Faculty Bibliography

The midline vertical forehead flap is an unheralded flap that has valuable and specific application. It is ideal for certain reconstructions around the nose, orbit, and upper melonasal regions. The color match is excellent. The donor area is repaired per primum and because there is a double blood supply it rarely fails when nondelayed and rotated 180 degrees.

An attempt has been made to compare the long-term results using preoperative radiation and surgery with radiation therapy alone in the treatment of squamous cell carcinoma of the pyriform sinus. There is a 33% survival for the combined therapy group and a 6% survival for the curative radiation group. Large primary lesions and the presence of cervical adenopathy portend a grave prognosis. The various surgical procedures used are presented with the extent of the primary lesion as the determining factor

Seven of the 7000 patients who underwent cardiopulmonary bypass at Bellevue and University Hospitals between 1969 and 1978 developed sudden loss of hearing in one ear immediately after surgery. Four of the seven patients showed subsequent improvement in hearing but none recovered completely. None had vertigo. All were male. The most likely cause is particulate microemboli generated by cardiopulmonary bypass

Misonidazole, a potent new antitumor agent that selectively increases the effect of ionizing radiations on poorly oxygenated tumor tumor cells, was given to 21 patients at New York University-Bellevue Medical Center. In 11 of the 21 patients, hearing loss developed secondary to drug ingestion. In all cases the hearing loss was sensorineural, of cochlear origin, and at least partially reversible. There did not seem to be a relationship between degree of hearing loss and age, sex, dose, anatomic site of lesion, or prior hearing loss

Contact granuloma of the vocal folds caused by physical trauma secondary to voice abuse has traditionally been treated by surgical removal. This mode of handling can be frequently disappointing since these lesions have a strong tendency to recur and may require additional operative procedures. This paper describes 17 patients in whom treatment of the primary problem was approached through voice therapy. Treatment consisted of a comprehensive history and voice evaluation, stress reduction, relaxation methods, auditory and kinesthetic feedback, pitch change and elimination of voice abuse. Patients were closely followed by the speech pathologist and laryngologist who worked together as a team. The results of voice therapy were evaluated by the laryngologist, the speech pathologist and the patient himself. As a result of voice therapy, the granuloma disappeared in 9 patients, was reduced in size in 4 and remained unchanged in 1. For the remaining three patients, posttherapeutic laryngoscopic findings were not available. The speech pathologist found voice and manner of phonation returned to normal in 4 patients, improved in 7 and remained unchanged in 6. Four patients felt that complete recovery had taken place, 10 felt that some improvement was noted, and 3 felt no change had taken place. Based on the assessments of all three evaluators, the success rate of treatment with voice therapy can be stated as 71% (12 of 17 cases) or 100% (eliminating 5 of 17 cases who terminated treatment very early).

We describe 19 cases of pulmonary disease due to Mycobacterium xenopi, a nosocomial infection related to the hospital water system. Pre-existing lung disease and prolonged environmental exposure during previous hospitalizations were apparent predisposing factors. Twelve patients had respiratory symptoms, including three with hemoptysis, at the time an abnormal chest roentgenogram was obtained. The predominant radiographic presentation of lung diseases caused by M. xenopi was a nodular or mass shadow, but cavitary disease and multiple nodular densities were also frequently observed. One subject had a solitary pulmonary nodule, and surgical resection was performed. In 12 patients who were skin tested with both M. xenopi sensitin and PPD-tuberculin, induration was consistently greater with M. xenopi. Initial isolates of M. xenopi were uniformly sensitive in vitro to 2.0 microgram of streptomycin, 1.0 microgram of isoniazid, and 10.0 microgram of para-aminosalicylic acid. In general, disease due to M. xenopi was successfully treated with standard antituberculosis drugs.

Temporal bones from five patients with hearing loss as a result of aminoglycoside treatment were examined by the method of microdissection and surface preparations, followed by celloidin embedding and serial sectioning of the modiolus. Three patients had received the newer antibiotics, gentamicin, tobramycin, and amikacin; the other two neomycin. In the cochleas from two patients of the first group there was only a small loss of hair cells, restricted to the lower end of the basal turn. The third, who had been treated with several antibiotics over a longer period of time, showed more extensive but strikingly asymmetrical patterns of degeneration in the two ears. This patient, as well as the fourth, who had received neomycin during peritoneal lavage, had numerous patchy areas of complete disappearance of Corti's organ in the basal turn, with incipient degeneration of the distal ends of the nerve fibers in adjacent portions of the osseous spiral lamina. The fifth patient, who had become deaf after prolonged treatment with neomycin by mouth, showed a complete loss of cochlear hair cells. Nerve fibers were present only in the middle and upper turns, where supporting cells remained. Midmodiolar sections showed a proportionately much greater loss of the distal than of the proximal processes of the cells of the spiral ganglion. These findings underscore once again the special hazard for the inner ear that is associated with the clinical use of neomycin, regardless of the route of administration.