Leiomyosarcoma of the larynx. Case report.

Leiomyosarcoma involving the larynx is extremely rare and may be difficult to diagnose. Likewise, because of the rarity of this lesion, little information exists with regard to long-term follow-up or optimal management. Reported here is a review of the literature and a case report of a patient with leiomyosarcoma of the larynx treated by surgery alone with 5 years of follow-up.     

Intraoperative measurement of the elastic modulus of the vocal fold. Part 2. Preliminary results.

This paper presents initial clinical experience using a device capable of measuring the transverse elastic modulus of the vocal fold. These initial results indicated that the device may be useful in determining stiffness inequalities between the vocal folds.     

Intraoperative measurement of the elastic modulus of the vocal fold. Part 1. Device development.

Although the concept of manipulating laryngeal biomechanics to improve vocal function is not new, there has been a recent proliferation in surgical techniques used to affect laryngeal function. These include methods which increase the stiffness of the vocal folds, medialize the vocal folds, alter the pitch by changing the tension of the vocal folds, and augment the tissues using injection of alloplastic materials. Despite these new and possibly revolutionary methods, no means are presently available to surgeons to intraoperatively evaluate and optimize results of a surgical intervention. This study involved the development of a device to measure the in vivo elastic modulus of the vocal folds.     

Symposium: management of tumors of the parotid gland. III. Management of the facial nerve.

The facial nerve is protected in parotid surgery by finding the main trunk first and peripherally dissecting free the branches. The most constant landmark is the groove between the mastoid and the bony ear canal. Wide exposure of this groove should be obtained without "tunnelling." The thick (2-3 mm) white trunk is dissected forward using the electric stimulator before cutting parotid tissue. Nerve injury is more common in the peripheral branches. Nerve location in recurrent parotid tumors is more difficult. The main trunk may be found more posteriorly than in the previous surgery, but often peripheral branches must be identified crossing the masseter, facial vessels, or the parotid duct; retrograde dissection to the trunk follows. For proven invading malignancy, the trunk or branches may be sacrificed, but immediate grafting should be attempted usually with the greater auricular nerve.     

Symposium: Congenital anomalies of the middle ear. II. Vascular anomalies of the middle ear.

Of all the abnormal situations that one encounters in performing a tympanotomy, probably the last one to be thought of is vascular anomalies, and yet, potentially, this is one of the most hazardous of anomalous problems with which we have to deal. Most of the anomalies which have been reported concern the persistent stapedial artery. This artery arises from the stump of the second aortic arch (stapedio-hyoid artery), it traverses the developing stapes bone, leaving behind a monument to its existence - the obturator foramen of the stapes. The artery exits from the middle ear along the horizontal portion of the facial nerve, traversing this area for a variable distance and then usually divides into an intra-cranial branch and a sphenoidal branch. The stapedial artery in its development before its regression, gives rise to the anlage of many important cranial arteries. These vessels are usually anastomosed with and distributed by the branches of the internal maxillary artery and the ophthalmic artery. The hyoid artery is represented in the adult by the carotico tympanic artery. Anomalies involving the internal carotid artery are much more rare. The anomalies that have thus far been reported are: 1. Absence of the internal carotids. 2. Aneurysms. 3. Unusual courses. Venous anomalies are generally uncommon and are usually represented by an abnormally placed jugular bulb which can simulate a glomus jugulari tumor.     

Symposium: Congenital anomalies of the middle ear. III. Congenital anomalies of the middle ear.

Congenital anomalies of the middle ear have been considered rare. The tremendous volume of middle ear surgery performed during the last 15 years has brought attention to numerous anomalies of the facial nerve, ossicles, and middle ear cleft, suggesting that middle ear anomalies are not as rare as once believed. This paper discusses anomalies of the descending and horizontal facial nerve which have been previously reported. The literature of anomalies of the ossicles is reviewed. A very rare anomaly of the carotid artery presenting in the middle ear is described and its surgical treatment outlined. Two anomalies of the middle ear associated with other branchial arch anomalies are reported and their treatment results discussed.     

Alfred Gardiner Brown (1838-1882) M.R.C.S.Eng., F.R.C.S.(Ed.). His contribution to the history of the development of the tuning fork.

Alfred Gardiner Brown was the first designated Aural Surgeon to be appointed to the consultant staff of The London Hospital, at the age of 38. In July 1880 he published the paper showing his adaptation of the way in which the tuning fork was applied to the head and its use in measuring hearing power by comparing it with the sense of touch. Had he been blessed with a longer life it is highly probable that he would have made a significant contribution as he was of an innovative and inventive mind. He died at the age of 44.     

Rhabdomyoma of the larynx. Report of a case.

Review of the English literature shows six reported cases of "rhabdomyoma of the larynx." As far as we have been able to determine, only three cases of these have been undisputed rhabdomyoma. The case reported herein represents the first rhabdomyoma of the larynx that was removed under microsurgical conditions, and adds a fourth case to the literature.     

Septoplasty. Rational surgery of the nasal septum.

The Submucous Resection (S.M.R.) operation ascribed to Killian, still widely taught as the standard surgical treatment of obstructive septal deformities, has serious deficiencies in many common clinical situations. The reasons for this are critically discussed in the light of the surgical anatomy and physiology of the nose as a whole. The rational, conservative and versatile principle of septoplasty has evolved over half a century, until today the author considers that it should largely supersed the old S.M.R. The principles and the indications for septoplasty are discussed. The basic septoplasty procedure used by the author is described with practical details, together with all the variations and extensions possible as far as a complete septo-rhinoplasty. The importance is stressed of accurate assessment of the whole nasal problem and precise correction of all primary and secondary obstructive factors.     

Noise and the RNA synthesis of the cochlea. Autoradiographic studies.

In cochlear basal turns of 22 guinea pigs with autoradiography, grain density was measured after injection of 3H-cytidine. Following high initial nuclear labelling, a low incorporation in cytoplasm was observed, even after 24 hours. Synthesis of ribosomal RNA in the organ of Corti seems to be slow. Low grain densities in the whole cochlea presuppose a blood-lymph barrier to cytidine. After white noise (85 dB SPL, 12 hours) were seen a more rapid incorporation into nuclei and after 24 hours an increased labelling of cytoplasm of ganglion cells, fibrocytes and inner hair cells, less of outer hair cells. This might be induced by increased blood flow, concentration of the precursor in the lymphs, cell permeability of alterations of the cellular nucleotide pool. But a real stimulation of cochlear RNA synthesis seems to be the most likely. On comparing different turns, a peak in grain density was found over nuclei of the organ of Corti after 1 hour in the 2nd turn. After 24 hours, cytoplasmic labelling showed a decrease only in outer hair cells towards apical turns.