The hybrid tracheoesophageal puncture procedure: indications and outcomes.

Objectives: This report aimed to describe a novel and efficient method of tracheoesophageal puncture using a hybrid device assembled from 2 commercially available puncture kits; to demonstrate the utility of this technique in the performance of primary and secondary procedures, under general and local anesthesia, with and without flap reconstruction; and to evaluate the efficacy of concurrent puncture and valve placement.

Methods: Thirty-four patients who underwent either primary or secondary tracheoesophageal puncture for voice restoration. Charts were reviewed retrospectively for complications, time to first valve change, operative time, and blood loss.

Complications of patient selection: recognizing the difficult patient.

This article reviews some basic principles of patient selection for facial plastic surgery. There are patients who are not good candidates, independent of the deformity and the ability of the surgeon. Reasons include subtle and not so subtle psychiatric disorders, unrealistic expectations, lack of communication despite multiple visits, and litigious patients.

Continuous lesser palatine nerve block for postoperative analgesia after uvulopalatopharyngoplasty.

Objectives: Uvulopalatopharyngoplasty (UPPP) is a commonly performed surgical intervention used to treat obstructive sleep apnea (OSA) syndrome. Continuous peripheral nerve blocks have been shown to reduce postoperative pain and opioid requirements for other surgical procedures but have not been described previously for palate surgery. We present the use of a continuous lesser palatine nerve block catheter as a part of the multimodal postoperative pain management for UPPP.

A self-adjusting ossicular prosthesis containing polyurethane sponge.

Hypothesis: Middle ear ossicular replacement prostheses whose length can adjust in vivo to changes in middle ear dimensions following insertion may have acoustic advantages.

Background: Optimal tension is an important factor in the acoustic performance of incus-stapes replacement prostheses. Length is the primary determinant of postinsertion tension with conventional prostheses.

The floating mass transducer on the round window versus attachment to an ossicular replacement prosthesis.

Hypothesis: The Vibrant Soundbridge floating mass transducer (FMT) is part of a commercially available implantable hearing device in which the FMT can be placed in the round window (RW) niche or attached to a partial (V-PORP) or total ossicular replacement prosthesis (V-TORP) contacting the stapes head or footplate. The goal is to provide efficient transfer of sound vibration into the cochlea. The hypothesis is that the FMT location on the prosthesis is superior to the RW location.

Brow elevation ratio: a new method of brow analysis.

Objective: To introduce a novel quantitative method measuring preoperative and postoperative brow position and apply it to a cohort of patients undergoing endoscopic brow suspension.

Design: Retrospective review of patients who underwent endoscopic brow- and forehead-lift using a consistent operative technique and method of fixation. Changes in brow position were measured using standardized digital photographs of patients taken before and after surgery.

Effect of absence of malleus on ossiculoplasty in human temporal bones.

Objective: We evaluated the effect of malleus presence or absence on middle ear sound transmission after middle ear reconstruction in a temporal bone model.

Study Design: Human cadaveric temporal bone study.

Methods: The velocity of the stapes footplate was measured using a laser Doppler vibrometer.

The unhappy patient following facial plastic surgery: what to do?

Some patients are unhappy with the results of facial plastic surgery, even if the surgeon is pleased with the outcome. Dealing with this potential problem begins with the preoperative assessment as to how the patient might handle a result that is less than perfect. "When in doubt, don't" is a good rule but needs refinement.

Success and failure in treatment of sleep apnea patients.

A variety of surgical procedures exist to treat obstructive sleep apnea in adults. Some, such as tracheotomy and maxillomandibular advancement, have very high cure rates, over 90%. These procedures have significant disadvantages, however, and there is a need to define the best combination of low morbidity procedures to provide similar success.

Mature results from a randomized Phase II trial of cisplatin plus 5-fluorouracil and radiotherapy with or without tirapazamine in patients with resectable Stage IV head and neck squamous cell carcinomas.

Background: The objective of this article was to report the results from a randomized trial that evaluated the efficacy and toxicity of adding tirapazamine (TPZ) to chemoradiotherapy in the treatment of patients with head and neck squamous cell carcinomas (HNSCC).

Methods: Sixty-two patients with lymph node-positive, resectable, TNM Stage IV HNSCC were randomized to receive either 2 cycles of induction chemotherapy (TPZ, cisplatin, and 5-fluorouracil [5-FU]) followed by simultaneous chemoradiotherapy (TPZ, cisplatin, and 5-FU) or to receive the same regimen without TPZ. Patients who did not achieve a complete response at 50 Grays underwent surgical treatment.

Advanced-staged tonsillar squamous carcinoma: organ preservation versus surgical management of the primary site.

Background: Our aim was to review our experience in the management of advanced tonsillar squamous cell carcinoma (SCC) and to compare treatment outcomes between patients treated with and without surgery to the primary site.

Methods: The records of 74 patients with advanced-stage tonsillar SCC were reviewed. The median age at diagnosis was 58 years.

Bone-conducted sound: physiological and clinical aspects.

Objective: The fact that vibration of the skull causes a hearing sensation has been known since the 19th century. This mode of hearing was termed hearing by bone conduction. Although there has been more than a century of research on hearing by bone conduction, its physiology is not completely understood.

Transmission properties of bone conducted sound: measurements in cadaver heads.

In the past, only a few investigations have measured vibration at the cochlea with bone conduction stimulation: dry skulls were used in those investigations. In this paper, the transmission properties of bone conducted sound in human head are presented, measured as the three-dimensional vibration at the cochlear promontory in six intact cadaver heads. The stimulation was provided at 27 positions on the skull surface and two close to the cochlea; mechanical point impedance was measured at all positions.

Outcomes of hyoid suspension for the treatment of obstructive sleep apnea.

Objective: To examine the efficacy of hyoid myotomy and suspension as a treatment of hypopharyngeal obstruction in obstructive sleep apnea.

Design: Prospective, observational study.

Setting: Academic medical center.

Experimental study of an adjustable-length prosthesis in a temporal bone model.

Conclusions: This prosthesis has the advantage of rapid adjustment at the time of insertion in order to achieve optimal tension and, as a result, optimal sound transmission.

Objective: To test the acoustic performance of a new, adjustable incus replacement prosthesis in a human temporal bone model.

Material And Methods: Experiments were performed in seven human temporal bones, before and after removal of the incus and insertion of the prosthesis.

Round window membrane motion with air conduction and bone conduction stimulation.

The vibration patterns of the round window (RW) membrane in human cadaver temporal bone specimens were assessed by measurements of the velocity of reflective targets placed on the RW membrane with an approximate spacing of 0.2 mm. The velocity was measured in the frequency range 0.

Fluid volume displacement at the oval and round windows with air and bone conduction stimulation.

The fluids in the cochlea are normally considered incompressible, and the fluid volume displacement of the oval window (OW) and the round window (RW) should be equal and of opposite phase. However, other channels, such as the cochlear and vestibular aqueducts, may affect the fluid flow. To test if the OW and RW fluid flows are equal and of opposite phase, the volume displacement was assessed by multiple point measurement at the windows with a laser Doppler vibrometer.

Basilar membrane and osseous spiral lamina motion in human cadavers with air and bone conduction stimuli.

It is generally accepted that bone conduction (BC) stimuli yield a traveling wave on the basilar membrane (BM) and hence stimulate the cochlea by the same mechanisms as normal air conduction (AC). The basis for this is the ability to cancel or mask a BC tone with an AC tone and the ability to generate two tone distortion products with a BC tone and an AC tone. The hypothesis is proposed that BC stimulates the BM not only through the hydrodynamics of the scala vestibuli and scala tympani, but also through osseous spiral lamina (OSL) vibrations.

Airway management after maxillectomy: routine tracheostomy is unnecessary.

Objectives/hypothesis: There is a paucity of data to guide the optimal management of the airway in patients after maxillectomy. The decision on whether a concomitant tracheostomy is needed is often dictated by the surgeon's training and experience. We reviewed our experience with maxillectomy to assess the need for tracheostomy in postoperative airway management.

Three-dimensional stapes footplate motion in human temporal bones.

The literature provides conflicting information on whether the motion of the stapes footplate is piston-like or some other type of motion, such as rotational or rocking. Examination of the three-dimensional (3D) motion of the stapes footplate appears to be an excellent way to understand this complicated motion. Five microsphere reflective targets were placed on the stapes footplate in ten fresh human cadaver temporal bone preparations, and their vibration measured through an extended facial recess approach using a laser Doppler vibrometer.

Factors contributing to bone conduction: the outer ear.

The ear canal sound pressure and the malleus umbo velocity with bone conduction (BC) stimulation were measured in nine ears from five cadaver heads in the frequency range 0.1 to 10 kHz. The measurements were conducted with both open and occluded ear canals, before and after resection of the lower jaw, in a canal with the cartilage and soft tissues removed, and with the tympanic membrane (TM) removed.