patients with 16 SMFE repaired using an MFC approach between January 1999 and April 2006 were included. INTERVENTIONS: Patients were evaluated clinically and radiologically with computed tomography or magnetic resonance imaging. Encephaloceles were approached via MFC, and the cranial base was repaired in multilayered fashion using a variety of materials, including hydroxyapatite cement. Patients were followed clinically after discharge. MAIN OUTCOME MEASURES: Postoperative complications, including CSF leak and the need for surgical revision, are evaluated. Patient factors, diagnostic testing, and operative findings are reviewed. RESULTS: Diagnosis was made using clinical and radiologic evaluation in most patients. Beta2-transferrin testing was occasionally used in the diagnostic workup. Intraoperatively, multiple defects of the floor of the middle fossa were found in more than half of patients. Fifteen SMFE in 14 patients were successfully repaired via MFC alone. One patient required revision with a combined transmastoid/MFC approach due to recurrent CSF leakage. Hydroxyapatite cement was used for repair of the cranial base in 9 patients without complication. CONCLUSION: An MFC approach can be used to repair SMFE with CSF leakage with a high level of success. Hydroxyapatite cement is a safe and useful adjunct to aid in reconstruction of the cranial base defects in cases of SMFE.