Research Interests:
Research Interests:
Research Interests:
Until recent years cricothyroidotomy has been condemned as an elective surgical procedure because of reports of a high incidence of subglottic stenosis. In this study of cricothyroidotomy the effects of trauma, denudation of the mucous... more
Until recent years cricothyroidotomy has been condemned as an elective surgical procedure because of reports of a high incidence of subglottic stenosis. In this study of cricothyroidotomy the effects of trauma, denudation of the mucous membrane of the anterior half of the cricoid cartilage, and the prophylactic administration of antibiotics (ampicillin) on the development of subglotttic airway narrowing were evaluated in 40 mongrel dogs. Two of the dogs developed minimal anterior narrowing of the airway. None of the dogs developed clinically important stenosis.
Research Interests:
Research Interests:
Research Interests: Cleft Palate, Norwegian, Adolescent, Medicine, Humans, and 15 moreChild, Genetic Testing, Obstructive sleep apnea, Case Study, Female, Male, Clinical Sciences, Aged, Middle Aged, Adult, Airway Obstruction, Diagnostic Criteria, Child preschool, Obstructive Sleep Apnea Syndrome, and Mandibulofacial dysostosis
Research Interests:
Research Interests:
Carotid artery involvement by neoplastic disease has grave prognostic implications. However, with the advent of postoperative radiation therapy and chemotherapy, carotid artery sacrifice and replacement is more widely performed. In this... more
Carotid artery involvement by neoplastic disease has grave prognostic implications. However, with the advent of postoperative radiation therapy and chemotherapy, carotid artery sacrifice and replacement is more widely performed. In this report the authors discuss their experience with preoperative and intraoperative evaluation of cerebral blood flow and complications of carotid artery replacement.
Research Interests: Medicine, Head and Neck, Brain, Humans, Female, and 15 moreMale, Clinical Sciences, Aged, Middle Aged, Oral Squamous Cell Carcinoma (OSCC), Meningitis, Retrospective Studies, Prognosis, Brain Abscess, Cerebral Infarction, Otolaryngology Head and Neck Surgery, Postoperative Complications, Carotid Arteries, Ligation, and Laryngeal neoplasms
The authors present an extensive review of current literature as well as their ten‐year experience in management of patients with retropharyngeal abscesses. Emphasis is placed upon age, sex, type and duration of symptoms, bacteriology,... more
The authors present an extensive review of current literature as well as their ten‐year experience in management of patients with retropharyngeal abscesses. Emphasis is placed upon age, sex, type and duration of symptoms, bacteriology, methods of diagnosis, therapy, and complications. The author's series reveals that retropharyngeal abscesses are found in adults, there is a wide spectrum of bacteriological organisms represented, and with appropriate antibiotic and surgical management the majority of patients survive without major residual sequelae.
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CHAIRMAN'S COMMENTS: The management of open and infected wounds is one of those disagreeable tasks that face all surgeons. Infected wounds in the head and neck require extensive nursing care and are associated with high morbidity... more
CHAIRMAN'S COMMENTS: The management of open and infected wounds is one of those disagreeable tasks that face all surgeons. Infected wounds in the head and neck require extensive nursing care and are associated with high morbidity and an appreciable incidence of mortality. Koopmann and Coulthard, from the University of Arizona, relate their experiences with a new agent, Dextranomer (Debrisan), that has shown remarkable ability for cleaning and debriding infected wounds. This material will be of interest to all otolaryngologists who deal with this problem.
Research Interests:
Five patients were treated with a combination of Adriamycin/cis-platinum/cyclophosphamide for far-advanced and/or recurrent cancer of the salivary gland. Adriamycin, 40 mg/m2, and cis-platinum, 50 mg/m2, were given on day 1;... more
Five patients were treated with a combination of Adriamycin/cis-platinum/cyclophosphamide for far-advanced and/or recurrent cancer of the salivary gland. Adriamycin, 40 mg/m2, and cis-platinum, 50 mg/m2, were given on day 1; cyclophosphamide, 200 mg/m2 daily for four days, was given by mouth on the third to sixty day of each monthly therapy course. Two patients achieved a complete remission, each lasting five months, and the three others had partial remissions from one to seven months (median six months) in duration. Therapy was well tolerated. Severe nausea and vomiting occurred on the first day of therapy but was self-limited. There was only mild to moderate leukopenia, no significant thrombocytopenia or elevations of serum creatinine, and no evidence of dose-limiting peripheral neuropathy. Adriamycin/cis-platinum/cyclophosphamide chemotherapy appears to be effective in the treatment of advanced parotid gland cancers.
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Research Interests:
Research Interests:
Physician reimbursement has changed drastically since the advent of the RBRVS methodology by Medicare in the late 1980s. Physician payment policy has evolved into a complex, multi-faceted exercise that now involves private payers as well... more
Physician reimbursement has changed drastically since the advent of the RBRVS methodology by Medicare in the late 1980s. Physician payment policy has evolved into a complex, multi-faceted exercise that now involves private payers as well and affects all aspects of medical practice.It is imperative that physicians understand how the payment system works. This will allow the medical community to objectively evaluate utilization of limited resources to maximize the evolution of effective patient care. The payment system also plays a great role in the scope of practice decisions being made in all areas of medicine and the legislative and regulatory posturing reshaping the entire health delivery system.The Panel will discuss in an interactive fashion with the audience: (1) the evolution of the RBRVS payment system to today’s version; (2) how the CPT, RUC, and PEAC function; (3) how physicians can use the system to evaluate their practice and new technologies; (4) how academy members can influence policy to benefit otolaryngology and their patients.
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Summary Sialadenitis in children has been discussed. A literature review highlighting salient points in sialadenitis is presented. Classification of sialadenitis is discussed using the categories of several authors. An unusual case... more
Summary Sialadenitis in children has been discussed. A literature review highlighting salient points in sialadenitis is presented. Classification of sialadenitis is discussed using the categories of several authors. An unusual case involving acute suppurative parotitis in a child is presented. The development of contralateral disease while treatment was in progress was unusual. In this case, association with mumps parotitis was strongly suspected despite previous immunization. Progression of disease with abscess formation is also unusual. Mumps virus parotitis has been rarely reported in association with acute suppurative parotitis. Immunization affords protection, but a definite failure rate exists. Based upon histologic examination, mumps parotitis would seem to be a predisposing factor for bacterial infection.
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Research Interests:
This article is a general discussion of the mechanisms of soft-tissue wound healing with an emphasis on tissue. The overall phases of cutaneous wound healing and their influencing factors are described as are concepts for managing skin... more
This article is a general discussion of the mechanisms of soft-tissue wound healing with an emphasis on tissue. The overall phases of cutaneous wound healing and their influencing factors are described as are concepts for managing skin incisions to achieve a more optimal scar appearance.
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Research Interests:
Research Interests:
CHAIRMAN'S COMMENTS: The management of open and infected wounds is one of those disagreeable tasks that face all surgeons. Infected wounds in the head and neck require extensive nursing care and are associated with high morbidity and... more
CHAIRMAN'S COMMENTS: The management of open and infected wounds is one of those disagreeable tasks that face all surgeons. Infected wounds in the head and neck require extensive nursing care and are associated with high morbidity and an appreciable incidence of mortality. Koopmann and Coulthard, from the University of Arizona, relate their experiences with a new agent, Dextranomer (Debrisan), that has shown remarkable ability for cleaning and debriding infected wounds. This material will be of interest to all otolaryngologists who deal with this problem.
Research Interests:
Sleep apnea is an entity that is becoming more commonly diagnosed as the signs and symptoms are becoming better understood. In this report, the first known case of sleep apnea secondary to a lipoma of the submandibular area of the neck is... more
Sleep apnea is an entity that is becoming more commonly diagnosed as the signs and symptoms are becoming better understood. In this report, the first known case of sleep apnea secondary to a lipoma of the submandibular area of the neck is presented. A brief discussion of the types of sleep apnea, along with the most common signs and symptoms of the entity, are reported. The diagnostic workup, operative findings, and postoperative results in this patient are discussed.
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Research Interests:
Research Interests:
The authors investigated the effect of varying doses of ibuprofen upon the hearing of guinea pigs monitored with brain stem-evoked response procedures. In daily dosages comparable on a weight basis to therapeutic levels in humans,... more
The authors investigated the effect of varying doses of ibuprofen upon the hearing of guinea pigs monitored with brain stem-evoked response procedures. In daily dosages comparable on a weight basis to therapeutic levels in humans, ibuprofen was found not to have significant effects on response threshold or latency characteristics.
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Research Interests:
Research Interests:
Juvenile nasopharyngeal angiofibroma (JNA) appears to be an endocrine-responsive tumor. This concept was tested in five young men with JNA by treating them with a testosterone receptor blocker (flutamide) for 6 weeks preoperatively. Tumor... more
Juvenile nasopharyngeal angiofibroma (JNA) appears to be an endocrine-responsive tumor. This concept was tested in five young men with JNA by treating them with a testosterone receptor blocker (flutamide) for 6 weeks preoperatively. Tumor size was evaluated by axial computed tomography both before and after flutamide therapy. Four of the five patients had an average tumor shrinkage of 44%. The patients tolerated the drug well, and the serum testosterone levels 2 or more years posttherapy were normal. This pilot study demonstrate that preoperative hormonal pharmacoreduction of JNA is a feasible adjunct to surgical therapy that offers the possibility of reduced blood loss. However, the authors believe that a formal clinical trial of this treatment approach is warranted and should be done before widespread adoption of this agent.
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A review of the literature reveals that pyogenic gangrenosum (ecthyma gangrenosum) is fatal to most patients, especially infants. In this article, the authors review the differential diagnosis of facial necrosis, present two cases of... more
A review of the literature reveals that pyogenic gangrenosum (ecthyma gangrenosum) is fatal to most patients, especially infants. In this article, the authors review the differential diagnosis of facial necrosis, present two cases of infants who succumbed to the systemic manifestations of the disorder, and a third case of survival in an adult with concomitant systemic lupus erythematosus and pyogenic gangrenosum. Finally, a brief discussion of Pseudomonas gastroenteritis, Pseudomonas septicemia, and pseudomembranous enterocolitis is presented.
Research Interests:
Research Interests:
Research Interests:
Educational objective: To improve the knowledge of evaluation of apneic patients and nonsurgical and surgical therapeutic options for patients with sleep apnea.
Research Interests:
Five patients were treated with a combination of Adriamycin/cis-platinum/cyclophosphamide for far-advanced and/or recurrent cancer of the salivary gland. Adriamycin, 40 mg/m2, and cis-platinum, 50 mg/m2, were given on day 1;... more
Five patients were treated with a combination of Adriamycin/cis-platinum/cyclophosphamide for far-advanced and/or recurrent cancer of the salivary gland. Adriamycin, 40 mg/m2, and cis-platinum, 50 mg/m2, were given on day 1; cyclophosphamide, 200 mg/m2 daily for four days, was given by mouth on the third to sixty day of each monthly therapy course. Two patients achieved a complete remission, each lasting five months, and the three others had partial remissions from one to seven months (median six months) in duration. Therapy was well tolerated. Severe nausea and vomiting occurred on the first day of therapy but was self-limited. There was only mild to moderate leukopenia, no significant thrombocytopenia or elevations of serum creatinine, and no evidence of dose-limiting peripheral neuropathy. Adriamycin/cis-platinum/cyclophosphamide chemotherapy appears to be effective in the treatment of advanced parotid gland cancers.
Research Interests:
Research Interests: Cancer, Chemotherapy, Medicine, Humans, Toxicity, and 15 moreHead and Neck Cancer, Cisplatin, Aged, Middle Aged, Oral Squamous Cell Carcinoma (OSCC), Stomatitis, Adult, Drug evaluation, Allopurinol, Combined Modality Therapy, neoadjuvant therapy, leukopenia, Neoplasm staging, fluorouracil, and Head and neck neoplasms
Paranasal sinusitis may occasionally be complicated by intraorbital or intracranial spread of infection. In this presentation, the authors report the case of a 17-year-old male with left pansinusitis complicated by periorbital and... more
Paranasal sinusitis may occasionally be complicated by intraorbital or intracranial spread of infection. In this presentation, the authors report the case of a 17-year-old male with left pansinusitis complicated by periorbital and intracranial abscess secondary to an infection associated with Actinomyces spp. and coagulase-negative Staphylococcus spp. This appears to be the first case report of Actinomyces involvement in the orbit or frontal sinus. The potential morbidity and/or mortality associated with locally invasive paranasal sinus abscess is reviewed. The combined medical and surgical management of this problem is presented.
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The aging nose undergoes structural and functional changes, which can cause alterations in olfaction, breathing, cosmesis, and nutrition, as well as exhibiting increased incidence of epistaxis and rhinitis. A review of these factors and... more
The aging nose undergoes structural and functional changes, which can cause alterations in olfaction, breathing, cosmesis, and nutrition, as well as exhibiting increased incidence of epistaxis and rhinitis. A review of these factors and suggestions for management is presented.
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Until recent years cricothyroidotomy has been condemned as an elective surgical procedure because of reports of a high incidence of subglottic stenosis. In this study of cricothyroidotomy the effects of trauma, denudation of the mucous... more
Until recent years cricothyroidotomy has been condemned as an elective surgical procedure because of reports of a high incidence of subglottic stenosis. In this study of cricothyroidotomy the effects of trauma, denudation of the mucous membrane of the anterior half of the cricoid cartilage, and the prophylactic administration of antibiotics (ampicillin) on the development of subglotttic airway narrowing were evaluated in 40 mongrel dogs. Two of the dogs developed minimal anterior narrowing of the airway. None of the dogs developed clinically important stenosis.
Research Interests:
This article is designed to give the reader an appreciation of some of the more common or important facets of the management of head and neck disorders in the elderly patient. Readers are referred to the references for more detailed... more
This article is designed to give the reader an appreciation of some of the more common or important facets of the management of head and neck disorders in the elderly patient. Readers are referred to the references for more detailed descriptions of the topics.
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Research Interests:
Research Interests:
Research Interests:
An open-top oxygen tent has been developed for supplying humidified oxygen to the pediatric patient while allowing easy access to the child's head, neck, and upper thoracic region with limited impairment of either observations or... more
An open-top oxygen tent has been developed for supplying humidified oxygen to the pediatric patient while allowing easy access to the child's head, neck, and upper thoracic region with limited impairment of either observations or movement of the child. This tent is easily and economically fabricated from 0.002-in clear plastic sheeting and 3/4-in polyvinyl chloride pipe available from a local hardware store.
Research Interests:
There are only six case reports documenting the presence of glial tissue in the tongue. Because of the small number of cases, the presentation and biologic behavior of these lesions is poorly characterized. We present the case of a... more
There are only six case reports documenting the presence of glial tissue in the tongue. Because of the small number of cases, the presentation and biologic behavior of these lesions is poorly characterized. We present the case of a 10-day-old male infant who arrived at the University of Michigan Medical Center with a history of positional dyspnea, with resultant cyanosis and bradycardia, dysphagia, and a mass at the base of the tongue. Histopathologically, this lesion was initially labeled as a hamartoma, but was ultimately defined as a choristoma based on the exclusive presentation of glial tissue in the specimen. This paper will discuss the presentation, diagnostic evaluation, and therapeutic management of this case. In addition, the role of intraoperative electrodiagnostic monitoring to preserve neuromuscular function will be addressed.
Research Interests:
Carotid artery involvement by neoplastic disease has grave prognostic implications. However, with the advent of postoperative radiation therapy and chemotherapy, carotid artery sacrifice and replacement is more widely performed. In this... more
Carotid artery involvement by neoplastic disease has grave prognostic implications. However, with the advent of postoperative radiation therapy and chemotherapy, carotid artery sacrifice and replacement is more widely performed. In this report the authors discuss their experience with preoperative and intraoperative evaluation of cerebral blood flow and complications of carotid artery replacement.
Research Interests:
A full term one-day-old neonate developed respiratory distress secondary to a right intranasal mass. After exploratory craniotomy revealed no intracranial lesions, the child was observed for 6 months. At that time he experienced severe... more
A full term one-day-old neonate developed respiratory distress secondary to a right intranasal mass. After exploratory craniotomy revealed no intracranial lesions, the child was observed for 6 months. At that time he experienced severe apnea with cyanosis necessitating removal of the mass, which was diagnosed histologically as a fibrous histiocytoma. Seven year follow-up reveals no further problems. A discussion of fibrous histiocytoma of the nose and paranasal sinuses is briefly given.
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Myasthenia gravis is a disease characterized by muscular weakness and fatigability which afflicts 2-10 patients per 100,000 with 20% of cases presenting in childhood. Muscles innervated by cranial nerves are frequently involved with... more
Myasthenia gravis is a disease characterized by muscular weakness and fatigability which afflicts 2-10 patients per 100,000 with 20% of cases presenting in childhood. Muscles innervated by cranial nerves are frequently involved with ptosis and diplopia being the most frequent presenting complaints. We review the literature and report a case of a 20-month-old infant presenting with inspiratory stridor and cyanosis, resembling foreign body aspiration.
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Leukemic involvement of the temporal bone is not uncommon and may present in a variety of ways including auricular or external canal skin lesions, red or thick tympanic membrane, middle ear effusions, otitis media, hearing loss or... more
Leukemic involvement of the temporal bone is not uncommon and may present in a variety of ways including auricular or external canal skin lesions, red or thick tympanic membrane, middle ear effusions, otitis media, hearing loss or mastoiditis. Symptomatic facial nerve involvement, on the other hand, is extremely unusual. We discuss a pediatric patient whose sudden onset facial nerve paresis was the presenting symptom that led to her diagnosis of leukemia. At the time of mastoidectomy, a granulocytic sarcoma or chloroma was noted to be overlying the VIIth nerve.