Faculty Bibliography

Extensive study of 120 patients with hypernasal speech following adenotonsillectomy showed that 48 had no evidence of abnormal speech prior to surgery and 41 had minor speech anomalies exacerbated postoperatively. Thirty-five patients had the classical stigma of submucous cleft palate and another 20 had occult submucous clefts. Fifty-seven of the patients had adenotonsillectomies because of recurrent middle ear effusions, but in the majority of these cases, recurrent middle ear disease continued even after surgery, probably secondary to palatal abnormalities.

Radical resection of the anterior portion of the oral cavity, including a portion of the tongue, floor of the mouth, mandible, and neck, has always been, and remains, a perplexing problem in immediate rehabilitation of the area of the oral cavity and mentum. In the past, these deformities were classified as "Andy Gump." Attempts at correction of this deformity are protracted and complex. The use of the pectoralis myocutaneous flap offers an improvement in the concept of mamagement in that it supplies a skin lining for the oral cavity and augments the chin and neck in a single-stage procedure that may be combined with the primary operation.

The admission MMPI profiles of approximately half of 337 male alcoholics treated at the Hazelden Foundation (Center City, Minnesota) were classifiable into four groups: neurotic, classic alcoholic, psychopathic, and psychotic. The discharge MMPI profiles of the neurotic, classic, and psychotic types showed foreshortening but maintained their basic configurations. The psychopathic type's discharge MMPI profile showed no major change either in elevation or shape. Several biodemographic and treatment outcome differences were found among the four profile types.

The midline vertical forehead flap is an unheralded flap that has valuable and specific application. It is ideal for certain reconstructions around the nose, orbit, and upper melonasal regions. The color match is excellent. The donor area is repaired per primum and because there is a double blood supply it rarely fails when nondelayed and rotated 180 degrees.

Review of the literature reveals 76 cases of fibrous histiocytoma of the deep structures of the head and neck. To this we have added 11 of our own cases, and analyzed the total group to determine clinical and histological features of a high risk population. Age, sex, presence of pain, location of tumor, size of tumor, and local invasion appear to be important clinical criteria. Bizarre giant cells, numerous and atypical mitoses, necrosis, and inflammation appear to be important histologic features. The treatment of choice is wide local excision. Chemotherapy appears to produce tumor regression.

Only 4% of peripheral nerve sheath tumors of the head and neck occur in the paranasal sinuses. The most commonly involved sinus is the maxillary antrum and the most common histologic type is benign schwannoma. Two new cases of schwannoma occurring in the sphenoid and maxillary sinuses are reported. The clinical pathologic, and radiographic features of these lesions are reviewed.

The temporal bones from a 58-year-old white woman who had had hereditary congenital deafness were examined with the techniques of microdissection and surface preparations followed by sectioning of the modiolus. There was bilateral, almost total sensorineural degeneration, which also involved the saccule. The degeneration of the distal processes of the cochlear neurons in the osseous spiral lamina was almost complete, whereas numerous ganglion cells and proximal processes remained in the modiolus and the internal auditory canal. Severe cochleo-saccular hydrops was present in the left ear with Reissner's membrane bulging into the horizontal canal. X-ray diffraction and electron probe analysis were used to study the abnormal crystalline deposits in both ears. On the left side the saccular otoconia were composed of calcite, but the utricular macula was covered by a crust of apatite spherulites. More apatite occurred around the maculae and in the scala media. The cupulae were composed of apatite and octacalcium phosphate. On the right side the utricular otoconia were of normal calcite, but there was a deposit of apatite on the macula sacculi. The upper part of the scala media was completely filled by a deposit of apatite and octacalcium phosphate.

The comparative ototoxicity of hydroxygentamicin (Win 42,122-2), a new aminoglycosidic antibiotic, gentamicin and kanamycin was evaluated in guinea pigs by assessment of the Preyer (pinna) reflex response to pure tone frequencies ranging from 2.5 to 20.0 KHz, and by histologic examination of surface preparations of the organ of Corti. Daily subcutaneous administration of 80.0 mg/kg of gentamicin or 240.0 mg/kg of kanamycin to groups of six guinea pigs for 18 to 45 days resulted in loss of the Preyer reflex in all animals. The Preyer reflex was retained in 5 of 6 guinea pigs given 80.0 mg/kg/day of hydroxygentamicin for 77 days and in 6 of 6 guinea pigs given 160.0 mg/kg/day for the same period. Microscopic examination of cochleas from guinea pigs given gentamicin or kanamycin revealed extensive outer and inner hair cell loss in all animals. Cytocochleograms of 5 of 6 guinea pigs medicated with 160.0 mg/kg of hydroxygentamicin were comparable to those of the controls. In the sixth guinea pig there was a localized lesion involving all three rows of outer hair cells and some inner hair cells in the second turn. The results of this study indicated that hydroxygentamicin may be tolerated better than gentamicin in the guinea pig and therefore warrants further development as a new and less toxic aminoglycosidic antibiotic.

The contributions of the inner and outer hair cells of the mammalian cochlea to auditory intensity discrimination were evaluated in a combined behavioral-anatomical study of the guinea pig. Intensity difference thresholds were unchanged from baseline values after selective destruction of outer hair cells, suggesting that those cells are unnecessary for normal intensity discrimination.