Faculty Bibliography

Vertical hemilaryngectomy (VHL) is an effective treatment for localized true-vocal-cord carcinoma. Single- and double-contrast barium pharyngoesophagrams in 13 post-VHL patients (11 with dysphagia or suspected tumor recurrence, and two asymptomatic volunteers) were reviewed retrospectively. The two asymptomatic volunteers illustrated the normal postoperative appearance, demonstrating an unaltered pharynx, with no barium aspiration. Barium aspiration into the laryngeal vestibule or trachea was seen in 10 cases and was the only abnormal radiographic finding in four such patients. Three instances of tumor recurrence were identified. In two such cases, aspirated barium revealed a narrowed, irregular lumen of the residual laryngeal vestibule with a mass protruding into the subglottic part of the airway. The third example of recurrent malignancy was manifested by a tracheoesophageal fistula. Findings on the barium examination mimicked recurrent tumor in four cases. In one instance, a mound of granulation tissue protruding into the subglottic airway was confused with tumor recurrence. In three cases, the radiographs demonstrated apparent narrowing and mucosal irregularity of the residual laryngeal vestibule. This appearance was due to early postoperative edema or to transient deformity of the pliable residual hemilarynx during deglutition, as shown by videotaped fluoroscopy

A retrospective analysis of direct laryngoscopies performed at our institution in 1978 was undertaken utilizing computer technology. The population which consisted of 54% males and 46% females had an average age of 50.4 years. The most common symptom was hoarseness (83.6%). The most frequent benign and malignant diagnoses were vocal cord polyp and squamous cell carcinoma, respectively. Males predominated in all disease entities except vocal cord polyps. Benign disease entities presented most frequently with one or two symptoms, while malignant pathology presented with a varied array and number of symptoms. The indications: 'tumor' seen on indirect laryngoscopy, sore throat, dysphagia, otalgia, upper respiratory tract obstruction, hemoptysis, cough and leukoplakia were most frequently associated with malignancy. Voice abuse occupations were most commonly associated with vocal cord polyps and tobacco and alcohol use was most frequently associated with laryngeal cancer. Eighty-five percent of direct laryngoscopies were done under general anesthesia with two-thirds utilizing direct suspension microlaryngoscopy

The extrapharyngeal approach to the anterior cervical spine is a safe, rapid surgical exposure. Other surgical exposures such as the posterior, lateral, and intraoral (transpharyngeal) have inherent limitations that this approach avoids. By going anterior to the sternocleidomastoid muscle and great vessels, the surgical exposure of the anterior cervical spine is wide and the vital structures of the neck are visualized and not injured. We have used this extrapharyngeal approach to treat various disease states of the anterior cervical spine, such as trauma, osteomyelitis, neoplasia, and degenerative disease. Major complications have been neural injury, and pharyngeal fistula

CSF rhinorrhea can have many causes: traumatic, neoplastic, and iatrogenic origins are common. Most traumatic rhinorrhea ceases after a trial of conservative management. While obvious erosion or traumatic destruction of vital structures may be the underlying cause, other pathophysiologic mechanisms may be working in the formation of CSF rhinorrhea, which may require the combined skills of the otolaryngologist and the neurosurgeon. Leakage of CSF is seen in 'high-pressure rhinorrhea,' a pathophysiologic state wherein the underlying problem is poor CSF resorption. The result is increased intracranial pressure and eventual rhinorrhea or otorrhea. Areas of CSF leakage correspond to sites of congenital weakness in the cribriform plate region, the parasellar region, or the temporal bone. Weak areas in old base-of-skull fracture sites may leak with increased intracranial pressure. The initial management should stress correction of the deranged pathophysiology, namely shunting. Surgical repair is secondary to controlling the abnormal CSF dynamics

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

Recordings of nonsense syllables (VCV construction) were presented to groups of children aged 5, 7, 9, 11, and 13 years and young adults under monaural (reverberation time = 0.6s) and binaural (reverberation times = 0, 0.4, and 0.6 s) conditions of reverberation. Phoneme identification performance was affected by age, reverberation, and mode of presentation (monaural versus binaural). The major findings were (1) phoneme identification scores in reverberant conditions improved with increasing age and decreased with increased reverberation time; (2) children's performance in reverberant conditions did not reach asymptote until age 13; (3) binaural performance was consistently better than monaural performance for all age groups, with 5-year-olds showing the largest binaural advantage

The diagnosis of non-Hodgkin's malignant lymphoma of the nasal cavity, paranasal sinuses, and nasopharynx was made in 15 patients over a 7 year period (nasopharynx, 9; nasal cavity, 3; maxillary sinus, 2; frontal sinus, 1). A wide variety of head and neck symptoms, often characteristic of benign disease, was reported ranging from 2 weeks to 4 months prior to presentation. Of the 15 cases, the original diagnosis was inconclusive in 6; 4 of the 6 required rebiopsy, while the diagnosis in the other 2 was confirmed on further pathologic consultation. Tissue marker studies, which have recently become available, were performed in 7 cases and were crucial in the diagnosis of 2. B-cell lymphoma was diagnosed in the 7 patients who had tissue marker studies. Five patients had palpable cervical nodes, and none had distant adenopathy or masses. With further staging, 4 of the 15 patients were found to have disseminated disease. The paper emphasizes the need for early biopsy of suspicious lesions presenting in areas in which physical examination is limited. Recommendations are made for handling the biopsy specimen when malignant lymphoma is suspected, as well as for the evaluation of local and distant sites. The role of surgery is primarily diagnostic in patients with malignant lymphoma

Neonatal mice were reared in an acoustic environment that repetitively entrained activity in a large proportion of primary auditory afferents during the period when the frequency tuning of auditory neurons normally develops. The tuning curves obtained from these mice were significantly broader than those of normally reared mice of the same age. This suggests that the normal frequency tuning of neurons was prevented or delayed by synchronizing the pattern of activity imposed on the auditory pathway