Otolaryngologists
46 years of experience
Video profile
Accepting new patients
Dearborn
18101 Oakwood Blvd
Dearborn, MI 48124
313-253-0800
Locations and availability (5)

Education ?

Medical School Score
New York University (1964)
  • Currently 1 of 4 apples

Awards & Distinctions ?

Awards  
One of America's Leading Experts on:
Bone Transplantation
Facial Injuries
Head and Neck Cancer (Head and Neck Neoplasm)
Mandibular Fractures
Orbital Fractures
Skull Fractures
Squamous Cell Carcinoma
Hour Detroit Magazine's TOP DOCS: 2008, 2010, 2011, 2012
Detroit Hour Magazine's Top Docs (2010)
Associations
American Board of Facial Plastic and Reconstructive Surgery
American College of Surgeons
American Board of Otolaryngology

Affiliations ?

Dr. Mathog is affiliated with 30 hospitals.

Hospital Affilations

Score

Rankings

  • Crittenton Hospital Medical Center
    Otolaryngology
    1101 W University Dr, Rochester, MI 48307
    • Currently 4 of 4 crosses
    Top 25%
  • Beaumont Hospital,Troy
    Otolaryngology
    44201 Dequindre Rd, Troy, MI 48085
    • Currently 4 of 4 crosses
    Top 25%
  • St. John Macomb-Oakland Hospital (Macomb Center)
    Otolaryngology
    11800 E 12 Mile Rd, Warren, MI 48093
    • Currently 4 of 4 crosses
    Top 25%
  • DMC - Sinai-Grace Hospital
    Otolaryngology
    6071 W Outer Dr, Detroit, MI 48235
    • Currently 3 of 4 crosses
    Top 50%
  • Detroit Receiving Hospital & University Health Center
    Otolaryngology
    4201 Saint Antoine St, Detroit, MI 48201
    • Currently 3 of 4 crosses
    Top 50%
  • Oakwood Hospital and Medical Center
    Otolaryngology
    18101 Oakwood Blvd, Dearborn, MI 48124
    • Currently 3 of 4 crosses
    Top 50%
  • St. John Macomb-Oakland Hospital (Oakland Center)
    27351 Dequindre Rd, Madison Heights, MI 48071
    • Currently 3 of 4 crosses
    Top 50%
  • St. Joseph Mercy Oakland
    Otolaryngology
    44405 Woodward Ave, Pontiac, MI 48341
    • Currently 3 of 4 crosses
    Top 50%
  • Harper University Hospital
    Otolaryngology
    3990 John R St, Detroit, MI 48201
    • Currently 3 of 4 crosses
    Top 50%
  • Beaumont Hospital, Royal Oak
    Otolaryngology
    3601 W 13 Mile Rd, Royal Oak, MI 48073
    • Currently 3 of 4 crosses
    Top 50%
  • Saint Joseph Mercy Hospital
    Otolaryngology
    505 E Huron St, Ann Arbor, MI 48104
    • Currently 3 of 4 crosses
    Top 50%
  • Rehabilitation Institute of Michigan
    Otolaryngology
    261 Mack Ave, Detroit, MI 48201
    • Currently 3 of 4 crosses
    Top 50%
  • Huron Valley-Sinai Hospital
    Otolaryngology
    1 William Carls Dr, Commerce Township, MI 48382
    • Currently 2 of 4 crosses
  • Detroit Receiving Hospital
  • Oakwood Hospital
  • HARPER UNIVERSITY HOSPITAL & HUTZEL WOMEN'S HOSPIT
  • Rehabilitation Institute,Inc
  • Detroit Receiving
  • Karmanos Cancer Center
    4100 John R St, Detroit, MI 48201
  • Royal Oak (9 Years
  • Hutzel Women's Hospital
    3980 John R St, Detroit, MI 48201
  • Sinaigrace Hospital
  • Barbara Ann Karmanos Cancer Hospital
  • Harper Hospital
  • Hutzel Hospital
  • Sinai-Grace
  • Grace Hospital
  • Sinai-Grace Hospital
    6071 W Outer Dr, Detroit, MI 48235
  • Children's Hospital of Michigan
    3901 Beaubien St, Detroit, MI 48201
  • Beaumont Affiliation & Years on StaffRoyal Oak
  • Publications & Research

    Dr. Mathog has contributed to 106 publications.
    Title Cartilage Grafts in Dorsal Nasal Augmentation of Traumatic Saddle Nose Deformity: a Long-term Follow-up.
    Date November 2009
    Journal The Laryngoscope
    Excerpt

    To document the long-term advantages and disadvantages of cartilage grafts used to correct traumatic saddle nose deformity. Additionally, to demonstrate functional improvement and cosmetic satisfaction with the use of this graft.

    Title Conservative Management of Iatrogenic Esophageal Perforation in Head and Neck Cancer Patients with Esophageal Stricture.
    Date May 2009
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Evaluate the efficacy of conservative management of iatrogenic esophageal perforation following dilatation of a stricture secondary to the treatment of head and neck cancer.

    Title Tongue Base Schwannoma: Report, Review, and Unique Surgical Approach.
    Date June 2008
    Journal American Journal of Otolaryngology
    Excerpt

    Base of tongue schwannomas are exceedingly rare and therefore often are not immediately included in the differential diagnosis and treatment of oropharyngeal tumors. After a thorough review of the English literature, we found only 6 previously reported cases of tongue base schwannomas. We are contributing a report of a 37-year-old woman with progressive dysphagia, dysarthria, and large tongue base schwannoma. Diagnosis was confirmed by imaging studies and biopsy followed by surgical excision designed to preserve nerve function. A number of surgical approaches have been described for tongue base schwannomas. Each has its own degree of postoperative morbidity. The use of a unilateral transcervical incision with blunt dissection was simple and quickly accomplished with protection of nearby nerves. Histologic identification of Antoni A and B areas along with strong and diffuse staining with S-100 stain pathologically completed the diagnosis of schwannoma.

    Title Cell Carcinoma of the Paranasal Sinuses and Skull Base.
    Date January 2008
    Journal American Journal of Otolaryngology
    Excerpt

    PURPOSE: To evaluate patients with squamous cell carcinoma of the paranasal sinus and skull base for factors that might predict clinical outcome. METHODS: A multi-institutional 13-year retrospective review of anterior skull base malignancies. RESULTS: Of 73 patients with anterior skull base malignancies, squamous cell carcinoma was the most prevalent-30 patients or 41%. Twenty-three patients underwent craniofacial surgery with or without adjuvant chemotherapy. Seven patients, deemed unresectable or not willing to have surgery, were treated with standard radiation protocols often with chemotherapy. The 3- and 5-year survival rates after surgery were 32% and 16%, respectively, compared to a 28% survival rate at 3 and 5 years for the nonsurgical group. Most tumors were in advanced stages accounting for a relatively poor survival in both groups. A Cox regression analysis demonstrated that age (P = .0172) was an independent determinant of poor outcome. Although 3- and 5-year survival of tumors free of sphenoid sinus, dura, retromaxillary, and ptyerygoid space, and orbit treated with surgery showed no significant difference to those patients with involvement, their median time of survival was increased for all anatomical regions. CONCLUSIONS: Squamous cell carcinoma of the sinus invading the skull base carries a very poor prognosis regardless of treatment modality. Surgery with adjunctive radiotherapy and/or chemotherapy offers a survival advantage over nonsurgical methods, but treatment should be individualized weighing prognostic factors, such as age, stage, and anatomical extension with morbidity of treatment.

    Title Facial Fracture Repair in the Traumatic Brain Injury Patient.
    Date October 2007
    Journal Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons
    Excerpt

    PURPOSE: To review the surgical complications of patients who had facial fractures repairs in the setting of a traumatic brain injury (TBI). PATIENTS AND METHODS: A review of all individuals admitted with the diagnosis of TBI based on an evaluation by the neurotrauma service who also underwent facial fracture repair was performed. More than 600 charts were reviewed and 99 patients met study criteria. Univariate and mulitvariate logistic regression model analysis were performed comparing the complication rate in the immediate postoperative period to the patients' age, gender, mechanism of injury, zone of facial injury, preoperative Glasgow Coma score, presence of multisystem injury, mechanism of TBI and treatment, length of time from injury to surgical repair and length of surgical procedure. RESULTS: Of the 99 individuals studied, there was an 11% complication rate (8 minor, 3 major) in the immediate postoperative period. After univariate analysis, the length of time from injury to surgical repair, zone 1 facial injury and low Glasgow Coma score were all factors associated with increased complications. Multivariate logistic regression model analysis revealed that the odds of a patient sustaining a postoperative complication was 1.298 as the hour of procedure increased by 1 hour (95% CI, 1.065-1.582) and was 1.152 as the days of repair increased by 1 day (95% CI, 1.030-1.288). CONCLUSIONS: The overall complication rate of facial fracture repair in the TBI patient was 11%. A prolonged surgical procedure and delay in surgical repair were associated with higher complication rates as identified by multivariate logistical regression analysis.

    Title Visual Risks of Facial Fracture Repair in the Setting of Traumatic Optic Neuropathy.
    Date April 2006
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVE: To identify whether facial fracture repair in patients with traumatic optic neuropathy results in visual deterioration. DESIGN: A retrospective analysis was performed of all patients admitted from 1992 through 1997 with the diagnosis of facial fracture and traumatic optic neuropathy. Vision was recorded before and after fracture repair using logarithm of the minimum angle of resolution measurements. Visual outcome was compared with a nonsurgically treated group of patients with a similar diagnosis. SETTING: University trauma hospital. PATIENTS: A total of 700 medical charts were reviewed, and 54 patients met study criteria. All patients received megadose corticosteroid treatment and were divided into 3 groups: (1) facial fracture repair alone, (2) optic nerve decompression (OND) + facial fracture repair, or (3) nonsurgical treatment. RESULTS: For the 16 patients in the fracture repair alone group, 12 (75%) had improved vision and 4 (25%) had no change postoperatively. For the 10 patients in the OND + fracture repair group, 3 (30%) had improved vision, 5 (50%) had no change, and 2 (20%) had worsened vision postoperatively. For the 28 patients in the nonsurgical group, 18 (64%) had improved vision, 9 (32%) had no change, and 1 (4%) had worsened vision by discharge. Facial fracture repair alone and the nonsurgical groups both demonstrated significant visual improvement by discharge. The amount of improvement was not significantly different between all 3 groups (facial fracture repair, 0.38 +/- 0.40; OND + facial fracture repair; 0.32 +/- 1.38; and nonsurgical, 0.69 +/- 1.07). CONCLUSIONS: Facial fracture repair in the setting of traumatic optic neuropathy had no adverse effect on vision. Patients requiring OND + fracture repair had a significantly worse visual prognosis.

    Title Acinic Cell Carcinoma of the Parotid Gland: a 15-year Review Limited to a Single Surgeon at a Single Institution.
    Date February 2006
    Journal Ear, Nose, & Throat Journal
    Excerpt

    The course of acinic cell carcinoma of the parotid gland following surgical and nonsurgical interventions is variable. The objective of this study was to report our experience in treating this disease and to evaluate the factors that might be involved in the treatment of the tumor and the prognosis of the patient. To limit the contributory variables that are usually found in most studies, we included only those patients (n = 11) who had been treated by a single surgeon at a single institution from 1988 through 2003. Hospital and office records were evaluated for demographic information, signs and symptoms, treatment modalities, pathology, and outcomes. Additional follow-up data were obtained through telephone interviews. For the most part, treatment included either superficial parotidectomy or total parotidectomy with facial nerve preservation; 1 patient with coexisting adenocarcinoma underwent a more radical procedure, and 4 patients underwent adjuvant radiation therapy. The most prevalent morphologic pattern of these tumors was microcystic. Follow-up ranged from 1 year and 3 months to 10 years and 9 months (mean: 4 yr and 11 mo). During that time, we found no recurrences of acinic cell carcinoma and no evidence of metastatic disease. Therefore, we conclude that acinic cell carcinoma can be successfully treated with a superficial or total parotidectomy with sparing of the facial nerve. Radiation therapy may provide adjunctive benefit.

    Title Human Papillomavirus (hpv) Transcripts in Malignant Inverted Papilloma Are from Integrated Hpv Dna.
    Date August 2005
    Journal The Laryngoscope
    Excerpt

    OBJECTIVES: The objectives of the study were to detect human papillomavirus (HPV) sequences in nasal inverted papilloma (IP) lesions and to determine whether HPV is involved in the progression of IP to sinonasal squamous cell carcinoma (SCC). STUDY DESIGN: A retrospective study was performed on 14 patients diagnosed with IP within the last 12 years. Three of these 14 patients developed SCC. METHODS: Eighteen formalin-fixed, paraffin-embedded tissue blocks were obtained for these 14 patients. After DNA extraction, polymerase chain reaction (PCR) was performed, followed by hybridization using HPV 6, 11, 16, 18, 31, 33, 35, 45, and 52 specific DNA probes, in an attempt to identify HPV type in each specimen. After RNA extraction, the integration status of the HPV genome was evaluated based on the relative abundance of E7 and E5 viral transcripts, assessed by quantitative real-time PCR. RESULTS: HPV sequences were detected in samples from 3 of the 14 patients with IP. Of the three patients with SCC, HPV sequences were detected in two patients, whereas one patient was negative for the oligoprobes tested. Of the 11 patients diagnosed only with IP, 1 patient was positive for HPV DNA (HPV type 11). This difference in HPV positivity between IP and SCC was not statistically significant (P = .09, Fisher's Exact test, two tailed). Viral transcripts were detected in both patients with SSC who were HPV positive. Because HPV early transcripts are polycistronic, loss of 3' transcript sequences (E5) and retention of 5' sequences (E7) indicates integration. One of the SSC containing HPV 18 sequences showed a E7/E5 ratio of 776:1. The other SSC showed E7 transcripts and an absence of E5 transcripts CONCLUSION: HPV transcripts were present in SCC positive for HPV, and the relative level of E7 to E5 transcripts indicates integration of the viral genome. These findings are suggestive of HPV having an active role in the lesion. More extensive studies are needed to determine the exact role of HPV in IP and progression to SCC.

    Title Integration of Human Papillomavirus Type 11 in Recurrent Respiratory Papilloma-associated Cancer.
    Date February 2005
    Journal The Laryngoscope
    Excerpt

    OBJECTIVES/HYPOTHESIS: The main objective was to demonstrate that human papillomavirus (HPV) type 11 is an aggressive virus that plays a significant role in the development of laryngeal cancer in patients with a history of recurrent respiratory papillomatosis (RRP). We have done so by preliminary investigation into the molecular mechanism underlying the malignant transformation of RRP to invasive squamous cell carcinoma. STUDY DESIGN: An experimental, nonrandomized, retrospective study using tissue specimens from nine patients with a history of RRP that progressed to laryngeal or bronchogenic cancer was performed. METHODS: DNA and RNA were extracted from 20 formalin-fixed, paraffin-embedded specimens from six patients with a history of early onset RRP and laryngeal cancer and from three patients with early onset RRP and bronchogenic cancer. Polymerase chain reaction (PCR) was performed on DNA to determine the HPV type in each specimen. Reverse-transcriptase PCR specific for virus transcripts was performed on RNA to determine whether the viral genome was integrated into the host genome. RESULTS: HPV-11 but not HPV-6, 16, or 18 was found in all of the laryngeal and bronchogenic cancers in patients with a history of early onset RRP in this study. RNA, sufficiently intact for examination, was obtained from seven patients. Analysis of HPV 11 transcripts revealed integration of the viral genome in three of seven patients. CONCLUSIONS: HPV type 6 and 11 are considered "low-risk" viruses and are not associated with genital cancers, as are HPV types 16 and 18. However, our data suggests that HPV type 11 is an aggressive virus in laryngeal papilloma that should be monitored in patients with RRP.

    Title Transoral Versus Extraoral Reduction of Mandible Fractures: a Comparison of Complication Rates and Other Factors.
    Date March 2003
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVE: This retrospective study evaluates results and complications of the transoral and extraoral approaches for open reduction and internal fixation of mandibular body, angle, and ramus fractures. Our aim was to describe advantages and disadvantages of the techniques and to develop criteria for choosing between surgical approaches. STUDY DESIGN AND SETTING: A retrospective chart review was performed on patients with mandible fractures occurring between August 1999 and October 2001 at a level I trauma center. Only mandibular body, angle, and ramus fractures requiring open reduction were selected for this study. Cases were evaluated for cause, age, gender, dentition, site and extent of fractures, surgical approach, postoperative complications, operative time, and postoperative occlusion. RESULTS: Of the 227 patients with mandibular fractures, 78 had body, angle, or ramus fractures requiring open reduction. Of these, 36 were treated extraorally, and 42 were treated transorally. Criteria for selecting one procedure over another often involved training and surgeon experience and those factors normally considered important in defining the difficulty of treatment and prognosis of the patient. Seven of the 42 patients were converted from a transoral to an extraoral approach because of inadequate exposure. Similar complication rates occurred for the transoral and extraoral approaches, but because of the time required for converting from the transoral to extraoral approach, the average operative time was found to be increased in patients undergoing the transoral approach. CONCLUSION AND SIGNIFICANCE: Decisions regarding treatment approaches for open reduction of mandible fractures often relate to surgeon experience and training, modified by factors that can affect uncomplicated healing such as fracture locations and displacement, comminution of the fracture, infection, dentition, and atrophic changes of the mandible. In some cases, the choice is affected by availability of equipment and experience of operating room personnel. More difficult cases involving an edentulous, atrophic mandible or comminution should be considered for extraoral exposure.

    Title Hypothesis: Research in Otolaryngology is Essential for Continued Improvement in Health Care.
    Date September 2002
    Journal The Laryngoscope
    Excerpt

    The present report, in the form of a research proposal, is based on the hypothesis that research in otolaryngology is essential for continued improvement in health care. Examples of advances in otolaryngology as a result of research are noted, but for continued success, otolaryngology must maintain and find better ways to train clinically directed researchers. Traditional methods of training such as hands-on experience, courses in the basic principles of research, protected time, and mentoring are discussed and evaluated. Barriers to success such as age, time, and debt are noted. Potential solutions are presented with an emphasis on integration of the research and clinical training. Success of faculty will continue to depend on laboratory and financial support, technical assistance, protected time, salary equivalent to other faculty, and accessibility of research funds. For research to gain support and enthusiasm and to keep it strong and productive, cost-effectiveness and value must be recognized.

    Title A Comparison of Parietal and Iliac Crest Bone Grafts for Orbital Reconstruction.
    Date January 2002
    Journal Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons
    Excerpt

    PURPOSE: This study evaluated the results of cranial (membranous) versus iliac crest (endochondral) bone grafts as implants to correct post-traumatic globe malposition and/or diplopia. PATIENTS AND METHODS: Twenty-two patients underwent 25 orbital reconstructions with bone for enophthalmos, hypophthalmos, and diplopia after trauma to the orbit. Inclusion criteria consisted of at least 4 months postsurgical follow-up, pre- and postsurgical quantitative orbital measurements, photographic documentation, and complete medical records regarding inpatient and outpatient data. RESULTS: Nine cranial bone grafts and 16 iliac crest grafts were placed. Ages were similar in both groups. The average follow-up was 24 months for the cranial graft group (range, 4 to 54 months) and 18 months for the iliac crest graft group (range, 4 to 51 months). Preoperative enophthalmos averaged 4.11 and 5.06 mm in the cranial and iliac crest groups, respectively, and postoperatively the measurements were 1.78 and 1.37 mm, respectively. Changes in hypophthalmos generally reflected changes in the enophthalmos correction. In 10 patients diplopia was corrected by the procedure. There was a statistically significant change in the enophthalmos of patients when comparing pre- and postoperative status, but no statistically significant difference between the results of the cranial and iliac crest graft groups. CONCLUSION: There is no difference in the ability of cranial and iliac crest bone grafts to correct post-traumatic enophthalmos.

    Title Radiology Quiz Case 2. Silent Sinus Syndrome: Maxillary Sinus Atelectasis with Enophthalmos.
    Date January 2002
    Journal Archives of Otolaryngology--head & Neck Surgery
    Title Craniocervical Necrotizing Fasciitis: an 11-year Experience.
    Date October 2001
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVE: We review our experience and present our approach to treating craniocervical necrotizing fasciitis (CCNF). STUDY DESIGN: All cases of CCNF treated at Wayne State University/Detroit Receiving Hospital from January 1989 to April 2000 were reviewed. Patients were analyzed for source and extent of infection, microbiology, co-morbidities, antimicrobial therapy, hospital days, surgical interventions, complications, and outcomes. RESULTS: A review of 250 charts identified 10 cases that met the study criteria. Five cases (50%) had spread of infection into the thorax, with only 1 (10%) fatality. An average of 24 hospital days (7 to 45), 14 ICU days (6 to 21), and 3 surgical procedures (1 to 6) per patient was required. CONCLUSION: Aggressive wound care, broad-spectrum antibiotics, and multiple surgical interventions resulted in a 90% (9/10) overall survival and 80% (4/5) survival for those with thoracic extension. SIGNIFICANCE: This is the largest single institution report of CCNF with thoracic extension identified to date.

    Title Titanium Mesh Repair of the Severely Comminuted Frontal Sinus Fracture.
    Date June 2001
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    BACKGROUND: Severely comminuted frontal sinus fractures are difficult to contour and immobilize. Frequently, plates or wires are inadequate in fixating all fragments together, resulting in less than optimal outcomes. Advancements in the development of biomaterials have now made titanium mesh a new option for the repair of severely comminuted fractures. METHODS: Fourteen patients with severely comminuted frontal sinus fractures were treated with titanium mesh from 1994 to 1999. The fractures were reduced and immobilized using a simple algorithm: (1) Isolated anterior table fractures were repaired with reduced bony fragments attached to titanium mesh. (2) Anterior table fractures with nasofrontal duct involvement were repaired by sinus obliteration and anterior wall reconstruction with reduced bony fragments attached to titanium mesh. (3) Anterior and posterior table fractures with cerebrospinal fluid leak or displacement were treated with the cranialization of the sinus and anterior wall reconstruction with reduced bony fragments attached to titanium mesh. RESULTS: Of the 14 patients treated, 12 were available for postoperative evaluation. Parameters such as nasal function, cranial nerve V and VII function, cosmesis, and complications (hardware extrusions, sinusitis, meningitis, osteomyelitis, mucopyocele, brain abscess, pneumocephalus, and cerebrospinal fluid leak) were evaluated. All patients had good function of the superior division of cranial nerves V and VII. Two patients (16%) had minor wound infections, which resolved under treatment with antibiotics. All had excellent cosmetic results as measured by postreduction radiographs and personal and family perceptions of forehead contour. CONCLUSION: Titanium mesh reconstruction of severely comminuted frontal sinus fractures has few complications while providing excellent forehead contour and cosmesis.

    Title Nasal Alar Necrosis.
    Date October 2000
    Journal The Laryngoscope
    Excerpt

    OBJECTIVE: To describe an unrecognized clinical entity, nasal alar necrosis, and propose recommendations regarding the diagnosis, pathophysiology, and management of these cases. STUDY DESIGN: Retrospective review of four patients with this condition. METHODS: Histories, treatments, and outcomes were evaluated using office and hospital chart data. RESULTS: We noted that three patients had prior trauma or surgery, other than to the nose, in the head and neck region. All four patients had comorbidities such as diabetes, hypothyroidism, depression, or tobacco abuse. Three patients had sensory deficits over the distribution of the maxillary nerve, and three volunteered that they had a habit of picking the crusted wound. Two patients improved over several months with aggressive wound care. One patient refused treatment and another underwent successful reconstruction. CONCLUSIONS: After malignant and granulomatous diseases were ruled out, our evaluations suggested that the pathogenesis was multifactorial including several factors alone or in combination, such as, hypoesthesia, self-mutilation, and an inadequate blood supply. Deficits in vascularity and sensory innervation must be considered as potential obstacles in reconstruction. Psychological problems causing factitious wounding may complicate therapeutic interventions.

    Title Videostroboscopy of the Pharyngoesophageal Segment in Laryngectomy Patients Treated with Botulinum Toxin.
    Date August 2000
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    OBJECTIVES: The purpose of this investigation was to use videostroboscopy to study the physiologic and biomechanical effects of botulinum toxin (Botox) injection on the pharyngoesophageal segment (PES) in total laryngectomy patients with poor-quality tracheoesophageal puncture (TEP) voice caused by PES spasm. METHODS: The following was a prospective study. Videostroboscopy of the PES and videotaped recordings of patients performing TEP voice tasks were conducted before and after Botox injection of the PES. Ratings of videostroboscopic and speech samples were performed by 3 blinded judges with extensive experience with this patient population. RESULTS: Perceptually, TEP voice was more fluent and less strained after injection. Videostroboscopically, patients demonstrated improved PES volitional control and mucosal wave characteristics after Botox injection. CONCLUSION: Botox injection in total laryngectomy patients with poor-quality TEP voice caused by PES spasm provides improved physiologic and biomechanical function of the PES, as demonstrated for the first time videostroboscopically. These findings help explain the perceptual ratings of TEP voice improvement noted after Botox injection. Videostroboscopy can be used to provide diagnostic information to help confirm the clinical impression of PES spasm, as well as to document the effects of Botox injection on PES function.

    Title Nonunion of the Mandible: an Analysis of Contributing Factors.
    Date July 2000
    Journal Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons
    Excerpt

    PURPOSE: The aim of this study was to review our experience of nonunion of mandible fractures and to compare this information with the past and present literature. The analysis also evaluated risk factors and those conditions that lead to nonunion so that the complication may be better managed and possible avoided. PATIENTS AND METHODS: A retrospective review of mandible fractures in a major medical center was carried out on patients treated from 1994 through 1998. The nonunion cases were evaluated for factors such as age, sex, race, cause of fracture, location of fracture, delay until the patient obtained treatment, teeth in the fracture line, use of antibiotics, multiplicity of fractures, degree of fragmentation, medical problems, and drug and alcohol abuse. The adequacy of reduction and appropriateness of the fixation techniques were evaluated by analysis of the postoperative imaging studies. Postoperative occlusion and patient compliance were also included in the evaluation. RESULTS: Of the 906 patients with 1,432 mandible fractures, there were 25 nonunion complications, for an incidence of 2.8%. Most patients with nonunion were men who had received the fracture as a result of an altercation. The nonunion was frequently noted in the body, and was almost twice as common (39% vs 17.6%) in patients with multiple fractures than in a randomly selected group who did not have the complication. Delayed treatment was noted in 8 of the patients, and teeth were present in the fracture line in another 8. Alcohol and drug abuse were prevalent, and 1 of 5 of the patients removed their fixation devices. Eight patients were believed to be stabilized inadequately, and 1 patient also had a poor reduction. Osteomyelitis was a common complication. CONCLUSIONS: The incidence of nonunion appears to be unchanged over time regardless of the varied and presumably advanced methods of fixation and reduction. Multiple fractures were a contributory factor, and the body of the mandible appeared to be a common site. Many patients had osteomyelitis associated with the nonunion. Inadequate stabilization or reduction were important causes. Other suspected contributory factors included failure to provide antibiotics, delay in treatment, teeth in the fracture line, alcohol and drug abuse, inexperience of the surgeon, and lack of patient compliance.

    Title Anti-cd3/anti-cd28 Bead Stimulation Overcomes Cd3 Unresponsiveness in Patients with Head and Neck Squamous Cell Carcinoma.
    Date May 2000
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVES: To test whether T-cell CD3 responses are altered in patients with advanced-stage head and neck squamous cell carcinoma (HNSCC) and whether anti-CD3/anti-CD28 (alphaCD3/alphaCD28) bead stimulation could reverse CD3 unresponsiveness. DESIGN: Anti-CD3 (alphaCD3) monoclonal antibody immobilized on tissue culture plastic was used to stimulate lymph node mononuclear cells (LNMCs) and peripheral blood mononuclear cells (PBMCs) from patients with advanced-stage HNSCC. Proliferation, T-cell phenotype, and cytokines were measured during 8-day in vitro stimulation. Immune-enhancing properties of alphaCD3/ alphaCD28 beads were also tested on LNMCs and PBMCs. Cytotoxicity of bead-activated T cells (ATCs) was measured against autologous and allogeneic HNSCC. RESULTS: Six patients were nonresponders to alphaCD3 stimulation defined by tritium (3H) incorporation of less than 3500 cpm, whereas 11 patients were responders with 3H incorporation of 3500 cpm or more. Responders produced higher levels of interleukin (IL)-12 and interferon gamma (IFN-gamma) after alphaCD3 stimulation than nonresponders. No phenotypic or clinical differences were identified between groups. Stimulation with alphaCD3/alphaCD28 beads enhanced IFN-gamma and IL-2 produced by both groups. Bead ATCs were generated from PBMCs of patient 11 in the responder group and lysed (+/- SD) 100% +/-1% of autologous tumor and 49% +/-1% of allogeneic tumor. Bead ATCs from LNMCs of this patient lysed 58%+/-1% of autologous tumor and 63%+/-1% of allogeneic tumor. CONCLUSIONS: A subpopulation of patients with HNSCC who are nonresponders to alphaCD3 stimulation has been identified, showing reduced proliferation and IL-12 and IFN-gamma secretion. Nonresponders stimulated with alphaCD3/alphaCD28 beads reversed immune unresponsiveness and induced a type 1 cytokine response. Bead-generated ATCs from patient 11 in the responder group lysed autologous and allogeneic HNSCC in vitro, suggesting a possible effective immunotherapeutic modality in the treatment of HNSCC.

    Title Anti-cd3/anti-cd28 Monoclonal Antibody-coated Suture Enhances the Immune Response of Patients with Head and Neck Squamous Cell Carcinoma.
    Date November 1999
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVE: To test whether anti-CD3/anti-CD28 (alphaCD3/alphaCD28) monoclonal antibodies could be coated on surgical suture and used to enhance T-cell immune function in patients with advanced-stage head and neck squamous cell carcinoma (HNSCC). DESIGN: AlphaCD3/alphaCD28 monoclonal antibodies at varying concentrations and ratios were coated on surgical sutures and tested on peripheral blood mononuclear cells from normal donors to identify the optimal stimulating condition. Immune-enhancing properties of alphaCD3/alphaCD28 monoclonal antibody suture were tested on peripheral blood mononuclear cells and regional lymph node mononuclear cells isolated from patients with advanced HNSCC and on normal donor peripheral blood mononuclear cells. Proliferation, T-cell phenotype, and cytokines were measured during 8-day in vitro stimulation with alphaCD3/alphaCD28 suture and compared with alphaCD3/alphaCD28-coated tissue culture plastic, a previously recognized carrier. RESULTS: Optimal stimulation was observed with monofilament nylon incubated with alphaCD3/alphaCD28, 2 microg/mL, at a 1:1 ratio for 18 hours at 37 degrees C. Strong proliferation of peripheral blood mononuclear cells and lymph node mononuclear cells in patients with HNSCC was induced by alphaCD3/alphaCD28 suture. There was no difference in maximal proliferation between alphaCD3/alphaCD28 plastic and suture. On day 6 after alphaCD3/alphaCD28 suture stimulation, T-cell subpopulations expressing CD3, CD4, CD8, CD28, and CD45RO were enhanced. Suture stimulation significantly enhanced interleukin 2 secretion when compared with plastic stimulation (P = .01). Both alphaCD3/alphaCD28 suture and plastic stimulated interferon gamma secretion. CONCLUSIONS: To our knowledge, this study is the first to report the modification of surgical suture to create an immunomodulant. AlphaCD3/alphaCD28-coated suture expanded T cells from patients with HNSCC and induced a T(H)1 immune response, which may be a useful therapeutic tool in the treatment of HNSCC and other diseases.

    Title Platysma Muscle-cervical Fascia-sternocleidomastoid Muscle (pcs) Flap for Parotidectomy.
    Date August 1999
    Journal Head & Neck
    Excerpt

    BACKGROUND: Parotidectomy is useful in the treatment of benign and malignant neoplasms of the parotid gland, but often leads to sequelae of facial deformity and Frey's syndrome. This paper presents a retrospective review of parotidectomy results in 21 consecutive patients treated with either traditional techniques or with the rotation and advancement of combined platysma muscle-cervical fascia-sternocleidomastoid flap (PCS). METHODS: The surgical procedures utilized for removal and reconstruction are described. Information on appearance and function was obtained by analysis of hospital and office records and telephone questionnaire for patients with and without the flap. RESULTS: Of the 21 patients eligible for this study, only 9 of 10 patients with the PCS flap and 10 of 11 patients without the flap provided sufficient data for analysis. In the flap group all 9 patients either noted a mild fullness on the operated side or no difference between sides. In the nonflap group, 4 patients felt they had a moderate depression, 2 patients noted a mild depression, and 4 patients noted no difference between sides. Frey's syndrome was classified as mild in 2 patients in the PCS group, whereas in the nonflap group, 4 patients thought it was mild and 1, severe. Complications were rare in either group. CONCLUSION: The PCS flap prevents deformity and contributes to patient satisfaction following parotidectomy. The flap helps to prevent Frey's syndrome and is not associated with an increase in postoperative complications. The flap is recommended following removal of nonrecurrent or low-grade malignant parotid tumors.

    Title Orbital Measurement in Black and White Populations.
    Date July 1999
    Journal The Laryngoscope
    Excerpt

    OBJECTIVE: Obtain measurements of globe projection, intercanthal distance (ICD), interpupillary distance (IPD), palpebral fissure width (PFW), and palpebral fissure height (PFH) in a population of presumably normal white and black adults to determine if any significant differences exist between these groups. STUDY DESIGN: Prospective direct measurement of cohorts regarding orbital and globe measurements in a tertiary medical center. METHODS: Measurements of globe projection, ICD, IPD, PFW, and PFH were taken in 61 black adults and directly compared with measures taken from 65 white adults in an outpatient setting. Mean values and ranges were calculated and compared between races and sexes using an unpaired t test. RESULTS: A significant difference was found between races for globe projection, with black males demonstrating a mean projection of 18.23+/-2.26 mm as compared with 17+/-2.65 mm for white males (P < .025). Black females demonstrated a mean projection of 17.27+/-1.44 mm as compared with 15.98+/-2.22 mm for white females (P < .01). Similar differences were seen for measures of IPD and PFW, with greater mean values for black as compared with white adults. No racial differences existed for ICD or PFH. CONCLUSIONS: These findings suggest that racial differences exist for certain measures of globe and orbital position, i.e., projection, IPD, and PFW. Racial background should be considered when evaluating orbital anatomy.

    Title Facial Nerve Rehabilitation After Radical Parotidectomy.
    Date June 1999
    Journal The Laryngoscope
    Excerpt

    OBJECTIVE: Examine functional outcomes in patients undergoing radical parotidectomy and facial nerve grafting. Identify factors that may affect rehabilitation in these patients. STUDY DESIGN: Retrospective chart review and photographic analyses of 12 patients undergoing radical parotidectomy with interposition nerve grafts for facial nerve reconstruction. METHODS: Data obtained for each patient regarding age, sex, histology of parotid neoplasm, cable graft source, administration of postoperative radiotherapy, and treatment for eye rehabilitation. Functional outcomes were assessed with the House-Brackmann grading system at 6 months, 1 year, and 2 years after surgery. RESULTS: All nerve grafts were harvested from cervical plexus sensory nerves with microscopic epineural repair performed for all neurorrhaphies. Overall, 9 of 12 patients achieved a grade III 2 years after surgery. All patients under age 30 obtained a grade III. Of the seven patients receiving postoperative radiation, five achieved a grade III. Older patients often required surgical procedures to facilitate eye closure. CONCLUSIONS: Facial nerve rehabilitation after radical parotidectomy can be successfully achieved with cervical plexus interposition nerve grafts. Postoperative radiotherapy did not appear to affect return of function, and younger patients consistently achieved good functional outcomes after nerve grafting. Older patients frequently require surgical procedures for eye rehabilitation after radical parotidectomy.

    Title Botulinum Toxin Injection to Improve Tracheoesophageal Speech After Total Laryngectomy.
    Date March 1999
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Total laryngectomy patients, after undergoing a tracheoesophageal puncture (TEP), may have poor TEP speech because of hypertonicity or spasm of the pharyngoesophageal segment (PES). Conventional treatment options include speech therapy, PES dilation, pharyngeal neurectomy, and myotomy. Botulinum toxin injection into the PES has recently been reported to be effective for this disorder. However, data accumulated were based primarily on subjective analyses. This prospective investigation used both qualitative and quantitative measures to assess the effects of videofluoroscopy-guided botulinum toxin injection on TEP voice quality in laryngectomees with PES dysfunction. Patients underwent voice analyses, tracheal air pressure measures, and barium swallows before and after botulinum toxin injection. Seven of 8 patients had significant voice quality improvement, and tracheal air pressures normalized in 6 of 8 patients after injection. Videofluoroscopic botulinum toxin injection into the PES is efficacious, safe, and cost-effective and should be considered as a first-line therapy for the treatment of laryngectomees with poor quality TEP speech caused by PES dysfunction.

    Title Facial Fracture Classification According to Skeletal Support Mechanisms.
    Date January 1999
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    OBJECTIVE: To construct, propose, and evaluate the usefulness of a new clinical facial fracture classification scheme to accurately denote, communicate, and compare facial fractures. DESIGN: A retrospective, consecutive sample study with application of the proposed classification scheme to denote maxillary and zygomatic fractures with computed tomography. SETTING: Metropolitan tertiary care trauma center. PATIENTS: A total of 213 consecutive adult patients with facial fractures evaluated by means of 2-dimensional computed tomography. RESULTS: The classification scheme is defined according to fractures of vertical buttresses and horizontal beams. The scheme uses 3 primary descriptors of laterality and support sites to denote the clinical pattern of the fractures. This scheme was accurately applied and sufficient to describe 87 midfacial fracture patterns in this study. In addition, 118 (98%) of 120 mock fracture patterns were correctly transcribed and reproducibly communicated among 12 participating physicians. CONCLUSIONS: This newly proposed facial fracture classification scheme provides a convenient, specific, descriptive, and reproducible method of denoting fracture patterns. This scheme may be used to accurately communicate and compare, in greater detail than permitted using current independent classification schemes, the essential site and degree-of-severity characteristics of facial fractures critical to their surgical reduction and reconstruction. The usefulness of this classification scheme in determining optimal methods and subsequent outcomes in midfacial fracture reduction requires further investigation.

    Title Surgery of Traumatic Defects of the Orbital Floor.
    Date January 1999
    Journal Archives of Otolaryngology--head & Neck Surgery
    Title Videostroboscopy of the Pharyngoesophageal Segment in Total Laryngectomees.
    Date December 1998
    Journal The Laryngoscope
    Excerpt

    OBJECTIVES: The reconstructed pharyngoesophageal segment (PES) serves as the neoglottis following total laryngectomy, as it provides the source of vibration for production of tracheoesophageal puncture (TEP) voice. To date, little information exists regarding the vibratory characteristics of the PES. The purpose of this investigation was to study the anatomy and physiology of the PES using videostroboscopy. STUDY DESIGN: Prospective study investigating the anatomy and physiology of the PES in 34 laryngectomees who used TEP speech as their primary form of communication. MATERIALS AND METHODS: Videostroboscopy and voice recordings were graded by three trained, blinded judges using a seven-point scale. RESULTS: The patients demonstrated differences that allowed for separation of patients into two main groups: "poor" and "effective" TEP speakers. The voice quality differences were explained by anatomic and physiologic characteristics of the PES. Redundant, thick, and dyssynchronous PES features were observed in patients with poor TEP speech skills; the effective speakers exhibited less redundant, thinner mucosa and more synchronous vibratory patterns. Moreover, the latter subgroup consistently demonstrated a greater degree of volitional PES control and less spasmodic activity than their poorly speaking counterparts. Length of the PES opening (measured in the horizontal plane) as well as amount and consistency of secretions did not appear to influence TEP speech or voice proficiency. CONCLUSION: Videostroboscopy in laryngectomees is a noninvasive, inexpensive, easily performed procedure that may contribute valuable information regarding the anatomy and physiology of the PES, especially in patients who experience difficulties achieving satisfactory TEP voice and speech production.

    Title Nutritional and Zinc Status of Head and Neck Cancer Patients: an Interpretive Review.
    Date December 1998
    Journal Journal of the American College of Nutrition
    Excerpt

    In this review, we provide evidence based on our studies, for zinc deficiency and cell mediated immune disorders, and the effects of protein and zinc status on clinical morbidities in patients with head and neck cancer. We investigated subjects with newly diagnosed squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx. Patients with metastatic disease and with severe co-morbidity were excluded. Nutritional assessment included dietary history, body composition, and prognostic nutritional index (PNI) determination. Zinc status was determined by zinc assay in plasma, lymphocytes, and granulocytes. Pretreatment zinc status and nutritional status were correlated with clinical outcomes in 47 patients. Assessment of immune functions included production of TH1 and TH2 cytokines, T cell subpopulations and cutaneous delayed hypersensitivity reaction to common antigens. At baseline approximately 50% of our subjects were zinc-deficient based on cellular zinc criteria and had decreased production of TH1 cytokines but not TH2 cytokines, decreased NK cell lytic activity and decreased proportion of CD4+ CD45RA+ cells in the peripheral blood. The tumor size and overall stage of the disease correlated with baseline zinc status but not with PNI, alcohol intake, or smoking. Zinc deficiency was associated with increased unplanned hospitalizations. The disease-free interval was highest for the group which had both zinc sufficient and nutrition sufficient status. Zinc deficiency and cell mediated immune dysfunctions were frequently present in patients with head and neck cancer when seen initially. Zinc deficiency resulted in an imbalance of TH1 and TH2 functions. Zinc deficiency was associated with increased tumor size, overall stage of the cancer and increased unplanned hospitalizations. These observations have broad implications in the management of patients with head and neck cancer.

    Title Effects of Zinc and Nutritional Status on Clinical Outcomes in Head and Neck Cancer.
    Date September 1998
    Journal Nutrition (burbank, Los Angeles County, Calif.)
    Excerpt

    The head and neck cancer patient often presents with both protein malnutrition and trace element deficiencies. Zinc has been found to be deficient in many head and neck cancer patients. In this study, pretreatment zinc status and nutritional status (measured by the Prognostic Nutritional Index [PNI]) were correlated with clinical outcomes in 47 patients. The patients were followed-up for a median of 52 mo from the time of enrollment. Our results showed that the tumor size and overall stage correlated significantly to zinc status whereas no such correlation was seen with PNI, alcohol intake, or smoking in our subjects. The results also showed that impaired zinc status was associated with an increased number of treatment morbidities, unplanned hospitalizations, and treatment delays (P < 0.05). Nutritional status was not associated with any studied outcome variable. The disease-free interval was highest for the group which had both zinc-sufficient and nutrition-sufficient status. Although our data do not prove conclusively, they do suggest that impaired zinc status at presentation may contribute to treatment morbidity, and that for an optimal mean disease-free interval, a sufficient zinc and nutritional status is required.

    Title Zinc Deficiency in Head and Neck Cancer Patients.
    Date October 1997
    Journal Journal of the American College of Nutrition
    Excerpt

    BACKGROUND: Although a great deal of attention has been given to protein and calorie malnutrition in patients with head and neck cancer, zinc status has not been assessed properly in such patients in the past. METHODS: In this study we characterized zinc status by cellular zinc criteria and assessed several measures of protein and calorie malnutrition in patients with head and neck cancer. We determined prognostic nutritional index (PNI) based on serum albumin, serum transferrin, triceps skin fold measures, and delayed hypersensitivity, as proposed by Buzby et al. In this study, the baseline zinc status and PNI of 60 head and neck cancer patients were correlated with the tumor size and overall stage of the disease. RESULTS: Our results showed that the tumor size and overall stage correlated significantly to zinc status whereas no correlation was seen with PNI, alcohol intake, or smoking in our study subjects. CONCLUSION: We conclude that zinc status is a better indicator of tumor burden and stage of the disease in head and neck cancer patients than the patients' overall nutritional status.

    Title Mucoceles of the Maxillary Sinus.
    Date August 1997
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    The maxillary sinus is an uncommon site for mucoceles within the paranasal sinuses. In this study nine patients with maxillary sinus mucoceles are presented. Six of these patients were treated by open approaches, and three were treated by endoscopic drainage alone. For uncomplicated maxillary sinus mucoceles, endoscopic drainage appears to be a reasonable approach, whereas for more complicated cases extending outside the sinus, open approaches may be required.

    Title Trace Elements in Head and Neck Cancer Patients: Zinc Status and Immunologic Functions.
    Date July 1997
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    In this study we have assessed zinc status and zinc-dependent cell-mediated immune functions (interleukin-2 production by mononuclear cells, natural killer cell lytic activity, and interleukin-1 beta production by mononuclear cells) in adult patients with squamous cell carcinoma of the upper aerodigestive tract at diagnosis and before any therapy was instituted. Inasmuch as significant interactions between zinc, copper, and iron exist, we also assayed the plasma copper level, serum iron level, and total iron-binding capacity in our patients. We recruited 30 cancer subjects and 21 control subjects. On the basis of cellular zinc criteria, we diagnosed a mild deficiency of zinc in 53% of cancer subjects. The plasma zinc level was not decreased in our subjects. A univariate analysis was applied by use of one-way analysis of variance comparing study variables among the three study groups (controls and zinc-deficient and zinc-sufficient cancer patients) and Tukey's multiple comparison test, and we showed that interleukin-2 production and natural killer lytic activity were decreased in zinc-deficient cancer patients. Interleukin-1 beta production (ELISA assay) was increased in both zinc-deficient and zinc-sufficient groups. Plasma copper level was not different, but the iron utilization was decreased in both groups of cancer subjects. We conclude that zinc deficiency and zinc-dependent immunologic dysfunctions are present in more than half of the patients with head and neck cancer in the Detroit area.

    Title Early and Delayed Repair of Orbitozygomatic Complex Fractures.
    Date April 1997
    Journal Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons
    Excerpt

    PURPOSE: The goal of this study was to review experience with early and delayed repair of orbitozygomatic complex fractures and develop guidelines for repair based on timing and extent of injury. PATIENTS AND METHODS: Records of patients with orbitozygomatic complex fractures over a 10-year period were reviewed for cause of injury, signs and symptoms, length of time from injury to repair, and method of repair. Results were evaluated by office examination and telephone interviews at least 6 months to 10 years after surgery. RESULTS: Seventy-eight patients who had undergone 81 surgical procedures were analyzed. The series consisted of 49 primary repairs (1 to 22 days postinjury), 10 delayed repairs using osteotomies at 21 days to 5 months postinjury, and 22 delayed repairs requiring onlay bone grafting from 4 months to 16 years postinjury. Forty patients (43 procedures) were available for follow-up. Early surgical intervention dramatically improved esthetic and functional outcomes, whereas late repair was less satisfactory. Hypoesthesia was not improved by surgery. Osteotomy and onlay grafting techniques were necessary for delayed treatment. CONCLUSION: Orbitozygomatic fractures can be repaired up to 21 days postinjury using primary reduction and fixation techniques. Osteotomies are required after 21 days and can be used successfully up to 4 months postinjury. After 4 months, successful repair requires onlay bone grafting.

    Title Zinc Deficiency: Changes in Cytokine Production and T-cell Subpopulations in Patients with Head and Neck Cancer and in Noncancer Subjects.
    Date March 1997
    Journal Proceedings of the Association of American Physicians
    Excerpt

    Cell-mediated immune dysfunctions and susceptibility to infections have been observed in zinc-deficient human subjects. In this study, we investigated the production of cytokines and characterized the T-cell subpopulations in three groups of mildly zinc-deficient subjects. These included head and neck cancer patients, healthy volunteers who were found to have a dietary deficiency of zinc, and healthy volunteers in whom we induced zinc deficiency experimentally by dietary means. We used cellular zinc criteria for the diagnosis of zinc deficiency. We assayed enzyme-linked immunosorbent assay the production of cytokines from phytohemagglutinin-stimulated peripheral blood mononuclear cells and assessed by flow cytometry the differences in T-cell subpopulations. Our studies showed that the cytokines produced by TH1 cells were particularly sensitive to zinc status, inasmuch as the production of interleukin-2 (IL-2) and interferon-gamma were decreased even though the deficiency of zinc was mild in our subjects. TH2 cytokines (IL-4, IL-5, and IL-6) were not affected by zinc deficiency. Natural killer cell lytic activity also was decreased in zinc-deficient subjects. Recruitment of naive T cells (CD4+CD45 RA+) and CD8+ CD73+ CD11b-, precursors of cytolytic T cells, were decreased in mildly zinc-deficient subjects. An imbalance between the functions of TH1 and TH2 cells and changes in T-cell subpopulations are most probably responsible for cell-mediated immune dysfunctions in zinc deficiency.

    Title Rehabilitation of Patients with Extended Facial and Craniofacial Resection.
    Date February 1997
    Journal The Laryngoscope
    Excerpt

    Surgery of benign and malignant disease of the nose and sinuses can result in disfigurement and disability. Many patients have speech, mastication, and swallowing problems, anosmia, and pain. If the orbit is retained, visual loss, dystopia, diplopia, and epiphora can occur. This study reviews the senior author's experience with 34 patients over the last 18 years. Group and case analyses demonstrate that in patients with cancer, the eye can be preserved if one anatomical boundary is retained beyond a negative frozen section margin. Dystopia can be prevented by reconstruction of the floor with skin and fascial grafts or flaps. Epiphora can be reduced by repair of the medial canthus and dacryocystorhinostomy. Evidence is presented for prosthetic management of speech and swallowing and restoration of cheek contour. Case examples are used to illustrate the surgical techniques.

    Title Functional Outcome of an Implant-retained Edentulous Mandibular Resection Prosthesis: a Clinical Report.
    Date October 1996
    Journal The Journal of Prosthetic Dentistry
    Title Medial Orbital Wall Fractures: Classification and Clinical Profile.
    Date April 1995
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    This article reports our experience and proposes a clinical classification regarding medial orbital wall fractures. After a retrospective analysis of 2741 patients with facial fractures, we were able to evaluate 273 patients with 304 medial orbital wall fractures. The male-to-female ratio was 5:1, and most injuries involved the left orbit. Most fractures were caused by personal altercations, but more complex injuries were noted with automobile accidents and falls. Fractures were divided into types based on location and severity of injury: type I (confined to the medial orbital wall), type II (medial orbital wall continuous with floor), type III (medial orbital wall with floor-malar fractures), and type IV (medial orbital wall and complex midfacial injuries). Although visual loss (2%), diplopia (41%), and enophthalmos (12%) were seen, diplopia and enophthalmos were commonly observed with type II injuries. Imaging studies showed that about 52% of the fractures were associated with prolapse of orbital fat, but only 43% could be diagnosed with plain x rays. Type I fractures were generally explored through a frontoethmoid incision; other types were treated with subciliary or transconjunctival approaches. The usual treatment consisted of repositioning the fragments and repair of the wall with polyethylene mesh or cranial bone graft. Type I and type II fractures seemed best explained by the hydraulic mechanism of injury, whereas the type III and type IV fractures best fitted the buckling theory.

    Title Swallowing of Bolus Types by Postsurgical Head and Neck Cancer Patients.
    Date December 1994
    Journal Head & Neck
    Excerpt

    BACKGROUND. Clinically, head and neck cancer patients with anterior resections have better postoperative outcomes than do patients with posterior resections. METHODS. Videofluoroscopy was used to study the swallowing characteristics in postsurgery head and neck cancer patients and normal controls. Most patients received post-operative radiotherapy and chemotherapy, and no cancer recurrence was noted at the time of study, 4-8 months posttreatment. Bolus types included: 3 mL and 10 mL liquid barium, barium paste, and barium-coated cookie. Temporal measurements and a count of the number of swallows required to ingest each material were made from the videotaped data. Statistical analysis using an unbalanced univariate repeated measures ANOVA was performed. RESULTS. The major differences were found between bolus types, with few differences noted between surgical groups (anterior vs posterior resections) and normal controls. Patients took longer to ingest viscous material, accomplishing this by multiple piecemeal and clearing swallows. Coordination of mastication and swallowing of the cookie was different between normal and patient groups. CONCLUSIONS. Patients who are able to swallow reasonably well postoperatively maintain normal coordination and timing of swallowing activity and do not vary these parameters to compensate for structural inadequacy. Instead, repeated swallows are used.

    Title Bone Graft Implantation for Correction of the Anophthalmic Orbit.
    Date February 1994
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Prosthetic rehabilitation of the anophthalmic orbit may result in a syndrome characterized by retrodisplacement and tilt of the prosthesis, deepening of the upper eyelid sulcus, retraction of the upper eyelid, and stretching of the lower eyelid. Patients requiring enucleation of the orbit following trauma can also have accentuation of the enophthalmos, with hypophthalmos and displacement of the malar eminence. These cosmetic defect are difficult to manage, and a number of corrective surgical techniques have been described. In this study we review the pathophysiology of the anophthalmic orbit and present our recent experience utilizing the strategic placement of iliac crest bone grafts to compensate for the bony and soft-tissue injuries associated with traumatic loss of the globe. All six patients experienced subjective and objective improvement postoperatively. Results are presented as case presentations with accompanying photographs and follow-up data.

    Title Mandible Fractures--medical and Economic Considerations.
    Date April 1993
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    This article retrospectively evaluates 1278 mandibular fractures and compares intermaxillary fixation, plating, and interosseous wiring as to outcomes and cost-effectiveness of treatment. The predominance of young men with personal altercations reflects the urban patient setting. The infection from plating exceeds other methods and this difference is also reflected in increased patient days (in the hospital) and an increased length of time for postoperative care. No significant differences are observed between treatments for non-union, malunion, facial nerve injury, or temporal mandibular joint problems. Other factors, such as site and severity of injury and experience of the surgeons are considered. Cost implications are important, but should be just one factor in evaluation for the best treatment for each patient.

    Title A Clinical Approach to Dysphagia.
    Date August 1992
    Journal American Journal of Otolaryngology
    Title Management of Orbital Blow-out Fractures.
    Date June 1991
    Journal Otolaryngologic Clinics of North America
    Excerpt

    The sequelae of the blow-out fracture can be predicted from a knowledge of the pathophysiology of the fracture as well as an accurate history and clinical and radiologic examination of the patient. The main indications for exploration and repair are acute changes in globe position and mechanical restriction of gaze. Surgery should be performed at 7 to 10 days posttrauma. For the surgeon who possesses the skills and expertise, reparative procedures should help the patient and infrequently cause complications.

    Title Medial Maxillary Fractures.
    Date April 1991
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title The "plateau Effect" of Cis-platinum-induced Hearing Loss.
    Date April 1991
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Cis-platinum-induced hearing loss has been reported to exhibit a "plateau effect" over the 2 to 8 kHz range. We examined serial audiometry data from 27 patients treated with cis-platinum. Although a plateau at 60 to 70 dB HL often occurred, this hearing loss was clearly exceeded in a number of patients. We identified 14 patients with sufficient cis-platinum-induced sensorineural hearing loss to evaluate a plateau limit to hearing loss over the 4 to 8 kHz range. Half of these 14 patients had hearing losses that exceeded the plateau level. More severe 4 to 8 kHz hearing losses did not correlate with number of treatments, cumulative dosages of cis-platinum, pre-existing hearing loss, radiation therapy, other chemotherapeutic agents, or even hearing losses below 4 kHz. Although cis-platinum therapy can induce a plateau of moderate hearing impairment for some patients over the 4 to 8 kHz range, a significant proportion of patients will experience more severe hearing impairment in this range, even after only one or two courses of cis-platinum.

    Title Objective Assessment of Swallowing Function in Head and Neck Cancer Patients.
    Date March 1991
    Journal Head & Neck
    Excerpt

    Swallowing function was evaluated with scintigraphy in 37 patients with head and neck cancer. The patients were examined before and during the course of either surgery, chemotherapy, and/or radiotherapy. A total of 118 scintigraphic studies were performed. Scintigraphic results of bolus flow and aspiration were correlated with clinical findings. Both scintigraphic and clinical studies indicated a worsened swallowing function in 12 patients. These same studies indicated improvement of swallowing in another 13 patients. In 11 patients, both studies revealed either no apparent change or mixed changes in swallowing function after the course of therapy. In only 1 patient was there disagreement between the scintigraphic and clinical assessment of swallowing function. It is our opinion that scintigraphy is a useful method for objective assessment of swallowing function during and after the course of treatment of head and neck cancer patients.

    Title Vestibular Effects of Chronic Perilymph Fistula in the Cat.
    Date August 1990
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Chronic, unilateral perilymph fistulae were created in cats by removal of the round window membrane and placement of a tympanostomy tube into the round window. Rotary chair, fistula, caloric, and vestibulospinal tests were performed before and after fistulization, and periodically for 2 weeks. At 2 weeks, patency of the fistula was documented by fluorescein injection into the spinal fluid and visualization of leakage into the middle ear bulla via the fistula. All the cats had a patent fistula at 2 weeks, but one of the three cats had a greater perilymph leak than the others. The cat with the more active leak had a spontaneous nystagmus toward the side of the fistula on the first postoperative day; this changed to nystagmus toward the opposite side by the third postoperative day. The other cats had a spontaneous nystagmus toward the opposite side from the first postoperative day. Most abnormal test results returned to normal in the first week after fistulization. Histologic study of the temporal bones revealed that the cat with the greater leak had a wider cochlear aqueduct than the other cats.

    Title Tongue Mobility in Speech After Partial Glossectomy.
    Date July 1990
    Journal Head & Neck
    Excerpt

    Recovery of tongue mobility in speech was investigated in 5 partial glossectomy patients. Jaw range of motion used in speech, and tongue contour changes relative to the jaw, were assessed using sequential videofluoroscopic data recorded presurgery, postsurgery, and postradiotherapy. Data from 2 normal controls were included for comparison. Tongue mobility relative to the jaw was found to be restricted postsurgery. Approximately 4 months later, following radiotherapy, tongue mobility increased. Range of jaw motion used in speech was unchanged. Results are interpreted as preliminary evidence that in this small group of cancer patients, radiotherapy following surgery did not prevent continued recovery of tongue function for speech in the early postradiation period.

    Title Flap Reconstruction Techniques in Conjunctivorhinostomy.
    Date July 1990
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Dacryocystorhinostomy is usually the standard approach to treat epiphora caused by lower lacrimal tract obstruction. When the pathologic condition lies in the upper lacrimal passage, however, alternate bypass or reconstructive options must be considered. Conjunctivodacryocystorhinostomy, using the Jones tube, can effectively bypass the upper tract, but the technique may be complicated by granulation tissue formation, infection from unapposed mucosal flaps, and inefficient passage of tears through scar as a result of healing by secondary intention. Canaliculodacryocystorhinostomy affords the advantages of a physiologic reconstruction, but is limited by availability of sufficient canaliculus, requires a lengthy and tedious dissection, and must be performed using a microsurgical approach. We describe an alternate technique of conjunctivorhinostomy that provides total lacrimal bypass and has the advantages of bipedicled mucosal flap apposition, temporary stenting, and symptomatic improvement of epiphora. Several case examples illustrate the indications, advantages, and disadvantages of this technique.

    Title Mastication in Patients Treated for Head and Neck Cancer: a Pilot Study.
    Date June 1990
    Journal The Journal of Prosthetic Dentistry
    Excerpt

    Patients with head and neck cancer will experience alteration of oral anatomy and physiology caused by the disease and the treatment required. Despite the implied effects on the dynamics of mastication, objective studies have not been conducted to evaluate masticatory function of these patients. Masticatory performance and swallowing threshold performance were evaluated with Frito corn chips as the test substance. Edentulous patients treated for cancer demonstrated deficiencies in both tests. Masticatory performance and swallowing threshold performance improved with prosthodontic rehabilitation but this improvement was less than with comparable controls. Techniques to evaluate masticatory factors such as dentition, dentures, biting force, temporomandibular joint status, range of motion, and saliva are suggested.

    Title Posttraumatic Telecanthus.
    Date December 1989
    Journal Facial Plastic Surgery : Fps
    Title Aspiration in Patients with Head and Neck Cancer and Tracheostomy.
    Date September 1989
    Journal American Journal of Otolaryngology
    Excerpt

    Tracheopulmonary aspiration is a common occurrence in patients with dysphagia associated with head and neck cancer. We performed quantitative scintigraphic analysis of tracheopulmonary aspiration in 125 patients with head and neck cancer; 58 of these patients had a tracheostomy. Tracheopulmonary aspiration occurred in 58% of patients with a tracheostomy and in 23% of patients without a tracheostomy. In six of seven patients with a tracheostomy, tracheopulmonary aspiration significantly increased when the obturator was removed and, in these patients, occlusion of the tracheostomy tube during feedings eliminated or reduced the complication. Our studies suggest that aspiration can be monitored accurately and conveniently by scintigraphy, and that this technique is useful in the evaluation and management of dysphagia in debilitated patients.

    Title Repair of Orbital Floor Fractures with Marlex Mesh.
    Date August 1989
    Journal The Laryngoscope
    Excerpt

    The best method for reconstructing the acutely fractured orbital floor is controversial. In this review, the outcome of 81 patients with an operatively confirmed pure orbital blow-out fracture is evaluated with respect to postoperative enophthalmos, diplopia, infection, and extrusion. A Marlex mesh implant was used to repair 58 of the fractures, with minimal resultant complications. We believe that Marlex mesh is an ideal implant for use in repairing the early blow-out fracture.

    Title Injury to the Orbital Plate of the Frontal Bone.
    Date May 1989
    Journal Head & Neck Surgery
    Excerpt

    Twelve cases of fracture of the orbital plate of the frontal bone are reviewed to clarify this important clinical problem and to suggest satisfactory methods of management. Common signs and symptoms include forehead laceration and deformity, and fracture of the frontal sinus. Loss of vision can occur, and in the seeing eye, diplopia can develop in several fields of gaze. Downward or upward projection of the orbital plate of the frontal bone can cause exophthalmos or enophthalmos. Cerebrospinal fluid leak, with or without meningitis, and seizures can also be part of the syndrome. Effective treatment consists of repairing or obliterating the frontal sinus, reducing the orbital root fracture, and repositioning the globe. Rib or iliac crest grafts, acrylic implants, and temporalis muscle-galea flaps are useful in correcting the deformity and restoring appropriate function. Long-term follow-up examinations are an important part of patient care.

    Title Surgical Correction of Enophthalmos and Diplopia. A Report of 38 Cases.
    Date March 1989
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Enophthalmos, hypophthalmos, and diplopia are complications of orbital injury. This article reviews the causes of these sequelae, describes a method of strategic implantation of bone grafts to the orbit (and malar bone), and reports the long-term (six months to eight years) results in 38 cases. As a result of bone grafting, all but two patients had a correction of the enophthalmos to within 1 to 2 mm of the opposite eye. Of the 20 patients with diplopia, 15 had correction, and an additional four had an improvement of diplopia so it occurred in only one field of gaze. Of the 22 patients with grafts to the malar bone, 16 were thought to have good to excellent results; however, six developed some degree of reabsorption at the graft site. No patients had any decrease in vision. The advantages and disadvantages of the surgical procedure are described and compared with other methods.

    Title Self-inflicted Shotgun Wounds of the Face: Surgical and Psychiatric Considerations.
    Date October 1988
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    This study reviews the evaluation and treatment of patients with extensive self-inflicted shotgun wounds to the face. Five cases are presented and assessed with regard to reason for suicide, psychological reaction to facial reconstruction, and the potential for social rehabilitation. Mechanisms of injury, acute management, and definitive surgical and psychiatric treatment programs are discussed. Survival is expected for most patients, and carefully planned surgical reconstruction must be coordinated with skilled psychiatric intervention.

    Title Orbital Wall and Volume Relationships.
    Date July 1988
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Assuming that intraorbital volume is a space defined by the orbital walls, and that intraorbital contents represent a space occupied by soft tissues, changes between volume and contents will result in movement of the globe in usually a forward (exophthalmic) or backward (enophthalmic) direction. An understanding of the phenomenon is important if the clinician is to judge the effects of traumatic displacement of an orbital wall on globe positions and if the clinician is to design a reconstructive procedure to correct these changes. To study such relationships, we have designed physical models based on measurements of five dry human skulls. With these models, it has been possible to move a whole wall or part of a wall and, thereby, adjust the orbital volume. The experimental manipulations are useful in predicting the relationship of the orbital wall position and volume-information that can be ultimately used for diagnosis and reconstructive purposes.

    Title Temporalis Muscle-galea Flap in Craniofacial Reconstruction.
    Date December 1987
    Journal The Laryngoscope
    Excerpt

    With the advent of increasing technological and surgical sophistication in craniofacial surgery, reconstructive efforts are challenged to provide a reliable means of compartmentalization. When dural integrity is compromised in the face of nasopharyngeal or paranasal communication, the risk of ascending infection and potential life-threatening meningitis mandate cranial and facial compartments, separated by sufficient and healthy soft tissues. This paper describes a method of providing pedicled soft tissue coverage and support for the contents of the anterior cranial fossa using a temporalis muscle-galea rotation flap. The vascularized myofascial tissues, capable of carrying skin and bone grafts, are well suited to cover and protect large areas of the skull base. Several cases are described to show the advantages and disadvantages of the technique.

    Title Surgery of Massive Fibrous Dysplasia and Osteoma of the Midface.
    Date November 1987
    Journal Head & Neck Surgery
    Excerpt

    Since most bony lesions of the midface will stop growing or regress, it is generally not appreciated when fibrous dysplasia and osteoma occasionally continue to grow, causing functional and cosmetic problems. To demonstrate the potential of the disease processes and management options available to the surgeon, a series of patients with massive fibrous dysplasia and osteoma of the midface is reviewed. Most of the patients show a facial deformity alone or in combination with telecanthus, epiphora, exophthalmos, or nasal obstruction. Several types of radical and conservative surgical procedures are described to remove or control the bony lesions, to restore facial contour, and to reconstruct the sinuses, nasal passageways, lacrimal collecting system, and medial wall of the orbit.

    Title Detection and Quantification of Laryngotracheopulmonary Aspiration with Scintigraphy.
    Date November 1987
    Journal The Laryngoscope
    Excerpt

    Aspiration is analyzed by a new scintigraphic technique and standard videofluoroscopy in 78 patients with head and neck pathology and neurologic disorders. When both methods are compared to clinical aspiration and a positive x-ray film of pneumonia, they appear to complement each other and provide a very accurate evaluation. Scintigraphy is a more sensitive method for detecting aspiration below the vocal cords and also provides for flow dynamics and a method of quantifying the amount of aspirated material. Videofluoroscopy shows more clearly the mechanism of the swallowing disorder and how the bolus enters the tracheobronchial tree. Studies in patients following head and neck surgery demonstrate a high incidence of dysphagia, aspiration, and pneumonia.

    Title Open Treatment of Condylar Fractures with Biphase Technique.
    Date April 1987
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    Most fractures of the condyle of the mandible are managed by closed reduction techniques. Commonly used methods include intermaxillary fixation with a natural dentition or with dentures or splints. Fixation for a variable period of time provides for union of the fragments. In patients in whom the condyle is badly displaced and/or the adjoining mandibular segment is unstable, open techniques are often applied. This article discusses the indications for surgery and presents a method of reducing and maintaining fixation with an external device. Although the approach requires a major surgical procedure and can potentially cause injury to the facial nerve, there is a decided advantage in the direct visualization of the reduction and immobilization of the fracture. Several cases are presented to demonstrate the method and result.

    Title Fractures of the Sphenoid Bone.
    Date August 1986
    Journal Head & Neck Surgery
    Excerpt

    Fractures of the sphenoid bone occur following injury to the orbit and base of the skull. Such fractures are important since they can cause loss of vision and damage to various neural and muscular tissues. Ocular injury is also commonly associated. This paper reviews the hospital records of 112 consecutive patients with fractures of the base of the skull for the cause, frequency of signs and symptoms, and treatment of the sphenoid bone injury. Various deformities and dysfunctions are correlated with imaging data and classified to describe specific clinical syndromes. Several cases of sphenoid bone fracture serve as examples of diagnostic and treatment techniques.

    Title Restoration of Vision After Optic Canal Decompression.
    Date July 1986
    Journal Archives of Ophthalmology
    Title Posttraumatic Enophthalmos and Diplopia.
    Date March 1986
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Excerpt

    Malposition of the globe and failure to fuse visual images are late-developing complications of orbital injury. This article reviews the causes of specific sequelae, such as enophthalmos, hypophthalmos, and diplopia, and describes a procedure of strategic implantation of autogenous bone grafts to correct the condition(s). Using quantifiable methods of assessing globe position and motility, the authors demonstrate improvement in 18 of 19 patients. Vision is reported unchanged or improved in 13 sighted patients. Several cases are presented with analyses of preoperative and postoperative photographs. Indications, contraindications, advantages, and disadvantages of the surgical procedure are described and compared to others.

    Title Temporalis Muscle-galea Flap in Facial Reanimation.
    Date April 1985
    Journal Archives of Otolaryngology (chicago, Ill. : 1960)
    Excerpt

    When substantial destruction of the facial nerve occurs as a result of trauma, measures to animate the face, such as transfer of masticatory muscles, must be considered. Unfortunately, these techniques have been limited by a difficult reeducation process for the patient and failure of these muscles to reach sufficiently large areas. A method of extending the temporalis muscle with galea allows rotation into important areas of the face. Case presentations illustrate specific indications, advantages, and disadvantages of this technique.

    Title Malar Fractures Associated with Exophthalmos.
    Date April 1985
    Journal Archives of Otolaryngology (chicago, Ill. : 1960)
    Excerpt

    Although fracture of the malar bone is often associated with enlargement of the orbit and subsequent development of enophthalmos, occasionally, a blowin type of orbital floor fracture and exophthalmos occurs. The causes of the injury and the differential diagnosis of the blowin fracture are reviewed. An explanation is offered for the development of the symptoms. Early recognition, open reduction and fixation of the malar bone, and repair of the floor of the orbit defect are important for successful management of the injury.

    Title Hazards Encountered in Management of Basal Cell Carcinomas of the Midface.
    Date April 1984
    Journal The Laryngoscope
    Excerpt

    Basal cell carcinomas often exhibit aggressive and destructive behavior on the midface, with invasion into the orbit, paranasal sinuses, and even the frontal fossa. Minor modifications in surgical procedures for cosmetic considerations may have devastating consequences on the patient's survival. Tumor extirpation should not be compromised by preoperative planning of the method of reconstruction to be used. Margin control intraoperatively with either conventional frozen sections or the fresh tissue Mohs technique is mandatory for success. If any margin is questionable, reconstruction should be delayed at least until permanent sections confirm complete tumor removal. Ten cases are presented and the literature reviewed to emphasize that inadequate initial management probably contributes more to the observed destructiveness of these lesions than histologic aggressiveness or embryologic patterns of the midface.

    Title Nonunion of the Mandible.
    Date December 1983
    Journal Otolaryngologic Clinics of North America
    Title Reconstruction of the Orbit Following Trauma.
    Date December 1983
    Journal Otolaryngologic Clinics of North America
    Title Evaluation and Correction of Combined Orbital Trauma Syndrome.
    Date August 1983
    Journal The Laryngoscope
    Excerpt

    Injuries to the inferior and lateral orbital walls are traditionally classified as either "blow-out" or trimalar fractures. This simplified system has helped considerably in the understanding of the causes of the two types of injury and methods of repair. Unfortunately, simultaneous occurrence can cause immediate and delayed problems that potentiate each other. Enophthalmos and globe ptosis, in combination with a depressed malar eminence, present a major challenge to the reconstructive surgeon's efforts to achieve satisfactory function and appearance. This paper reports the results of combined orbital floor and lateral wall injuries as an important clinical trauma syndrome. The interaction of the two fractures with regard to pathophysiology, sequelae, and methods of correction will be discussed. A review of cases will be used to describe the authors' techniques of repair, and to illustrate the preferred methods of bone grafting for correction of retrusion and depression of the globe, muscle entrapment and depression of the malar eminence.

    Title Exercise and Recovery from Vestibular Injury.
    Date March 1983
    Journal American Journal of Otolaryngology
    Excerpt

    Exercise after vestibular injury is potentially an important modality in the recovery process. In this study, the effects of injury on the vestibular system were examined experimentally in cats. Data from healthy normal cats, labyrinthectomized cats, and labyrinthectomized cats treated with exercise were examined. Evaluation of performance was accomplished with caloric, optokinetic, and sinusoidal acceleration testing. Results in normal cats indicated stable, symmetrical vestibular responses on repetitive testing, without evidence for habituation. Comparison of the experimental groups showed that the animals treated with exercise had a significant difference in terms of recovery. The exercised group demonstrated a diminished directional preponderance, a shorter period of complete asymmetry, and a shorter recovery time, which was 58 to 70 per cent faster than that of the non-exercised group. The authors conclude that a general type of exercise will markedly affect and shorten the recovery pattern in the labyrinthectomized cat.

    Title Repair of Orbital Blowout Fractures with Marlex Mesh and Gelfilm.
    Date January 1982
    Journal The Laryngoscope
    Excerpt

    Thirty patients with surgically treated blowout fractures are reviewed. Of these, 3 had Caldwell-Luc procedures with antral packing, 23 had allograft implantation over the orbital floor fracture, and 4 required neither implantation nor antral packing. In 11 patients, with extensive defects, Marlex mesh was employed as the only support. Gelfilm implants were placed in 7 patients with relatively smaller defects. Three patients had Selastic implants and 2 had Mersilene allografts. There were no major complications in any of the 30 patients in the series, and overall results with allograft implants were satisfactory. Properties of the various allografts and indications for their use are discussed.

    Title Sinusoidal Harmonic Acceleration.
    Date November 1981
    Journal The Annals of Otology, Rhinology & Laryngology. Supplement
    Excerpt

    The need for accurate and reliable diagnostic tests for the evaluation of vestibular function has stimulated investigation of rotational methods and more recently, an evaluation of harmonic angular acceleration. Initial studies, using these techniques in humans, demonstrated a linear input-output function from 0.24 to 0.04 cycles/s at 0.4 radians/s2, but a reduction in the increase of response with an increase of acceleration or a decrease of frequency from this range. Nystagmic responses were symmetrical in these same normal individuals. In patients with vestibular disease, input-output functions, as well as symmetry, were altered, and appeared related to the degree of pathology. Evaluation of the test system in animals, rendered ototoxic with streptomycin, showed a depression in response similar to caloric tests. All data suggested that harmonic angular acceleration provided a reliable and sensitive method for evaluation of vestibular function, and a useful and important confirmation to the other methods that are available for these evaluations.

    Title Surgical Correction of Goldenhar's Syndrome.
    Date September 1980
    Journal The Laryngoscope
    Excerpt

    Goldenhar's syndrome is a variant of hemifacial microsomia - one of the more common congenital syndromes of the first and second arch. The Goldenhar's type is characterized by varying degrees of underdevelopment of craniofacial structures. The major deformities involve the mandible and the ear; but they also include the orbit and vertebral column, specific defects pathognomonic of this condition. Medical management requires reconstructive surgery of which treatment must take into consideration the timing of surgery and the effects of surgery upon the growth and development of the poorly formed structures. This paper presents a discussion of the pathogenesis and the favorable and unfavorable factors affecting the selection and timing of surgery. The literature is reviewed and two additional cases are added with an evaluation of the effects of early reconstruction. A single-stage procedure, utilizing rib autograft, is described for correction of the defective hemimandible, glenoid fossa, and zygoma. The results are evaluated by means of photographs and radiographs with a follow-up period of at least one and one-half years. The data suggest a remodeling of the grafts to resemble normal structures, and a downward growth of the maxilla to fill a space created by the reconstruction of the mandible and expansion of the lower portion of the face. Multiple stages of surgery as well as unnecessary delays in performing surgical procedures are challenged by the report.

    Title Temporal Artery-based Forehead Flap.
    Date December 1979
    Journal Head & Neck Surgery
    Excerpt

    The historical development of the forehead flap is reviewed, and an operative experience using delayed and nondelayed techniques in 30 cases is described. The reliability of the forehead flap is evaluated with regard to patient morbidity and correction of deformity and dysfunction in such sites as the cheek, lip, corner of the mouth, floor of the mouth, tongue, pharyngeal wall, and tonsil. Analyses include length of hospital stay and complications, as well as the relationship of these factors to the methods employed in the reconstructive processes. The advantages and disadvantages of the various techniques are illustrated using individual cases.

    Title Surgical Correction of Maxillary Hypoplasia.
    Date August 1979
    Journal Archives of Otolaryngology (chicago, Ill. : 1960)
    Excerpt

    In this report the pathophysiology of maxillary hypoplasia is reviewed, and two patients who underwent surgical treatment described. Included in the analyses are illustrations and photographs of the face, cephalometric measurements, predictive tracings, and model surgery. Corrective surgical techniques, consisting primarily of LeForte III osteotomies, are presented in detail. Segmental osteotomy of the lower jaw, sliding genioplasty, and augmentation rhinoplasty are discussed and shown as various adjunctive procedures in the correction of associated deformities. Postoperative tracings and photographs are used to illustrate the predictive changes and improved cosmetic and functional results.

    Title Head and Neck Manifestations of Maffucci's Syndrome.
    Date August 1979
    Journal Archives of Otolaryngology (chicago, Ill. : 1960)
    Excerpt

    Maffucci's syndrome consists of multiple cutaneous hemangiomas, dyschondroplasia, and often enchondroma. Once considered as a rare disorder, the syndrome has been frequently recognized and reported in the last 20 years. We report a case of multiple neoplasms of the head and neck and review the literature with regard to those manifestations of Maffucci's syndrome in the head and neck area. We also discuss treatment and the potential for malignant change.

    Title Posttraumatic Pseudohypertelorism. (telecanthus).
    Date March 1979
    Journal Archives of Otolaryngology (chicago, Ill. : 1960)
    Excerpt

    Telecanthus was evaluated in a large series of patients with midfacial trauma. Nine patients were selected for detailed analysis of cause, degree of injury, and results of surgical treatment. The evaluation suggests that fractures causing the medial canthal injury are extensive, often resulting in ocular and CNS damage. Late repairs are plagued with difficulty in identification of the ligament and mobilization of soft tissues in the medial canthal area. Satisfactory function and appearance can usually be obtained by early exploration of the injury, reduction of bone fragments, and restoration of the medial canthal ligament to its normal position.

    Title Combined Flap-wire Reconstruction of the Oral Cavity.
    Date July 1978
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    The concept of immediate reconstruction for head and neck defects following tumor resection provides the impetus for the development of new reconstructive techniques. In this article, the authors describe the evolution of local and regional flaps and the more recent use of composite tissues. The application of a combined forehead-deltopectoral flap and Kirschner wire for the reconstruction of a large defect involving the oral cavity, mandible and facial-cervical skin is presented in a case report and evaluated as to its efficacy in the treatment of head and neck cancer.

    Title Comparison of Caloric and Sinusoidal Tests in the Vestibulotoxic Cat.
    Date January 1978
    Journal The Laryngoscope
    Excerpt

    In order to evaluate the relative sensitivity of caloric and sinusoidal angular acceleration tests, thermal and rotational stimuli were administered to cats rendered vestibulotoxic with streptomycin sulfate. Three groups of six cats each, receiving daily subcutaneous injections of saline, 100 mg/kg streptomycin or 200 mg/kg streptomycin, were administered optokinetic, caloric and sinusoidal stimuli. Vestibular responses were evaluated by changes in the total slow phase displacement of the eyes and frequency of nystagmic beats. The results demonstrated that the saline treated animals had a decrease in response consistent with habituation; whereas, experimental animals showed a marked, rapid abolition of eye movement. The decrease in response was greater for the larger dose of streptomycin. Caloric or sinusoidal acceleration tests were equally sensitive in monitoring the degree of nystagmic depression. The data suggested that sinusoidal acceleration tests could be easily applied to the clinical vestibular assessment of ototoxicity.

    Title Vestibulotoxicity of Ethacrynic Acid.
    Date December 1977
    Journal The Laryngoscope
    Title Tympanostomy Tube Protection with Ear Plugs.
    Date August 1977
    Journal Archives of Otolaryngology (chicago, Ill. : 1960)
    Excerpt

    Protection by ear plugs from water-borne infection was evaluated in 35 patients with "tympanostomy" tubes, tympanic membrane perforations, or mastoid bowls. Stock and custom-made ear plugs were found to be equally effective up to four months during a period of frequent swimming and bathing activities. Infections were only noted to occur in those patients who did not follow instructions on appropriate use of the plugs.

    Title Ototoxic Interactions of Ethacrynic Acid and Streptomycin.
    Date May 1977
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    Various aminoglycoside antibiotics and potent diuretics are known to depress cochlear and vestibular function. Several clinical and research studies suggest that the drugs administered together produce enhanced ototoxicity. The present series of experiments determines the depressive effects of ethacrynic acid and streptomycin, alone or in combination, upon the vestibular system of the cat. The changes in function, when quantified, indicate an addition, rather than a potentiation of toxicity, and suggest different sites of action.

    Title Diagnosis in Persistent Cerebrospinal Fluid Fistulas.
    Date February 1977
    Journal The Laryngoscope
    Excerpt

    Cerebrospinal fluid (CSF) rhinorrhea and otorrhea have presented difficult problems in both diagnosis and management; moreover, the threat of impending meningitis necessitates early localization of the source of the leak. The most common techniques for evaluation and isolation of CSF rhinorrhea and otorrhea have included X-ray studies, intrathecal dyes, and radioactive cisternography...

    Title Effects of Hemodialysis on Hearing Threshold.
    Date September 1976
    Journal Orl; Journal for Oto-rhino-laryngology and Its Related Specialties
    Excerpt

    71 chronic renal failure patients undergoing long-term hemodialysis were evaluated for the effects of a dialysis event on hearing function. Osmotically active serum constituents were examined for relationship to fluctuating hearing threshold levels. Reliabiliity of hearing levels was found to be better in those patients tested without an intervening dialysis event. Those patients tested before and after hemodialysis demonstrated greater hearing fluctuation than those patients evaluated between dialysis events. This threshold fluctuation was unrelated to serum urea nitrogen, creatinine, K+, Na+, Ca++, or glucose. It was concluded that hearing test reliability in dialyzing renal patients is resonably good, but test results are likely to be more consistent if testing is accomplished a number of hour after a given dialysis event. Contrary to a number of reports in the recent literature, no direct relationship between hearing level fluctuation and fluctuation in individual osmotically active serum constituents appeared to be present.

    Title Nonunion of the Mandible.
    Date August 1976
    Journal The Laryngoscope
    Excerpt

    Nonunion of the mandible was evaluated over a five-year period (1968-1973). Fourteen cases were noted out of 577 mandibular fractures for an incidence of 2.4 percent. Causes of the complications were determined by a careful review of the poorly healing and successfully treated cases of mandibular fracture. The most important feature in nonunion cases was the large proportion of edentulous patients. In these cases immobilization appeared difficult, especially when only one form of fixation was used to stabilize the fracture. Other suspected causes of nonunion were postoperative trauma and osteomyelitis. These factors were most prevalent in the lower socio-economic groups. Factors which did not appear important were sex, age and cause of the fracture. Analysis of the site of injury, combinations of sites, timing of treatment, periosteal stripping and general health of the patient failed to demonstrate any predisposition to the complication. Treatment of nonunion was confined to standard techniques of debridement, antibiotic therapy and further immobilization. Although most patients responded to this therapy, six patients required closure of the deficit by bone grafting. On the basis of accumulated data, it was possible to clarify the factors in the development of nonunion. It was also possible to recommend methods of prevention of the complication and to substantiate the success of several forms of therapy.

    Title Complications in the Treatment of Facial Fractures.
    Date August 1976
    Journal Otolaryngologic Clinics of North America
    Excerpt

    The evaluation and treatment of the more common and severe complications of facial fractures are reviewed. This analysis includes such conditions as nonunion and malunion of the maxilla, mandible, and zygoma, temporomandibular ankylosis, diplopia, enophthalmos, hypertelorism, dacrocystitis, and cerebrospinal otorhinorrhea. The discussion attempts to stress the importance of diagnosis regarding cosmesis and functional abnormalities. When possible, the pathophysiology is elucidated and evaluated to decide about methods of prevention. Preferred traditional and improved techniques of management are noted and compared to some of the less satisfactory procedures.

    Title Hearing Function and Chronic Renal Failure.
    Date May 1976
    Journal The Annals of Otology, Rhinology, and Laryngology
    Excerpt

    In order to evaluate the degree and type of hearing loss in patients with chronic renal failure, 61 patients undergoing chronic hemodialysis were examined. Hearing threshold levels, adjusted for age and sex, demonstrated a significant high frequency deficit, which in some patients was noted early in the course of hemodialysis. Fluctuations in hearing were noted over single dialysis events but were transient and apparently independent of corresponding changes in Na, K, Ca, BUN, creatinine, glucose, mean blood pressure, and weight. Preliminary attempts to evaluate hyperlipidemia as a possible cause of hearing loss did not reveal any hearing deficit or gain as related to triglyceride or cholesterol levels. The data suggested other possible causes of observed auditory loss.

    Title Organizations in Otoryngology: How They Affect the Young Otolaryngologist.
    Date July 1975
    Journal Transactions. Section on Otolaryngology. American Academy of Ophthalmology and Otolaryngology
    Title Practice Restrictions on Young Otolaryngologist: Results of a Survey.
    Date July 1975
    Journal Transactions. Section on Otolaryngology. American Academy of Ophthalmology and Otolaryngology
    Title Ethacrynic Acid, Furosemide, and Vestibular Caloric Responses.
    Date May 1974
    Journal The Annals of Otology, Rhinology, and Laryngology
    Title Scar Revision.
    Date May 1974
    Journal Minnesota Medicine
    Title Testing of the Vestibular System.
    Date October 1973
    Journal Aerospace Medicine
    Title Averaged Evoked Auditory Responses in the Chronically Implanted Cat.
    Date August 1973
    Journal The Laryngoscope
    Title Ototoxic Effects of Ethacrynic Acid.
    Date January 1973
    Journal The Annals of Otology, Rhinology, and Laryngology
    Title Variable Slope Plotter of Nystagmic Velocity.
    Date January 1973
    Journal Archives of Otolaryngology (chicago, Ill. : 1960)
    Title Testing of the Vestibular System by Sinusoidal Angular Acceleration.
    Date November 1972
    Journal Acta Oto-laryngologica
    Title Croup and Laryngeal Inflammation.
    Date September 1972
    Journal Postgraduate Medicine
    Title Practical Otolaryngology.
    Date September 1972
    Journal Postgraduate Medicine
    Title Temporal Bone Preparation by Intralabyrinthine Perfusion.
    Date August 1971
    Journal Archives of Otolaryngology (chicago, Ill. : 1960)
    Title Delayed Massive Hemorrhage Following Tracheostomy.
    Date August 1971
    Journal The Laryngoscope
    Title Prolapse of the Ventricle.
    Date November 1970
    Journal The Annals of Otology, Rhinology, and Laryngology
    Title Ototoxicity of New and Potent Diuretics. A Preliminary Study.
    Date August 1970
    Journal Archives of Otolaryngology (chicago, Ill. : 1960)
    Title Electrodiagnosis in Facial Palsy.
    Date April 1970
    Journal Southern Medical Journal
    Title Ototoxicity of Ethacrynic Acid and Aminoglycoside Antibiotics in Uremia.
    Date June 1969
    Journal The New England Journal of Medicine
    Title Functional Outcomes of the Retromaxillary-infratemporal Fossa Dissection for Advanced Head and Neck/skull Base Lesions.
    Date
    Journal Skull Base Surgery
    Excerpt

    The retromaxillary-infratemporal fossa (RM-ITF) dissection, using a preauricular incision, was initially popularized for the treatment of temporomandibular joint disorders, facial fractures, and orbital tumors. This approach has been expanded for the treatment of advanced head and neck and skull base tumors extending into the infratemporal fossa. We studied prospectively eight consecutive patients requiring a RM-ITF dissection. Pre- and postoperative functional outcomes measured were mastication, speech, swallowing, cranial nerve function, pain, and cosmesis. A significant reduction in pain was noted postoperatively in all patients studied. Limited changes were identified in mastication, speech, swallowing, vision, hearing, or cosmesis postoperatively. The RM-ITF dissection should be considered when resecting advanced head and neck/skull base lesions that extend into this region. We have found minimal morbidity associated with this dissection. This procedure may have a useful place in palliation of patients with incurable pain caused by tumor invasion into the infratemporal fossa.

    Title Craniocervical Necrotizing Fasciitis with and Without Thoracic Extension: Management Strategies and Outcome.
    Date
    Journal American Journal of Otolaryngology
    Excerpt

    OBJECTIVE: First objective was to review cases of craniocervical necrotizing fasciitis (CCNF) at Wayne State University/Detroit Medical Center (Detroit, MI) for the last 18 years. Second was to analyze patients with and without thoracic extension for contributing factors. METHODS: Retrospective review of 660 patients with necrotizing fasciitis treated at WSU/DMC from January 1989 to January 2007 was conducted. Data regarding source/extent of infection, presenting signs/symptoms, computed tomography, microbiology, antibiotics, comorbidities, number/type of operations, hyperbaric oxygen (HBO) therapy, hospital duration, complications, and overall outcome were compared/analyzed between patients with and without thoracic extension. RESULTS: Twenty patients with CCNF for the past 18 years met the inclusion criteria. Ten patients had thoracic extension, and 10 patients did not have. Individuals in the thoracic extension group were likely to be older, had increased comorbidity, required more surgical debridement, experienced increased postoperative complications, and had lower overall survival. Three patients with thoracic extension underwent HBO therapy and 66% survived. CONCLUSION: This is the largest single institutional review of CCNF comparing patients with and without thoracic extension. Patients with thoracic extension have a poorer outcome as follows: 60% (6/10) survival vs 100% (10/10) for those without thoracic extension (P < .05). The CCNF patients without thoracic extension treated at our institution all survived after prompt medical and surgical intervention. Overall survival of CCNF patients without thoracic extension may be attributed to rigorous wound care, broad spectrum intravenous antibiotics, aggressive surgical debridement, and vigilant care in surgical intensive care unit. The HBO therapy should be included if the patient can tolerate it.


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