Faculty Bibliography

A modified pectoralis major myocutaneous flap was used to stabilize necrotic neck wounds rapidly in irradiated patients. The flap was a 'sandwich' flap that included an overlying 'parasternal' pectoral skin paddle for pharyngeal reconstruction, the pectoralis muscle for carotid protection, and a meshed skin graft applied to the undersurface of the muscle to replace cervical skin. This flap has been used to reconstruct seven patients with severe wound necrosis from pharyngeal fistula and infection. All patients had carotid exposure in the infected wound. Reconstruction in all patients accomplished restoration of pharyngeal continuity, carotid protection, and cervical skin replacement. Some patients required more than one procedure for closure. There were no carotid 'blowouts' in any of the patients. This technique enables the head and neck surgeon to stabilize these contaminated wounds rapidly and to reconstruct complex defects of the pharynx and cervical skin

Studies of squamous cell carcinoma of the oral cavity and oropharynx in young adults differ as to whether younger patients resemble the general population of head and neck cancer patients. A retrospective study was performed on 23 patients (40 years old or younger) with oral and oropharyngeal carcinoma at New York University Medical Center between 1961 and 1984. Patients with oropharyngeal cancer resembled the general population of head and neck cancer patients. In contrast, oral cavity carcinoma occurred more frequently in women under the age of 35 and lacked the usual etiologic factors of tobacco and alcohol abuse. Survival correlated best with the TNM stage of disease at initial presentation. Patients with Stage I and II lesions had an excellent response to surgical treatment alone and a high 5-year survival rate. Patients with advanced Stage III and IV disease had a poor survival rate with single modality treatment. We recommend surgery and radiotherapy in patients with advanced disease

Carcinoma adherent to the carotid artery may be present in advanced head and neck cancers. Angiography, ultrasound, computerized tomography (CT), and magnetic resonance imaging (MRI) are available for the preoperative evaluation of the carotid artery. This study demonstrates that CT is not accurate in demonstrating malignant invasion of the carotid artery. Ultrasonography appears to be the best modality for assessing carotid artery invasion. Magnetic resonance imaging may prove helpful in this determination

The audiograms of 59 patients who had 15 different types of tubes implanted in a prospective study from 1982 to 1985 were reviewed. The audiograms were analyzed for changes in air and bone thresholds at 250, 500, 1000, 2000, 4000 and 8000 Hz. The first post-operative audiogram was tabulated for all the initial post-operative visits and for only the initial post-operative visits in which the tubes were functioning. The change in pure tone average air conduction showed a range in improvement from 22.1 dB for the Armstrong Grommet Tube to 1.9 dB for the Canoe Tube. A total of 8 tube types showed mean improvements of 10 dB or better. With the exception of the Reuter Bobbin, all mean air conduction thresholds in functioning tubes were below 20 dB. For 5 tubes the mean threshold was less than 10 dB. The Armstrong Beveled Grommet, Donaldson, and Richard's Wing tubes showed the largest improvements in air conduction threshold with mean decreases of 22.1, 18.7 and 18.3 dB, respectively. Pure tone average bone conduction for all functioning tubes improved 2.8 dB.

While the development of excitatory responses has been the focus of considerable research, the ontogeny of inhibitory connections has received relatively little attention. The lateral superior olive (LSO), an auditory nucleus in the ventral brain stem, is a favorable system in which to compare the maturation of an inhibitory and an excitatory input. Neurons in the LSO are excited by stimuli delivered to the ipsilateral ear and inhibited by similar stimuli to the contralateral ear. Single-neuron recordings were made to characterize tone-evoked responses at the onset of hearing and in adult Mongolian gerbils. The results indicated that frequency selectivity was significantly poorer in young than adult animals. In several cases, neurons within the same animal were found to have disparate tuning properties, such that one of the units had 'adult-like' tuning, while the other was much more broadly tuned. No difference existed between excitatory and inhibitory tuning within any age group. The degree to which the excitatory and inhibitory characteristic frequencies of an LSO neuron were correlated was used as a measure of tonotopic map alignment. A significant improvement of matching was seen with increasing age. A comparison of excitatory and inhibitory thresholds indicated that the inhibitory system was relatively more efficacious in young than adult animals. The ability of LSO neurons to respond to interaural intensity differences, the binaural parameter to which they are sensitive, indicated 3 differences between adult and young animals: the dynamic range was smaller, the slope was shallower, and the sample of neurons encoded a constrained range of interaural intensity difference values. We conclude that the maturation of the inhibitory and excitatory systems are nearly identical

Sinus tumors can readily invade the orbit through their shared walls. The initial symptoms of a sinus neoplasm are often due to orbital invasion. A comprehensive overview of the pathology, diagnosis, and treatment of these tumors is presented

The relationship among otitis media, auditory sensitivity, and emerging language was examined in a group of 1-year-old children who were prospectively followed since birth. Pneumatic otoscopy was used to document the otologic status of the children's ears at each medical visit. There were 13 babies with normal ratings in each ear at 80% more of their visits (designated as "otitis free") and 12 babies with bilaterally positive otoscopy results at 30% or more of their first year visits (designated "otitis positive"). In comparison to the otitis free infants, the group of otitis positive babies demonstrated reduced auditory sensitivity as measured by auditory brain stem response (ABR) and poorer expressive language abilities. However, differences in receptive language were not detected. These results suggest that otitis media may have an impact on auditory sensitivity and developing language as early as 1 year of age.

Fine needle aspiration (FNA) biopsy is gaining in popularity among all diagnostic tests used in the evaluation of patients for thyroidectomy. Its safety and accuracy have been well documented, but criteria regarding when FNA is appropriate are lacking. We retrospectively reviewed our experience with 408 consecutive patients evaluated for thyroid surgery. Two hundred seventy-three ultimately underwent thyroidectomy; 100 of these had preoperative FNA. An additional 135 patients underwent FNA without surgery. Patients who benefited from FNA were those in whom cytologic findings led to surgery for otherwise unsuspected malignancy (15), and those with asymptomatic benign nodules who avoided unnecessary thyroidectomy on the basis of FNA findings (96). FNA is superfluous when clinical conditions mandate surgery. These include nodules that arouse clinical suspicion of malignancy, massive nodules that cause aerodigestive tract compression or cosmetic disfigurement, and nodules extending into the mediastinum. All patients with asymptomatic, clinically benign thyroid nodules should undergo FNA biopsy, as approximately 50% can anticipate significant benefit from the procedure

Otitis media is a disease involving the inflammation and infection of the middle ear. Despite modern medical therapy, its widespread incidence in all age groups makes it one of the most common illnesses seen by physicians. The advent of a wide range of antibiotics has helped to decrease the number of complications resulting from the disease. Nevertheless, the large number of missed school and work days and the hearing losses and related problems that accompany otitis media make it a perpetual menace to public health