Faculty Bibliography

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

Percutaneous cannulation of the internal jugular vein has become a widely accepted method for monitoring central venous pressure, hyperalimentation, and rapid fluid administration. Although complications from this procedure have been rare, many unusual case reports are found in the literature. Three cases of otolaryngologic importance are presented. A revised technique of the internal jugular vein catheterization is described

We report two cases of bilateral vocal cord paralysis in patients with Parkinson's disease and review the possible causes of this condition. We suggest that the vocal cord muscle paralysis is a manifestation of advanced disease. Bilateral vocal cord paralysis in Parkinson's disease may be seen more commonly in the future as therapy enables more patients to live longer

Extensive study of 120 patients with hypernasal speech following adenotonsillectomy showed that 48 had no evidence of abnormal speech prior to surgery and 41 had minor speech anomalies exacerbated postoperatively. Thirty-five patients had the classical stigma of submucous cleft palate and another 20 had occult submucous clefts. Fifty-seven of the patients had adenotonsillectomies because of recurrent middle ear effusions, but in the majority of these cases, recurrent middle ear disease continued even after surgery, probably secondary to palatal abnormalities.

Three children with post-meningitic hearing loss were seen for evaluation and aural rehabilitation over a 4-yr period. Fluctations in hearing levels during that time period were noted. The hearing of one child improved, while that of the other two children decreased. Changes in sensitivity were documented and discussed with reference to the habilitation process. The need for frequent monitoring and for otologic intervention in the post-meningitic child is emphasized

The remarkable integrity of the finely balanced membranous labyrinth is occasionally disrupted, resulting in fistulae of various types in a number of locations. Such leaking labyrinth lesions can be congenital origin, due to various types of malformations. They may be caused by destructive diseases such as syphilis, by many variants of acute and chronic otomastoiditis, and sequelae of otosclerosis surgery, and finally, as results of a variety of traumatic disruptions of labyrinthine integrity. Deafness dizziness, and tinnitus are frequent symptoms and sequelae may include meningitis and other intracranial complications. The clinical consideration of leaking labyrinth lesions must always be considered in otologic diagnoses.

Labyrinthectomy may be the therapy of choice for intractable and disabling vertigo that is caused by unilateral disease of the vestibular labyrinth. The transcanal method through the oval window offers the most direct surgical approach for complete ablation of the vestibular sense organs. The technique includes visual identification and removal of the utricle; this is followed by blind probing of the ampullae. This method was used in 124 patients, including 90 patients with unilateral Meniere's disease. Three of four cases of moderately severe continuing postoperative vertigo were successfully managed by revision transcanal labyrinthectomy. Twenty-seven (22%) of the 124 patients had continuing mild transient unsteadiness associated with quick head movements; this condition is considered to be the physiologic consequence of unilateral loss of vestibular function rather than unremitted disease

This is a retrospective study of the results of various types of surgical treatment of early breast cancer staged histologically using the following characteristics: (1) poor cytologic differentiation, (2) lymphatic permeation, (3) blood vessel invasion, or (4) invasion of the tumor into the surrounding soft tissue. Four hundred and three patients who had early tumors of the breast--228 T1N0M0 (tumor 2 cm or less in diameter, no nodal involvement, and no metastasis) and 175 T2N0M0 (tumor 2 to 5 cm in diameter, no nodal involvement, and no metastasis)--were treated at St. Vincent's Hospital and Medical Center between January 1, 1965, and December 31 1976. Eighty-three were classified as being at low risk 190 at intermediate risk, and 130 at high risk. At 10 years, 100% of the low-risk group were alive; 99% were free of disease, and any type of mastectomy performed--radical, modified radical, or total--was adequate. At 10 years, 44% of those at high risk were alive, and 30% were free of disease. Radiotherapy improved life expectancy when added to radical mastectomy in the high-risk group. We recommend a prior excisional biopsy for proper histologic evaluation to allow a more appropriate choice of surgical procedure.