Willard E. Fee

AMINOGLYCOSIDE OTOTOXICITY IN THE HUMAN

One hundred thirty‐eight patient courses of tobramycin (tobra) and gentamicin (genta) were prospectively monitored for ototoxicity using weekly audiograms and electronystag‐mograms. Twice weekly drug serum levels and kidney function tests were determined. A pre, during, and post‐therapy history was obtained and the results were analyzed to determine significant parameters of ototoxicity.

Treatment of maxillary sinus carcinoma: a comparison of the 1997 and 1977 American Joint Committee on cancer staging systems.

This study was conducted to assess the effectiveness of the 1997 American Joint Committee on Cancer (AJCC) staging system to predict survival and local control of patients with maxillary sinus carcinoma and to identify significant factors for overall survival, local control, and distant metastases in patients with these tumors.

Mature results from a randomized Phase II trial of cisplatin plus 5-fluorouracil and radiotherapy with or without tirapazamine in patients with resectable Stage IV head and neck squamous cell carcinomas

The objective of this article was to report the results from a randomized trial that evaluated the efficacy and toxicity of adding tirapazamine (TPZ) to chemoradiotherapy in the treatment of patients with head and neck squamous cell carcinomas (HNSCC).

One day VS. two days of prophylactic antibiotics in patients undergoing major head and neck surgery

Thirty patients undergoing major head and neck sugery were prospectively randomized to receive moxalactam (30 mg/kg) before surgery and for either 3 or 6 doses total postoperatively. Wound infection criteria were carefully specified and serum drug levels were monitored. Overall infection rate was 3%; the single infection occurred in a patient randomized to the 3 dose protocol. There was no statistically significant difference in infection rates between the two groups. Drug serum levels between the groups did not differ and none of the patients developed significant drug side effects.

Rhomboid flap principles and common variations

The rhomboid flap was initially popularized by a Russian, Alexander Limberg, and modified by Claude Dufourmentel of Paris. Numerous variations on the flap have been proposed more recently by Webster and Gunter. This flap has found its way into the practice of most surgeons doing head and neck surgery, with its primary advantage being that it is an extremely simple flap operation to learn, with great versatility. The general principles and their clinical application are presented in order to increase proper utilization of the flap.

A New Design for Intraoperative Facial Nerve Monitoring

Electrom yograph y of the facial muscles has proved to be an effective method of intraoperative facial nerve monitoring. With surface electrodes on the patient’s face, the surgeon is immediately made aware of any facial movement through a loudspeaker system that is driven by an amplifier connected to the electrodes. We have assisted in the development of a facial nerve monitor that is simplified in its operation, while at the same time is sophisticated in its signal processing. The device integrates an amplifier, loudspeaker, display screen, and nerve stimulator into a single compact unit with a rechargeable battery. A minimum number of controls eliminates the need for highly trained personnel to operate the device. All incoming signals from the facial electrodes are analyzed so that only those that have characteristics of facial muscle action potentials will alarm the loudspeaker. This feature eliminates a common, annoying problem with EMG monitoring in the operating room-namely, background electrical noises, including the electrocautery and stimulus artifact that falsely trigger the loudspeaker. Activity is continuously monitored on a liquid crystal screen that can also display frozen images of individual muscle action potentials. To assist the surgeon with identification of the facial nerve, a synchronized, constant current stimulus of up to 3 milliamps (mA) can be delivered to either a monopolar or bipolar nervestimulating electrode. We have used this monitor during otologic surgery and other procedures performed in the

Use of Intraoperative 125Iodine Implants for Large Tumors Attached to the Carotid Artery

Twenty-nine patients with large masses attached to the carotid artery underwent surgical resection with preservation of the artery, and intraoperative 125Iodine implantation via an absorbable suture. Eighteen were treated for recurrent neoplasms, having failed prior surgery and/or irradiation therapy. Eleven were treated primarily. With the minimum follow-up of one year, 76% were disease free in the implant volume and 62% were disease free in the entire neck. Distant metastasis occurred in 45%. Mean survival was 15 months in the primary group (range, 2-50 months) and 12 months in the recurrent group (range, 4-26 months). This technique shows promise in providing local control without necessity for sacrifice of the carotid artery.

Thyroidectomy under local anesthesia

Abstract Thyroidectomy under local anesthesia has a long history. Although the author performs only about one third of operations under local anesthesia, the technique is a time honored and valuable one and is similar to performing other procedures under local anesthesia. The technique is described in detail; conversion to a general anesthetic is required in less than 2% of patients and usually reflects poor patient selection. The procedure can be safely performed on an outpatient basis if only a hemithyroidectomy is performed, no active drain is necessary, and the patient has a responsible adult at home, leading to cost-efficient medical care.

Temporal arterial ligation in head and neck surgery with absorbable sutures.

Temporary arterial ligation is a useful concept in head and neck surgery for situations dealing with potential recurrent hemorrhage or recurrent vascular neoplasms. In this study, several absorbable sutures, including plain gut, chromic gut, and polyglycolic acid were used to ligate the common carotid artery in dogs. Arterial patency was followed by serial selective arteriograms. Only polyglycolic acid sutures proved to be a reliable material to achieve transient arterial occlusion.