Voice range in superior laryngeal nerve paresis and paralysis.

Evaluation of Physiologic Frequency Range (PFR) and Musical Frequency Range (MRP) of Phonation was performed on 56 adults (singers and nonsingers) presenting with superior laryngeal nerve (SLN) paresis or paralysis confirmed by laryngeal electromyography. The most common etiology was neuritis (69.7%), followed by iatrogenic and unknown causes,each accounting for 10.2% of cases, and finally trauma (8.9%). Both female and male singers with SLN paresis or paralysis had significantly higher PFR and MPR than nonsingers. Female classical singers presented PFR and MPR of up to 10 semitones (ST) higher than nonclassical singers and nonsingers. The lowest PFR and musical ranges were found in patients with SLN paresis associated with recurrent laryngeal nerve paresis or paralysis. The authors suggest that voice range measurement is a useful parameter for analyzing the effects of SLN paresis or paralysis on voice and that it may also assist in measuring outcome following voice therapy.

Arytenoid dislocation: diagnosis and treatment.

Disruption of the cricoarytenoid joint is a relatively uncommon event, according to the world literature. Only 31 reported cases of arytenoid dislocation or subluxation exist other than the 26 cases described in this paper. Often cases are misdiagnosed as vocal fold paralysis. Knowledge of the signs and symptoms of arytenoid dislocation aids in correct diagnosis and early treatment. Even when diagnosis has been delayed, surgery may be highly effective. Familiarity with state-of-the-art diagnostic techniques and new concepts in management helps optimize the chances for good voice quality.

Vestibular nerve section.

INTRODUCTION: Vestibular nerve section is considered to be the most effective surgical procedure for control of intractable symptoms secondary to labyrinthine and eighth nerve function. This study was developed to retrospectively evaluate the efficacy of vestibular nerve section in patients treated for disabling labyrinthine dysfunction. METHODS: A retrospective review of hospital and office records was carried out on 39 patients who underwent vestibular nerve section. All patients received a comprehensive questionnaire to subjectively evaluate efficacy. RESULTS: Questionnaires were returned from 36 of 39 patients. Follow-up averaged 51 months. A decrease in vertiginous attacks was reported by 94% of patients. An improvement in activity tolerance was reported by 30% of patients. Preoperative tinnitus and ear fullness reportedly improved after surgery in 53% and 65% or patients respectively. Complications encountered included cerebrospinal fluid (CSF) leak (six patients), meningitis (two patients), and intracranial fluid collection (one patient). CONCLUSION: Vestibular nerve section is a relatively safe and effective method of treatment for intractable vertigo.

Male soprano voice: a rare complication of thyroidectomy.

A soprano voice from cricothyroid fusion is a rare complication following thyroidectomy. Thyroid surgeons should be aware of this possibility and recognize it early if voice pitch rises following thyroid surgery. This patient's unfortunate complication may prove fortuitous for phonosurgeons and their patients. Cricothyroid fusion may provide a better long-term retention of frequency elevation than traditional cricothyroid approximation. It is also a reversible procedure. Cricothyroid fusion should be investigated as an alternative to cricothyroid approximation for pitch modification.

Cornelia de Lange syndrome. Otolaryngologic manifestations.

Cornelia de Lange syndrome (CDLS) is characterized by multiple congenital malformations and mental retardation. New studies have documented otolaryngologic abnormalities. We examined 45 patients with CDLS. Virtually all had hearing loss, and most had impaired language development. Other otolaryngologic abnormalities, including external auditory canal stenosis and cleft palate, were also common. Because of the high incidence of otolaryngologic abnormalities, and the need for early intervention, it is important for otolaryngologists to recognize CDLS manifestations in the head and neck.

Embryology of the facial nerve and its clinical applications.

Although many studies have investigated facial nerve development, most have been limited by available specimens and have not provided a comprehensive description of the development of this important structure. Even the best and most comprehensive articles on this subject have not systematically integrated the descriptions of facial nerve embryology with a summary of the development of other otologic structures. This study describes the parallel development of the facial nerve and ear, emphasizing practical applications for the otologic surgeon. The validity of these predictions has been tested through surgical procedures on patients with malformed ears.

Transfacial resection of intracranial tumor.

Tumors of the skull base with intracranial and extracranial components pose special access problems. Traditional craniotomy and extensive external incisions produce morbidity that can be avoided in properly selected cases. Current surgical techniques extend previously described operations to allow good visualization and safe resection through the face for certain intracranial tumors. Meticulous attention to surgical techniques and wide exposure for complete tumor visualization are essential to ensure the safety of these procedures.

Giant cholesterol cysts of the petrous apex.

The giant cholesterol cyst is a clinical entity distinct from cholesterol granulomas and other destructive lesions of the petrous bone. Preoperative assessment by computed tomographic scan and magnetic resonance imaging is extremely helpful. Attempts at total resection of the lesion are not necessary. Adequate surgical drainage may be established through the mastoid or middle fossa.

An easy guide to electronystagmography interpretations.

Although there are numerous text books and long articles written on electronystagmography, there are few comprehensive summary tables to assist in teaching ENG interpretation. The use of such a device, however, is particularly helpful for medical students, residents, audiologists, nurses, and medical specialists who do not interpret electronystagmograms regularly.

Compatibility of autologous fibrin adhesive with implant materials.

A safe, effective method for securing autologous and alloplastic implants would benefit modern surgery substantially. We studied the effects of a new autologous fibrin tissue adhesive with various alloplastic implants and ear cartilage. Twelve rabbits had Proplast (a woven combination of Teflon and organic fibers), Silastic, Supramid polyfilament surgical sheeting, and ear cartilage implanted. One side of each animal had implants secured with tissue adhesive. The other, control side had identical implants placed in "subcutaneous tunnels." The tissue adhesive was biodegradable and produced no apparent toxic reaction, infection, or foreign-body reaction. It did not adhere to Silastic, but bound to the other implants. Glued implants had no more clinical or histologic evidence of inflammation than controls. Autologous fibrin tissue adhesive seems to be promising as a safe, biologic bonding material for securing certain alloplastic and autologous implants.

Total temporal bone resection for squamous cell carcinoma.

Because of unsatisfactory results in treatment of malignant conditions of the temporal bone, a technique for total en bloc resection of the temporal bone and carotid artery was reported by Graham et al. in 1984. The procedure involves resection of the internal carotid artery, cranial nerves VI through XII, and structures adjacent to the temporal bone. Experience with two additional cases led to numerous modifications in the recommended procedure, as reported by Sataloff and Myers. Additional clinical experience with this technique and its complications has resulted in further modification. Additional pitfalls and specific changes in technique from previous reports are discussed in detail, including a new procedure to assure the adequacy of contralateral venous outflow.

Computed tomography of the face and paranasal sinuses: Part II. Abnormal anatomy and pathologic conditions.

Computerized tomography is extremely useful in delineating abnormal anatomy and pathologic conditions of the face and paranasal sinuses. The familiarity with normal anatomy is essential. Expert interpretation of CT scanning allows superior diagnosis of and treatment planning for lesions of the face and paranasal sinuses.