Faculty Bibliography

Middle ear effusion (MEE), in its various forms, is one of the most common disorders of childhood. There are several possible etiologies, depending on the makeup of the effusion. However, the common factor in many middle ear effusions is eustachian tube dysfunction, and the role of allergy, although only one of many possible causes, is significant. A relatively large number of children with MEE are found to have atopic disorders. Nonetheless, allergy treatment alone must not preclude the use of conventional medical and surgical therapy. Optimal results will be obtained if recurrent or persistent MEE is managed in a coordinated manner by the otologist, pediatrician and allergist

BACKGROUND: Despite numerous refinements in microsurgical technique and instrumentation, the microvascular anastomosis remains one of the most technically sensitive aspects of free-tissue transfer reconstructions. MATERIALS AND METHODS: Concurrent with the development of microsurgical techniques, various anastomotic coupling systems have been introduced in an effort to facilitate the performance and reliability of microvascular anastomoses. The microvascular anastomotic coupling device (MACD) studied here is a high-density, polyethylene ring-stainless steel pin system that has been found to be highly effective in laboratory animal studies. Despite its availability for human clinical use over the last 5 years, reported clinical series remain rare. Our clinical experience with this MACD in 29 head and neck free-tissue transfers is reported herein. RESULTS: Thirty-five of 37 (95%) attempted anastomoses were completed with 100% flap survival with a variety of donor flaps, recipient vessels, and clinical contexts. Two anastomoses were converted to conventional suture technique intraoperatively, and one late postoperative venous thrombosis occurred after fistulization and vessel exposure. CONCLUSIONS: We conclude that the MACD studied here is best suited for the end-to-end anastomosis of soft, pliable, minimally discrepant vessels. Previous radiation therapy does not appear to be a contraindication to its use. Interpositional vein grafts may also be well suited to anastomosis with the device. When carefully and selectively employed by experienced microvascular surgeons, this MACD can be a safe, fast, and reliable adjunct in head and neck free-tissue transfer reconstructions, greatly facilitating the efficiency and ease of application of these techniques

An expanded polytef (polytetrafluoroethylene [ePTFE]) soft-tissue patch was used in nine patients to reconstruct postparotidectomy defects and prevent Frey's syndrome. All nine cases were constructed primarily using either a 1- or 2-mm-thick patch depending on the depth of the defect. All nine patients achieved excellent, nearly normal contour that approximates the uninvolved side. None complained of Frey's syndrome. Average follow-up to date is 12 months

The brachial plexus is a complex structure that arises from nerve roots in the neck and terminates by dividing into peripheral nerves in the axilla. Imaging the brachial plexus can be difficult because of this anatomy. MRI now is the imaging modality of choice in the evaluation of brachial plexopathy. T1-weighted axial and oblique coronal images supplemented by T-2 weighted or STIR images are a standard protocol. MRI can be used to diagnose nerve root avulsion, neuromas, tumor, and radiation fibrosis.

PURPOSE/OBJECTIVE:This study evaluated the relationship of the mandibular third molar to the lingual nerve. MATERIALS AND METHODS/METHODS:An anatomic dissection of the lingual nerve in the third molar region was done on 20 cadavers (40 sides). RESULTS:The position of the nerve on one side bore no statistical relationship to the position of the nerve on the opposite side. The position of the lingual nerve was variable in both the sagittal and coronal planes. In two specimens the nerve lay superior to the lingual plate and in another the superior surface of the nerve was level with the crest of the lingual plate. CONCLUSION/CONCLUSIONS:These findings have implications for the avoidance of lingual nerve damage during surgery in the third molar and retromolar region of the mandible.

1. Although synaptic transmission is known to influence many aspects of neuronal development, activity rates are quite low at early ages. The present study describes a long-lasting postsynaptic response to brief periods of synaptic stimulation that may underlie such an influence. Whole-cell patch clamp recordings were made from the lateral superior olive (LSO) in a brain slice preparation from early postnatal gerbils. 2. Stimulation of the excitatory afferent pathway from the cochlear nucleus elicited a prolonged depolarization (PD) in approximately 60% of the LSO neurons tested. Low frequency stimulation (1 Hz) was as effective as tetanic stimulation in producing PDs. These synaptically evoked depolarizations ranged in amplitude from 3 to 32 mV and recovered spontaneously after 0.5-35 min. 3. The LSO neuron input resistance declined during every PD episode and remained significantly lower even after the membrane potential had recovered. These PDs were partially reversed by 2 mM Ni(+2), but 1 microM tetrodotoxin and 10 microM 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) were ineffective. The metabotropic glutamate receptor agonist, trans-1-aminocyclopentane-1,3-dicarboxylic acid (40 microM), produced depolarizations that outlasted the exposure period by an average of 20 min and were also partially repolarized by 2 mM Ni(+2). In contrast, the depolarizations produced by alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid or N-methyl-D-aspartate decayed within a much shorter period of time. 4. To test whether in vivo discharge rates are, in fact, very low during development, spontaneous activity was recorded from neurons of the auditory midbrain in gerbils before and during the onset of sound-evoked responses. The average discharge rate of auditory neurons was quite low (X = 0.4 spikes/s), although many cells displayed brief periods of rapid discharge rate (X = 37 spikes/ s). Together, these results demonstrate a novel form of developmental plasticity elicited by low rates of glutamatergic transmission that may involve a metabotropic pathway and prolonged calcium influx

BACKGROUND: Bronchospasm after intravenous hydrocortisone treatment has been reported in some patients with aspirin-sensitive respiratory disease. OBJECTIVE: This study was designed to determine the prevalence of sensitivity to hydrocortisone among patients with aspirin-sensitive respiratory disease. METHODS: We performed double-blind, placebo-controlled challenges with aspirin and 100 mg of hydrocortisone sodium succinate administered intravenously in 53 subjects. RESULTS: Forty-five of the 53 subjects (85%) undergoing oral aspirin challenge experienced respiratory reactions to aspirin. Forty-four of these 45 patients had neither naso-ocular, cutaneous, nor respiratory reactions to hydrocortisone sodium succinate. One aspirin-sensitive subject had bronchospasm and a naso-ocular reaction to hydrocortisone sodium succinate and a naso-ocular reaction with minimal bronchospasm to methylprednisolone sodium succinate. After desensitization to aspirin, and while receiving maintenance aspirin therapy, this subject again reacted to hydrocortisone sodium succinate with bronchospasm and naso-ocular reaction. CONCLUSION: We conclude that aspirin-sensitive patients with asthma are not preferentially sensitive to hydrocortisone and that hydrocortisone sodium succinate does not cross-react or cross-desensitize with aspirin