Intra-operative ultrasound-guided drainage of parotid abscess.

Parotitis complicated by parotid abscess remains a potentially life-threatening problem. Conventional surgical treatment involves incising the parotid parenchyma in the direction of the facial nerve until the abscess is located and evacuated. Intra-operative ultrasound greatly assists in localizing the abscess and in ensuring its complete drainage.

Evaluation of the viscoelastic properties of pharyngeal tissue.

The viscoelastic properties of the human pharyngeal tissue in tension were evaluated, based on both an experimental protocol-consisting of cyclic load, tensile stress relaxation, and incremental step load tests-and a quasilinear viscoelastic theory. The physical properties of the pharyngeal tissue were evaluated to facilitate the biomechanical modeling of human pharynx. The methodology described has potentially significant clinical importance when one considers engineering a similar type of tissue having the same material properties in the future.

Comparison of viscoelastic properties of the pharyngeal tissue: human and canine.

The viscoelastic properties of the human and canine pharyngeal tissue in tension were evaluated, based on both an experimental protocol-consisting of cyclic load, tensile stress relaxation, and incremental step load tests-and the quasi-linear viscoelastic theory. The reduced stress relaxation function and the elastic response of the pharyngeal tissues were derived from the experimental results specifically obtained from those tissues. The characteristic features of viscoelastic property were obtained for both human and canine pharyngeal tissues by applying the quasi-linear viscoelastic theory and compared with each other.

Patterns of metastases to the upper jugular lymph nodes (the "submuscular recess").

Background: Cervical lymphadenectomy to remove metastatic disease in level II encompasses lymph nodes associated with the upper third of the internal jugular vein and the adjacent spinal accessory nerve (SAN). Conservative neck dissection (ND) preserves these structures but requires manipulation of the SAN to remove tissue located in the posterosuperior aspect of level II. Limiting the dissection to the nodal group anterior to the SAN may reduce operating time and limit injury to it without compromising the removal of lymph nodes at risk for involvement with cancer.

Role of substance P in the laryngeal chemoreflex.

The laryngeal chemoreflex (LCR) is a potentially life-threatening reflex that is elicited in immature animals by the topical application of water to the laryngeal mucosa. The reflex response is characterized by immediate apnea and laryngeal adduction and delayed cardiovascular instability. The cardiorespiratory changes of the LCR may be life-threatening, particularly in very immature animals such as piglets under 2 weeks of age.

Risk factors for malignancy in adult tonsils.

Background: Tonsillectomy in adults (age 18 years and older) is performed for a variety of conditions. The palatine tonsils may harbor carcinoma or lymphoma, and this potentially unanticipated finding may follow routine tonsillectomy in the adult. The ability to preoperatively identify adult tonsillectomy patients at increased risk for tonsillar malignancy could sensitize the clinician to this possibility and the potential need for expedited rather than routine tonsillectomy scheduling.

Evaluation of a statistically derived decision tree for the cytodiagnosis of fine needle aspirates of the breast (FNAB).

A decision tree for the diagnosis of FNAB was derived from defined human observations using a rule induction method, C4.5 (a derivative of the ID3 algorithm). This algorithm is an implementation of the top-down induction method where the tree is determined iteratively by adding those nodes and branches which maximize the information gain at each step.

Incidence of deep venous thrombosis and pulmonary embolism in otolaryngology-head and neck surgery.

Objective: Postoperative deep venous thrombosis and pulmonary embolus are major causes of morbidity and mortality in patients undergoing surgical procedures. In contrast to other surgical fields, the incidence of these life-threatening conditions has not been studied in our specialty. The purposes of this study were to elucidate the incidence of deep venous thrombosis and pulmonary embolus in patients after otolaryngologic operations and to identify specific risk factors that may contribute to the development of these conditions.

Postmortem examination of the lungs: a preservation technique for opening the bronchi and pulmonary arteries individually without transection problems.

The classic methods of examining both the pulmonary arteries and bronchi postmortem partly destroy the anatomy of one of these systems. A technique is described whereby the bronchi and pulmonary arteries are dissected and preserved. The principal difference of this technique is that most of the upper lobe vasculature is opened from the hilum.

Medialization laryngoplasty with expanded polytetrafluoroethylene. Surgical technique and preliminary results.

Symptomatic unilateral laryngeal paralysis may be treated successfully by a wide variety of surgical techniques. These techniques share the concept that stabilization of the paralyzed vocal fold in a median position will improve glottic function. Medialization laryngoplasty with expanded polytetrafluoroethylene (ePTFE) incorporates the general principles of established medialization procedures, yet is unique in its simplicity.

Cost-identification analysis in oral cavity cancer management.

The objectives of this study were to investigate potential relationships between pretreatment patient-mix characteristics, treatment modalities, and costs generated during the pretreatment work-up, treatment, and 1-year follow-up periods for patients with oral cavity cancer (OCC). Another objective was to identify potential areas for cost reduction and improved resource allocation in the management of OCC patients. Using a retrospective cohort of 73 patients with OCC, pretreatment patient-mix characteristics and treatment modalities were evaluated in relation to university-based charges incurred during the pretreatment evaluation, treatment, and 1-year follow-up periods.

Gastric outflow obstruction caused by gall stones and leading to death by complex metabolic derangement.

A 67 year old woman was admitted with a three week history of vomiting, having become increasingly confused for three days. Investigations revealed deranged serum biochemistry consistent with a combination of a diabetic non-ketotic hyperosmolar state and a metabolic alkalosis consistent with gastric outflow obstruction. She was treated with intravenous saline, intravenous insulin, and subcutaneous heparin, but did not improve clinically and had an asystolic cardiac arrest the following day; she was transferred to the intensive care unit and despite treatment with inotropes she died 40 hours after admission.

When is bacterial vaginosis not bacterial vaginosis?--a case of cervical carcinoma presenting as recurrent vaginal anaerobic infection.

Vaginal anaerobic infection is the most common cause of vaginal discharge in women. We present a case of recurrent vaginal anaerobic infection and cervical carcinoma and discuss the association of the two conditions. More frequent cytology/colposcopy may be indicated in women who give a history of recurrent or persistent vaginal anaerobic infection.

Resource utilization and patient morbidity in head and neck reconstruction.

Many papers have addressed the technical aspects of free tissue transfer in head and neck cancer patients. However, there has not been a critical assessment of the impact of free tissue transfer on resource utilization and patient morbidity compared with pedicle flap reconstructions. Two cohorts of patients derived from 245 consecutive reconstructions were tightly matched by age, site, stage, and histology, yielding 44 patient pairs differing in method of reconstruction.

Pectoralis major myofascial flap: a valuable tool in contemporary head and neck reconstruction.

Background: The pectoralis major myofascial (PMMF) unit is rapidly mobilized, reliable, and extremely useful in a number of clinical situations calling for vascularized soft-tissue coverage in the head and neck. Although free-tissue transfer has emerged as the preferred method of reconstruction for a large variety of defects in the head and neck, the pectoralis major muscle should be considered when vascularized soft-tissue coverage is required in this area.

Methods: A retrospective chart review of 24 PMMF flaps performed at the University of Iowa Hospitals and Clinics between January 1, 1991, and May 1, 1996, was undertaken.

Risk factors for pulmonary complications in the postoperative head and neck surgery patient.

Background: Pulmonary complications are a primary source of increased cost and morbidity in surgically treated head and neck cancer patients. This study investigates potential risk factors related to postoperative pulmonary complications (pneumonia, adult respiratory distress syndrome (ARDS), and prolonged mechanical ventilation) in head and neck cancer patients.

Methods: Data from 144 major head and neck procedures performed at the University of Washington between 1985 and 1991 were retrospectively reviewed.

Botulinum neurotoxin injection after total laryngectomy.

Background: One of several causes of tracheoesophageal puncture (TEP) speech failure after total laryngectomy is disturbance in relaxation of the pharyngoesophageal (PE) segment. We introduce the use of chemical denervation of the PE segment through botulinum neurotoxin (Botox) injection to improve TEP speech.

Methods: An analysis was performed on eight patients who received Botox injections for TEP speech problems after total laryngectomy at the University of Iowa between June 4, 1991 and August 8, 1994.

Organ preservation therapy for advanced-stage laryngeal carcinoma.

The standard treatment for patients with advanced laryngeal cancer remains total laryngectomy. Radiotherapy as a primary treatment modality is a reasonable alternative. Surgical salvage by total laryngectomy is an important part of the treatment plan when irradiation is used primarily to treat advanced laryngeal cancer.

Laryngeal activity during swallow, phonation, and the Valsalva maneuver: an electromyographic analysis.

To better understand the mechanisms of airway protection during swallow, the authors of this study performed an electromyographic (EMG) analysis on the thyroarytenoid (TA) and interarytenoid (IA) muscles during a variety of tasks. The tasks included high, low, and comfortable pitch phonation, the Valsalva maneuver, saliva swallow, and 5- and 10-mL water swallows. Raw EMG signals were analyzed to obtain root mean square data, which correspond to a relative magnitude of muscle activation.

Early measurement of interstitial fibrosis predicts long-term renal function and graft survival in renal transplantation.

This study investigated the relationships between renal allograft interstitial fibrosis, renal function and graft survival. A total of 107 consecutive renal transplant recipients immunosuppressed with cyclosporin were studied. Needle core transplant biopsies were performed before operation and at 1, 6 and 12 months after transplantation.

Risk factors for advanced-stage oral cavity cancer.

Objective: To assess the association between risk factors for inadequate surveillance of oral cavity cancer and stage of disease (localized, T1, T2/N0 vs advanced, T1, T2/N1-3, T3, T4/N0 or N1-3).

Design: Convenience sample from a case series.

Setting: Otolaryngology clinic in a tertiary care hospital.

Neurotoxicity in a phase I trial of continuous infusion cisplatin with hyperfractionated radiotherapy for locally advanced head and neck cancer.

Background: Both twice daily fractionated radiotherapy and concurrent cisplatin with once-daily radiotherapy have been shown to improve local disease control in patients with head and neck cancer. The objective of this phase I trial was to determine the maximum tolerated dose of cisplatin which could be given as a continuous infusion concurrent with twice-daily radiotherapy to patients with locally advanced head and neck cancer.

Methods: Patients were treated with radiotherapy at doses of 110 cGy twice daily for 5 days per week to a total dose of 7040-7590 cGy.

The communicating vein and its use in the radial forearm free flap.

Thrombosis is the most frequent cause of failure in microvascular free-tissue transfer. The large communicating vein of the cubital fossa connects the deep and superficial venous drainage of the radial forearm free flap (RFFF). This vein allows the surgeon to simultaneously drain both systems by means of the large veins of the cubital fossa.