Multiple bilateral orbital abscesses secondary to nasal furunculosis.

Orbital inflammation secondary to sinus inflammation is a well known entity and has been widely reported. However, nasal furunculosis resulting in orbital inflammation is a rare occurrence. We present a case of a 2-year-old boy who developed multiple bilateral orbital abscesses secondary to nasal furunculosis. To our knowledge such a case has not been reported before.

Relationship between condylomata and laryngeal papillomata. Clinical and molecular virological evidence.

In a survey of 49 papilloma patients accurate maternal condyloma history was obtained in 31 instances and of these, 21 were positive for the presence of condyloma during pregnancy or parturition. Molecular virological studies indicate that positive hybridization could be demonstrated to human papilloma virus 2 in both laryngeal papilloma and condyloma by the Southern blot technique. Immunoperoxidase staining illustrated the presence of virus-related particles only near the surface of the mucous membrane papilloma, which is in contrast to the definite staining of the stratum granulosum and stratum corneum of verrucae. Collectively this provides convincing evidence for an etiological relationship between condyloma acuminata and some laryngeal papillomata. The highly contagious nature of human papilloma virus infection is discussed and the possibility of cesarian section in the presence of active condyloma must be considered.

Giant cell tumors of the maxilla in children.

Three types of giant cell lesions occur in the facial skeleton; namely, giant cell reparative granuloma, Brown tumor of hyperparathyroidism, and true giant cell tumor -- osteoclastoma preferably called giant cell neoplasm. An appraisal of the clinical course biochemical laboratory data, radiographic appearance, and histological features are all necessary to distinguish between these varieties. Differentiation is a prerequisite to treatment because the management differs in each lesion. Three case reports illustrate these features. The important considerations of facial growth following surgery to the facial skeleton of a child are discussed. Long-term observation is imperative.

Frequency and significance of epithelial atypia in laryngeal papillomatosis.

The clinical records and microscopic sections from 32 patients were reviewed in an attempt to correlate histopathologic features with clinical behavior. Three general clinical groups were identified on the basis of recurrence rates and extent of papillomatosis. In those lesions with the highest frequency of recurrences, epithelial atypia tended to be most pronounced. Although some of the lesions were quite disturbing, there was no evidence of invasive carcinoma. It remains unknown to date whether these cytologic abnormalities represent a neoplastic alteration or possibly atypia on the basis of rapid, but benign, cellular turnover. Further studies at our center and other institutions are necessary to test the proposed classification which, if validated, would provide a means of predicting the course of the disease and efficacy of the chosen management in these difficult cases.

Arytenoid dislocation.

The reported incidence of arytenoid cartilage dislocation is low. This may be due to the wide range and orientation of motion allowed by the cricoarytenoid articulation and the laxity of its joint capsule. In two previously reported instances of arytenoid dislocation, the authors have suggested that endotracheal intubation is generally not sufficient to cause dislocation of an arytenoid cartilage, but that, in their cases, a predisposing factor had set the occasion for dislocation. In this communication, three cases of arytenoid cartilage dislocation, which each followed a single instance of endotracheal intubation are presented. In all three cases, painful swallowing was the main presenting symptom. Clinical features that differentiate arytenoid cartilage dislocation from vocal cord paresis are summarized. Early reduction of the dislocation, while the patient is under local anesthesia, is recommended, and the techniques are described in detail.

Estimate of vitamin A in the guinea pig cochlea.

Microfluorometric estimates of the membranous structures of the freeze-dried guinea pig cochlea have demonstrated that vitamin A is present in these tissues at a concentration of 21.2 microgram/gm (SD +/- 4.77 microgram) which is approximately ten times the vitamin A concentration in most other tissues.

Mucoceles with intracranial and extracranial extensions. Report of two cases.

Two cases of unusual childhood mucocele are presented. These serve to illustrate the great potential these lesions have for slow, insidious development and insinuation of themselves into regions of the head and face where they are difficult to remove surgically. A description of the staged surgical excision is presented to emphasize the importance of radical removal of these benign lesions.

Ranula and the sublingual salivary glands.

The term "ranula" is poorly understood and is frequently applied to a variety of cystic structures in the head and neck. Ranulas classically are cysts of salivary gland origin, usually the sublingual glands, of which two varieties are described: a simple, epithelial lined cyst resulting from ductal obstruction, and a pseudocyst without epithelial lining resulting from extravasation of saliva that dissects through the tissue planes of the neck and may appear as a neck mass. Four cases are presented that illustrate the difficulties in diagnosis; treatment consists of meticulous dissection of the thin-walled sac in continuity with the excision of the sublingual glands that are the origin of these lesions.

Hearing loss in patients with dialysis and renal transplants.

Hearing loss in renal dialysis and renal transplant patients occurs quite frequently. An assessment of the likely etiological factors is nearly impossible in a retrospective analysis of any one patient because many factors exist simultaneously. In a prospective study of a large series of patients an identification of factors contributing to the hearing loss was possible in the majority of patients. During the study it became increasingly apparent that what was observed at any one time was the combined effect of many factors. Although one factor seemed to precipitate the hearing loss it was inadvisable to attribute total responsibility to that agent or circumstance. Further, this combined effect was not a simple addition of effects but potentiation. The serious implications of this phenomenon are discussed.

Temporal bone histopathology in experimental hypovitaminosis A.

Twenty-five years ago hearing loss was observed in some subjects during a comprehensive study of the effects of hypovitaminosis A on human volunteers. Experimental studies documenting histopathological changes in the temporal bone due to hypovitaminosis A are conflicting. Even the recent textbooks of otolaryngology and physiology make no mention of a role of vitamin A in the ear. To explore the role of vitamin A in the ear adult and weanling rats maintained on a diet totally lacking vitamin A were sacrificed at intervals. Their temporal bones were examined with the light microscope. After six weeks on a vitamin A free diet weanling rats showed hypertrophy of the periostial portions of the otic capsule. At 16 weeks a narrowing of the internal auditory canal due to bony exostoses was present. The neuroepithelia of the cochlea and the vestibular apparatus were histologically normal even in the longest surfiving animals. Adult rats maintained on a vitamin A free diet showed minimal thickening of the bone adjacent to the internal auditory meatus. The cochlea and the vestibular appartus in these animals remained normal throughout the 28-week experiment. Although we have demonstrated marked abnormalities of the otic capsule in hypovitaminosis A, our results do not support those of some earlier investigators who reported that atrophy of the cochlear and vestibular neuroepithelium occurred in the absence of dietary vitamin A.

The role of otolaryngology in primary care practice. Report of a survey.

A survey was conducted to assess how family practitioners rated certain knowledge skills and procedures in the field of otolaryngology. A questionnaire was designed as the instrument of the survey, and family practitioners were asked to complete the questionnaire based entirely on their experience in practice. The results of the survey showed that the practitioners considered that the majority (64%) of the items ranged from necessary to imperative. A highly consistent response was obtained. We discuss implications for curriculum design based on such surveys.

Deafness and renal failure due to potassium bromate poisoning.

Several substances are known to have a profound effect on both the kidney and the inner ear. The aminoglycoside antibiotics are toxic to both of these organs. Ethacrinic acid and furosemide affect transport mechanisms in the loop of Henle as well as the inner ear. In addition, studies have suggested antigenic similarities between the stria vascularis of the cochlea and the renal tubules. This report of potassium bromate poisoning and its resultant deafness and renal failure further emphasizes the curious relationship between these two organ systems.