Otolaryngology–Head and Neck Surgery

Vessel density and the ratio of the tissue area to the vessel surface area were studied by morphometric analysis techniques in normal rats, spontaneously hypertensive rats (SHR), and aged spontaneously hypertensive rats (aged SHR). Horseradish peroxidase was injected intravenously and the animals were killed 10 minutes later. The temporal bones were harvested, fixed in glutaraldehyde, and decalcified in 10% ethylenediamine tetraacetic acid (EDTA). After 7 days of decalcification, the cochleas were dissected and incubated with a diaminobenzidine tetrahydrochloride solution. Sections with stained vessels were projected onto the digitizing plate with the help of the camera lucida. The computer was used to calculate tissue area, vessel length, and vessel surface area. A statistically significant increase (p < 0.05) in both the tissue area to vessel length ratio and the tissue area to vessel surface area ratio was demonstrated in the SHR and the aged SHR groups when compared to the WKY in the stria vascularis. No statistically significant difference was found between the two SHR groups. These data show a decrease of the vessel density in the capillary beds of the stria vascularis in spontaneously hypertensive rats. No statistically significant difference was found in the diameters of the capillary among the three groups.

This is a comprehensive retrospective study (1965–1984) of 130 patients with malignant parotid gland tumors. Patients were studied by comparison of presenting symptoms, histopathologies, treatments, disease-free intervals, and ultimate intervals. Facial paralysis was noted on presentation in 23% of the cases and regional neck node metastases were noted in 13%. Both findings correlated with prognosis. Seventy patients underwent surgery alone and 30 patients received combined therapy. The remaining patients were excluded from the study. The overall 5-year survival rate was 50%, with a 44% risk of recurrence. Fifty-six percent of the patients whose conditions subsequently recurred had their facial nerves sacrificed at time of surgery. Selected patients who received combined therapy experienced better local regional control and a prolonged disease-free interval as compared with those who underwent surgery alone. Combined therapy, however, provided no survival benefit for this group of patients. Adjuvant radiation therapy is recommended in the treatment planning of selected malignant tumors of the parotid gland.

Juvenile nasopharyngeal angiofibroma (JNA) is an uncommon, histologically benign vascular tumor that occurs almost exclusively in adolescent males. While occasional mention is made of the occurrence of JNA in females and in older males, only four¹ cases have withstood rigorous clinicopathological review. This neoplasm accounts for less than 0.05% of all benign lesions that originate in the nasopharynx. Its clinically malignant behavior is a result of its propensity for locally destructive growth and fatal hemorrhage. The evolution in the management of these tumors has been the subject of much interest and much confusion. The advents of computed tomographic (CT) scanning, selective angiography with embolization, and refinements in surgical approaches have revolutionized operative management of these lesions by allowing more realistic selection of surgical candidates, better preoperative planning, and more flexible (yet aggressive) primary surgical treatment. The attendant reduction in morbidity and mortality of contemporary surgical management of this disease has largely obviated the argument of those who advocate use of radiotherapy as the primary treatment modality for this benign lesion. This latter view is based on the reports of massive hemorrhage, significant incidence of incomplete removal, and mortality reported in the older surgical literature. This article details our experience with a series of 31 patients who had clinicopathological diagnoses of JNA and were treated between 1954 and 1984. It furthermore represents an update of our previously reported series.²

Facial electromyographic (EMG) activity was continuously monitored via loudspeaker during eleven translabyrinthine and nine suboccipital consecutive unselected acoustic neuroma resections. Ipsilateral facial EMG activity was synchronously recorded on the audio channels of operative videotapes, which were retrospectively reviewed in order to allow detailed evaluation of the potential benefit of various acoustic EMG patterns in the performance of specific aspects of acoustic neuroma resection. The use of evoked facial EMG activity was classified and described. Direct local mechanical (surgical) stimulation and direct electrical stimulation were of benefit in the localization and/or delineation of the facial nerve contour. Burst and train acoustic patterns of EMG activity appeared to indicate surgical trauma to the facial nerve that would not have been appreciated otherwise. Early results of postoperative facial function of monitored patients are presented, and the possible value of burst and train acoustic EMG activity patterns in the intraoperative assessment of facial nerve function is discussed. Acoustic facial EMG monitoring appears to provide a potentially powerful surgical tool for delineation of the facial nerve contour, the ongoing use of which may lead to continued improvement in facial nerve function preservation through modification of dissection strategy.

Acoustic and perceptual analyses for the accomplished user of a voice prosthesis were performed. The study was performed to discover whether the performance and intelligibility of speech improved with the use of the tracheal stomal (TS) valve as compared with speech achieved by occlusion of the stoma with the thumb. Our data suggest that the speech produced in the patient tested was less desirable with the use of a TS valve than when manual occlusion was used.

The application of oral surgery osteotomy techniques, which are used in orthognathic surgery, to excision of squamous cell carcinomas in various oral cavity locations is described and illustrated in eight cases. These methods allow the full height of the inner table of the mandible to be removed as a margin for tumors which abut the lingual mucoperiosteum without radiologic evidence of bone erosion, while jaw continuity via the intact outer cortex is maintained. These techniques can also be used for marginal mandibulectomy and horizontal maxillectomy. Discussion includes criteria for selection of cases appropriate for such conservation surgery with respect to oncologic considerations, as well as complications encountered and their prevention.

It has been 4 years since liposuction was introduced^1,2 as a surgical technique to sculpture and remove the subcutaneous layer of fat in the head and neck. Otolaryngologists and facial plastic surgeons have been reluctant to incorporate this procedure into their surgical armamentarium, fearing that liposuction would be a passing fad and not live up to original expectations. Basic animal research and clinical studies now show that liposuction is a safe, fast, and effective means of removing subcutaneous fat.³