Faculty Bibliography

Contemporary head and neck hard tissue reconstruction incorporates bone transfers in the treatment of osseous discontinuity defects subsequent to congenital malformation, traumatic injury, ablative oncologic surgery, and failures of physiologic osteosynthesis. Bone grafts may also be applied in contour augmentation and in strengthening and stabilization roles in congenital and acquired aesthetic as well as posttraumatic deformities. The osseous healing process is dynamic and unique. An understanding of the physiology of these processes allows the reconstructive surgeon to choose techniques and donor sites appropriate to specific requirements, to maximize transplanted bone volume, to achieve consistent and reliable results, and to modulate the osseous healing process in a favorable direction

Fundamental to the choice and proper application of plating systems in osteosynthesis of the craniomaxillofacial skeleton is an understanding of the basic design and biomechanical characteristics that define them. Improper selection of systems and technical execution of rigid internal fixation is not uncommon and may result in hardware failure, dysfunction, and dysmorphology. The surgeon who is able to command the nuances of system design and discipline in application will achieve superior functional and aesthetic results that are predictable and reproducible

The evaluation and treatment of patients with unilateral vocal fold paralysis have evolved as improvements in objective measurements of phonatory function and new modalities for treatment have developed. A thorough history, physical examination, subjective voice evaluation, objective voice analysis, and electromyography are used to make a diagnosis, determine the cause, and plan treatment. The goal of treatment of the patient with a unilateral vocal fold paralysis is to restore normal phonatory function without aspiration. Multiple modalities have developed to allow for restoration of nearly normal phonatory function, and these include voice therapy alone or in combination with injection medialization, laryngoplastic phonosurgery, or laryngeal reinnervation. Otolaryngologists should be familiar with the incidence, cause, evaluation, and state-of-the-art treatment of unilateral vocal fold paralysis of optimize patient care and avoid suboptimal results often seen with antiquated or inappropriate treatment.

The oropharyngeal swallow of 10 patients with mild dysphagia at 3 weeks after a cerebrovascular accident (stroke), 10 normal subjects, and 8 neurologically impaired patients with moderate to severe dysphagia was studied videofluorographically to examine the effects of 2 bolus temperatures (room temperature and 33 degrees F), 2 volumes, and 2 viscosities on the durations of pharyngeal stage swallow events and the frequency and nature of oropharyngeal swallowing problems and bolus transit. Normal subjects exhibited significantly longer pharyngeal response times and longer laryngeal elevation only for 1 ml cold liquid. The stroke patients and the 8 significantly dysphagic neurologically impaired patients exhibited very few significant effects of temperature on swallowing disorders or swallow measures. Increases in bolus volume and viscosity decreased pharyngeal delay times in both neurologically impaired patient groups. Stroke patients exhibited significantly longer pharyngeal delay times but shorter pharyngeal response times, laryngeal closure, cricopharyngeal opening, and laryngeal elevation than normal subjects on some bolus volumes and viscosities. Results are discussed in terms of the potentially therapeutic effects of bolus volume and viscosity

Paired-comparison judgments of quality were obtained from 20 hearing-impaired listeners (half with a small dynamic range and half with a large dynamic range) for speech-in-noise (vent, apartment, and cafeteria) processed through a slow-acting compression hearing aid. Compression ratio was varied (1, 1.5, 2, 3, 5, and 10:1). Compression threshold, attack time, and release time were fixed. Sound quality judgments were significantly affected by compression ratio, noise, and dynamic range. Preference decreased with increasing compression ratio. The selection of compression ratio. The selection of compression ratios < or = 2:1 was significantly higher than of compression ratios > 3:1. Less compression (no compression or 1.5:1) was preferred with the highest level noise (cafeteria noise) than with the lower level noises (vent or apartment). In particular, the small dynamic range group preferred compression with the vent and apartment noises (noise below the compression threshold), but preferred a linear hearing aid with the cafeteria noise (above the compression threshold). The large dynamic range group showed a slightly greater preference for the linear hearing aid for all three noises

The potential influence of auditory information in the production of /s/ and /integral of/ was explored for postlingually deafened adults with four-channel Ineraid cochlear implants. Analyses of the spectra of the sibilant sounds were compared for speech obtained prior to implant activation, after early implant use and after 6 months of use. In addition, the output of the Ineraid device (measured at each of the four electrodes) was analyzed with pre- and postactivation speech samples to explore whether the speech production changes were potentially audible to the cochlear-implant user. Results indicated that subjects who showed abnormally low or incorrect contrast between /s/ and /integral of/ preactivation, and who received significant auditory benefit from their implants were able to increase the distinctiveness of their productions of the two speech sounds

The emergence of magnetic resonance imaging with gadolinium has dramatically enhanced our ability to accurately detect the presence of acoustic tumors as small as 2 mm in diameter. Early diagnosis and improved surgical techniques continue to reduce the morbidity associated with surgical removal of these lesions. There exists, however, a select group of patients in whom no treatment may be the most appropriate management. Since 1979, a total of 51 patients with radiographic evidence of an acoustic neuroma have been prospectively followed for tumor growth and progression of symptoms. Patients were chosen for this conservative approach on the basis of age, medical condition, tumor size, audiometric data, and patient preference. This study reveals that a significant number of patients with acoustic tumors can be safely followed with regular imaging studies and may never require treatment. Discussed are tumor growth rates, epidemiology, and the impact of these factors on patient management.

Effect of postsynaptic activity on the synaptic efficacy was studied in Xenopus nerve-muscle cultures. Repetitive postsynaptic depolarizations induced by injection of current pulses into singly innervated myocytes resulted in significant reduction in the frequency of spontaneous synaptic currents and the amplitude of nerve-evoked synaptic currents at the majority of synapses that showed immature synaptic properties. Repetitive hyperpolarizations and steady depolarizations of similar duration were without effect. The depolarization-induced synaptic depression appeared to result predominantly from a reduced ACh secretion from the presynaptic nerve terminal. Buffering the myocyte cytosolic Ca2+ at a low level with intracellular loading of a Ca2+ buffer, 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetra-acetic acid (BAPTA), significantly reduced the effect of the depolarizations. Thus postsynaptic electrical activity can regulate the synaptic efficacy of the developing neuromuscular synapases and the regulation may be mediated by retrograde transsynaptic interactions