Transverse palatopharyngoplasty

A statico-dynamic transverse pharyngopalatoplasty using the technique of superior constrictor pharynges transplant is described Two active (dynamic) nasopharyngeal sphincters are constructed, one on either side, in the pharyngeal lumen. This is a very simple and easy operation. The improvement in speech following this operation is good and the nasal breathing is not impeded. This operation cannot be done if the palate is very short which would require lengthening before undertaking this operation. This is a preliminary report of the operation. One requires to perform a good number of cases before it can be standardised.     

Cochlear Implantation after Bilateral Transverse Temporal Bone Fractures

Patients deafened by a severe head injury are rarely encountered. We report a case of a 65-yr-old man with bilateral transverse temporal bone fractures due to head injury. He underwent cochlear implant and achieved a satisfactory auditory rehabilitation. Imaging studies of temporal bone before performing a cochlear implantation provide important information on a patient with bilateral temporal bone fractures. Cochlear implantations with careful planning in such a patient may be a very effective method for aural rehabilitation.     

Transverse/Sigmoid Sinus Dural Arteriovenous Fistulas Presenting As Pulsatile Tinnitus

Objective/Hypothesis: Transverse/sigmoid sinus dural arteriovenous fistula (TSDAVF) is a diagnostically elusive entity that is critical for the otologist to account for, when confronted by pulsatile tinnitus in the face of normal otoscopy. Left untreated, TSDAVF may result in catastrophic outcome. We have previously proposed a grading system specifically for TSDAVF based on venous restrictive disease. Our objective was to assess the validity of this grading system for clinical severity and therapeutic outcome. Methods: Through a retrospective review of 41 patients with TSDAVF, we evaluated clinical presentation, diagnostic evaluation, therapy, and outcome. Patients were classified into four grades based on the severity of venous restrictive disease as determined by superselective angiography. Our treatment algorithm combined compression therapy, transarterial embolization, and for more severe grades, surgery. Results: Pulsatile tinnitus was the chief complaint of all the patients in this series, and of 90% of all cases of TSDAVF treated at our institution. While angiography remains the gold standard, magnetic resonance imaging/magnetic resonance arteriography is far superior to computed tomography scanning in detecting dural arteriouvenous fistulas. As normal venous outflow gives way to aberrant cortical venous drainage in higher grades, there is a dramatically increased risk for adverse consequences with therapeutic intervention. Using our treatment algorithm, 82% of patients achieved clinical resolution of symptoms. Half of these patients had complete angiographic obliteration of their TSDAVF. Conclusions: The TSDAVF-specific grading system for the severity of venous restrictive disease is reflective of clinical presentation, fundamental in planning treatment, and predictive of therapeutic outcome.     

Transverse lag screw fixation in midline mandibulotomy. A case series

Vertical midline mandibulotomy has provided a relatively simple and efficient means of obtaining access to intraoral tumors that are too large or too posterior to be removed transorally. Midline mandibulotomy has had the advantage of nerve and muscle preservation and places the osteotomy outside the typical field of radiotherapy, in contrast to lateral and paramedian osteotomies. Plate and screw fixation has been the usual means of osteosynthesis for these mandibulotomies; however, plate contouring over the symphyseal surface has been a time-consuming process. Unless the plate was contoured exactly, mandibular malalignment and malocclusion in dentulous patients has occurred. Use of parallel transverse lag screws has become a popular method of osteosynthesis for parasymphyseal fractures, and we have extended their use for mandibulotomy fixation. This paper reports our clinical experience with transverse lag screw fixation of midline mandibulotomies in 9 patients from 1994 to 1997. There were 7 men and 2 women with a mean age of 56 (range 35 to 71 years). The pathological diagnosis in all patients was squamous cell carcinoma; 8 cases were primary, and 1 patient presented with recurrent tumor. No tumors involved the mandibular periosteum. One patient had had previous radiotherapy, and 3 patients underwent postoperative radiotherapy. The mean follow-up has been 17 months (range 9 to 27). There was 1 minor complication and 1 major complication related to our technique. The major complication was a delayed nonunion of the mandibulotomy. This occurred because the 2 parallel screws were placed too close to one another, and this placement resulted in a delayed sagittal fracture of the anterior cortex and subsequent nonunion. Transverse lag screw fixation has not affected occlusion in our dentulous patients. Speech and diet were normal in the majority of our patients. Transverse lag screw fixation of the midline mandibulotomy has been a relatively safe, rapid, and reliable method for tumor access and postextirpation mandibular stabilization and has significant advantages over other current methods of mandibulotomy and fixation.     

Transverse trachero-oesophagoplasty a new one-stage operation for construction of a 'Neo-Larynx'

A new one-stage operation of constructing a 'Neo-Larynx' after total laryngectomy, transverse tracheo-oesophagoplasty, for a good alaryngeal ('Tracheo-Oesophageal') speech is described. A 'Neo-Epiglottis' is constructed from the posterior tracheal wall and a 'Pseudo-Glottis' in the tracheo-oesophagenal partition wall with a valvular mechanism for preventing aspiration into the trachea during deglutition. No extraneous tissue is used for the construction of the 'Neo-Larynx' and no practice is necessary on the part of the patient for developing alaryngeal 'Tracheo-Oesophageal' speech. The patient can phonate immediately after removal of the feeding tube and the silastic sheet and is ready for discharge five weeks after operation. Adequate surgical ablation is ensured and at the same time good functional rehabilitation is offered without jeopardizing the principles of cancer surgery, i.e. to be on the overdoing side rather than on the underdoing one in a futile attempt at retaining the function.     

Transverse and lateral mobility in outer hair cell lateral wall membranes.

Cochlear outer hair cell (OHC) electromotility is associated with the cell's lateral wall. The lateral wall contains two distinct membranes: the plasma membrane (PM) and the subsurface cisternae (SSC). We explored biophysical characteristics of these lipid structures using membrane-specific fluorescent dyes. We have previously demonstrated that di-8-ANEPPS stains the PM while NBD-C6-ceramide partitions to the SSC. In this report we show that NBD-cholesterol also partitions to the SSC. Transmigration of the SSC dyes across the PM was visualized under confocal microscopy, after separating the two membranes using the micropipette aspiration technique. The transverse mobility of NBD-cholesterol was faster than that of NBD-C6-ceramide. We then measured the lateral mobility of the dyes within both the PM and the SSC using fluorescence recovery after photobleaching (FRAP). The diffusion coefficients at 12 37 degrees C and the activation energies for diffusion were found to be similar to those of other biological membranes. These data indicate that both the PM and the SSC are membranes in the fluid phase, with no evidence of temperature-dependent phase transitions. Our observations are consistent with a fluid-mosaic model of the lateral wall membranes.     

Objective Pulse-Synchronous "Essential" Tinnitus due to Narrowing of the Transverse Dural Venous Sinus

Subjective tinnitus is a common problem with many etiologies. Objective tinnitus, in which the sound is perceived by both the patient and the examiner, is less common. Objective tinnitus of the vascular type, in which a pulse synchronous bruit is heard by an independent observer, is frequently related to an underlying arterial or arteriovenous malformation, most commonly a dural arteriovenous fistula (DAVF) involving the transverse and sigmoid sinuses. The remaining cases are usually termed "essential" vascular tinnitus, and are presumed to have a venous etiology. In these cases, the audible noise is generally assumed to be produced within the sino-jugular connection, or within an enlarged jugular bulb. We present four documented cases of objective pulse synchronous tinnitus due to focal narrowing (acquired and developmental) of the mid-portion of the transverse dural sinus. In all cases, a bruit was audible directly over a focal constriction in the sinus, demonstrated by cerebral angiography or direct catheter venography. In one case, selective venography revealed a distensible sinus narrowing, associated with a jet of contrast marking fast flow within a developmental sinus segmentation. In another case, a loud pulse synchronous bruit was heard directly over a focal transverse sinus stenosis, which was detected by angiography at the site of a vascular surgical clip. In this case, magnetic resonance (MR) falsely predicted sinus occlusion. In two other cases, an audible bruit was also heard directly overlying a narrowed transverse sinus, seen in the venous phase of angiography. Transverse sinus stenosis is an unappreciated cause of objective pulsatile tinnitus, and we believe that this mechanism may underlie many cases of "essential" or venous etiology tinnitus not otherwise anatomically explained. Non-invasive testing, computed tomography (CT) and MR and non-directed angiography may overlook it. Conventional catheter arteriography or venography should be performed in such cases, with attention to the dural sinuses, if other tests fail to define the anatomic basis of the audible bruit.     

Aerodynamic and Acoustic Parameters in CO2 Laser Posterior Transverse Cordotomy for Bilateral Vocal Fold Paralysis

The aim of this prospective study was to analyse airway improvement and acoustic and aerodynamic parameters after CO₂ laser posterior transverse cordotomy (LPTC) in bilateral vocal fold paralysis (BVFP). Four patients (2 males, 2 females) were recorded pre- and post-operatively at 1, 3, 6, 12 and 24 months. Forced inspiratory volume during the first second (FIV), vital capacity, peakflow, and forced expiratory volume during the first second (FEV) were measured with the Gould II spirometer. Acoustic frequency features (average fundamental frequency, standard deviation, jitter, shimmer and harmonic-to-noise ratio) and speech duration parameters (maximum phonation time, number of words read per minute, and number of words per breath) were measured. Aerodynamic parameters were measured with the Aerophone II. Three tasks were completed. Pneumo-phonatory parameters in ?maximum sustained phonation? and in ?comfortable phonation?, and laryngeal aerodynamic parameters (intraoral air pressure, oral airflow and sound pressure level) were measured non-invasively. Glottal resistance and vocal efficiency were calculated. FIV increased significantly after LPTC (p=0.01). Postoperatively, frequency features were undetectable by standard commercialized algorithms. Acoustic and aerodynamic parameters improved in the measures obtained at the 6th postoperative month. These results were stable 2 years postoperatively in all cases. We conclude that laryngeal aerodynamic parameters can be used objectively to follow patients longitudinally after LPTC.