Ear,Nose & Throat Journal

The original criteria for modifying a radical mastoidectomy were: (I) an intact pars tensa and a defective pars flaccid a with cholesteatoma; (2) normal or near normal hearing; and (3) an intact, functional ossicular chain. We propose a fourth criterion: that the cholesteatoma site be delineated lateral to the body of the incus. Control of the disease process is easily assured if the lesion is in that area. Our recommended fourth criterion is based on the results of a five-year study of fifty-two cases that met the original criteria. The cholesteatoma reoccurred in the middle ear in only one case. In six cases, periodic care is necessary because of retraction to the grafted attic area. The procedure and technique used in these patients and the excellent results are discussed in this article.

Congenital larygoceles are rare causes of respiratory distress in the newborn. We report a case of airway compromise in a two day old newborn boy secondary to a solitary giant external laryngocele. No internal component or other laryngeal pathology was found. The patient had a progressively enlarging neck mass and increasing stridor culminating in respiratory arrest. Tracheotomy was avoided and the lesion was excised in its entirety. Airway management, the role of CT scanning, and surgical excision of laryngoceles are discussed.

A case of Locked-in syndrome is reported with correlation of BAER and EOG with MRI for localization and identification of brain lesions, and 3-D MRA and 2-D gradient echoMR imaging, a non-invasive newdiagnostic modality for confirmation and visualization of vascular pathology.

There was thrombosis of the basilar artery with extensive infarct of ventral pons and lower mid-brain. The patient had ocular bobbing. This eye movement in its classical formconsists of irregular vertical oscillations, the fast component being downward with complete absence of horizontal eye movements. To our knowledge, the change from ocular bobbing to upbeat nystagmus has not been previously reported in the Locked-in syndrome. Bilateral involvement of the lateral lemniscus might have contributed to its appearance in our patient.

The recurrent laryngeal nerve is at risk of iatrogenic. injury during surgical procedures in which its anatomical location is exposed. Borrowing from biotechnology currently available for facial nerve monitoring, we have deve loped a method of electrophysio logically assessing the function of the recurrent laryngeal nerve during technically difficult neck surgeries. Electromyographic as well as nerve action potential recordings are monitored using the Xomed-Treace Nerve Integrity Monitor-2 (NIM-2). This method differs from those previously published in that it is much less cumbersome and time-consuming. The technique as well as an illustrative case are reported.

Thirty-four patient s with an identified muscular disease were referred to our department for assessment and treatment of swallowing difficulties. Their ages ranged from 16to 91 years (mea n 59). The diagnoses were oculopharyngeal dystrophy in 17 patients, Steinert myotonic dystrophy in 6, mitochondri almyopathies in 4, polymyositis in 3, and other types in 4 patients. The main consequences of the dysphagia were weight loss (12 patients), pulmonary infections (15 patients), modified food consistency (18 patients) and non-oral feeding (3 patients). Several techniques were used to assess the different stages of deglutition: physical examination during swallowing, videofluoroscopy, pharyngoesophagealmanometry, videofibroscopy ofthe pharynx during swallowing. Major pathological features found in the pharynx were decreased pharynx peristaltis and impaired UES relaxation.

Cricopharyngeal myotomy was performed in II myopathic patients (median follow-up 24.9months), while it was unnecessary, refused or contraindicated in the other patients. The procedure was successful in 8 patients whose dysphagia was dramatically improved, and failed in 3 patients. Pharyngeal perstalti s was severely impaired only in the 3 failures and was partly preserved in the improved cases.

We conclude that pharyngeal function is the major prognostic factor. Cricopharyngeal myotomy is an effective treatment in those cases where cricopharyngeal dysfunction is a predominant problem or where pharyngeal peristaltis is partly impaired, since the procedure removes one obstacle. It is contraindicated when pharynx propulsion is severely impaired.

Retropharyngeal hematomas are relatively rare. They are clinically important because of the close proximity of the retropharyngeal space to the upper airway. Any swelling in the space may cause the posterior pharyngeal wall to bulge anteriorly into the airway and cause airway obstruction. Management starts with securing and maintaining the patient's airway. Diagnosis rests upon clinical examination and radiographic studies. Treatment depends upon the size of the hematoma as well as the clinical course of the patient. Smaller hematomas may be observed. Larger hematomas and those that fail to reabsorb should undergo drainage. A case of retropharyngeal hematoma following minor blunt head and neck trauma is presented. We review the literature and present management and treatment principles for this group of patients.

This study has been performed between December 1990—March 1991 in the Microsurgery laboratory of the Marmara University Hospital. Twelve healthy albino guinea pigs were used as a study group while the control group consists of three animals. The potentials for cholesteatoma formation of the squamous epithelium, namely the squamous epithelium of the posterior superior part of the external ear canal skin and normal skin, were investigated. Among 24 subjects who were implanted by canal skin, cholesteatoma was fanned in 21 of them. Likewise, 19 of 24 animals implanted by normal skin came out with cholesteatoma formation. Between these two types of epithelium, there is no statistical difference in cholesteatoma formation (p >0.5).