Histologic findings of silastic medialization in the canine model.

OBJECTIVES: Examine the long-term histological effects of Silastic medialization using a canine model. STUDY DESIGN: Prospective study evaluating the effects of Silastic medialization in six canine larynges. METHODS: Two subject groups were evaluated. The first group of four dogs underwent recurrent laryngeal section followed by Silastic medialization on the paralyzed side and placement of a smaller implant on the mobile side. Two of the dogs were sacrificed at 9 months and two at 2 years. The second subject group consisted of two additional dogs who underwent Silastic medialization followed by removal of the implants at 7 months and were sacrificed 18 months later. The larynges were then processed, sectioned in the axial plane, and examined microscopically. RESULTS: Histological findings of both the mobile and paralyzed sides showed a thin (< 0.5 mm) fibrous capsule surrounding the implant and minimal inflammatory response. Vocal fold mobility was maintained in all cases in which the recurrent laryngeal nerve was left intact. Capsule formation and inflammatory response were similar in all cases. CONCLUSIONS: Minimal tissue reactivity over a prolonged period of time suggests that long-term results of Silastic medialization remain stable in paralyzed and mobile vocal folds for up to 2 years. Similar tissue response in the subjects in which the Silastic block was removed also suggests that Silastic medialization is a reversible procedure.

Pharyngeal fibrovascular polyp in a child.

Fibrovascular polyp of the upper aerodigestive tract is an uncommon tumor that may present in pediatric patients with symptoms ranging from dysphagia to asphyxiation and death. We present a unique case of a pediatric patient with an asymptomatic fibrovascular polyp noted as an incidental finding on a cervical ultrasound evaluation. This lesion extended from the posterior tonsillar pillar and prolapsed freely into the nasopharynx and esophagus. The literature relevant to this case is reviewed, and the etiology, pathophysiology, and management principles are discussed.

Isolated epithelial cysts of the uvula in children: a report of three cases.

Epidermoid cysts are unusual benign cysts that occur in the oral cavity less than 2% of the time. Epidermoid cysts isolated to the uvula are rare. A review of the literature has revealed only three confirmed cases of isolated uvular epidermoid cysts. We present a series of three such cases, two of which presented with significant symptomatology. The diagnosis and management of these unusual lesions will be discussed, as well as the differential diagnosis.

Nasal inverted papilloma with involvement of middle ear and mastoid.

Inverted papillomas of the paranasal sinuses have been characterized by their unusually benign histologic features, their ability to grow rapidly with bony destruction, and their tendency to recur if not adequately treated. The association of inverted papilloma with squamous cell carcinoma is well described, but malignant transformation is relatively rare. We report a case of a multiply recurrent inverted papilloma that spread to the middle ear and mastoid and eventually underwent malignant transformation with skull base invasion. Pathologic examination demonstrated many of the characteristics associated with malignant transformation. In addition, progesterone receptors were demonstrated that may have stimulated this tumor during the patient's pregnancy. To our knowledge, no similar cases have been reported in the literature.

Bilateral aberrant internal carotid artery case presentation.

Cases of aberrant internal carotid artery in the middle ear have been well documented. However, bilateral aberrant intratympanic carotid artery presentation, as in this case, is quite rare. In addition, in this case, there was unilateral duplication of the cervical and petrous portions of one internal carotid artery such that the duplicated portion rejoined the normal internal carotid artery in its petrous portion. The purpose of this article is to review the literature regarding aberrant internal carotid artery presentation in the middle ear and to discuss the related embryological and anatomical features as well as diagnosis of this lesion, using a unique case as an example.

The use of magnetic resonance imaging with high-resolution CT in the evaluation of facial paralysis.

Magnetic resonance imaging (MRI) has been widely used in the evaluation of suspected acoustic neuroma, but has not received the same attention with respect to facial paralysis. High-resolution computed tomography (HRCT) has been the radiologic test of choice to evaluate the facial nerve. The necessary HRCT projections, slices, and enhancement techniques to visualize each segment have been outlined. We have developed a radiologic protocol that uses MRI in conjunction with HRCT, applying the strengths of each to evaluate the facial nerve. We have evaluated 15 patients and have found that MRI is the better study to evaluate the brain stem/cerebellopontine angle segment of the facial nerve and better evaluates bone-soft tissue interfaces. HRCT is better in the evaluation of the intratemporal segment of the facial nerve and the assessment of the anatomic perspectives of a lesion within the temporal bone. The results are discussed and case reports illustrate the efficacy of this approach.

Pseudomyxoma peritonei: computed tomography and sonography.

Computed tomography was used to evaluate four patients with pseudomyxoma peritonei. Sonography was used to evaluate two of these patients. In three of four cases, the findings of liver scalloping and/or ascitis septations suggested the diagnosis. The differential diagnosis fo widespread peritoneal processes is considered.

Intracranial ring lesions: can we differentiate by computed tomography?

The ability to differentiate brain abscess, brain tumor (primary and metastatic), and cerebral vascular accident (CVA) using the patient's age, ten ring lesion image-parameters, and two mathematical algorithms (Bayes theorem and linear discriminant function analysis) was evaluated. From the eleven patients/image parameters, a subset of six parameters was found which could partially separate the patients having those three diseases in which ring lesions occurred. The correctness of the individual disease classifications was as follows: abscess (84% accuracy), tumor (96% accuracy), and CVA (17% accuracy). The ordered list of parameters which were found to be best for separating the diseases were 1) ring thickness variability, 2) patient's age, 3) outside ring diameter, 4) average value of CT numbers in ring center, 5) maximum ring thickness, and 6) lesion (edema)-to-ring ratio. The overall classification accuracy was 86%. Three additional subsets of six parameters were identified which were disease-specific; each subset, however, was slightly different for each disease. These data are useful both for diagnosis and for identifying lesion parameters which are disease-specific and therefore deserving of further experimental or observational analysis.

The Andy Gump fracture of the mandible: a cause of respiratory obstruction or distress.

Bilateral body fractures of the elderly edentulous atrophic mandible can cause a characteristic facial deformity and prolapse of the tongue into the pharynx, obstructing the airway (3). Early clinical and radiographic diagnosis of this injury is important. Stabilization of the fracture fragments restores the bony support for the tongue and helps establish patency of the airway.