Faculty Bibliography

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.

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.

Twenty-two patients with a diagnosis of spastic dysphonia were treated by laryngeal nerve crush. All patients had initial improvement. Success at 3-year follow-up was 13%. Laryngeal nerve crush is no longer advocated as treatment for spastic dysphonia.

Severe pathological changes were observed in the inner ear tissues of a 2-month-old patient who died of Reye's syndrome after 5 days of hospitalization. In the organ of Corti, the inner hair cells appeared to be more severely damaged than the outer hair cells. Various degrees of degeneration were observed in all non-sensory epithelial cells lining the cochlear duct. In most turns of the cochlear duct, Reissner's membrane was ruptured and/or collapsed onto the organ of Corti. Likewise, both sensory and non-sensory cells of the vestibular end organs were markedly degenerated. These observations suggest that the inner ear tissues are acutely affected in patients with Reye's syndrome, and that the changes may cause impairment of hearing and/or equilibrium in patients who recover.

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.

When a laryngologist treats a patient with a voice disorder it is often important to evaluate the sound of the voice over a long period of time and to demonstrate to the patient changes due to therapy. This may be vital to patient management especially when the results fail to correspond with the patient's expectations or when the voice is used professionally. Visualization of the vocal folds by the use of a mirror may be adequate for the diagnostic needs of the laryngologist, but a permanent record of laryngological features permits the sharing of objective information with referring physician, consultant, therapist, and, most importantly, with the patient. The illustrations can also be extremely useful in teaching.

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 use of myocutaneous flaps has resulted in improved methods for reconstruction involving the head and neck area. The platysma myocutaneous flap offers an excellent alternative for reconstructing appropriate oral cavity defects resulting from tumor ablation. It has certain advantages over other local or distant pedicled flaps and has been proved to be a reliable alternative for single-stage repair of these defects. The technique of this flap is described and a review of its use in six cases, including complications, is discussed

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