Radiation injury of the temporal bone.

Radiation injury of the temporal bone is a common occurrence following external beam treatments. Injuries can be mild, consisting of radiation otitis media, or more extensive, including bone and soft tissue necrosis with infection and intracranial complications. Pathogenesis of radiation-induced temporal bone injury along with treatment programs are discussed.

Laryngeal image biofeedback.

The proper treatment of many voice disorder patients includes modification of voice production. Laryngeal image biofeedback (LIB), a new technique to help selected patients modify vocal fold posture and thereby vocal production is described. The effectiveness of this technique as a learning tool is assessed in 20 subjects.

Laser resection for early oral cavity cancer. Results and complications.

Laser excision of early selected cancers of the oral cavity and pharynx is a well accepted and reported treatment. Postoperative radiation therapy is employed in patients with unfavorable pathologic findings and in patients expected to have a high recurrence and metastatic rate. In most patients the combination of laser excision and postoperative radiation therapy is well tolerated and results in satisfactory healing, excellent tumor control, and high-level posttreatment function. This report discusses the treatment and results in 28 patients treated for early cancer of the oral cavity and pharynx. The local control rate of 77% compares favorably with the reported results following either conventional or laser excision of these lesions. The overall complication rate was 39%, with a 25% rate for patients not receiving postoperative radiation therapy, and a 58% complication rate for patients treated with postoperative radiation.

Restricted growth at the frontonasal suture: alterations in craniofacial growth in rabbits.

Apposition of bone at the sutural margin is generally thought to be a compensatory adjustment to growing soft-tissue organs such as the brain or eyes within the skull. The frontonasal suture which is located at the interface between the cranial and facial skeletons is a site of extremely active growth in the young rabbit. Recently, we showed that premature closure of a cranial suture, the coronal suture, can alter the growth not only at the adjacent frontonasal suture but also of the basicranium and midface. This study examines the effects of restricted growth at the frontonasal suture on both growth at adjacent cranial sutures and linear growth of the basicranium and midface. Thirty newborn New Zealand White rabbits were subdivided into experimental and sham-treated groups of equal size and distribution for sex and birth weight. At 9 days of age, the frontonasal suture of each experimental animal was immobilized by bilateral application of methyl-cyanoacrylate adhesive across the frontonasal suture. Growth and morphometric changes were monitored by radiocephalometric methods through 120 days of age by bilateral implantation of radiopague markers on each side of frontonasal, coronal, and anterior lambdoid sutures. Results indicate that restricted growth at the frontonasal suture results not only in a significant shortening of the midface but also in significant decreases in growth at the coronal and internasal sutures. Growth at the interfrontal and sagittal sutures is increased. Furthermore, growth at the anterior portion of the nasal bones is significantly increased, thereby offsetting a portion of the decreased nasal bone length resulting from frontonasal restriction.

Skull expansion in experimental craniosynostosis.

Bilateral coronal suture immobilization was performed in 9-day-old rabbits to simulate the brachycephaly deformity characteristic of coronal synostosis. Growth abnormalities were documented by serial radiographic cephalometry. A "corrective" linear craniectomy procedure was performed on the rabbits with an immobilized coronal suture at 60 days of age. The degree of amelioration of the induced abnormalities by the surgery in these animals was compared with a similar group of animals that had the same surgery plus supplemental implantation of a spring expansion device at the coronal suture craniectomy site. The mean marker separation at the coronal suture was significantly greater (5.61 mm +/- 0.52 SE versus 2.53 mm +/- 0.38 SE; p less than 0.05) following spring expander implantation than with linear craniectomy alone. Similarly, induced anterior cranial base shortening and distortion of craniofacial cephalometrics were more significantly improved by the additional use of the spring expansion device.

Long-term function of duct-ligated and free-duct whole pancreas transplants.

This report compares endocrine and exocrine responses of "free-duct" and "duct-ligated" whole pancreas isografts in Lewis diabetic rats during a 1-year period of observation. Fasting blood sugar, serum amylase, serum insulin, pancreozymin-secretin test, and L-arginine tolerance test assays were performed prior to and at periodic intervals after transplantation. Histological examinations of transplanted and native pancreas were performed monthly on animals in each group. Whole pancreas transplantations led to immediate and sustained normalization of FBS and insulin levels. In the "duct-ligated" group there was a gradual but insignificant decrease of serum insulin levels after 9 months. Depressed serum amylase levels in diabetic rats were reversed in both groups. Isolated islet iso- and allografts also reversed depressed amylase levels. The results of pancreozymin-secretin tests in islet isografted animals supported the postulated trophic effect of endocrine pancreas on exocrine pancreas. Although both whole-pancreas transplant groups showed a normal response to GTT for 12 months after transplantation, the "duct-ligated" group showed a significantly lower response to L-arginine tolerance test than the "free duct" model as early as 4 months after transplantation, suggesting a defect in B-cell function in long-term "duct-ligated" graft. Serial histological examinations of transplanted pancreases revealed more rapid atrophy and more intense fibrosis of acinar tissue in the "duct-ligated" group than in the "free duct" group. These results suggest that a "free duct" pancreatic isograft maintains a more stable endocrine function in a long-term study than does the "duct-ligated" pancreas, and that exocrine dysfunction in diabetic rats may be related to the endocrine disorder which can be reversed by both islet cell and whole-organ pancreatic transplantation.

Carcinoma of the pyriform sinus: analysis of 102 cases.

The treatment of 102 patients with squamous cell carcinoma of the pyriform sinus seen at the University of Virginia Medical Center from 1958 through 1977 is reviewed. Eight-seven cases form the basis for this report. Surgery alone, radiation alone and combination of the two were the treatment modalities utilized for the patients in this study. The overall 3 year, no evidence of disease determinate survival was (37%). Recent literature has suggested that preoperative radiation obscures tumor margins with a decrease in survivals as compared to postoperative irradiation. Though the number of patients in both the preoperative (27) and postoperative (7) groups are small, our data suggests similar survivals. In addition, when pathology was examined, no tumor margins were transected in the preoperative irradiation group and only 5/23 patients had margins classified as close. The incidence of postoperative complications was not significantly difference between the combination therapy and surgery only groups. It is concluded that preoperative irradiation does not compromise the resection of adequate tumor margins nor significantly increase postoperative complications.