Faculty Bibliography

Free dermal-fat-fascia grafts are used for subdermal augmentation in soft tissue or bony deficiencies resulting from surgical extirpation of cancer, congenitally arrested development, and trauma. The most important determinant for graft survival is the health of the recipient area and the volume of the graft. At least 70% resorption of these large grafts must be anticipated. Imitial overcorrection has some justification but may be self-defeating. Calcification of dermal-fat-fascia grafts, common in other areas of the body, does not appear to be a problem in the head and neck region. When possible, other types of augmentation procedures should be considered.

Composite autografts of skin and cartilage from the auricule are useful in the reconstruction of defects in many areas of the head and neck. However, their use has certain limitations if minimal loss of the graft is to be achieved. A variety of examples are presented by the authors and the limitations are summarized.

A new diagnosis identifying a nonorganic basis of dysphagia is proposed in relation to behavioral conditioning processes and thereby labeled "conditioned dysphagia" (CD). Literature review of both animal and human studies documents that rapidly acquired and persistent avoidance responses are learned when autonomic functions are contiguous with traumatic physical events. Three case studies with primary diagnoses of TE fistula, congenital heart disease and pseudobulbar palsy demonstrated an association between CD and early childhood incidence of trauma involving the esophagus. Successful treatment was achieved by operant deconditioning therapy. Results of a pilot epidemiological study of 28 postpharyngeal flap surgery children and 47 controls showed significantly higher incidence of mild to moderate CD in the surgery group.

Previous studies which have measured acoustic-reflex responses to bone-conducted signals have not effectively differentiated reflex responses from artifacts. A convenient method for identifying such artifacts was developed and employed on some acoustic-reflex measures for bone-conducted signals. The findings indicated that artifacts result when a frequently-used acoustic admittance meter (Grason-Stadler 1720B) and a conventional bone vibrator were used to measure reflex responses for tonal and noise-activating signals. It was suggested that the method be employed in future studies which investigate the acoustic reflex in response to bone-conducted signals.

A previously unreported case of a synovial cyst of a temporo-mandibular joint imitating a parotid tumour is described. A surgical approach involving a total mobilization of the facial nerve is outlined.

Malignant mixed tumor (carcinoma within a pleomorphic adenoma) is an unusual tumor that rarely occurs in the minor salivary glands of the soft palate. We have reported a cases and a review of the terminology, diagnosis, and treatment.

A variety of tumors of the parapharyngeal space were operated upon during one training year at the Pack Medical Foundation, New York. These tumors characteristically present as a mass of the upper neck, behind the angle of the mandible and/or as a lateral pharyngeal mass bulging medially. Surgeons who operate in the parapharyngeal space must be thoroughly familiar with the complex anatomy of blood vessels, nerves, and muscles in this area and possess a thorough knowledge of the variety of tumors in this region of the head and neck.

The temporal bone findings in a case of hemifacial microsomia are described with photographs. The right facial hypoplasia was associated with anophthalmia and microtia on the same side. The right petrous bone was hypoplastic and showed total superior dehiscence of the internal acoustic meatus. Th otic capsule was deformed with an underdeveloped cochlear modiolus grossly deficient in spiral ganglion population. The spiralling cochlear shell showed partial deficiency of the interscalar septum between the middle and apical coils. The cochlear duct was shorter than that on the normal side; the organ of Corti however was normal. The vestibular system did not show any structural abnormality except for the degeneration and reduction of the Scarpa's ganglion cells and nerve fibers. An additional interesting fact was that the facial nerve was totally absent in the temporal bone except for its nervus intermedius component