Faculty Bibliography

Only a small number of ingested foreign bodies perforate the esophagus and even a smaller fraction migrate extraluminally. Four such penetrating and migrating foreign bodies of the upper aerodigestive tract are presented. Review of the literature revealed 321 cases of penetrating ingested foreign bodies, of which 252 remained intraluminal and 43 were found extraluminally, with the status of the remainder indeterminate. Analysis revealed that an intraluminal penetrating foreign body carried a higher overall mortality than one that migrated extraluminally. Although intraluminal and extraluminal penetrating foreign bodies may remain quiescent for years before presenting a complication, no correlation existed between mortality and the duration of the foreign bodies' retention. The greatest mortality was seen with vascular complications followed by diffuse and local suppurative processes. The overall mortality was significantly reduced in the post-antibiotic era.

One hundred thirty-six cases of subglottic hemangioma in infants have been reported in the English -language literature; four additional cases are reported here. The clinical presentations, diagnostic work-ups, treatments, and outcomes are analyzed. Twenty-one patients died, 17 of whom underwent autopsy. The histology of the laryngeal pathology from seven of these patients was reviewed by the authors. Possible correlation between the pathological findings and the clinical presentation is made. Approaches to diagnosis and treatment are suggested based on these findings.

Correction of ossicular defects in tympanoplasty most commonly involves the use of commercially available prostheses or preserved allograft ossicles. Incus autografts and tragal cartilage autografts are also used by many surgeons. Presculptured preserved allograft ossicles have not been used widely, but are used almost exclusively by our clinic. The fate of ossicular grafts has been reported by a number of in investigators with evidence obtained at revision surgery. In this paper we will be able to trace the fate of a presculptured preserved autograft ossicle clinically and pathologically. The unique aspect of this study is the demonstration of the ossicular status in post mortem temporal bone dissection followed by histopathological serial section studies.

The objective of this study was to explore the hypothesis (Van De Water, 1976) that differentiating sensory receptors of the inner ear may attract ingrowing neurites of the statoacoustic (VIIIn) ganglion by chemotaxis. Co-cultured embryonic inner ears which shared a single VIIIn ganglion were grown "in vitro" to the equivalent of 20 days gestation and then processed histologically to show both cytodifferentiation of sensory structures and the presence of neural elements. Specimens of both 11- and 12.5-day-old co-cultured otocysts showed that VIIIn ganglion neurites grew into sensory receptors of both(+) with and (-) without ganglion inner ear explants. Fourteen-day-old co-cultured inner ears revealed that only the (+) ganglion inner ear explants received VIIIn ganglion neurites into the sensory areas, and that neurites were not attracted into the (-) ganglion explants. The results were found to support the hypothesis of a limited period of chemotaxis as being a possible mechanism for the establishment of the pattern of innervation of inner ear sensory receptors by its VIIIn ganglion.

The relationships between vocal intensity (sound pressure level) and intrapulmonic pressure, mean flow rate, and aerodynamic powere were investigated in ten normal subjects. The intrapulmonic pressure was measured noninvasively and simultaneously with sound pressure level and mean flow rate during sustained phonation of the vowel/a/by means of plethysmographic and pneumotachographic methods. The aerodynamic power was calculated as intrapulmonic pressure times mean flow rate. The averaged values for the normal subjects represented (sound power) alpha (intrapulmonic pressure), (sound power) alpha (mean flow rate), and (sound power) alpha (aerodynamic power), where sound power at the open end of the pneumotachograph was estimated from sound pressure level. Vocal efficiency was defined as the ratio of sound power to aerodynamic power. Individual variation of coal efficiency (in dB) was satisfactorily small in the normal subjects, and was determined by the simple addition of individual variations of intrapulmonic pressure and mean flow rate (in dB) from the averaged values. These findings strongly suggested that the comparison of those three measurements against normative data for normal subjects such as provided by this study is useful in evaluating and clarifying the ineffective voice production of the pathological larynx.

Previously it has been very difficult or impossible for radiologists to delineate accurately the size and extent of glomus tympanicum tumors. By utilizing axial transverse and coronal computed tomography detailed enlargement techniques we have been able to accurately demonstrate four such lesions. We believe that this mode of investigation is now the method of choice for glomus tympanicum tumors

Infiltrating lipomata are unusual benign tumors that have been rarely associated with the head and neck areas. We present the only known documented case of an infiltrating lipoma of the sternocleidomastoid muscle. The literature is reviewed and the characteristics of these lesions are discussed. The head and neck surgeon should include these interesting tumors in the differential diagnosis of head and neck masses and be aware that, because of a known propensity for recurrence, total surgical excision is the treatment of choice.

In 17 cases of sinusitis-induced subdural empyema, all but 5 occurred in boys or men aged 13 to 33 years. Clinical features were headaches and fever (14 patients), nuchal rigidity (10), and seizures (8). Seven patients had periorbital cellulitis, and 15 had radiographic clouding of at least one sinus. Only five patients had a history of sinusitis. CT identified the empyema accurately in seven patients but failed in two patients who developed subdural empyema while being treated for sinusitis-induced cerebritis. Ten patients had specific bacteriologic etiologies determined by culture of empyema, blood, or sinuses.