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Objective: To assess the applicability and complications of slide tracheoplasty in the management of subglottic and upper tracheal stenosis in experimental animals., Design: Subglottic stenosis was induced in 10 dogs by cauterizing the subglottic area and the upper 3 to 4 cm of the trachea. After 21 days, the severity of stenosis ranged from 30% to 60%. The subglottic area was reconstruction with slide tracheoplasty, and the results were evaluated at 4, 12, and 24 weeks postoperatively., Subjects: Ten mongrel dogs (Canis familiaris) were included in the study, each weighing between 12 and 17 kg., Intervention: Slide tracheoplasty., Main Outcome Measure: Patency of the reconstructed segment., Results: Follow-up examination revealed no airway obstruction in any animal. Examination of the reconstructed segment revealed good healing without granulation tissue and a patent endotracheal lumen in all cases. Histopathological examination of sections taken at the suture line confirmed complete healing without granulation tissue., Conclusions: Slide tracheoplasty can be applied successfully to the subglottic area. It offers many advantages in tracheal reconstruction and can be used for the management of acquired subglottic stenosis. The vascularized tracheal cartilage heals without granulation tissue often seen after cartilage interposition grafts. Furthermore, this technique reduces the need for tracheal and laryngeal mobilization for the treatment of longer areas of stenosis.

Objective: To determine the incidence of intracranial injury, specifically in the temporal lobe, in patients with longitudinal fractures of the temporal bone., Design: Prospective inception cohort., Setting: University of Maryland Division of Otolaryngology-Head and Neck Surgery and the Maryland Shock Trauma Center, Baltimore., Patients: Twenty-seven consecutive patients with unilateral or bilateral temporal bone fractures., Main Outcome Measures: Evaluation of temporal bone and intracranial trauma using computed tomography (CT) and magnetic resonance imaging (MRI)., Results: Of the 27 patients enrolled in the study, 12 had the complete battery of MRI, CT, and physical and audiological examinations. In all 12 patients, MRI demonstrated adjacent middle cranial fossa meningeal enhancement. Results of non-contrast-enhanced CT and MRI demonstrated ipsilateral temporal lobe contusions in 6 of the 13 fractures for an overall incidence of 46%. In addition, MRI demonstrated 4 cerebral contusions not seen in the results of non-contrast-enhanced CT., Conclusions: While high-resolution CT remains the criterion standard for evaluation of temporal bone fractures, MRI revealed a higher incidence of related temporal lobe injuries. Magnetic resonance imaging data may be valuable in preoperative evaluation of patients who require surgical intervention through a middle cranial fossa approach to document pre-existing injury and potential morbidity before retraction of the middle cranial fossa dura mater and temporal lobe.

Four Arenberg endolymphatic shunts that had been implanted in patients for 6 years, 3 years, 24 months, and 11 months were removed during retrolabyrinthine nerve sections (two cases), labyrinthectomy (one case), or cochlear implant (one case). The shunts were examined and photographed grossly and the components were prepared for light and scanning electron microscopy. Acellular debris filled the vestibule around the valve in all cases. The same material filled the inside of the valve in two cases and could be seen coming through the valve in two cases. Two shunts had ingrowth of fibrous tissue into the sponge. The finding of greatest concern was multiple erosions seen in the Supramid tube (S. Jackson Inc, Alexandria, Va) that inserts into the endolymphatic sac. On scanning electron microscopy, these erosions appeared as a network of cracks in the outer surface of the tube. The two shunts implanted for the longest time had fenestrae completely through the tube wall. These findings question the long-term functioning and integrity of the Arenberg shunt.

Objective: To determine the effectiveness of two different physical therapy approaches for benign paroxysmal positional vertigo., Design: Randomized study., Setting: Outpatient clinic., Patients: Consecutive sample of 60 patients with benign paroxysmal positional vertigo., Intervention: Patients received either a single treatment based on the hypothesis that the vertigo and nystagmus of benign paroxysmal positional vertigo are due to debris adhering to the cupula of the posterior semicircular canal (cupulolithiasis) or a single treatment based on the hypothesis that the debris is free floating in the long arm of the posterior canal (canalithiasis). Patients were reevaluated 1 to 2 weeks after the treatment and again 4 to 6 months later., Outcome: Treatment outcome was classified as either asymptomatic, more than 70% improved as rated by the patient, or no change., Results: The treatment designed for cupulolithaisis resulted in remission of vertigo and nystagmus in 70% of the patients and in improvement of the symptoms in another 20%. The treatment designed for canalithiasis resulted in remission of vertigo and nystagmus in 57% of the patients and in improvement in another 33%. There was no statistically significant difference between treatments., Conclusions: These single-treatment approaches are equally effective treatments for benign paroxysmal positional vertigo. Further studies are needed to look at the long-term effectiveness of these treatments.

We present three patients in whom the diagnosis of intranasal meningoencephalocele was made by magnetic resonance imaging. The initial clinical evaluation and computed tomographic examinations of these patients failed to distinguish between chronic inflammation and intranasal meningoencephalocele. Although both computed tomography and magnetic resonance imaging are used to distinguish between normal, inflammatory, and neoplastic tissue in the nasal cavity and paranasal sinuses, limitations do exist and these are the focus of our communication. A clear understanding of the efficacy of these radiographic modalities will enhance surgical planning and can preclude severe complications.

Objective: To evaluate the complications of anterior craniofacial resection and correlate their impact with tumor control status., Design: We conducted a retrospective review of 32 consecutive, operable patients' records seen over a 6-year period, requiring 35 procedures., Setting: Academic tertiary referral medical center., Participants: Twenty-six patients (81%) had malignant lesions (esthesioneuroblastoma, squamous cell carcinoma, and a group of miscellaneous malignant tumors). Six patients had various benign neoplasms., Intervention: The surgical approach involved bifrontal craniotomy coupled with lateral rhinotomy in 19 cases (61%), facial degloving in 10 cases (32%), a total rhinectomy in one case, and endoscopic sinusectomy without facial incision in two cases., Outcome Measure: Clinically noted complications and oncologic outcome., Results: There was one avoidable perioperative death indirectly associated with the patient's procedure. Nine patients suffered significant intracranial neurological complications such as tension pneumocephalus and delayed epidural abscess. All of these complications were managed successfully. Of patients with malignant tumors, 13 (52%) are alive with no evidence of disease and one is alive with recurrence after a mean follow-up period of 28.9 months. The 10 patients who succumbed to disease had a mean postoperative survival of 22.9 months., Conclusions: In contrast to the perspective of only a decade ago, we conclude that craniofacial resection is a relatively safe, versatile, and effective procedure for surgical management of tumors involving the anterior skull base.

We have tested a new method of vascular repair using biocompatible, low-temperature, heat-shrinkable tubing on canine carotid arteries. All of 16 canine carotid arteries were patent immediately after the anastomosis. None of the anastomoses leaked after the clamps were released. Average time from severing the vessel to releasing the clamps was 12 minutes. At 2 weeks, nine of 12 vessels were patent; the three failures were attributed to infection of a seroma that occurred in all of the dogs' necks. Histologic evaluation of the uninfected cases showed no inflammatory exudate around the prosthesis. Macroscopic and electron microscopic examination confirmed healing of the endothelium across the anastomoses. Sutureless vascular anastomosis with biocompatible heat-shrink tubing is a potential new modality for the acute repair of severed vessels.

Thirty-three synthetic middle ear prostheses removed after two to 99 months of implantation were examined histologically. All prostheses were infiltrated by fibroblasts, capillaries, collagen fibrils, and multinucleate foreign body giant cells. Although some of the giant cells contained tiny particles of the prosthetic material, there was no evidence of erosion or engulfment of larger particles of the prosthesis or structural dissolution of the prosthesis. New histologic findings were aseptic necrosis and focal calcification in the interior of some of the prostheses.

alpha-Difluoromethylornithine is a new antineoplastic and antiparasitic drug that inhibits the synthesis of polyamines. It causes a sensorineural hearing loss in humans. We have established an animal model for alpha-difluoromethylornithine-induced hearing loss. The time course for onset and recovery of the hearing loss in animals was similar to that seen in humans. Electrophysiologic and histologic data suggest that the anatomic site of alpha-difluoromethylornithine-induced hearing loss is the organ of Corti. Unlike other drugs with ototoxic effects, the specific enzymatic site of action of alpha-difluoromethylornithine is known, making it a potentially important tool in auditory research.