Charles M. Stiernberg

Contemporary management of deep neck space infections

Deep neck infections continue to be seen despite the wide use of antibiotics. These infections follow along fascial planes to create deep neck space abscesses. The clinical presentation often points to the space involved. Understanding the regional anatomy gives the surgeon the ability to treat these grave infections. The records of 24 patients with a diagnosis of deep neck space abscess admitted to Hermann Hospital between 1988 and 1993 were reviewed. Fifty percent of the patients had received antibiotics for an infection of the ear, nose, or throat before the development of a neck space abscess. Ten patients had parapharyngeal abscesses, seven had retropharyngeal abscesses, six had submandibular space abscesses, and one had parotid space abscess. Thirty-five organisms were isolated in 18 cases (1.9 isolates per patient). The most common organism cultured was Streptococcus (13 of 18), followed by Staphylococcus (6 of 18), Bacteroides (5 of 18), Micrococcus (2 of 18), and Neisseria (2 of 18). One case each of Candida, Enterobacter, Enterococcus, Peptostreptococcus, Proteus, Proprionobacter, and Pseudomonas was cultured. Six patients had no growth on culture but did have organisms found on Grams stain. The operative techniques and antibiotics used are discussed. The main complications of jugular vein thrombosis, carotid artery rupture, and mediastinitis are described, as well as an unusual case of meningitis from a large retropharyngeal-parapharyngeal abscess.

Surgical Anatomy of the Lateral Nasal Wall

Both the success and safety of intranasal functional endoscopic sinus surgery depend on the surgeons knowledge of nasal and sinus anatomy, especially the lateral nasal wall. The purpose of this study was to determine measurements and angles between lateral nasal wall landmarks. Linear and angular measurements were made to determine the mean and range distances between selected structures. The results provide a guide for the surgeon.

Primary tracheoesophageal fistula procedure for voice restoration: The university of texas medical branch experience†‡

Voice restoration for laryngectomees is challenging, but in recent years the tracheoesophageal (TE) fistula procedure using a oneway valved prosthesis has had relatively good success. The purposes of this study were to determine the success rate for the primary TE fistula procedure, analyze failures, and study methods for selection and training of these patients.

Rhinoscleroma … a diagnostic challenge.

Rhinoscleroma is a rare chronic granulomatous infection predominantly affecting the upper respiratory tract. The patient presented here exemplifies several features of the disease, including the fact that diagnosis may elude the clinician for years, and this delay may increase morbidity substantially. The most common initial complaint is nasal obstruction, and physical examination frequently reveals erythematous granular or nodular swellings covered with crusts. Its tumor‐like appearance and local spread arouses suspicion of malignancy, but differential diagnosis also includes fungal infections and numerous granulomatous diseases. The classic histopathology consists of large vacuolated Mikulizs cells and transformed plasma cells with Russell bodies. Numerous antibiotics have been used for treatment of this infection with varying degrees of success. Long‐term follow‐up is important because these patients can have numerous relapses. Geographic distribution is also discussed.

Endotracheal tube safety during laser surgery

The most morbid complication of laryngeal laser surgery is an endotracheal tube lire. The purposes of this study were to determine the efficiency of saline solution‐soaked cottonoid pledgets in protecting endotracheal tube cuffs from the laser beam and to evaluate the safety of four commonly used endotracheal tubes.

Epithelial-Myoepithelial Carcinoma of the Parotid Gland

The EME carcinoma of intercalated duct origin is now recognized as a distinct salivary gland malignancy. A case has been reported that typifies clinical and pathologic features. Both the surgeon and pathologist should learn not only to recognize its dual cellular characteristics, but also to be aware of the potential destructive nature and possibility for metastases with this tumor.

Surgery of the lip

Normal lip anatomy and function, Karen H. Calhoun lip aesthetics, Karen H. Calhoun introduction to reconstruction, Karen H. Calhoun small defects, Byron J. Bailey and Mark L. Nichols reconstruction of medium size lip defects, Charles M. Stiernberg reconstruction of subtotal and total defects of the lips, Karen H. Calhoun reconstruction of the upper lip, Karen H. Calhoun reconstruction of the paralyzed lip, Sylvester Ramirez cervical metastasis from lip cancer, Charles M. Stiernberg congenital abnormalities, G. Richard Holt orthodontic considerations in lip morphology, David M. Sarver, DMD, MS.

Magnet extraction of frontal sinus foreign body.

We report a metallic foreign body that entered through the anterior table of the frontal sinus, and rolled down to lodge in the nasofrontal duct. An electromagnet was used to remove the foreign body through a trephination.

Influence of cisplatin on wound healing--an experimental model.

Recent clinical studies have shown that adjuvant chemotherapy may improve response rates to treatment for advanced head and neck carcinomas. Given preoperatively, some chemotherapeutic agents adversely affect wound heallng. The specific purpose of this study was to evaluate the Influence of cisplatin on wound healing when it is given preoperatively. Forty-four Swiss outbred mice were divided into control and treatment groups. One week before surgery, the treatment group received cisplatin (2 mg/ kg body weight) by subcutaneous injections on 2 consecutive days. Each control animal was given an equal volume of normal saline. A 1.5 cm transverse incision was made in each animal, and wounds were closed with surgical staples. The mean woundbreaking strength was determined for a minimum of 5 treatment and 5 control mice on postoperative days 6, 10, 13, and 16. Serum creatinine, blood cell counts, and changes in weight were also monitored. Results showed wound strength on postoperative day 10 to be significantly reduced in mice treated with cisplatin (P < 0.05). There was no significant difference for wound strength on any other days and all other variables were simllar between both groups. In conclusion, cisplatin has an adverse effect on wound healing, the peak of which probably occurs during the proliferative stage of wound healing. Further studies are needed to determine the optimal time for surgery after preoperative chemotherapy. All new chemotherapeutic agents, particularly those being considered in a preoperative regimen, should be tested in this manner.

Inhibition of Cholesteatoma Migration in vitro with all-Trans Retinoic Acid

Retinoids have recently become of interest to clinicians because of their ability to inhibit migration and proliferation of premalignant squamous cells while enhancing growth and proliferation of normal cells. An in vitro investigation was undertaken to determine whether retinoic acid exhibits similar inhibitory effects on cholesteatoma cells. Cholesteatoma specimens were obtained intraoperatively from 10 patients undergoing mastoidectomy or revision mastoidectomy for chronic ear disease. Cholesteatoma explant growth and en mass migration were observed daily, and topographic maps were constructed at various time intervals to quantity rate and direction of explant migration in the presence or absence of all-trans retinoic acid. Before all-trans retinoic acid administration, explants migrated very rapidly (1 to 2 mm/day). A maximum threefold inhibition of migratory rate occurred, with explants exposed to 0.1 micromol/L retinoic acid when compared with controls. A sixfold maximum inhibition was observed at higher retinoic acid concentrations (5 micromol/L). On removal of all-trans retinoic acid, twofold and fourfold increases in migratory rates were observed. The direction of explant migration varied significantly for long periods of time and appeared not to be affected by retinoic acid. This investigation suggests that all-trans retinoic acid has an inhibitory effect on cholesteatoma cell migration. Retinoids may have a role in controlling cholesteatoma disease in the future.