Form, function, growth, and craniofacial surgery

The introduction of craniofacial surgery in the early 1970's provided new treatment opportunities for patients previously ineligible for care and increased the number of patients presenting to multidisciplinary teams and private practitioners. Otolaryngologists together with other medical and paramedical professionals began to see patients whose overall phenotype was relatively unfamiliar. Complex craniofacial malformations raised questions concerned with the severity of the malformation process, the effect of growth, and the effect of surgery. For example, how does the anomalous craniofacial skeleton grow? Does the deformity become worse with time? Does it get better? Or does it stay the same? Additionally, how does surgery that is designed to restore form and function affect growth of the craniofacial complex? To answer these questions, this article examines the form, function, and pattern of craniofacial growth in four categories of malformations: cleft lip and palate, hemifacial microsomia, mandibulofacial dysostosis, and two of the craniofacial synostoses, the Apert and Crouzon syndromes. Each of these malformations is amenable to surgery. The timing and effect of surgery on growth are critical to successful habilitation and are discussed as part of the natural history of those anomalies.     

Evisceration, enucleation, and exenteration

The removal of the intraocular contents, the globe itself, or the entire orbital contents are three procedures that each present distinct pre- and postoperative problems. These procedures and the management challenges they present are discussed in this article.     

Office endoscopy--when, why, what, and how

Comprehensive diagnostic nasal endoscopy is a relatively recent advance in the office practice of rhinology. The examination is performed most commonly with 4.0-mm telescopes (0 and 30 degrees) and 2.7-mm telescopes (30 and 70 degrees). Nasal endoscopy provides the rhinologist with unparalleled visualization with brilliant illumination of the nasal cavity which permits more accurate diagnosis of nasal conditions. It also serves as an excellent teaching tool and source of photodocumentation.     

Allergy,immunology, psychosomatic,hypo- and hypertonus

Zusammenfassung Es wird der Einfluß seelischer oder psychischer Faktoren auf die Entstehung der Menièreschen Krankheit untersucht. Eine Wechselwirkung zwischen psychischen und physiologischen Faktoren wird angenommen.Die Konzentration von Immunglobulin E (IgE) erwies sich bei 28 Patienten mit fortgeschrittener Menièrescher Krankheit als normal. Die Blutanalysen von IgE Antikörpern (RAST) gegen 6 häufig vorkommende Allergene waren ebenfalls bei allen Patienten negativ. Die Ergebnisse zeigen, daß die akute Form der Überempfindlichkeitsreaktion in der Mehrzahl der Fälle ohne Bedeutung ist.Eine Hyperosmolarität wurde im Serum bei 34% der Patienten mit Menièrescher Krankheit festgestellt. Die Ursache der leicht erhöhten Serumosmolarität ließ sich noch nicht ermitteln. Sie mag der Ausdruck dafür sein, daß die Menièresche Krankheit ein Leiden ist, das den gesamten Organismus betrifft.

     

Somatization, paranoia, and language

Somatization and paranoia are circumscribed distortions of reality that are impervious to the normative process of consensual validation. These distortions are often postulated as a means of bolstering lowered self-esteem. We used computerized content analysis of the free speech of patients with these disorders in order to identify and compare dimensions of self-concept reflected in their lexical choices. Interestingly, patients with these disorders differed in the themes prominent in their speech. The higher frequency categories used by the somatization disorder group conveyed an overwhelming sense of negativism, distress, and a preoccupation with an uncertain self-identity. In contrast, the categories used by the paranoid patients portrayed an artificially positive, grandiose self-image and a defensive abstractness. Our exploratory analysis suggests that circumscribed distortions of reality in somatization and paranoid disorders are not associated with the same common defensive style attempting to bolster self-esteem.     

Nutrition, biochemistry, and tinnitus

Biochemical mechanisms are a significant factor in neurootological problems. Investigation of biochemical causes of neurootological problems, such as tinnitus, are warranted and can be cost-effective. Dietary, nutritional, chemical, hormonal, immunological, and stress factors are involved directly in neurootological problems and must be evaluated and considered in designing the treatment regimen for patients complaining of tinnitus.     

Correlation of clinical, radiologic, and histopathologic findings in laryngeal, hypopharyngeal, and oropharyngeal cancer

The correct staging of the tumors has important consequences in the planning of the treatment in the patients with cancer of larynx, hypopharynx and oropharynx. The objective of this paper is to study the correlation of the clinical, radiologic and pathologic staging with the purpose to evaluate if the computed tomography (CT) is effective in the diagnostic of the stage in the different tumoral findings. We did a retrospective study in 34 patients with pharynx and larynx cancer in the "Hospital Universitario Príncipe de Asturias" between the years 1994-1998. The method was: 1. Clinical history and ENT examination. 2. Head and neck CT. 3. Direct laryngoscopy and biopsy. 4. Surgical treatment and posterior pathologic staging of the removed specimen. The lesions were studied according the TNM-UICC classification with the T and N stage. The first thing to do was the clinical stage then the radiologic stage and at last compare it with the pathologic stage after surgical removal. The results are presented in percentages and confirm that the clinical and radiologic combined information improve the correlation between clinical and pathologic staging in the cancer of larynx, hypopharynx and oropharynx.     

Tinnitology, Tinnitogenesis, Nuclear Medicine, and Tinnitus Patients

Since the 1970s, clinical interest in otolaryngology and audiology for both diagnosis and treatment of the symptom of tinnitus has witnessed the evolution of a new discipline: tinnitology. Tinnitology is an integrated discipline of basic sciences, neuroscience, and clinical medicine for the understanding of aberrant auditory phenomena unrelated to an external source of sound. To patients with subjective idiopathic tinnitus, nuclear medicine techniques of positron emission tomography and single-photon emission computed tomography provide correlation of structure and function, which improves the accuracy of the tinnitus diagnosis. Additionally, they provide a monitoring system to establish the efficacy of modalities of therapy attempting to provide tinnitus relief. Further, they provide information of neuroreceptors and neurochemistry in brain underlying or accompanying basic mechanism for production of specific clinical types and subtypes of tinnitus. This study reports the application of nuclear medicine techniques for a new clinical neuropharmacology protocol for tinnitus treatment highlighted by intratympanic drug therapy in predominantly cochlear-type tinnitus. We further report a neuroprotective drug therapy to control tinnitogenesis, an auditory epileptiform phenomenon. Additionally, we report the hypothesis of a benzodiazepine deficiency syndrome.     

Pigmentation, anesthesia, behavioral factors, and salicylate uptake

In four experiments, 54 pigmented rats were used to examine the time course of sodium salicylate uptake in serum, cerebrospinal fluid, and perilymph. Subjects were tested under sodium pentobarbital anesthesia or while conscious. Compared with previously reported data from albino rats, pigmented subjects generally showed increased salicylate uptake. Moreover, the data suggested two different, time-dependent clearance mechanisms in conscious animals not observed in anesthetized rats. Daily injections of salicylate did not produce an accumulation of salicylate in serum. Systematically higher levels of salicylate were observed in perilymph compared with cerebrospinal fluid. Behavioral procedures, including water deprivation and conditioned suppression of ongoing drinking levels, had no effect on salicylate levels.     

Nasalance,nasality, voice,and articulation after uvulopalatopharyngoplasty

OBJECTIVES/HYPOTHESIS: The main purpose of the study was to determine the impact of uvulopalatopharyngoplasty (UPPP) on nasalance and nasality. It was hypothesized that nasalance would change from the presurgical to the postsurgical condition because the surgical protocol involves removal of palatal tissue. An additional objective of the study was to provide objective and subjective data about changes in voice and articulation after UPPP. Because the surgical procedure of UPPP does not involve laryngeal tissue, it was hypothesized that the voice characteristics remain relatively stable. Because of removal of effective velar length, articulation problems of the uvular /R/ can occur in the Dutch language. STUDY DESIGN: Prospective study in which 26 men were studied before (1 week before UPPP) and after (3 weeks after UPPP) surgery. METHODS: The Nasometer was used to obtain nasalance scores. The mirror-fogging test, a perceptual evaluation of each subject's readings, and the Gutzmann and the Bzoch hypernasality tests were used for the assessment of nasality. For the assessment of articulation, a phonetic analysis was performed. Voice assessment included a perceptual rating of the voice and a determination of fundamental frequency. RESULTS: No significant differences were found between the conditions before and after surgery regarding nasalance (except for the vowel /i/), nasality, and voice. Regarding articulation, only 1 patient showed a derhotacized /R/. CONCLUSIONS: The findings of the study indicate that UPPP does not have an impact on nasality, voice, and articulation. Regarding nasalance, no significant nasalance change occurred after UPPP, except for the high vowel /i/.