Mandibular osteoradionecrosis: part I: severity factors

INTRODUCTION: The severe evolution for some patient presenting with osteoradionecrosis, even if classified in the same stages as other patients, suggests that there are aggravating factors. MATERIAL AND METHOD: A retrospective study was made between 1992 and 2002 on all patient operated for mandibular osteoradionecrosis. Fifty-nine patients were included and the mandibular defects were reconstructed with a bone or a composite free flap (fibula 21%, iliac crest 49%, scapula 6%, antebrachial 3%), and with a periosteal free flap (13%). RESULTS: The study included severe cases (87% of stage II or III) operated on several times without success. Free flap reconstruction was successful in 90% of the cases. However, complications were present in 60% of cases (24% minor complications, 48% major complications), and were more frequent with a higher stage. The analysis allowed identifying morbidity factors. DISCUSSION: Studying the morbidity allowed identifying severity factors of osteoradionecrosis; spontaneous onset, important irradiation (important dose, bone proximity of the tumor, bilateral damage), vascular damage (symphyseal localization, lack of sequestrum, facial artery ligature, active tobacco addiction), actinomycosis colonization, non-observance of medical treatment. Understanding aggravating factors should allow us to offer more efficient surgery on an early osteoradionecrosis stage, also decreasing the morbidity linked to reconstructive surgery.     

Tongue strength: Part I: Following total laryngectomy

Surgical repositioning of the genioglossus muscle, as in total laryngectomy, may have an adverse effect on the protrusive strength of the tongue. To test this premise, anterior and lateral tongue strength measures were obtaind from 10 laryngectomized and 15 normal subjects by means of a pressure transducer and recording device. The results indicated no significant difference between laryngectomized and normal subjects on tongue strength measures. Further, all laryngectomized subjects were judged to have good to excellent esophageal speech. It was concluded that laryngectomy does not adversely affect the major musculature concerned with protrusive tongue strength for proficient esophageal speakers.     

Tongue strength: Part II: In artificial alaryngeal speech

Tongue strength does not appear to be reduced in proficient esophageal speakers. However, no data exist on tongue strength for laryngectomized subjects who have not developed esophageal speech. Anterior and lateral tongue strength measures were obtained from 13 laryngectomized subjects who used an artificial larynx and 15 normal subjects by means of a pressure transducer and recording device. The results indicated that laryngectomized subjects had significantly weaker tongues in two of three directions measured. It was concluded that laryngectomy may affect tongue strength, but that the method of alaryngeal speech utilized postoperatively influences the return to normal.     

Tutorials in clinical research: part V: outcomes research

OBJECTIVES: This is the fifth in a series of sequential "Tutorials in Clinical Research." The objective of the present report is to give the reader a broad overview of the field of outcomes research. This summary is intended to enable the reader to understand outcomes research methodology and to start the design of an outcomes research study. STUDY DESIGN: Tutorial. METHODS: The authors developed the report from available materials and refined it to be concise but complete for use by the practicing clinician. RESULTS: We describe the basic steps of record-based and patient-based outcomes research, including development of a staging system, identification of comorbid conditions, and creation or identification of an outcomes instrument. CONCLUSION: Outcomes research is a unique methodology that uses patient-based outcomes to assess the effectiveness of medical treatment.     

速尿对诊断膜迷路积水的临床探讨

为研究速尿试验诊断膜迷路积水的可靠性，对膜迷路积水患者（实验组）及非膜迷路积水的眩晕患者（对照组）各５４例行速尿试验。静脉注射２０ｍｇ速尿，眼震电图（ＥＮＧ）记录用药前后眼震的变化，以用药后眼震最大慢相速度（ＭＳＶ）上升２２．９７％为阳性指标。两组阳性率分别为７０．４％及２５．９％。两组速尿试验阳性患者用药后优势偏向（ＤＰ）阳性率均明显降低，实验组降低率为７７．８％（２１／２７），其中９例降至正常，提示ＤＰ的变化亦有重要意义。全部受试者无１例听功能受损或原症状加重。速尿试验为诊断膜迷路积水的有价值的方法之一。     

Infrared laser tissue ablation: holmium:YAG laser surgery.

The in vivo tissue ablation characteristics of a pulsed holmium:YAG laser (lambda = 1,980 nm) were studied. The laser energy was coupled onto nylon fibers 400 and 600 microns in core diameter. Laser incisions were made on white rats at different sites of the tongue and of the mucous membranes of the oral cavity. Power settings of 500 and 1,000 mJ/2.5-ms pulse at 5 pulses/s were used and the tissue responses examined by light microscopy. Wound healing was studied over a 6-week period. The results of this study are promising for future application of the holmium:YAG laser in otorhinolaryngology.     

Erratum: HNO (2001) 49:602–617

Ohne Zusammenfassung     

Lingual thyroid: iodine 131: a viable treatment modality revisited

PURPOSE: Lingual thyroid has a reported incidence between 1:10 and 1:100,000. When symptomatic, patients may present with dysphagia, choking, and/or dyspnea. Current surgical treatment options range from tumor extirpation or transposition to excision and reimplantation. Tracheotomies are often performed postoperatively for reliable airway control. Iodine 131 (131I) has not been a popular modality of treatment for lingual thyroid because of theoretical fears of increased airway obstruction from thyroiditis. We believe that these fears were not substantiated, and that symptomatic patients needed a reliable, nonsurgical treatment option. Therefore, our goal was to further investigate the use of 131I for the treatment of symptomatic lingual thyroid. PATIENTS AND METHODS: A 6-year retrospective chart review was performed. From 1994 to 2000, 2 patients with symptomatic lingual thyroid presented to the Arkansas Cancer Research Center Head and Neck Oncology clinic, University of Arkansas for Medical Sciences, Little Rock, AR. Patients underwent pretreatment computed tomography, and iodine 123 scans. They then received 1 oral dose of 131I. Doses ranged from 30 to 85 mCi. Patients were then followed daily for signs of airway compromise. RESULTS: Complete resolution of symptoms was seen 2 months after treatment. Patients did not complain of any increased airway compromise during treatment initiation. Patients remain symptom-free and are maintained on thyroid hormone replacement. CONCLUSIONS: Iodine 131 ablation of lingual thyroid is a safe and effective treatment in symptomatic patients and should be included in the algorithm when formulating a treatment plan.