Follicular variant of papillary carcinoma: the diagnostic limitations of preoperative fine-needle aspiration and intraoperative frozen section evaluation.

Objective: Fine-needle aspiration (FNA) and frozen section (FS) have been widely reported in the literature as having high sensitivity in the diagnosis of papillary carcinoma. With the increased recognition of the follicular variant of papillary thyroid carcinoma (FVPTC), several reports have pointed out the difficulty in diagnosing this variant of papillary carcinoma owing to its overlapping cytomorphological features with benign and malignant follicular lesions. We undertook this study to determine the sensitivity of FNA and FS in the diagnosis of FVPTC.

Effects of thyroplasty type I on vocal fold vibration.

Objective: To ascertain effects of medialization thyroplasty on vocal fold vibration in glottic incompetence dysphonia.

Study Design: Quantitative videostroboscopic glottic measurements and vocal function study were perioperatively undertaken in 20 patients undergoing Isshiki's thyroplasty type I.

Methods: In digitized images, the glottal area, glottal width, posterior glottal width, and amplitude over an entire glottal cycle were measured and normalized by membranous vocal fold length.

Surgical management of thyroid masses: assessing the need for frozen section evaluation.

Objective/hypothesis: To determine the need for intraoperative frozen section to guide the extent of thyroid surgery in the presence of an adequate preoperative fine-needle aspiration (FNA) finding.

Methods: Charts of patients who presented from 1995 to 1998 to the two senior authors were reviewed. A total of 82 patients were found who satisfied the inclusion criteria of having both an adequate FNA and frozen section.

Diagnostic value of the preoperative sestamibi scan in intraoperative localization of parathyroid adenomas: a case study.

A retrospective chart review of 43 patients who underwent technetium 99m (Tc-99m) sestamibi scans from June 1995 to January 1997 was performed. Only those who underwent subsequent parathyroid exploration with excision were included in the study. Twenty subjects (13 women and seven men) were included in the study.

Influence of size and etiology of glottal gap in glottic incompetence dysphonia.

This study investigates the relationship between glottal gap and vocal function in patients with glottic incompetence dysphonia. Twenty patients with vocal fold paralysis (VFP), 17 patients with vocal fold atrophy (VFA), and five patients with sulcus vocalis (SV) were examined. Glottal gap area at the most closed point of vibration was measured using digitized videostroboscopic images.

Vocal fold atrophy: quantitative glottic measurement and vocal function.

Videostroboscopic glottic measurements and vocal function were evaluated in 41 vocal fold atrophy patients with bowed vocal folds. The amount of bowing in the resting position and the glottal gap area and vibratory amplitude during phonation were measured from digitized videostroboscopic images. Vibratory amplitude was not decreased on atrophic vocal folds.

Acoustic characteristics of rough voice: subharmonics.

This study investigates the relationship between rough voice and the presence of subharmonics, which correspond to smaller yet distinct peaks located between two consecutive harmonic peaks in the power spectrum. Spectrum analysis was undertaken in 389 pathologic voices, of which 20 had subharmonics. Although all 20 voices had roughness perceptually, 8 had normal jitter and/or shimmer.

The management of post-thyroidectomy hypocalcemia.

Postoperative hypocalcemia was studied in 40 patients undergoing total thyroidectomy for a malignancy or massive goiter. Parameters evaluated included serum calcium, phosphate and magnesium levels. All patients exhibited a postoperative decline in serum calcium, however, the lowest serum calcium level was not seen until 48 hours after surgery.

Singing power ratio: quantitative evaluation of singing voice quality.

This paper presents a parameter for objectively evaluating singing voice quality. Power spectrum of vowel sound /a/ was analyzed by Fast Fourier Transform. The greatest harmonics peak between 2 and 4 kHz and the greatest harmonics peak between 0 and 2 kHz were identified.

Quantitative criteria for predicting thyroplasty type I outcome.

The purpose of this study was to ascertain the relation between preoperative glottal gap and postoperative vocal function in thyroplasty type I. Twenty-two of 64 patients who underwent thyroplasty type I between 1987 and 1994 were studied. In preoperative digitized laryngostroboscopic images, the glottal-gap, width (GGW), shape, and area were examined at the maximum closure of vibration and normalized by membranous vocal-fold length (MVFL).

Quantitative videostroboscopic measurement of glottal gap and vocal function: an analysis of thyroplasty type I.

The goal of surgical medialization of the vocal fold is to attain complete glottic closure. The purpose of this study is to quantify the glottal gap and to examine the relationship between glottal gap and vocal function perioperatively in thyroplasty type I. Glottal gap area was measured in 20 patients at the point of maximum closure of vocal fold vibration in digitized laryngeal stroboscopic images and was normalized by the square of vocal fold length.

Computer-generated presentations: current status and future directions.

The personal computer allows the user to create professional presentations as good as any created by commercially available services. With the new generation of inexpensive software, myriad fonts, layouts, graphics, and imported images can all be used by the novice. The technology is currently available that can project images directly from the computer, obviating the need for slides.

The turbulent noise ratio: an estimation of noise power of the breathy voice using PARCOR analysis.

The degree of turbulent noise in the breathy voice of 25 patients with incomplete glottal closure was determined by PARCOR (PARtial autoCORrelation) analysis. From 10,000 acoustic data points, 44 PARCOR coefficients were calculated to form the residue wave which is representative of the glottal source. The power difference between the residue wave and the original acoustic wave was calculated in order to define a new measurement of acoustic power termed the turbulent noise ratio (TNR).

Thyroplasty: a new approach.

A new type of thyroplasty implant (prosthesis) has been designed to be used of a surgical operation that accomplishes medial displacement of a paralyzed vocal cord. The implant is inserted through a rectangular window fashioned in the thyroid lamina on the side of the vocal cord paralysis. Instruments for measuring the location and outline of the window in the thyroid lamina are presented.

Combined approach for excision of cervical nerve tumors with dural extension.

Tumors of the cervical plexus are rare. Often these tumors are found on routine exam as asymptomatic masses. We present our experience in managing four patients with tumors with dural extension.

Functional facial nerve weakness after surgery for benign parotid tumors: a multivariate statistical analysis.

A retrospective study was done on 64 patients who underwent superficial or subtotal parotidectomy for a primary benign tumor of the parotid gland. Factors, such as age, sex, smoking, alcohol consumption, type of surgery, duration of surgery, pathology of lesion, and size of lesion, were reviewed in a multivariate statistical analysis to determine if any factor alone or in combination contributed to the development of functional facial nerve weakness postoperatively. Only the age of the patient was found to have a statistically significant causal relation using the Pearson chi-square method (p = 0.

Time series analysis of glottal airflow in normal and pathological phonation.

Time series analysis of glottal airflow was carried out on 26 normal controls and 40 patients with voice disorders, using a modification of Isshiki's original technique which uses a hot-wire flowmeter, taking cycle-by-cycle fluctuations into consideration. The mean flow rate and mean AC/DC were shown to have significant differences among normal and patient groups. The standard deviations of AC/DC and AC/DC perturbation were calculated from the AC/DC value of 50 cycles and shown not to vary significantly among the normal and patient groups.

H-Index: a new measure of glottal efficiency for the pathologic voice.

Taking advantage of the extended dynamic range of digital analysis of voice the H-Index represents the first proposed acoustical measure of glottal efficiency. "Hi" /hai/ was chosen to evaluate glottal efficiency since it provides an excellent test of glottal transformation from voiceless to voiced sound energy, the upper vocal tract having a neutral effect. Fifteen individuals with normal voices and 30 patients with hoarse voices were asked to say "hi.

High-frequency power ratio of breathy voice.

Digital technological advances have made detailed voice analysis possible. This report proposes, with the use of such equipment, a new method of quantifying differences in the high-frequency content of normal and breathy voices. The high-frequency power ratio, a ratio of high-frequency power versus total power, was calculated as the lower limit of the high-frequency range (Fc) and varied from 1 to 10 kHz.

Diagnostic dilemmas in soft tissue tumors of the head and neck.

Classifying soft tissue tumors of the head and neck is often difficult for both surgeon and pathologist because of the potential similarities in appearance of metastatic lesions, epithelial tumors, lymphomas, and inflammatory processes. This paper discusses four unusual soft tissue tumors of the head and neck: osteosarcoma of the mandible, biphasic synovial cell sarcoma of the hypopharynx, soft part sarcoma of the maxillary sinus/alveolus, and adult rhabdomyoma of the larynx. Precise diagnosis of these lesions requires adequate tissue sampling, immunocytochemical staining, and electron microscopy.

Head and neck trauma in taxicabs. A growing urban problem.

The passage of mandatory seat belt legislation has markedly decreased the incidence of head and neck trauma to passengers in private automobiles. However, taxicabs are exempt from seat belt laws in many states. Seat belts, which are included as standard equipment by automobile manufacturers, are often made inaccessible by taxicab operators.

Controlled laryngoplasty for vocal cord medialization: a technique using tissue expansion.

Laryngeal framework surgery has become an increasingly popular alternative to Teflon injection for vocal rehabilitation. Vocal cord medialization requires custom tailoring of the implant's size and shape to optimize individual vocal quality, whether it be via the interposition of Silastic implants between the thyroid ala and the inner thyroid perichondrium or through a cartilage window. A new technique is described for vocal cord medialization using an implanted miniature tissue expander.

Effects of lateral manual compression upon glottic incompetence: objective evaluations.

Forceful manual compression of the thyroid and cricoid cartilages modifies the position, shape, and tension of the vocal folds. This is the basis of the four laryngeal manual compression tests, adjunctive examinations used as a means of preoperative assessment of patients for medialization laryngoplasty, ie, Isshiki thyroplasty types I and IV and arytenoid adduction. The laryngeal manual compression tests are simple to perform and noninvasive.

The histopathologic diagnosis of head and neck tumors by special stains.

Various histochemical and immunocytochemical stains were useful in the diagnosis of six unusual head and neck neoplasms that included spindle-cell squamous carcinoma, synovial sarcoma, mucoepidermoid carcinoma, melanoma, T-cell lymphoma, and B-cell lymphoma. Close cooperation with a pathologist ensured rapid diagnosis and the initiation of appropriate therapy. Three cases required special histochemical stains to make a diagnosis or determined tumor differentiation.