Faculty Bibliography

We previously demonstrated that noxious peripheral stimulation (e.g. subdermal capsaicin injection in the hind paw) produces antinociception that is mediated by opioid receptors in nucleus accumbens. The current study used the trigeminal jaw-opening nociceptive reflex responses in the rat to assess the role of intra-accumbens mu-, delta- and kappa-opioid receptors in the antinociceptive effect of noxious stimulation and intra-accumbens opioid agonism. Whilst intra-accumbens injection of either the mu-receptor-selective antagonist Cys2,Tyr3,Orn5,Pen7amide (CTOP) or the delta-receptor-selective antagonist naltrindole blocked capsaicin-induced antinociception, neither the selective mu-agonist [D-Ala2,N-Me-Phe4,Gly5-ol]-enkephalin (DAMGO; 150 or 300 ng) nor the selective delta-agonist D-Pen2,5-enkephalin (DPDPE; 150 or 300 ng) alone induced antinociception. Simultaneous injection of DAMGO and DPDPE (150 ng each), however, produced significant antinociception. Capsaicin-induced antinociception was not blocked by the selective kappa-receptor antagonist nor-binaltorphimine, but was blocked by the kappa-agonist U69,593. U69,593 also antagonized the antinociceptive effect of the DAMGO/DPDPE combination. Thus, in nucleus accumbens, mu- and delta- but not kappa-opioid receptors contributed to capsaicin-induced antinociception; selective activation of individual receptor subtypes was insufficient, but coactivation of mu- and delta-opioid receptors induced antinociception, and kappa-receptors appeared to play an antianalgesic role in nucleus accumbens

PURPOSE: This article describes the use of the temporoparietal osteofascial flap (TOF) for reconstruction of bony defects in the midface and mandible. PATIENTS AND METHODS: We reviewed the demographics, etiology, indications, surgical technique, radiographic evaluation, and final outcome of 11 patients with upper or lower jaw defects who underwent reconstruction using the TOF between 1994 and 1999. RESULTS: The TOF was used to reconstruct a defect of the mandible in 7 patients, the hard palate in 2 patients, the maxilla in 1 patient, and the zygoma in 1 patient. The defect was a result of tumor resection in 9 patients and of trauma in 2 patients. The defect size ranged from 3 to 6 cm. Ten flaps (91%) were successful and 1 flap failed. There was 1 donor site complication (small dural tear) that was repaired immediately without sequelae. One patient had osseointegrated dental implants placed in the bone with good results. Exploration of the construction area was performed in 1 patient 13 months after surgery because of recurrent tumor. It showed a fully integrated bone flap. CONCLUSION: This vascularized calvarial bone flap can be used for the reconstruction of small to medium-sized defects of the maxilla and lateral mandible with good functional and cosmetic results. It can be performed without special microvascular expertise and with minimal donor site morbidity. A full-thickness bone flap can support osseointegrated dental implants

BACKGROUND: Squamous cell carcinoma of the tongue base can be treated with comparable control and survival rates when neck dissection (ND) is performed before radiation therapy (RT). METHODS: Fourteen patients were treated between 1990 and 2000. Tumor stage on presentation was: T2, 6; T3, 4; T4, 4. Average radiation dose was 7,268 cGy. Follow-up ranged from 2 to 11 years (median, 50 months). Ten patients (71.4%) who presented with cervical metastases underwent neck dissection. All neck dissections were performed prior to RT. RESULTS: The initial local control rate was 85.7%. The 10-year survival rate was 62.8%. Patients tolerated their procedure well and were ready for RT within 2 to 4 weeks. CONCLUSIONS: Our preliminary data indicate that our treatment protocol results in control and survival rates which are comparable with other regimens. It is our impression that in contrast to patients undergoing ND after radiation, our patients tolerated their initial ND well and were better prepared for the second part of the treatment. Future studies will use quality-of-life research methods to study this aspect of the treatment protocol

BACKGROUND: Complete circumferential pharyngoesophageal reconstruction has undergone remarkable changes and developments during the last three decades. Gastric transposition and microvascular techniques are the standards of care. However, in cases of failure, or where other factors such as severe comorbidities prevent the use of microvascular techniques, reconstruction with local flaps provide a reliable option. We have used the Wookey flap technique in six patients with complete circumferential loss of the pharynx and upper esophagus. To make the procedure more reliable, we added a 'delay' stage. METHODS: Retrospective review of charts of six Wookey-type reconstructions of the pharynx and upper esophagus done in our department at SUNY-HSC, Brooklyn, and The Long Island College Hospital. RESULTS: Five of the six patients had successful reconstruction of complete circumferential pharyngoesophageal resection. All five resumed oral alimentation. The flap failed in one patient. CONCLUSIONS: The Wookey flap may still provide surgeons with a 'last resort' reconstructive option after complete, circumferential pharyngoesophageal resection

Cartilaginous tumors of the larynx represent less than 1% of laryngeal tumors. Chondroma and 'low-grade' chondrosarcoma are the most common; 70%-75% of these tumors arise on the endolaryngeal surface of the posterior lamina of the cricoid cartilage. The clinical presentation is varied and directly dependent on the size and location of the tumor; stridor, hoarseness, dyspnea, or a neck mass are common presenting signs. CT scanning in the axial plane is the mainstay of radiographic imaging due to its ability to show size, extent of the tumor, and invasion into surrounding structures. Surgical extirpation is the standard therapy with no role for radiation therapy or chemotherapy. Although significant recurrence rates have been reported, there is not a significant difference between initial conservative therapy followed by salvage therapy versus initial radical therapy

Sarcoidosis is a systemic chronic granulomatous disease of unknown etiology. Although it most commonly affects African-Americans, Scandinavians, and the Irish, individuals of all races and ethnicities are susceptible. The otolaryngologist will most frequently encounter sarcoidosis involving the sinonasal region; however, other sites in the head and neck may be involved. Head and neck affliction with sarcoidosis most frequently accompanies pulmonary involvement, although, in rare cases, it may present in the absence of any systemic manifestations. We present a patient of Eastern European origin treated for persistent epiphora and recurrent dacryocystitis without any other medical problems. Because medical therapy and canalicular intubation failed, an endoscopic dacryocystorhinostomy (DCR) was performed. Histologic examination of the lacrimal sac showed noncaseating granulomas. Further workup revealed an elevated angiotensin-converting enzyme (ACE) level and hilar adenopathy. At no time did the patient have any other signs or symptoms of sarcoidosis. This unique case highlights 4 important issues for the otolaryngologist: (1) sarcoidosis may occur almost anywhere in the head and neck and is not strictly limited to the upper respiratory tract; (2) sarcoidosis may occur in the head and neck even in the absence of any pulmonary or other systemic involvement; (3) sarcoidosis may affect persons of all races, both sexes, and all ages; and (4) routine histopathologic examination after excision of the nasolacrimal sac is recommended

The power function exponent for loudness is traditionally determined by means of a process of magnitude estimation. It is demonstrated in this paper that the exponent can also be obtained by using the procedure of absolute identification of sound intensity. It has been shown that subjects' responses to tones of a given intensity are distributed in a normal distribution whose variance depends on the range, R, over which the tones are distributed. By means of a standard statistical transformation, the normal density in log space is converted to the corresponding probability density in linear space. The power function exponent can then be obtained directly from the linear probability density. We also suggest that there is a direct relationship between the information calculated from experiments on absolute identification of sound intensity and the neurophysiological, poststimulus histogram measured in a nerve fiber in the auditory nerve

The minimum age for cochlear implantation has been reduced to 12 months in an effort to provide auditory stimulation to children with hearing loss during early development. Because behavioral measures in such young children are limited, objective measures such as the electrically evoked compound action potential (EAP) from the auditory nerve are needed to facilitate measurement of stimulation level requirements. We assessed EAPs recorded by the Nucleus 24 neural response telemetry (NRT) system in children who underwent implantation between 12 and 24 months of age. We recorded EAPs in 37 such children (mean age at implantation, 18.1+/-3.6 months). The EAPs were of large amplitude, and thresholds fell between behavioral T and C levels. A correction factor applied to EAP thresholds provided useful predictions of T levels. The EAPs can be used to ensure that even very young children receive auditory stimulation with their cochlear implants upon device activation