Kenneth L. Pickrell

LXXXVI The Local use of the Sulfonamides, Gramicidin (Tyrothricin) and Penicillin in Otolaryngology

Practically all infections of the ears and sinuses are secondary to an acute coryza or nasopharyngitis. The number of ear and sinus complications seen by the otolaryngologist is growing less each year,· due to the widespread use of sulfonamides during the early stages of infection. There are objections to giving large doses of these drugs by mouth and saturating the entire body in order to cure or pre! vent a local infection. A more satisfactory method of using the sulfonamides to prevent sinus and ear infections is suggested by the publication of Pickrell! on the treatment of extensive skin burns. It has long been known that infection is a serious complication of burns, and Pickrell finds it may be prevented by spraying the burned area with a 2.5 per cent solution of sulfadiazine (2 sulfanilamidopyrimidine) in 8 per cent triethanolamine. This mixture has a pH of about 8.7, is not toxic and is readily absorbed by the tissues. To be effective it must be sprayed on the burned area freely and at frequent intervals, at least every hour during the first day, every two hours the second day, etc. Enough of the drug is absorbed under this treatment to maintain a high blood level, but the pre-

Lingual flaps: effect on speech articulation and physiology.

The large anterior palatal fistula is one of the more difficult problems of cleft palate care for both surgeon and speech pathologist. Difficult for the surgeon because, in most cases, previous operations have heavily scarred the adjacent palatal tissue making it insufficient in quality and quantity; difficult for the speech pathologist since persistent nasal escape cannot be improved by exercises and training as can certain gaps in the velopharyngeal region. Not infrequently, both surgeon and speech pathologist gladly accept a compromise, prosthetic closure. While prosthetic closure may be acceptable for some older patients with large anterior palatal defects, we do not feel it is desirable for young cleft patients. A prosthetic closure for the cleft palate patient frequently is associated with a multitude of problems and inconveniences without obtaining an ideal closure. We have recently used a relatively new procedure, the lingual flap, to obtain closure in these difficult cases.

Immediate reconstruction of the pharynx after combined therapy for advanced tonsillar carcinoma

Abstract A combined approach of radiation therapy and surgery has been used in ten patients with advanced tonsillar carcinoma. Moderate doses of preoperative irradiation were promptly followed by a composite resection and immediate cervical or forehead flap reconstruction. The technic is discussed. The results have demonstrated excellent healing and impressive oral function. A longer follow-up period will be necessary to determine the value of this approach as a curative procedure.

Tattooing the cornea.

T HE first recorded case of purposefu1 tatooing of the cornea occurred in 1870 when von Wecker [I] injected India ink into a scarred cornea. He noted previously “that in workmen wounded by the explosion of mines, the grains of powder remained in the cornea without producing any remarkable haziness in the surrounding tissue.” Williams [2] and Calhoun [?J in 1873 presented the first cases of tattooing the cornea in this country. In 1874 Mathewson [4] first suggested the possibility of tattooing the skin to concea1 or correct dishgurements“WhiIe thinking of this matter of conceaIing discolorations of the cornea by tattooing, it occurred to me that the same principIe might be applied to the reIief of dishgurements of the face and neck, such as those produced by extensive nevi or other permanent discolorations of the skin, some coloring being used which would produce a natura1 flesh tint.” Tattooing the cornea was abandoned temporariIy untiI 1925 when Knapp [T] attempted to stain a cornea1 scar with gold chIoride. At operation the scar was denuded of its epitheIium, after which a cotton applicator, moistened with a I per cent soIution of gold chIoride, was appIied to the denuded scar for two or three minutes. HoIth [6] tried Knapp’s method, but was not successfu1. Kreiker [7] attempted to coIor the buIbar conjunctiva of an albino using a 5 per cent soIution of goId chIoride, but the reaction was “too severe.” Aust [8] aIs0 produced a severe iritis when this soIution entered the anterior chamber. Karelus [9] recommended “subepitheIia1 tattooing” in which he circumscribed the scar with a scaIpe1 and undermined a11 of the scarred area except one smaI1 pedicIe. The ffap thus formed was turned up; the undersurface was painted with India ink which was allowed to dry, and the ffap was repIaced. Other investigators used different materiaIs-choroidal pigment obtained from animaIs, potassium ferrocyanide, iron sesquichIoride and pIatinum chIoride [IO]; however, these resuIted in faiIures for the most part which Iead Pischel [II], in 1930, to state that “most resuIts have been disappointing, both to the patient and to the surgeon. A fine black pupi achieved with much effort and pain becomes, in the course of a few days, woefuIIy Iight again. Therefore, any improvement in technique or resuIts must be weIcomed.” This chaIIenge was accepted by us [12] approximateIy ten years ago, and some of the resuIts obtained in tattooing we11 over IOO eyes wiI1 be presented herein.

Plastic surgery of the eyelids

p LASTIC and reconstructive surgery of any anatomic region implies rather specialized procedures on that part. Tile general surgeon, however, confronted with traumatic wounds, neoplastic lesions and deformities in and around the eyelids shonId have knowledge about the proper methods of excision and repair in order to avoid injurious consequences. With this thought in mind, this article is written for tile general surgeon rather than the specialist.