Faculty Bibliography

Voice-onset time (VOT) was measured in plosive-initial syllables uttered by five cochlear implant users prior to and repeatedly at intervals after activation of their speech processors. In 'short-term' experiments, the elicitation set was read after the subject's processor has been off for 24 h, then turned on them off again. Four out of five implant users increased voiceless and/or voiced VOTc (VOT corrected for changes in syllable duration) from preimplant baselines to final recordings made 1-3 years later. Measured acoustic correlates of speech 'posture' (average SPL, F0, and low-frequency spectral slope) changed concurrently. Results in the short-term study were largely consistent with the long term. Significant multiple regressions relating changes in VOTc to accompanying changes in postural correlates were found in both studies. This outcome is consistent with hypotheses that predict changes in both VOTc and in postural correlates with the restoration of some hearing and that allow for linkages between the two. Some of the reliable VOTc increases obtained over the long term that were not correlated with postural changes may have been caused directly by auditory validation of articulatory/acoustic relations that underlie synergisms for phoneme production

Herniation of the temporomandibular joint into the external auditory canal has been reported as a result of trauma, neoplasia, infection, inflammatory processes, or developmental malformations. This paper reviews the intimate relation of the temporomandibular joint to the temporal bone as well as the literature describing temporomandibular joint herniation into the external auditory canal. Four cases of temporomandibular joint herniation into the external auditory canal resulting from otologic surgery are presented. Their characteristic location, clinical and radiographic findings are described and contrasted to previously reported cases. Despite striking displacement of the temporomandibular joint into the external auditory canal, there were no clinical symptoms referable to this finding. The absence of symptoms distinguished this postoperative etiology of temporomandibular joint herniation from other etiologies mentioned above

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

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

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.

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