Analysis of disability resulting from treatment including radical neck dissection or modified neck dissection.

A multiinstitutional study to define the impact of total treatment programs involving radical neck dissection (RND) and modified neck dissection (MND) on patients' permanent disability was undertaken. A total of 243 patient responses were included in the study. Comparative analyses between the treatment groups show no advantage of one surgical operation over the other in returning patients to their pretreatment employment status. Radiation therapy was identified as adding significantly to the patient's permanent disability.

Prognostic factors affecting the success of duckbill vocal restoration.

This study analyzed a group of 20 patients undergoing duckbill vocal restoration at Ohio State University to determine if certain variables could predict success. Of the 20 patients, 19 developed successful speech. The 10 variables studied were age, alcohol use, living environment, stoma size, hearing acuity, educational level, work status, eye-hand coordination, concomitant medical problems, and current mode of communication. A multiple correlation analysis of this data was undertaken and alcohol abuse and stoma size were found to have the highest correlation with developing successful duckbill speech. A formula based on these two variables has been derived that will predict the patient's success. It is the conclusion of this study that since patients are not uniformly successful in developing duckbill speech such a formula is of value in predicting success and should help the clinician identify patients who may have difficulties.

Arachnia propionica (Actinomyces propionicus) as an unusual agent in tympanomastoiditis.

The actinomycetes are extremely uncommon causative agents in chronic tympanomastoiditis. Few cases have been reported in the literature, and, before the use of penicillin, the majority of patients died of intracranial extension of their disease. Two patients described in the recent literature could have had their conditions diagnosed preoperatively as cholesterol granuloma. They had intact but immobile or bulging tympanic membranes and histories of intermittent perforations with drainage. The diagnosis was suggested during surgery because of the presence of yellow-green amorphous "sulfur granules" scattered throughout the mastoid. Both patients were well following mastoidectomy and long-term penicillin therapy. The clinical history of a patient with tympanomastoiditis due to Arachnia propionica (Actinomyces propionicus) is discussed. To our knowledge, this is the first case reported of a patient with otic disease due to this strain of the organism.

Pneumocephalus from a frontal-ethmoid neurilemoma.

A 68-year-old man had memory lapse, character change, and unsteady gait. Skull films disclosed a spontaneous pneumocephalus with air in both ventricles. A dense, bony lesion in the right ethmoid area was thought to be an osteoma, a not infrequent cause of dural erosion. The bony lesion, however, proved to be an osteoid reaction around a primary neurilemoma. Neurilemomas arising in the paranasal sinuses are uncommon tumors and, to the best of our knowledge, this is the first reported case of a patient with a neurilemoma who had pneumocephalus. The lesion was excised through a Lynch approach, and the patient has remained free of tumor for the past two years.

Phenothiazine induced lingual trauma.

A 34-year-old woman presented with an unusual and unfortunate combination of complications to a phenothiazine drug. Rhythmic protrusion of her tongue was not a problem until it became trapped outside of her oral cavity by spasm of the muscles of mastication. Massive edema with questionable viability of her tongue ensued. She presented as an airway as well as therapeutic management problem.

Vocal cord paralysis. Association with superior mediastinal widening secondary to tortuosity of the great vessels.

A 60-year-old man had left vocal cord paralysis and a superior mediastinal mass. Rather than the expected mediastinal tumor involving the recurrent laryngeal nerve, he was found to have tortuosity of the great vessels of the neck that caused the mediastinal widening. In all likelihood, this was unrelated to the vocal cord paralysis. The diagnosis was suspected and invasive studies avoided due to close scrutiny of the lateral chest roentgenogram.

Cholesterol granuloma presenting as an isolated middle ear tumor.

Patients with cholesterol granuloma of the middle ear cleft will usually present with a secretory otitis media, and exhibit evidence of diffuse disease within the mastoid upon roentgenographic evaluation. The following patient with an isolated middle ear cholesterol granuloma presented with signs and symptoms more closely resembling a glomus tumor.

Lip transposition in patients with facial paralysis.

Since facial reanimation is not always possible in patients with facial paralysis, one must have alternate methods of reconstruction available. Satisfactory static reconstruction of the face may be accomplished with the use of a brow lift, tarsorrhaphy, and correction of the paralyzed mouth. Transposition of the corner of the mouth utilizing the Z-plasty technique has proven to be an effective method to correct the drooling and garbled speech associated with facial paralysis. When combined with a brow lift and tarsorrhaphy, symmetry of the facial appearance while at rest has also been obtained.

Fate of middle ear mucosa introduced into the vestibule.

The etiology of poststapedectomy reparative granuloma remains obscure. To evaluate the possibility of inadvertently introduced mucous membrane into the vestibule as a possible cause of granuloma formation, this animal study was devised. The stapes was removed from the right ear of four squirrel monkeys and middle ear mucosa placed in the vistibule, the stapes then being replaced. In the left ear, a control operation was done in which only the stapes was removed, then replaced. The animals were sacrificed between the 2nd and 17th day and their temporal bones were prepared and studied. The mucous membrane was identified within the vestibule of all animals. It was well-tolerated and did not evoke the inflammatory response, which would be expected if mucosa was a cause of granuloma formation. The mucosa was still present at 17 days, eventually becoming surrounded by the endosteal lining of the vestibule.

Thorotrast induced pharyngeal necrosis.

Thorotrast, a radioactive contrast material used between 1930 and 1950, is often permanently retained within the patient. Individuals who have had diagnostic studies with Thorotrast may develop serious complications many years later. These complications fall into two major categories, desmoplastic and neoplastic. The inadvertent infiltration of Thorotrast into soft tissue, usually the neck during carotid arteriography, may later result in severe fibrosis with constriction of the surrounding vessels and nerves. Malignancies, the second major problem, have occurred at the site of previous Thorotrast instillations throughout the body. The following report describes the clinical course of an 82-year-old woman who presented with a Thorotrast induced desmoplastic reaction of her neck, complicated by pharyngeal necrosis and the development of a pharyngeal cutaneous fistula. The latter problem is quite rare, having been previously reported only once. Despite extensive tissue destruction conservative management prevailed. Repetitive debridement, controlling the intermittent infections, maintaining her nutritional status, and relieving her pain allowed spontaneous healing to occur.

Aspergillosis of the sphenoid sinus.

Three of the four previously described patients with isolated aspergilosis of the sphenois sinus died, owing to intracranial extension of the infection. The case reports of two patients with sphenoid aspergillosis are presented in which surgical exteriorization and aeration of the involved sinus was curative.

Sarcoidosis of the head and neck.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology, occasionally presenting with signs or symptoms that occur within the head and neck. The diagnosis may be made by a combination of histological evaluation of involved tissue, the presence of a relative cutaneous anergy, a positive Kveim test, and certain abnormal laboratory or radiographic findings. Although pulmonary sarcoidosis is by far the most common manifestation of the disease, an occasional patient will present with involvement of the nose, tonsils, larynx, or parotid gland. The otolaryngologist should include this entity in his differential diagnosis of lesions which occur in these areas.

Middle ear effusion in experimental hypersensitivity.

Monkeys which were transfused with human serum containing a specific antibody developed a clear, middle ear effusion when the appropriate antigen (ragweed) was insufflated into their middle ear space via the Eustachian tube. The typical histological changes expected to occur in an immediate type 1 immune response were present. Intracellular edema, capillary dilation, and an initial exudative reaction were all seen. Serum IgE levels were found to be significantly raised in the animal following passive sensitization. IgE was also present in the effusion, and IgE specific fluorescent mast and plasma cells were noted in the middle ear mucosa of the sensitized animals.

Parotid branchial cleft cyst with facial paralysis. Report of a case.

Cysts of branchlogenic origin are an extremely unusual source of parotid swelling. I describe the clinical course of a patient with a branchiogenic cyst that initially developed as a rapidly enlarging parotid mass associated with a partial facial paralysis.

Trisomy 18. A temporal bone report.

Since Edwards first described the trisomy 17-18 syndrome in 1960, the findings in the temporal bones of only four patients with this condition have been reported. They varied widely, ranging from a normal temporal bone, to severe malformations of both the middle and inner ear structures. This study describes the temporal bone findings in a patient with this syndrome. Many of the abnormalities described previously were present as well as the following unreported findings: complete bony atresia of the external canal, an aberrant tensor tympani muscle that did not insert into the malleus but rather attached to a dehiscent area in the Fallopian canal, wide short utricular and saccular ducts, and a widely patent cochlear aqueduct. There was also a developmental arrest of the membranous structures within the cochlea that probably occurred during the 12th week of fetal life.