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

Right-hemisphere stroke rehabilitation inpatients were assessed by: (1) CT scans; (2) neurological exam; and (3) cognitive and affective psychometric measures. Damage to temporal, parietal, and occipital regions was associated with visual-spatial impairments. Surprisingly, parietal damage was no more related than temporal and occipital damage to severity of visual inattention. While the neurologist's ratings of lability and depression were related to CT-scan measures, patients' self-report of depression was not so related. These findings support a less specific and probably greater interlobule organization of the right, as compared with left, hemisphere, and highlight the need for multifaceted affective assessment in such a brain-damaged group

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

The diagnosis and management of cholesteatoma in children remains controversial. In the past 15 years, the senior author (S.C.P.) has treated 320 patients with cholesteatoma. Patients 18 years and younger composed 40% (125) of the overall group and are the basis for this report. The patient data were compiled using the history, physical examination, audiograms, radiographs, patient questionnaires, surgical findings, and postoperative observations. The surgical treatment selected was determined by the extent of disease, the configuration of the mastoid, and a clinical assessment of eustachian tube function. A middle ear tympanotomy approach was used in 17% of the patients, a canal wall up procedure in 31%, and a canal wall down procedure in 52.3%. The average clinical follow-up was 3.9 years, with the range being from 3 months to 13.5 years. Hearing was maintained or slightly improved in a majority of cases. Residual disease occurred in 8% of patients, and recurrent disease in only 3%

Two cases of schwannomas of the cervical sympathetic chain (CSC) are described. Eleven clearly documented cases have been described in the previous literature. These tumours are usually solitary, asymptomatic cervical masses that occur within the upper carotid sheath or parapharyngeal space. The lesions tend to be hypervascular, but not to the same extent as chemodectomas. Angiography may be employed for differential diagnosis. Schwannomas of the CSC are usually readily excised by a cervical approach. Horner's syndrome is a frequent post-operative sequel, despite anatomical preservation of the sympathetic chain. This neurological impairment is usually asymptomatic. Recurrences and malignant degeneration rarely occur

Human papillomaviruses (HPVs) have been identified in benign and cancerous epithelial lesions of the female genital tract. They have also been identified in papillomata and cancers of the upper aerodigestive tract. This study investigates the hypothesis that lesions of the cervicovaginal area are more common in women with cancers of the head and neck region. The presence of HPV in lesions of both regions is examined. Seven female patients with cancer of the upper aerodigestive tract had DNA analysis of their carcinoma specimens. HPV type 16 was found in two of the seven (28%). Fourteen female patients with upper aerodigestive tract cancers had Papanicolaou smears to search for cytologic evidence of HPV infection, and cervicovaginal lavages to analyze DNA from exfoliated cervical cells. Five of thirteen (38%) Papanicolaou smears revealed koilocytotic atypia and three of these patients had HPV DNA types 16 or 18 identified in the cervical lavage. The incidence of cervical atypia noted is 13-fold greater than average. One patient had HPV type 16 in both her supraglottic cancer and in her cervicovaginal lavage. Evidence of HPV infection at two separate anatomic sites suggests a systemic susceptibility to HPV infection

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