[Incisionless otoplasty with conchal bowl recession]. / "Incisionless Otoplasty": Anlegen des Cavum conchae ohne Hautschnitt.

Conchal bowl recession often plays a significant part in the overall success of incisionless otoplasty. Performing the appropriate pinna surgery is dependent on recognizing both a patient's antihelical fold and the conchal bowl problems. If either problem is undertreated then there may be a less than ideal cosmetic outcome. For ideal outcomes, subtle conchal bowl problems must be recognized and treated for cosmesis and stability of the correction. This paper will review the most effective technique for performing incisionless conchal bowl recession.

Incisionless otoplasty.

Otoplasty is a continually evolving procedure that significantly and beneficially alters the patient's facial appearance. Multiple techniques have been and are currently in use. A new method for partial or total correction of the "lop" protuberant ear deformity is described, the basis for this technique being percutaneous placement of retention sutures. Percutaneous placement leads to an incisionless otoplasty technique. Depending on the ear deformity, the incisionless technique may be used alone or in conjunction with other methods.

The versatile cartilage autograft in reconstruction of the nose and face.

This paper deals with the long-term follow-up of cartilage autografts taken from various parts of the body to reconstruct areas of the nose, ear, trachea, eyelid, and other areas of the body which require augmentation, effacement, and long-term support. Our thesis will be that the cartilage autograft is the implant of choice in many of these areas, and that fate of autogenous cartilage is well known and should be given strong priority in facial grafting.

Association of human papillomavirus type 11 DNA with squamous cell carcinoma of the tongue.

A 47-year-old man with a history of a benign papilloma of the tongue 5 years earlier was treated for a squamous cell carcinoma of the tongue with surgical resection. An analysis of the tumor DNA using several methods showed the presence of human papillomavirus (HPV) type 11 sequences that migrated with the high molecular weight cellular DNA, suggesting integration of viral DNA into the cellular genome. A segment of the HPV DNA was cloned from the lesion and shown to be similar to prototype HPV 11 DNA, except for some variability in the viral long control region. The proviral DNA contained part of the L1 region, all of the viral long control region, the entire E6 and E7 open-reading frames, and at least a portion of the E1 region; the E4 region appeared to be deleted. The integration sites of the HPV DNA could not be specifically identified. An analysis of the p53 tumor suppressor gene region of the tumor DNA showed no evidence of mutation. These results suggest that the HPV 11 DNA may have had a role in the origin of the cancer in this patient.

Sigmoid sinus thrombosis diagnosis by contrasted MRI scanning.

Septic thrombosis of the transverse-sigmoid sinuses and the jugular bulb is a highly lethal condition. The presenting signs and symptoms of this disease entity are subtle and not in proportion to the magnitude of the problem. Later in the disease course, sudden fulminant findings appear. A high index of suspicion, combined with scanning techniques of either enhanced MRI or CT, allows prompt diagnosis and treatment. MRI enhanced with gadolinium-DTPA (Gd) is a valuable adjunct that confirms the diagnosis and delineates the extent of suspected pathology.

Objective tinnitus in children.

OBJECTIVE: To discuss the various symptoms and causes of objective tinnitus in children. STUDY DESIGN: Retrospective case review. PATIENTS: Five children who had audible signals emanating from their ears caused by audible spontaneous otoacoustic emissions, palatal myoclonus, arteriovenous malformation, and acoustic trauma. MAIN OUTCOME MEASURE: The tinnitus reported by the patients was linked to acoustic signals that could be measured objectively or heard by the examiner. RESULTS: Four of the five children had essentially normal hearing. The one child who demonstrated a hearing loss audiometrically was thought to have normal hearing sensitivity, but his intense roaring objective tinnitus appeared to mask his low-frequency thresholds. All five patients had measurable acoustic signals in the ear canal that matched the patients' descriptions of their tinnitus. CONCLUSION: The cases illustrate how the objective tinnitus was diagnosed and measured, how a treatment algorithm was applied, and the expected results of treatment. In addition, the cases provide support for the use of psychologic counseling throughout the examination and treatment of objective tinnitus in children.

Endolymphatic mastoid shunt surgery using the Denver inner ear shunt.

This study, merging data from two different clinics, was undertaken to evaluate the efficacy of endolymphatic mastoid shunt surgery using the Denver Inner Ear Shunt operation for Meniere's disease. This surgery was performed by the senior authors (C.G.J., J.R.E.D., and M.E.G.) between May 1984 and October 1986, after we attended the Colorado Otologic Research Center (CORC) instructional course. Sixty-six and thirty-four cases, respectively, were performed. Follow-up questionnaires were sent to this total of 100 patients. Fifty-six patients returned completed questionnaires, which formed the basis of this report. A retrospective chart study was also carried out. The results of surgery and questionnaires are reported as statistical data, and, where applicable, the 1985 AAO-HNS criteria for reporting vertigo and hearing results in the treatment of Meniere's disease are used. Preliminary analysis of these data is reported because of its profound effect upon our treatment protocol for patients with Meniere's disease. Results on use of the Denver valve do not appear to be significantly different than the results of other shunt surgery not using the valve.

Management of sword-swallower injuries.

OBJECTIVE: To report an unusual case of hypopharyngeal perforation in a sword-swallower, with emphasis on management options. METHOD: Case report and review of the English language literature concerning sword-swallowing injuries to the hypopharynx and oesophagus. RESULTS: A 29-year-old male sword-swallower suffered hypopharyngeal perforation during a performance. The patient received conservative management, with intensive care unit admission, infectious disease consultation, intravenous antibiotics, discontinuation of oral intake and close observation. He progressed well, resumed oral intake on hospital day six, and was discharged home on hospital day eight. CONCLUSION: Sword-swallowing is an unusual vocation which may lead to potentially devastating injuries. This case report and review of the literature illustrates the management options for such hypopharyngeal and oesophageal injuries.

Decibel levels during extracorporeal lithotripsy for salivary stones.

PURPOSE: To determine the decibel sound pressure levels generated during extracorporeal lithotripsy for salivary stones, and if such lithotriptor noise levels have the potential for acoustic trauma. PATIENTS AND MATERIALS: Minilith SL-1 salivary gland lithotriptor, sound level meter; five patient survey. METHODS: Decibel measurements were conducted on the lithotripter-generated sounds, using a sound level meter at specific distances from the active element. In addition, a patient survey was conducted as a cross-reference, to enable comparison of predicted results with actual human perception of sound levels. RESULTS: Sound levels ranged between 68 and 80 dB during treatment sessions, for both the lithotriptor operator and the patient. CONCLUSION: During routine use, no acoustic trauma is incurred by either the lithotriptor operator or the patient.

An assessment of the value of triple endoscopy in the evaluation of head and neck cancer patients.

The purpose of this study was to evaluate the role of triple endoscopy in the routine diagnostic evaluation of head and neck cancer patients to (1) ascertain the accuracy and safety of this approach in identifying multiple neoplasms and (2) determine if such an approach is justifiable rather than relying on radiographic examinations coupled with the routine head and neck exam including indirect laryngoscopy. In this series, the incidence of second malignancies was found to be 11.3%, consistent with other reports in the medical literature. There were no complications noted as a result of triple endoscopy. There were no instances where the second malignancy was not diagnosed prior to triple endoscopy with either the physical exam or routine roentgenograms. There were no incidences where the treatment program of the primary tumor was altered by the information obtained at triple endoscopy. The results of this single institutional study suggest that triple endoscopy need not be a routine component of the diagnostic evaluation of every patient with head and neck cancer. However, every patient should probably have a thorough physical examination coupled with chest and esophageal roentgenograms to search for a simultaneous secondary neoplasm.