G. Joseph Parell

Cefazolin prophylaxis in head and neck cancer surgery.

This study evaluated the prophylactic use of cefazolin in reducing the incidence of infection in patients undergoing cancer surgery where the upper aerodigestive tract was entered from the neck. A prospective, randomized, double-blind design was conducted in a single hospital. The patient was given placebo or cefazolin, 1 gm intramuscularly with the preoperative medications, then 0.5 gm every six hours for four doses. Of 55 determinate patients, 32 received antibiotics and 23 placebo. Infection rate was 38% (12/32) and 87% (20/23) respectively, representing a statistically significant reduction in infection (P < 0.001). There were 30 wound and two nonwound (sinusitis and pneumonia) infections. In conclusion, the perioperative use of cefazolin in patients undergoing cancer surgery where the oral cavity or pharynx has been entered from the neck is useful in reducing the incidence of wound infection.

Barotrauma of the ears and sinuses after scuba diving.

Abstract The pathophysiology, differential diagnosis, and currently available management of barotrauma affecting the ears and sinuses after scuba diving are reviewed, along with medical standards for resuming scuba diving after barotrauma has resolved.

Conservative Management of Inner Ear Barotrauma Resulting from Scuba Diving

Fourteen patients who experienced inner ear barotrauma (IEBT) while scuba diving were examined shortly after the episode and were followed up until symptoms resolved or stabilized. On the basis of these observations and a review of the literature, three types of IEBT are hypothesized that usually result from forceful autoinflation of the middle ear: (1) hemorrhage within the inner ear, (2) labyrinthine membrane tear, and (3) perilymph fistula through the round or oval window. Presenting symptoms, treatment regimens, and final results are detailed.

Technique of preserving the spinal accessory nerve during radical neck dissection

Preserving the spinal accessory nerve during radical neck dissection eliminates shoulder disability and does not compromise the incidence of neck recurrence in properly selected cases. The literature and standard textbooks only superficially refer to the method of dissecting this nerve. We describe our technique of preserving the spinal accessory nerve during radical neck dissection.

Neurological Consequences of Scuba Diving With Chronic Sinusitis

Sinus barotrauma from scuba diving is relatively common, usually self‐limiting, and often the result of transient nasal pathology. We describe serious neurological sequelae occurring in two scuba divers who had chronic sinusitis. We suggest guidelines for evaluating and treating divers who have chronic sinusitis. Divers with nasal or sinus pathology should be aware of the potentially serious consequences associated with scuba diving even after endoscopic sinus surgery to correct this condition.

Temporal Bone Pathology in Scuba Diving Deaths

Scuba diving has long been associated with otologic injuries; however, little is known about temporal bone pathology in diving-related deaths. We examined 18 temporal bones from 11 divers who died, primarily from complications of rapid ascent. Bleeding into the middle ear and mastoid air cells was nearly universal. Inner ear damage included hemorrhage around Reissners membrane and the round window membrane and rupture of the utricle and saccule. Most of the observed inner ear damage was not surgically treatable. (OTOLARYNGOL HEAD NECK SURG 1993;109:514-21.)

The non‐value of preoperative and intraoperative cultures in predicting the bacteriology of subsequent wound infection in patients undergoing major head and neck cancer surgery

A prospective study of patients undergoing major head and neck cancer surgery was undertaken to define the value of preoperative and intraoperative cultures in identifying the patient at “high risk” of wound infection and in predicting the bacteriology of wound infection.

Otolaryngologic aspects of scuba diving.

Among the most common injuries encountered by the 700,000 active sport scuba divers in the United States are sinus and otitic barotrauma. The management of these injuries and the identification of high-risk patients during their required pretraining physical examination are discussed.

Inner Ear Barotrauma After Stapedectomy in the Guinea Pig

Objective: The safety of scuba diving after stapedectomy is controversial. Stapedectomy is thought to predispose to inner ear barotrauma (e.g., perilymph fistula); however, many individuals continue to scuba dive following stapedectomy without ill effects. The purpose of this study was to evaluate the cochlear effects of barotrauma, similar to that experienced with scuba diving, on inner ears previously treated with stapedectomy.

The Skin-Sternocleidomastoid Muscle Composite Flap for Neck Dissection (The Gator Neck Flap)

INTRODUCTION Radical neck dissection, first standardized by Crile in 19061 involves extensive elevation of the neck skin and sacrifice of the spinal accessory nerve (SAN), and sternocleidomastoid muscle (SCM). Frequent postoperative sequellae included sensory denervation of the neck skin, shoulder dysfunction, and cosmetic deformity. Lack of carotid coverage by the SCM on occasion resulted in carotid blow out, especially in the early days of radiation therapy and use of the trifurcate incision. To address these shortcomings, a modified neck dissection, which preserved the SCM and SAN was described by Suarez in1963,2 and later improved and popularized by Boca.3 These modifications alleviated many of the disadvantages of the radical procedure while maintaining comparable cure rates. Since that time numerous authors described other modifications in which a segment of the neck most likely to be involved with metastasis is dissected. Again comparable cure rates have been maintained. A weakness of these modifications is that the SCM is dissected free of the overlying skin when elevating the flap, compromising the vascular, and sensory supply to the muscle and the skin. Additionally surgical trauma to the muscle causes fibrosis with resultant functional loss. Also elevating a traditional flap may easily injure the SAN, as it is very superficial in the posterior triangle (area 2b). We describe a modified neck dissection in which the SCM is left attached to the overlying skin. Advantages compared with traditional neck dissections include improved cosmesis, and cutaneous sensitivity, no shoulder dysfunction and decreased likelihood of skin flap necrosis and enterocutaneous fistula. There is no compromise in surgical exposure (Figs. 1 and 2) or operative time. The senior author (N.J.C.) has used this technique successfully for over 30 years in several thousand patients. We call it the gator flap in honor of the “fighting gators” at the University of Florida, where it was developed.