Faculty Bibliography

OBJECTIVE: To prospectively evaluate the hearing results in surgically treated cases of stapes fixation in patients with osteogenesis imperfecta. STUDY DESIGN: A prospective study of osteogenesis imperfecta patients with stapes fixation. SETTING: One tertiary referral center. PATIENTS: Eighteen patients (23 ears) who underwent stapes surgery from 1994 to 2004 were prospectively included. INTERVENTION: Stapedotomy with vein graft interposition and reconstruction with a Teflon piston or a bucket handle (cup) prosthesis. MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone-conduction thresholds, and air-conduction thresholds were measured. Postoperative audiometry was performed at 6, 9, 12, 18, and 24 months after surgery and at a yearly interval thereafter. RESULTS: Overall, a postoperative air-bone gap closure to within 10 dB was achieved in 85.7% of cases. Postoperative improvement of air-conduction thresholds superior to 20 dB was found in 57% of cases. The postoperative bone-conduction thresholds were unchanged. CONCLUSION: This study shows that safe and successful stapedotomy is possible in cases of stapes fixation in patients with osteogenesis imperfecta.

OBJECTIVE: To report an original method of ossicular reconstruction with intact stapes and absent malleus. Ossiculoplasty is performed with a total ossicular replacement prosthesis positioned from the stapes footplate to the under-surface of the tympanic membrane, using a Silastic banding technique to stabilize the prosthesis. STUDY DESIGN: A prospective study of ossicular reconstruction using the Silastic banding technique. A consecutive series of cases with intact stapes superstructure and missing malleus handle (Austin-Kartush Group C) is presented. SETTING: One tertiary referral center. PATIENTS: Ninety-nine patients who underwent total ossicular reconstruction with Silastic banding technique were enrolled in the study from January 2000 to December 2002. INTERVENTIONS: Ossiculoplasty with total ossicular replacement prostheses with Silastic Rubber Band for chronic otitis media and non-inflammatory disease. MAIN OUTCOME MEASURES: Preoperative and postoperative audiometric evaluation using conventional audiometry. Air-bone gap, bone-conduction threshold, and air-conduction threshold were assessed. Postoperative audiometry was performed at the 6th, 9th, 12th, 18th, 24th, and 36th months. RESULTS: Overall, a postoperative air-bone gap closed to within 10 dB was achieved in 61.5% of cases. An air-bone gap smaller than 20 dB was obtained in 77% of cases. Postoperative improvement of air-conduction thresholds by at least 20 dB was found in 51% of cases. There was no case of postoperative sensorineural hearing loss. One case of extrusion of the prosthesis was seen (1%). CONCLUSION: Stabilizing the total ossicular replacement prosthesis with the Silastic banding technique when performing ossicular reconstruction is a safe, effective method when the stapes supra-structure is present and the malleus absent.

Synchronous activity is common in the neocortex, although its significance, mechanisms, and development are poorly understood. Previous work showed that networks of electrically coupled inhibitory interneurons called low-threshold spiking (LTS) cells can fire synchronously when stimulated by metabotropic glutamate receptors. Here we found that the coordinated inhibition emerging from an activated LTS network could induce correlated spiking patterns among neighboring excitatory cells. Synchronous activity among LTS cells was absent at postnatal day 12 (P12) but appeared abruptly over the next few days. The rapid development of the LTS-synchronizing system coincided with the maturation of the inhibitory outputs and intrinsic membrane properties of the neurons. In contrast, the incidence and magnitude of electrical synapses remained constant between P8 and P15. The developmental transformation of LTS interneurons into a synchronous, oscillatory network overlaps with the onset of active somatosensory exploration, suggesting a potential role for this synchronizing system in sensory processing.

The technique of endoscopic transnasal, nontransseptal, transsphenoidal pituitary surgery is gaining increasing popularity. Many pituitary surgical teams consider it the procedure of choice. It provides a rapid and safe approach to the sella turcica. Within the sella turcica, the endoscopes give the surgeon the ability to inspect around the corner and to remove residual tumor. The procedure avoids the complications related to the sublabial transeptal approach. Hospital stay is shorter

OBJECTIVES: To identify presenting symptoms, growth patterns, and outcomes of head and neck plexiform neurofibromas (PNs) in children with neurofibromatosis type 1 (NF-1); to determine which patients may benefit most from operative intervention in terms of duration of disease-free progression, perioperative morbidity, identification of malignancy, and symptom relief. DESIGN: A retrospective review of 39 pediatric patients with NF-1 who had PNs of the head and neck managed at a single tertiary referral center. RESULTS: Thirty-nine patients had 49 head and neck PNs, 11 small (<or=5 cm) and 38 massive (>5 cm and/or involving multiple deep neck sites). Thirty-nine surgical procedures were performed on 18 of 35 patients with massive disease, and 4 procedures were performed on 4 of 11 patients with small tumors. Tumors recurred in 1 (25%) of 4 patients with small tumors and in 18 (100%) of 18 patients with massive tumors (P = .001; mean time to regrowth, 3.1 years.) CONCLUSIONS: Size and location of PN tumors most influenced presentation of clinical symptoms. Complete tumor resection was possible only in patients with small PNs. Patients with PNs of the head and neck were more likely to benefit from surgery if the indications were to (1) exclude malignancy in a rapidly enlarging mass; (2) provide relief from neurogenic pain or motor weakness; (3) improve symptoms caused by airway compression; or (4) enhance cosmesis in those with disfiguring disease

OBJECTIVES AND HYPOTHESIS: This study has the specific aim of evaluating the insertion characteristics of a new cochlear implant electrode. Techniques for evaluation of fluoroscopic real time mechanical insertion dynamics, histologic electrode position and trauma results, hydraulic force, and mechanical insertion forces are presented. In addition, this study should serve to present a novel model for cochlear implant electrode insertion evaluations. STUDY DESIGN: Prospective analysis using a series of analytical techniques. METHODS: All studies are conducted in fixed cadaveric temporal bones. Real time fluoroscopic insertion evaluations, histologic evaluations for trauma and electrode position in embedded bones, hydraulic measures, and mechanical intracochlear force measurements are conducted with a current and new electrode. RESULTS: The Contour Advance electrode provides a more reliable and less traumatic insertion when deployed with the Advance Off Stylet technique. This is largely because of a reduction in intracochlear outer wall force generation. Fluoroscopic and histologic analysis reveal a smooth insertion without reliance on cochlear outer wall contact. No hydraulic forces were detected when measured from the superior semicircular canal ampulla. CONCLUSION: The model used for this study provides valuable information to cochlear implant surgeons and design engineers. The Contour Advance electrode, inserted with the Advance Off Stylet technique, represents an improvement over the Contour electrode inserted with the standard insertion technique

An understanding of normal CSF physiology is a prerequisite to treating problems such as CSF fistulae and pseudomeningoceles. CSF diversion techniques fall into two categories, external and internal. External lumbar drainage is useful when temporary CSF diversion is necessary (eg, in cases necessitating manipulation and retraction of the brain to gain access to deep lesions) and in treating otorrhea or rhinorrhea following traumatic or iatrogenic insults to the cranial base. Drawbacks include insertion discomfort and limited duration of therapy.LP and VP shunts came into widespread use in the 1970s, and both systems share risks of bowel perforation, obstruction, over drainage and wound-related complications. In addition, VP shunts add the risks of intracerebral hematoma and ventriculitis. New valve technology has made it possible to alter the volume drained, thus alleviating problems of over-and under drainage.

The deep plane face-lift is a safe and reliable technique for treatment of the aging face. It affords improvement in the lower face and midface. The use of fibrin glue in the face-lift has improved the healing and recovery of patients

BACKGROUND:Metastatic adenocarcinoma of the colon is a frequently encountered medical situation. Metastasis to the mandible from adenocarcinoma of the colon is very unusual and rarely reported. We report the case of a 73-year-old man with metastatic adenocarcinoma to the mandible. METHODS:The patient was referred for evaluation of a mass of 2 months' duration in the right parotid gland. He gave a history of watery bowel movements of unknown duration. Physical examination revealed a 7- x 6-cm hard mass, which seemed to be fixed to the right mandible. A CT scan revealed a destructive process involving the ramus and condyle of the right mandible that invaded the pterygopalatine fossa, pterygoid muscles, and middle cranial fossa. CT scans of the abdomen and pelvis revealed a 5-cm mass in the sigmoid colon with metastases to the liver. RESULTS:A biopsy of the mass in the mandible was performed, and metastatic adenocarcinoma of colonic origin was diagnosed. Colonoscopy and biopsy of the colonic mass substantiated that the sigmoid colon was the primary site of the cancer. Because the patient had disseminated disease, he declined treatment, and he died shortly thereafter. CONCLUSIONS:Although rare, metastatic adenocarcinoma from the colon to the mandible and parotid area should be included in the differential diagnosis of masses in this area. After analysis of our case and a review of the literature, we conclude that metastasis from adenocarcinoma of the colon is quite rare and represents incurable disseminated disease.