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After a varied history over the past 15 years, basic acoustic immittance measures now include certain physical measures and certain physiological measures. This article reviews current concepts in the terminology and the instrumentation used for these basic measures. It is designed to provide an understanding of standard acoustic immittance measures and a framework for interpreting the results of special acoustic immittance procedures discussed in this issue.

The head and neck surgeon is often consulted for evaluation and treatment of traumatic or neoplastic lesions of the lateral aspect of the face. Large malignant cutaneous lesions may require excision with wide margins, often parotidectomy, and possibly neck dissection. Traumatic lesions may involve notable soft-tissue loss, and parotid, facial nerve, or mandibular injury. Management of such planned or unplanned wounds challenges the surgeon due to the magnitude of the soft-tissue defect, cosmetic and functional considerations, and the need for soft-tissue protection and nourishment of repaired structures. Primary reconstruction with a large cheek-neck rotation flap provides the advantages of reliability, simplicity, excellent exposure, vital-structure protection, superior aesthetic results, and eliminates the need for a second operative site to harvest skin grafts or distant flaps. Four illustrative cases are reported, with a discussion to address parotid metastases from carcinoma of the lateral aspect of the face and initial treatment of shotgun injuries to the face.

Needle aspiration biopsies for cytology were performed on 224 patients with thyroid nodules. Diagnosis was confirmed by surgical exploration in 134 patients. Twenty-four biopsies were reported positive for malignancy; 23 were confirmed at operation and there was 1 false positive. Forty-one biopsies were reported benign. Three of these lesions were found to be malignant, representing false negatives. Sixty-nine biopsies were in the questionable category; 16 (23%) of these were malignant. None of the patients suffered complications from the biopsies. Routine employment of needle aspiration biopsy on our service has resulted in a marked increase in the incidence of carcinoma in thyroid nodules selected for surgery. This has resulted from detection of otherwise unsuspected malignancy, as well as avoidance of surgery in patients with benign lesions. Needle aspiration is not a substitute for surgery. It is a valuable diagnostic procedure, and should be performed in the evaluation of essentially all thyroid nodules. We continue to use radioiodine scanning to evaluate our patients, but have found the routine use of ultrasonography unnecessary when needle aspiration is employed. The ultimate decision regarding surgical exploration is based on a combination of factors including history, physical findings, radioiodine scan and needle aspiration biopsy

The cemento-ossifying fibroma, a mesodermal type of non-odontogenic tumor, is rarely discussed in the otolaryngologic literature. It is a tumor that is seen more in blacks than in whites, appears largely in the elderly, is chiefly located in the mandibular molar or premolar area and is generally neither aggressive nor excessively destructive. The triggering mechanism for its derivation from aberrant periodontal membrane growth or development from endosteal fibrous tissue remains controversial. We report a case of cemento-ossifying fibroma in a 26-year-old Hispanic male which was located in the posterior portion of the maxilla which destroyed the maxillary bone, orbital floor, and the lateral wall of the nose. One year prior to discovery of the lesion the patient sustained severe facial trauma resulting in facial bone fractures. It may be speculated that the trauma sustained was the critical triggering factor allowing for unchecked growth and destruction associated with an otherwise non-aggressive tumor, which may have been present prior to the traumatic incident

This study attempts to obtain a data base of objective formation on the phonatory characteristics of the partially ablated larynx. Twenty patients who had previously undergone partial laryngectomy with glottic reconstruction underwent videolaryngoscopy. The visualizations obtained revealed that the mechanism of voice production was due in part to sphincterization and compensatory hypertrophy of glottic and supraglottic remnants. Aerodynamic and phonatory function tests together with acoustical and perceived voice quality analyses of these partially ablated larynges tend to corroborate the videotape impressions in many instances. However, data accumulated thus far only reveal trends that cannot yet be subjected to definitive interpretations. With the incorporation of other methods of evaluation, augmented by the inclusion of more patient material, it is hoped that the information obtained can be used to improve reconstructive techniques, monitor surgical results, and enhance methods of voice rehabilitation in these patients

Ameloblastomas are locally invasive benign tumors believed to originate from the developing dental lamina. Maxillary ameloblastomas are rare, comprising only 20% of all ameloblastomas. Of these, 90% arise posterior to the canine tooth. As tumors of the posterior maxilla grow slowly, symptoms are few until the tumor has reached considerable size. At the time of presentation there may be evidence of extension into anatomic areas adjacent to the posterior maxilla. Hemimaxillectomy through wide surgical exposure has the best chance of achieving tumor control. However, once the tumor has extended beyond the confines of the maxilla the prognosis for control of the disease is poor

We have used a modification of the Blom-Singer technique in our last 24 tracheoesophageal punctures, performed on 20 patients. At the time of puncture a surgical stent with an indwelling Dacron polyester suture is placed to form the fistula. Forty-eight to 72 hours later the stent is backed out of the puncture site but the suture is allowed to remain. The Blom-Singer duckbill prosthesis is fitted and taped in the routine fashion. The suture is left to traverse the tracheoesophageal tract until the time of discharge, when it is removed. At discharge the patient is given a Silastic dilator, to be used if the puncture site becomes too small to allow for insertion of the duckbill prosthesis. Seventeen of the 20 patients in this group obtained good voice. Six operations would have been failures because of the loss of the patient's prosthesis in the immediate postoperative period if the modified technique had not been used