Faculty Bibliography

A review of 700 parotidectomies showed that 98 procedures were performed for parotid space tumors of non-salivary origin. The clinical presentation in this group of patients did not differ significantly from the larger group of salivary tumors except for a higher incidence (12%) of the former in the younger age group. Of the 98 cases, 54 proved to be lymph node tumors, both neoplastic and inflammatory and 44 were tumors of various somatic origins. Among the latter group, bone and joint tumors, vascular lesions and some connective tissue tumors may be recognized preoperatively. Generally, however, the entire group of non-salivary tumors can be distinguished only intra-operatively, if at all. Correct recognition may lead to variations in operative techniques and extent of resection.

A 38-year-old man was in a state of poor oral hygiene, with multiple broken carious teeth and diffuse inflammatory hyperplasia of the gingival tissues. A mandibular, alveolar soft tissue mass in the premolar-molar region was noted on the right side, in continuity with the gingival hyperplasia. Biopsy of the lesion ruled out a diagnosis of squamous cell carcinoma. The patient underwent extraction of his teeth, and all hyperplastic tissues including the tumefaction were excised. Five months later, the patient had a recurrent mass in the same location that was removed via hemimandibulectomy. The mass was diagnosed as a parosteal osteogenic sarcoma.

The philosophy of the recently proposed "Levels of Laboratory Service" program, which will be so vital to the conduct of a successful outpatient tuberculosis treatment and control program, is presented. The hallmark of this program is the decentralization of the diagnostic/monitoring services as they involve laboratory participation. In the long run this could mean more efficient operation, more reliable reporting, and probably less work for the participating laboratories. The greater emphasis on smear examination (Level I) as a monitoring tool will mean fewer cultures, thereby lessening the load for those laboratories that once went through countless clinically requested exercises of repetitively proving by culture the existence of M. tuberculosis in a given patient. Doubtless, the bulk of the work will be conducted in Level II laboratories; but here, too, identification of the most easily defined pathogen, M. tuberculosis, will minimize the over-all workload for these investigators while decreasing their concern about mycobacteria other than tubercle bacilli. Expertise gained in frequent repetitions of a limited number of tests (niacin, nitrate reduction, and pH 7/68 degrees C catalase) will ensure reliable speciation of the clinically most important Mycobacterium. The work of Level III laboratories should eventually be reduced primarily to organisms other than M. tuberculosis, thereby ensuring that a number of highly competent reference institutions will not only attain proficiency in taxonomic aspects of mycobacteria, but will also reflect the regional picture of the changing patterns in mycobacterial pathogens of man. Participation of laboratories in proficiency testing programs will encourage top-level performance in all areas. Additionally, such testing programs will serve a teaching role; a laboratory need not feel "locked in" at a given service level, but may increase its proficiency and move up a step in terms of the service it provides. In contrast, no laboratory need feel compelled to increase its activities; if daily workloads limit the extent of their involvement with mycobacteria, these laboratories can be confident that other institutions are providing needed services. The success of the entire "Levels of Laboratory Service" program depends on the recognition by individual laboratories of their own workload limitation, the directed motivation of personnel, and the maintenance of a free and open pipeline of communication to laboratories at the next higher level of service.

We report a case of an odontoma of the middle ear cavity. A brief description of odontomas and their development is given with an embryologic account of middle ear cleft development. The developmental relationships of a nasopharyngeal odontoma, an odontogenic craniopharyngioma, and an otic odontoma are presented

Tympanometry and acoustic reflex threshold data are reported for a series of presumable normal infants ranging in age from 55 to 132 days. In general, tympanograms displayed single peaks between +/- 50 mm H2O. Susceptance tympanograms with a 660-Hz probe frequency were sometimes characterized by monotonically increasing susceptance as ear canal pressure was changed from -200 to +200 mm H2O. Static values of acoustic conductance, susceptance, admittance, resistance, reactance, impedance, and phase angle were computed from tympanograms using the values of ambient and +200 mm H2O (0/+200 procedure) and maximum and minimum tympanometric values (MAX/MIN procedure). Comparison of the data from the two computational procedures suggested that the MAX/MIN procedure produces means and standard deviations of static values which are more manageable for establishing confidence limits with which to evaluate potentially pathological subjects. The MAX/MIN procedure resulted in lower mean values of conductance and susceptance for infant subjects relative to previously reported adult data using a similar computational procedure. Acoustic reflex thresholds were clearly present in all testable infants at coupler sound pressure levels similar to adult data, suggesting that the relations between reflex thresholds and hearing sensitivity demonstrated in adult subjects are similarly applicable to infant subjects. Mild sedation to induce sleep without altering the reflex would make acoustic reflex threshold measurement a useful procedure for screening large numbers of infants.