[Facial nerve injuries caused by firearms]. / Povrede facijalnog nerve izazvane vatrenim oruzjem.

In the period from 1990 to 1994, 52 facial nerve injuries caused by fragments firearm projectiles were managed. Their features (localization, severity and extensiveness) were correlated with 37 nerve injuries in blunt head injuries with fracture of temporal bone. In blunt head injuries, 81.1% patients were with the nerve lesion in the area of geniculate ganglion (labyrinthine and tympanic segment). Compression of nerve with bone fragments of fallopian tube was found in 56.8% cases, the cleft of neural sheath and intraneural hematoma were rarer, while the nerve tear was not found in any injured. The distal part of mastoid and beginning part of parotid nerve segment were injured in over 70% cases of gunshot injuries, and in 38.5% cases the injury was multiple. Direct suture was performed in 8 nerve injuries, neuroplasty in 6, and the other injuries were managed by skeletization of fallopian tube, nerve decompression or some other microsurgical procedure. Micro-surgery was performed 7-14 days after the injury.

[An atraumatic approach in stapes reconstruction]. / Atraumatski postupak u stapedoplastici.

In order to prevent complications which occur in classical stapedoplasty, authors applied a new atraumatic procedure in 138 patients with otosclerosis. Along with preserved ossicular chain, stapedotomy was performed and a piston-wire prosthesis placed. Disarticulation of incudostapedial joint was the next part of the procedure with removal of suprastructure of the stapes. Early and late cochlear disorders were rare while the final functional effects were much better. This paper analyzes numerous advantages of this procedure with directives for promotion of our work in the future.

[The inverse procedure in stapedioplasty]. / Inverzni postupak u stapedoplastici.

The inverse procedure in stapedoplastic with the primary stapedectomy was done in 55 patients with otosclerosis. The early cochleo-vestibular disorders (1.8-3.6%), graver sensoneural damage after 6 months (1.8%) and bone--air conduction gap were significantly better in relation to the patients operated in classical way. Many advantages of inverse procedure were analyzed in prevention of inner ear lesions and better functional outcome.

[Facial nerve lesions in gunshot injuries of the temporofacial region]. / Lezije zivca lica u strelnih povreda temporofacijalne regije.

Experiences and difficulties in the preoperative diagnostics and treatment of facial nerve lesions concerning nine injuries of the temporofacial region caused by firearms projectiles are presented. Otosurgery treatment of the damaged nerve occurred from the 8th to 22nd day, after the vital functions normalization and taking care of maxillofacial region injuries. Apart from facial nerve paralysis, in 7 injured cophosis occurred, but immediately after they had been injured all had vertiginous disorders. Before detecting the place of the nerve lesion complete skeletization of the fallopian tube was done. Since in four cases there was a complete disconnection of the facial nerve distally from stylomastoid foramen, authors point to the importance of nerve exploration in this segment. In all cases development of connective tissue was expressed just like granulation of mastoid cells and cavum, and in 4 injured there are clear signs of infection at the place of nerve lesion, so that there is a need to perform the operation as early as possible.

[Auditory evoked brain stem potentials in the diagnosis of disseminated demyelinating processes of the central nervous system]. / Auditivni evocirani potencijali mozdanog stabla u dijagnostici diseminiranih demijelinizacionih procesa centralnog nervnog sistema.

The results of auditory evoked potentials of the brain stem of 109 patients with different clinical form of multiple sclerosis have been analysed. Pathologic findings were classified into five stages. The subclinical lesions at the level of the brain stem were found in 62% of patients in early, monosymptomatic phase of the disease. This method provides a large contribution to early detection of multiple sclerosis.

[Complications in secretory otitis media treated with aeration-drainage tubes]. / Komplikacije sekrecionog zapaljenja srednjeg uva lecenog aeraciono-drenaznim cevcicama.

Nine hundred and twenty aeration-drainage tubes were implanted in 500 patients suffering from secretary otitis media. Besides visible improvement of the hearing in 85% of operated ears, the importance of some sooner or later complications should be pointed out. Usually this is intraoperative haemorrhage (50%). However tube obstruction (8%) or perception deafness were not rare. The importance of myringosclerosis (35%), and of the elimination of implant (12%) is emphasised. The appearance of postimplantation cholesteatoma and many other sooner or later complications are also analysed. The basic principles of microsurgical technique for the prevention of complications are enumerated.

[Neurophysiologic tests for the early detection of deafness in children]. / Neurofizioloski testovi u ranom otkrivanju nagluvosti u dece.

Using brainstem auditory evoked potentials and tympanometry the authors have examined 120 children aging from several months to five years and they have found a high percentage of children with hearing impairment with sensorineural deafness. The children had also secretory inflammation of the middle ear. It has been suggested that secretory inflammation of the middle ear deteriorates the basic hearing impairment because of which it should be early diagnosed and surgically treated. Owing to the complex problem of children deafness, the authors recommend that several methods of examination should be applied in the diagnostic procedure in order to determine precisely the auditory threshold and to initiate in time hearing and speech habilitation.

[Surgical treatment of facial nerve paralysis in fractures of the temporal bone]. / Hirursko lecenje paralize licnog zivca u fraktura temporalne kosti.

Of 36 patients with facial nerve palsy caused by the fracture of the temporal bone, 28 were treated surgically and 8 conservatively. The way of treatment was determined after the detailed radiologic, neurootologic, vestibular and functional hearing examinations as well as of the damaged facial nerve. Numerous neurootologic disorders have the decisive clinical value in evaluation of the site and degree of destruction and selection of adequate way of treatment. The authors have shown that early surgical intervention and combined transmastoid and translabyrinthine approach provide the most suitable conditions for surgical management of the facial nerve and all associated damages in the region of the middle and inner ear.

[Physico-chemical characteristics of submandibular salivary secretions in patients with peripheral paralysis of the facial nerve]. / Evaluacija fizicko-hemijskih osobina submandibularne salivarne sekrecije u bolesnika sa perifernom paralizom licnog zivca.

In 53 patients with peripheral facial palsy divided in the definite groups there have been continually followed up changes in the physico-chemical features of saliva of the submandibular salivary glands and the motor function of the mimic musculature in the course of a year-observation of pH, osmotic pressure and electrolöte secretion. The reduction of Na+ and CO2 secretion resulted in the low values of pH and osmotic pressure in all saliva samples at the site of lesion. The degree of this reduction has been shown to be in the direct relationship with the severity of the nerve lesion and its final outcome.

[Salivation in the submandibular salivary gland in the prognosis of peripheral facial nerve paralysis. Clinical study]. / Salivacija podvilicnih pljuvacnih zlezda u prognozi perifernih paraliza zivca lica. Klinicko istrazivanje.

The relationship between the quantitative submandibular gland secretion and neural motor function was examined in 157 patients with different types of peripheral facial paralysis. These two functions were followed up during the period of one year. In the patients with 40%, or more, of submandibular gland secretion one month after the onset of facial paralysis, the motor nerve function recovery was satisfactory, while, in the patients with submandibular gland secretion less than 20% the recovery was unsatisfying. When the submandibular gland secretion was more than 50% in the early stage of facial paralysis, the complete recovery was within 6 months. On the contrary, when it was less than 50%, the recovery period was much longer.

[Sudden sensorineural hearing loss of unknown origin]. / Nagli senzorineuralni gubitak sluha nepoznatog uzroka.

The study presents the results of a ten year experience in the treatment of abrupt hearing loss of unknown etiology in 248 patients. More successful treatment was achieved in patients with lesser degree of perceptive hearing reduction and those showing no vestibular symptomatology. A decisive factor for a favourable hearing recovery is time between the onset of the disease and the beginning of the therapy. Having this in mind, the authors insist on early diagnosis and early administration of drugs affecting the inner ear perfusion.

[Blast injuries of the ear]. / Blast trauma uva.

Blast injury of the ear is the actual military medical problem. The ear, due to its anatomo-physiologic characteristics, is more sensitive to effects of blast waves than other organs and systems. The anatomic and functional ear damages, their symptoms, etiology and clinical course are described. The diagnosis and treatment have been pointed out.

Problems in diagnosis and treatment of cholesteatoma in children.

Our clinical study includes 56 cases of cholesteatoma in children aged 3-14 years, treated in a 6-year period. Cholesteatoma was localized in attic (6 cases), in middle ear (6 cases), in attic plus middle ear (16 cases) and in attic + middle ear + mastoid (28 cases or 50% of the total number). In the surgical treatment combined approach tympanoplasty (intact canal wall technique) was used in 76.8%, radical tympanomastoidectomy in 16.1%, and other techniques in 7.1%. Intact ossicular chain was found in 25%. Reconstruction of the ossicular chain (including autograft, homograft and allograft material) was done in 59%, and the remaining 16% were treated by classic radical surgery. Hearing results: unchanged, 48%; improved, 45%; slightly worsened, 7%; and no dead ear. Recurrency in 31% is considerably higher as compared to 15% in adults found in another comparable study by us.

Can size or type of the pontocerebellar tumor be predicted by an ABR finding?

ABR waveforms were analyzed in 63 subjects with tumors of the pontocerebellar angle. The tumors were diagnosed by CT scan and the diagnoses were surgically confirmed. According to the latency changing and amplitude size, the ABR waveforms were classified into seven types (0, A, B, C, D, E and F). All tumors were divided into groups (depending on size), and into subgroups (depending on type). Types 0-E were found in tumors of all sizes. Type C of the brain stem response (BSR) waveform (only 1 deflexion present) was revealed in 75% of tumors greater than 20 mm. In this case tumor size may be predicted with the significance level of 5%. Type F of the BSR waveform was found in tumors other than neuromas. Contralateral BSR is affected by tumors greater than 20 mm, and from the statistic point of view significantly more often by neuroma (significance level 5%) than by other tumors.

[Fibrin glue in tympanoplasty]. / Fibrinski lepak u timpanoplastici.

In order to achieve more favourable anatomic and functionally more permanent position of the transmission materials, fibrin glue was applied in 68 patients undergoing different microsurgical interventions for the cure of inflammatory processes in the middle ear or improvement of conductive deafness of inflammatory or traumatic origin. Fibrin glue has shown to be equally suitable both in fixation of the biological materials - homografts and autografts and in fixation of alloplastic prostheses. The efficacy of preservation of the best position was demonstrated in all forms of direct collumelas, ossicular graft interposition, closure of the labyrinthine fistulas and reconstruction of the external attic wall.

[Brain stem auditory evoked potentials in various tumors in the cerebellopontine angle]. / Auditivno evocirani potencijali mozdanog stabla kod razlicitih tumora pontocerebelarnog ugla.

Abnormalities of brainstem auditory evoked potentials of 63 patients with tumours in the pontocerebellar angle were classified in 7 types and correlated by size and nature of tumours. Types A and B brainstem responses are characteristic for small tumours up 20 mm and are indicated for computed pneumocysternography in spite of the negative CT of the brain. Type C is statistically more frequently found than larger tumours over 22 mm in size. Other types of responses which are more characteristic for tumours which are not neurinomas are described. Auditory evoked potentials are the most reliable neuro-otologic methods in detection of PCU tumours and their careful analysis provides valuable data both about the size and nature of tumours.

[The significance of dystrophic changes in traumatic facial nerve paralysis]. / Znacaj distroficnih promena kod traumatskih paraliza licnog zivca.

In 61 animals, after experimental removal of the suprachoroid part, complete section, placement of neurosutures, incomplete section and contusion of the facial nerve in the tympanic and mastoid segment, the analysis of dystrophic changes was performed after a year of follow-up. In all animals, except for control group, the degree of the manifested changes was in the direct correlation with the degree of previous lesion. The studies performed pointed out the great importance of trauma and degenerative changes in evaluation of the functional state and actualization of the problem of an adequate otolaryngological treatment of all forms of the peripheral facial nerve paralysis.