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Focuses on the changes and innovations in surgical techniques for the neck. Dangers associated with radical neck surgery before World War II; Use of external implants to treat the neck during the period; Pioneers of safer approaches for neck surgery.

Background: While the rejection of heterotopic tracheal allografts is characterized by complete airway obliteration, the rejection of orthotopic allografts leads to airway edema and cellular infiltrate of the lamina propria, but is not associated with obliteration. We hypothesized that orthotopic tracheal allografts undergo reepithelialization with recipient-derived mucosa and that this process prevents airway obliteration. Methods: Thirty mice were randomly assigned to 6 experimental groups. BALB/c donor tracheal segments were transplanted orthotopically or heterotopically into syngeneic BALB/c or major histocompatability mismatched allogeneic C57BL/6 recipients. Recipients of allogeneic grafts were divided into a nonimmunosuppression group and an immunosuppression group (cyclosporine, 7 mg/kg per day). Twenty-one days after transplantation, histological assessment, immunohistochemistry for CD4 and CD8 lymphocyte infiltration and major histocompatibility-specific immunohistochemistry were performed on the grafts to assess rejection and donor or recipient origin of tissue. Results: Untreated heterotopic allografts underwent complete airway obliteration by day 21. This response was prevented with cyclosporine immunosuppression. Untreated orthotopic allografts, however, demonstrated edema and lymphocytic infiltrate of the lamina propria resulting in clinical stridor without airway obliteration. Immunosuppressed orthotopic allografts did not develop edema or infiltrate of the lamina propria and consequently stridor did not occur. Immunohistochemical analysis demonstrated migration of recipient-derived mucosa into the donor allograft segment in both the untreated and treated orthotopic groups. Conclusions: Airway obliteration characteristic of rejecting heterotopic tracheal allografts does not occur in the orthotopic allografts. Migration of recipient mucosa into the donor allograft appears to prevent airway obliteration in the orthotopic allografts. These... [ABSTRACT FROM AUTHOR]

Objective: To present and test a new method for conservative correction of prominent pinnae in children aged between 2 weeks and 5.5 years. Design: Prospective study on 56 pinnae from 44 children aged between 0.25 and 5.5 years, treated with the Auri method, which consists of a clip and a strip. The clip is a specially designed plastic clamp used during the night for an average of 4.3 hours per night. It squeezes the cartilage and makes a fold at the place of the missing anthelix. The strip is a double adhesive fixture used during daytime for an average of 8.9 hours per day. To test the efficiency of the treatment objective (thickness and stiffness of the pinna, cephaloauricular distance, and photo-documentation) and subjective (investigators' and parents' judgment of the shape and grade of the correction of the pinnae) parameters have been applied. Results: Of the children, 38 (86%) achieved good to fair correction of their pinnae. Of the parents, all 44 (100%) were satisfied with the treatment and 35 (80%) reported good to fair correction of their child's pinnae. Slight complications were observed in 13 children (30%): 10 (23%) had temporary irritation of the skin of the pinna and 3 (7%) had slight temporary squeeze marks of the pinnae. Of the 44 children, 31 were evaluated 10 months after completing treatment, and the pinnae of 38 children (86%) maintained their corrected shape. Conclusions: Correction of the prominent pinna can be done by the new nonsurgical Auri method in children aged between 0.25 and 5.5 years, which provided good to fair results in 89% of pinnae in this study. The method is efficient in the short term and easy to use by the parents, but it requires long-term motivation of the parents as well as the child. The child can be treated at early age, avoiding psychosocial and cosmetic problems during school age. [ABSTRACT FROM AUTHOR]

Objective: To develop a staging system for congenital cholesteatoma in predicting the likelihood of residual disease. Design: Retrospective analysis of data from a case series, to identify predictors of residual disease. Setting: Tertiary care pediatric hospital. Participants: Children undergoing surgical removal of congenital cholesteatoma. There were 156 patients, with 160 cholesteatomas; 4 children had bilateral disease. Interventions: Each case was scored as to quadrants of the middle ear involved, ossicular involvement, and mastoid extension. Main Outcome Measure: Surgically confirmed residual disease at any time after the initial procedure. Results: Four stages were defined as follows: stage I, disease confined to a single quadrant; stage II, cholesteatoma in multiple quadrants, but without ossicular involvement or mastoid extension; stage III, ossicular involvement without mastoid extension; and stage IV, mastoid disease. There was a strong association between stage and residual disease, ranging from a 13% risk in stage I to 67% in stage IV. Conclusions: This simple staging system may be particularly useful in standardizing the reporting of congenital cholesteatoma and in adjusting for severity in evaluating outcomes. It also provides information that is useful in counseling parents. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the anatomical abnormality of the keel nose and correlate the findings with etiologic maneuvers of a routine rhinoplasty procedure; to identify the contributing factors and offer suggestions to avoid or decrease the severity of these surgical complications; and to present an effective revisional procedure to correct the functional and cosmetic consequences of this deformity. Patients and Methods: A total of 47 patients (31 women and 16 men; age range, 18-71 years) with a keel-appearing nose presented for revision rhinoplasty. All had undergone at least 1 rhinoplasty procedure, and 39 had undergone 2 or more previous nasal procedures. All patients had bilateral lateral nasal wall collapse and an associated severely compromised internal nasal valve. All patients underwent reconstruction with a conchal cartilage overlay graft. Results: All patients had a moderate to excellent cosmetic improvement; the subjective improvement in nasal airway was more dramatic. Since patients with a keel nose have an associated internal valve collapse, both abnormalities are addressed simultaneously with the conchal cartilage overlay repair, which results in minimal morbidity with no major complications. Conclusions: Conchal cartilage overlay repair uses a cartilage graft from the auricle with a recommended external rhinoplasty for placement. Appropriate sizing and fashioning precede the precise placement and suture fixation. This technique addresses both functional and cosmetic abnormalities. [ABSTRACT FROM AUTHOR]

Objective: To determine the role of environmental pollutants in the etiology of nasal polyposis. Design: Case-control study. Setting: A community-based hospital practice in the Gaspesian peninsula in rural northeastern Quebec. Patients: Fifty-five case patients with nasal polyposis and 55 age-matched control subjects without nasal polyposis who were seen at one physician's practice (J.K.) from March 1, 1998, to December 19, 1998. Interventions: Exposure to woodstoves, indoor tobacco smoke, and pets and occupational exposures to noxious inhalant compounds. Results: Forty-five (82%) of the cases, but only 14 (25%) of the controls, reported using woodstoves, yielding a crude odds ratio (OR) of 13.1. The corresponding risk associated with occupational exposure to noxious inhalant compounds was also high (OR, 6.1). When adjusted in various ways for the presence of other factors, these ORs remained high and statistically significant. For woodstove use, the point estimates of the ORs were consistently above 10, with the lower limits of 95% confidence intervals above 5. For occupational exposures to noxious inhalant compounds, the various adjusted OR estimates were above 6, with the lower limits above 1.5. Conclusions: There is a strong association between the use of woodstoves as a principal source of heating and the development of nasal polyposis. Occupational exposures to noxious inhalant compounds (other than tobacco smoke) also play an important role in its etiology. [ABSTRACT FROM AUTHOR]

Objective: To compare plasma-mediated ablation (PMA) with monopolar electrosurgery (MES) for pediatric tonsillectomy. Design: Prospective, randomized, blinded study. Setting: Academic children's hospital. Participants: Thirty-four children, aged 4 to 7 years. Interventions: Tonsillectomy by means of PMA (n = 17) or MES (n = 17). Outcome Measures: We measured surgical efficacy, estimated blood loss, and surgical time during tonsillectomy and morphine use, immediate postoperative pain, and recovery scores after tonsillectomy. Parents recorded recovery of normal diet and activity and their own return to work for 10 days after surgery. Histopathologic evaluation of excised tonsils was performed. We reviewed medical records and attempted follow-up telephone contact. Results: With no significant difference in blood loss compared with MES, PMA was effective for tonsillectomy. Performance of PMA took longer (24 vs 16 minutes; P = .002). Results of histopathologic evaluation showed less thermal injury with PMA than with MES (P = .03). Morphine consumption, pain, and recovery scores were equivalent between groups. We found no significant difference in recovery of normal diet and activity or parental return to work. Patients undergoing PMA had a greater number of perioperative complications than those undergoing MES, including 2 patients in the PMA group (compared with none in the MES group) who required unplanned admission for postoperative airway obstruction. Conclusions: Plasma-mediated ablation for pediatric tonsillectomy resulted in less histopathologic thermal injury than MES, but did not show a statistically faster recovery to normal activity and diet or parental return to work. In addition, PMA took longer to perform, and had more complications. Therefore, PMA should not replace MES for pediatric tonsillectomy. The reduced thermal injury with PMA supports investigation into other means of using plasma ablation to treat tonsillar hypertrophy. [ABSTRACT FROM AUTHOR]

Objective: To report the results of sentinel lymph node biopsy (SLNB) for cutaneous head and neck melanomas (CMHNs). Design: Consecutive series followed for a median of 20 months. Setting: Tertiary cancer care center. Patients: Fifty-six individuals with clinically node-negative CMHN, median Breslow thickness, 2.6 mm (range, 0.2-20.0 mm). Interventions: Preoperative technetium 99m sulfur colloid lymphoscintigraphy (PLSG) followed within 4 hours by intraoperative handheld gamma probe localization (IHGP). Intraoperative injection of 1% isosulfan blue dye (IBD) was used in 48 patients. Immediate completion nodal dissection was performed for metastatic SLNs on intraoperative frozen section analysis and monitoring for negative SLNs. Main Outcome Measures: Rate of SLN identification, SLN and non-SLN positivity, same-basin recurrence, and disease-specific and recurrence-free survival. Results: Combination of IHGP and IBD improved SLN identification to 96% from 93% for IHGP and 73% for IBD alone. Four patients had a positive SLN on frozen section analysis. A negative SLNB correctly predicted regional nodal control in 47 of 48 patients but missed 1 of 5 patients who had regional lymphatic disease. All 4 patients who failed SLNB remain alive and free of recurrent disease. Two-year Kaplan-Meier disease-specific and relapse-free survival was 91% and 88%, respectively. Two-year disease-specific survival was 93% for SLN-negative patients and 50% for SLN-positive patients (P= .20). Conclusions: Combining PLSG with IHGP and IBD improves the success rate of SLNB. Although SLNB is a reliable indicator of the status of the draining lymphatic basins in CMHN, patients with negative SLNs must be observed for longer periods to understand the true implications of the procedure. [ABSTRACT FROM AUTHOR]

Background: Earlier studies have mapped the autosomal recessive nonsyndromic deafness locus, DFNB15, to chromosomes 3q21.3-q25.2 and 19p13.3-13.1, identifying one of these chromosomal regions (or possibly both) as the site of a deafness-causing gene. Mutations in unconventional myosins cause deafness in mice and humans. One unconventional myosin, myosin 1F (MYO1F), is expressed in the cochlea and maps to chromosome 19p13.3-13.2. Objective: To evaluate MYO1F as a candidate gene for deafness at the DFNB15 locus by determining its genomic structure and screening each exon for deafness-causing mutations to identify possible allele variants of MYO1F segregating in the DFNB15 family. Methods: We used radiation hybrid mapping to localize MYO1F on chromosome arm 19p. We next determined its genomic structure using multiple long-range polymerase chain reaction experiments. Using these data, we completed mutation screening using single-stranded conformational polymorphism analysis and direct sequencing of affected and nonaffected persons in the original DFNB15 family. Results: Radiation hybrid mapping placed MYO1F in the DFNB15 interval, establishing it as a positional candidate gene. Its genomic structure consists of 24 coding exons. No mutations or genomic rearrangements were found in the original DFNB15 family, making it unlikely that MYO1F is the disease-causing gene in this kindred. Conclusions: Although we did not find MYO1F allele variants in one family with autosomal recessive nonsyndromic hearing loss, the gene remains an excellent candidate for hereditary hearing impairment. Given its wide tissue expression, MYO1F might cause syndromic deafness. [ABSTRACT FROM AUTHOR]

Background: Interleukin 6 (IL-6) is a multifunctional cytokine with effects on central and peripheral neurons. Objective: To investigate the role of IL-6 in peripheral nerve regeneration by comparing IL-6 knockout and wild-type mice in a sciatic nerve model of injury and repair. Design/Subjects: Forty C57/BL6 (wild-type) and 40 IL-6 knockout mice were randomly assigned to 1 of 4 groups: sham surgery, sciatic nerve crush injury, sciatic nerve transection without repair, and sciatic nerve transection with epineurial suture repair. Walking tracks were assessed preoperatively and postoperatively at 10-day intervals for 50 days by means of a previously described mouse sciatic functional index. Distal segments of the sciatic nerves were harvested at the completion of the study for histomorphometric evaluation. Results: The wild-type and knockout mice that underwent sham surgery showed similarly unimpaired function (P = .64 on day 50). The IL-6 knockout mice with the crush injury demonstrated decreased function on day 10 compared with the wild-type mice (P<.01) but completely recovered by day 40 (P = .55). Both IL-6 knockout and wild-type mice that underwent nerve transection without repair failed to recover function (P = .06 on day 50). There was no statistical difference in recovery between wild-type and IL-6 knockout mice that underwent nerve transection with epineurial suture repair (P = .30 on day 50). The morphometric data showed no significant differences in distal axon count between the wild-type and knockout mice after suture repair or crush injury (P>.32). Conclusions: The absence of IL-6 does not appear to impair peripheral nerve recovery after sciatic nerve injury. Although in vitro and in vivo studies suggest a role for IL-6 in peripheral nerve physiology, this cytokine does not appear to have a substantial effect on functional recovery in a mouse sciatic nerve injury and repair model. [ABSTRACT FROM AUTHOR]

Background: Velocardiofacial syndrome (VCFS) is associated with a broad clinical spectrum that frequently overlaps the DiGeorge syndrome. Both have been linked to chromosomal microdeletions of chromosome 22 (22q11.2). DiGeorge syndrome is associated with T-cell dysfunction. What is the incidence of immune cytopenias in children with VCFS? Objectives: To (1) identify, (2) characterize, (3) quantify, and (4) follow up the immunologic deficits in children initially seen in our institution with VCFS. Design: Prospective clinical evaluation of patients with the features of VCFS. Patients: Twenty consecutive children with the clinical diagnoses of VCFS. Setting: Tertiary care children's hospital. Main Outcome Measures: All 20 children had genetics evaluation with chromosomal analysis. Immunologic evaluations included serum immunoglobulin concentrations, lymphocyte studies, and mitogen and antigen stimulation studies. Results: Five (25%) of 20 children were noted to have T-cell dysfunction with a clinical presentation marked by recurrent upper respiratory tract infections. Three of these 5 children had resolution of the T-cell dysfunction over a 2-year period. The 2 children with persistent cytopenias combined with immunoglobulin dysfunction required intravenous IgG infusions to control their infections. Conclusions: Velocardiofacial syndrome is associated with an increased incidence of immune cytopenias and, thus, warrants evaluation in any child with the clinical diagnosis of VCFS. This immune deficit may be transient and depends on the age of the evaluation of the child. [ABSTRACT FROM AUTHOR]

Objectives: To design and develop a biodegradable tracheal stent that can be used internally to stabilize and support surgically reconstructed airways. Design: In vitro mechanical and degradative properties of 80:20 poly(D,L-lactide-co-glycolide) (PLGA) "finger-like" stents were determined. The stents were then tested in vivo in rabbits that underwent anterior patch tracheoplasties with fascia lata grafts. Comparisons were made between a control group and an internal stent group for stridor development, overall group mortality, reconstructed airway lumen size, and histological findings. Subjects: Twenty-five New Zealand white rabbits. Results: The average dry modulus for the internal stents was 6800 kPa. All of the internal stents cracked by 4 weeks in buffer solution. Significant mass loss was not noted in vitro until after 5 weeks in buffer solution. By 14 weeks, the stents were nearly 100% degraded. The attrition rate for the control group was 23% compared with 17% for the experimental group. The stridor rate for the control group was also higher at 38% compared with 17% for the stented group. The stented rabbits had a significantly smaller average stenosis (23%) across the entire reconstruction site than the control group (34%) (P<.05). Conclusion: Biodegradable PLGA stents degrade in a predictable fashion and have a statistically significant effect in augmenting anterior patch tracheoplasties with fascia lata grafts in rabbits. [ABSTRACT FROM AUTHOR]

Objective: To assess the medical costs and the number of quality-adjusted life years lost owing to juvenile-onset recurrent respiratory papillomatosis (JORRP). Design: We examined hospital and physician charges for JORRP surgical procedures in Maryland in 1994 adjusting for inflation and the cost-charge ratio. Centers for Disease Control and Prevention data on treatment intensity for JORRP were augmented with a review of treatment records for 18 patients with JORRP. Sensitivity analyses were performed. To illustrate the application of our cost estimates, we compare the costs of JORRP to the costs of the surgical procedures that would be necessary to prevent it. Results: We find that the present value at birth of the cost of a single case of JORRP is $201,724 (range, $61,822-$474,334). The annual cost for a single case of JORRP is $57,996 (range, $32,407-$94,114). The annual cost of JORRP in the United States is between $40 million and $123 million depending on the prevalence. Cesarean section (CS) for women with condyloma has been suggested as a potential strategy to prevent JORRP, but its efficacy remains to be determined. Our results suggest that if only 1% of the CSs actually prevented JORRP, this strategy would be a cost-effective means to prevent JORRP. Conclusions: Studies to reduce the uncertainty surrounding the efficacy of CS and the effect of both CS and JORRP on families need to precede consideration of a policy of CS for women with clinically evident genital condyloma. Patients should be kept thoroughly informed about the role of CS for the prevention of JORRP and the nature of the remaining uncertainties. [ABSTRACT FROM AUTHOR]

Background: We have previously reported that preconditioning allergic subjects with hot, humid air (HHA) (temperature, 37°C; relative humidity >95%) in an environmental chamber resulted in partial inhibition of the early response to nasal allergen challenge. Objective: To investigate whether this inhibitory effect could be achieved by inhalation of HHA via a face mask. Design: Randomized, 4-way crossover study. Subjects: Eighteen subjects with seasonal allergic rhinitis participated in the study outside of their allergy season. Interventions: Subjects underwent preconditioning with room air (RA) (temperature, 25°C; relative humidity <20%) or HHA either in a chamber or delivered via a face mask for 1 hour prior to and during nasal challenge with diluent for the allergen extract followed by 2 increasing doses of allergen. Results: Net changes from diluent challenge for all parameters were compared between HHA and RA in each delivery method. Hot, humid air delivered by mask significantly inhibited the mean±SEM number of allergen-induced sneezes (HHA, 2.7±0.6; RA, 6.6±2.1; P=.03), congestion score (HHA, 2.3±0.5; RA, 3.4±0.5; P=.01), and secretion weights (HHA, 26.9±4.4 mg; RA, 38.6±5.0 mg; P=.048). However, HHA inhaled in a chamber significantly inhibited only the mean±SEM allergen-induced congestion (HHA, 1.2±0.4; RA, 3.6±0.6; P=.002) and pruritus (HHA, 0.7±0.3; RA, 2.3±0.5; P=.002) scores. Conclusions: Preconditioning the nasal mucosa with HHA partially decreases the early response to nasal challenge with antigen irrespective of the administration technique. The secretory response, however, is only inhibited by localized delivery of HHA to the nose. The inhibitory effects of HHA are therefore probably related to local changes in the nasal mucosa and are not dependent on total body exposure to HHA. [ABSTRACT FROM AUTHOR]

Objective: To determine if administration of brain-derived neurotrophic factor (BDNF) after peripheral nerve transection can improve the functional outcome in situations where epineurial repair must be delayed. Design: Randomized, blinded, controlled trial. Subjects: Thirty-four Sprague-Dawley rats. Intervention: Sciatic nerves were transected and, after a 2-week delay, repaired with epineurial sutures. Animals were assigned to receive daily administration of lactated Ringer solution (LR [control] group); BDNF delivered at the time of nerve transection through 2 weeks after nerve repair, for a total of 4 weeks (BDNF-early group); or BDNF delivered at the time of nerve repair through 2 weeks after repair (BDNF-late group). Outcome was assessed using sciatic functional indices (SFIs) and histomorphometric analysis. Results: The SFI maximal recovery was superior in the BDNF groups, but this difference did not reach statistical significance (SFI, -90.1 ± 9.6 [LR group], -85.7 ± 7.6 [BDNF-early group], and -84.6 ± 4.8 [BDNF-late group], where normal function is 0 and complete loss of function is -100; P=.27). The mean axon diameter tended to be greater in the BDNF groups compared with the LR group, ie, 2.43 ± 0.23 µm (LR group), 2.80 ± 0.44 µm (BDNF-early group), and 2.83 ± 0.38 µm (BDNF-late group) (P=.05). Conclusions: The local administration of BDNF to nerves that underwent transection and then repair after a delay resulted in an increase in axonal diameters and maximal SFIs, a difference that did not reach statistical significance. The timing of BDNF administration after nerve transection did not affect neuronal regeneration. [ABSTRACT FROM AUTHOR]

Objectives: To summarize our quality-of-life (QOL) research findings for patients with head and neck cancer, to suggest areas for future productive QOL research, and to discuss how to undertake QOL studies in a cost-effective manner. Design: Review of previously published analyses of advanced larynx cancer, advanced oropharynx cancer, and neck-dissection cases and current data from the complete set of patients. Patients: From January 1, 1993, through December 31, 1998, data on 549 patients were entered in our head and neck database. Of these patients, 364 met additional criteria for histologic findings (squamous cell carcinoma) and the restriction of their cancer to 4 major anatomical sites (oral, oropharynx, hypopharynx, or larynx). Of these, 339 patients were more than 1 year beyond initial treatment. Complete baseline TNM staging and QOL data were obtained for 260 of these patients, of whom 210 presented with an untreated first primary tumor (index cases) to the University of Washington, Seattle. Intervention: Pretreatment QOL was assessed with an interviewer-supervised self-administered questionnaire. Subsequent self-administered tests were completed at 3, 6, 12, 24, and 36 months. Other data collected on each patient included cancer site, stage, treatment, histologic findings, type of surgical reconstruction, and current disease and vital status. Results/Conclusions: It is difficult to achieve "statistically significant" results in a single-instution setting. The "composite" QOL score may not be a sufficiently sensitive tool. Analysis of separate domains may be more effective. [ABSTRACT FROM AUTHOR]

Presents a reprint of the speech by Ashok R. Shaha addressed at the annual meeting of the American Head and Neck Society at Palm Desert, California on April 25, 1999.

Objective: To test whether irrigation during bipolar cautery confers thermoprotection from neuronal injury. Design: A rat animal model (15 rats for each treatment group) was used to test the thermoprotective effects of irrigation during bipolar cautery. In this model, the sciatic nerve was exposed, and a 1-second stimulus was applied using bipolar cautery forceps at 40 or 20 W placed directly on the nerve in the presence or absence of simultaneous irrigation. The effects of cautery were determined on the basis of clinical gait analysis by means of the Sciatic Functional Index, temperature response, and neuropathological findings. Results: The degree of paresis was reduced with irrigation. Neuropathological examination of the sciatic nerve after cautery showed significant axonal loss (more small than large fibers) with concomitant demyelination, which was partially inhibited by irrigation (χ[sup 2]; P = .04). The mechanism of thermoprotection by irrigation was not the result of a reduction in the temperature spike that followed cautery, but resulted from a reduced temperature response during the 15 seconds that followed 40- or 20-W stimulation with bipolar cautery. Conclusions: Simultaneous irrigation and bipolar cautery enhance temperature recovery to basal levels and protect the peripheral nerve from the effects of cautery. [ABSTRACT FROM AUTHOR]

Presents a schedule of workshops and conferences related to medicine from September 1999 to May 2000.

Background: Multiple primary upper aerodigestive tract carcinomas can occur in up to 15% of patients. We have shown previously that half of the patients with multiple upper aerodigestive tract squamous cell carcinomas are initially seen with synchronous tumors. Most metachronous squamous cell carcinomas become manifest within 3 years. Objective: To examine the expression of 2 proteins—cyclin D1 and p53—in an attempt to predict the occurrence of multiple primary malignant neoplasms (MPs). Materials and Methods: Monoclonal antibodies to cyclin D1 (DCS-6 [dilution, 1:50], Novocastra Laboratories Ltd, Newcastle, England) and p53 (DO-7 [dilution, 1-100], Dako Corp, Carpinteria, Calif) proteins were used. Resection specimens from a total of 47 patients, 12 patients with MP and 35 patients with nonmultiple primary malignant neoplasms, were analyzed. Those in the nonmultiple primary malignant neoplasm group had longer than 3 years' follow-up to ascertain the absence of MP. Results: Tumor overexpression of cyclin D1 was significantly associated with the development of MP (P<.01). Tumor overexpression of p53 was also frequent in patients with MP although statistical significance was not achieved. The combination of these 2 parameters was an even greater predictor of MP (P<.001). Conclusions: Overexpression of cyclin D1 and p53 proteins was highly correlated with the development of MP. Additional studies are neccesary to confirm this finding. Immunohistochemical evaluation of primary squamous cell carcinomas for cyclin D1 and p53 overexpression may become an important fact of surgical pathologic reporting for primary upper aerodigestive tract squamous cell carcinomas. [ABSTRACT FROM AUTHOR]

Objective: To determine the feasibility, toxicity, and compliance of an intense treatment regimen for patients with advanced, previously untreated, resectable head and neck squamous cell carcinomas. Design: Prospective, nonrandomized, controlled (phase 1 or 2) clinical trial; median time at risk, 25 months (range, 7 days to 36 months). Setting: Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University, Columbus. Patients: Forty-three patients (median age, 59 years; range, 32-76 years) with resectable, previously untreated stage III or IV squamous cell carcinomas of the oral cavity, oropharynx, or hypopharynx or stage II squamous cell carcinomas of the hypopharynx (referred sample of patients). Interventions: Days 1 to 4, perioperative, slightly accelerated, hyperfractionated radiotherapy (9.1 Gy) to off cord fields; days 1 to 3, cisplatin, 30 mg/m[sup 2] per day; day 4, surgical resection and intraoperative radiotherapy boost (7.5 Gy); days 45 to 52, postoperative radiotherapy (40 Gy to the primary site and upper neck and 45 Gy to the supraclavicular areas); days 24, 45, and 66, paclitaxel, 135 mg/m[sup 2]per 24 hours, with routine granulocyte colony-stimulating factor support; and days 25 and 46, cisplatin, 100 mg/m[sup 2]. Main Outcome Measures: Toxicity, compliance, local control, and distant metastatic rates. Results: Patient compliance was 91% (39 of 43 patients), but protocol compliance was only 58% (25 of 43 patients), reflecting increased toxicity of the systemic regimen (2 [5%] of the 43 patients experienced grade 5 hematologic toxicity due to the regimen; 16 [37%], grade 4; and 10 [23%], grade 3). Local-regional control was 92% (23 of 25 patients), and the distant metastatic rate was 8% (2 of 25) in patients completing treatment per protocol. One patient had surgical salvage of a second primary tumor. Conclusions: Local control and patient compliance were encouraging, but systemic toxicity was unacceptabl... [ABSTRACT FROM AUTHOR]

Hemophilia A is the most severe of the inherited bleeding disorders. Otolaryngologists are frequently asked to assist in the care of a patient with this disorder who has intractable bleeding from sites in the head and neck. This disorder is transmitted in an X-linked recessive manner and results from factor VIII deficiency. Factor replacement therapy has contributed much to the management of acute bleeding episodes and the prevention of long-term sequelae in patients with hemophilia. A consequence of factor replacement therapy that occurs in as much as 16% of patients is the development of antibodies to the exogenous factor. These antibodies inactivate any supplemental factor VIII, resulting in continued bleeding despite attempts at replacement therapy. This poses an extremely challenging clinical problem because other standard therapies have had limited usefulness. Activated prothrombin complex has been shown to be efficacious in the treatment of patients with inhibitors. This has led to the production of factor VIII inhibitor bypassing activity (FEIBA), which contains activated forms of factors II, VII, IX, and X. The mechanism of action of this preparation remains unknown, but it seems to bypass the need for factor VIII in the clotting cascade. Factor VIII inhibitor bypassing activity is not as effective as factor VIII concentrates in patients with normally responsive hemophilia, and patients with low inhibitor levels may be given larger doses of factor VIII. Disseminated intravascular coagulation is most often mentioned as a potential complication of the administration of factor VIII inhibitor bypassing activity, although it has been rarely reported. Otolaryngologists should be familiar with this clinical phenomenon and understand its implications. Two patients with bleeding diatheses were recently treated at our institution. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of topical ascorbic acid application in treating mild to moderate photodamage of facial skin using an objective, computer-assisted image analysis of skin surface topography and subjective clinical, photographic, and patient self-appraisal questionnaires. Design: A 3-month, randomized, double-blind, vehicle-controlled study. Setting: Facial plastic surgery private practice. Patients: Nineteen evaluable volunteer sample patients aged between 36 and 72 years with Fitzpatrick skin types I, II, and III who were in good physical and mental health with mild to moderately photodamaged facial skin were considered for analysis. Intervention: Coded, unmarked medications were randomly assigned to the left and right sides of each subject's face, one containing the active agent, topical ascorbic acid (Cellex-C high-potency serum; Cellex-C International, Toronto, Ontario), the other, the vehicle serum (Cellex-C International). Three drops (0.5 mL) of each formulation were applied daily to the randomly assigned hemifaces over the 3-month study period. Treatment assignments were not disclosed to subjects, clinicians, or personnel involved in analyzing skin replicas. Main Outcome Measures: Specific clinical parameters were evaluated and graded on a 0- to 9-point scale (0, none; 1-3, mild; 4-6, moderate; and 7-9, severe). Reference photographs were used to standardize grading criteria. Overall investigator scores were compared with baseline and graded as excellent (much improved), good (improved), fair (slightly improved), no change, or worse. Patient self-appraisal questionnaires rated the degree of improvement (much improved, improved, slightly improved, no change, or worse) and reported adverse effects (burning, stinging, redness, peeling, dryness, discoloration, itching, and rash). Standard photographs were taken at baseline, including anteroposterior and left and right oblique views to facilitate subsequent clinical evaluations, and ... [ABSTRACT FROM AUTHOR]

Objective: To determine whether cricopharyngeal myotomy can improve dysphagia associated with head and neck cancer surgery. Design: Prospective, randomized, multicenter trial. Setting: Twelve clinical sites across the United States. Patients: Between 1989 and 1994, 125 patients undergoing combined modality therapy for head and neck cancer, including resection of the tongue base or supraglottic larynx, were prospectively entered into the trial. Intervention: Cricopharyngeal myotomy on a randomized basis. Main Outcome Measures: Videofluoroscopic examination to determine oropharyngeal swallowing efficiency, which is defined as the ratio of percentage of the bolus swallowed to total swallowing time using 3 different bolus consistencies. Results: No significant difference in oropharyngeal swallowing efficiency between myotomy vs no myotomy was seen at 6 months of follow-up regardless of bolus consistency. Conclusions: In this prospective test of cricopharyngeal myotomy, the procedure fails to significantly improve dysphagia associated with head and neck cancer surgery. The efficacy of this surgical procedure in other disease entities should also be rigorously explored. [ABSTRACT FROM AUTHOR]

Objectives: To delineate the endogenous growth factors that regulate cricoid cartilage growth at the molecular level. Specifically, to attempt to establish the presence of cartilage-derived morphogenetic proteins (CDMPs), cartilage-specific members of the bone morphogenetic protein family, in newborn bovine cricoid chondrocytes and to assess the expression of these endogenous growth factors with the addition of exogenous growth hormone or insulinlike growth factor 1 in an in vitro chondrocyte culture model. Methods and Design: Basic science molecular biologic research methods, including high-density monolayer and explant chondrocyte cultures with extraction of messenger RNA and quantitation via Northern blot hybridization via radiolabeled complementary DNA probes. Setting: Intramural basic science research laboratory. Results: Both CDMP-1 and CDMP-2 were found in newborn cricoid chondrocytes. Addition of exogenous growth hormone did not appear to influence the expression of CDMP-1 or CDMP-2. Addition of exogenous insulinlike growth factor 1 appeared to down-regulate the expression of CDMP-1 but had no effect on the expression of CDMP-2. No major differences in CDMP level of expression were noted between high-density monolayer cultures vs explant cultures. No tissue specificity differences were noted in regulation of CDMPs between cricoid and articular chondrocytes. Conclusions: Our preliminary studies indicate the presence of endogenous morphogenetic proteins in newborn bovine cricoid chondrocytes. These novel polypeptide hormones (CDMP-1 and CDMP-2) have not been previously reported in laryngeal cartilage chondrocytes. Change in level of transcription of these morphogenetic proteins under various in vitro conditions suggests that these proteins are subject to regulation and/or play a regulatory role in cricoid chondrocyte growth and differentiation. Further experimentation is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Objective: To investigate the anatomical characteristics of the nasal cavity and paranasal sinuses in relation to the presence of sinusitis in patients with cleft lip and palate. Design: Retrospective survey. Setting: Tertiary care hospital. Patients: Forty-seven consecutive patients with cleft lip and alveolus with or without cleft palate. Main Outcome Measures: The patients underwent computed tomographic scans of the maxilla, and the following parameters were evaluated: nasal septal shift from the midline, soft tissue density shadow of the maxillary sinus, cross-sectional area of the maxillary sinus, and height of the floor of the maxillary sinus. Results: The nasal septum was convex to the cleft side in most of the patients with unilateral clefts, and there was a significant correlation between the cleft side and the direction of nasal septal deviation (P<.001). Sinusitis was more severe in the noncleft side than in the cleft side (P=.04), and in the concave side than in the convex side (P=.02). The cross-sectional area of the maxillary sinus was not statistically different between the cleft side and noncleft side, nor between the septal concave side and convex side. The floor of the maxillary sinus was situated higher in the cleft side than in the noncleft side (P=.02). Conclusions: The occurrence of maxillary sinusitis associated with cleft lip and palate is dependent on both the cleft side and the deviated nasal septum, but not on the size of the sinus. The cleft side is responsible for the direction of the septal deviation and the height of the floor of the maxillary sinus. A low-situated sinus floor may be in contact with the root of the teeth, and thus may be one of the etiologic factors of sinusitis in patients with clefts. [ABSTRACT FROM AUTHOR]

Objective: To clarify the cause, clinical course, and management of children with angioedema. Design: Retrospective review. Setting: Urban tertiary care hospital for children. Patients: Consecutive sample of all children hospitalized from January 1, 1987, to December 31, 1997, with the diagnosis of angioedema. Complete records permitting analysis were available for 10 patients. Main Outcome Measures: Sex, age, site, symptoms at initial examination, cause, therapeutic management, and clinical outcome. Results: Seven boys and 3 girls, a mean age of 7.7 years, had angioedema of the head or neck, most often facial (8/10 [80%]). Manifesting symptoms, in addition to swelling, were tenderness or pain in 4 children (40%), dyspnea in 3 (30%), dysphagia (including drooling and spitting) in 3 (30%), and hoarseness in 1 (10%). Angioedema was due to food in 4 children (40%), insect bites in 3 (30%), infection in 2 (20%), and an antibiotic in 1 (10%). Treatment was pharmacological in all cases. No child required intubation or tracheotomy. Care in the intensive care unit was necessary for 1 child (10%). Conclusions: Pediatric angioedema exhibits a different cause and clinical manifestations than does adult angioedema. Prompt diagnosis and early treatment with an intravenous corticosteroid, an antihistamine, and/or epinephrine lead to rapid resolution and may, in appropriately staffed settings, avoid the need for care in the intensive care unit or airway intervention. Management algorithms based on adult experience must be modified to account for the milder pediatric manifestations of this immunologic disease. [ABSTRACT FROM AUTHOR]

Objectives: To measure and quantitatively compare the degree of force dissipation in pediatric and adult skulls subjected to similar dynamic forces. Design: An anatomical study using electronic speckle pattern interferometry, which allows generation of displacement vectors after application of a force. Subjects: Five human skulls (3 pediatric and 2 adult). Intervention: Each skull was subjected to a reproducible and quantifiable force created by a steel ball pendulum striking a precise periorbital focus: (1) infraorbital foramen, (2) supraorbital notch, (3) malar eminence, and (4) nasofrontal suture. Electronic speckle pattern interferometry was used to construct interferogram fringe patterns to determine skull regions with the greatest degree of displacement. Results: Interferogram analysis revealed that the adult skull has a tendency to dissipate force with minimal resultant displacement. In contrast, the pediatric skulls demonstrated greater displacements (ie, increased fringe density) at the same periorbital foci. Conclusions: The pediatric skull dissipates periorbital stress differently than the adult skull, as illustrated by quantitative interferogram analysis. This finding parallels clinical data that demonstrate a varying pattern of fractures in pediatric and adult skulls related to craniofacial development. [ABSTRACT FROM AUTHOR]

Background: For more than 70 years, the coexistence of asthma and paranasal rhinosinusitis has been noted in the medical literature. Causal relationships have been proposed but not proved. To date, limited evidence exists suggesting that asthma improves after surgical correction of rhinosinusitis. Objective: To determine whether asthma control improved after first-time functional endoscopic sinus surgery (FESS). Patients and Methods: A retrospective medical record analysis was performed on 13 patients with chronic bronchial asthma who underwent FESS for medically refractory chronic rhinosinusitis. Patients received comprehensive asthma care before and after FESS (mean, 19.3 and 33.1 months, respectively). Outcomes analyzed included pre- and post-FESS individual and group mean asthma symptom scores, medication use scores, pulmonary function test results, and emergency department visits or hospital admissions for asthma. Patient medical records were obtained from a private allergy-immunology practice affiliated with a medical school. The surgical procedure was performed at a tertiary care teaching hospital by a single ear, nose, and throat surgeon (R.L.). Results: Following FESS, there was no statistically significant change in group mean asthma symptom scores, asthma medication use scores, pulmonary function test results, and the number of emergency department visits or hospital admissions. Only a few patients demonstrated statistically significant improvement after FESS in asthma symptom scores (1 patient), medication use scores (1 patient), or pulmonary function test results (2 patients). Conclusions: The data do not support the hypothesis that first-time FESS for medically refractory chronic rhinosinusitis in adult patients with chronic asthma leads to reduced postoperative asthma symptoms or asthma medication use or improved pulmonary function. Based on this limited study, a reexamination of the benefits of sinus surgery... [ABSTRACT FROM AUTHOR]

Objective: To determine the safety and efficacy of ofloxacin otic solution in the treatment of acute otorrhea in children with tympanostomy tubes. Design: Multicenter study with an open-label, prospective ofloxacin arm and retrospective historical and current practice arms. Setting: Ear, nose, and throat pediatric and general practice clinics and office-based practices. Subjects: Children younger than 12 years with acute purulent otorrhea of presumed bacterial origin and tympanostomy tubes. Intervention: Instillation of 0.3% ofloxacin, 0.25 mL, twice daily for 10 days in the prospective arm; review of medical records in the retrospective arms. Main Outcome Measures: The primary index of clinical efficacy was absence (cure) or presence (failure) of otorrhea at 10 to 14 days after therapy. The primary index of microbiologic efficacy (in the ofloxacin arm only) was eradication of pathogens isolated at baseline. Safety was evaluated in the ofloxacin arm only. Results: Significantly more clinically evaluable ofloxacin-treated subjects were cured (84.4%; 119/141) than were historical practice subjects (64.2%; 140/218) (P≤.001) or current practice subjects (70%; 33/47) (P≤.03). All baseline pathogens were eradicated in 103 (96.3%) of 107 microbiologically evaluable ofloxacin subjects. Adverse events considered "possibly" or "probably" treatment related occurred in 29 (12.8%) of 226 ofloxacin-treated subjects. Conclusion: Ofloxacin is safe and significantly more effective than treatments used in historical or current practice for acute purulent otorrhea in children with tympanostomy tubes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and efficacy of expanded polytetrafluoroethylene (PTFE) (Gore-Tex; W. L. Gore & Associates, Flagstaff, Ariz) for augmentation of deep nasolabial creases. Design: Retrospective chart review with a minimum of 12 months of follow-up. Setting: Private practice ambulatory surgery center. Study Population: One hundred consecutive patients (average age, 49 years) undergoing expanded PTFE augmentation of the nasolabial crease. Main Outcome Measures: A standardized, reproducible rating scale assessed preoperative crease severity. Clinical effectiveness was determined by the numerical degree of improvement in crease severity rating after surgery, and by the number of procedures required to achieve the desired aesthetic results. Results: Patients initially had grade 1 (14.5%), grade 2 (54.0%), grade 3 (20.0%), or grade 4 (11.5%) crease severity ratings. On average, patients with grade 1 creases required 1.17 total augmentation procedures, those with grade 2 required 1.60, those with grade 3 required 1.93, and those with grade 4 required 1.86. On average, with each augmentation, patients with grade 1 improved 0.61 relative severity points; those with grade 2, 0.85; those with grade 3, 1.29; and those with grade 4, 1.28. Nine patients developed late postoperative sequelae. Four creases (2.0%) displayed an unnatural mounded appearance because of superficial expanded PTFE placement. All 4 creases underwent elective removal of a single superficial PTFE strip, with resultant return of aesthetically correct crease augmentation. Five creases (2.5%) developed implant site infections; in all 5 cases, the involved strips were removed and the infection was resolved with a 10-day course of oral antibiotics. Conclusions: Expanded PTFE augmentation presents a safe, effective method for softening deep nasolabial creases. Patients with more severe creases are likely to show more improvement with each augmentation, but... [ABSTRACT FROM AUTHOR]

Objective: To measure the concentration of ofloxacin in otorrhea, serum, and middle ear mucosa after topical administration of 0.3% ofloxacin otic solution. Design: Study of 0.3% ofloxacin otic solution administered in a single dose of 0.5 mL in adults or 0.25 mL in children with chronic suppurative otitis media and perforated tympanic membrane, with serial sampling of otorrhea and serum up to 8 hours after dosing and middle ear mucosa up to 2 hours after dosing. Setting: Three hospitals in Kagoshima, Japan. Patients: Thirty-eight patients (age range, 3-81 years) with chronic suppurative otitis media and perforated tympanic membrane; 20 patients had sampling of otorrhea and serum and 18 patients (who required middle ear surgery) had middle ear mucosa and serum sampling. Results: High concentrations of ofloxacin were measured in otorrhea samples taken immediately after dosing, followed by a rapid, nonlogarithmic decline. Elimination of the drug through otorrhea was believed to be related to loss from the application site with ear drainage, rather than to biologic mechanisms. Maximum concentration of ofloxacin in otorrhea was seen at the initial sampling time, 30 minutes after dosing, with concentrations measured up to the last sampling at 8 hours. Very low concentrations of ofloxacin were found in serum after topical administration of the drug. Concentrations were not detected in serum samples of most of the patients. The highest concentration measured was 10 ng/mL. Drug concentrations were detected primarily in samples obtained up to 1 hour after the dose was administered. Mucosal drug concentrations were highly variable, ranging from nondetectable to 602 µg/g. For the 6 bacterial strains isolated from the middle ear, the highest minimum inhibitory concentration of ofloxacin was covered by otorrhea drug concentrations measured at up to 8 hours after dosing in some patients. No adverse events were observed. No clinicall... [ABSTRACT FROM AUTHOR]

Discusses the use of autologous grafting material for orbital floor reconstruction. Overview of orbital floor defects; Advantages of autologous bone grafts; Disadvantages in using autologous tissue.

Focuses on the treatment of allergic fungal rhinosinusitis (AFRS) through immunotherapy and antifungal drugs. Features of AFRS; Advantages and disadvantages of immunotherapy in treating the disease; Use of corticosteroids in the treatment of AFRS as an adjunct to surgery in the treatment of AFRS.

Objective: To determine whether there is a relationship between the presumed complexity of auditory processing and the time course of recovery of auditory function in children with a history of otitis media with effusion (OME). Design: Longitudinal testing over a 1-year period following insertion of tympanostomy tubes in clinical and control groups. Subjects: A total of 34 children with a history of OME were tested. Twenty-five were tested both just before the placement of tympanostomy tubes and on up to 3 separate occasions (1 month, 6 months, and 1 year) after the placement of the tubes. With subject attrition, there were 27, 16, and 10 listeners at the 1-month, 6-month, and 1-year tests, respectively. An age-matched control group of 29 children was tested. Methods: The comodulation masking release (CMR) paradigm was used to measure the ability of the listener to detect a signal in a noise background composed of a simple (1 amplitude modulation pattern) or more complex (2 amplitude modulation patterns) masking background. Results: Children with a history of OME had reduced masking release before and 1 month after insertion of tympanostomy tubes for both the simple and complex CMR tasks. After surgery, the CMR results for simple task was not significantly different from that in controls by 6 months, but CMR for the complex task remained significantly reduced even 1 year after surgery. Conclusion: Our results suggest a slower recovery of auditory function for more complex auditory tasks in children with a history of OME. [ABSTRACT FROM AUTHOR]

Objective: To determine if brain-derived neurotrophic factor (BDNF) and ciliary neurotrophic factor (CNTF) can be successfully delivered to transected and repaired peripheral nerves by cross-linking the factors to collagen tubules (CTs). Methods: Forty-eight Sprague-Dawley rats underwent left sciatic nerve transection and repair. In the control group, CTs were implanted with no neurotrophic ligand (n=13). There were 3 experimental groups: CT with BDNF covalently linked to the collagen matrix (CT/BDNF; n=12), CT with CNTF covalently linked (CT/CNTF; n=12), and CT with both BDNF and CNTF covalently linked (CT/BDNF/CNTF; n=11). Functional outcome of neural regeneration was assessed every 10 days using walking track analysis, which was submitted to a sciatic functional index. Nerve morphometry, electrophysiologic studies, and molecular analysis for neural proteins were performed at the completion of the study at postoperative day 90. Results: Animals in all 3 experimental groups achieved significantly superior maximal functional recovery, larger nerve cross-sectional areas, and a greater number of axons when compared with the control CT group (P<.001, P<.05, and P<.05, respectively). The animals in the CT/BDNF/CNTF group displayed the best functional recovery and had the largest axon diameters, greatest amplitude, and the fastest nerve conduction velocities. Molecular analysis revealed significant differences in the expression of neurofilament, neural cell adhesion molecule, myelin-associated glycoprotein, and myelin basic protein. Conclusions: We present the first evidence that CNTF covalently linked to CTs can improve functional recovery compared with CTs alone. We also support the previous finding that BDNF covalently linked to CTs significantly increases the functional recovery of transected and repaired nerves. Finally, we found that cotreatment produced the best functional recovery in our model. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety, efficacy, and patient acceptance of closed dressings after full facial resurfacing with the carbon dioxide laser. Design: Prospective cohort of men and women undergoing full facial carbon dioxide laser resurfacing. Setting: Ambulatory surgical center at a university hospital. Patients: Forty consecutive patients randomized to 1 of 4 dressing groups. Interventions: All patients underwent full facial resurfacing with a carbon dioxide laser system. One of 5 closed dressings (single- or 3-layer composite foam, plastic mesh, hydrogel, or polymer film) was placed immediately after the procedure. Closed dressings were changed on postoperative day 2 and removed on postoperative day 4. Outcome Measures: Objective postoperative criteria of erythema, scarring, reepithelialization, and surface irregularities were recorded and photodocumented. Comparisons were made among the closed dressing groups as well as with a group of historical control subjects treated with open dressings. The ease of application, office time for preparation and application, and cost of the individual dressings were collected. Patient characteristics of overall acceptance, comfort, and ease of maintenance were recorded with a visual analog scale. Results: There were no complications of scarring, surface irregularities, or contact dermatitis from the application or maintenance of the closed dressings. There were no significant differences in the number of days of postoperative erythema or in the rate of facial reepithelialization among the groups. Most patients preferred not to continue with the closed dressings past 2 days. Positive features from the use of closed dressings included reduction in crust formation, decreased pruritus, decreased erythema, and decreased postoperative pain, compared with historical controls. Negative features included time in preparation and application of the dressings. Costs ranged from $9.79 to $50 per dressing change. Conclusions... [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effect of intranasal corticosteroids in the treatment of polyps in patients with severe polyposis listed for surgical treatment and to determine the treatment effect on the progression of the disease. Design: A double-blind, randomized, parallel-group, placebo-controlled, 12-week study at a single center. Setting: A tertiary referral center in London, England. Patients: Thirty-four patients with severe polyposis listed for endoscopic surgical treatment. Intervention: By random allocation, fluticasone propionate aqueous nasal spray (FPANS), 200 µg twice a day; beclomethasone dipropionate aqueous nasal spray, 200 µg twice a day; or placebo nasal spray twice a day was administered. Patients received 2 actuations to each nostril in the morning and in the evening. Main Outcome Measures: Efficacy end points were the need for polypectomy at the end of treatment, the results of acoustic rhinometry, the polyp score, the peak nasal inspiratory flow rate, and an assessment of symptoms. Results: The polyp score was significantly decreased in the FPANS-treated group (P≤.01). The nasal cavity volume was significantly increased in both the FPANS-treated group and the group receiving beclomethasone compared with placebo (P≤.01) at the end of treatment. The percentage change in the mean morning peak nasal inspiratory flow rate was greater in the FPANS-treated group, with a significant effect observed at week 2 (P=.01). Nasal blockage was significantly decreased in both active groups compared with the group receiving placebo. No significant difference was observed between the treatment groups in the number of patients requiring polypectomy. Conclusions: Fluticasone and beclomethasone aqueous nasal sprays are effective in treating the symptoms of severe nasal polyps. There was some evidence that the group treated with FPANS responded more quickly to intervention and that the magnitude of the response was greater than in ... [ABSTRACT FROM AUTHOR]

Background: Connective tissue autografts are commonly used as interpositional grafts between septal flaps in the repair of septal perforations. The most common graft materials used include temporalis fascia and pericranium, both of which are accompanied by donor site morbidity, do not provide septal bulk, and are exceedingly thin and difficult to manage. Objective: To study the use of an acellular human dermal allograft (AlloDerm, LifeCell Corp, The Woodlands, Tex) as a connective tissue interpositional graft in septal perforation repair. Setting: Private facial plastic surgery and reconstructive practice of 1 of the authors (R.W.H.K.), Houston, Tex, and the private and university practice of another author (H.F.), Alexandria, Egypt. Patients: Twelve consecutive patients with septal perforation who received the acellular dermal allograft constituted this evaluation. The causes of the septal perforations were previous nasal surgery, previous nasal cautery, or cocaine use by the patient. Design: Interposition grafting between mucoperichondrial flaps for septal perforation repair was accomplished with decellularized human dermal grafts. Follow-up periods ranged from 3 to 14 months. Main Outcome Measures: The repair was considered successful when, on postoperative examination at 3 months, the right and left mucoperichondrial flaps were entirely healed. From the experience of 1 author (R.W.H.K.) with the repair of more than 75 septal perforations, no perforation that was healed at 3 months broke down at a later date, unless trauma or cocaine use occurred after the operation. An outcome was considered acceptable but nondesirable if a perforation was still present after the operation but the number and severity of the patient's symptoms were reduced and the perforation was considerably smaller than before the operation. Results: Eleven of the 12 patients had successful outcomes with complete closure of their perforations. The 1 remaining patient had an acceptable... [ABSTRACT FROM AUTHOR]

Objective: To present a decision paradigm for facial defect reconstruction, and test the ability of this paradigm to improve resident performance. Design: A decision paradigm for reconstruction of facial skin defects is proposed and explained, with patient examples. The paradigm's usefulness is then tested with residents. Setting: Otolaryngology residency training program at a tertiary hospital. Study Participants: Otolaryngology residents. Interventions: Twelve residents took a pretest wherein they were presented with drawings of skin defects and asked to choose the "best" (most aesthetically pleasing) type of reconstruction from a closed set. This paradigm was presented to these residents, and their posttest consisted of choosing again with the same defects and closed set of choices. Main Outcome Measures: Cosmetic outcomes of reconstructive decisions on the pretest and posttest were rated on a scale of 0 to 5 (with 0 indicating poor; 5, excellent). Results: There was a significant improvement in reconstructive choices between the pretest and posttest (P<.001, Student t test). Conclusion: This paradigm can be easily modified to accommodate different surgical approaches preferred by individual surgeons and is thus useful in almost any reconstructive teaching situation. [ABSTRACT FROM AUTHOR]

Objectives: To assess the incidence of hypothyroidism after hemithyroidectomy and to identify risk factors for the development of hypothyroidism. Design: Retrospective analysis. Setting: A tertiary care academic medical center. Patients: The study included 90 patients who underwent a hemithyroidectomy from 1999 to 2004. Main Outcome Measures: Hypothyroidism was defined as a serum thyrotropin level greater than 6.0 mIU/L at least 8 weeks after hemithyroidectomy. All patients were analyzed for age, sex, surgical indications, preoperative and postoperative thyrotropin levels, weight of resected specimen, final pathologic analysis, and length of followup. Multivariate analysis was performed to identify multiple risk factors for the development of hypothyroidism. Results: The final pathologic analysis demonstrated 49 follicular adenomas, 17 cases of Hashimoto thyroiditis, 10 multinodular goiters, and 14 other abnormalities. The overall incidence of the development of hypothyroidism after hemithyroidectomy was 27% (24 of 90 patients). When the groups were broken down by pathologic diagnosis, the incidence of hypothyroidism developing during follow-up among the Hashimoto thyroiditis and multinodular goiter groups was 59% and 50%, respectively. Also, the patients who developed hypothyroidism were noted to have statistically significant higher preoperative serum thyrotropin levels (3.15 mIU/L vs 1.95 mIU/L; P<.001) than those who remained euthyroid. There was no relationship between age, sex, or weight of the resected tissue and the subsequent risk of hypothyroidism. Conclusions: The overall incidence of posthemithyroidectomy hypothyroidism was 27%, and the majority of cases developed in the first 6 to 12 months after surgery. Risk factors for the development of hypothyroidism include pathologic diagnosis (Hashimoto thyroiditis and multinodular goiter) as well as a high-normal serum thyrotropin level. Routine monitoring of serum thyrotropin levels should be performed in all patients who undergo a hemithyroidectomy [ABSTRACT FROM AUTHOR]

Profiles the Iowa-born surgeon, Hayes Martin. Career history of Martin; Contributions of Martin to the development of the field of otolaryngology; Notable studies published by Martin; Achievements; Professional affiliations.

Background: Although the determinates of paranasal sinus development and sinusitis are not well defined, a candidate factor is blockage of the choana. Hypothesis: Maxillary sinuses ipsilateral to unilateral choanal atresia are comparatively small and have more evidence of sinusitis than do the contralateral sinuses. Design: Retrospective. Setting: Children's hospitals. Patients: Sixteen nonsyndomic children with isolated unilateral congenital choanal atresia. Main Outcome Measures: Determination of maxillary sinus volumes and mucoperiosteal thickening on preoperative computed tomograms. Results: Maxillary sinuses ipsilateral to unilateral choanal atresia have slightly larger volumes than, and mucoperiosteal thickening that is similar to, the contralateral sinuses. Conclusion: These data suggest that maxillary sinus development and sinusitis are independent of posterior nasal ventilation and drainage. [ABSTRACT FROM AUTHOR]

Objective: To investigate dose-related effects of ephedrine on olfactory function in healthy subjects. Design: Placebo-controlled, randomized, double-blind study. Methods: Drug effects were assessed using olfactory and trigeminal psychophysical measures (intensity ratings, odor discrimination, butanol and formic acid thresholds); nasal patency was assessed by means of anterior rhinoresistometry. The investigation was performed in 24 healthy volunteers; subjects were assigned to treatments A, B, or C (3 groups with 8 subjects each; 4 women and 4 men per group). All subjects received either placebo or ephedrine in both nostrils; group A subjects received placebo, and group B and C subjects received ephedrine in dosages of 0.12 and 0.24 mg, respectively. Results: Treatment with ephedrine produced a tendency toward an increase of nasal airflow. However, during the time of observation there was no significant difference between effects produced by the 2 dosages. Ephedrine had no systematic effect on measures of olfactory function. The only significant correlation to the nasal airflow was found for perceived intensity of the trigeminal stimuli, which increased with increasing flow. Conclusions: Ephedrine appeared to have neither negative nor major positive effects on intranasal chemosensory function in healthy subjects. This indicates that ephedrine may be used as a decongestant in studies on olfaction. [ABSTRACT FROM AUTHOR]

Discusses whether e-mail is an effective medium for physician and patient interactions. Background on Internet use of patients and otolaryngology; Benefits of e-mail correspondence; Disadvantages of using e-mail.

Deals with the Web site of the 'Archives of Otolaryngology Head and Neck Surgery.' Features of the Web site; Operations of Web-only publications; Advantages of using the Internet for continuing medical education.