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Utrasonic irradiation of the labyrinth via the round window is effective in controlling otological vertigo. This method of surgical management for incapacitating vertigo is presented with demonstrative intraoperative electronystagmograms and irradiated cat neuro-epithelium. Such data suggest that more intense irradiation doses than previously reported should be applied to effectively destroy the diseased labyrinthine end organs. Precise end points of destructive irradiation are defined by characteristic intraoperative electronystagmograms. The authors suggest this is an ideal procedure when the situation of an unaffected cochlea, coexisting with a diseased labyrinth, requires a minimally invasive, destructive procedure which preserves hearing while eradicating vertigo.

The benign, monomorphic adenoma, derived from the respiratory epithelium of the middle ear, is a well circumscribed, greyish, avascular tumor. Its histology--documented by light and electron micrographs contained in this report--supports a distinct entity and pathogenesis apart from the malignant adenocarcinoma. Utilizing two case reports, this compendium emphasizes the clinical presentations, as well as radiographic and audiometrical characteristics, of the tumor. The first case represents the typical tumor with conductive hearing loss. The second case is the first reported facial paralysis associated with hemorrhagic infarction of an adenoma which was reversible by surgical resection of the tumor. Based on the histology and four year postoperative follow-up, the authors conclude the adenoma may be effectively managed by surgical resection.

Direct evidence is presented that establishes the existence of an Eusta-chian tube surface tension lowering substance (S.T.L.S.) in the canine experimental model. The physiological role of this Eustachian tube S.T.L.S. is to facilitate middle ear ventilation by lowering the opening pressure needed to aerate the Eustachian tube and middle ear. While S.T.L.S. possesses characteristics similar to those of the pulmonary surfactant, experimental data suggest that it does not reduce the surface tension in the auditory conduit of the middle ear to the degree that the surfactant does in pulmonary system. Neither does Eustachian S.T.L.S. exhibit the physical characteristic of “hysteresis” that the alveolar surfactant demonstrates. The paper presents brief discussion of the physical phenomenon of surface tension as it exists in the Eustachian tube. Various methods of physical surface chemistry used in measuring the surface pressure of the canine Eustachian S.T.L.S. extract are discussed, including criticism of the indirect methodology of previous researchers in investigating the possibility of an Eustachian tube S.T.L.S. Direct methodology, utilizing the Langmuir Trough with Wilhelmy surface balance, was employed. S.T.L.S. is considered in its physiologic role in maintaining Eustachian tube patency. It is suggested that a decreased amount of Eustachian S.T.L.S. may be implicated in the pathophysiology of the serous acellular sterile middle ear transudate in serous otitis media. Finally, it is stressed that this preliminary work needs further histochemical and physiological investigation.

The location of the facial artery beneath the facial mimetic muscles of the nasolabial groove allows surgical development of a true musculocutaneous flap. This report of 20 surgical flaps and six cadaveric dissections highlights the nasolabial musculocutaneous flap with its direct muscle perforating arteries which nourish the overlying skin. The absence of any flap's ischemic failure emphasizes the durability of the flap for various midface and oral reconstructive situations. Inferiorly-based flaps are preferable on the basis of discussed anatomical findings. The musculocutaneous flap is especially suited for circumferential interruption of cutaneous blood supply as in the "V-to-Y" and island pedicle flaps.

The nevus sebaceus of Jadassohn (SNJ) is a congenitally-occurring, hamartomatous disorder of the skin and its adnexa of infrequent occurrence. This presentation of five cases emphasizes the smooth, waxy, yellow-brown lesion's progression into a thickened sebaceous tumor of premalignant predilection. The incidence of neoplastic degeneration of these hamartomatous nevi may be as high as 30% with the capacity of metastasis occasionally reported. Because of malignancy risks as well as cosmetic considerations, early surgical removal is recommended. Previously unreported problems of dysphagia and malnutrition secondary to pulsion diverticulum at the esophageal inlet and cleft palate, obliterative aural stenosis with associated conductive hearing loss are documented. Regardless of SNJ's occurrence as either an isolated lesion or as the fully developed syndrome, including mental retardation and epilepsy, this congenital malformation of the skin, its hair, and sebaceous glands presents rare and histologically intriguing problems for the practitioner.

Although ganglioneuroblastomas occur infrequently in the head and neck area, if they are recognized and completely excised initially, the chances of cure are greatly increased. Two patients are reported who demonstrate some of the more important aspects of diagnosis and treatment. The first patient, whose retropharyngeal tumor was diagnosed when he was 12 years of age, was treated with transoral excisional biopsy. He is alive and tumor-free 3 1/2 years later. The second patient, a 2-year-old , was treated by incisional biopsy without a major resection. He died on year later. The diagnostic evaluation of a patient with suspected neurogenic tumor includes a complete physical examination for distant adenopathy, abdominal masses, hypertension, and neurological impairment. Intraoperatively, neurosurgical and pathological consultation should be available.

The nevus sebaceus of Jadassohn (SNJ) is a congenitally-occurring, hamartomatous disorder of the skin and its adnexa of infrequent occurrence. This presentation of five cases emphasizes the smooth, waxy, yellow-brown lesion's progression into a thickened sebaceous tumor of premalignant predilection. The incidence of neoplastic degeneration of these hamartomatous nevi may be as high as 30% with the capacity of metastasis occasionally reported. Because of malignancy risks as well as cosmetic considerations, early surgical removal is recommended. Previously unreported problems of dysphagia and malnutrition secondary to pulsion diverticulum at the esophageal inlet and cleft palate, obliterative aural stenosis with associated conductive hearing loss are documented. Regardless of SNJ's occurrence as either an isolated lesion or as the fully developed syndrome, including mental retardation and epilepsy, this congenital malformation of the skin, its hair, and sebaceous glands presents rare and histologically intriguing problems for the practitioner.

Modern day understanding of the microcirculation of musculocutaneous flaps has initiated this reconsideration of the nasolabial flap with the context of modern flap physiology and nomenclature. Surgical incorporation of the circumoral and facial muscles within the skin of the overlying nasolabial groove constitute a musculocutaneous flap based upon the underlying facial vessels. This thick musculocutaneous flap provides an extremely reliable vascularity for reconstruction of the floor of the mouth and oral sphincter in a one-stage procedure. The donor nasolabial flap is easily accessible in the same surgical field and may be obtained with minimal donor area morbidity. Cosmetic and functional impairment are minimal. Anterior tongue mobility for articulation is preserved. Eleven nasolabial flaps for oral reconstruction following burn reconstruction as well as resections for carcinomas of the labial and oral areas are presented.