Faculty Bibliography

Because of the anatomy of the deep lobe of the parotid and its restrictive boundaries, retromandibular tumors may be asymptomatic until reaching massive size. Removal by an intraoral approach may be not only disappointing but also disastrous, with disintegration of the tumor and generalized spillage in the wound. Our experience suggests that the best approach to any type of tumor in this region is through the upper lateral cervical tissues with consideration of a mandibular osteotomy if the tumor extends into the retropharynx or the nasopharynx. This review of 12 patients who required osteotomy describes a high success rate with minimal complications.

Stapedectomy has become recognized as the procedure of choice in the surgical treatment of clinical otosclerosis. Based on results obtained in stapes surgery performed in 1977, profiles were established for hearing improvement, vertigo, tinnitus, chorda tympani injury and temporary threshold shift of high tones. Tympanometric and stapedial muscle reflex tests in cases of proved clinical otosclerosis also are discussed. The profiles indicate that stapedectomy performed on a regular basis and under ideal conditions is highly successful for the improvement of hearing. The incidence and probable causes of complications are presented and discussed. This study reveals, however, that the number of new patients with otosclerosis has decreased steadily since its peak in 1964. Should the number of surgical cases continue to diminish, it may be impossible for the practicing otologist to maintain sufficient expertise for the performance of an occasional stapedectomy. Also, it may become impossible to provide sufficient experience in otosclerosis surgery for all trainees in otolaryngology.

The campomelic syndrome is characterized by dwarfism, craniofacial anomalies, bowing of the tibiae and femora, cutaneous dimpling overlying the tibial bend, respiratory distress, and early death. Otolaryngologic manifestations include flat facies with a broad nasal bridge, low-set ears, cleft palate, mandibular hypoplasia, and tracheobronchial malacia. The underlying pathologic feature appears to be disturbance in cartilage growth involving the affected bones and the respiratory tract cartilage. The cause is unknown. We report clinical and histopathologic features in two cases of this syndrome. The endochondral layer of the otic capsule contained no cartilage cells. The cochlea was short and flattened, presenting a scala communis. The vestibule and the canals were deformed by bone invasion. Defective endochondral ossification of the petrooccipital synchondroses possibly explains the shortened skull base seen in this syndrome. The tracheobronchial malacia significantly contributes to respiratory distress and neonatal death

This case report illuminates the high possibility of catastrophic complications in the lateral neck, the vagaries associated with the preoperative therapeutic information, the technical effort to gain maximum surgical security, and the overwhelming complications associated with chemotherapy, irradiation, and surgical intervention.

Thread augmentation, a subsurface technique for correcting facial rhytides, is especially applicable to perioral wrinkles, melolabial furrows, and frown lines about the forehead. It is basically an augmentation technique which places a volume of well-tolerated, slowly absorbable or nonabsorbable sutures underneath the wrinkle. These threads produce augmentation by their volume and the mild local reaction of edema, lymphocytic infiltration, and fibrosis. This process gradually progresses to internal scar formation as the suture material is dissolved by slow hydrolysis in the presence of tissue fluid over a period of months; the nonabsorbable suture remains as a permanent implant. A high level of patient satisfaction with minimal complications has proved the value of this technique in over 100 cases.