Otolaryngology–Head and Neck Surgery

Office photography of the larynx is a simple, practical way to obtain objective records of laryngeal lesions. This paper describes a method of office photography used by the authors, discusses the problems commonly encountered, and recommends solutions to the problems. The authors recommend a lightweight, single-lens reflex camera with 70- to 105-mm lens, endoscopic focusing screen, coupler to a 90° laryngeal telescope, and xenon arc or flash illumination.

Head and neck disorders may be documented photographically for record keeping by the office practitioner. These photographs serve as a repository of visual teaching aids. A photographic system consisting of the Olympus OM 2 camera, the OM 50 f-3.5 auto-macro lens, the flash OM T-10 ring light, and the OM T-10 power control, along with details of technique and a method of filing and retrieval, are presented in this report.

A side- or oblique-viewing needle otoscope is helpful in locating lesions and in diagnosing middle ear diseases. Photographs can be taken by connecting the needle otoscope with a special camera equipped with an automatic exposure system and a self-winding system.

Three currently available methods of tympanic membrane photography—Kowa camera photography, microscopic photography, and telescopic photography—are reviewed and their advantages, disadvantages, and results discussed.

Telescopic photography produces high-quality pictures of the “entire” tympanic membrane. It is the most effective and reliable method of tympanic membrane photography available in 1981.

We present two simple techniques for intraoperative laryngeal photography. New developments in high-intensity flash units coupled to recently developed high-quality optical telescopes or through a new fiberoptic light guide to an operating microscope have made this possible. Either method makes high-quality documentation of intraoperative laryngeal procedures a convenient routine operation. We describe the instruments, the techniques, and the past literature leading to these results.

A ten-year study of all patients undergoing surgical treatment for hyperparathyroidism at Loma Linda University is presented. Clinical characteristics, laboratory analysis, differential diagnosis, associated diseases, operative techniques, and postoperative management of potential complications are evaluated. Some patients with secondary hyperparathyroidism underwent autotransplantation with good results; this technique is discussed. An approach is detailed that is successful in maintaining euparathyroidism.

The benign but socially embarrassing problem of gustatory sweating and flushing (Frey syndrome) has been studied in the past in search of a simple but effective treatment. Twenty-two patients participated in clinical trials of glycopyrrolate on an investigational basis, 17 of which have been followed up for four to five years. Double-blind comparisons of the efficacy and side effects of topical scopolamine (solution and cream) and glycopyrrolate (roll-on lotion, solution, and cream) are also presented. The use of 1% glycopyrrolate roll-on lotion and cream were associated with an average of three days of complete control of gustatory sweating and a remarkably low incidence of side effects.

Giant lymph node hyperplasia is a rare, benign tumor infrequently occurring in the head and neck. A 31-year-old woman with this disorder, present as a large submucosal parapharyngeal mass, is presented and the literature reviewed.

Radiographic evidence of the extreme vascularity of this lesion was remarkable, emphasizing the value of arteriographic evaluation of masses located in this region. Preoperative embolization facilitated its complete resection, and follow-up examination has shown no evidence of recurrence, which is commonly the course of the disease elsewhere in the body. Consideration of this rare entity is warranted in the work-up of parapharyngeal masses.

Laryngeal carcinoma usually occurs in men between the ages of 50 and 70. In general, epithelial malignancies other than those involving the skin are rare in the young adult. Those squamous carcinomas arising in the lip, tongue, and tonsil appear to have a poorer prognosis than in the older adult. This study is a review of the medical records of 33 patients under the age of 35 years with squamous cell carcinoma of the larynx. The follow-up of the entire series was at least 24 months with an overall survival rate of 81%. These results contrast to five-year survival rates of 79%, 45%, and 14% of the lip, tongue, and tonsil, respectively, in patients from a similar age group.

Cricopharyngeal myotomy has gained widespread acceptance as surgical treatment for various forms of cervical dysphagia. The case records of 33 patients who underwent cricopharyngeal myotomy for dysphagia originating from varying underlying diseases are reviewed. The majority of these patients were able to resume oral feeding following myotomy. Analysis of preoperative pharyngoesophageal manometry and contrast radiography identified diagnostic criteria for appropriate case selection.

Ten dogs underwent exploration and section of the right recurrent laryngeal nerve. A segment was removed and both stumps were ligated. Reoperation at three months and again at 15 months revealed neural regeneration through the ligated site and reconstitution of the distal nerve in seven of the eight dogs surviving the 15-month period. This strong regenerative capability of the recurrent laryngeal nerve may explain recurrences of spastic dysphonia after nerve section. It is recommended that patients be advised of the possibility for return of the spasms. Investigators should always note whether the recurrent laryngeal nerve has regained stimulability in reporting results of experimental laryngeal paralysis and reinnervation.

One hundred seventy-one patients had closure of symptomatic nasal septal perforations by insertion of a Silastic nasal septal prosthesis between June 1972 and August 1981. Follow-up revealed that successful closure of the defect was accomplished in 73% of cases, with reduction in crusting and epistaxis and improvement in nasal respiration in many cases. Prefabricated prostheses have been effective in treating smaller perforations. The treatment of four patients with unusually large septal perforations by custom-carved prostheses sized using computerized axial tomographic scanning is described.

This year, 1981, is the 50th anniversary of facial nerve decompression for Bell's palsy. The procedure was first suggested in 1923 but not performed until 1931. From the start, facial nerve decompression has generated disagreement regarding the indication and timing for surgical treatment and the anatomic extent of decompression. In each decade as the postonset time within which to perform surgical intervention has decreased, the anatomic extent of decompression has increased. Otologists continue to disagree, and we need to reevaluate our past and analyze how the difference may be resolved in the future. This critical review, in chronologic order, of the history and present status of facial nerve decompression is the necessary first step in resolving some of the persistent problems in surgical management of patients with Bell's palsy.

Four biomaterials, UF45S5 Bioglass, Silastic, Plasti-Pore, and Proplast, were used to replace the incus in a mouse ear model. Bioglass, a bioactive glass ceramic, compared favorably with the other test materials in maintaining surgical positioning between malleus and stapes and remaining stable to a blast of nitrogen gas and to pick manipulation. In a short-term animal study, Bioglass showed histocompatibility comparable to that of these other implant materials now used in ossicular replacement surgery in humans.

Experimental hydrops caused by underabsorption of endolymphatic fluid is a model of remissional stage of Meniere's disease. In this study, another type of model, ie, hydrops caused by overproduction of endolymphatic fluid, was accomplished by applying various pressures into scala media through a micropipette via stria vascularis. This type of hydrops could be a model of attacks of Meniere's disease. By using two types of the model, effects of glycerol administration and of opening the endolymphatic sac were discussed.

The goals of treatment in Meniere's disease are hearing preservation and control of vertigo. Controversy abounds with regard to the most expeditious and efficacious means of attaining these goals. Low-salt diet, diuretic therapy, endolymphatic-mastoid shunt, and middle cranial fossa vestibular neurectomy are all modes of treatment employed for Meniere's disease at the University of Iowa. This review of our experience from 1973 to 1980 summarizes the efficacy of each therapeutic option.

The Kodak instant close-up camera produces a standard-size preoperative photograph from which an immediate calibrated analysis can be performed. By using a direct proportion calculation, precise measurements can be transferred to the actual surgical setting to determine how much to lower the dorsum or shorten the nose in order to produce an esthetically pleasing nose.

Extraskeletal Ewing's sarcoma is a rare malignant neoplasm. Arising from a primitive mesenchymal stem cell and primarily affecting young adults, this lesion demands aggressive therapy, including surgical treatment, radiation therapy, and chemotherapy.

A cervical prolongation of the thymus gland occurring as an upper cervical mass in a pediatric patient is presented. Embryologic development and modes of presentation of thymic tissue in the neck are reviewed. Thymic cysts are uncommon but important entities because complete surgical removal may require dissection below the clavicle into the superior mediastinum.

A case of advanced papillary carcinoma in a 16-year-old boy is presented. While this case is typical of the indolent and locally invasive character of papillary carcinoma, it is remarkable for the extent of tumor involvement appearing as reactive lymphadenopathy. The pronounced tumor vascularity and the similarity of the needle biopsy specimen to chemodectoma both conflicted with the initial diagnostic impression. The correct diagnosis was confirmed only with definitive surgical therapy.

A cervical spine hemangioma in a 32-year-old woman is reported. Because of herniation of the mass between the deep muscles of the posterior triangle, the clinical differential diagnosis was confusing. The lesion required a two-stage procedure in conjunction with neurosurgical evaluation for total removal. The amount of bone destruction of the spine and exact location of the lesion are graphically displayed in a computed tomography (CT) scan of the neck. An arteriogram showing partial occlusion of the vertebral artery and a myelogram displaying extrinsic spinal cord compression, along with the CT scan, showed the full extent of the lesion.

Although nasal polyposis is a common entity, it is seldom considered a cause of bony destruction with consequent ophthalmologic and neurologic sequelae. Acute bilateral visual loss developed suddenly in a young, healthy woman with nasal polyps. Evaluation revealed erosion of the floor of the anterior cranial fossa, with compression of the optic nerves secondary to extensive paranasal and nasal polyposis. The clinical course, treatment, and histopathologic findings are discussed.

Bilateral mucocele formation in the frontal, ethmoid, sphenoid, and maxillary sinuses with intraorbital and intracranial extension is described. The pathophysiology, diagnosis, and treatment of paranasal sinus mucoceles are reviewed.

Osteogenic sarcoma is the most common primary malignant neoplasm of bone, though it rarely involves the facial skeleton. The first reported case of osteogenic sarcoma arising in the ethmoid sinus is presented.

Giant cell tumors (osteoclastoma) occur infrequently in the head and neck and are extremely rare in children. The occurrence of such a lesion in the ethmoid sinus of a 14-year-old girl is presented and discussed.

Primary small cell carcinoma of the nose and paranasal sinuses is rare. This tumor appears to behave differently from the pulmonary small cell tumor, with propensity for local recurrence rather than early distant spread. Two new cases will be presented.