Faculty Bibliography

OBJECTIVE:To review the classification of fungal sinusitis as well as discuss current approaches to diagnosis and management. DATA SOURCES: A MEDLINE literature search was performed using the index terms sinus infection, fungal, diagnosis, radiology, microbiology, and treatment. The search was restricted to the English language and human subjects. With one exception the references were restricted to the last 10 years. Clinical data from studies performed at our institution were also included. RESULTS: Fungal sinusitis can be divided into four primary categories: (1) acute/fulminant (invasive), (2) chronic/indolent (invasive), (3) fungus ball, and (4) allergic fungal sinusitis. Each subtype has unique immunologic, pathologic, and clinical features. Allergic fungal sinusitis is the most recently described and most common form. The treatment and prognosis of fungal sinusitis varies significantly among the four different categories. CONCLUSION: Recent advances in endoscopy and computed tomography have enhanced the understanding of fungal sinusitis; however, they remain diseases surrounded by controversy. New insights into the etiology and pathogenesis of these diseases along with advances in diagnosis and treatment will lead to improved medical therapy

Although root fractures are among the less common oral injuries (6 percent), a careful diagnostic evaluation of such injuries is required to arrive at an appropriate treatment plan. The position of the fracture in the root will determine the proper management. The problem of luxation due to trauma often involves the use of dental splints, which, if not properly designed, may cause root resorption, loss of alveolar bone, pulpal necrosis and pulp canal obliteration. The guidelines for the type of splint to use and conditions under which it should be placed are presented

The presence of dysphagia, drooling, and stridor in an adult subsequent to thermal or caustic injury should alert the treating physician to the possibility of injury to the supraglottic structures with resultant epiglottitis. These adults possess many of the features seen in acute infectious epiglottitis and should be handled with the same consideration for potential upper airway obstruction. Epiglottic injuries of this type should be suspected in adults with mental disorders or communication difficulties

The association between early otitis media, styles of primary caregivers, and language development was prospectively examined in 26 2-year-old children from lower socioeconomic backgrounds (of mixed perinatal status) followed prospectively since birth. Based on otoscopic evaluations during the first year of life, there were 14 children who were classified as bilaterally otitis-free (OM-) and 12 children who were classified as bilaterally otitis-positive (OM+). At 2 years of age, all children were administered standardized measures of cognitive and language function along with a 20-minute videotaped play session with one of their primary caregivers. The language of both the children and caregivers was analyzed. Results indicate that caregivers of OM+ and OM- children used language nearly identically when interacting with their children. However, caregivers of OM+ children whose communication style was marked by a high percentage of directives and a corresponding low percentage of both questions and information-giving had the children with the lowest scores on all measures of naturalistic language. Controlling for neonatal illness did not alter the relationships found. The results suggest that caregiver language may compensate for some of the auditory deprivations associated with otitis media.

We have previously shown that inhibitory afferents regulate dendrite size in the gerbil lateral superior olive (LSO) during the first 3 postnatal weeks. To determine how rapidly this effect occurs, we performed unilateral cochlear ablations at one week postnatal, and LSO neurons were filled with biocytin-containing whole cell electrodes in the acute brain slice preparation. The manipulation leads to excitatory denervation in the ipsilateral LSO, and inhibitory denervation in the contralateral LSO. Filled neurons were analyzed with a computer-based morphometric system at 1 to 6 days after the manipulation. For all contralateral neurons examined there was a significant increase in the total number of dendritic branches and the total dendritic length, as compared to control neurons. A time-course analysis of the change in branch points showed that inhibition exerted its effect with a latency of 2-3 days. Excitatory denervation led to a significant reduction in soma size, although dendrites neither shrank nor expanded. Since cochlea removal was performed 5 days before sound-evoked activity began, the hypertrophy of the contralateral LSO neurons indicates that trophic modulation may be attributed to spontaneous inhibitory synaptic transmission

Cutaneous squamous cell carcinoma has a relatively low metastatic rate (0.5% to 16%), but patients with the disease should always be evaluated for possible regional nodal involvement. We reviewed the records of 37 patients with metastatic disease among the 388 patients with head and neck cutaneous squamous cell carcinoma who were treated at New York University Medical Center between 1961 and 1992. In this group of patients the most common primary sit was the cheek or preauricular region and the most common metastatic site was the level I neck lymph nodes. Seven patients (18%) had metastases at initial presentation. Among the remaining patients the average time to the development of metastases was 19 months. Nineteen patients (51%) had recurrence at the primary site before metastasis; 11 (30%) developed metastases with control of the primary tumor. Analysis of the records of 31 patients treated for cure revealed that 13 were treated by surgery, 2 by radiation therapy, and 16 by a combination of surgery and radiation therapy. During the mean follow-up period of 49 months, 11 (35%) of these 31 patients died of their disease. Recurrence of the primary tumor appeared to increase the risk for nodal and distant metastases

BACKGROUND: Tamoxifen, a nonsteroidal estrogen agonist-antagonist, is used in the treatment of breast cancer. CASE: A postmenopausal woman, aged 73, while being treated with Tamoxifen, developed continuous growth of her myomatous uterus, became symptomatic and required surgery. CONCLUSION: Tamoxifen at a dose of 40 mg/d has been associated with endometrial carcinoma. The growth of myomas seen with Tamoxifen in this patient seems to be a result of its direct agonist properties.

PURPOSE/OBJECTIVE:This cadaver dissection studied the relationship of the buccal branch of the facial nerve to the parotid duct and its relevance to surgical procedures in this area. MATERIALS AND METHODS/METHODS:Ten cadaveric heads (twenty sides) were dissected. The superficial tissues were removed, and the buccal branch of the facial nerve and the parotid duct were identified. The vertical and horizontal relationships were recorded and analyzed. RESULTS:Eighty-five percent of the cadavers had a single buccal branch of the facial nerve, whereas 15% had two branches. In 75% of cases, the nerve was inferior to the duct as it emerged from the parotid gland, whereas in 25% of cases the nerve crossed the duct, usually from superior to inferior. CONCLUSION/CONCLUSIONS:The buccal branch of the facial nerve has a close relationship with the parotid gland for over 2.5 cm after it emerges from the parotid gland; it normally lies inferior to the duct. This relationship is of importance in performing parotid gland surgery, parotid duct surgery, and some facial cosmetic surgery.