Faculty Bibliography

Radical resection of the anterior portion of the oral cavity, including a portion of the tongue, floor of the mouth, mandible, and neck, has always been, and remains, a perplexing problem in immediate rehabilitation of the area of the oral cavity and mentum. In the past, these deformities were classified as "Andy Gump." Attempts at correction of this deformity are protracted and complex. The use of the pectoralis myocutaneous flap offers an improvement in the concept of mamagement in that it supplies a skin lining for the oral cavity and augments the chin and neck in a single-stage procedure that may be combined with the primary operation.

The temporal bones from a 58-year-old white woman who had had hereditary congenital deafness were examined with the techniques of microdissection and surface preparations followed by sectioning of the modiolus. There was bilateral, almost total sensorineural degeneration, which also involved the saccule. The degeneration of the distal processes of the cochlear neurons in the osseous spiral lamina was almost complete, whereas numerous ganglion cells and proximal processes remained in the modiolus and the internal auditory canal. Severe cochleo-saccular hydrops was present in the left ear with Reissner's membrane bulging into the horizontal canal. X-ray diffraction and electron probe analysis were used to study the abnormal crystalline deposits in both ears. On the left side the saccular otoconia were composed of calcite, but the utricular macula was covered by a crust of apatite spherulites. More apatite occurred around the maculae and in the scala media. The cupulae were composed of apatite and octacalcium phosphate. On the right side the utricular otoconia were of normal calcite, but there was a deposit of apatite on the macula sacculi. The upper part of the scala media was completely filled by a deposit of apatite and octacalcium phosphate.

Only 4% of peripheral nerve sheath tumors of the head and neck occur in the paranasal sinuses. The most commonly involved sinus is the maxillary antrum and the most common histologic type is benign schwannoma. Two new cases of schwannoma occurring in the sphenoid and maxillary sinuses are reported. The clinical pathologic, and radiographic features of these lesions are reviewed.

The comparative ototoxicity of hydroxygentamicin (Win 42,122-2), a new aminoglycosidic antibiotic, gentamicin and kanamycin was evaluated in guinea pigs by assessment of the Preyer (pinna) reflex response to pure tone frequencies ranging from 2.5 to 20.0 KHz, and by histologic examination of surface preparations of the organ of Corti. Daily subcutaneous administration of 80.0 mg/kg of gentamicin or 240.0 mg/kg of kanamycin to groups of six guinea pigs for 18 to 45 days resulted in loss of the Preyer reflex in all animals. The Preyer reflex was retained in 5 of 6 guinea pigs given 80.0 mg/kg/day of hydroxygentamicin for 77 days and in 6 of 6 guinea pigs given 160.0 mg/kg/day for the same period. Microscopic examination of cochleas from guinea pigs given gentamicin or kanamycin revealed extensive outer and inner hair cell loss in all animals. Cytocochleograms of 5 of 6 guinea pigs medicated with 160.0 mg/kg of hydroxygentamicin were comparable to those of the controls. In the sixth guinea pig there was a localized lesion involving all three rows of outer hair cells and some inner hair cells in the second turn. The results of this study indicated that hydroxygentamicin may be tolerated better than gentamicin in the guinea pig and therefore warrants further development as a new and less toxic aminoglycosidic antibiotic.

Administration of cyclosporin A, a new selective immunosuppressive agent, to mice infected with Schistosoma mansoni resulted in a significant reduction in the number of mature and immature male and, to a greater extent, female worms. With lower, subeffective, doses a reduction in hemoglobinase activity and protein content of female schistosomes is produced. Evidence available so far suggests that the antischistosomal effects of cyclosporin A are mediated through a stimulation of host mechanisms directed against the parasite.

The contributions of the inner and outer hair cells of the mammalian cochlea to auditory intensity discrimination were evaluated in a combined behavioral-anatomical study of the guinea pig. Intensity difference thresholds were unchanged from baseline values after selective destruction of outer hair cells, suggesting that those cells are unnecessary for normal intensity discrimination.

The shifting of skin and superficial musculo-aponeurotic system (SMAS) fascia in the facelift procedure represents an important development in the improvement of the lax and sagging skin of the face and neck. The pathology of aging skin is reviewed, the anatomy of the SMAS fascia is described, and the use of SMAS fascia in surgery along with attendant potential hazards are discussed

Necrotizing fascitis of the head and neck is a rare condition with only 7 cases recorded in the literature. Two cases are presented in which there was massive necrosis of the soft tissues of the neck with extension into the mediastinum. The offending organisms were a mixed bacterial flora which produced gangrene accompanied by subcutaneous emphysema. Both patients were successfully treated with a regimen of intravenous antibiotics, fasciotomy, radical debridement, and hyperbaric oxygenation (1 case). The clinical features, bacteriology, and treatment of necrotizing faciities are reviewed