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Hereditary hemorrhagic telangiectasia is a challenging problem for the otolaryngologist since frequent, often severe epistaxis is the major symptom. Options for therapy in the past have included nasal packing, electrocautery, systemic estrogens, septal dermatoplasty, arterial embolization, and arterial ligation. Although successful treatment has been achieved with some of these methods, particularly septal dermatoplasty, other forms of therapy are needed prompting the use of laser photocoagulation. The neodymium yttrium-aluminum-garnet (Nd-YAG) laser was used to treat a group of 19 patients with hereditary hemorrhagic telangiectasia over a 4-year period without complications. Endonasal laser photocoagulation was effective in decreasing epistaxis in patients not requiring frequent transfusions prior to laser therapy. Three patients with the most severe epistaxis received minimal or no benefit from Nd-YAG laser photocoagulation. In most patients Nd-YAG photocoagulation is successful in treating epistaxis associated with hereditary hemorrhagic telangiectasia and should be a therapeutic option for this chronic disease having no available cure. [ABSTRACT FROM AUTHOR]

The evaluation of fractures involving the frontal sinus is important since significant complications can occur acutely or many years following injury. Thorough roentgenographic analysis, with special emphasis on the status of the nasofrontal duct, is required. The extent of soft tissue injury cannot be used as a guide. Furthermore, the proper treatment of fractures involving the posterior table has been controversial. In general, all fractures of the posterior table should be explored. Complete neurological evaluation is necessary and an observation period of approximately 48 hours is recommended prior to surgery. A coronal incision is suggested since a craniotomy can be performed with the exposure obtained. In selected patients, conservative treatment may be warranted but close follow-up with serial X-rays is necessary. Primary adipose obliteration of the injured sinus is recommended as treatment since complications are eliminated by a single operation which is cosmetically acceptable. This is supported by existing clinical series and experimental evidence. Adipose tissue possesses certain advantages which make it the tissue of choice for obliteration. Infection involving the implanted fat does not appear to be a significant problem. Bony fragments of the posterior table may safely be left in place. Dural lacerations occurring immediately behind the posterior table can be managed through the sinus without the necessity of craniotomy. [ABSTRACT FROM AUTHOR]

Experiments using cats were performed to examine the natural history of posterior table fractures of the frontal sinus and the methods available for treatment. Elevation of depressed fractures and obliteration by either fat or osteoneogenesis and fibrosis were the modalities of treatment used. Comparisons were made with untreated controls. Fascia reinforcement of the dura and plugging of the nasofrontal duct were variables. The nasofrontal duct is critical in the natural history of these injuries. All fractures of the posterior table heal if drainage into the nose is maintained. Fractures which are elevated heal by bony union with associated mucosal and dural healing. Loose fragments of the posterior table heal if left in place. Mucoceles form if the nasofrontal duct is obstructed, if mu-cosa is inadequately removed during obliteration and, in some instances, where islands of mucosa are isolated by mucosal laceration. Viable adipose tissue in the sinus prevents significant ingrowth of mucosa from the nasofrontal duct. Growth of mucosa into fracture lines was not a problem. Both adipose transplants and intrasinus fascia reinforcement appeared to contribute to well defined posterior table healing. [ABSTRACT FROM AUTHOR]

Sarcoidosis is an idiopathic disease which presents in anatomic areas of concern to otorhinolaryngologists. It can cause dysfunction of both auditory and vestibular systems. In patients known previously to have sarcoidosis, this disease should be seriously considered. In patients presenting with otologic disorders and associated facial nerve paralysis or other neuropathies, uveitis, granulomatous meningitis or diabetes insipidus, sarcoidosis should be suspected. An examination of the eyes as well as a chest X-ray is imperative. Sudden and fluctuating neurosensory hearing loss has been reported. There is a great need for the study of temporal bones from sarcoidosis patients. [ABSTRACT FROM AUTHOR]

Tuberculosis of the larynx, once a common disease, has become quite rare with the advent of anti-tuberculous chemotherapy. In the pre-antibiotic era two modes of laryngeal infection were recognized; bronchogenic and hematogenous. The literature is briefly reviewed. Thirteen patients in the past 15 years in whom tuberculous laryngitis was diagnosed upon indirect laryngoscopy by members of the University of Michigan Department of Otorhinolaryngology are presented. Bronchogenic infection was present in 11, and in two patients the disease was consistent with hematogenous spread. Tissue biopsy from a case of bronchogenic contamination demonstrated epithelioid tubercles, while numerous subepithelial acid-fast bacilli without typical tuberculous histological change were present in a case of hematogenous laryngeal infection. A case of cicatricial laryngeal stenosis was successfully treated surgically by laryngofissure, excision of fibrosis with arytenoidectomy, and free mucous membrane grafting. Finally, the initial subtle presentation of many of our patients emphasizes the importance of a consideration of tuberculosis in the differential diagnosis of chronic laryngitis. [ABSTRACT FROM AUTHOR]

A retrospective study of patients with parapharyngeal tumors has been completed, and this report concerns 40 patients cared for during the years 1962-1973. The parapharyngeal space is a potential anatomical space with three rigid walls so that growth of a tumor proceeds either medially or inferiorly or both. This pattern of growth accounts for the distinct clinical appearance of a displaced palate and pharynx. As noted in this series of cases, Table I depicts the types of tumors which involved the parapharyngeal space. Eighty-two percent of the cases presented with benign tumors. On the other hand, 18 percent of the patients had malignant tumors. Benign mixed cell tumors and schwannomas are the most commonly noted benign tumors. Several cases presented with unusual tumors. In most patients the tumor was discovered on routine physical examination. Arteriography has become a valuable and safe diagnostic study. These procedures often help the surgeon to determine the extent of tumor, vessel displacement and the possibility of chemodectoma and even malignancy in some patients. An external surgical approach is recommended for surgical excision of the benign parapharyngeal tumor in most patients. Intraoral incisional biopsy in patients with benign tumors is to be avoided because of dangers of vessel and nerve injury as well as 'seeding' of the biopsy site. On the other hand, malignancy may be diagnosed with incisional biopsy either performed externally or intraorally, depending on the judgment of the surgeon as to the anatomical location and site of the neoplasm. In final analysis the external surgical approach allows the surgeon systematically to identify tumor, important cranial nerves including the facial nerve and the great vessels. Every effort should be made by the surgeon not to violate the capsule of a benign mixed tumor during its removal. Removal of tumor is enhanced frequently by preliminary excision of the submandibular gland, vessel ligation and mandibulotomy. In the latter instance the patient must undergo tracheostomy. Postoperative cranial nerve palsies occurred for the most part in those patients who underwent surgical excision of schwannomas. These tumors originated from the vagus nerve or cervical sympathetic chain. Sacrifice of these nerves during removal caused little morbidity. Follow-up examinations in this series of patients revealed that if benign tumors are removed from the parapharyngeal space in a deliberately planned manner, recurrence rates are extremely low. In patients who are treated for malignant lesions, prognosis must be guarded, as mortality rates are high regardless of the type of therapy. [ABSTRACT FROM AUTHOR]